John Hopkins Shared Agenda for Social and Behavior Change in Family Planning -REFRESH

Strategic priority areas

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We can accelerate progress towards our family planning goals by coordinating our efforts

It takes a village: A shared agenda for social and behavior change in family planning

Breakthrough ACTION worked with partners from 24 donor and implementing organizations to develop and validate a global shared agenda for social and behavior change (SBC) in family planning

Improving SBC for service delivery

Employee Stock Ownership Program (ESOP)

Improving SBC for service delivery

SBC is an underutilized tool for improving family planning service delivery

Working together

Drawn from and validated by iterative consultations, this Shared Agenda seeks to catalyze stakeholder coordination by:

• Identifying strategic priorities in SBC for family planning that need greater coordination and/or investment • Proposing opportunities for coordination and collaboration to enhance complementarity across investments

The Shared Agenda identifies five strategic priorities for SBC in family planning across three areas where increased investment, coordination, and collaboration are most needed.

Focus areas of national Costed Implementation Plans (CIPs) and annual action plans

Strategic priority areas

Strategic Priorities

Endorse the Shared Agenda

Technical

The strategic priorities are not intended to represent all priorities for all actors. Rather, they highlight the need for increased coordination and investment in specific, critical areas.

Financial

Geographic

Fostering a Supportative Enviroment for FP/RH

Understanding and meeting the needs of youth

Increasing coordinated investments in SBC for family planning

Focusing on Francophone West Africa

Endorsements

Resources

These priorities were selected based on a range of factors, including:

• Motivation • Satisfaction • Norms

We need to work together to:

Motivate demand for family planning before seeking services

Hover on graph to explore how SBC improves health outcomes thoughout the Circle of Care

In many cases, social change cuts across multiple health and development sectors and can serve as an opportunity to promote greater program integration

Enhance understanding of the provider perspective, including:

Better coordinate SBC and service delivery investments

Compile more evidence about effective provider behavior change approaches

Agree upon, adhere to, and report according to a uniform bank of process, output, outcome, and impact indicators, disaggregated by sex and age as necessary

Strengthen the links between actors working at a variety of levels, including:

• Individual-level behavior change • Policy and structural change • Norms shifting and gender transformative interventions

• Human rights advocacy • Community health

Seek consensus on a prioritized set of measurement indicators and processes to measure social change

Increase attention to ethical considerations related to shifting social and gender norms and broad social change

Apply existing social change theories to program design

Improve our capacity to identify, respond to, and measure our progress in addressing social and gender factors that impact family planning outcomes

Normative dimensions

Policy and structural factors

Social accountability

In many cases, social change cuts across multiple health and development sectors and can serve as an opportunity to promote greater program integration

Social change includes a mix of approaches in:

We need to work together to:

Employee Stock Ownership Program (ESOP)

Supporting social change for family planning

Greater emphasis on social change is critical to achieving family planning goals

Seek out innovations in referral systems (e.g., mobile-based referrals) to overcome service-seeking barriers using SBC approaches.

Improve quality of care with better client experience and improved provider attitudes and behaviors

Donors’ stated priorities and allocated funding

Improve the client-provider interaction during service delivery

Support family planning use after services are received

Expert stakeholder consultations

Recent evidence summaries

Document effective integrated programs that meet young people’s needs for positive youth development, including:

• Meaningful employment • Safety

• A gender equitable world

Prioritize youth as a cross-cutting issue across family planning programs, rather than as a separate program discipline

Increase youth-driven SBC programs and meaningful youth engagement and partnership

Learn, in real time, what other partners are testing, what works, and what does not work

Girls under the age of 18 who give birth in low- and middle-income countries every day

20k

Pregnancy and childbearing in adolescence carry significant health risks. While a majority of national Costed Implementation Plans for family planning include youth as a priority population — and many donors have made significant investments in this area — work is not always aligned and the results are not consistently shared.

Social change includes a mix of approaches in:

We need to work together to:

Employee Stock Ownership Program (ESOP)

Understanding and meeting the needs of youth

Greater alignment and information sharing is needed to meet the family planning needs of young people

Improve segmentation of youth to understand their different needs, preferences and challenges, as well as behavioral patterns across the life course

Ages where pregnancy-related complications are the leading cause of death among girls

15 to 19 years

Improve understanding and appreciation of high-quality SBC, its cost-effectiveness, and its return on investment

Girls under the age of 18 who give birth in low- and middle-income countries every day

20k

Current investments are insufficient, particularly at the country level, to support the implementation of high-quality SBC as a proven intervention to achieve family planning goals. Notably, many donors and governments vary in their understanding of and appreciation for SBC, leading to uneven support.

Social change includes a mix of approaches in:

We need to work together to:

Employee Stock Ownership Program (ESOP)

Increasing coordinated investments in SBC for family planning

SBC is not yet anchored as a core element of family planning in major development organizations or in government planning mechanisms, such as Costed Implementation Plans

Build appreciation for SBC as an essential component of national family planning strategies

Increase use of shared measurement indicators to allow comparison of program evaluations

Make a targeted effort to improve the coordination of SBC investments to maximize existing resources

Advocate for full funding of SBC elements within Costed Implementation Plans and other national strategies

Increase appreciation among governments, donors, and implementers of how investing in SBC contributes to the achievement of regional and national family planning goals

Ouagadougou Partnership countries: Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo

New contraceptive users between 2015 & 2018

1.4M

Social change includes a mix of approaches in:

We need to work together to:

Employee Stock Ownership Program (ESOP)

Focusing on Francophone West Africa

The Ouagadougou Partnership countries pledged to reach 2.2 million additional family planning users by 2020, but funding is limited for demand generation

Implement high-quality SBC interventions by advancing SBC technical capacity in the region

Invest in demand-side approaches, including social norms awareness and, where appropriate, norms shifting and gender transformative interventions

Increase youth-led and youth-centered SBC for family planning

Improve coordination of SBC investments and activities in the region to avoid duplication of efforts and address gaps

New users needed to reach the 2020 goals

817k

Of the Ouagadougou Partnership donor funding focuses on demand, including SBC

12%

Reaching global family planning goals depends on extraordinary and unprecedented cooperation, collaboration, and shared visioning across the family planning community

To achieve our shared goals, we need to:

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Working together

Identify

SBC champions and key influencers, and connect them to family planning coalitions and working groups at the global, regional, and national levels

Fund & conduct

SBC research across the strategic priorities and promote research utilization through coordinated dissemination

Advocate

For the inclusion of high-quality SBC approaches in national planning processes according to the strategic priorities

Harmonize

Strategies and messages at the national level through collaborative planning, messaging workshops, and ongoing communication

Develop

Coordinated, long-term technical assistance plans for SBC in family planning at the global and regional levels

We encourage all family planning stakeholders to commit to support, use and disseminate the Shared Agenda to ensure its operationalization and to harness the power of SBC for improved family planning outcomes.

• Kara Tureski • Lauren Rushton • Lindsay Swisher • Laurette Cucuzza • Lynn Van Lith • Mande Limbu • Olivia Carlson • Olumide Adefioye • Omar Cheick • Pamela Onduso • Peter Ejim Christopher • Radha Rajan • Rayana Rassool • Rebecka Lundgren • Sarki Othman • Susan Krenn • Uttara Bharath Kumar

Endorsements

Add your name or organization to the list

Read the summary brief

Resources

Global Shared Agenda for SBC in FP

Read the full report

Ouagadougou Partnership Shared Agenda

Read the full report

SBC for Service Delivery Shared Agenda

Acknowledgements

Many thanks to the organizations that contributed to developing this Shared Agenda: Bill and Melinda Gates Foundation, Camber Collective, Care USA, Chemonics International, CORE Group, David and Lucille Packard Foundation, Development Media International, FHI 360, FP2020, Gates Institute, Georgetown University Institute for Reproductive Health, ideas42, Jhpiego, Johns Hopkins Center for Communication Programs, Pathfinder International, Population Council, Population Media Center, Population Services International, Promundo, Save the Children, Syntegral, ThinkPlace, USAID headquarters and country/regional Missions, and the William and Flora Hewlett Foundation.

1. Rosen, J. E., Bellows, N., Bollinger, L., Plosky, W. D., & Weinberger, M. (2019). The business case for investing in social and behavior change for family planning. Washington, DC: Population Council. 2. Huezo, C., & Diaz, S. (1993). Quality of care in family planning: clients’ rights and providers’ needs. Advances in Contraception, 9(2), 129–139. Retrieved from: https://doi.org/10.1007/BF01990143 3. World Health Organization. (2012). Preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries: What the evidence says. Geneva, Switzerland: World Health Organization. 4. Adding it up: Investing in contraception and maternal and newborn health in the Ouagadougou Partnership countries. (2018). Retrieved from https://www.guttmacher.org/fact-sheet/adding-it-up-contraception-mnh-ouagadougou-partnership 5. Based on analysis by Camber Collective (2019).

+ Footnotes

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The Global Shared Agenda for SBC in Family Planning was one of three shared agendas created.

Read the full report

This website is made possible by the support of the American people through the United States Agency for International Development (USAID). Breakthrough ACTION is supported by USAID’s Office of Population and Reproductive Health, Bureau for Global Health, under Cooperative Agreement #AID-OAA-A-17-00017. Breakthrough ACTION is based at Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs. The contents of this website are the sole responsibility of Breakthrough ACTION and do not necessarily represent the views or positions of USAID, the United States Government, or Johns Hopkins University.