The Normative Dimensions of SBC as Part of a Community Action Cycle SUSAN IGRAS

1. Susan Igras
Institute for Reproductive Health,
Georgetown University
Using the Power of Social Networks
to Influence Norms That Affect Unmet Need
for Family Planning in Benin

2. PRESENTATION OVERVIEW
1. Effecting normative change using social networks
2. The social network package designed for scale
3. Cycles of reflection, diffusion, and tipping points
4. How well did it work?
5. Reflections

3. TÉKPONON JIKUAGOU
PARTNERS:
 Institute for Reproductive
Health, Georgetown
University
 CARE Benin
 Plan International
Reduce unmet need by addressing social barriers that stop women
and men from acting on their desires to space or limit births
GOAL:

4. WHY DOES
NORMATIVE CHANGE
MATTER?
“I don’t know what my wife
thinks about family
planning; we have never
talked about it. In our
culture men and women
should not talk about
these things – this is the
reason I have never
discussed FP with my wife.”

5. WHY A SOCIAL NETWORK APPROACH?
SOCIAL LEARNING
 Network members exchange
ideas and information; and
evaluate the relative benefits of
innovation
SOCIAL INFLUENCE
 Network members follow norms
of gatekeepers to gain approval
and avoid conflict
BASELINE RESEARCH - DIFFUSION
10% of women shared knowledge or
positive experiences with FP use with friends
or family (baseline)

6. Programmatically and evaluatively
Self-efficacy,
Intentions, Behaviors
Individual women &
men with unmet need
FP-enabling environment
Women & men’s social
networks

7. Shift social norms/
attitudes to foster
more equitable
behaviors
Systematic use of
reflective dialog
to generate new
ideas at
community level
Equal access by
women and men
Gender
synchronized
Designed for
scale – low cost,
simple, minimal
training & support
Systematic use of
social network
principles
Iterative use of
evidence to
develop, refine &
implement
package

8. GOAL:
ENGAGE COMMUNITIES
IN SOCIAL MAPPING
SUPPORT INFLUENTIAL
GROUPS IN REFLECTIVE
DIALOGUE
ENCOURAGE INFLUENTIAL
INDIVIDUALS TO ACT
LINK FP PROVIDERS WITH
INFLUENTIAL GROUPS
USE RADIO TO CREATE AN
ENABLING ENVIRONMENT
1
2
3
4
5
Women and men with unmet need for for family planning receive
new ways of thinking and acting via their social networks
TÉKPONON JIKUAGOU:
SOCIAL NETWORK INTERVENTION PACKAGE

9. Light Touch, Time Bound
Month 1 2 3 4 5 6 7 8 9
STAFF PREPARE
COMMUNITY IDs
INFLUENTIALS
GROUPS REFLECT, DISCUSS & DIFFUSE IDEAS
INFLUENTIALS ENGAGE CONSTITUENCIES
RADIO BROADCASTS EXPAND EXPOSURE TO STORIES/DISCUSSIONS
FP PROVIDERS LINK TO
INFLUENTIAL GROUPS EACH ONE INVITES THREE
CEREMONY
SOCIAL NETWORK DIFFUSION PACKAGE:
ILLUSTRATIVE TIMELINE

10. STAFF PREPARE TO IMPLEMENT SOCIAL
NETWORK DIFFUSION APPROACH
PREP

11. COMMUNITIES IDENTIFY SOCIALLY
INFLUENTIAL GROUPS + INDIVIDUALS
1

12. GROUPS REFLECT, DISCUSS, DIFFUSE IDEAS
2

13. INFLUENTIAL PEOPLE ENGAGE
CONSTITUENCIES TO ADDRESS UNMET NEED3

14. RADIO BROADCASTS EXPAND EXPOSURE
TO STORIES AND DISCUSSIONS
4

15. FACE-TO-FACE MEETINGS AND THE
‘EACH ONE INVITES 3’ CAMPAIGN LINK FP
PROVIDERS TO INFLUENTIAL GROUPS
5

16. ENGAGE 3
INFLUENTIAL
GROUPS AND 5
INFLUENTIALS
WEEKLY
BROADCASTS
OF GROUP
REFLECTIVE
DIALOGUES
50% OF ADULT
WOMEN AND
MEN REACHED
TO CREATE A
SOCIAL TIPPING
POINT OF NORM
CHANGE
+ =
IN ONE VILLAGE OVER 12 MONTHS:

17. RESULTS – PILOT EFFECTIVENESS

18. Quasi-experimental
Base and endline surveys in
intervention and control
groups
Stratified 2-stage cluster
samples
Benin: 2,160 women and
men
• Perceived social norms and
support for family planning
• Perceived access to services
• Peer &couple communication
• Intention to use FP
• Contraceptive use
METHODS AND OUTCOME
MEASURES

19. 19
“I have often talked with 15 or so people at a
time. During these sessions we talked a lot
about the number of children we have and
family planning... I have talked about these
things with my sisters; my co-wives; my mother,
with my friends and with my sister-in-law.”

20. Discusses FP 2.7 
odds (2.05-3.50)***
1.3 
odds (1.00-1.65)*
Approves of FP 3.4 
odds (2.54-4.45)***
2.0 
odds (1.51-2.53)***
Uses FP 4.0 
odds (3.04-5.13)***
2.5 
odds (1.91-3.26)***
Adjusted for age, education, religion, number of children, number of co-wives; P-values: * p<.05; ** p<.01; *** p<.001
…THE ODDS THAT I WILL USE FP INCREASE GREATLY
IF I BELIEVE THAT
MY NETWORK…
ENABLING ENVIRONMENT

21. TALKS TO PARTNER ABOUT
WHICH METHOD TO USE
2.5 
odds (2.00-3.16)***
1.8 
odds (1.47-2.20)***
TALKS TO PARTNER ABOUT
HOW TO OBTAIN A METHOD
2.7 
odds (2.17-3.46)***
1.9 
odds (1.56-2.37)***
EXPOSURE TO GROUP DISCUSSIONS AND INFLUENTIALS
INFLUENCED COUPLE COMMUNICATION ABOUT FP
Adjusted for age, education, religion, number of children, number of co-wives; P-values: * p<.05; ** p<.01; *** p<.001
FAMILY PLANNING BEHAVIOR

22. USES A METHOD
1.5 
odds (1.17-1.97)**
1.1
odds (.894-1.49)
MET NEED
1.5 
odds (1.19-2.00)**
1.2 
odds (1.02-1.57)*
Adjusted for age, education, religion, number of children, number of co-wives; P-values: * p<.05; ** p<.01; *** p<.001
FAMILY PLANNING BEHAVIOR
EXPOSURE TO THE PACKAGE INFLUENCED
FP METHOD USE & MET NEED

23. 0
10
20
30
40
50
60
Radio Influentials Groups Story/
activity
cards
Infograph EOI3 Any
component
Women (n=1080) Men (n=1080)
OVERALL EXPOSURE TO TJ:
INTERVENTION & CONTROL AREAS

24. Before, I didn’t understand,
but now I deeply understand
and see that for us to be
happy, we need to speak
about this subject…
- MALE PARTICIPANT
…before, our husbands did not
know that they could
communicate with us, but they
are doing it now.
- FEMALE PARTICIPANT

25. REFLECTIONS

26.  Start change process from within
 Catalyze discussion and critical
reflection, “trust the process”
 Repetition and cumulative
building on reflection and ideas
 Interventions at different levels
 Gender- synchronized
interventions
FOSTERING SHIFTS IN SOCIAL NORMS

27.  Embed normative change in all activities and materials
 Staff mindset to ‘pass the baton’ to new scale-up actors
 Staff mindset to embrace diffusion and ‘doing the minimum
needed’ to support implementation
DEVELOPING SCALABLE
NORMATIVE INTERVENTIONS

28. REACHING THE TIPPING POINT
 Greater depth and
coverage needed
 May require
 Time
 Effort
 Better diffusion strategies
 Stickiness factor

29. TEKPONON JIKUAGOU RESOURCES
ABOUT THE PROJECT
http://irh.org/projects/tekponon_jikuagou/
PILOT RESULTS http://bit.ly/1V6kkO7
PROGRAM DESCRIPTION http://bit.ly/1TcZRaX