We all do better when we work together. This is particularly true in the social justice world, in which systems change and collaboration are intricately and inextricably linked: systems change cannot happen without key players, systems, and sectors joining together to accomplish a common goal. Recently, I had an opportunity to dive deep into a systems change process that laid the groundwork for supporting collaborative initiatives in Kenya to address challenges in family planning.

Kenya’s relatively new constitutional family planning provision states “every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.” However, despite this constitutional mandate, there are high unmet family planning needs in Kenya, the reasons for which are varied and complex.

Enter, the systems approach.

I visited four remote villages in an effort to identify the levers that could shift the system in a way that supports family planning,. There, I worked with the communities to detangle their family planning attitudes and beliefs and understand how this translated to their behaviors.

What I discovered was a complex, intricate system of players, policies, and programs, which influenced individual beliefs and behaviors in an often negative way. While individuals understood the importance of family planning, many were not using it for reasons that ranged from propagation of contraceptive myths and misinformation at the individual level to government policies regulating the availability and use of contraceptives at the countrywide level. Tackling these barriers to family planning in Kenya lends itself to a collaborative approach: true impact will require addressing the interconnected nature of these factors and coordinating effort across sectors and silos.

But where to start?

The Social Ecological Model is often used in public health as a tool for prevention strategies and illustrates the interactional effects of individuals, their relationships, and their environment, including the community and society in which they live, on behavioral outcomes. Each of these levels is a part of the larger system, all with the ability to act on and influence one another.

In order to collectively address the factors contributing to family planning beliefs, attitudes, and behavior, my colleague Araceli Alonso and I applied the Social Ecological Model to identify mediators associated with family planning behavior. We then developed policy and system change recommendations based on the model:


The Social Ecological Model allowed us not only to make recommendations at each level, it provided us an opportunity to take a step back and apply a systems lens to the issue. We were able to make connections across policies, funding, and formal and informal processes in our recommendations. By taking this holistic approach, rather than looking at the factors individually, we hope to have opened the door to moving the system to change family planning behavior in a positive, sustainable way over time.

Michele Coleman will be presenting this research at the Annual Public Health Association meeting in Denver this fall. A full publication is set to be released in the World Medical and Health Policy Journal, special edition “Women’s Health in the Global Perspective” in spring 2017, under the title “A qualitative study exploring how family planning beliefs and attitudes contribute to family planning behavior in rural, southeastern Kenya: application of the Social Ecological Model.”

Araceli Alonso is a 2013 United Nations Award Winner for her activism in women’s health and human rights. Dr. Alonso is an Associate Faculty at the University of Wisconsin-Madison in the Department of Gender and Women’s Studies and in the School of Medicine and Public Health, where she teaches classes on women’s health and international human rights. Alonso holds a Nursing degree and a Ph.D. in Anthropology. She is also the Founder and Director of the numerous award-winning non-profit organization Health by Motorbike, through which this research took place, that provides a comprehensive model of health and well-being for women and children in rural communities of southeastern Kenya.