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Research Article
Gender and Reproductive Outcomes: The Effects of a Radio
Serial Drama in Northern Nigeria
Fatou Jah, Scott Connolly, Kriss Barker, and William Ryerson
Population Media Center, Shelburne, VT 05482, USA
Correspondence should be addressed to Fatou Jah; ah@populationmedia.org
Received April ; Revised July ; Accepted July ; Published September
Academic Editor: Kathryn Kost
Copyright © Fatou Jah et al. is is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A large body of evidence has documented the eectiveness of mass-media communication programs in increasing family planning
use and changing reproductive behavior. But the potential impact of these programs on the mediating role of gender norms has
not been systematically assessed in Nigeria. Regionally representative cross-sectional end line data collected for the evaluation of a
long-running entertainment-education radio serial drama program aired in northern Nigeria are examined for program eects on
both reproductive and gender outcomes as well as the relative eect of gender on reproductive outcomes. e drama was popular,
with % of the sample listening weekly. Results show that the drama positively impacted both sets of outcomes especially the
reproductive outcomes. Results further indicate a strong relative eect of gender on reproductive issues.
1. Introduction
e eectiveness of mass-media entertainment-education
programs in increasing contraceptive use, spousal reproduc-
tive decision-making including family size and fertility regu-
lation, and positive reproductive behavior is well documented
[–].
However, relatively few of these programs have evaluated
the eect of program exposure on various dimensions of
gender that mediate the link between program strategies
and reproductive processes, especially in sub-Saharan Africa.
ere are several reasons for this gap. Program compo-
nents that specically address how gender norms have been
impacted are relatively nascent in Africa, having gained
attention in the reproductive health (RH) sphere only in the
past decade largely due to the emphasis placed on the role of
gender issues in RH by the International Conference on
Population and Development [].
Program activities may unintentionally inuence gen-
der norms, simply because these sociocultural factors are
inextricably linked to all aspects of reproductive, social,
and economic relations. Family planning (FP) and RH
programscanhaveanempoweringeectongirlsandwomen.
Averting unintended pregnancies through FP fosters girls’
continued schooling and women’s engagement in protable
employment and reduces maternal and child morbidity and
mortality. At the same time, the ability of women and girls
to enjoy these empowering and health benets of FP is
constrained by the overarching sociocultural milieu, which is
rooted in gender inequality [,]. Husbands and partners
who have vested interest in having many children are the
usual gatekeepers of reproductive decision-making, limiting
women’s reproductive agency [].
Yet, most evaluations have focused their attention on
assessing program eects on reproductive outcomes but not
specically on gender outcomes (see [–,,,,,
,]). Substantive evaluations of these mediating gender
outcomes using African data are even more scant because of
unavailability of the kind of systematic gender disaggregated
data that permit such evaluations.
e goal of this paper is to help ll the existing gap in
simultaneous assessments of program eects on changes in
both reproductive outcomes and gender outcomes employing
African data and focusing on both males and females. It takes
advantage of unique regionally representative cross-sectional
survey data assessing the eects of a long-running radio
Hindawi Publishing Corporation
International Journal of Population Research
Volume 2014, Article ID 326905, 24 pages
http://dx.doi.org/10.1155/2014/326905
International Journal of Population Research
serial drama aired in northern Nigeria to address problems
of maternal and child mortality and morbidity arising from
low contraceptive use. ese data are unique in the fact that
they contain a rich set of measures on both reproductive and
gender outcomes, permitting a simultaneous assessment of
both sets of outcomes. e study attempts to answer three
research questions.
(i) What is the eect of the drama on FP and RH
attitudes, intentions, and behaviors?
(ii) What is the eect of the drama on gender norms and
attitudes that are presumed to mediate RH and FP
attitudes, intentions, and behavior?
(iii) What is the relative eect of gender on each of the RH
outcomes?
e study’s focus on sub-Saharan Africa is timely. Fertility
desires and intentions of both marital partners are important
predictors of a couple’s fertility []. Evaluating the eects
of a RH intervention in northern Nigeria (a region where
reproductive indicators have been persistently dismal) with
an additional focus on gender norms and attitudes pro-
vides an avenue for improving program eectiveness and
informing future programs. On a continental scale, Africa
remains the only world region where fertility is persistently
high; it trails behind other developing regions in reaching
the Millennium Development Goals (MDGs) [], the inter-
national blueprint for development in the new millennium.
Although several countries in the region have initiated
fertility transition, recent reports indicate unanticipated stalls
in the transition in some of these countries during the
latter part of and early s [–]. As we get close
to , the target date for the attainment of the MDGs,
focus on the RH, and gender inequality nexus has never
been more imperative, as has been reiterated by scholars
[].
2. Context
With a population estimated at over million, Nigeria
ranks as the largest country in Africa in terms of population
size. An annual growth rate of .% that shows no sign of
abating makes Nigeria a very youthful country with % of
the population aged below []. is high growth rate is
blamed on low contraceptive prevalence and high fertility.
Between and modern contraceptive use by married
women increased by only percentage points, from % to
% []. About in currently married Nigerian women
(%)intendtouseFPinthefuture[]. Reported reasons
for future nonuse include religious, spousal, or women’s own
opposition to FP and the desire for large families. Lack of
contraceptive services or cost was reported by just .% of
currently married Nigerians as barriers to future use []. Of
all births in Nigeria, % were wanted at the time; % were
wanted later; and % were unwanted []. Studies conducted
in the country have also cited “perceived lack of need for
contraception and fear of side eects” as reasons for nonuse
[,].
Total fertility rate (i.e., the average number of children
borne by women) in is . children, unchanged since
[]. Ideal family size for Nigerian women is children
( children for men), making actual fertility lower than
desired fertility []. Experts agree that a -year interval
between deliveries is ideal for maternal and child health
(MCH) and that child spacing can contribute to both a
reduction in fertility rates of a country [] and infant
mortality [].But%ofNigerianwomenhavebirth
intervals shorter than two years [], leaving infant mortality
unacceptably high, at deaths per , live births [].
Maternal mortality, estimated at maternal deaths per
, live births [], is high as is maternal morbidity.
Prolonged obstructed labor is common and the incidence of
vesicovaginal stula (VVF) is . per cases annually
[]. According to recent estimates, only in women in
Nigeria receive skilled assisted childbirth, resulting in %
of births considered as high risk []. Life expectancy is just
years [], impacted indirectly by HIV/AIDS. e HIV
prevalence rate in was .% in the adult population,
making Nigeria the second country with the largest number
of people living with HIV in Africa, aer South Africa [].
Health and socioeconomic indicators are even more dis-
mal in northern Nigeria. In addition to closely spaced births
and pregnancies among older women, teenage pregnancies
(ages –) contribute to high-risk births in this region of
the country. While, nationally, teenage childbearing is %,
the rate is the highest in northern Nigeria, at about %
[]. Teenage childbearing and its associated problems of
obstructed labor in the north result in high incidence of
maternal mortality and morbidity and bowel and bladder
incapacitating vesicovaginal stula (VVF), with the latter
linked to considerable stigma for aicted women []. Early
onset of childbearing stems from early marriage as discussed
below.
Childhood marriage of girls in northern Nigeria remains
the highest in the country, contributing to many social and
health problems. e latest available gures []indicatethat
% of women are married by age . But there are large
regional dierences, with the mean marriage age being over
years lower in the northwest (. years) than in the southeast
(. years) regions. Further, based on the NPC and ICF
Macro report [] the median age at rst marriage was .
years for women aged –, but years for men in the
same age range. is highlights substantial age gaps between
spouses, an important correlate of gender asymmetries in
marriage in the area of reproductive decision-making. One
inmarriedwomenhavecowivesinNigeria,butthegureis
highest in the northeast region (%). is high prevalence
of polygyny in northeast Nigeria, a phenomenon closely
linked to wide spousal age gaps, further highlights gender
inequalities within marriage. Nationally, the average woman
desires children, already high compared to most sub-
Saharan African countries []. But the level is even higher
in Nigeria’s northeast where women, on average, want .
children []. is greater desire for large families by women
in the northeast is reected in married women’s relatively
lower use of modern contraceptives (%) compared to their
southwestern peers (%).
International Journal of Population Research
Discussion of sex is traditionally a very private and
sensitive issue due to cultural and religious reasons []. Such
sensitivity, combined with a preference for large families, has
made family planning initiatives in northern Nigeria chal-
lenging. Despite these sociocultural barriers, FP providers
have found that discussion of fertility and FP with a spouse
or partner has a strong positive association with contraceptive
use [,,]. Furthermore, in Islamic cultures, birth/child
spacing for - years has gained widespread popularity
because it is aligned with religious values promoted by the
Koran and by many religious leaders as a means to promote
maternal health [].
3. Gender and Reproduction: A Framework
is study is conceptualized on the well-recognized connec-
tion between reproductive outcomes and various dimensions
of gender recognized in the sociodemographic literature
[–,–]. ese various dimensions of gender are
reected in women’s socioeconomic position as determined
by education and employment, age at marriage, decisions
around marriage, marriage structure such as polygyny,
spousal communication about pregnancy timing and family
size, contraceptive behavior, and participation in household
decision-making.
To take advantage of their education, educated women
engage in paid employment, adopt small family norms, use
contraception, and have lower fertility compared with their
noneducated counterparts [,–]. Educated women also
enjoy better RH and have healthier children because they
engage in positive health care behaviors [,,]. In
this sense, education becomes an engine of socioeconomic
mobility, which leads to greater reproductive agency. e
education/fertility association is premised on education’s role
as a source of knowledge and information and in turn a
transformer of attitudes. Women with formal education tend
to question gender norms and existing power structures
[]. But the nature of this relationship is quite complex.
Beyond being indirect, the education fertility relationship is
further conditioned by the gender/marriage nexus, as has
been attested in the demographic literature [].
Women’s delayed age at marriage stemming from pro-
longed schooling and employment has been hypothesized
to lead to greater autonomy in their marriage decisions and
an increase in consensual unions/cohabitation []. Such
heightened autonomy is expected to translate into women’s
greater control of their fertility and reproductive behavior. On
the other hand, polygyny, especially when coupled with large
spousal age gaps, has been linked to gender inequality within
marriage and less spousal communication about reproduc-
tive preferences, intentions, and behavior [,]. Women’s
participation in household decision-making and control over
their earnings are viewed as a source of empowerment
and more equitable gender relations in marriage. However,
this leverage within marriage for women has been qualied
in the literature. Eloundou-Enyegue and Calves []nd
that, in Cameroon, women’s marital leverage holds only
where women are both equally or more educated than their
husbands and are engaged in paid employment.
Related to Basu’s []deemphasisonindividualedu-
cation as an empowering factor in wives’ fertility, the sig-
nicance of the prevailing gender context in conditioning
reproductive processes and behavior has gained recognition
in the gender and reproductive behavior literature. In a study
ofveethnicgroupsinNigeria,Kritzetal.[]ndthat
demand for children is the highest among two ethnic groups:
the Hausa in northern Nigeria and the Kanuri in northeastern
Nigeria relative to the Ibo, Ijaw, and Yoroba residing in other
regions of the country. Importantly, the connection between
ethnicity and reproductive behavior is inuenced by the
larger gender equity environment. Kritz and her colleagues
[] nd asymmetric gender relations to be higher among the
Hausa and Kanuri in Nigeria’s north than the Ibo, Ijaw, and
Yoroba in the southern and eastern regions of the country.
Similarly, Mason and Smith [] observe greater agreement
between spouses over FP and reproductive intentions in
gender contexts that are equitable than in very asymmetric
gender contexts.
e conceptual framework presented above suggests that
interventions should be designed to promote positive behav-
ioral changes and gender attitudes in reproductive decision-
making. To foster appreciation among northern Nigerians
of the benets of FP and equitable spousal RH decision-
making, Population Media Center (PMC) produced and
broadcast a long-running -episode radio serial drama,
Ruwan Dare. e drama was broadcast in the Hausa language
in Kano, Kaduna, Katsina, and Sokoto states from July
to June . e objectives of the drama program were
to promote small family size norms; eective FP and birth
spacing; delayed marriage and avoidance of obstructed labor
and stula; and gender equity. e government of Nigeria
is signatory to international conventions promoting FP and
reproductive wellbeing, including the ICPD program
of action []andtheMDGs[], and the United Nations
Population Fund (UNFPA) is active in the country to help the
government achieve these international commitments. e
drama was designed in tandem with Nigeria’s institutional
and policy mandates to enhance FP/RH through behavioral
change communication programs [].
Ruwan Dare, which means “Midnight Rain” or “Midnight
Dew” in Hausa, represents a metaphor for the intimate late
night couple discussions surrounding FP and their lives in
general []. is metaphoric conceptualization embodies
positive, negative, and transitional (i.e., neutral) characters in
the drama’s storylines that gradually model how to discuss
sensitive issues such as birth spacing, contraception, family
size, and their gender dimensions and whether to seek
maternity care to avoid obstructed labor and stula. e
drama sought to modify attitudes toward FP/RH and gender
issues through the respective stories of Azumi and Bawa.
Azumi’s Story. Azumi, Lawai’s rst wife, is pregnant with her
second child shortly aer having given birth to a baby son.
She is very ill during this second pregnancy, and the health
worker says that if they do not give Azumi’s body time to rest
aer this pregnancy, she will die. As Azumi recovers, she and
Lawai decide to use FP to space their children. Lawai decides
to get another wife because he wants to let Azumi rest. Azumi
International Journal of Population Research
hears her parents’ disapproval of her use of contraception
andconvincesLawaitoallowhertohaveanotherbaby,but
she almost dies during the pregnancy. Because of jealousy
and greed, Lawai’s second wife, Asibi, wants as many children
as possible with Lawai and has several closely spaced births.
Asibi becomes pregnant again, goes into a dicult labour, and
dies during delivery. Asibi’s death nally convinces Azumi
that she should not get pregnant again so soon and to resume
using FP.
Bawa’s Story. Bawaandhiswifehavethreedaughtersandlive
together happily. However, his mother (Kulu) is not content,
becauseBawadoesnothaveason.WhenKulumovesin
with him, she berates Bawa’s wife and beats the children—
making life miserable for Bawa. Kulu becomes blind, and one
of Bawa’s daughters, little Kulu, is tasked with supervising her
in town. She saves her grandmother from being hit by a car,
but her grandmother blames her, saying that girls are stupid
andshouldnotbegivenresponsibilityandinsistsonhiring
a boy to lead her. Bawa agrees, but the boy abandons the old
womanwhenheseeshisfriends.LuckilylittleKuluisacross
the street as she blindly steps in front of a speeding car. She
saves her grandmother’s life again, and the relieved person
driving the car, a senator, rewards her with a scholarship for
school. Bawa realizes the value of his wife and daughters and
regrets having always listened to his mother.
4. Broadcast Setting and Medium
e northern states of Kaduna, Kano, Katsina, and Sokoto
were identied as the target region for broadcast because
they present the greatest need for a FP and reproductive
behavior intervention. ese northern states also house the
highest rates of maternal mortality and VVF, nationally. e
above proposed gendered framework is even more apt in the
context of northern Nigeria relative to the remaining regions
of the country as well as other countries in the subregion.
In a sociocultural environment, where Hausa tradition is
overlaid with Muslim ideology, Shariah Law, and the practice
of seclusion for women, it becomes clear why reproductive
and gender outcomes are less favorable than in the rest
of the country or elsewhere in the continent. Accordingly,
women and men play very dierent roles and enjoy dierent
levels of authority in Hausa land compared to other regions
[]. Hausa is the dominant language and Islam the primary
religion in the region. Radio is the optimal channel for FP
messages for several reasons. It is the most widely consumed
media in Nigeria, and almost in (%) households in
Nigeriaownaradio[]. Further, it has the widest reach
across the country and is more accessible and aordable
than print or television. Among –-year-old men and
women, % and % have heard FP messages on the radio,
respectively [].
5. Methodology
5.1. Data Collection. To evaluate the program, a pretest,
posttest research design was employed. In April and
prior to broadcast, a regionally representative baseline cross-
sectional survey was conducted to collect benchmark data on
all programmatic indicators and sociodemographic factors
in the broadcast area of Kaduna, Kano, Katsina, and Sokoto
states.Withineachstate,multistagestratiedsamplingwas
utilized for the sampling frame. In each state ve urban
locations and ve rural locations were randomly chosen
to ensure wide representation. Each local government area
(LGA) of a state formed a cluster from which households
were randomly selected.
Face-to-face interviews were conducted with reproduc-
tive age women (–) and men (–) using household,
women’s and men’s schedules, with questions mirroring
those in the Nigeria Demographic and Health Sur-
veys (DHS). Aligned with the program indicators, a wide
range of themes were covered under the following modules:
() sociodemographic characteristics, () media access, ()
marriage, () reproduction and fertility preferences and
spousal communication about FP, () contraception, ()
sexual activity, HIV/AIDS, and other sexually transmitted
infections, and () work and gender norms. Summative data
werecollectedthroughanendlinesurveyinJuly,shortly
aer broadcast of the last drama episode. For analytical
comparability, the same survey design and instrument used
inthebaselinewererepeatedintheendline.Toassess
listenership to the drama, an exposure module that measured
listenership, character recall, and opinions about the drama
was added to the end line instrument.
To improve data quality, enumerators and supervisors
were trained on the protocol for implementing the survey
prior to the eldwork. Training stressed the need to pay
attention to courteousness, condentiality, sensitivities, cul-
ture, religion, and values of respondents. Female enumerators
interviewed female respondents and male enumerators inter-
viewed male respondents. A total of respondents were
drawn for the end line sample of which completed the
survey, translating in a response rate of %.
5.2. Indicators. is study analyzes two sets of outcomes.
Consistent with the goals of the project, Ruwan Dare,the
rst set of outcomes focuses on four aspects of FP/RH: ()
knowledge(“doyouknowaplacewhereyoucanobtaina
method of FP?”; “can people reduce their chances of getting
the AIDS virus by using a condom every time they have
sex?”); () attitudes (“is using contraception against the will of
Allah/God?”; “couples should space their children at least .
to years apart”; “can becoming pregnant every year put the
mother at risk?”; “people should plan how many children they
will have”; “would you say that you approve or disapprove
of couples using a family planning method to avoid getting
pregnant?”; “what age do you think is most appropriate
for a female to start bearing children?”; “would access to
contraceptives encourage indelity?”); () intentions (“would
like to have no more children”; “do you think you will use a
contraceptive method to delay or avoid pregnancy at any time
in the future?”); and () behavior (“are you currently doing
somethingorusinganymethodoffamilyplanningtodelay
or avoid getting pregnant?”; “in the last months have you
International Journal of Population Research
discussed the practice of family planning with your family,
friends, or neighbors?”).
e analyses also examine the eect of the drama on
a second set of outcomes, gender norms as they relate to
reproductive issues and focus on three broad indicators
of gender. e rst is attitudes and behaviors related to
normative beliefs and gender equality, including “what do
you consider to be the ideal marriage age for a female?”;
“discussed FP with spouse/partner in the last months”;
“couples should share responsibility for making decisions
about family size”; “girls should be encouraged to continue
their education to high levels”; “do you think that your
husband/partner approves or disapproves of couples using a
contraceptive method to avoid pregnancy?”; “who had the
nal say in the decision that you would get married to or
live with your (rst) husband/partner?”; “women should not
be allowed to express their opinion on important family
matters”; “a woman should be free to ask her husband to
use a condom”; “a woman’s value is judged by marriage
before her rst menses and by the number of children she
has”; and “a man is never sterile but a woman can be.”
Scholars have argued that women’s involvement in household
nancial issues and decision-making is a key component of
women’s empowerment []. us the second set of gender
outcomes relates to attitudes surrounding women’s economic
empowerment such as “who in your family usually has the
nal say on making large household purchases?” and “who
mainly decides how the money you earn will be used?”
e third set of gender outcomes focuses on attitudes
related to domestic violence. e questions pertain to agree-
ment with the following statements: “do you think a wife is
justied in refusing to have sex with her husband if she knows
he has a sexually transmitted infection?”; “do you think a wife
is justied in refusing to have sex with her husband if she
istiredornotinthemood?”;and“doyouthinkawifeis
justied in refusing to have sex with her husband if she knows
he had sex with women other than his wives?” e study
also asks about agreement over the following statements: “is
a husband justied in hitting his wife if she goes out without
telling him?”; “is a husband justied in hitting or beating
his wife if she argues with him?”; “is a husband justied in
hitting or beating his wife if she burns the food?”; and “is
a husband justied in hitting or beating his wife if food is
not cooked on time?” Although past studies []havecreated
indices from these various gender measures for analyses, this
study nds that dierent gender outcomes inuence dierent
RH outcomes as evidenced in the Section ,andcomputing
indices would have disguised these varying eects.
e independent variable considered in the study is an
exposure variable that compares listeners to nonlisteners on
key program indicators. Listenership is measured by a series
of questions. Respondents were asked if they had “heard of
the drama Ruwan Dare.”osewhoanswered“yes”were
asked if they had listened to “ or more episodes” of the
drama. If they indicated “yes”, they were further asked “how
many episodes have you listened to each week?”, with as
the maximum amount. Regular listeners were identied as
having listened to or more episodes per week; those who
havenotheardaboutorlistenedtothedramawithless
frequency were considered as nonlisteners.
Control variables are drawn from respondents’ social and
demographic characteristics. ese include seven correlates:
age, sex, marital status, educational attainment, ethnicity,
state of residence, and urban/rural residence. e selection
of these control variables is premised on large dierentials
in both the reproductive and gender outcomes by age,
sex, ethnicity, marital status, education, rural versus urban
residence, and state of residence in Nigeria, particularly in the
northern parts of the country [].
5.3. Analysis. is study examined the end line data that
provide information on exposure to the drama. To answer
the study’s three research questions, the investigation was
organizedinthreestages.Instage,wemodeledtheeectof
exposure to the drama on the gender outcomes and, in stage
, we modeled the eect of drama exposure on the FP/RH
outcomes. In the nal stage, to quantify the relative eect of
gender on the FP/RH outcomes, we introduced measures of
the gender outcomes as predictors in the models estimated in
stage , essentially estimating the mediating eect of gender
on the FP/RH outcomes. e equations associated with the
threequestionsaregivenbelow.
Stage 1 Equation
Log 𝑌
(1−𝑌
)=𝛽
0+𝛽
𝑙𝐿+𝛽
𝑐𝐶+𝜀. ()
log 𝑌/(1−𝑌) is the log odds of the respective gender outcome
being examined; 𝐿measures the eect of drama exposure; 𝐶
is a matrix of the correlates; 𝜀is the error term; the 𝛽sarethe
regression coecients for the corresponding outcomes and
correlates; 𝛽0is the constant.
Stage 2 Equation
Log 𝑌
(1−𝑌
)=𝛽
0+𝛽
𝑙𝐿+𝛽
𝑐𝐶+𝜀. ()
log 𝑌/(1−𝑌) is the log odds of the particular FP/RH outcome
being examined; 𝐿measures the eect of drama exposure; 𝐶
is a matrix of the correlates; 𝜀is the error term; the 𝛽sarethe
regression coecients for the corresponding outcomes and
correlates; 𝛽0is the constant.
Stage 3 Equation
Log 𝑌
(1−𝑌
)=𝛽
0+𝛽
𝑙𝐿+𝛽
𝑐𝐶+𝛽
𝑔𝐺+𝜀. ()
log 𝑌/(1−𝑌) is the log odds of the particular FP/RH outcome
being examined; 𝐿measures the eect of drama exposure;
𝐶is a matrix of the correlates; 𝐺is a matrix of the gender
outcomes employed as predictors in these models; 𝜀is the
error term; the 𝛽s are the regression coecients for the
corresponding outcomes and correlates; 𝛽0is the constant.
To assess the success of the drama, dierences between
listeners and nonlisteners on the outcomes were analyzed
using statistical techniques that included chi-square and
International Journal of Population Research
logistic regression in SPSS Version (SPSS IBM). Each
measure of reproductive and gender outcome was regressed
on the listenership measure (our main predictor). In each
of the three stages above, the models estimated both bivari-
ate (without adjusting for any correlates) and multivari-
ate (adjusted for the correlates) eects. us, the bivariate
models estimate the gross eects of the drama while the
multivariate models estimate net drama eects. Further, in
the multivariate models, the measures for the correlates are
serially incorporated. is allows us to detect the variable
responsible for any critical change in the predictor. Given
that logistic regression was used, all the outcome and control
(except education which had several categories) variables
were dichotomized.
6. Results
Table shows the summary statistics of key variables used
in the study. Results indicate that respondents were
successfully interviewed throughout the four states, of which
had heard about the drama. Of those who had heard of
the drama, % regularly listened to Ruwan Dare at least once
a week. Notwithstanding, considerable missing values due to
nonresponse were observed for this exposure variable. e
concern of nonresponse was more common with males, the
married, urban residents, in Sokoto and Kaduna compared
with Kano and Katsina, and among those whose ethnicity is
Hausa. Further, there are dierences across background char-
acteristics in listenership. More females (%) followed the
drama. Similarly, listenership was signicantly greater among
married/cohabiting individuals and among those whose rst
language is Hausa. ose with secondary education or higher
and rural residents listened to the drama slightly more than
those with less education and urban residents. However,
Table reveals no signicant dierences in background
characteristics except along marital lines and rst language.
e remaining sections present the logistic regression results
presented as odds ratios (bivariate estimates) and adjusted
odds ratios (multivariate estimates), with signicance and
condence levels set at %.
6.1. Bivariate and Net Eects. is section presents the results
of the evaluation of the eect of the drama on both the gender
andreproductiveoutcomesatthebivariateandmultivariate
levels, with interpretations based mainly on the multivariate
estimates.
6.1.1. Knowledge. Tab l e indicates that exposure to the
drama had a positive association with knowledge about RH.
Multivariate comparison of listeners and nonlisteners reveals
that the odds of knowing a FP source were . times greater
for listeners compared with nonlisteners. Similarly, the odds
of listeners citing consistent use of condoms as a method of
preventing HIV/AIDS were . times greater for listeners than
nonlisteners. Interestingly, the bivariate eects on both out-
comes were nonsignicant but the eect on knowledge of a FP
source was rendered signicant when the variable “state” was
controlled for while knowledge of condoms as an HIV/AIDS
prevention methods turned signicant when education was
adjusted for. ese results suggest that failure to control for
correlateswouldhaveyieldedverydierentinterpretations.
6.1.2. Attitudes. e odds of disagreeing with the statement
that “using contraceptives is against the will of Allah” were .
times greater for listeners than nonlisteners. Closely spaced
births have an adverse eect on maternal and child health,
posing greater risks for VVF. Respondents were asked “can
becoming pregnant every year put the mother at risk?” e
odds of listeners compared with nonlisteners agreeing with
the statement were . times greater. Like the knowledge
outcomes, the bivariate eects of the drama on these two
attitudinal outcomes were nonsignicant and only turned
signicantwiththeintroductionofthestatevariableinthe
model. Change in attitude toward birth spacing was also
evaluated. Results show that the odds of listeners agreeing
with the statement “couples should space children . to
years apart” were . times greater than those of nonlisteners.
Similar to the eect of the drama on the link between
frequent pregnancies and maternal health, a positive change
in attitude was observed for two other indicators: “people
should plan how many children to have” and “would you say
that you approve or disapprove of couples using a FP method
to avoid getting pregnant?” Multivariate comparisons on both
indicators suggest program eects: the respective odds were
. and . times greater for listeners than for nonlisten-
ers. Program eects on the last two attitudinal outcomes
examined, disagreement with the notion that access to FP
is associated with indelity and the ideal age for the onset
ofchildbearing,werenilinthesensethatnosignicant
dierences between listeners and nonlisteners were observed,
whether examined by chi-square statistics or multivariate
analysis.
6.1.3. Intentions. Tab l e also gives the ndings on the two
indicators of reproductive intentions that were evaluated:
“would like to have no more children” and “do you think you
will use a contraceptive method to delay or avoid pregnancy
at any time in the future?” On both outcomes, exposure
tothedramahadnoeects,judgingfromthemultivariate
assessments of listeners and nonlisteners.
6.1.4. Behaviors. Ta b l e also shows two indicators of behav-
ior change among the sample. e rst relates to “are you
currentlydoingsomethingorusinganymethodofFPtodelay
or avoid getting pregnant?” and the other to “in the last
months have you discussed the practice of family planning
with your family, friends, or neighbors?” Results from the
multivariate estimations indicate positive drama eects, with
the odds of listeners stating they currently use some form of
FP (. times) and that they had discussed FP with others (.
times) signicantly higher than those of nonlisteners.
6.2. Gender Outcomes. e lower half of Tab l e reports
the results of the analysis of the eect of the Ruwan Dare
radio drama on the study’s gender outcomes. Beginning
with the outcomes pertaining to norms and gender equality,
International Journal of Population Research
T : Summary statistics on study independent, dependent, and control variables evaluation of Ruwan Dare in northern Nigeria (Kaduna,
Kano,Katsina,andSokoto),.
Key variables 𝑁Percentage
Independent variable
Listened to Ruwan Dare (exposure).
Nonlisteners . .
Regular listeners . .
Family planning (FP) and reproductive health (RH) outcomes
Do you know a place where you can obtain a method of family planning (FP)?
No (ref.) . .
Ye s . .
Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?
No, DK (ref.) . .
Ye s . .
Is using contraception against the will of Allah/God?
Ye s , D K ( r e f . ) . .
No . .
Couplesshouldspacetheirchildrenatleast.toyearsapart.
Disagree (ref.) . .
Agree . .
Can becoming pregnant every year put the mother at risk?
No, DK (ref.) . .
Ye s . .
People should plan how many children they will have.
Disagree, DK (ref.) . .
Agree . .
Would you say that you approve or disapprove of couples using a family planning method to avoid getting
pregnant?
Disapprove, DK (ref.) . .
Approve . .
What age do you think is the most appropriate for a female to start bearing children?
– years (ref.) . .
years+ . .
Would access to contraceptives encourage indelity?
Ye s , D K ( r e f . ) . .
No . .
Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
No (ref.) . .
Ye s . .
Would you like to have no more children?
No (ref.) . .
Ye s . .
Are you currently doing something or using any method of family planning to delay or avoid getting
pregnant?
No (ref.) . .
Ye s . .
In the last months have you discussed the practice of family planning with your family, friends, or
neighbors?
No (ref.) . .
Ye s . .
International Journal of Population Research
T : C ontinu e d .
Key variables 𝑁Percentage
Gender outcomes
Attitudes related to normative beliefs
Did you discuss FP with spouse in the last months?
No (ref.) . .
Ye s . .
Couples should share responsibility for making decisions about family size.
Disagree, DK (ref.) . .
Agree . .
What do you consider to be the ideal marriage age for a female?
years and below (ref.) . .
years + . .
A woman’s value is judged by marriage before her rst menses and by the number of children she has.
Agree, DK (ref.) . .
Disagree . .
A man is never sterile but a woman can be.
Agree, DK (ref.) . .
Disagree . .
Girls should be encouraged to continue their education to higher levels.
Disagree, DK (ref.) . .
Agree . .
Do you think that your husband/partner approves or disapproves of couples using a contraceptive method
to avoid pregnancy?
Disapprove, DK (ref.) . .
Approve . .
Who had the nal say in the decision that you would get married to or live with your (rst)
husband/partner?
Spouse, parents/-in law, others (ref.) . .
Jointly with spouse . .
Women should not be allowed to express their opinion about important family matters.
Agree, DK (ref.) . .
Disagree . .
A woman should be free to ask her husband to use a condom.
Disagree, DK (ref.) . .
Agree . .
Attitudes related to economic empowerment
Who in your family usually has the nal say on making large household purchases?
Spouse, respondent, others (ref.) . .
Jointly with spouse . .
Who mainly decides how the money you earn will be used?
Spouse, respondent, others (ref.) . .
Jointly with spouse . .
Attitudes related to domestic violence
Do you think a wife is justied in refusing to have sex with her husband if she knows he has a sexually
transmitted infection?
No (ref.) . .
Ye s . .
International Journal of Population Research
T : C ontinu e d .
Key variables 𝑁Percentage
Do you think a wife is justied in refusing to have sex with her husband if she knows he has sex with
women other than his wives?
No (ref.) . .
Ye s . .
Do you think a wife is justied in refusing to have sex with her husband if she is tired or not in the mood?
No (ref.) . .
Ye s . .
Is a husband justied in hitting or beating his wife if she goes out without telling him?
Ye s ( r e f . ) . .
No . .
Is a husband justied in hitting wife if she burns the food?
Ye s ( r e f . ) . .
No . .
Is a husband justied in hitting wife if food is not cooked on time?
Ye s ( r e f . ) . .
No . .
Control variables
Age
through (ref.) . .
through . .
through . .
Sex
Female (ref.) . .
Male . .
Marital status
Not married (ref.) . .
Currently married . .
Urban/rural
Rural (ref.) . .
Urban . .
Education
Primary (ref.) . .
Secondary . .
Higher . .
Ethnicity
Other (ref.) . .
Hausa . .
Sate of residence
Sokoto (ref.) . .
Kaduna . .
Kano . .
Katsina . .
exposure to the drama led to a signicant positive change in
spousal communication about FP; listeners showed greater
odds (. times) than nonlisteners of holding discussions
about FP issues with their spouses/partners. Likewise, on the
outcome regarding shared responsibility between couples for
making family size decisions, the multivariate results reveal
higher odds for listeners relative to nonlisteners, implying a
signicant drama eect. With respect to the outcome “what
do you consider to be the ideal marriage age for a female?” the
eect of exposure to the drama was also positive. e odds
International Journal of Population Research
T : Estimates of the eect of a serial radio drama Ruwan Dare on family planning/reproductive health and gender outcomes in four
states in northern Nigeria (Kaduna, Kano, Katsina, and Sokoto), .
Bivariate analysis Multivariate analysis
Odds ratio % CI Adjusted odds ratio % CI
RH outcomes
Knowledge
Do you know a place where you can obtain a method of family planning (FP)?
=yes,=no,DK(ref.) . .–. 1.93∗∗a.–.
Can people reduce their chances of getting the AIDS virus by using a condom every
time they have sex?
=yes,=no,DK(ref.) . .–. .∗b.–.
Attitude
Is using contraception against the will of Allah/God?
=yes,=no,DK(ref.) . .–. .∗c.–.
Couplesshouldspacetheirchildrenatleast.toyearsapart.
=agree,=disagree(ref.) .∗∗∗ .–. .∗∗∗ .–.
Can becoming pregnant every year put the mother at risk?
=yes,=no,DK(ref.) . .–. .∗c.–.
People should plan how many children they will have.
=agree,=disagree(ref.) .∗∗ .–. .∗∗∗ .–.
Would you say that you approve or disapprove of couples using a family planning
method to avoid getting pregnant?
= approve, = disapprove, DK (ref.) .∗∗ .–. .∗.–.
What age do you think is the most appropriate for a female to start bearing children?
= years+, = – years (ref.) . .–. . .–.
Would access to contraceptives encourage indelity?
=no,=yes,DK=(ref.) . .–. . .–.
Intentions
Would you like to have no more children?
=yes,=no,DK(ref.) . .–. . .–.
Do you think you will use a contraceptive method to delay or avoid pregnancy at
any time in the future?
=yes,=no,DK(ref.) . .–. . .–.
Behavior
Are you currently doing something or using any method of family planning to delay
or avoid getting pregnant?
=yes,=no,DK(ref.) .∗∗∗ .–. .∗∗ .–.
In the last months have you discussed the practice of family planning with your
family, friends, or neighbors?
=yes,=no,DK(ref.) .∗∗∗ .–. .∗∗∗ .–.
Gender outcomes
Attitudes and behaviors related to normative beliefs and gender equality
Discussed FP with spouse in the last months.
=yes,=no,DK(ref.) .∗∗∗ .–. .∗.–.
Couples should share responsibility for making decisions about family size.
=yes,=no,DK(ref.) .∗∗ .–. .∗.–.
What do you consider to be the ideal marriage age for a female?
= years+, = years and below (ref.) . .–. .∗d.–.
A woman’s value is judged by marriage before her rst menses and by the number of
children she has.
= disagree, = agree (ref.) .∗.–. .e.–.
International Journal of Population Research
T : C ontinu e d .
Bivariate analysis Multivariate analysis
Odds ratio % CI Adjusted odds ratio % CI
A man is never sterile but a woman can be.
= disagree, = agree (ref.) . .–. . .–.
Girls should be encouraged to continue their education to higher levels.
=agree,=disagree(ref.) . .–. . .–.
Do you think that your husband/partner approves or disapproves of couples using a
contraceptive method to avoid pregnancy?
= approve, = disapprove, DK (ref.) . .–. . .–.
Who had the nal say in the decision that you would get married to or live with
your (rst) husband/partner?
= jointly, = spouse, respondent, others (ref.) . .–. . .–.
Women should not be allowed to express their opinion about important family
matters.
= disagree, = agree (ref.) . .–. . .–.
A woman should be free to ask her husband to use a condom.
=agree,=disagree(ref.) . .–. . .–.
Attitudes related to economic empowerment
Who in your family usually has the nal say on making large household purchases?
= jointly, = spouse, respondent, others (ref.) . .–. . .–.
Who mainly decides how the money you earn will be used?
= jointly, = spouse, respondent, others (ref.) . .–. . .–.
Attitudes related to domestic violence
Do you think a wife is justied in refusing to have sex with her husband if she
knows he has a sexually transmitted infection?
=yes,=no,DK(ref.) .∗∗∗ .–. .∗∗ .–.
Do you think a wife is justied in refusing to have sex with her husband if she
knows he has sex with women other than his wives?
=yes,=no,DK(ref.) .∗∗∗ .–. .∗∗ .–.
Do you think a wife is justied in refusing to have sex with her husband if she is
tired or not in the mood?
=yes,=no,DK(ref.) . .–. .∗f.–.
Is a husband justied in hitting or beating his wife if she goes out without telling
him?
=no,=yes,DK(ref.) . .–. . .–.
Dierences between surveys and between listeners and nonlisteners are signicant at ∗∗∗𝑃< .001,∗∗𝑃<.01,∗𝑃<.05.
ameans the introduction of the correlates, state, education, and ethnicity turned the eect of drama exposure signicant; bmeans the introduction of the
correlate, education turned the eect of drama exposure signicant; cmeans the introduction of the correlate, state turned the eect of drama exposure
signicant; dmeans the introduction of the correlate, current marital status turned the eect of drama exposure signicant; emeans the introduction of the
correlate, current marital status turned the eect of drama exposure nonsignicant; fmeans the introduction of the correlate, ethnicity turned the eect of
drama exposure signicant.
of listeners agreeing with the statement were almost twice
greater than those of nonlisteners. It is of note to mention
that the bivariate association between exposure to the drama
and this latter attitudinal gender outcome was not statistically
signicant, but it became signicant when current marital
statuswascontrolledforinthemultivariatemodel,suggesting
that the relationship is conditioned by dierences in marital
status. Similarly, the importance of controlling for marital
status was also observed on the association between exposure
tothedramaandtheoutcome:“awoman’svalueisjudged
by marriage before her rst menses and by the number of
children she has.” e direction of the bivariate eect was
negative,butthisapparenteectwasduetoafailuretocontrol
for marital status in the model and once this control was
introduced, the relationship became statistically nonsignif-
icant. According to the table, the remaining ve attitudinal
outcomes regarding girls’ education, sterility, approval of FP,
marriage decisions, wife’s ability to ask her husband to use
condoms, and the appropriateness for women to express their
opinions on family matters were not aected by the drama.
In terms of the two gender outcomes associated with
attitudes toward economic empowerment, the drama’s impact
International Journal of Population Research
T : Estimates of the relative eects of a serial radio drama “Ruwan Dare” and gender on reproductive outcomes in four states in northern Nigeria (Kaduna, Kano, Katsina, and Sokoto),
.
Relative drama and gender eects
Currently using contraceptives
for delaying or stopping
Discussed FP with family, friends,
or neighbors in the last months
Intends to use contraception
for delaying or stopping
Would like to have no
more children
Adjusted
odds ratio % CI Adjusted odds
ratio % CI Adjusted odds
ratio % CI Adjusted
odds ratio % CI
Normative beliefs model
Listened to Ruwan Dare (exposure).
= regular listener, = nonlistener (ref.) .∗.–. .∗∗ .–. . .–. . .–.
Discussed FP with spouse in the last months.
= yes, = no (ref.) .∗∗∗ .–. na na .∗∗∗ .–. .∗.–.
What do you consider to be the ideal marriage age
for a female?
= years+, = years and below (ref.) .∗.–. na na na na na na
Girls should be encouraged to continue their
education to higher levels.
= agree, = disagree (ref.) .∗∗ .–. .∗∗ .–. . .–. na na
A woman should be free to ask her husband to use
a condom.
= agree, = disagree (ref.) na na na na .∗∗ .–. .∗.–.
Economic empowerment model
Listened to Ruwan Dare (exposure).
= regular listener, = nonlistener (ref.) .∗∗ .–. na na na na . .–.
Discussed FP with spouse in the last months.
= yes, = no (ref.) .∗∗∗ .–. na na na na .∗.–.
What do you consider to be the ideal marriage age
for a female?
= years+, = years and below (ref.) .∗.–. na na na na na na
Girls should be encouraged to continue their
education to higher levels.
= agree, = disagree (ref.) .∗∗ .–. na na na na na na
A woman should be free to ask her husband to use
a condom.
= agree, = disagree (ref.) na na na na na na .∗.–.
Whoinyourfamilyusuallyhasthenalsayon
making large household purchases?
= jointly, = spouse, respondent, others (ref.) .∗.–. na na na na .∗.–.
International Journal of Population Research
T : C ontinu e d .
Relative drama and gender eects
Currently using contraceptives
for delaying or stopping
Discussed FP with family, friends,
or neighbors in the last months
Intends to use contraception
for delaying or stopping
Would like to have no
more children
Adjusted
odds ratio % CI Adjusted odds
ratio % CI Adjusted odds
ratio % CI Adjusted
odds ratio % CI
Domestic violence model
Listened to Ruwan Dare (exposure).
= regular listener, = nonlistener (ref.) .∗.–. .∗∗ .–. . .–. . .–.
Discussed FP with spouse in the last months.
= yes, = no (ref.) .∗∗∗ .–. na na .∗∗∗ .–. .∗.–.
What do you consider to be the ideal marriage age
for a female?
= years+, = years and below (ref.) na na na na na na na na
Girls should be encouraged to continue their
education to higher levels
= agree, = disagree (ref.) .∗∗ .–. na na . .–. na na
Couples should share responsibility for making
decisions about family size
=yes,=no,DK(ref.) na na .
∗∗ .–. nana nana
A woman should be free to ask her husband to use
a condom
= agree, = disagree (ref.) na na na na .∗∗ .–. .∗.–.
Whoinyourfamilyusuallyhasthenalsayon
making large household purchases?
= jointly, = spouse, respondent, others (ref.) .∗.–. na na na na .∗.–.
Do you think a wife is justied in refusing to have
sex with her husband if she knows he has a
sexually transmitted infection?
=yes,=no,DK(ref.) .
∗.–. na na na na na na
Do you think a wife is justied in refusing to have
sex with her husband if she goes out without
telling him?
=yes,=no,DK(ref.) na na .
∗.–. nana nana
Is a husband justied in hitting wife if she burns
the food?
= no, = yes, DK (ref.) na na na na . .–. na na
Is a husband justied in hitting wife if food is not
cooked on time?
=no,=yes,DK(ref.) na na na na na na . .–.
Dierences between surveys and between listeners and nonlisteners are signicant at ∗∗∗𝑃 < .001,∗∗ 𝑃<.01,∗𝑃<.05.
na means coecient was removed from the model because it was statistically nonsignicant.
International Journal of Population Research
was null. On the other hand, signicant drama eects on
the outcomes reecting domestic violence were generally
observed. Based on the multivariate estimates, the odds of
listeners agreeing with the statement “do you think a wife
is justied in refusing to have sex with her husband if she
knows he has a sexually transmitted infection?” were .
times greater than those of nonlisteners. On the following
outcomes:“doyouthinkawifeisjustiedinrefusingtohave
sexwithherhusbandifsheknowshehadsexwithwomen
other than his wives?” and “do you think a wife is justied
in refusing to have sex with her husband if she is tired or
not in the mood?” the respective odds for listeners relative
to nonlisteners agreeing with the statements were . and
.. Furthermore, results show that the latter outcome was
mediated through ethnicity because the association turned
signicant only aer the introduction of the ethnicity variable
in the estimation model, even as the eect of this correlate
was nonsignicant. Conversely, no signicant dierences
between listeners and nonlisteners were found regarding
disagreement with the statement “is a husband justied in
hitting or beating his wife if she goes out without telling him?”
6.3. Relative Eect of Gender on Reproductive Outcomes. To
investigate the relative eect of gender on the reproductive
outcomes, the measures for each of the three dierent
dimensions of gender (normative beliefs, attitudes toward
economic empowerment, and domestic violence) were added
to the various models estimating the net eect of the drama
(i.e., controlling for all the study correlates) on the reproduc-
tive outcomes. For each reproductive outcome, the gender
measures were sequentially incorporated in three models. In
the rst model, all the gender variables reecting normative
beliefs surrounding gender equality were introduced. e
second model added the gender measures denoting eco-
nomic empowerment, and the third model further added the
domestic violence measures. For parsimony, only the gender
measuresthatturnedouttobesignicantinatleastoneof
the three models were generally retained. In instances where
none of the respective gender predictors being considered
under a particular model were statistically signicant, at least
onemeasurewasretainedtokeepthemodel.Forcomparison,
therelativeeectsofthedramaestimatedinthethreemodels
are also presented, whether signicant or not. e results are
shown in Tables through for twelve RH outcomes.
Table shows the relative eect of the three dimensions
of the gender predictors on the two behavioral and the two
intentional RH outcomes, namely, “are you currently doing
somethingorusinganymethodofFPtodelayoravoidgetting
pregnant?”; “in the last months have you discussed the
practice of FP with your family, friends, or neighbors?”; “do
you think you will use a contraceptive method to delay or
avoid pregnancy at any time in the future?”; and “would like
to have no more children.” Results indicate positive eects
for several of the gender predictors in each of the three
models on current FP use. In model (norms regarding
gender equality), discussion of FP with spouse and attitudes
toward ideal age at marriage for women and encouraging
girls’ continued schooling had a positive impact on current
use of contraceptives. In the second economic empowerment
model, in addition to the gender eects observed to be
signicant in the rst model, spouses’ joint decision on
large household purchases was also positively associated with
the RH outcome. In the third model (domestic violence),
agreement with wife’s justication in denying her husband
sex if he has a sexually transmitted infection, in addition to
the signicant gender eects in the two models above, had
a signicant eect on current use. Exposure to the drama
continued to signicantly impact current use of FP, with the
presence of the gender predictors as well as the correlates in
the model.
Unlike current use of FP, the eects of the gender
predictors on discussion of FP with family, friends, and
neighbors were quite modest. In the rst gender model, only
encouraging girls’ continued schooling positively predicted
this RH outcome. In the third model, respondents’ agreement
with “couples should share responsibility for making deci-
sions about family size” and disagreement with “is a husband
justied in hitting or beating his wife if she goes out without
telling him?” positively impacted discussion of FP with
family, friends, and neighbors among respondents while none
of the gender predictors considered in the second economic
empowerment model had an impact on the outcome. As with
currentFPuse,therelativeeectofthedramaontheoutcome
remained positive and signicant.
In contrast, the lack of association between exposure to
the drama and the two intentional RH outcomes investigated
(observed in Ta bl e ) persisted aer the three sets of gender
predictors were incorporated in the respective models. Yet,
two gender predictors in the normative beliefs model, spousal
discussion of FP in the last three months and agreement
among respondents with the statement “a woman should be
free to ask her husband to use a condom,” were positively
associated with intention to use FP in the future. e same
two gender predictors continued to positively impact the two
intentional outcomes in the nal domestic violence model
while none of the domestic violence predictors were inuen-
tial. However, in the case of the latter outcome “would like
to have no more children,” the gender predictor concerning
joint decision between spouses on large household purchases
also had a negative eect.
In Table , we show four of the seven RH outcomes
reecting attitudinal changes, specically, “is using con-
traception against the will of Allah/God?”; “can becoming
pregnant every year put the mother at risk?”; “couples should
space their children at least . to years apart”; and “people
should plan how many children they will have.” Surprisingly,
the eects of the drama relative to the gender predictors on
the rst two attitudinal outcomes were nonsignicant, sur-
prisingly, because the drama eect was signicantly positive
inthepresenceofcontrolsonly,asTa b l e shows. is means
that for these two outcomes the gender mediators are more
important than exposure to the drama. On the other hand,
various gender predictors (discussion of FP with spouse in
the last three months, agreement with “what do you consider
to be the ideal marriage age for a female?”, and disagreement
with “women should not be allowed to express their opinion
about important family matters”) had a positive eect on
International Journal of Population Research
T : Estimates of the relative eects of a serial radio drama ”Ruwan Dare” and gender on reproductive outcomes in four states in northern Nigeria (Kaduna, Kano, Katsina, and Sokoto),
.
Relative drama and gender eects
Using contraceptives is
against the will of Allah
Becoming pregnant every year
puts mother’s health at risk
Couples should space their
children at least . to years
apart
People should plan how many
children they will have
Adjusted
odds ratio % CI Adjusted odds ratio % CI Adjusted odds ratio % CI Adjusted odds ratio % CI
Normative beliefs model
Listened to Ruwan Dare (exposure).
= regular listener, = nonlistener (ref.) .a.–. .a.–. .∗∗ .–. .∗.–.
Discussed FP with spouse in the last months.
=yes,=no(ref.) .
∗∗∗ .–. .∗∗∗ .–. na na na na
What do you consider to be the ideal marriage age
for a female?
= years+, = years and below (ref.) .∗∗ .–. na na .∗∗ .–. .∗.–.
Girls should be encouraged to continue their
education to higher levels.
=agree,=disagree(ref.) na na .∗∗∗ .–. .∗∗∗ .–. .∗∗∗ .–.
Children should be treated equally regardless of
their sex.
= agree, = disagree, DK (ref.) na na .∗∗∗ .–. na na na na
Couples should share responsibility for making
decisions about family size.
=yes,=no,DK(ref.) na na .∗∗ .–. .∗∗∗ .–. na na
A woman should be free to ask her husband to use
a condom.
=agree,=disagree(ref.) na na .∗∗∗ .–. .∗∗ .–. .∗∗∗ .–.
Women should not be allowed to express their
opinion about important family matters.
=disagree,=agree,DK(ref.) .
∗.–. .∗∗ .–. na na na na
Economic empowerment model
Listened to Ruwan Dare (exposure).
= regular listener, = nonlistener (ref.) . .–. . .–. .∗∗ .–. .∗.–.
Discussed FP with spouse in the last months.
=yes,=no(ref.) .
∗∗ .–. .∗∗∗ .–. na na na na
What do you consider to be the ideal marriage age
for a female?
= years+, = years and below (ref.) . .–. na na .∗.–. . .–.
Girls should be encouraged to continue their
education to higher levels.
=agree,=disagree(ref.) na na .∗∗∗ .–. .∗∗∗ .–. .∗∗∗ .–.
Children should be treated equally regardless of
their sex.
= agree, = disagree, DK (ref.) na na .∗∗∗ .–. na na na na
International Journal of Population Research
T : C ontinu e d .
Relative drama and gender eects
Using contraceptives is
against the will of Allah
Becoming pregnant every year puts
mother’s health at risk
Couples should space their
children at least . to years
apart
People should plan how many
children they will have
Adjusted
odds ratio % CI Adjusted odds ratio % CI Adjusted odds ratio % CI Adjusted odds ratio % CI
Couples should share responsibility for making
decisions about family size.
=yes,=no,DK(ref.) na na .∗∗ .–. .∗∗∗ .–. .∗.–.
A woman should be free to ask her husband to use
a condom.
=agree,=disagree(ref.) na na .∗∗∗ .–. .∗.–. .∗∗∗ .–.
Women should not be allowed to express their
opinion about important family matters.
= disagree, = agree, DK (ref.) . .–. .∗∗ .–.nanana na
Whoinyourfamilyusuallyhasthenalsayon
making large household purchases?
= jointly, = spouse, respondent, others (ref.) . .–. . .–. . .–. . .–.
Domestic violence model
Listened to Ruwan Dare (exposure).
= regular listener, = nonlistener (ref.) . .–. . .–. .∗∗ .–. .∗.–.
Discussed FP with spouse in the last months.
=yes,=no(ref.) .
∗∗∗ .–. .∗∗∗ .–.nanana na
What do you consider to be the ideal marriage age
for a female?
= years+, = years and below (ref.) .∗.–. .∗∗ .–. .∗∗ .–. . .–.
Girls should be encouraged to continue their
education to higher levels.
=agree,=disagree(ref.) na na .∗∗ .–. .∗∗∗ .–. .∗∗∗ .–.
Children should be treated equally regardless of
their sex.
= agree, = disagree, DK (ref.) na na .∗∗∗ .–. na na na na
Couples should share responsibility for making
decisions about family size.
=yes,=no,DK(ref.) na na .∗∗ .–. .∗∗∗ .–. .∗.–.
A woman should be free to ask her husband to use
a condom.
=agree,=disagree(ref.) na na .∗∗∗ .–. .∗∗ .–. .∗∗∗ .–.
Women should not be allowed to express their
opinion about important family matters.
=disagree,=agree,DK(ref.) .
∗.–. .∗.–.nanana na
International Journal of Population Research
T : C ontinu e d .
Relative drama and gender eects
Using contraceptives is
against the will of Allah
Becoming pregnant every year
puts mother’s health at risk
Couples should space their
children at least . to years
apart
People should plan how many
children they will have
Adjusted
odds ratio % CI Adjusted odds ratio % CI Adjusted odds ratio % CI Adjusted odds ratio % CI
Whoinyourfamilyusuallyhasthenalsayon
making large household purchases?
= jointly, = spouse, respondent, others (ref.) na na na na na na . .–.
Do you think a wife is justied in refusing to have
sex with her husband if she knows he has a
sexually transmitted infection?
=yes,=no,DK(ref.) . .–. .∗.–. na na na na
Is a husband justied in hitting or beating his wife
if she goes out without telling him?
=no,=yes,DK(ref.) na na na na na na . .–.
Is a husband justied in hitting or beating his wife
if she argues with him?
=no,=yes,DK(ref.) na na na na . .–. na na
Dierences between surveys and between listeners and nonlisteners are signicant at ∗∗∗𝑃 < .001,∗∗ 𝑃<.01,∗𝑃<.05.
na means coecient was removed from the model because it was statistically nonsignicant.
ae eect of drama exposure, net of the controls was signifcant but was rendered nonsignifcant aer the measure for spousal discussion of FP was added in the model.
International Journal of Population Research
T : Estimates of the relative eects of a serial radio drama “Ruwan Dare” and gender on reproductive outcomes in four states in northern Nigeria (Kaduna, Kano, Katsina, and Sokoto),
.
Relative drama and gender eects
Approve or disapprove
of couples using FP
Ideal age for childbearing is
or older
Access to contraception
would encourage indelity Know a place to obtain a FP method
Adjusted
odds ratio % CI Adjusted
odds ratio % CI Adjusted
odds ratio % CI Adjusted odds
ratio % CI
Normative beliefs model
Listened to Ruwan Dare (exposure).
= regular listener, = nonlistener (ref.) .a.–. . .–. . .–. . .–.
Discussed FP with spouse in the last months.
= yes, = no (ref.) .∗∗∗ .–. .∗∗ .–. .∗∗∗ .–. .–.
Do you think that your husband/partner approves
or disapproves of couples using a contraceptive
method to avoid pregnancy?
=approve,=disapprove,DK(ref.) nananananana ..–.
What do you consider to be the ideal marriage age
for a female?
=years+,=yearsandbelow(ref.)nananananana na na
Girls should be encouraged to continue their
education to higher levels.
=agree,=disagree(ref.) .
∗∗ .–. .∗∗ .–. na na .∗∗ .–.
Couples should share responsibility for making
decisions about family size.
=yes,=no,DK(ref.) .
∗∗ .–.nananana na na
A woman should be free to ask her husband to use
a condom.
= agree, = disagree (ref.) .∗∗∗ .–. na na .∗∗ .–. na na
Women should not be allowed to express their
opinion about important family matters.
= disagree, = agree, DK (ref.) na na .∗∗∗ .–. .∗∗ .–. na na
Economic empowerment model
Listened to Ruwan Dare (exposure).
= regular listener, = nonlistener (ref.) . .–. 0.22∗b.–. . .–. . .–.
Discussed FP with spouse in the last months.
= yes, = no (ref.) .∗∗∗ .–. na na .∗∗ .–. .∗∗ .–.
Do you think that your husband/partner approves
or disapproves of couples using a contraceptive
method to avoid pregnancy?
=approve,=disapprove,DK(ref.) nananananana .
∗∗ .–.
Girls should be encouraged to continue their
education to higher levels.
=agree,=disagree(ref.) .
∗∗∗ .–. . .–. na na .∗.–.
International Journal of Population Research
T : C ontinu e d .
Relative drama and gender eects
Approve or disapprove
of couples using FP
Ideal age for childbearing is
or older
Access to contraception
would encourage indelity Know a place to obtain a FP method
Adjusted
odds ratio % CI Adjusted
odds ratio % CI Adjusted
odds ratio % CI Adjusted odds
ratio % CI
Children should be treated equally regardless of
their sex.
=agree,=disagree,DK(ref.) nanananananana na
Couples should share responsibility for making
decisions about family size.
=yes,=no,DK(ref.) .
∗.–. . .–. na na na na
A woman should be free to ask her husband to use
a condom.
= agree, = disagree (ref.) .∗∗∗ .–.nanananana na
Whoinyourfamilyusuallyhasthenalsayon
making large household purchases?
= jointly, = spouse, respondent, others (ref.) na na .∗.–. .∗∗∗ .–. . .–.
Who mainly decides how the money you earn will
be used?
= jointly, = spouse, respondent, others (ref.) . .–. .∗∗∗ .–. na na
Domestic violence model
Listened to Ruwan Dare (exposure).
= regular listener, = nonlistener (ref.) . .–. .∗.–. . .–. . .–.
Discussed FP with spouse in the last months.
= yes, = no (ref.) .∗∗∗ .–. na na .∗.–. .∗.–.
Do you think that your husband/partner approves
or disapproves of couples using a contraceptive
method to avoid pregnancy?
= approve, = disapprove, DK (ref.) na na na na na na .∗∗ .–.
Girls should be encouraged to continue their
education to higher levels.
=agree,=disagree(ref.) .
∗∗ .–. . .–. na na .∗.–.
Children should be treated equally regardless of
their sex.
=agree,=disagree,DK(ref.) nanananananana na
Couples should share responsibility for making
decisions about family size.
=yes,=no,DK(ref.) .
∗.–. . .–. na na na na
A woman should be free to ask her husband to use
a condom.
=agree,=disagree(ref.) .
∗∗∗ .–.nanananana na
International Journal of Population Research
T : C ontinu e d .
Relative drama and gender eects
Approve or disapprove
of couples using FP
Ideal age for childbearing is
or older
Access to contraception
would encourage indelity Know a place to obtain a FP method
Adjusted
odds ratio % CI Adjusted
odds ratio % CI Adjusted
odds ratio % CI Adjusted odds
ratio % CI
Whoinyourfamilyusuallyhasthenalsayon
making large household purchases?
= jointly, = spouse, respondent, others (ref.) na na .∗∗ .–. .∗∗∗ .–. na na
Who mainly decides how the money you earn will
be used?
= jointly, = spouse, respondent, others (ref.) na na . .–. .∗∗∗ .–. na na
Do you think a wife is justied in refusing to have
sex with her husband if she knows he has a
sexually transmitted infection?
= yes, = no, DK (ref.) na na na na . .–. na na
Is a husband justied in hitting or beating his wife
if she goes out without telling him?
=no,=yes,DK(ref.) .
∗.–. .∗∗ .–. na na . .–.
Is a husband justied in hitting or beating his wife
if she argues with him?
=no,=yes,DK(ref.) nananananana na na
Dierences between surveys and between listeners and nonlisteners are signicant at ∗∗∗𝑃 < .001,∗∗ 𝑃<.01,∗𝑃<.05.
na means coecient was removed from the model because it was statistically nonsignicant.
ae eect of drama exposure, net of the controls was signifcant but was rendered nonsignifcant aer the measure for spousal discussion of FP was added in the model.
be eect of drama exposure, net of the controls was signifcant but was rendered nonsignifcant aer the measure for use of earnings was added in the model.
International Journal of Population Research
the rst outcome, “is using contraceptives against the will
of Allah/God?” Similarly, with respect to the outcome “can
becoming pregnant every year put the mother at risk?” a host
of gender predictors, particularly those considered under the
normative beliefs model, had positive eects. An exception to
this general observation is the eect of the predictor “children
should be treated equally regardless of their sex” on the
outcome, which turned out to be negative.
In terms of the other two outcomes, “couples should space
theirchildrenatleast.toyearsapart”and“peopleshould
plan how many children they will have,” the relative eect of
thedrama,likeinthemodelsinTa b l e that adjusted for the
correlates only, remained positive and strong throughout the
three gender predictor models. A set of gender predictors but
generally dierent than those discussed above were positively
associated with the outcomes. ese include respondents’
agreement with “girls should be encouraged to continue
their education to higher levels”; “couples should share
responsibility for making family size decisions”; “a woman
should be free to ask her husband to use a condom”; and
“what do you consider to be the ideal marriage age for a
female?” (only in the case of “couples should space their
children at least . to years apart”).
Table presents the nal set of RH outcomes examined
in the study: three pertaining to changes in attitudes ()
“would you say that you approve or disapprove of couples
using a FP method to avoid getting pregnant?”; () “what
agedoyouthinkismostappropriateforafemaletostart
bearing children?”; and () “access to contraception would
encourage indelity” and one relating to knowledge “do
you know a place where you can obtain a method of FP?”
about RH issues. Based on the table, the drama had no
impact on all the outcomes, with the gender predictors in
the models even though the drama had a positive eect
on the latter two outcomes with just the correlates in the
models. On the other hand, some of the gender predictors
showed positive associations with the four outcomes. For
instance, in the nal model, the predictor “discussed FP with
spouse in the last three months” had positive eects on the
rst, third, and fourth RH outcomes; respondents’ agreement
with the predictor “girls should be encouraged to continue
their education to higher levels” positively impacted the rst
and the fourth outcomes; and “who mainly decides how the
money you earn will be used?” was positively associated with
the second and third outcomes.
A spouse’s approval of FP had a positive eect on
the fourth outcome among respondents. Agreement with
“couples should share responsibility for making family size
decisions” and “a woman should be free to ask her husband to
use a condom” both had a positive eect on the rst outcome
and“whomainlydecideshowthemoneyyouearnwillbe
used?” positively predicted the third outcome. Joint spousal
decisions on the purchase of large household items showed a
positive impact on the second outcome and a negative impact
on third outcome while disagreement among respondents
with “is a husband justied in hitting or beating his wife if
she goes out without telling him” had a positive eect on the
second outcome but negatively impacted the rst outcome.
7. Discussion and Conclusion
Sociocultural factors, including inegalitarian gender rela-
tions, have limited the success of RH behavior change com-
munication programs in northern Nigeria. Population Media
Center developed and aired Ruwan Dare, a Sabido-style radio
dramainfourstatesintheregion,Kaduna,Kano,Katsina,and
Sokoto, to mitigate these sociocultural and gender challenges
that tend to hinder the adoption of positive reproductive
healthattitudesandbehaviors.estudysetsouttoevaluate
the impact of Ruwan Dare on two sets of outcomes, RH and
gender issues pertaining to RH, by comparing listeners and
nonlisteners on changes in knowledge, attitudes, intentions,
and behaviors surrounding the two groups of outcomes.
With respect to the study’s second research question and
in concert with past studies conducted in Africa [–,,,
,]andelsewhere[,,,,,,] the results suggest
that the radio drama succeeded in modifying attitudes toward
FP/RH. Several reproductive outcomes are in the anticipated
direction in terms of exposure to the drama, most notably the
behavioral, knowledge, and most of the attitudinal outcomes
investigated. e success of the drama can be attributed
to the Sabido methodology, a unique and transformative
approach that utilizes audience research and long-running
serial dramas to allow bonding between audience and the
characters, and a whole society approach that has the capacity
to reach a wide audience [,,]. ese results, conrmed
by the program’s analysis of the listener diaries, highlight the
strong identication of the audience with the storylines on
FP and RH. One striking nding from the analysis of listener
diaries was the case of Maimuna, a -year-old mother of
ve who not only was an avid listener but also gradually
persuaded her husband to begin listening as well. In her diary,
shenarratedhowthedramaforgedahealthydiscussionofthe
benets of FP with her husband, which ultimately led her and
her husband to seek FP services.
Similarly and in response to the study’s research question
on gender, Ruwan Dare impacted gender issues associated
with FP/RH. However, the impact was not as widespread
across the gender outcomes relative to that observed for the
RH outcomes, highlighting the multilayered and complexity
oftheroleofgenderinreproductivebehavior.estudy
therefore advocates for greater programming on gender in
RH to both sustain gains already made and extend these gains
to other reproductive health outcomes.
e study also examined the mediating eect of gender
on the association between exposure to the drama and RH
outcomes by including measures of three dimensions of
gender and the drama exposure variable as predictors in the
same model while controlling for the seven study correlates.
In this way, the study was able to establish the relative eect
of both the drama and gender on RH outcomes. e ndings
are very insightful. For the twelve RH outcomes evaluated,
the relative eects of the drama (i.e., in the presence of the
gender predictors in addition to the study correlates) were
consistent with the net drama eects (i.e., in the presence of
the correlates only) on eight of them. Like the net eects, the
relative drama eects continued to be positive for four out-
comes (current use of FP; FP discussion with family, friends,
International Journal of Population Research
and neighbors; birth inter vals of . to years; the importance
of couples planning how many children to have) and nil for
another four (intention to use contraceptives; want no more
children; ideal age for childbearing is years or older; access
to contraceptives would encourage indelity). However, for
the remaining four outcomes (“using contraceptives is against
the will of Allah,” “becoming pregnant every year puts the
mother’s health at risk,” “should couples use contraceptives
to avoid pregnancy,” and “knowledge of a place to obtain a FP
method”), the drama eect lost its initial positive signicance
to the gender predictors (see Tables –).
As indicated by Tables –, the most illuminating nding
isthatalltwelveRHoutcomeswerepositivelyimpacted
by many of the gender predictors. ese ndings on the
signicance of gender in RH are consistent with the general
interpretation from earlier studies conducted in Nigeria [,
,]. e ndings also conrm claims in the broader
demographic literature [,,]andbytheinternational
development community [] regarding the critical role of
gender in RH outcomes. Similarly, the strong positive eect
of FP communication between spouses and to a lesser extent
those of joint decision of spouses on RH decisions corrob-
orates assertions by authors [,,]oftheimportance
of spousal communication and agreement on reproductive
outcomes.
e divergent eects of the gender predictors on the RH
outcomes support the study’s detailed focus on a comprehen-
sive set of predictors. Had we examined just a few predictors
or had we constructed composite indices of the predictors,
wewouldhavemissedmuchofthendingsontherelative
eect of gender on RH issues. Finally, the ndings on the
mediating eects of this large number of indicators of gender
aord researchers an opportunity to better determine which
group of gender measures to include in composite indices,
depending on the outcomes being investigated.
8. Limitations
Despite the study’s achievements, a number of limitations
deserve comment. Randomized controlled experimental
design is the gold standard for the evaluation of behavioral
change programs. However, the radio drama was aired
throughout the target region, thereby precluding the use of
randomized controlled designs. e pretest/posttest cross-
sectional design adopted in the evaluation of drama tends
to introduce threats of validity []andbiasinthedata,
from both the self-reporting of sensitive information and self-
selection of participants (e.g., respondents who habitually lis-
tentoradiohealthprogramsmayalsohavegreatertendency
tolistentothedrama).Toascertainifthedatasuerfromself-
selection, we determined how listenership to general radio
health programs was associated with listenership to Ruwan
Dare. We found that, among regular listeners to Ruwan
Dare, percent also listened to general health programs
on the radio compared with % of nonlisteners, and these
dierences were nonsignicant statistically, ruling out any
serious bias from self-selection.
Conflict of Interests
e authors declare that there is no conict of interests
regarding the publication of this paper.
Acknowledgment
PMC would like to thank the David and Lucile Packard
Foundation for funding the drama program, Ruwan Dare.
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