The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP) cites research indicating that the minimum legal age of marriage in Pakistan is 16 years for females and 18 years for males; however, 14% of females and 7% of males get married before they reach the legal age. Most women in Pakistan by age 20 will have given birth to one child and women in their early 30's have an average of 4 births (National Institute of Population Studies (NIPS), 2001). Only 28% of currently married women reported using any method of contraception at the time of the research. Among young married women (15-19 years old), only 4.8% report ever using any contraceptive method and only 2% report ever using any modern method. Current estimates indicate that about 61% of women have a need for family planning, which includes a 33% with an unmet need.

In an effort to respond to this situation, CCP joined with Greenstar Social Marketing (GSM) of Pakistan to develop a televised entertainment-education drama called "Kaisey Kahoon" ("How Shall I Say It"), telephone hotlines, and a clinic-based programme that counsels newlyweds on a wide range of health topics, including reproductive health, family planning, and maternal health.

The research involved both a quantitative and qualitative component. A post-only household survey was conducted in the cities of Karachi and Lahore following use of a 2-stage sampling area technique to select the sample population. The survey consisted of face-to-face interviews with females between the ages of 16-24 and males between the ages of 18-29. The questionnaires were pretested prior to field work and appropriate revisions made based on feedback from the field. Interviewers undertaking the study underwent a 3-day training to ensure that they were familiar with the questionnaires as well as the interviewing procedures.

Then, STATA 9.0 software was used to undertake propensity score matching to create matched exposed and unexposed groups. One-on-one matching with no replacement was used to create a subset of 301 unexposed respondents who were matched with the 301 respondents who were exposed to the Youth First media messages. There were no significant differences among the exposed and the matched group of unexposed respondents with regard to any of the 15 socio-demographic and socio-economic variables.

A total of 301 individuals reported being exposed to at least one mass media component of the Youth First campaign; highest exposure was related to the TV spots (valid number (N) for TV Spots is 1082 respondents who reported having seen any messages on TV related to family planning in the last 3 months.) Very few respondents reported recalling the radio spots (N for exposure to the TV drama and the music video is 2088).

All respondents were asked if they had had any discussions about family planning in the last 3 months. Exposed respondents were slightly more likely to respond in the positive (15.6% of those exposed, compared with 12% of the matched unexposed group). There were no significant differences among exposed and matched unexposed married respondents (N = 198) with regard to spousal communication regarding family planning, but exposed respondents were slightly more likely to report having discussed family planning with their spouse than matched unexposed respondents (53.8% exposed respondents compared with 44.6% matched unexposed group respondents). When asked about how easy they found it to discuss family planning with their spouse, exposed respondents were significantly less likely to report finding such discussions difficult than the matched unexposed group respondents. When asked about specific topics pertaining to reproductive health and family planning, exposed respondents were slightly more likely to have discussed most topics with their spouse - with the significant exception of their desire to have a male child.

Whereas 30.2% of exposed respondents knew about newlywed counseling at Green Star Clinics, 19.3% of the matched unexposed group knew.

Study participants provided some indication of specific actions related to family planning that they intended to take as a result of exposure to the Kaisey Kahoon TV drama. For example, a 28-year old unmarried male participant from Lahore indicated that as a result of watching the TV drama he would plan his marriage and think carefully about the number of children to have. A 20-year-old unmarried male from Lahore reported that as a result of watching the TV drama he had learned about the importance of family life and when he got married he would spend most of his time with his wife and children. A 24-year-old married female participant from Karachi, who was pregnant with her first child, reported that as a result of watching Kaisey Kahoon she was only planning to have 2 or 3 children.

With regard to perceptions about the importance of seeking newlywed counseling services, 29.90% of exposed respondents deemed it "very important" that couples go together to Green Star Clinics, whereas 16.61% of the matched unexposed group thought so. 28.57% of exposed respondents deemed it "very important" for young married couples to seek newlywed counseling services immediately after their marriage, in comparison to 17.61% of matched unexposed group respondents. Whereas 23.5% of exposed respondents intended to use newlywed counseling at Green Star Clinics in the future, 13.1% of the matched unexposed group so intended. Respondents who were exposed to the media components of the Youth First Campaign were significantly more willing to personally advocate for the use of newlywed counseling services among their married friends.

Respondents were asked to report on issues that were important to them for their future life planning. Exposed respondents were significantly more likely than their matched unexposed counterparts to report that issues such as marriage, taking care of their reproductive health needs, and family planning were "very important" to their future life plans. At the same time, exposed respondents were slightly less likely to report that having a male child was "very important" to them.

Whereas 42.3% of exposed respondents had used newlywed counseling at Green Star Clinics, 33.3% of the matched unexposed group had done so.