What do Pineapples Have to do with Teens and Contraceptives?
“Pineapples are special!” Cathreen Bukuku, one of PSI-Tanzania’s innovation coordinators, exclaimed as she held one of the spikey fruits out in front of her. She was at the private Arafa Ugweno Health Facility in Dar es Salaam, speaking to a room overflowing with teen girls who listened, captivated. “They stand tall—they are proud! They wear a crown, like a queen who knows her worth and demands respect. And even though they are tough on the outside, they are beautiful and sweet on the inside.”
The girls tittered and smiled—unable to resist the cheeky charm of the pineapple—the mascot for Tanzania’s Kuwa Mjanja (Be Smart) movement, initiated through an investment from philanthropist and design thinker Pam Scott and expanded through the Adolescents 360 Project (A360). The Adolescents 360 project is working to revolutionize the way adolescent girls access contraceptives in Tanzania, Nigeria, and Ethiopia. Latifa Masasi, a nurse midwife at the clinic, popped in and welcomed the girls, her smile warm above the pineapple emblem on her white lab coat.
Kuwa Mjanja, a brand deeply rooted in Tanzanian culture and puberty rituals, is about growing up strong and smart. A key part of the program is making contraceptives relevant to adolescent girls right now. Kuwa Mjanja brings the benefit of contraceptives into a girl’s present by positioning contraceptives as “the first step to making your life your own.” The program promotes contraceptives as a useful tool for girls who dream of a better future. It reassures girls that when they are ready to have the children they dream of, their fertility will be waiting for them. It sends the message to girls who already have children that their destinies are not fixed and their lives are not over.
Kuwa Mjanja activities—like girl-led club meetings for young moms, pop-up goal-setting events in markets, and group sessions held in clinics—give Tanzanian girls aged 15-19 (married and unmarried) fun opportunities to connect with other girls, get to know their bodies, ask embarrassing questions in a safe setting, and think about some immediate life goals and the steps to achieve them. At the same time, all of the girls present are invited and encouraged to have an opt-out private conversation with providers right on site who have been verified (by adolescent mystery clients!) as youth-friendly.
Kuwa Mjanja represents a significant departure from the narrative that we as a public health community have been promoting—ineffectively—for a long time: that “family planning” (a term that young people do not relate to at all) is all that sexually-active girls need in order to finish school and achieve their dreams.
Through A360’s research, we have learned that many girls don’t recognize themselves as “sexually active” unless they are married and, even if they do relate to that term, they don’t think they are going to get pregnant now. As A360’s resident developmental scientist, Ahna Suleiman, from the University of California at Berkeley Center on the Developing Adolescent will tell you, heightened risk-perception is not a hallmark of adolescence. If they are married, girls often feel they have no choice but to prove their fertility and secure their marriage. Many girls have heard scary stories and suspect that using contraceptives is actually a choice to never have children. Messages that extoll the virtues of long acting methods’ effectiveness and minimize bleeding changes do nothing to assuage fears of infertility. And girls know that there are a lot of practical things standing in the way of them finishing school—much less finding a job. When we put ourselves in a girl’s shoes, the stories we typically tell don’t make much sense.
In contrast, Kuwa Mjanja meets girls where they are now. Kuwa Mjanja recognizes that, married or not, girls feel anxious about the future, unclear about their dreams and how to achieve them, scared about the little information they get about contraceptives, and isolated with no one to turn to for an honest conversation and answers they can trust.
One mother brought her daughter to a Kuwa Mjanja session because she has been worried about how to help her daughter thrive in these changing times, and she trusts this hospital. Cathreen invited this shy 16-year-old to read the story of the pineapple out loud to the group.
“Pineapples stand tall,” she whispered, “They stand on their own. That’s who Kuwa Mjanja girls are. You stand up for what you believe in, whether it’s your faith, your rights, or your own body! A Mjanja Girl is worth more than she knows…” Her voice grew stronger “The beauty of a pineapple is in her crown…remember you are a queen, you deserve respect, happiness and love. Mjanja girls don’t settle for anything less. Guard your heart and know your worth.” Her face beamed, framed by her colorful head covering. “Despite its thorns, we love the pineapple for its inner beauty. Let your inner beauty shine! Choose to follow your dreams. Show the world what you can do!” Her voice rang strong and clear across the room, and the girls applauded.
By the end of that session, 19 of the 55 girls went home with a modern contraceptive method, with more scheduling private conversations with Latifa later in the week.
The team at Adolescents 360 believes we’re making significant progress towards understanding how to unlock the huge latent demand for contraceptives among the 25% of Sub-Saharan Africa’s girls aged 15-19 who are having sex, don’t want a baby now, and are doing nothing to prevent pregnancy. The solutions Adolescents 360 is piloting in Ethiopia and Nigeria represent variations on the Kuwa Mjanja model—and they are all showing great promise. In Ethiopia, A360’s Smart Start is using financial planning as an entry point with young engaged and married couples. In Nigeria, A360 is partnering with Society for Family Health on 9ja Girls, a program that teaches girls practical skills around life, love, and health.
And it’s not just Adolescents 360—we see a global movement in the making that encourages youth engagement by embedding contraceptive services inside of empowering activities that girls enjoy and communities support. Projects like Marie Stopes Kenya’s Future Fab in Kenya, Jhpiego’s G-Amani project in Kenya, and PSI’s Ignite activities in Haiti are all helping adolescents unlock their potential with variations on this theme.
Because of that movement, in advance of International Youth Day, we on the Adolescents 360 team are filled with hope. Girls and young couples are deciding to dream, and seeing contraceptives as a first step to making their lives their own. Let’s join together to help them take that step!
Adolescents 360 (A360) is a four-and-a-half year initiative co-funded by the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation (CIFF). The project is led by Population Services International (PSI) together with IDEO.org, University of California at Berkeley Center on the Developing Adolescent, the Society for Family Health Nigeria, and Triggerise. The project is being delivered in Ethiopia, Nigeria and Tanzania, in partnership with local governments, local organizations, and local technology and marketing firms. In Tanzania, A360 is building on an investment from philanthropist and design thinker Pam Scott.
August 9, 2017