(1) Department of Population and Family health Sciences, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA, (2) School of Medicine, University of Southern California, Los Angeles, CA, USA

March 2002

Published in International Family Planning and Perspectives in 2002, this article presents the findings from a five-year panel study in Nepal that assessed the influence of a mass media intervention on spousal communication about family planning, and the impacts of spousal communication on family planning adoption. The study draws on the Radio Communication Project, a multi-faceted reproductive health communication campaign developed in the early 1990s.

The study is built on existing research findings that showed that the amount of communication on family planning issues between partners is positively associated with contraceptive use. The study makes a contribution to this research area by shedding light on the direction of the relationships between spousal communication, mass media campaigns, and behaviour adoption.



Evaluation/Research Methodologies:

The Radio Communication Project in Nepal was developed in response to high levels of "unmet need" for family planning (unmet need is defined as the discrepancy between an expressed preference to limit/space births and the absence of contraceptive use). The Radio Communication Project consisted of two entertainment-education radio serials (a radio soap opera addressing couples of reproductive age, and a dramatised distance education radio serial for health workers), supplemented with radio spots, national-level orientation workshops, district-level training workshops and printed materials. This study specifically analyses the first radio serial that addressed married couple of reproductive age and its impacts on spousal communication and contraceptive use.

The radio serial was broadcast nationally once a week from December 1995. The serial provided information on contraceptive techniques, pregnancy and birth spacing, and dealt with broader issues that influence family planning use, such as gender bias and family planning decision-making. Spousal communication was one of the major themes of the serial.



A panel study - a baseline survey in 1994 and two follow-up surveys in 1997 and 1999 - collected information from men and women of reproductive age in four districts representing three diverse regions. The questionnaire in each survey wave included spousal communication items, a media campaign exposure item, and items asking about family planning attitudes and practices.



Key Findings/Impact:
Two types of findings are reported: (1) factors influencing spousal communication, and (2) the impacts of spousal communication, campaign exposure, and other factors on contraceptive use.

1. Factors influencing spousal communication

Respondents who were exposed to the radio serial experienced a significantly greater increase in spousal communication from 1994 to 1997 than those not exposed. No significant differences in the impacts of the radio serial on spousal communication were observed between 1997 and 1999. The researchers attribute the discrepancies between the two periods to the following possibilities: (a) the impact of the radio spot ads, which were broadcast only during the first period, and (b) the limited potential for further gains in spousal communication when the level of communication is already high (which was the true).

Spousal communication reported in the 1999 survey was positively associated with spousal communication at baseline (1994 survey), potentially suggesting the presence of individuals or couples who were predisposed to spousal communication independent of exposure to the radio serial. When variables measuring exposure to the radio serial were added to the regression model, however, those who had been exposed to the radio serial at wave three (1999 survey) had significantly higher odds than those who had not been exposed of having discussed family planning with their spouse and of believing that he/she approved of family planning.

Other findings include:

• Young respondents (those in their prime reproductive years) had significantly more positive attitudes toward spousal communication than older respondents. At each survey wave, the spousal communication scores increased for most age groups, but the differences between age groups remained.
• Ethnicity was associated with spousal communication. No differences in spousal communication were observed in terms of respondents' household expenditure. The ethnic gaps in spousal communication had narrowed but remained throughout the three survey waves.
• Predictably, spousal communication was greater among couples who made family planning decisions jointly than those couples who made decisions separately.

2. Impacts of communication and other factors on contraceptive use

The study compared the impacts of three decision-making patterns - jointly between the husband and the wife, by the husband only, and by the wife only - on contraceptive use. In both 1994 and 1997 surveys, contraceptive use was highest among couples in which the husband made family planning decisions. In 1999, however, contraceptive use was highest among the couples who jointly made family planning decisions, and lowest among the couples in which the husband alone made decisions. The authors remark that the observed patterns indicated (a) the dominance of husbands in family planning decision-making in earlier periods, and (b) a shift in balance of power favouring women toward the later period.

The associations among a couple's contraceptive use, spousal communication, and exposure to the radio serial were analysed in logistic regression models. After controlling for demographic variables, the result indicated that family planning use at wave three (dependent variable) was significantly associated with, in order from higher to lower odds,

• contemporaneous spousal communication (i.e., spousal communication reported in the third survey);
• prior contraceptive use at baseline;
• desire to have no more children at baseline; and
• contraceptive use at wave two.

Family planning use at third wave was not significantly associated with

• spousal communication at either baseline or wave two; and
• exposure to the radio serial at either wave two or wave three.

Both education and age were significantly associated with family planning use at wave three but were weaker predictors than spousal communication or prior contraceptive use.

Finally, the study used a structural equation model to further assess how spousal communication relates to contraceptive use over time, controlling for the influence of these variables at earlier times as well as for demographic variables and the desire to have no more children. The model showed that:

• contraceptive use at baseline was strongly associated with contraceptive use at wave three;
• contraceptive use at baseline was also associated with having exposure to the radio programme at wave three, though to a much lesser extent.

Overall, this study revealed complex mechanisms by which mass media exposure and spousal communication influence family planning use. The authors identify two pathways to family planning adoption.

1. Couples who view family planning favourably tend to communicate about the number and spacing of their children, and tend to adopt contraception. For these individuals, communication campaigns can provide information that can promote further informed discussion, keep family planning on the couple's agenda, and provide information on family planning services, costs and other information resources.

2. For other couples, media campaigns can prompt the gradual initiation of spousal communication about family planning, which in turn will induce contraceptive use.

The authors call for improved intervention and assessment methods tailored to the specific needs of different population segments that vary in adoption and communication stages. They argue that traditional impact assessment indicators tend to overlook, for example, the segment of the population who may already be inclined to practice the behaviour being promoted. Similarly, the authors recommend the use of tailored intervention designs that address socio-cultural factors linked to specific ethnic groups.

The authors also propose that the observed shift in power balance within couples' relationships can be used to support the linking of family planning programmes with interventions that empower women to better negotiate family planning decision-making with their husbands.

Sharan, M., & Valente, T. W. Spousal communication and family planning adoption: Effects of a Radio Drama Serial in Nepal. International Family Planning Perspectives Volume 28, Number 1, March 2002.