Social Norms: Promoting Community Support for Family Planning

"...who has the power to make decisions; when and how many children to have; who is allowed and when it is appropriate to engage in sexual activity; and who is allowed and when it is appropriate to seek health services...[?]"

Implementing interventions that address social norms to support an individual's or couple's decision-making power to meet their reproductive intentions is one of several proven "high-impact practices in family planning" (HIPs) identified by the HIP partnership and vetted by the HIP Technical Advisory Group. This HIP brief provides information on what works in family planning social and behaviour change (SBC) programmes that focus on social norms.

As the brief explains, social norms define acceptable and appropriate actions within a given community or group. Descriptive social norms are beliefs about what other people do, whereas injunctive social norms are beliefs about what other people approve or disapprove of. Social norms are sustained and enforced by people whose opinions or behaviours matter to an individual (e.g., sexual partners, friends, peers, family members, religious or community leaders) - so-called "reference groups". Gender norms, a subset of social norms, are particularly important in sexual and reproductive health decision-making, as they shape societal expectations of men and women and often consolidate power and resources among men and male-dominated institutions.

Why is this practice important?

• Social norms can inhibit an individual's ability to act on their reproductive intentions.
• Social norms influence couples' communication about family planning, which in turn influences contraceptive use.
• Social norms affect individuals' and couples' decisions about when to have children.
• Social norms influence contraceptive use.
• Social norms can facilitate or hinder efforts to access good-quality sexual and reproductive health care.

Interventions that address social norms typically do one or more of the following: (i) identify the social norms and reference groups relevant to the behaviours of interest; (ii) seek change at the community rather than individual level; (iii) confront power imbalances such as those related to gender and age; and/or (if) create or reinforce positive norms to support healthy behaviours.

Several SBC interventions that have addressed social norms have resulted in increased use of voluntary contraception (see Table 1 in the brief, though experts believe that social norms have played a larger role than is shown here). These interventions have included multiple channels of communication, including reflective dialogues, mass media, interpersonal communication, and an intervention sent via text messages. In alignment with the socioecological model, these interventions generally use multiple components to reach individuals, couples/households, communities, and systems.

Tips for implementing interventions that address social norms:

• Identify the norms and the power dynamics underlying norms and behaviours.
• Ensure staff and facilitators have the training and skills to support community-led social norm processes.
• Create or reinforce positive social norms by modeling desired behaviour(s).
• Anticipate, plan for, monitor, and mitigate pushback and unanticipated harmful effects.

Following a section on implementation measurement, priority research questions are outlined, including:

• How do we best evaluate the effectiveness of interventions that address social norms?
• Most interventions with evidence showing that norms were successfully shifted included reflective dialogues. What other types of interventions (e.g., mass and digital media, advocacy for policy change) and what combinations of interventions can effectively address family-planning-related social norms?
• Do interventions that address social norms lead to sustained changes in family planning behaviours by creating an environment in which contraceptive use is considered normal and approved of? If so, how can programmes accelerate diffusion of positive social norms?

The brief concludes with links to related tools and resources.

Editor's note: Click here to watch a video (also available below) and/or to download presentation slides (47 pages, PDF) from a May 31 2023 webinar on the above brief.