Dwi Aini Bestari
The use of communication to create behavior change is not new, especially in public health. Approaches used in this process have evolved from focusing on individual behavior change to a broader scope of social and behavior change; referred as SBCC. SBCC is the strategic use of communication to change behaviors “by positively influencing knowledge, attitudes, and social norms”. It combines multiple communication channels to reach various levels of society. SBCC adopts the conceptual framework from the Socio-Ecological Model (SEM), the underlying principle of which is that individual behavior is influenced by different levels of society that can facilitate or obstruct the desired change.
As Indonesia’s first public health and communication consultancy, Savica has previous experience with SBCC related projects. One of our projects was assisting SurfAid in developing a SBCC strategy and materials to increase the rate of mothers who give exclusive breastfeeding for 6 months in Nias district, North Sumatera province in 2019. Using a co-creation approach, training participants were not only exposed to information on SBCC but they were also directly involved in a practice to develop SBCC strategy. All ideas, information, and input from the training were then used to develop their own SBCC strategy on exclusive breastfeeding program for two subdistricts (Gido and Hiliduho). Since a SBCC strategy should be developed based on evidence, a rapid assessment was conducted in both subdistricts prior to the training. Data showed that the problems women faced were not limited to a lack of knowledge on exclusive breastfeeding, but were also related to cultural barriers, support from families, limited capacity of local health workers and insufficient health facilities in terms of numbers and qualities.
Sadly, many women face a similar situation, including myself, living in an urban area. My baby was 3 months old when I had problems with breastfeeding. As a new mother, I was extremely confused. I thought about purchasing formula milk after a senior family member told me my baby might not like my milk. I ended up visiting a lactation counsellor, and I remember she asked, “Do you want to keep breastfeeding him? For how long?”, to which I immediately replied, “Yes, maybe a year? or more?”. Honestly, I did not know then. I never really learned about breastfeeding until I actually had to do it. Nobody told me why it was crucial and how it had to be done; not the obstetricians during my pregnancy and not even the pediatrician who was in charge of my baby after delivery.
In the larger context of Indonesia, breastfeeding has indeed been a challenging process for women. UNICEF and WHO revealed that only 1 in 2 infants below 6 months old receive exclusive breastfeeding. Throughout the years, efforts have been made to encourage mothers to exclusively breastfeed through government policy, education/ information distribution, and more. However, we still have a long way to go.
Creating an Enabling Environment and Behavior Change in the Long Run
In promoting exclusive breastfeeding, SBCC can be used to firstly identify the different challenges at each level of society, as illustrated by the examples from Nias and my personal experience. We cannot only focus on messages/ information around exclusive breastfeeding such as posters, video campaign and modules, but should also combine engaging, involving and building capacities of communities and organizational level. Nowadays, the internet and social media platforms have opened more channels for the government and various communities to promote exclusive breastfeeding. Ayah ASI, (Breastfeeding – Supporting Fathers) is an excellent example and considered successful in promoting exclusive breastfeeding through the participation of fathers.
Using social media, Ayah ASI has increased knowledge about breastfeeding among the general public. Its shares science-based information to correct existing myths in a casual and fun way, answer common questions about breastfeeding from its followers and more. However, to achieve positive behavior changes toward exclusive breastfeeding in the long run, initiatives like Ayah ASI need to be engaged by the government and be part of a systematic national strategy. Most importantly, an enabling environment needs to be created, where national and local policies on adequate maternity and paternity leave, availability of nursing rooms in public and working space, and formula milk marketing restriction are consistently endorsed and enforced.