“Mercy*,” a 15-year-old orphan from the Obunga village in Kenya, tried twice to seek family planning advice at her local clinic. Both times, she walked away, fearful of judgment from unfriendly health care workers.
Sadly, Mercy’s story is not unique. In many places around the world, social stigma against youth contraceptive use, lack of emotional support from family and friends, and deep-seated mistrust between youth and health care workers converge to form a wall, preventing many young people from getting the contraceptive, family planning, and reproductive health services they need.
Catalyzing Connections
To help health care workers provide more compassionate and youth-centered contraceptive care, USAID’s Breakthrough ACTION project developed Empathways. The card deck, available in English and French, comprises ice breakers, discussion prompts, and youth-authored service delivery scenarios. Over three rounds, the cards encourage joint reflection between health care workers and their potential young clients about youth contraceptive service access in a safe, supportive setting.
In 2022, Breakthrough ACTION worked with government, multilateral, and USAID implementing partners, and youth networks in Kenya and Liberia to incorporate the card activity into health care provider training curricula. In Kenya, during an adolescent sexual and reproductive health service delivery training, and in Liberia, during a training on interpersonal communication and counseling, select providers paired up with a young person to work through the card deck, together, in front of a larger group of provider participants, before processing their experience in plenary with a facilitator.
In both Kenya and Liberia, providers found the exercise eye-opening. Now, instead of seeing their young clients as “too young to be having sex,” they’ve begun to view youth as individuals with unique fears, hopes, and dreams who deserve to be treated with empathy and care.
Providers said using Empathways gave them the practice, knowledge, and skills needed to deliver more youth-centered care. Empathways helped them probe deeply and listen with an open mind to better understand their young clients’ contraceptive needs and challenges.
“I take my time nowadays. I read both the verbal and non-verbal communication. I understand that each of [my young clients] is unique and, hence, treat each and every one as an individual. It has even improved my interaction and general relationship with my kids,” reflected a nurse from Rachuonyo South Sub-County Hospital in Kenya who attended one of the training sessions.
Youth who participated in the Empathways activities also found the tool valuable. “This way of working with us [young people] … makes it easy to speak freely about our problems,” said one young participant from Montserrado, Liberia. “If this continues, it will make more young people to feel free to come to the [health facility].”
The Path Forward
The trainings have created ripple effects that go beyond individual service providers and youth.
In Kenya, health centers whose providers participated in the trainings and Empathways exercise are carving out more time during consultations with their adolescent clients. This extra time allows providers to deliver tailored FP care, leveraging skills practiced during their Empathways experience, and in-line with the Kenyan Ministry of Health’s Adolescent Package of Care provider guidance document. Many health facilities also put up Empathways posters to spark conversations about youth-centered care, and to encourage more young people to seek FP services when at the clinic. The Ministry of Health has expressed interest in formally adapting Empathways to the Kenyan context, and for it to be mainstreamed within the Ministry’s adolescent and youth sexual and reproductive health programs.
In Liberia, some health facilities initiated adolescent-specific outreach activities using Empathways techniques to raise awareness and increase access to contraceptive, antenatal, and postnatal care for youth in those communities. The Liberian Ministry of Health has requested Breakthrough ACTION’s help to reinforce provider capacity to deliver youth-centered family planning and reproductive health services and scale up youth-friendly health services, in alignment with national policies and FP2020 commitments that prioritize expanding youth access to these services. Breakthrough ACTION will continue to coordinate with the Liberian Ministry to include Empathways in future interpersonal communication and counseling health provider trainings, and to incorporate regular provider mentoring and coaching on youth-friendly family planning service delivery into regular quality supervision visits. These visits take place on a monthly and quarterly schedule, and are conducted by county and district health teams.
Going Further
Empathways has also found a home in other countries and health contexts.
In 2021, Breakthrough ACTION adapted the tool for use between youth and community leaders to increase informed, voluntary contraceptive access for youth in urban districts in Burkina Faso, Côte d’Ivoire, Niger, and Togo.
Soon after, the Kefeta project in Ethiopia launched an Amharic translation of Empathways to help family planning and reproductive health service providers and civil society organizations train providers on delivering quality youth-centered services in youth hubs, health facilities, universities, and job-site clinics in 18 cities throughout the country. Select icebreaker, discussion prompt, and scenario cards from this new deck are being used as job aides by providers to spark discussions with their young clients during consultations.
Projects in Nepal and Mali have also reached out with their plans for using the tool.
Beyond family planning and reproductive health, the MOSAIC and RISE projects adapted Empathways for youth HIV pre-exposure prophylaxis service delivery in Nigeria, Côte d'Ivoire and Lesotho. In March 2023, the MOSAIC project launched two similar adaptations to train providers to deliver HIV/PrEP services to young clients, and to LGBTQI+ youth, in Kenya, Lesotho, South Africa, Uganda, and Zimbabwe under the CATALYST Study, and in Eswatini under the Ring Pilot Study.
Empathways was designed to help family planning and reproductive health service providers treat young clients like Mercy with empathy. As progress toward that goal continues in Kenya and Liberia, the tool’s flexibility endures to support improved, youth-centered healthcare across the globe.
*Name changed to protect her identity.
Written by Meei Child, with contributions from Erin Portillo, Alfayo Wamburi, Paul Quiminee, Jamesetta Smith, Tyler Best, and Saratu Olabode-Ojo