World Health & Population

World Health & Population 17(1) September 2016 : 5-15.doi:10.12927/whp.2016.25042
Discussion Paper

International Family Planning: How Political and Religious Conservatives Respond and How to Shape Messaging for Successful Advocacy

Jenny Eaton Dyer, Brian L. Heuser and Shannon Franklin

Abstract

As a global health organization committed to advocacy and research, Hope Through Healing Hands directed two national polling projects. The 2016 National Survey of Registered Voters Tracking was a longitudinal study to compare and contrast the results from a 2013 national polling project with the same sampling and questionnaire. The primary finding here was that in 2016, conservatives show a statistically significant shift indicating greater, more positive, beliefs in the correlation of contraceptives and women in developing nations and saving lives, although the rest of the populace (moderates and liberals) remained unchanged. In the Optimized Messaging Study of Political, Religious Conservatives (PRCs), we examined emotionally and cognitively held beliefs and attitudes toward the language of family planning. We found that PRCs resonate best with language that is clear and understandable, such as contraceptives. Moreover, this group bases their opinion on family planning on their own morals and beliefs.

Background 

As international development efforts increasingly focus on enhancing individual capabilities and promoting sustainable outcomes, one of the key objectives of many global health organizations has become to promote reproductive, maternal, newborn and child health. One major component of policy that can improve outcomes for mothers and children concerns family planning, with an emphasis on healthy timing and spacing of pregnancies, as well as supported counseling for, education about and access to contraceptives. 

In 2013, with support from the Bill and Melinda Gates Foundation, the Winston Group conducted research to understand how the politically engaged public, including conservative audiences, understood and interpreted issues related to international development and family planning. That research provided guidance on the core issues of international family planning and highlighted messages on the topic that would resonate most effectively with conservative audiences. 

Three years later, Hope Through Healing Hands has commissioned a three-part opinion research project aimed at building on the 2013 findings that involves data gathering and analysis of conservative people of faith across the US. These included Catholics, mainline and conservative Protestants and other conservatives, to determine the attitudes and beliefs in regard to the language/rhetoric and concepts of, as well as the rationale for, international family planning. 

Our goal in this research was twofold. First, we hoped to determine whether overall public opinion has shifted meaningfully since the 2013 research. Second, we sought to assess the efficacy of language/rhetoric and concepts for educating and activating faith communities and other conservative populations in the US towards advocacy efforts for international family planning. This report contains the primary findings of this project, directed by Hope Through Healing Hands, administered by Echelon Insights and analyzed by researchers at Peabody College, Vanderbilt University. The findings are aimed at providing actionable guidance to partners and advocates for programs that support healthy timing and spacing of pregnancies in the developing world. 

Introduction 

“Family planning” has been at the heart of the US culture wars for the past 45 years. Among conservatives, this phrase is often construed as a euphemism for “abortion,” which tends to be a confounding issue where policy considerations are concerned. In 2015, 19% of the public believed that abortion should be illegal under all circumstances, and 51% believed it should be legal only under certain circumstances. Moreover, 44% self-identified as pro-life (GALLUP.org 2015). And while a majority of Americans may now be favorably disposed to a “pro-life” position, concerns about abortion are the “elephant in the room,” as we seek to rethink the rhetoric, concept and dialogue with religious and political conservatives associated with family planning for women in the developing world. 

In 2013, the Winston Group, as part of the research agenda of the Bill and Melinda Gates Foundation, conducted a national survey among registered voters, with a special focus on conservatives, with regard to the messaging and attitudes related to contraceptives for women in developing nations. Based on their descriptive analyses, the Winston Group concluded that, when contraceptives were specifically coupled with the outcomes of “education” or “saving lives,” conservatives’ attitudes showed striking support for access to contraception for these women. 

This finding was particularly helpful to organizations in the arena of family planning policy and advocacy, particularly with regard to those who live in the American heartland, in terms of developing messaging related to contraceptives. Specifically, policy makers and advocates came to understand the need for careful messaging to educate and activate conservatives to reconsider the critical importance of family planning in the lives of women and children around the world. 

Although this study was a helpful start, we also believe that there were limitations worth noting. First, the survey tool that was administered was quite lengthy and likely had a strong priming effect. When respondents were finally asked questions about women and access to contraceptives (Q26), he or she had already been informed/influenced about the issues through previous questions for about 12–15 min. Further, the answers to the questions (agree/disagree/neutral) were posed in a such way that may have allowed the respondent to remain a “distanced observer,” as there were no direct questions about a respondent’s opinion, as it involved our government or the respondent’s own involvement in the issues surrounding international family planning. 

Because the poll was conducted by landline telephone, there could also have been a mode effect of social desirability, that is, the respondents wished to appease the moderator with positive responses. Moreover, congruent with literature on survey research, it is highly likely that the use of landline phones had a significant effect on the representativeness of the sample. Perhaps most importantly, the larger concept, or construct, of family planning or international family planning was not tested.1 

Hope Through Healing Hands and other organizations have been working for the past few years in the conservative, faith-based arena to bring about awareness of the issues of international family planning in developing nations. Thus, for continued effective advocacy, it was essential to assess the attitudes towards and the emotional and cognitive responses to the rhetoric and adjacent issues related to international family planning in US foreign assistance. 

To do so, we directed a separate national polling project focused on individuals who identify as politically and religiously conservative.2 For this research, we administered a two-part, “Optimized Messaging Survey” (OMS) that made use of a mixed-method (qualitative and quantitative) approach and tested the use of certain language associated with international family planning. It is important to note that these political, religious conservatives (PRCs) are different from self-identified conservatives, by degree, in the National Survey of Registered Voters Tracking Study (2013–2016). In order to be consistent with Winston’s previous research, we used their same sampling methodology in replicating the Tracking Study, which involved a much simpler screening/determination of conservative orientation of respondents. As described later, the OMS study used a sophisticated process to create a stratified random sample of PRC respondents. 

Thus, we conducted three separate, but related pieces of research: 

  1. National Survey of Registered Voters Tracking Study (2013–2016). 
  2. Part Optimized Messaging Study of Political, Religious Conservatives. 
  3. Focus Groups of Religious, Political Conservatives in Indianapolis, IN. 

National Survey of Registered Voters Tracking Study (2013–2016) 

To begin, the good news for everyone who works in the fields of international health and development is that the attitudes across sectors – conservatives, moderates and liberals – regarding foreign aid spending remain largely stable (Figure 1). 

Figure 1. Tracking study – Opinion of all registered voters on foreign aid spending 

 

Interestingly, however, there have been significant changes in the opinions on access to contraceptives. Conservatives show a statistically significant shift between 2013 and 2016, indicating greater, more positive beliefs in the following statements: 

  • Women in developing nations want greater access to birth control and contraceptives (Figure 2). 
  • If there were greater access to contraceptives in developing countries, women’s lives could be saved (Figure 3). 

These findings represent very encouraging news for those on the front-lines of awareness and advocacy among conservatives for international family planning issues. Although the rest of the populace (moderates and liberals) remains unchanged, there is movement among conservatives. This could signal that our collective effort in the field with this group is working (Figures 2 and 3). 

Unfortunately, we are unable to empirically compare the results for the PRCs of the OMS, presented below, with those of the tracking study above. As noted above, the respondents in the tracking study above self-identified as “very conservative,” “somewhat conservative,” “moderate,” “somewhat liberal” or “very liberal.” However, we do not know the basis on which they are making these identifications. For example, an individual might be fiscally conservative but socially progressive. 

Figure 2. Tracking study – increase in positive beliefs about contraceptives 

 

RVs = registered voters. 

Figure 3. Tracking study – increase in positive beliefs about contraceptives among conservative RVs (B)  

RVs = registered voters.

Unfortunately, we are unable to empirically compare the results for the PRCs of the OMS, presented below, with those of the tracking study above. As noted above, the respondents in the tracking study above self-identified as “very conservative,” “somewhat conservative,” “moderate,” “somewhat liberal” or “very liberal.” However, we do not know the basis on which they are making these identifications. For example, an individual might be fiscally conservative but socially progressive. 

Moreover, we have no way of identifying among these conservatives who are specifically political or religious conservatives. 

Nevertheless, to hone in on the population of interest, Yougov.com developed a highly sophisticated sampling protocol for the OMS. Specifically, a stratified random sample of PRCs was constructed by using responses to questions about beliefs, rituals and practices in their religious and political lives from existing social surveys. 

Optimized Messaging Study of Political, Religious Conservatives 

This study took a psychologically conscientious approach to ascertain, among PRCs, raw responses – emotionally and cognitively – to family planning, international family planning, contraceptives and healthy timing and spacing of pregnancies. We sought to obtain a neutral, psychosocial, unbiased response (with efforts to reduce any priming or mode effect or related issues) to the language, constructs and arguments of the current messaging that is used to educate and activate religious, political conservatives to join in support for US Government funding for international family planning. 

For that reason, after one warm-up question, we asked an open-ended question, “What is the first thing you think of when you read or hear the term ‘family planning’?” and then, subsequently, the same question for international family planning, healthy timing and spacing of pregnancies and contraceptives. We also used a seven-point Likert scale, including an “I don’t know” option. The responses among this sample of conservatives were quite candid, with a significant difference by race between blacks and whites.3 We, in addition, tested for differences between income levels, age groups, education levels and gender, but we found little to no significant differences; where notable differences were found, they are discussed in turn. 

These open-ended questions allowed for the coding of responses. This coding was translated into word clouds aggregated by those that offered positive, neutral or negative responses. For the purposes of the summary, the negative cloud for international family planning and the positive cloud for contraceptives are shown below. 

Family planning 

Overall, when PRCs are asked about family planning, 28.6% responded positively, 22% were neutral, yet 40% were negative. The qualitative coding on family planning shows that those who view the term negatively, by and large, equate it with abortion; white PRCs correlated family planning with abortion 190 times and listed Planned Parenthood 67 times. 

Black PRC respondents do not feel as negatively about family planning, on the whole, as do white respondents. Those who do feel very negative towards the phrase (only six respondents, or 10%), however, do so for the same reasons as their white counterparts: they associate it with abortion and, thus, view it as bad. Because we need absolute clarity among PRCs that international family planning, in fact, does not include abortion because of the Helms Amendment of 1973, we recommend other verbiage be used to garner support from this group. 

International Family Planning 

When presented with the same question about international family planning, the overall numbers of positive responses decreased by half among most demographics. Here, only 18% were positive, and 33% were negative. 

The phrase international family planning garnered even more negative responses among white PRC’s, for whom significantly more confusion was noted: >25% of the respondents did not know what the term meant. This is a salient point; specifically, lack of clarity due to either misinformation or a lack of information makes this a problematic phrase to use with this group of people. 

Of the very negatives, abortion was cited 84 times, which was less than the 190 times for family planning. Planned Parenthood was mentioned a few times, but “government control” and “overreach” were the more prevalent themes. Several people even mentioned China’s one-child policy. 

The black PRC respondents were also confused by the phrase international family planning. Specifically, 14 stated that they did not know what it meant, up from 4 on family planning. As with family planning, all those who responded very negatively cited abortion in their open-ended response. The responses of the somewhat negative ran the gamut from abortion to citing the United Nations to simply asking, “What is this?”, suggesting in such cases that, although they did not know what it was, they did not like it. 

Overall, this phrase is problematic for both blacks and whites because neither group understands what it actually means. It appears that the support that is there is often misinformed in terms of what international family planning actually entails. 

The Figure 4 negative word cloud illustrates how PRC respondents immediately responded to the term “international family planning,” whereby the larger fonts denote the greater quantity of times by which the word(s) were coded. 

Healthy Timing and Spacing of Pregnancies 

This phrase garnered a much more positive response from white PRC respondents. Of the 816 white respondents surveyed, 40% responded very positively or somewhat positively. Of those who responded positively, between 33% and 40% were accurately able to describe the goal: to protect the health of the mother and baby. This tells us that understanding is critical for positivity. 

In addition, 203 (25%) were neutral. Only 113 (~14%) had a very negative reaction, and 59 (7%) had a somewhat negative reaction. This indicates that 21% responded negatively as compared with 43% who responded negatively to family planning and 39% who responded negatively to international family planning. Notably, the majority of respondents still did not respond positively, although 35 respondents were unsure, and 86 did not know what healthy timing and spacing of pregnancies meant. 

Black PRC respondents were much more positive in their reactions to healthy timing and spacing of pregnancies than to international family planning. Specifically, 41 (63%) were somewhat or very positive. Only 10 (6%) were very or somewhat negative, 10 (6%) were neutral and 10 (16%) were either unsure or didn’t know what it meant. 

Here, the largest difference between white and black respondents is that none of the black respondents equated this phrasing with abortion. Abortion was not mentioned by any of the black respondents. Those who are negative about it seem to be so because of perceived government overreach or control. 

The Figure 5 word cloud illustrates the positive reaction to “healthy timing and spacing of children” among PRC respondents. 

Contraceptives 

Somewhat surprisingly, as compared to healthy timing and spacing of pregnancies, contraceptives received the most positive reaction from white PRC respondents. Specifically, 51% had a very positive reaction or a somewhat positive reaction, while 31% were neutral. Only 15% were negative, with only 8% who were very negative. 

Those 226 (28%) who were very positive talked largely about birth control, condoms, preventing pregnancy and related concerns; see the Figure 6 word cloud. Specifically, 172 (76%) who were very positive mentioned some form of birth control. In addition, 22 (10%) simply stated that it was smart or a good idea. Finally, 146 (77%) of the somewhat positive respondents talked about birth control, condoms, preventing pregnancy and related concerns. 

Figure 4. OMS Study – open-ended negative responses of PRCs to “family planning”  

OMS = Optimized Messaging Study; PRCs = Political, Religious Conservatives. 

 

Figure 5. OMS study – open-ended positive responses of PRCs to “HTSP” 

HTSP = healthy timing and spacing of children; OMS = Optimized Messaging Study; PRCs = Political, Religious Conservatives. 

 

Figure 6. OMS study – open-ended positive responses of PRCs to “contraceptives” 

OMS = Optimized Messaging Study; PRCs = Political, Religious Conservatives.

Interestingly, age cohorts had a statistically significant difference: Those in their mid-40s to mid-60s had a somewhat positive response to the phrase contraceptives, whereas those who were younger, mid-20s to 30s, were more neutral. 

Of those who were very negative, 10% mentioned abortion, and 22% cited the pill, birth control or condoms. The somewhat-negatives were more likely to mention the pill or birth control, 33 (58%), and less likely to mention abortion, 4 (7%). It should be noted that there is a statistically significant difference between the responses of politically and religiously conservative Hispanics compared with blacks and whites, whereby the latter two groups are more positive. It is possible that this is because Hispanics tend to be Catholic and are influenced by teachings against hormonal contraception. 

Black respondents were again overwhelmingly positive in their response to contraceptives. Specifically, 40 (65%) were very or somewhat positive, the same as were very or somewhat positive about healthy timing and spacing of pregnancies. However, fewer were very or somewhat negative about contraceptives, i.e., 10 (6%) for contraceptives and 6 (10%) for healthy timing and spacing of pregnancies. This mirrors what was seen with white respondents, as only 122 (15%) responded negatively to contraceptives, whereas 171 (21%) responded negatively to healthy timing and spacing of pregnancies. 

Based upon all of our data collection and analysis, we argue that the terms family planning and international family planning should not be used among religious conservatives. The phrase healthy timing and spacing of pregnancies garners more neutral support, but contraceptives receives the most positive reactions and the least negative reactions, we believe because of the assumed understanding of the definition. 

Using the definition of international family planning contained in the following question as a cornerstone for the study, we find that, when international family planning is fully defined and explained as below – emphasizing that it differs from abortion – there is much greater support (Figure 7): 

Enabling women and couples in developing nations to determine the timing and spacing of pregnancies in a manner that includes voluntary methods of preventing pregnancy – not including abortion – that are harmonious with their religious beliefs and values. 

Figure 7. OMS Study – positive response by PRCs when provided a definition of international family planning 

OMS = Optimized Messaging Study; PRCs = Political, Religious Conservatives. 

Figure 7 shows a critical increase in support by PRC respondents, compared with the results on international family planning, suggesting that a new definition of international family planning, with clarity, addressing personal autonomy and the absence of abortion, resonates well among the majority of religious conservatives. 

Although the previous terms that were analyzed showed a statistically significant difference in terms of race between blacks and whites, here, we see no significant difference between races, with almost all, on average, stating that they would somewhat support efforts to promote international family planning. 

Beliefs about international family planning 

We sought to ascertain the foundation or source of beliefs about international family planning. We were concerned with whether PRC respondents base their responses on how the issue affects society and culture; the financial or economic impact of the issue; the politics or policy surrounding the issue; and personal, individual morals and beliefs about what is right. Respondents, 718 of the 1,000 (72%), overwhelmingly stated that personal morals and beliefs determined their emotive and rational responses to international family planning (Figure 8). 

Figure 8. OMS Study – source of beliefs among PRCs about international family planning 

We believe this finding is highly beneficial, as we seek to promote awareness among PRCs, change minds, stimulate positivity and move this group to advocacy. To shift an individual from negative to neutral to positive to action, we must appeal with arguments that will shape personal morals and beliefs in regard to international family planning. 

The messenger is also of import. In our survey, we found that PRC respondents trust the beliefs of their pastors or ministers on what can best help those who live in developing countries, albeit blacks more so than whites. However, it should also be taken into consideration that decision-making is rarely this linear or unidirectional, and respondents are often unaware of the myriad of influences on their perceptions. 

Next Steps: How to Discuss and Message International Family Planning to Political, Religious Conservatives 

In OMS, we experimented with a new mixed-method approach to collect data about full statements, as well as phrases within the statements. The goal was to ascertain whether certain phrases resonated more positively on international family planning messaging in terms of associated issues, e.g., education, prevention of mother-to-child transmission, HIV/AIDS, gender equality, sex trafficking or governmental programs. 

Unfortunately, we found that this particular method did not elicit the specific results we were seeking with any statistical significance. In all cases, most people agreed with each of the statements. Further, if they agreed with the statement as a whole, they generally agreed with the separate phrases inside the statement as well. The encouraging news is that most people are neutral or positive about each statement on international family planning, which means there is room for positive movement. 

The data analysis and our own anecdotal experience tell us that using messaging that has tested positively among PRCs can motivate this constituency to action, including sustained advocacy efforts. 

New rhetoric, transparent language and clear messaging about using contraceptives for women and families worldwide to time and space their pregnancies are key. Avoiding the social constructs and symbolism of abortion, Planned Parenthood (or planning language generally) and governmental control with international family planning are also critical. 

Coupling such nuanced use of language should be the rationale, or argument, to shape belief. In ranking order, we recommend the following in terms of articulating the critical importance of international family planning to PRCs: 

  • First, debunk, head on, the myth that foreign assistance through the US Government (or multi-lateral institutions) has not worked, reminding PRCs that it remains <1% of the budget. Share the data from the historic initiative, the US President’s Emergency Plan for AIDS Relief (PEPFAR) (e.g., from 50,000 people in Africa on antiretrovirals [ARVs] in 2002 to over 15 million in 2015). 
    Doing so discloses the goal early, offers transparency and legitimizes the “disliked” governmental programs with facts from the beginning. 
  • Second, contextualize international family planning by framing the challenges in developing nations. Remind religious conservatives that we are talking about issues among populations who live on <$1/day. Multiple issues are at stake, and contraceptives are one, albeit central, solution that can address many other issues, including extreme poverty, lack of education and high mortality. 
  • Third, explain that healthy timing and spacing of pregnancies save lives of mothers and newborns and children worldwide. Contraceptive access then becomes a life-and-death issue, combating both maternal and infant mortality. Although not statistically significant, we found that this language, coupled with that of allowing girls to stay in school, enabling mothers to provide for their families and empowering women and families to thrive, generally resonates well among religious conservatives. 
  • Finally, framing the issue in terms of “Our Christian faith calls us to serve others” reminds conservatives of duty, morality, ethics and the gospel message to serve the poor and oppressed. Quoting scriptures to uplift vulnerable populations and to speak up on behalf of the poor allows advocacy to truly become a Christian practice that is worthy of attention and action both at home and in the church. 

Conclusions 

These studies, which included focus groups, offer a window into the psychology of conservatives, as they think and feel with regard to the issues of international family planning. We sought an unbiased emotional and cognitive response to assess the raw attitudes of PRCs. Moreover, we tested various forms of rhetoric, language and rationale to discover which messaging would resonate best, statistically, among PRC respondents. 

We conclude that leading with easily understood language, such as contraceptives, elicits the strongest, most positive results among whites and blacks. 

What not to use, in terms of language, may even be more important than what language to use. We find that PRCs are fundamentally opposed to “planning” language, and we recommend relinquishing its use among this group and rethinking policy and legislation writing for stronger, bipartisan support. 

There is much more research to be done, but, for now, these studies show positive movement among conservatives and PRCs. We recommend more research on minority racial groups of PRCs, with a special focus on blacks and Hispanics. We note that the construction of the region variable in this survey did not allow us to analyze meaningful regional differences; thus, we recommend further research on differences between geographical areas and cultural dispositions. Honing the data and analysis that we currently have at hand, we hope to continue on the path to educate and activate PRCs to advocate for increased US Governmental funding and access to contraceptives for women and families in the developing world. 

Notes  

  1. In the national survey of N = 1,000 “religious conservatives,” they were defined as those who: 
    • Describe themselves as politically conservative (“conservative” or “very conservative”) on a five-point ideology scale in response to the question, “In general, how would you describe your own political viewpoint?” 
    • Describe themselves as considering religion to be “very important” or “somewhat important” in their lives in response to the question, “How important is religion in your life?” 
  2. The survey was conducted 16–22 January 2016, of panelists selected by YouGov from their pool of online panelists who met the above criteria in their respondent profile. YouGov estimates the margin of sampling error for the overall sample to be ±4.1%. 
  3. For the OMS, the demographic breakdown for race was the following: White = 816; Black = 63; Hispanic = 58; Asian = 15; Native = 10; Mixed = 21; and Other = 17.

About the Author

Jenny Eaton Dyer, PhD, Executive Director, Hope Through Healing Hands, Nashville, TN

Brian L. Heuser, EdD, Department of Leadership, Policy and Organizations, Peabody College, Vanderbilt University, Nashville, TN

Shannon Franklin, PhD, Fellow, Vanderbilt University, Nashville, TN 

Correspondence may be directed to: Jenny Eaton Dyer, Executive Director, Hope Through Healing Hands, Nashville, TN E-mail: jenny@hopethroughhealinghands.org 

References

GALLUP.org. 2015. Americans Choose “Pro-Choice” for First Time in Seven Years. Retrieved November 11, 2016. <www.gallup.com/poll/183434/americans-choose-pro-choice-first-time-sevenyears.aspx>. 

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