When I was 23 and unmarried, I got pregnant. I was using the rhythm method and condoms, as I had been told, incorrectly, that intrauterine devices and oral contraceptives would adversely affect my fertility. My partner and I wanted to pursue our careers. Parenthood was not in our plans at that time.
Once we decided not to have the baby, I visited four doctors, where I got no support or sympathy but received very rude treatment, as if I were a delinquent. My abortion was underground, expensive and unsafe.
After that experience, I decided to use a modern contraceptive, but since no doctor was prepared to counsel me, I used them all in the subsequent six years — injections, oral contraceptives, implants, emergency contraception and an IUD.
My situation is unfortunately not unusual, even today, for women in my native Mexico; unplanned pregnancy is a big problem in Latin America and the Caribbean. The poor quality of reproductive health care and lack of information available to adolescents in Mexico leaves a lot of unanswered questions, as this study shows.
Almost three-quarters of pregnancies among adolescents aged 15-19 in my region are unplanned, according to the Guttmacher Institute, and about half of those end in abortion. Among all women aged 15-19 who need contraceptives, 36 percent of them are not using a modern method. Unmet need is highest in Central America, where 46 percent of sexually active adolescents who want to avoid pregnancy are not using modern contraceptives.
So in 2015, as the director of DKT Mexico, a nongovernmental organization that uses social marketing to prevent HIV and promote contraceptives in Latin America and the Caribbean, my colleagues and I set about to change this paradigm in Mexico.
We launched a traditional family planning campaign that took a formal, medicalized approach that educated young people on the contraceptive methods available. We spoke a lot about the myths of various contraceptive methods. We were a bit preachy.
This campaign did not achieve the results we had hoped. Few young people attended our talks, visited the website or engaged with our social media. Even when there was engagement, these more clinical messages did not resonate. Thus, the anemic communication translated into anemic contraceptive sales.
Alternatively, we launched a highly successful Prudence condom brand campaign with well-attended events, a Facebook page with 800,000 followers and a Twitter account with 47,000 followers. Everything we did was imbued with fun and showmanship. Our condom sales tripled from 15 million in 2012 to 45 million in 2016.
Our experiences with the two diverse campaigns taught us four important lessons about effectively promoting contraceptives to young people:
1. Be fun and not boring.
2. Focus on the benefits of using contraception. Stop talking about the myths of contraception. That just reinforces the myths.
3. Talk about “unplanned pregnancies” not “unwanted pregnancies.” Most people in Mexico think of babies as blessings from God, and not “unwanted.”
4. Talk about “life planning” not “family planning.” Adolescents and young adults do not think in terms of family planning but are interested in not interrupting their education, travel and careers.
In short: We stopped being preachy and started being fun. What worked was adopting similar entertaining messages and approaches we were already using to market the Prudence condoms.
We created “Planficame Esta,” or “Plan me this,” a lively digital platform with a website, and a presence on Facebook, Instagram and YouTube. These tools offer exciting and colorful messages about the importance of having a life plan and avoiding pregnancy until you are ready. There are plenty of ribald jokes, frank discussions and flirty talk full of double-entendres that are appealing to young people. Our Facebook page now has more than 1.2 million followers.
DKT International’s founder wrote that two of the institutional obstacles to advances in family planning are overmedicalization of family planning and fear of sex. In Mexico, we have overcome both hindrances. Our main message has become “Have sex, have fun, but use double protection against a sexually-transmitted disease or an unplanned pregnancy that will change the course of your life.”
But it’s not enough to have fun messaging; it’s imperative that young people who are motivated to use contraception are connected to welcoming clinics that offer appropriate products and services. In our case, we created a network of youth-friendly clinics called RED DKT to improve sexual and reproductive health and encourage greater use of long-acting reversible contraception such as IUDs.
DKT began this work in Mexico but we have have now expanded into Guatemala, the Dominican Republic, El Salvador and Venezuela. In 2017, we plan to expand into Colombia, Costa Rica, Cuba, Haiti, Honduras, Nicaragua, Panama and Puerto Rico.
The result is that more young people are reading our websites and social media platforms, sharing information with their friends and coming to our events and clinics. More importantly, they are converting that knowledge to better health behavior — using contraception to avoid unplanned pregnancy and STDs. Our couples’ “year of protection” — the amount of contraception to protect a couple for one year — have more than doubled between 2014 and 2016.
The bottom line is that fewer girls and young women will be forced to go through what I did. And that is why I am so passionate about this work.