POPULATION MEDIA CENTER

Report to the Weeden Foundation on the Social Merchandising Project in to incorporate Reproductive Health Issues into Prime-Time Programs of TV Globo

April 2006 – March 2007

SUMMARY

Population Media Center, Inc. (PMC) is a non-profit, international non-governmental organization working worldwide to promote use of effective communication strategies for promoting behavior change to encourage family and reproductive health. The organization’s work is concentrated on entertainment broadcasting, particularly on long-running serial dramas in which characters evolve into role models for adoption of family planning, delayed marriage and childbearing, elevation of women’s status, avoidance of AIDS, and related social and health goals. PMC is a 501(c)(3) organization.

In Brazil, PMC is working in partnership with Comunicarte, a non-governmental organization in Rio, to influence the prime-time programs of TV Globo. The staff of this project meets regularly with the writers of the three prime-time soap operas on TV Globo to suggest themes and storylines addressing reproductive health and related issues that they can incorporate into their programs. In 2006, the project was successful in assisting TV Globo to incorporate 1,148 scenes dealing with health and social issues. These programs are broadcast nationwide in Brazil and exported to dozens of countries worldwide, dubbed into various languages.

ORGANIZATIONAL MISSION

PMC uses a specific methodology for behavior change communication developed by of . His work is described in a book by Heidi Noel Nariman entitled Soap Operas for Social Change (Praeger, 1993). Research on entertainment-education programs in , Mexico, India, , and Tanzania has shown this methodology to be uniquely effective at bringing about population-wide changes in behavior with regard to reproductive health and social development goals.

PMC was founded in 1998 with the intention of using the extensive experience of its key personnel to spread the application of the Sabido methodology in addressing population and reproductive health issues. In addition, the organization is pioneering the use of new methodologies for informing people about reproductive health issues and promoting behavior change.

In each country where it has projects, PMC works to build a collaborative process with broadcasters, government ministries, UN agencies, and non-governmental organizations to design and implement an effective media strategy for addressing reproductive health issues.

Population Media Center Report on Social Merchandising Project in Brazil 2006 - Page 1 BRAZIL

Brazil is Latin America’s most populous country, with a population of 184.2 million in 2005. Its fertility rate has declined significantly in the last 15 years and now stands at 2.4 children per woman. Although the overall fertility rate has declined, large families persist in a number of rural and impoverished regions of the country, and teenage parenthood is an important issue. Brazil also has one of the highest rates of HIV infection in South America.

Television is a favorite pastime of Brazilians. About 87 percent of households in Brazil own a color television set. Brazil is an also an important country to target with social change mass- media programming because it is increasingly a source of TV programs worldwide, including all of Spanish-speaking Latin America.

TV Globo is by far the largest television network in Brazil, with a 65 percent audience share, and it exports its programs, expertly dubbed into various languages, to dozens of countries worldwide. In Latin America and in other regions of the world, the Brazilian programs are extremely popular and have the potential to significantly influence audiences. Thus, a project that helps to incorporate reproductive health values into Brazilian serial dramas is of importance on a global scale.

Unlike American soap operas, Brazilian generally last six to twelve months (with broadcasts five days per week) and then are replaced by a new program.

PROJECT DESCRIPTION

Because of the popularity of the commercially-sponsored serialized dramas of TV Globo, PMC is working in partnership with a Brazilian NGO, Comunicarte, and with TV Globo to provide suggestions and background information on social and health issues, particularly focused on reproductive health, that the writers can insert into the serialized dramas.

PMC has an agreement with TV Globo that encourages the writers of the prime-time telenovelas to weave social issue themes we suggest into the lives of key characters. In return, PMC provides pro bono research to the writers regarding the issues they choose to incorporate into the programs. The writers and product placement division of TV Globo have been very enthusiastic about the collaboration with Comunicarte/PMC. In fact, TV Globo has received numerous national and international awards for the social relevance of its soap operas.

TV Globo also sees the social content of its prime-time soap operas as one of the key reasons for its rating success. Audience research has shown that people value educational content in entertainment programming, as long as it is not presented in a boring way.

TV Globo inserts messages related to reproductive health in its most popular programs at no cost to Comunicarte/PMC. The air time TV Globo has donated to issues of social concern would have costs tens of millions of dollars within the last year alone.

Population Media Center Report on Social Merchandising Project in Brazil 2006 - Page 2 During the year, a team of two Comunicarte/PMC staff members meets frequently with the writers of the three prime-time melodramas during the two-month planning period prior to the launch of each . They review plans for the evolution of various characters with the writers and make suggestions regarding health and social themes that can be woven into their lives. To monitor coverage of the issues suggested by the project team, project staff and volunteers also track the three prime-time telenovelas, and report on how issues were treated in the programs.

As part of the planning process for a new telenovela, the Comunicarte/PMC team prepares a “writer’s book,” which is a referenced manual containing a series of briefings on the various social and health issues that might be appropriate for that program, including referrals to experts and institutions, articles on entertainment-education, and a retrospective of the author’s previous television writing, with an emphasis on the social issues addressed in his or her work. The writer’s book also includes a prospective calendar that provides the writer with concise information in advance of important dates or events that might serve as “hooks” for entertainment-education scenes (such as the International Day for Women, the International Day for the Environment, World AIDS Day and World Population Day). The writer’s book has become very popular in many departments within TV Globo.

The strategy PMC is using with TV Globo is quite different from that of organizations that lobby for inclusion of one issue in various programs (as with Hollywood lobbyists). The PMC/Comunicarte project is focused on being of service to TV Globo broadly, providing them with information on a range of social and health issues that go beyond reproductive health, so that the programs are not seen as focusing on one particular issue and so that project staff are seen as being responsive to TV Globo’s needs and not just pursuing their own agenda.

In addition to tracking coverage of social and health themes by the telenovelas, the Comunicarte/PMC staff monitors daily news media coverage of population issues and reports on the results to Comunicarte, and back to TV Globo. Another project activity is that journalists are selected to appear as guest lecturers to give invited lectures to journalism students through the partnership PMC and Comunicarte have with the National Association of Journalists in Brazil. Being selected as a visiting professor has come to be seen as an honor, and the journalists give these lectures at no cost.

PMC and Comunicarte have also formed a partnership with the Children’s Rights News Service, which uses monthly reports by project staff on coverage of children’s issues in the media in its three publications: Newsclip Analysis, Free Radicals, and Young Media. Of particular interest to the Children’s Rights news service are the socio-educational themes related to childhood and adolescent issues, especially those related to the rights of children and adolescents.

The PMC country representative in Brazil, and the director of this project, is Dr. Marcio Schiavo. He is the director of our partner NGO for this project, Comunicarte Social Marketing. Previously, he served as President of the Brazilian national affiliate of the International Planned Parenthood Federation.

Population Media Center Report on Social Merchandising Project in Brazil 2006 - Page 3 RESULTS

As mentioned above, project staff members monitor the prime-time serial melodramas of TV Globo and document all social and health issue themes that are incorporated as a result of suggestions made by the project. The total number of such scenes in 2006 was 1,148. This is a slight reduction in the number reported to the Foundation in January that resulted from a redefinition of which scenes qualify as ones that contain social content. Interestingly, TV Globo requested us to make this revision by counting only those scenes in which they not only included treatment of the issue, but also incorporated an intentional educational message. For PMC, the distinction is not very important, since we know that role modeling by characters in dealing with an issue is probably more influential than educational “messages” related to an issue. The request from TV Globo resulted from news media discussion of TV Globo’s socially responsible broadcasting, which led our colleagues at TV Globo to ask us to use their conservative definition in any report we make public in order that the network would be in a position to defend each scene so categorized as making a positive educational contribution to the audience’s understanding of the issue. As a result, the analysis of social content scenes during the second half of 2006 was revised, and the table below shows the combined numbers of scenes by program and by issue area.

In total in 2006, eight telenovelas carried social themes suggested by project staff: Malhação (Working Out), Alma Gêmea (Twin Soul), O Profeta (The Prophet), Bang Bang (Bang Bang), Cobras & Lagartos (Snakes & Lizards), Pé na Jaca (Stepping on the Jackfruit), Belíssima (Gorgeous) and Páginas da Vida (Pages of Life).

Of the 1,148 social and health themes incorporated in the ten prime-time novelas on TV Globo in 2006 in response to project staff suggestions, 600 of these (or about 52%) dealt specifically with sexual and reproductive health, sexuality and related gender issues. Another 464 themes dealt with other social issues, such as public security and crime, rights and citizenship, agrarian reform, armed conflicts in the field, familial income, education, health, and family. Seventy-five themes addressed drug abuse. This thematic distribution demonstrates how the serial dramas are representative of the concerns of Brazilian society. The number and type of scenes integrated by the telenovelas are presented in the table below.

Population Media Center Report on Social Merchandising Project in Brazil 2006 - Page 4 Table 1: The number and type of social-content scenes integrated by each telenovela

Telenovelas and Social Sexual and Issues Reproductiv Sexuality Drug Gender Social e Health Abuse Relations Issues Total Malhação 33 143 12 30 151 369 (Working Out) Alma Gêmea 01 33 ------12 46 (Twin Soul) O Profeta 02 09 --- 02 08 21 (The Prophet) Bang Bang 12 28 02 08 12 62 (Bang Bang) Cobras & Lagartos 10 54 02 01 32 99 (Snakes and Lizards) Pé na Jaca 11 08 02 02 06 29 (Stepping on the Jackfruit) Belíssima 36 63 03 05 41 148 (Gorgeous) Páginas da Vida 26 56 63 27 202 374 (Pages of Life)

TOTAL in 2006 131 394 84 75 464 1,148

TV Globo has become interested in selective research on the effects of including certain themes in their programs. For example, in 2001, the writer of one telenovela included a theme related to leukemia and bone marrow donations. Following the treatment of that subject on the soap opera, the number of volunteers who came forward to donate their bone marrow climbed from 20 per month to 900 per month.

In 2006, PMC engaged Dr. Arvind Singhal, Presidential Research Scholar at Ohio University’s School of Communications to conduct impact research to measure the effects of the current telenovela, Paginas da Vida. Dr. Singhal traveled to Brazil in September 2006 to train Comunicarte staff on participatory research techniques. This participatory research was conducted in November 2006.

Comunicarte and PMC have engaged a team from BEMFAM (Planned Parenthood) to conduct an evaluation of the impact of Paginas da Vida on health seeking behaviors, including attending BEMFAM family planning clinics. Paginas da Vida ended its broadcast run on March 2. The research firm has concluded the quantitative data collection, and is currently analyzing the data. Preliminary data on the family planning effects is now available and is given below.

Population Media Center Report on Social Merchandising Project in Brazil 2006 - Page 5

Paginas da Vida also included content about Down Syndrome. The Brazilian National Down Syndrome Association conducted a quantitative study about the effects of the telenovela on information and service-seeking behavior. A summary of the findings follows.

Evaluation Research Findings

TV Globo, the largest television network in Brazil, produced and broadcast a 203-episode telenovela (soap opera) titled Paginas da Vida (“Pages of Life”) which completed broadcast March 2, 2007. Communicate, PMC’s partner in Brazil, worked with TV Globo to incorporate social messages into the telenovela about Down Syndrome and family planning.

Communicarte has been working with TV Globo for years to use social merchandizing in their telenovelas, but until now, the impact of these insertions has never been scientifically evaluated.

The research was both quantitative and qualitative, and the results and outcomes will likely be useful for application in other social merchandising activities in Brazilian telenovelas.

Quantitative Research – Family Planning

As mentioned above preliminary data has been provided by the team who conducted the research at BEMFAM family planning clinics. Following is data on 474 women at the clinics, who were interviewed to determine if they had watched the program and if it had influenced their decision to seek family planning services. The age ranges of the women interviewed are shown in the following table.

Table 2: Percent distribution of women interviewed, by age

Age Percentage

18-24 21.10 25-29 18.99 30-34 21.73 35-39 18.35 40-49 19.83 Total 100%

Number 474

Among the women interviewed, there was widespread viewership of the telenovela. Table 3 below gives the percentage of women who watched the program, by level of frequency of viewing.

Population Media Center Report on Social Merchandising Project in Brazil 2006 - Page 6 Table 3: Percent distribution of women interviewed who watched Páginas da Vida, by frequency of viewing

Frequency of Percentage Viewing Daily 41.35 Three times per week 28.06 Twice per week 13.92 Rarely 16.67 Total 100%

Number 474

The data from the 474 women interviewed shows about two-thirds of them indicated they felt the program had influenced them to take steps to prevent unwanted pregnancy, as shown in Table 4 below.

Table 4: Distribution of women interviewed who said that the telenovela influenced whether they would take care to prevent unwanted pregnancy, by age

Did the telenovela influence Age Total you with regard to family 18-24 25-29 30-34 35-39 40-49 planning? I learned that I should take care to prevent unwanted 71.00 64.44 66.99 64.37 59.57 65.40 pregnancy No influence on my behavior 29.00 35.56 33.01 35.63 40.43 34.60 Total 100% 100% 100% 100% 100% 100%

Number, by age range 100 90 103 87 94 474

As mentioned above, the data from the BEMFAM clinics is still being analyzed. We will provide an update on this report when the remaining data is fully analyzed. In the meantime, it is clear from these 474 interviews that the program most likely stimulated viewers to seek family planning services and to take steps to avoid unwanted pregnancies.

Qualitative Research – Down Syndrome

Qualitative research was incorporated as part of the impact evaluation of social merchandising. The main objective of this phase of research was to use focus groups to evaluate the changes in knowledge, attitudes and practices among viewers potentially reached by the storyline that involved people living with Down Syndrome. The focus groups addressed four main issues, these being (i) the social environment of people with Down Syndrome, particularly in school, and within the family, (ii) the relevance of the subject of Down Syndrome in Brazil, (iii) identification of the scenes involving Down Syndrome, how people with Down Syndrome were

Population Media Center Report on Social Merchandising Project in Brazil 2006 - Page 7 portrayed in the drama, and whether it reflected reality, and (iv) the socio-educational and developmental processes of infants and children with Down Syndrome.

The use of the focus groups was fundamental for exchange of experiences and dialogue about how watching the specific storyline involving Down Syndrome in Paginas da Vida affected the lives of the focus group participants, in large or small ways. Discussion included how participants felt while watching the dilemmas, difficulties and joys expressed by the characters in the telenovela, particularly Clara (the young girl in the telenovela who had Down Syndrome), as well as her mother and the characters they lived with. Several discussions developed about this storyline in Paginas da Vida, stimulating a broad debate regarding the challenges and successes of TV Globo’s use of social merchandising in this telenovela. The focus groups also completed a participatory sketching exercise to provoke expression of opinions, experiences, and emotions through means of visual communication, rather than solely verbal or written communication.

Quantitative Research – Down Syndrome

The purpose of the quantitative research was to measure the effectiveness of using social merchandising in Paginas da Vida to influence attitudes, behaviors, and practices in relation to Down Syndrome. This part of the research consisted of a questionnaire which was sent via the internet to eligible respondents, who filled it out and returned it to the researchers. The sample consisted of 201 respondents who were affiliated with FUNLAR (the Brazilian National Down Syndrome Association). In all research of this type, respondents leave some questions blank, and for this reason, the number of respondents will vary in the different answers. Data was analyzed using the percent of valid responses.

We wanted to know how how many people regularly watched the telenovela Paginas da Vida. Of the 198 respondents to this question in the Down Syndrome questionairre, 164 respondents (82.8%) watched the telenovela, at least sometimes, and 34 respondents (17.2%) did not watch the telenovela.

Respondents were asked how often they saw various issues pertaining to Down Syndrome the telenovela Paginas da Vida addressed, and their responses are shown in the graph on the next page.

Population Media Center Report on Social Merchandising Project in Brazil 2006 - Page 8 Table 5: Percent distribution of the frequencies of issues addressed relating to Down Syndrome

Inclusion in the Workforce

Family Relationship

Social Inclusion

Inclusion in School

Health Issues

0 1020304050

Inclusion in Family Inclusion in the Health Issues Social Inclusion School Relationship Workforce 4 or more times 25.7 29.7 35.2 45.2 13.6 3 times 15.7 19.4 15.8 17.9 9.1 2 times 16.4 21.7 17.6 11.3 10.6 1 time 22.9 17.7 20 17.9 22 never 19.3 11.4 11.5 7.7 44.7

Of the respondents that answered this question (total of 192), hardly any (0.5%) reported that they did not remember having seen scenes about issues related to Down Syndrome, while the remaining 191 (99.5%) did recall scenes in the storyline pertaining to Down Syndrome. As this is one of the important issues discussed in the telenovela, it can be inferred that respondents who did not observe this issue in the telenovela rarely, or sporadically, watched the telenovela. Respondents confirming having seen Down Syndrome addressed in the telenovela, were asked to identify which issues they remembered seeing, and with what frequency. The results indicate that the family relationship was the most frequently observed issue, followed by social inclusion, inclusion in school and health issues. These were all seen four times or more in the program by a significant percent of respondents, as illustrated in the above graph.

One question was inserted to determined whether viewers had gained information from watching Paginas da Vida. It is known that television can be an excellent tool for learning. Among the studies of social psychology that focus on beliefs, attitudes, and values, Fishbein and Ajzen noted that behavior can be modified through the beliefs about the subject, and that these can be developed through interpretation of external and internal information. This idea of belief formation implies that individuals have the capacity to absorb new information and modify attitudes. These attitutes then go on to influence behavior. The media is one social product that can influence the system of beliefs of the individual. The graph below shows that the majority of

Population Media Center Report on Social Merchandising Project in Brazil 2006 - Page 9 respondents report that their knowledge of Down Syndrome increased markedly through watching Paginas da Vida:

Figure 1: Percent distribution of change in knowledge about Down Syndrome among viewers of Paginas da Vida

0.5 26.9

Increased Remained the Same Decreased

72.6

The following question pertained to the level of increase in knowledge about various issues relating to Down Syndrome resulting from watching Paginas da Vida. The results are presented in the graph below, by category:

Table 6: Percent distribution of the increase in knowledge about issues relating to Down Syndrome

80 70 60 50 40 30 20 10

0 Small Medium Large

Health 26.7 38.6 34.7 Education in General 6.9 27.6 65.5 Inclusion in School 8.5 2 0 71.5 Social Inclusion 6.7 27.5 65.8 Family Relationships 10.7 2 7 62.3 Inclusion in the Workforce 40.2 2 8 31.8

Population Media Center Report on Social Merchandising Project in Brazil 2006 - Page 10 Another question explored the influence the telenovela Paginas da Vida had on knowledge, attitudes and practices. It was important to determine whether the topics addressed in the telenovela had an impact on the lives of repondents. The results of this question are presented in the table below:

Table 7: Percent distribution of the effect of the telenovela Paginas da Vida on knowledge, attitudes and behaviors regarding Down Syndrome

80 72 70 63.8 62.5 60 50 36.4 Knowledge 40 34.5 28 Attitudes 30 Practices 20 10 1.1 0 1.7 0 Increase Decrease No Influence

Clearly, the vast majority of respondents indicated that the telenovela Paginas da Vida had effects not only on their level of knowledge about Down Syndrome, but also changed their attitudes and behavior with regard to this issue. As with the preliminary family plannning data, the data gathered among clients at the Brazilian National Down Syndrome Association point to widespread effects of this popular telenovela. Because of the way in which the writers developed the storyline of a Down Syndrome baby born to a teenage mother, it is also likely that the Down Syndrome content motivated adolescent viewers to seek family planning services in order to avoid having a Down Syndrome baby.

We greatly appreciate the support of the Weeden Foundation that made possible the work with TV Globo and the evaluation research to measure its impact.

Population Media Center Report on Social Merchandising Project in Brazil 2006 - Page 11