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Contraception

One of our main priorities is to ensure universal access to, and informed use of effective contraception. Millions of people lack the knowledge and information to determine when or whether they have children, and they are unable to protect themselves against sexually transmitted infections (STIs).

Articles by Contraception

Nurse Leias Obed attending to a patient
02 June 2020

Cyclone Harold response: A 'hidden agenda'?

Leias Obed is a registered nurse working with the Vanuatu Family Health Association (VFHA). She’s part of the Emergency Medical Team operating out of Pangi in south Pentecost, as part of the Cyclone Harold response, which hit in April 2020. We caught up with her there. Sexual and reproductive health is a "hidden agenda", she said, putting a positive spin on the phrase. Women often have to hide their sexual and reproductive health issues and concerns, for fear of stigmatization, or even coercion and violence. By joining the relief effort as part of larger joint medical teams capable of addressing numerous concerns for both men and women, the VHFA staff are able to use the opportunities presented to contact potential clients discreetly and without putting them at risk. Informal exposure to skilled medical staff and counsellors is often enough to initiate a process that results in better, more manageable living conditions for women and their families. Unaware of their own pregnancy “We came to central Pentecost,” said Leias, “and we came across many issues affecting women and girls, but it's like I mentioned, it's a 'hidden agenda'. One thing that we found out is that many women have large numbers of children and their spacing is too close together. But they don't see it as a problem. It's not a problem for them." “Some women who became pregnant during the disaster weren't even aware of their status, but when they came to see us, we have pregnancy tests, and when we test them, they're positive. They're pregnant, and a lot of them have family planning needs.” “Their communities are a long long way from accessing facilities like [these] clinics. We go there and we help them understand, about implants that last five years. A lot of them didn't really understand. They didn't know, it but their main issue is family planning.” Information and education for all “During a response we're more concentrated on the issues facing women right now but it's clear there's a need for us to come back. We must come back so that people can come to understand: What exactly is family planning? Why is it important to use contraceptive treatments? “They really don't understand well at all about family planning products.” The information and education process needs to reach everyone, though: “It would be good if we came back. We come back and present small workshops to fathers, chiefs and to communities at large. To young girls, to mothers so they can come to understand.” There’s a need to follow through, she says. “Family planning is an individual right. We won't force anyone to take it. But there's a need. The more we stay with them, the more we explain, then they can begin to change their mind-set. Then they can freely choose to take family planning.”

Woman with contraception
15 April 2020

Contraception and COVID-19: Disrupted supply and access

Globally, the unmet need for contraception remains too high. It’s estimated that 214 million women and girls are not using modern contraception, despite wanting to avoid pregnancy. And this was before the COVID-19 pandemic, which is set to further derail access to contraception for women and girls around the world.  Disrupted supply chains Lockdown measures taken globally to respond to COVID-19 are bringing major disruptions to contraceptive supply chains. Large manufacturers of contraceptives in Asia have had to halt production or operate at reduced capacity, and we may see similar developments in other regions as COVID-19 takes hold.  For example, the world’s largest condom producer – Malaysia’s Karex Bhd – which makes one in every five condoms globally, was forced to close for a week in March and only given permission to reopen at 50% capacity. Production of IUDs in India – a major global producer of IUDs – has come to a standstill with the Indian government also curtailing export of any product containing progesterone, a key component of a number of contraceptives.   In addition to this, the closures of borders and other restrictions imposed in the face of COVID-19 further affect the shipping and distribution of commodities.  Delays in the production and delivery of contraceptive supplies at global and national levels will lead to stockouts of supplies, severely impacting contraceptive access.  Disrupted access Beyond this, at country level, sexual and reproductive health services, staffing and funds may be diverted to support COVID-19 responses, leaving women and girls unable to access contraceptive and other sexual and reproductive health care. Provision of sexual and reproductive health services will also be affected by infection prevention measures, including health workers’ access to personal protective equipment (PPE). Yet, this is just part of the picture. Even where contraceptives are available and continue to be provided through clinics or pharmacies, the impact of COVID-19 on women’s and girls’ lives will curtail their access in multiple other ways. Quarantine measures and mobility restrictions will affect women’s and girls’ ability to seek out contraceptive services. Financial insecurity and additional caregiving burdens brought on by lockdown measures will be further impediments. Marginalized populations will face additional barriers. What’s the impact for our clinics on the ground?  In 2018, we delivered 81.2 million contraceptive services and distributed over 300 million condoms through our Member Associations (MAs). Contraceptive care, either through clinics or outreach programs, makes up the largest portion of our service provision to communities by far.  Now, in the face of the COVID-19 pandemic, we are receiving concerning updates from our MAs who are worried about impacts on supply chains and their ability to operate. 5,633 static and mobile clinics and community-based care outlets have already closed because of the outbreak, across 64 countries. They make up 14% of the total service delivery points IPPF members ran in 2018. For MAs that are still running limited services, an immediate need is PPE.  Where does this leave us?  At IPPF, supporting all our MAs through this pandemic is our priority. We are working to understand the stresses being placed on our MAs and to deliver as much direct support as possible. We actively monitor the impact of COVID-19 on the supply of contraceptives and other sexual and reproductive health commodities, and work with partners and manufacturers to do what we can to meet MAs’ needs – including for PPE – and ensure continued availability of supplies. We are also working to identify opportunities to modernize our service offering to respond to the rapidly changing landscape, with a view to expanding no touch and digital services and self-management of care, and make a strong case for additional resourcing in these challenging times.  And we are calling on others – national governments, donors and international agencies – to recognize sexual and reproductive healthcare, including contraceptive services, as essential in this crisis, and to take measures to address disruptions in supply chains and ensure continued service provision at national level.   If women, girls and marginalized communities cannot access contraceptive care in this crisis, we can expect to see a rise in unintended and forced pregnancies, an increase in sexually transmitted infections, including HIV, and, ultimately, a sharp rise in unsafe abortions. The impacts on women’s and girls’ lives now, and beyond this crisis, will be severe.   

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.”

	Janet Pinamang, Mim Cashew Factory worker,.32

"It has helped me a lot, without that information I would have given birth to many children..."

Factory workers at Mim Cashew, in a small town in rural Ghana, are taking their reproductive health choices into their own hands, thanks to a four-year project rolled out by Planned Parenthood Association Ghana (PPAG) along with the Danish Family Planning Association (DFPA). The project, supported by private funding, focuses on factory workers as well as residents in the township of about 30, 000, where the factory is located. Under the project, health clinic staff in Mim have been supported to provide comprehensive abortion care, a range of different contraception choices and STI treatments as well as information and education. In both the community and the factory, there is a strong focus on SRHR trained peer educators delivering information to their colleagues and peers. An increase in knowledge  So far, the project has yielded positive results - especially a notable increase amongst the workers on SRHR knowledge and access to services - like worker Janet Pinamang, who is a 32-year-old mother of two. She says the SRHR project has been great for her and her colleagues. "I have had a lot of benefits with the project from PPAG. PPAG has educated us on how the process is involved in a lady becoming pregnant. PPAG has also helped us to understand more on drug abuse and about HIV.” She also appreciated the project working in the wider community and helping to address high levels of teenage pregnancy.  "I have seen a lot of change before the coming of PPAG little was known about HIV, and its impacts and how it was contracted - now PPAG has made us know how HIV is spread, how it is gotten and all that. PPAG has also got us to know the benefits of spacing our children." “It has helped me a lot” Pinamang's colleague, Sandra Opoku Agyemang, 27, is a mother of a six-year-old girl called Bridget. Agyemang says before the project came to Mim, she had only heard negative information around family planning. "I heard family planning leads to dizziness, it could lead to fatigue, you won't get a regular flow of menses and all that, and I also heard problems with heart attacks. I had heard of these problems, and I was afraid, so after the coming of PPAG, I went into family planning, and I realised all the things people talked about were not wholly true." Now using family planning herself, she says the future is bright for her, and her family. "It has helped me a lot, without that information I would have given birth to many children, not only Bridget. In the future, I plan to add on two [more children], even with the two I am going to plan."  

Gifty with her son, Ghana

“Despite all those challenges, I thought it was necessary to stay in school"

When Gifty Anning Agyei was pregnant, her classmates teased her, telling her she should drop out of school. She thought of having an abortion, and at times she says she considered suicide. When her father, Ebenezer Anning Agyei found out about the pregnancy, he was furious and wanted to kick her out of the house and stop supporting her education.  Getting the support she needed But with support from Planned Parenthood Association of Ghana (PPAG) and advice from Ebenezer’s church pastor, Gifty is still in school, and she has a happy baby boy, named after Gifty’s father. Gifty and the baby are living at home, with Gifty’s parents and three of her siblings in Mim, a small town about eight hours drive northwest of Ghana’s capital Accra.  “Despite all those challenges, I thought it was necessary to stay in school. I didn’t want any pregnancy to truncate my future,” Gifty says, while her parents nod in proud support. In this area of Ghana, research conducted in 2018 found young people like Gifty had high sexual and reproduce health and rights (SRHR) challenges, with low comprehensive knowledge of SHRH and concerns about high levels of teenage pregnancy. PPAG, along with the Danish Family Planning Association (DFPA), launched a four-year project in Mim in 2018 aimed to address these issues.  For Gifty, now 17, and her family, this meant support from PPAG, especially from the coordinator of the project in Mim, Abdul- Mumin Abukari. “I met Abdul when I was pregnant. He was very supportive and encouraged me so much even during antenatals he was with me. Through Abdul, PPAG encouraged me so much.” Her mother, Alice, says with support from PPAG her daughter did not have what might have been an unsafe abortion. The parents are also happy that the PPAG project is educating other young people on SRHR and ensuring they have access to services in Mim. Gifty says teenage pregnancy is common in Mim and is glad PPAG is trying to curb the high rates or support those who do give birth to continue their schooling.  “It’s not the end of the road” “PPAG’s assistance is critical. There are so many ladies who when they get into the situation of early pregnancy that is the end of the road, but PPAG has made us know it is only a challenge but not the end of the road.” Gifty’s mum Alice says they see baby Ebenezer as one of their children, who they are raising, for now, so GIfty can continue with her schooling. “In the future, she will take on the responsibly more. Now the work is heavy, that is why we have taken it upon ourselves. In the future, when Gifty is well-employed that responsibility is going to be handed over to her, we will be only playing a supporting role.” Alice also says people in the community have commented on their dedication. “When we are out, people praise us for encouraging our daughter and drawing her closer to us and putting her back to school.” Dad Ebenezer smiles as he looks over at his grandson. “We are very happy now.” When she’s not at school or home with the baby, Gifty is doing an apprenticeship, learning to sew to follow her dream of becoming a fashion designer. For her, despite giving birth so young, she has her sights set on finishing her high school education in 2021 and then heading to higher education. 

Dorcas.Amakyewaa , Mim Cashew Factory worker and peer educator, 42

"They teach us as to how to avoid STDs and how to space our childbirth"

As the sun rises each morning, Dorcas Amakyewaa leaves her home she shares with her five children and mother and heads to work at a cashew factory. The factory is on the outskirts of Mim, a town in the Ahafo Region of Ghana. Along the streets of the township, people sell secondhand shoes and clothing or provisions from small, colourfully painted wooden shacks.  “There are so many problems in town, notable among them [young people], teenage pregnancies and drug abuse,” Amakyewaa says, reflecting on the community of about 30,000 in Ghana.       The chance to make a difference  In 2018, Amakyewaa was offered a way to help address these issues in Mim, through a sexual and reproductive health rights (SRHR) project brought to both the cashew factory and the surrounding community, through the Danish Family Planning Association, and Planned Parenthood Association Ghana (PPAG).  Before the project implementation, some staff at the factory were interviewed and surveyed. Findings revealed similar concerns Amakyewaa had, along with the need for comprehensive education, access and information on the right to key SRHR services. The research also found a preference for receiving SRHR information through friends, colleagues or factory health outreach. These findings then led to PPAG training people in the factory to become SRHR peer educators, including Amakyewaa. She now passes on what she has learnt in her training to her colleagues in sessions, where they discuss different SRHR topics. “I guide them to space their births, and I also guide them on the effects of drug abuse.” The project has also increased access to hospitals, she adds. “The people I teach, I have given the numbers of some nurses to them. So that whenever they need the services of the nurses, they call them and meet them straight away.” Access to information One of the women Amakyewaa meets with to discuss sexual and reproductive health is Monica Asare, a mother of two.  “I have had a lot of benefits from PPAG. They teach us as to how to avoid STDs and how to space our childbirth. I teach my child about what we are learning. I never had access to this information; it would have helped me a lot, probably I would have been in school.” Amakyewaa also says she didn’t have access to information and services when she was young. If she had, she says she would not have had a child at 17. She takes the information she has learnt, to share with her children and other young people in the community. When she gets home after work, Amakyewaa’s peer education does not stop, she continues. She also continues her teachings when she gets home. “PPAG’s project has been very helpful to me as a mother. When I go home, previously I was not communicating with my children with issues relating to reproduction.” Her 19-year-old daughter, Stella Akrasi, has also benefitted from her mothers training. “I see it to be good. I always share with my friends give them the importance of family planning. If she teaches me something I will have to go and tell them too” she says.

Male condom illustration
12 February 2020

How to use an external (male) condom

What is a condom? A condom is a form of contraception, usually made from latex, that is used during foreplay or sexual intercourse to help protect against STIs (including HIV) and unintended pregnancies.  Why use a condom? Condoms are the only form of contraception that prevents unintended pregnancies and protects you from STIs, including HIV.   External (male) condoms are 87-98% effective, depending on what type you use and if you use them correctly and consistently. Condoms are recommended alongside another form of short or long form contraception, like an IUD or contraceptive pill. Learn more about other forms of contraception How to put on an external (male) condom Packs of condoms will always come with instructions, so be sure to read them beforehand. But if you’re in a rush, here are a few things to remember: Always check the expiry date on the condom. If it’s out of date then do not use it, as it is more likely to break. Check the packet has a certification mark, usually FDA, BSI, CE, ISO or Kitemark. A certification mark means they have been tested and have passed the required safety standards. The marks look like this: Be careful when you or your sexual partner open the condom. Avoid using your teeth or a sharp object as you risk tearing the condom. The condom should be put on the penis when it is erect (hard) and before the penis comes into contact with a sexual partner (vaginally, anally or orally). Once the condom has been removed from the packet, place it on the tip of the erect penis. Squeezing the tip of the condom, carefully roll it down to the base of the penis. If the condom will not unroll easily, it may be on the wrong way. If this happens, start again with a new condom as pre-ejaculatory fluid (aka "pre-cum") can contain sperm. Once it’s on properly, you’re good to go! Learn more about pre-cum and if it can cause pregnancy How to remove a male condom After ejaculation and with the penis still erect (hard), hold the condom at the base and carefully remove your penis from your partner’s body – if you do not remove your penis from your partner whilst it is still erect, there is a risk of sperm leaking or the condom falling off. Only completely remove the condom when you are no longer in contact with your partner’s body. Wrap the used condom in some tissue and dispose of it in the bin. Do not flush your condom down the toilet as this can have a negative impact on the environment. Remember you cannot use the same condom twice (even if you rinse it)! Learn more about some of the types of condoms available Using lubricant with a condom If you want to use lubricant (also known as lube), used a water-based one as oil-based lubricants can cause condoms to break.  Remember to use it on the external area of the condom and/or on your partner’s genitals.  Do not place lubricant directly onto the penis as this can cause the condom to slip off. Learn more about lubricant  

IMAP statement on expanding access and contraceptive choice
06 December 2019

IMAP statement on expanding access and contraceptive choice through integrated sexual and reproductive health services

In 2018, IPPF endorsed the WHO/UNFPA Call to Action to Attain Universal Health Coverage Through Linked Sexual and Reproductive Health and Rights and HIV Interventions.13 This IMAP statement serves as a reminder of this call to action to ensure all people have access to comprehensive SRH services, including integrated contraceptive and HIV/STI services, provided through primary healthcare.

echo trial
28 October 2019

After the ECHO trial – Expanding access and choice through integrated services

Since the early 1990s, the evidence has been inconclusive as to whether using hormonal contraception increases women’s risk of acquiring HIV, particularly among progestogen-only injectable users. Observational studies indicated that women using progestogen-only injectable contraceptive methods may be at higher risk of acquiring human immunodeficiency virus (HIV).  The Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial finds no link between HIV acquisition and the use of DMPA-IM, progestogen implant, and non-hormonal copper IUD. For more information please see the technical brief on the ECHO trial.  Following the release of the result of the ECHO trial and the WHO latest guidance statement and revised Medical Eligibility Criteria (MEC) for contraceptive use, IPPF developed a follow-up technical brief to support IPPF MAs and frontline service providers’ work regarding the provision of the integrated contraceptive, HIV and other STI programmes to expand access and contraceptive choice. For more information, please see the attached technical brief After the ECHO trial – Expanding access and choice through integrated services, available in English and French.

ECHO trail
09 July 2019

IPPF Technical Brief on the ECHO trial

Since the early 1990s, the evidence has been inconclusive as to whether using hormonal contraception increases women’s risk of acquiring HIV, particularly among progestogen-only injectable users. Observational studies indicated that women using progestogen-only injectable contraceptive methods may be at higher risk of acquiring human immunodeficiency virus (HIV).  The ECHO trial finds no link between HIV acquisition and the use of DMPA-IM, progestogen implant, and non-hormonal copper IUD. 

Nurse Leias Obed attending to a patient
02 June 2020

Cyclone Harold response: A 'hidden agenda'?

Leias Obed is a registered nurse working with the Vanuatu Family Health Association (VFHA). She’s part of the Emergency Medical Team operating out of Pangi in south Pentecost, as part of the Cyclone Harold response, which hit in April 2020. We caught up with her there. Sexual and reproductive health is a "hidden agenda", she said, putting a positive spin on the phrase. Women often have to hide their sexual and reproductive health issues and concerns, for fear of stigmatization, or even coercion and violence. By joining the relief effort as part of larger joint medical teams capable of addressing numerous concerns for both men and women, the VHFA staff are able to use the opportunities presented to contact potential clients discreetly and without putting them at risk. Informal exposure to skilled medical staff and counsellors is often enough to initiate a process that results in better, more manageable living conditions for women and their families. Unaware of their own pregnancy “We came to central Pentecost,” said Leias, “and we came across many issues affecting women and girls, but it's like I mentioned, it's a 'hidden agenda'. One thing that we found out is that many women have large numbers of children and their spacing is too close together. But they don't see it as a problem. It's not a problem for them." “Some women who became pregnant during the disaster weren't even aware of their status, but when they came to see us, we have pregnancy tests, and when we test them, they're positive. They're pregnant, and a lot of them have family planning needs.” “Their communities are a long long way from accessing facilities like [these] clinics. We go there and we help them understand, about implants that last five years. A lot of them didn't really understand. They didn't know, it but their main issue is family planning.” Information and education for all “During a response we're more concentrated on the issues facing women right now but it's clear there's a need for us to come back. We must come back so that people can come to understand: What exactly is family planning? Why is it important to use contraceptive treatments? “They really don't understand well at all about family planning products.” The information and education process needs to reach everyone, though: “It would be good if we came back. We come back and present small workshops to fathers, chiefs and to communities at large. To young girls, to mothers so they can come to understand.” There’s a need to follow through, she says. “Family planning is an individual right. We won't force anyone to take it. But there's a need. The more we stay with them, the more we explain, then they can begin to change their mind-set. Then they can freely choose to take family planning.”

Woman with contraception
15 April 2020

Contraception and COVID-19: Disrupted supply and access

Globally, the unmet need for contraception remains too high. It’s estimated that 214 million women and girls are not using modern contraception, despite wanting to avoid pregnancy. And this was before the COVID-19 pandemic, which is set to further derail access to contraception for women and girls around the world.  Disrupted supply chains Lockdown measures taken globally to respond to COVID-19 are bringing major disruptions to contraceptive supply chains. Large manufacturers of contraceptives in Asia have had to halt production or operate at reduced capacity, and we may see similar developments in other regions as COVID-19 takes hold.  For example, the world’s largest condom producer – Malaysia’s Karex Bhd – which makes one in every five condoms globally, was forced to close for a week in March and only given permission to reopen at 50% capacity. Production of IUDs in India – a major global producer of IUDs – has come to a standstill with the Indian government also curtailing export of any product containing progesterone, a key component of a number of contraceptives.   In addition to this, the closures of borders and other restrictions imposed in the face of COVID-19 further affect the shipping and distribution of commodities.  Delays in the production and delivery of contraceptive supplies at global and national levels will lead to stockouts of supplies, severely impacting contraceptive access.  Disrupted access Beyond this, at country level, sexual and reproductive health services, staffing and funds may be diverted to support COVID-19 responses, leaving women and girls unable to access contraceptive and other sexual and reproductive health care. Provision of sexual and reproductive health services will also be affected by infection prevention measures, including health workers’ access to personal protective equipment (PPE). Yet, this is just part of the picture. Even where contraceptives are available and continue to be provided through clinics or pharmacies, the impact of COVID-19 on women’s and girls’ lives will curtail their access in multiple other ways. Quarantine measures and mobility restrictions will affect women’s and girls’ ability to seek out contraceptive services. Financial insecurity and additional caregiving burdens brought on by lockdown measures will be further impediments. Marginalized populations will face additional barriers. What’s the impact for our clinics on the ground?  In 2018, we delivered 81.2 million contraceptive services and distributed over 300 million condoms through our Member Associations (MAs). Contraceptive care, either through clinics or outreach programs, makes up the largest portion of our service provision to communities by far.  Now, in the face of the COVID-19 pandemic, we are receiving concerning updates from our MAs who are worried about impacts on supply chains and their ability to operate. 5,633 static and mobile clinics and community-based care outlets have already closed because of the outbreak, across 64 countries. They make up 14% of the total service delivery points IPPF members ran in 2018. For MAs that are still running limited services, an immediate need is PPE.  Where does this leave us?  At IPPF, supporting all our MAs through this pandemic is our priority. We are working to understand the stresses being placed on our MAs and to deliver as much direct support as possible. We actively monitor the impact of COVID-19 on the supply of contraceptives and other sexual and reproductive health commodities, and work with partners and manufacturers to do what we can to meet MAs’ needs – including for PPE – and ensure continued availability of supplies. We are also working to identify opportunities to modernize our service offering to respond to the rapidly changing landscape, with a view to expanding no touch and digital services and self-management of care, and make a strong case for additional resourcing in these challenging times.  And we are calling on others – national governments, donors and international agencies – to recognize sexual and reproductive healthcare, including contraceptive services, as essential in this crisis, and to take measures to address disruptions in supply chains and ensure continued service provision at national level.   If women, girls and marginalized communities cannot access contraceptive care in this crisis, we can expect to see a rise in unintended and forced pregnancies, an increase in sexually transmitted infections, including HIV, and, ultimately, a sharp rise in unsafe abortions. The impacts on women’s and girls’ lives now, and beyond this crisis, will be severe.   

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.”

	Janet Pinamang, Mim Cashew Factory worker,.32

"It has helped me a lot, without that information I would have given birth to many children..."

Factory workers at Mim Cashew, in a small town in rural Ghana, are taking their reproductive health choices into their own hands, thanks to a four-year project rolled out by Planned Parenthood Association Ghana (PPAG) along with the Danish Family Planning Association (DFPA). The project, supported by private funding, focuses on factory workers as well as residents in the township of about 30, 000, where the factory is located. Under the project, health clinic staff in Mim have been supported to provide comprehensive abortion care, a range of different contraception choices and STI treatments as well as information and education. In both the community and the factory, there is a strong focus on SRHR trained peer educators delivering information to their colleagues and peers. An increase in knowledge  So far, the project has yielded positive results - especially a notable increase amongst the workers on SRHR knowledge and access to services - like worker Janet Pinamang, who is a 32-year-old mother of two. She says the SRHR project has been great for her and her colleagues. "I have had a lot of benefits with the project from PPAG. PPAG has educated us on how the process is involved in a lady becoming pregnant. PPAG has also helped us to understand more on drug abuse and about HIV.” She also appreciated the project working in the wider community and helping to address high levels of teenage pregnancy.  "I have seen a lot of change before the coming of PPAG little was known about HIV, and its impacts and how it was contracted - now PPAG has made us know how HIV is spread, how it is gotten and all that. PPAG has also got us to know the benefits of spacing our children." “It has helped me a lot” Pinamang's colleague, Sandra Opoku Agyemang, 27, is a mother of a six-year-old girl called Bridget. Agyemang says before the project came to Mim, she had only heard negative information around family planning. "I heard family planning leads to dizziness, it could lead to fatigue, you won't get a regular flow of menses and all that, and I also heard problems with heart attacks. I had heard of these problems, and I was afraid, so after the coming of PPAG, I went into family planning, and I realised all the things people talked about were not wholly true." Now using family planning herself, she says the future is bright for her, and her family. "It has helped me a lot, without that information I would have given birth to many children, not only Bridget. In the future, I plan to add on two [more children], even with the two I am going to plan."  

Gifty with her son, Ghana

“Despite all those challenges, I thought it was necessary to stay in school"

When Gifty Anning Agyei was pregnant, her classmates teased her, telling her she should drop out of school. She thought of having an abortion, and at times she says she considered suicide. When her father, Ebenezer Anning Agyei found out about the pregnancy, he was furious and wanted to kick her out of the house and stop supporting her education.  Getting the support she needed But with support from Planned Parenthood Association of Ghana (PPAG) and advice from Ebenezer’s church pastor, Gifty is still in school, and she has a happy baby boy, named after Gifty’s father. Gifty and the baby are living at home, with Gifty’s parents and three of her siblings in Mim, a small town about eight hours drive northwest of Ghana’s capital Accra.  “Despite all those challenges, I thought it was necessary to stay in school. I didn’t want any pregnancy to truncate my future,” Gifty says, while her parents nod in proud support. In this area of Ghana, research conducted in 2018 found young people like Gifty had high sexual and reproduce health and rights (SRHR) challenges, with low comprehensive knowledge of SHRH and concerns about high levels of teenage pregnancy. PPAG, along with the Danish Family Planning Association (DFPA), launched a four-year project in Mim in 2018 aimed to address these issues.  For Gifty, now 17, and her family, this meant support from PPAG, especially from the coordinator of the project in Mim, Abdul- Mumin Abukari. “I met Abdul when I was pregnant. He was very supportive and encouraged me so much even during antenatals he was with me. Through Abdul, PPAG encouraged me so much.” Her mother, Alice, says with support from PPAG her daughter did not have what might have been an unsafe abortion. The parents are also happy that the PPAG project is educating other young people on SRHR and ensuring they have access to services in Mim. Gifty says teenage pregnancy is common in Mim and is glad PPAG is trying to curb the high rates or support those who do give birth to continue their schooling.  “It’s not the end of the road” “PPAG’s assistance is critical. There are so many ladies who when they get into the situation of early pregnancy that is the end of the road, but PPAG has made us know it is only a challenge but not the end of the road.” Gifty’s mum Alice says they see baby Ebenezer as one of their children, who they are raising, for now, so GIfty can continue with her schooling. “In the future, she will take on the responsibly more. Now the work is heavy, that is why we have taken it upon ourselves. In the future, when Gifty is well-employed that responsibility is going to be handed over to her, we will be only playing a supporting role.” Alice also says people in the community have commented on their dedication. “When we are out, people praise us for encouraging our daughter and drawing her closer to us and putting her back to school.” Dad Ebenezer smiles as he looks over at his grandson. “We are very happy now.” When she’s not at school or home with the baby, Gifty is doing an apprenticeship, learning to sew to follow her dream of becoming a fashion designer. For her, despite giving birth so young, she has her sights set on finishing her high school education in 2021 and then heading to higher education. 

Dorcas.Amakyewaa , Mim Cashew Factory worker and peer educator, 42

"They teach us as to how to avoid STDs and how to space our childbirth"

As the sun rises each morning, Dorcas Amakyewaa leaves her home she shares with her five children and mother and heads to work at a cashew factory. The factory is on the outskirts of Mim, a town in the Ahafo Region of Ghana. Along the streets of the township, people sell secondhand shoes and clothing or provisions from small, colourfully painted wooden shacks.  “There are so many problems in town, notable among them [young people], teenage pregnancies and drug abuse,” Amakyewaa says, reflecting on the community of about 30,000 in Ghana.       The chance to make a difference  In 2018, Amakyewaa was offered a way to help address these issues in Mim, through a sexual and reproductive health rights (SRHR) project brought to both the cashew factory and the surrounding community, through the Danish Family Planning Association, and Planned Parenthood Association Ghana (PPAG).  Before the project implementation, some staff at the factory were interviewed and surveyed. Findings revealed similar concerns Amakyewaa had, along with the need for comprehensive education, access and information on the right to key SRHR services. The research also found a preference for receiving SRHR information through friends, colleagues or factory health outreach. These findings then led to PPAG training people in the factory to become SRHR peer educators, including Amakyewaa. She now passes on what she has learnt in her training to her colleagues in sessions, where they discuss different SRHR topics. “I guide them to space their births, and I also guide them on the effects of drug abuse.” The project has also increased access to hospitals, she adds. “The people I teach, I have given the numbers of some nurses to them. So that whenever they need the services of the nurses, they call them and meet them straight away.” Access to information One of the women Amakyewaa meets with to discuss sexual and reproductive health is Monica Asare, a mother of two.  “I have had a lot of benefits from PPAG. They teach us as to how to avoid STDs and how to space our childbirth. I teach my child about what we are learning. I never had access to this information; it would have helped me a lot, probably I would have been in school.” Amakyewaa also says she didn’t have access to information and services when she was young. If she had, she says she would not have had a child at 17. She takes the information she has learnt, to share with her children and other young people in the community. When she gets home after work, Amakyewaa’s peer education does not stop, she continues. She also continues her teachings when she gets home. “PPAG’s project has been very helpful to me as a mother. When I go home, previously I was not communicating with my children with issues relating to reproduction.” Her 19-year-old daughter, Stella Akrasi, has also benefitted from her mothers training. “I see it to be good. I always share with my friends give them the importance of family planning. If she teaches me something I will have to go and tell them too” she says.

Male condom illustration
12 February 2020

How to use an external (male) condom

What is a condom? A condom is a form of contraception, usually made from latex, that is used during foreplay or sexual intercourse to help protect against STIs (including HIV) and unintended pregnancies.  Why use a condom? Condoms are the only form of contraception that prevents unintended pregnancies and protects you from STIs, including HIV.   External (male) condoms are 87-98% effective, depending on what type you use and if you use them correctly and consistently. Condoms are recommended alongside another form of short or long form contraception, like an IUD or contraceptive pill. Learn more about other forms of contraception How to put on an external (male) condom Packs of condoms will always come with instructions, so be sure to read them beforehand. But if you’re in a rush, here are a few things to remember: Always check the expiry date on the condom. If it’s out of date then do not use it, as it is more likely to break. Check the packet has a certification mark, usually FDA, BSI, CE, ISO or Kitemark. A certification mark means they have been tested and have passed the required safety standards. The marks look like this: Be careful when you or your sexual partner open the condom. Avoid using your teeth or a sharp object as you risk tearing the condom. The condom should be put on the penis when it is erect (hard) and before the penis comes into contact with a sexual partner (vaginally, anally or orally). Once the condom has been removed from the packet, place it on the tip of the erect penis. Squeezing the tip of the condom, carefully roll it down to the base of the penis. If the condom will not unroll easily, it may be on the wrong way. If this happens, start again with a new condom as pre-ejaculatory fluid (aka "pre-cum") can contain sperm. Once it’s on properly, you’re good to go! Learn more about pre-cum and if it can cause pregnancy How to remove a male condom After ejaculation and with the penis still erect (hard), hold the condom at the base and carefully remove your penis from your partner’s body – if you do not remove your penis from your partner whilst it is still erect, there is a risk of sperm leaking or the condom falling off. Only completely remove the condom when you are no longer in contact with your partner’s body. Wrap the used condom in some tissue and dispose of it in the bin. Do not flush your condom down the toilet as this can have a negative impact on the environment. Remember you cannot use the same condom twice (even if you rinse it)! Learn more about some of the types of condoms available Using lubricant with a condom If you want to use lubricant (also known as lube), used a water-based one as oil-based lubricants can cause condoms to break.  Remember to use it on the external area of the condom and/or on your partner’s genitals.  Do not place lubricant directly onto the penis as this can cause the condom to slip off. Learn more about lubricant  

IMAP statement on expanding access and contraceptive choice
06 December 2019

IMAP statement on expanding access and contraceptive choice through integrated sexual and reproductive health services

In 2018, IPPF endorsed the WHO/UNFPA Call to Action to Attain Universal Health Coverage Through Linked Sexual and Reproductive Health and Rights and HIV Interventions.13 This IMAP statement serves as a reminder of this call to action to ensure all people have access to comprehensive SRH services, including integrated contraceptive and HIV/STI services, provided through primary healthcare.

echo trial
28 October 2019

After the ECHO trial – Expanding access and choice through integrated services

Since the early 1990s, the evidence has been inconclusive as to whether using hormonal contraception increases women’s risk of acquiring HIV, particularly among progestogen-only injectable users. Observational studies indicated that women using progestogen-only injectable contraceptive methods may be at higher risk of acquiring human immunodeficiency virus (HIV).  The Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial finds no link between HIV acquisition and the use of DMPA-IM, progestogen implant, and non-hormonal copper IUD. For more information please see the technical brief on the ECHO trial.  Following the release of the result of the ECHO trial and the WHO latest guidance statement and revised Medical Eligibility Criteria (MEC) for contraceptive use, IPPF developed a follow-up technical brief to support IPPF MAs and frontline service providers’ work regarding the provision of the integrated contraceptive, HIV and other STI programmes to expand access and contraceptive choice. For more information, please see the attached technical brief After the ECHO trial – Expanding access and choice through integrated services, available in English and French.

ECHO trail
09 July 2019

IPPF Technical Brief on the ECHO trial

Since the early 1990s, the evidence has been inconclusive as to whether using hormonal contraception increases women’s risk of acquiring HIV, particularly among progestogen-only injectable users. Observational studies indicated that women using progestogen-only injectable contraceptive methods may be at higher risk of acquiring human immunodeficiency virus (HIV).  The ECHO trial finds no link between HIV acquisition and the use of DMPA-IM, progestogen implant, and non-hormonal copper IUD.