The effect of an educational campaign on contraception seeking in Northern Nigeria: an interrupted time series analysis using routine health information system data

Abstract

In Nigeria, unmet need for contraception results in three million unintended pregnancies annually. Despite no-cost contraception availability at health facilities, only 38% of reproductive-aged women in Nigeria used effective contraception methods in 2023. We evaluated the impact of a radio-based contraception education campaign on contraception seeking in Kano State, Nigeria. Using monthly, facility-level data from Nigeria's National Health Management Information System, we measured contraception seeking according to the number of family planning clients counselled and new family planning acceptors divided by facility catchment population estimates derived from Geo-referenced Infrastructure and Demographic Data for Development (GRID3). Using controlled interrupted time series analyses, we estimated contraception seeking before (Jan 2019-Sept 2021) compared with after (Nov 2021-Dec 2024) the radio campaign intervention in Kano. We controlled for pre-intervention trends and estimated changes relative to the neighboring control state of Jigawa. Among 376 health facilities in Kano and 241 facilities in Jigawa with sufficient data points, we observed an increasing pre-intervention trend in family planning clients counseled and new family planning acceptors. The radio campaign was associated with a small non-significant decrease in family planning clients counselled in Kano immediately post-intervention compared to Jigawa. This was offset by a decrease in the trend of 0.27 fewer clients per 1,000 women per month in Kano thereafter (95% CI: 0.10-0.44), meaning the effects were not sustained. Similarly, new family planning acceptors increased by 1.62 (95%CI: 0.12 to 3.12) in Kano relative to Jigawa. This effect was also offset by a relative decline in the trend of 0.29 per 1,000 fewer women per month (95% CI: 0.22 - 0.36). The introduction of a radio-based campaign in Kano, Nigeria had no long-term effect on contraception seeking at health facilities. Alternative strategies are needed to increase contraception service use in Nigeria and similar contexts.