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Latest stories from IPPF

Spotlight

A selection of stories from across the Federation

Humanitarian response team, Fiji.
Story

In pictures: Humanitarian photographers share their experiences of storytelling in the field

IPPF’s localized approach to humanitarian emergencies is led by our Member Associations' response teams and whenever possible, we deploy local photographers.
Healthcare worker with combipack.
story

| 23 September 2020

In pictures: Innovating during COVID-19

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

Healthcare worker with combipack.
story

| 20 May 2022

In pictures: Innovating during COVID-19

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

volunteer holds a family planning poster, Togo
story

| 25 February 2019

In pictures: Togo and the rise in contraception use

Félicité Sonhaye ATBEF Regional Coordinator The Association Togolaise pour le Bien-Être Familial (ATBEF), has led a pioneering programme training community health workers to administer contraception in the rural areas where they live. “The injection is used more than any other method. Around 60% of women use it,” said Félicité Sonhaye, ATBEF Regional Coordinator for Togo’s Plateaux region, which covers Ilama. “Women appreciate the reliability and long-lasting effects of the injection, which allow them to stop worrying about unexpected pregnancies”, Sonhaye added. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sossou Sagna Ilama village chief Men like Sossou Sagna, have great influence and respect within Togo’s rural communities. As Ilama’s village chief his approval was required for the ATBEF community project to take root. “I sent my own wife to seek family planning. The lady helped us and it worked really well. I also went with my older brother’s wife and she was very satisfied. Every member of this community is now aware that having a large family drives them towards poverty. Ignorance was the reason why we had so many children per family here before. Now with the family planning advice we have received, spacing births has become a reality and the reduction of the number of children per family.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Abla Abassa Community health worker Abla is a community health worker, and spends her days cycling around Ilama’s dusty streets visiting households that have signed up to an innovative programme providing contraception in hard-to-reach places. “Before, people didn’t have a lot of information about contraception. With the project the community is now able to space their births. I have seen the number of children per family going down. That’s contraception but also the increasing cost of living, and the fact that everyone wants to send their children to school.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Essivi Koutchona Client Facing prohibitive costs of school fees and food prices for six children, Essivi Koutchona, began using the contraceptive injection after deciding with her husband they did not want another child. She has received the injection every three months and has not experienced any side effects. “The community health worker passed by our house one day and explained the method and a bit about the possible side effects. We agreed as a couple that we wanted me to start using the injection.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Edem Badagbo Client 33-year-old Edem is a widowed father of three children. Edem hopes to have a vasectomy within the next month or so. His wife died following the birth of their third child but he is adamant he wants to follow through with a procedure they agreed upon before her death. “My wife agreed with the idea. I was scared when I first heard of it, but that’s because there was so little information available. When I came to the ATBEF clinic I received a lot more detail and that’s when I decided to do it. I have three children. That’s enough.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Yaori Ajossou Vasectomy client Yaori Ajossou, a retired soldier, heard about vasectomy while listening to an ABTEF awareness raising campaign on the radio. It prompted him to take on the responsibility for family planning in his marriage. “Before I had the idea that maybe I'd want to have more children, but after the campaign, and after my wife had talked a little bit about her health problems, I thought, well, maybe it's better to put the brakes on. I was about to retire. Why carry on having children? Six children is already a lot. It's already maybe too many.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Dede Koussawo Client 34-year-old Dede visits the ATBEF clinic in Lomé, Togo with her husband, Edem. “We do this together if his schedule permits it. I asked and he accepted. It's not typical (for men to come). Before the pregnancy, I was taking the pill. Before the first I was taking the pill and I used an IUD after my son's birth and after my daughter's birth as well. We've been really happy with the family planning we've got here so we decided to come here for Prescillia’s birth as well.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Mensah Awity Teacher and ABTEF youth club coordinator in Tohoun Mensah Awity is a teacher at a local school in Tohoun. He also coordinates the ABTEF youth club where they provide information and opportunities for the students to talk about sexual health, pregnancy, contraception. “At the beginning it was difficult for the club. Now teachers have started accepting the ideas and some pupils behave much better so it’s hard for them to keep condemning it. There are three girls who gave birth and who came back to school afterwards. At the beginning it was tough for them but we explained to the students that they shouldn’t be treated differently. The rate of pregnancy has definitely gone down at school.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Emefa Charita Ankouy Youth activist and student “I'm studying for a degree in English and I'm a young activist volunteer with the IPPF youth movement. We promote, we try to help young girls who are in education to have more information about sexual health and reproduction to help them to adopt a method to avoid a pregnancy. They don't have enough information about sexual health and reproduction. I think it's because of that that they've become pregnant. They want to have sex quite early. There is pressure and there's a lack of communication between the students and their parents. Here in Togo sex is taboo for everyone, above all for parents.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Evedoh Worou Community Health Worker, Ilama “The ones who prefer the pill are young students or apprentices. Often, they take it to reduce PMS, and it regulates their period. Sometimes women will forget to take the pill, which means the injection is preferred as it’s just once for three months. The women here have more autonomy and they now have the space to earn money themselves for the household as a result of the programme. At the beginning, there were some reservations among the men in the community but after our awareness campaigns, more and more of them accompany women for family planning.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Photography by Xaume Olleros for IPPF

volunteer holds a family planning poster, Togo
story

| 20 May 2022

In pictures: Togo and the rise in contraception use

Félicité Sonhaye ATBEF Regional Coordinator The Association Togolaise pour le Bien-Être Familial (ATBEF), has led a pioneering programme training community health workers to administer contraception in the rural areas where they live. “The injection is used more than any other method. Around 60% of women use it,” said Félicité Sonhaye, ATBEF Regional Coordinator for Togo’s Plateaux region, which covers Ilama. “Women appreciate the reliability and long-lasting effects of the injection, which allow them to stop worrying about unexpected pregnancies”, Sonhaye added. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sossou Sagna Ilama village chief Men like Sossou Sagna, have great influence and respect within Togo’s rural communities. As Ilama’s village chief his approval was required for the ATBEF community project to take root. “I sent my own wife to seek family planning. The lady helped us and it worked really well. I also went with my older brother’s wife and she was very satisfied. Every member of this community is now aware that having a large family drives them towards poverty. Ignorance was the reason why we had so many children per family here before. Now with the family planning advice we have received, spacing births has become a reality and the reduction of the number of children per family.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Abla Abassa Community health worker Abla is a community health worker, and spends her days cycling around Ilama’s dusty streets visiting households that have signed up to an innovative programme providing contraception in hard-to-reach places. “Before, people didn’t have a lot of information about contraception. With the project the community is now able to space their births. I have seen the number of children per family going down. That’s contraception but also the increasing cost of living, and the fact that everyone wants to send their children to school.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Essivi Koutchona Client Facing prohibitive costs of school fees and food prices for six children, Essivi Koutchona, began using the contraceptive injection after deciding with her husband they did not want another child. She has received the injection every three months and has not experienced any side effects. “The community health worker passed by our house one day and explained the method and a bit about the possible side effects. We agreed as a couple that we wanted me to start using the injection.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Edem Badagbo Client 33-year-old Edem is a widowed father of three children. Edem hopes to have a vasectomy within the next month or so. His wife died following the birth of their third child but he is adamant he wants to follow through with a procedure they agreed upon before her death. “My wife agreed with the idea. I was scared when I first heard of it, but that’s because there was so little information available. When I came to the ATBEF clinic I received a lot more detail and that’s when I decided to do it. I have three children. That’s enough.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Yaori Ajossou Vasectomy client Yaori Ajossou, a retired soldier, heard about vasectomy while listening to an ABTEF awareness raising campaign on the radio. It prompted him to take on the responsibility for family planning in his marriage. “Before I had the idea that maybe I'd want to have more children, but after the campaign, and after my wife had talked a little bit about her health problems, I thought, well, maybe it's better to put the brakes on. I was about to retire. Why carry on having children? Six children is already a lot. It's already maybe too many.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Dede Koussawo Client 34-year-old Dede visits the ATBEF clinic in Lomé, Togo with her husband, Edem. “We do this together if his schedule permits it. I asked and he accepted. It's not typical (for men to come). Before the pregnancy, I was taking the pill. Before the first I was taking the pill and I used an IUD after my son's birth and after my daughter's birth as well. We've been really happy with the family planning we've got here so we decided to come here for Prescillia’s birth as well.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Mensah Awity Teacher and ABTEF youth club coordinator in Tohoun Mensah Awity is a teacher at a local school in Tohoun. He also coordinates the ABTEF youth club where they provide information and opportunities for the students to talk about sexual health, pregnancy, contraception. “At the beginning it was difficult for the club. Now teachers have started accepting the ideas and some pupils behave much better so it’s hard for them to keep condemning it. There are three girls who gave birth and who came back to school afterwards. At the beginning it was tough for them but we explained to the students that they shouldn’t be treated differently. The rate of pregnancy has definitely gone down at school.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Emefa Charita Ankouy Youth activist and student “I'm studying for a degree in English and I'm a young activist volunteer with the IPPF youth movement. We promote, we try to help young girls who are in education to have more information about sexual health and reproduction to help them to adopt a method to avoid a pregnancy. They don't have enough information about sexual health and reproduction. I think it's because of that that they've become pregnant. They want to have sex quite early. There is pressure and there's a lack of communication between the students and their parents. Here in Togo sex is taboo for everyone, above all for parents.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Evedoh Worou Community Health Worker, Ilama “The ones who prefer the pill are young students or apprentices. Often, they take it to reduce PMS, and it regulates their period. Sometimes women will forget to take the pill, which means the injection is preferred as it’s just once for three months. The women here have more autonomy and they now have the space to earn money themselves for the household as a result of the programme. At the beginning, there were some reservations among the men in the community but after our awareness campaigns, more and more of them accompany women for family planning.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Photography by Xaume Olleros for IPPF

Dahide, a mother and trainee tailor in Togo
story

| 25 February 2019

“I want to use it for a couple of years and then maybe we will think about having another child”

  Every three months, Mawoula Dahide meets a community health worker in her village in central Togo to receive a single contraceptive injection and then carries on with her busy day. Dahide, 20, has a two-and-a-half year old son and a husband living in the capital and juggles an apprenticeship in tailoring with caring for her child. After recovering from the birth, Dahide tried the injection and immediately felt relief, knowing she would decide when she got pregnant again. “I want to use it for a couple of years and then maybe we will think about having another child,” she said.   Lack of access  Until 2013, Dahide and the other women living in the village of Ilama had no access to regular contraception at all, and its use was sometimes regarded with suspicion, and even fear. In her community, the average age of a mother’s first pregnancy is around 16, and women might bear a total of six or seven children compared to the national average of 4.7, according to local health workers. That trend is changing with a pioneering programme run by the Association Togolaise pour le Bien-Être Familial (ATBEF), which has trained community health workers to administer contraception in the rural areas where they live. ATBEF has focused their distribution of contraceptives within poor and rural communities, and with mobile outreach clinics that go to villages with no trained health workers. The unmet need for contraception in Togo stands at 34% of the population, and in rural communities, this is even higher.  The association contributes a fifth of overall contraception cover to couples in Togo, a West Africa nation of 7.8 million people. There is a clear favourite among the methods offered, which include male and female condoms, the pill, and the contraceptive injection. “The injection is more used than any other method. Around 60% of women use it,” said Félicité Sonhaye, ATBEF Regional Coordinator for Togo’s Plateaux region, which covers Ilama. Women appreciate the reliability and long-lasting effects of the injection, Sonhaye added, which allow them to stop worrying about unexpected pregnancies.   From client to advocate Dahide has become an advocate for the method among her peers within her community. “My friends are getting the injection as well. I was the first to start using it and it was great, so I told them about it,” she said. Another convert to the injection is Ilama’s village chief, Sossou Sagna. The father of seven agreed with his wife they didn’t want anymore children.  “I sent my own wife to seek family planning. The lady helped us and it worked really well. I also went with my older brother’s wife and she was very satisfied,” Sagna noted in the cool of the shade.  “My wife chose the three-month injection,” he added. Sagna had not anticipated some of the wider effects of increasing contraceptive use within the community, which have become prevalent over the last couple of years. “Every member of this community is now aware that having a large family drives them towards poverty,” he said. Families have more money to spend feeding and educating their children in an economy where the cost of living keeps rising. Villagers who see Sagna attending family planning sessions are also convinced that rumours about contraception making them ill are untrue. “Ignorance was the reason why we had so many children per family here before. Now with the family planning advice we have received, spacing births has become a reality and the reduction of the number of children per family,” he added. The gains of the ATBEF rural programme will now go even further with the imminent introduction of Sayana Press, a contraceptive injection that women can self-administer.   Learn more about some of the most popular contraception methods available and if they are right for you    Photography by Xaume Olleros for IPPF

Dahide, a mother and trainee tailor in Togo
story

| 20 May 2022

“I want to use it for a couple of years and then maybe we will think about having another child”

  Every three months, Mawoula Dahide meets a community health worker in her village in central Togo to receive a single contraceptive injection and then carries on with her busy day. Dahide, 20, has a two-and-a-half year old son and a husband living in the capital and juggles an apprenticeship in tailoring with caring for her child. After recovering from the birth, Dahide tried the injection and immediately felt relief, knowing she would decide when she got pregnant again. “I want to use it for a couple of years and then maybe we will think about having another child,” she said.   Lack of access  Until 2013, Dahide and the other women living in the village of Ilama had no access to regular contraception at all, and its use was sometimes regarded with suspicion, and even fear. In her community, the average age of a mother’s first pregnancy is around 16, and women might bear a total of six or seven children compared to the national average of 4.7, according to local health workers. That trend is changing with a pioneering programme run by the Association Togolaise pour le Bien-Être Familial (ATBEF), which has trained community health workers to administer contraception in the rural areas where they live. ATBEF has focused their distribution of contraceptives within poor and rural communities, and with mobile outreach clinics that go to villages with no trained health workers. The unmet need for contraception in Togo stands at 34% of the population, and in rural communities, this is even higher.  The association contributes a fifth of overall contraception cover to couples in Togo, a West Africa nation of 7.8 million people. There is a clear favourite among the methods offered, which include male and female condoms, the pill, and the contraceptive injection. “The injection is more used than any other method. Around 60% of women use it,” said Félicité Sonhaye, ATBEF Regional Coordinator for Togo’s Plateaux region, which covers Ilama. Women appreciate the reliability and long-lasting effects of the injection, Sonhaye added, which allow them to stop worrying about unexpected pregnancies.   From client to advocate Dahide has become an advocate for the method among her peers within her community. “My friends are getting the injection as well. I was the first to start using it and it was great, so I told them about it,” she said. Another convert to the injection is Ilama’s village chief, Sossou Sagna. The father of seven agreed with his wife they didn’t want anymore children.  “I sent my own wife to seek family planning. The lady helped us and it worked really well. I also went with my older brother’s wife and she was very satisfied,” Sagna noted in the cool of the shade.  “My wife chose the three-month injection,” he added. Sagna had not anticipated some of the wider effects of increasing contraceptive use within the community, which have become prevalent over the last couple of years. “Every member of this community is now aware that having a large family drives them towards poverty,” he said. Families have more money to spend feeding and educating their children in an economy where the cost of living keeps rising. Villagers who see Sagna attending family planning sessions are also convinced that rumours about contraception making them ill are untrue. “Ignorance was the reason why we had so many children per family here before. Now with the family planning advice we have received, spacing births has become a reality and the reduction of the number of children per family,” he added. The gains of the ATBEF rural programme will now go even further with the imminent introduction of Sayana Press, a contraceptive injection that women can self-administer.   Learn more about some of the most popular contraception methods available and if they are right for you    Photography by Xaume Olleros for IPPF

Abassa is a community health worker
story

| 20 February 2019

“Some of the young women can’t educate their own children because they had to drop out of school themselves”

Abla Abassa lives in the village of Ilama, population 2,000, in rural central Togo. After waking up early each morning to prepare for the day ahead, she sits down to map out her route. Abassa is a community health worker, and spends her days cycling around Ilama’s dusty streets to visit households who have signed up to an innovative programme that provides contraception in hard-to-reach places. The village is an hour by bumpy dirt track from the regional capital of Atakpamé, and few residents have the time or money to travel into town on a regular basis to refill prescriptions. For years, that meant the women of the community had just one form of protection against pregnancy: avoiding sex altogether. In 2013, Abassa became one of 279 community health workers in the Plateaux region funded by the Association Togolaise pour le Bien-Être Familial (ATBEF), working in two districts where the unmet need for contraception was greatest. Today, Abassa has three different clients, but can deal with as many as five a day. The health worker meets women on their own or with their husbands, and conversation flows about village life before she administers a contraceptive injection, or leaves behind a small pile of condoms.   Reaching those in need She begins the day a few doors down at the home of Essivi Koutchona, a mother of six who has used the contraceptive injection for the last two-and-a-half years. “The community health worker passed by our house one day and explained the method and a bit about the possible side effects,” Koutchona said. “We agreed as a couple that we wanted me to start using the injection”.   Koutchona’s husband, Konou Aboudou, credits Abassa and the ATBEF with improving his marriage, which he said was strained by the rhythm [calendar] method and supporting many young children at once. “Now we can better understand and support our wives. We avoid adultery and pregnancies are planned,” he explained. “Before, people didn’t have a lot of information about contraception. With the project we have undertaken with ATBEF since 2013, the community is now able to space their births,” Abassa said, adding the couple had told her they wished the programmed has started years ago. Togo currently has a fertility rate of 4.7 children per woman, according to the United Nations Statistics Division, but is trying to bring that number down.    Battling misinformation The government faces entrenched attitudes about the value of a large family, and misinformation spread about contraception. A community health worker has two roles: safely providing contraception, but also reassuring women that many of the rumours they have heard that the injection or pill will make them sick are false. “I tell them that side effects come from the product, so if they have an irregular period it’s not because they are ill,” Abassa said, adding it had taken much persuasion over the last five years to reach the point where she was now trusted. Abassa’s next client preferred to meet at the health worker’s home for some privacy. At 45, Adjo Amagna is still having periods and wants to avoid any chance of another pregnancy. “I think I want to go for the injection. I have never used contraception before so I think I will do it for three months to see how it goes,” she said.  After the death of her fifth child, the only baby she had with her second husband, Amagna wants to focus on caring of the four children she has left. She sat down with the health worker and was passed condoms, femidoms and the pill, while Abassa explained how the injection works. After a half hour chat, Amagna agreed to begin the injection on her next visit.   Changes within the community  On the way to see Mawoula Dahide, a 20-year-old with one child, her last client of the day, Abassa reflected on the changes she has seen in the community since her job began. “I have seen the number of children per family going down,” she said. “That’s contraception but also the increasing cost of living, and the fact that these days everyone wants to send their children to school.” The prevalence of contraceptive use was at 17% before the programme began, but with the focus on rural communities this has risen to 23% nationwide, even though not all areas of Togo are covered by dedicated health workers yet. We met Dahide in a quiet corner as she took a short break from an apprenticeship in tailoring.  “It’s pretty tough balancing my son and my apprenticeship. If I had waited to have a kid before starting it would have been a lot easier,” she admitted. “My husband is studying at the university in Lomé so I only see him during the holidays and maybe a few weekends during term time.” Younger women like Dahide are sometimes harder to reach, said Abassa, and have a greater unmet need for contraception in a community where many have their first child around the age of 16. “Some of the young women can’t educate their own children because they had to drop out of school themselves,” the health worker explained, adding her focus was always on recruiting more teenagers to her cause. As she heads home for the day, Abassa waved to clients and neighbours, while wondering who might be on her doorstep looking for advice when she gets there.   Photography by Xaume Olleros for IPPF

Abassa is a community health worker
story

| 20 May 2022

“Some of the young women can’t educate their own children because they had to drop out of school themselves”

Abla Abassa lives in the village of Ilama, population 2,000, in rural central Togo. After waking up early each morning to prepare for the day ahead, she sits down to map out her route. Abassa is a community health worker, and spends her days cycling around Ilama’s dusty streets to visit households who have signed up to an innovative programme that provides contraception in hard-to-reach places. The village is an hour by bumpy dirt track from the regional capital of Atakpamé, and few residents have the time or money to travel into town on a regular basis to refill prescriptions. For years, that meant the women of the community had just one form of protection against pregnancy: avoiding sex altogether. In 2013, Abassa became one of 279 community health workers in the Plateaux region funded by the Association Togolaise pour le Bien-Être Familial (ATBEF), working in two districts where the unmet need for contraception was greatest. Today, Abassa has three different clients, but can deal with as many as five a day. The health worker meets women on their own or with their husbands, and conversation flows about village life before she administers a contraceptive injection, or leaves behind a small pile of condoms.   Reaching those in need She begins the day a few doors down at the home of Essivi Koutchona, a mother of six who has used the contraceptive injection for the last two-and-a-half years. “The community health worker passed by our house one day and explained the method and a bit about the possible side effects,” Koutchona said. “We agreed as a couple that we wanted me to start using the injection”.   Koutchona’s husband, Konou Aboudou, credits Abassa and the ATBEF with improving his marriage, which he said was strained by the rhythm [calendar] method and supporting many young children at once. “Now we can better understand and support our wives. We avoid adultery and pregnancies are planned,” he explained. “Before, people didn’t have a lot of information about contraception. With the project we have undertaken with ATBEF since 2013, the community is now able to space their births,” Abassa said, adding the couple had told her they wished the programmed has started years ago. Togo currently has a fertility rate of 4.7 children per woman, according to the United Nations Statistics Division, but is trying to bring that number down.    Battling misinformation The government faces entrenched attitudes about the value of a large family, and misinformation spread about contraception. A community health worker has two roles: safely providing contraception, but also reassuring women that many of the rumours they have heard that the injection or pill will make them sick are false. “I tell them that side effects come from the product, so if they have an irregular period it’s not because they are ill,” Abassa said, adding it had taken much persuasion over the last five years to reach the point where she was now trusted. Abassa’s next client preferred to meet at the health worker’s home for some privacy. At 45, Adjo Amagna is still having periods and wants to avoid any chance of another pregnancy. “I think I want to go for the injection. I have never used contraception before so I think I will do it for three months to see how it goes,” she said.  After the death of her fifth child, the only baby she had with her second husband, Amagna wants to focus on caring of the four children she has left. She sat down with the health worker and was passed condoms, femidoms and the pill, while Abassa explained how the injection works. After a half hour chat, Amagna agreed to begin the injection on her next visit.   Changes within the community  On the way to see Mawoula Dahide, a 20-year-old with one child, her last client of the day, Abassa reflected on the changes she has seen in the community since her job began. “I have seen the number of children per family going down,” she said. “That’s contraception but also the increasing cost of living, and the fact that these days everyone wants to send their children to school.” The prevalence of contraceptive use was at 17% before the programme began, but with the focus on rural communities this has risen to 23% nationwide, even though not all areas of Togo are covered by dedicated health workers yet. We met Dahide in a quiet corner as she took a short break from an apprenticeship in tailoring.  “It’s pretty tough balancing my son and my apprenticeship. If I had waited to have a kid before starting it would have been a lot easier,” she admitted. “My husband is studying at the university in Lomé so I only see him during the holidays and maybe a few weekends during term time.” Younger women like Dahide are sometimes harder to reach, said Abassa, and have a greater unmet need for contraception in a community where many have their first child around the age of 16. “Some of the young women can’t educate their own children because they had to drop out of school themselves,” the health worker explained, adding her focus was always on recruiting more teenagers to her cause. As she heads home for the day, Abassa waved to clients and neighbours, while wondering who might be on her doorstep looking for advice when she gets there.   Photography by Xaume Olleros for IPPF

Healthcare worker with combipack.
story

| 23 September 2020

In pictures: Innovating during COVID-19

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

Healthcare worker with combipack.
story

| 20 May 2022

In pictures: Innovating during COVID-19

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

volunteer holds a family planning poster, Togo
story

| 25 February 2019

In pictures: Togo and the rise in contraception use

Félicité Sonhaye ATBEF Regional Coordinator The Association Togolaise pour le Bien-Être Familial (ATBEF), has led a pioneering programme training community health workers to administer contraception in the rural areas where they live. “The injection is used more than any other method. Around 60% of women use it,” said Félicité Sonhaye, ATBEF Regional Coordinator for Togo’s Plateaux region, which covers Ilama. “Women appreciate the reliability and long-lasting effects of the injection, which allow them to stop worrying about unexpected pregnancies”, Sonhaye added. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sossou Sagna Ilama village chief Men like Sossou Sagna, have great influence and respect within Togo’s rural communities. As Ilama’s village chief his approval was required for the ATBEF community project to take root. “I sent my own wife to seek family planning. The lady helped us and it worked really well. I also went with my older brother’s wife and she was very satisfied. Every member of this community is now aware that having a large family drives them towards poverty. Ignorance was the reason why we had so many children per family here before. Now with the family planning advice we have received, spacing births has become a reality and the reduction of the number of children per family.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Abla Abassa Community health worker Abla is a community health worker, and spends her days cycling around Ilama’s dusty streets visiting households that have signed up to an innovative programme providing contraception in hard-to-reach places. “Before, people didn’t have a lot of information about contraception. With the project the community is now able to space their births. I have seen the number of children per family going down. That’s contraception but also the increasing cost of living, and the fact that everyone wants to send their children to school.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Essivi Koutchona Client Facing prohibitive costs of school fees and food prices for six children, Essivi Koutchona, began using the contraceptive injection after deciding with her husband they did not want another child. She has received the injection every three months and has not experienced any side effects. “The community health worker passed by our house one day and explained the method and a bit about the possible side effects. We agreed as a couple that we wanted me to start using the injection.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Edem Badagbo Client 33-year-old Edem is a widowed father of three children. Edem hopes to have a vasectomy within the next month or so. His wife died following the birth of their third child but he is adamant he wants to follow through with a procedure they agreed upon before her death. “My wife agreed with the idea. I was scared when I first heard of it, but that’s because there was so little information available. When I came to the ATBEF clinic I received a lot more detail and that’s when I decided to do it. I have three children. That’s enough.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Yaori Ajossou Vasectomy client Yaori Ajossou, a retired soldier, heard about vasectomy while listening to an ABTEF awareness raising campaign on the radio. It prompted him to take on the responsibility for family planning in his marriage. “Before I had the idea that maybe I'd want to have more children, but after the campaign, and after my wife had talked a little bit about her health problems, I thought, well, maybe it's better to put the brakes on. I was about to retire. Why carry on having children? Six children is already a lot. It's already maybe too many.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Dede Koussawo Client 34-year-old Dede visits the ATBEF clinic in Lomé, Togo with her husband, Edem. “We do this together if his schedule permits it. I asked and he accepted. It's not typical (for men to come). Before the pregnancy, I was taking the pill. Before the first I was taking the pill and I used an IUD after my son's birth and after my daughter's birth as well. We've been really happy with the family planning we've got here so we decided to come here for Prescillia’s birth as well.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Mensah Awity Teacher and ABTEF youth club coordinator in Tohoun Mensah Awity is a teacher at a local school in Tohoun. He also coordinates the ABTEF youth club where they provide information and opportunities for the students to talk about sexual health, pregnancy, contraception. “At the beginning it was difficult for the club. Now teachers have started accepting the ideas and some pupils behave much better so it’s hard for them to keep condemning it. There are three girls who gave birth and who came back to school afterwards. At the beginning it was tough for them but we explained to the students that they shouldn’t be treated differently. The rate of pregnancy has definitely gone down at school.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Emefa Charita Ankouy Youth activist and student “I'm studying for a degree in English and I'm a young activist volunteer with the IPPF youth movement. We promote, we try to help young girls who are in education to have more information about sexual health and reproduction to help them to adopt a method to avoid a pregnancy. They don't have enough information about sexual health and reproduction. I think it's because of that that they've become pregnant. They want to have sex quite early. There is pressure and there's a lack of communication between the students and their parents. Here in Togo sex is taboo for everyone, above all for parents.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Evedoh Worou Community Health Worker, Ilama “The ones who prefer the pill are young students or apprentices. Often, they take it to reduce PMS, and it regulates their period. Sometimes women will forget to take the pill, which means the injection is preferred as it’s just once for three months. The women here have more autonomy and they now have the space to earn money themselves for the household as a result of the programme. At the beginning, there were some reservations among the men in the community but after our awareness campaigns, more and more of them accompany women for family planning.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Photography by Xaume Olleros for IPPF

volunteer holds a family planning poster, Togo
story

| 20 May 2022

In pictures: Togo and the rise in contraception use

Félicité Sonhaye ATBEF Regional Coordinator The Association Togolaise pour le Bien-Être Familial (ATBEF), has led a pioneering programme training community health workers to administer contraception in the rural areas where they live. “The injection is used more than any other method. Around 60% of women use it,” said Félicité Sonhaye, ATBEF Regional Coordinator for Togo’s Plateaux region, which covers Ilama. “Women appreciate the reliability and long-lasting effects of the injection, which allow them to stop worrying about unexpected pregnancies”, Sonhaye added. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sossou Sagna Ilama village chief Men like Sossou Sagna, have great influence and respect within Togo’s rural communities. As Ilama’s village chief his approval was required for the ATBEF community project to take root. “I sent my own wife to seek family planning. The lady helped us and it worked really well. I also went with my older brother’s wife and she was very satisfied. Every member of this community is now aware that having a large family drives them towards poverty. Ignorance was the reason why we had so many children per family here before. Now with the family planning advice we have received, spacing births has become a reality and the reduction of the number of children per family.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Abla Abassa Community health worker Abla is a community health worker, and spends her days cycling around Ilama’s dusty streets visiting households that have signed up to an innovative programme providing contraception in hard-to-reach places. “Before, people didn’t have a lot of information about contraception. With the project the community is now able to space their births. I have seen the number of children per family going down. That’s contraception but also the increasing cost of living, and the fact that everyone wants to send their children to school.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Essivi Koutchona Client Facing prohibitive costs of school fees and food prices for six children, Essivi Koutchona, began using the contraceptive injection after deciding with her husband they did not want another child. She has received the injection every three months and has not experienced any side effects. “The community health worker passed by our house one day and explained the method and a bit about the possible side effects. We agreed as a couple that we wanted me to start using the injection.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Edem Badagbo Client 33-year-old Edem is a widowed father of three children. Edem hopes to have a vasectomy within the next month or so. His wife died following the birth of their third child but he is adamant he wants to follow through with a procedure they agreed upon before her death. “My wife agreed with the idea. I was scared when I first heard of it, but that’s because there was so little information available. When I came to the ATBEF clinic I received a lot more detail and that’s when I decided to do it. I have three children. That’s enough.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Yaori Ajossou Vasectomy client Yaori Ajossou, a retired soldier, heard about vasectomy while listening to an ABTEF awareness raising campaign on the radio. It prompted him to take on the responsibility for family planning in his marriage. “Before I had the idea that maybe I'd want to have more children, but after the campaign, and after my wife had talked a little bit about her health problems, I thought, well, maybe it's better to put the brakes on. I was about to retire. Why carry on having children? Six children is already a lot. It's already maybe too many.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Dede Koussawo Client 34-year-old Dede visits the ATBEF clinic in Lomé, Togo with her husband, Edem. “We do this together if his schedule permits it. I asked and he accepted. It's not typical (for men to come). Before the pregnancy, I was taking the pill. Before the first I was taking the pill and I used an IUD after my son's birth and after my daughter's birth as well. We've been really happy with the family planning we've got here so we decided to come here for Prescillia’s birth as well.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Mensah Awity Teacher and ABTEF youth club coordinator in Tohoun Mensah Awity is a teacher at a local school in Tohoun. He also coordinates the ABTEF youth club where they provide information and opportunities for the students to talk about sexual health, pregnancy, contraception. “At the beginning it was difficult for the club. Now teachers have started accepting the ideas and some pupils behave much better so it’s hard for them to keep condemning it. There are three girls who gave birth and who came back to school afterwards. At the beginning it was tough for them but we explained to the students that they shouldn’t be treated differently. The rate of pregnancy has definitely gone down at school.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Emefa Charita Ankouy Youth activist and student “I'm studying for a degree in English and I'm a young activist volunteer with the IPPF youth movement. We promote, we try to help young girls who are in education to have more information about sexual health and reproduction to help them to adopt a method to avoid a pregnancy. They don't have enough information about sexual health and reproduction. I think it's because of that that they've become pregnant. They want to have sex quite early. There is pressure and there's a lack of communication between the students and their parents. Here in Togo sex is taboo for everyone, above all for parents.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Evedoh Worou Community Health Worker, Ilama “The ones who prefer the pill are young students or apprentices. Often, they take it to reduce PMS, and it regulates their period. Sometimes women will forget to take the pill, which means the injection is preferred as it’s just once for three months. The women here have more autonomy and they now have the space to earn money themselves for the household as a result of the programme. At the beginning, there were some reservations among the men in the community but after our awareness campaigns, more and more of them accompany women for family planning.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Photography by Xaume Olleros for IPPF

Dahide, a mother and trainee tailor in Togo
story

| 25 February 2019

“I want to use it for a couple of years and then maybe we will think about having another child”

  Every three months, Mawoula Dahide meets a community health worker in her village in central Togo to receive a single contraceptive injection and then carries on with her busy day. Dahide, 20, has a two-and-a-half year old son and a husband living in the capital and juggles an apprenticeship in tailoring with caring for her child. After recovering from the birth, Dahide tried the injection and immediately felt relief, knowing she would decide when she got pregnant again. “I want to use it for a couple of years and then maybe we will think about having another child,” she said.   Lack of access  Until 2013, Dahide and the other women living in the village of Ilama had no access to regular contraception at all, and its use was sometimes regarded with suspicion, and even fear. In her community, the average age of a mother’s first pregnancy is around 16, and women might bear a total of six or seven children compared to the national average of 4.7, according to local health workers. That trend is changing with a pioneering programme run by the Association Togolaise pour le Bien-Être Familial (ATBEF), which has trained community health workers to administer contraception in the rural areas where they live. ATBEF has focused their distribution of contraceptives within poor and rural communities, and with mobile outreach clinics that go to villages with no trained health workers. The unmet need for contraception in Togo stands at 34% of the population, and in rural communities, this is even higher.  The association contributes a fifth of overall contraception cover to couples in Togo, a West Africa nation of 7.8 million people. There is a clear favourite among the methods offered, which include male and female condoms, the pill, and the contraceptive injection. “The injection is more used than any other method. Around 60% of women use it,” said Félicité Sonhaye, ATBEF Regional Coordinator for Togo’s Plateaux region, which covers Ilama. Women appreciate the reliability and long-lasting effects of the injection, Sonhaye added, which allow them to stop worrying about unexpected pregnancies.   From client to advocate Dahide has become an advocate for the method among her peers within her community. “My friends are getting the injection as well. I was the first to start using it and it was great, so I told them about it,” she said. Another convert to the injection is Ilama’s village chief, Sossou Sagna. The father of seven agreed with his wife they didn’t want anymore children.  “I sent my own wife to seek family planning. The lady helped us and it worked really well. I also went with my older brother’s wife and she was very satisfied,” Sagna noted in the cool of the shade.  “My wife chose the three-month injection,” he added. Sagna had not anticipated some of the wider effects of increasing contraceptive use within the community, which have become prevalent over the last couple of years. “Every member of this community is now aware that having a large family drives them towards poverty,” he said. Families have more money to spend feeding and educating their children in an economy where the cost of living keeps rising. Villagers who see Sagna attending family planning sessions are also convinced that rumours about contraception making them ill are untrue. “Ignorance was the reason why we had so many children per family here before. Now with the family planning advice we have received, spacing births has become a reality and the reduction of the number of children per family,” he added. The gains of the ATBEF rural programme will now go even further with the imminent introduction of Sayana Press, a contraceptive injection that women can self-administer.   Learn more about some of the most popular contraception methods available and if they are right for you    Photography by Xaume Olleros for IPPF

Dahide, a mother and trainee tailor in Togo
story

| 20 May 2022

“I want to use it for a couple of years and then maybe we will think about having another child”

  Every three months, Mawoula Dahide meets a community health worker in her village in central Togo to receive a single contraceptive injection and then carries on with her busy day. Dahide, 20, has a two-and-a-half year old son and a husband living in the capital and juggles an apprenticeship in tailoring with caring for her child. After recovering from the birth, Dahide tried the injection and immediately felt relief, knowing she would decide when she got pregnant again. “I want to use it for a couple of years and then maybe we will think about having another child,” she said.   Lack of access  Until 2013, Dahide and the other women living in the village of Ilama had no access to regular contraception at all, and its use was sometimes regarded with suspicion, and even fear. In her community, the average age of a mother’s first pregnancy is around 16, and women might bear a total of six or seven children compared to the national average of 4.7, according to local health workers. That trend is changing with a pioneering programme run by the Association Togolaise pour le Bien-Être Familial (ATBEF), which has trained community health workers to administer contraception in the rural areas where they live. ATBEF has focused their distribution of contraceptives within poor and rural communities, and with mobile outreach clinics that go to villages with no trained health workers. The unmet need for contraception in Togo stands at 34% of the population, and in rural communities, this is even higher.  The association contributes a fifth of overall contraception cover to couples in Togo, a West Africa nation of 7.8 million people. There is a clear favourite among the methods offered, which include male and female condoms, the pill, and the contraceptive injection. “The injection is more used than any other method. Around 60% of women use it,” said Félicité Sonhaye, ATBEF Regional Coordinator for Togo’s Plateaux region, which covers Ilama. Women appreciate the reliability and long-lasting effects of the injection, Sonhaye added, which allow them to stop worrying about unexpected pregnancies.   From client to advocate Dahide has become an advocate for the method among her peers within her community. “My friends are getting the injection as well. I was the first to start using it and it was great, so I told them about it,” she said. Another convert to the injection is Ilama’s village chief, Sossou Sagna. The father of seven agreed with his wife they didn’t want anymore children.  “I sent my own wife to seek family planning. The lady helped us and it worked really well. I also went with my older brother’s wife and she was very satisfied,” Sagna noted in the cool of the shade.  “My wife chose the three-month injection,” he added. Sagna had not anticipated some of the wider effects of increasing contraceptive use within the community, which have become prevalent over the last couple of years. “Every member of this community is now aware that having a large family drives them towards poverty,” he said. Families have more money to spend feeding and educating their children in an economy where the cost of living keeps rising. Villagers who see Sagna attending family planning sessions are also convinced that rumours about contraception making them ill are untrue. “Ignorance was the reason why we had so many children per family here before. Now with the family planning advice we have received, spacing births has become a reality and the reduction of the number of children per family,” he added. The gains of the ATBEF rural programme will now go even further with the imminent introduction of Sayana Press, a contraceptive injection that women can self-administer.   Learn more about some of the most popular contraception methods available and if they are right for you    Photography by Xaume Olleros for IPPF

Abassa is a community health worker
story

| 20 February 2019

“Some of the young women can’t educate their own children because they had to drop out of school themselves”

Abla Abassa lives in the village of Ilama, population 2,000, in rural central Togo. After waking up early each morning to prepare for the day ahead, she sits down to map out her route. Abassa is a community health worker, and spends her days cycling around Ilama’s dusty streets to visit households who have signed up to an innovative programme that provides contraception in hard-to-reach places. The village is an hour by bumpy dirt track from the regional capital of Atakpamé, and few residents have the time or money to travel into town on a regular basis to refill prescriptions. For years, that meant the women of the community had just one form of protection against pregnancy: avoiding sex altogether. In 2013, Abassa became one of 279 community health workers in the Plateaux region funded by the Association Togolaise pour le Bien-Être Familial (ATBEF), working in two districts where the unmet need for contraception was greatest. Today, Abassa has three different clients, but can deal with as many as five a day. The health worker meets women on their own or with their husbands, and conversation flows about village life before she administers a contraceptive injection, or leaves behind a small pile of condoms.   Reaching those in need She begins the day a few doors down at the home of Essivi Koutchona, a mother of six who has used the contraceptive injection for the last two-and-a-half years. “The community health worker passed by our house one day and explained the method and a bit about the possible side effects,” Koutchona said. “We agreed as a couple that we wanted me to start using the injection”.   Koutchona’s husband, Konou Aboudou, credits Abassa and the ATBEF with improving his marriage, which he said was strained by the rhythm [calendar] method and supporting many young children at once. “Now we can better understand and support our wives. We avoid adultery and pregnancies are planned,” he explained. “Before, people didn’t have a lot of information about contraception. With the project we have undertaken with ATBEF since 2013, the community is now able to space their births,” Abassa said, adding the couple had told her they wished the programmed has started years ago. Togo currently has a fertility rate of 4.7 children per woman, according to the United Nations Statistics Division, but is trying to bring that number down.    Battling misinformation The government faces entrenched attitudes about the value of a large family, and misinformation spread about contraception. A community health worker has two roles: safely providing contraception, but also reassuring women that many of the rumours they have heard that the injection or pill will make them sick are false. “I tell them that side effects come from the product, so if they have an irregular period it’s not because they are ill,” Abassa said, adding it had taken much persuasion over the last five years to reach the point where she was now trusted. Abassa’s next client preferred to meet at the health worker’s home for some privacy. At 45, Adjo Amagna is still having periods and wants to avoid any chance of another pregnancy. “I think I want to go for the injection. I have never used contraception before so I think I will do it for three months to see how it goes,” she said.  After the death of her fifth child, the only baby she had with her second husband, Amagna wants to focus on caring of the four children she has left. She sat down with the health worker and was passed condoms, femidoms and the pill, while Abassa explained how the injection works. After a half hour chat, Amagna agreed to begin the injection on her next visit.   Changes within the community  On the way to see Mawoula Dahide, a 20-year-old with one child, her last client of the day, Abassa reflected on the changes she has seen in the community since her job began. “I have seen the number of children per family going down,” she said. “That’s contraception but also the increasing cost of living, and the fact that these days everyone wants to send their children to school.” The prevalence of contraceptive use was at 17% before the programme began, but with the focus on rural communities this has risen to 23% nationwide, even though not all areas of Togo are covered by dedicated health workers yet. We met Dahide in a quiet corner as she took a short break from an apprenticeship in tailoring.  “It’s pretty tough balancing my son and my apprenticeship. If I had waited to have a kid before starting it would have been a lot easier,” she admitted. “My husband is studying at the university in Lomé so I only see him during the holidays and maybe a few weekends during term time.” Younger women like Dahide are sometimes harder to reach, said Abassa, and have a greater unmet need for contraception in a community where many have their first child around the age of 16. “Some of the young women can’t educate their own children because they had to drop out of school themselves,” the health worker explained, adding her focus was always on recruiting more teenagers to her cause. As she heads home for the day, Abassa waved to clients and neighbours, while wondering who might be on her doorstep looking for advice when she gets there.   Photography by Xaume Olleros for IPPF

Abassa is a community health worker
story

| 20 May 2022

“Some of the young women can’t educate their own children because they had to drop out of school themselves”

Abla Abassa lives in the village of Ilama, population 2,000, in rural central Togo. After waking up early each morning to prepare for the day ahead, she sits down to map out her route. Abassa is a community health worker, and spends her days cycling around Ilama’s dusty streets to visit households who have signed up to an innovative programme that provides contraception in hard-to-reach places. The village is an hour by bumpy dirt track from the regional capital of Atakpamé, and few residents have the time or money to travel into town on a regular basis to refill prescriptions. For years, that meant the women of the community had just one form of protection against pregnancy: avoiding sex altogether. In 2013, Abassa became one of 279 community health workers in the Plateaux region funded by the Association Togolaise pour le Bien-Être Familial (ATBEF), working in two districts where the unmet need for contraception was greatest. Today, Abassa has three different clients, but can deal with as many as five a day. The health worker meets women on their own or with their husbands, and conversation flows about village life before she administers a contraceptive injection, or leaves behind a small pile of condoms.   Reaching those in need She begins the day a few doors down at the home of Essivi Koutchona, a mother of six who has used the contraceptive injection for the last two-and-a-half years. “The community health worker passed by our house one day and explained the method and a bit about the possible side effects,” Koutchona said. “We agreed as a couple that we wanted me to start using the injection”.   Koutchona’s husband, Konou Aboudou, credits Abassa and the ATBEF with improving his marriage, which he said was strained by the rhythm [calendar] method and supporting many young children at once. “Now we can better understand and support our wives. We avoid adultery and pregnancies are planned,” he explained. “Before, people didn’t have a lot of information about contraception. With the project we have undertaken with ATBEF since 2013, the community is now able to space their births,” Abassa said, adding the couple had told her they wished the programmed has started years ago. Togo currently has a fertility rate of 4.7 children per woman, according to the United Nations Statistics Division, but is trying to bring that number down.    Battling misinformation The government faces entrenched attitudes about the value of a large family, and misinformation spread about contraception. A community health worker has two roles: safely providing contraception, but also reassuring women that many of the rumours they have heard that the injection or pill will make them sick are false. “I tell them that side effects come from the product, so if they have an irregular period it’s not because they are ill,” Abassa said, adding it had taken much persuasion over the last five years to reach the point where she was now trusted. Abassa’s next client preferred to meet at the health worker’s home for some privacy. At 45, Adjo Amagna is still having periods and wants to avoid any chance of another pregnancy. “I think I want to go for the injection. I have never used contraception before so I think I will do it for three months to see how it goes,” she said.  After the death of her fifth child, the only baby she had with her second husband, Amagna wants to focus on caring of the four children she has left. She sat down with the health worker and was passed condoms, femidoms and the pill, while Abassa explained how the injection works. After a half hour chat, Amagna agreed to begin the injection on her next visit.   Changes within the community  On the way to see Mawoula Dahide, a 20-year-old with one child, her last client of the day, Abassa reflected on the changes she has seen in the community since her job began. “I have seen the number of children per family going down,” she said. “That’s contraception but also the increasing cost of living, and the fact that these days everyone wants to send their children to school.” The prevalence of contraceptive use was at 17% before the programme began, but with the focus on rural communities this has risen to 23% nationwide, even though not all areas of Togo are covered by dedicated health workers yet. We met Dahide in a quiet corner as she took a short break from an apprenticeship in tailoring.  “It’s pretty tough balancing my son and my apprenticeship. If I had waited to have a kid before starting it would have been a lot easier,” she admitted. “My husband is studying at the university in Lomé so I only see him during the holidays and maybe a few weekends during term time.” Younger women like Dahide are sometimes harder to reach, said Abassa, and have a greater unmet need for contraception in a community where many have their first child around the age of 16. “Some of the young women can’t educate their own children because they had to drop out of school themselves,” the health worker explained, adding her focus was always on recruiting more teenagers to her cause. As she heads home for the day, Abassa waved to clients and neighbours, while wondering who might be on her doorstep looking for advice when she gets there.   Photography by Xaume Olleros for IPPF