- - -

There is no content tagged with this country

Back to the previous page

Mozambique

Articles by Mozambique

Arnilda - WISH

"Being a single mother at 14 was a suffocating experience and it could have been worse if I hadn't been accompanied by the Adolescent and Youth Friendly Services"

Five years ago, when Arnilda Simango was 13, she started dating a boy from her community, outside Xai-Xai City, in Gaza Province in southern Mozambique. A year later she got pregnant, at his insistence, and he left her shortly after the baby was born. AMODEFA’s youth services offered her counselling and advice throughout her pregnancy and became the network through which she made new friends.  Today, at the age of 18, she is raising her son, with help from her mother and plans to return to school. “When I started dating, I thought I wanted a partner who could take care of me and that could maybe fill the void I felt for not having a father. When I started the relationship with my boyfriend, he insisted that he needed a son because all his friends already had one. I had little space to say no because he threatened to date someone else and I was convinced he was the right person for me. When I got pregnant in 2016, he started behaving strangely. He stopped being affectionate and gave indications that he did not want to be with me anymore. That's when a friend of mine told me that there was a youth center where I could get advice on how to proceed in this situation". The Adolescent and Youth Friendly Services (SAAJ) center, based at the Patrice Lumumba Urban Health Center, on the outskirts of Xai-Xai, is run by AMODEFA and provides HIV testing and treatment, prenatal and postpartum consultations, and other information and services around sexual health and rights. The center is supported by the Women’s Integrated Sexual Health (WISH2ACTION) programme, led by IPPF.   "One day I walked there and received a lot of advice. As I was already 4 to 5 months pregnant, I was advised to open a prenatal form. They did all the follow-up until I gave birth to my son.” "Believe me, being a single mother at 14 was a suffocating experience and it could have been worse if I had not been accompanied by [the SAAJ]. I do not know how to thank them. I practically felt alone without knowing what to do, but I had a lot of advice here and made friends with other girls". Planning for the future  Arnilda dropped out of 7th grade once she became pregnant and helped her mother selling basic goods from a stall in her home. It is from this small business that her mother supports her two children who are still living at home, as well as five grandchildren. Arnilda plans to return to school next year to continue her studies now her son is old enough to stay with his grandmother. Her dream is to be a professional model. Until then she does not want to have another child, so she goes to the SAAJ for family planning purposes. Arnilda says she walks 50 minutes to the center every three months for the contraceptive injection.  "I wanted the implant, but it doesn't settle well with me, so I renew the injection every three months.  I do this because I need to continue studying to have a decent job that allows me to support my son. Next year I will go back to school. "A second child is not in the plans. I still consider myself a minor. Even the first child I only had because at the time I had no one to give me advice and show me the best way. I believed in my ex-boyfriend and today I have this lesson. Today I can say that I have come to my senses, not only from the experience of being a mother, but from everything I learn here [at the SAAJ]. There is no friend of mine who does not know SAAJ. I always advise them to approach here because I know they will have all kinds of counselling and accompaniment.”

Emerson Chaves, clinical psychologist in Mozambique
28 August 2019

Psychosocial support after a disaster: Cyclone Idai in Mozambique

On the evening of 14 March 2019, Cyclone Idai made landfall in the city of Beira in central Mozambique. With wind speeds of 185 kilometers per hour, it was the largest cyclone on record to hit the Southern Hemisphere and Africa. The impact was devastating, leading to the loss of life and extensive damage to infrastructure – not only in Mozambique, but in Malawi, Madagascar and Zimbabwe. In Mozambique alone, more than 130,000 people had to seek shelter in the 136 accommodation centers (emergency tented camps) that were set up across the county. The situation was dire, and the Mozambican government had to call for assistance to rebuild crucial infrastructure like health, transport and communications. The Associação Moçambicana para Desenvolvimento da Família (AMODEFA), IPPF’s Member Association in Mozambique, responded in the most affected areas of Mozambique, including Beira, Tete, Chiomoio and Zambezia. AMODEFA is still there providing sexual and reproductive awareness and services.  A committed volunteer  None of this would have been possible without the help of volunteers like Emerson Chaves, a clinical psychologist. Emerson is stationed in Chimoio, Manica Province. He is a passionate 29-year-old with a desire to offer psychosocial support to his community. Emerson performs his work with dedication as part of AMODEFA’s emergency response team to Cyclone Idai.  “The people of Chimoio were unable to seek for help after the disaster,” Emerson said. “Trying to survive had become a priority as opposed to seeking health services. Most people will not come for services unless we talk to them first.” Emerson’s work is not without its challenges. He works within a community that has deep-rooted cultural traditions that make talking about sex difficult. Yet his work involves sensitizing people about sexual and reproductive health and rights (SRHR), both at the health facility and within the community. This work is especially targeted at women and girls, who are disproportionately affected by issues of displacement. Emergency situations leave girls and young women vulnerable and at a higher risk of sexual exploitation and forced marriage, and they lack basic health services including sexual and reproductive healthcare. These circumstances increase the need for accurate information and quality services on family planning and reproductive health. “Due to the cultural background, I have to approach the topic in a special way and sensitize my community about sexual and reproductive health and rights,” Emerson points out.  Tackling gender-based violence  He shared his experience dealing with cases of gender-based violence; Emerson said the norm in many communities is that the family of a girl that is sexually assaulted receives a ‘bride price’ from the perpetrator’s family. This is usually done as a negotiation between the families. Once this takes place, the case does not get reported to the authorities – if one reports the case the ‘bride price’ is taken away. Many cases of gender-based violence are not reported because of these types of cultural barriers. Fortunately, the IPPF Humanitarian response was able to utilize the Minimum Initial Service Package (MISP), a set of life-saving activities to be implemented at the onset of every humanitarian crisis. MISP focuses on areas such as preventing sexual violence and maternal and infant mortality, and reducing the transmission of HIV, Through AMODEFA, IPPF rolled out the MISP in the affected areas where more than 130,000 people had been displaced, reaching 9,983 people in total, and 3,350 people with sexual and reproductive health (SRH) services. For IPPF, protecting the SRHR of communities and delivering the necessary SRH services in these humanitarian settings is the main objective.  A day with Emerson Emerson beings his day with a plan at the health facility. He has a choice to visit either of six facilities in his area: Motocoma, Chipinda Umue, Inchope, Zembe, Marera or Macate. At these facilities, Emerson receives clients who have been referred from community mobilizers to seek psychosocial support. On Saturdays, he is out with the community mobilizers to sensitize the community on SRHR. He begins with the group sessions then conducts door-to-door visits. The psychosocial care that people need in humanitarian settings is unique – especially when SRHR are concerned. “People in the community are not aware that the facility is offering services,” he said. “They still think that it is closed after the disaster. It is my duty to give correct and updated information on the situation about health services. The community needs to be aware that we are offering services, especially the community members who need SRH services at this time.” 

Cyclone Idai
02 April 2019

Cyclone Idai: The impact so far in Malawi and Mozambique

Updated 29 April   Cyclone Idai tore through Malawi, Mozambique and Zimbabwe on 14 March, leaving hundreds dead, thousands of homes destroyed and almost 2 million impacted. Among those affected by the cyclone are close to 75,000 pregnant women, of whom 43,000 are expected to give birth during the next six months.  IPPF, along with Member Associations (MAs) and partners, are on the ground in Malawi and Mozambique to assess the needs and to deliver healthcare services to those in dire need.   The impact of so far   Malawi The Government of Malawi confirmed the current death toll at 59 with close to 867,000 people impacted by the cyclone. More than 87,000 are currently displaced. Mozambique In Mozambique, the city of Beira – home to over 500,000 people – was hit the hardest by Cyclone Idai, with the government declaring a cholera outbreak in the city on 27 March. The cyclone has damaged and destroyed close to 100,000 homes and has claimed the lives of over 500 people, the number still rising. The Global Gag Rule Though the Global Gag Rule did not directly deny funding for humanitarian work, the ripple effect has had a devasting impact on the capacity at our MAs like AMODEFA, when responding to humanitarian crises.  Due to the loss of funding from the GGR, AMODEFA had to close eight clinics and end programs including the sex worker outreach program in Beira – one of the worst affected areas from the cyclone. This has meant that instead of having a functioning program and staff, and volunteers to mobilize and on which to base the emergency response, AMODEFA only had one remaining staff member in Beira.  Recruiting and training new volunteers for the humanitarian response then requires spending extra money and time, resources that are already scarce. On top of this, there are reports of an increase in sex worker activity along the main truck corridor, an area with an existing HIV prevalence of around 15%. It is not uncommon for women to turn to sex work in the wake of an emergency in order to provide for their families.  Even if the GGR does not have a direct impact on humanitarian SRH funding, it certainly has an impact on the response capacity and lives of the affected population through reduced access to SRH services.     Our response    Malawi Update:  The conditions in the camps are very dire, there is no food, so some people are returning to their homes or to family members houses. Most of the camps are closing off due to this. Our MA has been providing outreach for over two weeks, through two teams, who have reached a total of 16 camps. FPAM is the only organization that is on the ground providing both SRH information and services right in the camps. Clients are accessing our services in large numbers. There is high demand for family planning, HIV testing, and cervical cancer screening in all the camps we have visited. Additionally, there have been anecdotal reports to our team members that some girls and young women said that men with authority at the camp were coaxing girls to exchange food with sex. The risk of STI transmissions and teenage unwanted pregnancies is high as most sites have no access to SRHR services due to long distances from to health facilities, coupled with low levels of knowledge on SRHR issues. This has been exemplified by people`s inability to understand basic SRH issues. There is a strong need for long term, sustainable, access to SRH care and long acting contraceptive supplies. IPPF’s MAs in Malawi and Mozambique are on the ground working with partners to help deliver life-saving healthcare. During times of crisis and humanitarian situations, vulnerable populations such as people living with HIV, children and pregnant women are at a greater risk due to disruptions in healthcare services and systems. IPPF’s response in Malawi is being led by our MA – Family Planning Association of Malawi (FPAM) – who are working with partners like UNFPA to help deliver hygiene kits to affected areas. They are also co-ordinating efforts with the Malawi Association of Midwives on identifying and delivering essential maternal healthcare services. Carlos Sitoe of Family Planning Association of Malawi said: “Cyclone Idai has devastated Malawi. Some health centres have been submerged, and we are hearing reports that women are having to give birth at evacuation centres without skilled attendants.  It is imperative that we are able to reach people affected by this disaster with sexual and reproductive healthcare. Our teams have started providing outreach services but will require many more resources to be able to sustain the response for months to come.”  We continue to operate throughout 16 camps, there has been 1,828 family planning services, 1,059 STIs services, total clients of 21,365 thus far. Mozambique  The Associação Moçambicana para Desenvolvimento da Família (AMODEFA), IPPF’s MA in Mozambique, are currently on the ground assessing needs with local partners and delivering hygiene kits in a coordinated effort with UNFPA. Santos Simione, Executive Director, AMODEFA: “Mozambique has been severely affected by Tropical Cyclone Idai in the last few weeks. Our organisation is on the ground doing assessments and providing training to staff and volunteers in order to be able to reach the thousands of people that are in dire need of sexual and reproductive healthcare. In the coming weeks and months we will be providing life saving care including contraception, prenatal care and safe deliveries. Our commitment is to saving lives, minimizing suffering and restoring people's dignity.”

Muna, Antonio and Sineang
20 March 2019

20 March: International Day of Happiness

Our Member Associations around the globe help bring happiness to people every day, by allowing them to access the sexual and reproductive rights they are entitled to. This International Day of Happiness, we’re sharing just a few of the stories of those who told us they were glad to be the recipient of IPPF services. "I’m so happy I now don’t have to worry about contraception for another 5 years" – Muna, Nepal Muna, now 21, got married when she was a teenager and soon had two children, a girl and a boy. She was keen to know more about her contraception options, particularly after flash flooding hit her country. IPPF Humanitarian, through the Family Planning Association of Nepal, were able to step in to help her. Read more about Muna "I am happy about life here" – Antonio, Mozambique 12-year-old Antonio moved in with his aunt after both his parents died from HIV-related illnesses. Antonio is also HIV positive, and with the help of IPPF Member Association AMODEFA, his aunt was able to tell him about it in an appropriate way, and to seek medication that best suited him. Read more about Antonio  "I was very happy when my daughter was born" – Sineang, Cambodia After three years of marriage, garment worker Sineang had started to wonder why she hadn’t yet become pregnant. After noticing some vaginal discharge, she visited a Reproductive Health Association of Cambodia clinic to seek treatment, and for support on her journey to become a mother. Read more about Sineang

Marinho Malavi is an activista with AMODEFA, Mozambique

“For people who live too far from the hospital to receive treatment, this programme saves their lives."

Marinho, 30, works as an activista for Amodefa’s Challenge TB programme, bringing treatment to remote villages in the Ribaué district of Nampula. Since August last year he has identified 84 cases of TB in the eight communities in which we works; “75 patients are in treatment at the moment, the rest are recovered,” he says. Before Amodefa started work in Nampula, Marinho says, “people were dying because they couldn’t reach the hospital, but with this programme it is becoming easier because we bring the medication to the patients.” However, lack of transport means it is a challenge for him to keep on top of all his cases. “The distances are far and the few bikes we have are breaking,” Marinho says. Yesterday he travelled 40 km to visit his patients. Some of the communities he visits are up to 50 km away. In the first quarter of this year 1,318 people were tested for TB in the eight districts where Amodefa operates; in the second quarter, 2,106 were tested; and in the third quarter, the number reached 3,154. More than half of these people were diagnosed to have TB. The surge in the number of people going for tests is in a large part due to Amodefa’s ‘Day of the Cough’.  On the 27th of each month teams of activistas and volunteers go into communities, schools and jails to educate people about TB.   Before volunteers had to go from house to house to identify patients, “but now, with the lectures, it’s easy to find people who are TB positive because they are identifying themselves,” says Marinho. Children are particularly receptive to Amodefa’s message, Marinho says. He remembers one woman who had been sick for a long time and her daughter, knowing he was an activist, sought him out. The patient’s initial test for TB came back negative, so she was given alternative medication.  “She took the tablets but she was still sick - she was unable to walk or to eat,” Marinho says.  “We brought her here to the clinic, examined her and she immediately started TB treatment. Now she has started her recovery and is able to sit.” Lessons taught during the ‘Day of the Cough’ means communities are also now taking greater precautions against the disease, he says. Steps such as opening windows, cleaning the house, not eating from one communal bowl, and practising ‘coughing etiquette’ have all helped limit the spread of TB.  “People understand now and are taking serious measures to prevent it,” Marinho says. However, the US decision to withdraw funding from Amodefa following the introduction of the Global Gag Rule , could halt the Challenge TB programme just as it is gaining momentum. “If the programme stops the people will suffer,” says Marinho. “For people who live too far from the hospital to receive treatment, this programme saves their lives. Knowing Amodefa has come to eliminate TB, it can’t stop. If they stop now the TB will get resistant, so we’ve got to keep going, we’ve got to get stronger.”   SUPPORT OUR WORK WITH A DONATION

Amodefa staff with clients in Maputo suburbs. credits: IPPF/Lee Neuenburg/Mozambique/2017

Al Jazeera highlights Global Gag Rule impact for IPPF Member Association in Mozambique

In the latest People and Power documentary, the team travel round Mozambique with AMODEFA, to look first-hand at the human impact the Gag rule has had in the country. The Global Gag Rule denies U.S. funding to organisations like IPPF if they use money from other donors to provide abortion services, counselling or referrals—even if abortion is legal in a country. It blocks critical funding for health services like contraception, maternal health, and HIV prevention and treatment for any organisation that refuses to sign it. The documentary talks to AMODEFA clients and staff who have been involved and helped by the US funded health programmes covering young people, HIV and Tuberculosis. AMODEFA faces significant losses to their programming budget of $2 million. Work that has built trust and provided support and treatment for many people who would have been left behind. The documentary spans several provinces, with the team visiting specialised outreach services that go out to the most rural populations. ‘We will have generations that are sick without knowing what they have. They will run the risk of transmitting HIV to other people because they do not know their HIV status,’ says project leader, Dr Marcel Kant. ‘We are condemning our society to live with this illness and there will be a large number of deaths.’ IPPF is working with AMODEFA to find alternative sources of funding. Executive Director Santos Simione, is working tirelessly with his team to ensure AMODEFA’s works continues, “We must be resilient! This also means being resilient to ensure that the progress made in sexual and reproductive health and rights continues and the provision of services minimizes the suffering of our population, particularly adolescents and young people, women and children”. The team Read more about AMODEFA's tireless work in Mozambique

Antonio Junior Xiranza

“I am happy about life here”

Antonio Junior Xiranza is 12 years old. He lives with his Aunt Talita Agosto Mujovo, 39, and her three children in Maputo, Mozambique, after his parents both died from HIV-related illnesses. Antonio is HIV positive, something that Talita was able to reveal to him over the course of nine counselling sessions through IPPF Member Association AMODEFA’s Ntyiso programme. When Antonio was sent to Talita in 2015 he had no understanding of his illness. He was severely underweight and wouldn’t take his medication. “I didn’t think he was going to make it,” says Talita. But following AMODEFA’s intervention last year Antonio’s health has improved rapidly and is gaining weight. This is in large part because Antonio, though still young, has chosen to take on the responsibility for managing his illness himself.  “He takes his medication without being told”, says Talita. “If he’s injured he knows the other children can’t touch his wound.” Antonio is still small for his age but says he feels stronger. He is well enough now to attend school regularly and is already thinking about the future; when he grows up he wants to be a fireman.“I am happy about life here,” he says, shyly. Talita says she is “relieved” to see these changes in Antonio. “At first I was not going to say anything. I would have waited until he was 18 to tell him,” Talita says, which would have continued to put pressure on the entire family. “But with the help of the counselling I had through Ntyiso I was able to tell him now.” While Ntyiso was intended to help parents speak more openly about HIV with their children, it has given Talita the confidence to discuss the illness more widely. “I was able to tell my father, who was sick and had a wound, that he should get tested for HIV,” she says. Her father was diagnosed positive and is now in treatment. “Before I wouldn’t have advised people to take the test, I would have just kept quiet,” she says. Read more about AMODEFA's tireless work in Mozambique

Albertina Machaieie, Amodefa, Mozambique

“I like helping people, that’s why I do this job”

Albertina Machaieie has been working with HIV patients for Amodefa for 38 years and is their longest serving nurse. “I’m going to work forever,” she says. “I like helping people, that’s why I do this job.” Albertina heads up Amodefa’s home care programme which provides medical, nutritional and emotional support to HIV positive patients living in the poorest suburbs of Maputo, the capital of Mozambique. She has seen a dramatic change in attitudes to HIV in the 19 years she has been running the service. In the past she had to hide her car and would visit her patients anonymously. “People feared HIV so they feared me coming to them,” she says.Now people welcome her into the community as a friend and will direct new patients to her. “They call us ‘Muhanyisse’”, which means saviour in the local language Shangaan, she says. Albertina and another nurse work with a large team of volunteers, or ‘activistas’, most of whom are also HIV positive. As well as delivering medication and food to patients and performing health examinations, an important part of Amodefa’s work is continuing to change attitudes towards HIV. “The homecare project encompasses everything,” she says. “It’s not just treatment for illness, we also work with the mind – people need to change their mindset.” She and the activistas give lectures in the community to raise awareness of HIV, and also offer counselling to patients, many of whom find it difficult to accept their HIV positive status. “Husbands and wives stop understanding each other when one is living in denial of HIV,” says Albertina. “They blame the illness on witchcraft.” In other cases, those carrying the virus are scared to tell their families for fear of being rejected. “There are many stories of family members, particularly of wives, who have found they are HIV positive and partners have threatened to leave,” she says. “But when Amodefa has stepped in and advocated, the husband has stayed.” This holistic approach to its homecare has been so effective that medical and psychology students have come from Brazil, the US and Mexico to Mozambique to study the programme and to learn from Albertina’s experience. “I am the library for Amodefa,” she jokes. Over the course of her career Albertina has worked with many challenging cases – particularly men. “Women are more open to treatment because they want to get better so they can care for their children,” she says, “but men often won’t seek help until their health has severely deteriorated.” She recalls one case where a woman tested positive for HIV while she was pregnant. She told her husband to get tested but he refused, and he also prevented his wife from taking any treatment. As a result her baby was born HIV positive - as were her second and third born. “With her last child she started taking the treatment without her husband’s knowledge and the baby was born without HIV,” says Albertina. “This man now says, ‘People, you need to be open – I have three positive children and it is my fault because I would not accept the truth.’” “Children who are HIV positive and don’t know often abandon their medication because they are tired of taking the drugs,” says Albertina. “Ntyiso teaches the importance of taking the medicine. When they are aware of their status, they start taking the medicine normally.” Albertina worked with ten families during the pilot phase of the programme. “Already I have seen great changes in the children, it shows why this project of revelation is so important.” The Ntiyso is a pilot project implemented in Maputo City and it has its focus on disclosure of the HIV + status to adolescents. It targets mothers, parents and caregivers of adolescents. The main activities are: Education and training of Mothers, Parents and caregivers of adolescents to reveal HIV+ status to their adolescents. Due to the Global Gag Rule this project lost its funding and was forced to close. Read more about AMODEFA's tireless work in Mozambique

クリニックで順番を待つ患者たち
05 December 2017

Staff and volunteers remain dedicated and determined as the impact of the GGR takes effect

The continuation of many vital health services Amodefa offers in Mozambique are under threat following the reintroduction of the Global Gag Rule by the US Administration. The Global Gag Rule, or Mexico City Policy as it is formally known, stops US aid to all health programmes run by organisations who perform or counsel on abortion. The decision, which will deprive Amodefa of $2 million, 60% of its budget, will have devastating consequences for the fight against HIV in Mozambique, where an estimated 12% of the country’s nearly 30 million population are living with the virus. Photography © IPPF/Grant Lee Neuenburg

Palmira Enoque Tembe, Mozambique,

“I’m fine and I am making plans for the future. I know now to get ill is not to die”

Palmira Enoque Tembe, 54, is HIV positive She lives with two sons, who are also HIV positive, and four grandchildren in a small house in Bairro Feiroviaro on the outskirts of Maputo. Three times a week she is visited by Amodefa volunteers and once a week by a nurse who provide medication, food and therapy to the family. “Amodefa counsels me through the difficulties in life,” Palmira says. Palmira found out she had HIV when her youngest child was nine months old. He was diagnosed as HIV positive. Palmira asked her husband to get tested too,“He refused” says Palmira. “He said I was possessed by evil spirits and was trying to kill him and my son". Her husband abandoned the family and Palmira was left to battle the illness and raise the children on her own. “I was terrified. I lost hope. I didn’t want to do anything, just sit in my room and cry,” she says. Now, however, the nutritious food, medication and regular medical check-ups she receives as part of the homecare programme have given her a new lease on life. “I’m fine and I am making plans for the future. I know now to get ill is not to die,” says Palmira, who has started to subsistence farm again. At first she was wary of the service. “It seemed like an advertisement for having HIV and I didn’t want my neighbours to isolate me,” she says. “But now I depend on it.” It was through Amodefa’s new pilot counselling project, ‘Ntyiso’ - which translates as ‘The Truth’ in the local language, Shangaan - Palmira was finally able to open up to her son that he had HIV too. While he had always suspected he was carrying the virus, he needed to hear it from his mother for it to become real.“It has changed by life,” she says. “It has improved our relationship because I no longer feel ashamed.” The Ntiyso is a pilot project implemented in Maputo City and it has its focus on disclosure of the HIV + status to adolescents. It targets mothers, parents and caregivers of adolescents. The main activities are: Education and training of Mothers, Parents and caregivers of adolescents to reveal HIV+ status to their adolescents. Due to the Global Gag Rule this project lost its funding and was forced to close. Read more about AMODEFA's tireless work in Mozambique

Arnilda - WISH

"Being a single mother at 14 was a suffocating experience and it could have been worse if I hadn't been accompanied by the Adolescent and Youth Friendly Services"

Five years ago, when Arnilda Simango was 13, she started dating a boy from her community, outside Xai-Xai City, in Gaza Province in southern Mozambique. A year later she got pregnant, at his insistence, and he left her shortly after the baby was born. AMODEFA’s youth services offered her counselling and advice throughout her pregnancy and became the network through which she made new friends.  Today, at the age of 18, she is raising her son, with help from her mother and plans to return to school. “When I started dating, I thought I wanted a partner who could take care of me and that could maybe fill the void I felt for not having a father. When I started the relationship with my boyfriend, he insisted that he needed a son because all his friends already had one. I had little space to say no because he threatened to date someone else and I was convinced he was the right person for me. When I got pregnant in 2016, he started behaving strangely. He stopped being affectionate and gave indications that he did not want to be with me anymore. That's when a friend of mine told me that there was a youth center where I could get advice on how to proceed in this situation". The Adolescent and Youth Friendly Services (SAAJ) center, based at the Patrice Lumumba Urban Health Center, on the outskirts of Xai-Xai, is run by AMODEFA and provides HIV testing and treatment, prenatal and postpartum consultations, and other information and services around sexual health and rights. The center is supported by the Women’s Integrated Sexual Health (WISH2ACTION) programme, led by IPPF.   "One day I walked there and received a lot of advice. As I was already 4 to 5 months pregnant, I was advised to open a prenatal form. They did all the follow-up until I gave birth to my son.” "Believe me, being a single mother at 14 was a suffocating experience and it could have been worse if I had not been accompanied by [the SAAJ]. I do not know how to thank them. I practically felt alone without knowing what to do, but I had a lot of advice here and made friends with other girls". Planning for the future  Arnilda dropped out of 7th grade once she became pregnant and helped her mother selling basic goods from a stall in her home. It is from this small business that her mother supports her two children who are still living at home, as well as five grandchildren. Arnilda plans to return to school next year to continue her studies now her son is old enough to stay with his grandmother. Her dream is to be a professional model. Until then she does not want to have another child, so she goes to the SAAJ for family planning purposes. Arnilda says she walks 50 minutes to the center every three months for the contraceptive injection.  "I wanted the implant, but it doesn't settle well with me, so I renew the injection every three months.  I do this because I need to continue studying to have a decent job that allows me to support my son. Next year I will go back to school. "A second child is not in the plans. I still consider myself a minor. Even the first child I only had because at the time I had no one to give me advice and show me the best way. I believed in my ex-boyfriend and today I have this lesson. Today I can say that I have come to my senses, not only from the experience of being a mother, but from everything I learn here [at the SAAJ]. There is no friend of mine who does not know SAAJ. I always advise them to approach here because I know they will have all kinds of counselling and accompaniment.”

Emerson Chaves, clinical psychologist in Mozambique
28 August 2019

Psychosocial support after a disaster: Cyclone Idai in Mozambique

On the evening of 14 March 2019, Cyclone Idai made landfall in the city of Beira in central Mozambique. With wind speeds of 185 kilometers per hour, it was the largest cyclone on record to hit the Southern Hemisphere and Africa. The impact was devastating, leading to the loss of life and extensive damage to infrastructure – not only in Mozambique, but in Malawi, Madagascar and Zimbabwe. In Mozambique alone, more than 130,000 people had to seek shelter in the 136 accommodation centers (emergency tented camps) that were set up across the county. The situation was dire, and the Mozambican government had to call for assistance to rebuild crucial infrastructure like health, transport and communications. The Associação Moçambicana para Desenvolvimento da Família (AMODEFA), IPPF’s Member Association in Mozambique, responded in the most affected areas of Mozambique, including Beira, Tete, Chiomoio and Zambezia. AMODEFA is still there providing sexual and reproductive awareness and services.  A committed volunteer  None of this would have been possible without the help of volunteers like Emerson Chaves, a clinical psychologist. Emerson is stationed in Chimoio, Manica Province. He is a passionate 29-year-old with a desire to offer psychosocial support to his community. Emerson performs his work with dedication as part of AMODEFA’s emergency response team to Cyclone Idai.  “The people of Chimoio were unable to seek for help after the disaster,” Emerson said. “Trying to survive had become a priority as opposed to seeking health services. Most people will not come for services unless we talk to them first.” Emerson’s work is not without its challenges. He works within a community that has deep-rooted cultural traditions that make talking about sex difficult. Yet his work involves sensitizing people about sexual and reproductive health and rights (SRHR), both at the health facility and within the community. This work is especially targeted at women and girls, who are disproportionately affected by issues of displacement. Emergency situations leave girls and young women vulnerable and at a higher risk of sexual exploitation and forced marriage, and they lack basic health services including sexual and reproductive healthcare. These circumstances increase the need for accurate information and quality services on family planning and reproductive health. “Due to the cultural background, I have to approach the topic in a special way and sensitize my community about sexual and reproductive health and rights,” Emerson points out.  Tackling gender-based violence  He shared his experience dealing with cases of gender-based violence; Emerson said the norm in many communities is that the family of a girl that is sexually assaulted receives a ‘bride price’ from the perpetrator’s family. This is usually done as a negotiation between the families. Once this takes place, the case does not get reported to the authorities – if one reports the case the ‘bride price’ is taken away. Many cases of gender-based violence are not reported because of these types of cultural barriers. Fortunately, the IPPF Humanitarian response was able to utilize the Minimum Initial Service Package (MISP), a set of life-saving activities to be implemented at the onset of every humanitarian crisis. MISP focuses on areas such as preventing sexual violence and maternal and infant mortality, and reducing the transmission of HIV, Through AMODEFA, IPPF rolled out the MISP in the affected areas where more than 130,000 people had been displaced, reaching 9,983 people in total, and 3,350 people with sexual and reproductive health (SRH) services. For IPPF, protecting the SRHR of communities and delivering the necessary SRH services in these humanitarian settings is the main objective.  A day with Emerson Emerson beings his day with a plan at the health facility. He has a choice to visit either of six facilities in his area: Motocoma, Chipinda Umue, Inchope, Zembe, Marera or Macate. At these facilities, Emerson receives clients who have been referred from community mobilizers to seek psychosocial support. On Saturdays, he is out with the community mobilizers to sensitize the community on SRHR. He begins with the group sessions then conducts door-to-door visits. The psychosocial care that people need in humanitarian settings is unique – especially when SRHR are concerned. “People in the community are not aware that the facility is offering services,” he said. “They still think that it is closed after the disaster. It is my duty to give correct and updated information on the situation about health services. The community needs to be aware that we are offering services, especially the community members who need SRH services at this time.” 

Cyclone Idai
02 April 2019

Cyclone Idai: The impact so far in Malawi and Mozambique

Updated 29 April   Cyclone Idai tore through Malawi, Mozambique and Zimbabwe on 14 March, leaving hundreds dead, thousands of homes destroyed and almost 2 million impacted. Among those affected by the cyclone are close to 75,000 pregnant women, of whom 43,000 are expected to give birth during the next six months.  IPPF, along with Member Associations (MAs) and partners, are on the ground in Malawi and Mozambique to assess the needs and to deliver healthcare services to those in dire need.   The impact of so far   Malawi The Government of Malawi confirmed the current death toll at 59 with close to 867,000 people impacted by the cyclone. More than 87,000 are currently displaced. Mozambique In Mozambique, the city of Beira – home to over 500,000 people – was hit the hardest by Cyclone Idai, with the government declaring a cholera outbreak in the city on 27 March. The cyclone has damaged and destroyed close to 100,000 homes and has claimed the lives of over 500 people, the number still rising. The Global Gag Rule Though the Global Gag Rule did not directly deny funding for humanitarian work, the ripple effect has had a devasting impact on the capacity at our MAs like AMODEFA, when responding to humanitarian crises.  Due to the loss of funding from the GGR, AMODEFA had to close eight clinics and end programs including the sex worker outreach program in Beira – one of the worst affected areas from the cyclone. This has meant that instead of having a functioning program and staff, and volunteers to mobilize and on which to base the emergency response, AMODEFA only had one remaining staff member in Beira.  Recruiting and training new volunteers for the humanitarian response then requires spending extra money and time, resources that are already scarce. On top of this, there are reports of an increase in sex worker activity along the main truck corridor, an area with an existing HIV prevalence of around 15%. It is not uncommon for women to turn to sex work in the wake of an emergency in order to provide for their families.  Even if the GGR does not have a direct impact on humanitarian SRH funding, it certainly has an impact on the response capacity and lives of the affected population through reduced access to SRH services.     Our response    Malawi Update:  The conditions in the camps are very dire, there is no food, so some people are returning to their homes or to family members houses. Most of the camps are closing off due to this. Our MA has been providing outreach for over two weeks, through two teams, who have reached a total of 16 camps. FPAM is the only organization that is on the ground providing both SRH information and services right in the camps. Clients are accessing our services in large numbers. There is high demand for family planning, HIV testing, and cervical cancer screening in all the camps we have visited. Additionally, there have been anecdotal reports to our team members that some girls and young women said that men with authority at the camp were coaxing girls to exchange food with sex. The risk of STI transmissions and teenage unwanted pregnancies is high as most sites have no access to SRHR services due to long distances from to health facilities, coupled with low levels of knowledge on SRHR issues. This has been exemplified by people`s inability to understand basic SRH issues. There is a strong need for long term, sustainable, access to SRH care and long acting contraceptive supplies. IPPF’s MAs in Malawi and Mozambique are on the ground working with partners to help deliver life-saving healthcare. During times of crisis and humanitarian situations, vulnerable populations such as people living with HIV, children and pregnant women are at a greater risk due to disruptions in healthcare services and systems. IPPF’s response in Malawi is being led by our MA – Family Planning Association of Malawi (FPAM) – who are working with partners like UNFPA to help deliver hygiene kits to affected areas. They are also co-ordinating efforts with the Malawi Association of Midwives on identifying and delivering essential maternal healthcare services. Carlos Sitoe of Family Planning Association of Malawi said: “Cyclone Idai has devastated Malawi. Some health centres have been submerged, and we are hearing reports that women are having to give birth at evacuation centres without skilled attendants.  It is imperative that we are able to reach people affected by this disaster with sexual and reproductive healthcare. Our teams have started providing outreach services but will require many more resources to be able to sustain the response for months to come.”  We continue to operate throughout 16 camps, there has been 1,828 family planning services, 1,059 STIs services, total clients of 21,365 thus far. Mozambique  The Associação Moçambicana para Desenvolvimento da Família (AMODEFA), IPPF’s MA in Mozambique, are currently on the ground assessing needs with local partners and delivering hygiene kits in a coordinated effort with UNFPA. Santos Simione, Executive Director, AMODEFA: “Mozambique has been severely affected by Tropical Cyclone Idai in the last few weeks. Our organisation is on the ground doing assessments and providing training to staff and volunteers in order to be able to reach the thousands of people that are in dire need of sexual and reproductive healthcare. In the coming weeks and months we will be providing life saving care including contraception, prenatal care and safe deliveries. Our commitment is to saving lives, minimizing suffering and restoring people's dignity.”

Muna, Antonio and Sineang
20 March 2019

20 March: International Day of Happiness

Our Member Associations around the globe help bring happiness to people every day, by allowing them to access the sexual and reproductive rights they are entitled to. This International Day of Happiness, we’re sharing just a few of the stories of those who told us they were glad to be the recipient of IPPF services. "I’m so happy I now don’t have to worry about contraception for another 5 years" – Muna, Nepal Muna, now 21, got married when she was a teenager and soon had two children, a girl and a boy. She was keen to know more about her contraception options, particularly after flash flooding hit her country. IPPF Humanitarian, through the Family Planning Association of Nepal, were able to step in to help her. Read more about Muna "I am happy about life here" – Antonio, Mozambique 12-year-old Antonio moved in with his aunt after both his parents died from HIV-related illnesses. Antonio is also HIV positive, and with the help of IPPF Member Association AMODEFA, his aunt was able to tell him about it in an appropriate way, and to seek medication that best suited him. Read more about Antonio  "I was very happy when my daughter was born" – Sineang, Cambodia After three years of marriage, garment worker Sineang had started to wonder why she hadn’t yet become pregnant. After noticing some vaginal discharge, she visited a Reproductive Health Association of Cambodia clinic to seek treatment, and for support on her journey to become a mother. Read more about Sineang

Marinho Malavi is an activista with AMODEFA, Mozambique

“For people who live too far from the hospital to receive treatment, this programme saves their lives."

Marinho, 30, works as an activista for Amodefa’s Challenge TB programme, bringing treatment to remote villages in the Ribaué district of Nampula. Since August last year he has identified 84 cases of TB in the eight communities in which we works; “75 patients are in treatment at the moment, the rest are recovered,” he says. Before Amodefa started work in Nampula, Marinho says, “people were dying because they couldn’t reach the hospital, but with this programme it is becoming easier because we bring the medication to the patients.” However, lack of transport means it is a challenge for him to keep on top of all his cases. “The distances are far and the few bikes we have are breaking,” Marinho says. Yesterday he travelled 40 km to visit his patients. Some of the communities he visits are up to 50 km away. In the first quarter of this year 1,318 people were tested for TB in the eight districts where Amodefa operates; in the second quarter, 2,106 were tested; and in the third quarter, the number reached 3,154. More than half of these people were diagnosed to have TB. The surge in the number of people going for tests is in a large part due to Amodefa’s ‘Day of the Cough’.  On the 27th of each month teams of activistas and volunteers go into communities, schools and jails to educate people about TB.   Before volunteers had to go from house to house to identify patients, “but now, with the lectures, it’s easy to find people who are TB positive because they are identifying themselves,” says Marinho. Children are particularly receptive to Amodefa’s message, Marinho says. He remembers one woman who had been sick for a long time and her daughter, knowing he was an activist, sought him out. The patient’s initial test for TB came back negative, so she was given alternative medication.  “She took the tablets but she was still sick - she was unable to walk or to eat,” Marinho says.  “We brought her here to the clinic, examined her and she immediately started TB treatment. Now she has started her recovery and is able to sit.” Lessons taught during the ‘Day of the Cough’ means communities are also now taking greater precautions against the disease, he says. Steps such as opening windows, cleaning the house, not eating from one communal bowl, and practising ‘coughing etiquette’ have all helped limit the spread of TB.  “People understand now and are taking serious measures to prevent it,” Marinho says. However, the US decision to withdraw funding from Amodefa following the introduction of the Global Gag Rule , could halt the Challenge TB programme just as it is gaining momentum. “If the programme stops the people will suffer,” says Marinho. “For people who live too far from the hospital to receive treatment, this programme saves their lives. Knowing Amodefa has come to eliminate TB, it can’t stop. If they stop now the TB will get resistant, so we’ve got to keep going, we’ve got to get stronger.”   SUPPORT OUR WORK WITH A DONATION

Amodefa staff with clients in Maputo suburbs. credits: IPPF/Lee Neuenburg/Mozambique/2017

Al Jazeera highlights Global Gag Rule impact for IPPF Member Association in Mozambique

In the latest People and Power documentary, the team travel round Mozambique with AMODEFA, to look first-hand at the human impact the Gag rule has had in the country. The Global Gag Rule denies U.S. funding to organisations like IPPF if they use money from other donors to provide abortion services, counselling or referrals—even if abortion is legal in a country. It blocks critical funding for health services like contraception, maternal health, and HIV prevention and treatment for any organisation that refuses to sign it. The documentary talks to AMODEFA clients and staff who have been involved and helped by the US funded health programmes covering young people, HIV and Tuberculosis. AMODEFA faces significant losses to their programming budget of $2 million. Work that has built trust and provided support and treatment for many people who would have been left behind. The documentary spans several provinces, with the team visiting specialised outreach services that go out to the most rural populations. ‘We will have generations that are sick without knowing what they have. They will run the risk of transmitting HIV to other people because they do not know their HIV status,’ says project leader, Dr Marcel Kant. ‘We are condemning our society to live with this illness and there will be a large number of deaths.’ IPPF is working with AMODEFA to find alternative sources of funding. Executive Director Santos Simione, is working tirelessly with his team to ensure AMODEFA’s works continues, “We must be resilient! This also means being resilient to ensure that the progress made in sexual and reproductive health and rights continues and the provision of services minimizes the suffering of our population, particularly adolescents and young people, women and children”. The team Read more about AMODEFA's tireless work in Mozambique

Antonio Junior Xiranza

“I am happy about life here”

Antonio Junior Xiranza is 12 years old. He lives with his Aunt Talita Agosto Mujovo, 39, and her three children in Maputo, Mozambique, after his parents both died from HIV-related illnesses. Antonio is HIV positive, something that Talita was able to reveal to him over the course of nine counselling sessions through IPPF Member Association AMODEFA’s Ntyiso programme. When Antonio was sent to Talita in 2015 he had no understanding of his illness. He was severely underweight and wouldn’t take his medication. “I didn’t think he was going to make it,” says Talita. But following AMODEFA’s intervention last year Antonio’s health has improved rapidly and is gaining weight. This is in large part because Antonio, though still young, has chosen to take on the responsibility for managing his illness himself.  “He takes his medication without being told”, says Talita. “If he’s injured he knows the other children can’t touch his wound.” Antonio is still small for his age but says he feels stronger. He is well enough now to attend school regularly and is already thinking about the future; when he grows up he wants to be a fireman.“I am happy about life here,” he says, shyly. Talita says she is “relieved” to see these changes in Antonio. “At first I was not going to say anything. I would have waited until he was 18 to tell him,” Talita says, which would have continued to put pressure on the entire family. “But with the help of the counselling I had through Ntyiso I was able to tell him now.” While Ntyiso was intended to help parents speak more openly about HIV with their children, it has given Talita the confidence to discuss the illness more widely. “I was able to tell my father, who was sick and had a wound, that he should get tested for HIV,” she says. Her father was diagnosed positive and is now in treatment. “Before I wouldn’t have advised people to take the test, I would have just kept quiet,” she says. Read more about AMODEFA's tireless work in Mozambique

Albertina Machaieie, Amodefa, Mozambique

“I like helping people, that’s why I do this job”

Albertina Machaieie has been working with HIV patients for Amodefa for 38 years and is their longest serving nurse. “I’m going to work forever,” she says. “I like helping people, that’s why I do this job.” Albertina heads up Amodefa’s home care programme which provides medical, nutritional and emotional support to HIV positive patients living in the poorest suburbs of Maputo, the capital of Mozambique. She has seen a dramatic change in attitudes to HIV in the 19 years she has been running the service. In the past she had to hide her car and would visit her patients anonymously. “People feared HIV so they feared me coming to them,” she says.Now people welcome her into the community as a friend and will direct new patients to her. “They call us ‘Muhanyisse’”, which means saviour in the local language Shangaan, she says. Albertina and another nurse work with a large team of volunteers, or ‘activistas’, most of whom are also HIV positive. As well as delivering medication and food to patients and performing health examinations, an important part of Amodefa’s work is continuing to change attitudes towards HIV. “The homecare project encompasses everything,” she says. “It’s not just treatment for illness, we also work with the mind – people need to change their mindset.” She and the activistas give lectures in the community to raise awareness of HIV, and also offer counselling to patients, many of whom find it difficult to accept their HIV positive status. “Husbands and wives stop understanding each other when one is living in denial of HIV,” says Albertina. “They blame the illness on witchcraft.” In other cases, those carrying the virus are scared to tell their families for fear of being rejected. “There are many stories of family members, particularly of wives, who have found they are HIV positive and partners have threatened to leave,” she says. “But when Amodefa has stepped in and advocated, the husband has stayed.” This holistic approach to its homecare has been so effective that medical and psychology students have come from Brazil, the US and Mexico to Mozambique to study the programme and to learn from Albertina’s experience. “I am the library for Amodefa,” she jokes. Over the course of her career Albertina has worked with many challenging cases – particularly men. “Women are more open to treatment because they want to get better so they can care for their children,” she says, “but men often won’t seek help until their health has severely deteriorated.” She recalls one case where a woman tested positive for HIV while she was pregnant. She told her husband to get tested but he refused, and he also prevented his wife from taking any treatment. As a result her baby was born HIV positive - as were her second and third born. “With her last child she started taking the treatment without her husband’s knowledge and the baby was born without HIV,” says Albertina. “This man now says, ‘People, you need to be open – I have three positive children and it is my fault because I would not accept the truth.’” “Children who are HIV positive and don’t know often abandon their medication because they are tired of taking the drugs,” says Albertina. “Ntyiso teaches the importance of taking the medicine. When they are aware of their status, they start taking the medicine normally.” Albertina worked with ten families during the pilot phase of the programme. “Already I have seen great changes in the children, it shows why this project of revelation is so important.” The Ntiyso is a pilot project implemented in Maputo City and it has its focus on disclosure of the HIV + status to adolescents. It targets mothers, parents and caregivers of adolescents. The main activities are: Education and training of Mothers, Parents and caregivers of adolescents to reveal HIV+ status to their adolescents. Due to the Global Gag Rule this project lost its funding and was forced to close. Read more about AMODEFA's tireless work in Mozambique

クリニックで順番を待つ患者たち
05 December 2017

Staff and volunteers remain dedicated and determined as the impact of the GGR takes effect

The continuation of many vital health services Amodefa offers in Mozambique are under threat following the reintroduction of the Global Gag Rule by the US Administration. The Global Gag Rule, or Mexico City Policy as it is formally known, stops US aid to all health programmes run by organisations who perform or counsel on abortion. The decision, which will deprive Amodefa of $2 million, 60% of its budget, will have devastating consequences for the fight against HIV in Mozambique, where an estimated 12% of the country’s nearly 30 million population are living with the virus. Photography © IPPF/Grant Lee Neuenburg

Palmira Enoque Tembe, Mozambique,

“I’m fine and I am making plans for the future. I know now to get ill is not to die”

Palmira Enoque Tembe, 54, is HIV positive She lives with two sons, who are also HIV positive, and four grandchildren in a small house in Bairro Feiroviaro on the outskirts of Maputo. Three times a week she is visited by Amodefa volunteers and once a week by a nurse who provide medication, food and therapy to the family. “Amodefa counsels me through the difficulties in life,” Palmira says. Palmira found out she had HIV when her youngest child was nine months old. He was diagnosed as HIV positive. Palmira asked her husband to get tested too,“He refused” says Palmira. “He said I was possessed by evil spirits and was trying to kill him and my son". Her husband abandoned the family and Palmira was left to battle the illness and raise the children on her own. “I was terrified. I lost hope. I didn’t want to do anything, just sit in my room and cry,” she says. Now, however, the nutritious food, medication and regular medical check-ups she receives as part of the homecare programme have given her a new lease on life. “I’m fine and I am making plans for the future. I know now to get ill is not to die,” says Palmira, who has started to subsistence farm again. At first she was wary of the service. “It seemed like an advertisement for having HIV and I didn’t want my neighbours to isolate me,” she says. “But now I depend on it.” It was through Amodefa’s new pilot counselling project, ‘Ntyiso’ - which translates as ‘The Truth’ in the local language, Shangaan - Palmira was finally able to open up to her son that he had HIV too. While he had always suspected he was carrying the virus, he needed to hear it from his mother for it to become real.“It has changed by life,” she says. “It has improved our relationship because I no longer feel ashamed.” The Ntiyso is a pilot project implemented in Maputo City and it has its focus on disclosure of the HIV + status to adolescents. It targets mothers, parents and caregivers of adolescents. The main activities are: Education and training of Mothers, Parents and caregivers of adolescents to reveal HIV+ status to their adolescents. Due to the Global Gag Rule this project lost its funding and was forced to close. Read more about AMODEFA's tireless work in Mozambique