Stories

Geneviève Head of Youth and Stigma project and fundraising at the Association Beninoise pour la promotion de la famille (ABPF) Since joining ABPF in 1995, Geneviève has worked closely with community leaders to reduce stigma around abortion. Talking about the importance of young women having choice and access to abortion care, Geneviève says, “the law only applies in three circumstances, meanwhile everyday people need to access these services. Reproductive rights do exist, but that is something many people choose to ignore.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Hélène ABPF youth champion with the Young People’s Action Movement  27-year-old Hélène acts as a link between young people’s activities and the ABPF board. She has advocated for abortion rights at conferences locally and internationally.  “In my school there were a fair number of pregnant girls so I was already looking for a way to help. Every week I went to different classes to educate them about abortion and stigma. When my mother found out, she told me this was a movement of depravity! But after a while my mum became a member of the association and came with me, and even my dad. Now they say they are proud of what I’ve achieved.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Simon Gnansounou Community leader In the small town of Cocotomey-La Paix, Simon works closely with ABPF supporting their work to reduce abortion stigma within local communities. “It’s a project for social development, and I am all for that. It’s going to limit harm done to these girls. Parents don’t talk about this with their children. It’s taboo. This project helps us negotiate this difficult parent-child question. There is no development without health, and the politics of health are very complex.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Kader Youth champion 26-year-old Kader says his first youth meeting at ABPF was a positive experience. “They told me that there was a jam session at the event. What I liked is that it was run by young people. Everything that I know about reproductive health I learnt at the centre. A lot of young women I know got pregnant very early. I know people who have died because of unsafe abortion. We can avoid so much of it if people have the right information.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Souliya Mevo Tairou Midwife “Stigmatization complicates our work. Fourteen and 15-year olds come here without their parents and it’s hard to work with them. The girls are so scared that they can’t really explain what’s happening to them. They come here after going to the traditional healers when that hasn’t worked and they are bleeding or have an infection. Here, with the Youth and Abortion Stigma Project, we have awareness sessions. The young people and those supervising give out their numbers and tell them to call if they have a problem.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Amour University student “Her friends told her to take laxatives and other products, to put things in her vagina, to wash with hot water, to move about a lot.” 21-year-old Amour talks about a friend who confided in him when she discovered she was pregnant. “When we talk about abortion in Benin, it’s something people don’t want to hear about. It’s not well seen. Talking about sex is a problem. It’s still taboo. Thanks to the Youth and Abortion Stigma Project, I had benefited from training on how to talk to girls if they came to ask about abortion.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Flore Literature teacher Flore says some of her students go to her for support and advice: “They are quite shy because at home the subject of sex is always taboo. They are reticent; they think it’s a shame. We will only correct this problem over time. There is chatting and whispering in class ‘you know what she did?’ Can’t we support these children instead of stigmatizing them?” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Ida University student 19-year-old Ida attended a workshop on abortion and stigma for teachers and students at the Fiyegnon collège d’enseignement général. “It really helped. If we take our own decisions we will make it to the end, we will get what is right for us.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Amina is a peer educator trained by Family Planning Association of Malawi’s (FPAM) Linkages project. “I am a HIV positive sex worker and a peer educator,” she says. “I have 51 other sex workers in my care, I inform them on testing and treatment, also about STI treatment and condom use. I teach about the disadvantages of sharing ART (anti-retroviral therapy) and encourage them to go for tuberculosis testing if they are coughing.” Another educator called Cecilia adds: “I reached out to 60 female sex workers. We are all friends and they trust me. I refer them to services and we address abuse by the police. They rape us and steal our money but through the project, we can follow up since the project has access to the managers of the police.” Basic sexual health information Her colleague Florence says: “It also helped that the rogue and vagabond law was repealed.” The law was a permanent curfew, giving the police the power to round up, fine or jail anybody who was on the streets after eight o’clock at night. Lucy, also a peer educator, says part of the work is giving basic information. “I teach my friends on HIV and GBV (gender-based violence),” she explains. “And I teach how to use condoms and lubricants and how to persuade clients to use condoms. I also talk about family planning. Many female sex workers do not know they need it.” “The project helped me with condoms and I shared that with others,” says another client of the programme, Angela. “Through the project, I got tested for HIV and treated for STIs. I also encourage pregnant sex workers to go for pre-natal care so that they do not infect their babies. It is the first time that an organisation like FPAM worked with us. We got respected within the community because we are knowledgeable.” In the year the Linkages project ran, 627 female sex workers were supported in getting tested for HIV, the initiation of anti-retroviral treatment and therapy adherence. 2,700 women were referred to services and many more received information. The HIV prevalence rate among female sex workers went down from 77% to 62%. Global Gag Rule effects FPAM’s Linkages project was phased out in 2016 due to the Global Gag Rule. The effects are keenly felt amongst those who benefitted from the project: Amina says: “Many stopped taking medication. Healthcare facilities are not for us. I sing in a church choir, which is important to me. If they find out what I do, they will throw me out.” “My family thinks I work at a filling station at night,” says Lucy. Cecilia adds: “This project has to come back, please bring it back. If not, we will all die early.”

It used to take Matilda Meke-Banda six hours on her motorbike along dirt roads to reach two remote districts and deliver sexual and reproductive health (SRH) services. In this part of southern Malawi, Machinga, family planning uptake is low, and the fertility rate, at 6.6, is the highest in the country. The Family Planning Association of Malawi, known as FPAM, runs a clinic in the town of Liwonde and it’s from here that Matilda travelled out six times a month. “We have established six watch groups, they are trained to address SRH issues in the community,” she explains. Luc Simon is the chair of one of those groups.  “We teach about Family Planning,” he says. “We encourage parents and young people to go for HIV testing. We address forced early marriages, talk to parents and children to save a lot of young people.” And there are a lot of myths to dispel about family planning. Elizabeth Katunga is head of family planning in the district hospital in Machinga: “Family Planning is not very much accepted by the communities. Many women hide the use of contraceptives,” she says. “Injectables are most popular, easy to hide. We have cases here where husbands upon discovery of an implant take a knife and cut it out. It is not that people want big families per se but it is the misconceptions about contraceptives.” FPAM’s projects are based at the Youth Life clinic in Liwonde. The clinic offers integrated services: Family planning, HIV services, STI screening, cervical cancer screening and general healthcare (such as malaria). This joined-up approach has been effective says FPAM’s executive director Thoko Mbendera: “In government health facilities, you have different days, and long queues always, for family planning, for HIV, for general health, which is a challenge if the clinic is a 20 km walk away.There are privacy issues.” But now, FPAM’s services are being cut because of the Global Gag Rule (GGR), mobile clinics are grounded, and there are fears that much progress will be undone. Some of FPAM’s rural clients explain how the Watch Groups work in their community. “It starts with me as a man,” says group member George Mpemba. “We are examples on how to live with our wives. We are non-judgemental; we embark on a mutual learning process. Our meetings are not hearings, but a normal chat, there is laughing and talking. After the discussion we evaluate together and make an action plan.” Katherine, went to the group for help: “There was violence in my marriage; my husband forced himself on me even if I was tired from working in the field. When I complained there was trouble. He did not provide even the bedding. “He is a fisherman and he makes a lot of cash which he used to buy beer but nothing for us.I overheard a watch group meeting once and I realised there was a solution. They talked to him and made him realise that what he was doing was violence and against the law. It was ignorance.Things are better now, he brings money home, sex is consensual and sometimes he helps with household chores.”

It is 9.00pm in Lilongwe, the capital of Malawi , the fish market is one of the “hotspots” where the Family Planning Association of Malawi’s (FPAM) opens its trailer doors to  sex workers, a “key population” in the fight against HIV. Thoko Mbendera is the Executive Director of FPAM: “Key populations are groups whose needs you have to address if you ever want to bring down HIV prevalence in the general population. Sex workers clearly need help here: the HIV prevalence rate among them is 77% while among the general population it is 10.2%.” The clinic offers STI screening, family planning, HIV testing, tuberculosis (TBC) testing and cervical cancer screening. Outside, peer educators distribute condoms and talk to waiting clients. Thoko Mbendera says: “This group does not (have) access the public health sector, it is simple not an option for women who do not disclose what they do to anyone, so in the Linkages program we reach out to the hot spots at night.” Florence Mushani, is the coordinator of Linkages: “In the project we trained 63 peer educators. They are HIV positive; they approach their colleagues with information and advice. Our goal is the 90-90-90 target meaning 90% of sex workers know their status, 90% of HIV positive women are on anti-retroviral treatment (ART), and 90% of the women on ARTs will be virally suppressed. We also trained 21 peer navigators; they support others to adhere to therapy. We pay them a small stipend of 25 dollars a month, we expect a lot of them.” Tusekele Mwakasungula is FPAM’s Programs Manager: “The goal of the peer educators training is to build up the person,” he says. And it shows: these women are no shy victims of an unjust society, they are self-confident and outspoken, determined to improve the situation of female sex workers.” FPAM’s Linkages project was phased out in 2016 due to the Global Gag Rule.