"My husband used to work in India, and when he came back, he got ill and died," says Durga Thame. "We didn’t know that he was HIV-positive, but then then later my daughter got sick with typhoid and went to hospital and was diagnosed with HIV and died, and then I was tested and was found positive." Her story is tragic, but one all too familiar for the women living in this region. Men often travel to India in search of work, where they contract HIV and upon their return infect their wives. For Durga, the death of her husband and daughter and her own HIV positive diagnosis threw her into despair.  "My neighbours used to discriminate against me … and I suffered violence at the hands of my community. Everybody used to say that they couldn’t eat whatever I cooked because they might get HIV." Then Durga heard about HIV education classes run by the Palpa branch of the Family Planning Association of Nepal (FPAN), a short bus journey up the road in Tansen, the capital of Palpa.  "At those meetings, I got information about HIV," she says. "When I came back to my village, I began telling my neighbours about HIV. They came to know the facts and they realised it was a myth that HIV could be transferred by sharing food. Then they began treating me well." FPAN ran nutrition, hygiene, sanitation and livelihood classes that helped Durga turn the fortunes of her small homestead around. Durga sells goats and hens, and with these earnings supports her family – her father-in-law and her surviving daughter, who she says has not yet been tested for HIV. "I want to educate my daughter," she says. "I really hope I can provide a better education for her." Stories Read more stories about our work with people living with HIV  

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Women and girls are disproportionately affected in humanitarian crises and face multiple sexual and reproductive health challenges in these contexts. IPPF has been providing much needed support to vulnerable communities through our global federation of member associations, who provide contextualised, timely and tailored interventions drawing on local partners' knowledge and expertise. However, recent shifts in the global political landscape are concerning and threaten to undermine IPPF's mission and impact on the ground. We live in a time when crises, whether brought on by human causes or natural disaster, have displaced more people than at any point since the Second World War. The needs of those driven from their homes are not transitory. Refugees now find themselves facing impermanent conditions for an average of 20 years. They must resort to living in temporary shelters or makeshift accommodation, and their refugee status often leaves them ineligible to access public healthcare and education. The UN reports there are more than 125 million people worldwide in need of humanitarian assistance. Of those, a quarter are women and girls between the ages of 15 and 49. And one in five of these women and girls is likely to be pregnant. A woman who has been forced to flee is particularly vulnerable. More than 60% of maternal deaths take place in humanitarian and fragile contexts, according to the UN Population Fund (UNFPA). At least half of these women’s lives could easily be saved. And yet women and girls affected by humanitarian crises face other risks too. A breakdown in civil order following disasters consistently increases the occurrence of sexual violence, exposure to sexually transmitted infections including HIV, and unintended pregnancies. After the 2015 cyclone in the Pacific Island nation of Vanuatu, a counselling centre recorded a 300% spike in gender-based violence referrals. Likewise, a study with Syrian refugee women displaced by conflict found that more than 50% experienced reproductive tract infections, almost a third had experienced gender-based violence, and the majority had not sought medical care. IPPF is at the forefront of delivering life-saving services. Our sexual and reproductive health program in crisis and post-crisis situations (SPRINT), established in 2007 and supported by the Australian Government, has ensured access to essential sexual and reproductive health services for women, men and children in times of crisis. Under the banner of our new IPPF Humanitarian division, the SPRINT initiative is now part of a global movement that seeks to provide all those affected by crises worldwide with dignity, protection and care. As a federation of 142 locally-owned but globally connected member associations, IPPF has a unique model for providing these vital humanitarian services. Our focus on valuing local solutions means our responses are rapid and sustainable. We see it as vital to be on the ground before, during, and after crises. Member associations work to mitigate against sexual and reproductive health (SRH) issues ahead of a crisis to reduce negative impacts, and remain afterward to assist communities to recover and rebuild their lives. When Cyclone Winston struck Fiji in February last year, IPPF’s local member association, the Reproductive and Family Health Association of Fiji (RFHAF), was already preparing to mobilise teams of volunteers and health staff. Initially, sexual and reproductive health was not prioritised at a national level, thus the first challenge was to convince the Government of Fiji and lead agencies of the critical importance of including sexual and reproductive health issues in the response. With support from IPPF and SPRINT personnel, RFHAF successfully advocated with the government to include reproductive health concerns into the post-cyclone needs assessment, and supported the Government in carrying this assessment out. Coordination and collaboration was critical as the damage was across an extensive area on several islands. Working in partnership with the Ministry of Health (MoH), UNFPA, Red Cross Society and local non-government agencies, RFHAF provided SRH care to remote areas identified as being worst hit by the cyclone. Colleagues from SPRINT and RFHAF split into three teams, moving into the field simultaneously to conduct 37 mobile medical missions to reach women and girls, with vulnerable pregnant women and new mothers prioritised. Comprehensive follow up beyond the initial response post-cyclone was a particular challenge for an organisation of just 11 staff. To address this, RFHAF leveraged their existing partnership with the MoH to facilitate training and handover of SRH service provision to district nurses and sub-divisional health centres, once these facilities were again operational. The response in Fiji utilised the Minimum Initial Service Package for Reproductive Health, which IPPF helped to pioneer. Commonly referred to as ‘the MISP’, the package is a series of priority life-saving interventions that IPPF seek to implement as soon as possible following a crisis.

The lives of millions of the world’s poorest women and girls are in jeopardy because of the expansion of the US Global Gag Rule (GGR), IPPF’s Director General has said. The expansion of the GGR (or Mexico City Policy) will deny critical health care to many of the poorest women on the planet, forcing millions of them into unplanned pregnancies, unsafe abortions and leading to thousands of deaths. Tewodros Melesse was speaking after the announcement of the policy expansion last night. It means that access to critical affordable, high quality integrated reproductive healthcare services like contraception, Zika information, maternal health, ante-natal care, reproductive cancers, and HIV prevention and treatment will be denied around the world. The policy will hit hardest the women living at the margins of society – the poorest, the most remote and those under 25. Leaving millions behind and forced into unintended pregnancy, ill health or death because the essential services they need have or are being shut down. Tewodros Melesse, Director General, said: “This expansion of the Global Gag Rule is unprecedented and the largest of its kind. Leaving behind the hardest to reach and often poorest of marginalised women and communities is the worst possible situation. This policy asks IPPF to stop providing support, counselling and services which are entirely legal in the countries where our members provide them and women depend on them. We cannot do that. The consequences are fatal and will span generations. We believe women should be able to decide what happens to their bodies, safely and legally. We cannot accept a demand which we know will only increase the number of women being forced into pregnancy or worse. “    IPPF estimates that the withdrawal in funding from the Federation will lead to an additional 20,000 maternal deaths, 4.8 million unintended pregnancies and 1.7 million unsafe abortions.     The expanded policy also obstructs the potential health partnerships on the ground in developing countries where IPPF Member Associations work closely with other medical organizations for referrals and support of clients. This means that the very valuable space between medical providers and patients will be compromised as referrals options become limited and as valuable services are closed. USAID has been a proud supporter of family planning and public health programming for decades. The enormous expense on USAID to administer this kind of order, for what could be a limited time, means the very money allocated to what they have done best – saving lives will be hugely diminished in impact and effectiveness. International Planned Parenthood Federation will lose 100 M USD in critical funding. On behalf of their members, the Federation issued a statement in January explaining why they can't sign the Global Gag Rule.   Subscribe to our updates!

At the end of a long day, Anicia, closes the clinic with praise for her colleagues who never turn anyone away. "We open at 8am. From 8am we will be receiving a variety of clients for different services - whether post-abortion care, whether antenatal care - we have to give them all the services. We may end up to 10pm, because we'll never chase our clients, we'll never close the place when we have a client inside. People come when they have no hope. You receive them, and you give them hope by treating them properly and giving them quality services. The client gets better and will never forget you. And follow them up on the phone. "How are you doing?" It's good for us to know that they're doing well. Others even tell us 'The way you handle us, we love it so much'." Follow a day in the life of our team and clients in Gulu, Uganda 07:00 08:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 22:00 Prev Next 7am: The team prepare for the long day ahead "Every year tens of thousands of Ugandans come to our clinic. Everyone is welcome. Here are just a few of the people that we served in one day last month." READ MORE 8am: Nancy, 19, becomes a volunteer "I was suffering but when I came here, I was treated and I got better. Now I'm inspired to volunteer here" READ MORE 9am: Monica, 25, a sex worker's story "I am sex working. I came here for Hepatitis B testing and also counselling. I have so many personal problems, but here….they’re so caring." READ MORE 10am: Jane, 23, saved by family planning "After multiple miscarriages, family planning here has helped me a lot. I'm glad we've been able to space the number of children we've had. I am not growing old, I am fresh." READ MORE 11am: Vicky, handling disabilities "I'm deaf so accessing services is hard, but here they really try to speak in sign language." READ MORE 12pm: Dorcus, first time patient "This is the first time I've ever come here, I like the service. They give good counselling so I recommend coming." READ MORE 1pm: Christine, 45, a grandmother's tale of living with HIV "I am living with HIV and had HPV. They treated me and now I'm free of cervical cancer." READ MORE 2pm: Lilian, struggling mother of six with sickle cell " I have sickle cell disease and so do all my children. I want to have my tube removed so that I don't get pregnant again but I don't know if my husband will allow it." READ MORE 3pm: Brenda and Francis get fertility treatments "Fertility treatment is a sensitive issue in Uganda but they help us a lot and we get proper treatment." READ MORE 4pm: Joyce, 25, repected regardless of her disability "I realised that at this place they don't segregate. Us people with disabilities have challenges at the main hospitals. You go there, people around look at you as if you are not a human being and you don't fall sick." READ MORE 5pm: Mobile clinic provides outreach services to remote villages "Our outreach to remote communities is a 'one-stop-centre'. We give family planning, vaccines for HPV, malaria, and Hepatitis B, HIV testing and more." READ MORE 22pm: Still giving the last client our very best "Together, we have great teamwork. Sometimes we're still working up to 10pm because we never chase out our clients. We’ll never close the place when we have a client inside. People come when they have no hope." READ MORE

Every Thursday a team from RHU Gulu district provides a mobile outreach clinic in Atega village in the Omoro district in Northern Uganda. The outreach team goes out into this poor, remote area which would otherwise not have access to sexual and reproductive health services. The night before the outreach clinic RHU driver, Robert Nyeko and Godfrey Bedimot load up tents, chairs, medical equipment and supplies. The clinic needs to be set up and by 7am ready to receive clients from 8am. The outreach clinic provides a range of services including diagnosis, testing and treatment, family planning such as fitting implants, providing condoms and HPV vaccines. Laboratory technician, Denis Bongonyinge carries out testing for malaria, Hepatitis B, HIV/AIDS, pneumonia and other infections. Other members of the team provide immunisations and vaccinations. Typically men, women and children start arriving at the clinic by 7:30am. Two volunteers are on hand to direct them to the appropriate place to get the services they need. Some clients need a range of services. At 8am service provider, Anicia Filda, popularly known a 'Mama' in the community is ready with her team to start the day. There are now more than 200 clients waiting to be seen; with more people arriving to join the long queues. The longest queue is for the immunisation and vaccination services. The majority have come for either the Hepatitis B vaccine, which is a big threat in this community. Priority is given to the many young girls lining up for the Human Papilloma Virus (HPV) vaccine. Denis Bongonyinge takes blood samples for rapid tests for malaria, HIV, HPV and a range of other infections. Each client carries an exercise book where Denis records their results which is then taken to the staff giving out prescriptions. 32-year-Robert Otim pushes his bicycle to the outreach clinic. The single father has ridden 10 kilometres with his two young children. He lost his wife to Hepatitis B when their daughter was just six months. His four-year-old son was born prematurely and is now disabled. He has come today for his last Hepatitis B immunisation. His children need to be vaccinated as well as treated for malaria and coughs. Looking at the long queue, he says he doubts whether he will get the service today but he is lucky as one of the team who once treated his son, Geoffrey, notices Robert and they are given priority for treatment and prescriptions. Already by midday, one of the teams delivering minor surgeries, postnatal services, family planning and post abortion care have seen 47 mothers. This is almost the same as the number of clients they would treat at the Gulu Clinic during a normal day. Anicia Filda sends the driver to collect more supplies from the clinic; the stock is starting to run low because demand is so high There is no break for the team. Samuel Kedi, the only clinician at the outreach camp stands up, and picks up a bottle of water from his backpack for a quick drink before continuing with the next client. The clinic continues to see clients well into the evening. The outreach clinic is scheduled to finish by 5pm but Anicia says there is not one day they have closed on time: “We cannot close when clients are still lining up. It’s the same at the clinic in Gulu,” she says. As the clinic draws to a close for the day, the teams complete their report which records details of the numbers clients served, the types of services delivered and supplies of stock. It has been another busy but successful day for Anicia and her team. Provision of integrated services in such remote areas is vital for the local community; many men, women and children would not be able to receive the types of treatment and care that RHU works diligently to provide. Follow a day in the life of our team and clients in Gulu, Uganda 07:00 08:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 22:00 Prev Next 7am: The team prepare for the long day ahead "Every year tens of thousands of Ugandans come to our clinic. Everyone is welcome. Here are just a few of the people that we served in one day last month." READ MORE 8am: Nancy, 19, becomes a volunteer "I was suffering but when I came here, I was treated and I got better. Now I'm inspired to volunteer here" READ MORE 9am: Monica, 25, a sex worker's story "I am sex working. I came here for Hepatitis B testing and also counselling. I have so many personal problems, but here….they’re so caring." READ MORE 10am: Jane, 23, saved by family planning "After multiple miscarriages, family planning here has helped me a lot. I'm glad we've been able to space the number of children we've had. I am not growing old, I am fresh." READ MORE 11am: Vicky, handling disabilities "I'm deaf so accessing services is hard, but here they really try to speak in sign language." READ MORE 12pm: Dorcus, first time patient "This is the first time I've ever come here, I like the service. They give good counselling so I recommend coming." READ MORE 1pm: Christine, 45, a grandmother's tale of living with HIV "I am living with HIV and had HPV. They treated me and now I'm free of cervical cancer." READ MORE 2pm: Lilian, struggling mother of six with sickle cell " I have sickle cell disease and so do all my children. I want to have my tube removed so that I don't get pregnant again but I don't know if my husband will allow it." READ MORE 3pm: Brenda and Francis get fertility treatments "Fertility treatment is a sensitive issue in Uganda but they help us a lot and we get proper treatment." READ MORE 4pm: Joyce, 25, repected regardless of her disability "I realised that at this place they don't segregate. Us people with disabilities have challenges at the main hospitals. You go there, people around look at you as if you are not a human being and you don't fall sick." READ MORE 5pm: Mobile clinic provides outreach services to remote villages "Our outreach to remote communities is a 'one-stop-centre'. We give family planning, vaccines for HPV, malaria, and Hepatitis B, HIV testing and more." READ MORE 22pm: Still giving the last client our very best "Together, we have great teamwork. Sometimes we're still working up to 10pm because we never chase out our clients. We’ll never close the place when we have a client inside. People come when they have no hope." READ MORE

Vicky Acora is a married mother of two. She faces all the usual challenges that women face when it comes to getting sexual and reproductive health services but Vicky’s life is further complicated because she is deaf. She says the biggest challenge in accessing services is communication. “For example I come to the health centre, I meet a nurse but how will I communicate with her? “They speak to me in English but I know Acholi and then there’s sign language which they don’t know. Many times interpreters want money if you are to come with them,” explains Acora. Vicky stopped education in primary school after both of her parents died at the peak of the 20-year insurgency in Northern Uganda. Vicky learnt sign language through Gulu's Disable Person’s Union where she is a board member representing Deaf Women. She also went through the Gulu Deaf Association where she learnt how to communicate in sign language. Acora, first came to know about Reproductive Health Uganda in January this year when she was invited to volunteer to cook for participants at a training session. Then in June, she returned to the clinic to test for HIV. She says she had previously had a bad experience at a hospital in Gulu when she was seeking antenatal services when she was pregnant. “When I was pregnant, I entered the hospital, I sat in a queue, and the nurse asked me how can I help you? It was very hard for me to explain. I didn’t know what she was asking. And then the nurse asked what the problem with this woman was." Her experience at Gulu Clinic, however, was very different. “They are really most welcoming and they try to communicate even in the little sign language they know. They are really very warm.” She says she has since been advising other deaf people to seek services with Reproductive Health Uganda.   Through her interpreter Acora said: “I also encourage disabled people who use wheelchairs to come and access services here – not just deaf people.” Follow a day in the life of our team and clients in Gulu, Uganda 07:00 08:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 22:00 Prev Next 7am: The team prepare for the long day ahead "Every year tens of thousands of Ugandans come to our clinic. Everyone is welcome. Here are just a few of the people that we served in one day last month." READ MORE 8am: Nancy, 19, becomes a volunteer "I was suffering but when I came here, I was treated and I got better. Now I'm inspired to volunteer here" READ MORE 9am: Monica, 25, a sex worker's story "I am sex working. I came here for Hepatitis B testing and also counselling. I have so many personal problems, but here….they’re so caring." READ MORE 10am: Jane, 23, saved by family planning "After multiple miscarriages, family planning here has helped me a lot. I'm glad we've been able to space the number of children we've had. I am not growing old, I am fresh." READ MORE 11am: Vicky, handling disabilities "I'm deaf so accessing services is hard, but here they really try to speak in sign language." READ MORE 12pm: Dorcus, first time patient "This is the first time I've ever come here, I like the service. They give good counselling so I recommend coming." READ MORE 1pm: Christine, 45, a grandmother's tale of living with HIV "I am living with HIV and had HPV. They treated me and now I'm free of cervical cancer." READ MORE 2pm: Lilian, struggling mother of six with sickle cell " I have sickle cell disease and so do all my children. I want to have my tube removed so that I don't get pregnant again but I don't know if my husband will allow it." READ MORE 3pm: Brenda and Francis get fertility treatments "Fertility treatment is a sensitive issue in Uganda but they help us a lot and we get proper treatment." READ MORE 4pm: Joyce, 25, repected regardless of her disability "I realised that at this place they don't segregate. Us people with disabilities have challenges at the main hospitals. You go there, people around look at you as if you are not a human being and you don't fall sick." READ MORE 5pm: Mobile clinic provides outreach services to remote villages "Our outreach to remote communities is a 'one-stop-centre'. We give family planning, vaccines for HPV, malaria, and Hepatitis B, HIV testing and more." READ MORE 22pm: Still giving the last client our very best "Together, we have great teamwork. Sometimes we're still working up to 10pm because we never chase out our clients. We’ll never close the place when we have a client inside. People come when they have no hope." READ MORE

"I’m 25-years-old and a mother of two children. I lost my parents during the war, so I grew up alone. I ended up dropping out of school and I went for sex working. I am selling myself in order for me to sustain a living. "My second born is 10 months old and my first born is 7 years. He’s at home with me because I have no money to pay for his school fees. "I heard about Reproductive Health Uganda a few years ago but I couldn’t access it until they did their outreaches where I was staying. I stay far from town. "I came purposely here to RHU for Hepatitis B testing and also counselling because I have so many personal problems. I’m also on family planning and about to start using an IUD, I want to get that from here now also. "I like coming here, I’m satisfied with all the services because it's free of charge, they’re so caring, the way that they handle people. They handled us in a good way, they know how to talk to us. I’m so happy about the way I was welcomed here. Follow a day in the life of our team and clients in Gulu, Uganda 07:00 08:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 22:00 Prev Next 7am: The team prepare for the long day ahead "Every year tens of thousands of Ugandans come to our clinic. Everyone is welcome. Here are just a few of the people that we served in one day last month." READ MORE 8am: Nancy, 19, becomes a volunteer "I was suffering but when I came here, I was treated and I got better. Now I'm inspired to volunteer here" READ MORE 9am: Monica, 25, a sex worker's story "I am sex working. I came here for Hepatitis B testing and also counselling. I have so many personal problems, but here….they’re so caring." READ MORE 10am: Jane, 23, saved by family planning "After multiple miscarriages, family planning here has helped me a lot. I'm glad we've been able to space the number of children we've had. I am not growing old, I am fresh." READ MORE 11am: Vicky, handling disabilities "I'm deaf so accessing services is hard, but here they really try to speak in sign language." READ MORE 12pm: Dorcus, first time patient "This is the first time I've ever come here, I like the service. They give good counselling so I recommend coming." READ MORE 1pm: Christine, 45, a grandmother's tale of living with HIV "I am living with HIV and had HPV. They treated me and now I'm free of cervical cancer." READ MORE 2pm: Lilian, struggling mother of six with sickle cell " I have sickle cell disease and so do all my children. I want to have my tube removed so that I don't get pregnant again but I don't know if my husband will allow it." READ MORE 3pm: Brenda and Francis get fertility treatments "Fertility treatment is a sensitive issue in Uganda but they help us a lot and we get proper treatment." READ MORE 4pm: Joyce, 25, repected regardless of her disability "I realised that at this place they don't segregate. Us people with disabilities have challenges at the main hospitals. You go there, people around look at you as if you are not a human being and you don't fall sick." READ MORE 5pm: Mobile clinic provides outreach services to remote villages "Our outreach to remote communities is a 'one-stop-centre'. We give family planning, vaccines for HPV, malaria, and Hepatitis B, HIV testing and more." READ MORE 22pm: Still giving the last client our very best "Together, we have great teamwork. Sometimes we're still working up to 10pm because we never chase out our clients. We’ll never close the place when we have a client inside. People come when they have no hope." READ MORE

Even before Cyclone Winston, there was very little knowledge about contraception and sexually transmitted infections in Fiji. IPPF health professionals are now providing the affected population with counselling and advice on family planning and sexual health. 

IPPF Director General Tewodros Melesse has said that a decision by the US Government to withdraw funding from the United Nations Population Fund will have “devastating consequences” for women and girls around the world. Mr Melesse said: “The money the US administration now wants to withdraw would have been spent on health care for some of the poorest and most vulnerable women and girls in the world. “It will take away funding for contraception, maternal care and the safe delivery of babies, as well as  programmes to counter gender-based violence. “IPPF works closely with UNFPA in some of the most difficult situations in the world to provide this kind of care, especially in the poorest regions of the world’s poorest countries. The women and girls living in these situations are especially vulnerable, and this will have devastating consequences for them.” Mr Melesse added: “This is the second blow this year delivered to health care for women and girls around the world by the new US Administration. “The re-enactment of the Global Gag Rule (also known as the Mexico City Policy) has already denied US funding for contraception services, HIV programmes and work to counter the Zika outbreak to IPPF and other health organisations. “We estimate that the $100m in funding IPPF expects to lose will stop us from preventing 20,000 maternal deaths, will lead to 4.8m unintended pregnancies and 1.7 million unsafe abortions. “We should be clear. None of the funding being withdrawn by the US administration is spent in the provision of abortion or in support of coercive reproductive policies. This is a smokescreen for cuts in funding, nothing more. “As a rights-based organisation, IPPF works in partnership with UNFPA and other health and human rights organisations to provide tens of millions of women and girls with the right to choose how and when they use contraception and to access other live-saving health services. “UNFPA brings governments together to work on commonly-agreed policies such as the Sustainable Development Goals, which are vital in the fight to try to ensure sexual and reproductive health care for everyone. “I am deeply sorry that for a second time in the space of three months the US Administration has decided to deny critical health services to the people who need them most. We know that tens of thousands of lives will be lost as a result.”