Pop Planning--The Center for Communication Programs Mike Field ------------------ Staff Writer In Peru, women tap their forefinger against their forehead and say tromes!, meaning they are savvy to family planning. In the Philippines, a national tour featuring singer Lea Salonga promotes sexual responsibility among teenagers with the hit song "I Still Believe." As Salonga sings of love, commitment and abstinence, the audience joins in singing lyrics familiar to them all. In Egypt, a TV spot dramatizes the dangers of early marriage and pregnancy when a teenage bride nearly dies during childbirth. Each of these images conveys information meant to help women plan their families and the number of children they wish to have. Each uses one or more forms of popular mass communication-- including television, radio, print and display advertising--to deliver its message of improved health for women and children through family planning. And each was developed with the assistance and expertise of the School of Public Health's Center for Communication Programs, a pioneer in the field of using today's communication technologies to improve child and maternal health. "We believe in the communication revolution," says Phyllis Tilson Piotrow, director of the center and senior associate in Population Dynamics at the School of Public Health. Piotrow has good reason to believe. In 30 years of population and family planning work, she has witnessed--and helped direct--a growing public education movement based on the accessibility, portability and near-universality of the new forms of communication. With the help of CCP, 45 nations around the world have discovered that daunting public health problems such as the spread of AIDS, infant mortality and uncontrolled population growth are most effectively addressed through a joint effort linking accessible and high-quality health services to widespread public education. Yet the direction and momentum of that effort faces severe disruption, the victim of the ongoing budget battles in Washington. Much of the CCP's annual $25 million budget is funded through the U.S. Agency for International Development. Recently, in an effort led by House conservatives, Congress voted to cut the agency's family-planning assistance by 35 percent and to further hamper USAID's efforts by imposing a nine-month moratorium on funding. The move is an effort on the part of some in Congress to prevent spending for abortion, even though USAID has been specifically prohibited from this practice since 1973. Critics charge the spending reductions could have just the opposite effect, as studies have shown that women will turn to illegal-- and oftentimes self-induced--abortion when other methods of birth control are unavailable. In the West African nation of Cameroon, for instance, public health officials must cope with women who ingest large quantities of chloroquine--a readily available and relatively inexpensive anti-malarial drug--to induce spontaneous abortion. Often, the uncontrolled dosages are enough to harm and even kill both fetus and mother. In Bolivia, which has the Western Hemisphere's highest infant and maternal mortality rates, illegal abortions account for a substantial portion of the unnecessary deaths. Nor is abortion the only threat to maternal and child health. "Childbearing itself is an inherently risky procedure, especially when a mother is very young, or has been weakened by illness or disease," notes CCP deputy director Alice Payne Merritt. Even in developed nations, until relatively recently, childbirth was the No. 1 cause of death among women of reproductive age. Yet, according to Merritt, many of the risks and dangers of childbirth and early infancy can be addressed. The answer, she says, lies in the dissemination of vital information- -such as how to treat an infant's diarrhea through oral rehydration therapy or the need for immunization--by means of mass communication. From increased literacy coupled with the copier and inexpensive offset printing, to radios, TV, cassette players, cellular phones, CD-ROMs and computer networks, new technologies offering new means of reaching even the remotest village have swept the world. Today, it hardly seems surprising when schoolchildren in Nepal know of Michael Jackson, or villagers on a Pacific atoll want to drink Coca-Cola. Such is the power of global mass marketing. The Center for Communication Programs taps into this highly developed expertise in devising images that sell products and uses its potential to transmit information and ideas that promote health and save lives. "If you think of 20 years ago, and how much time people spent in contact with other individuals, and then you compare it to our reality today, you begin to get some idea of how tied we are to the mass communication culture," says CCP project director Jos‚ Rimon. "Today, you may get up and watch Good Morning America, drive to work listening to National Public Radio, work all day on a computer connected to a network, drive home listening to NPR again, and then end the day watching the evening news. How much more of your central nervous system is plugged into communication technology than just two decades ago? For better or for worse, the communication revolution that is taking place today affects how we live and work and learn." In less developed nations, the reach of modern technologies is still impressive. Recent survey data shows that 99 percent of the population of Egypt has access to television, says Rimon, and even in nearby Yemen, one of the world's poorest nations as measured by the World Bank, access to television is estimated at 70 percent. Throughout the world, the battery-powered radio and the inexpensive cassette player have brought songs, drama and programming of all types into homes often lacking the rudimentaries of electricity and running water. In the eyes of CCP workers, this growing web of international communication represents one of the most potent tools in the public health worker's bag of community medicines. "Our goal is to make family planning a household word, a community norm and an informed individual choice," Piotrow says. "Mass communication allows us to promote the idea of individual consent and informed choice. When coupled with community mobilization, meetings and group activities, and better counseling by health providers, it has proven highly effective at saving lives and improving women's health." In November, prior to the budget cuts, the center was awarded a competitive $109 million cooperative agreement by USAID to continue its work in family planning and reproductive health communication through the year 2000. It is the fourth consecutive cooperative agreement CCP has won since the communication program was begun at Hopkins in 1978. Yet the planned cuts currently approved by Congress could derail and possibly even disband some of the center's most effective international programming. "No one knows how this is going to work out," Piotrow says of the current uncertainty surrounding the government's plans. In February, Maryland second district Congressman Bob Ehrlich (R) toured the downtown Baltimore facilities and listened attentively as staff members described the center's work. "We hope a lot of congressmen and senators will hear from their constituents about these horrendous cuts. Sens. Sarbanes and Mikulski have been very supportive," says Piotrow. In the meantime, there is much to do. On Feb. 29 the center premiered "Hits for Hope," a video about a campaign in Uganda that invited local singing groups to compose and perform their own AIDS education theme song. The winning song was professionally produced, and is now being distributed to radio stations, record stores and discotheques throughout the country. The idea is to get young people talking about the behavioral changes necessary to stop the spread of the disease. Wherever the virus can travel, the song-- titled "A Ray of Hope"--will travel too. "There has been a tremendous extension of communication worldwide in the last 20 years," says Piotrow. "Our goal is to harness that technology and use it as a tool for public good."
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