An Adaptable Communication Strategy for Demand Generation: Emergency Contraception

This strategy document is written to support communication on one of the "13 Lifesaving Commodities" as described in Demand Generation Implementation Kit for Underutilized Commodities in reproductive, maternal, newborn, and child health (RMNCH), the I-Kit. Materials associated with the I-Kit, like this commodity-specific strategy document for emergency contraception, were created to support the efforts of communication professionals working directly on social and behaviour change communication (SBCC) programmes, as well as other professionals working in RMNCH.

It was created as a "quick-start foundation based on available evidence to provide guidance" for communication designed to: create new users; convince members of the intended audience to adopt new behaviours, products, or services; increase demand among existing users; convince current users to increase or sustain the practice of the promoted behaviour and/or to increase or sustain the use of promoted products and services; and take market share from competing behaviours (e.g., convincing caregivers to seek health care immediately) and products or services (e.g., convincing families to use emergency  contraception). Thus, the goal is to create informed and voluntary demand, help providers and clients interact effectively, shift social and cultural norms to support sustained commodity uptake, and encourage appropriate use of the commodity.

The strategy document offers key concept discussions on SBCC, social marketing, and channels and approaches, including advocacy, community mobilisation, entertainment-education, information and communication technologies (ICTs), and mass and traditional media. The conceptual framework for the strategy is structured as a multi-directional continuum of social and environmental contexts: the individual level, family and peer networks, community, and social and structural. The communication strategy includes 6 steps:

• "Analyze the Situation
• Define a Vision
• Choose Intended Audiences
• Select Key Messages
• Determine Activities and Interventions
• Plan for Monitoring and Evaluation"

The illustrative strategy for emergency contraception (beginning on page 29) details each step for this specific commodity used to support family planning and reproductive health. The health and commodity contexts are detailed with information on:

• unmet need for contraception (215 million women);
• commodity formulation recommendations for emergency contraceptive (ECPs) products (generally one or two pills that, according to research, cause interference with ovulation)  and their availability; and
• an audience and communication analysis - "A recent global synthesis of existing demand creation evidence for ECPs found that there are three significant barriers [with additional barriers listed here as well] to address in order to increase provision of ECPs (Health Communication Capacity Collaborative, 2013)":
• Low awareness, knowledge, and acceptability at individual, community, and societal levels
• Provider knowledge and skills - e.g., significant pharmacist confusion between products in Mexico; outdated or inadequate clinical information in Kenya
• Provider bias and negative attitudes - e.g., "Pharmacists in several countries report not being willing to stock ECPs on the ground of personal beliefs because they think it causes abortion, or because they think it increases promiscuity or discourages clients from using a barrier method."
• Other aspects influencing availability and use of ECPs include: type and number of products registered and distributed in the country (choice); price levels and availability (is there a public sector offer or a socially marketed product or only commercial products?); inclusion of ECPs in national family planning programmes, including essential medicine lists, policies, and distribution systems; restrictions on age; and number and reach of outlets providing ECPs.

The description of choosing primary and secondary (influencing) audience segments is illustrated by a detailed audience analysis with examples of possible audience members and their situations.  Message development is individuated for each audience in its particular locale and includes an objective, positioning, a key promise, support statements, and key messages. For example, for women of reproductive age, messages might give "peace of mind", e.g., "ECPs are safe and have very limited side-effects which are temporary and will disappear after use." For women at risk of violence, for example, messages may include: "ECPs give you a chance to avoid a pregnancy when you had sex unwillingly, including with your husband or partner." For pharmacy staff, pride in skills and provision of solutions to customers might include a message such as: "Denying access to ECPs on the basis of age, marital status or repeat use is not ethical." For male partners and friends, for example, messages may suggest encouraging partners/peers to access ECPs if needed.

Activities and interventions of message dissemination are detailed, as a starting point for situational customisation, providing a base for message integration across a range of intervention areas and communication channels. The following are examples of potential messaging strategies from charts (starting on page 56) of examples for mass media, clinic-based services, pharmacies, and community-based  services and outreach. These charts detail intervention areas, activities, purpose, and intended audience for each. For example, under mass media, interventions might include: develop TV or radio ads addressing major misconceptions on ECPs and benefits of using ECPs for awareness raising among women of reproductive age (WRA), male partners, and peers/friends. Clinical service interventions might include: offer digital distance learning for medical staff through a hotline or texting options with trained medical personnel. Community health worker (CHW) outreach might include, among other activities: developing/adapting materials and job aides to provide guidance on counselling and referral for ECPs;  developing badges, buttons, and other items that support the central positioning and promotion of quality; or developing and producing radio distance learning programmes for community workers that model positive behaviours and relationships with communities and referral clinics. Work with police and crisis centres might include, among other activities, training police officers on comprehensive care for sexual assault survivors and addressing how they can provide women with the help and assistance they need, as well as allowing police officers to administer ECPs.

Monitoring and evaluation is detailed in examples of indicators, metrics, methods, sources to leverage, and tracking alignment, among others.

The Demand Generation for Reproductive, Maternal, Newborn, and Child Health Commodities activities are implemented by the Health Communication Capacity Collaborative (HC3) at Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHU-CCP), with support from the RMNCH Trust Fund and the United States Agency for International Development (USAID), in partnership with Demand Generation sub-group of the UNCoLSC Demand, Access and Performance Technical Resource Team, including Population Services International (PSI), International Consortium on Emergency Contraception (ICEC), Jhpiego, and other partners.