In Somalia, conversations about family planning rarely start in health clinics.

They start in mosques, in homes, in the language people use to talk about family, faith and responsibility.

For years, those conversations have been difficult. In Somalia, religious and social norms strongly shape how reproductive health is understood and discussed.

Somalia faces one of the highest maternal mortality rates in the world, with more than 500 deaths per 100,000 live births, and modern contraceptive use remains very low. These realities reflect not only access to services, but also how reproductive health is spoken about in everyday life.

That’s where the Johns Hopkins Center for Communication Programs, in collaboration with the International Rescue Committee and the Federal Ministry of Health in Somalia, came together with religious leaders and communities. Under the Women’s Integrated Sexual Health (WISH 2), led by the International Planned Parenthood Foundation, they worked to adopt the term birth spacing instead of family planning, and co-created messages for different audiences, making the topic easier to discuss. This reframing helped strengthen dialogue around reproductive health.

This work will be presented at the 2026 International Social and Behavior Change Communication Summit in Panama, where practitioners are examining how social norms, trust, and communication shape health behaviors in complex settings. There is still time to register.

In Somalia, the challenge is not only whether services exist. It is whether people feel able to talk about them in the first place.

“Family planning is not a neutral phrase in many communities,” says CCP’s Alfayo Wamburi, a senior regional advisor for the WISH2 project. “It can feel foreign or morally loaded. That alone can stop a conversation before it starts.

So, the program took a different approach. They stopped leading with the term.

Instead, as part of the co-creation session, they asked a simpler question: how do people already talk about having children?

The answer was consistent: people talk about birth spacing, the idea of allowing time between pregnancies to protect the health of mothers and children. This is often linked to healthier outcomes, including safer pregnancies and better survival for newborns.

That insight changed how the work moved forward.

The program began with listening through interviews and community discussions with youth, health care providers and local leaders. The goal was not to measure knowledge, but to understand what people felt comfortable saying and discussing in everyday life.

What emerged was clear. People were not rejecting the idea of healthier timing between births. They were responding instead to language and framing that did not always fit how they understood the topic in their own context.

In Somalia, CCP worked with IRC and engaged the trusted religious leaders and Islamic scholars to reframe family planning as birth spacing, empowering them to guide discussions, promote acceptance, and deliver messages with health workers. This engagement with imams and faith leaders has not only been to share information but also to shape how the issue is discussed within communities.

Together, they reframed family planning as birth spacing. It connected to values people already understood, like protecting mothers, supporting children, and strengthening families. It also made the topic easier to talk about in public.

Messages then spread through sermons, radio programs, and community conversations.

At the same time, attention turned to health facilities. Even when services are available, demand stays low if care feels judgmental or unwelcoming. Providers were trained to listen more closely, reduce judgment, and engage young clients in a more supportive way.

Together, these shifts in community dialogue and changes in health care workers behaviors began to show results. Changes in community engagement and provider practice began to shift outcomes.

In one facility, youth visits rose from 689 to 935 in a matter of months. The number of married youth receiving family planning services nearly doubled. Male condom uptake increased from virtually zero to 470 within three months.

But some of the most important changes were not captured in numbers.

Providers described greater confidence in speaking with young clients. Men became more involved in conversations about reproductive health. Topics that were once avoided began to surface more naturally.

“What changed was not only behavior,” Wamburi says, “but whether people felt able to speak up. People understood the issue. What they lacked was a way to talk about it that felt acceptable within their social and cultural context.”

Once the language changed, the conversation changed. And once the conversation changed, behavior followed.

In settings where religion and social norms shape daily life, behavior change rarely starts with information. It starts with whether an idea fits how people see their world.

In Somalia, religious leaders led this shift, providers reinforced it, and trusted channels carried it.

The result was not a sudden transformation, but a quieter shift in what people felt able to talk about.