Creating safe spaces to improve urban adolescent health and family planning outcomes: lessons from a multi-sectoral intervention in Nigeria.

Out-of-school adolescents (OSY) in urban slums face layered vulnerabilities and are often excluded from mainstream reproductive health services. The Youth-Powered Ecosystem to Advance Urban Adolescent Health (YPE4AH) project in Nigeria implemented a multi-sectoral, safe-space-centered model to improve access to family planning (FP) for this group. The project, implemented across Lagos and Kano States from 2021 to 2024, utilized a hub-and-spoke model, combining youth-designed safe spaces (Youth Hubs) with a network of adolescent-friendly health providers. All participants received a foundational life-skills curriculum (SKILLZ), a financial literacy training (SKILLZ Club), and supplemental livelihood and leadership tracks, driven by peer-learning and mentoring. The design utilized a mixed-method approach comprising review of service statistics, longitudinal survey from program participants, and regression analysis to assess trends in uptake of FP services. Quantitative data were drawn from service statistics, longitudinal survey data, and regression analysis of FP uptake. Over 66,000 adolescents completed the SKILLZ curriculum, with a 90% transition into SKILLZ Club. Adolescent preference for non-traditional health spaces was validated, with hubs acting as entry points to broader health services. More than 75,000 adolescents accessed FP services through hub-based and referral pathways, contributing 16,303 couple years of protection (CYPs) and averting an estimated 7,324 unintended pregnancies and 39 maternal deaths. FP uptake increased steadily over time, with a diverse method mix and regional variation in preferences. Integration was achieved through collaboration with public systems, not by co-locating services in primary healthcare centers, but by embedding free FP commodities and referral systems within adolescent-friendly environments. For OSY (especially those in urban slums), safe spaces grounded in youth participation and community trust can serve as critical platforms for FP access. When designed as entry points (not endpoints), and supported by intentional integration with government supply systems, such models offer an alternative pathway to adolescent-responsive health delivery. The YPE4AH experience challenges traditional models of integration and provides a replicable blueprint for reaching marginalized adolescents at scale.