Mary, a 30-year-old sex worker, happily drinks a beer at one of the bars she works at in downtown Lilongwe. Her grin is reflected in the entirely mirrored walls, lit with red and blue neon lights.    Above her, a DJ sat in an elevated booth is playing pumping dancehall while a handful of people around the bar nod and dance along to the music. It’s not even midday yet.    Mary got introduced to the Family Planning Association of Malawi through friends, who invited her to a training session for sex worker ‘peer educators’ on issues related to sexual and reproductive health and rights as part of the Linkages project.    “I learnt about condoms and even female condoms, which I hadn’t heard of before,” remembers Mary.  Life-changing care and support   But the most life-changing care she received was an HIV test, where she learnt that she was positive and began anti-retroviral treatment (ART). “It was hard for me at first, but then I realized I had to start a new life,” says Mary, saying this included being open with her son about her status, who was 15 at the time.    According to UNAIDS 2018 data, 9.2% of adult Malawians are living with HIV. Women and sex workers are disproportionately affected - the same year, 55% of sex workers were estimated to be living with HIV.    Mary says she now feels much healthier and is open with her friends in the sex worker community about her status, also encouraging them to get tested for HIV.  “Linkages brought us all closer together as we became open about these issues with each other,” remembers Mary.  Looking out for other sex workers   As a peer educator, Mary became a go-to person for other sex workers to turn to in cases of sexual assault. “I’ll receive a message from someone who has been assaulted, then call everyone together to discuss the issue, and we’d escort that person to report to police,” says Mary.    During the Linkages project - which was impacted by the Global Gag Rule and abruptly discontinued in 2017 - Mary was given an allowance to travel to different ‘hotspot’ areas. In these bars and lodges, she explains in detail how she would go from room-to-room handing out male and female condoms and showing her peers how to use them.    FPAM healthcare teams would also go directly to the hotspots reaching women with healthcare such as STI testing and abortion counselling. FPAM’s teams know how crucial it is to provide healthcare to their clients ensuring it is non-judgmental and confidential. This is a vital service: Mary says she has had four sex worker friends die as a result of unsafe abortions, and lack of knowledge about post-abortion care.    “Since the project ended, most of us find it difficult to access these services,” says Mary, adding that “New sex workers don’t have the information I have, and without Linkages we’re not able to reach all the hotspot bars in Lilongwe to educate them.”

In Chigude, a usually quiet rural village in northern Malawi, young people gather around two tables laughing and chatting animatedly.    On one table, they are playing a traditional mancala board game Bawo. On the other, volunteers demonstrate putting a condom onto a wooden model penis. Though this is inevitably met with shouts and giggles, the largely male crowd watches intently.    “Most of them have come here for condoms, but I don’t just give them out,” says Kondwani, a 22-year-old Youth Action Movement (YAM) volunteer. “I ask them how do you use a condom? How is it useful to somebody who is using it?”  Committed to sharing knowledge with their peers  Activities like this in hard-to-reach areas are one of many that the Youth Action Movement delivers across Malawi. Trained and hosted by Youth Life Centres, which provide sexual and reproductive healthcare aimed at youth, the volunteers meet regularly and reach out to their peers in schools, universities, and on social media.    Phoebe, 22, is a YAM volunteer in Malawi’s capital, Lilongwe. “It’s hard for girls to speak out about sexual abuse because they fear the community will talk about them and blame them,” she explains, adding that a particular fear of being thrown out of their homes after opening up to their parents is one reason why girls are more comfortable opening up to their peers.    This is why trained volunteers like Phoebe are often approached by other young women who have been sexually assaulted. “When this happens, I speak to other YAM members about it and we decide what advice to give,” she says.    This will usually involve giving advice and sometimes going with young people to their local Youth Life Centre for STI testing and abortion counselling, as well as the hospital and the police, depending on the case.    “I tell girls they can decide what to do about their lives, their future and their bodies,” says Phoebe proudly, hanging out with her friends from YAM at Lilongwe Youth Life Centre.  Offering a range of care for youth communities   Chipiliro, the District Manager for Lilongwe, says that the centre focuses mainly on youth, as well as women and under-served communities. Their healthcare is integrated, meaning that “when a client comes in this room for one condition, they should also be able to claim our other services,” says Chipiliro.    He explains that this helps to “reduce stigma” as a client who is at the Youth Life Centre for one reason, for example to pick up condoms, can also then be offered other care that they might be less confident to ask for such as STI testing or abortion counselling.    Also, at the centre is Fane, a 33-year-old mother of three who has come to get the contraceptive pill. “I had the injection before but it had some bad side effects, so I wanted to change,” she explains.    Before Fane moved to Lilongwe, she says she had little understanding about contraceptive options and healthcare was difficult for her to reach from her remote village.    When she learned more about the different contraceptive methods available to her, she discussed them with her husband and has been using them ever since. “Family planning is very important because it relieves the anxiety I used to have before,” says Fane, remembering she used to avoid having sex with her husband for fear of getting pregnant.  “Now, I don’t have those anxieties and we’re having sex again like we used to!” She smiles, adding that the other major benefit of contraception has been spacing the ages of her children well. “This means I’m able to focus on my business selling mandazi (local donuts) and tomatoes.” 

Abdoulaye Camara is the best dancer in the neighbourhood, and he’s not afraid to show it. Abdoulaye grooves to the beat blaring from hastily assembled speakers, accompanied by two friends who follow his lead in a slickly choreographed routine. He soon gathers a crowd outside a cafe in Commune IV, a working class area of Mali’s capital, Bamako. Young men who spend the day mining for gold are trudging home, and stop to take a look. Girls holding younger siblings by the hand sidle up to the crowd, which is growing in size with every new track. "We distract them with dance and humor" Abdoulaye’s moves are not just for fun. He is head of the dance troupe of the Youth Action Movement, belonging to the Association Malienne pour la Protection et la Promotion de la Famille (AMPPF), which uses dance and comedy sketches to talk about sex. It’s a canny way to deliver messages about everything from using condoms to taking counterfeit antibiotics, to an audience who are often confused and ashamed about such topics. “We distract them with dance and humor and then we transmit those important messages about sex without offending them,” explained Abdoulaye. “We show them that it’s not to insult them or show them up, but just to explain how these things happen.” The average Malian woman will give birth to six children, according to the World Bank, one of the highest fertility rates in the world. In the closely packed streets of Commune IV, teenagers hear whispers about pregnancy and sexually transmitted infections, but are scared to ask more. Everyone knows everyone else’s business.  “Young people don’t like us to talk too directly to them about sex or sexually transmitted infections. We can’t also speak frankly about early pregnancy either,” Abdoulaye said. “They will tell us ‘I know all about this’ but then we see more girls pregnant and more infections, so it’s not true.” For five years now, Abdoulaye and his loyal band of dancers have staged street shows in schools, streets and cafes. In a recent sketch he played a bisexual man conducting a relationship with a man and a woman simultaneously, only to have to warn them both he had a sexually transmitted infection. The three young actors played for laughs, making light of a scenario that is highly taboo in Mali. Meeting unmet needs The centrepiece of all the dances and sketches is the use of contraception, and hints at what safe, consensual sex might look like. In Mali, a quarter of women have an unmet need for contraception, leading to an estimated 418,000 unwanted pregnancies a year. Abdoulaye and his team speak in the local language, Bambara, and ask the audience about their preconceptions about using condoms or getting a contraceptive implant. The majority of the audience is illiterate, and with no books, internet or schoolteachers, they lack reliable sources of information on preventing pregnancies or spacing children. Oumou Konaté, 25, was watching from the sidelines with a smile on her face. She became a mother while still in her teens, and began using an implant after the birth of her daughter. “I came here because I like the activities and what they are doing. I wanted to know more about family planning and condoms. I really appreciated what they showed us,” Oumou said. “I got the information that I wanted, lots of things I didn’t know before.” As the sun sets over the hills behind Commune IV, the music dies down and Abdoulaye helps to pack up the troupe’s props and equipment. “We want to reach everyone in Bamako and across Mali. We are the first but I hope we aren’t the last,” he said.

Five years ago, when Arnilda Simango was 13, she started dating a boy from her community, outside Xai-Xai City, in Gaza Province in southern Mozambique. A year later she got pregnant, at his insistence, and he left her shortly after the baby was born. AMODEFA’s youth services offered her counselling and advice throughout her pregnancy and became the network through which she made new friends.  Today, at the age of 18, she is raising her son, with help from her mother and plans to return to school. “When I started dating, I thought I wanted a partner who could take care of me and that could maybe fill the void I felt for not having a father. When I started the relationship with my boyfriend, he insisted that he needed a son because all his friends already had one. I had little space to say no because he threatened to date someone else and I was convinced he was the right person for me. When I got pregnant in 2016, he started behaving strangely. He stopped being affectionate and gave indications that he did not want to be with me anymore. That's when a friend of mine told me that there was a youth center where I could get advice on how to proceed in this situation". The Adolescent and Youth Friendly Services (SAAJ) center, based at the Patrice Lumumba Urban Health Center, on the outskirts of Xai-Xai, is run by AMODEFA and provides HIV testing and treatment, prenatal and postpartum consultations, and other information and services around sexual health and rights. The center is supported by the Women’s Integrated Sexual Health (WISH2ACTION) programme, led by IPPF.   "One day I walked there and received a lot of advice. As I was already 4 to 5 months pregnant, I was advised to open a prenatal form. They did all the follow-up until I gave birth to my son.” "Believe me, being a single mother at 14 was a suffocating experience and it could have been worse if I had not been accompanied by [the SAAJ]. I do not know how to thank them. I practically felt alone without knowing what to do, but I had a lot of advice here and made friends with other girls". Planning for the future  Arnilda dropped out of 7th grade once she became pregnant and helped her mother selling basic goods from a stall in her home. It is from this small business that her mother supports her two children who are still living at home, as well as five grandchildren. Arnilda plans to return to school next year to continue her studies now her son is old enough to stay with his grandmother. Her dream is to be a professional model. Until then she does not want to have another child, so she goes to the SAAJ for family planning purposes. Arnilda says she walks 50 minutes to the center every three months for the contraceptive injection.  "I wanted the implant, but it doesn't settle well with me, so I renew the injection every three months.  I do this because I need to continue studying to have a decent job that allows me to support my son. Next year I will go back to school. "A second child is not in the plans. I still consider myself a minor. Even the first child I only had because at the time I had no one to give me advice and show me the best way. I believed in my ex-boyfriend and today I have this lesson. Today I can say that I have come to my senses, not only from the experience of being a mother, but from everything I learn here [at the SAAJ]. There is no friend of mine who does not know SAAJ. I always advise them to approach here because I know they will have all kinds of counselling and accompaniment.”

We can all agree that a lot has happened in 2020 – but let’s not forget that this year also marks the 60th anniversary of the game-changing contraceptive pill. For 60 years, “the Pill” has been approved for use in the US market, changing the face of reproductive control for millions of people since.  Although taking a few years longer to become widely available to all women, the Pill was the first oral hormonal contraceptive – and the massive impact of this tiny pill cannot be understated.  It allowed women to take real ownership over if and when they had children, and how many they had, giving them control over their lives in a way that had never been seen before. As a by-product, the Pill also enabled its users to make freer choices about other aspects of their lives, such as their careers, education, and sexual habits, and we can see why it remains one of the most popular forms of contraceptive to-date.  How it works The way the Pill works is that this hormonally active medication is usually taken on a daily basis. They contain either two hormones combined (progestogen and estrogen) or a single hormone (progestogen), and they generally work by suppressing ovulation, and causing a thickening of the cervical mucus, blocking sperm penetration. The Pill is 92-99% effective, offering continuous protection against unintended pregnancy when used consistently and correctly. It also produces regular and shorter periods (and frequently a decrease in menstrual cramps), and it can protect against ovarian and endometrial cancer, ectopic pregnancies and infections of the fallopian tubes. Possible side effects include nausea, breast tenderness, mild headaches, weight gain or loss. Very rarely, it can lead to serious health risks (e.g. blood clots, heart attack, and stroke), and risks are higher for women over 35 years who smoke. It’s important to note that the Pill does not protect against sexually transmitted infections (STIs, including HIV). To protect against STIs, an internal or external condom must be used. Learn more about how the Pill works.  What next? For years, many people have been calling for a “male Pill”, due to the limited number of contraceptive options available to men beyond condoms and a vasectomy. This often places undue pressure on women or people with uteruses to be “in charge” of contraception – although it is important to note that it is, in fact, everyone’s responsibility. Research is ongoing into contraceptive solutions for men, including pills, injections and gels, but so far none have made it to public use.  Thus the Pill remains one of the most trusted and widely-used forms of hormonal contraception, and in the troubling face of challenges to reproductive freedoms, we truly hope that this vital component of healthcare remains freely available to all who want and need it. 

Dr Zarka Riaz sits behind her desk at the Family Health Model Clinic (FHMC) set up by Rahnuma Family Planning Association of Pakistan (FPAP) in a low-income neighbourhood in Rawalpindi, a city of over two million next to Pakistan’s capital Islamabad. Even on this wet monsoon day, over a dozen women are gathered in the waiting area of the clinic.  “Pakistan is experiencing a population explosion, women, especially those from underprivileged and marginalized sections of society are not able to gain access to contraception they so desperately want and need, to make choices for their families,” says Dr Zarka. Dr Zarka is a gynecologist, with a specialization in family planning. She has been working with FPAP for ten years but started working at this clinic 18 months ago. The family clinic is supported as part of the Women’s Integrated Sexual Health (WISH2ACTION) programme funded by the Foreign Commonwealth and Development Office (FCDO), under the strategy to ‘Leave No One Behind’.  Across the country – Rahnuma-FPAP works through cluster networks. A pioneering model that brings together public and private specialist sexual and reproductive and health centers within a close radius referral network to ensure women and girls can receive life-changing care. Networks use poverty data mapping to ensure that services are targeted to areas where the population needs them most.   "Under WISH we are offering free family planning services, which is extremely important for a low-income area such as this”, explains Dr Zarka.  FPAP works in partnership with government and private clinics, community-based distributors, disability organizations and religious and community leaders as part of the clusters. Local pharmacies are also part of these networks and provide condoms and birth-control pills free of cost.    Dr Zarka observes that a lot of women worry about unintended pregnancies but are not aware of family planning methods available. Pakistan is the world's fifth-most populous country, home to over 220 million people with an annual fertility rate of 3.6 children per couple.  “There are a lot of myths and misconceptions about family planning. In male-dominated societies such as ours, women are often not able to make decisions about their reproductive health, which is why it is essential to engage men and mothers-in-law." Dr Zarka notes that it is becoming increasingly common for women in low-income areas to try to terminate unwanted pregnancies by getting unsafe abortion. “Abortion pills are readily available, and people use the internet to find out ways to abort unwanted pregnancies. However, women often take the wrong dosage and end up with too much bleeding or infections,” she says. “Access to free contraceptives can reduce the need for unsafe abortions, allow women to space their pregnancies and gain autonomy over their health and wellbeing,” she adds. Rahnuma implements the WISH programme across five provinces across the country and through its community awareness work is changing the discourse in Pakistan on family planning and sexual and reproductive health and rights.     

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

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

In a room that is bare but for a few beds, Kuzema Abba Naga is resting after giving birth hours before to her tenth child, and now she thinks, her last. Before coming from her village to this remote and rural government health center in the Kebele district to give birth, Naga never knew it was possible to choose when or whether to have a baby. “I am 38 years old and I had my first baby at age 15,” she said. “This is my first baby for eight years.” Naga named the baby Nejat, which translates to ‘liberation’, after giving birth and discovering the contraception options available to her, she decides to have an IUD fitted immediately. Lack of access to contraception in rural areas This is the first time midwife Rewda Kedir has fitted a woman who has just had a baby with an IUD, though it is not uncommon to meet women coming from rural areas who have never heard about family planning. When they do, many are interested in it, even if they have to fight their husbands to use it or they are forced to hide it from them. “They want contraceptives to space out their children,” said Kedir. “Sometimes their husbands don’t like them coming in to get family planning, so we have to lock their appointment cards away. Their husbands want more children and some think that women who do not keep having their children will go with other men,” she said. Kedir says that most women prefer using the contraceptive implants because they feel few side effects, are long-lasting, easy and painless to have fitted and to conceal. “Here, people believe that more kids means more wealth, and religion restricts family planning services,” she said. “Only 28 percent of women aged 15 to 49 use modern contraceptives,” says Dessalegn Workineh, who manages the Family Guidance Association of Ethiopia’s south west area office in Jimma. Expanding contraceptive access in Ethiopia  With support from the Family Planning Association of Ethiopia (FGAE), who work with the Ethiopian government, clinics in remote rural areas like this one can now provide a full range of sexual and reproductive health (SRH) services for free.  Having all the products and services available and under one roof makes it easier to reach people who might really benefit from help with family planning.  In Oromia, 43 percent of women give birth at a health facility. Kedir finds a lot of women coming in for maternal and post-natal health services who she speaks to about family planning, end up staying or returning to get family planning services.   “Before, it was very difficult to persuade people to use family planning and we had to have a lot of conversations. Now, they come 45 days after delivery to speak to us about this when they get their babies immunised,” she said.  Staff at the clinic also provide family counselling to try and encourage men that contraception is a good idea for the whole family. “We tell them that continuously giving birth can affect the mother’s health and might lead to maternal death, damage the uterus and lead to long-term complications,” said Kedir. A number of staff at the clinic have been trained on family planning and can answer queries and deliver services, “So when I’m not here, people can help.” “The implant procedures are better because there are newer products,” said Kedir, who sits next to a handmade poster with the options for contraception glued on that still has the older, match-sized implants and the new, thinner implants. Providing comprehensive abortion care The clinic also provides comprehensive abortion care and for the past six years, medical abortions. This involves taking a pill rather than having vacuum aspiration or surgery, and is helping to stop women turning to unsafe abortion methods. “Before, there was no safe abortion. People would go to traditional healers and then come here with complications like sepsis, bleeding, anaemia and toxic shock,” said Kedir.  “The good thing is that the women that have [safe] abortions get proper care and the counselling and education has improved,” said Kedir. In Ethiopia, these services are vital “to save mothers from dying due to cases of unsafe abortion,” says Workineh. “Working on comprehensive abortion care reduces complications and therefore maternal mortality,” he added. Kedir says women still have to fight their husbands to get access to family planning and cases can end up in court or divorce. But the cases of complications resulting from unsafe abortion have plummeted.  “We used to see about 40 a year. Now it’s one or two,” she said.

Meseret* and Melat*, volunteers Known in their local community as demand creators, Meseret and Melat, from the Family Guidance Association of Ethiopia’s (FGAE) confidential clinic head out to visit sex workers in Jimma town. This group of volunteers are former, or current, sex workers teaching others how to protect themselves from sexually transmitted infections (STIs) and unintended pregnancy. Their work is challenging, and they travel in pairs for safety - their messages are not always welcome. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Meseret* and Melat*, volunteers Meseret and Melat from the Jimma clinic talk to sex workers in their local community about sexual health concerns, as well as provide contraception. “It’s very difficult to convince sex workers to come to the clinic. Some sex workers tend to have no knowledge, even about how to use a condom.” says Meseret. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Melat, volunteer It can be challenging persuading women that the staff at the confidential clinic are friendly towards sex workers and will keep their information private. “When we try to tell people about HIV we can be insulted and told: ‘You are just working for yourself and earn money if you bring us in.’ They sometimes throw stones and sticks at us,” said 25-year-old Melat. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Fantaye, sex worker Getting information and contraception to women often involves going out to find them, such as Fantaye, a sex worker currently living in a rental space in Mekelle. Peer educators focus on areas populated with hotels and bars and broker's houses, where sex workers find clients. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sister Mahader, FGAE Sister Mahader from FGAEs' youth centre talks to sex workers in Mekelle, about sexual health, wellbeing, and various methods of contraception. This outreach takes place weekly where information and advice is given to groups of women, and contraception is provided free of charge. Under threat from the loss of funding from the US Administration, the Jimma clinic has been forced to reduce the range of commodities available to its clients such as sanitary products, soap and water purification tablets. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Hiwot Abera*, sex worker Hiwot* after her appointment at FGAEs confidential clinic in Jimma. The clinic offers free and bespoke healthcare including HIV and STI testing, treatment and counselling, contraceptives and safe abortion care. Many sex workers have experienced stigma and discrimination at other clinics. In contrast, ensuring confidentiality and a safe environment for the women to talk openly is at the heart of FGAEs’ healthcare provision at its clinics.*pseudonymPhotos: ©IPPF/Zacharias Abubeker Share on Twitter Share on Facebook Share via WhatsApp Share via Email