Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHU/CCP) and Sante Familiale et Prevention du SIDA (SFPS) launched a family planning community awareness project which involved the building of Gold Circle clinics in Cameroon, Burkina Faso, Togo and Cote d'Ivoire. The primary audience for this programme was urban or peri-urban women of reproductive age (20-49) living with a partner and at least one child. The secondary audience included the women's partners and family members. The GO campaign's objectives were to increase 1) use of modern family planning methods, 2) clinic attendance at GO and family planning clinics, 3) positive attitudes toward family planning and 4) discussion by couples about family planning.

The data analysed in this article are derived from two main sources: a follow-up survey of the 1998 Demographic and Health Survey (DHS) and Santé Familialeet Prévention du SIDA (SFPS) site statistics collected between October 1998 and November 1999. Most of the questions in the follow-up were similar to those included in the 1998 DHS. The survey also sought to assess overall exposure to the GO campaign. While 1,367 women participated in the original DHS survey, the follow-up survey interviewed 1,150 women (571 of whom had been previously interviewed). Thus, 42% of the women in the initial DHS sample were effectively re-interviewed during the follow-up between 18 and 22 months later. Many baseline respondents could not be re-interviewed because they were no longer at their place of residence or because they refused to further participate in the survey. This high rate of loss to follow-up raises concerns about the conclusions that can be drawn from the survey data. Fortunately, using the 1998 DHS data, it is possible to compare the pertinent characteristics of the women who were followed up and those who were lost to the follow-up. Furthermore, many of the women who were followed up are comparable to the initial group in terms of age, place of residence, education, and exposure to family planning information. However, there are significant differences in parity, marital status, and knowledge of modern methods.

In Cameroon, 58% of women and 45% of men of reproductive age were aware of the campaign. 58% reported exposure through radio and 52% through television. Education was a determinant in the likelihood of exposure and those with primary education (25.9% of the sample) were 4.2 times more likely to have been exposed; those with secondary or greater (55.9%) were 5.8 times more likely to be exposed than those with no education at all (18.2%). Christians, who make up over three-quarters of the sample, were almost half (0.53 times) as likely to have been exposed, as were those 35 or older (0.57 times).

The data revealed increased discussion of family planning with peers and spouse/partner that led to a more positive approach to the idea of family planning. Of those exposed, the number who discussed family planning with their spouse was 52.8% at follow-up vs. 41.9% at baseline.

Members of the communities of Cameroon, Togo, and Burkina Faso felt more comfortable seeking advice from new Gold Circle (GO) clinics, which were promoted to be safe, friendly, and respectful of clients' privacy. There were significant improvements in knowledge of modern methods: of those exposed, the mean increased from 5.18 to 5.70.

Six months after the GO launch, the number of new clients continued to grow, compared to its pre-launch level. Based on client exit interviews at the various clinics, clinic visitors felt very satisfied with the services they received. 98% felt they were well-treated, more than 90% felt the waiting time was acceptable, and 92% felt that privacy was observed during their visit. There was also a significant change in the percent - from 28.65 to 45.2% - of exposed respondents who noted that their spouse or partner approves of family planning.

The campaign had a positive impact on contraceptive use and on overall knowledge regarding family planning. Contraceptive prevalence for all women increased by 20% between the baseline and the follow-up. While the prevalence of contraceptive use increased slightly among women who were not exposed to the campaign (4%), the change among those exposed was much greater (39%). Women who were exposed to the campaign contributed the large majority (89%) of the overall increase in contraceptive use. There has also been a notable shift towards the acceptance of modern family planning methods: 23% began to use a modern method as opposed to only 8% among those not exposed to the campaign.

The campaign had a considerable positive influence on both family planning ideation and contraceptive use. Exposure to the campaign was associated with improved contraceptive ideation. Impact was greatest on knowledge of modern contraception methods.

Communication Impact Newsletter March 2001 # 11; and "The Impact of a Regional Family Planning Service Promotion Initiative in Sub-Saharan Africa: Evidence from Cameroon". Stella Babalola, Claudia Vondrasek, Jane Brown and Regina Traoré . International Family Planning PerspectivesVolume 27, Number 4, December 2001. Click here for the online version of this article; click here to download the PDF version.