Table 3.

Challenges and recommendations to overcome these challenges

Challenge	Recommendations to overcome the challenge
Identification of parliamentarians	Engage strong organisations (eg, NGO) with missions oriented towards improving health and with interaction with political entities. These local partners can facilitate the engagement of parliamentarians who may be more receptive and possibly with previous engagements on these issues so that previous experiences and knowledge are taken into account.
Identification of groups and individuals to support the activities	Engage strong local NGOs with capacity to build sound strategic relationships with local groups and individuals who can be persuaded to support in advocacy efforts.
Operationalisation of the collaboration	The selection of the constituencies is crucial for sustained effort. Local organisations are able to identify constituencies with previous experience or engaged in these issues.
Design an appropriate and culturally acceptable framework to position caesarean section	Even though the reduction of caesarean section was already set as a priority in Italy, it is crucial to design an advocacy framework in a positive light with a positive message that cannot be misunderstood. Ensure that the use of caesarean section when medically necessary is not stigmatised and establish the focus on the reduction of the overuse, that is, the non-medically necessary caesarean section.
Design of activities	The inclusion of partners with complementary expertise is highly recommended. WHO identified the unmet need and provided the technical and scientific information while the strengths of other partners were directed towards the design of the interventions and activities. Based on experience and local capacity, these activities need to be locally relevant and culturally acceptable.
Engaging the media	Ensure the participation of the journalists in technical meetings in which issues such as the overuse of caesarean section, risks and benefits of each mode of birth and the effects in the women, children and health systems are analysed. Sensitising and ‘educating’ the media is key. Engage communication experts with interest in the topic who are able to frame public health issues with tailored messages that connect and resonate with the public and with the society as a whole.

NGO, non-governmental organisation.