Development of behavioural change communication strategies to promote the use of intrauterine contraceptive device in Addis Ababa, Ethiopia

Abstract

Intrauterine contraceptive devices (IUCDs) are one of the long-acting contraceptive methods that provide protection from pregnancy for duration up to 12 years. IUCD is the most efficient, cost-effective, and extensively used contraceptive technique in the world, yet it is rarely utilized in Ethiopia. The purpose of this study was to develop social and behavioural change communication strategies (SBCC) to improve the utilization of IUCD in Addis Ababa, Ethiopia, through understanding intention and its determinants. The research was conducted in Addis Ababa among users of family planning methods in health facilities using complex mixed research approaches. Reasoned Action Approach was used as the study’s theoretical framework and the research was completed in three consequetive phases. In the first phase, qualitative data from users of a short and long-acting method of family planning was obtained, and the findings were utilized to help construct a questionnaire that was employed in the second phase of the study. Correlational quantitative cross-sectional approach was used in the second phase to collect data from representative samples of users of short-acting contraceptive methods in health facilities. Using the findings from the second phase, the SBCC model and communication strategy for IUCD promotion in Addis Ababa was developed in the third phase. Only 8.4% of short-acting contraceptive have intention to use IUCD in the coming year. Unfavourable attitudes and a negative perceived social norm on the use of IUCD were the main drivers of poor intention. The specific underlying beliefs responsible for the observed low intention and its direct determinants were presence of fear and shyness related to the procedure of IUCD insertion, believing that IUCD is not allowed for them, perception that IUCD causes infertility, need for approval from husband, preference to do as their close friends and neighbours, and preference to hear experience from other IUCD users. SBCC model and communication strategy were designed to address the identified underlying beliefs, to result in a positive attitude, supporting social norm, and enhanced intention toward the usage of IUCD, which will ultimately improve uitiliztion of IUCD and family planning method mix in Addis Ababa.