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Strategies for Introduction of EC in India : Expert Viewpoints

Emergency contraception : Media approach for public awareness
– Dr Anjali Nayyar, Population Council, New Delhi

Increasingly, organizations and governments are realizing that providing information to people in a way that they can understand and act upon is an essential part of offering quality health service. The mass media as an informant is a powerful force in our society. Its ability to influence the public agenda, and amplify and lend legitimacy to the voices of our nation’s debates on important issues renders it an essential catalyst for change. The rapid spread of television and radio, the rise of an independent press, and increasing literacy rates makes the mass media an increasingly powerful force in our societies.

Some of the concerns which were reflected in the previous sessions, when they talked about over-publicity are very relevant. We all have had at some point of time, some of the negative fall-out of media at some stage in our life. The population council actually did a media campaign on EC, using a strategy that was known as media advocacy.

Media Advocacy involves the innovative and strategic use of mass media. Media advocacy is intended to make explicit the conflict of values and the political nature of public health that cover sensitive issues such as alcohol and drug-related problems, HIV/AIDS, violence and contraceptive methods. Similar to the news, the primary strategy of media advocacy is story-telling. But unlike the news, media advocacy attempts to tell a story in a way that promotes specific outcomes. As Michael Pertshuk, one of the architects of this approach explains, media advocacy is the strategic use of media for advancing a social or policy initiative. Initially, the goal of media advocacy must be determined and articulated. Then a story needs to be developed based on facts and values and made meaningful to a clearly defined audience. The primary audience will likely be a more clearly defined group of decision makers, legislators, community leaders or community groups. Media advocacy is about targeting the two or three per hundred who will get involved and make a difference. It is about starting a chain reaction and reaching a critical mass Media advocacy by using mass media strategically, aggressively and effectively can become a significant force for influencing public debate on Emergency Contraception.

There is a need for Media Advocacy for Emergency Contraception as opposed to a Traditional Information Campaign as it is a sensitive subject.

Using emergency contraception within the specified time period, which is soon after unprotected intercourse, remains critical to its effectiveness. Therefore, women need to have the knowledge about the method and the regimen in advance and must be able to access it either in advance of the need for use or upon identification of need. This may prove to be difficult in many service delivery settings.

Some providers may restrict emergency contraception only to certain groups of women whom they consider appropriate users based on their personal beliefs or values. Some individuals and groups will oppose Emergency Contraception in the incorrect belief that it acts as an abortifacient. Hence, the nature of the political and service delivery obstacles to expansion of access, coupled with the fact that women must have advance knowledge of emergency options, present a communication challenge. For these reasons, a communication campaign for Emergency Contraception must pay attention to:

- the needs of the intended audiences,

- anticipated problems such as provider bias,

- limitations on IEC component of service delivery systems in the absence of a policy statement, and

- the content of key messages.

The Council’s strategies involved:

a) Building consensus

In December 1996, the Council organised the first national workshop on emergency contraception in India. The workshop brought together leading women’s health advocates, service-providers, policy-makers, reproductive health researchers and members of the media from India, Bangladesh, Kenya, Indonesia, the United Kingdom and Vietnam. Most participants had never heard of emergency contraception before receiving the background material. While the workshop provided information about the method to participants, more importantly, it offered a forum for participants from diverse countries to share their experience with EC and for the group to discuss the appropriate niche for emergency contraception methods in India.

b) Research

Population Council planned a media campaign to strengthen provider’s knowledge and understanding of Emergency Contraception, increase women’s awareness of availability and distribution of methods, and thus increase access to Emergency Contraception. In order to strengthen communication efforts and the media campaign, the Council undertook a multi-centric collaborative research project in three states to obtain Indian data on the provider and user knowledge and attitudes on eC. The respondents were policy-makers at the Centre and State level; service- providers including doctors, nursing personnel, pharmacists and health workers; and clients in need of family planning in the age group of 15-49 years.

The study indicated that there was a unanimous agreement on the need for EC and making it available. There was a general lack of awareness and a need to dispel misconceptions. There were also some concerns about EC leading to promiscuity and side-effects on future fertility and on the menstrual cycle, which need to be dispelled through media campaign and sex education. There was unanimity among all respondents on EC being provided by the trained health workers or the medical community. The study, also identified :

- the target audience

- social, cultural and religious barriers

- principal and subordinate messages to be communicated for specific audience segments.

c) Information dissemination through the media

The Council’s media campaign sought to raise awareness among the public and to build support for Emergency Contraception. A major success of the campaign was that the television and radio messages were developed in close collaboration with the Ministries of Health and Family Welfare, Women and Child Development and Information and Broadcasting. In addition to the media campaign, information fact-sheets were prepared for policy-makers, service-providers and users. These fact-sheets were widely disseminated in India and are now being adapted for dissemination in Bangladesh.

Some of the lessons we learnt from our media campaign were:

• There are low levels of awareness about oral contraceptives across India. Hence, information on Emergency Contraception has to be very clear and precise.

• Due to low levels of awareness and biases, each article placed in the media must be carefully thought through. Information cannot be disseminated through newspapers, unless the reporters are well-informed.

• Since there is no dedicated product, a communication campaign can only raise awareness about the concept without going into specific dosages till a dedicated product is made available.

• While providing information is critical, it is also essential to build support among key constituencies.

• The media campaign must be based on locally relevant data. It is also necessary to maintain an ongoing dialogue with relevant stakeholders.

The idea is to present issues in a way that are newsworthy, are of high level of interest to the public, and have direct links to community well-being. Rather than being supplicants for public time, media advocates present themselves as partners in the news-making and news-gathering process. By having various experts assist the media in framing messages, we ensured that the information on Emergency Contraception was factually correct, unbiased, and provided the right perspective.

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