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Contraception

One of our main priorities is to ensure universal access to, and informed use of effective contraception. Millions of people lack the knowledge and information to determine when or whether they have children, and they are unable to protect themselves against sexually transmitted infections (STIs).

Articles by Contraception

Why we will not sign the Global Gag Rule

Why we will not sign the Global Gag Rule

On 23 January 2017 President Trump signed an executive order reinstating the Global Gag Rule, or the Mexico City Policy.  The International Planned Parenthood Federation (IPPF) believes in the right of every individual to decide about their own health and well-being.  As an organisation that seeks to protect and improve the lives of women, men and children around the world, IPPF and its partners in 170 countries will not sign a policy that denies human rights and puts the lives of women at risk.   The Global Gag Rule denies U.S. funding to organisations like IPPF if they use money from other donors to provide abortion services, counselling or referrals—even if abortion is legal in a country. It blocks critical funding for health services like contraception, maternal health, and HIV/AIDS prevention and treatment for any organisation that refuses to sign it. When it has been enacted by previous Republican Presidents, evidence has shown that the Global Gag Rule has not reduced the number of abortions; rather, by eliminating access to contraception, it has led to more unintended pregnancies and more unsafe abortions.     IPPF is the largest non-governmental provider of contraception in the world. It has worked with the U.S. government for decades. Our global network of local partners delivers more than 300 services every minute of every day, including 70 million contraceptive services every year.  The Global Gag Rule’s reinstatement will result in additional unintended pregnancies and countless other needless injuries and deaths. It means IPPF will lose $100 million USD for proven programs that provide comprehensive sexual and reproductive health services for millions of women and youth who otherwise go without these vital services, including women suffering the burden of health and humanitarian crises.  Over the years USAID has been a huge supporter of family planning – with a budget of over $600 million per year. Reinstatement will mean that years of progress to increase access to essential services globally, will be lost. We cannot—and will not—deny life-saving services to the world’s poorest women.  We will work with governments and donors to bridge the funding and service gaps the Global Gag Rule creates. We will ensure that women can exercise their rights and access safe abortion and family planning.  WANT TO GET INVOLVED? SUPPORT OUR WORK WITH A DONATION     Subscribe to our updates!

A healthcare worker demonstrates to a patient how a vasectomy works on a poster
11 July 2022

Vasectomy: what you should know

A vasectomy is a medical procedure for people who have decided that they do not want to have children in the future.  It is a safe and effective way to prevent pregnancy, and it works by eliminating sperm from the semen. It is nearly 100% effective at preventing pregnancy, which makes it one of the most effective methods of contraception.  A vasectomy does not protect against sexually-transmitted infections or HIV – for this, a condom should be used.  What is the vasectomy procedure like? A vasectomy is usually performed under local anaesthetic, which means you are awake for the procedure, but you will be numbed in the surgery area. The procedure is quick – usually taking less than 30 minutes. It involves a doctor numbing the surgery area with a local anaesthetic injected into the skin of the scrotum. They will then make a small incision in the scrotum and locate the vas deferens, the tube that carries sperm from the testicle. The doctor withdraws part of the vas deferens through the incision, ties it off and cuts it. The vas deferens is then returned to the scrotum and the incision is closed.  Swelling, bruising, and pain following the procedure is normal, particularly after the first couple of days. Your doctor will probably advise you to wear tight-fitted underwear to support the scrotum and to avoid strenuous activity for a few days. They will also advise you to avoid sexual activity that may lead to an ejaculation for a week or so while you heal. When is a vasectomy effective? It’s important to note that a vasectomy is not effective straight away. In fact, in the following weeks/months after the procedure (and after your rest period), you’ll need to ejaculate about 15-20 times to ensure that there are no traces of sperm remaining in your semen.  It’s likely that your doctor will arrange a follow-up several weeks after your vasectomy to do an analysis of your semen to make sure there’s no sperm left in it. Once they have confirmed this, then you can have sex without using another contraceptive and without the worry of an unintended pregnancy.  In the meantime, you should use condoms or another form of contraception to prevent pregnancy.   Myths and facts about vasectomies Myth: “I can get a vasectomy now, and have it reversed if I change my mind.” Fact: While technically vasectomies can be reversed, the reversal procedure is complicated, requires specialist surgeons, and not always effective. That’s why all vasectomies should be considered permanent, and only people who are sure they are done having children or never want to have a(nother) biological child should go ahead with the procedure. Myth: “My reproductive organs could be permanently damaged.” Fact: The risk of permanent damage is rare if the procedure is provided by qualified healthcare professionals.  Myth: “The surgery will hurt too much.” Fact: As with most surgical procedures, some minor pain or discomfort during or after the procedure is normal, and for most people will go away within a few days.  Myth: “My sexual drive/ability will be affected by a vasectomy.” Fact: This is not true at all – apart from taking a break from sexual activity for a short time after the surgery, your sex drive/abilities will be what they were before the procedure. If anything, your sex drive might be higher without the worry of an unintended pregnancy! If you think a vasectomy could be a good option for you, contact your local sexual and reproductive health provider to discuss further. 

The American flag with stars and stripes

Statement on the U.S Congress' FY22 spending bill which fails to permanently repeal the global gag rule

U.S congressional leaders have announced they have reached a final spending deal for the fiscal year 2022. This bill results from months of negotiations over funding and policy decisions, including those that impact sexual and reproductive healthcare globally. Despite the inclusion of language to permanently repeal the global gag rule passed in the House and introduced in the Senate, the final legislation fails to permanently end the harmful policy that has destroyed the lives of women and girls around the world for so many years. It also does not remove discriminatory abortion bans like the Hyde, Helms, and Weldon amendments or include much-needed new investments in sexual and reproductive healthcare and international family planning programs. Dr Alvaro Bermejo, Director-General of the International Planned Parenthood Federation, said: “We are outraged to learn that the long-awaited U.S spending bill failed to permanently repeal the global gag rule, nor did it include other areas of sexual and reproductive health and rights progress on which advocates had built strong momentum. The bill fell foul to anti-choice Congress members whose primary goal is to control the bodies and reproductive rights of women and girls they will never know, whose lives they could never imagine. “Failure to utilize this golden opportunity risks the continuation of the flip-flopping of American policy that has played with the lives of millions across the globe for nearly 40 years. Ultimately the global gag rule destroys long-term access to lifesaving contraception, maternal health and HIV/STI services and forces vulnerable women and girls to carry pregnancies to term or make the agonizing decision to get a potentially deadly unsafe abortion. It also manipulates the ability of international organizations, like IPPF, to use their own funding to provide legal, safe abortion, which unethically denies women care and imposes neo-colonial policies around the world. “While the global gag rule poses serious challenges to sustained engagement with USAID, especially at a time when anti-choice movements continue to attack the rights of people worldwide, IPPF is grateful to the Biden-Harris administration for the current rescission of the policy. We will continue to engage with U.S Government global health assistance programs when possible. We are also thankful to our relentless Member Association, the Planned Parenthood Federation of America. Despite the challenges, they have worked tirelessly alongside thousands of women’s rights campaigners across the United States and worldwide to advocate for vulnerable women and girls everywhere. The fight for reproductive rights and justice will not end until every person can access high-quality sexual and reproductive healthcare when and where they need it.” Santos Siminone, Executive Director at Associação Moçambicana para Desenvolvimento da Família (AMODEFA), said: “We are deeply saddened by the failure to permanently repeal the Global Gag Rule. For AMODEFA, IPPF’s Member Association in Mozambique, a national provider of sexual and reproductive healthcare in the country since 1989, the impact of the global gag rule meant a $2 million gap in funding - about 60% of our total budget. “The impact was almost instantaneous, forcing the closure of six programs across 12 districts in Mozambique. This denied nearly 390,000 clients access to contraception, STIs, HIV, malaria, and tuberculosis services. Almost every local population was affected, with closures impacting adolescents, youths, women, and marginalized people. “For the people we serve, the permanent repeal of the policy would have meant an end to the violation of human rights. It would have meant dignity and that women’s lives would no longer be at risk. It would have meant an end to fear, pain, tears, and chaos, especially for black and brown women from low-income countries who bear the brunt of restrictive abortion policies.” For media enquiries, please contact Karmen Ivey on [email protected] or [email protected]  

ukraine flag

Statement on the escalating conflict in Ukraine

Following the disturbing reports coming out of Ukraine, IPPF has released a media statement on behalf of the Federation and its Member Association in Ukraine.   Despite the fact that sexual and reproductive healthcare (SRHR) needs increase significantly during conflict and humanitarian situations, the significant vulnerabilities of affected populations and displaced people are often overlooked, especially the experiences of women, girls and marginalized populations who are at increased risk of unintended pregnancy, sexually transmitted infections and sexual and gender-based violence. IPPF’s Director-General, Dr Alvaro Bermejo, said:   "The International Planned Parenthood Federation (IPPF) is deeply concerned about the escalation of conflict in Ukraine. We take our responsibility to preserve the enormous gains made in life-saving sexual and reproductive healthcare across the country very seriously, especially for women, girls and marginalised populations, whose vulnerability and experiences are so often overlooked in humanitarian situations.  "For 20 years, IPPF has consistently worked to strengthen and protect the reproductive rights of people in Ukraine, working in the frontline conflict zones of Lugansk and Donetsk since 2014, training medical specialists to provide life-saving reproductive healthcare, psychosocial support and quality care to survivors of sexual and gender-based violence. “Our teams are now contingency planning across the region to address not only the needs of those still in Ukraine, but also the millions who are likely to be displaced by the conflict and who will require critical support to continue accessing healthcare. We will work closely with partners and other NGOs to ensure the least possible disruption to services. "IPPF stands in solidarity with the international community and the brave people of Ukraine who for the last eight years have faced terrifying and difficult circumstances that nobody should ever have to suffer through. We stand by IPPF's frontline team, who, despite the dangers, continue to facilitate life-saving healthcare for those who need it most. We will be monitoring the situation closely to ensure the safety of our colleagues across the region.” For European outlets, please contact [email protected] For UK and other international media outlets, please contact Karmen Ivey on [email protected] or [email protected]  

A healthcare worker in Ghana shows a client the Pill
14 January 2022

Ghana offers free long-term contraception in a ‘game changer’ for women’s reproductive health rights

In a major win for women’s reproductive rights, Ghana’s National Health Insurance Program has expanded to include free long-term contraception from 1 January 2022. The move will allow millions of women of reproductive age who are already covered by national health insurance to avoid paying out of pocket for family planning methods such as the implant, coil and injections. It comes after a two-year pilot study found that including family planning services in health benefits packages resulted in a greater uptake of long-term contraception and future government savings in direct care costs.   “We are excited that at long last, long-term family planning methods are included in the National Health Insurance Scheme,” said Abena Adubea Amoah, the Executive Director of the Planned Parenthood of Ghana (PPAG), an IPPF Member Association. “This means long time peace of mind for women, girls and their families with potential positive impact on their health and economic life.”   Tackling deep-rooted barriers to healthcare In late 2021, the government of Ghana launched a year-long campaign aimed at raising awareness of and preventing maternal deaths in line with Goal 3: Good Health and Wellbeing of the United Nations Sustainable Development Goals. The role of family planning in reducing preventable maternal death is well documented, with unsafe abortion being one of the leading causes. Yet, Ghana is a country where deep-rooted cultural norms and structural barriers perpetuate poor sexual and reproductive health, including high risks of maternal mortality, high numbers of sexually transmitted infections and low levels of contraceptive use. Despite making important progress in recent years, Ghana’s maternal mortality ratio is 308 per 100,000 live births, which is still well above the SDG target of less than 70 deaths per 100,000 live births by 2030.   PPAG will play an important role in supporting the government in its campaign to prevent maternal deaths and disabilities. Since 1967, PPAG has provided the people of Ghana with family planning services as well as maternal and child health care, infertility management, and voluntary counselling and testing for sexually transmitted infections including HIV and AIDS. With over 100 staff members, a team of 1,000 volunteers, and 300 peer educators, PPAG is well-positioned to deliver health services and programmes through permanent and mobile clinics in urban and rural communities across the country. The association's Youth Action Team, comprised of over 810 young people, leads a number of educational and awareness-raising activities at 1000 community-based service points across the country. 

Client & healthcare provider
16 December 2021

Delivering disability-inclusive healthcare in Madagascar

Understanding the challenges that people living with a disability face when accessing sexual and reproductive healthcare (SRH), and ensuring their rights are upheld, sits at the heart of Fianakaviana Sambatras’ (FISA) mission to reach vulnerable groups. Often on the fringes of Madagascan society, and classified as a vulnerable group, people living with a disability are one of FISA’s priority client groups. Through expansion of their delivery networks, FISA provides safe, confidential, and accessible integrated SRH to people living with a disability.  Barriers to inclusive healthcare  Often, FISA’s clients have a lack of awareness about their sexual and reproductive rights where to go for their healthcare - for example, limited access to information through disability-friendly locations and leaflets and posters creates a barrier to vital information unless adapted for visually impaired and blind people. Other challenges include communication for deaf clients, who in some cases may not be accompanied by a companion to assist them. In some instances, FISA learned that women living with a disability were forced by their families to have an abortion or undergo tubal sterilization during a caesarean delivery without their consent, further reinforcing stigma and stereotypical attitudes towards disability.    Understanding the needs of the client FISA’s experience with providing care to people living with a disability has led to a greater understanding of their clients’ needs. Provision of improved integrated healthcare delivery includes allowing for longer appointment times to give the correct level of support, which is especially important for counselling and consultations.  FISA offers free consultations to people living with a disability and prioritizes young people ensuring they can access youth-friendly care. The team also run sessions using sign language to raise awareness on sexual and reproductive health and rights and to provide information about the different contraceptive methods available, such as the IUD and pill. FISA encourages people living with a disability to participate in events such as International Women’s Day to help make their voices heard, to advocate for their rights, and to collaborate on the development of a comprehensive sexuality education guide through a series of workshops. Designing and delivering disability-inclusive healthcare FISA has adapted its healthcare delivery to be disability-inclusive and to raise awareness of, and advocate for, the sexual and reproductive rights of people living with a disability. Critical to providing healthcare is safeguarding access to comprehensive sexuality education for young people living with disabilities that are specific to their needs. Providing information resources in Braille, using diverse pictures, and training healthcare workers to be able to communicate using sign language makes FISA a go-to place for healthcare for people living with a disability. Clients are made to feel welcome and safe with FISA’s qualified healthcare team and accessible facilities.  “Our Member Association in Madagascar plays a leading role in ensuring that persons with disabilities have access to high-quality and integrated sexual and reproductive healthcare. Their work is a good example of our mission to provide care to the most vulnerable, underserved, and often marginalized members of our communities. Integrated disability-inclusive healthcare delivery strategies that are adapted to our beneficiaries’ needs remain a priority in our work on the African continent”, says Marie-Evelyne-Petrus-Barry, IPPF Africa Regional Director. FISA enables its clients, and especially young people and women, living with a disability to feel empowered to make their own decisions concerning their bodies, wellbeing, and SRH.

Illustration woman and nurse
22 July 2021

Rolling out self-managed contraceptive care to women and young people in Zambia

The COVID-19 pandemic has caused huge disruption and restrictions for individuals globally, and has been felt acutely with challenges to accessing sexual and reproductive healthcare. Yet, with challenges often come opportunities, and the pandemic has enabled a transformation in how we deliver health and contraceptive care – especially to women and girls who are among the most affected in times of crisis.   Adapting in a crisis to meet need  Like many of our Member Associations, Planned Parenthood Association of Zambia (PPAZ) acted swiftly in March 2020 to develop a new and efficient strategic approach to healthcare delivery for its clients. PPAZ introduced an initiative that, for the first time, offered self-managed contraceptive care to women and young people across the four districts of Choma, Livingstone, Lusaka, and Kitwe.   The PPAZ healthcare team identified eligible women to participate in the initiative through group counselling sessions on contraceptive methods (both hormonal and non-hormonal) via healthcare clinics and community outreach. The provision of accurate and easy-to-understand information on the types of contraceptive methods available gives women the knowledge and autonomy to make decisions about what method is right for them and their lifestyle.    Personal and convenient contraceptive care    Women who opted for oral contraceptives were provided with a six-month supply of Combined Oral Contraceptives (Microgynon, Zinnia-F), free-of-charge. Other women chose Sayana Press, which is the only self-administering contraception available in Zambia. They were trained on the correct technique for administering the dose (an injection in either the anterior thigh or abdomen), correct storage, and safe needle disposal. Effective for 12 weeks, the women were given a two-dose supply free-of-charge.    PPAZ healthcare teams trained 1,535 women on the Sayana Press method, and 3,070 doses of the contraceptive were provided. They also provided follow-up appointments with their clients over several months to ensure correct use and address any concerns.   Impressed with PPAZ’s presentation and discussion about how Sayana Press works and its benefits, 21-year-old Eunice Chikoti, chose the injectable because of its convenience. “They took time to explain how to self-inject and were very patient while doing so. They answered all my questions until I was satisfied,” she says. Despite her initial apprehension, Eunice was trained in how to self-inject safely and easily, “I thought it would be very difficult to self-inject, but once I followed the instructions of the nurse, I did so without any challenge,” she says. Eunice has a nine-month-old baby and hopes to have more children in the future.   Commitment to self-managed care   Due to the success of this strategy, which is not solely reliant on a healthcare provider, PPAZ plans to roll out the initiative to other districts across Zambia. This approach will ensure the most marginalized and low-resource settings are reached where access to healthcare and trained professionals is limited.  PPAZ’s initiative has gone a long way in advancing the rights of women and young girls to sexual and reproductive healthcare. Through self-management of their contraceptive needs, women and young girls are exercising their right to bodily autonomy and personal choice with confidence.  

Healthcare worker

The personal contraceptive delivery service

When Famia Planea Aruba (FPA) saw a gap in the market, the team developed an online contraceptive store and bespoke delivery service to better reach their clients. The online store is available in the local Aruban language, Papiamento, and has been designed to provide quick access to various contraceptive methods, with supporting information to help clients make choices based on their needs.   Ghislaine, Head of Information, Education and Communication Support at FPA has been managing the delivery service since it started in August 2018.  “Since the start of the delivery service in 2018, our clients were enthusiastic however, the usage started slow. I believe this was due to the unfamiliarity, and people were still in the transition phase to online services. Moreover, clients believed that the delivery transportation would have been in a car, completely covered in images of condoms, sperm cells and pills, which made them sceptic of using the service due to embarrassment”, says Ghislaine.   The site is accessible to both FPA members and non-members who can shop in privacy for their contraceptives and schedule a delivery. Orders are delivered by FPA staff with clients having the option to pay cash or debit upon delivery. To ensure a clients’ privacy and confidentiality orders are delivered discreetly.  Challenges and opportunities  As with any new service comes challenges as well as opportunities. “Some of the challenges we face are the overload of deliveries on one day.” Even though Aruba is a small island and there are traffic jams only at specific hours in the day. “Sometimes I get stuck in traffic and try to rush myself to deliver the products in the time slot and at times I find myself in places that I barely recognize and discover new locations.”  “The part I enjoy is the communication with the clients. Building a relationship with the client and vice versa provides a smoother transition of service but also provides the comfort and safe feeling for the client.”  Ghislaine says the service often calls for more than the delivery of contraceptive orders, as clients may have questions or need support about their health.  Personal and convenient healthcare  Damara is a data analyst and a member of the Sustainable Development Goals Commission. She started using FPA contraceptive delivery service a year ago.   “It definitely has made my life much easier, especially when I have a busy schedule. With the delivery service I simply order my products through the online store and choose the date and time that is most convenient for me”, she says.  Damara values the personal service and the convenience of paying by card and choosing a preferred delivery time. “I love this service because sometimes I place an order a few days before and the employees at FPA call to confirm the order the day of the delivery, which is great because it is like a personal reminder! The best part is that they also have a portable ATM machine. I get my products, guidance and have it delivered to my location, what more can you ask for?”  FPA’s bespoke healthcare delivery has seen a successful growth since it started, with an increase of 115% during 2019 and 170% in 2020. “There has been an immense increase in the service in 2020 due to the pandemic. We already had the service in place, so we just had to fill in the gaps; for example, providing more hours and dates for clients to make use of the service”, says Ghislaine.  Hilyann, a journalist, is another regular user of the online store. “Shopping on the FPA online store makes me feel very in control and empowered. I hope that more people of all ages take advantage of this service. I hear far too often that people say they don’t have time, nobody has actually, but FPA is there for you. Take control of your sexual and reproductive health, empower yourself, be the boss of your time and your body.”   

Volunteer

"I changed first...so can other men"

"One day, when I returned from work, Ms. Glenda and Mr. Martin from Pro-Familia were at my house. I heard what the volunteering was about, regarding the education of the men in the community, how to teach how to stop machismo, to be less violent, how to give the talks and visit the clients. They also talked about the contraceptive methods, medicines and many things that would change people's lives. The proposal seemed important to me and I accepted, since I like to work for my people," recalls José.  In 2008, the Asociación Demográfica Salvadoreña (Pro-Familia) developed a project focusing on sexual and reproductive health and the active participation of men in rural areas. It concentrated specifically on the integration of male participation in sexual and reproductive healthcare. Since 2014, the project has been integrated into the Community-Based Programme as part of the provision of healthcare for rural men.  "When I gave the talks on masculinities, they questioned me: 'Why can't you scream at home, if you're the man?' Or 'who do you think you are to say those things?', questions that I also asked myself once", says José. "Thanks to the training I have had and the support of the Pro-Familia staff, I have managed to learn and clarify my doubts. I take care of my own health, I share the responsibilities at home, I take care of my two-year-old son – before volunteering, I thought it was a woman’s job, I didn't do that."  Ensuring access to information and contraception   Educational activities in sexual and reproductive health remain a challenge, but Pro-Familia is committed to delivering their strategy. The role of the health promoter is to advocate – with other men – the use of contraception, counselling couples, and providing supplies (especially condoms) and medicines.   "I like the communication I have with the Pro-Familia staff, and the training reinforcements – they should keep it that way, because it's the way to learn and do things better in the community," he says.  "The change begins with oneself and then transmits it to others. I gather men in talks, make visits to their homes, give guidance on prevention of sexually- transmitted infections, on family planning, and how not to be violent", says José. "Older adult men are more difficult to change."  Increasing contraceptive use among men   José has seen the positive change among men in his community and those small achievements encourage him to keep going. "When men ask me about violence and condom use, I feel encouraged. For example: a co-worker uses a condom and confidently tells me that he does it because he learned from the talks he received, that motivates me to continue guiding towards new masculinities."  The Community-Based Program has a special fund for clients who are referred by promoters for a voluntary surgical contraception (VSC) procedure, so the service is free of charge for clients. In this regard, José is aware that there is still work to be done: "The issue of vasectomy is difficult with men in the community, the challenges continue."  "In the community, young people 'get to live together' [marital union] at an early age. Maybe I cannot change that, but I can help them to be better people, to respect each other. Just as I changed, so can other men," says José. 

Volunteer

Talking about contraceptive choice on the soccer field

"I decided to become a volunteer at Pro-Familia when I heard a talk the staff were giving at the Acajutla City Hall, where they explained what they were doing in the communities with the program, and they invited us to be part of the volunteer service. I liked what I could do with the men in the community. It’s been two-and-a-half years." Juan Martinez Leon is a volunteer with the Asociación Demográfica Salvadoreña (ADS/Pro-Familia) community-based programme. Juan’s remit is broad, working mainly with men to provide information on contraceptive methods and counselling to individuals and couples. He also provides contraceptive methods including the Pill, injectables and, especially, condoms. For some hormonal contraceptive methods, Juan refers his clients to Pro-Familia clinics or other public health facilities. Putting community first "I like to work for my community, despite the difficulties, and I help in four more communities for them to have the [contraceptive] methods and medicines, because they come to get me," says Juan. "I give talks on the soccer field in front of my house or I have meetings at my house. My children help me invite men to come and they also learn and admire the work." Juan visits clients at home and organizes talks – mainly with other men – to promote the importance of contraceptive use, and women and children's health. The importance of men’s health and their family group is a key element in Juan's role as a health promoter. “I like providing family planning counselling, because sometimes men don't like women using anything to prevent pregnancy. When I talk with the men of my community, people's lives change and you see the difference: you no longer see the domination over women, they let women plan, and [the woman] no longer requests the method secretly – although there are still some women who hide from their husbands. That's why we have to continue working on counselling, that's what awakens them." Changing behaviour and attitudes Juan runs informative talks on reproductive health and the prevention of STIs and HIV. "In some talks, some men have come out angry and questioned me. Who am I to tell those things? ‘Someone who has learned and who respects people's rights,’ I tell them. Now men come to ask for condoms, and even my wife confidently gives the condoms to them. She also supports me." Some men thank Juan for having "awakened their minds", and encouraged them to change to respect women and to help at home. “I think I help my community a lot. You wake them up. I like what I do, I like to help. Before there was no promoter and they had women submerged. Little by little that is changing, but only by talking to men is it achieved. I want to continue learning about sexual and reproductive health issues, it never ends. I would like to continue in training as we used to before the pandemic, and for Pro-Familia to come more often. Until God tells me, I feel that it is my obligation to attend to men or whoever seeks me to help them. That's what I'm for.”

Why we will not sign the Global Gag Rule

Why we will not sign the Global Gag Rule

On 23 January 2017 President Trump signed an executive order reinstating the Global Gag Rule, or the Mexico City Policy.  The International Planned Parenthood Federation (IPPF) believes in the right of every individual to decide about their own health and well-being.  As an organisation that seeks to protect and improve the lives of women, men and children around the world, IPPF and its partners in 170 countries will not sign a policy that denies human rights and puts the lives of women at risk.   The Global Gag Rule denies U.S. funding to organisations like IPPF if they use money from other donors to provide abortion services, counselling or referrals—even if abortion is legal in a country. It blocks critical funding for health services like contraception, maternal health, and HIV/AIDS prevention and treatment for any organisation that refuses to sign it. When it has been enacted by previous Republican Presidents, evidence has shown that the Global Gag Rule has not reduced the number of abortions; rather, by eliminating access to contraception, it has led to more unintended pregnancies and more unsafe abortions.     IPPF is the largest non-governmental provider of contraception in the world. It has worked with the U.S. government for decades. Our global network of local partners delivers more than 300 services every minute of every day, including 70 million contraceptive services every year.  The Global Gag Rule’s reinstatement will result in additional unintended pregnancies and countless other needless injuries and deaths. It means IPPF will lose $100 million USD for proven programs that provide comprehensive sexual and reproductive health services for millions of women and youth who otherwise go without these vital services, including women suffering the burden of health and humanitarian crises.  Over the years USAID has been a huge supporter of family planning – with a budget of over $600 million per year. Reinstatement will mean that years of progress to increase access to essential services globally, will be lost. We cannot—and will not—deny life-saving services to the world’s poorest women.  We will work with governments and donors to bridge the funding and service gaps the Global Gag Rule creates. We will ensure that women can exercise their rights and access safe abortion and family planning.  WANT TO GET INVOLVED? SUPPORT OUR WORK WITH A DONATION     Subscribe to our updates!

A healthcare worker demonstrates to a patient how a vasectomy works on a poster
11 July 2022

Vasectomy: what you should know

A vasectomy is a medical procedure for people who have decided that they do not want to have children in the future.  It is a safe and effective way to prevent pregnancy, and it works by eliminating sperm from the semen. It is nearly 100% effective at preventing pregnancy, which makes it one of the most effective methods of contraception.  A vasectomy does not protect against sexually-transmitted infections or HIV – for this, a condom should be used.  What is the vasectomy procedure like? A vasectomy is usually performed under local anaesthetic, which means you are awake for the procedure, but you will be numbed in the surgery area. The procedure is quick – usually taking less than 30 minutes. It involves a doctor numbing the surgery area with a local anaesthetic injected into the skin of the scrotum. They will then make a small incision in the scrotum and locate the vas deferens, the tube that carries sperm from the testicle. The doctor withdraws part of the vas deferens through the incision, ties it off and cuts it. The vas deferens is then returned to the scrotum and the incision is closed.  Swelling, bruising, and pain following the procedure is normal, particularly after the first couple of days. Your doctor will probably advise you to wear tight-fitted underwear to support the scrotum and to avoid strenuous activity for a few days. They will also advise you to avoid sexual activity that may lead to an ejaculation for a week or so while you heal. When is a vasectomy effective? It’s important to note that a vasectomy is not effective straight away. In fact, in the following weeks/months after the procedure (and after your rest period), you’ll need to ejaculate about 15-20 times to ensure that there are no traces of sperm remaining in your semen.  It’s likely that your doctor will arrange a follow-up several weeks after your vasectomy to do an analysis of your semen to make sure there’s no sperm left in it. Once they have confirmed this, then you can have sex without using another contraceptive and without the worry of an unintended pregnancy.  In the meantime, you should use condoms or another form of contraception to prevent pregnancy.   Myths and facts about vasectomies Myth: “I can get a vasectomy now, and have it reversed if I change my mind.” Fact: While technically vasectomies can be reversed, the reversal procedure is complicated, requires specialist surgeons, and not always effective. That’s why all vasectomies should be considered permanent, and only people who are sure they are done having children or never want to have a(nother) biological child should go ahead with the procedure. Myth: “My reproductive organs could be permanently damaged.” Fact: The risk of permanent damage is rare if the procedure is provided by qualified healthcare professionals.  Myth: “The surgery will hurt too much.” Fact: As with most surgical procedures, some minor pain or discomfort during or after the procedure is normal, and for most people will go away within a few days.  Myth: “My sexual drive/ability will be affected by a vasectomy.” Fact: This is not true at all – apart from taking a break from sexual activity for a short time after the surgery, your sex drive/abilities will be what they were before the procedure. If anything, your sex drive might be higher without the worry of an unintended pregnancy! If you think a vasectomy could be a good option for you, contact your local sexual and reproductive health provider to discuss further. 

The American flag with stars and stripes

Statement on the U.S Congress' FY22 spending bill which fails to permanently repeal the global gag rule

U.S congressional leaders have announced they have reached a final spending deal for the fiscal year 2022. This bill results from months of negotiations over funding and policy decisions, including those that impact sexual and reproductive healthcare globally. Despite the inclusion of language to permanently repeal the global gag rule passed in the House and introduced in the Senate, the final legislation fails to permanently end the harmful policy that has destroyed the lives of women and girls around the world for so many years. It also does not remove discriminatory abortion bans like the Hyde, Helms, and Weldon amendments or include much-needed new investments in sexual and reproductive healthcare and international family planning programs. Dr Alvaro Bermejo, Director-General of the International Planned Parenthood Federation, said: “We are outraged to learn that the long-awaited U.S spending bill failed to permanently repeal the global gag rule, nor did it include other areas of sexual and reproductive health and rights progress on which advocates had built strong momentum. The bill fell foul to anti-choice Congress members whose primary goal is to control the bodies and reproductive rights of women and girls they will never know, whose lives they could never imagine. “Failure to utilize this golden opportunity risks the continuation of the flip-flopping of American policy that has played with the lives of millions across the globe for nearly 40 years. Ultimately the global gag rule destroys long-term access to lifesaving contraception, maternal health and HIV/STI services and forces vulnerable women and girls to carry pregnancies to term or make the agonizing decision to get a potentially deadly unsafe abortion. It also manipulates the ability of international organizations, like IPPF, to use their own funding to provide legal, safe abortion, which unethically denies women care and imposes neo-colonial policies around the world. “While the global gag rule poses serious challenges to sustained engagement with USAID, especially at a time when anti-choice movements continue to attack the rights of people worldwide, IPPF is grateful to the Biden-Harris administration for the current rescission of the policy. We will continue to engage with U.S Government global health assistance programs when possible. We are also thankful to our relentless Member Association, the Planned Parenthood Federation of America. Despite the challenges, they have worked tirelessly alongside thousands of women’s rights campaigners across the United States and worldwide to advocate for vulnerable women and girls everywhere. The fight for reproductive rights and justice will not end until every person can access high-quality sexual and reproductive healthcare when and where they need it.” Santos Siminone, Executive Director at Associação Moçambicana para Desenvolvimento da Família (AMODEFA), said: “We are deeply saddened by the failure to permanently repeal the Global Gag Rule. For AMODEFA, IPPF’s Member Association in Mozambique, a national provider of sexual and reproductive healthcare in the country since 1989, the impact of the global gag rule meant a $2 million gap in funding - about 60% of our total budget. “The impact was almost instantaneous, forcing the closure of six programs across 12 districts in Mozambique. This denied nearly 390,000 clients access to contraception, STIs, HIV, malaria, and tuberculosis services. Almost every local population was affected, with closures impacting adolescents, youths, women, and marginalized people. “For the people we serve, the permanent repeal of the policy would have meant an end to the violation of human rights. It would have meant dignity and that women’s lives would no longer be at risk. It would have meant an end to fear, pain, tears, and chaos, especially for black and brown women from low-income countries who bear the brunt of restrictive abortion policies.” For media enquiries, please contact Karmen Ivey on [email protected] or [email protected]  

ukraine flag

Statement on the escalating conflict in Ukraine

Following the disturbing reports coming out of Ukraine, IPPF has released a media statement on behalf of the Federation and its Member Association in Ukraine.   Despite the fact that sexual and reproductive healthcare (SRHR) needs increase significantly during conflict and humanitarian situations, the significant vulnerabilities of affected populations and displaced people are often overlooked, especially the experiences of women, girls and marginalized populations who are at increased risk of unintended pregnancy, sexually transmitted infections and sexual and gender-based violence. IPPF’s Director-General, Dr Alvaro Bermejo, said:   "The International Planned Parenthood Federation (IPPF) is deeply concerned about the escalation of conflict in Ukraine. We take our responsibility to preserve the enormous gains made in life-saving sexual and reproductive healthcare across the country very seriously, especially for women, girls and marginalised populations, whose vulnerability and experiences are so often overlooked in humanitarian situations.  "For 20 years, IPPF has consistently worked to strengthen and protect the reproductive rights of people in Ukraine, working in the frontline conflict zones of Lugansk and Donetsk since 2014, training medical specialists to provide life-saving reproductive healthcare, psychosocial support and quality care to survivors of sexual and gender-based violence. “Our teams are now contingency planning across the region to address not only the needs of those still in Ukraine, but also the millions who are likely to be displaced by the conflict and who will require critical support to continue accessing healthcare. We will work closely with partners and other NGOs to ensure the least possible disruption to services. "IPPF stands in solidarity with the international community and the brave people of Ukraine who for the last eight years have faced terrifying and difficult circumstances that nobody should ever have to suffer through. We stand by IPPF's frontline team, who, despite the dangers, continue to facilitate life-saving healthcare for those who need it most. We will be monitoring the situation closely to ensure the safety of our colleagues across the region.” For European outlets, please contact [email protected] For UK and other international media outlets, please contact Karmen Ivey on [email protected] or [email protected]  

A healthcare worker in Ghana shows a client the Pill
14 January 2022

Ghana offers free long-term contraception in a ‘game changer’ for women’s reproductive health rights

In a major win for women’s reproductive rights, Ghana’s National Health Insurance Program has expanded to include free long-term contraception from 1 January 2022. The move will allow millions of women of reproductive age who are already covered by national health insurance to avoid paying out of pocket for family planning methods such as the implant, coil and injections. It comes after a two-year pilot study found that including family planning services in health benefits packages resulted in a greater uptake of long-term contraception and future government savings in direct care costs.   “We are excited that at long last, long-term family planning methods are included in the National Health Insurance Scheme,” said Abena Adubea Amoah, the Executive Director of the Planned Parenthood of Ghana (PPAG), an IPPF Member Association. “This means long time peace of mind for women, girls and their families with potential positive impact on their health and economic life.”   Tackling deep-rooted barriers to healthcare In late 2021, the government of Ghana launched a year-long campaign aimed at raising awareness of and preventing maternal deaths in line with Goal 3: Good Health and Wellbeing of the United Nations Sustainable Development Goals. The role of family planning in reducing preventable maternal death is well documented, with unsafe abortion being one of the leading causes. Yet, Ghana is a country where deep-rooted cultural norms and structural barriers perpetuate poor sexual and reproductive health, including high risks of maternal mortality, high numbers of sexually transmitted infections and low levels of contraceptive use. Despite making important progress in recent years, Ghana’s maternal mortality ratio is 308 per 100,000 live births, which is still well above the SDG target of less than 70 deaths per 100,000 live births by 2030.   PPAG will play an important role in supporting the government in its campaign to prevent maternal deaths and disabilities. Since 1967, PPAG has provided the people of Ghana with family planning services as well as maternal and child health care, infertility management, and voluntary counselling and testing for sexually transmitted infections including HIV and AIDS. With over 100 staff members, a team of 1,000 volunteers, and 300 peer educators, PPAG is well-positioned to deliver health services and programmes through permanent and mobile clinics in urban and rural communities across the country. The association's Youth Action Team, comprised of over 810 young people, leads a number of educational and awareness-raising activities at 1000 community-based service points across the country. 

Client & healthcare provider
16 December 2021

Delivering disability-inclusive healthcare in Madagascar

Understanding the challenges that people living with a disability face when accessing sexual and reproductive healthcare (SRH), and ensuring their rights are upheld, sits at the heart of Fianakaviana Sambatras’ (FISA) mission to reach vulnerable groups. Often on the fringes of Madagascan society, and classified as a vulnerable group, people living with a disability are one of FISA’s priority client groups. Through expansion of their delivery networks, FISA provides safe, confidential, and accessible integrated SRH to people living with a disability.  Barriers to inclusive healthcare  Often, FISA’s clients have a lack of awareness about their sexual and reproductive rights where to go for their healthcare - for example, limited access to information through disability-friendly locations and leaflets and posters creates a barrier to vital information unless adapted for visually impaired and blind people. Other challenges include communication for deaf clients, who in some cases may not be accompanied by a companion to assist them. In some instances, FISA learned that women living with a disability were forced by their families to have an abortion or undergo tubal sterilization during a caesarean delivery without their consent, further reinforcing stigma and stereotypical attitudes towards disability.    Understanding the needs of the client FISA’s experience with providing care to people living with a disability has led to a greater understanding of their clients’ needs. Provision of improved integrated healthcare delivery includes allowing for longer appointment times to give the correct level of support, which is especially important for counselling and consultations.  FISA offers free consultations to people living with a disability and prioritizes young people ensuring they can access youth-friendly care. The team also run sessions using sign language to raise awareness on sexual and reproductive health and rights and to provide information about the different contraceptive methods available, such as the IUD and pill. FISA encourages people living with a disability to participate in events such as International Women’s Day to help make their voices heard, to advocate for their rights, and to collaborate on the development of a comprehensive sexuality education guide through a series of workshops. Designing and delivering disability-inclusive healthcare FISA has adapted its healthcare delivery to be disability-inclusive and to raise awareness of, and advocate for, the sexual and reproductive rights of people living with a disability. Critical to providing healthcare is safeguarding access to comprehensive sexuality education for young people living with disabilities that are specific to their needs. Providing information resources in Braille, using diverse pictures, and training healthcare workers to be able to communicate using sign language makes FISA a go-to place for healthcare for people living with a disability. Clients are made to feel welcome and safe with FISA’s qualified healthcare team and accessible facilities.  “Our Member Association in Madagascar plays a leading role in ensuring that persons with disabilities have access to high-quality and integrated sexual and reproductive healthcare. Their work is a good example of our mission to provide care to the most vulnerable, underserved, and often marginalized members of our communities. Integrated disability-inclusive healthcare delivery strategies that are adapted to our beneficiaries’ needs remain a priority in our work on the African continent”, says Marie-Evelyne-Petrus-Barry, IPPF Africa Regional Director. FISA enables its clients, and especially young people and women, living with a disability to feel empowered to make their own decisions concerning their bodies, wellbeing, and SRH.

Illustration woman and nurse
22 July 2021

Rolling out self-managed contraceptive care to women and young people in Zambia

The COVID-19 pandemic has caused huge disruption and restrictions for individuals globally, and has been felt acutely with challenges to accessing sexual and reproductive healthcare. Yet, with challenges often come opportunities, and the pandemic has enabled a transformation in how we deliver health and contraceptive care – especially to women and girls who are among the most affected in times of crisis.   Adapting in a crisis to meet need  Like many of our Member Associations, Planned Parenthood Association of Zambia (PPAZ) acted swiftly in March 2020 to develop a new and efficient strategic approach to healthcare delivery for its clients. PPAZ introduced an initiative that, for the first time, offered self-managed contraceptive care to women and young people across the four districts of Choma, Livingstone, Lusaka, and Kitwe.   The PPAZ healthcare team identified eligible women to participate in the initiative through group counselling sessions on contraceptive methods (both hormonal and non-hormonal) via healthcare clinics and community outreach. The provision of accurate and easy-to-understand information on the types of contraceptive methods available gives women the knowledge and autonomy to make decisions about what method is right for them and their lifestyle.    Personal and convenient contraceptive care    Women who opted for oral contraceptives were provided with a six-month supply of Combined Oral Contraceptives (Microgynon, Zinnia-F), free-of-charge. Other women chose Sayana Press, which is the only self-administering contraception available in Zambia. They were trained on the correct technique for administering the dose (an injection in either the anterior thigh or abdomen), correct storage, and safe needle disposal. Effective for 12 weeks, the women were given a two-dose supply free-of-charge.    PPAZ healthcare teams trained 1,535 women on the Sayana Press method, and 3,070 doses of the contraceptive were provided. They also provided follow-up appointments with their clients over several months to ensure correct use and address any concerns.   Impressed with PPAZ’s presentation and discussion about how Sayana Press works and its benefits, 21-year-old Eunice Chikoti, chose the injectable because of its convenience. “They took time to explain how to self-inject and were very patient while doing so. They answered all my questions until I was satisfied,” she says. Despite her initial apprehension, Eunice was trained in how to self-inject safely and easily, “I thought it would be very difficult to self-inject, but once I followed the instructions of the nurse, I did so without any challenge,” she says. Eunice has a nine-month-old baby and hopes to have more children in the future.   Commitment to self-managed care   Due to the success of this strategy, which is not solely reliant on a healthcare provider, PPAZ plans to roll out the initiative to other districts across Zambia. This approach will ensure the most marginalized and low-resource settings are reached where access to healthcare and trained professionals is limited.  PPAZ’s initiative has gone a long way in advancing the rights of women and young girls to sexual and reproductive healthcare. Through self-management of their contraceptive needs, women and young girls are exercising their right to bodily autonomy and personal choice with confidence.  

Healthcare worker

The personal contraceptive delivery service

When Famia Planea Aruba (FPA) saw a gap in the market, the team developed an online contraceptive store and bespoke delivery service to better reach their clients. The online store is available in the local Aruban language, Papiamento, and has been designed to provide quick access to various contraceptive methods, with supporting information to help clients make choices based on their needs.   Ghislaine, Head of Information, Education and Communication Support at FPA has been managing the delivery service since it started in August 2018.  “Since the start of the delivery service in 2018, our clients were enthusiastic however, the usage started slow. I believe this was due to the unfamiliarity, and people were still in the transition phase to online services. Moreover, clients believed that the delivery transportation would have been in a car, completely covered in images of condoms, sperm cells and pills, which made them sceptic of using the service due to embarrassment”, says Ghislaine.   The site is accessible to both FPA members and non-members who can shop in privacy for their contraceptives and schedule a delivery. Orders are delivered by FPA staff with clients having the option to pay cash or debit upon delivery. To ensure a clients’ privacy and confidentiality orders are delivered discreetly.  Challenges and opportunities  As with any new service comes challenges as well as opportunities. “Some of the challenges we face are the overload of deliveries on one day.” Even though Aruba is a small island and there are traffic jams only at specific hours in the day. “Sometimes I get stuck in traffic and try to rush myself to deliver the products in the time slot and at times I find myself in places that I barely recognize and discover new locations.”  “The part I enjoy is the communication with the clients. Building a relationship with the client and vice versa provides a smoother transition of service but also provides the comfort and safe feeling for the client.”  Ghislaine says the service often calls for more than the delivery of contraceptive orders, as clients may have questions or need support about their health.  Personal and convenient healthcare  Damara is a data analyst and a member of the Sustainable Development Goals Commission. She started using FPA contraceptive delivery service a year ago.   “It definitely has made my life much easier, especially when I have a busy schedule. With the delivery service I simply order my products through the online store and choose the date and time that is most convenient for me”, she says.  Damara values the personal service and the convenience of paying by card and choosing a preferred delivery time. “I love this service because sometimes I place an order a few days before and the employees at FPA call to confirm the order the day of the delivery, which is great because it is like a personal reminder! The best part is that they also have a portable ATM machine. I get my products, guidance and have it delivered to my location, what more can you ask for?”  FPA’s bespoke healthcare delivery has seen a successful growth since it started, with an increase of 115% during 2019 and 170% in 2020. “There has been an immense increase in the service in 2020 due to the pandemic. We already had the service in place, so we just had to fill in the gaps; for example, providing more hours and dates for clients to make use of the service”, says Ghislaine.  Hilyann, a journalist, is another regular user of the online store. “Shopping on the FPA online store makes me feel very in control and empowered. I hope that more people of all ages take advantage of this service. I hear far too often that people say they don’t have time, nobody has actually, but FPA is there for you. Take control of your sexual and reproductive health, empower yourself, be the boss of your time and your body.”   

Volunteer

"I changed first...so can other men"

"One day, when I returned from work, Ms. Glenda and Mr. Martin from Pro-Familia were at my house. I heard what the volunteering was about, regarding the education of the men in the community, how to teach how to stop machismo, to be less violent, how to give the talks and visit the clients. They also talked about the contraceptive methods, medicines and many things that would change people's lives. The proposal seemed important to me and I accepted, since I like to work for my people," recalls José.  In 2008, the Asociación Demográfica Salvadoreña (Pro-Familia) developed a project focusing on sexual and reproductive health and the active participation of men in rural areas. It concentrated specifically on the integration of male participation in sexual and reproductive healthcare. Since 2014, the project has been integrated into the Community-Based Programme as part of the provision of healthcare for rural men.  "When I gave the talks on masculinities, they questioned me: 'Why can't you scream at home, if you're the man?' Or 'who do you think you are to say those things?', questions that I also asked myself once", says José. "Thanks to the training I have had and the support of the Pro-Familia staff, I have managed to learn and clarify my doubts. I take care of my own health, I share the responsibilities at home, I take care of my two-year-old son – before volunteering, I thought it was a woman’s job, I didn't do that."  Ensuring access to information and contraception   Educational activities in sexual and reproductive health remain a challenge, but Pro-Familia is committed to delivering their strategy. The role of the health promoter is to advocate – with other men – the use of contraception, counselling couples, and providing supplies (especially condoms) and medicines.   "I like the communication I have with the Pro-Familia staff, and the training reinforcements – they should keep it that way, because it's the way to learn and do things better in the community," he says.  "The change begins with oneself and then transmits it to others. I gather men in talks, make visits to their homes, give guidance on prevention of sexually- transmitted infections, on family planning, and how not to be violent", says José. "Older adult men are more difficult to change."  Increasing contraceptive use among men   José has seen the positive change among men in his community and those small achievements encourage him to keep going. "When men ask me about violence and condom use, I feel encouraged. For example: a co-worker uses a condom and confidently tells me that he does it because he learned from the talks he received, that motivates me to continue guiding towards new masculinities."  The Community-Based Program has a special fund for clients who are referred by promoters for a voluntary surgical contraception (VSC) procedure, so the service is free of charge for clients. In this regard, José is aware that there is still work to be done: "The issue of vasectomy is difficult with men in the community, the challenges continue."  "In the community, young people 'get to live together' [marital union] at an early age. Maybe I cannot change that, but I can help them to be better people, to respect each other. Just as I changed, so can other men," says José. 

Volunteer

Talking about contraceptive choice on the soccer field

"I decided to become a volunteer at Pro-Familia when I heard a talk the staff were giving at the Acajutla City Hall, where they explained what they were doing in the communities with the program, and they invited us to be part of the volunteer service. I liked what I could do with the men in the community. It’s been two-and-a-half years." Juan Martinez Leon is a volunteer with the Asociación Demográfica Salvadoreña (ADS/Pro-Familia) community-based programme. Juan’s remit is broad, working mainly with men to provide information on contraceptive methods and counselling to individuals and couples. He also provides contraceptive methods including the Pill, injectables and, especially, condoms. For some hormonal contraceptive methods, Juan refers his clients to Pro-Familia clinics or other public health facilities. Putting community first "I like to work for my community, despite the difficulties, and I help in four more communities for them to have the [contraceptive] methods and medicines, because they come to get me," says Juan. "I give talks on the soccer field in front of my house or I have meetings at my house. My children help me invite men to come and they also learn and admire the work." Juan visits clients at home and organizes talks – mainly with other men – to promote the importance of contraceptive use, and women and children's health. The importance of men’s health and their family group is a key element in Juan's role as a health promoter. “I like providing family planning counselling, because sometimes men don't like women using anything to prevent pregnancy. When I talk with the men of my community, people's lives change and you see the difference: you no longer see the domination over women, they let women plan, and [the woman] no longer requests the method secretly – although there are still some women who hide from their husbands. That's why we have to continue working on counselling, that's what awakens them." Changing behaviour and attitudes Juan runs informative talks on reproductive health and the prevention of STIs and HIV. "In some talks, some men have come out angry and questioned me. Who am I to tell those things? ‘Someone who has learned and who respects people's rights,’ I tell them. Now men come to ask for condoms, and even my wife confidently gives the condoms to them. She also supports me." Some men thank Juan for having "awakened their minds", and encouraged them to change to respect women and to help at home. “I think I help my community a lot. You wake them up. I like what I do, I like to help. Before there was no promoter and they had women submerged. Little by little that is changing, but only by talking to men is it achieved. I want to continue learning about sexual and reproductive health issues, it never ends. I would like to continue in training as we used to before the pandemic, and for Pro-Familia to come more often. Until God tells me, I feel that it is my obligation to attend to men or whoever seeks me to help them. That's what I'm for.”