Aminata Sonogo listened intently to the group of young volunteers as they explained different types of contraception, and raised her hand with questions. Sitting at a wooden school desk at 22, Aminata is older than most of her classmates, but she shrugs off the looks and comments. She has fought hard to be here. Aminata is studying in Bamako, the capital of Mali. Just a quarter of Malian girls complete secondary school, according to UNICEF. But even if she will graduate later than most, Aminata is conscious of how far she has come. “I wanted to go to high school but I needed to pass some exams to get here. In the end, it took me three years,” she said. At the start of her final year of collège, or middle school, Aminata got pregnant. She is far from alone: 38% of Malian girls will be pregnant or a mother by the age of 18. Abortion is illegal in Mali except in cases of rape, incest or danger to the mother’s life, and even then it is difficult to obtain, according to medical professionals. Determined to take control of her life “I felt a lot of stigma from my classmates and even my teachers. I tried to ignore them and carry on going to school and studying. But I gave birth to my daughter just before my exams, so I couldn’t take them.” Aminata went through her pregnancy with little support, as the father of her daughter, Fatoumata, distanced himself from her after arguments about their situation. “I have had some problems with the father of the baby. We fought a lot and I didn’t see him for most of the pregnancy, right until the birth,” she recalled. The first year of her daughter’s life was a blur of doctors’ appointments, as Fatoumata was often ill. It seemed Aminata’s chances of finishing school were slipping away. But gradually her family began to take a more active role in caring for her daughter, and she began demanding more help from Fatoumata’s father too. She went back to school in the autumn, 18 months after Fatoumata’s birth and with more determination than ever. She no longer had time to hang out with friends after school, but attended classes, took care of her daughter and then studied more. At the end of the academic year, it paid off. “I did it. I passed my exams and now I am in high school,” Aminata said, smiling and relaxing her shoulders.  "Family planning protects girls" Aminata’s next goal is her high school diploma, and obtaining it while trying to navigate the difficult world of relationships and sex. “It’s something you can talk about with your close friends. I would be too ashamed to talk about this with my parents,” she said. She is guided by visits from the young volunteers of the Association Malienne pour la Protection et Promotion de la Famille (AMPPF), and shares her own story with classmates who she sees at risk. “The guys come up to you and tell you that you are beautiful, but if you don’t want to sleep with them they will rape you. That’s the choice. You can accept or you can refuse and they will rape you anyway,” she said. “Girls have to know their rights”. After listening to the volunteers talk about all the different options for contraception, she is reviewing her own choices. “Family planning protects girls,” Aminata said. “It means we can protect ourselves from pregnancies that we don’t want”.

The village of Missala sits an hour south of Mali’s sprawling capital, Bamako. Most of the few hundred villagers here remain reliant on agriculture, and despite their proximity to the city, poor roads and lack of public transport have left them isolated.  It’s a real event when the mobile clinic of the Association Malienne pour la Protection et la Promotion de la Famille (AMPPF) rolls into town once a month, and midwife Mariame Doumbia opens her doors to a fast growing crowd of women.  “The mobile clinic is important for accessibility, so that the women living in poorly serviced areas can access sexual and reproductive health services, and reliable information,” Doumbia said, as the first client climbed the metal stairs into her consulting room.  Serving vulnerable women and girls The three mobile clinics operated in remote areas by AMPPF in Mali serve some of the most vulnerable women and girls in the country. They are maintained with Canadian Government funds via the SheDecides project, which stepped into the yawning gap left by the reinstatement of the Global Gag Rule (GGR) in 2017. That year, AMPPF worried it would lose all of its mobile clinics, and a lifeline for these women. “There are a lot of early pregnancies here. They call me often to come here for that reason,” Doumbia added. The mobile clinic provides free contraception and smear tests/pap smears, and women also ask for advice on all aspects of their health and wellbeing.  Kadidiatou Sogoba, a mother of seven, waited nervously for her turn. “I came today because I keep getting ill and I have felt very weak, just not myself, since I had a Caesarean section three years ago. I lost a lot of blood,” she said. “I have been very afraid since the birth of my last child. We have been using condoms and we were getting a bit tired of them, so I am looking for another longer term type of contraception.”  After emerging half an hour later, Sogoba clutched a packet of the contraceptive pill, and said next time she would go for a smear test.  "I come here all the time to ask when the clinic is coming back" Others consult the midwife about their problems with infertility. “I come here all the time to ask when the mobile clinic is coming back. I used to come for the contraceptive injection to protect myself,” said Aminata Traoré, who married at 15 and has one child aged eight. “I want another child now but I can’t get pregnant and I have irregular periods. The midwife prescribed me some fertility drugs,” she said.  Adama Samaké, chief of the Missala Health Centre, oversees the proceedings as a village elder with deep trust from his community. When the mobile clinic isn’t around, his centre offers maternity services and treats the many cases of malaria that are diagnosed in the community. “Given the distance between here and Bamako, most of the villagers around here rely on us for treatment,” he said. “But when we announce that the mobile clinic is coming, the women make sure they are here”. Samaké’s wife is a client of the clinic, and they have decided to stop having more children. He believes the community has built a relationship of trust with Mariame Doumbia and her AMPPF colleagues. “The midwives know their job and they do it well. Fewer people go to see the local witch doctor now. They know the modern methods of contraception are more reliable,” he said. 

Abdoulaye Camara is the best dancer in the neighbourhood, and he’s not afraid to show it. Abdoulaye grooves to the beat blaring from hastily assembled speakers, accompanied by two friends who follow his lead in a slickly choreographed routine. He soon gathers a crowd outside a cafe in Commune IV, a working class area of Mali’s capital, Bamako. Young men who spend the day mining for gold are trudging home, and stop to take a look. Girls holding younger siblings by the hand sidle up to the crowd, which is growing in size with every new track. "We distract them with dance and humor" Abdoulaye’s moves are not just for fun. He is head of the dance troupe of the Youth Action Movement, belonging to the Association Malienne pour la Protection et la Promotion de la Famille (AMPPF), which uses dance and comedy sketches to talk about sex. It’s a canny way to deliver messages about everything from using condoms to taking counterfeit antibiotics, to an audience who are often confused and ashamed about such topics. “We distract them with dance and humor and then we transmit those important messages about sex without offending them,” explained Abdoulaye. “We show them that it’s not to insult them or show them up, but just to explain how these things happen.” The average Malian woman will give birth to six children, according to the World Bank, one of the highest fertility rates in the world. In the closely packed streets of Commune IV, teenagers hear whispers about pregnancy and sexually transmitted infections, but are scared to ask more. Everyone knows everyone else’s business.  “Young people don’t like us to talk too directly to them about sex or sexually transmitted infections. We can’t also speak frankly about early pregnancy either,” Abdoulaye said. “They will tell us ‘I know all about this’ but then we see more girls pregnant and more infections, so it’s not true.” For five years now, Abdoulaye and his loyal band of dancers have staged street shows in schools, streets and cafes. In a recent sketch he played a bisexual man conducting a relationship with a man and a woman simultaneously, only to have to warn them both he had a sexually transmitted infection. The three young actors played for laughs, making light of a scenario that is highly taboo in Mali. Meeting unmet needs The centrepiece of all the dances and sketches is the use of contraception, and hints at what safe, consensual sex might look like. In Mali, a quarter of women have an unmet need for contraception, leading to an estimated 418,000 unwanted pregnancies a year. Abdoulaye and his team speak in the local language, Bambara, and ask the audience about their preconceptions about using condoms or getting a contraceptive implant. The majority of the audience is illiterate, and with no books, internet or schoolteachers, they lack reliable sources of information on preventing pregnancies or spacing children. Oumou Konaté, 25, was watching from the sidelines with a smile on her face. She became a mother while still in her teens, and began using an implant after the birth of her daughter. “I came here because I like the activities and what they are doing. I wanted to know more about family planning and condoms. I really appreciated what they showed us,” Oumou said. “I got the information that I wanted, lots of things I didn’t know before.” As the sun sets over the hills behind Commune IV, the music dies down and Abdoulaye helps to pack up the troupe’s props and equipment. “We want to reach everyone in Bamako and across Mali. We are the first but I hope we aren’t the last,” he said.

My name is Mariame Doumbia, I am a midwife with the Association Malienne pour la Protection et la Promotion de la Famille (AMPPF), providing family planning and sexual health services to Malians in and around the capital, Bamako. I have worked with AMPPF for almost six years in total, but there was a break two years ago when American funding stopped due to the Global Gag Rule. I was able to come back to work with Canadian funding for the project SheDecides, and they have paid my salary for the last two years. I work at fixed and mobile clinics in Bamako. In the neighbourhood of Kalabancoro, which is on the outskirts of the capital, I receive clients at the clinic who would not be able to afford travel to somewhere farther away. It’s a poor neighbourhood. Providing the correct information The women come with their ideas about sex, sometimes with lots of rumours, but we go through it all with them to explain what sexual health is and how to maintain it. We clarify things for them. More and more they come with their mothers, or their boyfriends or husbands. The youngest ones come to ask about their periods and how they can count their menstrual cycle. Then they start to ask about sex. These days the price of sanitary pads is going down, so they are using bits of fabric less often, which is what I used to see.  Seeing the impact of our work  We see cases of early pregnancy here in Kalabancoro, but the numbers are definitely going down. Most are from 14 years old upwards, though occasionally they are younger. SheDecides has brought so much to this clinic, starting with the fact that before the project’s arrival there was no one here at all for a prolonged period of time. Now the community has the right to information and I try my best to answer all their questions.

My name is Fatoumata Yehiya Maiga. I’m 23-years-old, and I’m an IT specialist. I joined the Youth Action Movement at the end of 2018. The head of the movement in Mali is a friend of mine, and I met her before I knew she was the president. She invited me to their events and over time persuaded me to join. I watched them raising awareness about sexual and reproductive health, using sketches and speeches. I learnt a lot. Overcoming taboos I went home and talked about what I had seen and learnt with my family. In Africa, and even more so in the village where I come from in Gao, northern Mali, people don’t talk about these things. I wanted to take my sisters to the events, but every time I spoke about them my relatives would just say it was to teach girls to have sex, and that it’s taboo. That’s not what I believe. I think the movement helps girls, most of all, to know their sexual rights, their bodies, what to do and what not to do to stay healthy and safe. They don’t understand this concept. My family would say it was just a smokescreen to convince girls to get involved in something dirty.  I have had to tell my younger cousins about their periods, for example, when they came from the village to live in the city. One of my cousins was so scared, and told me she was bleeding from her vagina and didn’t know why. We talk about managing periods in the Youth Action Movement, as well as how to manage cramps and feel better. The devastating impact of FGM But there was a much more important reason for me to join the movement. My parents are educated, so me and my sisters were never cut. I learned about female genital mutilation at a conference I attended in 2016. I didn’t know that there were different types of severity and ways that girls could be cut. I hadn’t understood quite how dangerous this practice is. Then, two years ago, I lost my friend Aïssata. She got married young, at 17. She struggled to conceive until she was 23. The day she gave birth, there were complications and she died. The doctors said that the excision was botched and that’s what killed her. From that day on, I decided I needed to teach all the girls in my community about how harmful this practice is for their health. I was so horrified by the way she died. Normally, girls in Mali are cut when they are three or four years old, though for some it’s done at birth. When they are older and get pregnant, I know they face the same challenges as every woman does giving birth, but they also live with the dangerous consequences of this unhealthy practice.  The importance of talking openly  The problem lies with the families. I want us, as a movement, to talk with the parents and explain to them how they can contribute to their children’s sexual health. I wish it were no longer a taboo between parents and their girls. But if we talk in such direct terms, they only see disobedience, and say that we are encouraging promiscuity. We need to talk to teenagers because they are already parents in many cases. They are the ones who decide to go through with cutting their daughters, or not. A lot of Mali is hard to reach though. We need travelling groups to go to those isolated rural areas and talk to people about sexual health. Pregnancy is the girl’s decision, and girls have a right to be healthy, and to choose their future.

In 2017, the Association Malienne pour la Protection et la Promotion de la Famille (AMPPF), lost $1,500,000 of funding to be spent over three years as a result of the reinstatement of the Global Gag Rule (GGR). The UN Population Fund (UNFPA), a key contributor to AMPPF, also had its budget slashed, further depleting AMPPF’s resources. AMPPF provides comprehensive sexual and reproductive health care to hundreds of thousands of women in Mali, a country with one of the highest rates of teenage pregnancy and early marriage in the world. The Global Gag Rule (GGR), or Mexico City Policy, denies U.S. funding to organizations like IPPF if they use non-U.S. funds to provide abortion care, counselling or referrals in accordance with national law. It blocks critical funding for care like contraception, maternal health, and HIV prevention and treatment. Loss of funding triggers clinic closures  The results of the GGR policy change in Mali were immediate and devastating. AMPPF had planned an expansion to 50 service points and eight mobile clinics, which was immediately put on hold. Some clinics had to close temporarily, leaving Malians without safe places to obtain contraception and treatment for sexually transmitted infections. Outreach and educational activities ground to a halt. As a result, AMPPF served 242,500 clients rather than the 505,000 it had planned to help in 2017. Staffing numbers fell from 98 dedicated personnel to just 41 in 2017, and dropped even further to just 29 employees in 2018. This included midwives serving some of the poorest communities in Mali. “I have worked at the Kalabancoro clinic in Bamako for almost six years, but there was a break when the funding stopped,” said Mariame Doumbia, a midwife with AMPPF who lost her job due to GGR funding cuts.  SheDecides renews hope and opportunity  The situation turned around with Canadian government funds of $329,599 to the SheDecides project, which has filled the gap left by GGR. “I was able to go back to work with the SheDecides project,” Doumbia said. This money has also been used to target the most vulnerable clients who would otherwise be left without access to sexual health care from the Malian state or other NGOs. “SheDecides has helped us a lot, above all in our work outside our own permanent clinics. When we go out in the community we have a lot of clients, and many women come to us who would otherwise not have the means to obtain advice or contraception,” explained Mama Keita Sy Diallo, a midwife and AMPPF board member. She runs consultations at community health centers in underserved areas of the Malian capital. “Everything is free for the women in these sessions. We also work in government clinics, where people are really in need.” She Decides has allowed AMPPF to maintain three mobile clinics, travelling to more remote areas where transportation costs and huge distances separate women from access to family planning. The project also ensured that AMPPF’s Youth Action Movement could restart its outreach activities, raising awareness about sexual health in the streets, in schools, and in community centers. Targeting local youth  “After the arrival of SheDecides, we intensified our targeting of vulnerable groups with activities in the evening, when domestic workers and those working during the day could attend,” said Mariam Modibo Tandina, who heads the national committee of the Youth Action Movement in Mali. “That means that young people in precarious situations could learn more about safe sex and family planning. Now they know how to protect themselves against sexually transmitted infections and unwanted pregnancies.” The funding has also reinforced data gathering through new computer equipment, allowing AMPPF to better understand its client base and how they use its health care. Step by step, She Decides has reinforced the provision of family planning in Mali, and reached clients who were most in need of care when the global gag rule cut off their access. “SheDecides came at a crucial moment. The project has filled in the gaps after our funds disappeared. We needed a solution and SheDecides was that solution. We won’t see the impact immediately, but for the next few decades,” said Mamadou Bah, a young AMPPF volunteer.

In 2017, the Association Malienne pour la Protection et la Promotion de la Famille (AMPPF), was hit hard by the reinstatement of the Global Gag Rule (GGR). The impact was swift and devastating – depleted budgets meant that AMPPF had to cut back on key staff and suspend education activities and community healthcare provision. The situation turned around with funding from the Canadian Government supporting the SheDecides project, filling the gap left by GGR. AMPPF has been able to employ staff ensuring their team can reach the most vulnerable clients who would otherwise be left without access to sexual healthcare and increase their outreach to youth. Putting communities first Mama Keita Sy Diallo, midwife The SheDecides project has allowed AMPPF to maintain three mobile clinics, travelling to more remote areas where transportation costs and huge distances separate women from access to health and contraceptive care.“SheDecides has helped us a lot, above all in our work outside our own permanent clinics. When we go out in the community we have a lot of clients, and many women come to us who would otherwise not have the means to obtain advice or contraception,” explained Mama Keita Sy Diallo, a midwife and AMPPF board member. She runs consultations at community health centers in underserved areas of the Malian capital. “Everything is free for the women in these sessions.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email SheDecides projects ensures free access to healthcare and contraception Fatoumata Dramé, client By 9am at the Asaco Sekasi community health center in Bamako, its wooden benches are full of clients waiting their turn at a SheDecides outreach session. Fatoumata Dramé, 30, got here early and has already been fitted for a new implant. “I came here for family planning, and it’s my first time. I’ve just moved to the area so I came because it’s close to home,” she said. Bouncing two-month-old Tiemoko on her knee, Dramé said her main motivation was to space the births of her children. “I am a mum of three now. My first child is 7 years old. I try to leave three years between each child. It helps with my health,” she explained. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Targeting youth Mamadou Bah, Youth Action Movement “After the arrival of SheDecides, we intensified our targeting of vulnerable groups with activities in the evening, when domestic workers and those working during the day could attend,” said Mariam Modibo Tandina, who heads the national committee of the Youth Action Movement in Mali. “That means that young people in precarious situations could learn more about safer sex and family planning. Now they know how to protect themselves against sexually transmitted infections and unwanted pregnancies.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Speaking out against FGM Fatoumata Yehiya Maiga, youth volunteer Fatoumata’s decision to join the Youth Action Movement was fueled by a personal loss. “My parents are educated, so me and my sisters were never cut. I learned about female genital mutilation at a conference I attended in 2016. I didn’t know that there were different types of severity and ways that girls could be cut. I hadn’t understood quite how dangerous this practice is. Two years ago, I lost my friend Aïssata. She got married young, at 17. She struggled to conceive until she was 23. The day she gave birth, there were complications and she died. The doctors said that the excision was botched and that’s what killed her. From that day on, I decided I needed to teach all the girls in my community about how harmful this practice is for their health. I was so horrified by the way she died.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Using dance and comedy to talk about sex Abdoulaye Camara, Head of AMPPF dance troupe Abdoulaye’s moves are not just for fun. He is head of the dance troupe of the AMPPF’s Youth Action Movement, which uses dance and comedy sketches to talk about sex. It’s a canny way to deliver messages about everything from using condoms to taking counterfeit antibiotics, to an audience who are often confused and ashamed about such topics. “We distract them with dance and humour and then we transmit those important messages about sex without offending them,” explained Abdoulaye. “We show them that it’s not to insult them or show them up, but just to explain how these things happen.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Determination to graduate Aminata Sonogo, student Sitting at a wooden school desk at 22, Sonogo is older than most of her classmates, but she shrugs off the looks and comments. She has fought hard to be here. “I wanted to go to high school but I needed to pass some exams to get here. In the end, it took me three years,” she said.At the start of her final year of collège, or middle school, Sonogo got pregnant. She went back to school in the autumn, 18 months after Fatoumata’s birth and with more determination than ever. At the end of the academic year, it paid off. “I did it. I passed my exams and now I am in high school,” Sonogo said, smiling and relaxing her shoulders. She is guided by visits from the AMPPF youth volunteers and shares her own story with classmates who she sees at risk of an unwanted pregnancy. Share on Twitter Share on Facebook Share via WhatsApp Share via Email AMPPF’s mobile clinic offers a lifeline to remote communities Mariame Doumbia, midwife “I work at a mobile clinic. It’s important for accessibility, so that the women living in poorly serviced areas can access sexual and reproductive health services, and reliable information.I like what I do. I like helping people, especially the young ones. They know I am always on call to help them, and even if I don’t know the answer at that moment, I will find out. I like everything about my work. Actually, it’s not just work for me, and I became a midwife for that reason. I’ve always been an educator on these issues in my community.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Trust underpins the relationship between AMPPF’s mobile team and the village of Missala Adama Samaké, village elder and chief of the Missala Health Center Adama Samaké, chief of the Missala Health Center, oversees the proceedings as a village elder with deep trust from his community. When the mobile clinic isn’t around, his center offers maternity services and treats the many cases of malaria that are diagnosed in the community. “Given the distance between here and Bamako, most of the villagers around here rely on us for treatment,” he said. “But when we announce that the mobile clinic is coming, the women make sure they are here.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Contraceptive choice Kadidiatou Sogoba, client Kadidiatou Sogoba, a mother of seven, waited nervously for her turn. “I came today because I keep getting ill and I have felt very weak, just not myself, since I had a Caesarean section three years ago. I lost a lot of blood,” she said. “I have been very afraid since the birth of my last child. We have been using condoms and we were getting a bit tired of them, so I am looking for another longer-term type of contraception.”After emerging half an hour later, Sogoba clutched a packet of the contraceptive pill, and said next time she would go for a cervical screening.Photos ©IPPF/Xaume Olleros/Mali Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Adama lost her best friend due to an unsafe abortion. This tragedy pushed her to work for and with young people to ensure them access to sexual and reproductive health information and services.   WANT TO GET INVOLVED?   SUBSCRIBE NOW TO GET UPDATES FROM IPPF SUPPORT OUR WORK WITH A DONATION