Core's country selection is aligned to the Bill & Melinda Gates Foundation’s country goals and grantee priorities. Focus areas within project countries are guided by the life course approach, and were refined and selected based on extensive secondary research of national data, priorities, programmes and strategies for sexual and reproductive health. Dialogue with experts and the foundation’s strategy teams as well as field interactions with girls and women further informed our focus.

India

Core’s focus in India is the adolescent ‘pre-marriage’ period, or the life course moments encompassing adolescence related transitions such as puberty and sexual initiation affecting women’s health and well-being around this time. Core has used the Discover design research stage to hone in on this critical period, to understand the challenges faced through an intergenerational lens. It seeks to collaborate with ongoing initiatives in the region, using human-centered design to co-create solutions.

An extensive landscape analysis, in-depth discussions with technical experts and partners, and immersive interviews and group discussions with community women directed Core’s focus in India to the ‘pre-marriage’ period, encompassing adolescence and related life course moments such as puberty and sexual initiation. Research indicates that marriage alters the biological, psychological, and social lifeworlds of women significantly, and the period prior to marriage is an especially sensitive time for the development of health behaviours that affect outcomes in later life.

This period becomes a critical entry point for Core as girls enjoy relatively greater amount of freedom and mobility and can therefore be approached directly. In Bihar where Core’s work is focused, 17 is the median age of marriage, with girls often considered adults at the onset of menarche around age 14, and adolescence predominantly viewed as a preparatory phase for marriage, underscoring the need for intervention to ensure the marriage transition does not eclipse optimal formative development in women and result in poor future outcomes.

Core’s efforts intersect with the adolescent, reproductive, and maternal health programmes underway in the region, as well as complement the work of partners in Bihar and the National Adolescent Health strategy targeting 10-19 year-olds, which focuses on nutrition, reproductive health, and menstrual hygiene management in rural areas, among others. The project hopes to hone in on this critical period, understand the challenges faced through an intergenerational lens, collaborate with ongoing initiatives, and use human-centred design to tackle gaps and seize opportunities for intervention improvement and innovation for young Indian women.

 

Core’s focus in India is the adolescent ‘pre-marriage’ period, or the life course moments encompassing adolescence related transitions such as puberty and sexual initiation affecting women’s health and well-being around this time. Core has used the Discover design research stage to hone in on this critical period, to understand the challenges faced through an intergenerational lens. It seeks to collaborate with ongoing initiatives in the region, using human-centered design to co-create solutions.

Nigeria

In Nigeria, Core will serve as a collaborative learning platform for implementing partners, the design community and the foundation’s country office. Core seeks to design a tailored learning journey with multiple learning modalities and engagement opportunities along the human-centered design stages of work. Our approach for Nigeria is informed by an extensive landscape analysis, discussions with technical experts and partners at a workshop conducted in November 2018, as well as a grounding field trip in early 2018.

In Nigeria, Core will serve as a collaborative learning platform for implementing partners, the design community and the foundation’s country office. Core seeks to design a tailored learning journey with multiple learning modalities and engagement opportunities along the human-centered design stages of work. Our approach for Nigeria is informed by an extensive landscape analysis, discussions with technical experts and partners at a workshop conducted in November 2018, as well as a grounding field trip in early 2018.

Core expects its focus in Nigeria to centre on sharing methodologies, materials and skills with stakeholders that can have a foundational impact in improving health systems and services. Core aims to support Nigerian innovation by developing a community of practice with schools, universities, designers, creative studios, government departments and civil society to build capacities for human-centered design and social innovation.

In Nigeria, Core will serve as a collaborative learning platform for implementing partners, the design community and the foundation’s country office. Core seeks to design a tailored learning journey with multiple learning modalities and engagement opportunities along the human-centered design stages of work. Our approach for Nigeria is informed by an extensive landscape analysis, discussions with technical experts and partners at a workshop conducted in November 2018, as well as a grounding field trip in early 2018.

Tanzania

Core seeks to explore adolescent transitions among women and girls in Tanzania. Both phases of design research for the Discover stage were carried out in late 2018. Core developed and employed bespoke design research tools to gain nuanced insights into adolescent behaviour with the aim to better understand the sexual and reproductive health needs of adolescents in order to help inform the government’s new strategy on adolescent health.

Core’s focus is the exploration of pre-adolescent and adolescent moments in the life course of Tanzanian women. Extensive desk research and in-depth discussions with technical experts and partners, and immersive interviews and group discussions with women in communities informed our focus, underscoring the high incidence of child marriages and transacted sex with a reported lack of contraception use resulting in high fertility rates, teenage pregnancies and poor overall health outcomes.

While systemic provisions exist – Tanzanian schools offer sex and HIV/AIDS education as part of its life skills curriculum, and adolescent-friendly reproductive health services are provided by service delivery points and community-based outlets – several crucial service innovation gaps render them unable to tackle the issue. For instance, sex education often starts at a secondary school age, which reaches only a few, as most drop out of school after the primary level. At delivery points and community outlets, the lack of privacy, confidentiality, and equipment, as well as negative attitudes from service providers are reported as key barriers.

Research suggests that the adolescent transition in the life course of women is especially sensitive for the development of health behaviours that affect outcomes in later life. Given this, Core aims to deploy design research and design to hone in on this period to ensure the critical formative development of young women. It seeks to gain a clearer understanding of the sexual and reproductive health needs of adolescents and inform the government’s new strategy on adolescent health. Core will work with adolescent groups and actively involve government representatives in all the phases of work, enabling the two groups to co-design key innovations.

Core seeks to explore adolescent transitions among women and girls in Tanzania. Both phases of design research for the Discover stage were carried out in late 2018. Core developed and employed bespoke design research tools to gain nuanced insights into adolescent behaviour with the aim to better understand the sexual and reproductive health needs of adolescents in order to help inform the government’s new strategy on adolescent health.

Kenya

In Kenya, Core seeks to better understand the drivers and barriers to trial and adoption of family planning methods from the perspective of both, men and women. Over the course of the two design research Discover phases, Core explored how family planning decisions are made, especially the role of men in decision-making as well as their influence on the sexual and reproductive health of their partners in general.

In Kenya, Core seeks to better understand the drivers and barriers to trial and adoption of family planning methods from the perspective of both, men and women. We honed in on this as the focus area following extensive desk research, in-depth discussions with technical experts and partners, and immersive interviews and group discussions with men and women in communities. The focus on family planning is complementary to national policies and programmes in place as well as the foundation’s country priorities.

Data indicates that a third of Kenyan women of reproductive age have unmet needs for family planning. Unmet needs are highest among young, single, uneducated, and underprivileged women. Misconceptions and fears are a major barrier to uptake of modern contraceptives and family planning methods in this group. Evidence underscores that counselling and education leads to informed and voluntary decision-making among young people, increased uptake and continuation of family planning services, and improved health outcomes for Kenyan women.

For Core, this presents an opportunity to gain insights into the unmet needs of women across their life course, into how family planning decisions are made, especially the role of men in decision-making as well as their influence on the sexual and reproductive health of their partners in general. The focus on family planning brings a futures element to our work, prompting us to reflect on the dynamic between societal change and women’s lives, and work with partners, providers, government and civil society to co-design innovations that positively impact the sexual and reproductive health of women.

 

In Kenya, Core seeks to better understand the drivers and barriers to trial and adoption of family planning methods from the perspective of both, men and women. Over the course of the two design research Discover phases, Core explored how family planning decisions are made, especially the role of men in decision-making as well as their influence on the sexual and reproductive health of their partners in general.