Asking the important questions, listening to the communities served, and looking at the problem differently—before an intervention is designed—is a transformative approach to public health.
Pathfinder International’s (re)solve project uses this transformative approach to develop interventions that seek to reduce the unmet need for contraception among women and adolescent girls in low- and middle-income countries.
(re)solve is discovering what holds girls and women back from using contraceptives when they say they want to use a method and avoid unintended pregnancies. (re)solve deepens our understanding of the factors that influence women’s and girls’ family planning decisions.
Our team of cross-disciplinary experts and partners are creating innovative and transformative solutions—so that more girls and women can form intent, move to action, and use contraception to realize their goals.
The four-year project creates adaptable, scalable solutions based on context-specific learning from diverse populations in Bangladesh, Burkina Faso, and Ethiopia. These solutions will be used to inform the global family planning community about how we can work faster and smarter—helping women to make and act on their reproductive choices.
We are thrilled to have the opportunity to share our findings and experience from (re)solve’s work in Burkina Faso at the Francophone Summit for Social Change and Behavior, in Abidjan, during the Youth and Health panel, on February 26, from 16:15-17:15 GMT.
Identifying her unique needs
In Burkina, we first undertook a segmentation analysis. The analysis helped to identify six sub-groups of young girls with diverse needs, attitudes, and willingness to change behavior. We identified three segments of unmarried girls, and two of those segments–the Skeptic Youth and the Ambitious Risk Takers–had unique characteristics that informed design of our solutions.
Skeptic Youth tend to be in relationships, distrust the health system, perceive high levels of provider bias, and avoid going to health facilities. Ambitious Risk Takers tend to be in relationships, sexually active, prefer to use condoms over other methods, and have more agency. Ambitious Risk Takers also tend to believe that parents can play a role in their health decisions. Both groups want more information about side effects and have concerns about contraception causing infertility.
Understanding her environment and her own intention
While our segmentation analysis helped us go wide—by looking at a whole population and breaking it down into subgroups with unique needs and desires—our behavioral diagnosis helped us go deep. We used instruments and methods backed by behavioral science (behavioral psychology and economics) to understand what information and cues girls used from their environments to form an intention or take action. This could be the intention to avoid getting pregnant, or the intention to use contraception before going to a health facility (for any reason), or the intention to use contraception once at the health facility. These cues helped us to identify bottlenecks and contextual features, the influence of which can be addressed through our solutions.
Girls may be too optimistic and overlook potential consequences they are personally most likely to suffer.
Unmarried girls think that if they become pregnant their boyfriends will marry them more often than they do.
Girls overestimate their ability to use the rhythm method to avoid pregnancy.
They fear infertility, preventing many girls from considering the use of contraceptives.
They are especially afraid that a contraceptive implant will disappear in their bodies.
Girls feel that health facilities are too public and that their acquaintances will assume that they are having sex just because she was they are at the clinic.
We used our data and findings to design a game, a health passport, and clinic posters with girls and health providers. These solutions are currently being tested to collectively address the segmentation findings and the bottlenecks.
(re)solve is our opportunity to set aside our own biases and ‘expert lens’ and listen to what unmarried girls in Burkina want, what they fear, how they form relationships, how they navigate adolescence, and how they make decisions about their health and well-being. This is where the transformative solutions lie—in customizing family planning programs to the needs, motivations, and lived experiences of the women and girls we serve.
Zakari Congo is the monitoring and evaluation director with Pathfinder in Burkina Faso.