In the adolescent sexual reproductive health sector, we talk a lot about choice—a girl has choice when she knows her options, when she knows where to go, when she can afford services. For the past five years—alongside girls, their communities, and with our partners —we’ve had the opportunity to explore, learn, and design for choice.
Designing for choice means getting to the core of what might propel girls forward and what barriers may hold them back. The answer is never cut and dry. Is it meaningful choice if she takes up a contraceptive method, but her mother takes her back to the clinic the next day to have it removed? Have we designed for choice if she doesn’t understand the value it can play in her life? Have we given her choice if she learns about the benefits and risks of different contraceptive methods, but we haven’t addressed her fears and misconceptions? If a provider turns her away at the clinic, have we created the conditions for her to be able to choose?
At IDEO.org, we’ve had the opportunity to design for key moments in a girl’s journey towards contraceptive choice. While the solutions themselves may take different forms depending on the context, we’ve found there are common elements in every journey: relevance, acceptance, confidence, guidance, and access.
Lead with what already matters to her.
Talking about contraception isn’t usually the best place to start a conversation. So what is? Well, whatever matters to her. Are her aspirations grounded in immediate desires, or is she looking ahead and daydreaming about what her future might hold? When was the last time she laughed really hard? Who does she look up to? We’ve learned it’s helpful to lead with what moves her and makes her tick. Relevance is about speaking in her terms.
While we were in rural Benin—where many girls face limited educational and economic opportunities and sometimes have to resort to sex to pay for basic needs—we learned that young people cared about solving their short-term financial needs. In partnership with PSI, we launched L’Académie, a vocational experience where girls master new skills and crafts, like beading or soap-making, to make their own income while learning lessons about how to protect their bodies. It’s a space where contraception is linked to self efficacy and made relevant to their future.
Build support among the people in her life.
No matter how acceptable contraception is to girls, if they live in communities where it is still taboo and the consequences of use are severe, their choice is limited. Girls often have to balance the demands of many people in their lives, like strict parents, peer-pressuring friends, boyfriends, and authoritative community leaders. Understanding her environment and existing perceptions of those around her to is critical to determining if a solution should speak directly to her or if it should also bring in those around her.
In Abidjan, Côte d’Ivoire, sex is a social currency for men and having multiple sexual partners brings bragging rights amongst friends. However, if a girl does this, she’s seen as unfaithful. In order to build acceptance around contraception, we created Didier, a telenovela-style campaign that uses storylines about dating, love, and sex to encourage young men to be protagonists in the protection of themselves and their partners.
Help her understand her options.
The clinical language around contraception can be intimidating, impersonal and, let’s face it, confusing. Girls want to learn from people they trust, and this varies. We often consider whether she is more receptive to facts or real-life testimonials, to learning from authority figures or getting advice from peers. We want to build her confidence by equipping her with knowledge in a way that engages her mind and heart.
When we designed the Diva Centres—youth-friendly clinics—with Marie Stopes Zambia, we wanted to help girls enter uncharted territory with greater ease. So we created materials that made the educational component feel more like a personality quiz than a health brochure. Girls learn about five relatable characters, The Divine Divas, with attributes that each relate best to one form of contraception.
Equip providers to support her journey.
Providers can make or break her experience by helping her feel accepted and supported or dismissed or judged. Some rise to the occasion with much enthusiasm and misinformation while others, afraid of community backlash, don’t condone something they wouldn’t approve of for their own daughter. To best equip providers, we get to know them.
In rural Ethiopia, there’s a robust Health Extension Worker (HEW) network throughout the country—but they usually don’t have the resources or influence to address all of the community’s needs, much less talk about contraception to every single girl. In order to equip providers and make space for this conversation earlier, we created Smart Start, a youth-friendly aide that introduces contraception through simple, clear illustrations and links it to financial planning. The visuals are so compelling and easy to understand that girls can recite it back after seeing it once.
Ensure services respond to her needs and lifestyle.
When a girl goes to access contraception, she should feel welcomed and comfortable. But for some girls, the barriers that exist are still too great, from physical distance to the clinic to perception of clinics as being for the ill to fear of being judged by their communities. In our work, we’ve looked to create access points that affirm a girl’s contraception choice rather than cast doubt on it.
Many girls in the Democratic Republic of Congo don’t feel safe walking into a clinic and, though pharmacies often offer more anonymity, there is a widespread problem of girls buying incorrect methods like deworming pills, which they believe prevent pregnancy. In order to create an experience that would resonate with girls at the moment of choice, we designed Batela Lobi Na Yo! Pharmacies to be youth-friendly, staffed with providers that teach with clarity and without judgement.
As the largest generation of adolescents in history enters reproductive age, the choices they make today will shape their futures and those of their communities and countries. Yes, progress is being made. But there is still so much work to be done.