(re)solve

(re)solve worked by looking at women's real needs, desires, and contraceptive choices and devising solutions - in partnership with them - to empower them to exercise their contraceptive choice, while making those choices as effective as possible. Applying segmentation analysis, behavioural design, and public health insights, (re)solve focused on the gap between women saying they intend to use a contraceptive method to prevent pregnancy - and whether they actually do. (re)solve embedded its solutions in existing platforms: the United States Agency for International Development (USAID)-funded Shukhi Jibon project, private pharmacies, and Marie Stopes Bangladesh clinics and communities in Bangladesh; Project Yam Yankré ("My Choice") in Burkina Faso; and the USAID-funded Transform: Primary Health Care project in Ethiopia.

In each country in which (re)solve worked, collaborators undertook 4 main steps: landscape analysis, behavioural diagnosis, design and user testing, and implementation. Specifically:

1. (re)solve started with a behavioural landscape analysis, delving into different segments of the population and defining the "drivers of intention" to use contraception for each of them. These "drivers" include the following:
   • Health Optimism: The degree of openness in a woman's outlook on health and contraception (health proactivity, perceived provider bias, and perception of western influence on contraceptive use)
   • Unmet Demand: The gap between want and use of modern contraception (for whom pregnancy would pose a problem)
   • Agency: A woman's ability and desire to make her own decisions about using contraception (perceived control/voice in health decisions, autonomy in contraceptive and reproductive decision-making, ability to decide when to have sex with partner, use of contraception without partner permission, willingness to try something new)
2. Then, through a behavioural diagnosis, (re)solve "mapped" a behavioural problem, generating hypotheses about the behavioural bottlenecks or barriers that may be inhibiting women and girls from using contraception and the underlying drivers that trigger those bottlenecks. Collaborators refuted or confirmed these hypotheses through research and then prioritised the behavioural barriers they wanted to address. They mapped these barriers back to the population segments they were working with.
3. Next, (re)solve undertook a design process that led to customised solution sets for that behavioural problem. Through an iterative approach, collaborators tested and tweaked the solutions with the women and girls they are meant for - helping ensure they would accept and use the solutions, which:
   • in Bangladesh included visual reminders and stickers for pill packs, as well as a telephone hotline allowing women to receive a reminder to take the pill, geared toward women working in the ready-made garment industry, whose lack of leisure time makes it easy for them to miss taking the contraceptive pill every day;
   • in Burkina Faso consisted in a portable, locally sourced board game related to contraceptive decision-making (La Chance), along with health passports, posters, and IDs - all designed to reach sexually active unmarried young women; and
   • in Ethiopia involved a counseling sheet, referral card, and home visit tracking tool for use by health extension workers (HEWs) among postpartum women, who experience low contraceptive prevalence rates in this country.
4. (re)solve's solutions have been implemented and/or evaluated in all three countries. In brief:
   
   • Bangladesh: (re)solve worked with the government on scaling up the solutions through Shukhi Jibon, the national USAID-funded family planning programme. As of March 2021, the government had supported family planning initiatives in 400 factories, and a scale-up plan was in place to reach an additional 50 factories with (re)solve solutions. The government has incorporated the (re)solve solutions into training curricula used at factory health clinics and will apply evidence from the testing phase to develop a national scale-up plan that includes factories in rural areas.
   • Burkina Faso: (re)solve solutions were implemented in 16 randomly selected secondary schools - 8 each in Bobo-Dioulasso (Bobo) and Ouagadougou (Ouaga). Regional Health Directorates and secondary-education departments supported the introduction of the solutions in health facilities and schools, respectively. A total of 3,120 girls in grades 3ème and 4ème played La Chance between December 2019 and March 2020, and facilitators distributed 11,908 passports to girls in this timeframe. See Related Summaries, below, for a report on the mixed-methods evaluation.
   • Ethiopia: (re)solve implemented the solution set in 7 primary health care units (PHCUs) in Tigray from April to December 2021. A total of 183 male and female providers were oriented to the (re)solve project, objectives, and process and trained on proper implementation of each tool. See Related Summaries, below, for a report on the mixed-methods evaluation.

Click here to access additional reports and information about (re)solve.

Family Planning, Women, Youth

In each of the three countries where (re)solve worked, between one-quarter and one-third of all children born were either mistimed or unintended. In Bangladesh, (re)solve identified solutions to reach garment workers, who tend to incorrectly or inconsistently use oral contraceptives, or discontinue use because of long periods of abstinence when workers live away from their partners. In Burkina Faso, (re)solve worked with sexually active unmarried young women, whose unintended pregnancy rate is 57%. And in Ethiopia, (re)solve geared its activities toward postpartum women, 2.6% of whom use modern contraception one month of giving birth and 15.6% who do so six months following their deliveries.