What does taking steps to use family planning look like to you?
Perhaps you think of visiting your doctor’s office. Depending on where you’re from, you may have a flashback to a lecture from high school health class. Or maybe you think of the first time you nervously bought condoms at a gas station, corner store, or market stall, rushing up and willing the transaction to be over as quickly as possible, hoping feverishly that no one you know would see you and that the shopping bag wouldn’t be too see-through.
The methods and specific images that come to mind might vary wildly depending on the person, but here’s something that is more likely to have a common answer: When you envision family planning, instead of options and how you might obtain them, have you ever thought about the people providing family planning products and services?
If not, you probably aren’t the only one. Most of us have some sort of underlying assumption that successfully obtaining and using family planning falls entirely on the individual or couple. That’s how most of us were introduced to family planning, after all—as users.
Two years ago, when the family planning team at ideas42 set out to identify and address challenges preventing people in Nepal from seeking family planning methods after an abortion, we had the same underlying assumption – that the barrier to uptake was related to clients and their partners. However, one of the benefits of behavioral science is it gives us a new lens through which to view tough problems, which sometimes leads to the discovery of surprising solutions. Our process also requires us to work openly with our partners, who are keenly aware of barriers in their programs. This helped us think a bit differently from the outset—we looked at all the decisions and actions related to family planning uptake for both clients and providers, distancing ourselves from our own underlying assumptions and biases.
Doing this made it clear that the biggest opportunity to increase usage of family planning methods in Nepal was to address overlooked, subtle obstacles that service providers face in the clinic setting—not clients. Frontiers in Public Health, a peer-reviewed journal, recently published a paper on the collaborative process ideas42 and Marie Stopes International-US undertook to de-bias ourselves, diagnose the situation, and design behavioral solutions.
Working with our partner Sunaulo Parivar Nepal, implementing partner of Marie Stopes International in Nepal, we found that providers had strong intrinsic motivation to provide family planning to women, and the skills to discuss options with their clients, but didn’t have the information necessary to prioritize their family planning-related roles among the dozens of other roles they have as women’s health service providers. We designed a poster that will be sent on a monthly basis to providers showing their clinic’s family planning uptake rates compared to a few similar clinics. The poster harnesses the power of social comparison – the theory that we look to others to gauge our performance. Social comparison interventions like this have been shown to be effective for reducing energy use and outdoor water consumption and increasing condom sales by hairdressers in Zambia.
As behavioral insights become more commonly used tools among practitioners, it is our hope that the insights are applied by public health program managers as they design and tweak new and existing programs to make them even more effective for the people they serve.