Shifting social and gender norms - what is the evidence?

Utilizing community-based participatory research methods along with research and knowledge justice frameworks, this team has built a statewide coalition to advance equitable policies and to disrupt stigma and misinformation related to contraception and abortion in the U.S. state of Pennsylvania. Following the Dobbs Supreme Court ruling that overturned national abortion protections in the U.S., nearly half of U.S. states have now outlawed or severely restricted access to abortion. Funding cuts to contraceptive programs have also severely restricted availability of and access to contraceptive services nationally. To protect abortion and contraception access in Pennsylvania, researchers at the University of Pittsburgh convened a statewide coalition of community-based reproductive justice advocates, patient support advocates, legal experts, clinicians, politicians, and researchers. Through collaborative brainstorming activities, the coalition identified research and policy priorities. These included 1) evidence-based interventions that disrupt stigma and misinformation by improving knowledge and shifting attitudes, social norms, and voting behaviors to 2) pass and implement expansive contraception and abortion policies (e.g., pharmacist provision of contraception, 12-month dispensing, eliminating bans on public funding of abortion). The team is currently fielding a statewide survey to measure baseline knowledge, attitudes, social norms, behaviors, and stigma. Findings will inform communication strategies, which will be tested and refined through rapid experiments and then deployed statewide. The current presentation will detail how the coalition was formed, how it guides the study team's research and policy priorities, and how baseline survey findings are shaping subsequent communication strategies.

Formative research for social and behavioral change communication interventions addressing the needs of adolescent girls and young women (AGYW) typically assesses individual knowledge, attitudes, and practices, with some incorporating couple-level dynamics. However, social norms theory posits that behaviors are fundamentally shaped by individuals' perceptions of actions and expectations, with reference groups enforcing them through sanctions. This indicates that understanding what shapes AGYW's decisions requires identifying reference group and key norm components - sanctions, sensitivity to sanctions, and exceptions. 
This Gates Foundation-funded study (2024) investigated the social norms influencing AGYW's health and economic empowerment decisions in Kenya and Nigeria. Utilizing CARE's Social Norms Analysis Plot (SNAP) framework and UCSD's Social Norms Exploration Tool (SNET), we explored the determinants of AGYW decisions, emphasizing who truly influences the potential for change.
Qualitative data were collected in Kenya and Nigeria through rapid interviews with adolescents (aged 15–24 years) to identify key reference groups, followed by focus group discussions that employed participatory tools, such as vignettes.
Analysis revealed critical patterns: (1) Husbands' peers and mothers-in-laws appeared as unexpected enforcers applying social pressure through mockery and gossip, indirectly restricting AGYW's economic participation and family planning choices; (2)Mothers and community health workers, served as hidden allies, quietly facilitating contraception access; (3) These create two-tier power structures where visible decision-makers' attitudes are readily measurable, but invisible reference groups' sanctions and hidden supporters actually determine behavioral outcomes. These insights underscore the importance of examining all norm components as prescribed by social norms theory.

Some persistent social and gender norms remain powerful barriers to achieving equitable Sexual and Reproductive Health and Rights (SRHR) outcomes, particularly in fragile and conservative contexts across Africa. While existing social norm measurement approaches have provided valuable insights, they are often too complex, costly, and time-consuming for use within short program cycles. As a result, many SRHR programs struggle to generate timely evidence and adapt interventions accordingly. The Women's Integrated Sexual Health (WISH2) project, funded by the UK's FCDO, is addressing this gap by operationalizing two low-cost, frontline-driven tools-an activity observation tool and a staff reflection tool-within routine monitoring systems across seven countries. The seven countries are Burundi, Ethiopia, Madagascar, Somalia, South Sudan, Sudan and Zambia. These tools enable quick documentation of community-level interactions and reflections on evolving gender and social norms, providing rapid insights that inform adaptive programming. Early implementation has demonstrated strong buy-in from program and field teams, across seven countries with over 39 staff oriented and integration of the tools planned during supportive supervision and review meetings. The approach demonstrates practical ways to devolve evidence generation, empowering teams to track and adapt interventions as appropriate. This model offers a replicable framework for global SRHR programs seeking to institutionalize adaptive, Social and Behavior Change (SBC) programming in complex environments.

Social and gender norms profoundly shape health behaviors and outcomes, yet many SBC programs still struggle to meaningfully integrate gender considerations. Over eight years, Breakthrough ACTION implemented gender-integrated SBC programming across multiple countries and health domains, applying an adaptive approach that centered social norm change, community leadership, and enabling environments. This presentation synthesizes cross-project insights on what it takes to intentionally integrate and advance gender transformation within large-scale SBC initiatives.
Key lessons highlight the importance of examining and addressing internal staff biases and attitudes early in project implementation to strengthen organizational commitment and capacity. Utilizing systematic tools-such as gender analyses and theories of change-at program inception helped ensure intentional design rather than retrofitted gender components. Importantly, iterative adaptation in response to local evidence and lived experience led to more contextually grounded gender-transformative approaches. Engaging local governments, religious leaders, and community actors was essential to shifting norms related to sensitive issues such as child marriage. Strengthening women's leadership, engaging men and fostering joint decision-making in households helped address underlying power dynamics and avoid reinforcing harmful norms.
These insights contribute new evidence on how SBC programs can move beyond communication to influence relational, structural, and systemic drivers of inequality. We present practical recommendations for SBC practitioners and donors seeking to operationalize gender transformation at scale.