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

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/reproductive health

In 2018-2019, 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. In 2021-2022 Breakthrough ACTION conducted a desk review and an online survey and hosted an expert consultation with over 40 international participants to determine if the priorities were still relevant, given the COVID-19 context.

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/reproductive health (FP/RH) 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 FP/RH 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 supportive enviroment for FP/RH

Understanding and meeting the RH needs of youth

Increasing coordinated investments in SBC for FP/RH

Focusing on SBC for FP/RH in 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:

Improve FP/RH service delivery through increased coordination and sharing between donors and implementing partners

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

Improve measurement and use common indicators of SBC for service delivery

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

Improve inclusive male and community engagement around FP/RH, including enhanced social accountability for FP/RH services

Greater attention to the social determinants of health in SBC for FP/RH programs, including through improved multi-sectoral partnerships

Increase prioritization of equity in SBC for FP/RH programs

Increase integration of gender considerations in SBC for FP/RH programs across the life course

Policy,

Structural factors, and

Social accountability

While several more recent programs have paid increased attention to normative dimensions, there has been less exploration of approaches in the areas of:

We need to work together to:

Employee Stock Ownership Program (ESOP)

Fostering a supportive environment for FP/RH

Explore the root causes of health disparities related to FP/RH and how SBC approaches can and should be used to address them

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 informed by online survey and desk review

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

• Meaningful employment • Safety

• A gender equitable world

Increase advocacy with decision-makers and influencers to support FP/RH programming for youth and increase youth access to program budgets to cement youth as partners for change

Improve segmentation of youth to understand their different needs and how/where to reach them, rather than viewing them as a homogenous group

Increase youth-driven programs and meaningful youth engagement and partnership for program and policy design and implementation

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 RH of youth

Greater alignment and information sharing is needed to meet the reproductive health needs of young people

Stronger prioritization of youth as a cross-cutting theme across FP/RH programs, not as separate program discipline

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

15 to 19 years

Improve coordination related to SBC to maximize the resources in place while pushing to fully fund SBC within CIPs and beyond

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 FP/RH 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 FP/RH

SBC is not yet anchored as a core element of major development organizations' FP strategies

Improve understanding of, and appreciation for, the social and behavioral determinants of FP, and the potential return on investment of high-quality SBC programs, among governments, donors, and other FP partners

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 for how investing in SBC contributes to the achievement of FP goals in the region

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

Average mCPR for all women in the nine OP countries

18.2%

Social change includes a mix of approaches in:

We need to work together to:

Employee Stock Ownership Program (ESOP)

Focusing on SBC for FP/RH in francophone West Africa

The mission of Ouagadougou Partnership is to double the number of users of modern contraception in the region to 13 million by 2030

Greater inclusion of SBC approaches that address gender inequalities and power dynamics related to FP/RH

Increase youth-powered and youth-centered SBC RH activities in the region

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

Of OP countries' population is young women aged 15-24

42%

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 FP/RH and SBC communities

To achieve our shared goals, we need to:

+ Hover for more info

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 stakeholders engaged in SBC, FP/RH, and service delivery to commit to support, use, and disseminate the Shared Agenda to ensure its operationalization and to harness the power of SBC for improved global FP/RH outcomes.

• Lauren Rushton • Lindsay Swisher • Laurette Cucuzza • Lynn Van Lith • Mande Limbu • Olivia Carlson • Omar Cheick • Pamela Onduso • 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. Advance Family Planning. (2018). Ouagadougou Partnership countries. https://www.advancefamilyplanning.org/OPcountries#_ftn1 6. Ouagadougou Partnership Coordinating Unit. (2020). Adapting to a changing world: The emerging PO Strategy post 2020. https://beyond2020.partenariatouaga.org/la-strategie-emergente-du-po-apres-2020/ 7. United Nations Sustainability Development Group. (2021). Leave no one behind. https://unsdg.un.org/2030-agenda/universal-values/leave-no-one-behind 8. Igras, S., Kohli, A., Bukuluki, P., et al. (2020). Bringing ethical thinking to social change initiatives: Why it matters. Global Public Health, 16(6), 882–894. https://doi.org/10.1080/17441692.2020.1820550

+ Footnotes

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The Global Shared Agenda for SBC in FP/RH 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.

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

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

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

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

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

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

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

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

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

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

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

Compile more evidence about effective provider behavior change approaches

Better coordinate SBC and service delivery investments

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

• Motivation • Satisfaction

• Norms

Continue the conversation

Endorsements

• Alice Payne Merritt • Alfayo Wamburi • Alison Pack • Angela Brasington • Antonia Morzenti • Dominick Shattuck • Elizabeth Serlemitsos • Eric Ramirez-Ferrero • Erin Portillo • Foyeke Oyedokun-Adebagbo • Gertrude Odezugo • Jarret Cassaniti • Joanna Skinner • Kamden Hoffmann • Kara Tureski

Read the summary brief