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Poverty and a lack of resources can limit healthcare access,1 leading to poor maternal and child health outcomes.2 However, even where resources are not a constraint, social norms and traditions can impede mothers’ and children’s health.3
Take, for example, the prevalent food taboos for pregnant and weaning women in various countries: Ethiopia,4 India,5 Ghana,6 and Indonesia,7 to name a few. Due to long-standing traditional beliefs, many communities regard highly nutritious foods such as dairy products,8 meat, eggs, fruits, or vegetables as harmful to mothers. This limits their nutritional intake even where food availability might not be a problem. During field work across the state of Rajasthan in India, I have met pregnant women who have cows at home, but do not drink their milk.
Patriarchal strictures can similarly affect maternal health.9 In many communities, women are allowed to have their meals only after all other family members have eaten.10 If there isn’t enough food at home, they have to go hungry while others eat their fill. These norms apply to pregnant women as well, even though their nutritional requirements can be higher than those of others.11 Besides, women continue to be disproportionately saddled with domestic responsibilities, even during pregnancy, which does not allow them to get adequate rest.12
So, how do we go about changing these harmful norms and traditions? A common strategy is Social and Behavior Change Communication (SBCC), which uses behavior science to positively influence knowledge, attitudes, and practices.13 SBCC is not just about sharing knowledge,14 but also creating a conducive environment for behavior change.
While many might not be familiar with the term SBCC, they would recognize the technique from campaigns to promote safe sex, handwashing, social distancing, and masking, among other healthy behaviors. It has been successfully used in a variety of contexts and geographies, including to promote maternal and child health.15
In this blog, I would like to share some first principles that can help social impact organizations effectively design and implement SBCC initiatives. These are based on my experiences of working on communications programs and are inspired by the back-to-basics approach of Kelly and Barker.16
SBCC cannot be a one-way street, where we merely provide information and expect societal norms and individuals’ behaviors to change. Rather than trying to convince people, we need to understand why they hold certain beliefs or follow certain behaviors and enable them to foster changes on their own.
One such technique is participatory learning and action, which facilitates the community’s involvement in identifying challenges and appropriate solutions through group reflection and learning.17 It has led to a reduction of maternal mortality and neonatal mortality across several low- and middle-income countries and could potentially save 300,000 mothers and babies every year.18
Policymakers and nonprofit staff often have more access to knowledge and resources than the communities they work with. It is important to recognize these differences and find ways to overcome them when designing and implementing SBCC campaigns. Nobody likes to be told what to do, especially by someone who might be more privileged. However, by putting oneself in others’ shoes and prioritizing their lived experiences, we can begin to build bridges.
Nonprofits conduct research with affected communities to assess what SBCC techniques might be best suited for their context. However, many do not involve them in the design and planning of SBCC interventions or materials, such as posters or brochures.
A study under the Manoshi project in Bangladesh found that while the SBCC materials influenced mothers to change their healthcare-seeking behaviors, they were uncomfortable with some aspects of it.19 They did not want to keep posters with human images in their house as it was forbidden in their religion.
While studies are important to assess the impact of SBCC programs, involving communities in these initiatives’ creation and execution helps cater to their sensibilities, avoid gaffes, and ensure greater receptivity throughout the program.
While these ground rules can help plan and implement more effective SBCC campaigns, they are by no means exhaustive. It is also important to recognize that SBCC is only part of the solution and might need to be combined with other measures, such as cash transfers,20 policy changes or affirmative action, to be truly effective.
The mission of the Boston Congress of Public Health Thought Leadership for Public Health Fellowship (BCPH Fellowship) seeks to:
It is guided by an overall vision to provide a platform, training, and support network for the next generation of public health thought leaders and public scholars to explore and grow their voice.
