Sarari is a program that promotes a supportive environment for birth spacing and family planning in Niger, funded by USAID and implemented by Population Services International with the technical assistance of YLabs. As the YLabs project lead, I managed all matters related to design research, prototyping, and service design, as well as project timelines, deliverables, client relationships, and capacity building.
Population Services International (PSI) / USAID
Project Lead, Research Lead, Design Lead
2017 - 2018
Zinder Region, Niger
Niger has the highest fertility rate in the world, at 7.2 children per woman. It is also a country where the role of marabouts (local clerics) is particularly relevant, since Islam is the dominant religion in Niger and is practiced by more than 90% of the country’s population. In striving to design a program that would promote a supportive environment for family planning, our team’s challenge was to understand the religious, but also health, social, and economic contexts that influence the local Zinder community’s reproductive health decisions, and the role of religious leaders, as well as other influential figures, in swaying those decisions.
We used ethnographic and design research methods to uncover the community’s perspective on, and knowledge of, reproductive health products and services, especially practices used to space births. Individual interviews and focus groups with religious leaders, young men and women, healthcare providers, village chiefs, and other stakeholders allowed us to observe and better understand the health, social, and economic contexts that influence attitudes and decision making. Speaking with a variety of community groups allowed us, not only to dig deeper into each group's needs, but also to get a sense of how one group might influence another.
UNDERSTANDING THE LANGUAGE
It was particularly important to understand how the community talks about sensitive topics and what language they use in doing so. We used role-play to simulate and explore certain community dynamics, such as the arguments people used when trying to persuade or dissuade a peer to use family planning. One particular insight we learned through this activity, was that the community uses Hausa proverbs to talk about the need for balancing family size with financial means, which we later tapped into as part of our design.
PARTICIPATORY DESIGN RESEARCH AND CO-CREATION
Co-creation workshops helped us unearth insights that were harder to observe or talk about in conversation. This is extremely important for taboo topics, as it minimizes the need for sustained eye contact. For instance, we asked young men and women to show us the difference between a small family compared to a large one through drawings. This allowed us to understand what aspirational values young parents or parents-to-be associate with family size and number of children. We also asked participants to use play money to demonstrate various household expenses incurred by month. Being able to see how much children really cost was an insightful demonstration of how having a child can impact the family's financial health.
After synthesizing our research, we surfaced two main opportunities: first, religious justifications which address responsible parenting, and second, a focus on the expenses incurred by having children and how quality of life is impacted by family planning. Building on these opportunities, we generated solution concepts that we prioritized for prototyping and testing.
Before I began building prototypes, I led the team in identifying underlying assumptions behind each solution concept in order to put in place the appropriate conditions to test each assumption. For example, one of our concepts was a financial planning training program delivered through an existing UNFPA-run network called “Schools of Husbands.” To be successful, the concept assumes that (1) the UNFPA will want to implement this program in their schools, (2) the Schools of Husbands instructors will have the time and capacity to conduct this training, and (3) young men will absorb the content of the training in a way that might affect their reproductive health decisions. We planned to test this concept through (1) meetings with the UNFPA to discuss a potential partnership, (2) observation of a day in the life the Schools of Husbands instructors and a mock training session, and (3) A/B testing of different training contents, formats, and facilitators with young men as well as testing information retention after a few days.
We relied on pictorial elicitation to collect deeper feedback on how participants understood the imagery that we would prototype on posters, or other communications materials. Visual communication was particularly important, given the low average literacy levels in the community. In this case, realistic representation of daily life scenes were more successful than abstract diagrams or graphic conventions, such as speech or thought bubbles. We also used card sorting as a technique to structure visual information into different categories or priorities. For instance, card sorting was a useful technique to determine which members of the community youth would trust the most to moderate a public debate on family planning. It also proved useful in assessing the types of incentives religious leaders would prefer to use, in order to take a public stance in favor of birth spacing.
PROTOTYPING AND TESTING
We also tested a number of prototypes based on audio messaging, such as sample religious sermons encouraging birth spacing. We learned that known and trusted sources of information are key, so we recorded audio snippets using the voice of local religious leaders, in order to increase community trust in the message. We also put a number of physical prototypes in the hands of the community as representations of ideas that they could interact with and critique. This allowed us to test the usability of various training tools meant to evaluate the financial implications of having children.
Driven by the testing feedback we collected, we refined and improved our solution concepts in preparation for live prototyping, during which we would test our final prototypes in a context as close to reality as possible. I designed all of the elements in high-fidelity, so they could be used in real-world conditions.
PREPARING FOR IMPLEMENTATION
We also used the live prototyping phase as an opportunity to think about the hand-off after the program was fully designed. We developed and field tested implementation guides, participant recruitment tools, and guidance on where to source the required equipment and materials locally. This was crucial to ensure all elements of the program design were then locally-owned and sustainable.
CHALLENGES AND OUTCOMES
One of the main challenges we faced in this project related to the role of women in the program. Early on in our exploration, we realized that, for married women, the primary factor determining contraceptive use was support from their husband. This meant that Sarari focused largely on husbands as the main reproductive health decision-makers. However, young men later reported going door-to-door, following live prototyping, to recruit female women to participate in the financial planning exercise. Similarly, during the pilot, women across implementing villages advocated strongly that female religious leaders be trained in under Sarari.
At the end of this process, Sarari was born and subsequently piloted for 6 months in five villages in the Zinder region, during which local partners and communities have continued to iterate upon Sarari data collection and programmatic tools in order to best suit their needs. Religious leaders have altered the self-reporting tools to monitor the number of sermons, koranic school lessons, and private consultations given in support of birth spacing and family planning. Additionally, youth leaders added new expense categories for their financial planning tools to better fit the way they budget. To date, over 550 men and women have directly participated in the pilot.
TO LEARN MORE
- My blog post describing the final design of Sarari and the design research and prototyping insights that led us there: “Who Who Decides about Family Planning in Niger? The Imam, the Parents, or the Wallet?”
- My blog post exploring the power of Hausa proverbs in the context of this project: "Researching family planning through proverbial Hausa."
- Presented at the 2018 Design Research conference in Melbourne, in a talk titled “The Power of Proverbial Expression in Design Research.”
- Featured on PSI Impact, as well as the Health Communication Network (the latter including a link to three downloadable reports documenting this engagement).