the-impact-of-a-family-planning-multimedia-campaign-in-bamako-mali

The Impact of a Family Planning Multimedia Campaign in Bamako, Mali
Author(s): Thomas T. Kane, Mohamadou Gueye, Ilene Speizer, Sara Pacque-Margolis and Danielle
Baron
Source: Studies in Family Planning, Vol. 29, No. 3 (Sep., 1998), pp. 309-323
Published by: Population Council
Stable URL: http://www.jstor.org/stable/172277 .
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The Impact of a Family Planning Multimedia
Campaign in Bamako, Mali
ThomasT.Kane,MohamadouGueye, Ilene Speizer,
SaraPacque-Margolis,and Danielle Baron
An integratedmultimediacampaignfeaturingfamilyplanningmessagessaturatedthe900,000-
personcityofBamako,Mali,for threemonthsduringthespringof1993.Withtraditionaltheater
andmusic,familyplanningmessageswererepeatedlybroadcaston radioandtelevisionthatconveyed
informationaboutmoderncontraceptivemethods,theneedformalesexualresponsibility,thehealth
and economicadvantagesoffamily planning, the needfor communicationbetweenspouses, and
thatIslam,thepredominantfaithofMali,doesnotopposefamilyplanning.A separatesamplepretest-
post-test quasi-experimentalresearchdesign was used to evaluatethe effectsof the campaignand
exposuretospecificmessageson changesin contraceptiveknowledge,attitudes,andpractice.Results
indicatea highlevelofexposuretoandagreementzviththemessages.A dramaticdropwasfound in
theproportionofmenandwomenwhobelievethatIslamopposesfamilyplanning.Logisticregression
results indicatethat contraceptiveknowledgeand use and morefavorableattitudes towardfamily
planning are positively associatedwith intensity of exposureto the projectinterventions, after
controllingforrelevantvariables.(STUDIESINFAMILYPLANNING1998;29,3:309-323)
Mass media communication techniques have been found
to be an effective way to diffuse information about fam-
ily planning and to effect changes in attitudes toward
and practice of contraception in a variety of populations
(Rogers and Rogers, 1976; Rogers and Kincaid, 1981;
Gallen and Rinehart, 1986;Bertrand et al., 1987;Hornik,
1989 and 1990; Piotrow et al., 1990 and 1992; Valente,
1994;Westoff et al., 1994aand 1994b;Guilkey et al., 1995;
Westoff and Rodriguez, 1995). In traditional societies,
at the early stages of adoption of modern contraceptive
ThomasT. Kaneis OperationsResearchScientist,
OperationsResearchProject,HealthandPopulation
ExtensionDivision, InternationalCentreforDiarrhoeal
DiseaseResearch,Bangladesh,GPO Box128, Dhaka-1000,
Bangladesh.MohamadouGueyeis SeniorDemographer,
CERPOD,Bamako,Mali. IleneSpeizeris Assistant
Professor,TulaneUniversitySchoolof HygieneandTropical
Medicine,New Orleans,LA. SaraPacque-Margolisis
UnitedStatesAgencyfor InternationalDevelopmentLiaison
Officerto CERPOD,Bamako.Danielle Baronis Program
Officer,JohnsHopkinsUniversity Centerfor
CommunicationsPrograms,Baltimore,MD.
practice, traditional norms, values, and beliefs remain
strong. In these cultural contexts, messages about fam-
ily planning may have to be presented in particularly
acceptable ways. The use of traditional media such as
songs, music, plays, and proverbs using local languages
in familiar settings is one strategy for reaching segments
of some populations that are illiterate or closely tied to
certainbeliefs and practices.
In this report, the results are discussed of an evalu-
ation of a 1993 information, education, and communi-
cation (IEC)campaign that integrated traditional forms
of communication and modern mass media to present
family planning messages through radio and television
to men and women in Bamako, Mali.
Several theoretical frameworks developed over the
past two decades have helped to explain the role that
mass media IEC messages play in influencing contra-
ceptive knowledge, attitudes, and behavior, including
the health belief model (Becker, 1974), the theory of rea-
soned action (Fishbein and Ajzen, 1975; Fishbein, 1980;
Fishbein et al., 1991),and social cognitive learning theory
(Bandura, 1986; Nazeer, 1995). Hornik (1989 and 1990)
has reviewed some of these alternative models of health-
behavior change, many of which have been applied to
public health and family planning.
In the application of the health belief model to
Volume 29 Number 3 September 1998 309

change in contraceptive behavior, an individual would
be motivated to use a contraceptive method if he or she
perceives (1) that he/she is susceptible to unplanned
pregnancies or at risk of having a larger family size than
desired; (2) a high degree of negative consequences, in
terms of health risks or economic or social costs result-
ing from having a family size larger than desired or from
an unplanned pregnancy; (3) the potential benefits of
practicing contraception; and (4) the barriers that must
be overcome in order to practice contraception (Becker,
1974;Hornik, 1990). The "cues to action" for adopting a
contraceptive method may come in the form of mass
media messages or from interpersonal communication,
or may result from adverse personal experiences with
an unplanned pregnancy, or from any combination of
these elements (Becker, 1974;Hornik, 1990).
According to Fishbein's theory of reasoned action
(Fishbein, 1980), contraceptive behavior may be seen as
subject to two major influences: (1) the attitude of the
individual toward the practice of contraception and (2)
the individual's "subjective norm" or belief concerning
what his or her sexual partners will think regarding the
practice or nonpractice of contraception. Mass media
family planning messages can have a positive effect on
both of these influences, and thus may lead to the deci-
sion to use a contraceptive.
The social cognitive learning theory approach (Ban-
dura, 1986) has also been a useful model for predicting
contraceptive behavior, whereby the individual's (or
couple's) concept of self-efficacy with regard to the prac-
tice of contraception is also taken into account. Mass
media IECinterventions can include information or mes-
sages designed to increase the individual's (or couple's)
self-confidence in her or his ability to practice contra-
ception effectively and behave responsibly in sexual situ-
ations. Such messages can be presented in televised fam-
ily planning plays or spots, through persuasion
techniques as part of the IECmessages, and by enhanc-
ing negotiation skills. Montgomery and Casterline (1993
and 1996) have provided empirical evidence demon-
strating the impact of social learning and social influ-
ence on the diffusion of fertility-control behavior.
Mass media family planning IECcampaigns can in-
fluence men and women to use contraceptive methods
to control their fertility by: (1) conveying family plan-
ning messages through television and radio that allow
couples to consider, some for the first time, the possi-
bility of contraception; (2) legitimizing the practice of
contraception as acceptable behavior; (3) pointing out
some of the economic, social, and health advantages of
smaller family size achieved through effective contra-
ceptive practice;and (4)providing information about the
use of and sources for modern contraceptive methods
and encouraging sexual responsibility and communica-
tion between partners on the subject of family planning.
The IECmessages contained in the television and radio
broadcast campaign reported on and evaluated in this
study cumulatively addressed all of the four points
above, through the entertainment-education approach
of using television and short radio spots and dramas.
Thisapproachhas been shown to be an increasingly popu-
lar and effective strategy for this purpose (Lettenmaieret
al., 1993;Valente, 1994;Yoder et al., 1996).
Background
In terms of income per capita and natural resources, Mali
is one of the world's poorest and least developed coun-
tries. Composed of diverse ethnic groups (Bambara,
Peul, Soninke/Sarakole, Malinke, Songhai, Tuareg,
Bozo, Dogon, and others), this predominantly Muslim
West African country situated in the Sahel region has
only recently begun to embrace modern family planning
practice as part of the country's programs for improved
health and economic development. Prevalence of con-
traceptive use nationwide remains low. According to the
Demographic and Health Surveys (DHS) conducted in
Mali in 1987 and again in 1995-96, current use of any
method of contraception among currently married
Malian women increased from only 5 percent to 7 per-
cent in the period between the two surveys, and cur-
rent use of modern methods increased from only a little
more than 1 percent in 1987 to 4 percent in 1995-96
(Traoreet al., 1989;Coulibaly et al., 1996). With a popu-
lation of almost 10 million in 1997 and an annual rate of
population growth of 3.0 percent, Mali's population
could double in 23 years (Haub and Cornelius, 1997).
During the last five years, efforts to bring family
planning services to Mali have increased dramatically
through the work of the Ministry of Health; the private
family planning association, Association Malienne pour
la Protection et la Promotion de la Famille (AMPPF);and
the SOMARC contraceptive social marketing project,
which promotes and sells contraceptives at subsidized
prices through pharmacies and stores (SOMARC II,
1992). Bamako, the capital and by far the largest city in
Mali, has a population of about 900,000-almost 10 per-
cent of the total population-and is still a predominantly
traditional society. The Bambara are the largest ethnic
group in Bamako, and most other ethnic groups living
in Bamako speak Bambara as well as their native lan-
guages.
In 1989, AMPPF, in collaboration with the Johns
Hopkins University/Population Communication Ser-
vices project (JHU/PCS), began a project entitled "Mod-
310 Studiesin FamilyPlanning

ern and Traditional Media to Promote Family Planning
in Mali." The project included various family planning
IEC activities, and covered the District of Bamako and
the city of Segou, the two urban areas in Mali where
AMPPF runs family planning clinics. The purpose of the
projectwas to strengthen the institutional capacity of the
AMPPF at the central and regional levels in order to in-
crease the use of existing family planning services.1
The Mass Media Campaign of 1993
The 1993 mass media campaign conducted by AMPPF
in Bamako was part of the project to promote family
planning in Mali. The campaign's objectives-to effect
changes in contraceptive knowledge, attitudes, and prac-
tice-are examined here in relation to background socio-
demographic factors, exposure to radio and television,
and to the specific family planning IEC interventions
of the intensive campaign conducted in Bamako by
AMPPF.The campaign consisted of four television plays,
four short television spots, and two recorded songs con-
taining various family planning messages that were
played on the radio during the intervention period. Dur-
ing the campaign period, each of the four 30-minute
plays aired two times, the four short spots (one minute
each) aired more than 40 times (at least ten times each),
and the two songs were played more than 70 times. The
campaign was part of a larger AMPPF three-year tradi-
tional and modern media project. The purpose of the
larger project was to increase the adoption of family
planning in Bamako and selected other cities in Mali and
to increase the use of AMPPF family planning services.
In addition to the radio and television messages, spots,
and plays, the projectdesigned and launched a national
family planning logo during the first week of the three-
month IEC campaign period. The main messages con-
tained in the ten IECinterventions used in the campaign
are described in Table 1.
The interventions primarily targeted married men
and women. Specific messages were designed to address
some of the important barriers to family planning ac-
ceptance, such as misconceptions and lack of knowledge
about specific methods, men's disapproval of family
planning and their high desired family size, and the
widespread perception that Islam is opposed to contra-
ceptive practice.
The purpose of the evaluation of the AMPPF tradi-
tional and modern media project was twofold: (1)To de-
termine the impact of the mass media interventions on
contraceptive knowledge, attitudes, and practices of men
and women of reproductive age living in Bamako by ex-
amining changes over the six-month period between the
baseline and postintervention surveys that included the
three-month campaign; and (2) to determine whether the
media interventions attracted new clients to the AMPPF
clinic in Bamako. The clinic-based results are reported
elsewhere (see Mbodji et al., 1994).2
To achieve these objectives, four surveys were car-
ried out in Bamako: the population-based 1992 Bamako
Baseline Survey, the 1993Bamako Postintervention Sur-
vey, the 1992 AMPPF Clinic Baseline Survey, and the
1993 AMPPF Clinic Postintervention Survey on sources
of referral of new family planning acceptors at the clin-
ics (Gueye et al., 1993 and 1994;Mbodji et al., 1994). The
baseline surveys conducted in November-December 1992
preceded the AMPPF family planning television and ra-
dio IECcampaign, which began in early April 1993 and
continued to the end of June 1993.
Methodology
A separate sample pretest-post-test quasi-experimental
design was used for the population-based evaluation in
Bamako. A separate sample quasi-experimental design
was chosen to avoid certain threats to the internal va-
lidity of the study (for example, against such biases as
testing and selection) (Fisher et al., 1991). No control-
group population was available for comparison with
Bamako (the intervention area) because of the vast dif-
ference in the size, structure, and mass media access of
the population of Bamako compared with the next-larg-
est urban areas of Mali.3Also, experimental and control
areas within Bamako were not available because televi-
sion and radio interventions reached all segments of the
city. Two independent two-stage, stratified, random-
sample surveys of adult men and women of reproductive
age living in Bamako were conducted. The preinter-
vention baseline survey was conducted in November-
December 1992 with a sample of 402 men and 422 wom-
en, and the postintervention survey was carried out in
July-August 1993 with a sample of 418 men and 450
women.4'5The surveys assessed respondents' exposure
to the mass media interventions, their agreement with
the messages and actions taken, as well as their knowl-
edge and use of contraceptives, attitudes toward family
planning, awareness of AMPPF services, and back-
ground sociodemographic characteristics. Multivariate
binomial logistic regression models are used to exam-
ine the effects of demographic and socioeconomic vari-
ables on the likelihood of exposure to the AMPPF inter-
ventions, and to assess the effects of exposure to the
interventions on contraceptive knowledge, attitudes, and
practice, while controlling for demographic and socio-
economic variables.

Table 1 Elements of the AMPPF three-month mass media familyplanning campaign, Bamako, Mali, 1993
_- ,;,-
-
? - I_- I CI-e -I- ?II?C ?---
Element
Songs
Song 1(forradio):"WoloMuso"(WomanWhoProcreates),
sungbyDjenebaSeek
Song2 (forradio):"SereDen"(SpacedBirths),sungbyPayiCamara
Fourtelevision Kotebaplays (30 minutes each)
Play1:"Ladilikan"(TheCounseling)bySigliDolo
Play2:"Konamani"byElMoctarToure
Play3:"Sauvonsdes Vies"(LetUsSave Lives)
byAliouBabaCoulibaly
Play4:"DamakegneoulaJusteMesure"(TheCorrectMeasure)
byMamadouTraor6
Fourtelevision spots (one minuteeach)
Spot1:Intheyardofa housingcompound,Gimba,a singleman,
discusses birthspacingwitha couple.
Spot2:Gimbaoverhearsa discussionaboutcondomsbetween
a mananda marketwomanwhosells peanuts.
Spot3:Gimbaandanothermanplaycheckersanddiscussthe
financialandotheradvantagesoffamilyplanning.Gimbacitesthe
Bambaraproverb,"Onehealthylioncubisworthmorethana basket
oflittlekittens."
Spot4:GimbaandanothermandiscusstheKoranandbirthspacing
as theyleavethemosque.Gimbaagreeswiththeimamwhoexplained
duringprayersthatfamiliesshouldstophavingchildrenwhentheydonot
havethemeanstosupportthem.TheothermanthinksIslamisopposed
tofamilyplanning.
Message/story
Birthspacingisgoodforchildren'shealth.Breastfeedingwomenshoulddelay
pregnancytopreventmalnutrition,weakness,anddiseases intheirchildren.Birth
spacingallowswomentobecomestrong.Putbrakesoncloselyspacedpregnancies
andthewholefamilybenefits.Womenwhospace theirchildrenwillliveingreater
harmonywiththeirfamilies,andtheyandtheirchildrenwillbe moresolidand
healthier.
Avoidingmultiplebirthsandcloselyspaced birthssaves themother'sandthechild's
lives.Tomakeyourfamilya happyone, adoptmodernmethodsoffamilyplanning
thatareofferedatAMPPF.(Atleasteighttimesinthesong,thesingerurges
womentovisittheAMPPFclinic.)
Twocouplesdecidetouse AMPPFfamilyhealthservicesinS6gou:Onecouple
adoptscontraceptiontoavoidanundesiredpregnancyandtheothercoupleseeks
treatmentforaninfertilityproblem.
Twoyounggirlsbecomepregnantandone dies. Thethemeis sexualresponsibility.
Thispieceuses themaskedsymbolofa pregnantwomen.Themaskedfigureofa
pregnantwomanappearscontinuouslyas theconscienceofthecommunityand
remindspeopleaboutthedangersandconsequences ofunwantedpregnanciesand
oftheresponsibilityofparentsandthecommunity.
Twobrothersarecompared:Oneiswell-establishedandplanshisfamily,andthe
otherhas problemsanddoes notplanhis.Theirattitudestowardfamilyplanningare
contrastedandusedtofosterdiscussionsshowinga rangeofmen'sopinions
concerningfamilyplanningandtoofferresponsestoquestionsthatmenpose about
familyplanning.
Acouplesearchesforadvicefroma marabout(Muslimtraditionalhealer)aboutfamily
planning(thehusbandwantschildrenandisconcernedaboutinfertility,whereasthe
wifeissecretlyusingthepillbecause she isafraidtohavechildrenafterhearingabout
a maternaldeathinthevillage).AMPPFprovidersvisitthevillagetotalkaboutfamily
planning.Theplayaddressestheconflictbetweenspouses concerningfamily
planningandthecoexistenceoftraditionalmedicine,Islamicreligion,andfamily
planning.Theplayis basedona truestory.
Thespotillustratesthecouple'sneedtocommunicateaboutfamilyplanning.
Don'tlistentorumors;get reliableinformation.
Thereareeconomicadvantagestobe gainedwithfamilyplanning.
Islamdoes notopposefamilyplanning.
Questionnaires
The baseline and postintervention questionnaires were
designed to evaluate the exposure and impact of the
campaign's television and radio family planning mes-
sages. The same individual questionnaire was used for
both men and women. Changes in knowledge and atti-
tudes on these topics between the baseline and postin-
tervention surveys in Bamako were examined in relation-
ship to exposure to the IECmass interventions containing
the various family planning messages.
For this purpose, several composite exposure vari-
ables were constructed: intensity of exposure to televi-
sion and radio (ranging from no exposure-did not see
any television or hear the radio at all during the last six
months-to high exposure-saw television and heard
the radio every day or almost every day during the last
six months) and intensity of exposure to the AMPPF's
IECmass media campaign (measured from zero to ten,
whereby zero means "did not see or hear any of the ten
interventions" and ten means "saw or heard all ten of
the interventions").
Questions about two contraceptive social marketing
products, namely Protector? condoms and Pillplan?moral
contraceptives, were added to the questionnaire because
the social marketing project of SOMARC and the
Pharmacie Populaire du Mali had carried out a televi-
sion and radio advertising campaign to promote Pro-
tector condoms during a six-month period prior to the
1992 Bamako baseline survey. Inclusion of questions on
contraceptive social marketing products and activities
enabled the authors to control for some possible mul-
312 Studiesin FamilyPlanning

tiple-treatment effects that could have threatened the in-
ternal validity of the study results.6
The short period between the preintervention base-
line survey and the postintervention survey and the
documentation of other events occurring in Bamako dur-
ing the study period also helped the study to control
for "history" (unforeseen events that may also effect out-
come variables).
As noted above, the use of two separate random
samples for both the Bamako baseline (preintervention)
and the postintervention survey avoided some selection
biases and testing effects thatcould also have undermined
the internal validity of the study results. Except for the
inclusion of additional questions at the end of the post-
intervention questionnaire about the AMPPF mass me-
dia interventions and Pillplan oral contraceptives, the
question sequence and wording of the two question-
naires were kept exactly the same for the two surveys
to avoid possible biases resulting from changes in the
survey instruments. The relatively short time between
the baseline and postintervention surveys (six months)
helped to avoid some other potential threats to internal
validity, such as maturation and mortality/migration/
dropout/contamination effects. The separate sample
pre- and post-test design is appropriate because it con-
trols for several effects that could have undermined the
external validity or generalizability of the results (that
is, interaction of testing and the intervention; interaction
of selection and the intervention; and reactive arrange-
ments [Hawthorne effects] [see Campbell and Stanley,
1963]).
In this analysis, the total three-month mass media
campaign, which included all ten television and radio
interventions, is considered to be the intervention be-
ing evaluated. No attempt is made to compare the rela-
tive effects of each television and radio intervention on
contraceptive knowledge, attitudes, and practice;rather,
the overall impact of the campaign is examined. However,
the differentials in exposure of the population to the sepa-
rate interventions are compared and the determinants of
exposure to each intervention areexamined.
Results
Selected sociodemographic characteristics of the male
and female respondents in the pre- and postintervention
surveys are provided in Appendix Table Al. Because
the age range for men was 15-59 compared with that of
15-49 for women, the proportion of men aged 15-24 was
lower than the proportion of women of this age group.
Also, because men tend to marry much later than wom-
en (about 10 years later on average), the proportion of
unmarried men is much higher than the proportion of
unmarried women for both the baseline and post-
intervention surveys. Inboth surveys, the men had higher
levels of education overall than did the women surveyed.
Reported education composition was comparable in the
two surveys for both the male and female samples. The
pretest and post-test samples generally had similar dis-
tributions by age, number of living children, education,
and other variables. Although the differences were not
statistically significant, slightly fewer women were in-
terviewed in the 15-24 age group in the postintervention
survey sample than in the baseline survey sample, which
may account for the significantly lower proportion of
unmarried women and higher proportion of monoga-
mously married women interviewed in the postinter-
vention survey than in the baseline survey sample. The
same random sampling procedure was used for both the
baseline and postintervention surveys. Apart from ran-
dom variations in the demographic structure of the ar-
eas selected for the two samples, another explanation
may account for these differences.7
Although the Bambara ethnic group makes up only
about one-third of the male and female samples, most
ethnic groups, particularly those who live in Bamako,
speak and use the Bambara language. Bambara, the of-
ficial language of Mali, is used in all the AMPPF cam-
paign interventions (Mali's lingua franca is French).
About one-fifth of the male samples and about one-third
of the female samples have no formal schooling. The vast
majority of respondents are Muslims. About 95 percent
of male and female respondents have access to a radio
in their households, and well over one-half of the men
and women have access to a television set at home.
Family Planning Attitudes and Intentions
In Table 2, selected attitudes and fertility intentions of
both men and women are shown according to responses
from the baseline and postintervention surveys. Sharp
and statistically significant increases in the proportion
of men and women who intend to use modern contra-
ceptives in the future are observed between the base-
line survey and the postintervention survey (from 54
percent to 75 percent for men; and from 46 percent to 63
percent for women).
One of the most dramatic shifts in attitudes observed
was the significant decline in the proportion of both men
and women who believe that Islam opposes family plan-
ning (57 percent of women in the baseline survey be-
lieved that Islam is against family planning, whereas
only 17 percent of women in the postintervention sur-
vey said they believed that this was so). The dramatic
change in both men's and women's attitudes and beliefs

Table 2 Percentage of male and female respondents who
indicated selected attitudes and fertilityintentions according to
the baseline (November-December 1992) and postinterven-
tion (July-August 1993) surveys, Bamako, Mali
Men (15-59) Women (15-49)
Post- Post-
Attitude/intention Baseline intervention Baseline intervention
Intendto use modern
method inthe futurea 54.5 75.4* 46.2 63.1*
Feel that ideal birth
intervalis >30 months 63.2 67.4 61.3 63.8
Believe Islam opposes
familyplanning 21.5 14.4* 56.6 16.9*
Believe a man who
practices familyplanning
is a responsible person 86.7 90.7 81.0 86.0*
Desire more children 86.3 86.6 73.9 74.2
Mean number of additional
children desired 3.7 3.5 3.3 3.1
(N) (402) (418) (422) (450)
Significant at *p<0.05. "Includesboth current users and nonusers.
concerning Islam's stance regarding contraception can
be directly linked to the positive messages in some of
the campaign's interventions that Islam and the Koran
support the idea of family planning. The impact of these
messages is particularly important for women of repro-
ductive age, who normally do not visit mosques and
who are often illiterate and, therefore, less likely than
men to be up-to-date on current Islamic teachings.
Other favorable attitudes toward family planning
were observed in the postintervention survey compared
with the baseline survey. For example, increases were
found in the proportion of men and women who think
that men who practice family planning are acting re-
sponsibly (among men, an increase from 87 percent to
91 percent; among women, from 81 percent to 86 per-
cent). Decreases were also seen in the proportion of both
men and women who think talking about family plan-
ning with their spouses/partners is difficult (among
men, from 11 percent to 6 percent; among women, from
17 percent to 13 percent) (not shown). Substantial in-
creases in awareness of both men and women about
AMPPF services were found over the campaign period.
Among men, awareness about AMPPF services in-
creased from 69 percent to 82 percent; among women,
awareness increased from 50 percent to 57 percent (not
shown).
Contraceptive Knowledge
The baseline survey indicated that awareness of contra-
ceptive methods was already high among both men and
women, leaving little room for improvement in this in-
dicator over the intervention period (not shown). About
94 percent of married men knew of at least one modern
method in the baseline survey, compared with 98 per-
cent in the postintervention survey. Among unmarried
men, 97 percent in the baseline survey and 100 percent
in the postintervention survey knew of at least one mod-
ern method. Among unmarried women, 90 percent of
those responding to the baseline survey stated that they
knew of at least one modern family planning method,
compared with 94 percent in the postintervention sur-
vey. Oral contraceptives and the condom were by far
the best-known methods according to the baseline and
postintervention surveys, whereas vasectomy and vagi-
nal tabletswere the least well-known modem methods ac-
cording to both surveys among both men and women.
The level of knowledge of male sterilization re-
mained very low and virtually unchanged among mar-
ried men (27 percent in the baseline survey versus 26
percent in the postintervention survey) and among mar-
ried women (8 percent in both surveys). The lack of a
significant increase in men's and women's knowledge
of male and female sterilization is not a surprising find-
ing, because the IECintervention messages did not em-
phasize these methods; rather they focused more on
pills, condoms, injectables, IUDs, and vaginal tablets.
More than one-fifth of the men (21 percent) and
women (22percent) who stated that they knew of at least
one modern method did not know where to obtain these
methods in the 1992baseline survey, although these pro-
portions declined to 16 percent for men and 15 percent
for women in the postintervention survey (not shown).
Of course, simple awareness of a modern method does
not reflect depth of knowledge (how to use the method,
how the method prevents pregnancy, contraindications
to use, side effects, effectiveness, advantages and dis-
advantages, or where to obtain the method). Some of
the AMPPF televized interventions not only showed the
different contraceptives, but also explained how to use
them and where to obtain them.
CurrentUse of Modern Contraceptives
A consistent increase in current use of modern contra-
ceptives among married couples is observed during the
short period between the baseline and postintervention
surveys for unmarried and married men and women
(see Table 3). Changes in current use of modern contra-
ceptives were less pronounced in the unmarried popu-
lation, although the overall prevalence of modern con-
traception was generally higher among unmarried men
and women of reproductive age than among married
men and women (not shown). Given that current use of
modern methods is higher among the unmarried than
among the married, the lower proportion of unmarried
314 Studies in Family Planning

Table 3 Percentage of currentlymarriedmen and women
who reported that they currentlyuse a modern contraceptive,
by method, according to the baseline (November-December
1992) and postintervention (July-August 1993) surveys,
Bamako, Mali
Mena(15-59) Women" (15-49)
Post- Post-
Method Baseline intervention Baseline intervention
Any modern method 26.9 29.6 11.8 15.4
Pill 14.3 18.6 8.8 12.1
IUD 1.1 1.4 0.1 1.9
Injectables 0.7 1.1 0.4 0.3
Condom 15.5 18.4 1.6 0.6
Vaginaltablets 1.6 1.4 0.0 0.3
Femalesterilization 0.3 0.5 0.9 0.7
Vasectomy 0.0 0.0 0.0 0.0
(N) (198) (199) (257) (310)
aCurrentuse of moderncontraceptivemethodschangedbyless thanone per-
centagepointbetweenthebaselineandfollow-upsurveyforbothunmarriedmen
(from51.5 percentto 52.2 percent)andunmarriedwomen(from17.1percentto
16.5percent).
women observed in the postintervention survey may re-
sult in an underestimate of the overall impact of the project
interventions on the total female sample.
Substantial increases in married women's reported
use of oral contraceptives and men's reports of their part-
ners' use are also shown in the table. Although married
men reported a substantial increase in the use of con-
doms between the baseline and postintervention sur-
veys, married women reported no such increase. Possi-
ble explanations for married women's reporting lower
condom use include: (1) because it is a male method;
and (2) because the condom is associated with commer-
cial sex workers rather than married couples, making
the subject of its use embarrassing for married women
to discuss. Married men may report higher use because
they use condoms with commercial sex workers or in
casual extramaritalrelationships (to prevent STDs/AIDS
as well as pregnancy) or because, in polygamous mar-
riages, men use condoms with only one of several wives
(Ezeh and Mboup, 1997).
Unmarried men and women living in Bamako were
more likely to be using modern contraceptive methods
to prevent pregnancy than were married men and wom-
en. The lack of significant change in modern contracep-
tive prevalence between the baseline and postinter-
vention surveys among unmarried men and women
could result from the way most family planning mes-
sages were presented, that is, in a context most imme-
diately relevant-or indeed, specifically targeted to-
married men and women.
The prevalence of modern contraceptive use among
currently married women in Bamako increased from 6
percent in 1987 (Traore et al., 1989) to 12 percent in the
1992baseline survey-over a period of about 65 months
-and from 12 percent in November-December 1992 to
15 percent in the July-August 1993 postintervention sur-
vey over a period of only seven months. The 1995-96
Mali DHS shows that current use of modern contracep-
tives among currently married women in Bamako was
16 percent (Coulibaly et al., 1996), only one percentage
point higher than the 1993 postintervention survey esti-
mate, about two and a half years earlier.
Exposure to Mass Media and Family Planning
Messages
Exposure to television and radio and to the ten specific
project interventions was remarkably high, as shown in
Table 4. Because most households, concessions, and
compounds in Bamako have radios and the majority
have television sets, and because the choice of channels
is limited (one television station and two local radio sta-
tions), a high proportion of the respondents were ex-
posed to the mass media campaigns.8
The proportion of men and women who had lis-
tened to the radio during the previous six months was
high in both the baseline and postintervention surveys
(95 percent and 96 percent for men, respectively; and
for women, it increased from 90 percent in the baseline
survey to 94 percent in the postintervention survey). Be-
tween the surveys, however, dramatic increases oc-
curred in the proportion of radio listeners who heard
about family planning on the radio. Among men, the
proportion increased significantly, from 69 percent to
90 percent; and among women, the proportion also in-
creased significantly, from 65 percent to 87 percent.9
Similarly, the proportion of men and women who
had watched television during the previous six months
was high in both baseline and postintervention surveys
(86 percent and 88 percent for men, respectively; and 83
percent for women in both surveys). The proportion of
male television watchers who saw something about fam-
ily planning on television increased significantly, from
73 percent to 96 percent between the baseline and the
postintervention surveys, as did that of women, from
68 percent to 92 percent.
The significant increase in exposure of both men and
women to family planning messages broadcast on ra-
dio and television during the relatively short six-month
period between the baseline survey and postintervention
survey in Bamako can be attributed largely to the in-
tense AMPPF media campaign conducted during the
three-month period of April and June 1993. About two-
thirds of both men and women of reproductive age in-
terviewed in the postintervention survey reported hear-
ing and/or seeing at least five or more of the ten project
interventions during the campaign period.
Volume29 Number3 September1998 315

Table 4 Percentage of male and female respondents exposed to mass media and AMPPF's IECinterventions, according to the
baseline (November-December 1992) and postintervention (July-August 1993) surveys, Bamako, Mali
Men(15-59) Women(15-49)
Post- Post-
Exposure Baseline (N) intervention(N) Baseline (N) intervention(N)
Exposedtomass media
Listenedtoradioinprevioussixmonths 95.1 (402) 95.7 (418) 90.2 (422) 94.4* (450)
Heardfamilyplanningmessages onradio 68.5 90.3* 65.4 87.1*
Watchedtelevisioninprevioussixmonths 85.6 (402) 87.6 (418) 82.9 (422) 82.9 (450)
Sawfamilyplanningplays/messagesontelevision 73.1 95.6* 67.5 92.2*
ExposedtoAMPPFIECinterventions (418) (450)
Song 1:'"WoloMuso" - 61.5 - 74.7
Song2:"SereDen" - 53.6 - 69.6
TVPlay1:"Ladilikan" - 56.0 - 56.0
TVPlay2:"Konomani" - 53.1 - 55.3
TVPlay3:"Sauvonsdes Vies" - 46.4 - 51.1
TVPlay4:"Damakegne" - 35.4 - 45.1
TVSpot1:Spousalcommunication - 74.2 - 66.0
TVSpot2:Rumors - 65.3 - 59.6
TVSpot3:Economicandhealthadvantagesoffamilyplanning - 69.1 - 61.6
TVSpot4: Islamandfamilyplanning - 67.2 - 61.8
Sawfamilyplanninglogo - 38.8 - 20.0
Correctlyidentifiedfamilyplanninglogoa - 51.9 - 33.1
Significantat*p<0.05. - = Notapplicable;baselinesurveywasconductedbeforeinterventions.
Note: Numbersinparenthesesrepresentnumberofobservations. aManywhodidnotsay theyhadseen the logowereableto guess correctlyorrec-
ognizedthelogoaftertheywereaskedtopickitoutfromamongthesixdifferentlogosshowntothemduringtheinterview.
Regarding the impact of this exposure on contracep- The proportion of men and women who know about
tive use, a cautionary note should be sounded: A po- or are currently using modern contraceptives is shown
tential bias could exist in the measurement of exposure in Tables 5 and 6, according to exposure status to radio
status to the family planning messages. If, in fact, the and television and family planning messages (see Table
people who most sympathize with family planning mes- 5) and exposure status for each of the ten project inter-
sages also tend to be the ones who recall the television ventions (see Table 6). Results indicate that a lack of ex-
and radio programs and messages, it is difficult to make posure to radio or television within the six months prior
causal inferences about the effects of this exposure on to the survey is associated with much lower levels of
current use of modern contraceptives. awareness of modern contraceptive methods and a sig-
Table 5 Percentage of male and female respondents who know of or are currentlyusing a modern contraceptive, by exposure
status to radioand television, according to the postintervention survey (July-August 1993), Bamako, Mali
Knowa modern Currentlyusing a
methoda.boc modernmethod a,d,e
Exposurestatus Men(N) Women(N) Men(N) Women(N)
Radio
Didnothearradioinlastsixmonths 88.9 (18) 72.0 (25) 11.1 (18) 0.0 (25)
Heardradio,butdidnothearaboutfamilyplanningontheradio 97.4 (39) 87.3 (55) 23.1 (39) 9.1 (55)
Heardradioandheardaboutfamilyplanningontheradio 100.0 (361) 97.0 (370) 44.9 (361) 18.1 (370)
Total(N) (418) (450) (418) (450)
Television
Didnotwatchinlastsixmonths 98.1 (52) 83.1 (77) 7.7 (52) 5.2 (77)
Watched,butdidnotsee playsormessages aboutfamilyplanning 87.5 (16) 86.2 (29) 12.5 (16) 6.9 (29)
Watchedandsaw plays/messagesaboutfamilyplanning 100.0 (350) 98.0 (344) 48.0 (350) 19.0 (344)
Total(N) (418) (450) (418) (450)
aModernmethodsinclude:oralcontraceptives,IUDs,injectables,condoms,vaginaltablets,spermicides,andmaleandfemalesterilization. bChi-squareanaly-
ses forlineartrendintheproportionsofmenandwomenwhoknowmodernmethods,accordingtoexposureto radioandtoexposuretofamilyplanningmessages on
theradio,aresignificantatthe0.01 level.Morethan15observationsineachcategory. "Chi-squareanalysesforlineartrendinproportionsofmenandwomen
whoknowmodernmethods,accordingtotelevisionexposureandtoexposuretofamilyplanningmessages ontelevision,aresignificantatthe0.01 level. dChi-
squareanalysesforlineartrendinthe proportionsof menandwomenwhoarecurrentlyusingmodernmethods,accordingto exposureto radioandto exposureto
familyplanningmessages on the radio,are significantatthe 0.01 level.Morethan15 observationsineach category. eChi-squareanalysesforlineartrendin
proportionsof menandwomenwhoarecurrentlyusingmodernmethods,accordingto televisionexposureandto exposureto familyplanningmessages on televi-
sion,aresignificantatthe0.01 level.

Table 6 Percentage of respondents currentlyusing mode n contraceptives, by theirexposure to AMPPF's mass media
interventions, according to the postintervention survey (July-August 1993), Bamako, Mali
Men (I5-59)b Women (1549)b
Interventionsa Exposed (N) Unexposed (N) Exposed (N) Unexposed (N)
Song 1: "WoloMuso" 47.1* (257) 31.4 (18) 17.0 (336) 17.6 (68)
Song 2: "Sere Den" 50.0* (224) 32.7 (153) 17.9 (313) 14.9 (94)
Play 1: "Ladilikan" 50.0* (234) 30.2 (159) 19.8* (252) 9.9 (162)
Play 2: "Konomani" 55.8* (222) 24.9 (193) 18.9 (249) 11.9 (193)
Play 3: "Sauvons des Vies" 52.1* (194) 32.0 (219) 20.0* (230) 11.8 (211)
Play 4: "Damakegne" 56.1* (148) 32.9 (264) 20.2 (203) 13.1 (236)
Spot 1: Spousal communication 48.1* (310) 21.7 (106) 19.9* (297) 9.3 (151)
Spot2: Rumors 50.9* (273) 23.8 (143) 20.1* (268) 9.0 (178)
Spot 3: Economic and health advantages of family planning 51.9* (289) 18.3 (126) 20.9* (277) 8.2 (170)
Spot 4: Islam and familyplanning 49.8* (281) 24.1 (133) 20.9* (278) 8.3 (169)
Significant at *p<0.05. "Allcategories contain more than 60 observations. bThe small number of missing values and "don'tknow"cases have been ex-
cluded.
nificantly lower prevalence of current use of modern
methods compared with awareness and current use
among men and women who listened to the radio or
watched television during the past six months. Further-
more, radio listeners and television watchers who were
exposed to family planning messages in general and to
the specific project intervention messages were signifi-
cantly more likely to know about and use modern con-
traceptive methods than were listeners and television
watchers who did not recall hearing or seeing any of the
family planning messages or programs during the pre-
ceding six months.
Table 7 examines the bivariate relationship between
the intensity of exposure to the interventions and cur-
rent use of modern contraceptive methods. In this in-
stance, intensity of exposure is measured in terms of the
number of project interventions heard or seen, ranging
from no exposure to exposure to all of the interventions.
Table 7 Percentage of respondents currentlyusing modern
contraceptives, by intensity of their exposure to AMPPF's IEC
mass media interventions, according to the postintervention
survey (July-August 1993), Bamako, Mali
Number of AMPPF IEC Men,ab Womena.b
interventions heardlseen (15-59) (15-49)
None 11.1 2.6
1-2 18.3 8.1
3-4 34.8 15.4
5-7 40.7 16.3
8-9 52.4 18.3
10 (all) 67.7 23.7
Total sample 41.4 15.8
(N) (418) (450)
Relative risks:
Exposed to 10/exposed to none 67.7/11 .1 = 6.1""** 23.7/2.6 = 9.0**
Significant at **p<0.01.
Notes: Instances of repeat or multiple exposure to the same intervention are
not taken into account in the counts of number of interventions heard/seen listed
above. aChi-square analyses for linear trend inthe proportionsof men and
women who are currentlyusing modern methods, according to number of inter-
ventions exposed to, are significant at p<0.01. bAllcategories have more
than 30 observations.
As the number of IEC interventions heard or seen in-
creases, the prevalence of current use of modern con-
traceptives rises significantly and dramatically for both
men and women. Men who heard or saw all ten IECin-
terventions were six times more likely to be using mod-
ern contraceptives than were men who were exposed
to none of the interventions; women who heard or saw
all ten interventions were about nine times more likely
to be using a modern method than were women who
did not hear or see any of the interventions.
Although an obvious socioeconomic selectivity fa-
vors men and women who have access to radio and tele-
vision over those who do not, the consistent and drama-
tic increase in modern contraceptive prevalence with
increasing exposure to greater numbers of project inter-
ventions suggests apositive linkbetween exposure to fam-
ily planning IEC mass media interventions and modem
contraceptive use. Theoretically, the causal path would
begin with exposure leading to improved knowledge
and attitudes toward family planning and an increase
in an individual's motivation to use a modern method.
The increased motivation to practice contraception would
ultimately lead to adoption of a modern method.
Multivariate Logistic Regression Results
A number of logistic regression models were tested to
examine the socioeconomic and demographic determi-
nants of exposure to the AMPPF project interventions
using the postintervention survey results for men and
women combined (Table 8 [model 1]). In a second stage
of the regression analysis, the question of whether the
intensity of exposure to the mass media campaign mes-
sages is linked to current use of modern contraceptives
was examined, again using the postintervention survey
data (Table 9 [model 2]). In another multivariate logis-
tic regression analysis, the association of exposure to a

Table 8 Logistic regression odds ratios showing the direction and significance of effects of selected demographic and
socioeconomic variables on the likelihoodof male and female respondents' being exposed to each of the ten AMPPF's IEC
interventions, according to the postintervention survey (July-August 1993), Bamako, Mali
Odds ratio
Variable Song 1 Song 2 Play1 Play2 Play3 Play4 Spot 1 Spot 2 Spot 3 Spot 4
Age 1.01 1.01 1.00 1.00 0.99 0.99 1.01 1.00 1.01 1.00
Sex
Female(r) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
Male 0.56** 0.45** 0.94 0.83 0.82 0.68* 1.61** 1.30 1.38 1.31
Maritalstatus
Unmarried(r) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
Married 0.93 0.95 1.01 0.90 0.92 1.29 0.61* 0.97 1.00 1.07
Numberoflivebirths 1.06 1.00 0.91* 0.83 0.95 0.96 0.91 0.94 0.88* 1.18
Education
None(r) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
Koranic 0.96 1.00 0.95 0.83 1.05 0.84 1.05 1.32 1.16 1.18
Primary 1.29 1.16 1.48* 1.28 1.28 1.34 1.65* 2.18** 1.98** 1.87**
Secondary 1.00 1.54 1.30 1.37 1.25 1.45 1.01 1.99* 3.03** 2.07*
Postsecondary/university 0.92 1.25 1.39 1.49 1.37 1.81 1.14 2.56* 2.18 1.68
Ethnicgroup
Bambara 1.02 0.90 0.79 0.83 0.87 0.82 0.89 0.86 1.00 0.77
Allother(r) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
Radioinhousehold
No(r) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
Yes 2.21** 2.33* 0.98 0.88 0.88 1.20 1.58 1.52 1.35 1.00
TVinhousehold
No(r) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
Yes 1.16 1.39* 4.27** 4.44** 4.02** 3.75** 10.24** 6.60** 9.27** 8.21**
PseudoR2 .03 .04 .11 .12 .10 .10 .24 .20 .25 .21
(r)=Referencecategory. Significantat*p?0.05;**p<0.01.
Notes: Numberofcases =868. Eachofthetencolumnsisa multipleregressionmodelofvariablesaffectingexposuretotherespectivemediainterventionlisted.
specific IECintervention having a targeted message (for
example, the positive views of Islam regarding family
planning) with the respondents' likelihood of stating a
favorable attitude or belief (for example, the belief that
Islam is not opposed to family planning) is explored,
while controlling for other relevant demographic and
socioeconomic variables in the model (Table 10 [model
3]). The analysis shown in Table 10 is restricted to Mus-
lim respondents. The regression models in Tables 8-10
control for respondents' age, sex, education, ethnic group,
marital status, religion, number of live births, and ex-
posure to television and radio during the six months be-
fore the survey, as well as for the intensity of exposure
to the campaign.10In the tables, the double asterisks in-
dicate that the relationships between each of the inde-
pendent variables listed and the dependent variables in
the models are significant at the 99 percent confidence
level or better."
Compared with women, men had a significantly
lower exposure to certain AMPPF campaign interven-
tions, particularly to the two songs played on the radio,
to television play number 4, and to television spot num-
ber 1, as shown in Table 8. Men were more likely, how-
ever, to report knowledge of modern cntraceptive meth-
ods (not shown) and current use of modem contracep-
tives than were women (see Table 9). Men were also
more likely than women interviewed in the postinter-
vention survey to believe that Islam does not oppose
family planning (see Table 10).
Educational level and presence of a television in the
household were both significantly and positively linked
to exposure to the project interventions (as shown in
Table 8), to knowledge of modern contraceptive meth-
ods (not shown), to current use of modern contracep-
tives (see Table 9), and to the belief that Islam is not op-
posed to family planning (see Table 10).Not surprisingly,
the presence of a radio in the household was signifi-
cantly and positively associated with exposure to the
two AMPPF family planning songs aired on the radio
as part of the campaign (see Table 8).
In the multivariate regression model 2 (Table 9),
married respondents were significantly less likely than
unmarried respondents to report current use of mod-
em contraceptives. The table also shows thatmodem con-
traceptive use was significantly and positively associated
with the respondents' reported number of live births,
with having a television in the household, with having
higher than a primary education, and with being male.
A significant positive association (direct effect) was
found between the highest educational levels and cur-
rent use of modern contraceptives, whereas a positive
but not significant association (direct effect) was found

Table 9 Logistic regression coefficients and odds ratios
showing the effects of intensity of exposure to the AMPPF's
IECmass media campaign and sociodemographic
characteristics on the likelihoodof currentlyusing a modern
contraceptive method, according to the postintervention
survey (July-August 1993), Bamako, Mali
-r, . 1 , - l ,,,:-
Characteristic
Age
Agesquared
Sex
Female(r)
Male
Maritalstatus
Unmarried(r)
Married
Numberoflivebirths
Education(directeffects)
None(r)
Koranic
Primary
Secondary
Postsecondary/universi
Ethnicgroup
Bambara
Othergroups(r)
Televisioninhousehold
No(r)
Yes
Currentuse of modernmethod
Coefficients Odds ratios
+0.3334** 1.40**
-0.0055** 0.99**
1.00
+1.3681** 3.93**
-0.7711
+0.1604
-1.3370**
-0.0190
+0.4284
+1.3494**
+0.0737
+0.4291 *
Intensityofcampaignexposure +0.0360 1.04
(exposure0 through10interventions)
(directeffects)
Interactioneffects:
Intensityofcampaign +0.1486** +Significant
exposurexeducationa atp=0.01
Intensityofcampaignexposurex -0.0414 - Not
ethnicgroup significant
PseudoR2 .26
(r)= Referencecategory. Significantat*"p0.05; *"p<0.01.
Notes: Numberof cases = 868. Modernmethodsincludepill,condoms,
IUDs,injectables,maleandfemalesterilization,vaginaltablets,andspermicides.
aThe"education"variableusedfortheinteractiontermisdichotomous(noschool-
ingversussome schooling,whereasthe "intensityof campaignexposure"vari-
ableistreatedas continuous[values0-10]).
Table 10 Logistic regression odds ratios showing the effects
of exposure to AMPPF's television spot number 4 and the
effects of demographic and socioeconomic background
variables on the likelihoodof male and female Muslims stating
the attitudethat Islam is not opposed to family planning,
according to the postintervention survey (July-August 1993),
Bamako, Mali
Odds ratios
Believe thatIslamis not
opposed to familyplanning
1.01
Characteristic
Age
Sex
Female(15-49) (r) 1.00
Male(15-59) 1.80**
Maritalstatus
Unmarried(r) 1.00
Married 1.22
Numberoflivebirths 1.03
Education
None(r) 1.00
Koranic 0.88
Primary 1.57**
Secondary 1.73**
Postsecondary/university 1.88*
Ethnicgroup
Bambara 1.04
Othergroups(r) 1.00
Televisioninhousehold
No(r) 1.00
Yes 1.41"*
Exposuretotelevisionspotnumber4a
Unexposed(r) 1.00
Exposedb 1.53**
PseudoR2 .21
Significantat*p<0.05;**p<0.01. (r)= Referencecategory.
Notes: Numberofcases =840, excluding28 non-Muslimrespondents.
aTelevisionspotnumber4 addresses Islamandfamilyplanning.Testsforinter-
actionsbetweenthevariables"exposuretotelevisionspotnumber4"and"edu-
cation"andbetween"exposureto televisionspot number4"and"ethnicgroup"
werenotsignificantandwere,therefore,notincludedinthe model. bThe
bivariateodds ratioof the beliefthatIslamis not opposed to familyplanning
amongrespondentsexposed to televisionspot number4 comparedwiththose
notexposedtothespotis OR= 3.05,whichis significantatthe0.05 level.
Discussion
between intensity of exposure to the campaign interven-
tions and current use (see Table 9). An important find-
ing in the multivariate logistic regression analysis shown
in the table was the significant positive interaction ef-
fect on current use found between the "intensity of cam-
paign exposure" variable and the "education" variable.
In other words, the effect of exposure on current use de-
pended on level of education (none versus some educa-
tion). "Intensity of campaign exposure" had no signifi-
canteffect on use for respondents with no schooling.
A significant positive association was also found be-
tween exposure to the television spot dealing with Islam
and family planning and respondents' belief that Islam is
not opposed to family planning, as shown in Table10.
Results from the postintervention survey indicate a high
level of exposure to and agreement with the messages
contained in the AMPPF's IEC mass media interven-
tions. During the six-month period between the base-
line and postintervention surveys, statistically signifi-
cant increases occurred in the proportion of men and
women who stated they had seen a family planning mes-
sage on television or heard a family planning message
on the radio. An equally dramatic increase was seen in
the proportion of men and women who stated that they
intended to use modern contraceptive methods in the
future. A substantial rise in the proportion of married
women using modern contraceptives in Bamako was
observed over the same six-month period between the
baseline (12 percent) and postintervention (15 percent)

surveys. Increased knowledge of family planning meth-
ods, increased awareness of AMPPF services, and more
favorable attitudes toward family planning were also
observed over the campaign period.
Given the reportedchanges in family planning knowl-
edge, attitudes, and practice during the six-month time
period between the baseline and postintervention sur-
veys and the general absence of other intensive IECmass
media efforts or changes in family planning service de-
livery or changes in the sociopolitical environment dur-
ing this same period, the impact of AMPPF's mass me-
dia campaign in Bamako may reasonably be considered
to be both positive and significant.
The intensity and diversity of the campaign, the tar-
geting of messages to men, to married women, and to
married couples, and the use of both traditionaland mod-
em media to convey family planning messages may ac-
count for the apparent positive impact the IECcampaign
had on knowledge of and attitudes toward family plan-
ning and on current use of modern contraceptives in a
major urban center of Mali. For the most part, contra-
ception continues to be viewed as a means of spacing
births ratherthan of limiting family size. However, these
surveys suggest that modern contraceptive practice is
rapidly becoming more acceptable in this urban setting.
The multivariate analysis indicates that education,
access to radio and television, and exposure to the mass
media messages are positively and significantly linked
to the use of modern contraceptive methods and to the
belief that Islam does not oppose family planning.
The postintervention survey revealed that some
negative attitudes about family planning persisted and
that the proportion of women who currently use mod-
ern contraceptives is still low in Bamako, well below the
proportion of women desiring no more children, a find-
ing indicating that a continued need exists forbetter fam-
ily planning information and services in Mali. Although
the mass media campaign appears to have had a mea-
surable positive impact, such efforts should be contin-
ued along with high-quality and easily accessible fam-
ily planning services, if such positive impact is to be
sustained and further progress is to be made.
The IECcampaign messages were not explicitly di-
rected toward adolescents or unmarried men and wom-
en, and these groups might also benefit from similar tar-
geted IEC efforts in the future. The AMPPF and the
Malian government are now attempting to conduct simi-
lar IECinterventions and evaluations in other urban ar-
eas and are planning to use traditional media to reach
rural populations through radio broadcasts of family
planning songs and through performances of traveling
Koteba theater troupes.
The AMPPF's intensive mass media family planning
campaign using traditional theater, music, and proverbs
in local languages and familiar settings appears to be an
effective way of creating a bridge between traditional
cultural values and practices and the acceptance of new
ideas about family planning.
Appendix
Table Al Percentage distributionof the baseline (Novem-
ber-December 1992) and postintervention (July-August
1993) survey samples, by selected characteristics and mass
media exposure, according to sex, Bamako, Mali
Men(15-59) Women(15-49)
Post- Post-
Characteristic Baseline intervention Baseline intervention
Agegroup
15-24
25-34
35-44
45+
Maritalstatus
Nevermarried
Married/monogamous
Married/polygamous
Widowed/divorced
Numberoflivebirths
0-1
2-5
6+
Education
None
Koranic
Primary
Secondary
University/postsecondary
Medersaa/other
Ethnicgroup
Bambara
Peul
Soninke
Malinke
Other
Religion
Muslim
Catholic
Other
Total
(N)
30.2
30.3
23.1
16.3
50.4
39.2
10.0
0.4
56.6
28.0
14.4
20.8
11.7
31.4
20.1
11.0
5.0
30.1
15.7
10.9
15.1
28.3
96.0
1.7
2.3
100.0
(402)
29.0
31.4
26.4
13.6
50.5
35.9
11.7
2.2
44.9
33.0
16.5
5.6
36.0
39.0
21.9
3.1
58.2 46.8
25.9 31.1
15.9 22.1
17.7
13.9
34.7
18.2
9.6
6.0
33.7
12.9
11.7
17.2
24.5
96.4
2.2
1.4
100.0
(418)
Massmediaexposure
Mediaaccess inhousehold
Radio 94.5 93.8
Television 61.7 54.8*
Frequencyofradiolisteningduringpastsixmonths
Daily/almostdaily 80.8 86.8*
Lessfrequently 13.7 8.9*
Notatall 5.5 4.3
Total 100.0 100.0
Frequencyoftelevisionviewingduringpastsixmonths
Daily/almostdaily 67.2 68.2
Lessfrequently 18.4 19.4
Notatall 14.4 12.4
Total 100.0 100.0
(N) (402) (418)
34.7
18.8
30.2
9.2
1.1
6.0
32.8
13.4
10.3
10.5
33.1
98.6
0.9
0.5
100.0
(422)
94.5
59.5
74.4
16.8
8.8
100.0
59.2
23.7
17.1
100.0
(422)
40.6
36.7
18.7
4.2
27.6*
49.8*
19.3
3.3
44.0
35.5
20.5
32.7
16.0
31.6
7.8
1.3
10.9*
31.7
15.1
11.1
14.2
27.9
97.1
2.7
0.2
100.0
(450)
95.8
59.1
77.1
17.3
5.6
100.0
61.8
21.1
17.1
100.0
(450)
Significantat*p<0.05. aMedersais a combinationofIslamicreligioustrain-
ingandWestern-styleschoolingwithinone formalschoolsetting.

Notes
1 As part of this project, the AMPPF, with assistance from the Johns
Hopkins University Center for Communications Program, devel-
oped and implemented several activities, including: an IECwork-
shop for IEC coordinators and regional AMPPF leaders and
health workers; a consensus-building seminar with AMPPF part-
ners; a theater and song contest held in Bamako and Segou; the
production and launching of a national family planning logo; and
under a contract with the Centre de Services de Production Au-
dio-Visuelles (CESPA), a videotaping of the four best theatrical
plays and the four television spots and a recording of the two
best songs. AMPPF also pretested the IEC interventions with re-
ligious and village leaders, and men and women.
2 Clinic records on new and continuing acceptors were analyzed,
examining trends in numbers of new male and female clients be-
fore, during, and after the media interventions. A baseline (pre-
intervention) survey and a postintervention source-of-referral
survey of new acceptors were conducted at the AMPPF clinic to
determine the extent to which the IEC media interventions and
other sources of media contact and individuals influenced men
and women to come to the clinic to adopt family planning. A to-
tal of 252 new female clients at AMPPF were interviewed in the
baseline AMPPF clinic survey, and 250 were interviewed in the
postintervention AMPPF clinic survey. The main findings from
the clinic-based evaluation were that monthly attendance at the
AMPPF clinics increased substantially (more than 12 percent)
during the three-month campaign period, and that attendance
was sustained at a higher level after the campaign, compared with
attendance levels prior to the campaign. In addition, the propor-
tion of new clients at the AMPPF clinic in Bamako who heard
the campaign song "Sere Den" on the radio, the song that invites
women eight times to visit the AMPPF clinic, was significantly
higher (88 percent) than the proportion of women in the general
population reporting to have heard the song, as indicated by the
representative survey of women in Bamako. These and other find-
ings suggest that the IEC campaign had a positive impact on
AMPPF clinic attendance during and after the campaign period
(Mbodji et al., 1994).
3 The next-largest urban towns of Segou, Mopti, Sikasso, Gao, and
Kayes have fewer than 100,000 inhabitants each (according to the
1987 Mali Census of Population [DNSI, 1987]). Populations in
these other urban areas of Mali have far more limited access to
radio and television and also to family planning services than
do the residents of Bamako.
4 The two population-based Bamako surveys' sample designs were
two-stage random samples using probability proportionate to size
(PPS) sampling for selection of enumeration areas (EAs) in the
first stage. The study population consisted of all women aged 15
to 49 and all men aged 15 to 59 living in Bamako. The survey
plan involved taking a representative sample of more than 400
men and 400 women from the six communes that make up the
District of Bamako. A total of 70 enumeration areas (approxi-
mately one-third of the total enumeration areas that make up
Bamako) were selected using PPS sampling. EA maps from the
1987 general population census were updated in 1992. Thirty-five
EAs were randomly selected from the 70 sampled EAs for the
baseline survey, and the remaining 35 EAs were used for the
postintervention survey. Each of the selected EAs, which varied
in size of population, was subdivided into segments of about 30
households per segment. In each of the even-numbered house-
holds listed in the randomly selected segment of each EA, one
eligible male was randomly selected for the interview, and one
eligible female was randomly selected from each of the odd-
numbered households listed in the selected segment.
5 Data collection for the 1992 Bamako preintervention baseline sur-
vey was carried out in two phases. In the first, two teams of in-
terviewers, one with five female interviewers and the other team
with four male interviewers, drew up a list of households and
eligible men and women. Each team had a same-sex supervisor.
The household listings for the baseline survey ran from 26 Octo-
ber to 3 November 1992 and for the postintervention survey, from
23 June to 4 July 1993. The selection of eligible survey respon-
dents yielded 464 men and 476 women for the baseline survey.
The second phase-data collection-was carried out by two
teams, one comprised of four female interviewers, the other com-
prised of four male interviewers, each team under the direction
of a supervisor. All interviewers participated in compiling the
list of eligible men and women. A total of 422 women aged 15 to
49 were interviewed. The response rate for women chosen for
the survey who were actually interviewed was 89 percent. The
interviews for the men's baseline survey took longer than the
women's interviews. A total of 402 men in the sample represented
87 percent of the men chosen for the survey. The longer inter-
view period can be explained by the fact that many of the men,
particularly those in outlying areas, arrived home from work very
late. Two to three visits were required, on average, to make con-
tact with the eligible men. The fieldwork for the 1993 Bamako
postintervention survey of men and women ran between 5 and
26 July 1993 for the female sample and from 5 July to 5 August
1993 for the male sample. The selection procedure for eligible
women and men in the sampled households resulted in a total
of 517 women and 499 men being chosen for the postintervention
survey. Interviews were conducted with a total of 450 eligible
women, a completion rate of 87 percent. A total of 418 eligible
males were successfully interviewed in the follow-up survey, an
interview completion rate of 84 percent for men. The proportion
of individuals actually interviewed in relation to the number cho-
sen varied by gender of respondents and by enumeration area.
Producing unbiased results for the different indicators being stud-
ied required that weighting coefficients be calculated for each of
the enumeration areas for each of the two sexes. The calculation
of the weighting coefficient uses the number of individuals cho-
sen and the number actually interviewed.
6 Television and radio advertising for the Protector condom ceased
before the baseline survey began and did not resume until after
the Bamako postintervention survey had been conducted. The
advertising and marketing campaign for Pillplan oral contracep-
tives did not begin until after the AMPPF IEC media campaign
was completed in June 1993, and the television advertisements
for Pillplan were taken off the air during the first week of mar-
keting because of opposition from the conservative Malian medi-
cal community, who were concerned about the promotion of a
specific brand of contraceptive and that women should have
medical screenings and prescriptions before using oral contra-
ceptives. The social marketing activities, therefore, were likely
to have had only a minimal effect, if any, on the outcome vari-
able measured during the AMPPF campaign period.
7 In the follow-up survey, the female interviewers inadvertently
may have avoided questioning some of the younger unmarried
females or missed many of these young women because they were
not available during the time of the follow-up survey, for ex-

ample, because school was out and the young women returned
to their home villages or they were working on crop planting and
cultivating during the farming season. To eliminate the possible
effects of slightly differing age and marital compositions, age and
marital status variables are introduced as control variables in the
tabulations and multivariate analyses. For the 1987 Demographic
and Health Survey, a total of 530 females aged 15-49 and 230
males ages 20-54 were interviewed in Bamako. Analysis of the
sociodemographic characteristics of these data reveal that the 1987
DHS samples were similar to the 1992 baseline survey and the
1993 postintervention survey samples in terms of ethnic and re-
ligious composition. However, the 1992 and 1993 samples had
higher proportions who were never married, lower average par-
ity, and higher proportions of men and women with at least some
schooling than did the 1987 DHS sample. Although the DHS
sample is not exactly comparable to the 1992 and 1993 surveys
because of different sampling procedures and a different age
range for the male sample (20-54 in the 1987 DHS sample versus
15-59 in the 1992 and 1993 samples), these comparisons provide
at least some indication that a trend toward later marriage, de-
layed childbearing, and more universal school enrollment may
have occurred in Bamako since 1987. In the 1987 DHS sample, 90
percent of women reported that there was a radio in the house-
hold, compared with 94 percent of women in the 1992 baseline
survey and 96 percent of women in the 1993 Bamako post-
intervention survey. Only 30 percent of women living in Bamako
in 1987 reported having a television in the household, compared
with 59 percent of women interviewed in the 1992 baseline sur-
vey and in the 1993 postintervention survey, an apparent dou-
bling of the proportion of households with televisions in only
five years.
8 The two recorded songs used traditional Malian instruments and
singing styles (griotte) to convey family planning messages on
the radio. Popular singers and recording artists were used to in-
crease the acceptability and popularity of the interventions. A
popular male actor was used to convey the family planning mes-
sages targeted for men and married couples in the four televi-
sion spots. The four televised Koteba plays (social dramas) used
the centuries-old Koteba theater format to tell the stories and con-
vey family planning messages. The origins of the Koteba genre
began with a game a Malian king created centuries ago in an ef-
fort to avoid revolts by allowing his subjects one evening a year
to amuse and entertain themselves by criticizing the king. Both
traditional village and modern urban settings were employed in
some of these plays.
9 In addition to the two family planning songs, the audio portions
of some of the short television spots and the launching of the Na-
tional Family Planning logo were also aired on the radio (as part
of the AMPPF IECcampaign); the SOMARC social marketing ra-
dio advertising for the Protector condom had ceased before the
baseline survey and did not resume until after the follow-up sur-
vey was conducted. Few, if any, other family planning programs
were aired on the radio during the intervention period.
10 Because the vast majority of households have radios, access to a
radio in the household was not used as a control variable in the
logistic regression models shown in Tables 9 and 10. Access to
television in the household was included as an independent vari-
able in the logistic regression model results shown in Tables 9
and 10 so that the additional effects of exposure to the interven-
tions on the dependent variables (that is, current use of modern
contraceptives in Table 9 and positive attitude about Islam and
family planning in Table 10) could be examined after controlling
for access to television.
11 The assumption is made that the sample design will produce re-
sults similar to the simple random sampling approach. DEFF es-
timates for cluster-design effects on key variables (for example,
current use of modern contraceptives; attitudes of men and
women concerning Islam and family planning) have been calcu-
lated in both the female and male cluster samples using STATA
software. Because all the DEFF values estimated were substan-
tially below 2 except for one that was equal to 2, the logistic re-
gression results were not adjusted for the potential effects of the
two-stage stratified cluster sample design. To the extent that the
cluster sample yields greater sampling error than a simple ran-
dom sample, the significance of the regression coefficients will
be so affected. If the error in the population is greater than the
error in the sample as a result of clustering effects, the signifi-
cance of the coefficients from the sample may be exaggerated.
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Acknowledgments
The authors would like to express special thanks to Eli Sim-
para, IECDirector, AMPPF, Bamako, Mali for his crucial role
in developing, implementing, and managing the AMPPF's IEC
traditional and modern mass media interventions and cam-
paign and for his technical assistance in the design of the sur-
vey questionnaires, his input on the final report, and his ad-
ministrative and technical support for the dissemination
seminar of the study findings. The authors also gratefully ac-
knowledge the technical, administrative, and research assis-
tance of the staff of CERPOD,particularly Dieudonne Ouedra-
ogo; Mamadou Konate, for assistance in sampling; Fara
Mbodji, Issa Guindo, and Alpha Toure, for data processing;
the staff at JHU/PCS/CCP, particularly Miriam Jato, for the
questionnaire design; Claudia Vondrasek and Carol Van
Hulzen, for graphics preparation; and Susan Gaztanaga and
Faith Forsythe, for assistance in preparation of the text and
tables; to the staff of AMPPF, particularly Lansina Sidibe, Yaya
Diakite, Adama Diallo, and Amidou Toure; and all the sur-
vey interviewers and particularly the field supervisors, Michel
Diawara of CERPOD and Mariam Traore of AMPPF. We also
very much appreciate the helpful comments and advice pro-
vided by Phyllis Tilson Piotrow, Gary Lewis, Johanna Zachar-
ias, and Karen Hardee. The authors wish to thank Indu Bhu-
shan and Robert Foreman for their computer assistance.
Research was carried out by CERPOD in collaboration with
Johns Hopkins Center for Communications Program and
AMPPF. Financial support for this research was provided by
the Johns Hopkins Center for Communications Program, by
the United States Agency for International Development, and
by the USAID/mission in Bamako, Mali.

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