A Smart Start For Girls

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Access to sexual and reproductive health (SRH) information and services is critically important for the health of women, adolescents and their children, and has a ripple effect on the health of society as a whole. In Ethiopia, almost half of the country’s girls are married before the age of 18, and the pressure to conceive immediately is high (a familiar situation for many girls and young women around the world). Four in five adolescent pregnancies happen within marriage. In rural areas – where 75% of girls aged 15–19 live – girls take up their first method of contraception at age 24, on average, after giving birth to three or more children. As a result, they face a greater risk of maternal mortality and are too often denied education and economic opportunity. This, in turn, has a negative impact on their and, by extension, their community’s ability to lift themselves from poverty.


Population Services International (PSI) has a proven model to change the conversation around contraception by addressing the contextual challenges that drive adolescent pregnancy in early marriage. From January 2018 through June 2020, PSI’s Smart Start SRH program in Ethiopia – a part of PSI’s global Adolescents 360 program (A360) – has supported 33,745 rural, married adolescent girls to voluntarily adopt modern contraception. They plan to increase that number by at least tenfold through Smart Start’s integration into the health system in Ethiopia, and by expanding and/or bringing the program to new contexts in Nigeria, Tanzania, and Kenya, with similar programs over the next five years.


PSI partnered with a diverse crew of experts—including IDEO.org, developmental scientists, anthropologists and young people themselves – to design this groundbreaking, girl-centered program. Co-created with Ethiopian youth for Ethiopian youth, Smart Start works with young couples, starting with a conversation about their life dreams, and the economic benefits of delaying first pregnancy and spacing out subsequent babies.


  • Expand the Smart Start program nationally in Ethiopia through the close partnership and leadership of the Ethiopian Federal Ministry of Health, with additional funding from the Children’s Investment Fund Foundation. The program will be embedded into the country’s primary healthcare system under the new name, RISE, supporting over 1 million married girls by the end of 2025 to receive information and access to contraception. This program alone has tremendous capacity to help support the Ethiopian public health system reach its SDG target for all adolescents, to satisfy over 75% of the total demand for family planning.
  • Thanks to new investments from the next-generation philanthropic collective, MaverickNext, PSI will deepen male engagement in Smart Start and test an economic empowerment initiative with German NGO Deutsche Stiftung Weltbevölkerung (DSW). These additions to Smart Start will be ready for launch in two of the RISE project regions in Ethiopia in early 2020.
  • Expand Adolescents 360’s program in Northern Nigeria - Matasa Matan Arewa - from 3 pilot sites to 30 active sites, thanks to a new private investment of $1.055 million from Gates Philanthropy Partners.


  • As of February 2020, Smart Start – through RISE – is being taken to scale through integration into the Ethiopian government’s Health Extension Program. The project has further completed live prototyping across two of RISE’s sites aimed at strengthening Smart Start’s male engagement component.
  • The program has reached 71,122+ girls aged 15-19 with SRH information, of which 33,745+ (75%) have voluntarily chosen a contraceptive method.
  • Additional investment has been secured from Global Affairs Canada (GAC) for PSI and Marie Stopes International (MSI) to take Smart Start to 48 districts across rural Ethiopia. The effort will aim to increase health system capacity to reach rural, married girls aged 15-19 with SRH services.


This approach has the potential to reach all 23 million adolescent girls in the world who want to prevent pregnancy but don’t have access to contraception. To reach that goal, PSI needs new funding partners and country implementers to work with them to co-design adolescent and reproductive health interventions based on this innovative, impactful model. 


Invest with us to expand PSI’s successful programs - incubated in Ethiopia – to extend the Adolescents 360 model in Tanzania and Nigeria, and to reach new markets in Kenya, India, and beyond. Visit https://www.psi.org to learn more.


Implement PSI’s scalable, culturally adaptive, measurable youth-powered programs in your country or region. Explore A360’s applicable tools, available at https://a360learninghub.org/open-source for more information.


The repercussions of adolescent pregnancies run deep – for girls, their communities, and for countries as a whole. Spread the word and the power of our work with your networks - https://www.psi.org.

To join us or learn more, contact smartstart@psi.org