An Assessment of Family Planning Decision Makers' and Advocates' Needs and Strategies in Three East African Countries.

CONTEXT: Despite decades of evidence-based advocacy for family planning in developing countries, research on how decision makers perceive and respond to such efforts is lacking.

METHODS: A literature review yielded 10 peer-reviewed journal articles published between 1999 and 2012 on decision makers' needs for and experiences with health advocacy and evidence. Two sets of questions about family planning research and advocacy-one for decision makers and another for advocates-were developed from emerging themes and used in structured interviews with 68 key informants in Ethiopia, Kenya and Malawi.

RESULTS: Decision makers reported understanding family planning's value and confirmed that advocacy had helped to spur recent favorable shifts in government support of family planning. Key informants stressed that advocacy messages and formats must be tailored to the needs and interests of particular audiences to be effective. Messages must also consider barriers to decision makers' support for family planning: constituents' negative attitudes; fear that increased adherence to family planning will shrink the size and influence of specific voting blocs and ethnic groups; and competing economic, social, cultural, religious and political priorities. Decision makers reported valuing the contributions of international family planning organizations and donors, but were more comfortable receiving advocacy messages from local sources.

CONCLUSIONS: According to decision makers, sustained and strategic family planning advocacy developed and delivered by culturally attuned national actors, with support from international actors, can diminish barriers to government support for family planning.