What is Sarari?

 

Sarari is an intervention that aims to increase the support of influential community leaders for reproductive health practices in Niger. The Sarari program is comprised of three main activities.

Transform/PHARE, a USAID funded five-year project, introduces innovative practices from marketing, advertising, human-centered design and behavioral economics to strengthen health-related behavior change programming.  Led by Population Services International (PSI), in collaboration with its partners Camber Collective and IDEO.org, the Transform/PHARE project designs, implements, evaluates and disseminates innovative social and behavior change strategies for improving reproductive health in Francophone Africa.

- In Hausa, Sarari means “spacing,” ”comfort,” and “well-being.”

 
 
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1. Leaders EngagÉs

A structured collective of religious leaders who serve as agents of change by openly advocating (through preaches, teaching at the Koranic school, or private consultations) on the importance of birth spacing for maternal and infant health, and overall family well-being.

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2. SÉMinaire des Leaders

A series of debates between religious and youth leaders on the topic of birth spacing and family planning, held either in private (followed by a form of public dissemination of their choosing), or in public with the community in attendance to benefit from this exchange.

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3. Dede Ruwa Dede Tsaki

Communication tools and a financial planning exercise designed to inspire responsible parenthood and encourage young families to evaluate the financial implications of having children. Youth leaders in each village are trained to facilitate this exercise amongst their peers.


 

1. Leaders Engagés

 
 

Through conversations with religious leaders, youth, and communities, we sought to uncover the extent to which young people rely on religious leaders and their faith for guidance on whether to use contraception, and if so, when. We learned that while religious leaders carry moral authority within the community, they were not considered by youth as a go-to source for information on health matters, even among devout Muslims. Instead, religious leaders indirectly influence decision making among young men and women through their influence and sway over parents and elders, which sets the tone for community norms and values. Youth, on the other hand, rely on their peers and their spouses for guidance on contraceptive decision-making. 

We learned that although several religious leaders support birth spacing, they feared that any public support in favor of the use of contraception would jeopardize their reputation and undermine their authority  in the community. In light of this, our challenge was to design a solution that would minimize risk to religious leaders who were supportive of the use of contraception to achieve optimal birth spacing. In working to design these solutions with religious leaders, we uncovered two important findings: 1) strength in numbers would be essential in encouraging religious leaders to promote positive reproductive health behaviors, and 2) rock-solid back up taken from the Koran or Hadith would be needed to justify their positions.


 

“I would talk about the consequences of frequent pregnancies and the advantages of spacing births in favor of a fulfilled family in private, but never in public, given the susceptibilities of the population of my village.”

         — Religious leader, 36 years old.

 
 
 

As such, we designed Leaders Engagés (in French, “committed leaders”), a collective that enables religious leaders to serve as agents of change in their community. Through the support of pre-prepared teachings that draw on religious texts, these leaders became comfortable with openly advocating — either through sermons, teaching at the Koranic school, or through private consultations — on the importance of birth spacing for the family's overall well-being.

The design team developed religious justifications within sermons in both audio and visual formats that advocate for birth spacing, wellness, responsible parenting, and condemn spousal abandonment. 

The content for these sermons are derived from direct verses from the Koran and extracts from the Hadith to provide leaders with the religious arguments to justify the importance of birth spacing, not only for maternal and infant health, but for future prosperity. For example, the Koran prescribes a period of two years for mothers to breastfeed her children, while teachings from the Prophet recommend that parents leave their heirs rich and well-off rather than poor and begging.  

 

 

2. Séminaire des Leaders

 
 

In speaking with community members about reproductive health, we noticed that there were many misconceptions about the forms of contraception available and their potential side effects. One belief was that an implant could disappear in a woman’s body should she gain weight. Another fear was that using contraception could lead to  infertility.

Such myths were reinforced by group ‘echo chambers,’ as individuals often discussed these issues within smaller groups of neighbors and friends. We realized that both religious leaders and youth wanted to improve their knowledge and dispel myths about reproductive health, but didn't have a mechanism in place in which to do so. 


“If you die with an implant, are you really going to go to God’s house with that thing in your body? ”

         — Young woman, 22 years old.

 
 

To address this need, we designed Séminaire des Leaders, (in French, “Leader Seminars”), community dialogues between religious leaders and youth association leaders to dispel myths and misconceptions about family planning and birth spacing.

In this public forum these two influential groups had a forum to engage in candid discourse on the use of family planning for birth spacing. The public nature of the debate generated awareness with the larger community, and set a precedent that could be referenced by young families when seeking family planning.

When moderated by a health worker, as often requested by young parents, this discussion also allows the community to improve their knowledge and dispel myths about reproductive health.

 

 

3. Dede Ruwa Dede Tsaki

 
 

For married women, the primary factor determining contraceptive use was support from their husband. And while men were the main decision makers on contraceptive use, they didn’t consider the financial implications of having more children than they could afford. Additionally, arranged early marriage means that young men and women entering into a union as strangers. As a result, conversations about use of contraception to space their children or plan for ideal family size rarely happen early in marriage. It is not until the second or third child, when parents begin to feel the burden of parenthood, that this conversation occurs. 

How could we encourage parents, especially husbands, to plan for their ideal family size earlier and understand better the real costs of raising children?

Through testing different approaches, we found that a combination of understanding the expenses incurred with having children, combined with exposure to messaging on the religious and moral obligations to raise their children responsibly, helped families understand and visualize how they can work towards achieving a better quality of life for their families. 


“I manage the finances and spending for my family. My wife uses the pill and it was my decision because I’m the man.”

         — Young man, 24 years old.

“I want to talk to my wife about the number of children after the third birth, so that she will understand. Now, it’s too early.”

         — Father of one child, 22 years old.

 
 

The result was Dede Ruwa Dede Tsaki, “Just the right amount of water for the flour”⏤an approach named after a Hausa proverb that expresses the need for balance. The activity combines two essential elements: 1) a financial planning and budgeting tool facilitated by youth leaders that helps calculate how household expenses increase according to the desired number of children and; 2) religious-themed posters which display verses from the Koran and extracts from the Hadith (teachings of the Prophet) in favor of birth spacing and responsible parenthood. These messages focused on pain points that were commonly held by parents struggling to raise more children than they could afford⏤from the deteriorating health of the mothers, to the struggle to provide food, clothes, and shelter to the family. The posters were hung in fadas, areas in the community where men congregate. Men shared that having a visual reminder which depicts a balanced quality of life would motivate men to discuss these issues openly with one another and help them to hold each other accountable. These two elements⏤budgeting and religious arguments⏤encouraged informed decision making on desired family size while helping families calculate the financial implications of having more children.