She Leads.

By Seun (Oluwaseun) Taylor, A360 Young Designer, Society for Family Health (SFH) Nigeria

“Your symptoms?” the doctor asked. “Nausea and a headache,” I said. He looked me up and down. “Wayward girl,” he muttered.

Sure, my symptoms matched those of early pregnancy. And yes, Nigerian culture stigmatizes teen pregnancies. But pregnant, I was not.

“Malaria,” the doctor confirmed, my test results in hand.

It was too late; his initial response had tainted my trust in him and, by extension, the health system writ large. How could I show up with questions, when I feared being judged? How could I be sure that I’d receive the medical support I needed, no matter the medical issue in question?

Things needed to change. Now, four years later, I’m helping to disrupt the status quo through my work as a Young Designer for A360’s 9ja Girls, PSI’s flagship adolescent sexual and reproductive health (ASRH) program in southern Nigeria.

Led by PSI and implemented by SFH Nigeria, 9ja Girls works with and for girls and the health system to deliver scalable girl-centered contraceptive programs across public health facilities. We Young Designers gather and analyze girls’ insights to understand how we can support girls to reimagine how they view, value and see themselves as part of a health system that serves them.

I start by asking girls about their dreams for their lives and the barriers standing in their way.

• “I want to be a mother,” many say. “But I fear that contraception could hurt my fertility.”
• “My body is changing. I have questions but no safe space nor person to turn to.”
• “I tried going to the clinic for SRH services. But the provider called me a ‘bad girl’ for asking about contraception. I felt judged.”
• “I want to be independent and take control of my life, but I don’t know how.”

These insights delivered the base by which we – a team of young people and “adults” together –designed and continue to adapt 9ja Girls’ combined vocational and life skills training and ASRH services for unmarried girls aged 15-19.

Girls’ Insights Set the Foundation

Our Life, Love and Health (LLH) programming and contraceptive counseling starts the conversation with girls’ goals to help girls and their families see the relevance of contraception. We train adolescent-friendly providers and work alongside community leaders to create an enabling environment for girls’ contraceptive use. And we host all programming in girls-only spaces in public health clinics to make girls feel safe, seen and heard.

During the COVID lockdown, girls told us they worried they’d get the virus if they went to the clinic. So we moved our LLH sessions and contraceptive counseling to WhatsApp. We now offer virtual trainings for mobilizers and providers on how to use social media to reach girls with information on the pandemic. We developed a Facebook page that reaches 11,000+ girls with pertinent ASRH information.

The evidence shows that girls are most likely to discontinue a contraceptive method while still in need. COVID has challenged us to adapt – how could we extend the trust built within clinics, beyond? We asked girls. Of those with mobile access, they told us that, with their consent, we could share their phone numbers with 9ja Girls’ providers to receive one-on-one counseling by phone.

This insight-driven, consumer-powered work catalyzes impact. In a typical week, 9ja Girls reaches 2,000+ girls with SRH information, of which 1,500 girls will voluntarily adopt contraception. 2 in 5 girls choose long-acting methods.

Learning to Unlearn

I’ve learned that when #SheLeads, adults can learn to not jump to a solution thinking that they know best.

When girls share that they feel judged at the clinic, I’ve seen providers respond empathetically, recalling their own struggles as young people making SRH choices. I’ve seen how they’ve applied that compassion to counseling girls. I’ve seen religious leaders, parents and adults transform from skeptics to ASRH champions. And I’ve seen the government progressively commit to making ASRH a priority, with youth insights at the fore.

As we gather for #NotWithoutFP, I challenge you to consider:

• How can #SheLead so that we – young people like me and adults together – design, deliver and scale consumer-powered ASRH programs that build from and continually respond to health consumers’ feedback?
• How can #SheLead so together, we create a health system responsive to her holistic needs, within and beyond her reproductive health?
• How can #SheLead so we can channel innovations, from contraceptive self-injections to digital ASRH services, to help her be an active participant in her health choices?

19-year-old me had turned up at the hospital with symptoms of malaria, only to engage with a doctor who saw stigma ahead of solutions. Then, I never knew things could be different. But now, with girls like me steering ship, I feel good about where we are going.