As we observe World Contraception Day, it’s essential to recognize that contraception is not just a concern for cisgender people. For many trans men, trans women, and non-binary individuals, access to contraception is a critical aspect of sexual and reproductive health. However, the healthcare system often overlooks or inadequately serves trans people when it comes to contraception. This blog highlights the reasons why trans people need access to contraception and the importance of developing trans-friendly healthcare services. Why Trans People Use Contraception Contraception is relevant to many trans people, regardless of their transition status or identity. For trans men who have sex with cis men, contraception may be necessary to prevent pregnancy, even if they are on testosterone. While testosterone can reduce the likelihood of ovulation, it does not entirely eliminate the possibility of pregnancy. Additionally, some trans men use hormonal contraception to stop menstruation, which can help align their physical experience with their gender identity. For trans women, while pregnancy prevention may not be a direct concern, contraception can still play a significant role. Some trans women in sexual relationships with cis women may use contraceptive pills or other methods to help prevent unintended pregnancies for their female partners. Additionally, trans women may use contraception to protect against sexually transmitted infections (STIs) or to manage hormone levels in ways that complement their gender-affirming treatments. In short, contraception plays a role beyond pregnancy prevention—it is an important part of broader sexual and reproductive health for all trans people.

Emergency contraception refers to any contraceptive method that can be used after having unprotected or inadequately protected sexual intercourse but before pregnancy occurs. It prevents an unwanted pregnancy. Emergency contraception is a safe and effective method for preventing unwanted pregnancy. It can reduce the risk of pregnancy by up to 99%. There are several methods for emergency contraception, including copper IUDs and various pills (emergency contraceptive pills). The most effective method for emergency contraception is placement of a copper intrauterine device (IUD) within five days of an episode of unprotected sex. If oral emergency contraception pills are preferred, UPA is the method of choice because it is more effective than Levonorgestrel, particularly if more than 72 hours have lapsed. However, if Levonorgestrel is more readily available and the window of 120 hours has not been exceeded, it is generally advisable to use Levonorgestrel, as the effectiveness of emergency contraception pills decreases over time. If a progestogen‑containing contraceptive (which is true for all hormonal contraceptive methods) has been taken within a week prior to the emergency contraception pill use or if the start of such a method is planned within five days after emergency contraception use (or since unprotected sex), then Levonorgestrel should be recommended. Where no dedicated emergency contraception pill products are available, the Yuzpe method is an option, because 8‑10 ordinary combined oral contraceptive pills (OCPs) can be used, depending on their dosage (adding up to 0.1 mg of ethinyl estradiol and 0.5 mg of LNG, with the same dose repeated after 12 hours). Women with high body weight who do not want to use an IUD may be advised to take UPA. There is some evidence that the effectiveness of Levonorgestrel emergency contraception pills decreases with increasing body weight, more so than with UPA emergency contraception pills.             INTRAUTERINE DEVICES The most effective method for emergency contraception is placement of a copper intrauterine device (IUD) within five days of an episode of unprotected sex. When the time of ovulation can be estimated, a Cu‑IUD can be inserted beyond five days after intercourse, as long as insertion does not occur more than five days after ovulation. Any copper IUD is safe and effective. After post‑coital insertion of an IUD, the pregnancy rate is less than 0.1%. Furthermore, the IUD can provide up to 12 years of ongoing contraceptive protection after placement. The main mechanism of action of the IUD is to prevent fertilisation by inhibiting sperm viability and function. If ovulation has already occurred and fertilisation has taken place, copper ions influence the female reproductive tract and impair endometrial receptivity. If a woman is already pregnant, use of an IUD is contraindicated.   LEVONORGESTREL PILLS According to the World Health Organization (WHO), Levonorgestrel emergency contraception pills can be used until 120 hours (five days) after unprotected or inadequately protected sexual intercourse, but they should be used as soon as possible. Based on recent analyses, the Faculty of Sexual and Reproductive Healthcare (FSRH) in the United Kingdom has concluded that Levonorgestrel is ineffective after 96 hours. The effectiveness of Levonorgestrel emergency contraception pills was studied in a multicentre World Health Organization (WHO) trial in 1998. Overall, 1.1% of the women became pregnant after using Levonorgestrel ECPs within 72 hours after unprotected or inadequately protected sexual intercourse. In a meta‑analysis of two more recent studies, comparing Levonorgestrel emergency contraception pills with ones containing ulipristal, the effectiveness appeared to be lower. In this meta‑analysis, 2.2% of the women became pregnant despite using Levonorgestrel emergency contraception pills. Levonorgestrel is a progestin that has been used for contraception for more than 50 years. Each emergency contraception pill contains 1.5 mg of Levonorgestrel. It is also available in the form of two pills of 750 mcg, which can be taken together. Levonorgestrel emergency contraception pills work by inhibiting or delaying ovulation. Levonorgestrel emergency contraception pills have no effect on sperm function, embryo viability, or endometrial receptivity. Because ovulation is delayed, no fertilisation takes place. Levonorgestrel emergency contraception pills do not cause an abortion. They are no longer effective if ovulation or fertilisation have occurred.   ULIPRISTAL ACETATE PILLS Ulipristal acetate (UPA) is a selective progesterone receptor modulator. It was recently introduced as an alternative to Levonorgestrel emergency contraception pills. It is dosed at 30 mg. UPA emergency contraception pills have been approved for use until 120 hours (five days) after unprotected or inadequately protected sexual intercourse. The previously mentioned meta‑analysis of studies in which Levonorgestrel and UPA were compared showed a higher effectiveness of UPA. Of the women who had used UPA emergency contraception pills within 72 hours after UPSI, 1.4% became pregnant, compared to 2.2% pregnancies within the Levonorgestrel group. If emergency contraception was taken within 24 hours after unprotected sex, there was an even larger difference (0.9% versus 2.3% in the UPA and Levonorgestrel groups respectively). Like Levonorgestrel emergency contraception pills, the main mechanism of action of UPA is prevention of follicular rupture and ovulation. However, in contrast with Levonorgestrel, UPA is still effective after the onset of the luteinising hormone (LH) surge which precedes ovulation but not post LH peak. This means that there is a wider ‘window of effect’ for UPA, which explains its higher effectiveness.   STI risk Emergency contraception pills do not prevent the transmission of sexually transmitted infections (STIs). It is important to emphasise that this applies to all contraceptives other than condoms and should not constitute a selective bias against emergency contraception pills. If a woman is at risk of an unwanted pregnancy, she may be at risk of STIs as well and STI and HIV testing could be offered.

There are several methods for emergency contraception, including copper IUDs and various pills (emergency contraceptive pills). The most commonly used methods are described below.   INTRAUTERINE DEVICES The most effective method for emergency contraception is placement of a copper intrauterine device (IUD) within five days of an episode of unprotected sex. When the time of ovulation can be estimated, a Cu‑IUD can be inserted beyond five days after intercourse, as long as insertion does not occur more than five days after ovulation. Any copper IUD is safe and effective. After post‑coital insertion of an IUD, the pregnancy rate is less than 0.1%. Furthermore, the IUD can provide up to 12 years of ongoing contraceptive protection after placement. The main mechanism of action of the IUD is to prevent fertilisation by inhibiting sperm viability and function. If ovulation has already occurred and fertilisation has taken place, copper ions influence the female reproductive tract and impair endometrial receptivity. If a woman is already pregnant, use of an IUD is contraindicated.     LEVONORGESTREL PILLS Levonorgestrel is a progestin that has been used for contraception for more than 50 years. Each emergency contraception pill contains 1.5 mg of Levonorgestrel. It is also available in the form of two pills of 750 mcg, which can be taken together. According to the World Health Organization (WHO), Levonorgestrel emergency contraception pills can be used until 120 hours (five days) after unprotected or inadequately protected sexual intercourse, but they should be used as soon as possible. Based on recent analyses, the Faculty of Sexual and Reproductive Healthcare (FSRH) in the United Kingdom has concluded that Levonorgestrel is ineffective after 96 hours. The effectiveness of Levonorgestrel emergency contraception pills was studied in a multicentre World Health Organization (WHO) trial in 1998. Overall, 1.1% of the women became pregnant after using Levonorgestrel emergency contraception pills within 72 hours after unprotected or inadequately protected sexual intercourse. In a meta‑analysis of two more recent studies, comparing Levonorgestrel emergency contraception pills with ones containing ulipristal, the effectiveness appeared to be lower. In this meta‑analysis, 2.2% of the women became pregnant despite using Levonorgestrel emergency contraception pills. Levonorgestrel emergency contraception pills work by inhibiting or delaying ovulation. Levonorgestrel emergency contraception pills have no effect on sperm function, embryo viability, or endometrial receptivity. Because ovulation is delayed, no fertilisation takes place. Levonorgestrel emergency contraception pills do not cause an abortion. They are no longer effective if ovulation or fertilisation have occurred. They also do not harm a pregnancy if the woman is already pregnant.   ULIPRISTAL ACETATE PILLS Ulipristal acetate (UPA) is a selective progesterone receptor modulator. It was recently introduced as an alternative to Levonorgestrel emergency contraception pills. It is dosed at 30 mg. UPA emergency contraception pills have been approved for use until 120 hours (five days) after unprotected or inadequately protected sexual intercourse. The previously mentioned meta‑analysis of studies in which Levonorgestrel and UPA were compared showed a higher effectiveness of UPA. Of the women who had used UPA emergency contraception pills within 72 hours after UPSI, 1.4% became pregnant, compared to 2.2% pregnancies within the Levonorgestrel group. If emergency contraception was taken within 24 hours after unprotected sex, there was an even larger difference (0.9% versus 2.3% in the UPA and Levonorgestrel groups respectively). Like Levonorgestrel emergency contraception pills, the main mechanism of action of UPA is prevention of follicular rupture and ovulation. However, in contrast with Levonorgestrel, UPA is still effective after the onset of the luteinising hormone (LH) surge which precedes ovulation but not post LH peak. This means that there is a wider ‘window of effect’ for UPA, which explains its higher effectiveness.   OTHER EMERGENCY CONTRACEPTION METHODS A few methods are less common: Low‑dose mifepristone pills (10, 25 or 50 mg) are available in a few countries, such as Russia, China and Vietnam. A high dose of combined hormonal pills (the Yuzpe method) was commonly used until Levonorgestrel‑only pills were introduced, and they still are in contexts where no other options are available. This consists of a dose of 0.1 mg ethinylestradiol and 0.5 mg Levonorgestrel and a repeat dose 12 hours later. It is less effective and leads to more side effects than Levonorgestrel‑only ECPs.   How do I choose the right emergency contraceptive method? Many people are unaware that the copper IUD can be used as emergency contraception. Because of its high effectiveness and its ability to function as an ongoing method, the IUD should be made available and offered to every woman who needs emergency contraception. Women who decide to use an IUD must be medically eligible for the insertion. If oral emergency contraception pills are preferred, UPA is the method of choice because it is more effective than Levonorgestrel, particularly if more than 72 hours have lapsed. However, if Levonorgestrel is more readily available and the window of 120 hours has not been exceeded, it is generally advisable to use Levonorgestrel, as the effectiveness of emergency contraception pills decreases over time. If a progestogen‑containing contraceptive (which is true for all hormonal contraceptive methods) has been taken within a week prior to the emergency contraception pill use or if the start of such a method is planned within five days after emergency contraception use (or since unprotected sex), then Levonorgestrel should be recommended. Where no dedicated emergency contraception pill products are available, the Yuzpe method is an option, because 8‑10 ordinary combined oral contraceptive pills (OCPs) can be used, depending on their dosage (adding up to 0.1 mg of ethinyl estradiol and 0.5 mg of Levonorgestrel, with the same dose repeated after 12 hours). Women with high body weight who do not want to use an IUD may be advised to take UPA. There is some evidence that the effectiveness of Levonorgestrel emergency contraception pills decreases with increasing body weight, more so than with UPA emergency contraception pills.

  Emergency contraception is safe All common emergency contraception methods are extremely safe and have limited side effects.  The World Health Organization (WHO) eligibility criteria have no absolute contraindications for using emergency contraception pills.   The main contraindication against all emergency contraception methods is a pre‑existing pregnancy. In such cases, emergency contraception pills are no longer effective. A pregnancy test is however not necessary before taking emergency contraception pills, since they have no adverse effect on an existing pregnancy.   What are the side effect of emergency contraception methods? The side effects that are reported by users of Levonorgestrel* and UPA** emergency contraception pills are similar. Most common are headaches, which are mentioned by less than 20%. Dysmenorrhoea and nausea are each reported by less than 15% of users. Abdominal pain, dizziness, fatigue, upper abdominal pain and back pain are mentioned by around 5% or less of users. Additionally, women may experience irregular vaginal bleeding after using emergency contraception pills. The side effects after insertion of an IUD for emergency contraception are the same as when an IUD is inserted for ongoing contraception. These include abdominal discomfort and changes in vaginal bleeding or spotting. Some of the side effects of copper IUDs, such as expulsion or heavy menstrual bleeding, are only relevant when a woman decides to keep the IUD for ongoing protection.   * Levonorgestrel (LNG) is a progestin that has been used for contraception for more than 50 years. ** Ulipristal acetate (UPA) is a selective progesterone receptor modulator. It was recently introduced as an alternative to LNG emergency contraception pills. It is dosed at 30 mg. UPA emergency contraception pills have been approved for use until 120 hours (five days) after unprotected sex.   Are there long-term health effects? No serious adverse health effects have been reported for emergency contraception pills. Specifically, no causal relationship has been found with thromboembolism after emergency contraception pills use. Because emergency contraception pills are used occasionally, the hormonal intake is much lower than among women who use Levonorgestrel for a longer period of time, therefore adverse events are unlikely. Experience with UPA is less extensive, but so far no serious adverse health outcomes have been identified.   Is the use of IUD as an emergency contraception method safe? The most effective method for EC is placement of a copper intrauterine device (IUD) within five days of an episode of unprotected sex. When the time of ovulation can be estimated, a Cu‑IUD can be inserted beyond five days after intercourse, as long as insertion does not occur more than five days after ovulation. Any copper IUD is safe and effective. No evidence exists on the effectiveness and safety of hormonal intrauterine contraception as emergency contraception. After post‑coital insertion of an IUD, the pregnancy rate is less than 0.1%.7 Furthermore, the IUD can provide up to 12 years of ongoing contraceptive protection after placement. The main mechanism of action of the IUD is to prevent fertilisation by inhibiting sperm viability and function. If ovulation has already occurred and fertilisation has taken place, copper ions influence the female reproductive tract and impair endometrial receptivity. If a woman is already pregnant, use of an IUD is contraindicated. The only examination that is essential before using copper IUDs is a pelvic/genital examination/STI clinical risk assessment. It is recommended that a routine pregnancy check is done before insertion of an IUD, because this may lead to a spontaneous abortion if a woman is already pregnant. IUDs may be inserted regardless of history or risk of STIs, previous ectopic pregnancy, young age, and nulliparity. However, if a woman is diagnosed with STIs, particularly gonorrhoea or chlamydia, broad‑spectrum antibiotics should be used.   What are the emergency contraception methods to use if a woman is breastfeeding? When a woman is breastfeeding, IUDs can be used for emergency contraception. If emergency contraception pills are preferred, Levonorgestrel emergency contraception pills may be used. Although a small amount of Levonorgestrel appears in breast milk, no adverse effects on the quality or quantity of the milk, or on the infant have been identified. When UPA emergency contraception pills are used, it is recommended to pump and discard the milk during one week, after which breastfeeding can be resumed. Nevertheless, studies on mifepristone (a compound very similar to UPA) at higher doses show very low levels in breast milk that are not considered to be harmful.         What emergency contraception method a woman with severe cardiovascular disease, migraine or severe liver disease should take? In case of a history of severe cardiovascular disease, migraine or severe liver disease, there may be theoretical risks in using emergency contraception pills, but the advantages generally outweigh the disadvantages.   Is there a health risk in case of repeat use of the emergency contraception? There are no known adverse health effects if emergency contraception pills are used more than once during the same menstrual cycle, although the bleeding pattern will be affected. Although no long‑term adverse health effects are to be expected from repeat use, women do suffer more from side effects if they use emergency contraception pills repeatedly, particularly bleeding irregularities. Effectiveness of emergency contraception pills is not affected by repeat use.

  When can emergency contraception be used? Emergency contraception is recommended after any episode of unprotected or inadequately protected sexual intercourse for any girl or woman or person with a uterus who wants to avoid becoming pregnant. Unprotected or inadequately protected sexual intercourse generally means that either: No contraceptive method was used during intercourse, Or that the effectiveness of the contraceptive method was compromised during its use. Example: The effectiveness of contraception may be lower due to, for example, irregular use of pills or incorrect use of a condom. If a woman is aware of these risks, she may reduce the chance of getting pregnant by taking emergency contraception. The time frame for using emergency contraception It is important to let women know that emergency contraception may still be used later than ‘the morning after’. However, emergency contraception pills should be taken as soon as possible after unprotected or inadequately protected sexual intercourse. The effectiveness of emergency contraception pills is highest when they are taken within 24 hours of unprotected sex. Emergency contraception can be used to prevent pregnancy up to 120 hours (five days) after unprotected sex.   Repeat use of the emergency contraception There are no known adverse health effects if emergency contraception pills are used more than once during the same menstrual cycle. Although the bleeding pattern will be affected. Repeated use of emergency contraception pills would entail the same contraindications as those of regular hormonal contraceptive methods. Although no long‑term adverse health effects are to be expected from repeat use, women do suffer more from side effects if they use emergency contraception pills repeatedly, particularly bleeding irregularities. Effectiveness of emergency contraception pills is not affected by repeat use. However, overall effectiveness over one‑year use is lower than most modern contraceptives, so emergency contraception pills should not be recommended as an ongoing method of contraception. Concerns have been raised about whether easy access to emergency contraception pills could lead to lower uptake of regular contraception. However, there is no evidence of such a relationship. Example: Women who receive an advance supply of emergency contraception pills have been found to be more likely to use them when they have had unprotected sex, but are not more likely to abandon regular contraception. However, if overall effectiveness over one‑year use of emergency contraception pills is lower than most modern contraceptives, so emergency contraception should not be recommended as an ongoing method of contraception. If a woman has many episodes of unprotected or inadequately protected sexual intercourse, it may be advisable to recommend that she considers using a more effective contraceptive method or that she changes her current method. An IUD as emergency contraception may be useful in this case, and should be suggested as a first choice. What about STI risk? Emergency contraception pills do not prevent the transmission of sexually transmitted infections (STIs). It is important to emphasise that this applies to all contraceptives other than condoms and should not constitute a selective bias against emergency contraception pills. If a woman is at risk of an unwanted pregnancy, she may be at risk of STIs as well and STI and HIV testing could be offered.

A vasectomy is a medical procedure for people who have decided that they do not want to have children in the future.  It is a safe and effective way to prevent pregnancy, and it works by eliminating sperm from the semen. It is nearly 100% effective at preventing pregnancy, which makes it one of the most effective methods of contraception.  A vasectomy does not protect against sexually-transmitted infections or HIV – for this, a condom should be used.  What is the vasectomy procedure like? A vasectomy is usually performed under local anaesthetic, which means you are awake for the procedure, but you will be numbed in the surgery area. The procedure is quick – usually taking less than 30 minutes. It involves a doctor numbing the surgery area with a local anaesthetic injected into the skin of the scrotum. They will then make a small incision in the scrotum and locate the vas deferens, the tube that carries sperm from the testicle. The doctor withdraws part of the vas deferens through the incision, ties it off and cuts it. The vas deferens is then returned to the scrotum and the incision is closed.  Swelling, bruising, and pain following the procedure is normal, particularly after the first couple of days. Your doctor will probably advise you to wear tight-fitted underwear to support the scrotum and to avoid strenuous activity for a few days. They will also advise you to avoid sexual activity that may lead to an ejaculation for a week or so while you heal. When is a vasectomy effective? It’s important to note that a vasectomy is not effective straight away. In fact, in the following weeks/months after the procedure (and after your rest period), you’ll need to ejaculate about 15-20 times to ensure that there are no traces of sperm remaining in your semen.  It’s likely that your doctor will arrange a follow-up several weeks after your vasectomy to do an analysis of your semen to make sure there’s no sperm left in it. Once they have confirmed this, then you can have sex without using another contraceptive and without the worry of an unintended pregnancy.  In the meantime, you should use condoms or another form of contraception to prevent pregnancy.   Myths and facts about vasectomies Myth: “I can get a vasectomy now, and have it reversed if I change my mind.” Fact: While technically vasectomies can be reversed, the reversal procedure is complicated, requires specialist surgeons, and not always effective. That’s why all vasectomies should be considered permanent, and only people who are sure they are done having children or never want to have a(nother) biological child should go ahead with the procedure. Myth: “My reproductive organs could be permanently damaged.” Fact: The risk of permanent damage is rare if the procedure is provided by qualified healthcare professionals.  Myth: “The surgery will hurt too much.” Fact: As with most surgical procedures, some minor pain or discomfort during or after the procedure is normal, and for most people will go away within a few days.  Myth: “My sexual drive/ability will be affected by a vasectomy.” Fact: This is not true at all – apart from taking a break from sexual activity for a short time after the surgery, your sex drive/abilities will be what they were before the procedure. If anything, your sex drive might be higher without the worry of an unintended pregnancy! If you think a vasectomy could be a good option for you, contact your local sexual and reproductive health provider to discuss further. 

U.S congressional leaders have announced they have reached a final spending deal for the fiscal year 2022. This bill results from months of negotiations over funding and policy decisions, including those that impact sexual and reproductive healthcare globally. Despite the inclusion of language to permanently repeal the global gag rule passed in the House and introduced in the Senate, the final legislation fails to permanently end the harmful policy that has destroyed the lives of women and girls around the world for so many years. It also does not remove discriminatory abortion bans like the Hyde, Helms, and Weldon amendments or include much-needed new investments in sexual and reproductive healthcare and international family planning programs. Dr Alvaro Bermejo, Director-General of the International Planned Parenthood Federation, said: “We are outraged to learn that the long-awaited U.S spending bill failed to permanently repeal the global gag rule, nor did it include other areas of sexual and reproductive health and rights progress on which advocates had built strong momentum. The bill fell foul to anti-choice Congress members whose primary goal is to control the bodies and reproductive rights of women and girls they will never know, whose lives they could never imagine. “Failure to utilize this golden opportunity risks the continuation of the flip-flopping of American policy that has played with the lives of millions across the globe for nearly 40 years. Ultimately the global gag rule destroys long-term access to lifesaving contraception, maternal health and HIV/STI services and forces vulnerable women and girls to carry pregnancies to term or make the agonizing decision to get a potentially deadly unsafe abortion. It also manipulates the ability of international organizations, like IPPF, to use their own funding to provide legal, safe abortion, which unethically denies women care and imposes neo-colonial policies around the world. “While the global gag rule poses serious challenges to sustained engagement with USAID, especially at a time when anti-choice movements continue to attack the rights of people worldwide, IPPF is grateful to the Biden-Harris administration for the current rescission of the policy. We will continue to engage with U.S Government global health assistance programs when possible. We are also thankful to our relentless Member Association, the Planned Parenthood Federation of America. Despite the challenges, they have worked tirelessly alongside thousands of women’s rights campaigners across the United States and worldwide to advocate for vulnerable women and girls everywhere. The fight for reproductive rights and justice will not end until every person can access high-quality sexual and reproductive healthcare when and where they need it.” Santos Siminone, Executive Director at Associação Moçambicana para Desenvolvimento da Família (AMODEFA), said: “We are deeply saddened by the failure to permanently repeal the Global Gag Rule. For AMODEFA, IPPF’s Member Association in Mozambique, a national provider of sexual and reproductive healthcare in the country since 1989, the impact of the global gag rule meant a $2 million gap in funding - about 60% of our total budget. “The impact was almost instantaneous, forcing the closure of six programs across 12 districts in Mozambique. This denied nearly 390,000 clients access to contraception, STIs, HIV, malaria, and tuberculosis services. Almost every local population was affected, with closures impacting adolescents, youths, women, and marginalized people. “For the people we serve, the permanent repeal of the policy would have meant an end to the violation of human rights. It would have meant dignity and that women’s lives would no longer be at risk. It would have meant an end to fear, pain, tears, and chaos, especially for black and brown women from low-income countries who bear the brunt of restrictive abortion policies.” For media enquiries, please contact Karmen Ivey on [email protected] or [email protected]  

Following the disturbing reports coming out of Ukraine, IPPF has released a media statement on behalf of the Federation and its Member Association in Ukraine.   Despite the fact that sexual and reproductive healthcare (SRHR) needs increase significantly during conflict and humanitarian situations, the significant vulnerabilities of affected populations and displaced people are often overlooked, especially the experiences of women, girls and marginalized populations who are at increased risk of unintended pregnancy, sexually transmitted infections and sexual and gender-based violence. IPPF’s Director-General, Dr Alvaro Bermejo, said:   "The International Planned Parenthood Federation (IPPF) is deeply concerned about the escalation of conflict in Ukraine. We take our responsibility to preserve the enormous gains made in life-saving sexual and reproductive healthcare across the country very seriously, especially for women, girls and marginalised populations, whose vulnerability and experiences are so often overlooked in humanitarian situations.  "For 20 years, IPPF has consistently worked to strengthen and protect the reproductive rights of people in Ukraine, working in the frontline conflict zones of Lugansk and Donetsk since 2014, training medical specialists to provide life-saving reproductive healthcare, psychosocial support and quality care to survivors of sexual and gender-based violence. “Our teams are now contingency planning across the region to address not only the needs of those still in Ukraine, but also the millions who are likely to be displaced by the conflict and who will require critical support to continue accessing healthcare. We will work closely with partners and other NGOs to ensure the least possible disruption to services. "IPPF stands in solidarity with the international community and the brave people of Ukraine who for the last eight years have faced terrifying and difficult circumstances that nobody should ever have to suffer through. We stand by IPPF's frontline team, who, despite the dangers, continue to facilitate life-saving healthcare for those who need it most. We will be monitoring the situation closely to ensure the safety of our colleagues across the region.” For European outlets, please contact [email protected] For UK and other international media outlets, please contact Karmen Ivey on [email protected] or [email protected]  

In a major win for women’s reproductive rights, Ghana’s National Health Insurance Program has expanded to include free long-term contraception from 1 January 2022. The move will allow millions of women of reproductive age who are already covered by national health insurance to avoid paying out of pocket for family planning methods such as the implant, coil and injections. It comes after a two-year pilot study found that including family planning services in health benefits packages resulted in a greater uptake of long-term contraception and future government savings in direct care costs.   “We are excited that at long last, long-term family planning methods are included in the National Health Insurance Scheme,” said Abena Adubea Amoah, the Executive Director of the Planned Parenthood of Ghana (PPAG), an IPPF Member Association. “This means long time peace of mind for women, girls and their families with potential positive impact on their health and economic life.”   Tackling deep-rooted barriers to healthcare In late 2021, the government of Ghana launched a year-long campaign aimed at raising awareness of and preventing maternal deaths in line with Goal 3: Good Health and Wellbeing of the United Nations Sustainable Development Goals. The role of family planning in reducing preventable maternal death is well documented, with unsafe abortion being one of the leading causes. Yet, Ghana is a country where deep-rooted cultural norms and structural barriers perpetuate poor sexual and reproductive health, including high risks of maternal mortality, high numbers of sexually transmitted infections and low levels of contraceptive use. Despite making important progress in recent years, Ghana’s maternal mortality ratio is 308 per 100,000 live births, which is still well above the SDG target of less than 70 deaths per 100,000 live births by 2030.   PPAG will play an important role in supporting the government in its campaign to prevent maternal deaths and disabilities. Since 1967, PPAG has provided the people of Ghana with family planning services as well as maternal and child health care, infertility management, and voluntary counselling and testing for sexually transmitted infections including HIV and AIDS. With over 100 staff members, a team of 1,000 volunteers, and 300 peer educators, PPAG is well-positioned to deliver health services and programmes through permanent and mobile clinics in urban and rural communities across the country. The association's Youth Action Team, comprised of over 810 young people, leads a number of educational and awareness-raising activities at 1000 community-based service points across the country. 

Understanding the challenges that people living with a disability face when accessing sexual and reproductive healthcare (SRH), and ensuring their rights are upheld, sits at the heart of Fianakaviana Sambatras’ (FISA) mission to reach vulnerable groups. Often on the fringes of Madagascan society, and classified as a vulnerable group, people living with a disability are one of FISA’s priority client groups. Through expansion of their delivery networks, FISA provides safe, confidential, and accessible integrated SRH to people living with a disability.  Barriers to inclusive healthcare  Often, FISA’s clients have a lack of awareness about their sexual and reproductive rights where to go for their healthcare - for example, limited access to information through disability-friendly locations and leaflets and posters creates a barrier to vital information unless adapted for visually impaired and blind people. Other challenges include communication for deaf clients, who in some cases may not be accompanied by a companion to assist them. In some instances, FISA learned that women living with a disability were forced by their families to have an abortion or undergo tubal sterilization during a caesarean delivery without their consent, further reinforcing stigma and stereotypical attitudes towards disability.    Understanding the needs of the client FISA’s experience with providing care to people living with a disability has led to a greater understanding of their clients’ needs. Provision of improved integrated healthcare delivery includes allowing for longer appointment times to give the correct level of support, which is especially important for counselling and consultations.  FISA offers free consultations to people living with a disability and prioritizes young people ensuring they can access youth-friendly care. The team also run sessions using sign language to raise awareness on sexual and reproductive health and rights and to provide information about the different contraceptive methods available, such as the IUD and pill. FISA encourages people living with a disability to participate in events such as International Women’s Day to help make their voices heard, to advocate for their rights, and to collaborate on the development of a comprehensive sexuality education guide through a series of workshops. Designing and delivering disability-inclusive healthcare FISA has adapted its healthcare delivery to be disability-inclusive and to raise awareness of, and advocate for, the sexual and reproductive rights of people living with a disability. Critical to providing healthcare is safeguarding access to comprehensive sexuality education for young people living with disabilities that are specific to their needs. Providing information resources in Braille, using diverse pictures, and training healthcare workers to be able to communicate using sign language makes FISA a go-to place for healthcare for people living with a disability. Clients are made to feel welcome and safe with FISA’s qualified healthcare team and accessible facilities.  “Our Member Association in Madagascar plays a leading role in ensuring that persons with disabilities have access to high-quality and integrated sexual and reproductive healthcare. Their work is a good example of our mission to provide care to the most vulnerable, underserved, and often marginalized members of our communities. Integrated disability-inclusive healthcare delivery strategies that are adapted to our beneficiaries’ needs remain a priority in our work on the African continent”, says Marie-Evelyne-Petrus-Barry, IPPF Africa Regional Director. FISA enables its clients, and especially young people and women, living with a disability to feel empowered to make their own decisions concerning their bodies, wellbeing, and SRH.