A variety of factors influence what mothers and caregivers choose to feed their infant children – which partly explains why changing complementary feeding behaviors is so challenging. Consider a mother who wants to feed her 8-month-old fish and eggs. She has recently learned that these are nutritious foods that will support her child’s healthy development. Further, her local market has these items and the family can afford them. And yet, she might still decide against feeding her child fish and eggs. Why? One answer could be social norms. Social norms are the implicit or explicit rules that govern behaviors within a group. For this mother, if feeding her child fish and eggs transgresses social norms, there’s a good chance she simply will not do it. Cristina Bicchieri has been studying social norms for decades. She is the author of Norms in the Wild and featured professor in the joint University of Pennsylvania-UNICEF online Social Norms course. We recently spoke with Cristina about social norms related to nutrition.
A&T: Thank you for talking with us today Cristina. Let’s start right at the beginning. How would you describe social norms for nutrition behaviors?
Cristina: First of all, I do not believe that the choices about nutrition are usually a social norm, per se. I think such choices instead may be supported by other, underlying social norms. People are using the term “social norm” too often, without a proper diagnostic analysis, and very often it turns out that the behavior is not a social norm. This mistake has serious consequences for interventions. Social norms are the behavioral rules that govern human interactions. They tell you what to do, how to behave in a set of situations – not just a single situation, but families of similar situations. They are grounded on our expectations of what others who matter to us do, and also on what they approve or disapprove of. When a behavioral rule is a social norm, if people violate it there will be some sort of sanction. And remember, norms are properties of groups, not of single people. So we always have to study the network within which a norm exists.
A&T: Since nutrition behaviors are not in and of themselves social norms but rather supported by social norms, could you discuss social norm considerations in feeding children?
Cristina: We just finished a report for UNICEF in Mali about childhood nutrition, and it's very interesting because they were quite successful in convincing young mothers to give first milk to newborns. But there is a big gap about what to give or not to give infants beyond milk. And what we discovered is that the main decision-maker about nutrition is the mother-in-law. So even if you try to convince the young mothers that giving tea is a bad idea, you still would have to convince the mother-in-law. The important reference network are the mothers-in-law. Giving tea to kids or other solid foods is not a [social] norm per se. Here we have a mixed model: we have a custom supported by a social norm. In this case, nutrition decisions are based upon the strong social norm of obeying the mother-in-law.
A&T: The nutrition community working on child feeding has long recognized the importance of the mother-in-law in addressing changes in child feeding behaviors. How does the social norm of “obeying the mother-in-law” change what we might do? Would we work to change that social norm? How might we do that?
Cristina: This is a crucial question. Often when someone violates a social norm there will be some sort of sanction. It could be minimal – people might gossip about them. Or it could be major – sometimes violence or death. People have to feel safe in behaving differently. What you need to change first and foremost is the belief that people are able to change behavior and behave differently without being severely punished. They must know they can do it and succeed. How can this happen? How can expectations change? In my book Norms in the Wild, I give the example of the wife of the village leader that started nursing her kids and people saw that they were very healthy and happy. She had power. So, it could be a very influential person that starts doing something different, what I call a trendsetter. Trendsetters are people within the community that show others that one can act differently and not suffer terrible consequences. Another way to spur change is to have focus groups – in our case a group of women that commit to changing behavior. And if they are trusted in the community, it will lead to a change because people will believe that these committed women will act differently and this belief will encourage others to try different things with less fear of being punished.
A&T: This idea of using community influencers as trendsetters to affect social norms sounds great but how do we go about identifying who the trendsetters are in a community? Are there different kinds of trendsetters to consider?
Cristina: One analysis I have done focuses on trendsetters that initiate new norms. Typically, these people may be at the center of a network, because they have a lot of links with other people, lots of people observe them. For example, important media people are at the center of huge networks, so they are potential key trendsetters. But what is more challenging is identifying the trendsetters who push for the end of a negative social norm. Because social norms are usually well-established, there is a risk going against them, so the trendsetter has to have certain characteristics to be the first to transgress such norms. Typically, many of these people will not be at the center of a network – they will be at the periphery. I have studied the psychological characteristics of trendsetters, and in a recent study of the Swachh Bharat sanitation program in India we have discovered that trendsetters at every level of involvement, from state governments down to villages, display these characteristics. In a nutshell, a trendsetter usually has what I call “low sensitivity” to a specific practice, which is to say she does not value it. She also has low risk perception and high self-efficacy, and -- very importantly -- a high degree of autonomy in making decisions. All these characteristics can be measured. I discuss them in the last chapter of my book, Norms in the Wild. If you analyze a network you will know who are the potential trendsetters –the people who can influence a specific behavior and motivate change. Women may have more influence than men because the nutrition of children is usually a woman's task. And among the women, you can learn who could be the strongest trendsetter, depending on their view of nutrition, their propensity to take risks, and their belief that they can influence others. So, when you analyze a network, try to learn who will act first and approach them, rather than working with the whole undifferentiated population. It’s cheaper.
A&T: You mentioned media personalities are at the center of huge networks, and nutrition programs – like many development programs – have sought to use the media to raise awareness of various key messages. How do you think the media is best leveraged for social norms change for nutrition?
Cristina: This is my conviction: the only way to scale up interventions is through the media. How? I think we have a lot of evidence by now that soap operas have a huge effect on the population. People can identify with these characters. People see that these characters are trendsetters. In the soap opera the new mother might fight with the mother-in-law, and the husband may be upset, but in the end she triumphs. In a soap opera a woman would see a village woman like herself that does something different and goes through hurdles as the woman herself would in her village, but there is success at the end of the road. This is a very powerful incentive to change behavior; so, I am a strong believer in producing good soap operas to introduce new, better practices. So, nutrition programs might consider partnering with the producers of an existing soap opera to have the star demonstrate positive feeding practices and convince the more traditional mother-in-law. Husbands, too, can play an important role, as they can see they have a say in the matter. An important aspect of soap operas is that they are usually collectively debated, that people would see new behaviors and discuss them, absorb them, and learn from them together.
A&T: That sounds like a good idea. Mothers will pay attention if they recognize a challenge like feeding a fussy toddler, and they see their respected star demonstrating new ways to get the child to eat vegetables. That could be particularly effective if they see her doing these positive behaviors with her toddler over and over again. What about using short-format media or short-term media campaigns for scaling up social norms change? Is that approach effective?
Cristina: No, it's not enough. Especially if you see that the problem is persistent. People have to absorb and internalize the messages. They have to see people they can identify with behave differently, see what happens to them, and how they solve problems. This takes time. I can tell you the most successful soap operas that have been studied have lasted quite a long time, often many years. So, if you can produce an interesting and long-lasting soap opera, where nutrition and complementary feeding are part of the story, you can be very successful. I would predict that.
A&T: Thank you for this interesting discussion today Cristina. We’ve taken your Coursera course and highly recommend it to anyone looking to learn more about social norms research and programming. We look forward to following your latest research on social change and trendsetters. Have you used a social norms approach in your nutrition programs? Or have you used influencers or media to change behavior? What more could we be doing in nutrition to address social norms that impact complementary feeding? Share your ideas in the comments section below or on social media using the hashtag #Inspire4SBC