As a provider of sexual and reproductive health services, it’s clear to us that many women and girls don’t access these important services because there are social barriers in their way.
This can take the form of misinformation circulating about contraception and abortion, giving people pause, stirring up questions of trust.
Women can face backlash or judgement from their community or family, and feel fear about whether these services are confidential or not.
Adolescents are sometimes told that reproductive healthcare services are just for married adults, not for them.
Social information and norms like these have a powerful effect on how we act. To expand access to reproductive healthcare further, we have to challenge these assumptions and design services that reach the right people with the right message.
MSI’s social and behaviour change (SBC) approach begins by understanding these social barriers and designing tailored approaches to overcome them.
How MSI approaches SBC
We take time to understand community context and build acceptance among influential community members. Keeping women and girls at the centre, we engage with men and boys, community and religious leaders, healthcare workers and government partners to understand what people believe, fear, value and need.
We draw on service data and client feedback combined with population-level analysis and geo-spatial mapping to identify where unmet need is greatest, which barriers are preventing access, and how to design the most effective response.
From rural settings to urban centres, we segment and tailor communicate on campaigns and materials to align with the needs and preferences of different groups, so they feel relevant to the audience.
We collaborate with community-based mobilisers, government community health workers, teachers, youth champions, local organisations and community leaders to address myths, model supportive norms and refer people to access services. Satisfied clients are our most effective advocates.
As a provider, our SBC efforts are directly connected to the sexual and reproductive health services we provide or that we support within the public sector. This ensures that every person we reach through SBC knows how they can access further information and services. Our free hotlines in 36 countries offer additional ways for people to get accurate information to support them in their journey.
We use values clarification and client-centred care training to ensure that our providers offer inclusive services tailored to clients’ needs and concerns, cultivating an environment of belonging and trust so people can feel safe, heard and respected. This ensures that the behaviour of accessing services is supported and reinforced.
We work closely with governments to create the policy, financing and institutional conditions needed for long-term sexual and reproductive healthcare access and behaviour change.
Big Sisters: An MSI SBC initiative
MSI ‘Big Sisters’ are helping young people in the Democratic Republic of the Congo change their futures with contraception.
In this story, meet Thérèse and two other MSI Big Sisters – young women employed by MSI to raise awareness of reproductive health services among their peers.
“Being young helps. It allows young people to trust us. We talk about everything! Starting with topics they know like menstrual hygiene opens the door to discussing sexual health without judgement. We can talk about sex, our challenges, things we couldn’t discuss with our parents.”
This has been an innovative way to reach adolescents in the DRC and a major success. Our latest data shows that where Big Sisters are working, up to half of clients visiting our providers are adolescents – this means many more young people are seeking services than in other places. And it costs £10 or less for every young person reached.
‘The ideal family’: An MSI SBC initiative
‘The Ideal Family’ is a game including conversation-starting cards that encourage couples and family members to talk about contraception and reproductive health.
In some rural areas, these conversations may never happen without intervention, as reproductive healthcare is often seen as taboo. So, with these light-hearted tools, we’ve found a way to open discussion that builds support for contraceptive use.
It’s especially helpful for engaging with husbands and for helping families understand why adolescents need to access reproductive health services too.
This initiative has been seeing great results and has been integrated by MSI’s programmes in Burkina Faso, Mali, Niger and Senegal. In Mali and Senegal, the tools have even been endorsed by the government and integrated into their national strategies.
A comic, a card game and real talk: An MSI SBC initiative
In Mali, more than half of sexually active young women who want to avoid pregnancy are not using modern contraception. Less than 3% report having decision-making power over their own sexual and reproductive health and rights.
That’s why building awareness and acceptance of contraception is so critical. MSI peer educators are working hard to do this.
A new toolkit is helping to support this work of breaking taboos around adolescent sexuality. Combining a comic strip, a truth game, and a new app, we’re sparking discussions on sensitive topics like contraception, consent, STIs, and peer pressure.
The toolkit is helping peer educators confidently challenge myths, improve knowledge, and create safer spaces for dialogue in their communities. It’s helping move beyond basic messaging to create the open, trust-based conversations that are essential for meaningful behaviour change.
Behaviour change isn’t a quick win. It takes consistent education, honest conversation and well-designed interventions with community buy-in over a long time, and it’s critical that MSI and others are doing this work. Because we can’t provide healthcare services if people don’t feel that they can use them.
Our country programmes have designed many different SBC initiatives with and for local communities. Each one is piloted and evaluated; the successful ones are expanded further.
For more resources on this, visit our Social Norms Hub.
How we’re engaging community leaders
When local leaders have the right information and training, they can play a vital role in changing attitudes and norms in their communities.
How we’re empowering community health workers
Community health workers can bring sexual and reproductive health information and services straight to their neighbours’ doorsteps.
