Below is an example of a set of questions to consider when conducting audience and communication analysis:

Knowledge and attitudes

• What proportion of providers, women, men and other audiences are aware of female condoms?
• What proportion of providers, women, men and other audiences have accurate knowledge about female condoms?
• What are the perceived benefits of using female condoms by providers, women and their partners?
• What are the perceived barriers to accessing and using female condoms for providers, women, and their partners?
• Are there common misconceptions or misinformation about female condoms?

Normative and Structural Considerations

• What are the gender norms in country among couples, both married and unmarried, and how do these affect female condom use?
• Under what circumstances is it acceptable to use female condoms? Under what circumstances is it not acceptable?
• How does the level of income affect use of female condoms? Do poorer women and couples have access to both information and product?
• Who are the stakeholders, key players, and gatekeepers who impact or influence demand and utilization of female condoms?
• How are these stakeholders, key players, and gatekeepers influencing demand and utilization of female condoms?

Service Provision

• Do providers have adequate skills to counsel on female condoms?
• Are HIV and family planning (or maternal, newborn, child health services) services integrated with other services?

Media and Communication

• Do couples communicate about using female condoms or similar commodities?
• Through what channels (including media and interpersonal) do providers, women, and their partners prefer to receive health-related information?
• What channels can support the level of communication needed to increase knowledge of HIV and family planning and demand for female condoms?
• What communication materials and programs already exist related to female condoms?
• What is the technical and organizational capacity of media partners?

Below is an example of a set of questions to consider when analyzing the health and commodity-specific context relevant to ECPs:

• What is the contraceptive prevalence rate?
• What is the contraceptive method mix?
• What is the unmet need for contraception?
• How many pregnancies are unintended?
• How many pregnancies result in abortions or unwanted births?
• How many abortions occurring in the country are (estimated to be) unsafe?
• How many pregnancies result from contraceptive failure?
• What are the socio demographic characteristics of women with unintended pregnancies?
• What are the socio demographics of the young population (15-24) and what contraceptive method(s) do they mostly use?
• Are emergency contraceptives registered in country? What brands (formulation, packaging)? Which, if any, are on the Essential Medicines List? If not registered, what is the registration process – time, requirements, etc.?
• Is there a regional or local manufacturer?
• What regulations or policies govern supply, distribution, and availability? How may these affect demand?
• How is ECP procurement being funded?
• What is the price of ECPs in the private and public sector? What are the costs of services associated with counselling and administering ECPs?
• What is the availability of ECPs by region/district?
• What patterns exist in uptake of ECPs over the past 5-10 years (increased, declined, remained static)?
• What is the number of private sector vs. public sector clinics offering ECPs by region/district?
• What level of provider (doctor, nurse, midwife, etc.) is permitted to prescribe, administer, and/or counsel on ECPs?

Below is an example of a set of questions to consider when conducting audience and communication analysis:

Knowledge and attitudes

• What proportion of women have used ECPs?
• What proportion of providers, women, men and other audiences are aware of ECPs?
• What proportion of providers, women, men and other audiences have accurate knowledge about ECPs?
• What are the perceived benefits of using ECPs by providers, women, their partners and other influencing audiences?
• What are the perceived barriers to accessing and using ECPs for providers, women, their partners?
• Are there common misconceptions or misinformation about ECPs?

Normative and Structural Considerations

• What are the gender norms in country among couples, both married and unmarried, and how do these affect contraceptive use?
• What is the incidence of gender-based violence in the country? Are there specific areas with social unrest that may increase likelihood of gender-based violence (GBV) and rape? What kind of support is available to those who experience gender-based violence? Is post-violence counseling offered to victims of sexual violence? Does it cover the use of ECPs?
• Under what circumstances is it acceptable to use ECPs? Under what circumstances is it not acceptable?
• How does the level of income affect use of ECPs? Do poorer women and couples have access to both information and product?
• Are there regulations in place that limit access to ECPs for specific populations?
• Who are the stakeholders, key players, and gatekeepers who impact or influence demand and utilization of ECPs?
• How are these stakeholders, key players, and gatekeepers influencing demand and utilization of ECPs?

Service Provision

• Are clinical and counseling guidelines available at all levels of the health system?
• Are protections in place in national counseling guidelines to ensure informed and voluntary decision-making related to ECPs?
• Do counseling guidelines ensure adequate information on ECPs, including side effects and use?
• Do pre-service and in-service curriculum materials cover ECPs adequately?
• Do providers share accurate and appropriate information about the product with their clients, including with adolescents and unmarried women?
• Do providers offer ECPs as part of a range of available contraceptive options with their clients, including with adolescents and unmarried women?
• What are the main challenges for providers regarding provision of ECPs? What are typical concerns that providers may have regarding the provision of ECPs?
• Are ECPs systematically available in crisis settings? Are crisis workers trained to provide it?
• What are the perceived barriers and benefits to accessing ECPs services in the private vs public sector?
• Do providers have adequate skills to counsel, prescribe, and/or administer ECPs?
• How integrated are ECPs with other FP programs?

Media and Communication

• Do couples communicate about using ECPs or other contraceptive methods?
• Through what channels (including media and interpersonal) do providers, women, and their partners prefer to receive health-related information?
• What channels can support the level of communication needed to increase knowledge of family planning and demand for ECPs?
• What communication materials and programs already exist related to ECPs?
• What is the technical and organizational capacity of media partners?

Below is an example of a set of questions to consider when analyzing the health and commodity-specific context relevant to contraceptive implants:

• What is the contraceptive prevalence rate?
• What is the unmet need for contraception?
• What proportion of contraceptive users currently uses contraceptive implants? What proportion of contraceptive users currently uses hormonal methods? Long-term methods? 
• Are contraceptive implants registered in country? What brands? If not registered, what is the registration process – time, requirements, etc.?
• What regulations or policies govern supply, distribution, and availability? How may these affect demand?
• What is the price of contraceptive implants in the private and public sector?
• What is the availability of contraceptive implants by region/district?
• What proportion of women, disaggregated by age and location (and other characteristics as relevant) currently use contraceptive implants?
• What is the estimated unmet need for contraceptive implants?
• What patterns exist in uptake of contraceptive implants over the past 5-10 years (increased, declined, remained static)?
• Number of private sector vs. public sector clinics offering implants by region/district?
• What level of provider (doctor, nurse, midwife, etc.) is permitted to insert/remove contraceptive implants?
• What is the price of the commodity in the private and public sectors? What are the costs of services associated with counselling, insertion and removal? 

Below is an example of a set of questions to consider when conducting audience and communication analysis:

Knowledge and attitudes

• What proportion of providers, women, men and other audiences are aware of contraceptive implants?
• What proportion of providers, women, men and other audiences have accurate knowledge about contraceptive implants?
• What are the perceived benefits of using contraceptive implants by providers, women, their partners and other influencing audiences, such as mothers-in-law and community leaders?
• What are the perceived barriers to accessing and using contraceptive implants for providers, women, their partners and other influencing audiences, such as mothers-in-law and community leaders?
• Are there common misconceptions or misinformation about contraceptive implants?

Normative and Structural Considerations

• What are the gender norms in country among couples, both married and unmarried, and how do these affect contraceptive use?
• Under what circumstances is it acceptable to use contraceptive implants? Under what circumstances is it not acceptable?
• How does the level of income affect use of contraceptive implants? Do poorer women and couples have access to both information and product?
• Who are the stakeholders, key players, and gatekeepers who impact or influence demand and utilization of contraceptive implants?
• How are these stakeholders, key players, and gatekeepers influencing demand and utilization of contraceptive implants?

Service Provision

• What proportion of services for contraceptive implants is provided by the private sector and public sector? What are the perceived barriers and benefits to accessing services in each sector?
• Are protections in place in national counseling guidelines to ensure informed and voluntary decision-making related to contraceptive implants?
• Do counseling guidelines ensure adequate information on contraceptive implants, including side effects and use?
• Do providers have adequate skills to counsel, prescribe, and/or administer contraceptive implants?
• Are family planning (or maternal, newborn, child health services) services integrated with other services?

Media and Communication

• Do couples communicate about using contraceptive implants or similar commodities?
• Through what channels (including media and interpersonal) do providers, women, and their partners prefer to receive health-related information?
• What channels can support the level of communication needed to increase knowledge of family planning and demand for contraceptive implants?
• What communication materials and programs already exist related to contraceptive implants?
• What is the technical and organizational capacity of media partners?

Below is an example of a set of questions to consider when analyzing the health and commodity-specific context relevant to chlorhexidine:

• What is the neonatal mortality rate in your country? How many neonatal deaths result from infection?
• Are there particular regions, areas, or populations where neonatal infections and death are common?
• What proportion of infections are due to contamination of the umbilical cord stump?
• What are the prevailing cord care practices?
• What are the hygienic conditions in homes?  In facilities?
• What percentage of births occur at home? In (public/private) facilities?
• Are local studies needed to assess the effectiveness of chlorhexidine in reducing neonatal mortality, or will studies from other countries suffice?
• Is 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) for umbilical cord care available? If so, is it available in gel, liquid or both presentations? What other concentrations of chlorhexidine are available for other purposes?
• What is the availability of chlorhexidine by region/district? What is the number of private sector vs. public sector clinics stocking chlorhexidine by region/district?
• If not available in the concentration recommended for cord care, what are the options for making it available at community level? At the facility level (public and private)?
• Is chlorhexidine registered in country? What brands? If not registered, what is the registration process – time, requirements, etc.?
• Are any efforts underway to add 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) for umbilical cord care to the country’s essential medicines list?
• What regulations or policies govern supply, distribution, and availability? How may these affect demand?
• Are clean birth kits sold or otherwise distributed?
• What would be the options, advantages, and disadvantages of adding 7.1% chlorhexidine digluconate to clean birth kits or providing it alongside clean birth kits?
• What is the price of chlorhexidine in the private and public sector? What are the costs of services associated with counseling, and administration?
• If available in the concentration recommended for cord care, at what levels is chlorhexidine being used for cord care? Is it being used in homes and communities? At both public and private hospitals/clinics?
• What are the current programs/projects (government and non-governmental) promoting chlorhexidine use for umbilical cord care, if any? In what regions/districts are they working? What are their challenges to increasing chlorhexidine uptake?

Below is an example of a set of questions to consider when conducting audience and communication analysis:

Knowledge and attitudes

• What is the rationale behind cord care practices in the community?
• What do the various cadres of health care providers – including pharmacists, TBAs, CHWs, and Health Promoters (HPs) – know and teach about cord care?
• In a given area, who performs the first cord care, and who does it day-to-day?
• In a given area, who most influences cord care? What opportunities exist for others to influence cord care?
• What do pregnant women, mothers, grandmothers, other family members, and other community-level influencers believe and do about cord care?
• What proportion of women, families and other audiences are aware of chlorhexidine?
• What proportion of women, families and other audiences have accurate knowledge about chlorhexidine?
• How do providers, women and their families perceive chlorhexidine for cord care as compared to other methods (modern and traditional) of cord care?
• Is there any confusion among providers and end-users about the different uses of chlorhexidine at various concentrations?
• What are the perceived barriers to accessing and using chlorhexidine for providers, women, their families and other influencing audiences?
• Are there common misconceptions or misinformation about chlorhexidine?
• How much are women/families willing to pay for chlorhexidine for cord care?

Normative and Structural Considerations

• What are the official guidelines for cord care at health facilities?
• What are the official guidelines for cord care for home and community births?
• To what extent and how does typical cord care practice deviate from the guidelines, at health facilities and at home births?
• What is the current context for advancing/improving newborn care? (Are there existing programs/activities that could/should successfully integrate chlorhexidine for cord care?)
• What are the opportunities and obstacles for making adequate quantities of 7.1% chlorhexidine digluconate available for cord care?
• What have proven to be the most effective channels for reaching women, families, and providers with information about improving newborn care?
• What are the gender norms in country among couples, both married and unmarried, and how do these affect chlorhexidine use?
• How does the level of income affect use of chlorhexidine? Do poorer women and couples have access to both information and product?

Service Provision

• What are the current practices at each level of the health system (e.g., health post, health center, mobile health workers, hospitals) for preventing umbilical cord infection?
• How feasible is it to supply 7.1% chlorhexidine digluconate through ANC, CHWs, and facilities?
• How can chlorhexidine for cord care best be integrated into facility deliveries and post-delivery instructions provided after facility deliveries?
• How feasible is it for facilities to work with TBAs to teach and distribute chlorhexidine for cord care after home and community births?
• Do counseling guidelines ensure adequate information on chlorhexidine, including side effects and use?
• Do providers have adequate skills to counsel, prescribe, and/or administer chlorhexidine?
• Are newborn health services integrated with other services, such as maternal health services?

Media and Communication

• Do couples communicate about using chlorhexidine or similar commodities?
• Through what channels (including media and interpersonal) do providers, women, and their families prefer to receive health-related information?
• What channels can support the level of communication needed to increase knowledge of umbilical core care and infections and demand for chlorhexidine?
• What communication materials and programs already exist related to chlorhexidine?
• What is the technical and organizational capacity of media partners?

Below is an example of a set of questions to consider when analyzing the health and commodity-specific context relevant to magnesium sulfate:

• What are the maternal and neonatal mortality rates in the country?
• What is the maternal mortality rate due to pre-eclampsia/eclampsia (PE/E)?
• What is the incidence rate of PE/E?
• In what areas of the country does PE/E occur, or occur frequently?
• How many births are attended by people who are not skilled birth attendants? [1]
• How is PE/E currently prevented or treated in urban, rural, and peri-urban settings?
• What commodities are on the national Essential Medicine List (EML) for PE/E (magnesium sulphate, antihypertensives, calcium gluconate)?
• Is magnesium sulfate registered in country? What brands? If not registered, what is the registration process – time, requirements, etc.?
• What regulations or policies govern supply, distribution, and availability? How may these affect demand?
• What is the price of magnesium sulfate in the private and public sector?
• How is magnesium sulfate procurement funded?
• What is the availability of magnesium sulfate by region/district?
• Are there local or regional manufacturers of magnesium sulfate?
• What are the stock levels in health facilities?
• What are the distribution channels, and how effective are they at ensuring the product’s availability and use?
• In what format/packaging/dose is it available? (Injectable only? What dose or formulation? What is the quantity per package?)
• What is the first-line treatment? What other treatments are available and used? Where, how often, and in what circumstances?
• What patterns exist in uptake of magnesium sulfate over the past 5-10 years (increased, declined, remained static)?
• What level of provider (doctor, nurse, midwife, etc.) is permitted to administer/dispense magnesium sulfate?

Below is an example of a set of questions to consider when conducting audience and communication analysis:

Knowledge and attitudes

• What do local communities and pregnant women and their families know about PE/E and the related danger signs?
• What proportion of providers, pregnant women, and other audiences are aware of magnesium sulfate?
• What proportion of providers, pregnant women, and other audiences have accurate knowledge about magnesium sulfate?
• What are the perceived benefits of using magnesium sulfate by providers, pregnant women, and other audiences?
• What are the perceived barriers to accessing and using magnesium sulfate for providers, pregnant women, and other audiences?
• What are typical concerns of providers about the use of magnesium sulfate?
• Are there common misconceptions or misinformation about magnesium sulfate?

Normative and Structural Considerations

• What are the current policy documents and service delivery guidelines related to PE/E? How aligned are they with international standards?
• What is the content of the curriculum material related to screening and treatment of PE/E for in-service and pre-service provider training (for all levels of providers)?
• Do women seek ANC? If so, when do they initiate and how often do they return?
• How does the level of income affect use of magnesium sulfate? Do poorer women and couples have access to both information and product?
• Who are the stakeholders, key players, and gatekeepers who impact or influence demand and utilization of magnesium sulfate?

Service Provision

• How much attention is given to PE/E during ANC?
• What PE/E screening and treatment supplies and equipment are available at each level of the health system?
• How are (all levels of) providers trained on PE/E and how often?
• What community-based programs focus on pregnancy complications? Are referral systems in place between non-clinical and clinical settings?
• Do providers have adequate skills to counsel, prescribe, and/or administer magnesium sulfate?
• What are the current practices for screening and treatment of PE/E? What supplies are used for screening of PE/E (BP machines, urine tests)?
• How is a decision made for treatment of PE/E?
• What are the challenges for providers associated with screening and treating PE/E?
• What tools can providers access to ensure accurate knowledge and proper treatment of PE/E?

Media and Communication

• Do couples communicate about maternal health care?
• Through what channels (including media and interpersonal) do providers, women, and their families prefer to receive health-related information?
• What channels can support the level of communication needed to increase knowledge of PE/E and demand for magnesium sulfate?
• What communication materials and programs already exist related to magnesium sulfate?
• What is the technical and organizational capacity of media partners?

Below is an example of a set of questions to consider when analyzing the health and commodity-specific context relevant to misoprostol:

• What are the maternal, neonatal and child mortality rates in the country?
• How many maternal deaths result from postpartum hemorrhage (PPH)?
• What are the other costs of PPH (e.g., disability, need for transfusion)? 
• What percentage of women deliver with a skilled birth attendant (SBA)? [1] With traditional birth attendant (TBA)? Alone or with an unskilled family member?
• How is PPH currently prevented or treated in urban, rural, and peri-urban settings? What is the first line treatment? What other uterotonics are available and used? Where, how often, and in what circumstances?
• What proportion of women giving birth receive a uterotonic to prevent PPH?
• Is misoprostol registered in the country? What brands? If not registered, what is the registration process – time, requirements, etc.?
• What regulations or policies govern supply, distribution, and availability of misoprostol? How may these affect demand?
• What level of provider (doctor, nurse, midwife etc.) is permitted to administer/dispense misoprostol? Are community health workers (CHWs), TBAs, and other community-based health personnel permitted to provide misoprostol?
• What is the price of misoprostol in the private and public sector?
• What are the costs of services associated with counselling, administration, and follow-up?
• What is the availability of misoprostol? By region/district? By public/private sector?
• In what forms is it available? (Tablets? How many micrograms? How many per package?)
• If misoprostol is not available, what efforts are underway or could be taken to make it available?
• What proportion of women, disaggregated by age and location (and other characteristics as relevant) used misoprostol at last birth?
• What percentage of women use uterotonics (chemical or herbal) for labor augmentation?
• What opportunities exist that can improve misoprostol demand and use?
• What patterns exist in uptake of misoprostol over the past 5-10 years (increased, declined, remained static)?

---

[1] For the purposes of this document, “skilled birth attendant” refers to people with midwifery skills such as midwives, nurses, and doctors who have been trained to proficiency in the skills necessary to manage normal deliveries and diagnose, manage, or refer obstetric complications.

Below is an example of a set of questions to consider when conducting audience and communication analysis:

Knowledge and attitudes

• What proportion of providers, women, men and other audiences are aware of misoprostol?
• What proportion of providers, women, men and other audiences have accurate knowledge about misoprostol?
• What do the various cadres of health care providers–including SBAs, pharmacists, TBAs, CHWs, and health promoters–know about PPH and about misoprostol?
• Are there common misconceptions or misinformation about PPH or misoprostol?
• What do women, their partners, and other gatekeepers perceive as the benefits of using misoprostol?
• What do women, their partners, and other gatekeepers perceive as barriers to using misoprostol?
• How do providers perceive misoprostol vs. other ways to prevent and treat PPH?
• How might use and perceptions of uterotonics other than misoprostol impact perceptions and use of misoprostol?
• What do women, their partners, and other gatekeepers perceive as facilitators to using misoprostol?

Normative and Structural Considerations

• What are the gender norms in country among couples, both married and unmarried, and how do these affect misoprostol use?
• Under what circumstances is it acceptable to use misoprostol? Under what circumstances is it not acceptable?
• How does the level of income affect use of misoprostol? Do poorer women and couples have access to both information and product?
• Who in the family decides what level and type of prenatal, delivery, and postpartum care women receive?
• To what extent is cost a factor in accessing prenatal, delivery, and postpartum care?
• To what extent is culture or religion a factor in accessing prenatal, delivery, and postpartum care, or in the availability of misoprostol?
• Who are the stakeholders, key players, and gatekeepers who impact or influence demand and utilization of misoprostol?
• How are these stakeholders, key players, and gatekeepers influencing demand and utilization of misoprostol?
• What existing channels (e.g., national health worker volunteer program) can be leveraged for reaching women, partners, gatekeepers, and providers with information about PPH and misoprostol?
• To what extent is it believed that community-based distribution of misoprostol will lead to correct use by CHWs and/or women?

Service Provision

• What percentage of pregnant women seek prenatal care?
• How early in the pregnancy do women seek prenatal care?
• What percentage of women request uterotonics (chemical or herbal) for labor augmentation?
• Do counseling guidelines ensure adequate information on misoprostol, including side effects and use?
• Do providers have adequate skills to counsel, prescribe, and/or administer misoprostol?
• To what extent are guidelines for uterotonic use and PPH management up-to-date, disseminated, and followed?
• What other structural or health system barriers affect demand and use of misoprostol?

Media and Communication

• Do couples communicate about maternal health care and using misoprostol or similar commodities?
• Through what channels (including media and interpersonal) do providers, women, and their partners prefer to receive health-related information?
• What communication materials and programs already exist related to PPH and misoprostol?
• What channels can support the level of communication needed to increase knowledge of PPH and demand for misoprotol?
• What is the technical and organizational capacity of media partners?

Health and Commodity Context

Below is an example of a set of questions to consider when analyzing the health and commodity-specific context relevant to ORS and zinc:

• What is the proportion of children under five with diarrhea who receive care from an appropriate health care provider?
• What proportion of children under five with diarrhea are treated with ORS? With zinc?
• Are ORS and zinc registered in country? Are ORS and zinc designated as over-the-counter commodities? What brands? If not registered, what is the registration process – time, requirements, etc.?
• What regulations or policies govern supply, distribution, and availability? How may these affect demand?
• What is the price of ORS and zinc in the private and public sector?
• What is the availability of ORS and zinc by region/district?
• What proportion of caregivers of children under five, disaggregated by age and location (and other characteristics as relevant) have treated their child’s diarrhea with ORS and zinc?
• What patterns exist in uptake of ORS and zinc over the past 5-10 years (increased, declined, remained static)?
• What are the number of private sector vs. public sector clinics, shops, pharmacies offering ORS and zinc by region/district?

Below is an example of a set of questions to consider when conducting audience and communication analysis:

Knowledge and attitudes

• What proportion of providers, caregivers of children under five and other audiences are aware of ORS and zinc?
• What proportion of providers, caregivers of children under five and other audiences have accurate knowledge about ORS and zinc?
• What are the perceived benefits of using ORS and zinc by providers, caregivers and other influencing audiences, such as mothers-in-law and community leaders?
• What are the perceived barriers to accessing and using ORS and zinc for providers, caregivers, and other influencing audiences, such as mothers-in-law and community leaders?
• What are there common misconceptions or misinformation about ORS and zinc among providers, caregivers, and other influencing audiences?

Normative and Structural Considerations

• What are the gender norms in-country among couples, both married and unmarried, and how do these affect ORS and zinc use?
• How does the level of income affect use of ORS and zinc? Do poorer women and couples receive information about ORS and zinc and have access to ORS and zinc?
• Who are the stakeholders, key players, and gatekeepers who impact or influence demand and utilization of ORS and zinc?
• How are these stakeholders, key players, and gatekeepers influencing demand and utilization of ORS and zinc?

Service Provision

• What proportion of services for ORS and zinc is provided by the private sector and public sector? What are the perceived barriers and benefits to accessing services in each sector?
• Is ORS and zinc the recommended first-line treatment for diarrhea?
• Do counseling guidelines ensure adequate information on ORS and zinc?
• Do providers (and over-the-counter vendors) have adequate skills?
• Are child health services integrated with other services?

Media and Communication

• Do couples communicate about using ORS and zinc to treat their children?
• Through what channels (including media and interpersonal) do providers and caregivers of children under five prefer to receive health-related information?
• What channels can support the level of communication needed to increase knowledge of diarrhea and demand for ORS and zinc?
• What communication materials and programs already exist related to ORS and zinc?
• What is the technical and organizational capacity of media partners?

Below is an example of a set of questions to consider when analyzing the health and commodity-specific context relevant to amoxicillin:

Below is an example of a set of questions to consider when conducting audience and communication analysis:

Knowledge and attitudes