A large body of evidence has documented the effectiveness of mass-media communication programs in increasing family planning use and changing reproductive behavior. But the potential impact of these programs on the mediating role of gender norms has not been systematically assessed in Nigeria. Regionally representative cross-sectional end line data collected for the evaluation of a long-running entertainment-education radio serial drama program aired in northern Nigeria are examined for program effects on both reproductive and gender outcomes as well as the relative effect of gender on reproductive outcomes. The drama was popular, with 70% of the sample listening weekly. Results show that the drama positively impacted both sets of outcomes especially the reproductive outcomes. Results further indicate a strong relative effect of gender on reproductive issues.
The effectiveness of mass-media entertainment-education programs in increasing contraceptive use, spousal reproductive decision-making including family size and fertility regulation, and positive reproductive behavior is well documented [
However, relatively few of these programs have evaluated the effect of program exposure on various dimensions of gender that mediate the link between program strategies and reproductive processes, especially in sub-Saharan Africa. There are several reasons for this gap. Program components that specifically address how gender norms have been impacted are relatively nascent in Africa, having gained attention in the reproductive health (RH) sphere only in the past decade largely due to the emphasis placed on the role of gender issues in RH by the 1994 International Conference on Population and Development [
Program activities may unintentionally influence gender norms, simply because these sociocultural factors are inextricably linked to all aspects of reproductive, social, and economic relations. Family planning (FP) and RH programs can have an empowering effect on girls and women. Averting unintended pregnancies through FP fosters girls’ continued schooling and women’s engagement in profitable employment and reduces maternal and child morbidity and mortality. At the same time, the ability of women and girls to enjoy these empowering and health benefits of FP is constrained by the overarching sociocultural milieu, which is rooted in gender inequality [
Yet, most evaluations have focused their attention on assessing program effects on reproductive outcomes but not specifically on gender outcomes (see [
The goal of this paper is to help fill the existing gap in simultaneous assessments of program effects on changes in both reproductive outcomes and gender outcomes employing African data and focusing on both males and females. It takes advantage of unique regionally representative cross-sectional survey data assessing the effects of a long-running radio serial drama aired in northern Nigeria to address problems of maternal and child mortality and morbidity arising from low contraceptive use. These data are unique in the fact that they contain a rich set of measures on both reproductive and gender outcomes, permitting a simultaneous assessment of both sets of outcomes. The study attempts to answer three research questions. What is the effect of the drama on FP and RH attitudes, intentions, and behaviors? What is the effect of the drama on gender norms and attitudes that are presumed to mediate RH and FP attitudes, intentions, and behavior? What is the relative effect of gender on each of the RH outcomes?
The study’s focus on sub-Saharan Africa is timely. Fertility desires and intentions of both marital partners are important predictors of a couple’s fertility [
With a population estimated at over 160 million, Nigeria ranks as the largest country in Africa in terms of population size. An annual growth rate of 2.5% that shows no sign of abating makes Nigeria a very youthful country with 45% of the population aged below 15 [
Total fertility rate (i.e., the average number of children borne by women) in 2008 is 5.7 children, unchanged since 2003 [
Maternal mortality, estimated at 545 maternal deaths per 100,000 live births [
Health and socioeconomic indicators are even more dismal in northern Nigeria. In addition to closely spaced births and pregnancies among older women, teenage pregnancies (ages 15–19) contribute to high-risk births in this region of the country. While, nationally, teenage childbearing is 23%, the rate is the highest in northern Nigeria, at about 45% [
Childhood marriage of girls in northern Nigeria remains the highest in the country, contributing to many social and health problems. The latest available figures [
Discussion of sex is traditionally a very private and sensitive issue due to cultural and religious reasons [
This study is conceptualized on the well-recognized connection between reproductive outcomes and various dimensions of gender recognized in the sociodemographic literature [
To take advantage of their education, educated women engage in paid employment, adopt small family norms, use contraception, and have lower fertility compared with their noneducated counterparts [
Women’s delayed age at marriage stemming from prolonged schooling and employment has been hypothesized to lead to greater autonomy in their marriage decisions and an increase in consensual unions/cohabitation [
Related to Basu’s [
The conceptual framework presented above suggests that interventions should be designed to promote positive behavioral changes and gender attitudes in reproductive decision-making. To foster appreciation among northern Nigerians of the benefits of FP and equitable spousal RH decision-making, Population Media Center (PMC) produced and broadcast a long-running 208-episode radio serial drama,
The northern states of Kaduna, Kano, Katsina, and Sokoto were identified as the target region for broadcast because they present the greatest need for a FP and reproductive behavior intervention. These northern states also house the highest rates of maternal mortality and VVF, nationally. The above proposed gendered framework is even more apt in the context of northern Nigeria relative to the remaining regions of the country as well as other countries in the subregion. In a sociocultural environment, where Hausa tradition is overlaid with Muslim ideology, Shariah Law, and the practice of seclusion for women, it becomes clear why reproductive and gender outcomes are less favorable than in the rest of the country or elsewhere in the continent. Accordingly, women and men play very different roles and enjoy different levels of authority in Hausa land compared to other regions [
To evaluate the program, a pretest, posttest research design was employed. In April 2007 and prior to broadcast, a regionally representative baseline cross-sectional survey was conducted to collect benchmark data on all programmatic indicators and sociodemographic factors in the broadcast area of Kaduna, Kano, Katsina, and Sokoto states. Within each state, multistage stratified sampling was utilized for the sampling frame. In each state five urban locations and five rural locations were randomly chosen to ensure wide representation. Each local government area (LGA) of a state formed a cluster from which 200 households were randomly selected.
Face-to-face interviews were conducted with reproductive age women (15–49) and men (15–59) using household, women’s and men’s schedules, with questions mirroring those in the 2003 Nigeria Demographic and Health Surveys (DHS). Aligned with the program indicators, a wide range of themes were covered under the following modules: (1) sociodemographic characteristics, (2) media access, (3) marriage, (4) reproduction and fertility preferences and spousal communication about FP, (5) contraception, (6) sexual activity, HIV/AIDS, and other sexually transmitted infections, and (7) work and gender norms. Summative data were collected through an end line survey in July 2009, shortly after broadcast of the last drama episode. For analytical comparability, the same survey design and instrument used in the baseline were repeated in the end line. To assess listenership to the drama, an exposure module that measured listenership, character recall, and opinions about the drama was added to the end line instrument.
To improve data quality, enumerators and supervisors were trained on the protocol for implementing the survey prior to the fieldwork. Training stressed the need to pay attention to courteousness, confidentiality, sensitivities, culture, religion, and values of respondents. Female enumerators interviewed female respondents and male enumerators interviewed male respondents. A total of 793 respondents were drawn for the end line sample of which 671 completed the survey, translating in a response rate of 85%.
This study analyzes two sets of outcomes. Consistent with the goals of the project,
The analyses also examine the effect of the drama on a second set of outcomes, gender norms as they relate to reproductive issues and focus on three broad indicators of gender. The first is attitudes and behaviors related to normative beliefs and gender equality, including “what do you consider to be the ideal marriage age for a female?”; “discussed FP with spouse/partner in the last 3 months”; “couples should share responsibility for making decisions about family size”; “girls should be encouraged to continue their education to high levels”; “do you think that your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy?”; “who had the final say in the decision that you would get married to or live with your (first) husband/partner?”; “women should not be allowed to express their opinion on important family matters”; “a woman should be free to ask her husband to use a condom”; “a woman’s value is judged by marriage before her first menses and by the number of children she has”; and “a man is never sterile but a woman can be.” Scholars have argued that women’s involvement in household financial issues and decision-making is a key component of women’s empowerment [
The third set of gender outcomes focuses on attitudes related to domestic violence. The questions pertain to agreement with the following statements: “do you think a wife is justified in refusing to have sex with her husband if she knows he has a sexually transmitted infection?”; “do you think a wife is justified in refusing to have sex with her husband if she is tired or not in the mood?”; and “do you think a wife is justified in refusing to have sex with her husband if she knows he had sex with women other than his wives?” The study also asks about agreement over the following statements: “is a husband justified in hitting his wife if she goes out without telling him?”; “is a husband justified in hitting or beating his wife if she argues with him?”; “is a husband justified in hitting or beating his wife if she burns the food?”; and “is a husband justified in hitting or beating his wife if food is not cooked on time?” Although past studies [
The independent variable considered in the study is an exposure variable that compares listeners to nonlisteners on key program indicators. Listenership is measured by a series of questions. Respondents were asked if they had “heard of the drama
Control variables are drawn from respondents’ social and demographic characteristics. These include seven correlates: age, sex, marital status, educational attainment, ethnicity, state of residence, and urban/rural residence. The selection of these control variables is premised on large differentials in both the reproductive and gender outcomes by age, sex, ethnicity, marital status, education, rural versus urban residence, and state of residence in Nigeria, particularly in the northern parts of the country [
This study examined the end line data that provide information on exposure to the drama. To answer the study’s three research questions, the investigation was organized in three stages. In stage 1, we modeled the effect of exposure to the drama on the gender outcomes and, in stage 2, we modeled the effect of drama exposure on the FP/RH outcomes. In the final stage, to quantify the relative effect of gender on the FP/RH outcomes, we introduced measures of the gender outcomes as predictors in the models estimated in stage 2, essentially estimating the mediating effect of gender on the FP/RH outcomes. The equations associated with the three questions are given below.
To assess the success of the drama, differences between listeners and nonlisteners on the outcomes were analyzed using statistical techniques that included chi-square and logistic regression in SPSS Version 21 (SPSS IBM). Each measure of reproductive and gender outcome was regressed on the listenership measure (our main predictor). In each of the three stages above, the models estimated both bivariate (without adjusting for any correlates) and multivariate (adjusted for the correlates) effects. Thus, the bivariate models estimate the gross effects of the drama while the multivariate models estimate net drama effects. Further, in the multivariate models, the measures for the correlates are serially incorporated. This allows us to detect the variable responsible for any critical change in the predictor. Given that logistic regression was used, all the outcome and control (except education which had several categories) variables were dichotomized.
Table
Summary statistics on study independent, dependent, and control variables evaluation of
Key variables |
|
Percentage |
---|---|---|
|
||
Listened to |
||
Nonlisteners | 193.00 | 24.30 |
Regular listeners | 456.00 | 57.50 |
|
||
Do you know a place where you can obtain a method of family planning (FP)? | ||
No (ref.) | 222.00 | 28.00 |
Yes | 459.00 | 57.90 |
Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex? | ||
No, DK (ref.) | 179.00 | 22.60 |
Yes | 476.00 | 60.00 |
Is using contraception against the will of Allah/God? | ||
Yes, DK (ref.) | 223.00 | 28.10 |
No | 335.00 | 42.20 |
Couples should space their children at least 2.5 to 3 years apart. | ||
Disagree (ref.) | 160.00 | 20.10 |
Agree | 496.00 | 62.50 |
Can becoming pregnant every year put the mother at risk? | ||
No, DK (ref.) | 239.00 | 30.10 |
Yes | 458.00 | 57.80 |
People should plan how many children they will have. | ||
Disagree, DK (ref.) | 187.00 | 23.60 |
Agree | 447.00 | 56.40 |
Would you say that you approve or disapprove of couples using a family planning method to avoid getting pregnant? | ||
Disapprove, DK (ref.) | 286.00 | 36.10 |
Approve | 411.00 | 51.80 |
What age do you think is the most appropriate for a female to start bearing children? | ||
10–19 years (ref.) | 238.00 | 30.00 |
20 years+ | 380.00 | 47.90 |
Would access to contraceptives encourage infidelity? | ||
Yes, DK (ref.) | 369.00 | 46.50 |
No | 324.00 | 40.90 |
Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future? | ||
No (ref.) | 243.00 | 30.60 |
Yes | 70.00 | 8.80 |
Would you like to have no more children? | ||
No (ref.) | 344.00 | 43.40 |
Yes | 96.00 | 12.10 |
Are you currently doing something or using any method of family planning to delay or avoid getting pregnant? | ||
No (ref.) | 249.00 | 31.40 |
Yes | 259.00 | 32.70 |
In the last 3 months have you discussed the practice of family planning with your family, friends, or neighbors? | ||
No (ref.) | 367.00 | 46.30 |
Yes | 329.00 | 41.50 |
|
||
|
||
Did you discuss FP with spouse in the last 3 months? | ||
No (ref.) | 520.00 | 65.60 |
Yes | 273.00 | 34.40 |
Couples should share responsibility for making decisions about family size. | ||
Disagree, DK (ref.) | 130.00 | 16.40 |
Agree | 538.00 | 67.80 |
What do you consider to be the ideal marriage age for a female? | ||
18 years and below (ref.) | 221.00 | 27.90 |
19 years + | 462.00 | 58.50 |
A woman’s value is judged by marriage before her first menses and by the number of children she has. | ||
Agree, DK (ref.) | 473.00 | 59.60 |
Disagree | 237.00 | 29.90 |
A man is never sterile but a woman can be. | ||
Agree, DK (ref.) | 465.00 | 58.60 |
Disagree | 242.00 | 30.50 |
Girls should be encouraged to continue their education to higher levels. | ||
Disagree, DK (ref.) | 147.00 | 18.50 |
Agree | 565.00 | 71.20 |
Do you think that your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy? | ||
Disapprove, DK (ref.) | 132.00 | 16.60 |
Approve | 246.00 | 31.00 |
Who had the final say in the decision that you would get married to or live with your (first) husband/partner? | ||
Spouse, parents/-in law, others (ref.) | 470.00 | 59.30 |
Jointly with spouse | 135.00 | 17.00 |
Women should not be allowed to express their opinion about important family matters. | ||
Agree, DK (ref.) | 266.00 | 33.50 |
Disagree | 446.00 | 56.20 |
A woman should be free to ask her husband to use a condom. | ||
Disagree, DK (ref.) | 274.00 | 34.60 |
Agree | 437.00 | 55.10 |
|
||
Who in your family usually has the final say on making large household purchases? | ||
Spouse, respondent, others (ref.) | 589.00 | 74.30 |
Jointly with spouse | 83.00 | 10.50 |
Who mainly decides how the money you earn will be used? | ||
Spouse, respondent, others (ref.) | 184.00 | 23.20 |
Jointly with spouse | 78.00 | 9.80 |
|
||
Do you think a wife is justified in refusing to have sex with her husband if she knows he has a sexually transmitted infection? | ||
No (ref.) | 69.00 | 8.70 |
Yes | 531.00 | 67.00 |
Do you think a wife is justified in refusing to have sex with her husband if she knows he has sex with women other than his wives? | ||
No (ref.) | 86.00 | 10.80 |
Yes | 512.00 | 64.60 |
Do you think a wife is justified in refusing to have sex with her husband if she is tired or not in the mood? | ||
No (ref.) | 220.00 | 27.70 |
Yes | 373.00 | 47.00 |
Is a husband justified in hitting or beating his wife if she goes out without telling him? | ||
Yes (ref.) | 79.00 | 10.00 |
No | 619.00 | 78.10 |
Is a husband justified in hitting wife if she burns the food? | ||
Yes (ref.) | 45.00 | 5.70 |
No | 654.00 | 82.50 |
Is a husband justified in hitting wife if food is not cooked on time? | ||
Yes (ref.) | 54.00 | 6.80 |
No | 646.00 | 81.50 |
|
||
Age | ||
40 through 59 (ref.) | 198.00 | 10.70 |
15 through 24 | 85.00 | 42.90 |
25 through 39 | 340.00 | 25.00 |
Sex | ||
Female (ref.) | 477.00 | 60.20 |
Male | 316.00 | 39.80 |
Marital status | ||
Not married (ref.) | 112.00 | 14.10 |
Currently married | 595.00 | 75.00 |
Urban/rural | ||
Rural (ref.) | 420.00 | 53.00 |
Urban | 373.00 | 47.00 |
Education | ||
Primary (ref.) | 139.00 | 17.50 |
Secondary | 197.00 | 24.80 |
Higher | 205.00 | 25.90 |
Ethnicity | ||
Other (ref.) | 129.00 | 16.30 |
Hausa | 591.00 | 74.50 |
Sate of residence | ||
Sokoto (ref.) | 199.00 | 25.10 |
Kaduna | 195.00 | 24.60 |
Kano | 199.00 | 25.10 |
Katsina | 200.00 | 25.20 |
This section presents the results of the evaluation of the effect of the drama on both the gender and reproductive outcomes at the bivariate and multivariate levels, with interpretations based mainly on the multivariate estimates.
Table
Estimates of the effect of a serial radio drama
Bivariate analysis | Multivariate analysis | |||
---|---|---|---|---|
Odds ratio | 95% CI | Adjusted odds ratio | 95% CI | |
|
||||
|
||||
Do you know a place where you can obtain a method of family planning (FP)? | ||||
1 = yes, 0 = no, DK (ref.) | 1.39 | 0.96–2.00 |
|
1.17–3.21 |
Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex? | ||||
1 = yes, 0 = no, DK (ref.) | 1.26 | 0.85–1.85 |
|
1.05–3.24 |
|
||||
Is using contraception against the will of Allah/God? | ||||
1 = yes, 0 = no, DK (ref.) | 1.25 | 0.85–1.84 |
|
1.10–3.36 |
Couples should space their children at least 2.5 to 3 years apart. | ||||
1 = agree, 0 = disagree (ref.) |
|
1.37–3.00 |
|
1.63–5.19 |
Can becoming pregnant every year put the mother at risk? | ||||
1 = yes, 0 = no, DK (ref.) | 1.27 | 0.89–1.83 |
|
1.08–3.24 |
People should plan how many children they will have. | ||||
1 = agree, 0 = disagree (ref.) |
|
1.15–2.46 |
|
1.47–4.68 |
Would you say that you approve or disapprove of couples using a family planning method to avoid getting pregnant? | ||||
1 = approve, 0 = disapprove, DK (ref.) |
|
1.13–2.28 |
|
1.12–2.93 |
What age do you think is the most appropriate for a female to start bearing children? | ||||
1 = 20 years+, 0 = 10–19 years (ref.) | 0.83 | 0.57–1.22 | 0.78 | 0.44–1.37 |
Would access to contraceptives encourage infidelity? | ||||
1 = no, 0 = yes, DK = 0 (ref.) | 1.12 | 0.79–1.58 | 1.24 | 0.80–1.92 |
|
||||
Would you like to have no more children? | ||||
1 = yes, 0 = no, DK (ref.) | 1.51 | 0.86–2.64 | 1.20 | 0.56–2.57 |
Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future? | ||||
1 = yes, 0 = no, DK (ref.) | 1.15 | 0.61–2.17 | 1.97 | 0.75–5.19 |
|
||||
Are you currently doing something or using any method of family planning to delay or avoid getting pregnant? | ||||
1 = yes, 0 = no, DK (ref.) |
|
1.56–3.60 |
|
1.336–4.41 |
In the last 3 months have you discussed the practice of family planning with your family, friends, or neighbors? | ||||
1 = yes, 0 = no, DK (ref.) |
|
1.45–2.95 |
|
1.23–3.26 |
|
||||
|
||||
Discussed FP with spouse in the last 3 months. | ||||
1 = yes, 0 = no, DK (ref.) |
|
0.37–2.85 |
|
1.17–3.05 |
Couples should share responsibility for making decisions about family size. | ||||
1 = yes, 0 = no, DK (ref.) |
|
1.17–2.70 |
|
1.10–3.87 |
What do you consider to be the ideal marriage age for a female? | ||||
1 = 19 years+, 0 = 18 years and below (ref.) | 1.04 | 0.71–1.50 |
|
1.02–2.93 |
A woman’s value is judged by marriage before her first menses and by the number of children she has. | ||||
1 = disagree, 0 = agree (ref.) |
|
0.47–0.96 |
|
0.56–1.42 |
A man is never sterile but a woman can be. | ||||
1 = disagree, 0 = agree (ref.) | 0.76 | 0.53–1.08 | 1.01 | 0.63–1.63 |
Girls should be encouraged to continue their education to higher levels. | ||||
1 = agree, 0 = disagree (ref.) | 1.31 | 0.87–1.98 | 1.25 | 0.64–2.41 |
Do you think that your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy? | ||||
1 = approve, 0 = disapprove, DK (ref.) | 1.24 | 0.73–2.08 | 1.71 | 0.81–3.60 |
Who had the final say in the decision that you would get married to or live with your (first) husband/partner? | ||||
1 = jointly, 0 = spouse, respondent, others (ref.) | 0.78 | 0.50–1.21 | 1.56 | 0.85–2.86 |
Women should not be allowed to express their opinion about important family matters. | ||||
1 = disagree, 0 = agree (ref.) | 0.8 | 0.56–1.14 | 1.15 | 0.70–1.92 |
A woman should be free to ask her husband to use a condom. | ||||
1 = agree, 0 = disagree (ref.) | 1.08 | 0.76–1.53 | 1.30 | 0.76–2.23 |
|
||||
Who in your family usually has the final say on making large household purchases? | ||||
1 = jointly, 0 = spouse, respondent, others (ref.) | 0.82 | 0.48–1.40 | 0.86 | 0.46–1.61 |
Who mainly decides how the money you earn will be used? | ||||
1 = jointly, 0 = spouse, respondent, others (ref.) | 0.95 | 0.50–1.80 | 1.27 | 0.57–2.82 |
|
||||
Do you think a wife is justified in refusing to have sex with her husband if she knows he has a sexually transmitted infection? | ||||
1 = yes, 0 = no, DK (ref.) |
|
2.49–7.16 |
|
1.41–6.79 |
Do you think a wife is justified in refusing to have sex with her husband if she knows he has sex with women other than his wives? | ||||
1 = yes, 0 = no, DK (ref.) |
|
2.20–5.83 |
|
1.46–5.87 |
Do you think a wife is justified in refusing to have sex with her husband if she is tired or not in the mood? | ||||
1 = yes, 0 = no, DK (ref.) | 1.25 | 0.84–1.84 |
|
1.01–3.06 |
Is a husband justified in hitting or beating his wife if she goes out without telling him? | ||||
1 = no, 0 = yes, DK (ref.) | 0.89 | 0.52–1.53 | 0.79 | 0.39–1.62 |
Differences between surveys and between listeners and nonlisteners are significant at
ameans the introduction of the correlates, state, education, and ethnicity turned the effect of drama exposure significant; bmeans the introduction of the correlate, education turned the effect of drama exposure significant; cmeans the introduction of the correlate, state turned the effect of drama exposure significant; dmeans the introduction of the correlate, current marital status turned the effect of drama exposure significant; emeans the introduction of the correlate, current marital status turned the effect of drama exposure nonsignificant; fmeans the introduction of the correlate, ethnicity turned the effect of drama exposure significant.
The odds of disagreeing with the statement that “using contraceptives is against the will of Allah” were 1.9 times greater for listeners than nonlisteners. Closely spaced births have an adverse effect on maternal and child health, posing greater risks for VVF. Respondents were asked “can becoming pregnant every year put the mother at risk?” The odds of listeners compared with nonlisteners agreeing with the statement were 1.9 times greater. Like the knowledge outcomes, the bivariate effects of the drama on these two attitudinal outcomes were nonsignificant and only turned significant with the introduction of the state variable in the model. Change in attitude toward birth spacing was also evaluated. Results show that the odds of listeners agreeing with the statement “couples should space children 2.5 to 3 years apart” were 2.9 times greater than those of nonlisteners.
Similar to the effect of the drama on the link between frequent pregnancies and maternal health, a positive change in attitude was observed for two other indicators: “people should plan how many children to have” and “would you say that you approve or disapprove of couples using a FP method to avoid getting pregnant?” Multivariate comparisons on both indicators suggest program effects: the respective odds were 2.6 and 1.8 times greater for listeners than for nonlisteners. Program effects on the last two attitudinal outcomes examined, disagreement with the notion that access to FP is associated with infidelity and the ideal age for the onset of childbearing, were nil in the sense that no significant differences between listeners and nonlisteners were observed, whether examined by chi-square statistics or multivariate analysis.
Table
Table
The lower half of Table
In terms of the two gender outcomes associated with attitudes toward economic empowerment, the drama’s impact was null. On the other hand, significant drama effects on the outcomes reflecting domestic violence were generally observed. Based on the multivariate estimates, the odds of listeners agreeing with the statement “do you think a wife is justified in refusing to have sex with her husband if she knows he has a sexually transmitted infection?” were 3.1 times greater than those of nonlisteners. On the following outcomes: “do you think a wife is justified in refusing to have sex with her husband if she knows he had sex with women other than his wives?” and “do you think a wife is justified in refusing to have sex with her husband if she is tired or not in the mood?” the respective odds for listeners relative to nonlisteners agreeing with the statements were 2.9 and 1.8. Furthermore, results show that the latter outcome was mediated through ethnicity because the association turned significant only after the introduction of the ethnicity variable in the estimation model, even as the effect of this correlate was nonsignificant. Conversely, no significant differences between listeners and nonlisteners were found regarding disagreement with the statement “is a husband justified in hitting or beating his wife if she goes out without telling him?”
To investigate the relative effect of gender on the reproductive outcomes, the measures for each of the three different dimensions of gender (normative beliefs, attitudes toward economic empowerment, and domestic violence) were added to the various models estimating the net effect of the drama (i.e., controlling for all the study correlates) on the reproductive outcomes. For each reproductive outcome, the gender measures were sequentially incorporated in three models. In the first model, all the gender variables reflecting normative beliefs surrounding gender equality were introduced. The second model added the gender measures denoting economic empowerment, and the third model further added the domestic violence measures. For parsimony, only the gender measures that turned out to be significant in at least one of the three models were generally retained. In instances where none of the respective gender predictors being considered under a particular model were statistically significant, at least one measure was retained to keep the model. For comparison, the relative effects of the drama estimated in the three models are also presented, whether significant or not. The results are shown in Tables
Estimates of the relative effects of a serial radio drama “
Relative drama and gender effects | Currently using contraceptives for delaying or stopping | Discussed FP with family, friends, or neighbors in the last 3 months | Intends to use contraception for delaying or stopping | Would like to have no more children | ||||
---|---|---|---|---|---|---|---|---|
Adjusted odds ratio | 95% CI | Adjusted odds ratio | 95% CI | Adjusted odds ratio | 95% CI | Adjusted odds ratio | 95% CI | |
|
||||||||
Listened to |
||||||||
1 = regular listener, 0 = nonlistener (ref.) |
|
1.15–5.05 |
|
1.25–3.44 | 1.66 | 0.50–5.48 | 0.99 | 0.44–2.20 |
Discussed FP with spouse in the last 3 months. | ||||||||
1 = yes, 0 = no (ref.) |
|
5.17–19.88 | na | na |
|
2.75–27.24 |
|
1.14–5.01 |
What do you consider to be the ideal marriage age for a female? | ||||||||
1 = 19 years+, 0 = 18 years and below (ref.) |
|
1.18–5.59 | na | na | na | na | na | na |
Girls should be encouraged to continue their education to higher levels. | ||||||||
1 = agree, 0 = disagree (ref.) |
|
1.42–12.33 |
|
1.37–5.49 | 5.01 | 0.70–35.66 | na | na |
A woman should be free to ask her husband to use a condom. | ||||||||
1 = agree, 0 = disagree (ref.) | na | na | na | na |
|
1.81–32.1 |
|
1.26–11.46 |
|
||||||||
Listened to |
||||||||
1 = regular listener, 0 = nonlistener (ref.) |
|
1.30–5.93 | na | na | na | na | 1.07 | 0.46–2.52 |
Discussed FP with spouse in the last 3 months. | ||||||||
1 = yes, 0 = no (ref.) |
|
5.30–22.01 | na | na | na | na |
|
1.13–5.58 |
What do you consider to be the ideal marriage age for a female? | ||||||||
1 = 19 years+, 0 = 18 years and below (ref.) |
|
1.10–5.37 | na | na | na | na | na | na |
Girls should be encouraged to continue their education to higher levels. | ||||||||
1 = agree, 0 = disagree (ref.) |
|
1.43–12.35 | na | na | na | na | na | na |
A woman should be free to ask her husband to use a condom. | ||||||||
1 = agree, 0 = disagree (ref.) | na | na | na | na | na | na |
|
1.35–16.77 |
Who in your family usually has the final say on making large household purchases? | ||||||||
1 = jointly, 0 = spouse, respondent, others (ref.) |
|
1.16–10.15 | na | na | na | na |
|
0.06–0.99 |
|
||||||||
Listened to |
||||||||
1 = regular listener, 0 = nonlistener (ref.) |
|
1.11–5.54 |
|
1.27–3.59 | 1.88 | 0.55–6.46 | 1.03 | 0.44–2.45 |
Discussed FP with spouse in the last 3 months. | ||||||||
1 = yes, 0 = no (ref.) |
|
6.33–28.23 | na | na |
|
2.57–26.56 |
|
1.15–5.72 |
What do you consider to be the ideal marriage age for a female? | ||||||||
1 = 19 years+, 0 = 18 years and below (ref.) | na | na | na | na | na | na | na | na |
Girls should be encouraged to continue their education to higher levels | ||||||||
1 = agree, 0 = disagree (ref.) |
|
1.44–13.87 | na | na | 4.74 | 0.66–34.17 | na | na |
Couples should share responsibility for making decisions about family size | ||||||||
1 = yes, 0 = no, DK (ref.) | na | na |
|
1.37–5.64 | na | na | na | na |
A woman should be free to ask her husband to use a condom | ||||||||
1 = agree, 0 = disagree (ref.) | na | na | na | na |
|
1.72–30.99 |
|
1.40–17.43 |
Who in your family usually has the final say on making large household purchases? | ||||||||
1 = jointly, 0 = spouse, respondent, others (ref.) |
|
1.23–11.57 | na | na | na | na |
|
0.05–0.91 |
Do you think a wife is justified in refusing to have sex with her husband if she knows he has a sexually transmitted infection? | ||||||||
1 = yes, 0 = no, DK (ref.) |
|
1.00–31.56 | na | na | na | na | na | na |
Do you think a wife is justified in refusing to have sex with her husband if she goes out without telling him? | ||||||||
1 = yes, 0 = no, DK (ref.) | na | na |
|
1.09–4.31 | na | na | na | na |
Is a husband justified in hitting wife if she burns the food? | ||||||||
1 = no, 0 = yes, DK (ref.) | na | na | na | na | 0.67 | 0.06–6.93 | na | na |
Is a husband justified in hitting wife if food is not cooked on time? | ||||||||
1 = no, 0 = yes, DK (ref.) | na | na | na | na | na | na | 0.57 | 0.15–2.12 |
Differences between surveys and between listeners and nonlisteners are significant at
na means coefficient was removed from the model because it was statistically nonsignificant.
Table
Unlike current use of FP, the effects of the gender predictors on discussion of FP with family, friends, and neighbors were quite modest. In the first gender model, only encouraging girls’ continued schooling positively predicted this RH outcome. In the third model, respondents’ agreement with “couples should share responsibility for making decisions about family size” and disagreement with “is a husband justified in hitting or beating his wife if she goes out without telling him?” positively impacted discussion of FP with family, friends, and neighbors among respondents while none of the gender predictors considered in the second economic empowerment model had an impact on the outcome. As with current FP use, the relative effect of the drama on the outcome remained positive and significant.
In contrast, the lack of association between exposure to the drama and the two intentional RH outcomes investigated (observed in Table
In Table
Estimates of the relative effects of a serial radio drama "
Relative drama and gender effects | Using contraceptives is against the will of Allah | Becoming pregnant every year puts mother's health at risk | Couples should space their children at least 2.5 to 3 years apart | People should plan how many children they will have | ||||
---|---|---|---|---|---|---|---|---|
Adjusted odds ratio | 95% CI | Adjusted odds ratio | 95% CI | Adjusted odds ratio | 95% CI | Adjusted odds ratio | 95% CI | |
|
||||||||
Listened to |
||||||||
1 = regular listener, 0 = nonlistener (ref.) |
|
0.91–3.11 |
|
0.78–3.02 |
|
1.45–7.51 |
|
1.08–5.95 |
Discussed FP with spouse in the last 3 months. | ||||||||
1 = yes, 0 = no (ref.) |
|
1.94–6.64 |
|
1.67–6.24 | na | na | na | na |
What do you consider to be the ideal marriage age for a female? | ||||||||
1 = 19 years+, 0 = 18 years and below (ref.) |
|
1.45–4.92 | na | na |
|
1.29–6.36 |
|
1.17–6.65 |
Girls should be encouraged to continue their education to higher levels. | ||||||||
1 = agree, 0 = disagree (ref.) | na | na |
|
1.99–12.21 |
|
2.26–17.71 |
|
2.80–27.93 |
Children should be treated equally regardless of their sex. | ||||||||
1 = agree, 0 = disagree, DK (ref.) | na | na |
|
0.07–0.49 | na | na | na | na |
Couples should share responsibility for making decisions about family size. | ||||||||
1 = yes, 0 = no, DK (ref.) | na | na |
|
1.56–8.85 |
|
3.26–20.36 | na | na |
A woman should be free to ask her husband to use a condom. | ||||||||
1 = agree, 0 = disagree (ref.) | na | na |
|
1.74–7.48 |
|
1.46–7.99 |
|
3.57–16.44 |
Women should not be allowed to express their opinion about important family matters. | ||||||||
1 = disagree, 0 = agree, DK (ref.) |
|
1.08–3.70 |
|
1.44–5.64 | na | na | na | na |
|
||||||||
Listened to |
||||||||
1 = regular listener, 0 = nonlistener (ref.) | 2.48 | 0.71–8.68 | 1.69 | 0.82–3.48 |
|
1.46–7.86 |
|
1.09–6.75 |
Discussed FP with spouse in the last 3 months. | ||||||||
1 = yes, 0 = no (ref.) |
|
1.54–16.97 |
|
1.64–6.50 | na | na | na | na |
What do you consider to be the ideal marriage age for a female? | ||||||||
1 = 19 years+, 0 = 18 years and below (ref.) | 0.91 | 0.30–2.71 | na | na |
|
1.12–5.86 | 2.35 | 0.93–5.93 |
Girls should be encouraged to continue their education to higher levels. | ||||||||
1 = agree, 0 = disagree (ref.) | na | na |
|
1.90–12.32 |
|
2.55–21.96 |
|
4.06–47.99 |
Children should be treated equally regardless of their sex. | ||||||||
1 = agree, 0 = disagree, DK (ref.) | na | na |
|
0.04–0.35 | na | na | na | na |
Couples should share responsibility for making decisions about family size. | ||||||||
1 = yes, 0 = no, DK (ref.) | na | na |
|
1.71–11.05 |
|
3.07–20.70 |
|
1.20–9.90 |
A woman should be free to ask her husband to use a condom. | ||||||||
1 = agree, 0 = disagree (ref.) | na | na |
|
1.76–8.35 |
|
1.14–6.79 |
|
3.56–18.06 |
Women should not be allowed to express their opinion about important family matters. | ||||||||
1 = disagree, 0 = agree, DK (ref.) | 1.88 | 0.61–5.79 |
|
1.47–6.47 | na | na | na | na |
Who in your family usually has the final say on making large household purchases? | ||||||||
1 = jointly, 0 = spouse, respondent, others (ref.) | 2.76 | 0.93–8.24 | 0.76 | 0.28–2.05 | 1.99 | 0.50–8.01 | 2.24 | 0.54–9.30 |
|
||||||||
Listened to |
||||||||
1 = regular listener, 0 = nonlistener (ref.) | 1.34 | 0.68–2.64 | 1.20 | 0.57–2.56 |
|
1.37–7.20 |
|
1.07–6.62 |
Discussed FP with spouse in the last 3 months. | ||||||||
1 = yes, 0 = no (ref.) |
|
2.05–7.57 |
|
1.72–7.25 | na | na | na | na |
What do you consider to be the ideal marriage age for a female? | ||||||||
1 = 19 years+, 0 = 18 years and below (ref.) |
|
1.20–4.34 |
|
1.78–12.66 |
|
1.36–6.96 | 2.27 | 0.88–5.88 |
Girls should be encouraged to continue their education to higher levels. | ||||||||
1 = agree, 0 = disagree (ref.) | na | na |
|
1.61–13.16 |
|
2.15–16.72 |
|
4.04–48.00 |
Children should be treated equally regardless of their sex. | ||||||||
1 = agree, 0 = disagree, DK (ref.) | na | na |
|
0.05–0.46 | na | na | na | na |
Couples should share responsibility for making decisions about family size. | ||||||||
1 = yes, 0 = no, DK (ref.) | na | na |
|
1.76–12.66 |
|
3.09–19.50 |
|
1.16–9.82 |
A woman should be free to ask her husband to use a condom. | ||||||||
1 = agree, 0 = disagree (ref.) | na | na |
|
1.87–9.81 |
|
1.55–8.66 |
|
3.47–17.99 |
Women should not be allowed to express their opinion about important family matters. | ||||||||
1 = disagree, 0 = agree, DK (ref.) |
|
1.15–4.20 |
|
1.23–5.75 | na | na | na | na |
Who in your family usually has the final say on making large household purchases? | ||||||||
1 = jointly, 0 = spouse, respondent, others (ref.) | na | na | na | na | na | na | 2.37 | 0.57–9.92 |
Do you think a wife is justified in refusing to have sex with her husband if she knows he has a sexually transmitted infection? | ||||||||
1 = yes, 0 = no, DK (ref.) | 2.03 | 0.79–5.26 |
|
1.08–13.44 | na | na | na | na |
Is a husband justified in hitting or beating his wife if she goes out without telling him? | ||||||||
1 = no, 0 = yes, DK (ref.) | na | na | na | na | na | na | 1.1 | 0.33–3.70 |
Is a husband justified in hitting or beating his wife if she argues with him? | ||||||||
1 = no, 0 = yes, DK (ref.) | na | na | na | na | 0.32 | 0.08–1.30 | na | na |
Differences between surveys and between listeners and nonlisteners are significant at
na means coefficient was removed from the model because it was statistically nonsignificant.
aThe effect of drama exposure, net of the controls was signifcant but was rendered nonsignifcant after the measure for spousal discussion of FP was added in the model.
Estimates of the relative effects of a serial radio drama “
Relative drama and gender effects | Approve or disapprove of couples using FP | Ideal age for childbearing is 20 or older | Access to contraception would encourage infidelity | Know a place to obtain a FP method | ||||
---|---|---|---|---|---|---|---|---|
Adjusted odds ratio | 95% CI | Adjusted odds ratio | 95% CI | Adjusted odds ratio | 95% CI | Adjusted odds ratio | 95% CI | |
|
||||||||
Listened to |
||||||||
|
|
0.72–2.38 | 0.65 | 0.34–1.24 | 1.02 | 0.64–1.62 | 1.82 | 0.63–5.29 |
Discussed FP with spouse in the last 3 months. | ||||||||
1 = yes, 0 = no (ref.) |
|
5.94–22.39 |
|
1.53–8.56 |
|
1.80–4.46 | 1.41–11.00 | |
Do you think that your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy? | ||||||||
1 = approve, 0 = disapprove, DK (ref.) | na | na | na | na | na | na | 4.45 | 1.66–11.93 |
What do you consider to be the ideal marriage age for a female? | ||||||||
1 = 19 years+, 0 = 18 years and below (ref.) | na | na | na | na | na | na | na | na |
Girls should be encouraged to continue their education to higher levels. | ||||||||
1 = agree, 0 = disagree (ref.) |
|
1.48–10.21 |
|
1.48–9.20 | na | na |
|
1.35–16.20 |
Couples should share responsibility for making decisions about family size. | ||||||||
1 = yes, 0 = no, DK (ref.) |
|
1.40–8.64 | na | na | na | na | na | na |
A woman should be free to ask her husband to use a condom. | ||||||||
1 = agree, 0 = disagree (ref.) |
|
2.22–8.95 | na | na |
|
1.29–3.44 | na | na |
Women should not be allowed to express their opinion about important family matters. | ||||||||
1 = disagree, 0 = agree, DK (ref.) | na | na |
|
1.69–6.27 |
|
1.24–3.61 | na | na |
|
||||||||
Listened to |
||||||||
1 = regular listener, 0 = nonlistener (ref.) | 1.38 | 0.73–2.62 |
|
0.06–0.83 | 1.33 | 0.54–3.27 | 2.24 | 0.74–6.83 |
Discussed FP with spouse in the last 3 months. | ||||||||
1 = yes, 0 = no (ref.) |
|
6.53–27.39 | na | na |
|
1.24–5.96 |
|
1.58–13.73 |
Do you think that your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy? | ||||||||
1 = approve, 0 = disapprove, DK (ref.) | na | na | na | na | na | na |
|
1.46–11.15 |
Girls should be encouraged to continue their education to higher levels. | ||||||||
1 = agree, 0 = disagree (ref.) |
|
1.96–15.78 | 3.41 | 0.21–55.42 | na | na |
|
1.40–17.38 |
Children should be treated equally regardless of their sex. | ||||||||
1 = agree, 0 = disagree, DK (ref.) | na | na | na | na | na | na | na | na |
Couples should share responsibility for making decisions about family size. | ||||||||
1 = yes, 0 = no, DK (ref.) |
|
1.24–8.30 | 3.18 | 0.57–17.64 | na | na | na | na |
A woman should be free to ask her husband to use a condom. | ||||||||
1 = agree, 0 = disagree (ref.) |
|
2.08–8.91 | na | na | na | na | na | na |
Who in your family usually has the final say on making large household purchases? | ||||||||
1 = jointly, 0 = spouse, respondent, others (ref.) | na | na |
|
1.37–20.73 |
|
0.02–0.24 | 3.27 | 0.70–15.36 |
Who mainly decides how the money you earn will be used? | ||||||||
1 = jointly, 0 = spouse, respondent, others (ref.) | 2.76 | 0.95–7.99 |
|
2.39–15.59 | na | na | ||
|
||||||||
Listened to |
||||||||
1 = regular listener, 0 = nonlistener (ref.) | 1.26 | 0.68–2.33 |
|
0.06–1.02 | 1.25 | 0.50–3.14 | 2.14 | 0.71–6.46 |
Discussed FP with spouse in the last 3 months. | ||||||||
1 = yes, 0 = no (ref.) |
|
6.49–26.76 | na | na |
|
1.14–5.86 |
|
1.39–11.37 |
Do you think that your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy? | ||||||||
1 = approve, 0 = disapprove, DK (ref.) | na | na | na | na | na | na |
|
1.46–10.90 |
Girls should be encouraged to continue their education to higher levels. | ||||||||
1 = agree, 0 = disagree (ref.) |
|
1.42–10.13 | 1.41 | 0.08–23.93 | na | na |
|
1.45–18.57 |
Children should be treated equally regardless of their sex. | ||||||||
1 = agree, 0 = disagree, DK (ref.) | na | na | na | na | na | na | na | na |
Couples should share responsibility for making decisions about family size. | ||||||||
1 = yes, 0 = no, DK (ref.) |
|
1.25–8.02 | 2.93 | 0.42–20.29 | na | na | na | na |
A woman should be free to ask her husband to use a condom. | ||||||||
1 = agree, 0 = disagree (ref.) |
|
2.43–10.29 | na | na | na | na | na | na |
Who in your family usually has the final say on making large household purchases? | ||||||||
1 = jointly, 0 = spouse, respondent, others (ref.) | na | na |
|
1.87–45.11 |
|
0.02–0.21 | na | na |
Who mainly decides how the money you earn will be used? | ||||||||
1 = jointly, 0 = spouse, respondent, others (ref.) | na | na | 1.7 | 0.52–5.53 |
|
2.84–22.30 | na | na |
Do you think a wife is justified in refusing to have sex with her husband if she knows he has a sexually transmitted infection? | ||||||||
1 = yes, 0 = no, DK (ref.) | na | na | na | na | 2.02 | 0.69–5.90 | na | na |
Is a husband justified in hitting or beating his wife if she goes out without telling him? | ||||||||
1 = no, 0 = yes, DK (ref.) |
|
0.16–0.99 |
|
2.20–36.72 | na | na | 0.58 | 0.15–2.23 |
Is a husband justified in hitting or beating his wife if she argues with him? | ||||||||
1 = no, 0 = yes, DK (ref.) | na | na | na | na | na | na | na | na |
Differences between surveys and between listeners and nonlisteners are significant at
na means coefficient was removed from the model because it was statistically nonsignificant.
aThe effect of drama exposure, net of the controls was signifcant but was rendered nonsignifcant after the measure for spousal discussion of FP was added in the model.
bThe effect of drama exposure, net of the controls was signifcant but was rendered nonsignifcant after the measure for use of earnings was added in the model.
In terms of the other two outcomes, “couples should space their children at least 2.5 to 3 years apart” and “people should plan how many children they will have,” the relative effect of the drama, like in the models in Table
Table
A spouse’s approval of FP had a positive effect on the fourth outcome among respondents. Agreement with “couples should share responsibility for making family size decisions” and “a woman should be free to ask her husband to use a condom” both had a positive effect on the first outcome and “who mainly decides how the money you earn will be used?” positively predicted the third outcome. Joint spousal decisions on the purchase of large household items showed a positive impact on the second outcome and a negative impact on third outcome while disagreement among respondents with “is a husband justified in hitting or beating his wife if she goes out without telling him” had a positive effect on the second outcome but negatively impacted the first outcome.
Sociocultural factors, including inegalitarian gender relations, have limited the success of RH behavior change communication programs in northern Nigeria. Population Media Center developed and aired
With respect to the study’s second research question and in concert with past studies conducted in Africa [
Similarly and in response to the study’s research question on gender,
The study also examined the mediating effect of gender on the association between exposure to the drama and RH outcomes by including measures of three dimensions of gender and the drama exposure variable as predictors in the same model while controlling for the seven study correlates. In this way, the study was able to establish the relative effect of both the drama and gender on RH outcomes. The findings are very insightful. For the twelve RH outcomes evaluated, the relative effects of the drama (i.e., in the presence of the gender predictors in addition to the study correlates) were consistent with the net drama effects (i.e., in the presence of the correlates only) on eight of them. Like the net effects, the relative drama effects continued to be positive for four outcomes (current use of FP; FP discussion with family, friends, and neighbors; birth intervals of 2.5 to 3 years; the importance of couples planning how many children to have) and nil for another four (intention to use contraceptives; want no more children; ideal age for childbearing is 20 years or older; access to contraceptives would encourage infidelity). However, for the remaining four outcomes (“using contraceptives is against the will of Allah,” “becoming pregnant every year puts the mother’s health at risk,” “should couples use contraceptives to avoid pregnancy,” and “knowledge of a place to obtain a FP method”), the drama effect lost its initial positive significance to the gender predictors (see Tables
As indicated by Tables
The divergent effects of the gender predictors on the RH outcomes support the study’s detailed focus on a comprehensive set of predictors. Had we examined just a few predictors or had we constructed composite indices of the predictors, we would have missed much of the findings on the relative effect of gender on RH issues. Finally, the findings on the mediating effects of this large number of indicators of gender afford researchers an opportunity to better determine which group of gender measures to include in composite indices, depending on the outcomes being investigated.
Despite the study’s achievements, a number of limitations deserve comment. Randomized controlled experimental design is the gold standard for the evaluation of behavioral change programs. However, the radio drama was aired throughout the target region, thereby precluding the use of randomized controlled designs. The pretest/posttest cross-sectional design adopted in the evaluation of drama tends to introduce threats of validity [
The authors declare that there is no conflict of interests regarding the publication of this paper.
PMC would like to thank the David and Lucile Packard Foundation for funding the drama program,