A360 has invested heavily in designing and delivering a unique experience for girls, from initial exposure to service provision and follow up. As A360 entered its final year, staff sought further evidence on how girls were experiencing the interventions, and the factors affecting whether girls continued contraception in the months following adoption.
In summer 2019, Itad conducted Participatory Action Research case studies in Nigeria and Ethiopia to explore these issues, visiting two kebeles in two regions of Ethiopia (Oromia and Amhara) where the A360 ‘Smart Start’ intervention was implemented, and two facilities in Ogun state, Nigeria, where the A360 ‘9ja Girls’ intervention was taking place.
We found that girls’ experiences of Smart Start and 9ja Girls were broadly in line with the intended User Journeys. The aspirational components of the models helped bring girls into the program and made contraception feel relevant to them, and contraceptive counselling appeared to be generally high quality, with girls reporting feeling safe and comfortable during counselling sessions. Investigating the reasons for continuation and discontinuation uncovered an interplay of factors – in particular, girls’ experience of side effects (which often tied into fears and misconceptions about contraception), and pressure or discouragement from husbands, family or the wider community to stop using contraception.
While proactive follow up from service providers helped some girls to manage side effects and continue using contraception, in many cases, this was not enough to overcome deep-rooted fears about changes to menstrual cycles, misconceptions about alternative methods, or opposition from spouses, family or communities.
This report was written in conjunction with Serawit Omer, Shimljash Braha, Morenike Ukpong and Oluwatoyin Alaba.