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Recap: Striving for Equality

Using Social and Behavior Change to Address Gender and Social Norms

On October 21, 2021, Breakthrough ACTION hosted a roundtable discussion on the topic of gender and social norms. This event provided an opportunity for those working in family planning and reproductive health to learn about Breakthrough ACTION’s work addressing gender and social norms across diverse country programs and to share their own experiences. Missed this session? You can view the recording on the Breakthrough ACTION YouTube page.

Introduction to Gender and Social Norms

This virtual session began with opening remarks from Joanna Skinner, Population and Reproductive Health technical lead with Breakthrough ACTION. She started by defining some key terms:

  • Social and behavior change (SBC) is a discipline that uses a deep understanding of human and societal behavior and evidence-based interventions to increase the adoption of healthy behaviors by individuals and influence the social and structural factors that underpin them.
  • Gender norms are the informal, mostly unwritten, rules and shared social expectations that distinguish expected behavior on the basis of gender.
  • Social norms are the perceived informal rules that define acceptable, appropriate, and obligatory actions within a given group or community.
Members of the Kasanje youth club meet to discuss sex education and family planning methods, at the laval clinic. Photo courtesy of Johnathan Torgovnik/Getty Images/Images of Empowerment. Some rights reserved.
Photo courtesy of Johnathan Torgovnik/Getty Images/Images of Empowerment. Some rights reserved.

Ms. Skinner stressed that social and gender norms are learned, sometimes explicitly but often implicitly, and evolve over time. She then shared some key lessons from Breakthrough ACTION related to gender and social norms:

  • Develop country-specific gender strategies early on (ideally during the first year of the project).
  • Make sure all staff, stakeholders, and donors are committed to gender integration so that it is built into the project systems from the beginning.
  • Consider broader issues of equity. Recognizing the interconnected nature of social concepts like gender, race, and class is important across countries and contexts.
  • Focus on measurement. More work needs to be done by all working in SBC to standardize measurement around gender integration and outcomes.

Critical Elements for Successful Gender Integration

  • Provide a space for critical reflection of social and gender norms among mixed-gender groups.
  • Foster women’s leadership and influence at the community level.
  • Promote greater harmony and shared decision-making between couples.
  • Tailor gender integration approaches and accompanying messages and materials to the local context.
  • Commit to gender integration among staff, funders, and collaborators.
  • Give attention to staff and local partner capacity, including assistance from specific gender experts as well as staff-wide training in gender integration.

Roundtable Discussions

Participants then joined one of four roundtable sessions. They explored how Breakthrough ACTION programs have addressed social and gender norms through SBC programming and what the project has learned. Below are key takeaways from each of these sessions. Click each section to expand.

Group 1—Addressing Social and Gender Norms: Lessons from Engaging Communities in Northern Nigeria with Adalci as a Guiding Principle. Facilitator: Chizoba Onyechi, Senior Program Officer, Breakthrough ACTION Nigeria.

Chizoba Onyechi described the multi-channel SBC strategy used by Breakthrough ACTION in Nigeria. It addresses a range of health areas, from family planning to tuberculosis to nutrition. In Northern Nigeria, the gender work focuses on engaging male and female religious leaders as advocates for gender equality to help shift social and gender norms and leverage positive religious belief systems. She introduced the term adalci, a Nigerian Hausa word meaning “to provide a level playing field” or “ensure fairness and justice.” A commonly accepted principle, this concept provides a culturally appropriate framework for Breakthrough ACTION’s work in northern Nigeria to achieve gender equality and sustain healthy behaviors.

The roundtable discussion focused on the importance of using a multi-channel SBC approach—including community meetings, radio, and others—and ensuring alignment across projects. The group also discussed the importance of engaging community leaders and influencers—specifically religious leaders—so they are better prepared to address health issues in their community. Religious perspectives can aid in the uptake of certain behaviors, and this can be leveraged by SBC programs.

View the webinar.

Group 2—Gender Dialogue with Health Workers in Ethiopia. Facilitator: Esete Getachew, Gender and RMNCH Advisor, Breakthrough ACTION Ethiopia.

Esete Getachew provided an overview of Breakthrough ACTION’s integrated project in Ethiopia, which focuses on reproductive, maternal, newborn, and child health (RMNCH) and malaria. It uses innovative SBC approaches to influence positive social norms around gender and health. The project builds the capacity of health workers around interpersonal communication and conducts gender dialogues with health workers.

The discussion in this group centered around ways to sustain positive shifts in provider norms—recognizing that health providers are influenced by community gender norms, too. Communities should drive the change process, and there should be mechanisms to hold them accountable. It is important to keep in mind that changing social and gender norms takes time. In addition to identifying gender norms, we would like to change, it is also important to identify positive gender norms.

View the webinar.

Group 3—How Can Practitioners Feasibly Integrate Social and Gender Norms into Social and Behavior Change Programs? Facilitator: Lisa Cobb, Deputy Director, CCP Strategic Communication Programs Unit.

Lisa Cobb presented an overview of the “Getting Practical” tool, which helps integrate social norms into SBC programs. Developed by Breakthrough ACTION and the Social Norms Learning Collaborative, this tool is intended to be used by program designers and planners in a workshop setting to integrate social norms into program plans.

This roundtable discussed the need to understand pathways and to avoid making assumptions about how norms impact behavior. Participants also talked about the importance of a consultation process and the need to engage diverse community members before implementing an SBC project. They discussed how not all social and gender norms are negative. While projects often talk about shifting norms, there are also norms that can be amplified and fortified to promote healthy behaviors. These norms can serve as an important launching pad for individual and collective reflection.

View the webinar.

Group 4—How can SBC programs promote couple communication and shared decision-making in support of family planning, gender equity, and related health outcomes? Presenter: Carole Ilunga, Gender Advisor, Breakthrough ACTION Democratic Republic of the Congo.

Carole Ilunga presented an overview of how Breakthrough ACTION is using SBC to address social and gender norms and improve outcomes in its family planning and maternal, newborn, child, and adolescent health efforts in the Democratic Republic of the Congo (DRC).

Carole started with a brief overview of social and gender norms that affect family planning uptake and utilization in the DRC, including pro-natalism and women’s low purchasing and decision-making power in households and how they disproportionately and negatively impact women. Carole then broke down the different critical levels of behavior change on the socio-ecological model for both men and women (individual, families/peers/households, community, health service delivery, social and structural). She noted that various forms of SBC communication approaches (e.g., mass media, social/community mobilization, and interpersonal communication) can be used to address norms that operate at different levels. Building on these examples, Carole discussed various strategies, including:

  • Couples meetings.
  • Health quizzes at marketplaces.
  • Community debates.
  • Advocacy sessions with religious leaders implemented by Breakthrough ACTION to:
    • Address these norms.
    • Improve communication/discussions around utilization and adoption of healthy family planning and reproductive health behaviors.
    • Promote shared decision-making between couples and within households.

View the webinar.

Conclusion

This roundtable session ended with closing remarks from Afeefa Abdur-Rahman, senior gender advisor with USAID’s Office of Population and Reproductive Health. Afeefa emphasized a few key takeaways from the roundtable that align with key USAID gender priority areas for family planning and reproductive health. She noted that examining gender and other social norms is a way to support individuals and communities in addressing imbalances in power and how they negatively affect different groups of people. She pointed to how exploring social and gender norms provides stakeholders opportunities to discuss and challenge the benefits and disadvantages that these norms present for different individuals and groups and enables communities to make shifts. Afeefa also highlighted that using multiple theories and tools to address social and gender norms can help SBC implementers drive change. Afeefa ended her remarks by offering several ways forward in enhancing work on social and gender norms building on the themes of the roundtable:

  • Using SBC to help communities address agency and empowerment of individuals and couples.
  • Exploring how gender norms play out in the health system, including supporting the health workforce, which is especially relevant in the context of the COVID-19 pandemic.
  • Engaging men and boys in their roles as parents/partners and agents of change within their communities in order to enhance their health-seeking behaviors and address social and gender norms.
  • Considering how SBC can be further utilized to address social and gender norms affecting people of all genders and those who are non-binary.

Additional Resources

Missed this Session? Watch the Recording!

Did you miss this session? You can watch the recording on Breakthrough ACTION’s YouTube channel. You can also follow Breakthrough ACTION on Facebook, Twitter, and LinkedIn. Sign up for Breakthrough ACTION Moments to receive more information and news.

Recap: Striving for Equality
Sarah V. Harlan

Partnerships Team Lead, Knowledge SUCCESS, Johns Hopkins Center for Communication Programs

Sarah V. Harlan, MPH, has been a champion of global reproductive health and family planning for nearly two decades. She is currently the partnerships team lead for the Knowledge SUCCESS project at the Johns Hopkins Center for Communication Programs. Her particular technical interests include Population, Health, and Environment (PHE) and increasing access to longer-acting contraceptive methods. She is a co-founder of the Family Planning Voices storytelling initiative (2015-2020) and a co-author of several how-to guides, including Building Better Programs: A Step-by-Step Guide to Using Knowledge Management in Global Health.

Sarah Kennedy

Family Planning Program Officer, Johns Hopkins Center for Communication Programs

Sarah Kennedy is a Family Planning Program Officer at the Johns Hopkins Center for Communication Programs (CCP), providing core programmatic and knowledge management support across various projects. Sarah has experience in global health project management and administration, research, communications, and knowledge management and is passionate about making the world a more just and humane place and learning from others. Sarah holds a BA in Global Studies from the University of North Carolina at Chapel Hill and an MPH with a certificate in Humanitarian Health from the Johns Hopkins Bloomberg School of Public Health.

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