Family planning takes a 360-degree approach

In the elephant migration corridor near Tarangire National Park in Tanzania, a nurse named Happiness Chacha travels hut to hut to talk with villagers about family planning. Her work is a result of the Endangered Ecosystems Northern Tanzania, a project funded by the U.S. Agency for International Development that aims to make both people and wildlife more resilient to threats like climate change and population growth. While it might seem surprising to see efforts to promote family planning and combat wildlife poaching as part of the same program, the project reflects growing recognition among donors and implementers that sexual and reproductive health cannot be divorced from a wide spectrum of other development objectives. Unintended teen pregnancies are a major global health threat in sub-Saharan Africa, where 40 percent of girls and young women want to use contraception but are unable to access it. Every year, 70,000 adolescent girls die in developing countries from complications related to pregnancies, including unsafe abortions. “We haven’t addressed the fundamental drivers of such high levels of teenage pregnancies,” Mustafa Kudrati, Tanzania Country Representative at Pathfinder, told Devex by phone. “It requires trusted people in the community providing alternatives to what has been the norm and engaging with people on a continuous basis over time.” That kind of engagement and learning is exactly what human centered design is meant to bring about. Last week, Population Services International convened a “design immersion” on teen pregnancy in Dar es Salaam. An effort called Adolescents 360 will build upon this work to source adolescent family planning solutions from health providers and adolescents themselves at a much larger scale. With a $30 million grant from the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation, PSI is implementing Adolescents 360 in Tanzania, Ethiopia and Nigeria, along with partners including the Center on the Developing Adolescent from the University of California, Berkeley and the design firm IDEO.org. The name was chosen to reflect the need for a comprehensive approach to programming that works with and for adolescents and brings together expertise including social and creative marketing, adolescent cognitive development, and human centered design. “We wanted to use a methodology that starts with a clear end goal but allows us to test a wide range of solutions, that are created and designed by adolescents themselves, and that allows for rapid feedback on what works, what doesn’t, and how do we learn from it,” Clarissa Brundage of the Gates Foundation and Alice Molinier of CIFF wrote to Devex in a joint email. “This is exactly what design thinking allows us to do: it is incredible how having a tangible manifestation of what adolescents want to test triggers reactions, and illicit deeper insights from adolescents and their influencers that we would not have had otherwise understood using more traditional methodologies,” they wrote. PSI’s immersion leaders walked participants through communication guidelines like “Don’t call it family planning or birth control” and “Make it Tanzanian,” pointing to the complexity of something as seemingly simple as the branding of contraception. Across much of sub-Saharan Africa, including much of Tanzania where half of all babies are born to teenage girls, womanhood is often defined by having had children. “There is tremendous pressure that comes from society to prove you bear children because that changes how people ascribe self worth,” Kudrati said. Pointing to a range of reasons for unintended teen pregnancies, he mentioned girls who have sex in exchange for money or gifts, providers who refuse to provide girls with access to contraception, and the spikes in information from childhood to childbirth with major gaps in between. PSI included many of those same factors in reading materials ahead of the PSI immersion, but participants were reminded that the medical providers, their adolescent patients, and the people who influence them were the ones with the answers. “It takes a fair amount of humility,” Pam Scott, a designer and philanthropist who is working with PSI to incorporate human centered design, told the group. “We’re going to learn where our ideas don’t have traction and we’re going to let them go in a hurry.” Human centered design drove the design process from Post-it notes on the first day to prototypes on the fifth. Participants with multidisciplinary backgrounds added perspectives on the ways the drivers and impacts of unintended teen pregnancy require an integrated development approach that extends beyond public health. And the transformation that resulted from constant interviewing and iterating demonstrated the power of not only listening but co-creating. 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