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

Dr Ratni Palullungan is a fearless doctor, mother, and selfless volunteer providing sexual and reproductive healthcare to marginalized groups in fragile humanitarian settings.  Currently she is deployed with the Indonesian Planned Parenthood Association’s (IPPA/PKBI) response team in Majene District, West Sulawesi, following a magnitude 6.2 earthquake which occurred in January 2021.   In an open diary, Dr Ratni shares what a day in the life looks like for a volunteer doctor providing care to those affected by the earthquake.   5.30 – 8.30am I get up quite early and have my quiet time (prayer), then I gather my dirty laundry. Currently, I live with other volunteer teams in a place called PKBI Post in Majene, and there is a cooking schedule for everyone. After prayers, chores and breakfast, I get my daughter ready for the day as she accompanies me to work temporarily. After that, the team and I prepare medical equipment and medicine for the day's humanitarian mission. 8.30 – 11am Today the first location is Maliaya Village Health Centre, in Malunda District, Majene. Here, I attend to and examine 25 pregnant women. The pregnant women, on average, get married at a fairly young age. There are definitely risks to their reproductive health. There is a 43-year-old mother who is currently pregnant with her 11th child. To limit health risks, we advise her on the various safe family planning options.   There is also a 38-year-old woman who is eight months pregnant. However, the size of her belly is very small for a woman in her third trimester. In fact, I initially thought that she was only four or five months pregnant. After I examined her, it turns out that she is categorized as a ‘malnourished’ pregnant woman. It is very unfortunate because she admitted that she eats food without paying attention to her nutrition intake. In fact, she tends to eat instant noodles. So I advised her to drink milk, eat only nutritious foods, and always taker her vitamins.  11am – 2pm After visiting Maliaya Village, I travelled to Kabiraan Village. This village was severely affected by the earthquake. Here, I walk around the evacuation camp, most of which is still occupied by displaced people in this post-earthquake period. Even under the evacuation tent, I continue to conduct health examinations for pregnant women.  Due to the large number of cases of young marriages in Kabiiran Village, the team and I decide to conduct counselling sessions for the teenagers here. I advise the teenagers to get to know the risks that might occur to their reproductive health if they marry too young.  2 – 4pm The health volunteer team and I are finally able to take the time for lunch. We have our lunch near the beach, and get to enjoy local seafood as our menu. Enjoying the seafood while looking at the beautiful sea view is a precious time. I certainly won't forget this moment. 4 – 6pm We continue our journey to East Lombong Village. We have many elderly patients here. Yet interestingly, during one of the patients’ examination, there is one mother who wants to get the contraceptive implant. For me, this is quite a shock, given that we rarely find women in this village who want to do family planning. The mother admitted that she did not know much about the family planning program and has many children. She is grateful that the PKBI volunteer team and I came to their shelter camp for the health examination. 6pm The team and I decide to return to the PKBI Post. Today’s journey is quite tiring but there is a sense of pride and emotion for having carried out a humanitarian mission for teenage girls, mothers, the elderly and even toddlers who still stay in the shelter camp. 7 – 8pm At the PKBI Post, after cleaning and tidying up the medical equipment again for the next day’s program, I  prepare dinner for the team and assist my child with her studies. I am so grateful for each and every day that I am involved in this program. I feel encouraged to continue to provide sexual and reproductive healthcare to marginalized groups

Dr Ratni Palullungan is a fearless doctor, mother, and selfless volunteer providing sexual and reproductive healthcare to marginalized groups in fragile humanitarian settings.  Currently she is deployed with the Indonesian Planned Parenthood Association’s (IPPA/PKBI) response team in Majene District, West Sulawesi, following a magnitude 6.2 earthquake which occurred in January 2021.   In an open diary, Dr Ratni shares what a day in the life looks like for a volunteer doctor providing care to those affected by the earthquake.   5.30 – 8.30am I get up quite early and have my quiet time (prayer), then I gather my dirty laundry. Currently, I live with other volunteer teams in a place called PKBI Post in Majene, and there is a cooking schedule for everyone. After prayers, chores and breakfast, I get my daughter ready for the day as she accompanies me to work temporarily. After that, the team and I prepare medical equipment and medicine for the day's humanitarian mission. 8.30 – 11am Today the first location is Maliaya Village Health Centre, in Malunda District, Majene. Here, I attend to and examine 25 pregnant women. The pregnant women, on average, get married at a fairly young age. There are definitely risks to their reproductive health. There is a 43-year-old mother who is currently pregnant with her 11th child. To limit health risks, we advise her on the various safe family planning options.   There is also a 38-year-old woman who is eight months pregnant. However, the size of her belly is very small for a woman in her third trimester. In fact, I initially thought that she was only four or five months pregnant. After I examined her, it turns out that she is categorized as a ‘malnourished’ pregnant woman. It is very unfortunate because she admitted that she eats food without paying attention to her nutrition intake. In fact, she tends to eat instant noodles. So I advised her to drink milk, eat only nutritious foods, and always taker her vitamins.  11am – 2pm After visiting Maliaya Village, I travelled to Kabiraan Village. This village was severely affected by the earthquake. Here, I walk around the evacuation camp, most of which is still occupied by displaced people in this post-earthquake period. Even under the evacuation tent, I continue to conduct health examinations for pregnant women.  Due to the large number of cases of young marriages in Kabiiran Village, the team and I decide to conduct counselling sessions for the teenagers here. I advise the teenagers to get to know the risks that might occur to their reproductive health if they marry too young.  2 – 4pm The health volunteer team and I are finally able to take the time for lunch. We have our lunch near the beach, and get to enjoy local seafood as our menu. Enjoying the seafood while looking at the beautiful sea view is a precious time. I certainly won't forget this moment. 4 – 6pm We continue our journey to East Lombong Village. We have many elderly patients here. Yet interestingly, during one of the patients’ examination, there is one mother who wants to get the contraceptive implant. For me, this is quite a shock, given that we rarely find women in this village who want to do family planning. The mother admitted that she did not know much about the family planning program and has many children. She is grateful that the PKBI volunteer team and I came to their shelter camp for the health examination. 6pm The team and I decide to return to the PKBI Post. Today’s journey is quite tiring but there is a sense of pride and emotion for having carried out a humanitarian mission for teenage girls, mothers, the elderly and even toddlers who still stay in the shelter camp. 7 – 8pm At the PKBI Post, after cleaning and tidying up the medical equipment again for the next day’s program, I  prepare dinner for the team and assist my child with her studies. I am so grateful for each and every day that I am involved in this program. I feel encouraged to continue to provide sexual and reproductive healthcare to marginalized groups

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

My name is Fatoumata Yehiya Maiga. I’m 23-years-old, and I’m an IT specialist. I joined the Youth Action Movement at the end of 2018. The head of the movement in Mali is a friend of mine, and I met her before I knew she was the president. She invited me to their events and over time persuaded me to join. I watched them raising awareness about sexual and reproductive health, using sketches and speeches. I learnt a lot. Overcoming taboos I went home and talked about what I had seen and learnt with my family. In Africa, and even more so in the village where I come from in Gao, northern Mali, people don’t talk about these things. I wanted to take my sisters to the events, but every time I spoke about them my relatives would just say it was to teach girls to have sex, and that it’s taboo. That’s not what I believe. I think the movement helps girls, most of all, to know their sexual rights, their bodies, what to do and what not to do to stay healthy and safe. They don’t understand this concept. My family would say it was just a smokescreen to convince girls to get involved in something dirty.  I have had to tell my younger cousins about their periods, for example, when they came from the village to live in the city. One of my cousins was so scared, and told me she was bleeding from her vagina and didn’t know why. We talk about managing periods in the Youth Action Movement, as well as how to manage cramps and feel better. The devastating impact of FGM But there was a much more important reason for me to join the movement. My parents are educated, so me and my sisters were never cut. I learned about female genital mutilation at a conference I attended in 2016. I didn’t know that there were different types of severity and ways that girls could be cut. I hadn’t understood quite how dangerous this practice is. Then, two years ago, I lost my friend Aïssata. She got married young, at 17. She struggled to conceive until she was 23. The day she gave birth, there were complications and she died. The doctors said that the excision was botched and that’s what killed her. From that day on, I decided I needed to teach all the girls in my community about how harmful this practice is for their health. I was so horrified by the way she died. Normally, girls in Mali are cut when they are three or four years old, though for some it’s done at birth. When they are older and get pregnant, I know they face the same challenges as every woman does giving birth, but they also live with the dangerous consequences of this unhealthy practice.  The importance of talking openly  The problem lies with the families. I want us, as a movement, to talk with the parents and explain to them how they can contribute to their children’s sexual health. I wish it were no longer a taboo between parents and their girls. But if we talk in such direct terms, they only see disobedience, and say that we are encouraging promiscuity. We need to talk to teenagers because they are already parents in many cases. They are the ones who decide to go through with cutting their daughters, or not. A lot of Mali is hard to reach though. We need travelling groups to go to those isolated rural areas and talk to people about sexual health. Pregnancy is the girl’s decision, and girls have a right to be healthy, and to choose their future.

Women around the world have faced multiple barriers to accessing safe abortion care during the COVID-19 pandemic including the de-prioritization of sexual and reproductive healthcare, overwhelmed health systems and restrictions on movement. The COVID-19 crisis has sparked innovation among IPPF Member Associations who responded swiftly by developing new approaches to reach women with safe abortion care including telemedicine and home-based provision of medical abortion. Strong evidence generated from this work supports the continuation and strengthening of these approaches beyond the end of the pandemic. Cameroon Cameroon National Planning Association for Family Welfare (CAMNAFAW) To ensure that quality abortion care can be provided to women during travel restrictions, CAMNAFAW’s service providers travel to partner clinics in underserved areas and to clients’ homes to provide medical and surgical abortion care. This model of taking safe abortion care closer to women will continue even with easing of travel restrictions, as this has been found to be an effective and acceptable approach to increasing access.Photo: IPPF/Xaume Olleros/Cameroon Share on Twitter Share on Facebook Share via WhatsApp Share via Email Guinea Association Guinéenne pour le Bien-Etre Familial (AGBEF) Building on lessons learned during the Ebola crisis in Guinea, AGBEF quickly took measures to prevent infection in its clinics to continue providing sexual and reproductive healthcare, including surgical and medical abortion, in a safe environment. AGBEF donated protective materials to communities, including hand-washing stations, face masks and antibacterial gel, alongside messaging on infection prevention. This community visibility reassures clients they can safely attend AGBEF clinics for abortion and contraceptive care.Photo: AGBEF/Guinea Share on Twitter Share on Facebook Share via WhatsApp Share via Email India Family Planning Association of India (FPA India) FPA India and partners advocated to have sexual and reproductive healthcare, including abortion, recognized as essential by the government, which meant FPA India could continue healthcare delivery during the national lockdown. To reduce in-person clinic visits, FPA India established teleconsultation and counselling for abortion care, and is continuing to provide in-clinic care for both medical and surgical abortion. Photo: IPPF/Alison Joyce/India Share on Twitter Share on Facebook Share via WhatsApp Share via Email Nepal Family Planning Association of Nepal (FPAN) FPAN and partners advocated for interim approval of home provision of medical abortion and telemedicine for abortion counselling during COVID-19. FPAN is now implementing these approaches, ensuring continued access to abortion care in Nepal, where many people live in remote locations with limited mobility, which has been further restricted by COVID-19 lockdowns. Photo: FPAN/Nepal Share on Twitter Share on Facebook Share via WhatsApp Share via Email Pakistan Rahnuma – Family Planning Association of Pakistan (Rahnuma-FPAP) Rahnuma-FPAP and partners successfully advocated for the government to class sexual and reproductive healthcare as ‘essential’, which enabled the team to continue providing post-abortion care during the pandemic. Rahnuma-FPAP expanded its telemedicine and home-based provision for menstrual regulation counselling and post-abortion care. These new approaches have ensured continued access to services for clients unable to reach clinics.Photo: Rahnuma-FPAP/Pakistan Share on Twitter Share on Facebook Share via WhatsApp Share via Email Palestine Palestinian Family Planning and Protection Association (PFPPA) In response to the government-mandated closure of its clinics, PFPPA quickly established a toll-free call centre which provides consultations, counselling, referrals and follow-up, including consultation for abortion care through a harm reduction approach, ensuring that women are provided with accurate information. Due to its success, PFPPA is exploring options for continuing this healthcare delivery model beyond the pandemic, with the aim of keeping it free of charge for users.Photo: SAAF/Samar Hazboun/Palestine Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sudan Sudan Family Planning Association (SFPA) Following a nation-wide shutdown in April, SFPA  established  a call centre to increase access to healthcare, including abortion and contraceptive counselling and referrals.  An unexpected outcome of the new call centre is that it has reached an increased number of young women who regularly call to discuss their reproductive health and rights. SFPA  is working  towards institutionalizing this model for continuation beyond the pandemic.Photo: SFPA/Sudan Share on Twitter Share on Facebook Share via WhatsApp Share via Email Togo Association Togolaise pour le Bien-Etre Familial (ATBEF) ATBEF adapted its mobile application ‘Infos Ado Jeunes’, adding a toll-free teleconsultation service for young clients to use to access abortion consultations and pre- and post-abortion counselling. This app has given young clients ongoing access to care when they face challenges travelling to clinics. It has also eased overall client flow in clinics at a time when social distancing is being implemented.Photo: ATBEF/Togo Share on Twitter Share on Facebook Share via WhatsApp Share via Email