Cracking the Code

By Manya Dotson, Adolescents 360 Project Director

AN AUDACIOUS UNDERTAKING

Adolescents 360 (A360) has been a courageous and visionary investment—the sort of audacious venture that only philanthropists can stomach. I mean, who funds a project that basically says: “We want a lot of money to create dramatic change in three countries, but we won’t know what the money will be used for until we’ve spent a year and a half doing research and development using a process that we think could be cool, but are figuring out as we go along?” Bill and Melinda Gates, and Chris Hohn, that’s who. And who leads such a venture? A bold organization who has always been relentlessly committed to consumers and results: PSI.

Two years ago, I came back to PSI to lead A360 on behalf of these visionaries, because I was intrigued, and personally wanted to build on the evidence and “crack the code.” Contraceptive services for young people are a quagmire just about everywhere (including Montgomery County, Maryland, where my teen daughters are in school!). I look at the problem of adolescent access to contraceptives, and see a complex web of fear and shame, fraught interpersonal interactions, logistical headaches, complex cultural dynamics, economic and power dynamics, and dysfunctional systems—all perpetuated by well-intentioned people doing the best they can in really tough circumstances. 

In spite of some gains, I wasn’t convinced that the tools we’ve used to chip away at the edges of this issue were working well enough. A360 was a risky venture, but I thought it just might be different and audacious enough to get dramatically different results.

Spoiler alert: it was, and it has. 

DRAMATIC RESULTS

 A360 records a high method mix, and strong uptake of long-acting methods. *Data, from June '17-June '18, pending validation.

A360 records a high method mix, and strong uptake of long-acting methods. *Data, from June '17-June '18, pending validation.

In the last few months, A360 activities have rapidly scaled across vastly different contexts of urban and peri-urban Tanzania, rural Ethiopia and Southern and Northern Nigeria. And through it, we’ve seen, and keep recording dramatic results: highly resonant messages that girls and their communities are making go viral; strong method mix that proves that long-acting methods are equally resonant for youth as they are for women of all reproductive age; and more than 41,000 girls aged of 15-19—married and unmarried—not currently using a method adopting a modern method of contraception. Because A360’s activities efficiently bring together effective demand generation and compassionate service supply into a highly streamlined interaction, the cost is competitive and the investment case compelling. 

Project-Wide Total Cumulative Adopters Per Quarter I Actual Achievement (Green) v. Goal (Red) 

 A360’s rapid scale across our three intervention countries is reaching more girls, more effectively and more efficiently. In Q2 of 2018, we aimed to reach 25,564 adopters. But by June 2018, we’ve served more than 41,461 girls with modern contraception—a 62% increase from the bar initially set.  *Data, from June '17-June '18, pending validation 

A360’s rapid scale across our three intervention countries is reaching more girls, more effectively and more efficiently. In Q2 of 2018, we aimed to reach 25,564 adopters. But by June 2018, we’ve served more than 41,461 girls with modern contraception—a 62% increase from the bar initially set.

*Data, from June '17-June '18, pending validation 

CRACKING THE CODE: SECRETS OF SUCCESS

Sometimes, in clinical drug trials it becomes obvious that something is working so well it becomes unethical to not offer it to everyone—even the folks in the control group. While the data is pouring in, and while A360’s external evaluation will provide the final word, the programmatic data we have is now robust and reliable enough to share. A360 will be all over the International Conference of Family Planning sharing, with radical transparency and urgency, our evidence-based secrets of success.

 How might you reframe youth-focused contraceptive activities around a different narrative?

How might you reframe youth-focused contraceptive activities around a different narrative?

At risk of grotesquely oversimplifying, the “secret” to A360’s success can be summarized in three things our synergistic activity systems do differently—and what you could start trying right now:

  1. #GirlWithaPlan: A360 has reframed the choice to use contraceptives as a personal commitment to being a “girl with a plan.” Contraceptives are the FIRST STEP to making that plan a reality. The choice to use a contraceptive is an act of agency (not something functional you use when you become sexually active to protect your health and education). Our activities aren’t about contraceptives, they are about agency, making plans and powering girls to get what they want amidst complex times. Turns out, moms, husbands, and community leaders can get behind this—because it’s not about sex.
  2. #FertilityFirst: All interactions positively address girls’ beliefs that infertility would be more tragic than having a baby too soon. We get that she wants to be a mom someday. We reassure her that using contraceptives now will make that even better.
  3. #HereAndNow: Through engaging and inspiring demand generation coupled with on site, opt-out private conversations with providers, A360 makes it friction-free to immediately see a compassionate provider. A360 providers start the counseling by getting to know you and your dreams (which builds empathy and intrinsic motivation in providers). They assuage your fertility fears, and help you choose a method that fits your needs for discretion and ease, as well as your tolerance for changes to your period.

A BREAKTHROUGH PROCESS

Is human centered design really something new? Is empathy essential or a fad? Can we trust intuition? What is an insight anyway? Who has the time or resources for extended prototyping and concept test-driving? Does an iterative process ignore the evidence base? Are we rediscovering and reinventing the wheel? Is design the emperor’s new clothes?

The hive is abuzz.  

There’s heavy debate among us technocrats about the “right way” to get to effective solutions—and, frankly, a lot of defensiveness and self-promotion underpinning the noise.

Personally, I’m agnostic. I just want something that works, and this is working. Not because it’s fun and cool and inspiring (though it’s those things too), but because the data says it is.

A360’s process has been rigorous. It was structured around the mindset, toolset, and skillset of the world of design, AND informed by developmental scientists, a cultural anthropologist, public health specialists, international ethics review boards and—most importantly—girls themselves. We will be publishing more on our process in the year ahead. The benefit of hindsight allows us to guide you—and help you avoid some of our pitfalls and fails.

Stay tuned.

DARING GREATLY

Leading A360 has been a challenging, humbling, and fascinating experiment, and experience. I have witnessed our transdisciplinary approach target and segment smartly, unlock deeper understanding of the evidence, and connect the dots differently. I have witnessed program teams transformed into deeply committed advocates who are adaptable and responsive to data and girls’ voice. I have been part of “ah ha!” moments that both surprised and made perfect sense. I have supported the emergence of systems of activities that make girls feel seen, heard, and understood. They work for a wide variety of girls at different places in their developmental journey, and they work with the adolescent brain. The data tells us we are reaching more adolescent girls, more efficiently and effectively, than anything our field has seen.

It may have been risky to lead such an audacious undertaking… but the reward…. oh, the reward.

Maybe I’m not so agnostic anymore.

Emma BeckComment