Revolutionising access to digital menstrual health information for girls: Oky app

"I want to know what to do when I get my first period and what changes to expect during puberty, so I feel prepared, assured and confident to manage them.” – Oky user 

Girls have important questions about their health, and often they don’t know where to turn to find trusted, culturally sensitive information about their menstrual, sexual and reproductive health. UNICEF’s East Asia and Pacific Regional Office saw a need to close this gender digital divide and set forth to develop Oky – the world’s first period tracker app for girls and created with girls.

In today’s episode, we speak to Gerda Binder, UNICEF's advisor on gender and technology, about gender equality and digital technology in the region, and how the Oky app is helping to close that divide.

Gerda explains how the idea for the Oky app came about, the co-creation process with girls, their families, and communities, and how the app has been received in pilot countries of Indonesia and Philippines. We also discuss how her team is approaching the rollout of Oky in other countries like Papua New Guinea, where different cultural norms and religions play a part in access to an understanding of menstrual health.

Australia has provided $8 million to UNICEF to support the Oky app in Indonesia, the Philippines, and Papua New Guinea.

Find out more about the Oky app here: https://okyapp.info/

We encourage you to join the conversation and follow Australia's Ambassador for Regional Health Security Dr Stephanie Williams at @AusAmbRHS.

Transcript

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The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government.

Dr Stephanie Williams 00:27

Welcome to Contain This. I'm Dr Stephanie Williams, Australia's Ambassador for Regional Health Security. I'd like to acknowledge the traditional owners and custodians of country throughout Australia and our region. We recognise the continuing connection to land, waters, and community and pay our respects to Elders past and present. Today, we're talking about gender equality and digital technology. And I'm joined by Gerda Binder, who is UNICEF's regional gender advisor for East Asia and the Pacific. Gerda and her team with girls, their families, and communities, have developed Oky, the world's first period tracker app for girls and created with girls. Oky helps bridge the gender digital divide and provide young girls in the region with timely, culturally sensitive information about their menstrual, sexual, and reproductive health. Gerda and I speak about how the Oky app came about, the co-creation process, and how the app has been received in pilot countries of Indonesia and Philippines. We also discuss how her team is approaching the rollout of Oky in other countries where different cultural norms and religions play a part in access to understanding of menstrual health. I hope you enjoy the conversation.

Gerda, I get to talk to people who do a lot of interesting jobs doing this podcast and in, in my work, and I was hoping you could start us off with telling us a bit about your role. What do you do as the gender advisor at the UNICEF East Asia Pacific office?

Gerda Binder 02:02

Thank you so much, Stephanie. It's a pleasure to do this with you. I'm equally excited. I work with UNICEF, on gender equality and digital technology, which is a new and emerging area, it's so incredibly important that we don't look generically at the digital transformation that is happening in the world, but we use it and we leverage it for gender equality for girls and women's empowerment. And so how do we do that? We need to close the gender digital divide; we need to look at the various barriers that really hinder girls and women to benefit equally from digitally enabled support. And this is what I'm working on, especially on the Oky app.

Dr Stephanie Williams 02:50

So Gerda, how long have you been doing it? So how long has UNICEF had a specific focus on the digital divide with gender equality forefront? And maybe then you could lead us into telling us more about the Oky app that you just mentioned, which is our main area of interest for this podcast?

Gerda Binder 03:09

I think we all are aware of this gender digital divide for quite some time. But what has happened is that the focus on the adolescent girl wasn't there as much because it's much harder to get the data around this. There's a community of practitioners, research institutions that UNICEF has been collaborating with for quite a couple of years to raise this topic that girls and women don't benefit, and also don't participate as much in digital innovation in the use and adoption of digital tools. The focus on the adolescent girl we really have, particularly from the girls themselves, that actually also raised the issue is that there is not enough in the digital space that is relevant to their life. And one of the topics they raised was an area that’s so taboo, and so silent, and that was when they entered puberty, what's happening to their body, they want relevant content to their life that they can engage with, that they trust. And that is around menstrual health that is around sexual and reproductive health. 

Dr Stephanie Williams 04:22

So, you're describing a process by which UNICEF had some feedback from adolescent girls in different countries in East Asia and the Pacific in terms of the genesis Oky? Can you tell us a bit more about those early days?

Gerda Binder 04:37

Yeah, so that was around 2017-18, when more and more voices of girls shared with us directly in our programmes, in our engagements that they started to consider, you know, the internet is one of the sources to find answers to their questions. And we also know that the data still shows us that adolescent girls before their first period have very little to some in some contexts, and it in East Asia Pacific, no information about what's going to happen. And so of course, the anxiety that comes with it, of girls telling us stories about thinking that we're sick because they got their menstruation or having cancer and not being able to confide in anyone. And so this combination of really much higher connectivity level that is in not all of them, but many countries in East Asia Pacific now help them to look for the answers. And yet they said, but I don't know which one of these answers to trust. Sometimes I get conflicting messages, or I actually get information that is in a language that is either so scientific, or it is really not something that is in an empowering or positive format for me. So the adolescent girls in the region were the ones to raise, and initiated this initiative, and said, we want to break this taboo. But with that, we need to actually have access to trustworthy to girl-friendly, the information at our fingers. And in the language, you know, that works for us, about our body changes about during puberty, about relationships, about all relevant areas that we have and that impacts on our well-being and health as we grow up. 

Dr Stephanie Williams 06:28

So once you had collected this diagnosis of the information gap, as you described from the girls themselves, how did you get to the development of the Oky app? Where did it where was it designed and piloted?

Gerda Binder 06:43

It was a fantastic and amazing learning journey, because we really decided this will be completely informed and co-created by the adolescent girls themselves, and of course, their first social circle, right. And so what happened is we selected a human centred design approach that really put girls in the centre of putting ideas and input into what is it that they need, it was the girls that basically determined it needed to be a mobile app, a mobile application, because that's where you can run it offline, you can make sure that they can have completely protected privacy and data protection. So the Oky app does not collect any personal information from a user. So you're really protected if you don't have to give that information so it cannot be used in other purposes. And then the look and feel was the most fun and engaging process girls would like they will craft mockups, they would draw, they would show you what works for them. And the result was just beyond image like beyond what we could expect. They were really clear it needs to be a colourful, gamified tool, not just the tool, they actually said, Oky should be my friend, my friend accompanying me, in my journey to growing up to always be positive and empowering. Speak to me in the way that works for me. And it should be very personalised and individualised so they can change avatars, and they can change backgrounds and it grows with them. So does the way they can access information right, some of it is more factual yet in girl-friendly language. Others inquest form or tip of today or a method that your, you know, your Oky friends can view. They also asked for a period tracker. So they can actually learn about their own body on an individual basis. And I think that's something that was so clear. What is the number one question of girls, am I normal, you know, my period comes irregular, not the 28 days that they told or they talk about. So is something wrong with me. And so that providing that support and confidence, being able to track it. Maybe being able to know when is my next period to bring a sanitary pad with me to school, I'm not kind of surprised they're anxious about it. 

Dr Stephanie Williams 09:23

It makes so much sense now that you describe how it was co-created. I downloaded Oky to my phone, of course, to have a look. And I was all I could diagnose myself was with increasing age because I, it was so colourful, so much like a game, but with also clear and logical places to find information. Can you summarise… I mean, you've talked about it already a bit. So there's information about puberty interaction and tracking, are there other features of the app? 

Gerda Binder 09:53

There’s one very important feature is what we call the Help Centre. And that means that sometimes you know the content as you find it or read, it is not enough, you might be stressed about a specific issue, you might not find answers to questions you have. So girls need to know about what support services they can turn to. So the help centre gives them contact information, to help lines, to sexual reproductive health clinics that are adolescent friendly. And it also kind of tries and encourages you to contact them. 

Dr Stephanie Williams 10:29

Can you tell us more about the rollout of Oky in the Philippines and Indonesia? You know, how many girls or devices have downloaded it? How many people have you reached and and I guess in those countries, there are some very conservative communities to wondering how you've tackled the access to Oky and in some of the more conservative religious communities?

Gerda Binder 10:52

Indonesia was one of the pilot countries. So it was launched in 2020. And I think it was perceived, and the response was so overwhelmingly positive, it was just fantastic. How girls, how their families, communities and government stakeholders responded to it, right? So for example, the government in Indonesia, the Ministry of Education, put Oky on the teacher training platform. So also teachers could access it and use it when you know, delivering health education in the classroom. And that really kind of supported us in that decision. And with the amazing partnership with DFAT and the resource support to invest in how do we get the knowledge of Oky, to as many girls, as there are, and have access to some devices. And so impact and promotion in schools by local partners you know, you name them these were all local organisations having been working on girls education, health, menstrual, menstruation for a long time to go and visit schools do Oky promotion activities, activation events, where you know, all collaborating with the school leadership, the girls and boys did feel comfortable that they could download it, they could use it, they sometimes have interactive sessions with doctors. So we see the combination of in person and digital marketing is something that works because we have a very, you know, diverse target audience. At the moment Oky has been scaling to a lot of other countries to use so globally after they've been localised, we're now looking at about almost half a million of users and downloads, of course, then they're the more engaged users who come back every month. And that's also something why continuous engagement with our users the promotions resource to health services, to trust that adults and community leaders is especially important for girls to keep learning to enjoy and that we constantly improve it with them. You mentioned the Philippines, there was really a huge need and an ask, from the Philippines teams to take the learnings from Indonesia take the the app, but localise it to the Philippine context, because we do know that sexual and reproductive health information is particularly important, we did look at a particular focus, as you mentioned, into the Mindanao Region that is more conservative and come with their own kind of policies around how sexuality education should be delivered with an Islamic perspective. And so finding the right partner, but the beginning is always key, engaging with the girls to see, how would an Oky Philippine app look like right? And for the Mindanao Region, it really work because there was a commitment to respect as the concern of the government of the leaders, knowing that young people really want it to be supported and endorsed. And the concerns were mainly at the beginning. Because the Oky content is quite encompassing, right, it's quite comprehensive and touched upon a lot of perceived sensitive issues. And so, the team, the Oky Philippines implant, an amazing solution. They said, okay, fine, no problem, we'll go through the content together with you, we pick the ones that we testing for these initial consultations, and we just put them on big cardboard, we just make mockups, right. So we always find ways around building that trust that Oky is really something that aligns that aligns international standards that aligns to evidence base, you know, sexuality, education, that also really respect the cultural context that it’s in and overtime, the development of perseverance, the trust increased to the point that the Oky app in the Philippines now has an option that the user can opt for it to access the content as needed, or also get an additional Islamic perspective, which is absolutely, you know, aligned to the, to their policies and curricula, in school. And with that, we got the authorities and the community to be the greatest supporters I've ever seen of the Oky app. They want it to be used in schools, they promoted directly through their platforms and programmes, because they really said, you know, we know you could have done this without us. Because it's a digital tool. Anyone can, you know, release those, but you actually listened to us.  

Dr Stephanie Williams 15:53

So Gerda, I wonder from based on what you've learned in the Philippines and Indonesia, how you are approaching what I understand is the one of the next countries for rollout in Papua New Guinea with a very different digital landscape. What are some of the approaches you're taking in Papua New Guinea?

Gerda Binder 16:13

The digital landscape and the context in Papua New Guinea is so very different to most of the countries that we've worked with on localising Oky. So in acknowledging that, we actually took a step back and said, we want to, you know, go forward with what we have done in other countries, we will actually do a scoping study to really understand what are the needs, and the opportunities in the context that such challenging as in Papua New Guinea. And so we talk to governments or representatives, to local organisations that have been working in Papua New Guinea for a long time. And what really emerged was the recommendation to focus first on the content and information, and get that to adolescent girls, their families, and communities. And focus on the technology second, so the period tracking which is really useful too is the next priority once we get that kind of learning and knowledge happening. And so this led us to look into leveraging low tech options, which has been around for much longer. So the appropriate kind of approach that was identified with us the Oky content in terms of storytelling in radio shows for community listening, which would also be not just girls, but like their mothers and their siblings and the family, and more, so that it was a learning but also an engaging and interactive experience. And in parallel, to develop interactive voice response, IVR, which is basically where you can call through a menu, you can listen to prerecorded messages. And that helps you first to get more in-depth information. Because writing or reading sometimes is also a barrier to access information. And no internet is required there. And that is one of the most important things that connectivity will still you know, take some more time to be benefiting users in the Papua New Guinea context. 

Dr Stephanie Williams 16:29

And so my last question, you know, it's not all up to the Oky app, but you can't do it alone. Obviously, all our public health interventions need to be multimodal when we're looking to promote information and understanding on any topic. But thinking about Oky, how do you measure impact? So this is, you know, we've got downloads, we've got users. What are your kind of metrics for impact in Oky and how well you want to be in, say, five years? 

Gerda Binder 19:03

First, I would like to acknowledge absolutely, Oky is embedded in amazing national, regional, and global partnerships. It's a whole ecosystem that comes together to support you know, the quality of it that is continuous as girl friendly. It builds out it reaches them. It's across all sectors of society that we get really amazing support. And I think that is possible because we really have this clear vision and the shared value behind it. And that's really what is it that we want to see in that girls are empowered and experience gender equality to make informed decisions over their reproductive health and have you know their menstruation knowledge and their reproductive health knowledge that they need. At the same time, there's a couple of other as you spoke about metrics, areas that we're trying to measure, including, you know, shifting attitudes in communities to be more open, and able to speak about those sensitive topics around sexual and reproductive health with young people, that governments really endorse, and promote, not just the Oky app, but a lot more that, you know, it's one of the channels to help girls and boys to access the information they need. So we came up have a whole kind of if you like framework of metrics that we try to measure at the moment, we are really at the stage of looking in Indonesia and Philippines where Oky is running. How much do we achieve in terms of uptake? Which, you know, download numbers are a start, but of course, they don't tell you the story. So we also look at engagement, how often do they use it, we can see from the backend is completely anonymous and aggregated. Which features are being used, how long are they being used, we ask in the app itself? Have you learned something new? Do you share it with your peers? We look at responses we're getting through both impact, and then digital questions about confidence, about the impact that it has made on your own health and well-being. 

Dr Stephanie Williams 21:20

It's been so great to talk with you Gerda and to hear the story about the co-creation, that genuine co creation with girls aged 10 to 19. As well as that pause that you had, in the example with the Philippines, with their reflection that anyone can release an app but if you do take the time to build what app you are promoting, in with the broader ecosystem that you have described, plus a conversation about what might work in this context. Ultimately, you'd have a longer process but higher impact. And we really look forward to seeing more evidence as it accumulates from the measurement of impact that you've just described. So thanks so much for sharing the Oky experience with us today.

Gerda Binder 22:11

It was my pleasure. Thank you so much, Stephanie.

Dr Stephanie Williams 22:16

Today we had from Gerda Binder, UNICEF’s regional gender advisor in East Asia and the Pacific. We talked about the development, rollout, and future plans for the Oky app, the world's first period tracker app for girls that was created with girls, and how that app is helping provide information about periods in a fun, creative, and positive way straight into their hands through the tools that they use every day. Mobile phones. We've put a link to the Oky app website in the show notes for this episode. Thank you so much for your company. I'm Dr. Stephanie Williams, Australia's Ambassador for Regional Health Security. We look forward to your company in another fortnight on the next episode of Contain This.

Contain This is produced by the Indo-Pacific Centre for Health Security. You can follow Australia's Ambassador for Regional Health Security, Dr Stephanie Williams, on Twitter at @AusAmbRHS. You can also find that link in the show notes.