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New High Impact Practice Briefs on Social and Behavior Change for Family Planning

Three-Part Webinar Series Recap

Sarah V. Harlan
Published on July 18, 2023

The HIPs Partnership in collaboration with the IBP Network recently hosted a three-part webinar series to highlight three recently-published High Impact Practice (HIP) briefs on Social and Behavior Change (SBC) for family planning. The three briefs were launched at the SBCC Summit in December 2022. The webinar series, held in March-May 2023, shared information about the new briefs with a larger global audience. This blog post highlights key information from the webinar series; all HIP briefs and webinar recordings can be found on the HIPs website.

New HIP Briefs on Social and Behavior Change (SBC) for Family Planning

During the SBCC Summit in Marrakech, Morocco in December 2022, The HIPs Partnership hosted an event to launch three new High Impact Practice (HIP) briefs on Social and Behavior Change (SBC) for family planning. Titles and links to the briefs are as follows:

  1. Promoting healthy couples’ communication to improve reproductive health outcomes
  2. Knowledge, Beliefs, Attitudes, and Self-efficacy: strengthening an individual’s ability to achieve their reproductive intentions
  3. Social Norms: Promoting community support for family planning

The December 2022 event featured presentations from the authors of the new briefs—along with experts in these practices. The speakers offered their perspectives and highlighted the importance of the new briefs. The goal of this launch event was to share this new suite of SBC HIP briefs with public health decision makers and SBC practitioners who can use the briefs to advance family planning policies and programs.

Webinar Series on new SBC HIP Briefs

As part of continued dissemination of the new briefs, HIPs partners held a webinar series from March – May 2023 to offer a more in-depth look at the evidence and implementation guidance included in each of the new briefs. Each webinar included an overall introduction to the HIPs, a summary of the SBC HIPs, an overview of each new HIP brief, an implementation perspective, and question and answer (Q&A) session.

Below is a summary of the HIPs introduction, which was the same across all three webinars, followed by brief highlights from each webinar.

HIPs introduction (included in all three webinars)

Each webinar began with a welcome and introductory remarks from Maria Carrasco, Senior Implementation Sciences Technical Advisor, Office of Population and Reproductive Health, USAID. She introduced the webinar and then provided an introduction to the HIPs.

The HIPs are family planning practices that are vetted by experts against specific criteria: replicability, scalability, sustainability, cost-effectiveness, and evidence of impact in achieving certain family planning outcomes. HIP briefs are short and written using clear language. There are four categories of HIP briefs: Enabling Environment Service Delivery, Social and Behavior Change (SBC), and Enhancements. All HIP briefs include a summary of evidence as well as tips for implementation. All briefs can be found on the HIPs website.

Listen to a recording of this segment [02:17 – 07:57]

SBC introduction (included in all three webinars)

This webinar series focused on HIPs for SBC, and each webinar included a brief introduction to SBC—an evidence-driven approach to improve and sustain changes in behaviors that can lead to improved health outcomes. Of the six SBC briefs, three are new. The three existing SBC briefs focused on channels for reaching audiences: mass media, community group engagement, and digital health for SBC. The three new SBC briefs focus on addressing key behavioral determinants that can impact family planning outcomes: couples’s communication; knowledge, beliefs, and attitudes; and social norms. The intention is for these briefs to be used together, as a suite.

A graphic showing how the three new SBC briefs complement the three existing ones.
A graphic showing how the three new SBC briefs complement the three existing ones.

Listen to a recording of this segment [07:54 – 13:02]

Webinar on Couples Communication HIP

“We incorporate stories that show reality, but also stories of positive men and couples that can also serve as a good source of information [to promote couples’ communication].”
–Esete Getachew, CCP

Key information:

  • This brief focuses on interventions demonstrated to help couples and sexual partners discuss family planning and reproductive health and make equitable decisions to reach fertility intentions.
  • Healthy couples’ communication can increase uptake of modern contraception and help couples achieve their fertility intentions. Promoting couples’ communication can also improve gender equality.

The webinar took place on March 14, 2023 and included the following:

Agenda Item Speaker, Organization Link to recording
Opening and Welcome
HIPs & SBC Overview		 Maria Carrasco, USAID 00:00
Couples Communication HIP Brief Overview Robert Ainslie, Johns Hopkins Center for Communication Programs (CCP) 08:28
Implementation Perspective Esete Getachew, CCP Ethiopia 19:13
Questions & Answers All speakers 39:30

Highlights from the presentations

  • Rob Ainslie:
    • Programs can use a range of SBC interventions to improve couples’ communication, including: counseling sessions, mass media, peer education to reach men, and more.
    • It is important to address the gender and power dynamics within a context—including gender-based violence—before implementing couples’ communication interventions. Ensure that interventions “do no harm” to undermine women’s autonomy.
  • Esete Getachew:
    • Communication for Health, a USAID-funded integrated SBC project, was implemented in Ethiopia in 2015-2020. The program used a range of interventions to model and support healthy couples’ communication, including a weekly radio program, a mobile application, and job aids for health extension workers.
    • A mid-term evaluation indicated that the program’s interventions led to significant improvement on gender-equitable norms, and also resulted in improved health behaviors in a range of topics (including family planning, hand washing, antenatal care).

Highlights from the Q&A

  • Question: From all possible channels to use to address couples’ communication, how do we know which channel will work the best?
    • Answer (Rob): This is dependent on the objectives of the program, your budget, available resources, and what channels people prefer within their community. The more channels you are using to engage people, the better chance their behavior will be changed.
  • Question: How can we monitor radio and TV engagement?
    • Answer (Esete): We used “reach and recall” data collection to keep track of how many of our messages reached the target audiences. We made changes based on our findings. We also collected listener feedback through a free call-in line, and made changes accordingly.
    • Answer (Rob): Radio and TV stations also have social media channels, which can be used to obtain feedback from users.
  • Question: What challenges have you faced in implementing job aids for health extension workers?
    • Answer (Esete): Health extension workers have their own gender biases, which affect couples’ communication, even with the guides that we provided. We conducted training with them, to accompany the tool.
  • Question: Low- and middle-income countries are sometimes “media dark.” What methods can we use in these settings?
    • Answer (Rob): There are a number of ways to improve couples’ counseling without using mass media. The brief provides program examples including small group counseling, mixed couple counseling sessions, community mobilization efforts, and house-to-house visits.
    • Answer (Esete): We tried using the content from the radio and taking it to the community, organizing a “listeners group” where they listened to the story and had a discussion. However, we did not reach many listeners this way, because these techniques had resource challenges for our team.
  • Question: In real-world programs, we may not be able to use different channels due to resource constraints. What are the preferred channels to use in these situations?
    • Answer (Esete): Having something integrated within an existing system (such as the Health Extension Worker system in Ethiopia) is a powerful and cost-effective mechanism to reach households. Creating job aids that support their work in couples’ communication was impactful, because it was an existing system that can be reinforced.

Webinar on Knowledge, Beliefs, Attitudes, and Self-Efficacy HIP

“There is plenty of evidence showing that strengthening family planning knowledge is absolutely essential—and that individuals who have correct information about contraception, including side effects, tend to look more favorably upon, and are more likely to use family planning.”
– Lynn Van Lith, CCP

Key information:

  • Individuals with accurate and substantial family planning knowledge, such as knowledge of fertility or contraceptive side effects, are more likely to use family planning.
  • In addition to knowledge, other factors influencing an individual’s ability to reach their fertility intentions include beliefs, attitudes, and self-efficacy.

The webinar took place on May 16, 2023 and included the following:

Agenda Item Speaker, title Link to recording
Opening and Welcome
HIPs & SBC Overview		 Maria Carrasco, USAID 00:00
SBC Overview Joanna Skinner, CCP 07:40
Knowledge, Beliefs and Attitudes
HIP Brief Overview		 Lynn Van Lith, CCP 13:09
Implementation Perspective Laraib Abid, MASHAL 25:45
Questions & Answers All speakers 45:56

Highlights from the presentation

  • Lynn Van Lith:
    • Strengthening family planning knowledge is fundamental to voluntary, informed, and correct contraceptive use—and can help dispel myths and misconceptions.
    • Self-efficacy—or the power of a person to recognize one’s own capacity to execute behaviors to reach a goal—is strongly associated with voluntary contraceptive use.
    • A number of interventions have been shown to work, including mass media, counseling, participatory methods, and digital tools.
  • Laraib Abid:
    • Despite the availability of SRH services in Pakistan, many people do not use them because of the lack of knowledge. To address this, the Pakistani group MASHAL designed a digital health application, Bridge the GAP, to improve family planning and reproductive health knowledge.
    • Bridge the GAP has improved youth engagement and knowledge around family planning. The program has reached 3 million youth and has trained 10,000 youth in person.

Highlights from the Q&A:

  • Question: In some low-fertility context countries, traditional method use is very high, whereas modern methods are low. Are there any studies explaining why some people opt for traditional method use—by choice, access, social norms, etc? How can SBC frameworks help us dig deeper into this?
    • Answer (Lynn): In some contexts, traditional methods are the default since they are what most people are aware of. It is possible that knowledge around modern methods is low, but it would be important to see data around specific methods in those particular countries. Social norms, access issues, and other factors are also important to explore further by the specific setting. SBC interventions could help address this, once you know what the foundation is.
  • Question: What are gender synchronized approaches, and why are they important?
    • Answer (Joanna): This means working with both men and women in a coordinated way. Sometimes programs target just men or just women, and there can be a disconnect between the family planning information that women and men are getting. A gender synchronized approach can work to ensure that all people are getting the same information.
  • Question: We heard a lot about “nudging”—is this related to SBC or is it a separate approach?
    • Answer (Joanna): Nudging stems from behavioral economics, which influences SBC. It is looking at small actions that can push someone towards a behavior, if they already have an intention. It can be a mental nudge around knowledge, or a physical nudge to make choices more easily available. It stems from the idea of making something a bit easier to choose a specific family planning option.
  • Question: How can the technology that Laraib shared have more reach in the urban poor communities in Pakistan?
    • Answer (Laraib): Even in urban slums, many young people have access to the internet. There are also low-tech solutions used in areas where people lack access—this can include books, theater programs, in-person training, etc.

Webinar on Social Norms HIP

“It’s really important when you’re working on a social norms program to go back to [the question of] what are the norms and what are the reference groups that influence the behavior you’re interested in—for men, women, and couples.”
–Rebecca Lundgren, Center on Gender Equality and Health, University of California at San Diego

“At the beginning [of the Tékponon Jikuagou program], many people didn’t go to the health center, so we planned our [social norms intervention]. At the end, we had many people who had visited the health center.”
–Mariam Diakite, Tékponon Jikuagou

Key information:

  • This practice is defined as the implementation of interventions that address social norms to support an individual’s or couple’s decision-making power to meet their reproductive intentions.
  • Social norms define acceptable and appropriate actions within a given community or group, and are sustained and enforced by people whose opinions or behaviors matter to an individual (e.g., sexual partners, friends, peers, family members, religious or community leaders).

The webinar took place on May 31, 2023 and included the following:

Agenda Item Speaker, title Link to recording
Opening and Welcome
HIPs Overview		 Maria Carrasco, USAID 00:00
SBC Overview Maria Carrasco, USAID 07:30
Social Norms HIP Brief Overview Rebecka Lundgren, Center on Gender Equality and Health, University of California at San Diego 14:33
Implementation Perspective Mariam Diakite, Tékponon Jikuagou 27:13
Questions & Answers All panelists 46:50

Highlights from the presentation

  • Rebecka Lundgren:
    • Social norms are not the same as attitudes. Attitudes are internally driven (“what I believe”), while norms are externally driven (“what others expect of me”).
    • It is crucial to address social norms, because they often play a critical role in preventing women and men from acting on their reproductive intentions. Evidence shows that social norms affect couples’ communication about contraception, fertility intentions, and contraceptive use. They can also facilitate or hinder the access of family planning.
    • A number of interventions have successfully addressed social norms and increased use of voluntary contraception, including: multiple channels of communication; reflective dialogues; mass media; interpersonal communication; and text messaging.
    • The Tékponon Jikuagou program worked through social connections to reduce the barriers that lead to unmet need for contraception. The program used social mapping, community radio, and referrals to health providers.
    • This led to effects on both social norms and contraceptive use. For example, men who heard the radio broadcasts were more likely to believe their peers use contraception and were more confident to do so themselves. Also, the percentage of women and men using a contraceptive method almost doubled in less than a year.
  • Mariam Diakite:
    • Social norms mapping in 10 countries in Francophone West Africa identified gender norms as the most common type of norms, followed by those related to reproductive health and family planning.
    • The Tékponon Jikuagou program addressed a number of norms—including community beliefs, gender norms, and norms around fertility.
    • Program implementation components included social mapping, reflective dialogues, influential individuals, radio, and family planning providers. Norm shifting components were conducted at the community, interpersonal, and individual levels.
    • This program showed that SBC strategies based on diffusion through social networks reduced gender and other social barriers to family planning use.

Highlights from the Q&A:

  • Question: In the Tékponon Jikuagou intervention, were there always signpost referral to services in the dialogue and radio programs?
    • Answer (Rebecca): Yes, in any social norms program, there is usually a parallel effort to make sure that the services offered are high-quality and accessible. Tékponon Jikuagou included efforts to strengthen services, and included a services card/coupon.
  • Question: How have the projects managed group dynamics? Have they been able to keep the group together through the whole project?
    • Answer (Mariam): We did a mapping to select existing groups—we did not create new groups. We involved—community members, including women and youth leaders, village chiefs, teachers, etc.—who could represent the culture of the community. We had criteria to identify the most influential participants who can help catalyze discussions.
  • Question: Can you comment on embedding implementation science in Tékponon Jikuagou and other SBC interventions?
    • Answer (Rebecca): This was an implementation science project. We began with social network research to inform the interventions. We also used responsive feedback to improve and guide what we did along the way. This implementation science approach made the project successful.
  • Question: What was the impact of Tékponon Jikuagou on modern contraceptive prevalence or other family planning outcomes? And how did you measure your results and documenting results of norms interventions?
    • Answer (Rebecca): Our survey was our most important instrument to compare differences in contraceptive use and social norms (baseline/endline and control/intervention). The percentage of women and men using contraception doubled in less than a year. We asked a lot of questions about exposure to the intervention to tease out intervention component results. We had significant positive effects on both men and women, but the results were different. Our final report is available online.
    • Answer (Mariam): For the radio program, we measured the number of people who called and asked questions. We found that more men called than women. But when we took data, we found that women listened to the radio program too, but they didn’t have the means to call into the show. We also distributed invitation cards and went back to collect them—and collected data in the process.
  • Question: Are there any tips to share in terms about male engagement?
    • Answer (Rebecca): It is important to first understand men’s motivations and barriers are—and what their norms are. There are often different norms that influence men and women, and their reference groups are different.

Additional resources highlighted in the webinar series:

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 more than 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 leads the Inside the FP Story podcast and was a co-founder of the Family Planning Voices storytelling initiative (2015-2020). She is also a co-author of several how-to guides, including Building Better Programs: A Step-by-Step Guide to Using Knowledge Management in Global Health.

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