Introduction

We have a very young family planning programme in Zimbabwe. Although it began in the 1950s, a lot happened only after our country’s independence in 1980. According to the 1994 Zimbabwe Demographic and Health Survey (DHS), knowledge of modern contraception was actually universal, CPR (contraceptive prevalence rate) was 48 percent (42% modern, 6% traditional), with the TFR (total fertility rate) of 4.3. In Zimbabwe, as in many other countries, most of our family planning and maternal child health (FP-MCH) programmes were implemented as if there were no men around. Hence the people (that is, men) who were, or could be, equal participators in the process were not taken into account. So, who our FP-MCH programmes are really targeting are women and children but we realise that when it comes to reproductive health or family planning decisions, men play a very important role. To continue the upward trend in contraceptive prevalence, the Zimbabwe National Family Planning Council (ZNFPC) expanded its programme focus in the late 1980s to include men. It tried to see how best it can understand the needs of men, where the constraints are, and what kind of interventions it can come up with to address their needs. This effort was first made in 1988 by the ZNFPC in the form of a multi-media campaign on how best to involve men in the whole reproductive health process. This is a presentation on the campaign which we did with financial and technical assistance from the Johns Hopkins University, and also with the assistance of Mr Opiah M Kumah (now with UNFPA) who helped us package this presentation.

Campaign to Enhance Male Involvement

In 1989 the ZNFPC carried out a male fertility survey where it was noted that knowledge was very high and attitudes were fairly positive towards family planning among the males but the use of contraception (male methods) was very low. One concern that came out of this survey, especially from the focus group discussions we had with men, was that, although they considered themselves to be the decision-makers in the family, they were not as well informed as the women. The men, rightly or wrongly, did not feel comfortable with all these young girls coming and starting to talk about reproductive issues with them. They prefer the men to talk to other men.

With all these findings in mind, we carried out a male motivation and method expansion project in 1993 where the focus was men. (This was the second male involvement and motivation campaign. The first was implemented in 1988-89.) It was carried out over a six-month period, from September 1993 to March 1994. The two main objectives were: (1) to encourage couples to communicate about family planning and related methods; and (2) to improve the image for long-term FP methods, especially among males; and also to encourage couples to practise long-term FP methods.
 

We tried to address five main issues. One, men who have a strong influence on the couple’s family planning decisions. Two, the gap that exists between women’s perception of men’s attitude towards family planning (negative) versus men’s perception of their own attitudes (positive). Three, the limited or lack of discussions between spouses or between partners with respect to family planning and reproductive health. Four, to support men and to motivate them to support their spouse/partner if they decide to practise a modern contraceptive method. Five, to motivate men to use the few male contraceptive methods that are available.

a. Campaign sites

Five sites were chosen. Three of the country’s largest cities were among these sites, namely Harare, Bulawayo and Gweru. The campaign also extended to the rural areas. In Zimbabwe, we are trying to encourage development in rural areas where special areas called "Economic Growth Points" were set up. We chose two of these: Gutu Mupandawana and Murehwa.

b. Target groups

The primary target group for the campaign were men between 18 and 54 years of age, and the secondary target group included women between 15 and 49 years of age (women of reproductive age), FP service providers and influential community leaders.

Campaign Management

The management of the campaign was decentralized. In each of the five sites, committees were formed that were responsible for organizing the campaign so that the needs and activities arose from the community itself. In order to gain support of the community leaders and influential government officials, workshops were held at all the sites where ZNFPC officers explained what the campaign was all about and responded to criticisms and concerns. This was a productive exercise. We also conducted two workshops targeted at journalists and editors of the various newspapers and magazines, including the mass media. We briefed them and gave them information kits so that they could understand the campaign, and as the process went on, they could write good stories about the campaign. They were also included as members of the local campaign committees. Before the campaign activities were actually conducted, we made sure that we trained service providers in counselling, and in providing those kinds of FP methods that we hoped the men would come and ask for. As one of this campaign’s goals was to increase use of long-term FP methods, efforts to improve counselling skills for providers were necessary to ratify their traditional bias towards short-term methods. So there was a lot of training and making sure the facilities had enough of FP commodities and trained personnel.
 

Campaign Themes and Strategies

a. Themes and Slogans

One central theme, "Family planning: it is your choice", was chosen, and the campaign was divided into three phases, each with its own slogan. The first phase had the slogan "Do you have a dream?" and a lot of materials with that message were developed. The idea was to help people start discussions and try to find out if they have a dream, how family planning answer that dream. In the next phase, the slogan was "Play the game right". The men would try to find out how, by using family planning, they could play the game right. Which game are we talking about here? The idea was like playing a game if one wanted to plan one’s family. The slogan for the third phase was "It takes two to plan a family" which built on the two previous slogans. The idea was that if one wanted to plan a family, one needed to have joint decisions between the partners.

 b. Activities and Media

The main activities, centred around entertainment and sports, were based on the whole masculine notion of what make men feel good. The period of the campaign coincided with the qualification competition for the 1994 World Cup soccer tournament in the USA which Zimbabwe was trying to qualify for. There was a lot of euphoria about soccer and we wanted to capitalize on this. Besides basic IEC materials, radio, TV, advertisements, soccer tournaments, family days, entertainment and music were among the main manifestations of the multi-media approach used by the campaign.
 

Multi media Activities
Community Events	IEC Materials	Radio	Motivation Talks
'Family Fun Day' Soccer tournament Entertainment  (songs, dances, drama)	Advertisements Magazines Newspaper Posters	Drama Sports	In the community At the work places At drinking places

 Radio. The main medium was radio. A social drama, in two major local languages (Shona and Ndebele), was produced and aired every week during prime time. The major theme was male responsibility. This was supplemented by radio spots which were also broadcast at various appropriate time slots. In addition, particularly to target opinion leaders, there were also materials for TV.

IEC materials. There were also a lot of print materials including advertisements, magazines, newspapers, and the use of football metaphors and popular footballers. The advertisements were placed very close to the sports pages or at the pages where men were thought to go to first before the headlines. Posters published in materials like that were also produced.

Community events. There were community and sports events where the vice-president or other high-profile public figures were invited to address the people. We organized "Family Fun Days" where there was a lot of entertainment using popular Zimbabwe musicians and artistes, local dramas and traditional dances. During the preparations before the launch, we made sure that the musicians, if they were going to compose songs, they should include family planning messages. We also organized a soccer tournament, complete with a trophy and prize money, with the four most popular soccer teams in the country. The matches were broadcast live on radio. Before each match, at half time and end of the match, there would be lots of family planning messages on national radio.

Motivation talks. Male motivation talks were organized. The ZNFPC staff would go to the community and find out what their main concerns with respect to reproductive health were, and they would sit down with the men and discussed family planning issues openly. Instead of making the men come to us, we went to where they usually congregated such as workplaces, drinking places, etc.

Evaluation

Evaluation was an important component that ensured the effectiveness of the campaign. The evaluation strategy was improved on from the experience from the first campaign in 1988. For example, only men were surveyed in the first campaign; therefore no data on the effect on women were available. In 1988-89, data were collected only from one source, that is, surveys before and after the campaign. For this second campaign three ways of collecting data were used. One was the household survey that involved a nationally representative group of men before and after the campaign. A new source was the client exit interviews at the campaign sites to find out those who have come to use the services with what they were used to. A third source of data was service statistics from the facilities which were located at the campaign sites. These survey exercises were national in scope and were conducted in Shona and Ndebele languages so as not to limit the sampling population of men. From this variety of sources, we got a much better quality of data and hence better evaluation of the impact of the campaign activities.

Sustainability and Cost-Recovery

Financial sustainability was a major goal for the ZNFPC 1991-96 five-year plan. Hence, cost-recovery of the campaign expenses was planned. We had hoped that with high quality materials, there should be no reasons why we could not raise the sponsorship, but we ran into a few problems. The general economic recession in Zimbabwe at that time did not help things. On the question of sustainability, we realised the six months were not long enough. It was difficult for us to get the kind of sponsorship we had initially hoped we were going to get. For example, although our radio programme was very popular, most of our potential sponsors could get their advertisements just before or after our broadcast so they did not have to pay anything. They cashed in on the popularity of our radio programme while we did not benefit. Two of the campaign’s activites were able to generate some revenue, and they were the sales of tickets for soccer matches and sales of campaign merchandise. There was one donation which was used to cover the transportation costs incurred by the soccer teams for the tournaments. In all, Z$193,072, or 13 percent of campaign cost, was recovered.

Lessons from the Campaign

a. Communications strategy

We think that a well-designed communications campaign can actually reach everybody with FP messages, including men. We found that quite a number of men were exposed to at least one method of campaign activities and materials. A lot of men were exposed through multiple channels.

The radio was the main channel that proved to have the widest reach, although it was interesting to note that it reached more women than men. It confirmed earlier findings that men in Zimbabwe found radio to be an excellent source of family planning information. In terms of the radio drama, we found that it attracted a larger female audience although it was targeted at men with the male-relevant scripts.

Men exposed to the campaign were more likely to change their behaviour especially when it came to discussions with their spouses or partners. The use of soccer, the campaign’s most innovative activity, proved to be very effective in reaching men, as it capitalized on the action-oriented male masculinity element. This is one communications method we want to develop further. When it came to improving knowledge and changing attitudes or behaviour, it was noted that men who were exposed to many or at least more than three campaign components, were more likely to, themselves or their spouses, adopt modern family planning methods, and also to discuss contraception as couples. However, when it came to behaviour, especially those based on deep-seated cultural beliefs, we felt that a campaign of six months was not adequate to have much impact.

We learned that some of the campaign messages might not be clear; some men got the wrong end of the stick, so to speak. While the campaign had promoted joint decision-making, some men actually thought we were giving them the lessons to make these decisions by themselves as head of the family.

We found that the campaign, although focused on men as the primary target group, managed to reach out equally to women in many of the major activities (radio, motivational talks). We regarded this as having magnified the impact of the campaign.

Multiple or multi-media communications channels are really interesting and may be the best way forward. We were able to complement the same messages received through a variety of sources. We ended up with greater reception than if we had used a "one-use-one-method" approach.