World Health Organization · 1st edition, 2025 · 108 pages
Implementation guidance for policymakers and programme managers on designing, implementing, evaluating and scaling SBC interventions for family planning.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- Policymakers and programme managers in Ministries of Health and implementing partners responsible for contraceptive and family planning programmes
- Evidence
- Critical narrative review approach using systematic reviews, scoping reviews, evidence reviews and high-quality studies; evidence organized by socioecological model levels
- Reviewed
- 15 Oct 2026 · GMJ
What this guideline says
GMJ summary
This normative WHO guidance provides the first comprehensive framework for integrating social and behaviour change (SBC) interventions into contraceptive and family planning programmes. SBC is defined as an approach that addresses overlapping individual, social and environmental factors influencing behaviours to produce the behavioural and social change necessary for improved health and wellbeing. The guidance uses the socioecological model (SEM) and capability, opportunity, motivation and behaviour (COM-B) frameworks to systematically identify barriers and enablers at structural/institutional, social, interpersonal and individual levels.
The document presents a five-step process: define the specific behaviour or social change needed; diagnose barriers and enablers using formative research; design evidence-based interventions tailored to identified drivers; implement at small scale with iterative adaptation; and evaluate impact on both behavioural outcomes and intermediate drivers. Evidence reviews demonstrate that SBC interventions are cost-effective (US$438–1,051 per DALY averted across four countries) and significantly impact modern contraceptive use, couples communication, family planning approval and method continuation when interventions combine multiple approaches across socioecological levels.
Special considerations are provided for adapting interventions to adolescents, men and boys, postpartum women, postabortion women and vulnerable populations including people living with HIV, those with disabilities and populations in humanitarian settings. The guidance emphasizes human rights-based, gender-responsive and people-centred approaches, with meaningful community engagement throughout the design, implementation and evaluation process.
Key points
For clinicians — doses and thresholds as stated in the guideline
- SBC interventions targeting contraception cost US$438–1,051 per DALY averted (evidence from Egypt, Philippines, Zambia, Guinea) and are highly cost-effective.
- As of 2021, 164 million of 1.1 billion women of reproductive age needing pregnancy prevention were not using any contraceptive method.
- WHO recommends at least 24 months following a live birth before attempting another pregnancy; closely spaced births increase maternal and child morbidity and mortality.
- Effective adolescent interventions combine service delivery improvements, health worker training on youth-friendly services, demand-generation activities and community engagement, with adolescents actively involved in planning.
- For postpartum family planning: integrate counselling into antenatal care, postnatal care and immunization visits; home visits and community groups are especially effective for young married women and adolescents.
- Three in four women who had an abortion chose to adopt contraception following counselling when FP services were integrated with postabortion care in eight countries.
- Social accountability interventions (community score cards, social audits, citizen report cards) significantly improve reproductive health service satisfaction and reduce resistance to family planning.
- Monitoring and evaluation budgets for SBC interventions should comprise approximately 10% of the overall SBC programme budget.
Links between COM-B components and intervention functions
Table extracted from the guideline
| COM-B component | Education | Persuasion | Incentivization | Coercion | Training | Restriction | Environmental restructuring | Modelling | Enablement |
|---|---|---|---|---|---|---|---|---|---|
| Physical capability | ✓ | ✓ | ✓ | ||||||
| Psychological capability | ✓ | ✓ | |||||||
| Physical opportunity | ✓ | ✓ | ✓ | ||||||
| Social opportunity | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
| Automatic motivation | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
| Reflective motivation | ✓ | ✓ | ✓ | ✓ | ✓ |
Source: World Health Organization, Social and behaviour change interventions for contraception and family planning. Reproduced in summary form.
From the guideline
Verbatim
“SBC interventions use evidence-based approaches to reduce barriers and support enablers to achieve desired behavioural and social change. They aim to empower people to act on their intentions, enabling the fulfilment of individuals' health and rights.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
This is WHO's first normative guidance on social and behaviour change for family planning, filling a critical gap in our implementation toolkit. For Georgia, where contraceptive prevalence among married women aged 15–49 is approximately 53% (mostly traditional methods), the COM-B framework offers a systematic approach to diagnosing whether our service gaps stem from knowledge deficits, accessibility barriers, provider biases or restrictive social norms around specific populations. The most actionable recommendation for Georgian providers is integrating postpartum family planning counselling into our well-established antenatal care and immunization platforms—infrastructure we already have through the primary healthcare network and UHC programme. The realistic caveat is that meaningful community engagement and formative research to understand context-specific barriers require dedicated time and budget (the guidance recommends 10% for monitoring/evaluation); without this investment in diagnosis, we risk implementing interventions that address the wrong barriers or backfire by ignoring local gender dynamics and social expectations around fertility.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 15 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance is highly relevant as the region continues strengthening universal health coverage and reproductive health services. National family planning programmes would need to assess context-specific barriers including prevailing social norms around family size, gender dynamics affecting contraceptive decision-making, accessibility of services in rural mountainous areas, and provider attitudes toward specific populations (adolescents, unmarried women). The COM-B framework can systematically identify whether gaps in contraceptive uptake stem from knowledge deficits, service accessibility, social stigma or provider bias. Integration of SBC interventions into existing maternal-child health platforms, including antenatal care and immunization services delivered through Georgia’s primary healthcare network, offers cost-effective implementation pathways. Routine health facility data from the national DHIS2 system can inform SBC intervention prioritization and impact assessment without requiring separate data collection infrastructure.
Questions this guideline answers
Quick answers
What is the difference between SBC interventions and traditional health education?
SBC interventions go beyond awareness-raising and education. While educational approaches primarily address knowledge gaps (psychological capability), SBC interventions systematically address barriers across all levels—structural/institutional (e.g., service accessibility, policies), social (e.g., norms, stigma), interpersonal (e.g., partner dynamics, provider attitudes) and individual (e.g., self-efficacy, agency). Evidence shows that increasing knowledge alone is often insufficient to generate behaviour change, as people's intentions do not always match their behaviours.
How can routine health facility data be used to evaluate SBC interventions?
Health facilities routinely collect data on number of new family planning acceptors, continuing users, switchers, postabortion care clients leaving with contraception, and postpartum contraceptive uptake through systems like DHIS2. By comparing these outcomes in facilities or areas where SBC interventions have and have not been implemented, programmes can estimate impact. Gaps in uptake among particular groups where commodity distribution is sufficient often point to the need for SBC interventions.
What are the most effective SBC approaches for postpartum family planning?
Evidence shows that integrating family planning counselling into antenatal care visits (allowing informed pre-delivery decisions), postnatal care and immunization services is effective. Home visits and community group engagement are especially impactful for young married women and adolescents. Offering a broad method mix with availability during the immediate postpartum period (within 24 hours) and engaging male partners through couples counselling significantly increase postpartum contraceptive use.
Which popular adolescent SRH interventions have been shown to be ineffective?
Meta-analyses show that separate provision of adolescent SRH services in standalone youth centres, peer education programmes and high-profile meetings on adolescent SRH have not demonstrated effectiveness at changing knowledge, attitudes, beliefs and behaviours including contraceptive uptake. Instead, effective programmes combine service delivery improvements within existing facilities, health worker training on youth-friendly services, demand-generation activities and community engagement, with adolescents involved in planning.
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- Issuer
- World Health Organization
- Type
- Guidance (normative)
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2025-08-19
- Languages
- English
- Scope
- Social and behaviour change interventions for contraceptive and family planning programmes, addressing factors at structural/institutional, social, interpersonal and individual levels
- Audience
- Policymakers and programme managers in Ministries of Health and implementing partners responsible for contraceptive and family planning programmes
- Pages
- 108
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-011091-5
- Evidence
- Critical narrative review approach using systematic reviews, scoping reviews, evidence reviews and high-quality studies; evidence organized by socioecological model levels
- Record history
- Created 15 Oct 2026 · updated 15 Oct 2026 · next check Apr 2027
World Health Organization. Social and behaviour change interventions for contraception and family planning: implementation guidance for policymakers and programme managers. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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