FANOS — LIGHT TO YOUR PATH
CONSUMER-POWERED SEXUAL REPRODUCTIVE HEALTH PROGRAM FOR ADOLESCENT SCHOOL GIRLS.
BACKGROUND
PSI Ethiopia in partnership with young people and the Federal Ministry of Health, designed and implemented a project known as Adolescent 360 (A360). A360 is a project focused on increasing voluntary, modern contraceptive use among married girls between the ages of 15 and 19 in Ethiopia. It applied a human-centered design approach to develop a high-performing Adolescent Sexual Reproductive Health (ASRH) program called “Smart Start”.
It is with the design journey of A360, that the school-based Sexual Reproductive Health (SRH) program came to be. We gained insights that despite social stigma, many girls engage in sexual relationships. “Away from home, exposed to new cities, ideas, and of course boys” girls are at high risk for unwanted pregnancy and HIV, but they are scared to approach health providers for information and services. When girls do approach providers for services, they are often shamed and turned away.
THE PROBLEM
In Ethiopia, millions of young people are at high risk of Sexually Transmitted Infections (STIs), teenage pregnancy, and SRH problems. Women in Ethiopia begin sexual activity before men, the median age at first sex for women is 16.6 and for men is 17.1. 13% of adolescent women age 15–19 are already mothers or pregnant with their first child (EDHS, 2016). By age 19, about one-third of girls have a child or are pregnant and report that their last child was unintended or mistimed. We also know high rate of unintended pregnancy is also associated with the low utilization of family planning services by young people.
I wish I could know about methods before because I might save a girl I knew from abortion and related cases.” G03 age 17 secondary school student
“The one most responsible to tell kids about SRH things is family, then school. It’s good if they learn in school, then they’ll be careful”. 17 years old GirlG10 to G11
Some of the factors that increase the vulnerability of in-school adolescents for unwanted pregnancy, HIV, and STIs are the availability of the internet and pornographic sites, lack of awareness on HIV and other SRH issues, substance use (alcohol, Khat, Shisha, etc), sexual experimentation/risky sexual behavior, multiple and concurrent sexual partnerships, transactional and trans-generational sex. (FHAPCO, MOE June 2013)
ASRH IN-SCHOOL PROJECT
The project envisions an improvement in the reproductive health outcomes of 15–19 year-olds who are in-school in Mekele, Tigray by co-designing cultural and age-appropriate SRH Program.
THE DESIGN JOURNEY
SRH solutions for adolescent girls often fail because programs are designed for them, rather than with them. The in-school project has a multidisciplinary innovation team that places 15–19-year-old adolescents at the center of the design and development process. It proactively engages them through every phase. The program model that was developed co-created with adolescent girls and is based on evidence of their experiences and cultural context.
Initially, a study was conducted to get a deeper understanding of what adolescents believe and think beyond what they say and do. We learned that “young people struggle with competing desires of making their parents proud and seeking freedom to make their own decision” and “talking about {SRH} with young people is so uncomfortable that neither parents nor teachers will take the responsibility. Thus girls turn to unreliable source”. These insights inspired challenges and opportunities to develop and test multiple prototypes/program models. After going through various prototypes, we landed at an incredible model called Fanos that marries girls' desire to plan their future, SRH counseling followed by on-the-spot services provision.
“I like the part where I started building my dream and the bodyguard card“ — 15 Years old Girl
“I am happy to learn that obstacles may happen in my life and that I have to be ready by now.” — 17 Years old Girl
Through counseling, our program offers girls important information on the importance of proactively planning for their future, SRH, and provides them with choices on services that meet their needs. With this information, adolescent girls can make their own decision that fits their needs. As light eliminates darkness and gives us the vision to see the beauty around us — our brand serves as the light that clearly shows a girl’s path and dreams in an interactive counseling exercise. A light can be seen from afar and helps you find what you have lost and when girls have this light in their hands, they are in a better position to see potential obstacles they may face, and they can make decisions that fit them best.
INTERACTIVE COUNSELLING
Girls interact with a PSI/E female counselor at the Family Guidance Association of Ethiopia (FGAE) youth center and build their life plans on a timeline. The dream-building part of the counseling session is interactive which helps them open up. Girls get shocked when they realize their dreams might get shifted because of choices they make around sexual relations. This pivotal moment is used to talk about the importance of proactive planning on SRH. With the Fanos counseling model, the project has reached 607 girls with SRH counseling of which 99 girls received services (16% conversion rate).
