The post-partum approach has had considerable success in the family planning pro-
gramme. Special efforts are made to provide information, education and motivation to
recently delivered women in the field as well as post-partum hospitals. It was seen in this
experiment that family planning workers, talking to women who had been exposed to
family planning messages through making use of lady medical doctors' "competence credi-
bility" and communication skills, were able to motivate them to action at a faster rate.
Mr. Y. L. Arora is Senior Research Officer, Institute for Research in Reproduction,
Basically our communication strategies
should help in increasing knowledge, mak-
What is a Communication strategy? ing attitudes favourable, more practice and
Rogers defines strategy as a plan or a more crystallised intention about future
design for changing human behaviour on contraceptive behaviour. We have to devise
a large scale basis through transfer of new special strategies for specific areas of em-
ideas (Rogers, 1973:405). Basically we have phasis like post-partum programmes, urban
to transfer important information about slum dwellers, organised labour (Arora and
family welfare programmes with an inten-
Sharma, 1978). We also have to make
tion to change behaviour. Three types of special efforts to communicate with the
communication are essential in any family rural masses, illiterate women in rural areas,
welfare programme. These are informa-
village influentials and local leaders so as
tional, motivational and belief-clarifying. to increase proper knowledge of various
They can be overlapping. Informational family planning methods, bring about in-
communication includes population details, creased utilization of MCH and Family
family welfare methods, programme services planning facilities and services available in
and their locations, and motivational com-
the areas. Special strategies will have to be
munication includes benefits of a small devised to communicate effectively with the
family in contrast with a large family and rural masses, — illiterate women and per-
acceptance of family planning methods. This suade them about the advantages of the
is difficult to communicate. Belief clarifying small family in contrast with the large
includes answering query clients have family, stimulate inter-personal communi-
about the programme and family planning cation, provide knowledge and remove fears
methods etc. This is the most difficult and and doubts about the side effects and impart
hence most neglected part of communica-
knowledge about family planning facilities,
tion in the programme. Most often the location etc., and finally to motivate them
worker ends up by giving a directive com-
to use family planning method. For this
munication in the form of a lecture. This purpose a number of things have to be kept
is not very satisfying for the client as this in mind as follows:
does not remove his doubts, misconceptions,
etc., from the side effects of various I. Communicator's Credibility
This is one of the most important varia-
* This paper is a modified version of an earlier paper presented at Third Annual Con-
ference of Indian Association for the study of Population held on 16-18 March 1978,
Hyderabad. This study was conducted when the author was at Population Centre, and
written while at the Institute for Research in Reproduction, Bombay.

bles for making communication effective. according to what is needed. This would
Credibility is the degree to which a com-
also help the worker to give belief-clari-
municator is perceived as trustworthy and ficative information so as to remove doubts
competent by the receiver (Rogers, 1973). and misconceptions about the side effects
His expert knowledge of the topic and the of family planning methods.
trustworthiness with which a communicator
is viewed by the recipient have great III. Communicators' Empathy
influence over his success in communication.
Hence, a credible source communicates
Empathy is the ability of an individual
more effectively than a less credible source. to project himself into the role of another.
The lady doctor in a maternity ward has Empathy with clients is very difficult for
a certain amount of credibility because of the communicator when the clients are too
her technical expertise. Similarly the family different from himself. The communicator's
doctor has rapport with his clients and success is positively related to his empathy
hence he is best suited for advising with clients. A status-conscious, educated
on family planning. A satisfied acceptor has urbanite does not seem to be the best choice
credibility because of her positive expe-
for interpersonal communication in rural
rience with family planning methods in the areas. He cannot communicate effectively
past. So her communication introduces an with the ruralite because of his different
assurance for someone like herself and background, status and mannerisms. Hence
hence is trustworthy for the receiver. This a local field worker duly trained would be
is called safety credibility. Both these are more effective with clients.
very necessary for effective communication.
IV. Compatibility between Communicator
II. Communication Skill
and Clients
This is a must on the part of the com-
No source communicates as a free agent
municator. Lack of proper communication without being influenced by his position in
skills affect adversely. Some communi-
the Socio-cultural system. A communicator
cators do not listen to the clients pati-
should know the cultural context in which
ently and carefully nor do they encourage he communicates, the cultural beliefs and
them to ask questions and clear their the values that are dominant for him,
doubts. How to initiate a discussion, repeat norms of behaviour that are acceptable.
the messages at times and influence opinion Rogers (1969) has reported, that wide
are all very important considerations in cultural differences between communicator
which many family planning communica-
and communicatees affect adversely effective
tors are often wanting. As far as family communication between them. Language
planning workers in the field are concerned, incompatibility between communicator and
there is a need to increase their interpersonal clients in terms of not only dialect but also
communication skills. The Population the appropriateness and communicability of
Centre has conducted an experiment to words used, and the differences in their
study interpersonal communication in the interpretations can be an obstacle to effec-
field and it was seen that this was not car-
tive understanding. Southern ANMs and
ried out properly (Rao, 1977). Proper LHVs have this kind of problem in Uttar
training would help them in identifying the Pradesh as they cannot quite effectively
needs of clients and supplying information speak the same language. Besides, the com-

municators, like extension personnel, some-
structed. But these facilities have been con-
times develop a jargon of their own which structed in six project districts in the form
is beyond the comprehension of the average of eight maternity homes in Lucknow,
client of the area. Hence, as far as possible maternity and sterilisation Annexes in
the language used should be compatible district hospitals, and maternity and steri-
with the clientele. More effective communi-
lisation wings in 10 PHCs of two intensive
cation occurs when source and receiver are districts of India Population Project. The
homophilous (Repetto, 1977). Similarity in intention is to increase institutionalised deli-
background, appearance, status and know-
veries and conduct an effective post-partum
ledge between source and receiver are im-
programme for acceptance and thereby
portant for effective communication to increase post-partum acceptance. This is
relatively quite effective for increasing
family planning acceptance. In fact, this is
Post-partum Approach
one of the things being tested in the India
Population Project, namely to increase in-
The International post-partum programme stitutionalised deliveries and thereby in-
was launched in 1966 to demonstrate the crease post-partum acceptance of family
feasibility of providing efficient and effective planning as well as MCH. Most of the
family planning services in the context of advantages of post-partum family planning
the obstetrical care provided by Hospitals programmes can be had if the field workers
(Castadobt, 1975). This proved to be quite contact women just after delivery at their
effective and hence in India, hospital based residence. Our field staff has maternal and
post-partum programme was started in child health responsibilities besides family
1969, in 59 selected urban hospitals and planning work, hence the scope for post-
later it was extended to 324 post-partum partum work is considerably enhanced. The
centres as on March 1976.
post-partum programme usually focuses on
women who have recently delivered a child,
The is one of the approaches which has and hence may become pregnant after post-
had considerable degree of success in the partum amenorrhea. They need to be pro-
programme. It has many advantages. tected at the earliest possible moment in
Women involved are those who are cur-
contrast to the national programme aiming
rently fertile and they are the ones who to protect all women all the time.
need to be protected at the earliest before
they can be pregnant again. Motivation for
accepting any family planning method is
These recently delivered women have a
highest during post-partum period. The fresh memory of labour pains, and so they
post-partum period is normally taken as should be ready to listen to family welfare
three months following delivery. This ap-
informational and motivational messages,
proach is particularly suited for women which may result in a higher commitment
who had an institutionalised delivery. In-
to use some method in the near or distant
stitutionalised deliveries in India generally future. Taking advantage of this situation,
occur in urban areas. In fact one of the acceptors can be created at younger ages
aims of India Population Project is to in-
and lower parities through combining MCH
crease post-partum acceptance. This is and family planning services. Post-partum
possible through contacting women in hospi-
programme has the advantage of a more
tals. This does not seem economical at times suitable place for providing integrated
if the maternity facilities have to be con-
health and family planning services.

limitation and spacing of children. A few
The Contents of the Post-partum Programme messages also included the narration of
actual experiences of some satisfied accep-
In the presently run post-partum pro-
tors in the hospital, who got them-selves
gramme in Indian Hospitals, information, sterilised in the past. Their experience are
education and motivation are provided of great relevance to a would-be-acceptor,
through films on various aspects of family as this gives her security about their use.
welfare but the communication through Different messages covered different aspects
these films does not seem very effective at of family welfare so that these clients in
times. Also the range of communication the hospitals were subjected to 'competence
which can be included in a few films is credibility' of the lady doctor and 'safety
limited and so would be its impact. Hence credibility' of the satisfied user and this
there is a need to increase the effectiveness should hopefully make them more
of post-partum — communication in hospi-
knowledgeable and turn them into acceptors
tal as well as in the field. The present by removing their fears and misconceptions
experiment with inputs of a public address about family planning methods. Family
system and a social worker has been planning workers are already provided in
designed to increase effective communica-
this programme. A discussion between
tion among the patients in the hospital. patient and this lady worker helps in pro-
This system has certain advantages over the viding more complete information, assur-
present system as will be seen later. Each ance, reassurance and increased motivation
doctor has to deal with a large number for action. However this experiment was
of patients, and she can't pay much time specifically designed to increase knowledge,
and attention to individual patients. Under post-partum and post-abortion acceptance
such conditions, it would not be possible and also to test whether such a public
for the lady doctor to advise each and address system in maternity wards can in-
every patient about family welfare and crease the output of family planning com-
thereby provide complete knowledge and munication to which each target woman
remove doubts. Overcoming this problem, was exposed. Also to test whether credibi-
we have used a public address system in lity of the lady doctors of a maternity
the maternity wards of two urban hospitals ward can be exploited for an effective com-
in Lucknow for spreading the doctor's munication to the women during their
voice to each delivered women. During the lying-in period. The main hypothesis being
day, when doctors' round and visitors' times tested in this experiment was that lady
are over, and the atmosphere was condu-
workers, talking to women who had been
cive to listening, with most of the women exposed to family planning messages would
lying in bed without sleep, recorded family be able to motivate to action at a faster
welfare messages were played. The first rate. If so, the same messages can be play-
commentator would introduce the lady ed in the field as well during group meet-
doctors of the hospital and the subject of ings, hence communication would become
population problem and then the doctor's more effective.
voice takes over. These messages were in
the form of a well structured dialogue and Sampling Procedure
contained assurances and reassurances to
the patients, about the advantages and side-
The sample size for each of the baseline
effects of the various methods available for and final surveys was 200, for both the

experiments in Queen Mary's and Dufferin
Hospital. The samples were selected ran-
domly among the clients about to be dis-
charged from the maternity ward. This
generally included delivery or Medical Ter-
mination of pregnancy. Finding out a con-
trol group for an experimental design is
always a problem. In the present experi-
ment, it was not possible to find out a
strictly comparable control group. Hence
the inferences remain on a level of plausi-
bility rather than on a highly compelling
evidence. As strictly comparable groups are
difficult to get the same wards in both the
hospitals, had been taken as control and
experimental groups at two different points Dufferin were as high as 17.5 and 22.5
of time. In the control group, no such pro-
per cent respectively. There does not seem
gramme was introduced and general effects to be any significant differentials due to the
of routine post-partum programme were religious composition of the population.
studied through baseline survey. In the
experimental group women were exposed
to public address messages, and final sur-
vey was carried out.
(I) General characteristics
Age: Average age of respondents were
31.5 and 28.5 in Queen Mary's Hospital
and 26.6 and 27.5 in Dufferin Hospital in
baseline and final surveys respectively.
Sampled population in final surveys was
on an average 3 years younger than in
baseline survey in Queen Mary's Hospital,
whereas in Dufferin Hospital baseline was
on average a year younger than final sur-
vey. There were no significant differentials
as far as age was concerned.
Religion: In Queen Mary's percent of
Hindus in baseline and final survey were
89.5 and 91.5, (Table 2) while correspond-
ing figures for Dufferin were 80.0 and 75.0.
Around 8 percent were Muslims in Queen
Mary's Hospital, whereas proportions of
Muslims in baseline and final survey of * Others constitute Muslim, Sikh, Jain, Christian

Caste: Comparing baseline and final sur-
meaning small and limited family. Family
veys of Queen Mary's Hospital, it was seen planning as family welfare or treatment of
that per cent respondents belonging to sterility was not endorsed by any one in
higher caste were almost same. Per cent the sample. There also seemed to be
belonging to middle caste was higher by vagueness as to what constitutes small
11.0 per cent and per cent belonging to family and what should be the composition
lower caste was, less by 10 per cent in final of the planned family. Hence our com-
survey than in baseline survey. In Dufferin munication strategies for family welfare
surveys proportion of low caste women was should be more specific with reference to
same, while proportion of higher caste was the size and composition of the planned
less by 9.5 per cent and proportion of mid-
dle caste was higher by 4.5 per cent in final
Knowledge of Family Planning Methods
Education: Per cent illiterates was around
40 in Queen Mary's Hospital surveys, and Terminal methods were known to most of
43.5 and 49.0 in baseline and final surveys the respondents indicating the emphasis in
of Dufferin. In Queen Mary's final survey the programme. In Dufferin final survey,
29.5 per cent and in Dufferin baseline, 38.0 only one woman did not know about loop
per cent and final survey 28.5 per cent were and nirodh, while in baseline survey 3.5
educated up to Primary or Middle level. and 5.5 per cent women did not know
No significant differentials by education about the respective methods.
were noted.
Number of Children: All the women in
the sampled population had a child male KNOWLEDGE OF FAMILY PLANNING METHODS,
or female. Average number of children
ever born to women in Queen Mary's Hos-
pital baseline and final surveys were 3.5
and 3.0 and in Dufferin Hospital were 2.7
and 3.0 respectively.
(II) Family Welfare
Information on knowledge, attitude and
intention and practice of family planning,
had been collected. Awareness means
having heard about a family planning
method, while knowledge means awareness
plus knowing who uses the method, hus-
band or wife. Most of the women in each
survey had heard of family planning. However in Queen Mary's final survey,
Family planning generally meant small and 2.0 per cent did not know about the loop
limited family. Only a few respondents took and nirodh respectively. Knowledge of
family planning as improving the economic abortion increased from 78.5 per cent to
condition, having healthy children etc. 95.0 per cent in Queen Mary's Hospital and
However all these meanings were directly 58.0 per cent to 93.0 per cent in Dufferin
or indirectly related to family planning, Hospital from baseline to final survey.

Also, knowledge of oral pills increased divided into three categories Immediate,
from 62.0 per cent to 73.0 per cent and 47.5 Direct and Indirect. Immediate acceptors
per cent to 89.5 per cent in Dufferin Hospi-
are those who accept family planning
tal. Methods propagated through public before leaving the hospital. Direct accep-
address system included vasectomy, tubec-
tors are those who accept family planning
tomy, loop, nirodh, pill and abortion. method after delivery or abortion and after
Hence it seems that there was an increase discharge from hospital but within three
in knowledge of respondents exposed to months of delivery. Indirect acceptors are
this public address system communication. those who accept family planning method
This was one of the hypotheses in this three months after delivery.
study that such a system can increase the
In the final survey at Queen Mary's,
output of family planning communication 51.0 per cent of the women accepted tubec-
and it seems to be true. Thus the public tomy as compared to 36.0 per cent women
address system coupled with a social in the baseline survey (Arora, 1977). It
worker seems to be more effective seems that immediate acceptance of family
than showing family planning films for in-
planning methods in terms of terminal
creasing knowledge of various family plan-
methods is considerably more in final than
ning methods available in the programme. baseline data. All the women with 5 and
higher parity had accepted sterilization in
Family Planning Methods Known
the final survey while in the baseline sur-
vey only 52.1 per cent of the women ac-
Most of the respondents were knowing cepted sterilization at the same parity. Of
vasectomy and tubectomy. In baseline the women at 3rd and 4th parity, 84.4 and
Dufferin Hospital 66.0 per cent of respon-
96.8 per cent accepted tubectomy, while
dents knew 5 methods as compared to 85.0 corresponding figures for baseline were 52.2
per cent knowing five methods in final sur-
and 39.5 respectively. This seems to indi-
vey. Similarly 74.0 per cent in baseline and cate that it is easier to motivate higher
99.5 per cent of the respondents in final parity women for family planning through
survey were knowing 4 methods of family these messages. Among the women with
planning in Dufferin. These methods were 1-3 and 1-2 parity 36.0 and 12.8 per cent
vasectomy, tubectomy, nirodh and loop. in the final survey accepted tubectomy as
This confirms the hypothesis that the pub-
compared to 28.1 and 11.8 per cent of the
lic address system increases the total out-
women tubectomised in baseline survey.
put of family planning communication, par-
There seems to be an increase in the ac-
ticularly knowledge about the methods. ceptance of terminal methods at all parities
This is not to imply that these messages from baseline to final. In the Dufferin base-
achieve the objective of making an accep-
line only 9.5 per cent women accepted
tor in all cases but it definitely increases tubectomy, whereas in the final survey
the correct knowledge of various methods acceptance was 14.5 per cent.
available in the programme. So knowledge
definitely increases but it may or may not
Would-be acceptors: Per cent of would-be
lead to practice.
acceptors in Queen Mary's baseline was
55.5, while in the final it was 40.0 This
decrease was due to the fact that in the
(III) Post-partum Family Planning
baseline 36.0 per cent had accepted sterili-
sation, in comparison to 51.0 per cent in
Post-partum acceptance can generally be the final survey. In the Dufferin baseline,

74.0 per cent women proposed to use some tion and other methods of family planning.
method in future as compared to 85.5 per
In the Dufferin Hospital baseline survey,
cent in the final. It was also seen that more 24.5 per cent were proposing to use sterili-
women would be accepting family planning sation compared to 32.0 per cent in the final
at lower parity in the final survey. Women survey. Would-be acceptors in Dufferin
with higher parity (3 or above) would be baseline and final accepting nirodh, loop
adopting sterilisation later on, and the and pill were 27.5 and 34.0, 5.5 and 4.5,
majority of those who had lower parity 12.0 and 10.5 respectively. There was an
(1-2), were ready to practise non-terminal increase in would-be acceptors. This con-
method of family planning. In the final firms that there was an increase in imme-
survey at Dufferin Hospital, more women diate acceptance as well as would-be accep-
were ready to use contraception at each tance. Increase in immediate acceptance
parity. So there was an increase in imme-
was much larger in Queen Mary's as com-
diate acceptance as well as would-be accep-
pared to Dufferin. Hence the main hypo-
tance in both the final surveys.
thesis that lady workers talking to women
who have been exposed to these family
planning messages will be able to motivate
T A B L E 5
to action at a faster rate seems to be true.
Tubectomy acceptance increased from
36.0 per cent to 51.0 per cent in the final
survey at Queen Mary's Hospital. This
represents a substantial increase in com-
parison with Dufferin Hospital increase
which is 5 per cent. Clients in the final
survey accepted methods at lower parities.
Also most of the clients, who had not ac-
cepted tubectomy, were in general, willing
to use non-terminal methods. In fact we
Would-be Acceptors by Method
could not expect all these women to accept
terminal methods as some belonged to
Per cent of would-be acceptors in Queen lower parities. They are the ones who ac-
Mary's Hospital were 55.5 and 40.0 and in cepted non-terminal methods. This is indi-
Dufferin Hospital baseline and final survey cative of the fact that lady doctor's com-
were 74.0 and 85.5 respectively. In Queen petence credibility can be exploited more
Mary's Hospital baseline survey 35.0 per than family planning films for an effective
cent were ready to use terminal methods, communication through the public address
16.5 per cent nirodh and 4.0 per cent were system in maternity wards (Dubey, 1969).
proposing to use other methods of family Also it confirms that the post-partum
planning in future. In the final survey of approach is sound. Receptivity to family
Queen Mary's, people desirous to use ter-
planning is strong at this time. Hence it
minal methods had already adopted, and should be used in the field as well, parti-
20.0, 10.0, 2.0, 6.0 and 2.0 per cent were cularly in rural areas. Also for deliveries
proposing to use Nirodh, Loop, Pill, Injec-
conducted at home and supervised by dais,

trained or otherwise. The knowledge of dif-
nience as compared to film watching which
ferent methods of family planning increased is convenient only when they are sitting.
among the clients exposed to these experi-
Hence it is worth trying the present edu-
mental inputs. Most of the women in the cation-cum-motivational messages in the
final survey knew vasectomy, tubectomy, following situations to asses the impact of
loop, nirodh and pill. This seems to indi-
the same.
cate that a public address system using
family planning messages through making
1. Out-patient clinics and in field by
use of doctor's credibility, satisfied users
family planning workers.
credibility and persuasive credibility of
the family planning worker increases 2. Ante-natal clinics, ante-natal wards
the amount of family planning com-
and post-natal clinics.
munication and thereby psychologically
prepares client for acceptance. Also, listen-
3. Maternity wards of the District
ing to these messages, through the public
address system while lying in bed has the
additional advantage of positional conve-
Arora, Y. L. and
"Family Planning Communications in Queen's Mary's Hospital",
Sharma, G. D.
Population Centre News Letter.
Post-partum Family Welfare Communication Experiment in
Urban Hospitals (Mimeographed), Population Centre, Lucknow.
Castadobt. Robert,
The International Post-partum Family Planning Programme:
G. et. al
Eight Years of Experience, Report on Population/Family Plan-
ning, Population Council, New York, USA.
Dubey, D. C.
Family Planning Communication Studies in India, CFPI, Mono-
graph Series N o . 8.
Rao, T. V.
A Study of Family Planning Worker-client transactions IIMA,
Population Projects Units.
Repetto Robert
"Correlates of Field Worker. Performance in the Indonesia
Family Planning Programme. A Test of the Homophily — Hetero-
phily studies in Family Planning," Population Council Vol. 8
N o . 1, January 1977.
Rogers Evertt M.
Communication Strategies for Family Planning, New Y o r k :
The Free Press, page 405.