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A fresh approach to measuring social norms in women’s health programming

Interventions that aim to shift social norms hold strong appeal as a means of achieving development outcomes. Yet defining norms and measuring change is notably challenging. In this blog, we share tools and insights for effective and affordable solutions, drawing from our work on the UK’s flagship ‘Women’s Integrated Sexual Health’ programme.

Challenges of measuring shifts in social norms

Creating social norms change is often a slow and incremental process, and measuring change often involves complex and expensive methods that are not practical for local partners who have limited resources. This can make it difficult for programme managers and partners to know what’s working (and what isn’t), to measure and report on progress to stakeholders, and adapt or scale-up programme activities accordingly.

These were some of the challenges we sought to solve in our work with the Women’s Integrated Sexual Health (WISH) programme.

Tools and resources to support programme staff and partners

Itad has been the evidence and learning partner for the WISH programme since its inception in 2018. WISH seeks to improve global sexual and reproductive health rights (SRHR) by ensuring equitable access to family planning, and SRH services to women and girls across the globe, with a particular focus on vulnerable and marginalised populations.

Social norms, especially gender norms, present a barrier to uptake of modern family planning. For example, norms encouraging large families, or having children very soon after marriage, may prevent women from accessing modern family planning when they would like to do so. In response, WISH implementing partners delivered several interventions designed to shift harmful social norms preventing women from accessing family planning services.

Our work as evidence and learning partner focused on closely supporting WISH implementers to adopt and adapt low-cost, rapid and effective approaches to measuring social norms in their unique contexts.

We facilitated a range of learning webinars and produced new, accessible training materials for WISH teams in which we outlined recommended approaches. These materials included animated social norms learning videos in both English and French and three accompanying worksheets (links in table below).


1. Defining social norms:
– Worksheet: English / French
– Learning video: English / French
These resources provide clear definition of social norms, how they influence behaviour and which norms inhibit up-take of modern family planning.
2. Social norms checklist: 
– Worksheet: English / French
– Learning video: English / French
Here we review what works in shifting harmful social norms. We provide a checklist for implementers to assess their activities, and identify opportunities to adapt interventions to focus on social norms
3. Measuring social norms
– Worksheet: English / French
– Learning video: English / French
These resources review what to measure when tracking norm change and provide examples of low cost and rapid approaches to integrate norm measures into existing M&E systems including: (i) adding questions to existing surveys; (ii) focus groups or key informant interviews; (iii) vignettes; (vi) observation.

Applying social norms tools in practice: WISH partner experiences

Following the publication of these resources in 2021, WISH implementors have taken steps to apply them in practice to ‘test’ the tools and recommendations, adapt them for specific purposes and disseminate them amongst their country programme teams.

In addition, MSI (who co-lead the WISH consortium with IPPF) has incorporated and adapted the tools within an online ‘social norms hub’ aimed at providing resources for country programmes to set up, review and measure existing programming on social norms change.

Examples of testing/using the approaches and tools have included:

  1. MSI used the tools within an internal operational evaluation of the ‘Gagarabadau’ pilot programme which aimed to engage men and create community family planning champions among tea vendors in Northern Nigeria to challenge social norms around large families.In depth interviews incorporating vignettes and activity observations were used to explore the intervention’s impact on social norms. The vignettes were explored using Care’s SNAP framework, and generated clear and insightful data on norms, including that norms around birth spacing and family size were shifting. The findings revealed the potential positive impact of bringing together tea vendors and their wives to challenge norms around women’s roles in family decision-making.
  2. IPPF commissioned ORB International to test the tools / approaches in Burundi and South Sudan.  The pilot demonstrated that practical approaches to measuring norm change can be implemented without requiring advanced expertise. Observation and staff reflection templates were particularly successful, with IPPF Member Associations in Burundi and South Sudan incorporating them into their own routine monitoring.In Burundi, staff reflections drew attention to the role of negative attitudes to young women accessing contraception among health care providers. In South Sudan, the templates have been adapted to explore the impact of radio jingles, and the team would like to work with the Ministry of Health to institutionalise the measurement approaches.

Overall, implementing partners found the tools developed under WISH to be useful and relevant, filling a genuine gap in knowledge and practice. In particular the way in which the tools break down defining social norms and the simple ways to measure change were reported as ‘game changing.’

The challenge ahead is to keep the momentum going by continuing to adapt tools where necessary and encourage deeper thinking around what norms could be preventing women from accessing family planning services, how they could be shifted and how change can be measured.

Five takeaways from our experiences with WISH and beyond

1. Social norms need to be presented using clear, simple language, avoiding academic jargon.

Norms are best understood by giving people time to reflect on norms in their own local contexts. Refresher sessions may be useful to ensure everyone has a clear understanding of norms and how they influence behaviours.

2. There is rarely only one norm at play, so formative research is needed to identify and prioritise the different norms which influence a target behaviour.

Norms will not be the only influence on behaviour, so other factors such as knowledge, skills, and attitudes of service providers also need to be considered.

3. Social norms take time to shift, often longer than the lifespan of the typical development programme.

Therefore, implementers need to monitor intermediate outcomes, to check that they are moving in the right direction, and to adapt programming if necessary. These include greater community discussion of the norm, or religious and traditional leaders supporting norm change.

4. There are simple, practical methods to track norm change on an on-going basis.

These can be integrated into routine monitoring and management, and do not require advanced research skills. Nevertheless, teams will still need support to implement the approaches and to synthesise the data gained to identify programming implications.

5. Many organisations have developed excellent resources on identifying norms, programming strategies, and monitoring and evaluation of norm change.

For example, see: WISH social norms learning videos; the Institute for Reproductive Health’s ‘Passages Project’; the Align Platform’s ‘Social Norms Learning Collaborative’; and the Prevention Collaborative’s resource on ‘Social norms change’.

So, review these resources before starting out on a norm shifting programme, to make sure you build on existing evidence. Try to include social norm programming and measurement at the planning and design stage of your intervention, as it is easier to incorporate these approaches earlier in the programme cycle.

Philly Desai is an Independent Consultant in social and behavioural change and Mary Lagaay is a Consultant at Itad.