Involving Husbands in Safe Motherhood: Effects of the SUAMI SIAGA Campaign in Indonesia

Published in the Journal of Health Communication in 2004, this article evaluates the impacts of a multimedia safe motherhood campaign on male partners' involvement in pregnancy, birth preparedness and potential maternal emergency, and the value added to the campaign messages by interpersonal communication involving male partners. Suami SIAGA was a multi-media entertainment-education intervention implemented in 1999-2000 in Indonesia with a goal of reducing maternal death through a greater involvement of husbands in maternal care and safe motherhood. Husbands' participation in pregnancy was thought to reduce non-medical and indirect causes of maternal deaths, such as the delay in recognising pregnancy-related complications and the delay in reaching a healthcare facility promptly.

Two hypotheses were tested: (1) Husbands who have been directly exposed to the campaign are more likely to report acquiring new knowledge about maternal mortality prevention, especially if they have talked to someone about the campaign; and (2) husbands who have been directly exposed to the campaign are more likely to report that they have taken action toward becoming an alert husband, especially if they have talked to someone about the campaign. This study - informed by staged behaviour change theories, such as the diffusion of innovations theory - is built on an assumption that mass media campaign messages prompt individuals to discuss campaign messages among themselves, which, in turn, facilitates the behaviour change objectives of media campaigns.



Evaluation/Research Methodologies:

The Suami SIAGA campaign was implemented between 1999 and 2000 in Indonesia by the Ministry of Women's Empowerment with technical assistance from the Johns Hopkins University, Center for Communication Programs. The primary audience for this campaign was men of reproductive age, and the secondary audiences included married women of reproductive age, community leaders, community groups, and midwives. The key messages of the campaign prompted husbands to attend to their wives' needs during pregnancy and delivery, and to prepare with their wives a plan in case of an obstetric emergency.

By using information collected through qualitative formative research, the programme organisations designed and implemented:

• Ninety drama episodes, with specific messages about Suami SIAGA, to be broadcast in an existing radio drama series;
• A 3-episode entertainment-education television programme with messages about safe motherhood;
• Printed materials such as brochures and stickers;
• Interpersonal communication training materials for service providers;
• Community mobilisation activities to facilitate the multi-media campaign; and
• A variety of supplementary materials and resources such as T-shirts, hats, pins, and mobile van broadcasts.

The mass media components of the campaign (i.e., radio and television broadcasts) reached a national audience, but the remaining project components were implemented specifically in three high priority provinces (East Java, South Sulawesi, and South Sumatra), where the organisers considered the potential for behaviour change was the greatest.

The evaluation drew on a single survey conducted at the conclusion of the multimedia campaign in 1999. The survey addressed males between the ages of 15 and 45 years and from the lower socioeconomic strata in the three high priority provinces. The survey measured: (1) exposure to the campaign; (2) changes in knowledge of husbands, wives, midwives, community leaders, regarding what actions to take in the event of obstetric emergencies; and (3) changes in information-seeking and sharing behaviours of husbands, wives, midwives, and community leaders.



Key Findings/Impact:

About half of the intended audience was reached by the mass media campaign. The percentage of the survey respondents exposed to each communication channel was: 42% through television; 20% through a campaign poster in a health post; 17% via a poster inside someone's home; 16% on the radio; 13% through a campaign sticker; 9% via a campaign brochure; and fewer than 5% through campaign t-shirts, stickers, pins, or mobile van broadcast activities.

Results: hypothesis 1 (new knowledge acquisition)

Sixty-one percent of men exposed to campaign messages via television only reported acquiring new knowledge, 59% via radio only, and 57% via print media only. Sixty-one percent of men who stated that they gained new knowledge were exposed to television or print, or to television, or radio, or print. Some 28% of men reported new knowledge although they had not been directly exposed to the campaign. The results of logistic regression models indicated that:

• Husbands who were exposed to the campaign via television were six times more likely to acquire new knowledge than husbands who were not exposed to the campaign.
• Husbands who were exposed to television, radio, or print were seven times more likely to acquire new knowledge than husbands who were not exposed to the campaign.
• Husbands who talked to someone about becoming an alert husband were ten times more likely to say that they gained new knowledge compared to men who did not engage in interpersonal communication.
• Husbands who were exposed to television and talked to someone about the campaign were six times more likely to report having gained new knowledge about becoming an alert husband than men who were not exposed and did not speak to anyone.
• Husbands who were exposed to television and talked to someone about the campaign were three times more likely to report having gained new knowledge about becoming an alert husband than men who were exposed to television only.
• Husbands who were exposed to more than one medium and participated in some interpersonal communication about the campaign were 18 times more likely to have gained new knowledge than men who were not exposed and did not talk about becoming an alert husband.

Monthly income was the only control variable found to be a statistically significant predictor of new knowledge acquisition. Men who reported that they received a monthly income were more likely to report new knowledge following exposure to the campaign than those who did not receive a monthly income.

Results: hypothesis 2 (behaviour impacts)

Forty-one percent of men who reported taking some action were exposed to the campaign via television only, 51% via radio only, and 52% via print media only. Forty-three percent of husbands who were exposed to campaign messages via all three media channels reported taking action toward becoming an alert husband. Logistic regression models revealed that:

• Husbands who were exposed to the campaign via print media were five times more likely to report taking action than men who were not exposed to the campaign.
• Husbands who were exposed to the campaign via television, radio, or print were less likely to report taking action than men who were exposed to print only.
• Husbands who were engaged in interpersonal communication about becoming an alert husband were ten times more likely to report taking action.
• The odds of taking action for men who were exposed to the campaign via print media and who talked to someone about becoming an alert husband were higher than for men who were exposed to television and who talked to someone.
• Husbands who were exposed to television or print and who talked to someone about being an alert husband were about ten times more likely to take action compared to men who had no exposure and who did not talk to others.
• Men residing in urban areas were almost twice as likely to report taking action than men who lived in rural areas.
• Men who reported receiving a monthly income were less likely to report taking action than men who were not receiving monthly income.

The findings suggest that when husbands were exposed to multi-media campaign messages about maternal mortality prevention and birth preparedness, men's knowledge increased and men's action toward becoming an alert husband increased, and that the odds of knowledge acquisition and taking action were even higher for men who engaged in interpersonal communication about the campaign messages. Based on these findings, the authors recommend that health communication scholars should study the impacts of interpersonal communication in conjunction with the impacts from direct media exposure to evaluate the overall effects of mass media health interventions more accurately.