It Takes a Village: A Shared Agenda for Social and Behavior Change for Family Planning/Reproductive Health

"Reaching global FP goals depends on extraordinary and unprecedented cooperation, collaboration, and shared visioning across the FP/RH community."

While the Sustainable Development Goals (SDGs), Family Planning 2030 (FP2030), and Ouagadougou Partnership (OP) goals all uphold a desire to ensure universal access to family planning/reproductive health (FP/RH) information and services, it is unclear how major stakeholders can implement social and behaviour change (SBC) programming to meet those goals in a coordinated way. Developed by Breakthrough ACTION, this global shared agenda for SBC in FP/RH identifies five strategic priorities across three areas (technical, financial, and geographic) where coordination and collaboration are most needed. The document is designed to be a resource for all stakeholders - for example, as a framework for FP/RH advocacy efforts and as a guide to future programming and investments into SBC for FP/RH.

Breakthrough ACTION characterises SBC as "a proven, cost-effective approach to address the normative and behavioral challenges" surrounding FP use through use of "evidence-based interventions to increase the adoption of healthy behaviors by individuals, influence the social norms underpinning those behaviors, and catalyze social change by transforming social structures and institutions."

In 2018-2019, Breakthrough ACTION worked with partners from 24 donor and implementing organisations to develop and validate this agenda. 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. The 2022 refresh process confirmed the continued relevance of the original five strategic priority areas but includes increased attention to equity and structural factors and cross-cutting programmatic considerations related to the need for greater SBC programmatic and research capacity, the use of digital health for SBC for FP/RH, and private sector engagement.

The five areas include:

1. Improving SBC for service delivery - calls on stakeholders to:
   • work together to enhance our understanding of the provider perspective to inform future research and interventions;
   • better coordinate SBC and service delivery investments, working with both the public and private sectors;
   • use high-quality SBC approaches to improve quality of care with better client experience and improved provider attitudes and behaviours; and
   • improve measurement of SBC for FP/RH service delivery.
2. Fostering a supportive environment for FP/RH - calls on stakeholders to:
   • integrate gender considerations in SBC for FP/RH programmes across the life course, including interventions that transform structures and systems of power that perpetuate gender inequities;
   • prioritise equity in SBC for FP/RH programmes, and attend to the social determinants of health in SBC for FP/RH programmes, including through multisectoral partnerships; and
   • improve inclusive community engagement around FP/RH, including through enhanced social accountability for FP/RH services.
3. Understanding and meeting the sexual and reproductive health (SRH) needs of youth - calls on stakeholders to:
   • increase youth-driven programmes and meaningful youth engagement and partnership for programme and policy design and implementation;
   • prioritise youth as a cross-cutting theme across FP/RH programmes - not as a separate programme discipline;
   • segment youth to understand their different needs; and
   • advocate with decision makers and influencers to support FP/RH programming for youth and increase youth access to programme budgets to support them as partners for change.
4. Increasing coordinated investment in SBC for FP/RH - calls on stakeholders to:
   • coordinate SBC investments to maximise existing resources, while pushing to fully fund SBC; and
   • improve the understanding of, and appreciation for, the social and behavioural determinants of FP and the potential return on investment of high-quality SBC programmes, such as by packaging the evidence for SBC for FP/RH in creative ways to reach various audiences and convening regular knowledge management activities.
5. Geographic focusing on SBC for FP/RH in francophone West Africa - calls on stakeholders to:
   • increase appreciation among francophone West Africa governments, donors, and implementers on how investing in SBC contributes to the achievement of FP goals in the region; and
   • include SBC approaches that address gender inequalities and power dynamics related to FP/RH and increased youth-powered and youth-centred SBC SRH activities in the region.

Specific recommendations for achieving these shared goals include:

• Collectively generate evidence on SBC approaches that have produced significant changes in FP/RH behaviours, and package it in user-friendly ways so that it can be widely shared to advocate for the inclusion of SBC in FP/RH strategies.
• Engage and connect SBC champions, key influencers, and SBC coordinating networks to facilitate evidence exchange and advocacy.
• Develop long-term technical assistance plans based on SBC needs assessments capable of harmonising work across donors at the national and regional levels.
• Promote the inclusion of high-quality SBC components into national FP/RH planning processes and documents to guide stakeholder action and investment, such as CIPs.
• Promote the inclusion of SBC expertise into FP/RH coalitions and working groups at the global and regional levels.
• Harmonise strategies and messages at the national level across donor and partner efforts through collaborative planning, message harmonisation workshops, and ongoing communication.

In conclusion: "All stakeholders engaged in SBC, FP/RH, and service delivery must commit to socializing and endorsing the shared agenda. This ensures its operationalization, individually and within networks, at the donor, government, and implementation levels, allowing all involved to harness the power of SBC for improved global FP/RH outcomes."