Forced to flee from home... What would you do?People are being forced from their homes more than ever. Whether they are fleeing conflict or lose their homes to natural disasters, there are an estimated 70.8 million refugees worldwide. Women & girls are often most at risk – the threat of sexual and gender-based violence increases as does the risk of trafficking, and basic healthcare can get overlooked.  We want to know: what would you do under these circumstances? Life has always been largely peaceful in your country until one day civil war suddenly breaks out and you and your family are forced to flee home.Once you cross the border and are settled into a refugee camp, your husband refuses to use contraception and your injectable is only effective for 12 weeks.You are worried you’ll get pregnant again, something you do not want to happen whilst you are in the refugee camp with limited access to healthcare, and whilst your family is already struggling to survive.You decide to:Your name is Fatima, and you are a 29-year-old high school teacher. You are married with two young children – a daughter aged four, and a son, two. After a few months in the camp you realise you are pregnant. Abortion is legal in your host country, but as a refugee you are unsure of your rights and the closest hospital is over 60km away.You hear about abortion pills from other women in the camp that are available through local mobile clinics.You decide to:You seek advice on the methods of contraception available to you from the local outreach worker. You decide on a long-acting contraceptive method called Jadelle, an implant.As you are worried that your husband will find out, the outreach worker advises you to bring him along to a group session on contraception.You decide to:You are able to receive medical abortion pills through a nurse practitioner at the local clinic, who explains you the safe way to take the pills at home. She also provides you with contraception counselling and options for the future. At the local district hospital, medical practitioners are under the misbelief it is not possible to provide surgical abortions to refugees, whilst others refuse to provide abortions on moral grounds, therefore forcing you through an unintended pregnancy. You and your husband attend the family planning session with other couples from the camp. Your husband is convinced of the importance of contraception and you both agree that the Jadelle and condoms are the best options for you to avoid an unintended pregnancy.You now have up to five years of protection against unintended pregnancy. However, you are still worried about the risk of STI and HIV transmission but are unable to talk about contraception to your husband.

Humanitarian crises Largely brought on by sudden onset and slow-onset natural disasters, humanitarian crises are increasingly prevalent in the Pacific. During responses to humanitarian crises in the Pacific, sexual and reproductive healthcare is often under-prioritised and under-resourced. As a result, women and girls of reproductive age and vulnerable and marginalized groups are disproportionately affected and facing increased health and psychosocial risks. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Fragile environments Low topography, rising sea levels and insufficient fresh water supply leaves Kiribati’s population vulnerable to the effects of the climate crisis. The fragility of the outer islands of Kiribati during natural disasters is compounded by their geographic isolation, which makes transportation and communication during post-disaster relief and response both expensive and difficult. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Coastal exposure The majority of the population of 115,000 people live a subsistence lifestyle. Communities are geographically dispersed across 33 atolls covering 3.5 million square kilometres in the central Pacific Ocean. The population and infrastructure within Kiribati are largely concentrated on the coast, where communities face increased exposure to climate threats and natural hazards such as tsunamis, earthquakes, king tides, flooding, droughts, and occasionally cyclones. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Takaria, leader and youth organizer in the Tebikenikua community Takaria will be running to be a Member of Parliament in Kiribati in 2020. “I assist the youth with family problems and family planning and disasters. In our community there are unforeseen pregnancies, domestic violence, and disasters such as high tide waters and strong winds, which can also affect this community. The Kiribati Family Health Association (KFHA) is the key point for us with outreach and training so people in this community know how to prevent and treat STIs, etc. They all know where the KFHA clinic is and that they can get counselling or services there. The problem now is you can’t survive with the sea rise levels. I want all members of my community to live better and have better health and peace.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Susan*, sex worker Susan receives care at the Kiribati Family Health Association (KFHA) including a pap smear. Susan*, 28, is a sex worker from the town of Betio on the main island of Kiribati. Originally from an outlying island, she moved into Tarawa to seek work. Unable to find employment that would fulfill her dream of sending money back to her two children, she was introduced to sex work. With other sex workers, she regularly travels out to the large cargo ships from China, Philippines and Korea anchored off the coast of Kiribati. Despite her new income, she still can’t speak with her children or see them due to the restrictive costs involved of travel between islands.*pseudonym Share on Twitter Share on Facebook Share via WhatsApp Share via Email Theta, 25-year-old mother and youth volunteer Theta is part of the Humanitarian Youth Club set up by the Kiribati Family Health Association in her village. “We face a lot of situations here, one of them is disasters and the second is unemployment and school drop out with our youth. I have helped the Humanitarian Youth Club to apply for financial grants from the Australian High Commission [for $1,000] I am recognized as the smartest member who can write in English. We have learned how to design a disaster plan for the community and share our ideas on sexual and reproductive issues such as STIs. We discuss what we can do for the next strong tide, where we can gather as a community and what we can do if even the maneabe (town hall) floods? If the tide and wind is too strong, we need to go to another safer place, such as another community’s town hall. For now, I want to enjoy the chance to be in our own beloved country. I won’t move until the majority have already left. I want my daughter to grow up in the same place I grew up in.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Beitau, youth volunteer Beitau is the Chairperson of the Humanitarian Youth Club. “I was lucky to be selected as Chairperson as the Humanitarian Youth Club. I feel like I get more respect from the community now I am in this position. I would love advanced training on leadership now, to further assist the club. As I am the Chairperson of the HYC, my main target is to help people during a disaster. I have attended training through KFHA. What I took from this is that when a disaster strikes, we have to do our best for pregnant women, small children and people with disabilities. They more vulnerable and less able to survive a disaster.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Abe, youth officer Abe was involved with KFHA since 2012. “I was inspired by what they KFHA was doing and the issues they were addressing that affects youth. I was surprised to see how many young people come to the clinic as they are affected by STIs, HIV and teenage pregnancy. The lack of education here is a big problem, most people here have a lot of children and yet can’t afford to send them to school. Sexual and reproductive health is our responsibility and we must talk about it with young people. Climate change affects many countries, but Kiribati is small and low lying. I used to go visit a very nice beach with a lot of nice trees and plants. Now, the trees are gone, and the waves have taken over, and the houses have disappeared so no one can build there. In my role as a youth worker and activist, I tell people to fight climate change: to grow more mangroves, to clean up the beach, because we love our Kiribati.”©IPPF/Hannah Maule-Ffinch/Kiribati Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Healthcare providers in their PPE Lebanon Association for Family Health (SALAMA) “After the extension of the general mobilization and in order to provide the services to the most in need population, we decided to re-open the clinic. For this purpose, we are developing a plan for the work during the next weeks, taking into consideration the protocols and procedures taken in Lebanon. This will include an isolation room before the consultation and an assessment of the patient’s status and any symptoms that may relate to the coronavirus. In addition to all the precaution procedures including separation, our clinic was sterilized by a specialized company.”Lina Sabra, the Executive Director of the Lebanese Association for Family Health (SALAMA) Share on Twitter Share on Facebook Share via WhatsApp Share via Email Youth volunteers sort through medical donations China Family Planning Association The China Youth Network set up a donation working group and with the support of the China Family Planning Association and Hubei Family Planning Association, they received donations of menstruation supplies, and medical equipment. By March they had successfully donated 5,680 sanitary towels, 3,280 medical face shields, 1,200 hand disinfectants, 925 disposable beddings, 500 air disinfectants and some medical machines to 87 hospitals in Hubei Province. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Erbol, 17, is the chair of the youth committee of the Issyk-Kul branch Reproductive Health Alliance of Kyrgyzstan “At the present time we are using Instagram with detailed information about our organization and articles on sexual and reproductive health issues. We found new technologies and approaches to organize online meetings with the youth volunteers and planning of future branch activities through Zoom. It is planned to consider additional options in creation of channels on Telegram and Twitter because they are very popular among young people.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Healthcare providers put together hygiene kits for local communities Family Planning Association of Sri Lanka FPA Sri Lanka assembled 5,000 hygiene kits to be distributed to promote and enable frequent hand washing, personal hygiene and menstrual hygiene among vulnerable women and girls with limited incomes. These women and girls include mothers, widows with children, families who care for a member living with a disability, and women and girls living in slums during lockdown in high-risk areas for COVID-19. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Healthcare outreach teams distribute contraception and hygiene kits Family Health Association Iran “To reduce the number of visits to our clinics, we made some changes in the way we deliver services. We provide counselling services through online systems and creating different groups for clients to provide online educational training about COVID-19 for them, as well as some components of life skills and SGBV. For the vulnerable groups including sex workers and substance users we distribute contraceptives, COVID-19 preventive packages, and food through the outreach team instead of static clinics.”Zahra Fathi, Executive Director of the Family Health Association Iran (FHA Iran) Share on Twitter Share on Facebook Share via WhatsApp Share via Email Outreach teams sanitize people's homes in remote communities Sudan Family Planning Association Staff at the Sudan Family Planning Association conduct outreach work in local communities, including offering to sanitize people's homes. Remote areas in Sudan with no medical services will be affected with discontinued mobile clinics services. Access to all family planning, antenatal care, and postnatal care services will be affected due to restricted movement. Sudan, as will many other countries, will be impacted by any decrease in activity in the supply chain for healthcare supplies. Share on Twitter Share on Facebook Share via WhatsApp Share via Email A watercolour entry for a social media art competition Santé Sexuelle Suisse/Sexuelle Gesundheit Schweiz “With our Youth Network we created an artistic competition on our FB and Instagram platforms on issues such as masturbation, menstruation, coming out, female genitalia, pornography. The aim is to enhance creativity and make young people reflect about sexual and reproductive health and rights in a creative way during the corona pandemic. The aim was also to offer something fun and positive in this difficult time.”Noemi, 24, is the co-founder and coordinator of Santé Sexuelle Suisse/Sexuelle Gesundheit Schweiz's youth network. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Volunteers make hand sanitizer kits at a SFPA clinic. Syria Family Planning Association When the lockdown was announced SFPA had to stop running their mobile clinics but recently resumed this service. To keep the health facilities open they implemented a new shift rota for staff. The clinics are also following an extremely high-standard of sterilization procedures in all facilities to reduce the risk of catching or spreading coronavirus. SFPA started using social media to spread information on COVID-19. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Belmar Franceshi, Executive Director Asociacion Civil de Planificacion Familiar “The work we do is very important – despite being in our homes, we continue to work, research and look for alternatives to serve the hundreds of people who daily seek our services. It is one more challenge that we must face and will strengthen our actions, our interventions and the activities we carry out daily with communities, women and girls.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Enusring client and staff safety with PPE Family Planning Organisation of the Philippines The Family Planning Organisation of the Philippines (FPOP) is working safely with PPE equipment to ensure uninterrupted access to antenatal care and family planning methods for women and young girls through their clinics. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Delivering essential healthcare to women Family Planning Association of Nepal With PPE and hygiene kits FPAN’s healthcare providers can safely engage in delivering essential care to communities, including counselling, contraception methods, safe abortion, HIV/STI care, obstetrics and gynaecology care and sexual and gender-based violence support. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Reaching local communities Family Health Association Bangladesh FPAB key health workers have continued to provide essential sexual and reproductive healthcare in local communities during COVID-19. Share on Twitter Share on Facebook Share via WhatsApp Share via Email

An interview with Dr Kunio Kitamura, the Chairman of the Japan Family Planning Association (JFPA), on the impact of COVID-19. How has Japan been affected by COVID-19?   The coronavirus (COVID-19) is spreading rapidly. The Japanese government announced a national emergency on 7 April, but the impact of this policy is yet to be seen.     What impact is COVID-19 having when it comes to sexual and reproductive health (SRH) services?   With strict measures imposed on the movement of people and the economy, JFPA has been discussing ways to continue to provide SRH services according to our mission, which is: “Reproductive health services accessible for everybody, everywhere in Japan”. JFPA is a small organization of around 20 staff and board members. Our team was working hard before and after the start of the pandemic to provide SRH services to all those in need. Regardless of the situation, our services must continue to be provided. Taking into consideration the incubation period of the virus, JFPA introduced working from home for the first time. By keeping a limited number of staff present at the office to do essential tasks, other staff work from home to continue the business.   Which services will be the worst hit? Trainers’ training is one of our core missions, and in 2019, more than 8,000 trainers participated in a total of 70 training seminars hosted by JFPA. Seminars in 2020 were partly rescheduled to prevent the spread of the coronavirus, as large-scale in-person sessions cannot be done without close contact between the attendees in a confined environment. JFPA has been preparing for the rescheduled seminars so they can be held once the pandemic is over, and we are discussing ways to conduct online seminars soon.   Can you tell us about any innovative measures that have been introduced in Japan to provide services in a different way than usual?   JFPA’s Family Planning Research Center, or the JFPA Clinic, is open as usual to provide medical assistance including consultations, hotline services, public relations, and advocacy work.  The telephone hotlines, namely the Adolescent and Family Planning Hotline and EC/OC Helpdesk continue to be open from 10am to 4pm from Monday to Friday (excluding weekends and holidays), every week. The number of incoming calls has not risen rapidly for these two hotlines.  However, calls from women currently under fertility treatments have increased at the Tokyo Fertility Treatment Hotline, which is sponsored by the Tokyo Metropolitan government. This is because of the announcement made by the Japan Society for Reproductive Medicine on 1 April asking clinics to “propose hiatus to clients receiving fertility treatment until the pandemic has slowed down and the danger of contracting the virus has decreased, or drugs that prevent or cure COVID-19 that can be prescribed during pregnancy is produced.”   Have you been trialling anything else?   JFPA had already officially rolled out an easy-to-use search page in September 2019 for those in need of emergency contraception (EC). The page can be accessed via a QR code scanned by a smartphone camera, and by feeding the user’s GPS data, a list of 20 medical facilities starting from the nearest to the user’s location is displayed on a browser. Alerts are shown next to facilities that may be closed on that day. There is a MAP feature that provides step-by-step instructions to reach the facility.   Can you tell us more about the clinic services?   Our JFPA clinic has not been designated to take in clients that might have COVID-19 yet, but more women who are using low dose oral contraception (OC) and low estrogen/progestin (LEP) pills (covered by the national health insurance scheme) are visiting the clinic. Luckily, our clinic has not run out of medicine or other commodities, but many clients have voiced their fears of losing access to contraception once a severe lockdown is imposed.  The government issued a notice to launch online medical consultations from 10 April, regardless of previous face-to-face consultations at the clinic. Even so, medical professionals must be ready to provide the most needed, lifesaving SRH services.    What options are there for women to access emergency services?   There are two options for EC in Japan:  Reduce the possibility of pregnancy by 90.8% with emergency contraception using a gestagen pill (Levonorgestrel) within 72 hours of sexual contact Inserting a copper IUD within 120 hours of sexual contact.  EC is prescribed upon consultation with a gynecologist in case of sexual contact without contraception, failed contraception, rape, and other emergencies. In case you do need an EC prescription, contact the clinic and arrange a visit to talk about your needs. What message do you have for people and your staff in Japan when it comes to SRH services and COVID-19? Even under these extremely strained circumstances we cannot lose sight of our goal to “realize a society that allows access to reproductive health services, whenever and whoever it may be”. As we see the increased threats and attacks on sexual and reproductive health and rights (SRHR) issues, together we must continue to fight for the advancement of SRHR including comprehensive sex education. It is essential now more than ever.

An interview with Malak Dirani, a midwife at the Lebanese Association for Family Health (SALAMA) on the impact COVID-19 is having on the services she provides to vulnerable communities including Syrian refugees. What is your role at SALAMA? I am a midwife and trainer with the Order of Midwife in Lebanon for family planning so I provide a range of services, including: Pre-natal and post-natal care for pregnant women Gynaecological services  Providing VCT (Voluntary Counseling Test) for HIV with counseling pre and post-test Providing family planning services such as IUDs, contraceptive pills, emergency pills and condoms, as well as family planning and unsafe abortion counseling. How has your job been impacted by the outbreak of coronavirus/COVID-19?  Before the coronavirus crisis, I was conducting fields visits with social workers and volunteers once or twice a week. We would provide family planning services, gender-based violence (GBV) counseling, and providing awareness sessions on different sexual and reproductive health topics. Unfortunately, all outreach visits to field have now had to stop. Due to the current situation and the risk of spreading of COVID-19, we have been forced to reduce our activities and services, and to reduce the number of clients we can receive. For any client that does visit our clinics, they must follow the strict prevention and hygiene protocols before they enter. We also deliver small group information sessions with clients on coronavirus, what they can do to protect themselves, and advice on what to do if they have symptoms.  In the long-term, how do you think coronavirus/COVID-19 will impact sexual and reproductive health on a national and global scale? The immediate impacts of coronavirus on the communities we serve in the refugee camps are: An increased risk of malnutrition The number of unintended pregnancies will increase Communities that are living in camps are not protected from contracting COVID-19. Most tents contain at least six people, so coronavirus can very quickly spread through the camp if someone catches it  The majority of people in the camps are unemployed, so they have no way of securing even their basic needs. I think the long-term impact will be contraceptive supplies and the impact this will have on women. In Lebanon, we import all family planning methods, even condoms. Now airports are closed, those commodities are less available. Countries that produce family planning methods are some of the most affected ones by COVID-19 (such as India and China), so we will face a lack of these on a global scale, which will lead to an increase the number of unintended pregnancies and unsafe abortion. Do you have a message you’d like to share with other frontline healthcare workers who continue to deliver care during the COVID-19 pandemic? My message to healthcare workers across the world is that we are always here for people to secure their health rights. We are on the frontline, we were always the one who people trust! We are the nation's guiding light during this difficult time, so we can, with our efforts and power support patients, overcome this crisis, and save lives.

Updated:19 March 2020 Update: This appeal is now closed and all funds raised by 18 March were transferred to our partner the China Family Planning Association to contribute to their services. Further funds raised through the appeal will be used to help our Member Associations impacted by coronavirus. As of 10 February 2020, the novel coronavirus outbreak in China is ongoing and the number of cases continues to rise. In addition to the risk from the virus itself, there is a critical impact on the safe provision of other vital health services in China, including sexual and reproductive healthcare. IPPF’s member association in China, the China Family Planning Association (CFPA), has millions of volunteers and staff providing people with information, education, counselling and social services related to family planning, maternal and child health, healthier childbearing and adolescent sexual and reproductive health. We’re launching an appeal to give as much assistance to them as we can. That includes help in reducing the chance of contracting or transmitting the virus. It’s vital that volunteers and staff stay as safe as possible as they continue to support vulnerable groups, including women, young people and migrants. IPPF’s Director-General Dr Alvaro Bermejo said: “Global support for China is needed now. IPPF’s member association in China, the China Family Planning Association, is playing a vital role in maintaining its services as much as possible throughout the outbreak. In turn, we are going to do as much as we can to support CFPA’s volunteers and staff. That will include supplying badly needed commodities such as face masks, along with other prevention measures. China’s emergency is our emergency too.” CFPA’s Standing Vice President Mr. Wang Peian said: “The work of our volunteers and staff remains vital. CFPA is actively involved in disseminating knowledge about novel coronavirus, sourcing and distributing masks, assisting the health department by monitoring the health situation in communities on a daily basis, and setting up hotlines for psychological consultations. We continue to provide sexual and reproductive healthcare across China, as well as other provisions for both medical professionals and patients to help stop the spread of novel coronavirus especially for vulnerable people. We are grateful for the support of IPPF, and to everyone who makes a donation.” Our emergency fund will allow us to reach more people with these much needed, and overlooked, services. 100% of donations made to this fund by 18 March were transferred to our partner the China Family Planning Association to contribute to their  services. Want to know more? Take a look at the World Health Organization's latest information on novel coronavirus.  

On the evening of 14 March 2019, Cyclone Idai made landfall in the city of Beira in central Mozambique. With wind speeds of 185 kilometers per hour, it was the largest cyclone on record to hit the Southern Hemisphere and Africa. The impact was devastating, leading to the loss of life and extensive damage to infrastructure – not only in Mozambique, but in Malawi, Madagascar and Zimbabwe. In Mozambique alone, more than 130,000 people had to seek shelter in the 136 accommodation centers (emergency tented camps) that were set up across the county. The situation was dire, and the Mozambican government had to call for assistance to rebuild crucial infrastructure like health, transport and communications. The Associação Moçambicana para Desenvolvimento da Família (AMODEFA), IPPF’s Member Association in Mozambique, responded in the most affected areas of Mozambique, including Beira, Tete, Chiomoio and Zambezia. AMODEFA is still there providing sexual and reproductive awareness and services.  A committed volunteer  None of this would have been possible without the help of volunteers like Emerson Chaves, a clinical psychologist. Emerson is stationed in Chimoio, Manica Province. He is a passionate 29-year-old with a desire to offer psychosocial support to his community. Emerson performs his work with dedication as part of AMODEFA’s emergency response team to Cyclone Idai.  “The people of Chimoio were unable to seek for help after the disaster,” Emerson said. “Trying to survive had become a priority as opposed to seeking health services. Most people will not come for services unless we talk to them first.” Emerson’s work is not without its challenges. He works within a community that has deep-rooted cultural traditions that make talking about sex difficult. Yet his work involves sensitizing people about sexual and reproductive health and rights (SRHR), both at the health facility and within the community. This work is especially targeted at women and girls, who are disproportionately affected by issues of displacement. Emergency situations leave girls and young women vulnerable and at a higher risk of sexual exploitation and forced marriage, and they lack basic health services including sexual and reproductive healthcare. These circumstances increase the need for accurate information and quality services on family planning and reproductive health. “Due to the cultural background, I have to approach the topic in a special way and sensitize my community about sexual and reproductive health and rights,” Emerson points out.  Tackling gender-based violence  He shared his experience dealing with cases of gender-based violence; Emerson said the norm in many communities is that the family of a girl that is sexually assaulted receives a ‘bride price’ from the perpetrator’s family. This is usually done as a negotiation between the families. Once this takes place, the case does not get reported to the authorities – if one reports the case the ‘bride price’ is taken away. Many cases of gender-based violence are not reported because of these types of cultural barriers. Fortunately, the IPPF Humanitarian response was able to utilize the Minimum Initial Service Package (MISP), a set of life-saving activities to be implemented at the onset of every humanitarian crisis. MISP focuses on areas such as preventing sexual violence and maternal and infant mortality, and reducing the transmission of HIV, Through AMODEFA, IPPF rolled out the MISP in the affected areas where more than 130,000 people had been displaced, reaching 9,983 people in total, and 3,350 people with sexual and reproductive health (SRH) services. For IPPF, protecting the SRHR of communities and delivering the necessary SRH services in these humanitarian settings is the main objective.  A day with Emerson Emerson beings his day with a plan at the health facility. He has a choice to visit either of six facilities in his area: Motocoma, Chipinda Umue, Inchope, Zembe, Marera or Macate. At these facilities, Emerson receives clients who have been referred from community mobilizers to seek psychosocial support. On Saturdays, he is out with the community mobilizers to sensitize the community on SRHR. He begins with the group sessions then conducts door-to-door visits. The psychosocial care that people need in humanitarian settings is unique – especially when SRHR are concerned. “People in the community are not aware that the facility is offering services,” he said. “They still think that it is closed after the disaster. It is my duty to give correct and updated information on the situation about health services. The community needs to be aware that we are offering services, especially the community members who need SRH services at this time.” 

Sakuni is 36-year-old transgender woman from Sri Lanka. A transgender activist, she speaks passionately about the situation facing transgender people in Sri Lanka and her work with the National Transgender Network of Sri Lanka (NTNSL).  Sakuni was born with both male and female genitalia, but as her mother and father already had four daughters, her parents decided to raise her as a boy. But, “at the age of eight or nine, I felt like I am a girl. At the age of 11 or 12 I started to be attracted to boys at school”, she says.  She ‘came out’ to her family, who accepted Sakuni for who she was. “My family didn’t hide me away when I came out as transgender, they accepted me. My father has passed away, but my sisters and mother like to come visit me and like going places with me.”  “I am happy as a transgender person because my family loves me, but the other transgender people face many problems from their family,’” she says. “They cut their hair and force them to change their clothes and cut their nails. They don’t allow them to wear makeup or shave.”  Being able to shave is an integral part of being a transgender woman. Which is why during disasters, such as the severe flooding Sri Lanka experiences on a yearly basis, it’s important for transgender people to have access to razors.  A timely idea  Just before the October 2018 floods, Sakuni had been attending training at IPPF’s Member Association, the Family Planning Association of Sri Lanka (FPASL). It was there she came up with the idea to ask for some dignity kits to distribute to the transgender community in her area.  “At that awareness program, I learnt that FPASL supports transgender people during disasters. FPASL is the only organisation that talks about transgender people. I had this idea, if I can do something for transgender people by requesting dignity kits for them, then the awareness program is completed.”  These kits include items such as underwear, sanitary napkins, soap, toothbrushes, and towels, and are intended to help restore women's dignity and increase their mobility during crisis situations. Furthermore, the buckets that contain these items can double up as water containers.  NTNSL has long-standing ties with community-based organisations in these districts and transgender persons can be considered extremely vulnerable in crises sometimes not feeling safe or not being able to enter temporary shelters. They are also sometimes being excluded from distributions given that the gender marker on their identification form does not match their gender identity and appearance. It can be difficult to access these kits, or even if they do, the items are not designed with the transgender woman in mind. FPASL had specifically designed kits to be transgender-friendly.    “I distributed the kits myself. They were hugging me, they worshipped me for distributing those kits. It was really emotional for me. When I received the kits and saw what was inside, I wanted to protect the items as a souvenir. But of course, I used them! The items included things we have never got before as a transgender person. Receiving something like this for us makes us very happy. I feel like it’s a gift for us because normally we don’t get anything from any party as a transgender person.”  Discrimination in aid Transgender people are often unable to access humanitarian aid in emergencies due to discrimination. In Sakuni’s case, it was the lack of the right National Identification Card which prevented her and her friends from accessing aid. “We [the transgender community] weren’t registered in this area. So we couldn’t get any other food or aid. We are transgender so we selected this area to live so we are near to each other. We can’t just go anywhere; we have to stay in certain areas. This area is good for transgender people because it’s not crowded and we are used to this area, and the people are used to us. They don’t laugh at us.  But in other areas, we have problems.”  Because their ID cards didn’t match the location they were staying in, Sakuni and others were unable to receive aid. This is where most transgender persons in Sri Lanka face a huge obstacle, as their assigned gender at birth that is reflected on their National Identification Card does not match their real gender. If they queue up in the male line, the men shout at them. “So we just don’t vote”, she said.  Change is coming In Sri Lanka, changes are coming slowly. Sakuni says that, besides changes in attitude needed in the general public, it is also important that the Government reflect the LGBTI community. “Can’t a transgender person be in the parliament to represent our community, so our voice is there? I would like to go to parliament one day for my transgender community. I would ensure all transgender people can get the National Identification Card and voting rights.” National governments have their part to play, but the humanitarian community can do their part by incorporating transgender-friendly services in emergency responses. Last year, IPPF hosted the first ever Pride in the Humanitarian System consultation, which brought together hundreds of LGBTI+ activists to steps that can be taken in humanitarian emergencies to ensure our responses are more LGBTI+ inclusive.  The findings from this consultation were clear: understanding the needs of LGBTI+ people is critical to address the inequalities experienced during preparedness, response and recovery. Our trans-friendly dignity kits for Sakuni and her community are just a small step towards a much bigger goal. All actors in the humanitarian system must be mutually committed, responsible, and accountable to LGBTI+ people. It is only when we work together that we will achieve a just and equal response to humanitarian crises.   

The world is facing stronger and longer natural disasters, protracted complex emergencies, conflicts and epidemics. These humanitarian crises can expose weakness in health systems, with particularly serious consequences for women and girls in need of reproductive health care. To improve the quality and availability of post‑abortion care during a flood, the University of Leicester and International Planned Parenthood Federation South Asia Region (IPPF-SAR), in collaboration with the Government of Bangladesh, developed and measured the impact of an integrated intervention package, called RHCC. First tested in a flood-prone area of Bangladesh, this novel approach includes: i) Pre-positioning medicines and supplies, using the UNFPA’s Inter-Agency Reproductive Health Kit 8; ii) Capacity building of service providers; and iii) Community awareness raising. Supported by IPPF's Innovation Programme, the project aligns with IPPF’s commitment to ensuring that crisis-affected populations receive timely, quality, life-saving, gender-responsive and inclusive sexual and reproductive health services.  

In August 2017, weeks of continued and heavy rainfall across Nepal resulted in flash floods and landslides that affected 36 of the 75 districts. Many people lost their homes or were displaced. It was estimated that of those affected, 112,500 were women of reproductive age, including 8,694 pregnant women.  IPPF Humanitarian, through their Member Association, The Family Planning Association of Nepal (FPAN), activated its emergency response system early on. With funding support from the Australian Government, FPAN and IPPF Humanitarian initially mobilised their response in four of the worst affected districts (Sunsari, Saptari, Bardiya, and Dang). Mobile medical camps were established to meet the sexual and reproductive health needs of the affected population, including through the distribution of short and long acting methods of contraception, STI and HIV screening, and GBV referrals. In collaboration with the USAID-SIFPO project, services were then expanded into five more affected districts. IPPF Humanitarian spoke with 21-year old Muna in her home district of Sunsari in Nepal.  “I got married at 16 years old and have two children, a four-year-old girl and two-year-old boy.  In my caste, we get married early, so my parents took me to get an arranged marriage. I was in the 8th class at the time, and returned to school after I got married, but only lasted one year.  My husband works in construction and had to stop working for two weeks when the floods came. When he doesn’t work, he doesn’t get paid, so it’s been very difficult.  A FPAN social worker told me about the mobile medical camp today. I used to be on the three-month injectable but today I changed to the five-year implant in my arm.  When my youngest child was eight months old I found out I was pregnant again. I decided to discontinue that pregnancy, so I took the five small tablets given to me by my neighbourhood doctor. I was two months pregnant at the time.  From this, I had two days bleeding and cramp like pain, and then weakness. I decided to abort that pregnancy because my youngest will still only eight months old, and I didn’t want any more children.  If I had more than two children, it would be very difficult to feed and educate them, and would badly affect my body too. I’m so happy I now don’t have to worry about contraception for another five years.” Want to know more about safe abortion access? Join IPPF'S I Decide movement