Guest lecturer William Ryerson is President of the Population Media Center which produces radio and TV serial dramas in developing countries that aim to effect behavior change on women's status, family planning and AIDS. Working with governments and in-country media professionals, these melodramas run for hundreds of episodes and are watched by millions. Careful research shows major changes in audience knowledge, attitudes and practices.
Rogers, Vaughan, Rao Swalehe and Sood Svenkerud. "Effects of an Entertainment-Education Radio Soap Opera of Family Planning Behavior in Tanzania." Studies in Family Planning, no. 30 (1999), pp. 193-211
April 16, 2009
Professor Robert Wyman: Today we're enjoying the first beautiful day in quite some time. Today we're very pleased to have William Ryerson as our guest speaker and he is President of the Population Media Center, which by the end of the lecture period you will know what that is. He graduated from Amherst College and then he became one of us. He was a graduate student at Yale studying entomology, the ecology of insects. In that field people seem to realize that humans are pushing even the insects out of existence, so he then became interested in the human aspects of ecological and population kind of things.
Thirty-three years ago he started working in the field of reproductive health. Then after, I guess 15 years, in that he started being involved with a group that was making TV programs and radio dramas in developing countries and that are on social issues of things that are troubling the societies in which they're shown to. Eventually he founded this group, The Population Media Center, and is both the founder and the President of PMC.
These soap operas are different than the kind of soap operas that we're used to in America. Their purpose is to explore this social change and deal with the issues that are of great currency for developing countries where the cultures are changing rapidly in one direction or another, or not changing rapidly as the case may be. One of the big foci is women's reproductive issues, population issues, HIV issues, child bride issues, all the kinds of--a lot of the ones that we've been talking about in the class.
What's nice about him, and due to his Yale training of course, is that both in the design of these programs, he uses really good academic research, what's really known about social change and the induction of social change, they just don't go off and be artsy-fartsy about anything. They really study what is the successful way of doing this. Not only that, then there's really three stages of professionalism. One, understanding the academic stuff so you know what you're doing, then getting the very best people in whatever country you're working in, the real good actors, the major producers, and groups that really know what they're doing in terms of entertainment and that leads to great success, which he'll describe.
Then further, the third step, is once you've done it, did it work, and that's the real serious research, finding out if you've done something. You're hoping to incorporate some sort of social change, well did it work? That's not easy, but again Bill's group has used the most careful and stringent academic research to try to get at that issue.
These programs have turned out to be very popular successes and you will hear about that and they have indeed been successful in fostering social change. I put Bill into the category of 'people who have made a difference.' This is not a huge category, and so I'm very proud--to introduce him to you.
William Ryerson: Bob, thank you very much, pleasure to be with you. As Bob said, I started my career here at Yale as a graduate student in ecology and evolution, and it was just 40 years ago last October that I sat in the audience at the Forestry School and heard Paul Ehrlich talk about his then recently published book, The Population Bomb. He had been invited to give that lecture by Charles Remington who founded this course, and who was, along with Paul and an attorney from Connecticut named--whatever his name was, an attorney from Connecticut, along with Paul and Charlie Remington, founded Zero Population Growth immediately after the lecture that Paul gave.
I had dinner with Paul at Remington's house that night, got very interested in--Dick Bowers was the attorney's name. I knew it would come to me sooner or later when those synapses connected. --I had dinner with Ehrlich at Remington's house that night, took a huge interest in this issue, which of course continues to this day.
We're growing by the equivalent of a new Egypt every year on a global level, about 82 million net growth and the environmental impact of that growth is immense. I began, at that point, to think about how to address population issues, how to try to bring about a slowing of population growth rates, and how to also ameliorate the impact of humans on the planet. The conventional wisdom at the time was to set up family planning clinics, which indeed was a good idea. A lot of that happened, particularly in the 1970s with strong financial support and leadership from the U.S. Government, something that changed over the last few decades but is coming back into popularity with the new administration.
Indeed, what became evident, even in the 1970s, was that the solution was not just the medical model, setting up family planning clinics. Indeed, there was a need to get people to use them. There was great progress made, particularly in the 1970s in meeting the already existing demand, so we went from 10% of the world's couples using modern methods of contraception in 1960 to somewhere in the 40% in the late 1970s and then since then it has crept up to 55% of adult couples using modern methods. The 45% non-users, however, outnumber the 90% non-users of 1960 because of population growth.
We have as big a problem ahead of us as we did in 1960, but we also have another problem, which is the reasons that they give for non-use. Back in the early 1960s the primary reason was lack of access to contraceptive methods. Now, in country after country, it's less than 2% who give that as their reason, and the number one reason is wanting more children; that is, the bulk of the non-users of contraception. When you take them out, maybe 200 million couples, there is another 100 million that are not using contraception but don't want an additional pregnancy, at least not in the next two years, which is the standard question that's asked in demographic and health surveys.
The top four reasons they give for their non-use are fear of side effects, they've heard its dangerous, male opposition, religious opposition, and fatalism. Now a couple of stories about these; fear of side effects is something that indeed has been intentionally planted by some religious zealots who are spreading rumors, particularly around east Africa, that condoms contain the AIDS virus, so people are actually dying because of this misinformation. They're afraid of using condoms, they have heard that they contain the HIV virus, and so they're having unprotected sex and getting AIDS and dying. It's really a criminal misinformation campaign motivated by people who just think artificial methods of contraception are not a good idea for theological reasons that most of their victims don't understand, and, for that matter, that I don't understand but I've tried.
Male opposition is in part--male opposition, and it's in part lack of communication between husbands and wives. So, sometimes, in traditional societies, women think their husbands are opposed, but they've never had a conversation about it in their married life because this is something that they're embarrassed to bring up. Fatalism is the subject of a very interesting paper by Etienne Van Der Walt.
Professor Robert Wyman: They've read it.
William Ryerson: Oh, you've read it. Okay so you know about fatalism and beliefs that whatever God has decided for you must be fine without any idea that you have the right and the ability to determine--your own outcomes of your family life. Then religious opposition, when I say this in the mass media I always draw a lot of fire, but there is no religion that is opposed to family planning. You may have heard otherwise.
There are religions, like the Catholic Church and some conservative mullahs in Islam, who are opposed to certain methods of family planning, but there is no religion that is preaching that everybody should have as many children as possible. Indeed, the Catholic Church is in favor of people limiting their childbearing to those they can afford to care for and love. The issue is what methods are appropriate and certainly we know from Catholic teachings that methods that are considered artificial are not approved. But, indeed, the church goes to great lengths to teach what we used to call the rhythm method, periodic abstinence as a way of avoiding unwanted or unplanned pregnancy.
In the world of Islam there are liberal thinkers who are Islamic scholars, like Kutbuddin Aziz of Pakistan, who have written that the Koran, by calling on women to breastfeed their infants for at least two years, is inherently endorsing family planning. The Koran doesn't mention family planning, but by asking that women breastfeed their infants for two years in low nutrition societies, this means the woman must avoid pregnancy.
So there are in fact official findings at Al-Iman University to that effect. Some Muslim countries are making huge strides in adopting family planning, the leading one being Iran, which is now down at replacement level fertility. In part, driven by the Ayatollah's in that country who are promoting family use. In Pakistan now, the mosques are handing out contraception. So there's a dramatic change going on in the world of Islam.
Having been in the population field for a long time, I happened to go to the first World Population Conference. By the way, I got involved with Ehrlich and Remington and starting a Yale Chapter of Zero Population Growth, it no longer exists, and ended up on the National Executive Committee of that organization. I went to work with The Population Institute in Washington, an organization which I now also am President of, as of six months ago, just to keep me from running out of things to do.
At this first world conference on population, held in Bucharest in 1974, I took 65 students and 20 faculty members from around the U.S. to cover this event for newspapers across the U.S. Each of the students was accredited with a particular newspaper and they all went as reporters, and they filed daily reports, and it literally generated hundreds of news articles about this conference.
Margaret Mead happened to be at this conference, as did a colleague of mine from the institute, David Poindexter who now is the Honorary Chair of Population Media Center. The two of them looked at the proposed plan of action that the U.N. had put together and found that there was no reference to the status of women. So, they sat down and wrote a paragraph about the status of women and took it to Phil Claxton, who was the head of the U.S. delegation, a staff member of the State Department Under Secretary General--I mean Under Secretary of State Department on Population Affairs. They said, 'Phil, the plan of action says nothing about the status of women, so we've written a paragraph, could you please introduce this in the planning session of the intergovernmental meeting?' He said, 'Well this is a meeting about family planning, what's the status of women got to do with it?'
By 1994, the most recent U.N. Conference, which I also attended, the world had come to recognize that the status of women is central to everything having to do not only with population but with economic development. If you educate daughters, you educate the families of the future, whereas, if you educate a man, you educate a man. There is a huge need to change the bias among many people around the world that their daughter's place is in the kitchen, or for sale to some man in a polygamous marriage, and their son's place is in school. Indeed, promoting behavior change in that area, and the human rights of women to play an equal role with their husbands in making decisions about family life is critically important.
Now the first real interest I took in the population field, after hearing Ehrlich's talk about the ecological impact of human encroachment on the wild lands of the planet, and the threat to biodiversity, was the impact of different age structures of human populations on economic welfare. There is a Princeton--now deceased Princeton demographer and economist named Ainsley Cole, who did a lot of work in this area and I wrote--a paper at the Forestry School about his studies of the dependency ratios that grow from different age structures.
That is to say, the number of non-working children per working adult, and in very large family societies, i.e., rapid population growth countries, which are mostly low income, people spend a very high percentage of their income on immediate survival needs of their children, food, housing, and clothing. When they reduce family size, even without any change in family income, there's money left over and that money can be spent on elective goods which stimulates the manufacturing sector.
It can be invested in education, it can be invested through the government and infrastructure, both of those build economic productivity. Most important, it can be saved and put into investments or just savings accounts that builds capital that allows businesses to borrow money and grow, building employment. Indeed, it's the lack of capital in many poor, rapid population growth, countries that is keeping business from expanding and that, as a result, is leading to economic stagnation.
When you look at the history of the countries that have gone from developing status to developed status since World War II, South Korea, Japan, Hong Kong, Singapore, Taiwan, The Bahamas, and Barbados, each of those countries first instituted strong voluntary family planning programs and then their economies took off. Because once the fertility rate got down below about 2.3 money was left over, capital was formed, businesses expanded, and some of the Asian tigers, China being the lead among them, now are undergoing rapid economic growth for the same reason. Obviously, economic policies and various other factors affect this but demographics are a key aspect of economic welfare.
Infrastructure is also, as I mentioned, a key issue for economic productivity. If you don't have roads to get your crops or products to market, you don't have airports, you don't have clean water, and a lot of other things that public infrastructure consists of, number one being education, schools for the upcoming generations, then your economy is going to falter. The average developing country spends $13,000 for public infrastructure: schools, roads, municipal offices, water, sewer, etc., electricity over the lifetime of each person, so a per capita expenditure of $13,000.
When you multiply $13,000 times the net growth of the world's population every year of 82 million, what do you get? Have you done that in your head already? Its a trillion dollars a year. The price tag just to keep per capita infrastructure even in countries around the developing world is a trillion dollars a year. They are coming nowhere near making this expenditure, they can't; they don't have that kind of money, in part because of economic stagnation.
That is being aggravated by rural to urban migration and so you see urban centers in developing countries where the urban infrastructure is totally overwhelmed. I was in Kinshasa a year and a half ago, in Democratic Republic of the Congo, and that's a city that has infrastructure designed to handle 600,000 people with ten million people living there. In fact, hundreds of thousands of people are sleeping on open ground; they just have no place to sleep. The city floods every time it rains. There's inadequate sewage protection--or sewage treatment.
And the nuclear power plant that the Belgians, in their wisdom, put in before they left, is sitting at the edge of an erosion zone. They don't have the money to stop it so the plant is in danger of falling over. The environmental advisor to the governor of Kinshasa state, who met my plane, said he's been trying to--he and the governor have been trying to get the President of the country to shut the nuclear power plant down because, if it falls over, it's going to make the whole area, including Brazzaville across the river, uninhabitable for thousands of years. But, the President won't shut it down because he wants to get enough nuclear by-product to build a bomb so he can bomb Rwanda, because Rwanda has troops operating in eastern Congo, which I visited. I was in Goma about a little less than a year ago and I thought Kinshasa was bad until I got to Goma. Goma is where the fighting has been going on recently in North Kivu Province.
Now when you see these extreme examples of lack of infrastructure you realize this analysis by Ainsley Cole was really prophetic.
Now the environmental impacts that Paul Ehrlich talked about have gone way beyond loss of wild lands and threat to biodiversity. In fact, one of the biggest environmental threats, right now, is pumping out water from underground aquifers, 80% of which is used for irrigation. In China, in India, in the American Southwest, in every continent on the planet, because of our growing population and the demand for food, which you may have noticed went up in price recently, the farmers of the world are pumping out the underground aquifers at rates higher than the rate of replacement by rainwater.
This is a classic example of something that's not sustainable. It's like taking money out of the bank to pay for your daily living expenses. You can only do that so long. The water table in India is dropping by ten feet a year. A thousand farmers of India a couple of weeks ago committed mass suicide. They are having crop failures as they can no longer drill deep enough to reach the water. India's green revolution, which bought India maybe 30 years of time, according to Norman Borlaug who won the Nobel Prize for his research on high-yield wheat and rice, and by the way, who is a member of our program advisory board.
The green revolution crops are dependent on high volumes of water for irrigation and cheap oil. Not only to run the tractors but to make pesticides and fertilizer, to keep these crops growing, and in fact there's an article in The New York Times within the last week about the coming failure of the green revolution crops of India, but every country, or at least every continent, is facing this problem.
The yellow river in China does not reach the ocean two-thirds of the year because it's all being used for irrigation. What is keeping the rivers of India and China flowing periodically is the melting of the Himalayan glaciers that occurrs seasonally and waters those lands. However, with climate change, we're losing the glaciers and when they disappear, which will be in this century at the rate things are going and probably in the next three decades, that combined with inability to find any more underground water will lead to traumatic crises with regard to food in Asia. And, for that matter, the same thing is happening in Africa and we're losing farmland in the American Southwest with the same process going on.
This is a crisis in the making of global proportions combined with climate change which is causing rainfall patterns to change, and in some places rainfall to decrease. Climate change is indeed the very visible example of why our current pattern is unsustainable. We are already above 350 ppm in the atmosphere of carbon dioxide. That means, even if we stop driving cars and stop heating with oil tomorrow, and we burn no more fossil fuels of any kind, we are already going to have devastating climate change.
The arguments going on in the halls of Congress are, can we reduce the rate of increase, or can we maybe become so efficient that we level off or slightly decrease our rates of greenhouse gas output? This is like arguing over which deck chairs to sit in on the Titanic. Unless we actually stop producing greenhouse gases and find technology to withdraw carbon dioxide and methane from the atmosphere, the climate is going over a cliff this century. Now, don't slit your wrists, there are things we can do.
We have the technology to solve a lot of these problems and, indeed, the population issue is a clear cut example. Population, by the way, is a climate issue. How many children you have is a climate related decision because if, as an American, Americans have the highest per capita output of greenhouse gas, you have two children each of whom consume 10% less than you do, you're still creating an impact on the environment. If you have three children, you and your partner or spouse are more than replacing yourselves, and you're having a potentially devastating impact on the environment if a lot people make the same decision.
Decisions on reducing family size, in developed countries in particular, are the least expensive intervention we can make to reduce impact on the climate. Even in the developing world, where population growth is occurring the fastest, the rather optimistic median projection of the United Nations between now and 2050 is the addition of 2.5 billion people. That's eight times the U.S. population. At the rates of greenhouse gas output, on a per capita level, it's the carbon equivalent of adding two United States to the planet. If we don't solve the population problem, we're not going to solve the climate crisis either, so there are a whole bunch of things facing us.
Now how do we address all of these behavioral things, including the behavior of Americans? Well clearly the mass media is influential. Is there anybody here who's never watched television? No, now when I grew up we did not have a television. They existed, but my parents thought they were a bad idea, and they may have been right, I don't know. We went over to our friend's house and watched TV, but indeed, we listened to radio programs and in many of the developing world countries, people still spend their evenings listening to the radio because they can't afford TVs.
In Ethiopia only 4% of the population can afford a television, but radio is listened to by a vast majority of the population. In our programs we use primarily radio, although this methodology that I'm going to tell you about came out of the world of television. These are the countries in which we have been working.
We do long running serialized dramas, sometimes referred to as soap operas, in which characters evolve into role models for the audience for elevation of women's status, daughter education, use of family planning, small family norms. We're looking at the idea of applying this strategy in the United States to address climate issues and teenage pregnancy issues. We also do talk shows. We've produced print materials, but it is the entertainment serialized dramas that are on primetime in these countries, where we have the largest audiences, and therefore have the biggest potential for impact.
The creator of this methodology is a Mexican producer named Miguel Sabido who was Vice President of the biggest commercial network in Mexico, Televisa, until his retirement in 1998. In 1975, after looking at the social learning theory of Stanford psychologist Albert Bandura, who still is looking at how role models influence behavior psychologically, still is teaching at Stanford, and is probably the world's best known psychologist and is the most frequently cited psychologist in professional journal articles of those who are living. He [Sabido] went up to actually interview Bandura and went back to Mexico to create a program to promote adult education.
He realized, from his work in overseeing the audience research division of the network, that his programs were having a huge impact on audience members, so why not use them for good. He created a soap opera with three subplots, one of which had illiterate characters in it and the other two just were pure entertainment with changes of fortune, and cliffhangers at the end of each episode, and all the stuff that goes along with a soap opera. They were on at primetime, or this program was on at primetime, it was called Ven Conmigo, and it pulled in 33% of the nation's viewers.
You know, melodrama is defined as the battle of good versus evil, so the evil characters were telling the illiterate characters that they were too old or too stupid to learn and they should forget about that and stick with what they had. The positive characters are saying there's a whole infrastructure for adult education, you ought to give it a try, and you can master it, you're not stupid. One by one these illiterate characters decided to go to classes, sign up and take the courses, and get their diplomas, and when they did so their lives improved and this huge audience witnessed this.
Sabido then became intentional in promoting this and he ran an epilogue in which he gave addresses of registration sites for adult education. This epilogue followed the episode in which his most popular character got his diploma and it--I don't speak Spanish and I broke down in tears when I watched this episode because it's so emotional, this man crying, holding his diploma because finally he can read all the letters he's gotten over the years from his granddaughter, and then there's this epilogue. ‘Perhaps you too would like to do what this man has done,'
Sabido warned the Ministry of Public Education. He said, 'You may be aware of the show I'm doing on Televisa,' and they said, 'yes we like it very much, and it's reinforcing our public service announcements.' He said, 'Well I may generate a crowd because I'm going to run an advertisement after an upcoming episode in which I give addresses of your registration sites. Can you handle a crowd?' They said 'No problem. Last year before your program started we signed up 99,000 people so we're set up to handle large numbers,' so he ran that episode and the following day, in a single day, 250,000 people came in to try to register and he continued to run epilogues for the remaining weeks of that 260 episode program. By the time it was done 840,000 people had signed up for adult education.
Then he did a program called Acompáñame, Come With Me, that promoted family planning, as a solution to a problem of family harmony which is a perfect subject for a melodrama; a couple arguing over how many children to have and how to stay out of poverty and so on and they ultimately adopt a method of family planning and they live happily ever after. [It had a] similar impact on family planning use and it was during that program that David Poindexter, my colleague at Population Institute, discovered Sabido doing this program in 1976.
He did two things, he convinced Emilio Azcárraga who owned Televisa to have Sabido do four more telenovelas dealing with teenage pregnancy prevention and family planning promotion, and he took Sabido to meet Indira Gandhi in India. I had been in India in 1975 when she imposed involuntary sterilization around the country and it caused the family planning efforts in India to collapse, and she lost the next election as she should have. It was a total mess.
She was very concerned about India's population problem but she didn't try the right strategy and ultimately she got re-elected and before her assassination, Sabido was sitting in front of her saying, you don't need to use coercion, you can role model this, show people the benefits and they'll decide for themselves whether to do it. They ended up being sent to the head of the Indian Television Authority. Sabido trained a writer, Manohar Shyam Joshi who did India's first home grown soap opera which had huge impacts. it's the subject of a book called, India's Information Revolution.
It pulled in between 65% and 90% of anybody who had access to TV. It generated 400,000 letters from viewers to the Indian Television Authority, half of them addressed to characters by name, with advice on who they should marry and so on, but a lot of testimonials on how the program was impacting the audience members. I got very interested in this strategy and got involved in studying the second Indian soap opera, which had huge effects on its 230 million viewers with regard to attitudes about age of married women and acceptability of women in the workplace outside the home.
One of the reasons this strategy has been so effective, where it's been tried around the world, is the long running nature of the program. Because you can't get somebody from say the status of a woman in Sudan to Gloria Steinem with a 60 second public service announcement or with a one hour drama, you really need time to bring about meaningful change without creating backlash. By having gradual evolution of the transitional characters and only in response to situations that the audience understands and themselves are experiencing, can you bring about meaningful change.
The emotional content of melodrama is also very important for helping people remember what they learned from the programs, as well as remembering the program itself. Do you remember what you were doing on the morning of September 11, 2001? Do you remember as clearly what you were doing on the morning of September 10? Now what psychologists tell us is that emotional involvement enhances memory. So, if you're highly involved emotionally, in an emotionally based melodrama and you learn lessons from it, you remember those for the rest of your life. But if it's intellectual blah, blah, blah it may last not much longer than the final exam, and I'm probably guilty of that myself.
There are several other theories that Sabido incorporated into a theoretical framework, both psychological and communication theories for the creation of this methodology. I'm not going to take the time now to talk about them but they're very interesting, and I recommend you download this free book from our website that has those theories spelled out as well as examples of this strategy as it's been applied around the world. Thato Ratsebe, [Botswana] who is now working for Population Media Center--she is flying to Nairobi today.
In Tanzania, in 1993, I took Everett Rodgers, who was then Associate Dean of the Annenberg School of Communications at the University of Southern California, and a research design scientist from Minneapolis named Peter Vaughn to help design an experimental evaluation to measure the effects of a Sabido style radio serial. It was the second one done in Africa and it was broadcast with this pattern. You can see the transmitting towers, the dots, and the shaded areas around them are where you could hear the signal, but we intentionally chose early primetime when the tower in Dodoma was broadcasting locally produced music with no social or health content.
Twice a week, for two years, a 208 episode program, people in the shaded areas heard Twende Na Wakati, Let's Go With The Times or Let's Be Modern, while in the control area they heard music. Among the characters in this program was a negative character named Mkwaju. He was an alcoholic truck driver with a girlfriend at every truck stop and a subservient wife named Tunu waiting at home. He was, in Tanzanian society, every man's ideal. This guy was a sexual athlete, he was having a wonderful time, he had girlfriends everywhere draping over him at every truck stop, and so it attracted a huge male following, more men than women in this audience, but overall 58% of the adult population listening.
Much to Mkwaju's surprise, he found he was married to a transitional character. And Tunu, perhaps having read some of the thousands of letters addressed to her coming into radio Tanzania advising her that her husband was cheating on her, stood up to him when he was home on one of his visits and told him she had heard about the AIDS epidemic. She knew what he was up to on the road and he was going to have to use condoms, and she made that happen. She eventually took a job and ultimately she founded her own business and became a role model for female entrepreneurship in Tanzania.
Now if you're a scriptwriter you probably figured out Mkwaju becomes sick, for some time the audience doesn't know what has affected him, but they find out he now has AIDS and Tunu throws him out, but ultimately takes him back and cares for him in a separate bedroom until he dies.
The audience learned a few lessons out of this. We did a nationwide, random sample survey of 2,750 people annually, starting with a baseline just before going on the air and then repeated annually for four years 1993, 1994, 1995, 1996 and 1997. From 1993 to 1995 this was the pattern of broadcasting. From 1995 to 1997 we broadcast the program in Dodoma, so we were able to measure in broadcast areas and non-broadcast areas what was going on with regard to self reported knowledge, attitudes and behavior.
I also got the Ministry of Health to ask new family planning adopters why they had come to the clinics. Now in the survey at the end of year two, 58% of the adult population listening, 82% of the listeners said the program had caused them to change their behavior to avoid HIV infection. We were astounded by how high an impact it was.
The most common change people said they had made was reduction in the number of sexual partners. We didn't have the budget to hire enough private detectives to verify those claims, but we got the condom distribution data from the National AIDS Control Program broken down by district, and in the districts that made up the control area, where they got all the national programs about AIDS, except for this soap opera, there was a 16% increase in condom and distribution, while in the broadcast areas there was 153% increase in condom distribution.
Now when we took all of the reported behavior changes across the country and extrapolated it to wherever you could hear this program, the cost per person who changed behavior to avoid HIV infection was $0.08 U.S. On family planning we saw a 10% increase in the number of family planning adopters in the initial broadcast areas and zero change in the control area around the Dodoma transmitter.
When we broadcast the program in Dodoma, the following two years we had a 16% increase in family planning adoption. And in both areas, at the times the broadcasts were on the air in those areas, 41% of the new adopters named the program as their reason for coming in. The next most impactful intervention was named by 11%, so a 4:1 ratio of effects between this soap opera and the next most impactful intervention.
Now it was right after seeing this data that I started Population Media Center and I took Rose Haji, who produced the Tanzanian program, Tom Kazungu who was the first African trained by Sabido and the first radio person to use it, and Sabido himself to Ethiopia. We trained a team of writers to produce two programs, one in Amharic, the national language which was 257 episodes long and the second one 140 episodes in Oromiffa, the second most common language, and those were on the air for two and a half years starting in June of 2002.
The Amharic program was listened to by 47% of men, 45% of women. The Oromiffa program pulled in another 25% of the population, so we had well over 40 million people listening to this program. It became the subject of daily conversations, as well as thousands of letters; 15,000 poured into our office in Addis Ababa during the time these programs were on the air. Most of them in response to the Amharic language program which had a better time slot.
One of those letters was from a woman who said she was so happy we had addressed the issue of marriage by abduction because, you may not know this, but in rural Ethiopia the status of women is so low that it's considered socially acceptable for a man to grab a girl off the street. And I mean a school girl, take her home and rape her, and then she's considered to be his wife and she's stuck with her abductor for the rest of her life. And parent's won't take the daughters back because they're damaged goods and it would bring shame on the family. So they leave the girls with these abductors.
Now this is starting to change and courts are starting to allow these women to escape. We dealt with this in this very popular program and this letter said, 'Thank you so much for dealing with the issue of marriage by abduction through your character Wubahn. Our own daughter was abducted on her way to school at age 14 and ended up married as a result and we've been afraid to send our 12 year old girls to school for fear the same thing would happen to them. When your program played and dealt with this issue the entire village which had listened to it, came together, and we agreed to enforce the law against marriage by abduction and it's now safe to send our 12 year old girls to school.'
This is the kind of qualitative information we got from those letters. We also had listening groups that filled out diaries after each episode and periodic focus group discussions for feedback to the writers, and monitoring through 14,400 exit interviews at reproductive health clinics to ask people why they had come, and a baseline and post-broadcast quantitative survey across the country. At the 48 clinics where those 14,000 exit interviews were carried out, 63% of the new reproductive health clients were listening to the program or one of the programs, and over a fourth of the new clients cited one of the programs as the primary motivator for seeking services.
Radio Ethiopia has 100% public service broadcasting and a lot of programs dealing with AIDS and family planning. Of all the people who named Radio Ethiopia or other radio programs, 96% named one of our programs, 4% named any of the other programs on the radio as their source of motivation. This shows increase in use of family planning from baseline to non-listeners to listeners, the increase among the listeners was more than double the increase among non-listeners and highly statistically significant. Some of the non-listeners were clearly motivated through conversations with listeners.
Now this is a decrease in not knowing how to determine ones HIV status and this is actual reporting of going for HIV testing: male listeners sought HIV tests at four times the rate of non-listeners; female listeners sought tests at three times the rate of non-listeners.
Now we've done similar work in these countries. In Vietnam we're currently on the air with a program dealing with HIV/Aids on The Voice of Vietnam. In West Africa we did a program dealing with child slavery. It was actually something that was brought about through a request by Ben & Jerry's and funding from them to get started and then funding from the U.S. Government. We measured a quintupling of awareness among listeners of the problem of child trafficking/child slavery and a doubling of interventions by listeners to stop the practice.
We've just gone on the air in Mali with a program promoting family planning. We've done two programs in Nigeria, the first one was at the request of the Rotarian Action Group on Population and Development that was setting up a surgery to offer repair for women who have obstetric fistula, something that results from the daughter's in northern Nigeria being married off at age 9 and getting pregnant at age 12, and trying to deliver with an immature pelvis and having obstructed labor, and ending up somewhat torn to shreds and incontinent.
These girls married to older men in polygamous marriages generally then get thrown out on the street and live as beggars, and the Rotary Clubs of northern Nigeria set up a surgical center to repair them because, for $300, these women can be returned to a normal life. If they are unrepaired, they're incontinent and they live on the streets, and they smell bad, and they're social pariahs. In fact, there are 800,000 women in Nigeria with unrepaired fistulas.
We were able to measure, by promoting family planning, and delaying marriage and childbearing to adulthood, a third of the women coming to family planning clinics named our program as their reason for coming, and 54% of the women coming for surgical repair named the program as the reason they were at the clinic. The second program, that's on the air currently, is being named by 67% of family planning adopters as their motivation for seeking services.
In Rwanda, currently 57% of family planning clients and 59% of HIV testing clients name our program as their motivation for coming to the clinic. We're also using the program to promote preservation of mountain gorilla habitat, and more generally, wilderness areas in Rwanda. In Sudan, the program addressed the issue of female genital mutilation. Opposition to FGM in Sudan at the time that program was on the air went from 28% to 65% by the end of the program. In Niger we dealt with child trafficking also and in Senegal we've just gone on the air with two programs in two different languages.
In the U.S. we're working with the Hollywood community, in partnership with the Academy of Television Arts & Sciences and the Screenwriter's Guild of America. We've done two briefings for members of the Screenwriter's Guild, the most recent one on climate, population, health and security issues, we held in Hollywood in November and the one before that about a year and a half ago at Emory School of Public Health looking at the role of entertainment television and addressing public health issues.
These are countries in which we are developing projects. I was in Papua, New Guinea and Uganda in the development of new projects in the last two months, but we have projects in various stages of development in each of these countries.
Now how are we on time? Why don't I take just a few minutes and show you, if I can make this work, a clip from a documentary done by a CNN Vice President for Environment, no longer with CNN but she was head of Environment for CNN and Turner Broadcasting. A woman named Barbara Pile who did a documentary on this idea of social content soap operas in the Philippines where Cecil Alvarez produced a program.
I'm not sure if I'm going to be able to put this on full screen but let's see. This is a documentary about this Philippine program introduced by Jane Fonda and then the documentary is by Barbara Pile. The storyline is about two sisters, one of whom elopes at I think the age of 16 and has a baby every year trying to please her husband who wants a son and it's a tragedy
[video clip 54:25-1:01:50]
Well that fixed that. Are there lights? Thank you. That's a half hour documentary but you saw the part about it that is on that soap opera, and I guess with that I thank you for your attention and I'd be happy to take questions. Are there any questions or comments?
Professor Robert Wyman: What happened that there's so--in America you have a soap opera once a week for an hour--
William Ryerson: Well some are daily.
Professor Robert Wyman: Some are daily?
William Ryerson: Daytime.
Professor Robert Wyman: You see those too, right? How is it that--is that the standard mood in [inaudible]?
William Ryerson: It varies all over the place. In Latin America, its daily, daytime and primetime. In many countries it's twice a week. Some are once a week, but once a week is really not adequate because you have to hold the audiences interest for a whole week waiting for the resolution of the latest cliffhanger, so we like to do a minimum of twice a week, and some of them are three times a week. Yes.
Student: If you--if you're like having a program for like two years how do you draw people in and say it's halfway through the show or a quarter ways, how do you continue to inspire the new audience?
William Ryerson: Well--
Professor Robert Wyman: Repeat the question.
William Ryerson: Okay thanks. The question was how do we deal with people who are drawn into the program halfway through a two-year soap opera? The answer is one of the beauties about having several hundred episodes is you can have a lot of discussion of what's gone on in the past by the characters, so people who join the audience partway through the two or three years that it might be on the air learn a lot about it and they also may learn about it from other members of the community.
Particularly in countries where we have very high listenership, like northern Nigeria, our most recent measure was 82% of the adult population is listening every week. There it's become a cultural event, so people who are joining it hear both about the program from their neighbors, as well as hearing characters talking about the past and getting caught up that way.
One of the questions I'm often asked and maybe I should wait until somebody asks me this question is how do we decide what it is we're promoting. In a sense, what gives us, as an American organization, the right to go into some country and tell them how to live? Indeed, one of the things that we've adopted as a strategy is looking at the policies of each country; most countries are signatories of the Cairo Program of Action on Population and Development, and of the Beijing Platform of Action on Women's Rights.
If they're a signatory of those documents then part of their national policy is incorporated in those documents which are really global agreements on the rights and status of women and reproductive health. So, we use that as a starting point as the basis for the values that will be promoted by the program. Then the policies of the country may add nuances to that, so when we go into a country, we explain to them we are there to help them promote their policies, we're not trying to impose something from the outside. Yes.
Student: Well I was going to actually ask how--do you find that you have a lot of opposition from governments or other institutions?
William Ryerson: Hardly any.
Professor Robert Wyman: Repeat.
William Ryerson: The question was do we have opposition from governments? One of the things about this strategy is, because we're working to support the government's policies, they are very enthusiastic about it. Second, we get very little opposition from the public because of the very gradual evolution of the characters and because, by doing our homework and really understanding the culture before we ever get started, and having writers from that culture, all of our programs are written, produced, and managed by country nationals. We know what the taboos are and we steer clear of those, so we're not there to give people shock therapy, we're there to start where they are and move in the direction of better reproductive health and women's rights. We don't do it in a way that creates backlash or opposition. Yes.
Student: The Twilight books and Seventh Heaven, shows like that, I was wondering if people say that they are--they were made to promote things like abstinence and Seventh Heaven was always doing 'don't drink, don't smoke' episodes. I'm wondering how you think they relate to the programs that you guys show?
William Ryerson: The question is, with American shows like Seventh Heaven are we--what's the comparison between their strategy for promoting not drinking and driving, or abstinence with the kinds of programs we're doing? The answer is, there is some comparison. That is, producers and writers of American Hollywood shows are members of society and they're parents and they're very aware of some of the problems, and sometimes they attempt to address issues in the context of their program.
We had Neil Bear as a speaker at an event we did at Hofstra University about a month ago who produces Law & Order and also was a producer of ER, and there are very intentional efforts to use some of these programs to promote positive goals. They tend to do so in one or a few episodes as opposed to having a program that's designed around a set of issues, so it tends to be briefer mentions of these issues and sometimes they're done well and sometimes they're not.
Indeed, there are lots of examples of entertainment shows in Hollywood like the Bold & The Beautiful addressing HIV/AIDS through a character named Tony who finds out he's HIV positive. They got an 800 number from Donna Shalala when she was Secretary of Health & Human Services that they could run after those key episodes for people to call for information. That show generated more calls to that 800 number than the 60 Minutes' treatment of HIV/AIDs and 60 Minutes has a much bigger audience, but it was the emotional impact of Days of Our Lives that generated a huge response by the audience. So, some of these have been very useful interventions, but they're quite different in terms of methodology. Yes?
Student: Do you do follow up studies and is there any evidence to show that the contraception doesn't just like--contraception doesn't just increase immediately after the show but continues years after the shows have gone off the air.
William Ryerson: There is some evidence. Of course you're asking a fundraising question. It is hard to get grants for say a ten year study, but there is some evidence. For example, with Sabido's family planning programs, they stopped addressing family planning issues at Televisa, unrelated to the controversy or not of the content. They stopped doing social content broadcasting at Televisa in 1985, and the birthrate had come down dramatically. It was the most dramatic decline in birthrates of any developing country in the twentieth century during the ten years Sabido's five family planning soap operas were on the air. When they stopped, the birthrate plateaued, but it did not go back up.
However, our view is because there are new generations coming along every year, and because people continue to need information on a whole range of health and social issues, these programs should be seen as a long-term intervention. We shouldn't say do a program for three years and then walk away, in the same way that we wouldn't open a clinic for three years and then close it down and hope that the birthrate wouldn't go back up. We really see this as a long term intervention, but the evidence that we have is probably not conclusive, but it appears that these programs lead to permanent change in norms. Yes?
Student: Do you ever find yourself at a competitive disadvantage to the more traditional commercial soap operas?
William Ryerson: Certainly in countries that have a mature media market like India, like Brazil, we are adopting more a strategy of working with the producers of existing programs than trying to produce our own and compete. In Brazil, for example, we're working in partnership with the social merchandising department of TV Globo, which controls 65% of the Brazilian audience. That strategy--actually their department emerged because of the partnership we formed originally through a meeting David Poindexter and I had with Roberto Murino who owned the network and it was being done through the product placement division.
But ultimately they set up a whole division to promote social causes through the telenovelas, and so we helped them do that and we measure the effects. For example, 36% of the women at Planned Parenthood clinics in Brazil were there because of one soap opera we evaluated called Paginas Da Vida, Pages of Life. It's similar to what we're doing in Hollywood. We're not--We may do a You Tube soap opera, but we're not likely to get ourselves on the air on CBS, so we're instead focusing on working with writers of existing programs. Yes?
Student: I'm curious about the range of social issues of your audiences. I mean if they're writing into the characters and addressing them by name and giving suggestions, they may not be so savvy about the media, I'm wondering if that helps or hinders your project or both?
William Ryerson: It's a question that we try to understand before we ever go on the air, what are their attitudes, perceptions of, and consumption of entertainment media. Indeed, the audience is, in terms of their sophistication and their media savvy varied dramatically from a place like Ethiopia to a place like India. There's no one generalization, but there are many stories about our experiences in Ethiopia.
For example, the actress who played the positive female role model Furkurta in that first program I was talking about, went into a vegetable market and women recognized her voice from the radio show, and one of them said you're Furkurta and she said, well not really, and they said no, no, no we know you're Furkurta, we recognize you from Yeken Kignit, and one of them said, I named my baby daughter after you in hopes that she would be as wonderful as you are.
Clearly there--they are not seeing the distinction between fantasy and reality, but on the other hand, how many times have you heard this about American audiences? It's hard to know really, but clearly, probably the lack of sophistication leads to greater influence of the programs but it's hard to know. One more question.
Student: How do you feel applying those models to other social issues such as environmental degradation? Because it--I mean family planning is really based on family relationships and how people relate to each other and how do you see--I guess how do you--what's your belief of what the success rate of these programs will be--if it's more on environment issues or other type of social justices?
William Ryerson: The question is how do we feel about applying the strategy to other issues like environment as opposed to family life and family planning issues? The answer is we feel great about it, however, you point out it might not be the most exciting soap opera to do a soap opera on recycling, so it doesn't have the same sex appeal or audience appeal as a program about people's lives, so we mix issues and we like to do programs about life in the country.
In the eastern Caribbean, the nine countries where we're broadcasting a program, that program is addressing both family planning and preservation of the rain forests of the eastern Caribbean. In Rwanda, similarly. We're planning a program in Papua New Guinea that will address conservation of marine resources and family planning. Clearly, family life issues are a perfect subject for melodrama. You have to be very careful how much conservation kinds of content you put into a program, but indeed, you can have the life of a village in a soap opera, and for example, in Papua, New Guinea one of the fishing practices that is clearly a short term strategy is to use dynamite to blow up the reef and it stuns all the fish and they can scoop them out of the ocean.
That's not a sustainable livelihood, so we can demonstrate that through a two year soap opera in a way that might take many more years and be devastating to the marine environment if it--if people just wait until they're starving. The point is well taken, it's something where we have to be careful not to overload it with messages and boring information, it really has to remain an exciting program or we'll lose our audience. Well I think we better call it quits because we're past adjournment time. I thank you all very much.
[end of transcript]