Strengthening Social and Behavior Change for Family Planning in Fragile and Humanitarian Crisis Settings: A Landscape Analysis and Recommendations

"In all fragile and humanitarian crisis settings, people continue to have reproductive health needs....However, FP [family planning] continues to be under-prioritized in these contexts, and any pre-existing gaps in FP and sexual and reproductive health (SRH) quality and service access are further exacerbated in crisis settings..."



This report, published by Breakthrough ACTION, summarises the findings and insights from a landscape assessment on the resources and evidence that exist for family planning (FP) social and behaviour change (SBC) in fragile and humanitarian settings. It also highlights recommendations for strengthening FP SBC in these contexts. The findings are intended to inform actions among professionals and decision-makers at community, country, regional, and global levels who are working in development (pre-crisis), fragile, or humanitarian crisis settings in SBC or FP/sexual and reproductive health (SRH).



The landscape analysis conducted by Breakthrough ACTION included global, regional, and country-level (Democratic Republic of the Congo (DRC) and Yemen) activities and involved a desk review of peer-reviewed and grey literature; key informant interviews (KIIs) with global, regional, and country-level stakeholders; and technical consultations with experts working in SBC, FP/SRH, or fragile and humanitarian crisis settings at the global or regional level.



The analysis explored the following four research questions:

1. What SBC for FP crisis-related guidance, strategies, and tools exist at the global and regional levels?
2. How are SBC for FP activities and approaches currently considered and integrated into programming across all phases of a crisis?
3. Based on what has been done to date, what is known about the objectives, key stakeholders, audiences, and impact of SBC for FP in humanitarian crisis settings?
4. What are key gaps and opportunities for SBC for FP in crisis settings?

The findings discussed in the report include, in brief, the following:

• Understanding of SBC differs across the literature and by stakeholders in different sectors.
• The humanitarian, development, and peace communities have limited integration.
• Little documented research or literature is available that describes SBC activities across the different stages of crisis, which, according to Breakthrough ACTION can be categorised into five stages: preparedness, acute, post-acute, protracted, and recovery.
• Funding in fragile and humanitarian crises is disjointed, with limited, short-term funding focused on perceived life-saving interventions that do not always include FP/SRH.
• SBC for FP in humanitarian crisis settings is under-prioritised.
• Coordination challenges persist within the humanitarian community.
• Available, detailed guidance for how to implement SBC for FP/SRH in humanitarian crisis settings is limited.
• Opportunities are available to learn from other sectors' SBC work in humanitarian crisis settings beyond health.
• SBC is gaining traction among Inter-Agency Working Group on Reproductive Health in Crises (IAWG) partners and other coordinating bodies.
• Despite limited guidance documents, SBC for FP activities have been implemented in humanitarian settings for different audiences and at various levels of the Socio-Ecological Model (SEM), which considers how interrelated social and environmental factors impact health, knowledge, attitudes, and behaviour.
• SBC in combination with health systems strengthening (HSS) activities can improve FP adoption. SBC for FP/SRH and HSS interventions often share common or complementary behavioural determinants and can mutually reinforce one another.
• Community health workers (CHWs) are an integral part of many SBC for FP-related activities, including door-to-door visits, counselling, and access to commodities.
• People living with disabilities seem largely overlooked in FP/SRH programmes in fragile and humanitarian crisis settings.
• Gender considerations are often overlooked in FP/SRH crisis programmes and require more focus.

Based on the findings, the report offers the following recommendations:

• Define, clarify, and expand a common language between humanitarian and SBC professionals - Development and humanitarian actors should, for example, come together to discuss and agree on terms and definitions for SBC concepts and approaches, crisis contexts (e.g., conflict, infectious disease outbreaks, and natural disasters that may or may not be influenced by climate change, such as earthquakes, cyclones, and drought), and phases of humanitarian crisis and response.
• Define how to integrate SBC for FP in Nexus settings - The Nexus approach acknowledges the interlinkages between humanitarian, development, and peace actions and seeks to strengthen collaboration and complementarity between humanitarian and development actors. In light of this approach, involved actors should define entry points and design programmes and interventions that incorporate SBC for FP/SRH into Nexus programming.
• Develop operational SBC for FP/SRH tools and guidance for fragile and humanitarian response programme implementers - For example, the wealth of experience and evidence-based tools and guidance documents that have been used in development settings could be adapted and piloted in fragile or humanitarian settings. The report offers examples of content to include for each phase of crisis response.
• Prioritise SBC for FP programming for preparedness and protracted crisis environments - SBC activities during the preparedness phase have many functions, including building community resilience. For example, participatory, community-led processes build trust between community members and stakeholders (e.g., health workers, programmes, ministries of health, community leaders, etc.) and increase social accountability.
• Advocate for longer funding cycles in humanitarian settings, including funding for SBC for FP in fragile and humanitarian context - For example, longer-term and earlier humanitarian funding is required to achieve more holistic and effective SBC for FP activities in all phases of a crisis, starting with the preparedness phase. Lifesaving and essential interventions for FP/SRH should also be redefined to include SBC to ensure funding, community empowerment, and ownership of FP/SRH programmes.
• Include gender, social inclusion, and disability analyses in assessments - This inclusion may, for example, involve working with gender advisors to develop, revise, and adapt programmes to make them more gender-sensitive and gender transformative.
• Enhance and expand documentation, evidence building, and dissemination about FP/SRH SBC programmes in humanitarian crisis settings - Specifically, evidence on the most effective approaches for male engagement, gender-transformative work, and disability inclusion are needed. This evidence can be used to inform the development of evidence briefs, planning templates, and operational guidance and tools.

Click here for the French version of this 44-page report in PDF format.