Elevating Social and Behavior Change as an Essential Component of Family Planning Programs

"[T]he current supply-driven approach fails to sufficiently address the many social and behavioral barriers faced by women and couples in achieving their reproductive intentions and desired family size. Overcoming these barriers will require a better understanding of behavioral drivers and the social environment in which family planning decisions are made, along with an increased investment in social and behavior change (SBC) approaches."

According to this reflection piece, global and national strategies to increase family planning use often fail to sufficiently acknowledge the role of social and behaviour change (SBC). SBC programmes aim to create a supportive normative environment for people to set their own reproductive intentions and access modern contraception. This commentary explains why a more intentional focus on the science of human behaviour could help advance the achievement of global, regional, and national family planning goals.

It does so by demonstrating that:

• Significant social and behavioural barriers to family planning uptake and continuation remain in many settings - To cite only one barrier discussed here: Fear of social stigma and disapproval, as well as fear of active opposition, are among the reasons given for nonuse of contraception. A study that explored the role of both supply- and demand-side factors on increasing contraceptive use in Mozambique found that demand-side interventions are more likely to be effective. For example, increasing women's expectations that their partners will approve available forms of contraception by 25% raises contraceptive prevalence by 3.6%. "In sum, to fully understand nonuse of modern contraception, family planning programs need to consistently and systematically apply a behavioral lens to identify barriers and implement strategically designed SBC interventions. More attention is also needed to diagnose the social and gender norms related to family planning use, along with broader social determinants of health, and to improving the integration of social norms shifting interventions into family planning program design."
• SBC approaches to address these behavioural drivers are evidence-based and cost-effective - "Compilation and synthesis of the evidence of SBC over the past 10 years have cemented [the] evidence base on the effectiveness of SBC and identified key attributes of effective SBC interventions that can facilitate replication and scale up....One of the most significant of these key attributes is the impact of multichannel, multidose interventions. Evaluations consistently show that the higher the level of exposure to SBC interventions, the greater the increase in contraceptive use...In addition, effective interventions are commonly informed by behavioral theory, which specify the determinants of decision-making and is used to guide intervention design and persuasive messaging....SBC funders and implementers should therefore consider these high-impact attributes when making program decisions."
• Investments in SBC enhance those made in service delivery - "...program partners can seize opportunities to strengthen service delivery through behavioral thinking and interventions...Furthermore, programs should also increase understanding of the role of social norms in the context of health services, and design and evaluate effective norms-shifting interventions targeted at providers. These interventions must be designed and implemented in partnership with providers, facilities, and health systems, and they must avoid vilifying or dismissing providers as barriers to client access. Moreover, interventions to maximize provider performance must be paired with interventions to empower clients and build trust and accountability between providers, clients, facilities, and communities."

In conclusion: "the family planning community must continue to increase the quality, reach, and impact of SBC programs and do more to support and empower local stakeholders to design, implement, and monitor SBC interventions in their own context, recognizing and embracing complexity. Doing so will necessitate both increasing strategic and sustained investment in SBC, not only by donors, but also by governments and private sector partners, and coordinating investments to support national priorities at scale to avoid duplication of effort."