Examining norms and social expectations surrounding exclusive breastfeeding: Evidence from Mali

TL;DR

This study investigates how social expectations influence exclusive breastfeeding in Mali, showing that community behavior perceptions significantly predict individual practices and suggesting social norm interventions could improve health outcomes.

Contribution

It provides empirical evidence on the role of social norms in breastfeeding behavior and demonstrates the potential of norm-based interventions for health policy in Mali.

Findings

Expectations about community behavior strongly predict individual breastfeeding.

Beliefs about community approval are only modestly associated with behavior.

Manipulating perceived community norms can causally influence individual breastfeeding practices.

Abstract

Why do people engage in certain behavior. What are the effects of social expectations and perceptions of community behavior and beliefs on own behavior. Given that proper infant feeding practices are observable and have significant health impacts, we explore the relevance of these questions in the context of exclusive infant breastfeeding behavior using social norms theory. We make use of a primary survey of mothers of children below the age of two years in the Kayes and Sikasso region of Mali, which have a historically lower prevalence of exclusive breastfeeding. The findings from regression estimations, controlling for a host of potential confounding factors, indicate that expectations about the behavior of other community members can strongly predict individual exclusive breastfeeding. Beliefs about approval of the infant feeding behavior of the community though are found to be only modestly associated with it. In addition, mothers who hold false but positive beliefs about the community are found to exclusively breastfeed their kids. Further, using responses from randomly assigned vignettes where we experimentally manipulated the levels of social expectations, our data reveal a strong relationship between perceived prevalence of community level exclusive breastfeeding and individual behavior. This result indicates the existence of a potential causal relationship. We argue that our findings represent an important foundation for the design of policy interventions aimed at altering social expectations, and thus effecting a measurable change in individual behaviors. This type of intervention, by using social norm messaging to end negative behavior, avoids the use of coercive measures to effect behavior change in a cost-effective and efficient way.