Continuing Users Served Adoption Conversion Rates A Girl with a Plan! Reimagining Contraceptive Services with Adolescent Girls in Ethiopia, Nigeria and Tanzania Amy Uccello, Sr. AYSRH Technical Advisor, Manya Dotson, Melissa Higbie, Metsehate, Shahada, Fatima  1. BACKGROUND FIG. 1 –CONTRACEPTIVE ADOPTION RATES  (June 2017-September 2018) At A360’s inception, both modern contraceptive prevalence and unmet need for contraception among girls aged 15-19 remained relatively low in Ethiopia (32%/21%)1, Nigeria (5%/6%), and Tanzania (9%/11%) suggesting that many sexually active girls were either not seeking contraception, or may have desired fertility. AYSRH investments have commonly segmented young people according to demographics (married/unmarried, rural/urban, etc.) and behaviors (sexually active or not) with limited ability to include youth voice in project design. In doing so, many promising interventions have been created but most require high dosage (multiple sessions touchpoints) and high costs per adopter to achieve contraceptive uptake. Adolescents 360 (A360) is a four-and-a-half year project, funded by BMGF and CIFF, that revolutionizes the way adolescent girls age 15-19 access contraceptives. In Ethiopia, Nigeria and Tanzania three distinct programs were designed using a transdisciplinary approach including public health & social marketing, HCD, development neuroscience, social-cultural anthropology, and meaningful youth engagement. Country Program Adopters  Continuing Users Served Adoption Conversion Rates LARC Adopters Ethiopia Smart Start 8,975 4,198 51% 32,608 Nigeria 9ja Girls 13,918 949 42% 2,145 Nigeria MMA 1,864 41 69% 518 Tanzania Kuwa Mjanja 50,913 2,436 62% TOTAL 73,806 7,583 56% 67,879 2. METHODS A360 hypothesized that a girl-centered approach would lead to highly effective, low cost programs requiring fewer inputs and fostering rapid contraceptive adoption. A360 put youth voices and developmental, social, emotional and physical trajectories at the center of research and activity design Across all three countries, formative research was coupled with youth-powered design where young designers had equal decision-making, refined data analysis, and co-designed each the programs that would affect their lives 3. RESULTS 4. CONCLUSION Understand Girls: Insight - contraception is irrelevant, harmful, and at odds with girls’ identity and dreams of motherhood; Result – tailoring interventions to girls’ developmental & social trajectories and appreciating her attainable joys meant de-medicalizing contraception using our Counseling for Choice approach leading with return to fertility, side effects & method privacy all with an aim to protect fertility Identify with Girls: Insight - girls’ know their own goals & desires best and prioritize financial & social stability; Result - introduce contraception as relevant, valuable and a tool in service of her SELF-DEFINED dreams by pairing with financial planning & entrepreneurship skills, regardless of sexual activity to create a Girl with a Plan! Serve Girls: Insight - girls defined safe spaces differently & felt distant from the health sector; Result - services were offered when & how girls wanted them and youth-powered approaches cultivated empathy when girls were hired to co-design, co-implement and co-monitor interventions resulting in a diversity of influencers engaged, varying service delivery models offered (e.g. pop ups, CBD, public/private), providers validated as youth-friendly by girls, and reduced stigma using opt-out counseling all leading to contraceptive adoption in a single on-the-spot moment When youth-powered design ensures contraception is relevant to girls’ lives, aligned with their aspirations of motherhood, and supportive of their near term social & emotional needs and when on-the-spot youth-friendly services are offered in an opt-out moment to reduce stigma, AYSRH programs can achieve rapid, breakthrough results in high adoption rates, rapid service uptake and strong method mix. When girls feel heard, respected and valued as equal partners in creating and delivering the interventions they need most programs can adapt to girls self-defined dreams and to local context, rapidly catalyzing behavior change in a way that is more cost effective to implement than more intensive multi-exposure interventions Reframing contraceptives as the first step to achieving a near term goal—whether or not a girl identifies as sexually active—and contextualizing the discussion of contraception as the first step to achieving that immediate goal, increases girls’ motivation to take up a method.   1 data represents married girls 15-19; all other data represents unmarried girls 15-19 yrs A360LearningHub.org auccello@psi.org Adolescents 360 @Adolescents360

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