Over a four–year period, new research suggests, a program led by the Johns Hopkins Center for Communication Programs (CCP) in six large Nigerian cities was associated with a 10 percentage–point increase in the use of modern contraceptive methods and a similar increase in the desire of women to have fewer children.

In clinics, on television programs, in brochures, the message of the CCP program was the same: Know, Talk, Go. Know the facts. Talk to your partner. Go for services.

For the study, published online in the journal Studies in Family Planning, researchers from the Carolina Population Center at the University of North Carolina at Chapel Hill evaluated CCP’s Nigerian Urban Reproductive Health Initiative (NURHI), a six–city program that ran from 2010 until 2014. CCP is based at the Johns Hopkins Bloomberg School of Public Health.

“This study demonstrates that even in a context like urban Nigeria, with high maternal mortality and low contraceptive use, targeted programs can lead to important changes in modern contraceptive method use and fertility desires in a short period of time,” wrote the researchers, led by Ilene S. Speizer, PhD, a professor at the UNC Gillings School of Public Health.

In 2010–2011, the UNC researchers conducted a baseline survey in the Nigerian cities of Abuja, Ibadan, Ilorin, Kaduna, Benin City and Zaria, surveying more than 16,000 women. Respondents were asked questions about their contraceptive knowledge and practices as well as questions about exposure to family planning programming. They found that the use of modern contraceptive methods such as condoms, oral contraceptive pills and IUDs among women of childbearing age ranged from about five percent in Zaria to 30 percent in Abuja. They surveyed more than 10,000 of the same women in 2014 and found an average increase in the use of modern contraceptive methods of 10 percentage points. A similar increase was observed among the poorest women as was seen in the whole of the population.

Data were also collected from both private and public–sector health facilities in the six cities at the start and finish of the program. They found that women who lived within one kilometer of a health clinic which received support from the NURHI program were significantly more likely to use modern contraceptive methods after the program was completed.

NURHI’s success, its leaders say, comes not solely from improving contraceptive access at health clinics in Nigeria’s cities, but from creating a coordinated campaign to create the demand for those services. Much of CCP’s family planning work is based on using communication tools to help people understand the benefits of family planning and empower them to make healthy decisions. On this project, CCP also targeted health providers as audiences in need of behavior change.

Before implementing the program, the team spent a year interviewing women and men, religious leaders, health providers and more, learning about the unique barriers to contraceptive use in Nigeria’s cities and using that data to shape the customized program.

The work was done through countering the fears and misconceptions around family planning, providing fact–based information on the safety of contraceptive methods and the benefits of their use, making it acceptable to talk to partners, friends and religious leaders about contraceptive options and training health providers with the most up–to–date evidence around the value of birth spacing and smaller families.

NURHI also did “mini–makeovers” of government health clinics, cleaning up neglected facilities, fixing what was broken and raising the clinics’ profiles by celebrating the makeovers with members of the community, boosting provider morale in the process.