Digital Empowering to Decide

Latin America and the Caribbean have the second highest rate of teenage pregnancies globally, corresponding to 18% of all births in women under 20 years of age. In Colombia, the lack of adolescent pregnancy prevention represents around 0.56% of the Gross Domestic Product (GDP), equivalent to almost half of the additional collection with the 2022 tax reform (1.3% of GDP). This calculation corresponds to the lost opportunities in education, work, income, health, and well-being, which increase gender inequalities and the burden of unpaid work.

For this reason, reducing teenage pregnancy is a national priority, aligned with achieving the Sustainable Development Goals (SDGs). SDG 3.7, by increasing access to sexual and reproductive health services, effective contraception with modern methods, and reducing the fertility rate of adolescent girls, and with SDG 5, in the fight for gender equality.

In Colombia in 2020, teenage pregnancy rates were reported between 10-14 years of age of 12.1 and between 15-19 years of age of 66.3 per 1000 women. By 2022, despite a 15% decrease in pregnancies, 4,169 of 1,938,646 girls between 10 and 14 became pregnant, even though they are considered forced mothers, a product of abuse and sexual violence. Until the first half of 2023, 5 maternal deaths of girls in this age range were reported. At the current reduction speed, it will be achieved to 1,000 births in girls aged 10 to 14 by 2031 and less than 100 by 2046. In the same year, of 1,994,534 adolescents, 93,096 women became pregnant.

In the department of Valle del Cauca, the effective adolescent fertility rate has been decreasing from 71/1000 in 2007 to 27.4/1000 in 2022 due to the efforts of the public and private sectors. However, there are still municipalities in the northern and central subregions of the territory that maintain effective fertility rates well above the average, up to 98 per 1000. These municipalities are characterized by not having a unified policy of induced demand and active search of adolescents, barriers to access to sexual and reproductive health education, and administrative barriers to implementing long-term planning methods.

Accessing children, adolescents, and young people in these territories is quite a challenge and represents a significant economic investment for the traditionally proposed programs. Currently, there are no projects for virtual access to safe and reliable information on sexual and reproductive health for this population and their families, and the information published is partial, limited, and often distorted. This type of communication can generate risk due to the interactions that develop in these spaces for girls, boys, adolescents, and young people.

Digital Empowering to Decide is a digital educational model aimed at adolescents, young people, and their families in territories with a high adolescent fertility rate in the department of Valle del Cauca, implemented through established channels with social networks and a process of segmentation of the target population mediated by artificial intelligence.

The model is based on three fundamental pillars: strengthening sexual and reproductive rights, education in family planning, and updated access routes for contraception methods, with particular emphasis on adolescent-friendly services. Using social networks to enter the educational model eliminates the barriers to access to comprehensive and quality information and services in sexual and reproductive health for adolescents and young people. Additionally, due to the high penetration of mobile devices in Colombia and the social networks of Instagram, Facebook, and WhatsApp, the aim is to strengthen the Comprehensive Sexuality Education policy, which implies continuing the educational process inside and outside school. , in all areas of daily life, to empower girls, boys, adolescents, and young people and promote their bodily autonomy.

The themes of the educational model have been tested and implemented for health personnel by the team of specialists and students of the gynecology and obstetrics specialty of the Valle del Lili Foundation through the Hospital Padrino strategy with the local and regional government. For the challenge, the topics are adapted from the student's perspective to be carried out and accepted by the community of adolescents and young people.

Based on the sociodemographic information obtained from the different health entities of the department, the target population can be identified as adolescents, young people, and their families who live in the most vulnerable sectors with a high teenage pregnancy rate. With this data, a sectorization model will be generated using a digital algorithm so that the intervention is directed only at this population, and through high-penetration social networks, the information will be propagated with a platform that allows the establishment of a two-way channel. Through these means, primary data will be recorded, allowing traceability of the impact of the proposed educational model.

Population segmentation aims to reach the target community from any electronic device, with scientific information through short videos, infographics, and access to information links on previously generated platforms, but in an accessible and organized way. The model includes videos of testimonies from adolescents telling their experience of experiencing pregnancy during adolescence as a model for reflection on its impact. In addition, it will have a constant communication channel to provide information, resolve doubts, and indicate the access route to acquire the contraceptive method of your choice. Information on access methods will include health services, pharmacies, and educational programs with condoms in schools.

Digital Empowering to Decide benefits adolescents, young people, and their families from highly vulnerable territories with poor access to educational projects in sexual and reproductive health, initially in a Colombian territory but with the possibility of scaling up to a Latin American level. This benefit extends to the entire community, to the results of health services, and to governance to achieve the Sustainable Development Goals (SDGs).

 Around the world, especially in low and middle-income countries, adolescent pregnancy has become a problem; in 2019, it reported around 21 million unintended pregnancies each year, of which approximately 50% are unwilling, giving about 12 million newborns. Of that 21 million pregnancies, about 50% end in abortion, most of them in unsafe conditions that put the mother at risk of severe illness and even death.

 The other half of the pregnancies that don't finish in abortion have some risk exceeding the average population; for example, adolescent pregnancy has an additional risk of preeclampsia and sepsis compared with pregnant women aged 20-24. Besides, the babies have an additional risk of preterm birth, low birth weight, and being admired in the intensive care unit, which is an additional cost that impacts the health care system, and that cost is preventable.

A pregnant adolescent hurts her life and all her family and community, causing additional risks (described above) and will affect her life and her future. World Health Organization says preventing adolescent pregnancy and pregnancy-related mortality and morbidity are foundational to achieving positive health outcomes across the life course and imperative for achieving the SDGs related to maternal and newborn health.

The adolescent pregnancy rates are higher among those with less education or lower economic status; sometimes, they don't have access to contraceptive care in their city, or in many cases, they don't have money to buy the contraceptive method.

It is essential to consider that pregnant adolescents can significantly alter young women's life prospects and their children's. It has been demonstrated that these young women have lower educational attainment, which can perpetuate a cycle of poverty from one generation to the next. Thus, helping young women avoid unintended pregnancies can have far-reaching benefits for them, their children, and societies. Improving adolescent pregnancy rates will impact their lives, family members, and community.

We are a team of graduate students and professors from different disciplines in an academic environment with the training and medical educational reach to understand the problem of the free exercise of sexual and reproductive rights of children, adolescents, and young people in low and middle-income countries income, as well as the need and implement innovative solutions in the vulnerable population. We have extensive knowledge about women's reproductive rights and contraceptive methods, with over 50 publications on women's health generated in an alliance between the Fundacion Valle del Lili, a non-profit university hospital, and the ICESI University in Cali, Colombia. Furthermore, through the experience with the Hospital Padrino strategy, which seeks to impact the health of the Colombian population by knowing the health system's limitations in more than 160 public hospitals, we have held training sessions for health personnel, allowing us to learn about the existing barriers in the different populations. On the other hand, given our daily work at the university hospital, which is a level IV institution in Cali, in the southwest of Colombia with the largest obstetric critical care unit in the country, we are very close to the female population, which allows us to know first-hand the risks and complications of teenage pregnancy, showing the importance of intervening in this population to prevent unwanted pregnancies, working on female empowerment and strengthening sexual rights. So once the patient enters the hospital for delivery care, personalized contraceptive advice is provided, evaluating their knowledge and breaking myths to guarantee the use of a contraceptive method before leaving the hospital.

Our university hospital has the largest telemedicine service in Colombia, which has allowed us to strengthen telecare processes and has forced us to know, expand, and implement new models of telehealth and teleeducation. Since 2022, the first artificial intelligence service has been implemented for a hospital in our country, which already has a social innovation project in sexual and reproductive health.

We have gained experience developing focus groups with the community of migrant populations and those with a high degree of vulnerability to gender violence and armed conflict. The heartbreaking testimonies of patients have motivated us to train hospital teams in humanization, patient-centered care, and delivery care with a differential approach, favoring diversity, equity, and inclusion.

We are in the creation phase of the platform, while we visit the vulnerable areas we want to impact to fully understand the barriers faced by adolescents in fulfilling their sexual and reproductive rights. In addition, we have been in contact with health personnel who work in these areas to find out what barriers health entities have to guarantee contraception methods. 

Our solution proposes an innovative approach to preventing teenage pregnancy by integrating advanced artificial intelligence (AI) technologies with direct, personalized communication strategies through social media. This method is novel in its application and has the potential to catalyze broader and significant changes in this field. Below are the key elements that highlight the innovation of our proposal:

 Personalization and Direct Approach: Traditionally, prevention campaigns have used generalized messages that often fail to resonate with the personal experiences of adolescents. Our solution employs AI to segment the audience and personalize messages, ensuring that the information is relevant and resonates within the individual context of each teenager. This strategy increases the likelihood that the message will be compelling, as it considers each individual's unique circumstances.

 Use of Social Media: By choosing platforms that teenagers already use and trust, we remove access barriers and engagement challenges often faced by traditional campaigns. Additionally, social media allows for bidirectional interaction, where youth can ask questions and express their concerns in a familiar and safe environment.

 Advanced Application of Artificial Intelligence: Our solution is designed to learn and evolve beyond basic segmentation. It uses machine learning to analyze data, reactions, and feedback, adjusting messages and delivery methods in real-time to enhance effectiveness. This dynamic application of AI is a qualitative leap compared to traditional static strategies.

 Catalyst Impact in the Prevention Space: By demonstrating the effectiveness of a technological and user-centered approach, our solution could inspire other organizations to adopt similar tactics, creating a wave of innovation in the field. This new paradigm could improve not only teenage pregnancy prevention but other public health initiatives as well.

 Market Changes: This proposal can shift expectations and demands within the health and sex education market. It could drive the development of new tools, applications, and content specifically designed for teenage pregnancy prevention that use technology intelligently and strategically.

Innovative Business Model or Process: Our model relies on strategic collaborations between technology, education, and health sectors, creating a multifaceted support network. Furthermore, by gathering data and outcomes, we can offer valuable insights that attract investment in research, development, and prevention programs.

 In conclusion, our solution is innovative not just for the technology it employs but for how it applies it to fill a critical gap in teenage pregnancy prevention. By personalizing information, utilizing current platforms, and constantly learning and adapting, it offers a fresh and practical approach that addresses the issue directly and inspires broader changes in the reproductive health and sex education ecosystem.

Taking as a reference projects with high impact on evidence, such as California 2023, which implemented family planning education and promotion activities, the principal objective of the project would be to reduce the rate of teenage pregnancy in the municipalities of the central and northern subregions with the highest rates in the department of Valle del Cauca. The proposed reduction goal is 40%, jointly using this project and the alliance with the activities in development by the department's health secretary and the Hospital Padrina strategy in its sexual and reproductive health component. As mentioned above, these municipalities have dispersed rural areas and do not have adequate sexual education or access to contraceptive methods.

With this contribution, the Department of Valle del Cauca can modify its teenage pregnancy rates as follows:

• Between 10-14 years: from 1.4 per 1,000 women (2020) to 0.9 per 1,000 women

• Between 15-19 years: from 37.5 per 1000 women to 22.5 per 1000 women.

The second objective is to increase the insertion rate of implants and devices by 70% until reaching a rate of LARCS use in adolescents above 20%, the rate found in Central Asian countries, a global benchmark for success.

Sexual health and reproductive health education strategies that reach young people, especially promoting long-acting contraceptive methods (LARCS), have demonstrated greater adherence to contraceptive use, reducing unplanned pregnancies and increasing the rate of implant insertion.

Artificial intelligence models allow social networks to reach the target population, so it would be possible to have an impact, generating a cultural change in adolescents, educating them on sexual and reproductive rights, postponing the beginning of sexual relations, and using contraception that allows reducing teenage pregnancy rates.

This is called a theory of change or logical framework, and it should link your activities to immediate outputs and longer-term outcomes for your target population. In addition to illustrating logical links between activities, outputs, and outcomes, a strong theory of change provides evidence to support the existence and strength of those links, such as third-party research, findings from a process or impact evaluation, data from interviews with your target population, etc. 

There are seven physicians on the development team for the proposed solution: two obstetrics and gynecology residents who are the project leaders, one second-year resident, and one fourth-year resident. In addition, there are four gynecological and obstetrician doctors; one is a subspecialist in gynecologic endocrinology and sexual and reproductive health, and two are subspecialists in obstetric critical care. Additionally, an anesthesiologist is a systems engineer with a master's degree in artificial intelligence. Currently, all staff are full-time for medical and educational activities.

From our profession as health personnel, we work at Fundación Valle de Lili, a reference center for high-risk pathologies in the southwest of the country. Since 2009, the institution implemented the high-complexity obstetric unit, allowing us to be in close contact with pregnant adolescents in critical conditions, identifying different risk factors such as deficiencies in knowledge of sexual and reproductive rights. Since 2018, we have been working on social responsibility projects involving hospitals and the community, creating different strategies to reduce maternal mortality, in this case, by reducing adolescent pregnancy by overcoming certain intervenable risk factors.

Fundacion Valle del Lili, the center of the team's professional and academic performance, has developed a considerable movement in the last two years to incorporate the concepts of diversity, equity, and inclusion in patient-centered care and the training of all the institution's workers. At this time, we have a clear policy of differential approach to the care of our users, and the implementation of a tactical plan for equity, diversity, and inclusion of all clinic workers has begun. For this reason, we are implementing the inclusive route with the support of the Canadian organization Cuso International, and a leading group of 25 people is being formed in courses on gender, disability, LGBTIQ+ population, migrant population, etc.

Most FVL workers are women, including leadership positions; we have members of the LGBTIQ+ community and no restrictions of any kind for the entry of our collaborators. The project team comprises doctors with additional studies in social innovation in health and clinical epidemiology who constantly seek to understand diversity, equity, and inclusion as the compass that directs the project.

ICESI University is the team's training center and thinking center. It has been impacting the region's society from the axis of inclusion and equity through the three missionary functions that all its programs have - teaching, research, and social projection. From different disciplines, they have impacted economic and social development and environmental care with programs from the Center for Afrodiasporic Studies (CEAF) called Voices of Resistance, the Pacific Task Force on articulated and collective work that works to mitigate the impacts generated by the COVID-19 pandemic, the projects led by the Observatory for Women's Equality – OEM and the Yunus Center for Social Innovation.

Our business model, crafted to address teenage pregnancy prevention, is rooted in delivering substantial value in social impact and revenue generation. We are committed to fostering a more informed and secure environment for teenagers while establishing a sustainable, scalable platform. Here's how we plan to accomplish this:

1. Key Customers and Beneficiaries:

Our direct customers are educational institutions, public health organizations, and NGOs engaged in youth health and education. The beneficiaries, on the other hand, are teenagers who gain crucial information about pregnancy prevention.

2. Products and Services:

We offer a comprehensive service that includes:

a. Access to a user-centered, adaptive digital educational platform.

b. Interactive tools for self-exploration and understanding related to sexual and reproductive health matters.

c. Personalized education and awareness programs, backed by artificial intelligence, to ensure the content is relevant and engaging.

d. Online consultations and counseling with healthcare professionals for inquiries and follow-up.

3. Delivery Method:

Our services are digitally rendered, leveraging social media technology and other online platforms popular among teenagers. Artificial intelligence allows us to segment and personalize content, and users can access resources and professional advice anonymously, thereby removing common barriers to seeking sexual health information.

4. Need and Demand:

In the digital age, teenagers are looking for answers online. However, information about sexual health can be confusing, misleading, or inaccessible. We provide verified, scientific, and relevant information in a format that resonates with the youth. Institutions benefit by enhancing their outreach and impact, while teenagers gain life-changing resources.

5. Revenue Generation:

Our revenue model is based on several streams:

a. Subscriptions: Client institutions pay for Access to the platform and tools with various service tiers.

b. Strategic partnerships: We collaborate with health organizations and private companies for sponsored content and joint campaigns.

c. Licensing: Other programs and countries may license our technology and content.

d. Professional consultations: While Access to information is accessible for teenagers, direct consultations with health professionals might incur a fee.

6. Sustainability and Scalability:

Our strategy focuses on constant reinvestment in the platform, using the revenues to enhance technology, expand content, and reach more communities. As our user base grows, so does our value for sponsors and strategic partners, creating a cycle of sustainable growth. In summary, our business model strives not only to be a profitable venture but is deeply rooted in social commitment. By providing services that are both in market demand and critical for teenagers' well-being, we strike a balance between commercial sustainability and social impact, redefining success in the public health and sex education space. This dual-focus approach ensures that we're not just building a business but actively contributing to a healthier, informed, and empowered youth community

The project will have a sustained strategy subsidy by the Valle del Lili Foundation from its social responsibility area because the Foundation is a non-profit institution and must reinvest the profits resulting from the business in social responsibility and education programs. However, our revenue model is based on subscriptions, strategic partnerships, licensing, and special fees for professional consultations. Additionally, to be financially sustainable, it will require:

1. Donations from private companies under social responsibility and shared value concepts.

2. Application to challenges focused on the areas of public health and social innovation in health that seek to impact the sexual and reproductive health of adolescent girls.

3. Application to research calls with the Ministries of Sciences and Technology of Colombia in areas of public health and social innovation in health

4. Application to grants and challenges that may include research projects on social innovation networks in health and global health

5. As our user base grows, so does our value for sponsors and strategic partners, creating a cycle of sustainable growth.