The girls jittered as they looked down at the game board. If they moved their piece one more square forward, they would win the game.

Afia drew the game card for her team and the blood immediately drained from her face. Oh no—it was the dreaded Chance card.

The girls on the opposing teams shrieked with excitement.

“Read the card out loud,” nudged the game facilitator.

Afia cleared her throat and read the Chance card. “Last week, you and your boyfriend decided to have sex for the first time. Spin the top to see if you get pregnant.”

Afia’s teammates held their breaths while the other girls laughed and tapped their hands on the edge of the table, creating a dramatic drumroll.

Afia lifted the four-sided top, with two sides showing a pregnant girl and two sides showing a not-pregnant girl.

The top spun for what seemed like an eternity….

Afia is playing Chance—a game that empowers Ghanian girls to take control of their reproductive health. We tested the game with nearly 200  teens and each time, this pivotal moment was charged with suspense.

Board games for public health

In rural Ghana, one in five young women give birth before the age of 18. Among adolescent girls, nearly 70% do not use any form of contraception during their first sexual encounter. Many of the resulting pregnancies are unplanned, with girls often attempting to terminate the pregnancy on their own or dropping out of school.

Several organizations work to avoid these outcomes so that more Ghanaian girls can have increased agency over their health and economic futures. The Ghanaian nonprofit Women’s Health to Wealth (WHW) runs dozens of Girls Clubs to empower adolescent girls through health education, contraceptive access, and personal development. In collaboration with Americares—a global health-focused relief and development organization that supports the clubs—WHW ran a midline assessment of their sexual and reproductive health (SRH) curriculum and found that despite significant gains in SRH knowledge, girls lacked confidence in sharing and applying their learnings.  

Could there be a novel way to complement the SRH curriculum and enhance girls’ agency? WHW and Americares had heard about Chance—a board game that ideas42 developed with partners at Pathfinder (a global reproductive health organization) for adolescents in Burkina Faso. They wondered if the game could be adapted for the girls at WHW clubs.

In March 2024, ideas42 teamed up with WHW and Americares to adapt the game for Ghanaian teens, which they then tested across several clubs. Preliminary insights from the girls who played Chance indicate that the game combats myths around contraceptives, highlights their benefits, builds awareness on how to access them and strengthens agency around contraceptive use.

“I want to play the game every week!” one girl told us. After the game, girls chatted about previously held myths around contraception, and how they might benefit from it—revealing their own agency. 

“I learned that you can still give birth in the future if you choose contraceptives today,” said one player.

“I must negotiate on the use of condoms during sex,” reflected another.

Behavioral science insights amplify the impact of Chance

Chance stands out because it elevates—in a vivid and deeply personal way—risky behaviors that cause unintended pregnancy and their life-altering consequences. We modeled each scenario on real stories shared by adolescent girls.

Chance also offers a rare space to talk about sex and reproductive health, free of stigma. The excitement as girls openly shared their experiences and eagerly wished to play again demonstrates the power of games in spreading knowledge among youth.

While sexual and reproductive health educational curriculums often equip girls with knowledge about contraception, the information can sometimes feel abstract and disconnected from their personal experiences. In addition, stigma can prevent girls from sharing their learnings with their peers. Combining SRH curriculums with games like Chance addresses these challenges.

Approaches like this that center the human experience are a key feature of behavioral science. The field of behavioral science pulls from the latest academic research in psychology and economics, and can be applied in various settings to boost social impact. In addition to using it to craft reproductive health games like Chance, ideas42 has applied it to boost civic engagement, build equity in financial service access, and improve the quality of primary school education.  

Now let’s return to Afia and see how Chance can help her translate hypothetical decisions into real-world action.

A game-changing moment

The top spun for what seemed like an eternity.…

Afia bit her nails. She hated feeling out of control and powerless.

When it finally stopped, the face of a pregnant girl stared back at her.

Girls on the opposing teams erupted into cheers and celebration. “You have to go back to your grandmother’s house!” they shouted.

“Yes,” the facilitator explained. “Just like in real life, girls often go back to their grandmother’s house in the village to carry out an unexpected pregnancy.”

This would set Afia’s team back several squares on the gameboard. She felt a pang of regret. If only they had contraception, they could have avoided this outcome.

Could they learn from this experience?

Afia and her teammates studied the gameboard and its two paths more closely. They chatted amongst each other, whispering new strategies. Suddenly, their chatters turned to excitement. On their next turn, if they took the longer path to the health facility, they could get contraception and avoid the risks of Chance cards.

Afia smiled. They could still win.

*     *     *

About Americares

Americares is a health-focused relief and development organization that saves lives and improves health for people affected by poverty or disaster. Each year, Americares reaches 85 countries on average, including the United States, with life-changing health programs, medicine, medical supplies and emergency aid. Americares is one of the world’s leading nonprofit providers of donated medicine and medical supplies. For more information, visit americares.org.