Publication: Addressing provider bias in contraceptive service delivery for youth
The Project
One of the persistent and pervasive barriers that hinders young people from accessing sexual & reproductive health services is judgment and bias from the healthcare provider when they try to seek services.
The Beyond Bias project seeks to ensure that young people between 15 and 24 years of age have access to empathetic, non-judgmental, quality counseling and provision of a full range of contraceptive methods, regardless of their marital status or parity. By bringing together providers and the young people they serve, the project team designed and tested scalable solutions to address provider bias and improve contraceptive counseling and services.
YLabs partnered with Pathfinder International to lead the program design phase of Beyond Bias in Pakistan, Tanzania, and Burkina Faso. Beyond Bias is innovative in its multidisciplinary approach, which brought together experts in adolescent and youth sexual and reproductive health (AYSRH), social and behavior change communication, human-centered design (HCD), behavioral economics, and segmentation analysis. These complementary approaches enable a nuanced understanding of the drivers, manifestations, and outcomes of provider bias and inform tailored interventions to address that bias.
Pilot Results
In September 2019, Beyond Bias began its implementation phase in each of the three focus countries with a total of 233 clinics. A randomized controlled trial (RCT) was conducted to evaluate the project’s impact on provider behavior and attitudes over a period of 12 months. The RCT was completed in September 2021 (after a pause due to the COVID-19 pandemic).
The Beyond Bias program consisted of three components, which were co-designed and tested with providers through YLabs’ design process: 1. A one-day summit for providers to tell stories, recognize types of biases that may show up in their work, and create a plan to shift behavior to provide more youth-friendly care; 2. An interactive, peer-support forum for providers to share learnings about implementing unbiased practices, and 3. A quarterly, performance-based reward ceremony to incentivize clinics to collect feedback and recognize clinics that have made progress in reducing provider bias.
Survey data from the youth client exit interviews (n=32,307) and mystery client visits (n=756) demonstrated that, at the end of the pilot period:
The intervention led to less-biased beliefs and attitudes among providers in all three countries.
Youth clients in Tanzania and Pakistan received more comprehensive sexual and reproductive health counseling and better, more tailored treatment compared to the control group.
Providers in all three countries reported a shift in their own attitudes and behavior toward youth clients, which was demonstrated through more supportive counseling and fewer service refusals.
Evidence suggests that youth clients who were married and nulliparous (had not yet had children) may have experienced particular improvements in service quality; however, the small sample size of this type of client limits the conclusiveness of results.
Following the promising results of the Beyond Bias pilot, Pathfinder created a Beyond Bias adaptation guide, for use by governments and other healthcare delivery organizations to adapt and scale the Beyond Bias model in their contexts.
YLabs is also working with various partner organizations to begin to adapt the Beyond Bias model to other countries. If you are interested exploring working with YLabs to adapt the model to your context, please reach out to us to chat!
For more details on the project and RCT results, read the full evaluation report below.
For practical tips on how to integrate HCD into an AYSRH project, using the Beyond Bias project as an example, read this technical brief co-authored by YLabs and Pathfinder.
