Girls are More than Just Clients

By Bitania Lulu Berhanu, Adolescents 360 Young Designer PSI Ethiopia

In my home country of Ethiopia, a young woman’s success is measured by how soon she settles down and starts a family of her own.

That, however, is not unique to Ethiopia.

Girls across developing countries often face cultural pressures to marry young, with the expectation that they prove their worth by having a baby shortly after they wed. It means that girls don’t always have a say in how many children they and their partner want. Rather, that decision is influenced by their husband and his family.

© PSI/Benjamin Schilling

It’s a complex situation.

Through PSI’s youth-powered programming, we’re driving toward a future in which girls know that they can choose the lives they want to live. That’s why we’re working in partnership with young people to understand what matters for girls today, so we can deliver solutions that reframe how young people think about planning for their futures, including the decision to start a family, when they are ready. PSI’s flagship sexual and reproductive health (SRH) project Adolescents 360 (A360) in Ethiopia is a case study into how we, alongside the young people we serve, are changing the conversation around contraception by giving girls and their husbands a new way to plan for the children they desire, on their own terms.

Launched in 2016, A360 brings together young designers like myself alongside a range of experts—from cultural anthropology and adolescent developmental science, to public health, Human Centered Design (HCD) and meaningful youth engagement— committed to changing how we reach adolescent girls with modern contraception. It’s a mix of perspectives that’s created Smart Start, a contraceptive counseling tool that introduces financial messaging to help couples plan for the families, and lives, they want.

I joined PSI in 2017 when I was 22. Growing up, I was fortunate to have learned about contraception in school. But not every girl has the same opportunity. That’s been my motivation to pursue this work.

As a young designer, I am a youth voice that represents the needs and desires expressed by young girls. In Ethiopia, for example, girls and their husbands told us that they desired economic security amidst changing times. A smaller family, they said, could help achieve that goal. We developed Smart Start as a financial planning platform that supports rural couples to understand the cost benefit of delaying pregnancy. The approach views girls and their influencers as more than just clients with SRH needs, but rather as humans with many immediate desires.

© PSI/Benjamin Schilling

In the 13 months since implementation, more than 17,000 girls have voluntarily taken up a contraceptive method through Smart Start. We’re continually gaining momentum. The local Women’s Development Army—a group of volunteers who support health service outreach—works hand-in-hand with Smart Start to elevate the importance of the program among communities, all while supporting the health system to identify girls and mobilize them to services. At the same, we’re driving toward government integration with pilot sites in Northern Ethiopia.

PSI’s youth-powered approach has deepened my understanding of the physical, psychological and emotional changes that are a part of adolescence and, by extension, the value of a human centered approach to creating solutions that serve young people with the tools most relevant to their lives.

As a young designer, I am truly gratified to be a part of a PSI program that is impacting actual lives by transforming how we reach, inspire and serve young people with modern contraceptive programming. Together, we’re shifting how we talk about contraception—and we’re doing it by leading with what matters most to young people, today. PSI’s youth-powered approach has opened new ways of seeing and understanding how we, in partnership with health systems, can work with girls, for girls to reimagine the future of youth-powered SRH solutions.


Hear more from Bitania at the Women Deliver concurrent session, “Adolescent Sexual & Reproductive Health & Rights: Programming for a New Generation” on Wednesday, June 5 at 10:30am and again at her Power Talk on Thursday, June 6, at 1:55pm on the Women Deliver Power Stage.

This article appears in PSI’s Impact magazine, released in tandem with Women Deliver 2019, as part of an ongoing conversation about putting #PowerInHerHands.

Banner Image: A young couple engage in Smart Start counseling © PSI/Benjamin Schilling

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