By: Manya Dotson, Project Director, Adolescents 360
Going back to Cote d’Ivoire to join a Human Centered Design (HCD) sprint in Abidjan was a no-brainer.
PSI’s Cote d’Ivoire team is working with design firm IDEO.org to create safe spaces for girls 15-19 in Abidjan. Our goal: provide this cohort with the resources and services to prevent unplanned pregnancies. This work, generously supported by actress and Maverick Collective member Jess Jacobs, has been greatly inspired by Adolescents 360 (A360) PSI’s flagship adolescent and youth sexual and reproductive health (AYSRH) project. I HAD to check it out.
My hair doubled in size minutes after stepping off the plane into the moist and fragrant Abidjan night. I mazed my way through the modern airport, then flagged down a rusty local cab. I spent the 30-minute ride into the neon-lit city-center joyfully swapping jokes with a taxi driver about craving favorite local meals (the food in Cote d’Ivoire is INSANELY good).
This felt familiar. After all, Cote d’Ivoire holds a special place in my heart.
From 2000 to 2004, I worked in a rural Ivorian maternity clinic as a Peace Corps volunteer, and then as PSI’s representative leading PSI-Cote d’Ivoire. It was through my work with young mothers who came to that clinic that I discovered my passion for public health, and my “entree” into what, some two decades later, has morphed into a challenging, humbling and fascinating public health career.
Curiosity and a Learner’s Mindset
My anticipation was high. We were here to roll out the HCD process, working in partnership with a diverse team and the girls we were serving to co-create a bespoke solution to meet their reproductive health needs.
I was curious to see how HCD would work in this context, given PSI and IDEO.org’s experience on the issue of adolescent and youth sexual and reproductive health in other countries.
Would we ask the same questions?
Discover the same barriers already known to the field of public health?
What would we be looking for in this early discovery phase?
What would we be experientially testing?
Empathy and Discovery: Flexing our Heart Muscles
Activities commenced the very next morning. Our team of three spent the day in a peri-urban area on the edge of Abidjan, talking both with girls and the women girls had identified as trusted advisors.
Girls willingly opened up to us about their experiences, hardships. They had heard about contraceptives, and some showed us their implants, but almost everything they “knew” was misinformation.
All of the girls talked about experiences with teachers who swap sex for passing grades, yet still feel school is worth the risk. Two of the girls had finished secondary school—but had no idea how to translate school into the jobs and lives they dreamed of.
Still, they hadn’t lost hope.
We learned of the financial challenges young Ivoirians face. We heard of, and even witnessed “Cyberboys” who look to scam rich online girlfriends as an income generating activity. We met girls who talked about their dreams: to be an interior designer, a pharmaceutical detailer. One simply wanted, so badly, to go back to school. She shared that she had gotten pregnant at 15.. She had experienced an obstructed labor and had to have an emergency c-section. The baby died, and her family had spent all of their money saving her life. There wasn’t anything left for school fees, so she had left school.
At 15, no one had told her how a person gets pregnant. She and every girl felt that as soon as a girl gets her period she should be told the facts of life—and about contraceptives—in very practical terms.
Tough Love Tantie, a mother to an 18-year-old daughter and a trusted confidant to many young people in her community, offered insight into the success she has found in having a good rapport with youth. “When you listen to them without judgment, then they listen to your advice—and I ATTACK them with advice!” We heard a lot about advice: wanting it, giving it, asking for it, needing it.
Our team listened closely for entry points, openings. We watched body language, listened closely to what silences might tell us, and laughed together. My experience with HCD —and as a mother two teenage girls—has helped me understand that listening to adolescents is more than just hearing the words they say. But rather, observing how they act as they say them.
Through what they said and how they responded, we gathered that the young participants liked the idea of a quiet place for an intimate chat. We heard the term “entre nous,” or just between us,” many times over the course of the week (could that become something, we thought?). In the car ride back to the office, the team was reflective—both thinking and feeling, our empathy muscles flexed and stretched. The feeling thing always happens in the HCD process. It’s a big part of the point and a differentiator from traditional research which counts on academic objectivity and assumes emotional distance.
The Same but Different: Synthesizing
Back at the office with a million sticky notes capturing observations and quotes, we coded, clustered and organized our learning like clusters of leaves on a mango tree. There’s something here around hope, variations on the theme of people being good.
The boys are preoccupied with romance, love, and heartbreak. Being “serious” and practical/financial support are paired when girls talk about love. What’s this about intermediaries intervening to help smooth conflicts and facilitate difficult conversations on behalf of girls? Everybody talks about connections, friends—the isolation we saw in A360’s HCD activities in Tanzania and Nigeria doesn’t seem to be an issue here. And our overall impression: They say it’s a taboo to talk about these things, but everyone is so open! They are saying it wouldn’t be hard for them to get what they need—to go out to an event. Are these girls expressing agency? They seem to have a lot of independence They know stuff about contraceptives—pills, injections, implants. They aren’t shy about talking about it—showing us an implant in an arm. They are so eager to laugh and have fun! They have been through so much already… Their dreams are still so alive! They are sad and sassy at the same time.
How Might We?
We invited a whip-smart trio of young designers to play with ideas as our first step in designing experiments that we could try out with girls in the real world.
We asked: how might we make information about contraceptives feel easy and effortless to get in everyday life? How might we make it easier for moms and daughters to talk? How might we celebrate girls? How might we build trust?
There are no bad ideas here, we told our designers (and ourselves). Anything goes! The ideas came fast and furious—at one point the translator forgot to translate and started scribbling ideas onto sticky notes!
Using these ideas, IDEO.org began the following day creating some “sacrificial prototypes” to test concepts.
My favorite were posters for a community event coupling talks about avoiding unwanted pregnancy and contraceptives with four topics to select from: Smart Choices for Today, Love and Romance, Sex, or A Brighter Future. Mobilizers would go out and find girls and invite them to choose an event. To demonstrate commitment they also gave their phone number and permission to contact them.
Another involved a group of girls assigned to interview people using a series of questions about love and contraceptives. They had to ask a parent, a family member, a friend and an expert. We wanted to know more about who and how they would ask, how would those people respond? and how was the experience?
Another asked girls to design their ideal party. Who would be there? What would you do for fun? We’re trying to get at what delights girls here!
And yet another had a group of girls playing with craft materials in a co-design putting essential messages about contraceptives onto everyday objects—pads, matchboxes, nail polish, soap… There were AYSRH experts in the room… could we predict what would happen?
We then tested these prototypes with young people.
Some 40 girls aged 15-19, both in and out of school, unanimously chose the “Smart Choices” events.
Even more, they had all given a phone number. The few girls who didn’t have phones gave a family member’s number: mom’s (!) or an older brother.
We planned to do some crafts together, but as we started the activity the girls opened up to us and began to share. It got deep fast, as they poured out their experiences and hardships. They said they were craving having someone who they could really, really talk to about their lives—someone who could help and advise them. They also wanted affection, a space to ask their questions. Sticking messages into soap boxes just didn’t feel like the right activity—so instead we talked and then shared some quality information about contraceptives to clear up misinformation they were sharing.
The other prototypes had resonated, too. The girls who had talked with their parents had been surprised about how well it had gone, questioning if talking about sex is taboo? Perhaps it’s just uncomfortable?
And then we asked the mobilizers what had surprised them—what had they learned?
They had found this younger age group so open! So hopeful! They were filled with optimism that this group of girls—if connected to the right resources would be able to make the life-changing choice to use a contraceptive method. They had been emotionally moved, were inspired and motivated.
What I Learned
Instead of adults using research to decide ‘what’s good for girls,’ the HCD process gave us a structured way to step into these girls’ shoes, to begin co-designing solutions grounded in the cultural context and what girls told us they wanted—what they needed. The concepts we tested to learn more are a step toward promising opportunity ahead.
And of course, we got a chance to dance together. Dance parties break out at a moment’s notice in Cote d’Ivoire—a culture with a relentless joie de vivre. The session ended with lots of hugs, and a great deal of fun around a Polaroid camera. The girls had poured out their hearts and they didn’t want us to go. Back at the office, we shed some tears of our own.
Being back in Cote d’Ivoire brought back so many memories. Of dark nights spent in that clinic helping 15-year-old girls through difficult births by lamplight. Of hours spent crafting and talking about life with my Peace Corps Girls’ Club. Of the revolutionary sixth grade teacher who had tried to teach sexual education, and the practical parents who didn’t raise a fuss. Of palm wine and moonshine, and day-old chicks like lemon drops covered in silvery down. And, most of all, of the openhearted, engaged, dramatic, joy-loving, hopeful, practical and frank culture that will always be my first Africa love.
After this trip I am filled—like the girls we met—with heartache and hope. After seeing how powerfully A360’s solutions are resonating with girls in Ethiopia, Nigeria and Tanzania, I am confident that the PSI-Cote d’Ivoire team and IDEO.org will build on that work, and find the specific, tailored way to engage, inspire and serve the girl of Abidjan.
I can’t wait to see what happens there next.