Cross-Sectoral Social Behavior Change


The cross-sectoral SBC approach aims to provide information, educate and encourage dialogue in settings outside the traditional health-related context. The approach may focus on educating in agriculture, trading schools, businesses or any area within the environment of the target audience, but outside the health-related environment. Transform/PHARE is applying this approach in Benin, Niger and Cote d’Ivoire and the intention of the pilot activities is to understand if men and women who do not usually express interest in learning about family planning (FP) and contraception from health providers, would be more inclined to do so in non-health related environments.

Académie de l’Artisanat

Transform/PHARE designed a prototype craft academy, Académie de l’Artisanat, to reach young, out-of-school women with information on and referrals for modern contraceptive methods. A handcraft academy model was selected based on the insight that young, out-of-school women were interested in learning income generating skills, such as making crafts that also allows them to earn modest income. During the Académie workshops, beading specialists taught the young women how to make a variety of beaded handicrafts, including necklaces, bracelets, and bags. At the end of the workshop, a community facilitator provided lessons on modern contraceptive methods and referrals to contraceptive services. The craft academy has been implemented in two districts of the Dassa commune in central Benin – Dassa1 and Kèrè. A total of 14 beading workshops (8 in Dassa1 and 6 in Kèrè) were organized between July and September 2017 and a total of 99 women were reached.

Through the workshops knowledge of modern contraceptive methods improved on average from 25.4% in July to 98.4%in September. This rate was consistent for both sites. In addition, during the prototype period of July to September 2017, 10 women received modern contraceptives from healthcare providers.

Message Testing and Iteration Using IVR in Niger 

Interactive voice response (IVR), an interactive voice phone messaging system, was selected to target the segment identified as healthy proactivesHealthy proactives are women who are already interested in using or have tried a FP method in the past but are not currently using modern contraception.  Six messages were tested through interactive messaging phone calls. The two most effective messages were selected and further tested. These messages related to barriers to contraceptive use identified by healthy proactives; specifically, rumors about the negative behaviors of health providers, and misconceptions about the side effects of contraceptive methods. Messages were used to develop radio spots that aired nationally. Interactive voice response messaging also proved successful at identifying and developing messages that targeted a specific segment of women, although in the Dosso area technology use became a challenge.

Social Network Analysis and Training Community Influencers as FP Promoters in Niger

Social network analysis (SNA) was used to determine how social interaction influences individual behaviors and can trigger the adoption of positive FP behaviors. This approach was used to identify and target the segment called sheltered skeptics. SNA was selected, as this segment of women tends to mistrust contraception and mistrust the information coming from health workers regarding family planning.  The SNA identified several male and female key influencers on the behavior of sheltered skeptics. Later, identified influencers were trained on modern contraceptive methods, gender issues, and the use of communication technology to raise awareness to the benefits of FP.  Using social network analysis proved successful at identifying members of the community who are considered influential and trusted by women to provide accurate information on FP. By understanding the social network, Transform/PHARE was able to more effectively reach women who were previously mistrusting of FP information.

Social Behavior Change Communication landscaping using TMA in Côte d’Ivoire

The SBCC landscaping in Cote d’Ivoire, using the total market approach, allowed the project to identify existing FP products and linked communication. This analysis painted a full picture of the FP market in Cote d’Ivoire which in turn can inform programming at every level to support positive behavior change. Through this analysis it was found that the FP market includes 32 million condoms (79% of which are socially marketed), 2.5 million contraceptive pills, and injectables, which are primarily sold through the private sector. Unmet FP need in the country is estimated at 27.2%. It was also found that recurring inventory shortages often affected the providers’ ability to conduct quality services. In addition, due to high communication costs in the country, FP communication was often left out, which created an environment of negative perceptions surrounding FP products from consumers and even suppliers. The research indicates that in order for CDI to move ahead in reaching its FP goal, the Ministry of Health needs to encourage increased mass and social media communication activities on modern contraceptives and eliminate media taxes to motivate the different actors in promoting FP.

Engagement of Religious Leaders in Niger Using Human-Centered Design

Drawing from different research methodologies, the team sought to uncover youth and religious leaders’ perspectives, and knowledge, on reproductive health services and products in several villages in the Zinder region of Niger. While there were religious leaders who supported birth spacing, they perceived a significant amount of risk in publicly supporting family planning on their own. Furthermore, both religious leaders and youth shared a desire to improve their knowledge and ability to dispel myths about reproductive health in a public forum so that the larger community could benefit from candid discussions. Our research showed that the primary determining factor to contraceptive uptake among married women in Zinder was support from their husband. Yet, despite men being the main-decisions makers on contraceptive use, and essentially every household decision, we found that men lacked sufficient knowledge on the financial implications of raising children to inform their choices. Building on the design research findings, the team designed 10 low-fidelity prototypes that were subsequently rapidly field-tested and iterated with 41 religious leaders, 26 youth, and 5 healthcare workers. All materials were designed for non-literate populations. A scorecard methodology was used to evaluate the final three solutions which will be implemented during a six-month pilot program, called Sarari (meaning spacing in Hausa):

  • Leaders Engagés: a collective of religious leaders who serve as agents of change by openly advocating (either through sermons, teaching at the Koranic school, or through private consultations) on the importance of birth spacing for maternal and infant health, and overall family well-being.
  • Séminaire des Leaders: a series of debates between religious and youth leaders on the topic of birth spacing.
  • Dede Ruwa Dede Tsaki (Just the right amount of water for the flour)a budgeting activity and discussion tools based on Koranic verses to encourage participants to seek a balance between their financial resources and desired family size.

Promoting Male Engagement and Partners’ Dialogue in Côte d’Ivoire Using Human-Centered Design

This initiative will provide insights into the young male perceptions on contraception as well as their attitudes, beliefs, and barriers to engaging with their partners around family planning. The project will prototype ways to increase debate and interest on male involvement in contraception. The objective is to positively influence young male willingness and ability to communicate on the use of contraception in family planning with their partners and peers.