EWAS Project - Empowerment • Women • Awareness • Sexuality

The women condition requires attention to the consequences that poor reproductive planning and unknowledge of sexual and reproductive rights have for them, where choices about sexuality and reproduction are central to their present and future. In Brazil, women with lower schooling and income have less access to information and contraceptive services, contributing to high number of unplanned pregnancies. The project aims at solutions in reproductive planning (digital tool will facilitate monitoring by the health team, contributing to prevention and reduction of unplanned pregnancy cases in the main gaps in the coverage of care provided by contraceptive methods) and in sexual/reproductive rights education (permanent e-learning environment for health professionals training, mainly community health agents through up-to-date and accessible virtual content), improving women condition in developing countries by promoting reduction of gender inequality through school access, economic empowerment and well-being for all involved when adequate reproductive planning is achieved, especially for mother-baby.

Healthy cities require healthy individuals and environments, from conception to old age. Therefore, adequate family planning, where all pregnancies are planned, is a fundamental right to enable well-being and full life for all, and is equally important for achieving the Sustainable Development Goals (specially 3 and 5 - Health, Well-being and Gender equality). No country has yet fully guaranteed this right, and in developing countries this progress is even more unequal, contributing to high numbers of unplanned pregnancies, especially among girls and adolescents because they lack access to adequate information and effective contraception services. Analysis of 32 countries indicates more than 20% of cases of use of short-term methods show interrupted use in 12 months, despite the user wanting to avoid pregnancy. Only Brazil, in 2016, 24,000 children of girls up to 14 years of age and 477,000 children of mothers aged 15-19 years (20% of births) were born, 6/10 of whom didn’t work or study. In general, these women are less educated and in the poorest sectors of society - by having unplanned pregnancy they make it difficult to enter the labor market, perpetuating the cycle of poverty for themselves and their children, and impeding health excellence for all. 

Sexual and reproductive health services that serve the vast majority of Brazilian women, providing free care in reproductive planning through consultations and delivery of contraceptive methods, constitute health teams called the Family Health Strategy, working within low-income communities with a defined territory, where all individuals are registered and under the responsibility of the team. The critical socio-economic reality of these communities makes women's condition special because of the significant inequality of gender and income, and the profoundly shocking consequences that poor reproductive planning and lack of knowledge of their sexual and reproductive rights have in their lives, verified by high numbers of unplanned pregnancies - mainly among girls, adolescents, single women and late puerperal women. Our effort is to promote effective reproductive planning to meet demand through universal access to contraceptive services and methods through active search, appropriate monitoring of method use, and better training of health professionals to provide women with accurate information to understand reproductive planning and sexual / reproductive rights. Ensuring that such women develop awareness of this is paramount to health excellence, enabling them to make conscious choices about their sexual / reproductive lives, provided by trained professionals, transforming their lives, their society and their world.

The project creates a prototype of na app and a digital experience platform to be used by the health team in the cities, adapting reproductive planning to the reality of the community served and enabling actions to prevent and reduce unplanned pregnancy through a tool for data monitoring and education in reproductive and sexual rights (e-learning). The project is developed by analyzing population data (available in existing database that includes all women in the community) and by including this data in the application software, in order to generate information that directs actions in reproductive planning and in sexual / reproductive health, allowing the creation of digital tool for adequate registration, monitoring and control of all the follow-up process of the users by the health team, enhancing sexual and reproductive health care. With regard to sexual / reproductive rights education, the tool will allow a virtual environment for training and permanent information for health professionals, mainly community health agents, through updated and accessible content that can be used to guide users. One of the main reasons for deficits in the quality of service in reproductive and sexual health is related to the lack of responsibility and responsiveness of the team to the users of the service. Competent health information management systems, as well as efforts to systematically record and analyze all data and to identify deficits in care, would enable staff to monitor and confirm that these services are reaching the major gaps in coverage contraceptive methods (girls, adolescents, single women and women in the postpartum period, in a situation of social vulnerability, inhabitants of micro-areas of high risk for unplanned pregnancy and with high rates of gender violence in specific community of Porto Alegre). Up to now, users' access has been made on the basis of spontaneous demand - the use of contraceptive methods only involves those seeking health services - the users are also monitored by themselves for use and the use record is carried out in form sheets manual, without any effective control of the data. Emphasis on monitoring, as envisaged by UN Agenda 2030, provides opportunities to fill these gaps, especially for reproductive planning, aiming at a world where all pregnancies are planned, expanding access to contraceptive methods, and allowing all women to be accompanied, respected and attended in their reproductive and sexual choices, so that no woman is left behind.

Our solution proposes a change in the reproductive planning process, adapting the model to the needs and reality of the community through an application that improves data collection in reproductive/sexual health, appropriating statistics to promote improvements in the reduction and prevention of unplanned pregnancies (UP). The our innovation of the reproductive planning model makes it efficient to monitor, control visits / returns to the health center and register contraceptive use, increasing access to the use and consultations in reproductive planning and enabling adequate guidance to women by community health agents through e-learning environment, providing effective prevention of UP. At the moment there isn’t none information technology involved in the process - monitoring of patient data and the registration of contraceptive use is done in a manual worksheet, checking the renewal of the method when patient seeks service by spontaneous demand, and there isn’t active search for women at high risk of UP to start using contraceptives, although there are high rates of UP in the community. App will contain a complete database of all women of childbearing age in the community, enabling monitoring and contraceptive use, allowing community health agents to access information about which patients use what methods, what are the choices of each patient in relation to reproductive health / sexual, which contraceptive is more appropriate for each woman, which are dates of return to the health center to withdraw contraceptive, and receive push notifications about all this information, which facilitates follow-up and reduces chance of contraceptive failure.

Solution uses existing digital technology - application prototype – to build innovative model of reproductive planning adapted to the "Cidade de Deus" community in Brazil. App uses BEHAVIORAL DESIGN - methodology that applies changes in the reproductive planning process to encourage good choices on the part of women related to reproductive and sexual health – and THINKING DESIGN – approach that seeks to solve problems in collaborative way and creates maximum empathy with everyone involved. Software includes BIG DATA - containing general data from the community - and SMALL DATA - grouping general data on the female population of childbearing age (age, schooling, work, marital status, housing, basic sanitation), specific data on sexual health (gender, sexual orientation and age at the beginning of sexual life), reproductive health (choices in reproductive planning, desire for pregnancy and desire to use contraceptives) and specific information generated by such data (date of consultation/return, renewal and next withdrawal of contraceptives, frequency of orientation on contraceptives use), perceptions and experiences of community health agents in relation to the patients followed by them, allowing to calculate the main analysis objective (low, medium or high risk of unplanned pregnancy) to efficiently monitor and guide each woman according to her needs in planning productive. The application used by community health agents on their personal tablets will give them access to all women's data and allow them to receive real-time alert notifications about actions needed to reduce chance of contraceptive failure and to expand coverage and access to contraceptives.

Unplanned pregnancies have serious social consequences - deaths of women in clandestine abortions, abandonment of babies, impoverishment of families for the perpetuation of the cycle of poverty, and abandonment of studies among pregnant adolescents. In Brazil, the unplanned pregnancy rate is 55.4 % (percentage above the world average of 40%), and there are no targets for reproductive planning or unplanned pregnancy reduction. One of the main reasons for such deficits in the quality of reproductive and sexual health service, according to WHO, is related to the lack of responsibility and responsiveness to the users of the service. Based on the goal set by the UN Population Fund (none unplanned pregnancy), the use of health technology as our prototype data management application is capable of creating a stronger health information management system for monitor data in reproductive planning through efficient registration and systematic analysis of sexual and reproductive health choices of the entire female population of childbearing age in the community. Thus, it becomes possible to identify deficits in care, monitor the progress of actions and confirm that access to contraceptives is actually occurring and their use is being effective in preventing the occurrence of unplanned pregnancies by covering the gaps in care. Such emphasis on monitoring, as set out in Agenda 2030, provides opportunities to fill these gaps, as our technology improves data collection, recording and processing, promoting substance improvements is preventing unplanned pregnancies.

Our solution is currently serving a community of approximately 3.800 people, with approximately 1.700 women of child-bearing age being registered. In one year, the goal will be to use the app in all health centers in the city of Porto Alegre, serving about 450,000 women between 10 and 49 years. In five years, the goal will be to serve all health centers registered by the Brazilian Unified Health System, serving about 65 million Brazilian women of childbearing age.

The objective we have next year is to finalize the development of the data app, which is currently in the prototype phase, and move on to implementation phase of the app in all health centers in the city of Porto Alegre to be used by the community agents of health, in addition to also developing the platform of digital experience in sexual and reproductive health, which is currently in the planning stage, to be used by community health agents and users of the health system, allowing an adequate health e-learning environment sexual and reproductive health for training and continuing education. Over the next 5 years, the goal is to expand the implementation of the app and the digital experience platform on reproductive and sexual health in all health centers in Brazil.

The only barriers we currently have in our solution are the financial barrier and the barrier of weight partnerships and/or sponsors - in relation to the financial barrier, more programming investment is needed to develop a complete app and digital experience platform with an interface of great quality and functionality. With regard to partnerships, given the low investment of Brazilian governments in health technologies and the neglect of the current Brazilian government with sexual and reproductive rights and public policies on sexual and reproductive health, it is essential to provide technical, intellectual, logistic and even financial support of organizations such as the UN Population Fund, UN Women and other entities strongly involved in the cause.

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