By: Michelle Santos
MPH 655
Dr. Rhonda Sarnoff
May 2, 2013

MDG Monitor Goal 5:
Improve Maternal Health
• 41% any method

Why Empower Women?
• Implications for health of the whole country
• Relationship and program effectiveness is evidence-based

Evidence Base for
Empowering Women
• Women’s Sexual Empowerment and Contraceptive Use in Ghana
(2012)
• hypothesize that lack of sexual empowerment may pose an important barrier to reproductive health and adoption of family planning methods
• 2008 Ghana Demographic Health Survey Questionnaire
• Can you say “no” to your husband/partner if you do not want to have sexual intercourse?
• In your opinion, is a husband justified in hitting or beating his wife if she refuses to have sex with him?
• Could you ask your husband/partner to use a condom if you wanted him to?
• If a wife knows her husband has a disease that she can contract during sexual intercourse, is she justified in asking him to use a condom when they have sex?
• Is a woman justified in refusing sex if she is tired/not in the mood?

Evidence Base for
Empowering Women (cont’d.)
• Empowering sex workers in India to reduce vulnerability to
HIV and sexually transmitted diseases (2000-2001)
• The Sonagachi Project (1992)
• Education and leadership development,
• Media use and advocacy,
• Public education and participation, Organizing associations and unions,
• Work training and micro-enterprise,
• Enabling services and assistance, and
• Rights protection and promotion empowerment strategies can significantly impact a broader range of factors to reduce vulnerability to HIV/STDs.

Why use Social Marketing?
• Women’s cultural role
• Men’s attitudes vs. Women’s attitudes
• Focused toward men
• Effectiveness is evidence-based

Evidence Base for Social
Marketing Methods
• The reach and impact of social marketing and reproductive health
communication campaigns in Zambia (1992)
• The Zambia Social Marketing Program (ZSMP) was launched in 1992, and is implemented by the Society for Family Health (SFH)
• SFH makes extensive use of radio and television to promote healthy behavior, including use of Maximum brand condoms.
• For example, SFH's Club NTG (New Teen Generation) is a youthoriented radio program about issues that affect youth, such as teen pregnancy, HIV/AIDS, sexuality and condom use. Similarly, An Inside
Look is an interactive television talk show that addresses health and social issues [ 9 ]. SFH also produced and broadcast radio and television public service announcements with Dr. Kenneth David
Kaumba, the former President of Zambia.
• These public service announcements aim to discourage HIV-related stigma, and promote faithfulness, condom use, and voluntary testing and counseling [ 8 ].

Evidence Base for Social
Marketing Methods (cont’d.)
• Reducing Fertility in Bangladesh (1975)
• Deployment of young, married women as outreach workers, or family welfare assistants (FWAs)
• The provision of as wide as range of methods as possible to meet a range of reproductive needs
• The establishment of family planning clinics in rural areas to provide clinical contraceptive services
• The provision of information, education, and communication activities

Evidence Base for Social
Marketing Methods (cont’d.)
• Hombres Sanos: evaluation of a social marketing campaign for heterosexually identified Latino men who have sex with
men and women (2006)
• conducted cross-sectional surveys every other month with independent samples of Latino men before, during, and after implementation of the social marketing campaign
• reduced rates of recent unprotected sex with both females and males among heterosexually identified Latino MSMW
• increases in perception of HIV risk, knowledge of testing locations, and condom carrying among heterosexual Latinos.

My Project Proposal
• Target: Females ages 15-49
• Use civil registration data to identify what areas of the country have the most significant problems with maternal mortality
• Implementation
• 1) Deployment of young, married women as outreach workers
• 2) Mass media campaign targeting men’s attitudes toward contraception
• 3) Provision of as wide a range of methods as possible to meet a range of reproductive needs
• Evaluation
- Measure contraceptive use after every six months
- Qualitative surveys assessing quality and adherence

Deployment of Young, Married
Women as Outreach Workers
• Allows for broad coverage
• Trained to conduct home visits
• Offer contraceptive services and information
• Facilitates empowerment of women when combined with social marketing campaign to make individual choices on contraception

Mass Media Campaign
• Target male attitudes toward male contraception
• Via radio broadcasts and television programs
• Create likeable character/s with roles as a female community outreach worker or character supporting one, to encourage respect and acceptance

“Cafeteria Approach” for
Reproductive Needs
• Include as wide a variety as possible of various contraceptive options for women
• Provide referrals to clinics that specialize in long-term or permanent alternatives such as sterilization
• Offer informational resources

Evaluation
• Qualitative surveys every six months for both men and women
• Measure contraceptive prevalence rates before and after implementation, every year

Questions?