Using commercial advertising agencies in micronutrient promotion: lessons learned.

PIP: Lack of knowledge, beliefs about food, customs, and poverty are the main factors preventing millions of people from eating enough micronutrient-rich foods. Globally, more than 2 billion people are at risk of iron, vitamin A, and iodine deficiencies. Opportunities for Micronutrient Intervention (OMNI), a 5-year project funded by the Office of Health and Nutrition, US Agency for International Development, is dedicated to preventing and controlling micronutrient deficiencies in developing countries. OMNI's general approaches to reducing micronutrient deficiencies include fortification, supplementation, and dietary diversification. For all of those approaches, the project has stressed a social marketing methodology to define and motivate feasible behavior changes which will benefit maternal and child health and nutrition. The Manoff Group, the OMNI partner most responsible for behavior change, has had many positive experiences using social marketing to address micronutrient malnutrition, breast-feeding, and child feeding in many countries. Focusing mainly upon supplementation and dietary diversification, OMNI's experience to date in El Salvador, Nicaragua, Ecuador, and Bolivia is summarized.^ieng

Marketing social marketing to commercial partners: what's in it for them?

PIP: Commercial partnerships in social marketing have grown increasingly important in the context of diminishing resources from international donors in developing countries. In 1997, the Futures Group International (Futures) negotiated an agreement with Pharmacia & Upjohn/Brazil to introduce Depo-Provera, a 3-month injectable contraceptive, at a social marketing price with strong consumer marketing support. The key to the collaboration was to demonstrate that making Depo-Provera accessible to low-income consumers was a viable marketing strategy. The author describes the process of designing, negotiating, and implementing the successful commercial partnership. Brazilian women stand to gain the most from the partnership between Futures and Pharmacia & Upjohn/Brazil, for in the absence of such a coordinated effort, Depo-Provera would be available to only upper-income, breast-feeding women whose only source of information on the method would be private physicians. The partnership will bring Depo-Provera to a broader segment of Brazil's women.^ieng

Spotlight: Trinidad and Tobago.

PIP: Trinidad and Tobago's major source of income is oil. First discovered in the early 20th century, oil made the country one of the most prosperous in the Western Hemisphere during the 1970s, during which the government had an expansive program of infrastructure improvement. The oil industry also gave rise to the country's famous steel pan music. However, when oil prices collapsed in the 1980s, Trinidad and Tobago fell into a serious recession from which it has only recently emerged. Much of the hope for the economy now lies in natural gas, a significant amount of which is pumped by Amoco. Fertilizers, chemicals, and sugar are other important exports. In the country's 1990 census, East Indians comprised 40% of the population, slightly larger than the population of African descent. Trinidad and Tobago's population has about doubled since the first postwar census in 1946 and population halfway through 1996 stood at 1.3 million. This relatively modest growth of the population is due to a slowly declining birth rate and some emigration although the country receives some immigrants from neighboring islands. The total fertility rate fell to 2.0 in 1995, lower than replacement level, while infant mortality is low and life expectancy is rising to near that of developed countries. There is concern, however, that the poor economy has made health care and medical supplies less accessible. A 1987 Demographic and Health Survey found 53% of all married women using contraception and 44% using modern methods. The level of use has probably increased since then. Finally, Trinidad and Tobago enjoys an excellent education system and the proportion of women age 15 years and older in the labor force is increasing.^ieng

Unemployment, immigration, and NAFTA: a panel study of ten major U.S. industries.

PIP: The potential employment effects of the North American Free Trade Agreement (NAFTA) was the central concern of debate before the treaty was eventually passed. Panel data on unemployment rates in 10 major industries in the US during 1983-1994 were analyzed to assess the sensitivity of unemployment rates with respect to industry characteristics, macroeconomic variables, and Canadian and Mexican immigration to the US in the aftermath of the advent of NAFTA. The industries studied are mining; construction, durable goods, nondurable goods, transportation and public utilities; wholesale and retail trade; finance, insurance, and real estate; services; agriculture; and government. Analysis of the data determined that the output produced by the industry, unemployment insurance coverage, and interest rates are significant determinants of industry unemployment rates, but union presence does not affect industry unemployment. Both Canadian and Mexican immigrants seem to complement the US labor force, with Canadian immigrants being highly complementary to US labor. The Chow test found no evidence that NAFTA has changed the structure of unemployment determination in the industries studied.^ieng

Two horses of a different color: CSM in Thailand and Colombia.

PIP: The Colombian Association for Family Welfare (PROFAMILIA) and Indonesia's Community Development Association (PDA) operate social marketing projects which might more appropriately be called social sales projects. Unlike other social marketing projects, these 2 projects seek profits from their contraceptive sales. The profits are then used to subsidize other programs operated by these 2 nonprofit organizations. Indonesia's PDA initiated its sales project in 1974. It operates both an urban contraceptive retail sales (CRS) program and a rural community-based distribution sales (CBD) program. The CRS program sells 3 types of condoms, which it delivers directly to the 1750 retailers involved in the program. The condoms sell for US$.03-US$.07, somewhat more than condoms sold in most social marketing projects. The CBD project covers 10,200 villages in 157 of Indonesia's 620 districts. Each village has a CBD volunteer who sells oral contraceptives (OCs) and condoms and also promotes family planning and rural development. The program sells Norinyl, Ovostat, and Eugynon for US$.19-US$.30/cycle. PDA runs other profit-making projects. For example, it sells promotional T-shirts and calendars at its vasectomy clinics and through its CBD program. PDA also established the taxable Population and Development Corporation, which engages in marketing activities. Profits from the corporation are channeled back to PDA. PROFAMILIA also operates both an urban sales program and a rural community-based distribution program. In the urban program, condoms are sold at normal retail prices and OCs at prices 30% below retail prices. The profits derived form the urban sales are used to subsidize the rural project. In 1981, the urban program began selling 6 noncontraceptive products, e.g., distilled water and disposable diapers. Currently, the program sells only distilled water, as the other products failed to yield a profit. A table provides sales information for both the PDA and PROFAMILIA programs.^ieng

FPA withdraws from CSM project in Guatemala.

PIP: Guatemala's family planning association, the Asociacion Pro-Bienestar de la Familia (APROFAM) recently cut its ties with the nation's contraceptive social marketing program. The announced reasons for the disassociation was APROFAM's concerns about the legality of selling donated commodities. APROFAM helped create the program served as a member of the marketing program's board of directors, and was expected to function as the channel for the commidities donated by the US Agency for International Development (USAID). The marketing program will now be managed by the newly created Importadora de Farmaceuticos (IPROFA), a for-profit organization. This alters the legal status of the marketing program, and as a result, the program will be required to pay duties on USAID donated contraceptives. USAID cannot legally pay duties on its own contributions. Instead, the duies will be paid by IPROFA out of the revenues generated by the project. IPROFA will finance the 1st consignment of products with a bank loan, and the loan and duties on subsequent shipments will be paid out of the program's revenues. This strategy is not expected to pose legal problems for USAID, since the agency has no control over how programs use the revenues generated by selling the agency's commodities. As a result of the changed status, the marketing program must acquire it own storage and packaging facilities. According to Manuel DeLucca, the program's resident advisor, these problems will not delay the launch of the program's products scheduled for early 1985. The program plans to sell an oral contraceptive, a vaginal spermicidal tablet, and a condom. Orginal plans called for selling the low dose OC, Norminest; however, Norminest may not be approved for distribution in Guatemala, and USAID may replace Norminest with another product. As a result, the program may market Noriday, a normal dose pill instead of Norminest. Guatemalan registration of the spermicidal tablet the program is planning to sell is pending. The program is engendering considerable interest because of its unique legal status as a commercial enterprise and its freedom from bureaucractic constraints.^ieng

[Contraceptive frequency in Paraguay].

PIP: Data from the contraceptive frequency survey, conducted in Paraguay in 1977, indicate a high fertility rate, with more than 6 children per woman as average. Contraceptive usage is low, with only 24% of women between 15-44 using an effective method. There are notable differences in contraceptive usage and in fertility rate between urban and rural areas. In the capital of Asuncion about 44% of women use contraception; this, together with a high incidence of induced abortions, accounts for a crude birth rate of 24/1000. On the other hand, only 29% of women living outside the capital use contraception, and only 17% in rural areas. The greatest necessity for family planning programs is in the countryside, where about 50% of women are in need of all kinds of health services.^ieng

Retailers in social program strategy: the case of family planning.

PIP: The provision of contraceptive agents and devices through hospitals and clinics is not a cost-efficient procedure, therefore the distribution through retailers in a preexisting network is an attractive prospect. To really distribute contraceptives, e.g., birth control pills, the retailer would have to be trained in a format of questions. Two studies of retail marketing were conducted, one in Jamaica for condoms and one in Kenya where a subsidized marketing program for condoms was started in rural areas. More urban shops, which were larger in size, carried condoms than rural shops. Retailers in both areas were completely oriented to their immediate vicinity. Their concerns were with volume and with aggregate demand both before and after subsidized programs. The distribution system requires the additional support of advertising and marketing, but since the structure is in place it can be used with relatively little capital outlay. Research of retailers' attitudes and perceptions is inexpensive and often indicates customer preference and local market conditions.^ieng

Pill side effects, continuation found similar whether self-prescribed or prescribed by doctor.

PIP: In developing countries, especially Latin America, women obtain oral contraceptives without a physician's prescription. While these women experience more side effects, they have fewer accidental pregnancies than women who obtain the pills through a physician/prescription. A probability sample of 6692 Colombian women in Bogota were interviewed in 1974. Almost 1 in 20 of all women, and almost 1 in 13 of those married or living in a union, said they began using the pill on their own as their first method of contraception. The characteristics of the women without prescriptions were similar to those with, but self-prescribers were slightly older, had more children, and were less educated. 7 in 10 women of both groups continued pill use for 1 year; about 6 in 10 still used the pill after 2 years. Both groups gave side effects as their reason for discontinuation. The most frequently cited side effect was headache. None of the women reported the more serious complications, thrombophlebitis and thromboembolism. Women who did not begin with medical advice were less likely to seek it when they had side effects attributed to the pill. Half as many self-prescribers (24%), as users with a prescription (46%), reported visiting a private physician about side effects. 11% self-prescribers, compared with 25%, sought other professional help.^ieng

Corporate good citizenship pays off in Central America.

PIP: Fear of expropriation and increasing public scrutiny of the activities of multinational companies are forcing these companies to develop social programs in the countries where they operate. Frequently these programs are viewed as products of colonialism or as veiled attempts to dominate the nationals employed by these companies. The United Brands Company, which is involved in large scale banana production in several Central American countries, has adopted a program which seeks to reduce the paternalism which was associated with the operations of the United Fruit Company, the predecessor of the United Brands Company. A series of new programs emphasizing community self help projects were developed by a company-hired sociologist and initiated 4 years ago. In Panama, the projects were started by holding town meetings in which the citizens decided what projects to pursue. With company help the community has begun to build recreational and educational facilities and are also building new docks. The company is contributing $10 million annually to promote these projects. Other programs involve selling homes to workers for half the cost of constructing these homes and increasing efforts to put host country citizens into management positions. Home ownership is expected to stabilize the work force and increased opportunities for advancement are expected to increase productivity. Future plans include the construction of technical schools which will provide a pool of skilled technicians needed by the banana company.^ieng

Unique program in Antigua; stores distribute supplies.

PIP: The Antigua Planned Parenthood Association has initiated a controlle d project to have commerical, nonclinical distribution of contraceptives throughout the country. The government supports the program and has repealed the prescription requirement for oral contraceptives. They will soon be removed from the list of dutiable items, permitting a low retail price. 13 stores have agreed to participate in the project. All contraceptives are supplied at low prices and poor people can receive theirs free. A mass media advertising and informational campaign is planned. Evaluation will be conducted by the Westinghouse Population Center. International contraceptive experts are advising the project.^ieng

Non-medical birth control--a neglected and promising field.

PIP: The need for and methods of nonmedical family planning techniques are discussed in view of the continuing popularity of nonmedical channels of supply (5-7 million out of the 10-13 million who use contraception obtain supplies through nonmedical channels) and still unmet contraceptive needs in the United States. Lack of homogeneity in the population necessitates a choice of delivery mechanisms, and the passive system of medical service in family planning suggests the potential for the marketing approach to more effectively motivate potential family planning acceptors. Direct mail as contact and mail order as supply mechanisms are 2 especially promising aspects. Suggestions for research on how donor funds might be invested to explore the potential of these channels of information and delivery include market research on attitudes regarding contraceptive methods and delivery systems, experimentation with different delivery channels, ways of providing information at crucial points in the reproductive lives of individuals, and ways of preventing unwed teenage pregnancies.^ieng