1. Demystifying Counseling on Contraception Among Adolescent Girls in South Western Nigeria Through Individualized Counseling Increases Adoption
FIFI OGBONDEMINU1, JOY EDE1, ANTHONY EHON1, FATIMA MUHAMMED1, 
ALEXIS COPPOLA2, MELISSA HIGBIE2 
1.Society for Family Health/Nigeria,  2.Population Services International
FIG 1- Counseling vs Method uptake
1. BACKGROUND
In Nigeria, the National Demographic Health Survey (NDHS, 2013) shows that 43.5% of years old girls have had sex and that the median age of sexual debut is 16 years. This demonstrates a need for trained, youth-friendly providers that can provide individualized counselling on sexual and reproductive health (SRH) to adolescent girls. 
Qualitative research shows that many adults in Nigeria believe that teaching adolescent girls about contraception encourages promiscuity. This belief fuels girls’ fears around contraception and increases stigma for girls when they try to access SRH services. In many cases, adolescent girls are afraid of accessing contraception and providers do not want to serve girls. As a result, these services become inaccessible to them.
Adolescents 360 (A360) is a four-and-a-half-year long project, funded by BMGF and CIFF, that revolutionizes the way adolescent girls years access contraceptives. In Nigeria, 9ja Girls was designed using a transdisciplinary approach including public health, HCD, social marketing, development neuroscience, and social-cultural anthropology. The result is an integrated system that offers girls access to safe spaces where they can say what is on their minds, get answers to the questions they have from people they trust, receive skills training, and access SRH services. 
FIG 2- Counseling by Age Group
2. METHODS
FIG 3- Method Mix by Age Group
 9ja Girls was set up in 15 health facilities in Lagos, Ogun, and Oyo Sates in South Western Nigeria for a period of 10 months from September 2017 to June 2018.
Forty-two healthcare providers (nurses, midwives, and CHEWs) were selected and trained on youth-friendly health services and contraceptive technology and deployed to the sites to serve girls.
Adolescent girls can participate in 9ja through two entry points. The first entry point is the Life, Love, and Heath (LLH) class. During LLH, girls can ask questions anonymously, receive vocational skills and entrepreneurship training, and have access to an opt-out counseling session with a youth-friendly provider. LLH operates on Saturdays. The second entry point is walk-in counseling where a girl can come in any day of the week during working hours to attend a one-on-one counseling session with a youth-friendly provider. Both entry points offer an opportunity for girls to access private, individualized counseling.
Girls are referred to LLH and one-on-one counseling by trained mobilizers who provide information about the program and refer based on the girl's choice of entry.
FIG 4- Method Mix by State
3. RESULTS
4. CONCLUSION
Results and findings showed that introducing vocational skills to an adolescent program serves to bring in high numbers of adolescent girls, whereas private individualized counselling, where a girl can develop a trusted relationship with a trained counselor/ provider is more effective in meeting unmet contraceptives needs.
By integrating counseling into the skills classes for girls, many girls seamlessly transition from the class through counseling to services on their first visit at the spaces. 
 This streamlined path to method uptake creates operational efficiencies and provides a pathway to achieving impact at scale. Individualized counseling thus, demystifies contraceptive counseling making it normalized and removes the stigma associated with private sexual and reproductive health counseling.
Younger girls who may not be sexually active can develop a relationship with service providers and so likely to take a method when ready, whereas older girls prefer a walk- in approach and take up a method
 To ensure quality and consistency of counseling on this program, introduction of the “mystery client” model is an effective quality assurance approach. In addition, further investigations need to be carried out to understand what makes the girls to keep coming back to the LLH classes (or) to our walk-in clinics.
For all age groups, 62% of girls attending the program chose to receive SRH services through the walk-in counseling entry point
“I prefer one-on-one counseling as I can have private talk with a provider” -Unmarried Girl
Of the 62% of girls who came in through walk-in counseling, 78.4% received a contraceptive method
68% of total girls who came in through the LLH entry point were years old
Of the 7,375 girls who took up a method of contraception, 37.3% were aged years
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