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The Hewlett Foundation Blog




Taking Risks by Design 

June 30, 2014 — By Margot Fahnestock

One of the privileges of working at a foundation is the ability, with encouragement, to take risks. Over the last eighteen months, the Hewlett Foundation has been collaborating with some dynamic thinkers to energize our portfolio of investments in international reproductive health.  Among the more promising partnerships to emerge is one between IDEO.org, a non-profit organization born of the famed design firm, and the UK-based reproductive health care provider Marie Stopes International.

Reproductive health in the international sphere is what you’d call a “mature” field, which is to say that it has accumulated a great deal of knowledge,  mostly knows what it wants, and often tends to do the same things because that’s the way it has always been done.  When the field was young in the mid-twentieth century, it was fueled at once by medical doctors, demographers and “brave and angry women.” When Bill and Flora Hewlett and their son Walter sat down at their kitchen table in 1966 to create the Foundation and codify their concerns about women’s access to birth control and safe abortion services, the field was still relatively young.

Now, nearly 50 years later, the field is facing middle-aged challenges, often lacking the adolescent qualities of curiosity, creativity and eagerness.

In other words, how does the field of international reproductive health find its fountain of youth?

The question is neither academic nor romantic: while many donors, including the Hewlett Foundation, often support the most cost-effective and evidence-based approaches first through pilot tests and eventually “at scale,” we’ve had a hunch that to reach the next wave of contraceptive users – particularly young women, rural women and poor women in sub-Saharan Africa – donors, governments and service delivery organizations will have to think and do business differently.

And so we went with our hunch that seeking out new partnerships with experts outside the field of reproductive health and introducing an approach like “design thinking”, or human-centered design, into this mature field had the potential to solve some persistent challenges.  Challenges such as how to reach populations that do not currently use contraception because of social stigma, fear of side effects and infertility, lack of information; empower young people to take control of their reproductive health; and generally, overcome a bit of staidness that may have crept into our steadfast adherence to best practices.

What place does design thinking have in addressing young people’s reproductive health in sub-Saharan Africa?  The answer may not be immediately obvious. 

For the last several years, IDEO.org has been applying its expertise—i.e. using insights about what people want to design better products and services—as a strategy to reduce poverty.  IDEO.org’s approach begins with a deep inquiry phase over several weeks – one that I’d characterize as experiential– followed by a structured brainstorming process to imagine concepts and solutions, rapid prototyping of those concepts, refinement of the concepts that seem to be sticking, and finally, testing of the winning concepts in a controlled setting.  As opposed to starting with a log frame or results framework (or logic model, or theory of change, or…), IDEO.org enters a project with the ending largely unknown.  

I’ve come to appreciate that what underpins the process of design thinking – particularly as it pertains to redesigning reproductive health services – is a little bit of faith.  Faith that starting with blue sky thinking will in time lead us someplace we might not have ended up had we specified the solutions, activities, indicators, and targets ahead of time.  And what I’ve seen so far of the rapid prototyping process has made me believe at a visceral level that our field needs to just try new things – and test new ideas constantly (fail fast, fail often) so that we can quickly discover what might be a better idea.

So, last November, with the ambitious vision of using design thinking to make reproductive health services more responsive to young people, the Hewlett Foundation gave a pair of grants to IDEO.org and one of our longtime reproductive health service delivery partners, Marie Stopes International.  The two organizations are working together in Zambia, where there are an enormous number of young people vulnerable to HIV transmission and unintended pregnancy, to tackle the question of “how might we empower young people to take care of their sexual and reproductive health?”

As with any attempt to change the paradigm, we know we may fail in a manner of speaking. Peers may conclude that design thinking doesn’t really yield better outcomes, or that the innovations represent, at best, small ideas and incremental changes, or that the research methodology isn’t rigorous enough. That’s okay. Because with that feedback we can use what we’ve learned to refine the idea and revamp our efforts so that, in the end, the only way we truly fail is to stop listening to the young people we’re trying to help.  

Stay tuned.