SBCC Pathways for Improved Maternal, Infant, and Young Child Nutrition Practices

"Social and behavior change communication (SBCC) is a behavior-centered approach to facilitating individuals, households, groups, and communities in adopting and sustaining improved health and nutrition related practices."

In this working paper, the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project presents "pathways between SBCC delivery strategies and improved maternal infant and young child nutrition (MIYCN) practices." The authors outline how social and behaviour change communication is a vital part of addressing behaviours associated with the three key underlying causes of undernutrition: inadequate care and feeding practices, household food insecurity, and an unhealthy household environment and inadequate health services.

This paper is based on a review of SBCC strategies and theories, as well as a literature review exploring the effectiveness of SBCC approaches in changing priority MIYCN practices. It was produced to contribute to understanding which SBCC approaches and tools are most effective for different types of audiences and behaviours.

The paper presents a theoretical framework demonstrating "pathways from SBCC delivery strategies, targeting a range of populations in order to address key behavioral determinants, improve MIYCN practices and ultimately improve nutritional status." Underlying causes of undernutrition are "heavily influenced by behaviors at the household level: behaviors related to food production, purchase, storage, and intrahousehold distribution; behaviors related to MIYCN care, and behaviors related to the utilization and demand for health and sanitation services."

The theoretical framework includes three primary determinants associated with the adoption of a desired behaviour: demand, an enabling environment, and supply. In all cases awareness, knowledge, and motivation to act are influenced by attitudes, beliefs, and perceptions of social norms. Yet, in order to act, individuals also require an enabling environment and access to supply. For example, along with nutritional knowledge, caregivers must also have the necessary skills, self-efficacy, agency, and control of resources (i.e. allocation of food, finances, and time) to act. "The availability and quality of both affordable services and food, especially complementary foods and micronutrient-rich foods, in addition to health and support services, constitute supply. This requires enabling policies, finances, and systems to account for context (farming practices, markets, and industries, as well as cultural beliefs surrounding food and health), geography, gender, and intrahousehold resource allocation."

The framework also outlines the following key delivery strategies for improving MIYCN practices:

• "Community and social mobilization engages and supports participation of institutions, community networks, social/civic and religious groups to shift attitudes, structures, and norms to better support priority practices.
• Behavior change communication involves face-to-face dialogue with individuals or groups to inform, motivate, problem solve, or plan, with the objective to promote and sustain behavior change. BCC activities typically target those who need to adopt and sustain priority practices (mothers, fathers, caregivers, and service providers) and may occur at home, in the community, or at a facility.
• Advocacy informs and motivates leadership to create a supportive environment to achieve program objectives and development goals. Advocacy creates awareness and encourages leaders to take actions to enable the adoption of promoted practices.
• Non-communication strategies include policy development, distribution of products (e.g., food, micronutrients, de-worming medication), and strengthening of human resource management systems, logistics or supply chain management, food value chain systems, or health management information systems. "