MMA aims to deliver a unique experience for married adolescent girls in northern Nigeria. The intervention cultivates curiosity, taps into life goals and aspirations, helps girls feel respected and safe when accessing services, and supports girls and their partners to continue to use contraception for as long as desired in line with their goals and aspirations.
Under A360’s second investment phase, MMA is being institutionalized and scaled by the Nigerian government across four states in northern Nigeria – Kano, Jigawa, Kaduna, and Nasarawa.
new users of modern contraception reached
continuing users of modern contraception reached
health facilities implementing MMA
of new users voluntarily taking up a long-acting method
A married adolescent girls learns about MMA from a female mentor, or from her husband who is engaged by a male interpersonal communication agent (IPCA) with messages about the program. The mentor helps her start to understand how contraception can be a valuable tool for her in pursuing her aspirations. She is curious and decides either to walk-in directly to the health center for services or attend four sessions of Life, Family, Health (LFH) classes where she can learn about topics that are applicable for her and gain skills.
When she accesses services – either directly at the facility or through LFH classes, she is invited to share her vision for the future with the service provider. She feels heard without judgment and the provider asks about her preferences and experiences so that they can recommend a contraceptive method which is right for her. She can be supplied with her method of choice, for free, on the spot. She is confident that she can return to the health center whenever she has questions, experiences side effects, or needs a resupply of contraceptives. She continues to see contraception as relevant to achieving her goals.
Husbands are a key referral source for MMA. Male IPCAs meet with male partners of adolescent girls to orient them to the program and clarify how birth spacing can support their family and financial goals. Discussions with male IPCAs are an opportunity to increase men’s knowledge about contraception. Birth spacing is framed as a practice that can support healthy, thriving families, a shared goal within communities. The discussion, facilitated using a flip-chart style discussion guide (available in English and Hausa), emphasizes visiting a trained health provider before choosing a method, return to fertility, and the ability to pause contraceptive use to have children when they and their wives desire. The skills building content of MMA LFH classes is often another inducement for attendance in the program as this component is appealing to girls as well as their key influencers.
Adolescent girls can attend up to four LFH mentorship group sessions, each lasting from 2-2.5 hours. Some of these sessions take place in girls’ communities at a communal house or compound and a minimum or two are held at a health facility. Storytelling, rhythm, rhyme, and repetition help girls to internalize learning and make LFH sessions more interactive. Mentorship groups allow married girls the opportunity to socialize, reflect on course content, and discuss their goals in a safe and open environment. Mentors inform girls during sessions of the opportunity to walk-in to see the health provider at the facility for confidential, one-on-one contraceptive counseling.
In some cases, LFH classes are also able to provide girls with the opportunity to learn a vocational skill that they can use to begin to earn money to pursue their goals.
LFH mentors use a session guide, available in English and Hausa, to facilitate sessions.
MMA+, a more intensive economic empowerment intervention designed by A360 in 2021, provides married girls with a scaffolded package of soft, business, and vocational skills training combined with mentorship and coaching. Communities are oriented to the joint aims of the SRH and economic empowerment components of MMA and girls are mobilized through the same referral channels as for MMA (either through program mentors or their husbands). They are invited to attend an initial set of four curriculum sessions, each lasting 90 minutes, that focus on developing health related knowledge and core soft skills such as decision-making and communications.
After completing these initial sessions, girls are invited to move into a secondary curriculum that provides them with a combination of business and technical or vocational skills. After the secondary curriculum, girls can elect to learn one to two vocational skills through a vocational training center. Then girls are given mentorship support to develop and execute a business plan. Their participation culminates in a large, public graduation that doubles as a marketplace for girls to display the products and services from their newly gained skills. This is a chance for the community to show public support for the program and for girls to show their key influencers the value of what they have learned through their participation.
In 2022, A360 designed an adaptation to MMA which expands LFH to pregnant girls to provide them with the information and support they need to pursue a healthy pregnancy.
Like with the SRH-focused MMA intervention components, a pregnant married adolescent girl hears about MMA through a female mentor or through her husband. She may choose to go to LFH sessions or go straight to the facility to walk-in for ANC services. Male interpersonal communication agents (IPCAs) engage husbands using visually appealing assets called ANC Gallery to help them understand the benefits of accessing ANC as well as what support they can offer their wives during pregnancy.
Pregnant adolescent girls who decide to attend LFH sessions are introduced to an ANC journey map (provided both in a poster version as well as with individual brochures by pregnancy trimester) by trained facilitators. Facilitators utilize a pre-ANC LFH session facilitators guide. Through this engagement they are able to learn about the benefits of ANC, what they can expect while accessing care, and how to advocate for the kind of pregnancy experience they desire. After attendance at this pre-ANC LFH session, girls are referred to the facility to start their formal ANC journey.
This MNCH adaptation is currently being piloted across Kaduna and Jigawa states with promising results – 9 out of 10 girls who attend the pre-ANC LFH session complete a referral to attend ANC.
