Social Marketing

The expansion of family planning services in Uttar Pradesh requires a mix of strategies to address the
populations diverse needs. This document is one in a series of briefs that explore the relative merits of
these strategies based on a review of the literature and previous experiences around the world. Increasing
contraceptive use prevents unplanned pregnancy, and reduces maternal and newborn deaths.
Introduction
Social marketing is the systematic application of
commercial marketing strategies to social
problems. Audience segmentation, consumer
research, and competitive analyses are used to
influence consumer behaviour to better public
health. Social marketing also uses the four Ps of
marketingproduct, price, place, and
promotionas a framework for reducing barriers
and promoting factors that facilitate behaviour
[1] [2]
change.
Although social marketing has expanded to
[3] [4]
address numerous public health issues,
it was
first widely used to promote contraceptive uptake
in the 1970s. The strategy can be used to promote
many contraceptive methods, but it has been used
most often to promote oral contraceptive pills,
condoms, spermicidal foam tablets, and injectable
contraceptives. These spacing methods can more
easily be branded and distributed by multiple
vendors than limiting methods such as male and
[5] [6]
female sterilisation.
In contraceptive social marketing, donor agencies
usually provide contraceptive commodities to a
social marketing agency or a nongovernmental
organisation (NGO). Commercial and
noncommercial distribution networks then make
the subsidised commodities available to the target
population. The commodities can be distributed
through traditional outlets such as pharmacies and
chemist shops, or through nontraditional outlets
such as grocery stores and other retail outlets. In
some social marketing models, health workers and
community volunteers may also distribute the
commodities. Promotional activities (e.g., mass
media, interpersonal communication, traditional
media, events) targeting the intended
beneficiaries are essential to creating demand for
the products and, therefore, facilitating the social
marketing strategys success.

History of Social Marketing in India

The social marketing of contraceptives has a long
history in India, beginning with the launch of
Nirodh condoms by the government in 1968. Since
then, the national family planning programme has
added oral contraceptive pills and has adopted a
multibrand strategy that also supports NGO
brands of condoms and pills. Social marketing of
contraceptive pills began in 1987, with the launch
of Mala Da government brand available over the
counter without a prescription. In 1996/97, all
socially marketed brands of oral contraceptive pills
were made available without prescription.
The condom is the most popular birth-spacing
method and the most widely socially marketed
product in urban Uttar Pradesh, with about 17
percent of married women using condoms to
prevent pregnancies. The state of Uttar Pradesh
represents one of the largest condom markets in
the country, with an estimated 407 million
condoms sold every year.
About 56 percent of the condoms sold in urban
Uttar Pradesh are socially marketed brands (see
Figure 1).[7] Six social marketing organisations
provide the condoms (see Table 1), with the
largest market shares held by Hindistan Latex
Family Planning Promotion Trust (HLFPPT) and PSI.
Two brandsNirodh Deluxe and Mastiaccount
for about 39 percent of all condoms sold in urban
Uttar Pradesh.
Oral contraceptive pills are much less popular than
condoms in urban Uttar Pradesh, where pills are
[8]
used by only 3.2 percent of married women.
However, socially marketed brands are still
available. Five social marketing organisations
provide seven brands of oral contraceptive pills in
Uttar Pradesh. Mala D (distributed by HLL/HLLFPT
and PHSI) and Pearl (distributed by PSI) are the
most popular brands.

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Market share of condoms in Uttar Pradesh

Figure 1. Socially marketed condoms make up more than half of the total condom market in Uttar Pradesh. Manforce is the
main commercial brand. Source: Ballal and Chandrashekar (2010).

Table 1: Market Share of Socially Marketed Condoms in Uttar Pradesh, By Organisation and Brand.
Organisation
HLFPPT
PSI
Parivar Seva Sanstha
DKT India
PHSI
HLL

Brand

Percentage of total market

Nirodh Deluxe

19.9

Rakshak

1.9

Masti

18.9

Sawan

2.5

Milan

3.5

Zaroor

4.9

Thrill

1.5

Kamagni

2.0

Ustad

1.8

21.8
18.9
6.0
4.9
3.5
1.8

Source: Ballal and Chandrashekar (2010). Acronyms: HLFPPT: Hindustan Latex Family Planning Promotion Trust; PHSI:
Population Health Services (India); HLL: Hindustan Latex Limited.

Effect of Social Marketing on Contraceptive Use

Between The Second National Family Health
Survey (NFHS-2) (199899) and NFHS-3 (200506),
the use of condoms and pills increased overall in
urban Uttar Pradesh. Although use increased by
more than 8 percentage points for the nonpoor
(those in the three highest wealth quintiles), use
did not change for the poor (those in the two

[9]

lowest wealth quintiles) (see Table 2). As a

consequence, the gap in the use of condoms and
pills between the poor and the nonpoor has grown
from 5 to 14 percentage points. Since social
marketing programmes focus on condoms and
pills, the fact that this gap has more than doubled
is of concern.

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Table 2: Percentage of Women Using Condoms and Oral Contraceptive Pills in Urban Uttar Pradesh by Wealth
Status.
Overall
19.8
14.4

NFHS-3
NFHS-2

Poor
11.6
11.9

Nonpoor
25.7
17.0

Source: Murthy and Chauhan (2009).

As shown in Figure 2, social marketings share of

the overall market for condoms and pills grew
between NFHS-2 and NFHS-3 for both the poor
and the nonpoor. At the same time, the
commercial sectors market share decreased. The
increased overall use of condoms and pills by the
nonpoor (see Table 2) could be attributed in part
to nonpoor consumers taking advantage of lower

prices of socially marketed brands. However, given

that the overall use of condoms and pills has not
significantly changed among the poor, it seems
that the poor may have shifted their purchases
from commercial to socially marketed products,
but that social marketing didnt affect uptake.

Source of condoms and oral contraceptive pills according to wealth status

Source of condoms and pills (percent)

Other

100

4.8

Free

Social Marketing

17.8

5.7
7.3

43

58.6

8.2

90

Commercial

80
70

65.1

60
86.4

50
40
30
20

38.5

30.1

28.4

10

5.3

0
NFS-2

NFS-3

NFS-2

Poor

NFS-3
Nonpoor

Wealth status

Figure 2. The percentage of condom and oral contraceptive pill users who use socially marketed brands appears to be
increasing for both the poor and the nonpoor. However, these data represent only those users who were able to provide

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information on what brands of condoms and pills they used.

Source: Murthy and Chauhan (2009).

Barriers to Effective Social Marketing

The survey data from Uttar Pradesh and findings
from various social marketing programmes in India
have helped identify barriers to the use of
products provided by social marketing
programmes.
Two ongoing programmesInnovations in Family
Planning Services Project II (IFPS II) and Sadhan
[10]
Social Marketing Network have been
particularly informative. Both programmes focus
on increasing the use of birth-spacing methods,
especially condoms and pills, and have increased
access to contraceptives in Uttar Pradesh.
Although many social marketing efforts highlight
condoms for HIV prevention, these two emphasise
condoms for family planning.
The Yahi Hai Sahi campaign and the Goli ke
Hamjoli (Friends of the Pill) programme are two
previous initiatives that have provided additional
information on barriers to marketing condoms and
pills. Yahi Hai Sahi sought to increase condom use
in 10 northern Indian states, including Uttar
[11]
Pradesh. Goli ke Hamjoli aimed to increase and
create a more supportive environment for oral
[12]
contraceptive use in Uttar Pradesh.
Barriers that typically limit use of condoms or pills
promoted through social marketing programmes
include:
The poor often lack convenient access to
affordable birth-spacing methods. Even
though an estimated 90 percent of women
with an unmet need for spacing and 85
percent of slum residents have access to a
pharmacy or chemist within one kilometre,
many of these retail outlets do not carry
socially marketed products.
Owners of retail outlets may have little
incentive to stock and promote socially
marketed brands since they yield lower
profits than do commercial brands. This is
especially true for socially marketed
condoms.
Many pharmacies and chemists lack up-todate information about low-dose pills,
making it difficult for them to provide
women with reliable information about the
pills safety and efficacy.

Many men have unfavourable impressions

of the condom. Some believe condoms
decrease sexual pleasure or that condom
use indicates infidelity or a lack of trust on
the part of ones spouse. For these reasons,
both men and women may be embarrassed
to purchase condoms in a public venue.
Addressing Barriers to Social Marketing
The survey data from Uttar Pradesh and the social
marketing programmes described above have also
helped inform various strategies for overcoming
barriers to effective social marketing and
increased contraceptive uptake. Social marketing
programmes could reduce barriers through the
following approaches:
Include high-margin consumer products
(e.g., iodised salt and sanitary napkins) in a
bundle of products that includes condoms or
oral contraceptive pills. This could increase
profit margins for retailers and encourage
more retailers, especially nontraditional
outlets, to stock socially marketed condoms
and pills.
Introduce other financial incentives for
retailers (e.g., trade promotions, quantity
discounts, and gifts) to overcome the initial
barriers to stocking socially marketed
products. These incentives could also
sensitise retailers to the value of product
displays, point-of-purchase materials, and
other materials that help increase sales.
Increase the comfort of sales personnel in
selling contraceptives, especially by
providing them with information about the
products. As a result, they will be able to
help women use oral contraceptive pills and
provide women with better information,
such as technical updates to dispel myths
and rumours.
Develop and implement strategies for
increasing contraceptive demand. Demand
for condoms needs to be increased among
the poor to address the large gap in use
between the poor and the nonpoor.
Demand for oral contraceptives needs to be
increased among all women to help address
the low rates of use in India and in urban
Uttar Pradesh. Regardless of how

Expanding Contraceptive Use in Urban Uttar Pradesh: Social Marketing, (March 2010), www.uhi-india.org
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inexpensive contraceptive products are,

they will not be used if people do not want
them.
Offer more contraceptive variety to
potential clients. For example, none of the
current socially marketed brands of
condoms offer textured or other varieties of
condoms, but a larger selection might
appeal to young clients. Also, specific brands
of condoms and oral contraceptive pills
could be better targeted, and marketing
strategies could be created to encourage
poor men and women to use socially
marketed products and wealthier men and
women to use commercially available ones.
Develop messages to help men and women
overcome negative impressions of condoms.
These messages could include: Condom use
is an appropriate way for most couples to
space their pregnancies. Condoms are not
just for extramarital sexual activity. Men
neednt be embarrassed when purchasing
condoms.
Evaluating Social Marketing Programmes
Increasing the use of spacing methods through
social marketing programmes will require
substantial efforts. Of particular importance will
be evaluating the effectiveness of different social
marketing strategies.
Given that social marketing programmes aim to
increase contraceptive use among the poor,
programmes should evaluate not only changes in
total contraceptive use but also changes in use
within groups of people with varied ability to pay.
Social marketing programmes should ideally
increase the use of spacing methods and diminish
the variations in use between the rich and the
poor. However, very little literature is available on
this topic.
Most evaluations of social marketing programmes
provide information on product sales, adjusted
into couple years of protection (CYP) using
standard conversion factors. However, even if
programmes increase CYP, weve seen that rates
of overall contraceptive use will not necessarily

increase because current users may simply switch

to the lower-priced, socially marketed brand.
Ideally, wealthier buyers of condoms and pills
would not be attracted to the lower-priced brands.
Although programmes can differentiate brands to
limit the substitution of low-priced brands for
higher-priced brands, wealthy consumers may still
purchase the less-expensive socially marketed
brands, particularly if they perceive them to be of
high quality. For example, in urban Uttar Pradesh,
people in the wealthiest segments of the
population buy more socially marketed condoms
than do people in the poorest segments of the
population.
One evaluation that did not focus on CYP is a study
[13]
from the Honduras that sought to examine the
impact of a social marketing programme
(emphasising oral contraceptive pills) on
contraceptive use. The programme emphasised
pills and social marketing strategies that have
evolved since the study was conducted, but some
information may still be useful in evaluating
programme impact (namely information from
household surveys about which brands were
purchased, how much was paid for them, where
they were purchased, and the wealth of the
purchasers).
Evaluations that seek to include a costeffectiveness component traditionally consider the
average cost of providing a contraceptive method
or the CYP that the method provides. However, it
is important to also consider how the costs of
method provision through more than one
programme are affected when one of the
programmes is expanded. In the Honduran study,
while the social marketing programme drew
customers away from a community-based
distribution (CBD) programme, costs in the CBD
programme increased as the two programmes
completed with each other for customers and the
CBD programme sought to find new customers by
deploying more CBD workers. Thus, the interaction
between different types of programmes needs to
be considered in understanding the impact of a
social marketing programme on costs.

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Acknowledgements
Several people were involved in the production of this
document: V. S. Chandrashekar, Madhwaraj Ballal,
Barbara Janowitz and Gita Pillai.
Urban Health Initiative is supported by the Bill and
Melinda Gates Foundation, and implemented by FHI 360,
in collaboration with a consortium of partners
committed to improving urban health. The contents of
this paper do not necessarily reflect the views and
policies of Urban Health Initiative, Family Health
International, or Bill and Melinda Gates Foundation.

Notes
1.

2.

3.
4.

5.

6.

7.

8.

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