The Johns Hopkins Center for Communication Programs-led Breakthrough ACTION project is expanding a successful pilot program that helped a small group of adolescents get quality youth-focused family planning counseling in Kenya.
The pilot, which trained 30 health care providers in two Kenyan counties to give young people judgment-free and compassionate sexual and reproductive health services, will be expanded to 60 more providers this year. The program incorporates Breakthrough ACTION’s Empathways, a one-on-one card deck designed to spark rapport and joint reflection between providers and youth.
Historically, providers haven’t always felt comfortable talking with young people about family planning, believing that adolescents are too young to have sex. Young people, meanwhile, reported feeling stigmatized or ignored when they were trying to access modern contraception and counseling.
“Providers said the training showed them new ways, and the importance, of understanding adolescents and young clients as people, which strengthened their counseling quality,” says CCP’s Alfayo Wamburi, a social and behavior change advisor for Breakthrough ACTION in Kenya. “They said that they have been able to probe more deeply in a careful and sensitive manner during youth consultations, allowing young clients to feel safe and enabling providers to guide adolescents to make their own decisions.”
In Kenya, 15 percent of girls ages 15 to 19 have been pregnant, according to the country’s 2022 Demographic and Health Survey.
One Empathways-trained provider told the story of her encounter with a 15-year-old girl, who was already a young mother and needed to prevent further pregnancies. She was afraid of being judged by coming to the facility, but still, she did. By the time the provider met with her, the girl had been frightened away twice at the clinic, once because of how crowded the facility was and another time by the unfriendly-looking health care workers.
“At this point, I empathize with her and share my story about how I got a baby myself while still in school and faced all the stigma that came with it,” the health care provider said. “I congratulated her on her resolve to continue with school under those circumstances and encouraged her to press on” and the girl chose a long-lasting contraceptive implant to keep herself protected from another pregnancy.
Since the release of the Breakthrough ACTION Empathways tool in 2021, many countries across Africa have incorporated it into their youth work, including Liberia, Ethiopia, Burkina Faso, Côte d’Ivoire, Niger and Togo, to catalyze more youth-centered family planning service delivery. More countries have also integrated the tool, or are interested in doing so, including Nepal, the Democratic Republic of Congo, Mali, Indonesia, and others throughout southern and eastern Africa.
As the project continues in Kenya, Breakthrough ACTION and the Ministry of Health will further track Empathways’ implementation, as well as document the outcomes, especially the number of adolescents and young people receiving modern contraceptives at health facilities. Monitoring surveys showed that in the three months after receiving training, the 30 health care providers had delivered counseling and services to more than 1,900 youth and adolescents.
The Ministry of Health has also expressed interest in Breakthrough ACTION supporting a national-level adaptation process of the Empathways tool, so it can even more closely address issues specific to youth family planning and reproductive health services in Kenya and for it to become part of interventions adapted and mainstreamed within the Ministry’s programs, Wamburi said.
One Empathways-trained nurse says she is already seeing results in Kenya: “I take my time nowadays, I read both the verbal and non-verbal communication. I understand that each one of them is unique and hence treat each and every one as an individual. It has even improved my interaction and general relationship with my kids.”