How to Reduce Unplanned Pregnancies? Ask Consumers.

In January 2021, panelists from PSI Vietnam, Planned Parenthood Association of Ghana (PPAG), YLabs, and Pathfinder International Pakistan explored how human-centered design can deliver solutions for reducing unplanned pregnancies.

From Vietnam to Pakistan, Nigeria to Tanzania – we’re seeing over and over that the best solutions for sexual and reproductive health (SRH) programs come from the consumers themselves.  

As panelists shared during the webinar, “Now More than Ever: How SRH Continues during COVID” human-centered approaches to health program design can deliver the insights that lead to impact, even now during COVID-19. 

Van Dinh, PSI Vietnam’s Senior Human-Centered Design (HCD) Project Manager; Joshua Akharigeya Atabinore, Planned Parenthood Association of Ghana (PPAG)’s Advocacy Officer; Jordan Levine, YLabs’ Senior Epidemiologist; and Dr. Tabinda Sarosh, Pathfinder International Pakistan’s Country Director and Project Director for Naya Qadam (NQ), discussed:

  1. How consumer voices can drive digital innovation – and deliver SRH information into the palm of consumers’ hands; 
  2. How consumers can tell us – public health implementers, government stakeholders and donors alike – about the barriers that stand between consumers and their access to safe abortion services; 
  3. How, amidst a pandemic, HCD approaches can support the public health community to deliver on its promise to consumers and health systems, alike. 

All the organizations represented here have leveraged HCD approaches and other consumer-powered processes in our work. Given the successes we have all seen, we advocate for the wider and more consistent use of these approaches and processes in delivering critical tools to public health practitioners—especially those seeking to navigate COVID-19’s impact on consumers’ health access.

Key insights from our panelists to this effect are summarized below. 

1. When it comes to youth SRH programming, young people’s insights take us in new directions. But in order to make space for young people to feel comfortable and confident to use their voice, project teams must take the time to balance the scales.

As PSI’s Van Dinh, shares: trust the process. Before delving into design – and at key moments along the way – pause to support “adults” as they learn to lean out, and young people as they learn to lean in. That way, all have a space at the decision-making table. A tip: having a clear work plan that the team can follow, and collaborate on, is key. 

For PSI Vietnam, that led to informative insights.

Young people shared that, despite standard stigma around sex pre-marriage, young people’s perspectives are changing: love is important and, in a break from traditional viewpoints, young people shared that “pre-marital sex is an important part of a relationship.” Moreover, Vietnamese adolescents and youth said they wanted access to SRH information and products but needed the assurance of confidentiality.  

Working alongside youth facilitators and employing PSI’s Empathy, Insight and Prototyping (EIP) model, the PSI Vietnam team learned that young people felt that they had to travel too far to access condoms and contraception, and that entry points to buying these products occurred primarily in public spaces.  

Based on these responses, the team identified digital platforms as a safe and trusted way to reach young people with SRH information and link them to care, during and beyond COVID-19. Herein lies the development of “Love Voyage,” a Facebook community powered by young people for young people to support 34.7K+ young people aged 18-24 to make informed life, love and health choices.

Photo credit: Emmanuel Attramah
2. To reach young people, start by discussing their goals, to demonstrate how SRH services – including safe abortion access – can help them achieve their life plans. In Ghana, conversations were best received when delivered by peer mentors.

Although abortion has been legal in Ghana with few restrictions for many years, stigma still abounds. Unsafe abortion remains the second leading cause of maternal mortality in Ghana, with teenage girls too often bearing the brunt of the consequences.

Working in partnership with young Ghanaians and their influencers, PPAG’s Joshua Akharigeya Atabinore and YLabs’ Jordan Levine dug into consumer insights to understand how they view SRH – and rights (SRHR), how to meet them where they are, and what matters most. They learned that the term “family planning” did not resonate with young people focused on achieving goals like finishing school or starting a business. Through the Stigma-Free Abortion Services (StigFAS) project, the team designed in response to this insight – piloting a three-pronged, youth-driven intervention to increase adolescent girls’ access to safe abortion services and support. This included:

      • Girl Boss – a fun, community-based event led by mentors that engages adolescent girls in conversation around their life goals as an entry point to discussing SRHR.  
      • Sister Support – an anonymous youth helpline staffed by friendly female peer counselors who provide SRHR advice and link young people to safe services. 
      • Safe Pass – a referral partnership with pharmacists that supports girls to get accurate information and safe abortion services.

During COVID-19, PPAG adapted their implementation strategy. Girl Boss hosted fewer large community-based events, opting for smaller sessions with social distancing protocols. When prominent community members were unable to speak on plenary sessions about their careers due to safety concerns, mentors stepped in to share personal stories of how SRHR allowed them to plan for the future they wanted. This allowed mentors to better connect with girls during subsequent one-on-one mentorship sessions.  

Since July 2020, 441 girls have attended StigFAS’s four Girl Boss events; 271 received one-on-one peer mentoring sessions. Of the 184 consumers aged 14-37 who called the Sister Support helpline, 46 calls focused on abortion, with most individuals hearing about the helpline through social media. Leveraging social media and toll free call-back options are critical, especially when engaging with young people outside of target areas in the community. The scope of Sister Support proved wider than anticipated, as the helpline received calls from both young women and men all over Ghana. 

After engaging with the Girl Boss events and/or the helpline, 284 adolescent girls and young women came to the PPAG clinic in Accra; 149 received contraceptive methods and 46 received safe abortion services.

Diagram of the female reproductive system
Photo credit: Benjamin Schilling
3. COVID-19 disrupted life as we know it, but insights from consumers and health systems ensured that continuity of services was adapted to life in a pandemic.

Amidst COVID-19, Pathfinder’s Dr. Tabinda Sarosh saw the red flags. As health actors shared, many lacked personal protective equipment (PPE), supply chains in and out of the country faced significant disruptions, and community-based interpersonal communication agents did not have the resources to safely engage consumers and meet their health targets. With the rising stigmas around COVID-19, clients began to avoid showing up at clinics to access SRH care.

But SRH needs do not pause for a pandemic. Previous experiences had also created awareness and need for vigilance towards gender based violence, particularly, domestic violence.  

Therefore, the Naya Qadam (NQ) team, worked quickly to identify where and how COVID-19 policies and practices could include, and safeguard, SRH care. This included: 

      • Supporting the public sector to adapt post-pregnancy family planning policies to a COVID-19 environment, including addressing supply chain challenges and PPE requirements.
      • Maintaining continuity of service delivery by bringing care closer to women. This includes community midwives leading virtual support groups for youth champions, and community-based midwives and female health workers who provide quick referrals and identify best resources for women and girls. These groups, known as “NQ Community Response Clusters” include digital supportive supervision for service provider training, and mentoring as providers pivoted to the pandemic. Supply chains for commodities were strengthened through support to district management and facilitation of inter-facility redistribution.
      • Using a four-level mass media and community-based social behavior change campaign to counter misperceptions around COVID and encourage health seeking behaviors. This included signposting, public announcements through community hubs, audio-visual narratives delivered using social media through mobile and online applications, cable and radio and an SMS campaign.
To view the original webinar, access the recording here.

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