USAID's Lishe Endelevu Activity is a four-year cooperative agreement that aims to intensify and integrate nutrition support and improve the nutritional status of women, children and adolescents in four regions of Tanzania. The Activity conducted a gender analysis to collect information to support the development of a social and behavior change strategy to achieve the Activity's goals. The analysis used qualitative methods to elicit information, perspectives and experiences from pregnant or breastfeeding women, husbands of pregnant or breastfeeding women, adolescent girls, health and agriculture extension officers, community health workers and nutritionists. Qualitative methods included focus group discussions and in-depth interview with a total of 126 participants. The study found that men are reluctant to support their wives due to peer/societal pressure and the risk of being mocked by their male friends as weak. In addition, alcohol abuse and domestic violence surfaced as significant barriers that hinder couple communication, reduce quality time and bonding among couples and other family members, and reduce men's potential to fulfill their roles as the protectors and supporters of their families. Adolescent girls from rural areas find it difficult to communicate with their fathers on their nutrition and reproductive health needs, and instead rely on boyfriends to help them. In contrast, urban girls communicate with their fathers more easily, participate more in household decision making, and are able to offer their parents advice. The design of gender transformative social and behavior change strategies is enhanced by a gender analysis at the outset.

It has been argued that social norms (i.e., shared rules of acceptable behavior) are powerful drivers of behavior change. Using a quasi-experimental design and intent-to-treat analyses, this study examined how postpartum family-planning (PPFP)-related social norms and attitudes intersected to influence the Momentum project's impact on partner discussion of family planning (FP) in the immediate (0-2 months) postpartum period (PP); obtaining contraceptives in the immediate PP; and modern contraceptive use in the immediate and extended (0-11 months) PP among 1,924 first-time mothers (FTMs) age 15-24. Data were collected in 2018 and 2020 from three intervention and three comparison health zones in Kinshasa. Average treatment effects were estimated to compare Momentum's impact on PPFP when social norms existed simultaneously, independently, or not at all. Findings indicated that impact on two PPFP outcomes was greatest when both normative expectations and descriptive norms were in place. Normative expectations alone appeared to be more important than descriptive norms alone for impact on PPFP. Normative expectations intersected with personal approval of PPFP to impact the probability of obtaining a FP method and using modern contraception in the immediate and extended PPs. Momentum had significant impact on obtaining a FP method and using a modern method within 12 months when descriptive norms and personal approval co-occurred as when personal approval occurred alone. Our results supported social norms theory and emphasized the need for FP programs to simultaneously address PPFP-related normative expectations, descriptive norms, and attitudes.

While partner involvement is linked with positive health behaviors, a key gap in the literature exists on how this construct should be measured and the specific ways people in Uganda perceive partner involvement in their context. We pushed the boundary and sought to explore partner involvement from a gender equality lens. Our research question was: How do men and women in Uganda want their partners to be involved when it comes to family planning decisions and behaviors? We answered this question using a nationally representative quantitative survey and explored measures of spousal support in the context of family planning in Uganda among 1177 men and women in partnerships and found that the most important consideration for deciding to use family planning in Uganda was "discussing with partners" (85% of men and women each) which was associated with five times the odds of use family planning. Two-thirds (66%) of men and women wanted a high level of involvement from their partner which was associated with twice the odds of using family planning (aOR- 2.4). Specific ways partners could be involved include accompanying them to health services (39%), permitting them to get family planning services (26%) and jointly discussing family planning options (23%). Of note, more females wanted their partner to accompany them (45%) than men (33%) while more males (29%) wanted to jointly discuss options than females (15%).

High fertility and low contraceptive use in northwestern Nigeria are largely driven by high-fertility norms, pro-natal cultural and religious beliefs, misconceptions about contraceptive methods, and gender inequalities. From 2018 to 2025, the USAID-funded Breakthrough ACTION social and behavior change (SBC) program, known as Albishirin Ku!, aims to shift the drivers of high fertility through multiple channels including mass, social and digital media, as well as community-level events and home-visits by community volunteers. 

Breakthrough RESEARCH analyzed household survey data from 1,032 married couples in Kebbi state in northwestern Nigeria collected in late 2021. Questions were asked separately of husbands and wives about norms, attitudes, knowledge, communication, and outcomes related to contraception, permitting an analysis of how exposure to Albishirin Ku! is potentially associated with concordance (and discordance) within couples. The analysis also examined the differential effects of exposure to Albishirin Ku! within couples on modern contraceptive use, both directly and indirectly through effects on FP norms.

The study found important but differing effects of exposure for husbands and wives. The influence of husbands' exposure was indirect, affecting the likelihood that wives approved FP use for birth spacing. Exposure for wives was more direct; relative to couples with no exposure, couples in which the wife alone was exposed to Albishirin Ku! were 5.7 percentage points (pp) more likely to use modern contraception while exposure for the husband alone was associated with only 1 pp greater likelihood. Joint exposure was ideal, associated with 7.7 pp increase in contraceptive use.