At a time when resources for global family planning are dwindling, The Challenge Initiative (TCI), led in Nigeria by the Johns Hopkins Center for Communication Programs, is showing that governments can successfully do the work of increasing family planning use that has long been led by international donors.
In 10 Nigerian states where TCI was implemented, CCP’s Olukunle Omotoso and his colleagues found that governments were able to use social and behavior change approaches to increase demand for modern contraception and help changed norms around its uptake. They did this with increasingly less assistance from TCI, funded by the Gates Foundation and Bayer AG and set to end this year.
Omotoso will present these findings on Nov. 5, 2025, at the International Conference on Family Planning in Bogota, Colombia.
At its heart, the project’s success lies in a fundamental shift: from donor-driven programs to government-led systems. Traditionally, said Omotoso, senior technical advisor for advocacy and social and behavior change (SBC) for TCI, “People have believed that family planning interventions or demand generation are expensive, that governments cannot drive it themselves.
“But this work has shifted the narrative to show that the government, with the right tools, can make family planning uptake sustainable, without constant support from outside donors. The governments have reached a self-reliance stage, which means they are doing the work themselves.”
From 2021 to 2024, TCI equipped state governments with the tools, systems, and leadership training to own and lead social and behavior change interventions at scale.
By embedding SBC within government systems, revitalizing existing structures, and intentionally challenging prevailing social norms such as male dominance in reproductive decisions and addressing postpartum family planning myths, TCI redefined what sustainable, high-performing SBC looks like. The approach also promoted inclusive participation, gender-sensitive programming, and was culturally relevant.
The goal was to get more women to be referred to family planning clinics and to have more women choose a family planning method that works for them.
“States established SBC coordination platforms that integrated community leaders, women’s groups, and youth champions,” according to the abstract. “Government-trained social mobilizers delivered culturally sensitive messages to challenge harmful norms, drive high-quality community mobilization, and strengthen referral pathways. This included a targeted strategy to improve historically weak referral completion rates often under 50 percent through simplified tracking tools and accountability loops.”
Omotoso and his colleagues found that completion rates for family planning referrals, a key milestone for uptake, soared to about 72 percent overall over three years, up from less than 50 percent at the start of the effort. In some states, the figure reached over 80 percent. Women 25 years and older also have higher uptake rates.
Across more than 47,000 community mobilization events and 370 media spots, 727 government actors and mobilizers were trained. These efforts reached nearly 1.9 million women with family planning messages, resulting in nearly 980,000 referrals of which more than 705,000 were completed.
“This demonstrates tangible behavior change not just exposure or awareness,” Omotoso said.
Mobilizer feedback and community dialogues revealed increased acceptance of postpartum family planning, more first-time users among newly married couples, and reduced stigma around youth contraceptive access. Integrating traditional gatekeepers, such as clergy, and fostering peer-led mobilization accelerated community ownership and credibility of family planning messaging.
“This is a great example of what systems strengthening and localization really looks like in practice,” said CCP’s Taiwo Johnson, who leads TCI in Nigeria. “This isn’t CCP or TCI leading these SBC campaigns; it’s the state governments, and they are seeing measurable results. This also shows how to make new initiatives work and coordinate them across complex local governments and multiple actors.
“Anyone can spend money doing a training here or there, but to really institutionalize an SBC program, not just the SBC technical skills but also the governance of the program, that’s something likely to reap rewards for many years to come.”
