DOMAINS OF DELIGHT
SERVICES THAT MAKE YOU SMILE
High-quality sexual and reproductive health (SRHR) services for all, including access to services, information and education..
Services with a smile mean that all people are able to access high-quality SRHR services without fear or discrimination on the basis of sex, age, gender, race, ethnicity, socioeconomic status, dis/ability, migrant status, HIV status, marital status or any other distinguishing feature.
“FOR ME, THE PLACE [HEALTH SERVICE] THAT I OFTEN GO TO AND … LIKE THE MOST IS THE PLACE THAT IS COMFORTABLE WHEN I GO. THE PLACE WHERE I CAN GO TO EXPRESS MYSELF FREELY AND [WHERE] … THOSE PROBLEMS OF MINE WERE TAKEN SERIOUSLY, ARE LISTENED TO IN A FRIENDLY MANNER.”
(Captain, Tanzania)
DOMAINS OF DELIGHT
01
SERVICES THAT MAKE YOU SMILE
High-quality sexual and reproductive health (SRHR) services for all, including access to services, information and education..
Services with a smile mean that all people are able to access high-quality SRHR services without fear or discrimination on the basis of sex, age, gender, race, ethnicity, socioeconomic status, dis/ability, migrant status, HIV status, marital status or any other distinguishing feature.
“FOR ME, THE PLACE [HEALTH SERVICE] THAT I OFTEN GO TO AND … LIKE THE MOST IS THE PLACE THAT IS COMFORTABLE WHEN I GO. THE PLACE WHERE I CAN GO TO EXPRESS MYSELF FREELY AND [WHERE] … THOSE PROBLEMS OF MINE WERE TAKEN SERIOUSLY, ARE LISTENED TO IN A FRIENDLY MANNER.”
(Captain, Tanzania)
INTRODUCTION ▸
Services That Make You Smile
Services that make you smile are high-quality SRHR services for all. This includes:
- contraception and family planning services
- information and outreach education about safer sex and sexual health and rights
- comprehensive sexuality education
- prevention, treatment and care for sexually transmitted infections
- safe abortion care and post-abortion care
- referral pathways to specialist services such as those related to gender-based violence, housing and legal support.
Services that make you smile are offered and delivered in ways that address sexual risks but also encompass pleasure. These high-quality services are accessible, welcoming and affordable, inclusive, equitable, gender-transformative and rights-based.
Services that make you smile are high-quality SRHR services for all. This includes:
- contraception and family planning services
- information and outreach education about safer sex and sexual health and rights
- comprehensive sexuality education
- prevention, treatment and care for sexually transmitted infections
- safe abortion care and post-abortion care
- referral pathways to specialist services such as those related to gender-based violence, housing and legal support.
Services that make you smile are offered and delivered in ways that address sexual risks but also encompass pleasure. These high-quality services are accessible, welcoming and affordable, inclusive, equitable, gender-transformative and rights-based.
WHAT IT LOOKS LIKE IN PRACTICE?
What it looks like in practice?
Good Vibrations research with young adults in Tanzania found that young people who have access to confidential, youth-friendly, asset-based SRHR services have their needs met and also experience validation of their sexual lives and affirmation of their identities.
“In the future, it’s me and my partner going to health centres for contraceptive services and received by any doctor or nurse of any age and being given the service we need without being judged because of our sexuality.”
– Indigo, Tanzania
Our findings reinforce existing evidence suggesting that asset-based services can address the risks and realities of negative sexual health consequences in pragmatic and non-judgmental ways that do not perpetuate shame or fear. When this happens, people are more likely to seek out services, to reduce their risk of harmful outcomes, and to experience their sexuality and relationships in positive ways. Services must be welcoming, inclusive, well-informed and confidential for all – especially for unmarried and LGBTQI+ young adults.
In practice, high-quality SRHR Services with a Smile can encompass the following.
- Services are underpinned by laws that ensure universal access to SRH information and health care.
- Sexual pleasure is embedded in sexual health interventions.
- Every young person and adult in a community has access to SRHR services. The notion of ‘access’ should take into consideration diverse factors including costs (financial and opportunity costs), the distance service users must travel, the attitudes and behaviour of service providers towards clients (especially marginalized groups), privacy and confidentiality, and eligibility requirements for services or supplies.
- SRHR service provision is supported by existing health system structures aimed at ensuring quality-of-care.
- SRHR services have functioning referral networks in place for specialist services.
- Personnel are well trained and supported to provide inclusive, confidential, accessible, sex-positive and gender transformative care.
“ … initially, we had this perception that family planning methods like injections, pills, were intimidating, we didn’t know what to expect, what side effects they might have. But after getting educated and properly informed, I found out they are quite normal, they have no harmful effects and won’t cause any issues in my body. So, I go with confidence … I believe in myself more.”
– Shasa, Tanzania
Take a deep dive into Ana Autoestima
DELIGHT DIAGNOSTIC: ASSESS YOUR PROJECT OR ORGANIZATION
Assess your project or organization
We invite you to reflect on how your organization, project, or programme relates to the four levels of action that can help create and facilitate access to services that make people smile:
Increasing individual awareness and capabilities related to the existence and accessibility of services that make people smile;
Advocating for and strengthening policies and legal frameworks that help create and facilitate access to services that make people smile;
Addressing social and cultural norms that influence the creation and accessibility of services that make people smile;
Ensuring that resources—such as education, health services, housing, access to credit, and experiential support like having a voice, safety, and resilience—are available and accessible to enhance the creation and accessibility of services that make people smile.
These areas are facilitators rather than necessary components—services that make people smile can still be created and accessed even in challenging contexts.
You can think of these areas as waves that strengthen each other and help create more supportive environments for services that make people smile.
Below are some prompts you can use to reflect on your work, how it supports the four levels of action, and how services that make people smile show up in your mission, work, or outcomes—like ripples spreading through different areas.
Consider:
- Are these programmes/services free? What are the transport/opportunity costs? (resources)
- Can community members help shape services and have a say in who runs them, how they are run and/or give feedback about their experiences? (individual capabilities and social norms)
- Are all communities and individuals able to access services? Are all communities included, welcome and celebrated? (individual capabilities and social norms)
- Does your organization integrate pleasure and enjoyment into service delivery, advocacy, research and resources? (all levels)
- Are there policies, guidelines, or formal frameworks that support equitable access to services? Could your organization advocate for new policies or improve existing ones to strengthen access? (policies and legal frameworks)
Review:
- Review what feedback data is already collected on a service. Is there any data on whether service users feel safe, included, affirmed and/or listened to? (individual awareness and capabilities)
- Have any consultations been conducted locally that explore what people want from local services. Is there any data on how people want to be included, supported and listened to? (individual awareness and capabilities)
ACTIVITIES
Activity 4.1 Dream services that make people smile
Activity 4.1 Dream services that make people smile
In this activity, participants explore ideal SRHR services that are inclusive, affirming, pleasure-positive and gender-transformative, and then reflect on actionable steps to move toward these ideals.
Step 1 Imagine yourself in different situations and dream freely
- Ask participants to picture themselves in various scenarios:
- as they were young and 20 years in the future
- with a disability or another health condition they might be reluctant to discuss
- as LGBTQI+ or another marginalized identity.
- Encourage them to think freely and creatively about what SRHR services would make them smile in each scenario. Emphasize that they don’t need to worry about feasibility, resources or other current limitations. They can dream freely.
- On sticky notes or sheets of paper, participants list or draw the features of ideal SRHR services.
Step 2 Share and discuss
- Participants place their ideas on a flipchart/board.
- Discuss common themes, innovative ideas and surprising suggestions.
Step 3 Reality check
- Ask participants to reflect on the following.
- Which ideas could realistically be implemented?
- What is already being done in their programme/project?
- Where are the gaps between the ideal and current reality?
Step 4 Prioritize actions
- Each participant or group identifies 2–3 concrete actions to bring services closer to the “smile-worthy” ideal.
- Record these and discuss potential next steps or responsibilities.
Optional variation
- Role-play: participants act as different service users to explore how current services meet – or fail to meet – the ideals identified.
Activity 4.2 True talk
Activity 4.2 True talk
This is a highly adaptable activity. Participants could be asked to respond “yes” or “no” to the following statements (by standing in different parts of the room), after which the responses could be discussed:
- As a professional, I contribute to creating safe spaces for all.
- I believe men and women have the same responsibilities and freedoms.
- I believe that young people should receive information about sexual pleasure.
- I think talking about sexual pleasure with adolescents encourages them to start having sex earlier.
- I feel comfortable discussing topics like contraception, consent, and pleasure with adolescents.
- I think boys have stronger sexual needs than girls.
- I think gender minority groups should have access to sexuality education that reflects their realities.
- I believe that discussing sexuality openly reduces risky sexual behaviour.
INDICATOR OF SUCCESS
Input indicators
Comfort and competence demonstrated by health providers in discussing pleasure and inclusivity (e.g. via self-assessments or observed consultations)
Number of staff trained on gender-sensitive and pleasure-positive SRHR approaches.
Availability of private, confidential spaces for counselling and sexual health services.
Operating hours that accommodate diverse client needs (e.g. after-school, evenings)
Number of partnerships with local organizations that support sexual rights and well-being.
Outcome indicators
Percentage of clients from diverse backgrounds (e.g., age, gender identity, sexual orientation, disability, socioeconomic status) who access services
Patient perceptions of inclusivity (e.g., “I felt respected and included regardless of my identity/background”)
Patient-reported experiences with SRHR services regarding:
- feeling comfortable discussing sexual pleasure and preferences
- increased satisfaction with chosen contraceptive methods
Presence of tools/materials that explicitly address pleasure (e.g. posters, brochures, counselling guides)
Immerse youself in the other Domains
