Adolescent pregnancy in Kenya is one of the leading causes of school and university dropout, with up to 13,000 adolescent girls dropping out of school every year as a result of unplanned pregnancies (1). While contraceptive awareness in Kenya has consistently improved - as reflected in the steady decline in total fertility rate (TFR) from 6.7 births per woman in 1989 to 3.9 births per woman in 2014 and an increase in contraceptive prevalence rate from 27% in 1989 to 58% in 2014 (2,3) - this change has affected adolescents and young women far less than any other group of women of reproductive age:
- 18% of women aged 15-19 are in their first pregnancy or already mothers (3)
- Adolescent birth rate is reported to be 96.3 births per 1000 women aged 15-19 (3), although some national reports hold it to be an even higher 121 births per 1000 women aged 15-19 (4).
In the past, youth in Kenya have been perceived to have few reproductive health needs as compared to the adult population, as engaging in sexual relations outside marriage is frowned upon. However, Kenya’s social environment is changing, and sexual relations outside marriage are now fairly common. Family planning (FP) services, although available, are often difficult to access in practice, especially for the young population: only 10.1% all 15-19 year old women and 46% of 20-24 year old women report using any contraceptive method (3). A lack of family planning has left many young women in the country’s institutions of higher learning at a high risk of dropping out of college due to unintended pregnancy.
To address this need, Jhpiego’s Brighter Future project partnered with the public Jomo Kenyatta University of Agriculture and Technology (JKUAT) in Nairobi, Kenya to design and test a new approach to increasing demand for contraception. Working with the University as a proof-of-concept design laboratory, the Brighter Future used innovative user-centered approaches to engage students in program design, understand their real needs and concerns, and create a life-planning program built on, and responsive to, breakthrough insights and student prototypes.
User-centered design methods are commonly used in contemporary design and, in particular, consumer-oriented products. This entails the iterative involvement of the end user in the design process by eliciting formal feedback on reference and prototype versions of the intervention and formative usability testing of the system. This design methodology plays a key role in achieving user engagement, thus improving the likelihood of the intervention’s effectiveness.
Hypothesis: Increasing self-efficacy and future-orientation through life planning will increase contraceptive uptake among university students in Kenya.
Methodology: multiple cross-sectional mixed methods study design
User centered design engaged the peer mentors in a unique way, building a sense of ownership an responsibility for the success of Funguo. With very minimal support from the Brighter Future program, they independently started campus Brighter Future clubs, engaged fellow students, organized events, distributed condoms, and introduced a WhatsApp online peer mentoring group.
This is not an exaggeration as I have been going through tough times recently but knowing that at the back of my mind I have a life plan has gotten me going.” – PF1
Students who developed a life plan using Brighter Future materials reported higher usage of contraception in comparison to their colleagues who did not have a life plan.
Within the study period, the number of students reporting using a modern contraceptive method increased by 20 percentage points.
Implications for Service Delivery
- Empowering users (in this situation, university students) to play a leading role in the program design can result in to a user-driven demand creation strategy, branding, and materials that is likely to resonate with users’ unique concerns and needs.
“What motivated me most to participate in the Brighter Future activities was the fact that they talked about the facts of life that no one else talks about. Not even your mum, best friend, talks about it and these are the people you expect to talk to you about this. “ – PF2
User Centered Design techniques and program activities employed by the Brighter Future program are inexpensive and easily replicable for other clinical or service delivery programs targeting adolescent and youth sexual and reproductive health.
- Free social media communication channels, such as WhatsApp, provide an attractive, relevant, and low-cost, forum for discussion, questions and clarification of myths and misconceptions between peer mentors, cascadees, and youth-positive health clinic staff.
- Rebranding FP from Family Planning to “Future Protection” and contextualizing the discussion of contraception as one part of a holistic life plan increased students’ motivation to engage with peer educators and use contraception.
“I used to say that I cannot use a contraceptive. Why should I and yet he can also use one? I can’t give myself to him and still use a contraceptive (translated from Kiswahili). After I was informed fully, I understood that I wanted to have fun while having sex and that it’s my life; what if he disappeared? If I was to go back then I would ask how that would benefit me.” – PF1
“I have seen change, my friends are more open to protect themselves first and not leaving the responsibility of protection to the guy.” – CF1
- Empowering students to debunk the most common myths and misperceptions about contraception amongst their peers, and providing attractive IEC materials to reinforce accurate information, and remove a key barrier to uptake.
“Of course you can’t tell people not to have sex but tell them to use protection and if it happens accidentally then there are other methods of preventing pregnancy.” - CF7
“Your parents taught you that you should not touch them and when you come to school it becomes it is common to use them. I thank God that Funguo came to open our eyes to this and tell us more.” – PF8