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Addressing Unmet Need for Family Planning in Benin

Tekponon Jikuagou was an innovative Untied States Agency for International Development-funded project designed to address unmet need for family planning in Benin.

Since 2014, Plan International has worked in Benin to improve family planning and increase the use of modern contraceptive methods. Unmet need for family planning remains high in West Africa, and in Benin specifically at 33 percent. This is despite government and nongovernmental efforts to increase services, access to family planning information, and demand creation.

Tekponon Jikuagou (TJ) was an innovative Untied States Agency for International Development (USAID)-funded project designed to address unmet need for family planning in Benin by using women’s and men’s social networks as a means of addressing the social factors related to people not acting on their unmet need. By applying social network theory and analysis, TJ moved the focus from targeting individuals with behavior change activities to focusing on communities’ formal and informal networks that influence individual ideas and behaviors. This approach addressed social factors, such as community beliefs, social and gender norms, decision-making, and family planning stigma. Implemented by the Institute for Reproductive Health, CARE, and Plan International, the goal of the project was to decrease unmet need for family planning by addressing social barriers to family planning use.

As a social network intervention, TJ was designed using five foundational principles: 1) intervention rooted in in-depth formative research conducted during the first year to understand social networks, cultural norms, and values related to unmet need; 2) systematically applied social network principles to design the intervention; 3) a low-cost, simple approach that could be integrated at scale; 4) gender; and 5) addressing unperceived as well as perceived need for family planning.

With scale-up in mind, TJ started with the pilot phase to develop and test an effective intervention package for later scale-up. The pilot phase took place in the Couffo region of southwest Benin. Completed in December 2014, it was a one-year intervention implemented in 90 villages (45 Plan villages; 45 CARE villages). Based on formative research and iterative experience, the intervention package was developed, tested, and refined during the pilot phase and included five components. The first was community-based, identifying influential groups and individuals through a social mapping exercise. Within these groups, “influencers” or “catalyzers” were selected to lead reflective dialogue sessions. The second, using stories and activity cards, had groups engage in reflective dialogue and diffusion of ideas around their attitudes and values concerning fertility, family planning, and gender. Other components included encouraging influencers identified through the social mapping to act; radio broadcasts of TJ sessions to expand exposure of the stories and discussions through broadcasts; and linking family planning providers with influential groups. Through the intervention, the aim was to reach a “social tipping point of change” of 50 percent of women and men in a community.

What did we learn from the pilot phase? From the endline survey, we learned that women and men reached by the intervention were 1.5 times more likely to use modern contraception and have met their need for modern contraceptives. It led to significant increases in women and men talking about and acting upon their desire to space or limit births, particularly when it came to partner communication. Exposure encouraged significantly more women and men to take steps to obtain a method. Results showed that women who broke communication taboos like talking with someone in their network about family planning were more than five times as likely to talk with their partner about obtaining a method as those who did not. And, we learned that a supportive environment is significantly associated with modern family planning use, affirming the importance of using a social network approach that supports diffusion of new ideas through the most influential and connected network actors. In summary, changes in social networks led to increased family planning use and actual met need.

Scale-up started in April 2015 with a one-year intervention to test implementation of the TJ package by local partners through integration in “host projects.”  For Plan, this was done with two existing Plan partners – Centre Beninois pour le Developmmement des Initiatives a la Base (CBDIBA), Women and Youth Saving for Empowerment Project (WYSE)  Village Savings and Loans Groups,  and Groupe de Recherche et d’Appui aux Initiatives de Base pour un Developpement Durable (GRAIB) (nutrition and Village Savings & Loans Groups) – in 44 new villages in Couffo. This scale-up phase provided an opportunity to not only expand the approach but to test the effectiveness of the package within new organizations. The results were impressive: based on an assessment conducted, “Experiences and Effects of Using NGO Platforms to Scale-Up the TJ Social Network Package,” it was found that host projects implemented the package with no significant adaptation or changes.  

The assessment found “overwhelming appreciation for the social network diffusion approach.” It was felt that the social network approach could be applied to different technical interventions. One senior staff person suggested that it “offers cross-cutting cohesion to sectoral programming and that this approach was feasible and successful in its implementation.” Seeing the benefits, managers and implementers in the host organizations are identifying other options and opportunities for continuing scale-up and applying the TJ approach to other programmatic areas.

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