By: Mayra Flores, Associate Project Manager for Latin America and the Caribbean, PSI, and Carlos Vargas, Teen Moms Adelante Project Coordinator, PASMO
Picture this: in Nicaragua, one in four girls is about to give or has already given birth.
The health, financial and educational consequences of early or unintended pregnancy run deep—and for countries plagued by skyrocketing teen pregnancy rates, the impetus to deliver reproductive health services to adolescents remains paramount. Yet for young people, the availability of services alone is not enough to drive behavior change. Motivating adolescents to seek out care requires that we, the global health community, introduce youth-friendly environments that frame sexual and reproductive care as relevant and attainable.
We, PSI alongside our network member PASMO, embarked on a three-month mission in Nicaragua’s capital city to understand what would prompt Nicaraguan adolescents to turn to reproductive health services. To do so, we stepped into adolescents’ worlds to design a solution through the eyes of the population we sought to serve.
[supsystic-gallery id=1]
Transforming the Red Segura Clinic
Sourcing from the insight gathering phase of a Human Centered Design (HCD) approach, we partnered alongside adolescents aged 15-19 living in Nicaragua’s capital city of Managua to understand young people’s unique sexual and reproductive health (SRH) needs and experiences. These observations—drawn from a combination of a photo project led by our youth participants in March 2017 and in follow up conversations with young people and their influencers—delivered a baseline dataset from which we, together, could reimagine the way that the Red Segura Clinic, a reproductive health center, could cater specifically to adolescents.
Pulling from traditional adolescent health literature, we initially designed Red Segura as a bright, colorful facility in an attempt to attract young people. But with only a handful of young clients our first month in operation, we understood: décor alone would not be enough. Reaching 200 Nicaraguan youth with AYSRH services by December 2017 would require that we respond to the contextual forces fueling Nicaraguan adolescent’s life choices and health journey.
In the more than a year since we applied adolescent insights to Red Segura’s revamped youth-friendly operations, we’ve recorded a 500 percent increase in monthly clients, serving an average of 30 adolescents per month. From January 2017 to April 2018, 168 adolescents have adopted a contraceptive method, of which 85 percent of the girls are using long-acting reversible contraceptives (70 percent chose implants and 15 percent chose IUDs), while only 15 percent are using short term methods. Our new mode of delivery is yielding change—and fast.
[supsystic-gallery id=’2′]
A Snapshot of Adolescents’ Lives
Handing our three young participants a camera, we asked that they document the people and places that influenced their reproductive health decisions. The photos gave us a glimpse into the areas adolescents frequent outside of school hours, and who—family, friends, a partner—that time was spent with. We had a peek into the cultural values (like the central role families play in adolescents’ lives), social norms (like the uniforms worn to school) and economic realities (like the public bus taken as the main mode of transport) that shaped their day-to-day. These snapshots, followed by in-depth, one-on-one conversations, presented us with a rich look into the varied confounders informing teen’s world views, and the mindset shift we’d have to tap into as we sought to make Red Segura appeal to our target population.
Our interviews with our three photo participants, in addition to 15 other pregnant and non-pregnant teens, revealed that there remained an overriding desire for clinics that made adolescents feel safe, seen and respected. Young males and females wanted care delivered by providers who were young and highly-qualified, and who would respect adolescents’ time without scolding or judging them for seeking pregnancy care or contraceptive counseling. Adolescents told us that they prioritized a center that safeguarded privacy, provided services online and in-person, veered from the stale clinical environment associated with hospitals and located in an area that they could access by public transport and without parents knowing.
Young males expressed obstacles they faced in accessing family planning services and information (other than using a condom) given outreach typically targeted women. They too wanted to learn how they and their partners could prevent, or plan for another pregnancy.
The photos delivered a tangible visual to meaningfully engage our adolescent partners, all while challenging our own assumptions about our participants’ lives and unique needs. Making sense of what young people in Nicaragua wanted out of a clinic required a new way of problem solving. We had to probe further, dig deeper to truly get a sense for what youth like and even more importantly: what would make them feel most comfortable to access public, reproductive care.
Sourcing from Insights
Based on what young people told us, we began testing different furniture layouts in communal spaces while providing teens with varying options of where to wait for appointments. Interestingly, adolescents largely chose our balcony waiting space as it allowed for more privacy than our reception waiting area, located directly next to our check in desk. We trained clinic staff—everyone, from the front desk receptionist to the providers themselves—to engage in a youth-friendly manner, holding space that respects our young people’s rights as individuals, and privacy as clients. Our services reach adolescents not only within our physical clinic, but online as well through Q&A videos on Facebook and private counseling sessions via WhatsApp.
In Nicaragua and beyond, establishing youth friendly services requires a full grasp of the societal, cultural and economic factors that inform the life and health decisions of the teens we serve. It mandates reevaluating clinics that have previously missed the mark in reaching young people—and assess how the entire public health community can program differently to fill those gaps. Our photo project enabled us to get to the root of young people’s desire for privacy and accessibility. As a result, we’re delivering today SRH services to adolescents where they are and how they want.
The Red Segura Clinic proves that we can spark new ways of solving pressing health matters when we step into the world of the young people we serve to understand their needs first hand. In our case, it simply meant investing in rolls of film and disposable cameras as we worked alongside young people to design and deliver through the eyes of Nicaraguan youth.
