Can Social Networks Alter Community Social Norms to Improve Maternal Health?

From 2014 through 2016, I had the opportunity to support learning activities for the Community Benefits Health (CBH) project which aimed to address social norms and cultural practices influencing maternal health and breastfeeding behaviors in the Upper West region of Ghana.

A unique aspect of the CBH behavior change project was its focus on the community as a whole rather than individuals. This approach is grounded in an understanding that social relationships within the community have a strong influence on health behaviors. To leverage the power of these relationships, the project used social network analysis to identify who women were speaking to about pregnancy and breastfeeding behavior and then tailored health messages to social contacts identified during the social network analysis that could support and influence the uptake of improved maternal health and breastfeeding behaviors.

The CBH program included two components. The first component was a community-based incentive. Community members selected a borehole or emergency transport system as an incentive that was promised to the entire community if they fulfilled certain conditions over a two-year period, such as having men participate in educational meetings on maternal and child health issues. By incentivizing behavior change, CBH aimed to encourage the entire community to support women in adopting improved maternal health and breastfeeding behaviors and swiftly change community-wide social norms by the end of the two-year program. The second component of the intervention was a comprehensive health messaging strategy, which included the use of video and drama presentations at the community level, home visits from peer educators, community-based meetings facilitated by community health officers (CHOs), and radio programs.

A child plays with a borehole, a community-based incentive chosen by the community and a component of the CBH program. Photo credit: Emily Stammer, JSI.

A mixed methods evaluation summarizes findings from the project, including how social networks changed following exposure to the intervention. Among women who said they spoke with at least one partner about pregnancy or breastfeeding, we found significant improvements, indicating that efforts aimed at increasing communication across women and their social networks may lead to improved health outcomes. We also found evidence through qualitative research that demonstrated how social norms related to communication about maternal health behaviors had shifted over the course of the intervention.

“We used to be afraid of talking to someone’s wife because you could be accused of negative things. Because of CBH we freely talk to people without fear. Old and young men and women are talking about MNCH in the community. We now know the need for discussion.” (Community Influencer in Upper West Region Ghana)

Overall, we determined that using social network analysis to strengthen interventions focused on shifting social norms significantly improved uptake of maternal health and pregnancy behaviors.

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