Exposure to Family Planning Messages

through Mass Media and Interpersonal

Communication and Current
Contraceptive Use in Ghana

Claire Bailey
ceb504@soton.ac.uk
Supervisors: Dr J.W. McDonald & Dr Zo
Matthews

Outline of Presentation
Rationale

for study - The Ghanaian

context
Aims of study
Theoretical background
Introduction to data Ghana 2003 DHS
Methodology
Definition of study variables
Results
Conclusions

The Ghanaian Context

Estimated population
in 2005 of 21 million
Population growth rate
in 2005 was 1.25%.
The 2005 Total Fertility
Rate is 3.02
GDP per capita (ppp)
was estimated in 2004
as $2,300

Trends in Contraceptive Use in

Ghana
Trends in contraceptive use
among currently married women
aged 15-49 (% )
30
25
20
15
10
5
0

any method
modern method

1988

1993

1998

2003

traditional
method

Ghanas Poverty Reduction

Strategy
Vision 2020 Plan of Action
Aim to have contraceptive prevalence of
modern methods of 15% by 2000 and 50%
by 2020
Strategy to decentralize service delivery
and support national campaign on fertility
regulation including comprehensive
Information, Education and Communication
(IEC) programme to promote the use of
family planning

Aims of Study
The

aims of my study were to determine if

there is any association between current
use of modern contraceptives among
Ghanaian women and:
exposure to family planning messages
through a range of different mass media
channels
exposure to interpersonal communication
regarding the use of family planning

Theoretical Background

The appeal of using mass media communication

channels to promote family planning messages is the
wide spread coverage and cost effectiveness.
Some debate about its effectiveness and two primary
competing theories:
Ideational Hypothesis - media effects are universal
and each individual may be prompted to change their
attitude and behaviour by exposure to modern ideas
Diffusion of Innovation Theory - mass media is
effective at creating awareness and knowledge of
innovations, but interpersonal communication is
necessary for actual behaviour change

Data

2003 Ghana Demographic Health Survey (GDHS)

Sub-sample drawn to include all women who are
potentially at risk of pregnancy and therefore
potential contraceptive users:
All women aged 15-49 currently in union
(married or living with a man) AND
All unmarried women aged 15-49 who are
currently sexually active (within past month
of survey date) unmarried includes, never
married, separated, widowed and divorced

From this subset cases were excluded where the

women is
one or more of the following:
Currently pregnant
Amenorrheic
Infecund
Menopausal
Currently abstaining
The final data set contains 2065 cases

Methodology
Binary

logistic regression modelling with

current use of a modern contraceptive as
the response variable.
Multi-level modelling was used, to allow for
random variation at the group as well as
the individual levels, to account for the
hierarchical clustered data structure which
is a function of the sampling of the survey
and could lead to dependence among the
observations.

Study Variables
Binary response variable:
0 = not currently using a modern contraceptive method
1 = currently using a contraceptive method

Explanatory variables:
Exposure to Mass Media - Respondent has heard a family
planning message in the few months prior to survey
from:
Radio yes/no
Television yes/no
Newspaper/magazine yes/no

Explanatory variables
Interpersonal
communication:
Respondent has heard
a family planning
message from a
Health worker
Respondent has heard
a family planning
message at a
community Meeting
Respondent has
discussed family
planning with
someone other than
partner

Control variables:
Age
Education
Occupation
Religion
Ethnicity
Region
Urban/rural
Number of living
children
Marital status

Results Respondent
Characteristics
% of respondents (n)
Variable
% of respondents (n)

Variable

Total n=2065

Total n=2065

Response
Interpersonal Communication

Current use
No

71 (1461)

Fphealthworker

Yes

29 (604)

No

43.7 (903)

Yes

56.3 (1162)

FP exposure- mass media

fpnews
No

81.1 (1675)

Yes

18.9 (390)

Fptv
No

49.3 (1018)

Yes

50.7 (1047)

Fpradio
No

19.2 (396)

Yes

80.2 (1669)

Fpcommunity
No

63.0 (1301)

Yes

27.0 (764)

Discussedothers
No

69.9 (1443)

Yes

30.1 (622)

Results- Simple Logistic

Regression

SE ()

Exp ()

95% CI

fpnews

0.34**

0.12 1.40

(1.12,1.76)

fptv

0.36***

0.10 1.44

(1.19,1.74)

fpradio

0.43***

0.13 1.54

(1.19,1.99)

discuss

0.67***

0.10 1.96

(1.61,2.40)

fphealth

0.62***

0.10 1.85

(1.52,2.26)

fpcomm

0.18

0.10 1.20

(0.99,1.46)

***p<0.001; **p<0.01; *p<0.05

NB: The intercepts and the baseline categories are omitted from this table, all
baselines are =0 and Exp () = 1

Results- Multiple Logistic

Regression

SE ()

exp ()

95% CI

Discussed FP with someone

other than partner
No (RC)

0.00

Yes

0.91***

1.00
0.16

2.48

(1.82,3.38)

FP message from health worker

No (RC)

0.00

Yes

0.54***

1.00
0.12

1.72

(1.34,2.19)

FP message from community meeting

No (RC)

0.00

Yes

0.46*

1.00
0.23

1.58

(1.01,2.52)

***p<0.001; **p<0.01; *p<0.05 RC = Reference Category

What next? Model 2

To explore the possible indirect effect of exposure

to messages in the mass media a new model is
fitted with discussed family planning with others as
the response variable.
Discussing family planning with others was chosen
as the response as literature suggests it is an
intermediate behaviour change variable and part
of the mechanism through which receiving family
planning information from mass media influences
contraceptive behaviour.
All other variables and model specification remain
the same

Results- Simple Logistic

Regression

SE ()

Exp ()

95% CI

fpnews

1.18***

0.11

3.25

(2.59,4.08)

fptv

0.82***

0.10

2.28

(1.88,2.77)

fpradio

1.16***

0.15

3.19

(2.37,4.29)

***p<0.001; **p<0.01; *p<0.05 NB: The intercepts and the baseline

categories are omitted from this table, all baselines are =0 and Exp () = 1

Results- Multiple Logistic

Regression

SE ()

Exp ()

95% CI

FP message from radio

No (RC)

0.00

Yes

0.56**

1.00
0.18

1.76

(1.24,2.48)

FP message from Television

No (RC)

0.00

Yes

0.29*

1.00
0.13

1.34

(1.04,1.73)

FP message from Newspaper

No (RC)

0.00

Yes

0.53***

1.00
0.14

1.70

(1.26,2.28)

***p<0.001; **p<0.01; *p<0.05 RC = reference category

Other variables in the model are: Number of living children, Education, Region FP message from
health worker & FP message from community meeting

Random effects

Both final models were tested for the inclusion of

random effects components at the household and
cluster level.
The models were re-fitted with the same fixed effects
and adjusted to allow the intercept to vary first at
household then at cluster level.
In all cases it was concluded that there is no
significant clustering effect and all of the
observations in the data can be treated as
independent. The fixed effects models are a valid
and adequate approach to analysing this data.

Conclusions

Exposure to mass media family planning messages does

not have a direct association with current use of modern
contraceptives after controlling for socio-economic factors.
There is evidence that it does have indirect influence
through its strong positive association with interpersonal
communication which in turn is strongly and positively
associated with contraceptive use.
Results support the diffusion of innovation hypothesis
where mass media works as part of a two-step flow
process where knowledge disseminated through the media
prompts interpersonal discussions, which then diffuses
through social networks and prompts behaviour change.

Thank-you very much.

Claire Bailey
ceb504@soton.ac.uk