Beyond Condoms
Should social marketing programs
do more to promote abstinence
and partner reduction in Africa?
COMMERCIAL MARKET STRATEGIES
NEW DIRECTIONS IN REPRODUCTIVE HEALTH
IN PARTNERSHIP WITH
Abt Associates Inc.
Population Services International
What is Social marketing?
The use of commercial marketing
techniques to promote behavior
change and achieve a social goal
Adaptation of the “marketing mix”
or 4Ps to a public health context:
• Product (+ services, behaviors)
• Pricing (tangible, psychological)
• Place (product and service outlets)
• Promotion (advertising, BCC, IEC)
• Other Ps (people, policy, etc.)
COMMERCIAL MARKET
STRATEGIES
New Directions in Reproductive Health
In the developed world,
social marketing is
Communication-based
Driven by behavioral goals
Highly segmented
COMMERCIAL MARKET
STRATEGIES
New Directions in Reproductive Health
In developing countries,
social marketing has been:
Product-based, supply driven
Based on commercial strategies
Focused on population at large
Evaluated on sales
COMMERCIAL MARKET
STRATEGIES
New Directions in Reproductive Health
But things are changing in
many countries…
Increased focus on HIV/AIDS
Improved access to products
Emphasis of Behavior Change
Communication (BCC)
More population-based
behavioral research
More targeted interventions
Dissemination of Lessons
learned and best practices
COMMERCIAL MARKET
STRATEGIES
New Directions in Reproductive Health
Lessons learned in changing
youth behavior
Findings from US and
developing country research*
• Programs focusing on A and B
and C can improve reproductive
health outcomes
• The promotion of only one
behavior can potentially undercut
other behaviors.
• These behaviors should be
promoted simultaneously
* Source: (Doug Kirby, ETR
associates, 2003) COMMERCIAL MARKET
STRATEGIES
New Directions in Reproductive Health
The case of Uganda
One of the few countries where
HIV/AIDS prevalence has
declined since the late 1980s
(UNAIDS 2002)
Decline in HIV/AIDS coincided
with the following changes:
Changes in sexual behavior among men in Uganda late
1980s/early 1990s; GPA surveys
60
54
50
1989
1995
40 35 33
30
30
23
20 15 16 15 15
10
3
0
1+casual Extramarital Single 2+ 3+ non- Condoms,
partner sex partners regular ever use
partners
COMMERCIAL MARKET
STRATEGIES
New Directions in Reproductive Health
High risk vs. preventive behavior
Ugandans who engage in high or
potentially high risk behavior
Age group Percent
15-19 20.5
20-24 15.2
25-29 24.5
30+ 26.6
90% of respondents who did
something to avoid HIV/AIDS
Behavior Percent
Fidelity 41.7
Abstinence 22.3
Condom use 19.6
Other 16.4
Social marketing in Uganda
Historically focused on product
distribution and promotion
HIV/AIDS prevention campaigns
emphasized condom use
Use of lifestyle ads for mainstream
audiences aged 15-29
COMMERCIAL MARKET
STRATEGIES
New Directions in Reproductive Health
Program Impact
Total sales of social marketing
condoms in Uganda (million units)
25
20
15
10
5
1995 1996 1997 1998 1999 2000 2001 2002
Lifeguard 7 12.1 12.2 12.6 11.8
1995 1996 1997 1998 1999 2000 2001 2002
Lifeguard 7 12.1 12.2 12.6 11.8
0
1995 1996 1997 1998 1999 2000 2001 2002
Percent of single 15-24 year olds who had
sex in past 12 months with a casual partner
and used a condom at last sex
80
60
40 Men
Women
20
0
1995 2000/1
Condom use in Uganda
% Distribution of Condom Users by Age Groups
12 11 10 14
22 19 19
21 Over 30
25-29
36
42 43 38 20-24
15-19
27 35 27
24
Protector Lifeguard Engabu All users
% Distribution of Sexually Active Population
by Age Group
14
21 Over 30
53
25-29
20-24
38
25 15-19
27 13
9
Condom users High-risk group
Condom use in Uganda
% Distribution of Condom Users by
Level of Education
17 18 12 17
Post-secondary
53 Secondary
54 55 52
Primary
No schooling
27 31 27
25
2 2 4 4
Protector Lifeguard Engabu All users
% Distribution of Sexually Active Population
by Level of Education
6
17 Post-secondary
39 Secondary
52 Primary
No schooling
46
27
4 9
Condom users High-risk group
Condom use in Uganda
% Distribution of Condom Users by
by Marital Status
13 18 19 20
Married /
In union
Single
79 76 78 74
Other
6 6 3 6
Protector Lifeguard Engabu All users
% Distribution of Sexually Active population
by Marital Status
20
Married /
In union
79
Single
74
Other
17
6 4
Condom users High-risk group
Lessons learned
Condom brands tend to compete
for the same user group
Suppliers likely to focus on sales
and market share instead of
health impact
High-risk groups are not
appropriately targeted
Non-product based behaviors are
not promoted
COMMERCIAL MARKET
STRATEGIES
New Directions in Reproductive Health
Implications
Social marketing should promote
a range of safe behaviors
Segment population according to
sexual history, health risk and
likely behavioral choices
Make full use of social marketing
behavior change capability
Establish performance indicators
based on behavioral data
COMMERCIAL MARKET
STRATEGIES
New Directions in Reproductive Health
Social marketing is about
promoting safe behaviors
COMMERCIAL MARKET
STRATEGIES
New Directions in Reproductive Health