Iron-deficiency anemia is a blood disorder that affects more than half of women of reproductive age in many low and lower-middle income countries, including India. Although iron-folic acid (IFA) consumption has been promoted to reduce the burden of anemia, women of low socioeconomic status are disadvantaged by current IFA distribution practices, as these women face disproportionate barriers in seeking IFA from health professionals. The current study aims to understand if shifts in psychosocial factors can positively influence IFA seeking behaviors despite demographic factors, such as caste and education. The study uses data from the Reduction in Anemia through Normative Innovations (RANI) Project to test logistic regression models that predict IFA seeking behaviors across 18 months among women in Odisha, India. We test the effect of shifts in risk perception, outcome expectations, and various social norms (i.e., descriptive, injunctive, and collective) on the likelihood that a women will seek IFA from a health provider. After controlling for significant demographic factors that reflect socioeconomic status, we find that shifts in attitudes, beliefs, and social norms can influence IFA seeking behaviors. Intervention designers who wish to promote IFA consumption among populations with low socioeconomic status may find success by developing strategies to positively impact 1) perceptions around one's own risk of acquiring anemia, 2) attitudes around the outcomes of IFA consumption, 3) perceptions of how many others take IFA, and 4) the true prevalence of IFA consumption within one's own community.

High fertility rates and short spacing between births are associated with poor health outcomes for women and children. Many women report they would like greater control over timing and spacing of births but are not using contraception. According to WHO, the main barriers to contraceptive uptake in sub-Saharan Africa are lack of information and fear about contraceptives, rather than access to contraception. Mass media campaigns can potentially spread information and disinformation, but their impact is hard to rigorously measure.
Using a two-level randomized experiment covering 5 million people in Burkina Faso, we examined the impact on family planning knowledge and behaviors of both, general exposure to mass media (1,500 women received radios) and an intensive evidence-based family planning campaign (8 of 16 radio stations received the campaign). We found that in non-campaign areas, women receiving radios reduced contraception use by 5.2 percentage points (p=0.039). In particular, women with below median fertility preferences showed large reductions in contraception use, moving them closer to community norms. These findings suggest that in the absence of high-quality programming, access to mass media can lead to less progressive attitudes on women's role in society and lower modern contraceptive use.
In contrast, in campaign areas contraception use increased by 20% (5.9 percentage points, p=0.046), and women's self-assessed health and well-being increased by 0.27 standard deviations. Although knowledge improved and misperceptions about contraception declined, preferences and norms remained unchanged. A nationwide campaign scale-up cost an estimated US$7.7 per additional contraceptive user.

Au Bénin, la gamme des méthodes contraceptives est très rétrécie, réduisant le choix des potentielles utilisatrices de méthodes de Planification Familiale (PF). Le diaphragme Caya, un contraceptif moderne qui pourrait intéresser des femmes qui cherchent un produit péri coïtal, contrôlé par la femme, réutilisable dans la durée, non hormonal et sans effets secondaires, a été introduit dans le pays en 2020. Le produit a été placé dans deux communes pilotes du pays et une étude mixte a été menée six mois plus tard en 2021. L'objectif de l'étude était d'évaluer l'acceptabilité par les femmes adoptantes, les perceptions des hommes et des prestataires de santé. Il ressorte résultats que les femmes ont manifesté un grand enthousiasme pour la méthode ("Caya m'a vraiment donné la joie") car non seulement elle vient répondre aux attentes de celles désirant de nouvelles méthodes non hormonales, de celles déçues par des méthodes antérieures, mais elle donne la possibilité aux femmes de l'utiliser en temps voulu, sans l'aide de personne, augmentant ainsi leur pouvoir de décision et d'action en matière de PF. Les hommes ayant eu à expérimenter aussi la méthode ont manifesté une attitude favorable ("J'utilise Caya et cela marche correctement…pas d'inconvénient") et les prestataires de santé ont loué le vide que vient combler ce produit dans la gamme des contraceptifs modernes du pays. Avec l'engouement qu'a suscité le diaphragme Caya chez les femmes des zones pilotes, il mérite d'aller vers d'autres zones pour répondre aux besoins d'autres femmes.

In Uganda, youth, ages 15-24, account for approximately 20% of the total population and are coming of age in a country with one of the highest total fertility rates in the world and limited access to youth-responsive health services for family planning (FP). Participatory insights gathering and co-design sessions conducted by FCDO/Reducing high fertility rates and Improving Sexual Reproductive health outcomes (RISE) with youth and providers revealed provider stigma and bias, limited client-centered counselling, and negative clinical experiences were key barriers affecting youth's demand for and utilization of FP services. These barriers create inequalities in FP access and use, which adversely affect the health, economic, and social develop of youth.


To strengthen the health system to be more responsive to the needs of youth, RISE is implementing a comprehensive provider behavior change (PBC) initiative, using a group mentorship model centered on experiential learning and collective problem solving, coupled with tailored support supervision. Unlike traditional trainings, the group mentorship model puts providers in the driver's seat, letting providers identify current needs and gaps to improve upon at the beginning of the mentorship, and then using discussion and collective problem solving to identify best practices to address those needs and gaps. Since the initiative's launch in 2021, RISE has observed and reported improvements in providers' counselling skills, client-centered care, and provider attitudes towards youth accessing FP services.


In this presentation, we will present our model, its impact, and how it can be adapted to support PBC in other contexts.