formative research – married segment - fpkonet
TRANSCRIPT
Formative Research – Married Segment
Key Findings – A Presentation
August 20, 2018
2
Presentation Flow
• Quick recap from the Landscape AnalysisWhat we know
• Findings from Formative Research
What we wanted to know
• Directions for communication developmentWay forward
Section – 1
What We Know: Snapshot from Landscape
4
High Unmet Need Among Young Urban Women
• After a healthy growth for almost two decades the mCPR shows signs of slow down driven by sharp
decline in use of LAPMs (female sterilization)
• Usage of SAMs in urban areas has seen a consistent decline over the last decade
• Among the potential SAM users, the younger cohort (15-29 years) has the highest unmet need
13.6%
6.0%
12.6%
8.2%
Urban Rural
NFHS-3
NFHS-4
19.9% 15.7% 8.4% 3.1%1.0% 0.3%
2.3%
6.5%
10.3%
9.4%
7.3%5.5%
3.3%
26.9%
46.0%
62.8%
74.6%80.0%
84.0% 88.9%
15-19 20-24 25-29 30-34 35-39 40-44 45-49
Unmet need forlimiting
Unmet need forspacing
% of Demand satisfiedby modern methods
Usage of SAMs Unmet Need for Contraception
Source: NFHS-4 and NFHS-3, Base: Married Women 15-49 years
5
Negative Attitudes Towards Contraception Growing
• Negative beliefs and perceptions towards contraception have grown among men, especially in urban areas
• Side-effects, health concerns and effectiveness concerns are the key method related reasons driving discontinuation of SAMs
35.2%
19.3%
64.0%
18.6%
12.3%
72.4%
Contraception is women's business, men shouldn'thave to worry about it
Women who use contraception may becomepromiscuous
If a male condom is used correctly it protectsagainst pregnancy most of the time
Urban areas
NFHS-4
NFHS-3
38.6%
20.8%
58.9%
23.3%
18.3%
62.1%
Rural areas
Source: NFHS-4 and NFHS-3, Base: Married Men 15-49 years
6
Exposure to FP Messages Not Helping SAM Uptake
• While exposure to FP messages on mass and outdoor media has grown, especially among women,
contraceptive use has either plateaued or is declining
• Contraceptive sales trends confirm stagnant Condom and OCP sales over last 5 years
58.6%
53.3%
36.6%
18.0%
49.5%
26.7%
22.2%
32.8%
TV
Outdoor
Radio
Women
NFHS-4
NFHS-3
61.2%
58.6%
51.4%
22.1%
64.1%
55.9%
50.1%
52.9%
Men
Source: NFHS-4 and NFHS-3, Base: Married Women and Men 15-49 years
7
Condom Sales Stagnant
• Condom market is estimated to be around 2.4 billion pieces, growing at a CAGR of 1%
• Only commercial brands show a positive CAGR while SMO brands and free distributed condoms show negative CAGR
Source: Nielsen RMS Data for the Period March 2014 to March 2018, HMIS data from 2014 to 2017
1136.3 1123.9 1173 1199.61355.4
831.2 782.4 759.6 680
717.2
333.7313 318.6 329.4
329.3
MAT'14 MAT'15 MAT'16 MAT'17 MAT'18
Vo
lum
e in
Mill
ion
pie
ces
2301.22219.3 2251.2 2209.0
2401.8
*
*Estimated
Free distributed
SMO brands
Commercial brands
-0.3%
-3.6%
4.5%
CAGR
1.0%
*
8
OCP Volumes Also Not Growing
Source: HMIS, DKT, IMS. HMIS and IMS data is April- March, DKT data is Jan-Dec
45.6 41.3 40.3 40.6 43.4 45.5
41.9 55.149.2 43.8 32.7
34.8
31.4
31.833.5
35.236.4
37.1
4.0
2.85.6
5.06.2
6.4
0
20
40
60
80
100
120
140
2011 2012 2013 2014 2015 2016
Num
be
r o
f O
CP
cycle
s-
in m
illio
ns
Weekly pills (SMO) Commercial SMO+GoI brands Free distribution
• SMO plus Commercial brands account for 63% (78 million) of the OCP market
• SMO brands may have been impacted from 2014-2016 due to supply issues
CAGR
10%
+3.4%
-3.6%
-0.1%
123131 129 125
119124 +0.2%
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Section – 2:
What We Wanted to Know: Findings From Formative
Research
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Research Objectives
Barriers to Contraceptive Use
Triggers to Spousal Communication
Profiling Communicating Couples
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Methodology
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Factors Affecting Spousal Communication
Migrants, nuclear families, time & opportunities to be together, greater interdependence
• Type: None, symbolic, active • Led by: Wife, husband, either
Agency of decision making, powers of negotiation
• Compliance• Conflict avoidance• Passive subterfuge
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‘No Conversation’
They don’t regularly talk
outside of very functional
issues; sometimes wife takes
the lead if the need is pressing
otherwise mostly it is husband
‘Partial Conversation’
Most of their conversations
are indirect and through
innuendoes. Husband
keeps bringing in the topic
with wife mostly concurring
‘Honest Conversation’
Active conversations about
everything; open & trusting
space between them; anybody
can take the lead in key
discussions
Types of Spousal Communication Happening
Clearly, the Behavior Change we seek to script, will happen as more and more people shift
towards the right – which can be signified as and ideal precursor to intent for contraception usage
14
‘No Conversation’ ‘Partial Conversation’ ‘Honest Conversation’
Consumer Profiles based on Spousal Communication
Traditional Patriarch
Confused Conformist
Chup ChupKe
Willful Woman
Economically Driven
Dual Faced Grateful Couple
Progressive Couples
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The Traditional Patriarchal Couple
16
a
a
Contraception is wife’s responsibility – man doesn’t use condom
– no choice given to the woman
The Traditional Patriarchal Couple
“Main mard hu aur mujhe zyada pata hai kyunki main ghar kay bahar jaata hu”
“Mera farz hai apne pati ko khush rakhna.”
“Thake hue aate hai woh, mein toh ghar par he reheti hu. Jo bolenge woh karna hi padega”
Conversations
Man will initiate the conversation with wife.
There is little communication between the
partners and thus circumvents conflicts.
Conflict Resolution
No conversations hence no conflicts.
Power Dynamics
The depth of the relationship is based on duty &
respect. This couple is rooted within
conventional societal norms.
The most prominent trait of this genre - man is
greater and the woman needs to follow
irrespective of her needs, choice and desires.
There is an inherent subservience in the
marriage.
a
17
The Dual-faced Couple
18
a
FP conversation is mostly transactional with hardly any
choice given to woman
The Dual-faced Couple
““Inn se kuch bhi karne se pehele pooch leti hu taaki baadmein humare beech mein ladai na ho ya koi misunderstanding na ho jaye. Fir who jo kahenge mein wahikarti hu.”
“Condom or goliya hai. condom mein toh darr rehetahai kyuki woh plastic ka hota hai. Kahi andar reh gayatoh. Mein soch raha tha tum goliya lena shuru kar do”
Conversations
There is a conversation between the couple but it is the man
who initiates the conversation and takes the decision.
The man is dominating but regards his spouse-sometimes ask
her for her opinion
.Conflict Resolution
Little conversations hence no conflicts.
Power Dynamics
The wife is likely brought up in a patriarchal family
Conditioned by witnessing women’s needs and desires not
being heard at all.
On face value they showcase that they are progressive.
However, in the individual interviews it was found that they
are still rooted within conventional patriarchal societal
norms.
A sense of hesitation prevailed when it came to discussing
family planning - initially due to social stigmas around it and
subsequently due to the husband's unwillingness to discuss
it.
a
19
The Confused-Conformist Couple
20
a
a
Constantly looks out for inputs on family planning. The vision
for his family is vague and flexible
The Confused-Conformist Couple
“He works hard and barely gets any time to spend with us. So I make most of the decisions at home. If he is around, I will ask him. But mostly it is me who is keeping in touch with everyone in the extended family”
“I am always busy at work and I am seldom at home. She is the one who takes care of the family and expenses. She is even more in touch with my family than me”
Conversations
The most prominent trait amongst this genre of couples
is the indecision at the end of their conversations
Conflict Resolution
No decisions reached to lead to conflict
Power Dynamics
The couple has a constant fear of mishaps like
miscarriage, adverse effect on the wife’s health and
adverse effect on the future children
The couple mostly treats themselves as equals but the
societal pressure seems to directly fall on the wife
more than the husband
Low confidence in going against established societal
norms w.r.t family
21
The Economically Driven Couple
22
Responsibility is divided equally, but decision making
is skewed towards the husband
The Economically Driven Couple
“Marriage means running a home together. He provides for the home, and I manage it. I am proud to do everything I can to make him happy, because nobody knows him better.”
“Marriage means knowing to take the right steps to work towards a better future together. It is my duty to provide well for my home and family, and we shoulder equal responsibility.”
Conversations
Conversations happen across all couples who are economically
driven , however the nature of the conversation may vary from
low to medium to high.
Conflict Resolution
Conflict resolution can occur through a combination of
conversation and compliance as she sees the husband as the
provider
Power Dynamics
The depth of the relationship is based on honesty and transparency
and a strong sense of responsibility to provide the best for the family, in
the most economically beneficial way.
The couple functions as an independent unit, and while they pay heed
to societal norms, their decisions are based on what the husband
deems beneficial to himself and his family.
Latent conditioning to be the final authority: Believes that roles for man
and woman are pre-destined to be that of provider and nurturer
respectively.
Assumes that it is the wife’s assigned role to care for him, his child and
parents – though there is no oppression from his side
a
a
23
The Willful Woman
24
Sees it as her responsibility to step in and take charge if
the husband is disinclined or unable to address an issue
The Willful Woman
“Haan doctor se baat kar lete hain. Agar tumhe dawai nahi leni, toh main condom use kar lunga”
“Hum agla bachcha tab karenge jab pehle bachcha bada ho jayega. Mujhe time chahiye”
“Marriage means understanding each other’s needs and working towards a future together”
Conversations
It is wife who initiates conversations, whilst seeking the
husband’s cooperation through openness and rationality.
Though the wife takes initiative, decisions are taken with
mutual agreement
.Conflict Resolution
Conflict resolution leans more towards conversation, with an
element of compliance from the husband
.Power Dynamics
The couple is cognizant of oppressive societal norms, and
they function as a united front with the woman having more
authority – this can be motivated by guilt, rationality or
gratitude in the husband.
The Husband wants to be seen as a progressive man who is
not unjust to his wife
Believes in transparency and openness and trusts her
husband to let her take control when needed
a
a
a
25
The Chup-Chup ke Couple
26
The conversation on FP and related topics is via
indirect dialogue and through gestures
The Chup-Chup ke Couple
“Ismay bolna kya hai.. Ishaara he kaafi hai..”
“Pati-patni main pyaar or vishwaas toh hoga hi, bolnese kya hota ha.”
Conversations
Any one of the spouse initiates the conversation.
However, there is difficulty in communicating family
planning or related topics
Conflict Resolution
Since the communication barriers exist in certain ways
there is no clear understanding or resolution of conflicts
, if they exist.
Power Dynamics
Comfortable in conversing with same gendered
friends/peer group, specially husband.
The man considers family planning an important
aspect however, does not talk on the topic openly.
The woman, however, constantly takes advise from
her mother/close relatives.
a
a
27
The Grateful Couple
28
The spouses will readily agree to each others request
and compromise self’s need and preferences.
The Grateful Couple
“He takes care of me very well and never has stopped me from doing anything that I want to do”
“She is like the home minister. She keeps the entire family including my parents comfortable”.
Conversations
There are active conversations between the couples.
The most prominent trait of this genre of couples is the
recognition of each other’s contributions and
backgrounds.
Conflict Resolution
The relationship is based on mutual respect and
recognition of the contribution of each other to self.
Power Dynamics
The husband may consider himself greater but still
recognizes her contribution in the relationship
which is acknowledged without hesitation by the
wife.
He keeps on re-inventing himself to keep up the
spontaneity and romance in the relationship.
Marriage gives her a comfortable and safe
environment to thrive on.
a
a
29
The Progressive Couple
30
They both agree and husband takes the final action to
execute the decision
The Progressive Couple
“Dilon ki doori tay hoti hai baaton se...aap se tum, aur tum se tuwali gahri dosti...baton baton mein”
“Pehle ek bachcha karenge (ladka ho ya lakdi) fir spacing ke baare mein sochenge
“Marriage means great responsibility and also an equal partnership. I feel deeply for her and she makes me happy, and I try to do the same for her”
Conversations Any one of the spouse could easily initiate any conversation
with each other.
Wife is confident and trusting to open the conversation
without any hesitation .
The couple conversation is very bold and wife does not feels
no hesitation.
. Conflict Resolution
Conflict resolution is through spontaneous and honest
conversations.
Power Dynamics The most prominent trait of this genre of couple is the equal
Stature awarded to each other
The husband acknowledges the woman are generally
oppressed in the society
The depth of the relationship is based on love, a strong feeling
of trust and mutual dependence. This couple is a united front
against conventional societal norms.
The husband acknowledges the woman are generally oppressed in the society
a
a
a
What are the existing barriers to
contraception use?
32
OCP – Strong Association with ‘Medical’ Side
Effects
• High on awareness of the contraceptive category – prevalent in her social circle
•Seen akin to a traditional method – has been around for a long time – even my mother used to use this
• Easy recall of brands like Sakhi, Choice, Mala-D & Bandhan
•Not habituated to regular consumption – considers it cumbersome to build discipline
•Easy availability – often promoted by social health workers, doctors
• Low awareness of the category –little awareness of brands in the category
• Few men seem to be cognizant of the side effects including increase in weight of spouse
• Strong driver to discourage usage of pills to maintain ‘beauty’ of wife
• Perception that purchase of OCPs (not other contraceptives) is the wife’s responsibility – as she can procure it easily from a doctor or a pharmacist
•Both spouses been exposed to multiple anecdotes about the side effect of these pills (from wife’s social circle/mother) – adverse effect on health for the wife and future children •Onus on the wife to purchase and use the contraceptives as she consumes it
•Both spouses perceive that the effectiveness of the pills is comparable with traditional methods
WHAT IS THE DISPOSITION?
•Frequently referred to as ‘Goli’ and not by category or brand name.
•Strong associations with ‘medical’ side effects – such as kidney problems
•Anecdotal knowledge of side effects of the pills including:
•Increase in weight – weight gain or increased fat in women•Adverse effects on the health of the future children •Adverse effects on the fertility quotient of the wife
• Led by locus of usage association – strongly seen as a female led purchase for the category
COMPARITIVE DISADVANTAGECondom users see pills as troublesome in terms of
regularity required and more difficult to consume than condoms – which are use-and-throw
“Asha didi pakda deti hai yeh toh…I have heard my friends say that these pills cause you to put on
weight, especially on the thighs. I saw my friend put on weight like that”
Perception led by influence from
informal sources for both the spouses
a
33
Condom – Barrier to Sexual Pleasure
• Moderate awareness of the contraceptive category – discussed occasionally in her social environment
•Seen as protection required from infections and other STD’s more than an FP method
• Rare brand recall – mostly not named even to the pharmacist
•Seen as an easy-to-use method, but is cited as altering the experience for the husband
•Easy availability – often distributed free of charge at healthcare facilities
•High awareness of the category –little recall for brands in the category
• Men seem to primarily view condom usage as a barrier to sexual pleasure and more of a necessity for spacing
•Seen as a method meant for promiscuous, unmarried couples who require protection from STDs – a method for the ‘new generation’
• Purchase and use is seen as the man’s responsibility – it is viewed as a method that will avoid any harm to the wife (unlike OCPs or IUCD)
•Influencers for both spouses are younger relatives/peers in their social environment or media campaigns•Onus on the man to purchase and use the condoms – women have little or no role to play
•Both spouses perceive that the condoms are a necessary evil – a simple method to use, but obstructing their intimate encounters
“Mere bhaiya kehte hain ki ye 100% effective nahin hota hai. Aur agar ho bhi toh chance hai ki andar
reh jayega, phir surgery karwa ke nikaalna padega.” - Husband
Perception led by influence from
informal sources and media for both the
spouses
WHAT IS THE DISPOSITION?
•Known as nirodh or safety among couples
•A primary association with condoms is that of lessened pleasure for the man – something consistently pointed out by men and women, both
•Anecdotal knowledge of lack of efficacy creates fear of an unintended pregnancy
•Some instances of side effects such as allergies or rashes cited
• Led by locus of usage association – strongly seen as a male led purchase for the category. In some cases, the woman might procure them from the local healthcare facility
COMPARITIVE DISADVANTAGEOCP users see condoms as potentially causing harm if used incorrectly – likely to cause allergic reactions, possibility of tearing and requires more discretion to dispose
a
34
Who are the influencers and what
are the sources of information on
contraception available to the
couples?
35
Influencers
FORMAL INFLUENCERS INFORMAL INFLUENCERS
Informal Sources: Friends, Elder Relatives, Siblings, Extended Social Circle
Decision-making is heavily influenced by personal experiences of influencers in the couple’s extended social environment
In most contemplation and pre-contemplation stage couples, a close influencer advised against or for the usage of OCP/condom
E.g.: The man’s mother or brother, the woman’s friend or sister etc.
Formal Sources: Doctors/Nurses, Healthcare Intermediaries
Access to information on FP methods from formal influencers occurs in two cases:- Post the birth of the first
child (most common)- In case of an unplanned
pregnancy
It is very rare for couples to spontaneously approach doctors for family planning
Type of advise is positive towards adopting FP methods
“After my first child was born, the doctor advised that we should maintain a gap of 3 years, and then suggested a pill to be taken after 6 months”
“My friend usually looks up this information for me – she is the one who told me about the pill.”
Influencers are influenced by:• Doctors• Personal Experience• Tradition of using a certain method
36
Use of Technology
Mobile Internet (Google, Facebook, WhatsApp)*:
• Access to free flowing information
• Gives the ability to conduct research details about available methods, specifically side effects or failure
• Content shared on social media and messaging apps cited as a key source – and considered socially validated, especially by men
Television/Radio/Print: • Being a mass medium, maximum
exposure to campaigns on family planning and spacing comes from these media
• Phenomenon holds true across all 3 centres and types of couples
• Couples cite 3 year spacing requisite; exposure to condom ads and exposure to emergency contraception via these media
Healthcare facilities:• Moderate exposure to FP
methods and the concept of contraception comes from ads displayed at healthcare facilities
• Women cite access to free condoms at their facility, as well as visual display ads as exposing them to contraception
• Spacing as a concept also displayed in such locations
*Exclusively metro phenomenon – New Delhi; smartphone usage is low in other centres
37
Section – 3:
Way Forward
38
Rele
va
nce
Applicability
“Patriarchal”
“Confused
Conformist”
“Chup-chup
ke”
“Dual
Faced”
“Economic
ally Driven”
“Progressive
Couple”
“Wilful
Woman”
“Grateful
Couple”
We arrange all these into a “stack” of
relevance & applicability
39
• The research observed sense of sheepishness among the couples who
do not converse with each other
• Thus “Confused Conformist” and “Patriarchal” are not aspirational
enough spaces for communications design
• The research observed very few couples in this zone (Chup-Chup Ke &
Dual faced). Thus this might have very limited appeal.
• However, we can certainly use some cues form Chup-Chup ke to
rekindle the romance – in our stories in communications
Why Patriarchal, Chup-Chup ke, Confused
Conformist and Dual-faced will not work
40
• We believe that taking an “Economically driven” Couple approach would primarily result in creating a rational appeal
• This understanding can get used in the sub-text (via setup, apparels, kind of house etc.) of the communication
• However, it should not be the core theme of the communication due to its mainly rational character
Why Economically driven will not work?
41
• “Grateful couple” is an aspirational zone. However, compared to “Progressive Couple” this could be a weaker space. The core of this genre is gratitude for the presence of the spouse as compared to larger issues of gender equality, responsibility in the Progressive genre
• Wilful Woman: Low relevance, looking at the Indian social structure and male dominance, majority of couples (especially Men) would not be able to relate to this theme
• “Progessive Couple” comes on top.
The three archetypes that come on top
42
• For most of the couples we met the progressive couple seems to be aspirational
• Equal say in the decision making process
• Honest and open conversations
• Equal liability on initiating the conversations about family planning
• This platform also plays into woman’s perception of the ‘ideal husband’
• Higher frequency of conversations
• Perception of openness, care and mutual trust
• Less barriers in initiating a conversation from both sides
Why “Progressive Couple” will work as the
most enduring
Questions???