Background: Despite being acknowledged worldwide as essential maternal care providers, midwives remain marginalized in the Jordanian healthcare system. Further, considering Jordan’s goal to achieve a total fertility rate of 2.1 by 2030 and Jordanian women’s preference for female providers, enhancing midwives’ role could significantly promote the use of reproductive health and family planning services. Focus of the Article: We report on opportunities created by opening the boundary of our social marketing understanding to systems thinking in practice (STiP), using soft systems methodology (SSM) to engage with the complex situation of midwifery policy in Jordan. Research Question: In what ways could STiP benefit upstream social marketing interventions? We attempt to answer this question from the perspective of an SSM action research in Jordan. Program Design/Approach: The intervention combines stakeholder analysis and evidence-based policy with an SSM seven-stage cycle. We analyze the compatibility of SSM with social marketing through the NSMC’s eight benchmark criteria. Importance to the Social Marketing Field: The case offers to learn experientially about the relevance of a systems’ approach to complement social marketing frameworks. Drawing from the practical application of SSM, this study suggests that using systems’ tools in social marketing interventions might significantly contribute to achieving intended behavioral outcomes. Methods: Gordon’s alternative framework for upstream social marketing, “advocacy, relationship building and stakeholders’ engagement,” was enacted through the SSM’s seven stages. Research findings provided advocacy arguments. Rich pictures, conceptual modeling, and the CATWOE exercise fostered relationship building and stakeholders’ engagement toward the accommodation stage. Results: At the systematic level, that is, the linear chain of programmatic activities, the policy objective was achieved with an amended Law submitted to the Parliament for debate. At the systemic level, that is, the dynamic relationships among stakeholders, the social learning that emerged during the SSM process reduced policymakers’ resistance and fostered their collective action. Recommendations for Research or Practice: Social marketers can benefit from further experimentation with systems’ approaches to develop their STiP capabilities. Thus, social marketing practice, at this historical moment, could be better equipped conceptually and practically to manage for the emergence of positive behavior change in messy upstream situations where policy and politics are always enmeshed. Limitations: SSM calls for several iterations until stakeholders feel that no more change is needed. However, these iterations are challenging to implement during the limited time frame of development projects. In this case, another iteration was suggested to diffuse the conflict between midwives and obstetrician-gynecologists who saw themselves as victims of this policy reform. However, with Jordan Communication Advocacy and Policy ending in December 2019, this case legacy might be passed on to other projects.

中文翻译：

---

上游社会营销中的系统思考：使用软系统方法改进约旦的助产政策

背景：尽管助产士在世界范围内被公认为必不可少的孕产妇护理提供者，但在约旦医疗体系中仍然处于边缘地位。此外，考虑到约旦的目标是到2030年使总生育率达到2.1，以及约旦妇女对女性提供者的偏爱，增强助产士的作用可以大大促进生殖健康和计划生育服务的使用。文章重点：我们报告了通过将社会营销理解的界限与实践中的系统思维（STiP）结合使用软系统方法论（SSM）来应对约旦助产政策的复杂情况而创造的机会。研究问题：STiP可以通过哪些方式使上游社会营销干预受益？我们试图从约旦的SSM行动研究的角度回答这个问题。计划设计/方法：干预措施将利益相关者分析和基于证据的政策与SSM的七个阶段结合在一起。我们通过NSMC的八个基准标准分析了SSM与社会营销的兼容性。对社会营销领域的重要性：本案例旨在通过经验学习系统补充社会营销框架的方法的相关性。借鉴SSM的实际应用，这项研究表明在社会营销干预中使用系统工具可能会大大有助于实现预期的行为结果。方法：通过SSM的七个阶段，制定了戈登的上游社会营销替代框架，“倡导，建立关系和利益相关者的参与”。研究结果提供了辩护论点。丰富的图片，概念建模和CATWOE练习促进了在适应阶段的关系建立和利益相关者的参与。结果：在系统的水平（即计划活动的线性链）上，通过将修订后的法律提交给议会进行辩论，实现了政策目标。在系统层面上，即利益相关者之间的动态关系，SSM过程中出现的社会学习减少了决策者的抵制并促进了他们的集体行动。研究或实践建议：社交营销人员可以通过对系统方法的进一步试验来受益，以开发其STiP功能。因此，在这个历史时刻，社会营销实践 在理论上和实践上都可能有更好的装备来应对在总是陷入政策和政治困境的混乱上游情况下出现的积极行为变化。局限性：SSM要求进行多次迭代，直到涉众认为不再需要任何更改为止。但是，这些迭代在有限的开发项目时间内难以实现。在这种情况下，建议进行另一次迭代，以弥散助产士和妇产科医生之间的冲突，她们将自己视为这一政策改革的受害者。但是，随着《约旦通讯倡导和政策》于2019年12月结束，该案的遗产可能会转移到其他项目中。SSM要求进行多次迭代，直到利益相关者认为不再需要任何更改为止。但是，这些迭代在有限的开发项目时间内难以实现。在这种情况下，建议进行另一次迭代，以弥散助产士和妇产科医生之间的冲突，她们将自己视为这一政策改革的受害者。但是，随着《约旦通讯倡导和政策》于2019年12月结束，该案的遗产可能会转移到其他项目中。SSM要求进行多次迭代，直到涉众认为不再需要任何更改为止。但是，这些迭代在开发项目的有限时间范围内难以实现。在这种情况下，建议进行另一次迭代，以弥散助产士和妇产科医生之间的冲突，她们将自己视为这一政策改革的受害者。但是，随着《约旦通讯倡导和政策》于2019年12月结束，该案的遗产可能会转移到其他项目中。