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Comprehensive Sex Education

Every young person has to make  life-changing decisions about their sexual and reproductive health. However many of them cannot access clear, evidence-based information. IPPF's comprehensive sexuality education programmes enable young people to make informed decisions about their sexuality and health, while building life skills and promoting gender equality.

Articles by Comprehensive Sex Education

Healthcare worker

Providing information and contraceptive care to young people in school

Accessibility to information and contraceptives has always been a priority for Famia Planea Aruba (FPA) – whether through the office, delivery service, or in schools.   For over 15 years FPA has worked in partnership with one of the largest secondary schools on the island. The FPA team visits the school every month to provide guidance, counselling, and contraceptive care to students, and to help ensure they stay in school to complete their education.   “One of my first experiences providing comprehensive sex education with FPA was at the EPB School, during my education as a social worker. Many years later I still very much enjoy this”, says Richenella, FPA’s Finance and Information, Education and Communication (IEC) support staff.  Building trust  FPA’s client is at the heart of its healthcare provision. The FPA team works with students to build trust and ensure they feel safe to talk openly. This helps to provide a sense of consistency for the student, as well as efficiency for the team being familiar with specific students and cases. They are better able to notice if something changes, and if a student needs a referral to a medical doctor or other organization for additional treatment.  “The consultations are always fun; you get a change of scenery by stepping out of the office. Over the years you see so many faces and still somehow you manage to remember most of them. After just a few visits you can start to build a profile of most students; you can start to tell who the class clown is, the Mister Popular, the shy one, the loud one, and the one who just wants to take his time to avoid going back to class”, Richenella laughs.  Working in partnership with the school social worker   FPA places great value on the 14-year relationship they have with Adriana, the social worker at EPB San Nicolas School. Adriana is the person who has the most contact with the students, and the one most student’s turn to when they need help.   “Most of the time you get to have fun with the students, however every now and then you will come across a heartbreaking case. Since Aruba has so many different migrants, very often you will come across one person who is not insured at the moment, who needs products and can’t afford it – and you figure out a way to help”, Adriana says.  For registered youth under 21 years of age, the costs of the healthcare provision are covered by the national health insurance, however, some students fall outside of the system.  “For our second, third and fourth-year students, FPA has been collaborating with us to provide a monthly session where the students receive contraceptives and guidance on school grounds. Since around this age, most of our students are already sexually active, we try to help them stay safe in and out of school.”  “The love, patience, and dedication that FPA has shown our students over the years are outstanding. At the beginning of the COVID-19 crisis we had to stop the consultation hours, but thankfully we are now back at it, bigger and better. Due to the collaboration with FPA we were able to finish out our 2018-2019 school year with no new pregnancies, which was a first for our school. We hope to accomplish this again, now that we can continue our consultations, and keep our kids educated and in school for as long as we can so they can achieve the best possible future”, Adriana says.   

Aminata Sonogo in school

"Girls have to know their rights"

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

Two young people smiling
21 September 2020

It's All One Curriculum

Researchers have identified gender inequality as a key factor driving the AIDS pandemic. Policymakers have called for sexuality and HIV education that emphasizes gender equality and human rights. Educators want to teach young people the critical thinking skills needed to build compassionate and just societies. It's All One Curriculum responds to these calls.

masturbate-penis
03 September 2020

How to masturbate if you have a penis

It has been proven that masturbation is good for your health: it can reduce stress, can help you sleep better, and make you feel more confident with understanding what you do and don’t like sexually. And, as you are your ‘safest’ sexual partner, there is zero chance of unintended pregnancy and HIV/STI transmission, compared to having sex with a partner or partners. Masturbation is healthy and perfectly normal – it’s an act of self-care and exploration that can help build your sexual confidence. It’s your body and no one should make you feel ashamed or wrong for showing it some love. Next time you feel self-conscious about masturbating, remind yourself that it is good for your health, it’s perfectly normal, and most people do it. Find your rhythm and take your time Long strokes. Short strokes. Rapid strokes. Using your hand wrapped around the shaft (i.e. the length of the penis), find what works for you by experimenting with technique and pressure until you know what will make you orgasm. The tip of the penis and the testicles/scrotum are also good sources of pleasure, so feel that out too. Take your time when masturabating, listen to your body and enjoy exploring what works for you. And remember, preferences change over time so if your go-to rhythm is not working for you this time, try something new! Lube it up The friction of your hand directly onto your penis can cause some desensitization of your penis over time. Lube can be important and enjoyable for many sex acts from masturbation to sexual intercourse, as it reduces friction and can feel really great. Some people use lotion to masturbate with. We recommend using a water-based lube to avoid any irritation. Explore your pleasure spots Masturbation does not need to focus solely stimulating the penis or the testicles. People are aroused by many different areas including playing with their nipples, prostate (located internally) stimulation, and more. So get exploring your own body and you may surprise yourself by the various erogenous spots you discover.  Incorporate sex toys Incorporating sex toys when you masturbate can help add some fun to your routine. You can try a traditional vibrator, using it on the penis or testicles, or you can opt for a masturbation sleeve.  And don’t forget the prostate, which can be stimulated via the perineum, the area between the penis and the anus – there are a number of toys specifically for this if you’re interested. Talk about it  To remove the stigma that surrounds masturbation, we need to be talking about it. (We've also written about masturbating if you've got a vagina, if you want to take the conversation further!) The more healthy discussion on masturbation, the quicker we can break the taboo surrounding it.  Talking to your friends can help build confidence and creates a safe space for you to get together to talk about and ask questions on masturbation. Talking to your sexual partner or partners about what you like, what you don’t like, and your mutual fantasies can help build your sexual confidence which can lead to great sex. 

masturbate-vagina
03 September 2020

How to masturbate if you have a vagina

Did your sex education include anything about masturbation? Ours neither! That’s why we’d love to talk to you about it – specifically, if you have a vagina. (If you’ve got a penis, we’ve got some info for that too.)  First things first: there is absolutely nothing shameful about masturbation! Not in the slightest. It is perfectly normal and healthy. It can help relieve stress, and is a good way of exploring your own body and sexuality, and it just feels really good!  People of all ages, genders and sexualities do it. People in every single country in the world do it. Single people and people in relationships do it. Some people do it frequently, others do it occasionally and some don’t do it at all. It’s all normal. We’re glad we’ve cleared that up!  Getting started Next, how should it be done? There are plenty of ways, and it’s all about finding what works for you.  The two main ways people with vaginas masturbate is either clitorally or vaginally. Before you get going on the good stuff, a helpful place to start may be to see what you look like down there, by getting a hand mirror and trying to locate the clitoris, vagina opening, labia etc. The picture on the left might help you match up what’s what, but don’t worry if you’re still not sure – all vaginas are different and that’s OK! Stimulating the clitoris The clitoris (or clit), marked in the picture, has thousands of nerve endings making it a highly sensitive area, and is how most people with vaginas achieve orgasm. It can be stimulated with your fingers, or with a vibrating sex toy (more on that later).  Using either your fingers or a sex toy (or a combination of both) try rubbing the clitoris in circular or back-and-forth motions, with varying levels of pressure until you find something that brings you to a nice state of arousal.  You can also get the different parts of the labia involved (consult the picture again to find them), by seeing if stimulating them in a similar way feels good.  The G-spot The vagina may also be a source of joy for you, specifically the G-spot. It’s located internally, and can be trickier to find and stimulate. To find it, slowly insert one or two fingers into your vagina opening, and curl them upwards to touch or rub the textured area behind your pubic bone. Some people find this extremely satisfying, though it’s also pretty normal if it isn’t pleasurable or orgasm-inducing for you at all.  What products should I use? If you’re just starting out, you could consider a smaller sex toy, such as a bullet to stimulate your clitoris and labia. There are also toys specifically for the G-spot that can help you explore this sometimes-mysterious erogenous zone too! You might find that adding a few drops of lube onto your body or sex toy might enhance the pleasure too.  Remember to wash sex toys before and after use, and to wash your hands before and after masturbating or any kind of sexual activity. Positions For all types of masturbation, you might also want to think about positions. Many people choose to lie back on their bed for comfort, but you might find that, for example, kneeling, sitting or standing up works better, or masturbating in the shower might do it for you.  How long should it take? There’s no time limit for how long it may take to orgasm (which typically feels like an intense build-up, culminating in a pleasurable release), so take as long as you need. Is it safe to masturbate? No matter what you’ve heard, masturbation is completely safe – nothing bad will happen to you if you do it. In many ways it’s actually the safest form of sex there is, as there’s no risk of HIV/STI transmission or unintended pregnancy. Just make sure you masturbate in private, and if you choose to do it with a partner (which can also be a lot of fun), ensure that they have consented first.  Not only is it safe, it is probably a lot more common than you think. All in all, there is no right or wrong way to masturbate – it’s all about trying out different techniques to find something that works for you. Enjoy!

opening of the film
12 August 2020

Tanzania: A youth center on a mission to destigmatize sexual health

Cultural stigmas leave many young people in Tanzania in the dark about their sexual and reproductive health and rights. Our Member Association - Chama cha Uzazi na Malezi Bora Tanzania (UMATI) - has come up with a solution at their youth center in Dar es Salaam: peer-to-peer educators.  Every week over 100 youth sign up for services and training at the center. In 2017 the Global Gag Rule pulled funding from UMATI, however, the Belgian Government stepped in with emergency funding which allowed the center to remain open through the She Decides project.

Youth dancers in Jimma, Ethiopia
30 July 2020

Youth-led sexual healthcare through dance, song, and poetry

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.

Jumeya Mohammed Amin

"I wanted to protect girls from violence – like early marriage – and I wanted to change people’s wrong perceptions about sex and sexuality"

Seventeen-year-old student Jumeya Mohammed Amin started educating other people about sexual and reproductive health when she was 14 years old. She trained as a ‘change agent’ for her community through the Family Guidance Association of Ethiopia’s south west office in Jimma, the capital of Oromia region. Amin comes from a small, conservative town about 20km outside the city. "I wanted to protect girls from violence – like early marriage – and I wanted to change people’s wrong perceptions about sex and sexuality, because they [men in her community] start having sex with girls at a young age, even with girls as young as nine years old, because of a lack of education." "They suddenly had to act like grown-up women" "Before I started this training I saw the majority of students having sex early and getting pregnant because of a lack of information, and they would have to leave home and school. Boys would be disciplined and if they were seen doing things on campus, expelled. Girls younger than me at the time were married. The youngest was only nine. They would have to go back home and could not play anymore or go to school. They suddenly had to act like grown-up women, like old ladies. They never go back to school after marriage. My teacher chose me for this training and told me about the programme. I like the truth so I was not afraid. I heard about a lot of problems out there during my training and I told myself I had to be strong and go and fight this." "I have a brother and four sisters and I practiced my training on my family first. They were so shocked by what I was saying they were silent. Even on the second day, they said nothing. On the third day, I told them I was going to teach people in schools this, so I asked them why they had stayed silent. They told me that because of cultural and religious issues, people would not accept these ideas and stories, but they gave me permission to go and do it. Because of my efforts, people in my school have not started having sex early and the girls get free sanitary pads through the clubs so they no longer need to stay home during periods." Training hundreds of her peers "I know people in my community who have unplanned pregnancies consult traditional healers [for abortions] and take drugs and they suffer. I know one girl from 10th grade who was 15 years old and died from this in 2017. The healers sometimes use tree leaves in their concoctions.  We tell them where they can go and get different [safe abortion] services. The first round of trainings I did was with 400 students over four months and eight sessions in 2017. Last year, I trained 600 people and this year in the first trimester of school I trained 400. When students finish the course, they want to do it again, and when we forget we have a session, they come and remind me. At school, they call me a teacher. I’d like to be a doctor and this training has really made me want to do that more."

cashew nut factory worker, Ghana
20 February 2020

Ghana: Expanding healthcare for young people and factory workers

Mother of six Elizabeth Adom rides a staff bus up a long, dusty dirt road, through towering pine trees, past wooden bungalows and the outward stretch of the canopy of cashew trees, to reach the cashew factory she works at in a small town in rural Ghana. Adom never planned to have six children but struggled to access the right contraception. So when Planned Parenthood Association Ghana (PPAG) along with the Danish Family Planning Association (DFPA) in 2018 began rolling out a project at the factory and in the Mim township to help women like her take control of their reproductive health, she was pleased. Both PPAG and DFPA are focused on providing sexual and reproductive health and rights (SRHR) information and service, especially for women and girls.  "I am now currently accessing family planning. It is helping me. I don't want to give birth again," Adom emphatically says, while taking a break from peeling cashews at the factory. As a former-teen mother herself, she also shares what she has learnt with her children. "[There] is the danger associated with early childbirth, your life becomes difficult, and you encounter so many challenges in your life." Helping young people  The project also targets young people in Mim, which has a population of about 30,000. Traditionally Mim was known for its timber industry, but in recent years factories have collapsed or had to undergo mass layoffs to survive, leaving many in economic hardship.  Before rolling out the project, PPAG research of young people in Mim found almost 80 per cent had very low knowledge on SRHR, despite the majority of them having had sex - of those condom use was low, as was seeking STI treatments. Beliefs about rights to access information and services around reproductive healthcare were also low. They were also uncomfortable discussing SRHR with their parents, preferring to speak to their peers.  A meaningful way to get SRHR information both to young people and the factory workers is through peer educators. Adom often meets with a colleague who has received specialised training from PPAG to educate others on SRHR.  Abena Amoah, executive director of PPAG, says in Ghana, education on sexual and reproduction health rights is generally becoming more accepted but a lot more work needs to be done.  "Traditionally, it's not said in the open," she says. "A lot of people still do not subscribe to providing the information openly on sexual and reproductive health and even providing services." The four-year project in Mim is supported by private funding.  Health facility staff throughout Mim have been trained in youth-friendly services, to make it easier and quicker to get help and information rather than facing what can be bureaucratic processes in the healthcare system in Ghana.  Patients can access comprehensive abortion care, a range of different contraception options and STI treatments. The project also works with ten schools where  clubs have been formed to discuss SRHR. The project is also gearing up to offer livelihood training so young people can be economically independent, by placing young people from Mim in long-term apprenticeships or offering skills training so they can set up their own businesses. Discussing sexual health openly  Abdul-Mumin Abukari, the PPAG DFPA Mim project officer says so far, they have seen several positive changes, including creating an environment where SRHR can be discussed openly in the community. He also finds people now realise the need for the services. "There were a lot of teenage pregnancies, there were a lot of sexually transmitted diseases, there were a lot of challenges in this community, but someway, somehow people felt that it was normal. They had accepted the situation, and they were living with it. So, the project has come to create some kind of awareness on these issues - that there's nothing normal about 13-year-olds and 14-year-olds getting pregnant." Supporting workers  At Mim Cashew, workers like Adom steam, shell, sort, peel and package the organic cashews for export. The factory has colourful PPAG posters displayed on the walls throughout.  Factory manager Matthew Porter says so far, the project has increased sensitisation amongst the workers to protect themselves and plan their lives. "People can look after themselves better and their children," he says. Jemima Akusika Hansen, HR manager at Mim Cashew, says focusing on employees' health also helps the factory.  "We think that if that is done, it will reduce absenteeism, then some of the unintended pregnancies and then STIs will be reduced." Workers also feel more comfortable in speaking about going for birth control measures at the clinics. "Now they know pregnancy is a choice. So they plan when they want to have it and when they don't want to."

Sophia Abrafi, Midwife at the Mim Health Centre, 40

“Teenage pregnancies will decrease, unsafe abortions and deaths as a result of unsafe abortions will decrease"

Midwife Sophia Abrafi sits at her desk, sorting her paperwork before another patient comes in looking for family planning services. The 40-year-old midwife welcomes each patient with a warm smile and when she talks, her passion for her work is clear.  At the Mim Health Centre, which is located in the Ahafo Region of Ghana, Abrafi says a sexual and reproductive health and right (SRHR) project through Planned Parenthood Association of Ghana (PPAG) and the Danish Family Planning Association (DFPA) allows her to offer comprehensive SRH services to those in the community, especially young people. Before the project, launched in 2018, she used to have to refer people to a town about 20 minutes away for comprehensive abortion care. She had also seen many women coming in for post abortion care service after trying to self-administer an abortion. “It was causing a lot of harm in this community...those cases were a lot, they will get pregnant, and they themselves will try to abort.”   Providing care & services to young people Through the clinic, she speaks to young people about their sexual and reproductive health and rights. “Those who can’t [abstain] we offer them family planning services, so at least they can complete their schooling.” Offering these services is crucial in Mim, she says, because often young people are not aware of sexual and reproductive health risks.  “Some of them will even get pregnant in the first attempt, so at least explaining to the person what it is, what she should do, or what she should expect in that stage -is very helpful.” She has already seen progress.  “The young ones are coming. If the first one will come and you provide the service, she will go and inform the friends, and the friends will come.” Hairdresser Jennifer Osei, who is waiting to see Abrafi, is a testament to this. She did not learn about family planning at school. After a friend told her about the clinic, she has begun relying on staff like Abrafi to educate her. “I have come to take a family planning injection, it is my first time taking the injection. I have given birth to one child, and I don’t want to have many children now,” she says. Expanding services in Mim The SRHR project is working in three other clinics or health centres in Mim, including at the Ahmadiyya Muslim Hospital. When midwife Sherifa, 28, heard about the SRHR project coming to Mim, she knew it would help her hospital better help the community. The hospital was only offering care for pregnancy complications and did little family planning work. Now, it is supplied with a range of family planning commodities, and the ability to do comprehensive abortion care, as well as education on SRHR. Being able to offer these services especially helps school girls to prevent unintended pregnancies and to continue at school, she says.  Sherifa also already sees success from this project, with young people now coming in for services, education and treatment of STIs. In the long term, she predicts many positive changes. “STI infection rates will decrease, teenage pregnancies will decrease, unsafe abortions and deaths as a result of unsafe abortions will decrease. The young people will now have more information about their sexual life in this community, as a result of the project.”

Healthcare worker

Providing information and contraceptive care to young people in school

Accessibility to information and contraceptives has always been a priority for Famia Planea Aruba (FPA) – whether through the office, delivery service, or in schools.   For over 15 years FPA has worked in partnership with one of the largest secondary schools on the island. The FPA team visits the school every month to provide guidance, counselling, and contraceptive care to students, and to help ensure they stay in school to complete their education.   “One of my first experiences providing comprehensive sex education with FPA was at the EPB School, during my education as a social worker. Many years later I still very much enjoy this”, says Richenella, FPA’s Finance and Information, Education and Communication (IEC) support staff.  Building trust  FPA’s client is at the heart of its healthcare provision. The FPA team works with students to build trust and ensure they feel safe to talk openly. This helps to provide a sense of consistency for the student, as well as efficiency for the team being familiar with specific students and cases. They are better able to notice if something changes, and if a student needs a referral to a medical doctor or other organization for additional treatment.  “The consultations are always fun; you get a change of scenery by stepping out of the office. Over the years you see so many faces and still somehow you manage to remember most of them. After just a few visits you can start to build a profile of most students; you can start to tell who the class clown is, the Mister Popular, the shy one, the loud one, and the one who just wants to take his time to avoid going back to class”, Richenella laughs.  Working in partnership with the school social worker   FPA places great value on the 14-year relationship they have with Adriana, the social worker at EPB San Nicolas School. Adriana is the person who has the most contact with the students, and the one most student’s turn to when they need help.   “Most of the time you get to have fun with the students, however every now and then you will come across a heartbreaking case. Since Aruba has so many different migrants, very often you will come across one person who is not insured at the moment, who needs products and can’t afford it – and you figure out a way to help”, Adriana says.  For registered youth under 21 years of age, the costs of the healthcare provision are covered by the national health insurance, however, some students fall outside of the system.  “For our second, third and fourth-year students, FPA has been collaborating with us to provide a monthly session where the students receive contraceptives and guidance on school grounds. Since around this age, most of our students are already sexually active, we try to help them stay safe in and out of school.”  “The love, patience, and dedication that FPA has shown our students over the years are outstanding. At the beginning of the COVID-19 crisis we had to stop the consultation hours, but thankfully we are now back at it, bigger and better. Due to the collaboration with FPA we were able to finish out our 2018-2019 school year with no new pregnancies, which was a first for our school. We hope to accomplish this again, now that we can continue our consultations, and keep our kids educated and in school for as long as we can so they can achieve the best possible future”, Adriana says.   

Aminata Sonogo in school

"Girls have to know their rights"

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

Two young people smiling
21 September 2020

It's All One Curriculum

Researchers have identified gender inequality as a key factor driving the AIDS pandemic. Policymakers have called for sexuality and HIV education that emphasizes gender equality and human rights. Educators want to teach young people the critical thinking skills needed to build compassionate and just societies. It's All One Curriculum responds to these calls.

masturbate-penis
03 September 2020

How to masturbate if you have a penis

It has been proven that masturbation is good for your health: it can reduce stress, can help you sleep better, and make you feel more confident with understanding what you do and don’t like sexually. And, as you are your ‘safest’ sexual partner, there is zero chance of unintended pregnancy and HIV/STI transmission, compared to having sex with a partner or partners. Masturbation is healthy and perfectly normal – it’s an act of self-care and exploration that can help build your sexual confidence. It’s your body and no one should make you feel ashamed or wrong for showing it some love. Next time you feel self-conscious about masturbating, remind yourself that it is good for your health, it’s perfectly normal, and most people do it. Find your rhythm and take your time Long strokes. Short strokes. Rapid strokes. Using your hand wrapped around the shaft (i.e. the length of the penis), find what works for you by experimenting with technique and pressure until you know what will make you orgasm. The tip of the penis and the testicles/scrotum are also good sources of pleasure, so feel that out too. Take your time when masturabating, listen to your body and enjoy exploring what works for you. And remember, preferences change over time so if your go-to rhythm is not working for you this time, try something new! Lube it up The friction of your hand directly onto your penis can cause some desensitization of your penis over time. Lube can be important and enjoyable for many sex acts from masturbation to sexual intercourse, as it reduces friction and can feel really great. Some people use lotion to masturbate with. We recommend using a water-based lube to avoid any irritation. Explore your pleasure spots Masturbation does not need to focus solely stimulating the penis or the testicles. People are aroused by many different areas including playing with their nipples, prostate (located internally) stimulation, and more. So get exploring your own body and you may surprise yourself by the various erogenous spots you discover.  Incorporate sex toys Incorporating sex toys when you masturbate can help add some fun to your routine. You can try a traditional vibrator, using it on the penis or testicles, or you can opt for a masturbation sleeve.  And don’t forget the prostate, which can be stimulated via the perineum, the area between the penis and the anus – there are a number of toys specifically for this if you’re interested. Talk about it  To remove the stigma that surrounds masturbation, we need to be talking about it. (We've also written about masturbating if you've got a vagina, if you want to take the conversation further!) The more healthy discussion on masturbation, the quicker we can break the taboo surrounding it.  Talking to your friends can help build confidence and creates a safe space for you to get together to talk about and ask questions on masturbation. Talking to your sexual partner or partners about what you like, what you don’t like, and your mutual fantasies can help build your sexual confidence which can lead to great sex. 

masturbate-vagina
03 September 2020

How to masturbate if you have a vagina

Did your sex education include anything about masturbation? Ours neither! That’s why we’d love to talk to you about it – specifically, if you have a vagina. (If you’ve got a penis, we’ve got some info for that too.)  First things first: there is absolutely nothing shameful about masturbation! Not in the slightest. It is perfectly normal and healthy. It can help relieve stress, and is a good way of exploring your own body and sexuality, and it just feels really good!  People of all ages, genders and sexualities do it. People in every single country in the world do it. Single people and people in relationships do it. Some people do it frequently, others do it occasionally and some don’t do it at all. It’s all normal. We’re glad we’ve cleared that up!  Getting started Next, how should it be done? There are plenty of ways, and it’s all about finding what works for you.  The two main ways people with vaginas masturbate is either clitorally or vaginally. Before you get going on the good stuff, a helpful place to start may be to see what you look like down there, by getting a hand mirror and trying to locate the clitoris, vagina opening, labia etc. The picture on the left might help you match up what’s what, but don’t worry if you’re still not sure – all vaginas are different and that’s OK! Stimulating the clitoris The clitoris (or clit), marked in the picture, has thousands of nerve endings making it a highly sensitive area, and is how most people with vaginas achieve orgasm. It can be stimulated with your fingers, or with a vibrating sex toy (more on that later).  Using either your fingers or a sex toy (or a combination of both) try rubbing the clitoris in circular or back-and-forth motions, with varying levels of pressure until you find something that brings you to a nice state of arousal.  You can also get the different parts of the labia involved (consult the picture again to find them), by seeing if stimulating them in a similar way feels good.  The G-spot The vagina may also be a source of joy for you, specifically the G-spot. It’s located internally, and can be trickier to find and stimulate. To find it, slowly insert one or two fingers into your vagina opening, and curl them upwards to touch or rub the textured area behind your pubic bone. Some people find this extremely satisfying, though it’s also pretty normal if it isn’t pleasurable or orgasm-inducing for you at all.  What products should I use? If you’re just starting out, you could consider a smaller sex toy, such as a bullet to stimulate your clitoris and labia. There are also toys specifically for the G-spot that can help you explore this sometimes-mysterious erogenous zone too! You might find that adding a few drops of lube onto your body or sex toy might enhance the pleasure too.  Remember to wash sex toys before and after use, and to wash your hands before and after masturbating or any kind of sexual activity. Positions For all types of masturbation, you might also want to think about positions. Many people choose to lie back on their bed for comfort, but you might find that, for example, kneeling, sitting or standing up works better, or masturbating in the shower might do it for you.  How long should it take? There’s no time limit for how long it may take to orgasm (which typically feels like an intense build-up, culminating in a pleasurable release), so take as long as you need. Is it safe to masturbate? No matter what you’ve heard, masturbation is completely safe – nothing bad will happen to you if you do it. In many ways it’s actually the safest form of sex there is, as there’s no risk of HIV/STI transmission or unintended pregnancy. Just make sure you masturbate in private, and if you choose to do it with a partner (which can also be a lot of fun), ensure that they have consented first.  Not only is it safe, it is probably a lot more common than you think. All in all, there is no right or wrong way to masturbate – it’s all about trying out different techniques to find something that works for you. Enjoy!

opening of the film
12 August 2020

Tanzania: A youth center on a mission to destigmatize sexual health

Cultural stigmas leave many young people in Tanzania in the dark about their sexual and reproductive health and rights. Our Member Association - Chama cha Uzazi na Malezi Bora Tanzania (UMATI) - has come up with a solution at their youth center in Dar es Salaam: peer-to-peer educators.  Every week over 100 youth sign up for services and training at the center. In 2017 the Global Gag Rule pulled funding from UMATI, however, the Belgian Government stepped in with emergency funding which allowed the center to remain open through the She Decides project.

Youth dancers in Jimma, Ethiopia
30 July 2020

Youth-led sexual healthcare through dance, song, and poetry

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.

Jumeya Mohammed Amin

"I wanted to protect girls from violence – like early marriage – and I wanted to change people’s wrong perceptions about sex and sexuality"

Seventeen-year-old student Jumeya Mohammed Amin started educating other people about sexual and reproductive health when she was 14 years old. She trained as a ‘change agent’ for her community through the Family Guidance Association of Ethiopia’s south west office in Jimma, the capital of Oromia region. Amin comes from a small, conservative town about 20km outside the city. "I wanted to protect girls from violence – like early marriage – and I wanted to change people’s wrong perceptions about sex and sexuality, because they [men in her community] start having sex with girls at a young age, even with girls as young as nine years old, because of a lack of education." "They suddenly had to act like grown-up women" "Before I started this training I saw the majority of students having sex early and getting pregnant because of a lack of information, and they would have to leave home and school. Boys would be disciplined and if they were seen doing things on campus, expelled. Girls younger than me at the time were married. The youngest was only nine. They would have to go back home and could not play anymore or go to school. They suddenly had to act like grown-up women, like old ladies. They never go back to school after marriage. My teacher chose me for this training and told me about the programme. I like the truth so I was not afraid. I heard about a lot of problems out there during my training and I told myself I had to be strong and go and fight this." "I have a brother and four sisters and I practiced my training on my family first. They were so shocked by what I was saying they were silent. Even on the second day, they said nothing. On the third day, I told them I was going to teach people in schools this, so I asked them why they had stayed silent. They told me that because of cultural and religious issues, people would not accept these ideas and stories, but they gave me permission to go and do it. Because of my efforts, people in my school have not started having sex early and the girls get free sanitary pads through the clubs so they no longer need to stay home during periods." Training hundreds of her peers "I know people in my community who have unplanned pregnancies consult traditional healers [for abortions] and take drugs and they suffer. I know one girl from 10th grade who was 15 years old and died from this in 2017. The healers sometimes use tree leaves in their concoctions.  We tell them where they can go and get different [safe abortion] services. The first round of trainings I did was with 400 students over four months and eight sessions in 2017. Last year, I trained 600 people and this year in the first trimester of school I trained 400. When students finish the course, they want to do it again, and when we forget we have a session, they come and remind me. At school, they call me a teacher. I’d like to be a doctor and this training has really made me want to do that more."

cashew nut factory worker, Ghana
20 February 2020

Ghana: Expanding healthcare for young people and factory workers

Mother of six Elizabeth Adom rides a staff bus up a long, dusty dirt road, through towering pine trees, past wooden bungalows and the outward stretch of the canopy of cashew trees, to reach the cashew factory she works at in a small town in rural Ghana. Adom never planned to have six children but struggled to access the right contraception. So when Planned Parenthood Association Ghana (PPAG) along with the Danish Family Planning Association (DFPA) in 2018 began rolling out a project at the factory and in the Mim township to help women like her take control of their reproductive health, she was pleased. Both PPAG and DFPA are focused on providing sexual and reproductive health and rights (SRHR) information and service, especially for women and girls.  "I am now currently accessing family planning. It is helping me. I don't want to give birth again," Adom emphatically says, while taking a break from peeling cashews at the factory. As a former-teen mother herself, she also shares what she has learnt with her children. "[There] is the danger associated with early childbirth, your life becomes difficult, and you encounter so many challenges in your life." Helping young people  The project also targets young people in Mim, which has a population of about 30,000. Traditionally Mim was known for its timber industry, but in recent years factories have collapsed or had to undergo mass layoffs to survive, leaving many in economic hardship.  Before rolling out the project, PPAG research of young people in Mim found almost 80 per cent had very low knowledge on SRHR, despite the majority of them having had sex - of those condom use was low, as was seeking STI treatments. Beliefs about rights to access information and services around reproductive healthcare were also low. They were also uncomfortable discussing SRHR with their parents, preferring to speak to their peers.  A meaningful way to get SRHR information both to young people and the factory workers is through peer educators. Adom often meets with a colleague who has received specialised training from PPAG to educate others on SRHR.  Abena Amoah, executive director of PPAG, says in Ghana, education on sexual and reproduction health rights is generally becoming more accepted but a lot more work needs to be done.  "Traditionally, it's not said in the open," she says. "A lot of people still do not subscribe to providing the information openly on sexual and reproductive health and even providing services." The four-year project in Mim is supported by private funding.  Health facility staff throughout Mim have been trained in youth-friendly services, to make it easier and quicker to get help and information rather than facing what can be bureaucratic processes in the healthcare system in Ghana.  Patients can access comprehensive abortion care, a range of different contraception options and STI treatments. The project also works with ten schools where  clubs have been formed to discuss SRHR. The project is also gearing up to offer livelihood training so young people can be economically independent, by placing young people from Mim in long-term apprenticeships or offering skills training so they can set up their own businesses. Discussing sexual health openly  Abdul-Mumin Abukari, the PPAG DFPA Mim project officer says so far, they have seen several positive changes, including creating an environment where SRHR can be discussed openly in the community. He also finds people now realise the need for the services. "There were a lot of teenage pregnancies, there were a lot of sexually transmitted diseases, there were a lot of challenges in this community, but someway, somehow people felt that it was normal. They had accepted the situation, and they were living with it. So, the project has come to create some kind of awareness on these issues - that there's nothing normal about 13-year-olds and 14-year-olds getting pregnant." Supporting workers  At Mim Cashew, workers like Adom steam, shell, sort, peel and package the organic cashews for export. The factory has colourful PPAG posters displayed on the walls throughout.  Factory manager Matthew Porter says so far, the project has increased sensitisation amongst the workers to protect themselves and plan their lives. "People can look after themselves better and their children," he says. Jemima Akusika Hansen, HR manager at Mim Cashew, says focusing on employees' health also helps the factory.  "We think that if that is done, it will reduce absenteeism, then some of the unintended pregnancies and then STIs will be reduced." Workers also feel more comfortable in speaking about going for birth control measures at the clinics. "Now they know pregnancy is a choice. So they plan when they want to have it and when they don't want to."

Sophia Abrafi, Midwife at the Mim Health Centre, 40

“Teenage pregnancies will decrease, unsafe abortions and deaths as a result of unsafe abortions will decrease"

Midwife Sophia Abrafi sits at her desk, sorting her paperwork before another patient comes in looking for family planning services. The 40-year-old midwife welcomes each patient with a warm smile and when she talks, her passion for her work is clear.  At the Mim Health Centre, which is located in the Ahafo Region of Ghana, Abrafi says a sexual and reproductive health and right (SRHR) project through Planned Parenthood Association of Ghana (PPAG) and the Danish Family Planning Association (DFPA) allows her to offer comprehensive SRH services to those in the community, especially young people. Before the project, launched in 2018, she used to have to refer people to a town about 20 minutes away for comprehensive abortion care. She had also seen many women coming in for post abortion care service after trying to self-administer an abortion. “It was causing a lot of harm in this community...those cases were a lot, they will get pregnant, and they themselves will try to abort.”   Providing care & services to young people Through the clinic, she speaks to young people about their sexual and reproductive health and rights. “Those who can’t [abstain] we offer them family planning services, so at least they can complete their schooling.” Offering these services is crucial in Mim, she says, because often young people are not aware of sexual and reproductive health risks.  “Some of them will even get pregnant in the first attempt, so at least explaining to the person what it is, what she should do, or what she should expect in that stage -is very helpful.” She has already seen progress.  “The young ones are coming. If the first one will come and you provide the service, she will go and inform the friends, and the friends will come.” Hairdresser Jennifer Osei, who is waiting to see Abrafi, is a testament to this. She did not learn about family planning at school. After a friend told her about the clinic, she has begun relying on staff like Abrafi to educate her. “I have come to take a family planning injection, it is my first time taking the injection. I have given birth to one child, and I don’t want to have many children now,” she says. Expanding services in Mim The SRHR project is working in three other clinics or health centres in Mim, including at the Ahmadiyya Muslim Hospital. When midwife Sherifa, 28, heard about the SRHR project coming to Mim, she knew it would help her hospital better help the community. The hospital was only offering care for pregnancy complications and did little family planning work. Now, it is supplied with a range of family planning commodities, and the ability to do comprehensive abortion care, as well as education on SRHR. Being able to offer these services especially helps school girls to prevent unintended pregnancies and to continue at school, she says.  Sherifa also already sees success from this project, with young people now coming in for services, education and treatment of STIs. In the long term, she predicts many positive changes. “STI infection rates will decrease, teenage pregnancies will decrease, unsafe abortions and deaths as a result of unsafe abortions will decrease. The young people will now have more information about their sexual life in this community, as a result of the project.”