Exposure to general media programming and to family planning messages through the media has a strong impact on reproductive attitudes and behaviors in Pakistan, India and Bangladesh. According to analyses of national survey data, women in all three countries who regularly watch television and those who have been exposed to explicit family planning messages are more likely than other women to approve of family planning.¹ Having listened to explicit family planning messages on radio or television is associated with contraceptive use in all three countries.

Pakistan

The analysis of media effects for Pakistan is based on data from the National Demographic and Health Survey of 1990- 1991 and the Pakistan Contraceptive Prevalence Survey of 1994-1995. The samples for these surveys included 6,611 ever-married women aged 15-49 and 7,922 married women aged 15-49, respectively. The husbands of one-third of the women in the earlier survey were also interviewed.

The proportion of women not exposed to radio, television or print media declined from 59% in 1990-1991 to 43% in 1994-1995. Over the same time period, women's exposure to radio (27% vs. 33%) or television alone (30% vs. 46%) increased, while exposure to print media remained stable (14%). During that period, the proportion of women who had never heard a family planning message on either radio or television fell from 79% to 38%.

The more types of media a woman was exposed to, the more likely she was to practice contraception. Forty-five percent of women exposed to all three forms of media were using a method at the time of the survey in 1994-1995, compared with 31% of women exposed to two types of media and 9% of women exposed to no media. Further, women who had heard family planning messages on both television and radio and those who had heard a message on the radio only were more likely to use a method than were women who had not heard such messages (32% and 27% vs. 8%).

Among women not currently practicing contraception, media exposure increased the likelihood that they planned to use a method in the future. For instance, 58% of women exposed to three forms of media in 1994-1995 said that they would practice contraception in the future. Fifty-two percent of women who had heard family planning messages on both the radio and television reported that they intended to use contraceptives.

According to multivariate analyses that controlled for social and demographic characteristics, women who were regularly exposed to television were 1.4-1.6 times as likely as women without media exposure to know of at least one modern method in 1990-1991. During the same period, women who had heard family planning messages on the radio were 1.5 times as likely as other women to know of a modern method. Women who had been exposed to general television programming were 20% more likely than women who had not to have discussed family planning with their husbands (Table 1).

Media exposure had strong effects on attitudes toward family planning. In both periods, exposure to television, to print media or to family planning messages on radio or television significantly increased the odds that a woman approved of family planning (odds ratios, 1.3-2.2). The strength of this effect increased between the two periods for exposure to print media (from 1.4 to 1.7), to family planning messages on the radio (from 1.3 to 1.6) and to such messages on television (1.7 to 2.2).

The effect of media exposure to family planning messages on usage was significant only in the later period: In 1994-1995, women were 53% more likely to be using a method if they had heard such messages on the radio and 68% more likely to do so if they had been exposed to them on television. Exposure to general television programming had a significant effect in both periods (odds ratios of 1.7-1.8), while exposure to print media such as newspapers and magazines had a significant effect only in the later period (1.3).

When intention to use a method in the future was considered, the effect of general radio programming was significant only in the earlier period (odds ratio of 1.5), while that of general television exposure became significant in the later period (1.4). Print media had a stable, significant effect over both periods (1.4). In contrast, the effect of exposure to family planning messages grew stronger over time and became significant in 1994-1995 for both radio (1.8) and television (1.5).

The effects of general media exposure on whether women expressed their fertility desires in numeric terms were significant only in 1990-1991 for radio (odds ratio of 1.6) and in both years for television (1.5 and 1.2). Exposure to family planning messages on radio and television had a significant effect only in the later period (1.5 and 1.9, respectively).

Spousal discussion of fertility desires was significantly higher among women who had listened to the radio in the earlier period (odds ratio of 1.2) and among those who had been exposed to television or to print media in the later period (1.4 and 1.3, respectively). Women who read newspapers or magazines were significantly more likely to want no more children in both periods (1.5 and 1.4); watching television had a significant positive effect only in the first period (1.3), while exposure to family planning messages on the radio had a significant effect only in the later period (1.2).

In a separate analysis of media effects on illiterate women, listening to the radio had significant positive effects on all reproductive attitudes and behaviors except wanting no more children (odds ratios of 1.3-2.0) in the earlier period, but had such effects in the later period only on approval of family planning and expressing fertility desires in numeric terms (1.2 each). In contrast, general television programming had significant positive effects on the majority of variables in both periods.

Having heard family planning messages on the radio significantly affected only knowledge of modern methods (1.7) and approval of family planning (1.3) in 1990- 1991, but had significant effects on all seven of the attitudes and behaviors measured in 1994-1995. Exposure to such messages on television followed a similar pattern.

The 1990-1991 survey included husbands. Men who listened to the radio were significantly more likely than those who did not to know of a modern method, to approve of family planning, to intend to use a method in the future, to discuss family size with their wife and to want no more children (odds ratios, 1.4-1.7). The odds that men knew of at least one modern method were even more elevated among those who had heard family planning messages on the radio (3.4). In addition, men exposed to print media were more likely than other men to approve of family planning, to have ever used a method, to currently use a method, to have discussed family size with their wife, to want no more children and to provide a numeric response when asked about their desired family size (1.6-2.7).

For couples, the odds of knowing of a modern method were significantly associated with exposure to radio, television or print media (odds ratio, 2.3). In addition, couples in which both the man and the woman had heard family planning messages on radio or television had increased odds of knowing of a modern method (2.9).

India

The data for India are from the 1992-1993 National Family Health Survey, in which 90,000 ever-married women aged 13-49 were interviewed. No husbands were included in the survey.

In 1992-1993, 32% of Indian women reported watching television at least once a week, 44% listened to radio and 43% had heard family planning messages on either radio or television. Exposure to media varied according to state of residence: The proportion of women exposed to television at least once a week ranged from 13% in Bihar to 83% in Delhi. Current contraceptive use was highest in Kerala (63%) and Delhi (60%), and lowest in Nagaland (13%) and Bihar (23%).

Table 1 indicates that in India overall, women exposed to television and family planning messages on television or radio were more likely than women without media exposure to approve of family planning (odds ratios, 1.2-1.9). Women's odds of discussing family planning with their husbands were elevated among those exposed to general television or radio programming or to family planning messages on either medium (1.1-1.3). Further, exposure to media influenced a woman's contraceptive behavior: Women who watched television, listened to the radio or heard family planning announcements on either medium were more likely than those who did not to have used a method at some time (1.1-1.5). Exposure to general radio programming and to family planning messages on radio or television was associated with intention to use a method in the future (1.1-1.5). Current method use was associated with exposure to television, to radio or to family planning messages on the radio (1.1-1.4).

Among women living in the 10 states with contraceptive prevalence rates lower than 40%, listening to the radio was not significantly associated with women's contraceptive attitudes or behaviors. However, women who watched television were more likely than those who did not to approve of family planning, to have discussed family planning with their husbands, to have ever used a method, to currently practice contraception and to want no more children (odds ratios of 1.2-1.3). Having heard family planning messages on radio or on television was associated with approving of family planning (1.3-2.0), having discussed family planning with their spouse (1.3-1.4), having ever used a method (1.3), currently using a method (1.2-1.3), intending to use a method in the future (1.3-1.8) and having discussed desired family size (1.4-1.7).

Illiterate women who had been exposed to television or to family planning announcements on television were more likely than those who had not to approve of family planning (1.3-1.5). Exposure to general television programming or to family planning messages on television was also associated with discussing family planning with one's husband (1.2-1.4) and currently using a method (1.2-1.4). Among illiterate women, these variables were also linked to having discussed family size (1.3-1.4), wanting no more children (1.2-1.4) and preferring fewer than three children (1.1-1.4).

Bangladesh

Overall, 49% of married women in Bangladesh were exposed to either radio or television in 1996-1997, and 19% were exposed to both media; 45% heard family planning announcements on either radio or television. Women were more likely to have heard such messages on the radio than to have been exposed to them on television (39% vs. 22%).

Both general programming and family planning messages on television and radio were significantly related to family planning attitudes in Bangladesh in 1993-1994 and 1996-1997. Women who watched television were 30% more likely than those who did not to approve of family planning in the earlier period and twice as likely to do so during the later period. In contrast, the odds of approval associated with having heard a family planning message on television declined from 2.1 to 1.8 and became nonsignificant (Table 1).

Exposure to general television and radio programming had little effect on whether women had discussed family planning with their husband. In both years, however, having heard family planning messages on either medium significantly increased the odds of having had such a discussion (1.3-1.5).

The effects of media exposure on contraceptive behavior were, for the most part, small but significant and stable over time. In both 1993-1994 and 1996-1997, women who had heard a family planning message on television or radio were about 20% more likely than those who had not to have used a contraceptive method at some time. The odds of ever-use associated with exposure to general television programming were significant only in the later survey (1.3), while the odds associated with listening to the radio declined and lost significance (from 1.3 to 1.1).

Media effects on current use were slightly weaker. Exposure to general radio programming had a significant effect only in the earlier period (odds ratio of 1.2), while watching television had no significant effect. Having heard a family planning message on the radio was significant only in 1996-1997 (1.2), while the odds associated with having seen such messages on television rose from 1.2 to 1.3.

Exposure to media showed a different pattern of effects on contraceptive intentions. The odds associated with intentions to use a method declined between the two periods for general programming on radio (from 1.4 to 1.3), but were significant in both, while the odds associated with watching television were significant only in the early period (1.5). Having heard family planning messages on either medium had no significant effect.

In 1993-1994, women exposed to general programming on television or to family planning messages on radio or television were significantly more likely to have discussed family size with their spouse (odds ratios 1.3-1.6), with radio family planning messages having the greatest impact. Almost all women had had such a discussion in the later period, so the variable was dropped from the analysis. The desire for no more children was not strongly associated with media exposure. Listening to the radio had a significant effect only in 1993-1994 (1.2), while having heard a family planning message on the radio became significant in 1996-1997 (1.3).

Data collected from the husbands of women interviewed in the two surveys indicate that exposure of both spouses to family planning messages on radio and television had significant, positive effects on couples' current contraceptive use and discussion of family planning. When both spouses had heard family planning messages on radio or television, the odds of family planning approval, current use, discussions about family planning and discussions about family size were elevated (1.3-2.9).--I. Olenick