Evidence-based and co-created: Youth-adult partnership to reduce unmet need for contraception among married adolescent girls in rural Ethiopia Bethelhem Mulushoa November 2018 Hello all, My name is Bethelhem Mulushoa From PSI Ethiopia. I work on a program called Adolescent 360 I am very happy to stand in front of you to present my abstract today.

Youth-Adult Partnership Social Marketing Public Health User-Centered Design Developmental Neuroscience Socio-cultural Anthropology Youth-Adult Partnership “I think we young designers help to interpret the feelings of adolescents – our language, cultural aspects and our identity. Our involvement helps the project to be more clear -- on what the research means and to generate solutions.” Eyerusalem Demoz Young Designer in Tigray - A 360 is a program aiming to increase modern contraceptive demand and access among 15-19 adolescents. The program is implemented in 3 countries Ethiopia, Tanzania and Nigeria. It’s a 4 year project, funded by the Gates and CIFF. A360 program involved trans disciplinary experts on the process of designing a solution. And one of the experts who played a main role were the youth themselves. The program is designed by and with young people; putting the adolescent girl in the center. Youth Engagement- This project passed through a very intensive process to design a solution for adolescent contraception need. The youth were participating as an expert of their own issue. They have been engaged from the very beginning of the research up until implementation stage. They were able to help us understand the youth voice, were able to translate what the youth really mean when they say, in the analysis they pulled us from our adult biased mind and focused us on the actual meanings of the insights rather than what we adults think it meant. Youth engagement had its own hardship also, It was very difficult for PSI Ethiopia to get youth through the normal channels, we struggled to have the rural youth as a young designer because of language barrier which was necessary to link the youth with the other trans disciplinary team. The methodology(card sorting, story telling,……) we used when interacting with all the participants were very helpful also to understand how people really feel about issues raised on discussions than what they say or do. After we did our formative research we got very interesting insights that really contributed to where the program is now. We had to focus on the married adolescent girl’s insight as their was high unmet need for this group.

In It Together: Couples often desire joint decision-making in contraceptive use Uncertainty about changing times: Parents grapple with safeguarding their daughters amidst changing socio-economic and cultural contexts. Ascribed values of Child bearing: Proving fertility and having children is culturally revered. Changing Aspirations: Introduce them to contraceptives after having had at least one child. In It Together : We learnt that Couples desire to have joint decision making when it comes about their future goal and contraception, in most case they just struggle to understand the how as knowledge and agency as barrier. Changing Aspiration : We learnt that young married couples desire financial quality of life but parents/providers only introduce contraception after the couples have their first child. Uncertainty about changing times : We learnt here Parents do understand that resources are scarce but they struggle to understand the solution for balancing need for larger families and less resource to distribute. Ascribed value of Child bearing : Adolescent girl’s in rural Ethiopia life path is often decided for them. Furthermore, fertility is highly respected culturally, so girls are pressured to have children early in their marriage to secure their marriage and social status. 3

Smart Start is a co - created design solution for 15-19 yrs old married adolescent girls and people around the girls to enable them envision their future and position contraception as key asset to achieve their goal. If you want to here more of the how part, I have more tools to show you in my poster presentation.