Drawing from different research methodologies, the team sought to uncover youth and religious leaders’ perspectives, and knowledge, on reproductive health services and products in several villages in the Zinder region of Niger. While there were religious leaders who supported birth spacing, they perceived a significant amount of risk in publicly supporting family planning on their own. Furthermore, both religious leaders and youth shared a desire to improve their knowledge and ability to dispel myths about reproductive health in a public forum so that the larger community could benefit from candid discussions. Our research showed that the primary determining factor to contraceptive uptake among married women in Zinder was support from their husband. Yet, despite men being the main-decisions makers on contraceptive use, and essentially every household decision, we found that men lacked sufficient knowledge on the financial implications of raising children to inform their choices. Building on the design research findings, the team designed 10 low-fidelity prototypes that were subsequently rapidly field-tested and iterated with 41 religious leaders, 26 youth, and 5 healthcare workers. All materials were designed for non-literate populations. A scorecard methodology was used to evaluate the final three solutions which will be implemented during a six-month pilot program, called Sarari (meaning spacing in Hausa):
- Leaders Engagés: a collective of religious leaders who serve as agents of change by openly advocating (either through sermons, teaching at the Koranic school, or through private consultations) on the importance of birth spacing for maternal and infant health, and overall family well-being.
- Séminaire des Leaders: a series of debates between religious and youth leaders on the topic of birth spacing.
- Dede Ruwa Dede Tsaki (Just the right amount of water for the flour): a budgeting activity and discussion tools based on Koranic verses to encourage participants to seek a balance between their financial resources and desired family size.
The intervention strategy targeting Religious Leaders and youth showed good results when quoting specific sections of the Koran to discuss the benefits of birth spacing with the target audience, as well as other related topics, such as health of the children, treatment of spouses, and intra-couple communication, given that they were basing their sermons on religious scriptures. This approach succeeded in creating an enabling environment for religious leaders and couples to discuss family planning and gender dynamics.
The financial capacity tool proved an effective resource to start the conversation about family planning and birth spacing with young men. Although the immediate decision to have fewer children was emotional and may prove unstable over time, we see this as an important step into broaching the conversation with men around desired family size. Activities were successful in creating demand, however the lack of availability of quality services to meet demand was also noted as an issue to be addressed in any subsequent phase of the intervention.
During Year Four, Transform/PHARE will build upon the prototypes developed and lessons learned during the initial phase, and will roll out an enhanced strategy for reaching religious leaders and youth. Lessons learned from the work done with religious leaders, the male segmentation analysis and pilot, and the financial training of youth will be combined for this new approached. This next phase will be implemented in a larger number of villages and for a longer period of time, allowing for more robust testing of this innovative SBC strategy.
Social Network Analysis and Training Community Influencers as FP Promoters in Niger
Social network analysis (SNA) was used to determine how social interaction influences individual behaviors and can trigger the adoption of positive FP behaviors. This approach was used to identify and target the segment called sheltered skeptics. SNA was selected, as this segment of women tends to mistrust contraception and mistrust the information coming from health workers regarding family planning. The SNA identified several male and female key influencers on the behavior of sheltered skeptics. Later, identified influencers were trained on modern contraceptive methods, gender issues, and the use of communication technology to raise awareness to the benefits of FP. Using social network analysis proved successful at identifying members of the community who are considered influential and trusted by women to provide accurate information on FP. By understanding the social network, Transform/PHARE was able to more effectively reach women who were previously mistrusting of FP.
Using social network analysis proved successful at identifying members of the community who are considered influential and trusted by women to provide accurate information on FP. By understanding the social network, Transform/PHARE was able to more effectively reach women who were previously mistrusting of FP information.
Message Testing and Iteration Using IVR in Niger
Interactive voice response (IVR), an interactive voice phone messaging system, was selected to target the segment identified as healthy proactives. Healthy proactives are women who are already interested in using or have tried a FP method in the past but are not currently using modern contraception. Six messages were tested through interactive messaging phone calls. The two most effective messages were selected and further tested. These messages related to barriers to contraceptive use identified by healthy proactives; specifically, rumors about the negative behaviors of health providers, and misconceptions about the side effects of contraceptive methods. Messages were used to develop radio spots that aired nationally. Interactive voice response messaging also proved successful at identifying and developing messages that targeted a specific segment of women, although in the Dosso area technology use became a challenge.
Interactive Voice Response messaging also proved successful at identifying and developing messages that targeted a specific segment of women, although in the Dosso area it presented challenges associated to the use of technology. The initial set up time proved to be much longer, and more resource intensive compared to traditional market research, and we experienced much larger drop off rates than expected due to women’s difficulty in using the technology.
Male Segmentation in Niger
The intervention in Niger, led by Camber Collective, is centered on an analysis of male FP demand, including a statistical segmentation analysis. Quantitative research, analysis and key informant discussions will identify the men who are willing to change their FP behaviors, and identify key activities required to facilitate their behavior change. Ideally this would complement activities that were already identified to facilitate the behavior change of target segments of women. Camber Collective and PSI/Niger will then work with RISE consortium members to design 1-2 specific interventions, and these will be trialed over an estimated period of 3 months with direct support from PSI/Niger.