One size does not fit all. Segmenting programming to account for where girls are in their unique life stages enable us to better respond to girls’ differing needs.

Girls often lack safe sources—and safe spaces—to turn to for questions about their health and lives. At the same time, girls seek community acceptance yet experience a sense of social isolation as they move into new life stages, like marriage and motherhood.

Youth friendly health service provision furthers trust among consumers served, encouraging girls to return for more.

Increasing where and how girls engage with and partake in services reduces access to barriers.

Offering opt-out services removes friction by making it a norm to partake in contraceptive counseling.

Leveraging who girls define as safe influencers allows interventions to secure buy-in from those who shape how she makes her health and life decisions.

On the down-low: Adolescents often hide their relationships given dating has yet been embraced as a community norm, posing a challenge for how young couples engage in SRH conversations.

School-based SRH education is insufficient and overlooks those who drop out of school: Mozambican adolescents predominantly glean SRH information through their secondary school education, leaving behind girls who have dropped out due to limited access, financial obstacles or distance. For girls, the SRH lessons primarily focuses on preventing pregnancy and finishing school; boys learn about the dangers of and ways to prevent contracting HIV. But with classes taught by teachers who lack deep SRH information, the team found that most adolescents cannot articulate why one should use a contraceptive method, even after undergoing the SRH curriculum.

Privacy is a priority: Girls crave confidentially when accessing SRH services, and don’t feel that health providers uphold their privacy.

Contraception remains taboo: Girls and her influencers, hold deep myths and misperceptions that contraception can harm girls’ fertility or health. Men think long-acting methods change “the taste of women” or harm her physical appearance.

Parents often push girls into early marriages to avoid the shame an unwanted pregnancy would bring onto the family. This complicates how mothers – who girls view as sources for SRH information – impart information to their daughters: namely doing so in a prohibiting way that reinforces abstinence and discourages interaction with boys.

Grouping together outside of school: Vale-a-Pena’s Girl’s Group created a sense of exclusivity among girls where they could engage with peer facilitators who shared their personal reproductive health stories, while initiating “true and false” games to build bonds between girls and the group’s facilitator. Still, amendments were needed: the presence of adults, notably men, chipped at girls’ feeling of the clubs as a safe space to air burning SRH questions.   

Boys, too: Boys clubs, led by male providers, tap into boys’ expressed interested in involvement in SRH conversations. Providers facilities dialogue and then distributed health facility referral coupons for boys to pass along to girls. Yet in a culture in which adolescents stay quiet about their relationships, none of the participants who took a coupon referred a girl to services.

Getting creative and confidential: Program elements like “question boxes” and “true or false games” help dispel myths and misperceptions by offering young people safe and at times anonymous ways to explore questions and concerns.  Filmed testimonials played during mobile events – like the Kuwa Mjanja-inspired pop-up beauty tents and “love capsules” that offer opt-out SRH services – allows girls to see “girls like them” talking about their experience with and value in using contraception. Follow up op-out counseling removed the stigma by making it the norm for every girl to engage with a provider, unless she chooses not to. 

Reaching young people where they are and how they say they need: Door-to-door distribution was identified as a model preferred by girls who fear being exposed or shamed at a health facility. In contrast, condom shops intended to reach boys with information and condoms flopped as many young people maintain deep misperceptions of condoms as a harmful method.

Mothers are key to linking girls to services: Vale-a-Pena goes where mothers are. Engaging mothers within existing community groups, like “savings” groups, where mothers are already convened provides familiar and trusted environments for mothers to dive deeper into SRH topics and receive coupons for daughters to use at health facilities. But as the initial prototype found: multiple touchpoints are necessary for mothers to support daughters in showing up for SRH services.  

Addressing gender dynamics by engaging couples: Couples’ groups convened young, unmarried partners to discuss healthy relationships, their future plans and the contraceptive methods that would support them in achieving those goals. But as the team discovered, girls often go quiet with their boyfriends in the room; moreover, adolescents often keep their relationship under wraps. Reaching and mobilizing “secret” couples, therefore, poses its own challenge. 

Conversation starter kits: Family Planning kits for distribution to mothers/boyfriends/partners contained all the essentials to spark all the hard SRH conversations: brochures and condoms with SRH messaging and notebooks, flowers and bracelets to appeal to girls. But the prototype’s evolution will need to tailor the kits per audience to ensure included materials speaks directly to what resonates with mothers and boys, inspiring them to want to raise SRH topics with their daughters/wives/girlfriends.