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“I saw this challenge when children are having children and they're having a number of children at a very young age,” says 37-year-old Matiisetso Sefako, after emerging from the Lesotho Planned Parenthood Association (LPPA) tent in Mokhethoaneng village, an hour drive from the capital Maseru. “For them to be engaged in family planning, it would really help them.” The mother of two lives just outside the village and says she’s become something of a community activist on the issue of early child marriage and the need for family planning. After she receives services, she lingers for an hour, speaking with young women and teenage girls who are looking over at the LPPA mobile clinic with interest.    She herself was a 19-year-old mother and has been using contraceptives for nearly 20 years. Then, it was harder to come by and she would often have to travel at her own cost. Now, she comes regularly when LPPA makes the monthly visit to her village.  And she’s done quite a lot on this to advise people to try and convince them to come and access such services, she says.  “The only problem I encounter is that the biggest challenge within the village is that there is a high rate of teenage pregnancy. I try to convince them this tent will help.”  This is her fourth visit to the LPPA outreach to receive services herself. Her only wish? “That these services be here every day,” she says, explaining that there is a deeply-felt need in her community and her hope is that she can refer more young women to follow up and receive the same monthly services she benefits from.  

When Raphel Marafan Kori’s husband died in 2001, she was left to fend for herself, in a largely patriarchal society. Now 45-years-old, she keeps busy and earns an income as a peer educator in Tsenekeng village in Lesotho’s Semonkong region.  She goes door to door to counsel her neighbors and residents of the village in family planning options available. She’s been doing it for nine months and visibly brightens when she starts talking about the work. "I introduce myself, after that I explain to the people the services that we provide, the importance of the choices that we can make about contraceptives."  She was appointed by the village chief, Makholu Mahao, to participate in a training provided by LPPA in the capital, Maseru and soon after, dove into her fieldwork. Some people immediately understand and welcome the offerings, she says, while others take some time.  Protection & permission  Now nine months into the work, she says the biggest issue facing her community is “that adolescents still need consent from the parents. And the parents seem to have a problem with that because in a way, [they think] it is allowing them, giving them the freedom to indulge in sex.”  “Another way I can explain [is to] mention  HIV testing here and to remind [parents] it's not only they're getting protection but also for them to help them plan for future."   Going door to door Occasionally she’ll hold community gatherings, but mostly she has these conversations door to door. “I’m working very hard to make sure the children also engage in this for the future. It’s a challenge,” she admits. She herself comes to the mobile outreach post for family planning services, something she says helps break the ice when she is out in the community talking about family planning. She tells them she uses the pill because she is allergic to the injectable option offered here.  “I get to talk to people because I can counsel them on HIV and AIDS daily to make them understand that just because you have HIV it's not the end of the world but you need to take your medication properly and life continues,” she explains proudly, sitting a few meters away from the She Decides tent with a line of women outside. Overall, she says she has benefitted as much from her work as the beneficiaries. “I engage with people. I also learned a lot, it educated me especially on the protection side because even myself before I was not aware of such information but now I've learned and I can give other people this information.” 

“I was 18 when I married. But back then that was old!” 76-year-old Makholu Mahao laughs as she goes on to list her nine children – 4 boys, 5 girls including twins.  “At the time that I was married, if I knew about contraceptives, I wouldn’t have had so many children,” she insists.  Her tone becomes forceful and serious when she shifts to subjects like teenage pregnancy and childhood marriage, both ills that are prevalent in her village in the Semonkong region, known as Tsenekeng Hamojalefa.  The village sits atop a rocky hillside, most easily accessible by horse or donkey, and 114 kilometres from the capital, Maseru. She is the village chief now, a post she took up when her husband, the former chief, died.  And to her, “the big challenges are teenage pregnancy and early marriage. We’re seeing the difficulty in labor, children dying in labor, and young mothers dying in early labor. Those are the main things I need assistance with,” she explains to staff from Lesotho Planned Parenthood Association (LLPA), on a field visit to LPPA’s mobile clinic down the hill from Makholu’s home.  More than family planning “How can we stop this problem,” she asks her visitors.  Underage girls “marry at a young age, they don’t know what marriage is. They bear children and bear children and have problems, like death or infant death,” she reiterates. And it’s not just family planning that benefits the residents of her village. 16 villages ring the hillsides around the mobile outreach post, set up today to offer family planning, counseling, and HIV testing.  Before the arrival of LPPA on a monthly basis, “we were not receiving any other services other than the two clinics,” she explains, describing clinics approximately 40 km from her village. She adds, “We would leave early in the morning to get there at 9 or 10 to get the services. It was very congested so we would leave and get back here without getting any services.” Encouraging young people When it comes to combatting stigma in a patriarchal society, this great grandmother says some couples do go together for services or at least are in agreement about pursuing services. Still, “men cannot go with the women,” she explains. Throughout the day, men and women gather in separate groups outside the LPPA tents to receive consultations separately.  She sends a strong message by giving her OK for underage single women to seek family planning services. “It is acceptable that [minors] can get it [services], single or not,” she says. “At the end of the day, it’s protection for early pregnancy. The elderly – like me – don’t usually agree with that. But the [minors] will go on their own, however they can. I support that.”    

Bolelwa Falten in based in Losotho’s capital, Maseru, and has been working as a HIV counsellor for the better part of a decade, bouncing from different organizations depending on where the funding goes. Before she joined, IPPF nine months ago, 40-year-old Bolelwa worked with PSI Losotho. Now, she runs the “North team” as part of LPPA’s outreach program.  She handles five different outreach posts and today, she is running the HIV testing clinic at one site.  Bolelwa proudly takes us through the full range of tests and counseling services they offer there, taking particular pride in explaining how she follows up patients who test positive. She knows the beneficiaries appreciate the work – it’s something she sees every time she does an outreach day.  “They no longer need transport money, time to get to the clinic. Our being here is actually bringing the service to where they are and where they need it,” she says. But quickly, she follows up, noting that in general, HIV and STI mobile healthcare services have been hit-hard by funding cuts in recent years.

"This is a relief. I'm feeling very happy now that services have been brought,” 34-year-old Makamohelo Tlali, says, smiling outside the Lesotho Planned Parenthood Association (LPPA) tent on the hillside of Hamoshati village in Lesotho. Makamohelo is a relatively new beneficiary of family planning services offered monthly at a post near her village. This is her second visit. She walks over 30 minutes each way but says that’s by far the best option for her.  "I feel happy that services are here, for free. When I accessed them before it would take transport costs to get to the place."  In the past, it would cost her 40 rand for taxis to the closest clinic, plus the additional cost of family planning services.      Makamohelo first heard about these offerings from a peer mobilizer going door to door in her village.  “I met her along the way and discussed the way I can access family planning services. They’re scarce this side. And she told me on a specific date there would be LPPA people offering services." “Now here I am,” she says, laughing.  She takes advantage of the free HIV testing offered here as well and says she is hopeful the family planning will be maintained, mentioning that other NGOs have come and gone over the course of several years. For her and her husband, family planning is openly discussed in the household and important for the health of their current family. They have three children, 2 girls and a boy.  “Three is enough! My husband has no problem with me accessing family planning here,” she explains, adding that her husband relies on piecemeal jobs while she farms to feed the family. 

At a local bar, we meet nine women from Kirundo. They’re all sex workers who became friends through Association Burundaise pour le Bien-Etre Familial's (ABUBEF) peer educator project. Yvonne is 40 and has known that she’s HIV-positive for 22 years. After her diagnosis she was isolated from her friends and stigmatized both in public and at home, where she was even given separate plates to eat from. “I started to get drunk every day,” she says. “I hoped death would take me in my sleep. I didn’t believe in tomorrow. I was lost and lonely. Until I got to the ABUBEF clinic.” ABUBEF has supported her treatment for the past six years. “I take my pill every day and I am living example of having a good life even with a previous death sentence,” Yvonne explains. “But I see that the awareness of HIV, protection and testing provided by ABUBEF is still very small.” Yvonne became a peer educator, speaking in public about HIV awareness, wearing an ABUBEF T-shirt.  The project spread to the wider region, and volunteers were given travel expenses, materials and training, along with condoms for distribution. But funding cuts mean those expenses are no longer available. Yvonne says she’ll carry on in Kirundo even if she can’t travel more widely like she used to. Her friend, 29-year-old Perusi, shares her experience of ABUBEF as a safe space where her privacy will be respected. It often happens, she says, that her clients rape her, and run away, failing to pay. Since sex work is illegal, she says, and there’s no protection from the authorities, and sex workers like her often feel rejected by society.  But at ABUBEF’s clinics, they are welcomed.

Monica has never told anyone about the attack. She was pregnant at the time, already had two teenage sons, and rape is a taboo subject in her community in Burundi. Knowing that her attacker was HIV-positive, and fearing that her husband would accuse her of provocation - or worse still, leave her - she turned to a place she knew would help.   ABUBEF is the Association Burundaise Pour Le Bien-Etre Familial. Their clinic in Kirundo offered Monica HIV counselling and treatment for the duration of her pregnancy.  Above all, ABUBEF offered privacy.  Neither Monica nor her daughter has tested positive for HIV. “They saved the life of me and my child,” Monica says. “I hope they get an award for their psychological and health support for women.” Three years on from the attack, Monica, now 45, raises her children and tends the family farm where she grows beans, cassava, potatoes and rice. She’s proud of her eldest son who’s due to start university this year. She educates her boys against violence, and spreads the word about ABUBEF. Monica speaks to other women to make sure they know where to seek help if they need it. Her attacker still lives in the neighbourhood, and she worries that he’s transmitting HIV. But the ABUBEF clinic that helped Monica is under threat from funding cuts. The possibility that it could close prompted her to tell her story.    “This is a disaster for our community,” she says. “I know how much the clinic needs support from donors, how much they need new equipment and money for new staff. I want people to know that this facility is one of a kind - and without it many people will be lost.”

On Friday afternoon in Municipal Lycee of Nyakabiga, Burundi,  headmistress Chantal Keza is introducing her students to the medical staff from Association Burundaise pour le Bien-Etre Familial (ABUBEF). Peer educators at the school, trained by ABUBEF,  will perform a short drama based around sexual health and will answer questions about contraception methods from students. One of the actresses is peer educator Ammande Berlyne Dushime. Ammande, who is 17 years old is one of three peer educators at the school. Ammande, together with her friends, perform their short drama on the stage based on a young girls quest for information on contraception. It ends on a positive note, with the girl receiving useful and correct information from a peer educator at her school. A story that could be a very real life scenario at her school. Peer programmes that trained Ammande, are under threat of closure due to the Global Gag rule.   Ammande says, “I am afraid what will happen when there will be no more projects like this one. I am ready to go on with work as peer educator, but if there are not going to be regular visits by the medical stuff from the clinic, then we will have no one to seek information and advice from. I am just a teenager, I know so little. Not only I will lose my support, but also I will not be taken serious by my schoolmates. With such important topic like sexual education and contraception, I am not the authority. I can only show the right way to go. And this road leads to ABUBEF.” She says “As peer educator I am responsible for Saturday morning meetings at the clinic. We sing songs, play games, have fun and learn new things about sex education, contraception, HIV protection and others. Visiting the clinic is then very easy, and no student has to be afraid, that showing up at the clinic that treats HIV positive people, will ruin their reputation. Now they know that we can meet there openly, and undercover of these meetings seek for help, information, professional advice and contraception methods” Peer educator classes are a safe and open place for students to openly talk about their sexual health. The Global Gage Rule will force peer educator programmes like this to close due to lack of funding.   Help us bridge the funding gap   Learn more about the Global Gag Rule