Impact Magazine No. 24 by Impact Magazine

Cutting edge global health coverage from

In partnership with ICFP

No. 24

MAGA ZINE CONTRIBUTIONS FROM 10 Youth Editors! First Lady of Haiti Martine MoĂ?se Dr. Natalia Kanem Susan Packard Orr Dr. Jose "Oying" Rimon II Dr. Diane Gashumba

Tuesday Night Live @ ICFP! Come November 13 for the

Evening Among the Stars Celebrate the stars of the modern contraception movement—you! Join the ICFP organizing committee and PSI for a paparazzi-filled red carpet event to honor Bill Gates, Sr. with the Lifetime Achievement award and present the Future is Female award to Maverick Collective Member Jess Jacobs, an actress, speaker, advocate and cofounder of Invisible Pictures, a women-led production company. • 5:30 p.m • Bites and Mocktails

and stay for

The Method Remix: Not Your Mama's After-Party! Join Rwandan DJ and YouTube Sensation Makeda Mahadeo in a PSI and HCD Exchange-sponsored dance party and auditorium-wide interactive game! Don’t miss the Youth Poetry Jam to introduce the Commitment to Action: Ethics in Youth-Powered Program Design. • 7 p.m • Buffet and Open Bar Location: Convention Center Auditorium

T H E H OT T E S T P! T IC K E T S AT IC F

EDITOR’S LETTER

Who's While the International Conference on Family Planning (ICFP) focuses on the demographic dividend, at Impact magazine we decided it was time to stop speaking about young people and instead hear directly from them. This issue, jointly produced by PSI and the ICFP organizing committee, sees a youth takeover with no fewer than 10 youth editors, including PSI’er Emma Beck, a 20-something who scouted, found, hired and managed writers, photographers and designers from around the world all under the age of 29. At ICFP, PSI will be talking a lot about the unlikely teams needed to create Youth-Powered healthcare—who a young person wants #InMySquad. Read here for this issue’s Editor’s Note from Emma, the young person who put together Impact’s Youth-Powered squad. — Marshall Stowell, Editor-in-Chief, Impact magazine 2018 witnessed my generation’s power to drive progress forward. From the millions of Indian youth who formed a human chain in resistance against child marriage, to the U.S. Parkland students whose activism in the face of gun violence spurred the March for Our Lives, we’ve seen that youth can ignite momentum that reverberates around the world. We, young people, are doers and explorers. We disrupt the status quo with passion and dynamism, and we do it with an unbridled curiosity and willingness to collaborate across boundaries until change is achieved. Our voices matter. And the proof is in this magazine. Past Impact issues have featured the leaders among us revolutionizing the future of youth-powered healthcare. But for the magazine’s ICFP edition, it wasn’t enough to be written about. The time was now to pass us the editorial reins. So I posted a call for Youth Editors. In two weeks, 70 applications poured into my inbox. When you give us an opportunity to be heard, we show up: here and ready to serve. I am humbled to have partnered with nine other Youth Editors who unleashed their visions to reimagine this issue. Our Youth Photographer Tanaka Chirombo embedded himself in a Malawian village to show us the realities rural adolescents face in making health decisions. Our Youth Graphic Designer Haniffa Arista Putri, a young leader from Indonesia, breathed fresh energy into the magazine’s creative elements. And Christianah Aborisade and Chidimma Maduabum from Nigeria elevated the voices of four of ICFP’s youth video contest winners. Victoria Milanzi from Malawi and Esther Nantambi from Uganda interviewed public health trailblazers redfining how to meaningfully partner with young people. Surabhi Dogra from India outlined questions that adults, from donors to Ministry of Health representatives, can ask young leaders to grasp the ingenuity young people have to offer. And PSI’s President and CEO Karl Hofmann stepped aside as ICFP Youth Pre-Conference chairs Jillian Gedeon from London and Dr. Catherine Baye-Easton from the U.S. took over his final note. As a 27-year-old, I am at the tail-end of my youth years. But as I look to our Youth Editors, I’m excited by the passion I see in the young people driving us forward. Their energy is palpable, their perspectives invigorating. With this issue, step back into the vigor of adolescence. Through our voices, relive your early challenges of making reproductive health choices. And take from this Impact the magic we young people bring when adults make room for us to take the lead. —Emma Beck, Youth Editor for Impact magazine Issue No. 24

EMMA BECK Associate Communications Manager, PSI @emmashoshanna

MARSHALL STOWELL Vice President External Relations and Communications, PSI @MarshallPSI

TABLE OF CONTENTS

Meet the Youth Editors

Around PSI

Youth-Powered Radio Hour by Emma Beck

7 Questions with Dr. Natalia Kanem

A Commitment to Equity and access by Dr. Diane Gashumba

Our Adolescents and Youth Deserve a Better Future by Martine MoĂ?se

Consumer Powered Healthcare for Her: What Menstrual Health Can Teach Us by Cristina Ljungberg and Maria Carmen Punzi

I M P A C T M A G A Z I N E N O . 24

WHAT'S INSIDE?

Bringing Pleasure Back in the Conversation by Lindsay van Clief

The Voices Behind the Videos by Chidimma Maduabum and Christianah Aborisade

Let's Get Digital by Andrea Novella and Alejandra Cabrera

Reaching Teens With Technology by Marie Fedra Baptiste, Meredith Pierce, Ben Bellows, Dr. Rebecca Hope and Faridah Luyiga

Stepping Back Into Adolescence by Emma Beck

The Ethics of Youth-Centered Innovation by Rena Greifinger, Esther Nantambi and Amy Uccello

Paving Pathways to Contraceptive Self-Injection by Dr. Fannie Kachale

Young People Know What is Right for Them by Susan Packard Orr

The Quiet Revolution That's Bringing Healthcare Closer To You by Ann Morris

A Day In The Life by Tanaka Chirombo

Youth Ambassadors: Tell All by Surabhi Dogra

A Smart Start To Contraceptive Access by Emma Beck

Igniting Youth Access to Contraceptives by Alia Mckee and Sandy Garcon

Investing in Family Planning for a Lifetime of Returns by Dr. Jose G. Rimon II and Dr. J.M. Ian Salas

Change Starts with Choice: A Global Approach to Reproductive Health by Victoria Milanzi and Jess Jacobs

Disrupting the Norm by Jillian Gedeon and Dr. Catherine Baye-Easton

PSI NETWORK

Impact Team Editor In Chief

Art Director

Managing Editors

Graphic Designer

Marshall Stowell VP, External Relations & Communications MStowell@psi.org

Karen Sommer Shalett Deputy Director, External Relations & Communications KShalett@psi.org Sandy GarĂ§on Manager, External Relations & Communications SGarcon@psi.org Emma Beck Associate Communications Manager EBeck@psi.org ONLINE

psi.org @psiimpact @psiimpact facebook.com/PSIHealthyLives youtube.com/HealthyBehaviors

ADDRESS

Population Services International 1120 19th Street NW Suite 600 Washington, DC 20036 www.psi.org Population Services International (PSI) is a global non-profit operating in more than 50 countries worldwide, with programs in modern contraception and reproductive health, malaria, water and saintation, HIV, and non-communicable diseases. As PSI looks to the future, the organization will reimagine healthcare to put the consumer at the center and whenever possible bring care to the front door.

Dominique Brown Creative Manager, External Relations & Communications DBrown@psi.org

Cassie Kussy Associate Graphic Designer, External Relations & Communications CKussy@psi.org Contributors

Christianah Aborisade Marie Fedra Baptiste Dr. Catherine Baye-Easton Ben Bellows Alejandra Cabrera Nikki Charman Tanaka Chirombo Maria Dieter Surabhi Dogra Marie Fedra Baptiste Dr. Diane Gashumba Jillian Gedeon Rena Greifinger Elisabeth Harris Dr. Rebecca Hope Lizzie Hudson Jess Jacobs Dr. Fannie Kachale Dr. Natalia Kanem Staci Leuschner

Cristina Ljungberg Faridah Luyiga Chidimma Maduabum Alia McKee Victoria Milanzi Martine MoĂŻse Ann Morris Esther Nantambi Andrea Novella Susan Packard Orr Meredith Pierce Maria Carmen Punzi Haniffa Arista Putri Dr. Jose G. Rimon II Dr. J.M. Ian Salas Megan Shea Amy Uccello Lindsay van Clief Kellie Wellborn

COVER ART CREDIT: CASSIE KUSSY

AROUND PSI

Across countries and health markets, public health’s modus operandi is to increasingly give voice to the young people we serve. Together, we’re making room at the table for adolescents and youth to contribute, not just as clients, but as equal partners with lived experiences that inform the health solutions we’re designing together. This is a youth-powered prescription for a public health revolution. In Impact magazine, we’ve shared stories about young trailblazers at the helm of transforming the future of youth-powered healthcare. Now, we’re taking it one step further: handing the editorial reins to the next generation. Impact’s nine Youth Editors, selected from a call for submissions that drew some 70 applications worldwide, represent a cohort of talented young leaders. They have shaped the vision for a captivating issue of Impact centered on what it takes to reimagine how adolescents and youth access modern contraception. In that spirit, our Youth Editors share insight into learning about and decision-making related to their reproductive health.

1. Christianah Aborisade Youth Interviewer 23, Adolescents 360 Young Designer, SFH Nigeria, Ibadan, Nigeria “I believed in abstinence when I was younger. I wish I had had more knowledge about modern contraceptives, so I could have helped my peers avoid becoming victims of unintended pregnancies, losing their lives as a result of an unsafe abortion or not being able to complete their education.”

FUN FACT Christianah is driven by making a positive impact.

2. Jillian Gedeon Youth Writer 27, Executive Director, International Youth Alliance for Family Planning, London, England “We were moving houses on the day that I got my first period. I recall telling my mom who, unlike me, was overly excited. In line with Middle-Eastern customs, she told my dad, my sister, called her sisters, my cousins, heck, I wouldn't be surprised if she told the new neighbors. She was too excited for my liking!”

FUN FACT Jillian never leaves the house without snacks and a water bottle.

3. Surabhi Dogra Youth Interviewer 24, Manager, Public Health Foundation of India Noida, Uttar Pradesh, India “As teens, I wish we’d learned about the changes in our bodies beyond the rigid and limited information available in our biology books. We should have talked about how to protect ourselves from sexual violence and adolescent pregnancy.”

FUN FACT Surabhi enjoys using creative art forms like theater and photography to explore the nuances of health systems.

J_Ged (Photo credit: supplied by subjects) 4

I M P A C T M A G A Z I N E N O . 24

SurabhiDogra

4. Chidimma Maduabum

9. Esther Nantambi

Youth Interviewer

24, Adolescents 360 Project Assistant, SFH Nigeria Abuja, Nigeria

24, Radio Presenter and Communications Assistant, Youth Equality Center, Kampala, Uganda

“I turn to pharmacists and other healthcare professionals for my reproductive health decisions.”

“Growing up, my mother would say things like: ‘If you have sex with boys, you are going to disappoint God and get HIV/AIDS!’ Our neighbors would say she was ruining our innocence by using words like ‘sex.’ But we turned out just fine.”

FUN FACT Chidimma hates being late. “It stresses me out!”

FUN FACT Esther’s life goal is to create a youth mentorship system to

5. Haniffa Arista Putri

support the next generation in making healthy life decisions.

Youth Graphic Designer 22, Staff, Indonesian Planned Parenthood Association, Denpasar, Bali “I wish someone had told me the importance of sex education when I was younger. Nobody taught me, so I taught myself by reading books.”

FUN FACT When not advancing women's issues, you can find Haniffa supporting local products in her hometown of Denpasar.

6. Dr. Catherine Baye-Easton Youth Writer 29, Director of Country Coordinators, International Youth Alliance for Family Planning, Dallas, Texas “Teenage me should have known that using contraceptives didn’t make me a slut, immoral or promiscuous. Rather, it meant I was safe and could make informed decisions about my body, health and family.”

@ kisara_bali

FUN FACT Catherine’s favorite song is “Baby Shark!”

7. Victoria Milanzi Youth Interviewer

@ bayekate2

24, Media Monitor, Malawi Institute of Journalism under UNICEF, Blantyre, Malawi “What should teenagers know about contraceptive use? If you can't abstain, use contraceptives.”

FUN FACT Victoria prides herself on having never been to

vicmilanzi

boarding school.

8. Tanaka Chirombo Youth Photographer

youthEcenter

20, HIV/AIDS and SRHR facilitator, Youth and Society, Mzuzu, Malawi “My mother and grandmother are in my squad when it comes to my health decisions.”

FUN FACT Tanaka is a self-proclaimed social butterfly. “I love talking to everyone!”

TanakaChirombo1

AROUND PSI THE NEXT GENERATION OF PHILANTHROPY NEW CO-CHAIR OF MAVERICK COLLECTIVE DR. PRECIOUS MOLOI-MOTSEPE This September, Melinda Gates handed over the reins to her position as Maverick Collective co-chair to South African businesswoman and philanthropist Dr. Precious Moloi-Motsepe.

From left: Melinda Gates and Dr. Precious Moloi-Motsepe. (Photo Credit: Maverick Collective)

Going the Last Mile PSI was recently awarded $95 million to continue to reduce the HIV incidence rate and accelerate the HIV response rate in Zimbabwe. The new program, dubbed Going the Last Mile for HIV Control, was granted with support from the President's Emergency Plan for AIDS Relief through USAID and the Zimbabwean Ministry of Health and Child Care (MOHCC). The program will work closely with the MOHCC, as well as other USAID health partners and Development Objective Programs, to create and implement client-centered and evidence-based solutions to fasttrack the end of the AIDS epidemic by 2030. The program will change its interventions based on the needs of each population it serves in Zimbabwe at the district-level, creating intervention packages that include pre-exposure prophylaxis, voluntary medical male circumcision and condom market development. PSI will work on Going the Last Mile with partners, including design agency Ideo.org and international nonprofit Internews. — Staci Leuschner, Country Representative, PSI/Zimbabwe 6 I M PAC T M AG A Z I N E

“I believe that strategic investment in women and girls will ensure we address the most pressing issues that face women today. Addressing women’s issues is part of the UN’s Sustainable Development Goals and Maverick’s impact will extend toward closing gender parity gaps,” said Dr. Moloi-Motsepe. Gates noted, “I look forward to watching Precious harness the potential of Maverick Collective and bring it to more women and girls in more places.” Inspired by Melinda Gates, Her Royal Highness the Crown Princess of Norway and PSI’s Kate Roberts founded Maverick Collective five years ago as PSI’s philanthropic innovation lab. This community of strategic female philanthropists aims to uncover health solutions for women and girls globally. Dr. Moloi-Motsepe represents the next phase of growth for Maverick Collective to further internationalize and engage with innovators and philanthropists, particularly in Africa. — Lizzie Hudson, Community Manager, Maverick Collective, PSI

A SEAT AT THE TABLE “Don’t put us at the kiddie table, and don’t talk down to us.” That is the sentiment echoed by an increasing number of young people vying for a seat at the decision-making table when it comes to matters of their sexual and reproductive health and rights. Young people no longer want to be invited to meetings to be ‘decorations,’ to just observe or to only lead energizers. Instead, young people want to be heard and make decisions for themselves. In the spirit of youth-powered healthcare, CARE and PSI have launched Youth Lead, an innovative advocacy partnership with a vibrant network of young leaders in Côte d’Ivoire. Together, with support from the Sall Family Foundation, we will drive policy change to unlock youth access to contraception and ensure that young people can exercise their right to make free and informed decisions. Beyond this, the partnership will create an even greater impact: youth-led advocacy organizations will build their long-term advocacy capacity and strengthen the coherence, effectiveness and visibility of their movement for youth sexual and reproductive health and rights. — Sandy Garçon, External Relations & Communications Manager, PSI

N O . 24 (Photo credit: PSI/Benjamin Schilling) (Illustration credit: Cassie Kussy)

THE KEY TO EFFECTIVE HEALTH SOLUTIONS PSI has almost 50 years of experience in consumer-driven social marketing, but the needs of consumers continue to evolve and health markets are becoming increasingly complex. To help make universal health coverage a possibility, the way we market health solutions to consumers in developing countries needs to change, too. That’s why we’ve introduced the Keystone Design Framework, a new standard for program design that will guide teams across our network in developing effective, scalable and sustainable interventions. Keystone brings together public health excellence and enhanced marketing discipline and builds on PSI’s historical planning processes and our market development approach. The framework includes tools, templates, resources and practical guidance to help teams:

Diagnose problems in healthcare markets that make it difficult for

Decide

consumers to adopt healthy products, services and behaviors, which interventions will produce the greatest health impact,

Design solutions that are built upon input from our target audiences and

sound marketing and public health fundamentals,

Deliver actionable work plans and budgets to support successful

implementation,

Learn from experience and continually improve interventions. Keystone weaves a wide range of activities—from market landscaping to consumer journey mapping to portfolio management—into a structured yet flexible approach that can be adapted across health areas and market contexts. The framework is equally applicable to developing health market strategy, updating a marketing plan for an existing product or service and designing an intervention in response to a new business opportunity. Ultimately, Keystone is designed to give all of our major investments a strong underpinning of marketing discipline and public health expertise. We’ll capture evidencebased theories of change that will help us to better demonstrate the effectiveness of our services. We’ll learn and share what we find from this work to reach the ultimate goal: delivering lasting impact for consumer-powered healthcare. — Nikki Charman, Director, Global Marketing, PSI (Photo credit: PSI/Emma Beck)

Data for All PSI believes that sharing experiences can improve the quality of health services everywhere. PSI brings expertise in data practices to our role in strengthening national health programs by collaborating with partners to scale-up DHIS2, a management health information system. Implementing this data system in more than half of our 50 network countries has now positioned us to work directly with several national ministries of health to achieve our collective goal: making better quality data available faster to government decision-makers. The recent success of the DHIS2 integration with the USAID-funded “Health for All” project in Angola shows the

importance of incorporating effective tools at the national level. Leonardo Europeo Inocêncio, Angola’s State Secretary of Health Ministry for Hospital Area, congratulated the project, which included malaria and reproductive health programs. “This [support to the Ministry of Health] will facilitate the documentation of activities and help supply reliable information for decision-making at the local, provincial and national levels,” he said. He also recognized the benefits of real-time data collection in DHIS2, where decision-makers can reallocate resources at a larger and more accurate scale. — Elisabeth Harris, Intern, Global Business Systems, PSI and Megan Shea, Associate Program Manager, Global Business Systems, PSI

Youth-Powered Youth-Powered Healthcare Healthcare at at PSI PSI PSI is catalyzing bold ways of driving health breakthroughs, with and for the young people we serve. To own their destinies, young people need to take part in the decisions that shape their futures. That’s why we’re balancing the scales as we move from youth-focused to youth-powered healthcare.

Engaging Youth

Serving Youth 1 in 4 consumers across PSI countries is between 10-29 years old

young designers power PSI’s global youth programming

1 young PSIer honored as a

71 21 + 10 Million youth activities across

120 under 40 awardee

PSI network members

# of young people under the age of 25 we’ve pledged to reach with modern contraception by 2020

630

PSI youth-focused presentations at ICFP

10 youth editors who drove the vision for ICFP’s Impact edition

ICFP youth ambassadors representing PSI

Committing to Youth

and counting Organizations and individuals have signed onto the Commitment to Ethics in Youth-Powered Program Design (check out page 28 to read more!)

20 8

100% 100%

of PSI’s reproductive health services are regularly evaluated using quality assurance standards mandating services be youth-friendly

years that PSI has been committed to addressing young people’s needs in the health sector

ICFP: International Conference on Family Planning and youth sexual and reproductive health

KEY AYSRH: adolescent I M P A C T M A G A Z I N E N O . 24 (Infographic credit: Dominique Brown)

14 Places to Be @ ICFP

AROUND PSI

Join PSI at ICFP as we put Youth-Powered Healthcare at the forefront and share how better approaches can be designed by some of the most unlikely partners. While PSI invites you to our more than 80 posters, presentations and other exciting events, here are 14 mustn’t misses to learn who’s #InMySquad and let us know who’s in yours!

TUESDAY NOVEMBER 13

1 2 3 4

Flash Speed Round - Task sharing and task shifting to expand access to family planning session: Introduction of Depo-Medroxyprogesterone Acetate Subcutaneous Injection through Use of Community Based Distributors in Zambia, 8-11am in MH3 Oral Presentation - Involving men in family planning via vasectomy and the standard days method session: Bold male engagement strategy increases NSV coverage and male participation in family planning, 2:35-3:55pm in AD9

Oral Presentation - Client satisfaction measurement and Redefining Quality of Care session: Patient-Provider Trust: Findings from the Assessing Service Quality and Contraceptive Discontinuation (ASQ-D) Study in Uganda, 4:20-5:40pm in Auditorium Club 1

Evening Among the Stars, Celebrate the stars of the Modern Contraception Movement—you! Join the ICFP organizing committee and PSI for a paparazzi-filled red carpet event to honor the Lifetime Achievements of Bill Gates, Sr. and give the Future is Female award to Maverick Collective Member Jess Jacobs, an actress, speaker, advocate and co-founder of Invisible Pictures, a women-led production company. 5-7pm in the KCC Auditorium

The Method Remix - Not Your Mama’s After-Party, Join Rwandan DJ and YouTube Sensation Makeda Mahadeo in a PSI and HCD Exchangesponsored dance party and auditoriumwide interactive game! We’ll explore the major tenets of employing Human-Centered Design with Adolescents and Youth for solutions in Sexual and Reproductive Health. Don’t miss the Youth Poetry Jam to introduce the Commitment to Action: Ethics in Youth-Powered Program Design. Food and drink will keep us all going following The Evening Among the Stars. 7-9pm in the KCC Auditorium

Poster Presentation - Adolescent Girls Under Siege: Understanding the Sexual Pressures of Young Women and How To Empower Them Through Sexual And Reproductive Health session: Irrelevant, Dangerous, and at Odds with My Identity and Dreams: Qualitative research findings using human-centered methodology in Ethiopia, Nigeria and Tanzania reveal emotional dynamics complicating contraceptive use among adolescent girls, 8-11am at the Poolside Lounge

Oral Presentation - Innovation in public-private partnerships: lessons from four countries session: Private Public Partnership to Deliver Dramatically Improved Family Planning Outcomes in Public Health Facilities in Gaza Province, Mozambique, 10:25-11:45am in MH1

THURSDAY, NOVEMBER 15

Oral Presentation - No secrets in this house: Parental support for family planning session: ‘From barriers to allies’: supporting parents to create pathways to adolescent and youth sexual and reproductive health in urban and peri-urban settings of Tanzania, 10:25-11:45am in Atrium 3

Oral Presentation - Parental support for family planning; Parental consent: A hindrance or catalyst to adolescent’s access to contraception in Lagos State, Nigeria, 10:25-11:45am in Atrium 4

WEDNESDAY NOVEMBER 14

8 9

Preformed Panel - The Blossoming of Implant Use in Africa session: How It Happened and What Lies Ahead; Insights from Implant Users, and the Future of Consumer-focused Implant Services, 11:55am-1:15pm in MH2 Preformed Panel - The role of the private sector in family planning programming session: Helping private provider networks develop health financing options and contribute to national FP and UHC agendas: experiences from Cambodia, Nigeria, Tanzania and Uganda, 11:55am-1:15pm in Auditorium Club 1

Commitment to Action - Ethics in Youth-Powered Program Design, Come to the official launch of PSI and the HCD Exchange’s Commitment to Action: Ethics in Youth-Powered Program Design with the statement’s initial signors. This press-moderated roundtable discussion will explore the responsibilities of bringing the human-centered design process to vulnerable populations like Youth and Adolescents. We’ll discuss how to conduct this cutting-edge research underpinned with respect, justice and safeguards to ensure practitioners do no harm. Learn more and sign on if you haven’t already. 2:30-3:15pm in Media Room

11 12

Oral Presentation - Quality improvement in family planning session: Improving Client Service Experience and Satisfaction Through E-System Based Support Supervison - The HNQ JS Story, 4:20-5:40pm in Atrium 2 Preformed Panel - Women’s Self-Care in Sexual and Reproductive Health New Options, New Evidence session: Consumer powered healthcare: Home-based medication abortion, 4:20-5:40pm in MH2 9

Family Planning by the Numbers

AROUND PSI

2018 ICFP Infographic Series

AN INVESTMENT IN FAMILY PLANNING AN INVESTMENT IN FAMILY PLANNING AN INVESTMENT IN FAMILY PLANNING AN INVESTMENT IN FAMILY PLANNING A LIFETIME OF RETURNS BRINGS A LIFETIME OF RETURNS ANBRINGS INVESTMENT IN FAMILY PLANNING A LIFETIME OF RETURNS BRINGS APLANNING LIFETIME OF RETURNS AN INVESTMENT IN FAMILY ANBRINGS INVESTMENT IN FAMILY PLANNING AN INVESTMENT IN FAMILY PLANNING BRINGS A LIFETIME MORE PROSPEROUS HEALTHIER OF RETURNS UNLEASHED MORE PROSPEROUS HEALTHIER UNLEASHED BRINGS BRINGS A LIFETIME NATIONS FAMILIES OF RETURNS YOUTH POTENTIAL NATIONS FAMILIES OF YOUTH POTENTIAL MORE PROSPEROUS HEALTHIER UNLEASHED MORE PROSPEROUS HEALTHIER UNLEASHED BRINGS AA LIFETIME LIFETIME OF RETURNS RETURNS NATIONS FAMILIES YOUTH POTENTIAL NATIONS FAMILIES YOUTH POTENTIAL MORE PROSPEROUS HEALTHIER UNLEASHED MORE HEALTHIER UNLEASHED NATIONS FAMILIES YOUTH POTENTIAL MORE PROSPEROUS HEALTHIER UNLEASHED MORE PROSPEROUS PROSPEROUS HEALTHIER UNLEASHED IF... NATIONS FAMILIES YOUTH POTENTIAL IF INNATIONS THE NEXT ~50 YEARS, NATIONS FAMILIES YOUTH POTENTIAL FAMILIES YOUTH POTENTIAL THEN, COUNTRIES IF... IF IN THE NEXT ~50 YEARS, THEN, COUNTRIES IF... COUNRTIES COULD SEE UP TO COUNRTIES THEN, IF... IF COUNTRIES COULD SEE UP TO IF IN IN THE THE NEXT NEXT ~50 ~50 YEARS, YEARS,

$430 $430 & The 214 million women with BILLION $430 & BILLION AN INVESTMENT an unmet need could access & MODERN The 214 million women with Theunmet 214 million women with BILLION IN FAMILY PLANNING an need could access CONTRACEPTIVES & an unmet need could access The 214 million women with MODERN CONTRACEPTIVES THEN, COUNTRIES

FULFILL UNMET NEED COUNRTIES FOR FAMILY PLANNING COUNRTIES

COULD FULFILL UNMET NEED SEE COULD SEE UP UP TO TO FOR FAMILY PLANNING FULFILL UNMET NEED FULFILL NEED ACCESS TO ENSUREUNMET UNIVERSAL All pregnant women FOR FAMILY FOR FAMILY PLANNING PLANNING ENSURE UNIVERSAL ACCESS TO REPRODUCTIVE HEALTH SERVICES IN RETURNS PER YEAR and newbornswomen received All pregnant REPRODUCTIVE HEALTH SERVICES IN RETURNS PER YEAR Allnewborns pregnantreceived women and STANDARD CARE ENSURE UNIVERSAL ACCESS TO ENSURE UNIVERSAL ACCESS TO and newbornswomen received All pregnant REPRODUCTIVE IN STANDARD CARE IN RETURNS RETURNS PER PER YEAR YEAR REPRODUCTIVE HEALTH HEALTH SERVICES SERVICES

BRINGS A LIFETIME OF RETURNS STANDARD CARE MODERN CONTRACEPTIVES BECAUSE THEN, FAMILIES AND COMMUNITIES WOULD BE HEALTHIER. and newborns received

BECAUSE

an unmet need could access

STANDARD CARE MODERN CONTRACEPTIVES THEN, FAMILIES AND COMMUNITIES WOULD BE HEALTHIER. THEN, FAMILIES COMMUNITIES WOULD NEWBORN BE HEALTHIER. MATERNAL DEATHS AND UNINTENDED PREGNANCIES DEATHS HEALTHIER UNLEASHED WOULD DROP BY AND WOULD PREGNANCIES DROP BY WOULD NEWBORN WOULD DROP BY MATERNAL DEATHS UNINTENDED DEATHS THEN, FAMILIES COMMUNITIES BE HEALTHIER.

BECAUSE BECAUSE MORE PROSPEROUS NATIONS

MATERNAL DEATHS FAMILIESWOULD DROP BY

NEWBORN DEATHS YOUTH POTENTIAL WOULD DROP BY

UNINTENDED PREGNANCIES WOULD DROP BY WOULD PREGNANCIES DROP BY UNINTENDED WOULD DROP BY

75% 80% 74% 75% 80% SPENT ON 74% 74% IFSPENT INON THE NEXT ~50 THEN, COUNTRIES SPENT ON ANYEARS, INVESTMENT IN FAMILY PLANNING 75% 80% 74% SPENT ON

#ICFP2018 fpconference.org | icfphub.org

COUNRTIES

#ICFP2018 fpconference.org | icfphub.org

IN HEALTH AND ECONOMIC BENEFITS IN IN HEALTH HEALTH AND AND ECONOMIC ECONOMIC BENEFITS BENEFITS

[Source: Hans-Peter Kohler and Jere R. Behrman. Copenhagen Consensus Center. Post-2015 Consensus: Population and Demography Assessment, Summary of Targets from the Paper. 2014.]

#ICFP2018 #ICFP2018 fpconference.org | icfphub.org fpconference.org | icfphub.org

WOULD DROP BY MATERNAL DEATHS WOULD DROP BY IN HEALTH AND

ECONOMIC BENEFITS

AN INVESTMENT IN FAMILY PLANNING BRINGS A LIFETIME UNLEASHEDOF RETURNS BRINGS A LIFETIME OF RETURNS YOUTH POTENTIAL

$430 FACT BILLION 60% 1.2 BILLION 1.2 BILLION 60% IN RETURNS YEAR 1.2 BILLION PER60%

WHEN PEOPLE HAVE ACCESS TO A RANGE OF FAMILY PROSPEROUS WHEN PEOPLEMETHODS, HAVE ACCESS TOMORE AMORE RANGE OF FAMILY PLANNING THEY’RE LIKELY TO NATIONS WHEN PEOPLE HAVE ACCESS TO A RANGE OF FULFILL UNMET NEED PLANNING METHODS, THEY’RE MORE LIKELY TO WHEN PEOPLE HAVE ACCESS TO A RANGE OF FAMILY FAMILY CHOOSE AND USE ONE EFFECTIVELY. PLANNING METHODS, MORE FOR FAMILY PLANNING CHOOSE AND USETHEY’RE ONE EFFECTIVELY. PLANNING METHODS, THEY’RE MORE LIKELY LIKELY TO TO CHOOSE AND USE ONE EFFECTIVELY. CHOOSE AND USE ONE EFFECTIVELY.

HEALTHIER FAMILIES

[Source: Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. 2018.]

MORE PROSPEROUS

ENSURE UNIVERSAL ACCESS TO REPRODUCTIVE HEALTH SERVICES youth in the world

IMPLANT IMPLANT IMPLANT IMPLANT

HEALTHIER

NATIONS MORE PROSPEROUS NATIONS

There are

FEMALE CONDOMS FEMALE CONDOMS FEMALE CONDOMS FEMALE CONDOMS

#ICFP2018 fpconference.org | icfphub.org #ICFP2018 [Source: Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. 2018.] #ICFP2018 fpconference.org | icfphub.org fpconference.org | icfphub.org [Source: Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. 2018.] [Source: Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. 2018.] #ICFP2018 fpconference.org | icfphub.org

BRINGS A LIFETIME RETURNS ANOF INVESTMENT IN FAMILY PLANNING COULD SEE UP TO

[Source: Hans-Peter Kohler and Jere R. Behrman. Copenhagen Consensus Center. Post-2015 Consensus: Population and Demography Assessment, Summary of Targets from the Paper. 2014.]

[Source: Hans-Peter Kohler and Jere R. Behrman. Copenhagen Consensus Center. Post-2015 Consensus: Population and Demography Assessment, Summary of Targets from the Paper. 2014.] [Source: Hans-Peter Kohler and Jere R. Behrman. Copenhagen Consensus Center. Post-2015 Consensus: Population and Demography Assessment, Summary of Targets from the Paper. 2014.]

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SPENT ON

#ICFP2018 #ICFP2018 fpconference.org | icfphub.org fpconference.org | icfphub.org #ICFP2018 fpconference.org | icfphub.org #ICFP2018

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N O . 24

[Source: Hans-Peter Kohler and Jere R. Behrman. Copenhagen Consensus Center. Post-2015 Consensus: Population and Demography Assessment, Summary of Targets from the Paper. 2014.]

LEADING VOICES YOUTH-POWERED RADIO HOUR “In northern Malawi,” Maureen begins, “some parents exchange girls for cows.” Maureen turns to George, her YouthAlert! co-host. She points to him, “Remember that episode?” He nods his head vehemently. The girl’s parents had forced their 15-year-old daughter into marriage. They got the money. She got status as third wife, with contraception far from her purview. “That’s a story we told,” Maureen says. It’s one of more than 1,000 YouthAlert! radio programs that have aired in Malawi since the sexual and reproductive health programming took back to Malawi’s national airwaves four years ago. Across the districts where YouthAlert! airs, three in 10 Malawian girls aged 15-19 have either had or are expecting a child. Among this cohort, one in five girls will drop out of school. The need to bring health information to some of the country’s most vulnerable youth remains a priority. Since relaunching in 2014, the PSI-powered radio program— with support from USAID and the German Government through KfW Development Bank—has established itself as a mainstay in Malawian society, giving rural and urban youth aged 10-24 a platform to have their stories, voices and perspectives heard. From teenage breakups to young girls experiencing rape at the hands of family members, the magazine-style and youth-run show identifies topics of immediate relevance to young people’s lives. The weekly radio program injects information on sexual and reproductive health and gender-based violence prevention into the personal narratives aired, giving its monthly audience of 15,000 young listeners the tools and knowledge to own their health decisions. “This isn’t about rescuing youth. It’s about making change,” George says. “Young people do not have to suffer in silence. YouthAlert! delivers them a platform to speak out.” —With Contribution from Emma Beck, Associate Communications Manager, PSI @emmashoshanna 11

(Photo credit: PSI/Miguel Samper) (Illustration credit: Cassie Kussy)

QUESTIONS

Dr. Natalia Kanem

with

Youth-Powered Healthcare Will Change the World In 1994, 179 countries created a vision for the future that balanced sustainable development and individual well-being. Those who articulated this vision, called the Programme of Action of the International Conference on Population and Development (ICPD), made sure that young people were central to their agenda. That Programme of Action became the steering document for the United Nations Population Fund (UNFPA). More than two decades later, young people are still at the center of the agenda — notably at the 2018 International Conference of Family Planning. We ask UNFPA’s Executive Director Dr. Natalia Kanem about the development community’s responsibility to young people and the potential to reap the rewards of the demographic dividend.

Impact magazine: Why did the leaders of what

NK: Protecting the SRHR of the world’s 1.8 billion young

would become the modern contraceptive movement think to include youth more than 20 years ago?

people is not only a moral imperative. It is also a path to shared prosperity and sustainable development.

Dr. Natalia Kanem: If we want to make good on our promise to leave no one behind, young people’s full engagement and participation is crucial. The time has come to move beyond dialogue and give young people space and support to drive the ICPD forward, so that all people, everywhere, gain the power to take charge of their lives. Human rights are by their very nature universal—they apply to everyone, including young people. Yet this population is often unable to exercise their rights, particularly when it comes to making choices about their bodies and for their lives.

IM: What happens if we don’t increase access to sexual and reproductive health and rights (SRHR)?

We see the impact of failure to protect the health and rights of young people every day: 16 million girls aged 15–19 give birth each year in developing countries. Complications during pregnancy and childbirth are the leading cause of death for girls in this age group worldwide. About one in three new HIV infections occur among youth aged 15–25.

IM: What are the long-term impacts of reaching young people with SRHR information and services? NK: Evidence shows that investments in young people’s health and rights better equip them to take advantage of economic, educational and other opportunities that can lead to more secure futures.

LE ADING VOICES

IM: What does someone who doesn’t know the breadth of UNFPA’s work need to know?

NK: UNFPA is guided by the principles of gender equality and human rights embodied in the ICPD. Our activities in 155 countries and territories support access to youthfriendly sexual and reproductive health (SRH) services, including contraception and screening and treatment for HIV and other sexually transmitted infections. We support comprehensive sexuality education to help adolescents learn about their bodies, make healthy choices and think critically about gender and power dynamics in relationships. From 2014–2017, UNFPA programs enabled nearly 40 million adolescents to access SRH services.

IM: How would you advise other organizations to integrate young people into their work? NK: Our programs are collaborative, not prescriptive. We give space for young people to speak, and we listen and respond to their ideas and needs. Our focus is on inclusion. We involve young people—including those who are differently-abled, marginalized or who have less opportunity to be heard—as equal partners from the onset of programming.

IM: As young people under the age of 24 make up 40 percent of the population, how important is adolescent and youth SRH to the success of the United Nations Sustainable Development Goals (SDGs)? NK: We know that young people are pivotal to the success of the SDGs to be achieved by 2030, and by extension UNFPA’s own ambitious goals that we aim to achieve within the same timeframe, namely ending the unmet need for contraception; ending preventable maternal deaths; and ending gender-based violence and harmful practices against women and girls. These aims are underpinned by a commitment to ending invisibility through quality age- and gender-disaggregated population data. This will ensure that everyone is accounted for and reached. Young people stand to benefit from our actions to reach these goals and can play an important role in achieving them.

IM: What is your call-to-action for young people and adults working in the development space?

(Photo credit: UNFPA) ABOVE United Nations Population Fund (UNFPA) Executive Director Dr. Natalia Kanem @Atayeshe

NK: Around the world, young people are waiting to claim their power and fulfill their potential. Let’s help them exercise their rights and realize their aspirations. Let’s invest in their health, well-being and leadership, and then let’s get out of their way and let them lead!

LET’S HELP YOUNG PEOPLE REALIZE THEIR AS PIR ATIONS. LET'S GET OUT OF THEIR WAY A ND LE T THEM LEAD!

(Photo credit: UNFPA) 13

LE ADING VOICES

A COMMITMENT TO EQUITY AND ACCESS Rwanda is a family planning (FP) success story in recent history. The first decade of the 2000s witnessed a dramatic rise in the country’s contraceptive prevalence rate for modern methods and a drop in the total fertility rate from 6.1 percent in 2000 to 4.6 percent in 2010. In recent years, we have invested in our network of more than 58,000 community health workers, generated communications campaigns to drive demand and behavior change and provided training on long-acting and permanent contraceptive methods. Our continued commitment to FP is a way to ensure a healthy and prosperous future for the sustainable development of the Rwandan people and for the world. Rwanda’s sustained focus on strengthening health systems has improved preventive service coverage. We’ve increased immunization coverage to 95 percent. We’ve reduced the national maternal mortality rate and the infant mortality rate; we’ve stabilized the HIV prevalence at 3 percent since 2005, and increased life expectancy from 49 years in 2000 to a record 66.7 years in 2017. We’re proud that Rwanda was the first country to initiate routine HPV vaccination for young girls and, today, has the highest vaccine coverage globally at 93 percent. We’ve tapped into innovative drone delivery systems to deliver blood products throughout the country to pave new pathways to safe and sufficient blood and blood products. This has helped reduce rates of death and disability due to severe bleeding during delivery and after childbirth. Rwanda ranks among only 11 countries in Africa implementing a 100 percent voluntary nonremunerated blood donation program, according to the WHO 2013 survey on the status of blood safety in the WHO African Region. We commit to leaving no one behind when it comes to accessing health services. That’s why, in 2000, we created a national community-based health insurance scheme to improve a patient’s financial risk and healthcare accessibility by decreasing out-of-pocket payments. Since implementation, nine in 10 Rwandans now have health insurance coverage.

I M P A C T M A G A Z I N E N O . 24

(Photo credit: PSI/Kim Case Burns)

Under the leadership of President Paul Kagame, Rwanda’s political will is driven toward a commitment of universal health coverage. With a people-centered national foundation that values equity and sustainable development, Rwanda’s commitment to achieving FP targets, as well as a reduction in maternal and newborn deaths, is unwavering. The Government of Rwanda is privileged to host the fifth International Conference on Family Planning (ICFP) and extends a very warm welcome to its more than 3,500 delegates. It has been a unique and exciting journey to work with the Bill & Melinda Gates Foundation. We are excited to host the world’s largest scientific conference on reproductive health in Rwanda to continue our collective work and learn from each other’s experiences to identify innovative methods to reach the FP goals. Rwanda’s values of equity and increased access align deeply with ICFP’s overarching goal. This ICFP will serve as a strategic inflection point that will provide an opportunity for political leaders, scientists, researchers, policymakers, advocates and youth to disseminate knowledge, celebrate successes and identify next steps toward reaching the goal of enabling an additional 120 million women and girls access to voluntary, quality contraception by 2020. Nationally, and globally, we will come together during ICFP to explore pathways forward to reach success. We welcome you to Kigali and look forward to the innovative, productive sessions ahead.

DR. DIANE GASHUMBA Minister of Health, Ministry of Health of Rwanda @DianeGashumba @RwandaHealth

LE ADING VOICES

(Photo credit: PSI/Evelyn Hockstein)

OUR ADOLESCENTS AND YOUTH DESERVE A BETTER FUTURE “I would have been able to avoid this disaster, if I had access to information. I knew nothing about sex, babies or life. At my age, I should have finished my studies first and had a job. Now, I am older than an old lady. I have four children that I can only just manage to feed. It’s a real disaster,” admits Christelle, an 18-year-old Haitian mother of four living in Portau-Prince’s southern shanty town area. Her frank statement challenges and reminds us of how access to information and sexual and reproductive health (SRH) services is essential for Haiti’s young people to reach their potential and participate fully in the development of our country. The Ministry of Public Health and Population’s latest Mortality, Morbidity and Service Utilization Survey reveals that 13 percent of adolescents have had sex before they turn 15. One in 10 young women aged 15-19 has already started her reproductive life. Furthermore, even though all women surveyed said they had heard of at least one contraceptive method, only three in 10 women aged 15-49 were using a modern method of contraception at the time of the survey; and this decreases to just 8.1 percent for young women aged 15-19 years. Four percent of women of reproductive age reported having resorted to abortion at least once in their lifetime. These figures reflect the reality of far too many young girls who become mothers while they are still children themselves. This includes young girls who: have suffered sexual violence; dropped out of school because of unwanted pregnancies—

which helps fuel the cycle of poverty; contracted sexually transmitted infections or not survived the complications of unsafe abortions; and a lifetime of complications from pregnancy at a young age. A number of initiatives are underway and significant efforts are being made at the highest level of the government to strengthen prevention through information and awarenessbuilding as well as to improve access to family planning services. Given the importance of this issue, we must do more and do better. There is no time to waste! We must act to ensure that the young people who form the vast majority of our population can fully enjoy their rights, including their SRH rights. We must act so that young people have access to quality information to enable them to make responsible choices. We must also act to guarantee that young people have access to health services, where they feel welcome, free from judgment and able to access comprehensive information and modern contraceptive methods. The young people of our country expect a lot from us—rightfully so—and there is no room for error or failure. We must not disappoint them.

MARTINE MOÏSE First Lady of Haiti @martinejmoise

LE ADING VOICES

Consumer Powered Healthcare for Her: What

Menstrual Health Can Teach Us Menstruation is a critical but often overlooked component of girls’ sexual and reproductive health (SRH). Since 2016, PSI has joined forces with Maverick Collective member Cristina Ljungberg to make periods a priority in Nepal’s adolescent health landscape. The goal was to improve the health and lives of Nepali girls by designing innovative strategies addressing menstrual health and hygiene. From the start, the team was warned that no Nepali girl—especially no rural Nepali girl—would open up about her period. Within the first year, however, the team met over 100 girls who, in private, had many questions, about periods and sex. This raises the question: what role can—and does—menstrual health play in family planning (FP) and SRH work? Menstruation can be a conversation starter to familiarize youth with fertility and SRH. PSI’s work with adolescents repeatedly shows that adolescent girls don’t identify as sexually active and are uncomfortable in conversations about FP. Educating girls and boys about the bodily changes that come with puberty and menarche is an opportunity to introduce them to the concept of fertility. The reproductive cycle

I M P A C T M A G A Z I N E N O . 24

can encourage girls to seek FP methods later in life. Dispelling myths around periods and side effects of contraceptives can kick-start a healthy journey down the SRH path. Contraceptives often change bleeding patterns, and young women need to be prepared. Contraceptives can affect menstrual patterns, including a heavier flow, spotting or stopping bleeding altogether. Often in developing countries, adolescent girls fear disclosing irregular menstruation, concerned about stigma related to infertility and marriageability. Period irregularity is a leading cause for contraceptive discontinuation. When addressing girls, we need to understand their fears and desires and use the proper counseling tools such as FHI 360's NORMAL to inform them about menstrual bleeding changes. This insight can also help refine and strengthen the effectiveness of FP interventions, helping girls and young women feel confident about their contraceptive choices. Going forward, is menstruation key to SRH innovation? Period blood contains unique health data and can be used as a noninvasive method for early disease diagnosis and management. When girls and women

LE ADING VOICES

REFERENCES 1.

Maverick Collective is a philanthropic and advocacy initiative from PSI with a mission to build a community of strategic philanthropists and informed advocates who use their intellectual and financial resources to create change by investing in girls and women.

Insight from the PSI Adolescents 360 project in Ethiopia, Nigeria and Tanzania.

Sommer, M., Ackatia-Armah, N., Connolly, S., & Smiles, D. (2014). A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia. Compare: A Journal of Comparative and International Education, 45(4), 589-609.

4. (Photo credit: PSI Nepal)

Tolley, E., Loza, S., Kafafi, L., & Cummings, S. (2005). The Impact of Menstrual Side Effects on Contraceptive Discontinuation: Findings from

understand their cycle, they gain valuable insights about their fertilityâ&#x20AC;&#x201D;and overall healthâ&#x20AC;&#x201D;and are better equipped to report anomalies to their doctors and make consumer-powered decisions. As we keep working with, and not just for, girls and women, we cannot ignore the important role menstruation plays in their sexual and reproductive lives. Can we imagine a world in which, instead of managing menstruation, we see menstruation as a tool to improve the health of girls and women?

a Longitudinal Study in Cairo, Egypt. International Family Planning Perspectives, 31(01), 15-23. 5.

NORMAL counseling tool for healthcare providers, developed by PSI and FHI360.

CRISTINA LJUNGBERG Maverick Collective Founding Member @cjljungberg @caseforher

MARIA CARMEN PUNZI Menstrual Health Focal Point, PSI Europe @psiimpact

LE ADING VOICES

Bringing

PLEASURE Back into the

Conversation

Let’s celebrate sex Across global health, reproductive health messaging speaks to the rights and agency of consumers to access health services, tools and knowledge. But a powerful and intrinsic component is missing from the discussion: the pleasure element of our sexual and reproductive health journeys. Why do we skirt around sex? How can we bring sexual pleasure into the global health dialogue? And why does it matter? We explore this topic with Lindsay van Clief, a content strategist for RNW Media, a multimedia NGO that gives young people the tools to make informed decisions to take their futures into their own hands. What was it like to first get your period? My first period was awkward but exciting. I was a late bloomer and only got my period when I was almost 15-years-old. Though it was a bit uncomfortable since I left the tampon applicator in my vagina the entire week! Who gave you “the talk?” I was in a unique situation, as I received 18

excellent sex ed through my [Unitarian Universalist] church. My parents never really talked about sex with me but I did come home one day to find a book lying on my bed about “the change.” It terrified me. What is one thing you would tell your 13-yearold self? You do not have to be like everybody else. Being different will give you so many advantages that you can’t even fathom right now. What was your biggest misperception around contraception as a teen? I thought I had to figure out what was needed on my own. But I should have been able to talk to my partner about contraceptives. In global health, why does pleasure matter? Pleasure is important because it is the fundamental context of sexual education. We need to feel comfortable talking about sex and lust, which are often primary motivators for relationships. Talking about pleasure also helps humanize the conversation, making it less clinical and more relatable. Right now

I M P A C T M A G A Z I N E N O . 24

( Photo and Illustration credit: IDEO.org for Transform/PHARE. Illustrated by Nicole Kraieski and Lionel Ramazzini)

LE ADING VOICES

everyone is talking about user-centered design and Human-Centered Design. What is more human-centered than understanding that we, as humans, are pleasure-seeking? How do you navigate cultural context in discussions about womenâ&#x20AC;&#x2122;s pleasure? By listening. There is no single narrative or type of woman. We need to listen and hear others in their experiences, viewpoints and understandings. I take pleasure in learning about these experiences and the way women around the world understand their bodies, pleasure and relationships. Are we done hearing about men's pleasure? No. This should never be a black and white binary situation. We need to embrace every personâ&#x20AC;&#x2122;s story, body, sexual orientation, gender identity, etc. The more voices and perspectives we hear, the better we will be at understanding and sharing empathy. Can safety be sexy? Of course! Confidence and respect are incredibly sexy! When someone is thoughtful, proactive and takes precautions, it demonstrates care, respect and support for their partner. When I feel safe and respected, it allows me to relax, let my hair down and have even more fun. What do you wish your adolescent-self knew? Go for it! Explore and try new things! Sex is normal and it is natural. We need to make sure it is part of the conversation when we talk about health, relationships, diseases and families. Why in 2018 are we still skirting around sex?

LINDSAY VAN CLIEF Content Strategist, RNW Media @LvClief

LE ADING VOICES

The Voices Behind the Videos It’s not enough to have young people on the menu—they must have a seat at the table. Young people must be driving and shaping the health solutions that best serve them. And they are—in greater numbers and with greater power than ever before. The global community recognizes this shift, and the International Conference on Family Planning (ICFP) issued a call for young people aged 18-25 to lend their voice by submitting videos responding to this question: What does it look like to invest for a lifetime of returns? More than 550 youth applied. 100 winners from roughly 40 countries were selected. Impact magazine’s Youth Editors Christianah Aborisade and Chidimma Maduabum spoke with four winners to understand what inspired the compelling messages they’re bringing to the ICFP global stage.

CHIDIMMA

CHRISTIANAH

MADUABUM

ABORISADE

Adolescents 360

Project Assistant,

Young Designer,

SFH Nigeria

Baye Leinyuy Bongla

Jane Nyathi

Sadia Rahman

Sarmad Muhammad Soomar Ranani

25, Cameroon Vice Executive Director, Youth Health International

24 , Zimbabwe

24 , Bangladesh Country Coordinator, International Youth Alliance for Family Planning

23, Pakistan Co-Founder Sindh Chapter, Youth Advocacy Network Pakistan

Chidimma: What inspired your activism surrounding adolescent and youth access to reproductive health services?

Christianah: What are the key themes in your video?

Christianah: What does choice mean to you?

Jane: My video addresses the

Sadia: My video, “Choice Matters,” addresses the importance of giving young people the tools to access accurate, friendly and age-appropriate information so they can make informed choices about their sexual and reproductive health. All young people, including those with special needs and those from the most vulnerable groups, have the right to choose and access quality healthcare services. But that right is not always realized, especially for young people. It’s high time we invest in young people for a lifetime of returns for the world.

Chidimma: What message do you want young people to take away from your video?

Baye: I remember a 14-year-old girl getting turned away from our family planning unit when she asked for contraception. I later found out that she lost her life after an unsafe abortion. That was a turning point for me. Young people have a right to comprehensive information concerning their reproductive health. My video drives home that this access is not just a health issue, but also a human rights issue that affects us all. I want every young person, every donor and every government to understand the need to invest in reproductive health so young people can take charge of their lives.

District Facilitator, FHI 360

struggles many young women face in making reproductive health choices. It is about African society where men have traditionally viewed reproductive health as a woman’s concern, instead of a concern of women and men, boys and girls. It is about policies and programs that forget women are not the only decision makers when it comes to family planning. And it is about the policies that hinder young people below the age of 16 to fully access comprehensive family planning services. Investing in family planning betters the future of generations to come.

I M P A C T M A G A Z I N E N O . 24

Sarmad: My video, “A Better Choice Pays Off,” is a wake-up call for youth to add their voices and change their communities. I use my experience learning about reproductive health to demonstrate the challenges young people face when it comes to contraceptive access, and I provide practical ways that increased knowledge can impact communities for the better. I want my video to remind young people that they can take control of their lives and their health. View theirs and other youth ambassadors' videos throughout the conference.

GETTING CARE CLOSER LET’S GET DIGITAL It’s 9 a.m. and 100 unread messages already await a response on the Úsala Bien Facebook fan page. It’s time for Tania to get to work, helping change the world one adolescent at a time. Tania adjusts her computer screen and opens the first message. It’s from Laura, a 16-year-old who saw an Instagram video of her favorite radio host talking about the importance of avoiding unwanted pregnancies and tagging Úsala Bien. Laura has questions about birth control but is too embarrassed to ask anyone she knows. Laura’s message is one of nearly 10,000 messages received over a three-month period alone. Based in El Salvador’s capital city, Tania is one of 13 peer “cyber-educators” working across five countries in Central America and the Caribbean. It’s an initiative under the Jóvenes 3.0 program, implemented by PSI affiliates the Pan American Social Marketing Organization (PASMO) and Society for Family Health/Dominican Republic. Launched in 2017, Jóvenes 3.0 uses digital channels and social media to increase youth access to reproductive health information and services in a region where sexual education is limited and teen pregnancy rates remain high. The Úsala Bien page is part of a comprehensive strategy that integrates one-on-one cyber-education onto digital platforms to reach and serve young people on spaces they know and trust. Social media influencers engage users on the Úsala Bien page, which uses social listening insights to refine information delivery. This peer-to-peer strategy is bolstered by digital analytics, serving cyber-educators with real-time data and empowering the cyber-educators with evidence-based insights to quickly adapt outreach in response to target consumer engagement. In February, Jóvenes 3.0 launched a digital campaign that reached over 24 million young people online. More than 8,500 one-on-one online interventions were led by cyber-educators like Tania who help young people make informed decisions and take control over their sexual and reproductive health. —With Contribution from Andrea Novella and Alejandra Cabrera,

Pan American Social Marketing Organization (PASMO) @asociacionpasmo

(Photo credit: PSI/David Olson) (Illustration credit: Cassie Kussy)

GE T TING CARE CLOSER

REACHING TEENS WITH TECHNOLOGY

The intersection of health and technology delivers unprecedented means to reach our youngest consumers with sexual and reproductive health (SRH) information and tools at their fingertips. We’re blending digital muscle with innovative vision, and we’re bringing care and resources closer to young people than ever before. We surveyed some of public health’s leading trailblazers to map out the youth-centered digital solutions disrupting the status quo.

TAG THE MIDWIFE Setting the Scene Girls in Côte D’Ivoire often lack trusted sources to access health information. Through Project Ignite-Côte d’Ivoire, PSI creates digital links for girls aged 15-25 to attain the information they need to make their SRH choices. It’s a Facebook solution that reaches more than 32,000 followers and leverages real-time social media analytics to track how best to inspire and serve Ignite’s target consumers. Driving Breakthroughs Project Ignite's Facebook account serves adolescent girls and young women with content on love, life and health. Every Tuesday, Ignite’s Entre Nous Facebook page hosts “Sage-femme Gabi” where a PSI midwife answers girls’ health queries. The youth-friendly midwife posts her picture, a component integrated based on girls' expressed desire to chat with an actual person, with a scripture-inspired name to appeal to girls of all faiths. Seven in 10 of the page’s followers are under 24 years old. 98 percent are women. — Marie Fedra Baptiste, Country Representative, PSI Côte d’Ivoire

I M P A C T M A G A Z I N E N O . 24

(Photo Credit: AskNivi)

GE T TING CARE CLOSER

DIGITAL DATA ON DE MAND Setting the Scene Policy shifts made at the right time and in the right place can remove barriers blocking young people from SRH services. Often times, the most effective voice advocating for change is from young people themselves. All they need is the data to power their ask. Driving Breakthroughs Population Reference Bureau’s Youth Family Planning Policy Scorecard brings data to the fingertips of young advocates. The online dashboard, available in English and French, allows users to view 16 country policy commitments surrounding youth contraceptive access. The tool equips young leaders with data and verbiage they can use to hold their governments accountable in implementing or amending policies to improve how young people aged 15-24 access the care and resources they need for their health, their bodies and their futures. — Meredith Pierce Policy Analyst, Population Reference Bureau @meripierce

HAVE A QUESTION? ASK NIVI

CARE E RS AND CONTRACEPTION ... ALL ONLINE

SHIF TING POLICY BY SMS PE TITION

Setting the Scene By 2020, 725 million people will have access to a mobile phone in Africa. In Asia, seven in 10 people own, or have access to a mobile phone. Mobile phones offer new ways of reaching and serving consumers with content. It’s an opportunity digital health company Nivi is taking advantage of to provide women and girls in emerging markets with trusted SRH information. All users have to do is “Ask Nivi.”

Setting the Scene Rwanda has made significant strides in increasing the contraceptive prevalence rate over the past two decades. But sustaining that momentum requires continually tailoring how SRH services are delivered on-demand to meet young people’s evolving needs. That’s where CyberRwanda, created through HumanCentered Design with Youth Development Labs and PSI's Rwanda affiliate Society for Family Health, comes into play.

Setting the Scene In Uganda, one in four girls aged 15-19 has had or is expecting a child. This is the landscape that the Act Now to End Teenage Pregnancy (ANETP) campaign operates in, positioning youth at the forefront in the call for change.

Driving Breakthroughs Ask Nivi is an artificial intelligence-enhanced mobile platform that delivers free SRH information via SMS shortcode and on Facebook. Consumers text a question to Ask Nivi, which responds with SRH resources tailored to the individual’s needs. If the consumer is looking for a clinic, Ask Nivi produces a unique referral code that personalizes recommendations and can serve as a voucher to offset the cost of the contraceptive at the clinic. Once redeemed, Nivi follows up with consumers to rate the quality of their interaction with providers. Since 2017, Ask Nivi has served more than 38,000 young Kenyans. —Ben Bellows Co-Founder, Nivi. Inc. @benbellows

Driving Breakthroughs Working with more than 400 young people and their inf luencers, CyberRwanda delivers an interactive onestop-shop for adolescents and youth aged 15-19 to have their professional and health questions answered virtually by mentors. It also offers a place to confidentially order contraception from a local pharmacy. Young people can access CyberRwanda online and via SMS, or off line on networked tablets in school clubs and youth centers. The digital hub will launch in 2019 and be integrated into SFH Rwanda’s adolescent and youth SRH programming. CyberRwanda estimates it will serve 6,000 young people by 2021.

Driving Breakthroughs Led by White Ribbon Alliance Uganda, ANETP drives activists to a UNICEFdeveloped, free SMS-based platform to sign a petition calling on Uganda’s Prime Minister to implement a multi-sectoral plan—that involves young people— to address teen pregnancy. 120,000 activists signed the petition in the three months following launch, seven in 10 of whom were adolescents. The campaign secured the support from Ugandan Prime Minister Rt. Hon. Ruhakana Rugunda and, in the time since, has seen Uganda’s Ministry of Education and Sports pass a National Sexuality Education Policy to support curbing the nation’s teen pregnancy rate. —Faridah Luyiga Communications Officer, White Ribbon Alliance @fluyiga

—Dr. Rebecca Hope Director of Programs, Youth Development Labs @drrebeccahope

STEPPING BACK INTO ADOLESCENCE WHAT WOULD I TELL 13-YEAR-OLD-ME? Beginning on World Contraception Day, we invited young leaders and their influencers to share their teenage memories and early experiences learning about reproductive health. These poignant and endearing stories remind us of our teenage years and how tricky (and exciting!) it was learning about our bodies. But even more, the stories elevate the challenges young people face and the opportunities we have to revolutionize how the next generation can own their health decisions. Every girl and boy has the right to make informed health choices and plan for the futures they want and deserve. That’s our commitment to bringing care closer to the next generation with the power to change it all.

“My dad was the f irst person to give me 'the talk.' I had asked him what a condom is. He had to tell me more: what, when, and why it's used. But he didn't discuss the how. A peer educator handled the remaining part of the course. LOL!” @AgunyoCaren

(Photo credit: supplied by subjects)

I M P A C T M A G A Z I N E N O . 24

“When I was a teenager, I wish I knew that there were birth control options other than the pill.” — Caitlin Thistle, Family Planning and Reproductive Health Research Advisor at USAID @CaitlinNewmanT

“When I was a teenager, I wish an adult had talked to me about sex, at all!” — Sarah V. Harlan, Learning & Partnerships Director, K4Health @SarahVivianMPH

“You’ve got this girl. Enjoy the ride, you are magic just by being.” —Dr. Tlaleng Mofokeng, Doctor, DISA Clinic @dr tlaleng

“I thought that contraception is nothing of my concern, a condom was mainly for HIV and that generally, contraceptives are not safe and are reserved for 'careless' adults who can't use natural methods to prevent unwanted pregnancies.” —William Otuck, Director of Human Resources, International Youth Alliance for Family Planning @Otuck _William

“Biggest misconception? That sperm could penetrate multiple layers of clothing.” —Karl Hofmann, President and CEO, PSI @KarlHofmannPSI

“I thought contraception was wrong and immoral but I also wanted to know more about it. There's nothing wrong with SRH education. If anything it's empowering.” @AmakaAnne _

“Due to the lack of information, I thought using two condoms would protect me more when having sexual intercourse.” —Marcos Rodas, Social Media Coordinator, Pan American Social Marketing Organization, Guatemala

“I wish I understood as a teenager that it is a sign of emotional maturity and autonomy to take full control over my sexual health.” —Debra Messing, Actress, Producer, PSI Global Ambassador @DebraMessing

@asociacionpasmo

“Grateful that my mother AND father thought it was important to tell me about sex, contraception, being in control, and even the importance of pleasure.” —Beth Fredrick, Executive Director, Advance Family Planning advocacy initiative, The Bill & Melinda Gates Institute for Population and Reproductive Health @bethfredrick

“I grew up at the birth of the sexual revolution, and along with it, the pill, the IUD and the diaphragm, and, sadly, the misperception that birth control was a woman’s responsibility.” —Jonathan Stack, Co-founder, World Vasectomy Day @WorldVasDay

“As a teenager I wish condoms were easily accessible and affordable, and I knew how to use them. I never got 'THE TALK.' I learnt it all on my own after many failures. My biggest fear was contraceptive failure.” — Christopher Meraiyebu, 120 under 40 honoree, Market Development Technical Advisor, PSI East Africa

“In Texas, we didn't have comprehensive sex ed, but I had a mom serious about it. I'd tell my teen self 'Help! Be for your peers what Emma Gonzalez is for gun control.' Here's to activist adolescents!” — Claire Cole, Implementation Science & Learning Advisor, PSI @clairebcole

@shokays

GE T TING CARE CLOSER

THE ETHICS OF YOUTH-CENTERED INNOVATION Human-Centered Design (HCD) allows us to step into the lives of the young people we serve, and work together to better create solutions. If done correctly, HCD can spark innovative thinking to ignite breakthrough design. But without the proper systems and guidelines in place, the process can potentially be harmful to young people. Esther Nantambi asks Rena Greifinger, the senior lead for PSI’s MaverickNext program, and Amy Uccello, PSI's senior adolescent and youth sexual and reproductive health technical advisor why the time is now to refocus our attention on young people’s safety and integrity, particularly at the nexus of where research and program implementation meet. They discuss why PSI, in partnership with the HCD Exchange and dozens of signatories, is launching the Commitment to Ethics in Youth-Powered Program Design. Esther Nantambi: Before diving into guidelines, let’s start at the beginning. What is HCD? Rena Greifinger: HCD is a creative problem-solving process that brings health consumers in as equal project partners. Amy Uccello: HCD allows us to apply a human-centric lens to program design and infuse empathy and insights into the body of evidence we’re working with. In doing so, the process incites a unique programmatic response in a way that numbers alone often can’t.

RG: The Commitment complements rather than replaces existing validated guidelines and protocols for ethical research. The Commitment is a shared intention to continually improve, as well as an invitation to our community to openly discuss the complexity and nuances of this work. EN: What core principles does the Commitment outline? RG: There are 21 principles organized into three categories: Respect, Justice and Beneficence (Do No Harm). Respect means valuing young people and the lives they live. Justice refers to the inherent power imbalance between young people and adults, including those from within and outside the program country. We ensure justice by bringing young people into the HCD process as equals in program design and delivery. Beneficence means maintaining the well-being of young people when conducting HCD. EN: What is at risk if we don’t uphold these principles? RG: We risk making a vulnerable group even more vulnerable to stigma and negative consequences, while also losing their respect and partnership. Hopefully, everyone is already keeping ethics at the center of their work; it's just a friendly nudge to our community to continue to walk our talk of meaningfully and safely working in partnership with young people. AU: Global commitments help to keep each of us accountable, drive advocacy efforts among those who have not yet committed and instill clear and agreed upon parameters for all those who commit.

RENA GREIFINGER Senior Project Lead, MaverickNext @renagreifinger

(Photo credit: Ideo.org)

EN: What prompted the development of the Commitment to Ethics in Youth-Powered Program Design? AU: We’ve long-held to high-quality protection measures, such as Institutional Review Board (IRB) approvals. However, HCD is still new in global health and may not require IRB approvals. A mutually agreed upon Commitment among donors, implementers, evaluators, design firms and young people offers an additional safety net to ensure HCD remains a trusted and safe space for all young people involved.

ESTHER NANTAMBI Radio Presenter and Communications Assistant, Youth Equality Center @youthEcenter

AMY UCCELLO Senior AYSRH Technical Advisor, PSI @amy_uccello

I M P A C T M A G A Z I N E N O . 24

THE COMMITMENT TO ETHICS ING E T T I N G C A R E C L O S E R YOUTH-POWERED PROGRAM DESIGN There is growing interest and excitement across the global health sector—and particularly among those working on adolescent and youth sexual and reproductive health (AYSRH)—to reignite the way we design and deliver programs. HCD is a promising and innovative approach to design-thinking, and is often paired with other health systems approaches. The process allows practitioners to develop a nuanced understanding about what matters to people on a deep, emotional level. This intimacy is crucial, but could also cause harm if we do not uphold ethics throughout each stage of the design process. Through the leadership of PSI and the HCD Exchange, a representative group of implementers, designers and funders, developed this Commitment to honor and uphold ethical principles when conducting HCD with adolescents and youth. By signing this Commitment, the AYSRH community of practice commits to ensuring young people’s dignity and welfare when we put them, along with their wellbeing and data, at the center of design.

A SNAPSHOT OF THE PRINCIPLES

Whether they are implementing HCD or engaged as participants, adolescents and young people are our partners.

Foster environments that are safe, private and give adolescents and youth the power to express their voices and creativity in partnership with supportive adults.

The people and organizations embedded in local contexts are the experts of those contexts and cultures.

Strive for the equitable participation of adolescents and youth from across different genders, levels and positions of power in HCD work.

It is our responsibility to openly and honestly communicate expectations of the HCD process to all involved, most importantly the communities that are engaged in prototyping.

The emotional and physical wellbeing of adolescents and youth take priority over everything else.

1 2 3

Respect for adolescents and youth is core to ethical HCD for AYSRH.

4 5

HCD does not replace robust research when that research is needed. HCD interventions build on what is known in addition to adding new value.

It will take true partnership to fulfill our Family Planning 2020 goals. We are, therefore, asking organizations and individuals, including young people, to join hands with us by signing onto this Commitment.

JOIN

TEAR HERE

Tear this sheet out and drop off your signed Commitment at PSI’s ICFP booth (56 & 57) or sign and snap a photo, post on Twitter with #InMySquad and tag @PSIImpact! Name

Organization

Title

GE T TING CARE CLOSER

PAVING PATHWAYS TO CONTRACEPTIVE SELF-INJECTION In recent years, Malawi has seen significant improvements in increasing access to, and use of, modern contraception for girls and women. The modern contraceptive prevalence rate (mCPR) among married girls and women aged 15-49 reached 58 percent by 2016, up from 42 percent in 2010.

We understand that closing gaps in unmet needs mandates that we not only bring care closer to girls and women, but also place the decision-making directly into their hands.

But despite these gains, one in five married Malawian girls and women of reproductive age wants but still does not have access to modern contraception. Unmet need is highest among 15-19-yearolds, with one in two unmarried girls confronting gaps in access. In contrast, one in five married girls aged 15-19 have an unmet need for contraception. In 2016, three in 10 girls aged 15-19—most of whom live in rural areas—were bearing children. Paving new ways for girls and women to access the services and tools they need—to plan for the families and lives they want— remains the priority. The Malawi Costed Implementation Plan for Family Planning sets forth an ambitious plan for reaching the country’s Family Planning 2020 (FP2020) commitment, namely ensuring that three in five Malawian girls and women have access to modern contraception by 2020. It’s a bold pledge, and one that focuses heavily on our country’s largest demographic: adolescents and youth. Driving change requires overcoming long-standing challenges. The number of Malawian health facilities providing sexual and reproductive health services remains low; even more, the proportion of the population living within a five-mile radius of a health facility declined from 81 percent in 2011 to 76 percent in 2016.

(Photo Credit: PSI/Emma Beck)

I M P A C T M A G A Z I N E N O . 24

Learning lessons from previous years, the biggest increase in Malawi’s mCPR coincided with the expansion of communitybased disruption of injectable contraceptives. In 2016, three in 10 Malawian girls and women aged 15-49 used injectables. The evidence suggests that the discrete nature of injectables, as well as the ease in access through community-based distribution, fueled the uptake rates. This was an opportunity. That’s why in May 2018, the Malawi Ministry of Health and Population (MOHP) agreed to roll out contraceptive self-injections across the country through a phased approach for the next three years.

T H I S WA S A N O P P O R T U N I T Y. After a pilot project was conducted in the southern region of Malawi, evidence showed that women, when properly trained, were able to self-administer the injections. Self-injection was also likely to increase continuation of contraception. Introducing selfinjections in Malawi was an effective intervention the MOHP identified to bring services to some of the hardest-to-reach consumers, while delivering a sustainable workaround from the low numbers of community health workers trained to administer injectables. It’s part of our collective approach to drive toward our FP2020 goals. As a country, we see these efforts as a core part of how we are giving girls and women the tools to make healthy choices about their bodies and for their lives. For girls and women alike, selfinjection puts power into their hands. Girls and women can easily access the method in their communities and administer selfinjections in privacy, at a time and place convenient for them.

DR. FANNIE KACHALE Director of the Reproductive Health Department of the Ministry of Health and Population of Malawi @MoHandP_Malawi

GE T TING CARE CLOSER

YOUNG PEOPLE KNOW WHAT IS RIGHT FOR THEM As I reflect on the extraordinary achievements that will be highlighted during the 2018 International Conference on Family Planning (ICFP), I am gratified by the progress the field has made over time. However, we all have more work to do to ensure every woman and girl worldwide can live with dignity and have a voice in the decisions that affect her life. To reach the Family Planning 2020 goals, we need to ensure not only women and girls’ access to quality services but, equally as important, that we place the voices and experiences of women and young people at the center of the work. Women and young people are not simply the recipients of reproductive health services, but rather the agents of change in designing, defining and advocating for services that meet their specific desires and expectations. The David and Lucile Packard Foundation recognizes the need for finding new leaders, organizations and ideas to achieve these goals. To do this, we are supporting the next generation of leaders in a movement to define what type of reproductive healthcare is right for their own lives.

EACH TIME WE ASK PEOPLE FOR THEIR WE ARE INSPIRED B KNOWLEDGE, INSIG PASSION.

information and use their collective voice to get the quality care they want, need and deserve. The Packard Foundation’s role, based on the lived values of my parents, is to support the best leaders and organizations who can drive meaningful, lasting change. We constantly evaluate our progress, adapt our efforts and ask ourselves: How do women and girls define what quality care looks like? When looking at new ways of providing health services, are we measuring both quality and access? Are we making room for young people to lead? I encourage all of us to keep these questions front and center as we work together to make a real difference in the lives of women and girls everywhere.

SUSAN PACKARD ORR Chair of the Board of Directors of the David and Lucile Packard Foundation @PackardFdn

YOUNG IDEAS, Y THEIR HT AND

Through our Quality Innovation Challenge, first launched at the 2013 ICFP in Ethiopia, we supported a project to help young people define youth-friendly services, act as “mystery clients” to assess the services provided and to give feedback to the facility managers and providers. This project has demonstrated that young people can play an important role in improving the quality of care and delivering youth-friendly health services. We have also invested in the Youth Champions Initiative, which connects outstanding young leaders to peers and mentors, provides skills development and supports their innovative, locally-grounded solutions to sexual and reproductive issues. Young leader Tinbit Daniel partook in the project and created an animated TV series called Tibeb (meaning wisdom in Amharic) Girls, featuring teenage girl superheroes who fearlessly solve real-life challenges Ethiopian girls face by modeling empowering behaviors. These two youth-led projects are examples of many effective efforts we enthusiastically support. Around the world, we are seeing real change in how women and young people receive

(Photo credit: PSI/Manprit Shergill)

GE T TING CARE CLOSER

THE QUIET REVOLUTION THAT'S

BRINGING HEALTHCARE CLOSER TO YOU At 30 years old, Riziki Karisa is already the mother of 10 children; her youngest arrived just last spring. Living in a remote area of Kilifi County in coastal Kenya, she never had the chance to go to school, and her family survives on the income she and her husband earn from gathering wood and selling charcoal. For years, Karisa asked her husband if she could use contraception, permission she believed she needed based on the cultural norms of her community. With each ask, he said no. That was, until a community health worker visited the couple and offered counseling on their doorstep. Her husband agreed and she received an IUD at a local clinic. Bringing health information and services directly to consumers is a quiet revolution that is disrupting healthcare systems worldwide. New technology and task shifting to community health workers bring care— previously provided only by medical professionals in brick and mortar facilities—directly to patients, while making it safer and more affordable. Mobile phones and tablets allow community health workers to collect data and bring information and care directly to consumers in even the most remote areas.

THIS IS ONE OF THE MOST E XCI T IN G P U B L I C H E A LT H DEVELOPMENTS OF OUR TIME. AND IT’S NOT JUST ONE WE’RE SEEING IN THE GLOBAL SOUTH. In the U.S., skyrocketing healthcare costs and frustration over lack of access are fueling the community-based trend. In a low-income neighborhood in east Greensboro, N.C., residents walk down the street to the Mustard Seed Community Health Clinic, receiving treatment for common ailments like high blood pressure, asthma and yeast

I M P A C T M A G A Z I N E N O . 24

infections, as well as other basic health services they had trouble accessing before. For many residents, it’s the only healthcare they receive. “Many people in the community don’t have cars or gas money,” says Dr. Beth Mulberry, who helped found the Mustard Seed Community Health Clinic in 2016 and serves as its sole physician. “They don’t have a way to get to a doctor. We have patients with hypertension who haven’t received care in years.” Mustard Seed recruits community health workers from the surrounding neighborhoods, which include large immigrant and refugee populations. They make home visits, hold community meetings and spread the word about the clinic and its services. The clinic’s central location in the neighborhood is critical. “Primary care makes more sense in a community setting,” Mulberry notes. “You can [only] develop the trust of the community if you are part of the community.” The revolution is also underway in hundreds of CVS drug stores across the U.S. Customers can get treatment for ailments from strep throat to sexually transmitted infections to minor burns at the chain’s new “Minute Clinics.” Mainly staffed by certified family nurse practitioners and physician assistants, the clinics provide services that most Americans have traditionally received at a doctor’s office. “We’re in the community, we’re seeing those patients, we’re becoming part of their daily lives and routines,” CVS Chief Executive Officer Larry Merlo said in an interview with the Hartford Courant last year after the company’s merger with Aetna aimed to create a new model for healthcare. “We can help them achieve their best health and, at the same time, reduce the cost of healthcare today.” This trend is unfolding in Kenya, too.

GE T TING CARE CLOSER

As a thought partner and investor in a three-year pilot project implemented by Population Services Kenya, I’m seeing firsthand the advantages of training community health workers to provide a variety of contraceptive methods, including implants. Providing implants during home visits can be a game-changer, offering protection for up to five years so women can better manage their fertility. The pilot project advocates for a change in Kenya’s policy, which, similar to policies in most countries, requires that only medical professionals insert implants. This policy dramatically limits access, especially for women in remote areas. The project seeks to demonstrate that community health workers, who are widely available, can safely perform the procedure.

average; 22 percent of teens still experience unintended pregnancy. Improving those numbers will take innovative, community-focused solutions. The good news is that mobile, medical and diagnostic technology can change the way we diagnose, treat and manage health, and allows us to put more basic care and control directly in consumers’ hands. We can bring this care closer to consumers’ front doors to reduce the burden on health systems and improve health outcomes. What’s needed now is a wave of policy change that allows consumers and health workers to do just that.

(Photo credit: What Took You So Long?)

Task shifting is already underway. The Kenyan government recently approved a policy allowing community health workers to administer contraceptive injections that provide protection from pregnancy for three months. This progressive move paves the way for further change. Kenya has made strides in improving its contraceptive prevalence rate, surpassing its national goal and hitting 62 percent in 2016, but huge areas remain underserved. In Kilifi County, only three in 10 women use modern family planning methods. Teenage pregnancy is higher than

ANN MORRIS Maverick Collective Member @annmorrisNC

Ann Morris is a member of Maverick Collective, a philanthropic and advocacy initiative of Population Services International that is focused on improving the lives of women and girls in the developing world.

GE T TING CARE CLOSER

A DAY IN THE LIFE In Malawi, three in 10 girls aged 15–19 have had—or are expecting—a child. Half of these girls will be married by the time they are 18-years-old, and only one in five will have a comprehensive knowledge of the risks posed and what they can do to avoid contracting HIV/AIDS. These are numbers.

But behind each statistic is a young person navigating the realities of life, and the complexities Malawian youth face in making decisions that will shape their futures. Through this photo series, please join me as I step into the lives of Malawian adolescents living in Thunda, a rural village in northern Malawi. These images offer a glimpse into what it looks like to live in a remote area. This is what it looks like to have unmet needs in accessing health services. And this, for so many adolescents and youth across my nation, is what it looks like to live a day in the life as a young Malawian.

An adolescent couple and their toddler chat with a friend. The friend is in secondary school, but like so many adolescents and girls, she faces a heightened risk of dropping out of school due to unintended pregnancy.

I M P A C T M A G A Z I N E N O . 24

TANAKA CHIROMBO HIV/AIDS and SRHR facilitator, Youth and Society @TanakaChirombo1

Two adolescent girls walk to a traditional healer—what Thunda residents refer to as a witch doctor—to access health services. It’s a popular practice in rural areas even if, in most cases, the visit doesn’t deliver the intended results. Witch doctors lack medical knowledge and proper equipment to perform procedures or administer the right herbs. Some witch doctors blame the patient for causing his or her sickness. This often dissuades or blocks young people from accessing the information and health services they need.

GE T TING CARE CLOSER

Thunda’s village headman Mr. John Nyirenda and his wife talk to their grandson about his life and health while tending to the crops. In Malawi, parents and grandparents are key influencers who inform how adolescents make decisions about their bodies and their futures.

A young boy molds bricks to earn a living. High fees for school exams cause many young people like him to drop out of school.

A girl chats with her friend, who has dropped out of school. Many girls stop attending secondary education due to pregnancy or marriage. In areas far removed from the big cities, and without job prospects for those who do complete school, some girls say that they don’t see any benefit in completing their education. (Photo Credits: Tanaka Chirombo)

Adolescent girls pass time by chatting after completing their household chores. In Malawi’s rural villages, it’s beautiful to watch how young people talk together and help each other. 33

GE T TING CARE CLOSER

This young boy dropped out of school. He now farms to earn money, which gives him spare cash to grab a drink with friends.

Unfriendly healthcare providers result in many young people turning to friends, rather than health workers, for all things contraception. But gleaning information from friends means that young people may not receive the correct information on how to properly use and dispose of contraceptive methods like condoms. Moreover, rural Malawians may often feel they don’t need to use condoms given a widespread belief that sexually transmitted infections are only found in towns, rather than villages like Thunda. Only one in two Malawian girls aged 15–19 uses a condom to reduce her risk of contracting HIV.

Unlike government-run hospitals—the closest of which is 48 miles from Thunda—services at mission-run hospitals like this one are not free. In rural parts of Malawi, health services and staff are limited, and medical equipment may be outdated.

I M P A C T M A G A Z I N E N O . 24

GE T TING CARE CLOSER

Youth in rural Malawi walk great distances to school, which deters girls and boys alike. But the risk of Gender-Based Violence (GBV) for girls, in particular, is high. Sixty-five percent of girls in Malawi experience GBV in their lives, including heightened risk for rape as they pass through the bush.

(Photo Credits: Tanaka Chirombo)

Many young rural Malawians play games in their free time. Social interaction is a core part of how rural youth live their lives.

Bawo is a traditional mancala board game played in many parts of East and Southern Africa. Thunda men—young and old—gather to play. It’s a safe space for young men to raise questions about their health, family planning and what's best for their futures. 35

GE T TING CARE CLOSER

YOUTH AMBASSADORS: TELL ALL We young people aren’t just the future. We are the right now. As an International Conference on Family Planning (ICFP) Youth Ambassador and lifelong youth activist, I join more than 600 of my peers in representing the generation that is driving forward the ways in which public health works with—and for—youth like me to create solutions that serve our unique life trajectories. We can tell you about our hopes and our dreams. We can speak first hand about the obstacles that are too often blocking our access to the health services we need the most. And we can reflect on our diverse realities that shape our health rights in a world we have inherited. Our voices are powerful. But don’t take it from me. Listen to us all. Here’s my challenge to you: Find an ICFP Youth Ambassador at the conference, and engage in dialogue by asking any or all of the questions below. You can even make notes directly on this page, and bring the sheet to the Population Services International’s ICFP booth (56 and 57). To top it off, you’ll also receive a small token as our way of saying thank you for hearing our voices.

SURABHI DOGRA Manager, Public Health Foundation of India @SurabhiDogra

Youth Ambassador's Name:

Imagine yourself as a community health worker. How would you integrate local traditions and new technologies to position contraception as relevant and valuable for young people?

In your native language, what is a youthful tagline that resonates with you? Why?

What’s important to you right now? How does that influence how you make reproductive health decisions?

I M P A C T M A G A Z I N E N O . 24

What’s one way public health practitioners can integrate youth into programming, from big picture decision-making to on-the-ground service delivery?

Think of a pop culture reference that misrepresents young people’s sexual behaviors and attitudes. How would you tell the story?

What policy change would revolutionize how young people and their influencers not only perceive but access modern contraception?

A NEW WAY OF FUNDING A SMART START TO CONTRACEPTIVE ACCESS Ayana has a dream for his 25-year-old sister. It’s a dream for the same sister who teasingly calls him “competitive.” Ayana prefers his mother’s more flattering description of “brave.” But however you label them, these two characteristics feed Ayana’s commitment to helping girls find a pathway to achieving their dreams. “I want to see my sister become a person who can fully choose what she wants for her future,” the 27-year-old says. Across Ethiopia, ingrained cultural barriers often prevent young people from accessing the information and resources they deserve to make decisions about their sexual and reproductive health (SRH). Girls grow up without an understanding of the role contraception plays in planning or preventing pregnancy. Boys, Ayana says, grow up thinking contraception is not their problem. But it is. Shifting behaviors require new ways of broaching conversations around SRH. And through Adolescents 360 (A360), young people like Ayana are designing this new reality. Ayana is one of more than 280 young designers for A360, a youth-powered SRH project that works with and for young people to reimagine how girls aged 15-19 access and perceive contraceptives across Ethiopia, Nigeria and Tanzania. In Ethiopia, A360’s Smart Start uses financial planning to position contraception in service of rural couples’ self-defined goals. Girls and their husbands map out how much a child would cost in contextually relevant terms (like a sack of grains), a component developed with young designers like Ayana. One in two girls who interacts with Smart Start takes up a contraceptive method, of which three in 10 are long-acting methods. Smart Start equips young girls, like Ayana’s sister, with the tools to drive forward their futures. “I feel proud of this work and of what this means for our country's future,” says Ayana. —With Contribution from Emma Beck, Associate Communications Manager, PSI @emmashoshanna (Photo credit: PSI Ethiopia) (Illustration credit: Cassie Kussy)

IGNITING youth access to contraceptives

lthough there is progress, use of modern contraceptives in Haiti remains stubbornly low. At 31 percent, the country’s unmet need for family planning is among the highest in the world. Haiti also has a high rate of teen pregnancy, which intensifies risks for both girls and their babies. A startling one in three of those who give birth are under 20 years old. Fifty percent of girls and women ages 15 to 24 want contraception but don't have access to it. “We cannot continue to bury our heads in the sand when we have pregnancies that are happening to 14 and 15-year-olds,” says Dr. Reynold Grand' Pierre, director of the Family Health Unit of Haiti’s Ministry of Health. In support of efforts to reverse adolescent and youth sexual and reproductive health and rights (AYSRHR) trends in the country, PSI and the Dutch Ministry of Foreign Affairs have joined forces with the government of Haiti. Countering the risks associated with early pregnancy and unsafe abortions necessitates radically broadening how girls can source sexual and reproductive health services. Doing so effectively, however, requires better addressing the supply and demand realities on the ground. Through the Ignite project, PSI is working to give young consumers easier access to family planning solutions by transforming the health market and ensuring sustainability beyond the life of the project. We take a look at the different players along the supply chain working to increase and sustain the informed use of contraception among Haitian girls and women aged 15 to 24.

CAN N OT

CONT INUE BURY THE HAV E ARE

OUR SAND

TO HEADS WHEN

IN WE

PREGNANCIES HAPPENING

T HAT 14

AND

15-Y EAR-OLDS,” –DR. REYNOLD GRAND' PIERRE, DIRECTOR OF THE FAMILY HEALTH UNIT OF HAITI’S MINISTRY OF HEALTH

A N E W W AY O F F U N D I N G

THE CONVENOR OF MARKETS

PSI has a long been a key player in the family planning space in Haiti. In the early 1990s, PSI, in collaboration with USAID, successfully introduced the socially marketed Pantè condom brand, which became a household name. Despite widespread familiarity with condoms, injectables and oral contraceptives (OC), close analysis of the market revealed that most modern methods were largely unknown or simply absent in the private sector, where most Haitians seek care. OHMaSS, PSI’s local affiliate, discovered that the challenge was not getting commodities to Haiti, but instead was the means for wholesale distribution once the products arrived in the country. With a focus on increasing the availability and variety of contraceptive products, OHMaSS found a likely partner and presented Disprophar, a commercial distributor, an opportunity to become a leader in the contraception space. As a result, the distribution partner added to its business model a portfolio of family planning products, including OC, emergency contraception, intrauterine

devices (IUDs), implants, the injectable Sayana® Press and medical vacuum aspiration kits for post-abortion care. “In addition to our own brands, we leveraged our partnerships with manufacturers Merck and Pfizer to offer a menu of high-quality contraceptives at competitive prices,” explains Stéphane Docteur, OHMaSS medical services coordinator. “We took a big bet that we could change the way we do business in Haiti,” says Frédérick Persoons, OHMaSS executive director. “Now it’s a matter of promoting and making women aware that these methods are available on the market.” As a market convener, OHMaSS not only unblocked obstacles to supply, but also started to drive demand. Frédérick and his team looked no further than PSI’s Adolescents 360 (A360) project, which aims to increase contraceptive access for adolescent girls in Ethiopia, Nigeria and Tanzania. Applying an A360-inspired Human-Centered Design approach, OHMaSS worked alongside adolescent girls and young women (aged 15-24) to understand their

experiences, needs and barriers surrounding contraceptive access and use. Utilizing insights gathered, OHMaSS launched a multilayered marketing campaign built around the idea of creating a youth movement. The campaign is Djanm, which symbolizes strength, determination, vigor, dynamism and tenacity in Haitian Creole. It encompasses participation in major cultural events such as Carnival, organization of youth-focused events called Djanm Buzz in local communities and a presence on social media channels like Facebook and Instagram. Djanm’s dedicated Facebook page features videos, live Q&A with providers and other interactive content that has become a viable touch point to reach youth with AYSRHR information and services. At the community level, Djanm’s trained youth ambassadors are another element of the campaign critical to spreading the message to their peers. Already, Frédérick and his team have a greater vision for Djanm, “We want to create a movement that can serve as a sponsor to any form of positive attitude or activities that are related to sexual and reproductive health.”

The OHMaSS staff outside their office in Port-au-Prince. (Photo credit: OHMaSS/Maxence Bradley) 39

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THE DISTRIBUTOR

Daniel Malherbe greets guests at Disprophar, the pharmaceutical distribution company he founded with two colleagues 30 years ago, like he’s welcoming guests in his home. Disprophar’s founders, who started their careers as pharmaceutical sales representatives, are bringing their vast experience to help OMHaSS create a market for family planning products and services in the Port-au-Prince metropolitan area. Until recently, the family planning market in Haiti was completely supported by international nongovernmental organizations (NGOs). But a gap in NGO-provided reproductive health products has opened up the opportunity for a sustainable private sector market. “We have a social responsibility to diminish the number of unwanted children in Haiti,” remarks Daniel. “But first, we must sell family planning—not just the products, but family planning as a concept—to the Haitian people.” They’ve done it before and intend to do it again. Haitians are predisposed to eye diseases like glaucoma. But until recently, there was little demand for ophthalmology services due to lack of awareness. The Disprophar team identified the opportunity and launched a large-scale campaign to raise awareness about glaucoma and the importance of regular eye exams. With the help of a robust radio and television advertising campaign, Disprophar reached millions of Haitians and changed behaviors related to eye care. “We sold the disease, not the products,” Daniel says. “We must do the same thing for family planning.” Marie Lucie Poteau is part of the dedicated team of medical detailers employed by Disprophar to do just that. She focuses on getting doctors to both carry the family planning products that OHMaSS procures and counsel their patients— especially young women—on the benefits of contraception. She also connects the providers to trainings offered by OHMaSS.

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From left: Staff members Daniel Malherbe, Rapha lle Jean-Baptiste, and Jean Clifford Deshommes at Disprophar headquarters. (Photo credit: OHMaSS/ Maxence Bradley)

Disprophar General Director Daniel Malherbe. (Photo credit: OHMaSS/Maxence Bradley)

A team of commercial detailers focuses on working through pharmacies to get the products into the hands of consumers. They cater to more than 200 outlets in the Port-au-Prince metropolitan area, ranging from pharmaceutical depots, to high-end drugstores, to small shops. To help them more effectively sell their products, OHMaSS used an application called BaseCase. The tool helps manage potential objections from providers. Individual providers are categorized as one of the following: ‘aware of the products,’ ‘ready for trial,’ ‘already adopted,’ ‘advocate.’ Depending on where the provider falls, BaseCase provides videos and information

sheets that medical and commercial detailers can use to influence behaviors at each level. But Marie Lucie emphasizes that she doesn’t encounter much pushback from doctors. “My experience is that most doctors are willing and just need us to help them cut through the myths Haitians have about family planning.” Daniel and his team are optimistic about the market. “There is a huge unmet need for family planning services here. I only see demand going up.”

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"We have a social responsibility to diminish the number of unwanted children in Haiti, remarks Daniel. But first, we must sell family planning—not just the products, but family planning–as a concept—to the Haitian people."

“

OHMaSS Nurse Maritane Henry offers a client Meuri oral contraception. (Photo credit: OHMaSS/Maxence Bradley)

THE PROVIDERS

Many people are under the impression that women in Haiti do not take the proper precautions to avoid unwanted pregnancy. The truth is that most often these women don’t know they have options or where to turn. This is the reality that Dr. Pascal Thierry often faces. He is among the 150 providers— nurses and doctors—in the Port-au-Prince metropolitan area who were trained by Disprophar and OHMaSS to provide youthfriendly modern contraception services. He takes a break from his busy patient schedule to chat with Marie Lucie, the Disprophar medical detailer who sells him family planning products, including implants and IUDs. Few of his patients request family planning methods. “Those with more education ask for it,” says Dr. Thierry, “but other women, they don’t mention it at all.” Nevertheless, Dr. Thierry counsels women on family planning when he thinks the time is right.

“After I deliver a baby, I talk about a method. Twenty to 30 percent of women come back for one. If I think someone is sexually active, I’ll counsel her, too. But it can be awkward, especially if she comes in with her parents.” Dr. Thierry thinks PSI’s Djanm initiative is crucial to turn things around. “It’s a good project. We must reach young women in their early 20s who don’t want to get pregnant. I want them to say to me, ‘I saw this on Facebook and I want a method.’” Across town, more than 100 women crowd into the local community center in Simon-Pelé, a neighborhood bordering the infamous Cité Soleil slums. They are gathering for the OHMaSS mobile clinic that calls the community center home once every three months. Nurse Maritane Henry, whose mobile clinic team regularly visits underserved areas like Simon-Pelé, credits improved awareness in the community for the turnout. Many of the women learned of this mobile team through community criers who circulated through the neighborhood announcing the upcoming services.

“The mobile clinic is a way to provide services for those who cannot pay,” explains Maritane. Distribution is capped at 10 percent of the market so as not to interrupt the long-term health of efforts to go beyond aid. All of the women who visited the clinic were aware of at least one modern contraceptive method, the most common being condoms and injectables. Some were afraid of contraception after having heard stories of medical procedures gone wrong or being told by parents or peers that birth control is not good. At their local pharmacies, consumers can now purchase emergency contraceptives and, with a prescription, birth control pills and injectables. “There is always a shortage of emergency pills, because it is less expensive. We often have to suggest alternative methods because we stockout,” remarks pharmacist Leo Guerson. Providers like Leo must also get acquainted with new products and new brands that have replaced those that were discontinued. But there is much excitement for the new arrivals and providers are eager to test how the new products and brands fare with consumers. The next big challenge for OHMaSS is to design a network of clinics to help ensure service providers are youthfriendly, and to build partnerships that effectively spread the word. THE MENTOR “Yell loud so the priest can hear!” As usual, Lindsay Toulouse starts her peer counseling session by encouraging the young participants to belt out the Djanm motto: My life is my choice. 41

GE T TING CARE CLOSER

Lindsay Toulouse leads a Djanm youth session outside of the local Catholic church. (Photo credit: PSI/Evelyn Hockstein)

Not only are most of the participants members of Lindsay’s own Eucharistic Youth Movement chapter, this particular session is being held in the courtyard of a local Catholic church, with full blessings from the priest. At 22 years old, Lindsay is one of 19 peer mentors with the Djanm campaign, which aims to educate young Haitian women and men about family planning and empower them to play an active role in choosing the method that is right for them. “Many girls in my neighborhood are getting pregnant. I see it a lot, especially when I go to the mobile clinic. Last week, there was a 14-year-old holding twins.” Lindsay is a second-generation helper. Her father died when she was three years old. From that moment on, her mother Marie Carol Laurent dedicated herself to raising her children. She never remarried, and her professional career centered on helping people as a nurse, which inspired Lindsay to join the OHMaSS team as a community health worker. Marie Carol has seen all too well the damage unwanted pregnancy can inflict

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on young Haitian women. She mentions a girl who got pregnant and tried traditional methods to end her pregnancy. She was unsuccessful and after she had the baby, she visited Marie Carol, who told her about modern contraception. “It’s so important. Young kids don’t want to get pregnant and now that they can see Lindsay beforehand, it’s better.” Lindsay just finished her law studies and is writing her thesis. She also works full-time with Djanm. Every other day, she conducts one or two sessions educating her peers on contraceptive options and connecting them to providers through referrals. She also identifies community leaders in churches, schools and community centers who she can approach to advocate for the Djanm campaign. Getting people to attend her trainings is the hardest part of her job. But she remains confident in her message. She wants people in her community to be aware of how they can protect themselves from unwanted pregnancies.

THE CONSUMER

It takes Junie nearly two hours to travel to the clinic. To get there, she takes a tap tap, one of the iconic colorful buses that are most Haitians’ favored mode of public transportation. Then she hails a private taxi. She makes this trek every three months. She trusts the OHMaSS-trained nurses and doesn’t want to go anywhere else. “I came for the first time in December 2017,” Junie says. “I got an implant, but I had to take it out.” Junie lives with her older brother and sister. When they saw the implant under the skin in her arm, they told her to move out of the house. “They said I’m living a messed-up life. But I just don’t want a baby.” After an open talk with her siblings, they agreed to turn a blind eye as long as they couldn’t see the method. That’s why she asked Nurse Maritane Henry, the woman who runs the OHMaSS mobile clinic, to remove the implant and start giving her injections. And that’s why she returns to this clinic every three months.

After each visit Maritane gives Junie a note reminding her when to return. Junie is open about why she’s here. She is sexually active with her boyfriend Augustin, who is 22. They met when she was visiting a relative’s neighborhood. He saw her on the street and said, “You look like a model. Can you spare two minutes?” She agreed, and they made a date. They’ve been an item since, going to movies and spending time at each other’s homes. Augustin is supportive of Junie’s decision. “He appreciates that we don’t have the economic means,” she says. “He knows I have dreams.” Junie wants to be a nurse just like Maritane. “I’d like to be in her place. I would like to help women protect themselves. I would like to serve people like that.”

ALIA MCKEE

Principal, Sea Change Strategies @Aliamc

SANDY GARÇON

External Relations and Communications Manager, PSI @SanGarcon

Junie recieves her regular contraceptive injection at the Djanm community clinic. (Photo credit: PSI/Evelyn Hockstein)

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INVESTING IN FAMILY PLANNING

FOR A LIFETIME OF RETURNS For more than two decades, the global development community has anchored support for contraception in its role of advancing the reproductive health and rights of women worldwide. Since the 1994 Cairo Conference on Population and Development, family planning has been framed as a means to enable women to freely determine whether, when and how many children they will have. Many shied away from touting the economic benefits of family planning to avoid conflating it with the idea of population control and coercion. The health benefits of contraception—preventing unintended pregnancies,

averting unsafe abortions and reducing maternal and child deaths—were strongly emphasized while economic benefits were seemingly relegated to the background. A welcome development in recent years is the accumulation of evidence on the extensive and far-reaching dividends that investments in family planning yield beyond improving women’s health. We now know more definitively that family planning also leads to more educated communities, a healthier population and planet and wealthier nations.

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Family planning is the second-best “buy” for global development after liberalizing trade, a conclusion endorsed by Nobel laureates and other leading economists after their assessment of development priorities related to the Sustainable Development Goals. This research, published by the independent Copenhagen Consensus Center, indicates that achieving universal access to contraception could result in long-term health and economic benefits worth $120 for each dollar spent on family planning. Family planning helps nations climb the economic ladder faster. Harvard economists David Bloom and

David Canning estimated that a third of East Asia's economic boom was due to favorable changes in population size and age structure, which were brought about by smaller family sizes. This boost to economic growth is called the demographic dividend. A recent study projected that per capita income in Kenya, Nigeria and Senegal could rise by 47 to 87 percent by 2050 if their unmet need for family planning is satisfied. Government investment in family planning more than pays for itself. Economist Scott Moreland calculated

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that each dollar invested in family planning allows a government to forego $2 to $6 dollars of spending on other social services like education and immunization. Those extra dollars can go toward infrastructure, health and education to help governments harness the demographic dividend. Yale economist T. Paul Schultz found that family planning not only leads to better health and more education for both women and their children, it also results in higher income and greater household assets for their families. He reached this conclusion after analyzing data on the enduring effects of having improved access to family planning in Matlab, Bangladesh 20 years after the initial intervention. Family planning lifts families out of poverty. University of Michigan economist Martha Bailey and others found that in the U.S., people born in counties which received funding for family planning programs in the 1960s

Family planning promotes our planet’s health. Project Drawdown, led by noted environmentalist Paul Hawken, estimated that investments in family planning that slow down population growth will reduce carbon emissions by nearly 60 gigatons through 2050. Together with investments in girls’ education, these two strategies are considered the most effective existing solutions to mitigate climate change. All this evidence points to the same conclusion: family planning is one of the smartest and most cost-effective investments a country can make. We believe this is a key reason why there is renewed interest in family planning in sub-Saharan Africa. Because of stronger government and civil society support for family planning, the uptake of modern contraceptive methods has dramatically increased in countries like Ethiopia, Kenya, Malawi and Rwanda, paving the way for them to reap these benefits. However, many other stakeholders have yet to understand family planning’s exceptional return on investment and act on this information. Research confirms that family planning stands out as a development strategy because of the myriad of long-lasting benefits that it delivers. This message needs to be more widely and convincingly told. Let us reposition family planning as a development solution that goes beyond improving reproductive health and protecting women’s rights. Family planning is transformational not only because it enables girls and women to chart their own destinies, but also because it grows the economy, reduces poverty, promotes well-being of families, improves national security and safeguards the future of our planet.

(Photo credit: PSI/Manprit Shergill) DR. JOSE G. RIMON II

were 2 to 4 percent less likely to live in poverty in their childhood and as adults. Family planning improves a country’s political stability. Political demographer Richard Cincotta showed that countries with a youth bulge have a high risk of social unrest and political violence. This risk will dissipate when the youth bulge shrinks and each adult supports fewer children, which can be achieved through fertility decline.

Director, Bill & Melinda Gates Institute for Population and Reproductive Health, JHSPH and Director of The Challenge Initiative (TCI) Project @OyingRimon @GatesJHU

DR. J.M. IAN SALAS Assistant Scientist at the Department of Population, Family and Reproductive Health and Research Economist at the Bill & Melinda Gates Institute for Population and Reproductive Health, JHSPH @GatesJHU

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CHANGE STARTS WITH CHOICE: A GLOBAL APPROACH TO REPRODUCTIVE HEALTH Q&A WITH JESS JACOBS, MAVERICK COLLECTIVE MEMBER Young people who choose their health decisions often grow into adults who take charge of their lives. This is how change happens. For actress, speaker and advocate Jess Jacobs, choice and change start by ensuring women and girls worldwide can access sexual and reproductive health services when and how they need. But as she shares, solutions are not a country-by-country process. What happens in one part of the globe shapes and shifts the realities in places philanthropists like Jess devote their time and resources. Jess offers insight on how the next generation of philanthropists can ignite change by starting with choice. Victoria Milanzi: How do we examine adolescent-centered reproductive health solutions and access from a global perspective? Jess Jacobs: A U.S. administration shift [and reinstatement of the Mexico City policy] can topple years of work and effort in an instant in countries that rely on the U.S. for reproductive health funding. Similarly, a political change in a country in West Africa or Southeast Asia can impact the fight for access and rights, and the future of the country’s youth—all of which reverberates outward. Uncovering and applying reproductive health solutions cannot be approached as a zero-sum game. My Maverick work in Côte d’Ivoire is innovating how young people access modern contraception. It is leaving us with lessons that we can apply to all types of advocacy and philanthropic work in the U.S. Moreover, the impact and outcomes of work in the U.S. can influence how we approach uncovering solutions in Côte d’Ivoire. VM

How can the ability to choose one’s own health decisions equip the next generation of women to contribute to their country and to social change?

We usually think of the word [choice] in terms of choice in what to do with one’s own body, which is an

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(Photo credit: Katy Godfredson)

intrinsic element of reproductive health work: ensuring that women everywhere have bodily autonomy and the ability to choose what care best suits their needs. However, when those kinds of choices are available to women, it makes the concept of choice available to women in other arenas of life.

THIS IS HOW CHANGE HAPPENS. When a woman has control over her life, she is able to change the narrative for herself—and fellow women—by creating a life built upon her own choices. Choice is not about disrespecting elders or altering family traditions. It is simply allowing an individual to follow her own interests and desires and decide for herself what is right for her. Making her own choices brings her one step closer toward building the life she envisions for herself. VM JJ

How can we evolve philanthropy to address the health challenges of our times?

The issues we face worldwide today are growing exponentially. Our solutions need to match that momentum and growth. That doesn’t mean there isn’t room

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for traditional philanthropy, or that government dollars aren’t crucial to scaling effective programs. Rather, it means that we need to also listen to new voices and constituent voices, integrate our values and skills with our dollars and be willing to risk bigger and better. VM

What does listening to new voices mean to you?

It means taking a participatory approach to program development using a process like Human Centered Design. It means taking an empathetic, “put-yourself-inother-people’s-shoes” kind of approach with the constituents themselves as the leading voices. It means bringing the skillset one has built over the course of one’s life and career to his or her philanthropy. Whatever the philanthropist brings to the table can be incredibly valuable as we all seek innovative approaches to chronic inequalities and challenges. JJ

What questions should the next generation of donors be asking?

JJ The next generation of individual donors has the opportunity to lead the way by taking risks and funding new solutions to old problems. What kind of change do we want to see? What comforts are we willing to give up to facilitate this change? How can NGOs involve voices and philanthropists not trained in traditional development into their work? Answers to these questions have the potential to bring about the exponential change that is critical in addressing the global challenges we’re facing today.

I feel grateful to ICFP for this immense honor, and to Population Services International and the Maverick Collective for the opportunity to be a part of a youth-powered program. But most of all, I feel grateful to the women in Côte d’Ivoire for so generously giving their time, energy and insight in order to build the most effective program possible. Really, this award is about them. Every effort requires financial capital, and it is so meaningful to me to equip this team with needed resources. We are all part of this effort to ensure women worldwide—in Côte d’Ivoire, the U.S. and abroad, have access to the care they so rightly deserve. This is just the beginning.

VICTORIA MILANZI Media Monitor, Malawi Institute of Journalism under UNICEF

JESS JACOBS Maverick Collective Member, Co-Founder of Invisible Pictures, Actress and Advocate for Women and Girls @jessjacobsx

This November, the International Conference on Family Planning (ICFP) will honor you as the Future is Female Award. Tell us what this means to you.

(Photo credit: Katy Godfredson) 47

THE LAST WORD

Disrupting the Norm (Photo credit: Kim Case Burns)

Continuing Impact magazine’s Youth Takeover, PSI President and CEO Karl Hofmann invited International Conference on Family Planning (ICFP) Youth Pre-Conference Co-Chairs Jillian Gedeon and Dr. Catherine Baye-Easton to pen his longstanding column The Last Word, which details how to approach development differently. Here’s their take on what young people really need to transform their lives, communities and countries. Since our introduction to the international family planning community at ICFP in 2013, we have witnessed a shift in family planning development. Programs, conversations and national and international conferences like ICFP 2018 have made an effort to include youth to an extent that we actually didn’t see coming (but hope we had something to do with). Overall, the family planning community gets an ‘A’ for acknowledging youth leadership. It’s been enlightening and inspiring, but we’re voracious advocates who want to see more. As youth, we’re thankful that the family planning community is on the right track. But we have to go further. How? By disrupting two specific norms: empowering youth beyond family planning and changing the way we fund things.

skills. In this case, our work with this youth hits a wall and that potential is never realized. When we commit to supporting youth empowerment through family planning, we have to acknowledge what happens beyond the initial support. Without an enabling environment for that young person to continue growing into a contributing member of society, our investments no longer yield the greatest return. So what do we suggest? Donors and organizations should work together. You cannot simply invest in one area of development in silos and be done. It is imperative that you support other agencies and initiatives so that, together, we are solving the world's problems using a holistic approach. Did someone say demographic dividend?

YOUTH NEED AN

Traditionally, donors lead the agenda and the development we see around the world. But we want the decisions to be made from the ground-up. Rather than approaching nonprofit funding the traditional way and telling organizations how a specific project should be carried out in a specific region, we should do the reverse. Let’s take a page out of for-profit initiatives and approach donors like we would investors. We pitch to you. We tell you the expected return. You use your connections and your expertise to help us get there, and we hustle on the ground to ensure we reach our goals, together. Let’s turn the whole nonprofit industry on its head to ensure that voices on the ground are the ones determining what is being done, the timeline at which it’s being done and why it’s necessary to do it. We’ve come a long way. But let’s go further, together.

ENABLING ENVIRONMENT TO TACK LE AND CHANGE PARADIGMS. AND DEVELOPMENT CAN

Consider a young person who attends a meeting and gains tangible skills and networks, but goes back home to face political, environmental, structural, cultural and/or war-related barriers stopping practical application of these newly acquired

DRIVE THIS.

So donors, we want you to disrupt the existing structures and fast-track this paradigm shift. JILLIAN GEDEON AND DR. CATHERINE BAYE-EASTON

INTERNATIONAL CONFERENCE ON FAMILY PLANNING (ICFP) YOUTH PRE- CONFERENCE CO-CHAIRS

3-6 June 2019 | Vancouver, Canada

The worldâ&#x20AC;&#x2122;s largest conference on gender equality and the health, rights, and wellbeing of girls and women.

From keynotes to social enterprise pitches, workshops to film festivals, poster sessions to exhibition booths, there will be countless opportunities to engage, gather inspiration, and build a more gender equal world. More than 6,000 world leaders, influencers, advocates, academics, activists, and journalists under one roof. Will you be one of them?

ONLINE

psi.org @psiimpact @psiimpact facebook.com/PSIHealthyLives youtube.com/HealthyBehaviors

ADDRESS

Population Services International 1120 19th Street NW Suite 600 Washington, DC 20036 www.psi.org

Population Services International (PSI) is a global non-profit operating in more than 50 countries worldwide, with programs in modern contraception and reproductive health, malaria, water and sanitation, HIV, and non-communicable diseases. As PSI looks to the future, the organization will reimagine healthcare to put the consumer at the center and whenever possible bring care to the front door.