De chicas para chicas (From girls to girls)

Latin American and Caribbean (LAC) region is home to 106 million 10–19-year-olds and has the second highest rate of adolescent mortality in the world. The region is fact-based, characterized by its perdured high rates of violence and adolescent mortality. While half of death in boys are due to violence, in girls it is because of adolescent pregnancy. This latter situation is urgent in LAC because the adolescent pregnancy rate of the region continues to be the second highest in the world. Global adolescent pregnancy rate is estimated at 46 births per 1,000 girls, while in LAC is at 66.5 births per 1,000 girls aged 15-19 years, second only to Sub-Saharan Africa (PAHO). More critical, from that amount of pregnant girls, 14% died during the pregnancy or at giving birth (The Lanced Child and Adolescent Health). Global statistics show that the risk of maternal death is doubled in mothers younger than 15 years in low- and middle-income countries, such as many of our region countries. In addition, adolescent pregnancy is associated with negative health and socioeconomic outcomes (OECD)

Experts have suggested that the lack of information and restricted access to sex education and sexual and reproductive health services are related to adolescent pregnancies. Also, many of these pregnancies are a result of abusive relationship or inappropriate relationships (UNFPA). Attending this urgent call, and considering we already have free services seeking to decrease violence in teens of the region (1st death cause for male teens), several years ago TeenSmart decided to attend the 1st cause of death for female teens in our region. It became crucial to build girls-focused virtual free services concerned to sexual and reproductive health rights (SRHR)’ education and guidance. In 2017, a three-month online course (Conoce-T) was created to serve girls from 10 to 24 years, with specific contents according to their age group. We developed three versions for each of the three age groups we manage (10-13, 14-18, 19-24 years old). Moreover, several micro-messages sequences on SRHR were created, so the teens could get advices through short messages easy to read and which we expect they can soon get by WhatsApp too.

Traditionally, youth sexual and reproductive health support has been face-to-face, adult-centered, difficult to access, and clouded by misinformation and taboos.   Social norms for adolescent pregnancy and religious taboo continue to be the predominant sexual and reproductive health (SRH) knowledge transfers for teenage girls in many countries. Without access to unbiased, modern SRH information and skill-development, girls continue to be trapped not only in the statistics of teen pregnancy, but also in the ones related to school dropouts, poverty and underdevelopment. Teen mothers are more likely to parent alone, achieve less education, live in poverty, and experience gender inequality. 

Hence, our intervention is online services within a safe and confidential virtual space with health professionals working behind: jovensalud.net. This holds a proven satisfaction of 87% out of the +130,000 teens (of which +50% girls) that have used it so far.

An upgraded and updated version of the “Conoce-T” (Get to know yourself), an existing online course on Sexual and Reproductive Health Rights and Girls’ empowerment available on JovenSalud.net, which is a free 24/7 online platform for youth that has already served +130,000 Spanish-speaking teens from +19 countries, from which +50% are girls. The course Conoce-T enhances gender equality, self-knowledge, and education about sexual and reproductive health through three different versions that provide professional curated information for different age groups according to their life stages and needs (10-13, 14-18, 19-24 years old). In 7 years of Conoce-T and more than 1.000 graduates, results have shown that it helps to eliminate misconceptions about STDs, it increases the awareness of teen pregnancy and inappropriate relationships, as well as it improves knowledge of condom use or abstinence practice.

Our solution is an online intervention because -traditionally- youth sexual and reproductive health support has been face-to-face, adult-centered, difficult to access, and clouded by misinformation and taboos.  An online course can reach any girl who has a cellphone and internet access throughout the Americas. More than 1.000 adolescent girls have graduated from the course (watch a video here: https://www.youtube.com/watch?v=nK8iBSEfwY0&t=17s)and our goal now, is to redesign it with the help of graduated girls. We seek to carry out an upgraded solution that actively involves the population experiencing the problem first-hand, a solution “De chicas para chicas” (From girls to girls). This, by undergoing a participatory course’s re-design through a co-creation’s methodology. 

The co-creation will happen in 2024, involving a sample of graduated girls from each of the three age groups we serve, and who took the course in 2023 (to secure they are still in the same age range); and TeenSmart’s team members below 35 years old living in Nicaragua (the country with highest rate of adolescent pregnancy) and Mexico (the OECD country with the highest rate of adolescent pregnancy). 

Conoce-T course contents’ go from explaining sexuality and the changes from being a kid to being a woman, as well as exemplify what consent is and the importance of self-made decisions; to explaining in creative ways (real situation’s videos and images) the sexual transmitted diseases’ risks and how to prevent them using protection, and the explanation on how to use a condom. An important aspect of our contents is the empowerment section. We want to empower Latina girls to value themselves for what they are and their potential, to enhance healthy relationships, to identify improper ones (an older man with a teenager girl), and to understand the risks of human-trafficking. We are excited to re-elaborate our current course’s topics according to what girls will contribute on the co-creation process to get an updated and upgraded “Conoce-T: De chicas para chicas”.

TeenSmart’s primary population are Spanish-speaking Latin American and Caribbean adolescents. The American continent is at a historic moment: young people are, for the first time, the most populous population, with 230 million young individuals. According to the Pan American Health Organization (PAHO), approximately 80,000 adolescents (ages 10-19) and 150,000 young people (ages 15-24) die each year in the Americas. It is alarming that 1st death cause in girls is teen pregnancy (CIFRA). In this solution we focus on attending girls who look for the skills to be empowered, inspired, and informed to promote their sexual and reproductive rights and their equal participation in society, through personal and professional development. Why adolescents’ girls? Because teenage pregnancy is the 1st cause of death in LAC region’s girls. And because our region still has a big gender inequality in employment, services’ access, climate change impact, and intrafamilial violence. Hence, we trust that by providing girls with the tools to take smart decisions related to their sexual health and reproduction rights; they could easier set on the road to stay in school, have a job, and engage in healthy relationships. Conversely, they could become victims of poor motivation, limitations in education and employment access, and develop high-risk behaviors for their lives. It is proven that the decisions and actions taken during adolescence, related to their health and education, affect the trajectory of the rest of their lives (PAHO).

We expect that our solution impact girls’ lifes’ in the following aspects:

1) maximize their virtual educational opportunities in this formative moment in their lives and be more inclined to stay in school.

2) make smart sexual and reproductive health choices for their own well-being such as postponing sex and/or practicing safe sex.

3) recognize improper relationships (such as older men with young girls) and educate their peers around the dangers of human trafficking.

4)promote gender equal relationships, and hence be more likely to find a decent job and have self-development and financial independence.

TeenSmart International is a non-profit organization with 19 years of experience and legal status in the United States, Costa Rica and Nicaragua, and with impact in +19 countries. The services offered on our platform jovensalud.net have been evaluated with 85% satisfaction by the +130,000 teens we have served up to date.

TeenSmart has 19 years of success providing holistic health promotion and confidential personal leadership coaching to teens throughout Central America using the validated Health Belief Model. TeenSmart's innovation and impact has been recognized by the prestigious Carlos Slim Exceptional Health Institute Prize (2016) and the InterAmerican Development Bank Visionary Prize (2018). TeenSmart -through jovensalud.net- disrupts a health system that traditionally excludes youth and marginalized populations (girls, rural, indigenous) and that focuses too heavily on in-person, adult-centered therapy which is easily clouded by misinformation and taboo. It focuses on services co-designed by girls in context of most vulnerability, for girls living in similar contexts. It also gives the girls the power to guide her own knowledge process during the online course.

It’s important to remark that we have been developing sexual and reproductive health rights’ free and high quality online services for teens since our foundation but more in depth 7 years ago. In 2017 with the creation of Conoce-T, an online course explained before. In 2019, TeenSmart worked with the Interamerican Development Bank in the Mesoamerican pregnancy prevention project, where -through jovensalud.net, we provided virtual coaching for teens (girls and boys) in remote areas of Costa Rica. Moreover, TeenSmart finished a Grand Challenge Canada STARS Sexual and Reproductive Health Rights’ project “El Poder Esta en Ti” with the objectives to avoid early onset of sexual relations, prevent sexually risky behaviors, and prevent gender violence among 600 teens (girld and boys) 14-17 via micro-learning texts and email. After the successful completion of that project, TeenSmart was awarded with funding from Canadian Local Initiative Fund to develop another project named “Yo me empodero”, which was a mix of in-person and virtual intervention to impact 150 girls among 10-18 years old, regarding topics of sexual and reproductive health, gender equality and self-knowledge. Moreover, in 2021 we made a partnership with pharmaceutical company Roche, who sponsored a campaign on breast cancer prevention, and together we promoted it through our course Conoce-T and with a very attractive social media campaign. As a result of this, 300 new users registered for the online course, Conoce-T.

The team members involved in the projects mentioned before are eager to start working on our proposal for 4 her power challenge. The team previously involved in in-person interventions are fully under 35 years old, and the team involved on creating the virtual tools on SRH are both under 35 and above 35 years old.

Serving marginalized and vulnerable populations is the foundation of TeenSmart’s mission and values and all staff and volunteers are trained in our CRECER Para SER signature model for personal empowerment and communication in relationships. Staff then promote this through work with teens.

To date, 1,000 adolescent girls from different countries throughout America, have graduated from the Conoce-T course, including over 300 hundred girls + their moms (as indirect beneficiaries) that we impacted with our mix of virtual and in-person interventions. 

On jovensalud.net platform, so far we have served +130,000 teens from 19+ countries. That is our current potential. But we have the potential to reach 1 million teens before the end of the decade with our platform. If we are successful, we can have at least 100,000 girls registered for the course "Conoce-T: De chicas para chicas" by 2030.

• So, far on the platform, 80,000 youth have completed self-assessing health profiles, which provides immediate feedback to the teens. 
• 15,000 youth have graduated from our online life-skills courses (80-90% graduation rates)  
• Each week we receive 300-500 online counseling requests and our online counselors have worked through 110,000 online coaching sessions 
• 130+ schools and youth organizations throughout Central America implement TeenSmart with their teens  

Engaging girls through a free interactive online platform (jovensalud.net, a TeenSmart's platform) ensures that they are the agents of change whereas traditional approaches have focused on costly adult-led face-to-face interactions (difficult to scale) and on family and community factors (outside of their control). 

TeenSmart listens to youth where they feel safe and comfortable, without society bias or taboos imposed: online and on phones. Our courses, including Conoce-T, already have high-completion rate. Around 80-90% of teens get graduated from the courses they start, compared to other e-learning platforms that tend to have low engagement and high turnover. 

Moreover, TeenSmart already has a "Gen Z Advisory Council" with teens from different age groups and countries. They provide feedback on content, review graphic materials, create, produce, and collaborate. 

The project proposed for this challenge is innovative and unique because it:

•Grant a voice for girls from different age groups (non-discriminatory) and from different countries and contexts (inclusive), to be the co-designers of the solution which seeks to attend their sexual and reproductive challenges. A 100% solution“de chicas para chicas” (from girls to girls)

• offers virtual delivery which removes the geographic barrier for health service access, provides services during pandemic isolation, and allows for scalability to other geographies or groups when the project is successful,

• addresses 6 of the UN Millennium Development Goals: (3) Good Health and Well-Being, (4) Quality Education, (5) Gender Equality, (10) Reduced Inequality, (16) Peace and Justice, (17) Partnerships.

 Additionally, TeenSmart is

• cost-effective;
• scalable;
• smart and getting smarter: www.JovenSalud.net has an automated evaluation system that allows for continuous and immediate monitoring of use, satisfaction, and impact of services;
• based upon best behavioral science and practice. TeenSmart uses and evaluates health promotion content and methods from expert international organizations such as WHO and CDC.
• Focused on prevention: The majority of TeenSmart users are 10-13 years old which means that there is more possibility of preventing risky behaviors before they start.

Since 2004, more than +130,000 youth, half of them girls, have turned to TeenSmart with their goals, questions, and stories. They tell us that they are experiencing violence, lack of opportunity and education. These life experiences are the foundation for this project’s curriculum where girls are the main characters and will guide the building of a solution made for them. 

Through jovensalud, we help them to identify violent and unhealthy relationships with themselves and with others in their daily life, and, both in the physical and virtual world. Teens report improvements in family communication, decrease on adolescent pregnancy, decreased suicidal ideation, healthier relationships, among others.

As of October 2023, +130,000 youth have registered on JovenSalud.net and return on average 3-4 times. By 2030, we will have the capacity to serve 1 million of at-risk Latin American teens, from which at least half will be girls.

 We will look for the following impacts on girls in the region after they finish the course (short-term results, measured by a pre-course survey and a post-course test) and on the following year after the implementation of our solution (mid-term results based in a voluntary- responded survey):

• With the upgraded and updated version of “Conoce-T: De chicas para chicas”; we will increase girls’ registration on the course by at least 10%
• We expect a satisfaction rate with this course of 90%
• Improvement in knowledge, skills and behaviors, such as:
• Self-leadership development, including:
  • increased satisfaction with their lives
  • greater effective communication skills
  • greater feeling of control over their lives
• Sexual and reproductive health improvement:
  • increased belief in the importance of practicing sexual postponement until they decide so.
  • increased awareness of how teenage pregnancy affects study and work opportunities.
  • greater knowledge, as in the case of girls over 14 years of age, about the correct use of condoms.
• Gender equality development: 
  • greater knowledge and awareness of the inequality that exists in inappropriate relationships (relationships between a minor and an adult with a difference of 5 or more years) and how dangerous they are for the development of girls in a sex-free environment. violence and/or power.

After five years we will monitor some long-term indicators of success such as:

• Number and percentage of girls who stayed in school,
• Number and Percentage of girls who are doing community work (voluntarism, involvement in community groups, mentoring younger youth),
• Number and percentage of girls reporting developing life mission and goals (studying, working, community engagement),
• Number percentage of girls who perceive themselves in leadership positions (at School, family, community),
• Number and percentage of girls postponing sexual initiation,
• Number and percentage of girls reporting gender equal relationships and decreasing intimate partner violence.

We recognize that adolescents need knowledge, skills, and motivation (health belief model theory of change) to avoid these risky behaviors and do the real work of adolescence: advance through key developmental experiences and complex emotional and moral questioning on their path to adulthood. We believe that for teenagers as individuals and for the society that surrounds them, adolescence is an opportunity for skill-building, introspection, building community, questioning status quo, exploring, and learning.  We trust that when girls are empowered with knowledge, skills, and motivation, they will make smart choices to reduce or prevent risky behaviors. They also build life skills that promote education, employment, and social responsibility.

 TeenSmart has 19 years of success providing holistic health promotion and confidential personal leadership coaching to teens throughout Nicaragua and Central America using the validated Health Belief Model. TeenSmart's innovation and impact has been recognized by the prestigious Carlos Slim Exceptional Health Institute Prize (2016) and the InterAmerican Development Bank Visionary Prize (2018). In 2020, JovenSalud’s Nicaraguan users increased 24% from 2019 and now represent 55% of our global users, reflecting a need for support that may not otherwise be met.

We believe that when girls are provided with a tool (in this case a course), knowing that it was co-created by other girls (first-hand experiencers) and experts on the topic of Sexual and Reproductive Health Rights, they will:

• get more interested on taking the course and get more involved with it
• maximize their virtual educational opportunities in this formative moment
• make smart SRH choices for their own well-being such as postponing sex and/or practicing safe sex,
• recognize improper relationships (such as older men with young girls) and educate their peers around the dangers of human trafficking,
• promote gender equal relationships.

5 full-time staff

1-2 contractors

7 years.

With JovenSalud.net, teens who would otherwise not have access to a trained coach or a quality sex-education course, now have private, confidential, 24/7 control over their own health and risk behaviors. This is the aspect that makes our virtual intervention unique. With virtual interventions through jovensalud, it’s easier to serve with a different perspective offer by the traditional in-face health centers (which moreover are difficult to access by youth); and -mainly- virtual intervention’s scalability is faster than developing only in-face interventions. There are some challenges that virtual interventions have, mainly for us working in a region with high rates of poverty, such as: teens not having access to mobile phones or computers, and internet, so they could access jovensalud.net. However, in specific cases of the most vulnerable communities, we have carried out a project of “mobile libraries” where we grant free use of devices and internet to access jovensalud.net. Additionally, we have previously developed specific interventions that mix in-face and virtual practices with a specific population in determined cities and communities.  TeenSmart's virtual intervention with jovensalud.net, is based on the Health Belief Model theoretical framework which suggests that when youth feel competent, motivated, and knowledgeable, they will make smart choices and build skills for education, employment, and social responsibility; and thus, impact positive in their communities with a multiplier effect. 

Engaging girls through these technological interventions ensures that any of them with access to a cellphone/computer and internet, could become their own live´s agents of change, positively influencing their families & peers in their communities, whereas traditional approaches have focused on costly adult-led face-to-face interactions and on family and community factors (outside of teen’s control).  

At TeenSmart, we believe that meaningful change is only possible when the project is informed by the complex social and environmental circumstances and lived experiences of its beneficiaries. This is why the most vulnerable community members and youth co-design efforts are so important to TeenSmart and why we value cultural awareness and connection among our team. Staff live in Central America or Mexico, studied at its schools, and are - in many cases - raising families in its vulnerable neighborhoods. Several staff were originally users of JovenSalud.net who went on to become volunteer coaches while getting their bachelor's and advanced degrees. The Board of Directors is 50% female, 75% Central American-based, and have held leadership roles in major regional institutions such as INCAE Business School, Zamorano University in Honduras, and UPOLI University in Nicaragua. 

In addition, 130 institutions and NGO´s already implement/promote jovensalud.net’s tools, including our course Conoce-T regarding SRH. We have implementing and promoting partners through Central America who use jovensalud.net to add value to their health promotion activities & curriculum, I. e, community clinics, technical assistants in primary care, positive youth development organizations, Health Ministries, etc. In this way, we are reaching as many teens in need as possible, using different fronts.