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

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

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:

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.”

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)

Programmatically and evaluatively

Self-efficacy, Intentions, Behaviors Individual women & men with unmet need

FP-enabling environment Women & men’s social

networks

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

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

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

STAFF PREPARE TO IMPLEMENT SOCIAL NETWORK DIFFUSION APPROACH

PREP

COMMUNITIES IDENTIFY SOCIALLY INFLUENTIAL GROUPS + INDIVIDUALS

1

GROUPS REFLECT, DISCUSS, DIFFUSE IDEAS 2

INFLUENTIAL PEOPLE ENGAGE CONSTITUENCIES TO ADDRESS UNMET NEED 3

RADIO BROADCASTS EXPAND EXPOSURE TO STORIES AND DISCUSSIONS

4

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

5

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:

RESULTS – PILOT EFFECTIVENESS

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

“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.”

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

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

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

0

10

20

30

40

50

60

Radio Influentials Groups Story/activitycards

Infograph EOI3 Anycomponent

Women (n=1080) Men (n=1080)

OVERALL EXPOSURE TO TJ: INTERVENTION & CONTROL AREAS

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

REFLECTIONS

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

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

REACHING THE TIPPING POINT

Greater depth and

coverage needed

May require Time

Effort

Better diffusion strategies

Stickiness factor

TEKPONON JIKUAGOU RESOURCES

ABOUT THE PROJECT http://irh.org/projects/tekponon_jikuagou/

PILOT RESULTS http://bit.ly/1V6kkO7

PROGRAM DESCRIPTION http://bit.ly/1TcZRaX