In Senegalese culture, theater serves as a bridge between education and entertainment. Historically, theater has been used to disseminate information, share a story or educate people about events in and around their communities. Theater is considered a powerful tool for social change since it uses spoken word to reach all members of the community—even the illiterate. Theater engages its audience and raises community awareness in a relaxed and comfortable manner.
The 2011 baseline survey conducted at the household level by L’Initiative Sénégalaise de Santé Urbaine (ISSU) and the Measurement, Learning & Evaluation (MLE) Project on the provision of services in family planning in Senegal’s urban centers of Dakar, Guédawaye, Pikine, Mbao, Mbour and Kaolack showed that nearly all women (approximately 98 percent) were aware of at least one family planning method. However, only 12 to 20 percent of women currently use a modern method of contraception. Socio-cultural factors influence the use of contraceptive methods in Senegal among women who are aware of family planning methods. To change perceptions and address socio-cultural obstacles to family planning use, the ISSU project developed a variety of approaches, including community theater productions.
Though all staff undergo pre- and in-service training to update their family planning knowledge, many still do not possess the skills to provide family planning counseling and services. These health providers were paired with skilled providers who serve as mentors in order to ensure that facility staff becomes competent and proficient in the provision of family planning – especially in providing long-acting and permanent methods (LAPMs). Mentors work collaboratively with health facilities and mentees to schedule family planning mentorship activities based on facility needs. With mentees, they review family planning knowledge, practice clinical skills on humanistic models, conduct clinical demonstrations, practice clinical skills on humanistic models and supervise family planning provision to actual clients. This one-on-one instruction includes how to counsel clients on family planning and how to determine a client’s medical eligibility criteria.
The mentoring curriculum is standardized through a reproductive health learning guide and classroom-based training. Thus far, 110 of the 424 providers who entered the program have successfully completed it, resulting in 110 more providers who are now able to offer full family planning counseling and services.
Niches are interactive plays performed by community theater troops that have experience addressing important health issues previously identified by local health districts and through the ISSU baseline survey. ISSU project staff collaborate with health educators, providers, district health teams and theater troops to develop scripts which address these issues. Central themes include family planning, healthy timing and spacing of pregnancies and partner communication, and they are accompanied by subthemes including:
- Economic considerations such as education, health, housing and nutrition in families that grow too quickly
- Religious concerns linked to family planning
- Family planning myths and misconceptions
- The temporary nature and management of side effects from contraceptive methods
- Risks related to poorly spaced pregnancies
Actors in the niches typically represent key figures in Senegalese culture such as husbands who oppose family planning, wives who have too many children and are currently pregnant, mothers-in-law who want many grandchildren because of the gifts they will receive and religious leaders who are in favor of family planning.
Niches allow audience members to be both spectators and actors. In each scenario, the audience is invited to go on stage to give feedback, replay parts they enjoyed or even rewrite scripts to illustrate other emerging themes based on the dialogue. This interactive approach addresses family planning barriers directly. The play format offers opportunities for group reflection, facilitates individual and group decision-making and promotes family planning decision-making through group question and answer sessions and discussions related to the niche’s theme.
Given the niches’ wide acceptance and positive feedback, as well as the popularity of similar formats already on television and radio, ISSU aims to expand niches to a wider mass media channels to expand the reach and impact of positive family planning messages.
This story was originally written by the Measurement, Learning & Evaluation Project, which evaluated the Urban Reproductive Health Initiatives (UHRIs) in Kenya, Senegal, Nigeria and India. The Challenge Initiative is charged with expanding access to the proven solutions and successes developed under the UHRIs.