title: Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation.
abstract: Family planning is crucial for preventing unintended pregnancies and for improving maternal and child health and well-being. In urban areas where there are large inequities in family planning use, particularly among the urban poor, programs are needed to increase access to and use of contraception among those most in need. This paper presents the midterm evaluation findings of the Urban Reproductive Health Initiative (Urban RH Initiative) programs, funded by the Bill & Melinda Gates Foundation, that are being implemented in 4 countries: India (Uttar Pradesh), Kenya, Nigeria, and Senegal. Between 2010 and 2013, the Measurement, Learning & Evaluation (MLE) project collected baseline and 2-year longitudinal follow-up data from women in target study cities to examine the role of demand generation activities undertaken as part of the Urban RH Initiative programs. Evaluation results demonstrate that, in each country where it was measured, outreach by community health or family planning workers as well as local radio programs were significantly associated with increased use of modern contraceptive methods. In addition, in India and Nigeria, television programs had a significant effect on modern contraceptive use, and in Kenya and Nigeria, the program slogans and materials that were blanketed across the cities (eg, leaflets/brochures distributed at health clinics and the program logo placed on all forms of materials, from market umbrellas to health facility signs and television programs) were also significantly associated with modern method use. Our results show that targeted, multilevel demand generation activities can make an important contribution to increasing modern contraceptive use in urban areas and could impact Millennium Development Goals for improved maternal and child health and access to reproductive health for all.
authors.affiliation: The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, USA The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA ilene_speizer@unc.edu.
authors.forename: Ilene S
authors.initials: IS
authors.lastname: Speizer
authors.affiliation: The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Corroon
authors.affiliation: The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Calhoun
authors.affiliation: The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Lance
authors.affiliation: Harvard University Center for Population and Development Studies, Cambridge, MA, USA.
authors.forename: Livia
authors.initials: L
authors.lastname: Montana
authors.affiliation: International Center for Research on Women, Asia Regional Office, Delhi, India.
authors.forename: Priya
authors.initials: P
authors.lastname: Nanda
authors.affiliation: The University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA The University of North Carolina at Chapel Hill, Department of Economics, Chapel Hill, NC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Guilkey
mesh_terms: D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003273:Contraceptive Devices / Q000706:statistics & numerical data; D005193:Family Planning Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D007630:Kenya; D008137:Longitudinal Studies; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration*; D009549:Nigeria; D010353:Patient Education as Topic / Q000379:methods; D012675:Senegal; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult