Bringing Ethical Thinking to Social Change Initiatives: Why It Matters

"We hope to spark conversations that can raise our field's awareness of the need to engage with the ethical questions that arise in the design and implementation of NSI and to set a foundation for the development of practical tools and guidelines."

The past few decades have seen growing use of norms-shifting interventions (NSI) in low and middle-income countries (LMICs) to promote social and health behaviour change (SBC) toward achievement of the United Nations' 2030 Sustainable Development Goals (SDGs). One type of NSI, community-based NSI, seek to address gender, other inequalities, and the power structures that hold inequalities in place by creating and reinforcing positive norms that are rooted within communal values. In such contexts, designers and implementers, particularly if they are community outsiders, must ask ethical questions such as: Whose voices and values, at which levels, should inform intervention design? Based on a literature review and the authors' conversations and collaborations with international and local non-governmental organisation (NGOs) working on NSI to improve community health, this article proposes ten ethical values and practical ways to engage ethically with the social complexities of NSI and the social change they seek.

In seeking to engage and shift power dynamics and address social inequalities, NSI work at the intersection of three domains: public health, human rights, and social justice. To understand ethical reflections in each domain, the authors conducted a non-systematic literature review in 2018, focusing on these fields: norms-focused interventions, bioethics, public health, health promotion, social marketing, SBC communication (SBCC), medical anthropology, participatory research, social work/community organising, women's empowerment programmes, and humanitarian programmes. The review yielded 125 articles.

Various insights emerged from this review, including ten ethical values common across the three domains that are particularly relevant to NSI in their design and implementation.

While a values-informed approach is necessary, it needs to be structured in usable ways because people often live values but have not consciously examined them. "Without structured reflection, people often do not know or are not able to explicitly state the values guiding their actions. This leads to situations where Northern NGOs...[assume that] their intentions to do good are sufficient, without considering the perspectives, values and needs of local populations and organisations and how these views may inform programme focus and strategies. These Northern and other outsider organisations hold power over, justifying their approach as focused on achieving good, without considering that local communities are more deeply invested, now and long term, in doing good for their community. Therefore, how to engage in these relationships and how programmes are designed and implemented are essential."

To facilitate the process - the how - of making design decisions, the authors offer operational definitions for values that, in the authors' experience, are common to different cultures. They are adapted from the New Zealand National Ethics Advisory Committee document Getting Through Together: Ethical Values for a Pandemic (2007). Five values that can guide ethical decisions during NSI programme design:

• Inclusiveness: including those who will be affected by the decision; including people representing all cultures and communities; and taking everyone's contribution seriously.
• Openness: letting others know what decisions need to be made, how they will be made, and on what basis they will be made; letting others know what decisions have been made and why; and letting others know what will come next.
• Reasonableness: systematically considering alternative options and ways of thinking; being conscious to reflect cultural diversity; using a fair process to make decisions; and basing decisions on shared values and best evidence.
• Responsiveness: being willing to make changes and be innovative; changing when relevant information or the context changes; enabling others to contribute whenever we (and they) can; and enabling others to challenge our decisions and actions.
• Responsibleness: acting on our responsibility to others for our decisions and actions; and helping others to take responsibility for their decisions and actions.

Based on the above, some ideas for action that may be useful to those charged with design in contexts where outsider NGOs or other entities lead the design process are offered. A way forward is for designers to "engage community members as part of formative assessments and, when possible, in strategic decision-making during the definition of key project parameters and strategies. Incorporating values that expand the design environment...can build trust and demonstrate transparency to stakeholders. These efforts can assure people that the organisation implementing the NSI has integrity and holds a common belief about a common community good, even when universal agreement on decisions is not achieved." As designs are being finalised, these personnel would conduct internal checks on who is included as participants and who is not, and which power structures are most affected. A case study of Bell Bajao, a gender-transformative NSI to engage people in questioning and acting to prevent domestic violence in India, is provided. This experience on the part of Breakthrough India, a human rights organisation, makes concrete the kinds of ethical decisions that designers grapple with when working in the normative spaces of women and men to make violence unacceptable. (For more on the Bell Bajao campaign, see also Related Summaries, below).

Because they aim for normative change, NSI often encounter social pushback, opposition, or resistance during implementation. A shared set of project values held by project staff and its key partners can help implementers support/mitigate unintended negative consequences in ethically considered ways. Again drawing on Getting Through Together: Ethical Values for a Pandemic, the authors offer five ethical values that can be considered throughout NSI implementation:

• Do good; minimise harm: helping individuals and communities attain good health, minimising risks and potential harm; not harming other individuals or groups; and protecting one another from harm.
• Respect: recognising that every person matters and treating people accordingly; and supporting others to make their own decisions whenever possible.
• Fairness: ensuring everyone gets a fair go; prioritising fairly when there are not enough resources; supporting others to get what they are entitled to; and minimising inequalities.
• Reciprocity: helping one another; acting on any special responsibilities we may have (power of holding resources); and agreeing to extra support for those who have extra responsibilities in catalysing social change.
• Solidarity: working together when there is a need to be met; showing commitment to strengthening individuals and communities; and helping and caring for neighbours, friends, family, and relations.

Another case study from Breakthrough India (the Stand With Me. Be My Safe Space campaign) shows how an incorporation of values of openness and inclusiveness found in the NSI design, and by values of fairness and solidarity during implementation, enabled staff to make real-time ethical decision-making and address new issues of sexual harassment of young people and its prevention as they emerged.

In practice, implementers might need to ask: Who is accountable to communities when pushback is harmful (project organisers, community elders, local government)? "An ethical lens would allow safe spaces to reflect on how the direction of resulting actions and how they might reinforce power rather than move towards its redistribution. Early discussions and debate around values that are widely shared among all those who may be affected can clarify where accountability lies."

In conclusion: "Ethical thinking and the integration of ethical values is essential to NSI as it provides guidance that can contribute to building community social capital and contribute to health and SDG achievements....We need more systematic embedding/conscious inclusion of ethical decision-making as NSI move into mainstream SBC programming, both in their design and implementation." Specifically, the authors call for more field-tested tools that incorporate an ethical lens in the NSI design and implementation toolkit.

Click here to read a summary of the article on Research Outreach, "Doing good: Social change initiatives and ethical thinking".