28 January 2022 heralds one year since President Biden rescinded the harmful Global Gag Rule (GGR). Otherwise known as the Mexico City Policy, its expansion in 2017 under Trump affected 12 billion dollars of funding, impacting thousands of life-saving healthcare services worldwide – especially across low-income countries. But while rescindment is a positive first step, the long-term harm of the Global Gag Rule lingers on. For IPPF, 53 healthcare projects in 32 countries were hit, with some Member Associations losing up to 60% of their funding. Programmes affected include HIV prevention and care, maternal health and nutrition, STI services, gender-based violence prevention, and services for vulnerable children. And although we have begun to re-establish long-standing partnerships, it takes time for funding to flow and to re-open closed healthcare clinics and community services – with some lost forever. In the meantime, there are women and girls who desperately need healthcare that have nowhere to turn. But in February, the US Congress has an opportunity to change the sexual and reproductive health landscape forever through a final negotiated funding bill that includes a permanent end to the deadly Global Gag Rule. As we celebrate one year of rescindment, we know the work is not done yet, but we are hopeful for the futures of millions of women and girls worldwide. We urge the US Congress to permanently repeal the Global Gag Rule to fully eradicate the lasting impact of the Mexico City Policy that has harmed women and girls around the world for 40 years.   Dr Alvaro Bermejo, Director-General of the International Planned Parenthood Federation, said: "Five years ago, Trump expanded the Global Gag Rule, a devastating neo-colonialist policy that forbids US aid to any organization that supports access to safe abortion care, disproportionately affecting women and girls in low-income countries. Today we mark one year since President Biden rescinded it, but the long-term harm and impacts don't simply go away.  "The Gag Rule is a callously designed mechanism set up to deny women and girls the right to decide what happens to their bodies. Its implementation doesn't just destroy life-saving abortion services but erodes access to other sexual and reproductive healthcare, including contraception, leading ultimately to increases in unintended pregnancy and forcing many to turn to unsafe and dangerous abortion methods.   "While rescindment is a positive first step, the looming threat of reinstatement under future anti-rights administrations undermines the sustainability of global sexual health programs and the pace of progress. After 40 long years, the time to act is now – we urge the US Congress to end this political game and stand up for the futures of millions of at-risk women and girls by permanently repealing the Global Gag Rule.  "By leaving a legacy that gives hope and stability to the sexual and reproductive health of people worldwide, the US will once again be a champion, leader, and innovator of human rights for all." For media inquiries please contact [email protected] 

The Colombian Constitutional Court has a historical opportunity in its hands as it decides on whether or not to completely remove the crime of abortion from the penal code, making it a public health matter. Unlike many others in Colombia, I grew up in a home where I wanted for nothing. A fortunate child in a country where meeting basic needs continues to be a matter of privilege, the reflection of an unequal society mired by the infinite cycle of poverty. I grew up amid discussions of politics and human rights in a safe environment where I was encouraged to formulate my own thoughts. Yet even for me, like so many Colombian women and girls, speaking openly about sex and sexuality was strictly forbidden. Despite this, Colombia remains a society that sees motherhood as the only achievable goal in a woman's life. A paradox that is difficult to understand. From a young age, girls face the power of stereotypes and gender roles, coming to understand them as superior to anything else and realizing that when it comes to reproductive autonomy, there is no space to think, express opinions, and much less act. Since 2006, Colombian women have supposedly been able to access abortion care under three circumstances: if their life or health is at risk, in cases of fatal foetal abnormalities, or if the pregnancy is the by-product of rape or incest. Yet in spite of these laws, the criminalization of abortion persists. The Guttmacher Institute found that less than one per cent of the estimated 400,000 abortions carried out each year in Colombia are performed legally, with women, especially poor, rural, vulnerable and marginalized women, facing significant barriers to accessing safe and timely abortion care. Many women are forced to carry their pregnancies to term or else seek other methods to end them. Figures collected by ProFamilia, IPPF's Member Association and the largest provider of legal abortions in Colombia, showed that during 2020, there were at least 26,223 unsafe abortions across Colombia, a startling amount for which consequences range from infection to life-changing injuries to death. Other women have been imprisoned for up to four and a half years for having an abortion, even in cases where abortion should have been legal. In a sickening twist of events, charges actually increased by 320% from 2005 to 2008, with around 400 women prosecuted for procuring an abortion each year. Perhaps the most saddening example of discrimination is that most women charged were poor rural women, and a third, survivors of sexual violence. The decriminalization of abortion and the Green Wave movement is centred on public health, human rights, and the full citizenship and lives of girls, adolescents, and women – who, for multiple reasons, including gender-based violence, inequity, lack of education and barriers to healthcare – continue to face unintended pregnancies. And for whom the freedom to make choices about their pregnancies and their bodies will reduce adolescent and unintended pregnancy, reduce gender-based violence and help break the cycle of poverty that so many in Colombia face.   For the dedicated health care providers, who also bear the burden of criminalization and stigma, decriminalization is an opportunity to make reproductive healthcare an integral part of physical, mental and social well-being. And a chance for abortion care providers to finally be recognized as people who simply care about the needs of others.   So after a long, rigorous and objective process of data, figures, findings and stories, Colombia is on the cusp of change. To achieve total decriminalization would be groundbreaking, a decision that would change the course of Colombia and Latin America forever. Especially in the face of terrifying anti-choice movements which continue to plague nations across the globe, removing long-held rights from citizens, as we have seen in Texas and Poland. The magistrates should not be afraid of making the right decision. From Uruguay to Argentina, Mexico, and now Colombia, I am hopeful that my country will join the right side of history. Originally published by Thomson Reuters Foundation News

Ada's abortion journeyTake a journey with Ada to discover her story. Like many people, she has just found out that she is pregnant, but she cannot afford to raise another child. She has decided to have an abortion. What will her options be, and what will she choose? Take a couple of minutes today to share her journey – click "Start" to begin...Your name is Ada. You've found out you are pregnant, but you cannot afford to raise another child. You have decided to have an abortion.What do you do?On the internet, you discover safe2choose.org and read on their website about available abortion care in your country and about others who have also had an abortion. You also find a toll-free number for an IPPF member association in your country that offers abortion information and support.You decide to:You call your friend Maryam, who explains to you that she knows many women who have had one or more abortions. She tells you that she herself has had two. She gives you advice about how to find information online, and also about the clinic where she had her abortions. You decide to:You speak to a safe2choose counsellor by live chat, and she offers confidential and non-judgmental counselling in your language, free of charge.You learn that there are two types of abortion available to you:• An in-clinic procedure called a manual vacuum aspiration (MVA), which includes the use of a suction device to remove the pregnancy. This option is typically offered up to 13 weeks of gestation and takes about 10-15 minutes.• A medical abortion, which involves taking pills to induce an abortion. This option is typically offered up to 12 to 13 weeks' gestation and can be managed in clinic or at home.You decide to:You speak to an IPPF member service provider, who offers you confidential and non-judgmental counselling about your options. They explain the two types of abortion available to you, which the safe2choose counsellors had also explained – medical abortion with pills and manual vacuum aspiration (MVA).You decide to:They explain two types of abortion available to you:• An in-clinic procedure called a manual vacuum aspiration (MVA), which includes the use of a suction device to remove the pregnancy. This option is typically offered up to 13 weeks of gestation and takes about 10-15 minutes.• A medical abortion, which involves taking pills to induce an abortion. This option is typically offered up to 12 to 13 weeks' gestation and can be managed in clinic or at home.You decide to:On the internet, you discover safe2choose.org and read on their website about available abortion care in your country and about others who have also had an abortion. You speak to one of their counsellors by live chat, and she offers confidential and non-judgmental counselling in your language, free of charge.You learn that there are two types of abortion available to you:• An in-clinic procedure called a manual vacuum aspiration (MVA), which includes the use of a suction device to remove the pregnancy. This option is typically offered up to 13 weeks of gestation and takes about 10-15 minutes.• A medical abortion, which involves taking pills to induce an abortion. This option is typically offered up to 13 weeks in-clinic or up to 12 weeks at home.You decide to:You've made the choice that best suits your needs and situation, and you've been supported to do so throughout the process. safe2choose.org and IPPF offer information, support and a range of options for person-centred and rights-based abortion care for everyone, regardless of their age, religion, nationality or social class. safe2choose's team of international counselors are here for support throughout the process at anytime. IPPF offers quality and non-judgmental abortion care through static clinics, community-based care, remote counseling, and support for self-managed medical abortion.For further information, please visit the following:• safe2choose's information on medical abortion and manual vacuum aspiration (MVA)• IPPF's short videos on medical abortion and manual vacuum aspiration (MVA)• Brands of medical abortion available at country level – safe2choose information and MedAb.orgYou visit a midwife at an IPPF member clinic who offers you confidential and non-judgmental counselling about your options.They explain two types of abortion available to you:• An in-clinic procedure called a manual vacuum aspiration (MVA), which includes the use of a suction device to remove the pregnancy. This option is typically offered up to 13 weeks of gestation and takes about 10-15 minutes.• A medical abortion, which involves taking pills to induce an abortion. This option is typically offered up to 12 to 13 weeks' gestation and can be managed in clinic or at home.You decide to:You've made the choice that best suits your needs and situation, and you've been supported to do so throughout the process.Abortions are very common and one of the safest medical procedures when done under the right conditions and with the right information. Everyone regardless of their age, religion, nationality or social class deserves access to a safe abortion. safe2choose.org and IPPF offer information, support and a range of options for person-centred and rights-based abortion care.safe2choose's team of international counsellors are here to support you throughout the process at anytime.You speak to an IPPF member service provider, who offers you confidential and non-judgmental counselling about your options.They explain two types of abortion available to you:• An in-clinic procedure called a manual vacuum aspiration (MVA), which includes the use of a suction device to remove the pregnancy. This option is typically offered up to 13 weeks of gestation and takes about 10-15 minutes.• A medical abortion, which involves taking pills to induce an abortion. This option is typically offered up to 12 to 13 weeks' gestation and can be managed in clinic or at home.You decide to: Also available in French, Spanish, and Portuguese

Abortion stigma affects women and girls, abortion providers, reproductive rights advocates and communities. Although abortion is a common experience around the world, it is still largely stigmatised. Negative attitudes and beliefs about abortion may act as barriers to accessing safe services and can make it difficult for people to talk about their experiences of abortion. This can be very isolating, and may force people to continue unwanted pregnancies or to seek unsafe abortion. Since 2011 the David & Lucile Packard Foundation has supported IPPF to implement a range of initiatives to investigate and address abortion stigma. It is often young people who are most severely affected by abortion stigma, and who are most at risk of suffering health complications as a result of unsafe abortion. Since 2014 IPPF has delivered the Youth and Abortion Stigma project, a project focused on challenging abortion stigma and supporting young people’s access to safe abortion services – working with communities, service providers, and young people, conducting research, supporting youth initiatives and developing a range of resources to achieve an better environment for young people’s right to safe abortion and other reproductive and sexual rights. This project has conducted targeted work with our Member Associations in Benin, Burkina Faso, Ghana, India, Nepal and Pakistan. Implementing individual, community and clinic-based interventions in the countries where abortion stigma research was conducted. Abortion stigma was measured at the community level at the beginning and end of each phase of the project, by using an adaptation of the Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS) developed by Ipas. Read more about the SABAS results Find out more about this ground-breaking work in Reducing Abortion Stigma: Global Achievements since 2014. Read summary report Tools and resources Through this project IPPF has created a range of tools and resources to support understanding of abortion stigma and to increase the capacity of our Member Associations to advocate for safe abortion, and to provide non-stigmatising education and information. How to talk about abortion: A guide to rights-based messaging Designed to help individuals and organizations think about the language and images they use to communicate about abortion and offers best practice tips. AR EN FR ES Video: How to talk about abortion Bright and colourful short animation to share the tips from the guide “How to talk about abortion”. EN FR ES How to talk about abortion: A guide for journalists, editors and media outlets This guide encourages accurate reporting of the facts about abortion, and honest portrayals of abortion as part of real people’s lives and relationships. EN ES How to educate about abortion: the essentials Brief version of the guide “How to educate about abortion”. EN FR ES Video: How to educate about abortion Accompanying the guide with the same name, this short animation distils advice from the guide into just two minutes! EN FR ES How to educate about abortion: A guide for peer educators, trainers and teachers This comprehensive guide provides the rationale for teaching about abortion issues, as well a number of practical activities for doing so. EN FR ES Abortion matters: an introduction A free online class that covers all the basics of abortion. A free DisasterReady account is required. EN FR ES Understanding abortion: a visual resource This resource fills a gap in communication, reducing literacy and language barriers around abortion messaging. EN FR HI NE ES Strategies to improve young people’s access to stigma free services IPPF recognizes the value of young people’s voices, perspectives and insights, as well as their keen understanding of which messages, media and resources will resonate with their peers. We have listened to young people and employed a range of strategies to ensure that our initiatives were genuinely led by youth. Four of our Member Associations have shared their best practices to improve young people’s access to safe abortion services. These include strategies such as creating a ‘buddy system’ for young people accessing services, working with educational establishments, using social media, and youth friendly spaces. Bosnia and Herzegovina: Using a buddy system EN FR ES Cameroon: Partnering with educational institutions EN FR ES Ghana: Using social media EN FR ES Pakistan: Youth Friendly Spaces EN FR ES Youth-led projects to tackle abortion stigma As part of our work in tackling abortion stigma, this project has supported smaller ground-breaking youth-led projects in 14 different countries, in order to tackle the issue of abortion stigma in their communities. These small grants have been awarded to projects in Albania, Colombia, Ghana, Guinea, Kenya, Macedonia, Nepal, Nigeria, Palestine, Puerto Rico, Sierra Leone, Spain, Tanzania and Venezuela. Read more about these youth-led projects The ‘Youth Against Abortion Stigma’ blog features entries written by young IPPF volunteers, youth grantees and project champions from around the world. Visit the Youth Against Abortion Stigma blog For further information on this project, contact [email protected].

Abortion stigma affects everyone: individuals, communities and service providers. Young women and adolescent girls bear the brunt of abortion stigma. It causes delays in people seeking abortion and stops others from accessing it, leading to unintended pregnancies. Stigma drives abortion underground, where it is more likely to be unsafe. Since 2014, the support of the David & Lucile Packard Foundation has enabled IPPF to reduce abortion stigma affecting young people around the world, working directly with Member Associations in six countries (Bénin, Burkina Faso, India, Pakistan, Ghana and Nepal). Meaningful youth participation has ensured that young people’s lived experiences were central in every aspect of this work. This project has also supported smaller ground-breaking youth-led projects in 14 different countries: Albania, Colombia, Ghana, Guinea, Kenya, Macedonia, Nepal, Nigeria, Palestine, Puerto Rico, Sierra Leone, Spain, Tanzania and Venezuela. This document highlights the achievements and learnings from the Abortion Stigma Project between 2014 and 2020, including case studies, research and evidence generated around abortion stigma, and popular resources and tools developed throughout the project, and more. We invite you to read more on this ground-breaking work in Reducing Abortion Stigma: Global Achievements since 2014

The International Planned Parenthood Federation welcomes the news of the removal of abortion care from South Korea’s Criminal Code effective from 1 January 2021. This means those seeking abortion care will no longer face legal barriers in accessing care. Abortion in South Korea was illegal in most circumstances from 1953 to 2020. On April 11, 2019, the Constitutional Court ruled the abortion ban unconstitutional and ordered the law's revision by the end of 2020. Revisions to the law were proposed in October 2020, but not voted on by the deadline of 31 December 2020. The Ministry of Health and Welfare announced that they will consider expanding coverage of health insurance to include abortion care and the approval of mifepristone (used in medical abortion). IPPF’s Director-General, Dr Alvaro Bermejo said: “Abortion care is a human right, and those rights are now being realized in countries with some of the strictest abortion laws. The decision to remove abortion from South Korea’s criminal code is a step in the right direction for women’s rights, but we also know there is much work to do.    ‘Conscientious objection’ cannot be allowed to limit access to abortion care. IPPF and its Member Associations will continue to fight for safe and legal abortion care for those who need it.”  Ms Kyung Ae Cho, Secretary-General, Korea Population, Health and Welfare Association (KoPHWA) said:  “I am pleased that we reached here today [repeal of the criminal provision on abortion] as a result of many years of efforts led by Korean women.    "With these changes, law amendments and services are urgently needed, including expanding Universal Health Coverage (UHC), to ensure equal access to reproductive healthcare for all women. We [KoPHWA) shall continue to deliver accurate and rights-based information and counselling on safe abortion care appropriate to the Korean women context, and contribute to the fulfilment of universal access to sexual and reproductive health for all women worldwide.”   

During the COVID-19 pandemic, women globally face compounded barriers to accessing safe abortion care. The de-prioritization of sexual and reproductive health services including abortion care, overwhelmed health systems, restrictions on movement and fear of visiting health facilities have all created additional challenges for women to safely end a pregnancy. However, recognizing the need to adapt to ensure women have access to the care they need, this crisis has sparked innovation among IPPF Member Associations. They developed new approaches to reach women with safe abortion information and care, while keeping women’s choice and quality of care at the centre of their work.  This document illustrates some of the innovative approaches used to ensure continued access to quality abortion care during the pandemic.  

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

In Ethiopia, getting young people’s attention about sexual and reproductive healthcare is no easy task. But at a youth centre in Jimma, the capital Oromia region, groups of young people are getting vital messages about sexual health and contraception out to their peers through dance, song, and poetry. Student Jumeya Mohammed Amin came here to train as a peer educator for sexual and reproductive health [SRH] three years ago, when she was 14 years old. In her community – a conservative village 20 km outside the city – early marriage and pregnancy was common, and information about SRH practically unheard of. Navigating traditional norms “Girls younger than me at the time were married. The youngest was only nine,” said Amin, who would watch her classmates have to leave their home, school, and playmates behind. In Amin’s community, to opt out of unintended pregnancies involves unsafe abortion methods such as remedies prescribed by traditional healers – which can be fatal. “I know one girl from 10th grade who was 15 years old, and she died from this in 2017,” she said. But Amin’s work educating hundreds of young people each year on sexual health has changed attitudes in her community around early marriage, unplanned pregnancy and the options available to prevent it, she says, with many of her peers now waiting to start becoming sexually active. Tackling high rates of teen pregnancy Oromia has the third highest rate of teenage pregnancy in Ethiopia, after the Afar and Somali regions, says Dessalegn Workineh, who runs the Jimma office of the Family Guidance Association of Ethiopia [FGAE], which is supported by IPPF. “In Oromia, out of this rate of teen pregnancies, almost twenty percent end up in abortion,” he said. The region also has the third lowest uptake of contraceptives among women aged 15 to 49. 17-year-old peer educator Mastewal Ephrem says that the problem comes down to a lack of information. “People don’t know about reproductive health and they need this information about how to manage their family, sex and infections,” she said. Religious and social conservatism make this difficult, especially in poor and rural areas where families receive dowries in the form of money and gifts when their daughters marry. “Because of not having confidence and not talking to people, girls are doing early marriage,” said Ephrem. Poverty and other hardships also push girls out of their family homes early and leave them in precarious situations, where they run a high risk of encountering abuse. “I see girls aged 10, 13 and 15, who live on the streets and take drugs,” said Emebet Bekele, a counsellor working at an IPPF-supported clinic in Jimma that is aimed at helping sex workers. Bekele provides counselling and testing for HIV and STIs. She talks to girls and women about the full range of free and confidential family planning services available at the clinic. “Sometimes we bring them from the streets and we test them. Most of them get pregnant,” she said. She often supports students to get safe abortion care; including girls as young as 13. Taking sexual healthcare to the streets The youth centre reaches a lot of young people in schools and directs them towards the youth centre, where there is a library and many group activities and performances to teach them about SRH. Groups of young people practice and perform short plays and dances about topics such as unsafe sex and STIs here, as well as on the streets, where they draw a crowd. Fourteen-year-old Simret Abiyu has turned what she has learned into SRH-themed poems that she pens and performs to her peers in English, Amharic and Oromo. “Sometimes I get training here and write poems about family planning and the work of FGAE and the development of the country,” she said. Healthcare and advice via the phone University student Nebiyu Ephirem, 26, is a youth leader at the centre. He has been managing the two SRH helplines – located in a quiet back office – since it started in 2017. He answers a lot of calls from young people asking about contraception or their bodies and people dealing with emergencies and tries to answer their questions or refer them to public, private or FGAE clinics across the country. “Culturally, people used not to want to discuss sexual issues. They fear discussing these openly with family, and due to religious beliefs, so people like to call me,” said Ephirem. The youth centre reaches more than 11,000 young people a year through its work at schools, and through outreach clinics located in coffee plantations, where many young people work. Currently, the youth centre uses the helpline, radio adverts and social media to inform people about sexual health. The team hopes that media campaigns can spread the message wider in order to raise awareness about young peoples’ sexual health needs.

Rewda Kedir works as a midwife in a rural area of the Oromia region in southwest Ethiopia. Only 14% of married women are using any method of contraception here.  The government hospital Rewda works in is supported to provide a full range of sexual and reproductive healthcare, which includes providing free contraceptives and comprehensive abortion care. In January 2017, the maternal healthcare clinic faced shortages of contraceptives after the US administration reactivated and expanded the Global Gag Rule, which does not allow any funding to go to organizations associated with providing abortion care. Fortunately in this case, the shortages only lasted a month due to the government of the Netherlands stepping in and matching lost funding. “Before, we had a shortage of contraceptive pills and emergency contraceptives. We would have to give people prescriptions and they would go to private clinics and where they had to pay," Rewda tells us. "When I first came to this clinic, there was a real shortage of people trained in family planning. I was the only one. Now there are many people trained on family planning, and when I’m not here, people can help." "There used to be a shortage of choice and alternatives, and now there are many. And the implant procedures are better because there are newer products that are much smaller so putting them in is less invasive.” Opening a dialogue on contraception  The hospital has been providing medical abortions for six years. “Before, there was no safe abortion," says Rewda. She explains how people would go to 'traditional' healers and then come to the clinic with complications like sepsis, bleeding, anaemia and toxic shock. If they had complications or infections above nine weeks, Rewda and her colleagues would send them to Jimma, the regional capital. "Before, it was very difficult to persuade them to use family planning, and we had to have a lot of conversations. Now, they come 45 days after delivery to speak to us about this and get their babies immunised," she explains. "They want contraceptives to space out their children. Sometimes their husbands don’t like them coming to get family planning so we have to lock their appointment cards away. Their husbands want more children and they think that women who do not keep having their children will go with other men." "More kids, more wealth" Rewda tells us that they've used family counselling to try and persuade men to reconsider their ideas about contraception, by explaining to them that continuously giving birth under unsafe circumstances can affect a woman's health and might lead to maternal death, damage the uterus and lead to long-term complications. "Here, people believe that more kids means more wealth, and religion restricts family planning services. Before, they did not have good training on family planning and abortion. Now, women that have abortions get proper care and the counseling and education has improved. There are still unsafe abortions but they have really reduced. We used to see about 40 a year and now it’s one or two." However, problems still exist. "There are some complications, like irregular bleeding from some contraceptives," Rewda says, and that "women still face conflict with their husbands over family planning and sometimes have to go to court to fight this or divorce them.”