Using social diffusion approaches to increase family planning use in Rwanda: Experience and evaluation of the ‘Each One Invites 3' Campaign

Social diffusion can play important roles in spreading health information and ideas, depending on trusted individuals to diffuse information through their social networks. The ‘Each One Invites Three' campaign hypothesized that distribution of invitation cards by family planning (FP) users to their non-using friends would reduce cultural and gender bias and increase FP awareness and ultimately use. A successful, women-centered campaign in Madagascar was adapted to Rwanda in 2011/2012: Women and men not using FP were targeted. Community Health Workers (CHWs) and community association members favorable to FP acted as distributors to non-FP using clients and friends. Invitation cards included scenarios of men inviting men and women inviting women to visit local health agents. Implemented in two districts over a six-month period, the campaign was evaluated using time series analysis of service statistics in target and comparison districts, comparing new FP user rates six months prior to the campaign, to uptake during the campaign period. Results showed a greater increase in numbers of new FP users in the targeted districts than in comparison districts. Post-campaign interviews with a sample of health agents, association leaders, and community women and men, to understand perceptions of change due to the campaign, indicated that men and men's associations were energized to be involved in FP efforts with their peers. Health care providers and community health agents reported that those coming for FP with invitation cards were more sensitized to FP issues than clients who had not been reached by the campaign.