Designing for two: How enhancing human-centered design with behavioral nudges unlocked breakthroughs to promote young women’s psychological safety and access to reproductive care in Tanzania
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways
The Malkia Klabu intervention in Tanzania demonstrates how social norms that stigmatize adolescent girls’ access to sexual and reproductive health (SRH) can be strategically shifted through context-sensitive, peer-driven, and incentive-based approaches. The program capitalized on AGYW’s peer networks to normalize SRH-seeking behaviors, reduce gatekeeping by shopkeepers, and foster a sense of belonging and dignity. Through tools like symbol cards for nonverbal product requests and peer-informed education, the intervention subtly altered normative expectations, helping girls navigate restrictive cultural and gender norms without shame or judgment.
Objectives
This study aimed to evaluate whether integrating human-centered design (HCD) with behavioral economics “nudge” strategies could improve psychological safety and increase access to HIV self-testing and contraception for adolescent girls and young women (AGYW) in Tanzania via drug shops.
Methods
A mixed-methods evaluation was conducted over four months in Shinyanga, Tanzania, including a cluster-randomized pilot involving 20 drug shops (intervention and comparison arms), with additional piloting in six shops. Data sources included in-depth interviews with AGYW and shopkeepers, customer exit surveys, shop program records, and structured shop observations. Intervention features were designed using HCD and informed by behavioral economics strategies from the MINDSPACE framework to address known barriers and behavioral drivers.
Intervention Details
The Malkia Klabu (“Queen Club”) was a loyalty program offering AGYW small prizes for repeat visits and enabling discreet access to SRH products via symbol cards. Features included peer-led educational videos, free HIV self-test kits as opt-out gifts, girl-friendly branding, and colorful displays of SRH products. Shopkeepers were trained to act as SRH providers, incentivized through increased traffic and status recognition.
Results
The intervention significantly increased AGYW patronage, HIV self-test kit distribution, and contraceptive uptake compared to control shops. Social networks played a critical role in disseminating awareness and legitimacy of the program. AGYW reported feeling empowered by the privacy, dignity, and nonjudgmental environment. Shopkeepers experienced higher sales and increased community recognition, motivating continued engagement. Norm-shifting was evidenced through reduced stigma in AGYW–provider interactions and higher comfort with SRH product requests.
Conclusions
Integrating behavioral insights into HCD effectively supported AGYW’s SRH access by aligning incentives, reshaping provider roles, and subtly shifting social norms. The findings highlight the value of peer influence, emotional framing, and micro-incentives in fostering SRH agency among AGYW. The model offers scalable potential for other contexts with similar normative barriers.
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