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SPRINT
26 April 2022

SPRINT: Sexual and reproductive health in crisis and post-crisis situations

  The SPRINT Initiative provides one of the most important aspects of humanitarian assistance that is often forgotten when disaster and conflicts strike: access to essential life-saving sexual and reproductive health services. We build capacity of humanitarian workers to deliver essential life-saving sexual and reproductive health services in crisis and post-crisis situations through the delivery of the Minimum Initial Service Package (MISP) for reproductive health in emergencies.   Through funding from the Australian Government's Department of Foreign Affairs and Trade (DFAT), our SPRINT Initiative has brought sexual and reproductive health to the humanitarian agenda, increased capacity and responded to a number of humanitarian emergencies. Australia has funded the SPRINT initiative since 2007. Since then, the SPRINT initiative has responded to 105 humanitarian crises and worked with partners in 99 countries. SPRINT has reached over 1,138,175 people, delivering 2,133,141 crucial SRH services, and continues to respond to ongoing emergencies. In each priority country, we work with an IPPF Member Association to coordinate and implement life-saving sexual and reproductive activities. Through these partnerships, SPRINT helps strengthen the enabling environment, improve national capacity and provide lifesaving services during times of crisis. You can read more about IPPF Humanitarian’s Programme here. Australia's location in the Indo-Pacific provides DFAT with a unique perspective on humanitarian action. Australia is committed to helping partner governments manage crisis response themselves. This is done through building the capacity of the national government and civil society to be able to respond to disaster. DFAT also works with experienced international partners to prepare for and respond to disasters, including other donors, United Nations agencies, the International Red Cross and Red Crescent Movement and non-government organisations.          

A humanitarian worker in India

In pictures: World Humanitarian Day 2021

This World Humanitarian Day we reflect on the incredible work undertaken by our humanitarian response teams over the last 12 months. Last year, IPPF reached approximately 5.5 million people in humanitarian crises through our local Member Associations. This achievement would not have been possible without the dedicated and heroic healthcare teams providing vital sexual and reproductive healthcare in the most fragile humanitarian settings. COVID-19 response in Papua New Guinea Papua New Guinea Family Health Association (PNGFHA) PNGFHA responded to the COVID-19 outbreak in PNG, supported by the Australian government. With access to emergency healthcare facilities now extremely limited, PNGFHA health workers travel to hard-to-reach areas providing sexual and reproductive healthcare to the most marginalized communities.Clients like Vavine Kila receive a consultation at the PNGFHA mobile clinic. Share on Twitter Share on Facebook Share via WhatsApp Share via Email The humanitarian response teams taking healthcare into people's homes in Gaza Palestinian Family Planning and Protection Association (PFPPA) On 10 May 2021, Israel launched airstrikes on the Gaza Strip, killing over 220 people (including women and children) and leaving over 75,000 displaced. At the time, an estimated 87,000 women in the Gaza Strip and nearby areas were pregnant. The PFPPA humanitarian response team visited families in their homes, with each household expected to have four to five women of reproductive age needing healthcare. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Offering holistic care to families in Gaza Palestinian Family Planning and Protection Association (PFPPA) Children account for close to 50% of the population in Gaza. As part of the response, PFPPA youth volunteers entertained the children while their family members received life-saving sexual and reproductive healthcare and psychosocial support by the humanitarian response teams in privacy. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Ensuring ante- and post-natal care in the aftermath of an earthquake in West Sulawesi Indonesia Planned Parenthood Association (IPPA) On 15 January 2021, a 6.2 magnitude earthquake struck the West Sulawesi province in Indonesia leaving over 15,000 displaced, including many pregnant people and nursing mothers.As part of its response efforts, the IPPA set up mobile clinics near the shelters to provide vital ante- and post-natal care. Share on Twitter Share on Facebook Share via WhatsApp Share via Email A super cyclone and a pandemic Family Planning Association of India (FPAI) On 20 May 2020, severe Cyclone Amphan hit the Indian state of West Bengal, affecting millions of people in and around the state capital Kolkata. Emergency crises during the COVID-19 pandemic intensifies the impact of the disaster and puts a strain on health systems and access to sexual and reproductive healthcare.FPAI responded by providing emergency sexual and reproductive healthcare to affected communities, particularly focusing on the most marginalized and vulnerable people including the LGBTI community, sex workers, pregnant women, and survivors of sexual and gender-based violence (SGBV). Share on Twitter Share on Facebook Share via WhatsApp Share via Email Providing healthcare to hardest hit communities after Cyclone Yasa The Reproductive and Family Health Association of Fiji (RFHAF) In mid-December 2020, a category 5 severe Tropical Cyclone Yasa hit the island of Fiji and neighbouring Lau group of Islands. IPPF’s Member Association, RFHAF, was supported by the Australian government to provide life-saving sexual and reproductive healthcare in the hardest hit communities, including counselling on STI risk reduction, first-line support for survivors of SGBV, and contraceptive and ante-natal care. Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Healthcare worker with combipack.

In pictures: Innovating during COVID-19

Women around the world have faced multiple barriers to accessing safe abortion care during the COVID-19 pandemic including the de-prioritization of sexual and reproductive healthcare, overwhelmed health systems and restrictions on movement. The COVID-19 crisis has sparked innovation among IPPF Member Associations who responded swiftly by developing new approaches to reach women with safe abortion care including telemedicine and home-based provision of medical abortion. Strong evidence generated from this work supports the continuation and strengthening of these approaches beyond the end of the pandemic. Cameroon Cameroon National Planning Association for Family Welfare (CAMNAFAW) To ensure that quality abortion care can be provided to women during travel restrictions, CAMNAFAW’s service providers travel to partner clinics in underserved areas and to clients’ homes to provide medical and surgical abortion care. This model of taking safe abortion care closer to women will continue even with easing of travel restrictions, as this has been found to be an effective and acceptable approach to increasing access.Photo: IPPF/Xaume Olleros/Cameroon Share on Twitter Share on Facebook Share via WhatsApp Share via Email Guinea Association Guinéenne pour le Bien-Etre Familial (AGBEF) Building on lessons learned during the Ebola crisis in Guinea, AGBEF quickly took measures to prevent infection in its clinics to continue providing sexual and reproductive healthcare, including surgical and medical abortion, in a safe environment. AGBEF donated protective materials to communities, including hand-washing stations, face masks and antibacterial gel, alongside messaging on infection prevention. This community visibility reassures clients they can safely attend AGBEF clinics for abortion and contraceptive care.Photo: AGBEF/Guinea Share on Twitter Share on Facebook Share via WhatsApp Share via Email India Family Planning Association of India (FPA India) FPA India and partners advocated to have sexual and reproductive healthcare, including abortion, recognized as essential by the government, which meant FPA India could continue healthcare delivery during the national lockdown. To reduce in-person clinic visits, FPA India established teleconsultation and counselling for abortion care, and is continuing to provide in-clinic care for both medical and surgical abortion. Photo: IPPF/Alison Joyce/India Share on Twitter Share on Facebook Share via WhatsApp Share via Email Nepal Family Planning Association of Nepal (FPAN) FPAN and partners advocated for interim approval of home provision of medical abortion and telemedicine for abortion counselling during COVID-19. FPAN is now implementing these approaches, ensuring continued access to abortion care in Nepal, where many people live in remote locations with limited mobility, which has been further restricted by COVID-19 lockdowns. Photo: FPAN/Nepal Share on Twitter Share on Facebook Share via WhatsApp Share via Email Pakistan Rahnuma – Family Planning Association of Pakistan (Rahnuma-FPAP) Rahnuma-FPAP and partners successfully advocated for the government to class sexual and reproductive healthcare as ‘essential’, which enabled the team to continue providing post-abortion care during the pandemic. Rahnuma-FPAP expanded its telemedicine and home-based provision for menstrual regulation counselling and post-abortion care. These new approaches have ensured continued access to services for clients unable to reach clinics.Photo: Rahnuma-FPAP/Pakistan Share on Twitter Share on Facebook Share via WhatsApp Share via Email Palestine Palestinian Family Planning and Protection Association (PFPPA) In response to the government-mandated closure of its clinics, PFPPA quickly established a toll-free call centre which provides consultations, counselling, referrals and follow-up, including consultation for abortion care through a harm reduction approach, ensuring that women are provided with accurate information. Due to its success, PFPPA is exploring options for continuing this healthcare delivery model beyond the pandemic, with the aim of keeping it free of charge for users.Photo: SAAF/Samar Hazboun/Palestine Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sudan Sudan Family Planning Association (SFPA) Following a nation-wide shutdown in April, SFPA  established  a call centre to increase access to healthcare, including abortion and contraceptive counselling and referrals.  An unexpected outcome of the new call centre is that it has reached an increased number of young women who regularly call to discuss their reproductive health and rights. SFPA  is working  towards institutionalizing this model for continuation beyond the pandemic.Photo: SFPA/Sudan Share on Twitter Share on Facebook Share via WhatsApp Share via Email Togo Association Togolaise pour le Bien-Etre Familial (ATBEF) ATBEF adapted its mobile application ‘Infos Ado Jeunes’, adding a toll-free teleconsultation service for young clients to use to access abortion consultations and pre- and post-abortion counselling. This app has given young clients ongoing access to care when they face challenges travelling to clinics. It has also eased overall client flow in clinics at a time when social distancing is being implemented.Photo: ATBEF/Togo Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Woman sitting - India

IPPF welcomes the ruling to extend abortion care from 20 weeks to 24 weeks in India

The MTP (Amendment) Bill, 2020 passed by the Lok Sabha (Lower House of Parliament) has indeed been a momentous victory for women and girls of India. The celebrations are incomplete without recognising the tireless efforts of Family Planning Association of India (FPAI) and all the Civil Society partners, activists and women who never stopped demanding women’s rights to safe and legal abortions.  IPPF applauds the Cabinet on this landmark decision which approved the bill allowing abortion up to 24 weeks. The Bill allows abortion up to 24 weeks of gestational age for vulnerable categories of women including rape survivors, victims of incest, pregnancies with foetal abnormalities and minors. Replacing the term’ married couple’ to woman and her partner highlights that the government is acknowledging the changing social fabric in the country. It also takes a positive step towards ensuring confidentiality of information for the woman, except to a person authorised in any law which is in force. The Bill can now be said to be truly woman-centric which recognizes and respects a woman’s autonomy, her choice and her rights. Dr Kalpana Apte (Secretary General, Family Planning Association of India) said: “It was a very long battle that we have fought along with other CSOs and women groups. Although, the amendments are not fully what we fought for, we are happy with many achievements. The gestation age is expanded, now unmarried women can access safe abortions and reduction in numbers of specialists required for second trimester are some of the important wins. The battle is indeed won, the fight is still on to ensure women's sexual and reproductive rights are supported and protected through enabling legislation!” IPPF Director-General Dr Alvaro Bermejo added: “This bill passing represents a huge shift for the rights of women in India to access safe abortion care- though there is more work to be done. This win would have not been possible without the hardwork and dedication of the Family Planning Association of India, civil society partners and activist. Let this win in India inspire other organizations and activists to continue their fight for safe and legal abortion.” While the increase in gestational limit is only for “vulnerable categories of women”, there is a need to improve accessibility to abortion service for all women who want/need it. In addition to addressing stigma, a key requirement is to increase access to safe abortion services in India – in each and every part of the country women get high quality, dignified and stigma free abortion services, only then we can claim universal health coverage for all. 

Women in Leadership: Kalpana Apte, India
06 March 2020

Women in Leadership: Kalpana Apte, India

How did you get into sexual and reproductive health and rights (SRHR)? I joined FPA India as a Jr. Medical Officer in one of the clinics serving women from slums and marginalized groups. I was a young, newly graduated doctor, who was looking for some experience, before starting my own practice. I had done residency in Surgical Stream and wanted to gain practical experience in family planning (FP) and maternal & child health (MCH). FPA India, provided me an opportunity to understand the public health and rights based perspective that was lacking during my medical education. Once, I was conscious of these issues, I was hooked. Then came the watershed moment of ICPD in 1994.  That’s where I got hooked in interpretation of rights in a service delivery context, planning strategies to expand the FPA India’s existing FP-MCH service mix into a broader SRH service delivery mix. My role changed from a medical provider to more planning, capacity building and supervisory role. After that, there was no looking back. What was it like growing up in India when it came to SRHR? I grew up in Mumbai city in a middle income family. My parents were teachers. My mom was a teacher and father was a professor and education was the most important thing in our life. TV was not so popular in those days, but we saw a lot of films. It was a very common pastime to watch a movie. While I was growing up, almost all Hindi movies depicted romance between couples and that was a major source of information to us. There was no access to any SRHR related discussion in a formal manner. These were taboo topics. Very few books also provided information. It was not part of school teaching, I didn’t have any specific books or even any friends who knew about sex and sexuality. It was only in my teens, I read a book that narrated sex between a couple. I still didn’t understand much after reading though I felt embarrassed and excited and I told my mom. She was speechless and just kept quiet. Love marriage was considered a very 'forward' behaviour, so was hanging out with boys. But when I started my medical college, the atmosphere was much relaxed there. Hanging out with boys was okay and I made many friends, with whom the friendship continues to this date.  How open were your parents and society more generally about SRHR? I didn’t have any understanding of SRHR during my childhood. Even then, I can say that I had a happy childhood. Although, I did sense that there was something forbidden that happens between male and female, I wasn’t sure what. I also had a vague thought that it can only happen when you grow up. I absolutely didn’t have a clue about sex or rights or any such concept. I remember that my mom was very strict with us and didn’t allow sleepovers or overnight outings neither to me or my sisters or to my brother. She really was very careful, she would patiently explain that something wrong can happen to us and in her own way she explained the concept of good touch and bad touch. We were embarrassed and so was she. I remain thankful for that lesson and her protection. She also told me about menstruation. Not in detail but she told me that it was important to be careful, use pads and keep clean. Later, it was during a session conducted at school, I understood about the physiology and how it happened. My father never put any restrictions on us and expected us to excel in education. He was in denial that we were girls and he would get upset if we did girly things like makeup etc. We were brought up to think that natural is normal and wearing make-up is cheap behaviour. I don’t remember hearing the word ‘sex’ or ‘sexuality’ or reproductive rights etc while growing up. What taboos were there? Discussing sex or sexuality was a big taboo. When I was eight or nine, I remember asking my gran ma about how children were born or came in to the world and she was livid. She said that I was a bad girl for asking such a question. In my teens, talking with boys was frowned upon, not so much by my parents but society. Sex before marriage was totally taboo. An unmarried girl getting pregnant was the worst scenario. Asking for information on sex was taboo. It was considered being slutty. How did you and your friends find out about SRHR? I read a book where it was described. Incidentally, it was a mills and boon romance. Around the same time, my friend was told about sex by her married cousin sister. She was our major source of information. We had many questions which she narrated to her cousin and we got some replies. It was a lot of fun ( I think now). At that time, it was just so much cloak and dagger stuff and we were so full of dread, excitement, fervour, embarrassment and curiosity off course. What inspired or motivated you to get involved with SRHR? This is from 1991. I was 25 years old. I had just started working in FPA India as the Medical Officer. One day, towards the closing time, this lady with a small baby in her arms for immunization. It wasn’t our regular day for immunization, the clinic was almost empty. We were just finishing paperwork and winding down. I remember the OPD nurse coming with a bit irritation and telling me that now that we have completed giving her child immunization dose, she wants to see you. I was met the lady. She asked me for a contraceptive method, specifically an IUD and wanted it immediately inserted. It was the right time, she had come on the fifth day of her menstrual period, which was the right time to insert, as per the practice in those days. After examining her, I realised that we could not insert an IUD as she had uterine prolapse. We discussed possibility of another contraceptive option.    She already had six living children, two miscarriages and she didn’t want any more pregnancies. Her husband would not use a method and she could not talk to him about her problem. She was sure that she would die, if she had another pregnancy. I was helpless and I felt horrible. I failed that day as a doctor. I realized so many things that day. I had  treated and seen too many dowry deaths during my surgical residency. I did understand the gender inequality but this was the incidence that opened my eyes about women’s vulnerability and marginalization in context of SRHR. Women bear the consequences of having a uterus and are at a higher risk of death and disability. Yet, they don’t have choices and they can’t take decisions. She set me on this path.   When it comes to SRHR what does India need to focus on? Gender equality and equity is a fundamental issue that India must prioritize. Then only, SRHR can be realised and policies and programme can become successful. India is a country of young people. That is the biggest cohort of people at this time in history. Within this group of young people, adolescent and young girls are the most marginalized group. The face of poverty in India is a young girl. Girls have fewer choices, options and opportunity. The gap between boys and girls in terms of access to SRH services and information is huge. Thus, we need to focus on young people, particularly young girls. Literacy rate remain low (females’ age 15-49 year in 2015-16 are total 68.4% and among the total urban literacy rate is 81.4% and rural literacy rate is 61.5%(Ref: NFHS-4) Education, Health and empowerment are the three priorities for young girls. To what degree is CSE taught in schools? The Adolescent Education Programme is a basic curriculum with very limited information. The newer initiative, Rashtriya Kishor Swasthya Karyakram ( RKSK, meaning national youth health programme) has a broad curriculum but it does not cover some modules like pleasure. In most schools, this is topic that is not taught. Teachers feel embarrassed and they avoid this topic. In many states, sexuality education is banned. Only 15 % young people (male and female learners, aged 15-24) have received sexuality education in India. Thus, provision of CSE and advocacy to ensure access is a priority. What taboos still remain? Sex and sexuality are still taboo topics. Access to SRH information and services for unmarried adolescent is another big taboo. Being sexually active is a taboo. How have the issues around SRHR changed? Now, due to technology is a universal access to all sort of information. This is not validated or there are very few opportunity to ask questions and /or have a discussion. Many young people access pornography as an alternative to sexuality education. Also, there is a lot of change in social norms and relationships. As the age of puberty attainment is getting younger ( 9-11 years for girls and 11-12 for boys), the average age at first sex is also declining, incidence of premarital sex is on the rise. As the public health care is improving for FP MCH, there is still a large unmet need for SRH services for young people. How significant is the issue of opposition in India? There is no significant organized opposition in India. However, there has been issue based opposition to Injectables from women’s organizations for over two decades. Now that has died down as DMPA Injectables have been included in the Govt. programme. There is no specific religious or ideological opposition for safe abortions. Yet, there is a restrictive movement for safe abortions from groups working on gender, due to declining sex ratio. In order to improve sex ratio, inadvertently groups have rationalised that restricting abortions would balance the sex ratio. This, off course is a flawed thinking. But, on the ground, strategies to balance gender ratio have resulted in restricting access to safe abortions. How do you believe you can build a movement to change that We are already working to create evidence, share case studies and work with partners through networks to change this perception. We are also working with policy makers and decision makers to ensure that safe abortion services remain accessible to all. Strategies to restrict sex selection do not impact safe abortions on the ground. What change needs to happen? The Amendments to the Medical termination of Pregnancy Act are being debated at the Parliament. We expect that the amendments would be enabling and empowering. There is need to work at the community level to change the gender norms and change the concept of son preference that drives sex selection. Most of this is being done through multiple government policies and sensitized programmes. But, it needs to be upscaled. Aspirations of young people need to be the driving force changing mindsets and bring about gender empowerment. How hard is it to bring change? Change is constant yet it is difficult in context of socio-cultural norms. We see change in embracing the technology. Change is easier with young people. However, gender norms and stigma around sexual and reproductive health is difficult to change in short term. Also, gender based violence is another difficult area where changes are not easy to bring. Change happens through years, often in next generation of young people. Behaviours can change easily but attitudes take time. Yet, consistent and strategic engagement with people and communities does help in bringing change. Otherwise, there is no hope for progress and development. What are your biggest areas of concern? Women’s safety and well being is still not guaranteed in this day and age. Women still remain tied to their biology. It is said that ‘biology enables, culture binds’. All the medical and technical advances around the world still can not enable a women to make their own reproductive and sexual choices. Women remain shackled to their biology of becoming pregnant and delivering children. Any deviation from this societal expectation is stigmatized. That women are unable to enjoy scientific advances helping them to make SRH choices is one of my biggest concerns. Second concern is Sustainability of not-for profit work is the other big concern I have. Interventions and services aimed at most poor are not self-sustaining. When services and commodities are at cost, the profile of people accessing them changes. I feel, that at scale, interventions for the most vulnerable and marginalized people would need to be supported. Existence of Non-profit movements depends largely on funding support. The funding support often drives the design and direction of the intervention. I feel that the role of developmental agencies is becoming more and more dependent. Innovation, design freedom and individuality of working with communities to find solutions is becoming challenging. What do you think the biggest successes have been? The biggest success has been legislative and programmatic priority towards women’s health. Even when the scope of these laws and policies remains a bit limited, it helps women to access education, health, livelihoods. This leads to multiple wins. Prioritizing adolescent girls and their health is another important win. What are you doing to celebrate International Women's Day this year? I will be attending a meeting as a speaker at young women’s institute. I would be speaking with them about empowerment and journeys women take to realize their rights.

Beauty parlour-related training
08 August 2019

Watch - Beauty Behind Bars: Life after prison for women in India

India is home to 20 female-only prisons, that have the capacity to hold just 5,000 inmates. Women currently make up 4% of India's prison population. Before they reach prison, many women have already experienced sexual and gender-based violence. Many inmates face discrimination and are often ostracized from their community and their families once they are released. Realizing a gap in care for women once released, the Family Planning Association of India (FPAI) have stepped in to ensure women are equipped with not only healthcare whilst in prison but life training skills. Skills that will financially support them and their children with or without the support of their families. Established in 1949, the Family Planning Association of India has provided life skills training ranging from beauty parlour related work to car mechanics to 768 women in six locations.

Some IPPF volunteers - Zero Discrimination Day
28 February 2019

1 March: Zero Discrimination Day

On Zero Discrimination Day, IPPF stands for respect, dignity, compassion and care for all. We are committed to providing quality healthcare to every person that visits one of our Member Association’s clinics, regardless of their age, sex, gender identity, race, ethnicity, sexual orientation, religion, economic status or anything else.  When you provide healthcare with dignity and respect, you can inspire others to do the same. Meet some of people who were so motivated by the discrimination-free healthcare they received from our Member Associations, or by the potential to support their communities in need, that they decided to become much-valued volunteers. Lakshmi from Nepal, living with HIV – Community care mobiliser with the Family Planning Association of Nepal “I made a plan that I would come back home [to Palpa], disclose my status and then do social work with other people living with HIV, so that they too may have hope to live. I said to myself: I will live and I will let others living with HIV live.” Read more about Lakshmi Leilani, a trans woman from Tonga – Volunteer at the Tonga Leiti Association, supported by Tonga Health Family Association “I think Tonga Family Health has done a lot up to now. They always come and do our annual HIV testing and they supply us [with] some condoms.They really, really help us a lot. They [are the] only one that can understand us.” Read more about Leilani Eric from the USA – Outreach volunteer for the Planned Parenthood Federation of America  “The first thing I do when I have hardcore substance abusers sitting in front of me, I first show them identification, I let them know I understand just how they feel. I’ve been there feeling hopeless, helpless, confused about where to turn.” Read more about Eric Hasina from India – Sex worker and volunteer at the Family Planning Association of India “Selling my body doesn’t make me a bad person, but working as a peer educator has helped enabled me to help many like me.” Read more about Hasina Milan from Nepal, living with HIV – Community care mobiliser with the Family Planning Association of Nepal “There are 40 children in this area living with HIV,” he says. “I talk to them, collect information from them and help them get the support they need. And I tell them: ‘If I had given up at that time, I would not be like this now. So you also shouldn’t give up, and you have to live your life.” Read more about Milan Joseph from Botswana, a gay man living with HIV – Client at the Botswana Family Welfare Association “I never have any problems coming here. I feel comfortable here. At [the government clinic] there is no privacy; most of my friends are there. Sometimes if you go there you find them suspecting something, and everyone will be knowing your status. That’s why I prefer BOFWA [Botswana Family Welfare Association].” Read more about Joseph

Hasina, a sex worker and peer educator sits outside a brothel, India

"Selling my body doesn’t make me a bad person"

“Selling my body doesn’t make me a bad person, but working as a peer educator has helped enabled me to help many like me.” Hasina is one of the estimated 1,500 sex workers living in Haunman Tekri, a red-light area in Bhiwandi, a town near Mumbai. When her husband passed away six years ago leaving behind a three-year-old daughter, Hasina turned to sex work as her only option to earn money. She admits that it came with a feeling of powerlessness. "You don't choose this trade; it is the result of life circumstances.” She works as a peer educator with PSK, one of the Family Planning Association of India's (FPAI) clinics. "Working with Parivar Swasthya Kedra (PSK), has made me feel less helpless; it's given me some control over my body; the ability to choose whether or not to bring another life into this world.” Building trust through education Hasina has been a peer educator for three years, working within the district to educate other women on safe sex, contraception, and abortion. Hasina admits she was once wary of PSK workers. "I used to think that these workers who insist we use condoms, would only sabotage my clientele. But soon I realized they were only looking out for us." When talking with local women, Hasina advocates the use of contraception but says in the case of an unintended pregnancy, abortion is a viable option. "It's easy to judge us, but many of us have no choice; we simply cannot feed another on just Rs. 400 a day."  Hasina is now the go-to woman in the district when it comes to sexual health. "Since I am one of them, the women trust me." This is the secret behind PSK success; a model where sex workers educate their peers, understanding the complexities and prejudices of their daily lives. "I hope one day I am able to put all of this behind me. But I hope that through PSK I am able to make another woman's life just a little bit safer, a little bit better." Do you want to show your support for women and girls to be free to decide what happens to their body? Pledge your voice to our I Decide campaign,IPPF’s movement for safe abortion access for all. You'll be provided with toolkits on how to talk about abortion and you'll have access to a range of content from personal testimonies to videos explaining the different types of abortion available.

Neelam Dixit is the branch manager of FPA India's GCACI clinic in Gwalior in Madhya Pradesh.

"Most women are from marginalised sections of society and are denied the right to make their own decisions"

In the district of Gwalior in Madhya Pradesh, the summer season has started and the heat in town is already extreme. Here, the Family Planning Association of India GCACI clinic serves many people living in poverty. In the ten years since the GCACI project started there, the clinic has provided 16,301 women with comprehensive abortion care and 202,758 women with contraceptive services. The two-storey clinic is situated in a residential area and, inside, women queue up to see the counsellors and medical staff. Many are accompanied by link workers who have travelled with them from outlying districts. Neelam Dixit is in charge of the branch. “Most women are from marginalised sections of society and are denied the right to make their own decisions. By the time they visit our clinic, the woman is already a couple of months pregnant”. FPA India’s work is making an impact and Dixit is seeing views change on abortion. “There is a shift in attitude among women since FPAI started providing services. Presently, there is little stigma attached to abortion. Our aim is to provide quality health services at low cost. We create awareness about the consequences of unsafe abortion and train volunteers to be sure women in villages are aware of our clinic.” The clinic has served around 300,000 people from rural and semi-urban populations with comprehensive sexual and reproductive health services, and provides both first- and second-trimester abortion services.   

Nurse

In pictures: Expanding access to safe abortion in India

Konika* Mother of three, Parivar Swasthya Kendra (PSK) client Konika is 20 years old, and the mother of three girls. Like many local young women, she decided to have an abortion when she became pregnant for the fourth time within five years. Citing financial issues as the driving force behind her decision, despite her mother-in-laws desire for her to have another child, hoping this time it would be a boy. Through a neighbour, she approached the PSK clinic in Bhiwandi for an abortion. In Konika’s community, many young women are married and have kids by the time they are 20. Now with PSK, women like Konika have a choice to be pregnant or not. *Name has been changed Share on Twitter Share on Facebook Share via WhatsApp Share via Email Rehkha Parivar Swasthya Kendra (PSK) link worker Family Planning Association of India, works with a network of volunteer link workers, who disseminate information about services available in the PSK clinic, make referrals, and often accompany women to the clinic for support. One of these link workers is Rehkha. Rekha says: "I have been involved with PSK for five years. And today I can proudly say that since the first awareness campaigns, there has been not a single death in the village due to an unsafe abortion." She adds: "These women are my flesh and blood. They know I only want the best for them… Within our communities we spread the message of safe sex and safe abortion through songs and skits which are easily understood. And I think the trick is to include mother-in-laws in our work. We have a high success rate in providing safe abortion care.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Shajahan Parivar Swasthya Kendra (PSK) link worker Shajahan is a link worker in the nearby Muslim district, where women pack into a house in the narrow village lanes to wait to speak to her. She says: "I am a Muslim. In my community, abortion is frowned upon, and contraception is considered a sin. Initially, the women thought I was going against our customs, and the men thought I was a bad influence on their wives. Some of the men in our area even approached my husband and asked him to order me to stop these efforts." But her husband was supportive, telling other men that it was also their responsibility to be part of the process. It took several years, but eventually Shajahan won the trust of the women and men of her area. "Today, every woman in my area comes to me when it concerns matters of sexual health." Share on Twitter Share on Facebook Share via WhatsApp Share via Email Gauri Family Planning Association of India (FPAI) staff Gauri has worked for FPAI for years and remembers hearing about the experiences of women who’d had unsafe abortions. "I had heard first-hand accounts of [unsafe] abortions that left women reeling in pain, suffering permanent infertility. I had also seen the grief in the faces of men whose wives died. So today when I see women leaving us, after an abortion, in perfect health, I feel like I've done something right with my life." Gauri continues: "My work may have started with one area, but I want to reach every corner of the country with FPAI - so that no woman in India becomes a statistic." Share on Twitter Share on Facebook Share via WhatsApp Share via Email Nisha Mother of two At 23, Nisha Boudh is already a mother to two children and severely anaemic. She feels she is in no position to have a third child, but her in-laws are not supportive. Nisha chose to have an abortion at FPAI’s Gwalior clinic. “I have been weak since childhood and, honestly, motherhood has taken a toll on my health. Doctors in other clinics were not willing help me and I would have died had FPAI not come to my rescue. With their doctors’ advice I have now decided to undergo an operation [tubal ligation] as I do not want to conceive. My mother-in-law was upset with my decision but I want to live to see my other children grow,” said Boudh. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Diti* Sex worker Diti is a sex worker living in Kolkata. She says she, "owes her life to PSK". Diti was forced into an early marriage when she was just 12 years old. "Before my body could even develop, my husband was forcing himself upon me." By the age of 20, Diti had five children. Struggling to cope at such an early age, and married to an abusive husband, Diti ran away. "I don't enjoy having sex with strangers, but I need the money." She makes 300 rupees a day ($4 USD). When Diti became pregnant she didn’t want to continue with the pregnancy. "There's no way I can feed a child. Besides, this is no place to bring a child into the world. Another sex worker recommended the PSK clinic.” Diti was worried about visiting the clinic, fearing stigma and discrimination from staff for working as a sex worker. Her experience was vastly different, finding the clinic team to be welcoming, reassuring and supportive. "They treated me like a human being." Share on Twitter Share on Facebook Share via WhatsApp Share via Email Mala Medical officer “The big problem in this part of India is early marriage and pregnancy. Both of which need to be handled very delicately,” says medical officer Mala Tiwari. “Slowly, things are changing as women are becoming aware of their rights. Previously when GCACI did not exist there was very little interaction with the link workers, and they [and the community] feared it was illegal to get an abortion. They did not know they did not need the consent of their husbands and in-laws. They now know, women have a right over their body.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Manju Mother of two, Parivar Swasthya Kendra (PSK) client Manju Rana was forced to marry at fifteen. “I have had two children in eight years of marriage,” she says. “My mother-in-law wanted me to keep having children. She does not understand I would not be able to give them a good education if I had more children. My husband is a driver and we cannot afford to have any more. When I learnt I was pregnant, without taking anyone’s permission, I went with the link worker of my area to the clinic and had an abortion.” Manju adds: “In these affordable clinics we can choose about pregnancy. They also made sure I was counselled, as coming to a decision about abortion is not easy.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email

SPRINT
26 April 2022

SPRINT: Sexual and reproductive health in crisis and post-crisis situations

  The SPRINT Initiative provides one of the most important aspects of humanitarian assistance that is often forgotten when disaster and conflicts strike: access to essential life-saving sexual and reproductive health services. We build capacity of humanitarian workers to deliver essential life-saving sexual and reproductive health services in crisis and post-crisis situations through the delivery of the Minimum Initial Service Package (MISP) for reproductive health in emergencies.   Through funding from the Australian Government's Department of Foreign Affairs and Trade (DFAT), our SPRINT Initiative has brought sexual and reproductive health to the humanitarian agenda, increased capacity and responded to a number of humanitarian emergencies. Australia has funded the SPRINT initiative since 2007. Since then, the SPRINT initiative has responded to 105 humanitarian crises and worked with partners in 99 countries. SPRINT has reached over 1,138,175 people, delivering 2,133,141 crucial SRH services, and continues to respond to ongoing emergencies. In each priority country, we work with an IPPF Member Association to coordinate and implement life-saving sexual and reproductive activities. Through these partnerships, SPRINT helps strengthen the enabling environment, improve national capacity and provide lifesaving services during times of crisis. You can read more about IPPF Humanitarian’s Programme here. Australia's location in the Indo-Pacific provides DFAT with a unique perspective on humanitarian action. Australia is committed to helping partner governments manage crisis response themselves. This is done through building the capacity of the national government and civil society to be able to respond to disaster. DFAT also works with experienced international partners to prepare for and respond to disasters, including other donors, United Nations agencies, the International Red Cross and Red Crescent Movement and non-government organisations.          

A humanitarian worker in India

In pictures: World Humanitarian Day 2021

This World Humanitarian Day we reflect on the incredible work undertaken by our humanitarian response teams over the last 12 months. Last year, IPPF reached approximately 5.5 million people in humanitarian crises through our local Member Associations. This achievement would not have been possible without the dedicated and heroic healthcare teams providing vital sexual and reproductive healthcare in the most fragile humanitarian settings. COVID-19 response in Papua New Guinea Papua New Guinea Family Health Association (PNGFHA) PNGFHA responded to the COVID-19 outbreak in PNG, supported by the Australian government. With access to emergency healthcare facilities now extremely limited, PNGFHA health workers travel to hard-to-reach areas providing sexual and reproductive healthcare to the most marginalized communities.Clients like Vavine Kila receive a consultation at the PNGFHA mobile clinic. Share on Twitter Share on Facebook Share via WhatsApp Share via Email The humanitarian response teams taking healthcare into people's homes in Gaza Palestinian Family Planning and Protection Association (PFPPA) On 10 May 2021, Israel launched airstrikes on the Gaza Strip, killing over 220 people (including women and children) and leaving over 75,000 displaced. At the time, an estimated 87,000 women in the Gaza Strip and nearby areas were pregnant. The PFPPA humanitarian response team visited families in their homes, with each household expected to have four to five women of reproductive age needing healthcare. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Offering holistic care to families in Gaza Palestinian Family Planning and Protection Association (PFPPA) Children account for close to 50% of the population in Gaza. As part of the response, PFPPA youth volunteers entertained the children while their family members received life-saving sexual and reproductive healthcare and psychosocial support by the humanitarian response teams in privacy. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Ensuring ante- and post-natal care in the aftermath of an earthquake in West Sulawesi Indonesia Planned Parenthood Association (IPPA) On 15 January 2021, a 6.2 magnitude earthquake struck the West Sulawesi province in Indonesia leaving over 15,000 displaced, including many pregnant people and nursing mothers.As part of its response efforts, the IPPA set up mobile clinics near the shelters to provide vital ante- and post-natal care. Share on Twitter Share on Facebook Share via WhatsApp Share via Email A super cyclone and a pandemic Family Planning Association of India (FPAI) On 20 May 2020, severe Cyclone Amphan hit the Indian state of West Bengal, affecting millions of people in and around the state capital Kolkata. Emergency crises during the COVID-19 pandemic intensifies the impact of the disaster and puts a strain on health systems and access to sexual and reproductive healthcare.FPAI responded by providing emergency sexual and reproductive healthcare to affected communities, particularly focusing on the most marginalized and vulnerable people including the LGBTI community, sex workers, pregnant women, and survivors of sexual and gender-based violence (SGBV). Share on Twitter Share on Facebook Share via WhatsApp Share via Email Providing healthcare to hardest hit communities after Cyclone Yasa The Reproductive and Family Health Association of Fiji (RFHAF) In mid-December 2020, a category 5 severe Tropical Cyclone Yasa hit the island of Fiji and neighbouring Lau group of Islands. IPPF’s Member Association, RFHAF, was supported by the Australian government to provide life-saving sexual and reproductive healthcare in the hardest hit communities, including counselling on STI risk reduction, first-line support for survivors of SGBV, and contraceptive and ante-natal care. Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Healthcare worker with combipack.

In pictures: Innovating during COVID-19

Women around the world have faced multiple barriers to accessing safe abortion care during the COVID-19 pandemic including the de-prioritization of sexual and reproductive healthcare, overwhelmed health systems and restrictions on movement. The COVID-19 crisis has sparked innovation among IPPF Member Associations who responded swiftly by developing new approaches to reach women with safe abortion care including telemedicine and home-based provision of medical abortion. Strong evidence generated from this work supports the continuation and strengthening of these approaches beyond the end of the pandemic. Cameroon Cameroon National Planning Association for Family Welfare (CAMNAFAW) To ensure that quality abortion care can be provided to women during travel restrictions, CAMNAFAW’s service providers travel to partner clinics in underserved areas and to clients’ homes to provide medical and surgical abortion care. This model of taking safe abortion care closer to women will continue even with easing of travel restrictions, as this has been found to be an effective and acceptable approach to increasing access.Photo: IPPF/Xaume Olleros/Cameroon Share on Twitter Share on Facebook Share via WhatsApp Share via Email Guinea Association Guinéenne pour le Bien-Etre Familial (AGBEF) Building on lessons learned during the Ebola crisis in Guinea, AGBEF quickly took measures to prevent infection in its clinics to continue providing sexual and reproductive healthcare, including surgical and medical abortion, in a safe environment. AGBEF donated protective materials to communities, including hand-washing stations, face masks and antibacterial gel, alongside messaging on infection prevention. This community visibility reassures clients they can safely attend AGBEF clinics for abortion and contraceptive care.Photo: AGBEF/Guinea Share on Twitter Share on Facebook Share via WhatsApp Share via Email India Family Planning Association of India (FPA India) FPA India and partners advocated to have sexual and reproductive healthcare, including abortion, recognized as essential by the government, which meant FPA India could continue healthcare delivery during the national lockdown. To reduce in-person clinic visits, FPA India established teleconsultation and counselling for abortion care, and is continuing to provide in-clinic care for both medical and surgical abortion. Photo: IPPF/Alison Joyce/India Share on Twitter Share on Facebook Share via WhatsApp Share via Email Nepal Family Planning Association of Nepal (FPAN) FPAN and partners advocated for interim approval of home provision of medical abortion and telemedicine for abortion counselling during COVID-19. FPAN is now implementing these approaches, ensuring continued access to abortion care in Nepal, where many people live in remote locations with limited mobility, which has been further restricted by COVID-19 lockdowns. Photo: FPAN/Nepal Share on Twitter Share on Facebook Share via WhatsApp Share via Email Pakistan Rahnuma – Family Planning Association of Pakistan (Rahnuma-FPAP) Rahnuma-FPAP and partners successfully advocated for the government to class sexual and reproductive healthcare as ‘essential’, which enabled the team to continue providing post-abortion care during the pandemic. Rahnuma-FPAP expanded its telemedicine and home-based provision for menstrual regulation counselling and post-abortion care. These new approaches have ensured continued access to services for clients unable to reach clinics.Photo: Rahnuma-FPAP/Pakistan Share on Twitter Share on Facebook Share via WhatsApp Share via Email Palestine Palestinian Family Planning and Protection Association (PFPPA) In response to the government-mandated closure of its clinics, PFPPA quickly established a toll-free call centre which provides consultations, counselling, referrals and follow-up, including consultation for abortion care through a harm reduction approach, ensuring that women are provided with accurate information. Due to its success, PFPPA is exploring options for continuing this healthcare delivery model beyond the pandemic, with the aim of keeping it free of charge for users.Photo: SAAF/Samar Hazboun/Palestine Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sudan Sudan Family Planning Association (SFPA) Following a nation-wide shutdown in April, SFPA  established  a call centre to increase access to healthcare, including abortion and contraceptive counselling and referrals.  An unexpected outcome of the new call centre is that it has reached an increased number of young women who regularly call to discuss their reproductive health and rights. SFPA  is working  towards institutionalizing this model for continuation beyond the pandemic.Photo: SFPA/Sudan Share on Twitter Share on Facebook Share via WhatsApp Share via Email Togo Association Togolaise pour le Bien-Etre Familial (ATBEF) ATBEF adapted its mobile application ‘Infos Ado Jeunes’, adding a toll-free teleconsultation service for young clients to use to access abortion consultations and pre- and post-abortion counselling. This app has given young clients ongoing access to care when they face challenges travelling to clinics. It has also eased overall client flow in clinics at a time when social distancing is being implemented.Photo: ATBEF/Togo Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Woman sitting - India

IPPF welcomes the ruling to extend abortion care from 20 weeks to 24 weeks in India

The MTP (Amendment) Bill, 2020 passed by the Lok Sabha (Lower House of Parliament) has indeed been a momentous victory for women and girls of India. The celebrations are incomplete without recognising the tireless efforts of Family Planning Association of India (FPAI) and all the Civil Society partners, activists and women who never stopped demanding women’s rights to safe and legal abortions.  IPPF applauds the Cabinet on this landmark decision which approved the bill allowing abortion up to 24 weeks. The Bill allows abortion up to 24 weeks of gestational age for vulnerable categories of women including rape survivors, victims of incest, pregnancies with foetal abnormalities and minors. Replacing the term’ married couple’ to woman and her partner highlights that the government is acknowledging the changing social fabric in the country. It also takes a positive step towards ensuring confidentiality of information for the woman, except to a person authorised in any law which is in force. The Bill can now be said to be truly woman-centric which recognizes and respects a woman’s autonomy, her choice and her rights. Dr Kalpana Apte (Secretary General, Family Planning Association of India) said: “It was a very long battle that we have fought along with other CSOs and women groups. Although, the amendments are not fully what we fought for, we are happy with many achievements. The gestation age is expanded, now unmarried women can access safe abortions and reduction in numbers of specialists required for second trimester are some of the important wins. The battle is indeed won, the fight is still on to ensure women's sexual and reproductive rights are supported and protected through enabling legislation!” IPPF Director-General Dr Alvaro Bermejo added: “This bill passing represents a huge shift for the rights of women in India to access safe abortion care- though there is more work to be done. This win would have not been possible without the hardwork and dedication of the Family Planning Association of India, civil society partners and activist. Let this win in India inspire other organizations and activists to continue their fight for safe and legal abortion.” While the increase in gestational limit is only for “vulnerable categories of women”, there is a need to improve accessibility to abortion service for all women who want/need it. In addition to addressing stigma, a key requirement is to increase access to safe abortion services in India – in each and every part of the country women get high quality, dignified and stigma free abortion services, only then we can claim universal health coverage for all. 

Women in Leadership: Kalpana Apte, India
06 March 2020

Women in Leadership: Kalpana Apte, India

How did you get into sexual and reproductive health and rights (SRHR)? I joined FPA India as a Jr. Medical Officer in one of the clinics serving women from slums and marginalized groups. I was a young, newly graduated doctor, who was looking for some experience, before starting my own practice. I had done residency in Surgical Stream and wanted to gain practical experience in family planning (FP) and maternal & child health (MCH). FPA India, provided me an opportunity to understand the public health and rights based perspective that was lacking during my medical education. Once, I was conscious of these issues, I was hooked. Then came the watershed moment of ICPD in 1994.  That’s where I got hooked in interpretation of rights in a service delivery context, planning strategies to expand the FPA India’s existing FP-MCH service mix into a broader SRH service delivery mix. My role changed from a medical provider to more planning, capacity building and supervisory role. After that, there was no looking back. What was it like growing up in India when it came to SRHR? I grew up in Mumbai city in a middle income family. My parents were teachers. My mom was a teacher and father was a professor and education was the most important thing in our life. TV was not so popular in those days, but we saw a lot of films. It was a very common pastime to watch a movie. While I was growing up, almost all Hindi movies depicted romance between couples and that was a major source of information to us. There was no access to any SRHR related discussion in a formal manner. These were taboo topics. Very few books also provided information. It was not part of school teaching, I didn’t have any specific books or even any friends who knew about sex and sexuality. It was only in my teens, I read a book that narrated sex between a couple. I still didn’t understand much after reading though I felt embarrassed and excited and I told my mom. She was speechless and just kept quiet. Love marriage was considered a very 'forward' behaviour, so was hanging out with boys. But when I started my medical college, the atmosphere was much relaxed there. Hanging out with boys was okay and I made many friends, with whom the friendship continues to this date.  How open were your parents and society more generally about SRHR? I didn’t have any understanding of SRHR during my childhood. Even then, I can say that I had a happy childhood. Although, I did sense that there was something forbidden that happens between male and female, I wasn’t sure what. I also had a vague thought that it can only happen when you grow up. I absolutely didn’t have a clue about sex or rights or any such concept. I remember that my mom was very strict with us and didn’t allow sleepovers or overnight outings neither to me or my sisters or to my brother. She really was very careful, she would patiently explain that something wrong can happen to us and in her own way she explained the concept of good touch and bad touch. We were embarrassed and so was she. I remain thankful for that lesson and her protection. She also told me about menstruation. Not in detail but she told me that it was important to be careful, use pads and keep clean. Later, it was during a session conducted at school, I understood about the physiology and how it happened. My father never put any restrictions on us and expected us to excel in education. He was in denial that we were girls and he would get upset if we did girly things like makeup etc. We were brought up to think that natural is normal and wearing make-up is cheap behaviour. I don’t remember hearing the word ‘sex’ or ‘sexuality’ or reproductive rights etc while growing up. What taboos were there? Discussing sex or sexuality was a big taboo. When I was eight or nine, I remember asking my gran ma about how children were born or came in to the world and she was livid. She said that I was a bad girl for asking such a question. In my teens, talking with boys was frowned upon, not so much by my parents but society. Sex before marriage was totally taboo. An unmarried girl getting pregnant was the worst scenario. Asking for information on sex was taboo. It was considered being slutty. How did you and your friends find out about SRHR? I read a book where it was described. Incidentally, it was a mills and boon romance. Around the same time, my friend was told about sex by her married cousin sister. She was our major source of information. We had many questions which she narrated to her cousin and we got some replies. It was a lot of fun ( I think now). At that time, it was just so much cloak and dagger stuff and we were so full of dread, excitement, fervour, embarrassment and curiosity off course. What inspired or motivated you to get involved with SRHR? This is from 1991. I was 25 years old. I had just started working in FPA India as the Medical Officer. One day, towards the closing time, this lady with a small baby in her arms for immunization. It wasn’t our regular day for immunization, the clinic was almost empty. We were just finishing paperwork and winding down. I remember the OPD nurse coming with a bit irritation and telling me that now that we have completed giving her child immunization dose, she wants to see you. I was met the lady. She asked me for a contraceptive method, specifically an IUD and wanted it immediately inserted. It was the right time, she had come on the fifth day of her menstrual period, which was the right time to insert, as per the practice in those days. After examining her, I realised that we could not insert an IUD as she had uterine prolapse. We discussed possibility of another contraceptive option.    She already had six living children, two miscarriages and she didn’t want any more pregnancies. Her husband would not use a method and she could not talk to him about her problem. She was sure that she would die, if she had another pregnancy. I was helpless and I felt horrible. I failed that day as a doctor. I realized so many things that day. I had  treated and seen too many dowry deaths during my surgical residency. I did understand the gender inequality but this was the incidence that opened my eyes about women’s vulnerability and marginalization in context of SRHR. Women bear the consequences of having a uterus and are at a higher risk of death and disability. Yet, they don’t have choices and they can’t take decisions. She set me on this path.   When it comes to SRHR what does India need to focus on? Gender equality and equity is a fundamental issue that India must prioritize. Then only, SRHR can be realised and policies and programme can become successful. India is a country of young people. That is the biggest cohort of people at this time in history. Within this group of young people, adolescent and young girls are the most marginalized group. The face of poverty in India is a young girl. Girls have fewer choices, options and opportunity. The gap between boys and girls in terms of access to SRH services and information is huge. Thus, we need to focus on young people, particularly young girls. Literacy rate remain low (females’ age 15-49 year in 2015-16 are total 68.4% and among the total urban literacy rate is 81.4% and rural literacy rate is 61.5%(Ref: NFHS-4) Education, Health and empowerment are the three priorities for young girls. To what degree is CSE taught in schools? The Adolescent Education Programme is a basic curriculum with very limited information. The newer initiative, Rashtriya Kishor Swasthya Karyakram ( RKSK, meaning national youth health programme) has a broad curriculum but it does not cover some modules like pleasure. In most schools, this is topic that is not taught. Teachers feel embarrassed and they avoid this topic. In many states, sexuality education is banned. Only 15 % young people (male and female learners, aged 15-24) have received sexuality education in India. Thus, provision of CSE and advocacy to ensure access is a priority. What taboos still remain? Sex and sexuality are still taboo topics. Access to SRH information and services for unmarried adolescent is another big taboo. Being sexually active is a taboo. How have the issues around SRHR changed? Now, due to technology is a universal access to all sort of information. This is not validated or there are very few opportunity to ask questions and /or have a discussion. Many young people access pornography as an alternative to sexuality education. Also, there is a lot of change in social norms and relationships. As the age of puberty attainment is getting younger ( 9-11 years for girls and 11-12 for boys), the average age at first sex is also declining, incidence of premarital sex is on the rise. As the public health care is improving for FP MCH, there is still a large unmet need for SRH services for young people. How significant is the issue of opposition in India? There is no significant organized opposition in India. However, there has been issue based opposition to Injectables from women’s organizations for over two decades. Now that has died down as DMPA Injectables have been included in the Govt. programme. There is no specific religious or ideological opposition for safe abortions. Yet, there is a restrictive movement for safe abortions from groups working on gender, due to declining sex ratio. In order to improve sex ratio, inadvertently groups have rationalised that restricting abortions would balance the sex ratio. This, off course is a flawed thinking. But, on the ground, strategies to balance gender ratio have resulted in restricting access to safe abortions. How do you believe you can build a movement to change that We are already working to create evidence, share case studies and work with partners through networks to change this perception. We are also working with policy makers and decision makers to ensure that safe abortion services remain accessible to all. Strategies to restrict sex selection do not impact safe abortions on the ground. What change needs to happen? The Amendments to the Medical termination of Pregnancy Act are being debated at the Parliament. We expect that the amendments would be enabling and empowering. There is need to work at the community level to change the gender norms and change the concept of son preference that drives sex selection. Most of this is being done through multiple government policies and sensitized programmes. But, it needs to be upscaled. Aspirations of young people need to be the driving force changing mindsets and bring about gender empowerment. How hard is it to bring change? Change is constant yet it is difficult in context of socio-cultural norms. We see change in embracing the technology. Change is easier with young people. However, gender norms and stigma around sexual and reproductive health is difficult to change in short term. Also, gender based violence is another difficult area where changes are not easy to bring. Change happens through years, often in next generation of young people. Behaviours can change easily but attitudes take time. Yet, consistent and strategic engagement with people and communities does help in bringing change. Otherwise, there is no hope for progress and development. What are your biggest areas of concern? Women’s safety and well being is still not guaranteed in this day and age. Women still remain tied to their biology. It is said that ‘biology enables, culture binds’. All the medical and technical advances around the world still can not enable a women to make their own reproductive and sexual choices. Women remain shackled to their biology of becoming pregnant and delivering children. Any deviation from this societal expectation is stigmatized. That women are unable to enjoy scientific advances helping them to make SRH choices is one of my biggest concerns. Second concern is Sustainability of not-for profit work is the other big concern I have. Interventions and services aimed at most poor are not self-sustaining. When services and commodities are at cost, the profile of people accessing them changes. I feel, that at scale, interventions for the most vulnerable and marginalized people would need to be supported. Existence of Non-profit movements depends largely on funding support. The funding support often drives the design and direction of the intervention. I feel that the role of developmental agencies is becoming more and more dependent. Innovation, design freedom and individuality of working with communities to find solutions is becoming challenging. What do you think the biggest successes have been? The biggest success has been legislative and programmatic priority towards women’s health. Even when the scope of these laws and policies remains a bit limited, it helps women to access education, health, livelihoods. This leads to multiple wins. Prioritizing adolescent girls and their health is another important win. What are you doing to celebrate International Women's Day this year? I will be attending a meeting as a speaker at young women’s institute. I would be speaking with them about empowerment and journeys women take to realize their rights.

Beauty parlour-related training
08 August 2019

Watch - Beauty Behind Bars: Life after prison for women in India

India is home to 20 female-only prisons, that have the capacity to hold just 5,000 inmates. Women currently make up 4% of India's prison population. Before they reach prison, many women have already experienced sexual and gender-based violence. Many inmates face discrimination and are often ostracized from their community and their families once they are released. Realizing a gap in care for women once released, the Family Planning Association of India (FPAI) have stepped in to ensure women are equipped with not only healthcare whilst in prison but life training skills. Skills that will financially support them and their children with or without the support of their families. Established in 1949, the Family Planning Association of India has provided life skills training ranging from beauty parlour related work to car mechanics to 768 women in six locations.

Some IPPF volunteers - Zero Discrimination Day
28 February 2019

1 March: Zero Discrimination Day

On Zero Discrimination Day, IPPF stands for respect, dignity, compassion and care for all. We are committed to providing quality healthcare to every person that visits one of our Member Association’s clinics, regardless of their age, sex, gender identity, race, ethnicity, sexual orientation, religion, economic status or anything else.  When you provide healthcare with dignity and respect, you can inspire others to do the same. Meet some of people who were so motivated by the discrimination-free healthcare they received from our Member Associations, or by the potential to support their communities in need, that they decided to become much-valued volunteers. Lakshmi from Nepal, living with HIV – Community care mobiliser with the Family Planning Association of Nepal “I made a plan that I would come back home [to Palpa], disclose my status and then do social work with other people living with HIV, so that they too may have hope to live. I said to myself: I will live and I will let others living with HIV live.” Read more about Lakshmi Leilani, a trans woman from Tonga – Volunteer at the Tonga Leiti Association, supported by Tonga Health Family Association “I think Tonga Family Health has done a lot up to now. They always come and do our annual HIV testing and they supply us [with] some condoms.They really, really help us a lot. They [are the] only one that can understand us.” Read more about Leilani Eric from the USA – Outreach volunteer for the Planned Parenthood Federation of America  “The first thing I do when I have hardcore substance abusers sitting in front of me, I first show them identification, I let them know I understand just how they feel. I’ve been there feeling hopeless, helpless, confused about where to turn.” Read more about Eric Hasina from India – Sex worker and volunteer at the Family Planning Association of India “Selling my body doesn’t make me a bad person, but working as a peer educator has helped enabled me to help many like me.” Read more about Hasina Milan from Nepal, living with HIV – Community care mobiliser with the Family Planning Association of Nepal “There are 40 children in this area living with HIV,” he says. “I talk to them, collect information from them and help them get the support they need. And I tell them: ‘If I had given up at that time, I would not be like this now. So you also shouldn’t give up, and you have to live your life.” Read more about Milan Joseph from Botswana, a gay man living with HIV – Client at the Botswana Family Welfare Association “I never have any problems coming here. I feel comfortable here. At [the government clinic] there is no privacy; most of my friends are there. Sometimes if you go there you find them suspecting something, and everyone will be knowing your status. That’s why I prefer BOFWA [Botswana Family Welfare Association].” Read more about Joseph

Hasina, a sex worker and peer educator sits outside a brothel, India

"Selling my body doesn’t make me a bad person"

“Selling my body doesn’t make me a bad person, but working as a peer educator has helped enabled me to help many like me.” Hasina is one of the estimated 1,500 sex workers living in Haunman Tekri, a red-light area in Bhiwandi, a town near Mumbai. When her husband passed away six years ago leaving behind a three-year-old daughter, Hasina turned to sex work as her only option to earn money. She admits that it came with a feeling of powerlessness. "You don't choose this trade; it is the result of life circumstances.” She works as a peer educator with PSK, one of the Family Planning Association of India's (FPAI) clinics. "Working with Parivar Swasthya Kedra (PSK), has made me feel less helpless; it's given me some control over my body; the ability to choose whether or not to bring another life into this world.” Building trust through education Hasina has been a peer educator for three years, working within the district to educate other women on safe sex, contraception, and abortion. Hasina admits she was once wary of PSK workers. "I used to think that these workers who insist we use condoms, would only sabotage my clientele. But soon I realized they were only looking out for us." When talking with local women, Hasina advocates the use of contraception but says in the case of an unintended pregnancy, abortion is a viable option. "It's easy to judge us, but many of us have no choice; we simply cannot feed another on just Rs. 400 a day."  Hasina is now the go-to woman in the district when it comes to sexual health. "Since I am one of them, the women trust me." This is the secret behind PSK success; a model where sex workers educate their peers, understanding the complexities and prejudices of their daily lives. "I hope one day I am able to put all of this behind me. But I hope that through PSK I am able to make another woman's life just a little bit safer, a little bit better." Do you want to show your support for women and girls to be free to decide what happens to their body? Pledge your voice to our I Decide campaign,IPPF’s movement for safe abortion access for all. You'll be provided with toolkits on how to talk about abortion and you'll have access to a range of content from personal testimonies to videos explaining the different types of abortion available.

Neelam Dixit is the branch manager of FPA India's GCACI clinic in Gwalior in Madhya Pradesh.

"Most women are from marginalised sections of society and are denied the right to make their own decisions"

In the district of Gwalior in Madhya Pradesh, the summer season has started and the heat in town is already extreme. Here, the Family Planning Association of India GCACI clinic serves many people living in poverty. In the ten years since the GCACI project started there, the clinic has provided 16,301 women with comprehensive abortion care and 202,758 women with contraceptive services. The two-storey clinic is situated in a residential area and, inside, women queue up to see the counsellors and medical staff. Many are accompanied by link workers who have travelled with them from outlying districts. Neelam Dixit is in charge of the branch. “Most women are from marginalised sections of society and are denied the right to make their own decisions. By the time they visit our clinic, the woman is already a couple of months pregnant”. FPA India’s work is making an impact and Dixit is seeing views change on abortion. “There is a shift in attitude among women since FPAI started providing services. Presently, there is little stigma attached to abortion. Our aim is to provide quality health services at low cost. We create awareness about the consequences of unsafe abortion and train volunteers to be sure women in villages are aware of our clinic.” The clinic has served around 300,000 people from rural and semi-urban populations with comprehensive sexual and reproductive health services, and provides both first- and second-trimester abortion services.   

Nurse

In pictures: Expanding access to safe abortion in India

Konika* Mother of three, Parivar Swasthya Kendra (PSK) client Konika is 20 years old, and the mother of three girls. Like many local young women, she decided to have an abortion when she became pregnant for the fourth time within five years. Citing financial issues as the driving force behind her decision, despite her mother-in-laws desire for her to have another child, hoping this time it would be a boy. Through a neighbour, she approached the PSK clinic in Bhiwandi for an abortion. In Konika’s community, many young women are married and have kids by the time they are 20. Now with PSK, women like Konika have a choice to be pregnant or not. *Name has been changed Share on Twitter Share on Facebook Share via WhatsApp Share via Email Rehkha Parivar Swasthya Kendra (PSK) link worker Family Planning Association of India, works with a network of volunteer link workers, who disseminate information about services available in the PSK clinic, make referrals, and often accompany women to the clinic for support. One of these link workers is Rehkha. Rekha says: "I have been involved with PSK for five years. And today I can proudly say that since the first awareness campaigns, there has been not a single death in the village due to an unsafe abortion." She adds: "These women are my flesh and blood. They know I only want the best for them… Within our communities we spread the message of safe sex and safe abortion through songs and skits which are easily understood. And I think the trick is to include mother-in-laws in our work. We have a high success rate in providing safe abortion care.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Shajahan Parivar Swasthya Kendra (PSK) link worker Shajahan is a link worker in the nearby Muslim district, where women pack into a house in the narrow village lanes to wait to speak to her. She says: "I am a Muslim. In my community, abortion is frowned upon, and contraception is considered a sin. Initially, the women thought I was going against our customs, and the men thought I was a bad influence on their wives. Some of the men in our area even approached my husband and asked him to order me to stop these efforts." But her husband was supportive, telling other men that it was also their responsibility to be part of the process. It took several years, but eventually Shajahan won the trust of the women and men of her area. "Today, every woman in my area comes to me when it concerns matters of sexual health." Share on Twitter Share on Facebook Share via WhatsApp Share via Email Gauri Family Planning Association of India (FPAI) staff Gauri has worked for FPAI for years and remembers hearing about the experiences of women who’d had unsafe abortions. "I had heard first-hand accounts of [unsafe] abortions that left women reeling in pain, suffering permanent infertility. I had also seen the grief in the faces of men whose wives died. So today when I see women leaving us, after an abortion, in perfect health, I feel like I've done something right with my life." Gauri continues: "My work may have started with one area, but I want to reach every corner of the country with FPAI - so that no woman in India becomes a statistic." Share on Twitter Share on Facebook Share via WhatsApp Share via Email Nisha Mother of two At 23, Nisha Boudh is already a mother to two children and severely anaemic. She feels she is in no position to have a third child, but her in-laws are not supportive. Nisha chose to have an abortion at FPAI’s Gwalior clinic. “I have been weak since childhood and, honestly, motherhood has taken a toll on my health. Doctors in other clinics were not willing help me and I would have died had FPAI not come to my rescue. With their doctors’ advice I have now decided to undergo an operation [tubal ligation] as I do not want to conceive. My mother-in-law was upset with my decision but I want to live to see my other children grow,” said Boudh. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Diti* Sex worker Diti is a sex worker living in Kolkata. She says she, "owes her life to PSK". Diti was forced into an early marriage when she was just 12 years old. "Before my body could even develop, my husband was forcing himself upon me." By the age of 20, Diti had five children. Struggling to cope at such an early age, and married to an abusive husband, Diti ran away. "I don't enjoy having sex with strangers, but I need the money." She makes 300 rupees a day ($4 USD). When Diti became pregnant she didn’t want to continue with the pregnancy. "There's no way I can feed a child. Besides, this is no place to bring a child into the world. Another sex worker recommended the PSK clinic.” Diti was worried about visiting the clinic, fearing stigma and discrimination from staff for working as a sex worker. Her experience was vastly different, finding the clinic team to be welcoming, reassuring and supportive. "They treated me like a human being." Share on Twitter Share on Facebook Share via WhatsApp Share via Email Mala Medical officer “The big problem in this part of India is early marriage and pregnancy. Both of which need to be handled very delicately,” says medical officer Mala Tiwari. “Slowly, things are changing as women are becoming aware of their rights. Previously when GCACI did not exist there was very little interaction with the link workers, and they [and the community] feared it was illegal to get an abortion. They did not know they did not need the consent of their husbands and in-laws. They now know, women have a right over their body.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Manju Mother of two, Parivar Swasthya Kendra (PSK) client Manju Rana was forced to marry at fifteen. “I have had two children in eight years of marriage,” she says. “My mother-in-law wanted me to keep having children. She does not understand I would not be able to give them a good education if I had more children. My husband is a driver and we cannot afford to have any more. When I learnt I was pregnant, without taking anyone’s permission, I went with the link worker of my area to the clinic and had an abortion.” Manju adds: “In these affordable clinics we can choose about pregnancy. They also made sure I was counselled, as coming to a decision about abortion is not easy.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email