social marketing strategy brief

8/10/2019 Social Marketing Strategy Brief

1/6

Expanding Contraceptive Use in Urban Uttar Pradesh: Social Marketing, (March 2010), www.uhi-india.org

Page 1 of 6

The expansion of family planning services in Uttar Pradesh requires a mix of strategies to address the

populations diverse needs. This document is one in a series of briefs that explore the relative merits of

these strategies based on a review of the literature and previous experiences around the world. Increasing

contraceptive use prevents unplanned pregnancy, and reduces maternal and newborn deaths.

Introduction Social marketing is the systematic application ofcommercial marketing strategies to socialproblems. Audience segmentation, consumerresearch, and competitive analyses are used toinfluence consumer behaviour to better publichealth. Social marketing also uses the four Ps ofmarketing product, price, place, andpromotion as a framework for reducing barriersand promoting factors that facilitate behaviourchange. [1] [2]

Although social marketing has expanded toaddress numerous public health issues, [3] [4] it wasfirst widely used to promote contraceptive uptakein the 1970s. The strategy can be used to promotemany contraceptive methods, but it has been usedmost often to promote oral contraceptive pills,condoms, spermicidal foam tablets, and injectablecontraceptives. These spacing methods can moreeasily be branded and distributed by multiplevendors than limiting methods such as male andfemale sterilisation. [5] [6]

In contraceptive social marketing, donor agenciesusually provide contraceptive commodities to asocial marketing agency or a nongovernmentalorganisation (NGO). Commercial andnoncommercial distribution networks then make

the subsidised commodities available to the targetpopulation. The commodities can be distributedthrough traditional outlets such as pharmacies andchemist shops, or through nontraditional outletssuch as grocery stores and other retail outlets. Insome social marketing models, health workers andcommunity volunteers may also distribute thecommodities. Promotional activities (e.g., massmedia, interpersonal communication, traditionalmedia, events) targeting the intendedbeneficiaries are essential to creating demand forthe products and, therefore, facilitating the social

marketing strategy s success .

History of Social Marketing in IndiaThe social marketing of contraceptives has a longhistory in India, beginning with the launch ofNirodh condoms by the government in 1968. Sincethen, the national family planning programme hasadded oral contraceptive pills and has adopted amultibrand strategy that also supports NGObrands of condoms and pills. Social marketing ofcontraceptive pills began in 1987, with the launchof Mala D a government brand available over thecounter without a prescription. In 1996/97, allsocially marketed brands of oral contraceptive pillswere made available without prescription.

The condom is the most popular birth-spacingmethod and the most widely socially marketedproduct in urban Uttar Pradesh, with about 17percent of married women using condoms toprevent pregnancies. The state of Uttar Pradeshrepresents one of the largest condom markets inthe country, with an estimated 407 millioncondoms sold every year.

About 56 percent of the condoms sold in urbanUttar Pradesh are socially marketed brands (seeFigure 1). [7] Six social marketing organisationsprovide the condoms (see Table 1), with thelargest market shares held by Hindistan LatexFamily Planning Promotion Trust (HLFPPT) and PSI.

Two brands Nirodh Deluxe and Masti accountfor about 39 percent of all condoms sold in urbanUttar Pradesh .

Oral contraceptive pills are much less popular thancondoms in urban Uttar Pradesh, where pills areused by only 3.2 percent of married women. [8]

However, socially marketed brands are stillavailable. Five social marketing organisationsprovide seven brands of oral contraceptive pills inUttar Pradesh. Mala D (distributed by HLL/HLLFPTand PHSI) and Pearl (distributed by PSI) are the

most popular brands.

Social Marketing


2/6


Page 2 of 6

Market share of condoms in Uttar Pradesh

Figure 1. Socially marketed condoms make up more than half of the total condom market in Uttar Pradesh. Manforce is themain commercial brand. Source: Ballal and Chandrashekar (2010).

Table 1: Market Share of Socially Marketed Condoms in Uttar Pradesh, By Organisation and Brand.

Organisation Brand Percentage of total market

HLFPPTNirodh Deluxe 19.9

21.8Rakshak 1.9

PSI Masti 18.9 18.9

Parivar Seva SansthaSawan 2.5

6.0Milan 3.5

DKT India Zaroor 4.9 4.9

PHSIThrill 1.5

3.5Kamagni 2.0

HLL Ustad 1.8 1.8

Source: Ballal and Chandrashekar (2010). Acronyms: HLFPPT: Hindustan Latex Family Planning Promotion Trust; PHSI:Population Health Services (India); HLL: Hindustan Latex Limited.

Effect of Social Marketing on Contraceptive UseBetween The Second National Family HealthSurvey (NFHS-2) (1998 99) and NFHS-3 (2005 06),the use of condoms and pills increased overall inurban Uttar Pradesh. Although use increased bymore than 8 percentage points for the nonpoor(those in the three highest wealth quintiles), usedid not change for the poor (those in the two

lowest wealth quintiles) (see Table 2). [9] As aconsequence, the gap in the use of condoms andpills between the poor and the nonpoor has grownfrom 5 to 14 percentage points. Since socialmarketing programmes focus on condoms andpills, the fact that this gap has more than doubledis of concern.


3/6


Page 3 of 6

Table 2 : Percentage of Women Using Condoms and Oral Contraceptive Pills in Urban Uttar Pradesh by WealthStatus.

Overall Poor NonpoorNFHS-3 19.8 11.6 25.7NFHS-2 14.4 11.9 17.0

Source: Murthy and Chauhan (2009).

As shown in Figure 2, social marketings share ofthe overall market for condoms and pills grewbetween NFHS-2 and NFHS-3 for both the poorand the nonpoor. At the same time, thecommercial sectors market share decreased. Theincreased overall use of condoms and pills by thenonpoor (see Table 2) could be attributed in partto nonpoor consumers taking advantage of lower

prices of socially marketed brands. However, giventhat the overall use of condoms and pills has notsignificantly changed among the poor, it seemsthat the poor may have shifted their purchasesfrom commercial to socially marketed products,but that social marketing didnt affect uptake .

Source of condoms and oral contraceptive pills according to wealth status

Figure 2. The percentage of condom and oral contraceptive pill users who use socially marketed brands appears to beincreasing for both the poor and the nonpoor. However, these data represent only those users who were able to provide

0

1020

30

40

50

60

70

80

90

100

NFS-2 NFS-3 NFS-2 NFS-3

Poor Nonpoor

30.1

5.3

38.5 28.4

65.1

86.4

43 58.6

4.8 8.217.8 7.3

5.7

S o u r c e o

f c o n

d o m s a n

d p i l l s

( p e r c e n t )

Wealth status

Other Free Social Marketing Commercial


4/6


Page 4 of 6

information on what brands of condoms and pills they used.Source: Murthy and Chauhan (2009).

Barriers to Effective Social Marketing The survey data from Uttar Pradesh and findingsfrom various social marketing programmes in India

have helped identify barriers to the use ofproducts provided by social marketingprogrammes.

Two ongoing programmes Innovations in FamilyPlanning Services Project II (IFPS II) and SadhanSocial Marketing Network [10] have beenparticularly informative. Both programmes focuson increasing the use of birth-spacing methods,especially condoms and pills, and have increasedaccess to contraceptives in Uttar Pradesh.Although many social marketing efforts highlight

condoms for HIV prevention, these two emphasisecondoms for family planning.

The Yahi Hai Sahi campaign and the Goli keHamjoli (Friends of the Pill) programme are twoprevious initiatives that have provided additionalinformation on barriers to marketing condoms andpills. Yahi Hai Sahi sought to increase condom usein 10 northern Indian states, including UttarPradesh. [11] Goli ke Hamjoli aimed to increase andcreate a more supportive environment for oralcontraceptive use in Uttar Pradesh. [12]

Barriers that typically limit use of condoms or pillspromoted through social marketing programmesinclude:

The poor often lack convenient access toaffordable birth-spacing methods. Eventhough an estimated 90 percent of womenwith an unmet need for spacing and 85percent of slum residents have access to apharmacy or chemist within one kilometre,many of these retail outlets do not carrysocially marketed products.

Owners of retail outlets may have littleincentive to stock and promote sociallymarketed brands since they yield lowerprofits than do commercial brands. This isespecially true for socially marketedcondoms.

Many pharmacies and chemists lack up-to-date information about low-dose pills,making it difficult for them to providewomen with reliable information about thepills safety and efficacy .

Many men have unfavourable impressionsof the condom. Some believe condomsdecrease sexual pleasure or that condomuse indicates infidelity or a lack of trust onthe part of ones spouse. For these reasons,both men and women may be embarrassedto purchase condoms in a public venue.

Addressing Barriers to Social Marketing The survey data from Uttar Pradesh and the socialmarketing programmes described above have alsohelped inform various strategies for overcomingbarriers to effective social marketing andincreased contraceptive uptake. Social marketingprogrammes could reduce barriers through the

following approaches: Include high-margin consumer products

(e.g., iodised salt and sanitary napkins) in abundle of products that includes condoms ororal contraceptive pills. This could increaseprofit margins for retailers and encouragemore retailers, especially nontraditionaloutlets, to stock socially marketed condomsand pills.

Introduce other financial incentives forretailers (e.g., trade promotions, quantitydiscounts, and gifts) to overcome the initial

barriers to stocking socially marketedproducts. These incentives could alsosensitise retailers to the value of productdisplays, point-of-purchase materials, andother materials that help increase sales.

Increase the comfort of sales personnel inselling contraceptives, especially byproviding them with information about theproducts. As a result, they will be able tohelp women use oral contraceptive pills andprovide women with better information,

such as technical updates to dispel mythsand rumours.

Develop and implement strategies forincreasing contraceptive demand. Demandfor condoms needs to be increased amongthe poor to address the large gap in usebetween the poor and the nonpoor.Demand for oral contraceptives needs to beincreased among all women to help addressthe low rates of use in India and in urbanUttar Pradesh. Regardless of how


5/6


Page 5 of 6

inexpensive contraceptive products are,they will not be used if people do not wantthem.

Offer more contraceptive variety topotential clients. For example, none of the

current socially marketed brands ofcondoms offer textured or other varieties ofcondoms, but a larger selection mightappeal to young clients. Also, specific brandsof condoms and oral contraceptive pillscould be better targeted, and marketingstrategies could be created to encouragepoor men and women to use sociallymarketed products and wealthier men andwomen to use commercially available ones.

Develop messages to help men and womenovercome negative impressions of condoms.These messages could include: Condom useis an appropriate way for most couples tospace their pregnancies. Condoms are not just for extramarital sexual activity. Menneednt be embarrassed when purchasingcondoms.

Evaluating Social Marketing ProgrammesIncreasing the use of spacing methods throughsocial marketing programmes will requiresubstantial efforts. Of particular importance willbe evaluating the effectiveness of different socialmarketing strategies.

Given that social marketing programmes aim toincrease contraceptive use among the poor,programmes should evaluate not only changes intotal contraceptive use but also changes in usewithin groups of people with varied ability to pay.Social marketing programmes should ideallyincrease the use of spacing methods and diminishthe variations in use between the rich and thepoor. However, very little literature is available on

this topic.

Most evaluations of social marketing programmesprovide information on product sales, adjustedinto couple years of protection (CYP) usingstandard conversion factors. However, even ifprogrammes increase CYP, weve seen that ratesof overall contraceptive use will not necessarily

increase because current users may simply switchto the lower-priced, socially marketed brand.Ideally, wealthier buyers of condoms and pillswould not be attracted to the lower-priced brands.

Although programmes can differentiate brands tolimit the substitution of low-priced brands forhigher-priced brands, wealthy consumers may stillpurchase the less-expensive socially marketedbrands, particularly if they perceive them to be ofhigh quality. For example, in urban Uttar Pradesh,people in the wealthiest segments of thepopulation buy more socially marketed condomsthan do people in the poorest segments of thepopulation.

One evaluation that did not focus on CYP is a studyfrom the Honduras [13] that sought to examine the

impact of a social marketing programme(emphasising oral contraceptive pills) oncontraceptive use. The programme emphasisedpills and social marketing strategies that haveevolved since the study was conducted, but someinformation may still be useful in evaluatingprogramme impact (namely information fromhousehold surveys about which brands werepurchased, how much was paid for them, wherethey were purchased, and the wealth of thepurchasers).

Evaluations that seek to include a cost-effectiveness component traditionally consider theaverage cost of providing a contraceptive methodor the CYP that the method provides. However, itis important to also consider how the costs ofmethod provision through more than oneprogramme are affected when one of theprogrammes is expanded. In the Honduran study,while the social marketing programme drewcustomers away from a community-baseddistribution (CBD) programme, costs in the CBDprogramme increased as the two programmes

completed with each other for customers and theCBD programme sought to find new customers bydeploying more CBD workers. Thus, the interactionbetween different types of programmes needs tobe considered in understanding the impact of asocial marketing programme on costs.


6/6


Page 6 of 6

Acknowledgements

Several people were involved in the production of thisdocument: V. S. Chandrashekar, Madhwaraj Ballal,Barbara Janowitz and Gita Pillai.

Urban Health Initiative is supported by the Bill and

Melinda Gates Foundation, and implemented by FHI 360,in collaboration with a consortium of partnerscommitted to improving urban health. The contents ofthis paper do not necessarily reflect the views and

policies of Urban Health Initiative, Family HealthInternational, or Bill and Melinda Gates Foundation.

Notes 1. 1. Nova Corcoran, Communicating Health:

Strategies for Health Promotion (London: SAGEPublications, 2007).

2. Karen Glanz, Barbara K. Rimer, and FrancesMarcus Lewis (eds.), Health Behavior and HealthEducation: Theory, Research, and Practice , 3rd ed.(San Francisco: Jossey-Bass, 2 002).

3. Michael P. Fox, Condom Social Marketing:Selected Case Studies (Geneva: UNAIDS, 2000).

4. Phyllis Tilson Piotrow et al., HealthCommunication: Lessons from Family Planning andReproductive Health (Westport, CT: Praeger,1997).

5. Philip D. Harvey, "Advertising AffordableContraceptives: The Social Marketing Experience,"in Social Marketing: Theoretical and PracticalPerspectives, eds. Marvin E Goldberg, Martin

Fishbein, and Susan E. Middlestadt (Mahwah, NJ:Lawrence Erlbaum Associates, 1997): 147 167.

6. W. P. Schellstede and R. L. Ciszewski, "SocialMarketing of Contraceptives in Bangladesh,"Studies in Family Planning 15, no. 1 (1984): 30 39.

7. M. Ballal and V. S. Chandrashekar, "SocialMarketing: Expanding Contraceptive Use in UrbanUP," Social Marketing Strategy Brief (Lucknow,India: Urban Health Intiative, 2010).

8. International Institute for Population Sciences(IIPS), The Third National Family Health Survey(NFHS-3), India: 2005 06 (Mumbai: InternationalInstitute for Population Sciences, 2007).

9. Nirmala Murthy and Rajesh K. Chauhan, A WhitePaper on Family Planning and DemographicTransition in Urban UP. Document produced forthe Urban Reproductive Health Initiative, 2009.

10. McKinsey & Company. Intervention Assessment:Social Marketing. Report prepared for the UrbanReproductive Health Initiative, 2009.

11. USAID/India, ICICI Bank, and PSP- One, Yahi HaiSahi! Growing the Condom Market in North Indiathrough the Private Sector, 2008.

12. USAID/India, ICICI Bank, and PSP-One, "Gole KeHamjoli" Promotion of Oral Pills in Urban NorthIndia, 2008.

13. Barbara Janowitz et al., "Impact of SocialMarketing on Contraceptive Prevalence and Costin Honduras," Studies in Family Planning 23, no.2(1992): 110 17.

social marketing strategy brief

Documents