The most popular cartoonist in Jordan has, for years, been Emad Hajjaj, whose character, Abu Mahjoob, lampoons the foibles of society. Often controversial, the great popularity of the character has granted Hajjaj license to address issues otherwise left untouched.

The USAID/Jordan health project for the private sector, Commercial Market Strategies, (CMS) persuaded Hajjaj to create a school year calendar (August - July) that carried twelve health messages for women.

Each month presents a new topic. Some months carried familiar messages – such as the importance of screening for breast cancer – while others broke new ground. Illustrative of a familiar message is the cartoon at the right promoting spacing of births. The caption reads, “Every farmer knows the importance of spacing.” The accompanying text cites Koranic instructions and medical research that support longer birth intervals. Note that half the births in Jordan are spaced less than 24 months apart.

More daring topics included surgical contraception, emergency contraception, domestic violence, and condoms. Prior to issue of the calendar emergency contraception was rarely discussed in Jordan, nor were there educational materials on the topic. Presented with the usual Hajjaj flair, we see Abu Mahjoob and his wife in their post-coital bed, him content, her frightened. The accompanying text provided detailed instructions (how many pills when) on how to prevent pregnancy.

Effect

It was anticipated that the calendar would be popular, but demand outstripped expectations. Through the CMS outreach program 50,000 copies were quickly distributed to poorer women. There was an outcry for more. Another 20,000 were printed and distributed. The demand continued unabated and another 20,000 were printed and distributed. At this point we were well into the school year and the calendar was becoming out-dated. In response to the many aggrieved non-recipients, a new Abu Mahjoob calendar will be issued in January 2005.

Beyond popularity, did the calendar fulfill its intended function of educating women? It’s one thing to read and laugh at the cartoons; another to study the informational text on each page.

A survey of 300 women – divided between recipients and non-recipients – was conducted four months after distribution to gauge the educational impact.

The questions sampled from the material in the calendar and ranged from general to picky. The chart below shows how large the differences in knowledge were between those who had a calendar and those who did not.

The IUD question asked about the duration of effectiveness of the CuT380A as that is usually underestimated. A question on oral contraceptives (OCs) asked women to list as many advantages as they could recall; the chart shows the percentage of women who could provide six or more. The breast cancer question asked simply how often a woman should self-examine. The emergency contraception question inquired how long EC might be effectively practiced after unprotected intercourse. The spacing question asked about the recommended minimum interval between births. And, an unabashedly picky question, we tested to see if women recalled a minor point about the effect of Aspartame on short term memory.

These gratifyingly positive results are strong evidence that the recipients not only laughed at the humorous content, they also studied and learned the material. The sequel calendar will be distributed later this month.