Sexual & Reproductive Health, Family Planning: Effective Communication Strategies Should Be In Tune With Policy

In recognising the link between population and development, India kick-started the Family Planning (FP) program in 1951, post-independence. The program kept evolving; however, the focus remained on ‘small family’ and ‘population stabilisation’.

Reaching correct and timely information to individuals and the community is the key first step towards bringing about a positive behaviour change in sexual and reproductive health, including family planning (SRH/FP) issues. Scientifically designed social & behaviour change, based on time-tested conceptual frameworks, help in delivering desired results.

It is noteworthy that community engagement and ownership of the SRH/FP programme, through participatory methods, is an essential element of a successful and rights-based programme. In the earlier years, beginning in the decade of the 50s, employing communication in reaching family planning information to communities, including the then available contraceptives and their uses was integral to the population programme since its inception in India. With the mostly ‘one-way’ information dissemination in the previous decades and the near absence of an interpersonal form of community interaction, the programme was restricted to promoting FP methods. These were
limited to a handful of spacing methods and vasectomy and tubectomy.

From “Informing” to “Engaging”: People’s Participation in SRH Programmes
When the traditional FP programme is reviewed from the lens of health communication – also popularly referred to as IEC – the government invested in health promotion and awareness activities that were largely mono-linear and information-based models. Therefore, most countries, including India, were found tilting to perpetuate the top-down use of mass media and did not adequately appreciate the potential of participatory and community-based media. However, through evolving social research it became increasingly clear that members of the public were not passive recipients of information and that mass media alone could not change people’s
perceptions and behaviours, especially so when the desired outcomes address core health practices, including such issues that would deal with their sexual health and decisions about the birth of a child.

‘Community’: Centerpiece to Health & Development
As the top-down information awareness model started undergoing a conceptual shift, the ‘Another Development’ paradigm began to influence communication practitioners and scholars who argued, as it was within communities that the reality of development was experienced, community participation in the design and implementation of development programmes was an essential element to the positive change process. Alternative communication systems and media practices were, therefore, regarded as important means for local people to engage in development activities, and as a two-way process in which communities could participate as key agents in their own development.

By the late 80s, the notion of participatory development, particularly participatory rural collective action and appraisal, in which poor communities were directly engaged in defining their own problems and solutions had gained considerable currency within the development organisations, especially non-governmental organisations (NGOs). This is particularly applicable to the then family planning/welfare programme. Since then, increased priority has been given to horizontal, multi-directional communication methods that utilise a mix of channels and emphasise the importance of two-way communication through sustained dialogue in facilitating trust and mutual understanding, providing centre-stage to the voice of socially-excluded and disempowered people and empowering them to identify ways of overcoming the targeted problems to improve their own well-being and the overall quality of life issues.

The bottom-up approach, i.e. heightened use of community participation in health communication gained practice soon after the conclusion of the ICPD 1994 that emphasised a holistic approach in addressing sexual and reproductive health and rights issues with a women-centric approach. Considering this as a turning point, the programme gradually evolved from the conventional IEC to a more comprehensive and holistic SBCC (social & behaviour change communication) at a time when the national population programme too was evolving from a mere promotion of the family planning to broader SRHR interventions.

In fostering sustained social and behaviour change interventions in communities, within the gamut of development and health programmes, the proponents of various communication theories and frameworks have cited how social change takes place and how a positive and progressive change is communicated through select communication channels over a period of time to individuals, communities and society.

Evolution of SRH/FP: Information >IEC > BCC > SBCC > SBC
Health communication under the SRH/FP has evolved from one-way Public Information to Information, Education and Communication (IEC) to Behavior Change Communication (BCC) to Social and Behaviour Change Communication (SBCC) and now to SBC (Social & Behavioural Change). IEC as it was usually practised focuses on delivering information to a target, with an inherent assumption that subsequent to delivering accurate information, people would reduce damaging/harmful behaviours and thus, adopt desired positive behaviours. BCC acknowledged that information is necessary but not sufficient in most cases. And the social and behavioural change
(SBC) underlines the significance of the social environment and the role of the community around individuals that enables a shift to positive behaviours, such as limiting family size and seeking skilled-birth attendants.

India’s Population programme, which broadly covers the overall approach to sexual & reproductive health information & services, has apparently evolved to adapt to the comprehensive SBC approach. Population issues, over a period of time, have also gained political and social momentum. Yet the strategy for imbibing individual behaviours in fostering sustained quality SRH services that are accessible and affordable still lags behind. Therefore, the goal of equity and reaching out to the most vulnerable, hard-to-reach and socially excluded
populace still looms large.

In order to foster sustained social and behaviour change & community mobilisation interventions in communities, within the gamut of development and health programmes, the proponents of various social-communication theories and frameworks have cited how social change takes place and how a positive and progressive change is communicated through select communication channels over a period of time to individuals and communities.

Are Adolescents More Susceptible?
Needless to emphasise, discussing reproductive health or sexuality issues are considered taboo in India. However, due to media exposure, adolescents find themselves trapped between relatively conservative “socio-cultural norms” and glamorous popular culture. Research
studies have also demonstrated that adolescents have many doubts and unresolved questions about their own sexuality, giving a natural rise to increasing anxiety and perpetual confusion.

In addition, the current education system has a limited contribution to providing reproductive & sexual health knowledge to adolescents, which tend to misbelieve and indulge in unsafe or risky sexual activities by this group of the populace. Abundant Risks for the young Sexual and Reproductive Health (SRH) become a major area of concern during adolescence because of the apparent risky sexual behaviours which include early age sexual debut, multiple sexual partners, unprotected sexual intercourse, and sexual activity under the influence of alcohol or drugs.

These behaviours increase the risk of unintended pregnancy and/or Sexually Transmitted Infections (STIs) including Human Immunodeficiency Virus (HIV) infection. Therefore, sex-related anxiety and curiosity, sexually transmitted diseases (STDs), unwanted
pregnancies, substance/drug abuse, and unsafe backstreet abortions are important problem issues among adolescents. It is noted that girls are more vulnerable in this age group because of clearly marked unawareness and biological susceptibility to STDs. Therefore,
scientifically designed reproductive health education is a critical requirement.

Strengthening Social & Behaviour Change – Strategic Road Ahead for SRH/FP
Effective and results-based SBC strategies use concepts that range from psycho-social learning theories of role modelling communicated via multiple modes to the use of advocacy and social mobilisation. Dialogue with and active participation of individuals is an essential element in communication for behaviour and social change. For behaviours to change on a large scale, harmful cultural values, societal norms and structural inequalities have to be taken into consideration. Effective communication strategies have to be cognisant of and in tune with the policy and legislative environment and linked to the service delivery aspects. And in order to address the critical need for addressing SRH/FP issues, including maternal & neonatal child health during emergencies and natural disaster situations, both the Government and the communities should be better prepared now than ever before.

Due to the COVID-19 pandemic waves, the respective governments have gathered together the requisite experience in the outreach of core communication messages through appropriate modes along with the provision of skilled services at accessible and affordable health facilities.