Effects of a social and behavior change communication program on contraceptive use and its psychosocial determinants in Nigeria: A propensity score matching (PSM) analysis

Summary:

Nigeria continues to lag behind most African countries in terms of contraceptive prevalence and other reproductive health indicators. Nationally, the modern contraceptive prevalence rate was 12% in 2018. The Nigeria Urban Reproductive Health Initiative led by the Johns Hopkins Center for Communication Programs (CCP) with funding from the Bill and Melinda Gates Foundation works with governmental and non-governmental agencies in Nigeria to design and implement a three-pronged strategy aimed at increasing contraceptive use in Kaduna, Lagos and Oyo states. The analyses were informed by the ideation model (Kincaid, 2000) and applied propensity score matching on data from a 2018 household survey conducted among women of reproductive age. We assessed contraceptive use and six ideational variables that are strongly associated with the behavior: family size desires, contraceptive awareness, personal advocacy for FP, spousal communication on FP, perceived self-efficacy, descriptive norm, and rejection on myths. After controlling for sociodemographic and socioeconomic variables in a multivariable logistic regression, each of the six ideational variables assessed was significantly associated with contraceptive use. Judging by the magnitude of the fully standardized beta, it appears that personal advocacy, discussion of FP with spouse, and perceived self-efficacy are the strongest ideational correlates of modern contraceptive use. There is evidence of dose-response effects of exposure on contraceptive use and its three strongest determinants. SBC efforts should continue to target personal advocacy, discussion of FP with spouse, and perceived self-efficacy as these are the strongest ideational correlates of modern contraceptive use.

Background/Objectives

Nigeria continues to lag behind most African countries in terms of contraceptive prevalence and other reproductive health indicators. Nationally, the modern contraceptive prevalence rate was 12% in 2018. The Nigeria Urban Reproductive Health Initiative led by the Johns Hopkins Center for Communication Programs (CCP) with funding from the Bill and Melinda Gates Foundation works with governmental and non-governmental agencies in Nigeria to design and implement a three-pronged strategy aimed at increasing contraceptive use in three states. The strategy involved demand generation, advocacy and service provision strengthening.

Description Of Intervention And/or Methods/Design

The analyses were informed by the ideation model (Kincaid, 2000) and used data from a 2018 household survey conducted among women of reproductive age in Kaduna, Lagos and Oyo states. According to the ideation model, health communication interventions have a better chance of success if they target the psychosocial determinants of the behavior. In addition to use of modern contraceptives, we assessed six ideational variables that are strongly associated with contraceptive use: family size desires, contraceptive awareness, personal advocacy, spousal communication, perceived self-efficacy, descriptive norm, and rejection of myths. Exposure is defined as the number of demand-generation campaign activities to which the woman is exposed, including radio programs, jingles, FP song, and community mobilization activities. PSM involves matching exposed and unexposed respondents on the probability of campaign exposure derived from a set of variables. The behavior of the matched pairs is then compared to estimate campaign effects.

Results/Lessons Learned

After controlling for sociodemographic and socioeconomic variables in a multivariable logistic regression, each of the six ideational variables assessed was significantly associated with contraceptive use. Judging by the magnitude of the fully standardized beta, personal advocacy, discussion of FP with spouse, and perceived self-efficacy are the strongest ideational correlates of modern contraceptive use. Evidence from the PSM analyses shows that exposure to NURHI demand-generation activities led to improvements in each of the ideational variables. There is evidence of dose-response effects of exposure on the three strongest correlates of contraceptive use. In other words, the higher the level of exposure, the larger the effects on contraceptive use. For example, low level of exposure increased the probability of personal advocacy by 14.4 percentage points whereas high exposure increased the probability by 18.4 percentage points. Finally, the data showed a dose-response effect of exposure on contraceptive use.

Discussion/Implications For The Field

High level of substance use was detected in the current study setting. This high prevalence (three-month) of substance use affects the productive age groups which influence on the family and cause the rise of major public health and socio economic problems. The finding informed the need to integrate services for hazardous substance use such as brief intervention at different levels of primary care services in the district. Public health interventions to reduce hazardous substance especially on alcohol and smoking use also need to be initiate.

Abstract submitted by: 

Adane Weldeab

Tesfa Gedif

Telake Azale