Girls Served: 0 /17,738


Young Ethiopian couples want their children to have better quality lives—a factor that leads them to desire financial stability and smaller families. That’s why through “Smart Start” we introduce targeted financial messaging designed to help rural Ethiopian girls aged 15-19 and their husbands plan for the families, and lives, that they want.


Girls served with modern contraception


Sites activated


% of girls voluntarily adopting a method after engaging with A360


% of girls voluntarily taking up a long-acting method

 Data from Jan. 2018 through July 2020.

Situational Analysis

Across A360 Ethiopia’s target region, there are 534 thousand married 15-19-year-old girls who do not want to get pregnant. Yet at the start our work, 330 thousand girls were using modern contraception.

A360’s Smart Start uses financial planning as an entry point to engage young married couples in planning their futures and reaching financial stability, positioning contraception as a tool to achieve their self-defined goals. Smart Start – which, as of Feb. 2020, has been taken to scale through integration into the Ethiopian government’s Health Extension Program – supports girls aged 15-19 and their partners to understand the resources they’ll need for the families they desire.

Smart Start: A Case Study

We’ve packaged our experience in Ethiopia into a technical brief that analyzes A360’s strategy and lessons learned to date and offering considerations for similar ASRHR implementation in future settings.

Getting Girl-Centered

A360 flips traditional family planning messaging on its head— building from what girls say they want to deliver reproductive health services when and how they need.

Click the below breakouts to explore the insights that shaped how A360 is changing the conversation around contraception.

Insight: Proving fertility and having children is culturally revered, yet couples are beginning to desire smaller families.

Smart Start engages kebele leaders to build empathy for couples struggling in changing times and reducing the pressure for couples to have children now. The program supports Health Extension Workers to identify, reach, and serve young couples, engaging community actors to create supportive environments for change.

Insight: Girls fear that using contraceptives will bring them shame and infertility, and ruin their dreams of stability, marriage and family.

Smart Start uses financial planning as an entry point to engage young married couples in planning their futures, positioning contraception as a tool to achieve their goals for stability as well as to have a family.

Insight: Couples often desire joint decision making in contraceptive use, yet in reality, knowledge and agency continue to be a barrier.

Smart Start invites husbands in through financial planning conversations to encourage joint decision-making about their lives, including contraceptive use and family planning. Couples plan together and can access sexual and reproductive health services that help them achieve their life goals.

In Ethiopia, 4 in 5 girls will have a baby by age 20 before they understand the financial implications. Smart Start addresses this reality, and has been awarded by Bill and Melinda Gates as a 2019 Goalkeepers Accelerator.

Smart Start's Approach

Click the below breakouts to explore our approach.

Smart Start’s financial planning lens is one that girls and their communities not only understand, but embrace.

By blending adolescent developmental science with social marketing, cultural anthropology, Human-Centered Design (HCD) and Adolescent and Youth Sexual and Reproductive Health (AYSRH), we’re supporting health workers to reach girls and their partners by speaking directly to their developmental stage.

  • With Smart Start, health workers gain a tool that speaks directly to girls’ self-expressed dreams, with an understanding of how contraception can drive forward their life plan.
  • Through adolescent developmental science, we’ve identified that as testosterone levels rise, adolescents’ motivations tend to center externally, like on status and social recognition. And as testosterone levels plateau, motivations shift to more intrinsic interests, like safety and stability. To reach and resonate with youth, health messages need to be able to speak to both sides of the motivation coin, at whatever stage young people are in their developmental trajectory.
  • Cultural anthropology informed how Smart Start eases girls’ pathway to contraceptive access by building on existing national dialogue and pride in responsible stewardship of resources, to progress and develop as a country.

From the ground up: step by step, we're shifting population behaviors.

Smart Start builds on the national dialogue about the importance of resource stewardship to advance national, economic growth. Smart Start hones in on this message to dig into the value of delaying and spacing births so couples can establish needed income now, to support their family into the future.

And it works.

A360 Ethiopia’s activities are shifting population behaviors, potentially indicating a shift in beliefs and social norms reflecting that what matters most for girls, their husbands and their communities can change. Across our highest performing kebeles, Smart Start appears to be catalyzing productive conversations about finances and contraceptives between young wives and their husbands—and reflect a shift to couples prioritizing the ability to plan for the lives and the smaller families that they evidently desire.

Earlier insights into the lives of adolescent girls revealed pressure to submit to the cultural expectation that newly married girls must immediately prove their fertility. Smart Start programmatic data to date suggests that girls in intervention sites are successfully delaying first pregnancy: data shows that 1 in 2 girls who take up a method through Smart Start have not yet had their first child. Together with Health Extension Workers, Smart Start is reaching more girls with the right method of choice for her life — including the 24% percent who’ve selected a long-acting method (LARC), a figure that exceeds the country’s national average of 18 percent LARC uptake among this age group (Source: DHS).

In our journey to scale, we're leaving behind a stronger health system.

A360 Ethiopia engages kebele leaders and local community groups to build empathy for couples struggling in changing economic times and reduce the pressure for couples to have children right away. As we drive toward readiness for scale, we’re partnering with the government to ensure Smart Start works not only for girls but for the health system that will ultimately own and sustain AYSRH service delivery, with Smart Start as an ace up the sleeve. We’re activating an evidence-based adaptive implementation approach to explore how we can engage community structures to drive demand, easing the way for health extension workers to address supply.

Learn More

  • Through RISE, the Ethiopian Ministry of Health, with an investment from the Children’s Investment Fund Foundation and with technical assistance from PSI, will integrate Smart Start into Ethiopia’s national Health Extension Program – bringing Smart Start to 1 million girls by 2025.
  • Dive into our Emerging Insights for Design in Ethiopia by reading this A360 report.
  • There is a lack of evidence on the health impact of HCD-inspired projects. That is, until now. Learn how A360 Ethiopia is being evaluated here.

Voices from the Field

"Smart Start's financial planning orientation gives us negotiation power with the community and with husbands."


Health Extension Worker, Gelcha village

"I think we young designers help to interpret the feelings of adolescents—their language, cultural aspects and their identity."


Young Designer, A360 Ethiopia

"Contraception makes planning for a child a choice and allows us to continue our education and careers without any obstacles."

Genet Ebuy

Young Designer, A360 Ethiopia

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