Five years ago, when Arnilda Simango was 13, she started dating a boy from her community, outside Xai-Xai City, in Gaza Province in southern Mozambique. A year later she got pregnant, at his insistence, and he left her shortly after the baby was born. AMODEFA’s youth services offered her counselling and advice throughout her pregnancy and became the network through which she made new friends.  Today, at the age of 18, she is raising her son, with help from her mother and plans to return to school. “When I started dating, I thought I wanted a partner who could take care of me and that could maybe fill the void I felt for not having a father. When I started the relationship with my boyfriend, he insisted that he needed a son because all his friends already had one. I had little space to say no because he threatened to date someone else and I was convinced he was the right person for me. When I got pregnant in 2016, he started behaving strangely. He stopped being affectionate and gave indications that he did not want to be with me anymore. That's when a friend of mine told me that there was a youth center where I could get advice on how to proceed in this situation". The Adolescent and Youth Friendly Services (SAAJ) center, based at the Patrice Lumumba Urban Health Center, on the outskirts of Xai-Xai, is run by AMODEFA and provides HIV testing and treatment, prenatal and postpartum consultations, and other information and services around sexual health and rights. The center is supported by the Women’s Integrated Sexual Health (WISH2ACTION) programme, led by IPPF.   "One day I walked there and received a lot of advice. As I was already 4 to 5 months pregnant, I was advised to open a prenatal form. They did all the follow-up until I gave birth to my son.” "Believe me, being a single mother at 14 was a suffocating experience and it could have been worse if I had not been accompanied by [the SAAJ]. I do not know how to thank them. I practically felt alone without knowing what to do, but I had a lot of advice here and made friends with other girls". Planning for the future  Arnilda dropped out of 7th grade once she became pregnant and helped her mother selling basic goods from a stall in her home. It is from this small business that her mother supports her two children who are still living at home, as well as five grandchildren. Arnilda plans to return to school next year to continue her studies now her son is old enough to stay with his grandmother. Her dream is to be a professional model. Until then she does not want to have another child, so she goes to the SAAJ for family planning purposes. Arnilda says she walks 50 minutes to the center every three months for the contraceptive injection.  "I wanted the implant, but it doesn't settle well with me, so I renew the injection every three months.  I do this because I need to continue studying to have a decent job that allows me to support my son. Next year I will go back to school. "A second child is not in the plans. I still consider myself a minor. Even the first child I only had because at the time I had no one to give me advice and show me the best way. I believed in my ex-boyfriend and today I have this lesson. Today I can say that I have come to my senses, not only from the experience of being a mother, but from everything I learn here [at the SAAJ]. There is no friend of mine who does not know SAAJ. I always advise them to approach here because I know they will have all kinds of counselling and accompaniment.”

Menstrual regulation, the method of establishing non-pregnancy for a woman at risk of unintended pregnancy, has been a part of Bangladesh’s family planning program since 1979. It is allowed up to 10 –12 weeks after a woman’s last menstrual period. Nursing Supervisor Ms. Lovely Yasmin is one of several staff members providing family planning, menstrual regulation, and post-procedure care services at Upzila Health Complex in Belkuchi, Bangladesh. “Before this training we used to sometimes advise people on such services and provided menstrual regulation (MR) services but after the training I’ve have become and confident and efficient in providing MR services,” she says. “Earlier there could possibly have been mistake but now I can provide MR services efficiently and perfectly. I can now provide MR services in more organized manner.” But while Yasmin, who has worked in family planning for 16 years, says that the recent training has increased her confidence in properly doing MR procedures, the health complex still lacks basic supplies. “There were difficulties due to limited equipment,” she says. “We sometimes have to use personal equipment.” But, she says, the presence of Kit 8 has made life easier. “Prior to this kit, many clients did not complete the full course of medical as advices due to financial issues… during floods there are many hardships including financial difficulty,” she says. “However with this kit, most of the medicines are provided and clients are easily managing on their own.”

Menstrual regulation, the method of establishing non-pregnancy for a woman at risk of unintended pregnancy, has been a part of Bangladesh’s family planning program since 1979. It is allowed up to 10 –12 weeks after a woman’s last menstrual period. When Shana Khatun, a mother of three, became pregnant again she says she began to feel very weak and had issues with massive bleeding.Citing her age and the possibility of further medical complications, Khatun decided to undergo a menstrual regulation procedure. “But if the hospital and services weren’t there then I would have had to have continued with my pregnancy, even when (I do) not want another child” she says. Khatun says that the procedure went well, but that without the presence of medicine found in Kit 8 she would have lacked post-operation medicine. “After the menstrual regulations services I was prescribed a few medicines which I could not buy due to poor financial condition,” she says. “But the hospital gave me a number of medicines that I could take.” And while Khatun had talked with women about various family planning methods, she didn’t feel she could talk with anyone aside from her husband about getting the procedure. “I feared they would treat me poorly (the hospital),” she says. But Kahtun says she found the hospital trustworthy and helpful, even when she was suffering complications such as mass bleeding. “I will be very cautious that I should not get pregnant again however in event if I get pregnant again then I will come to this hospital only,” she says.

Menstrual regulation, the method of establishing non-pregnancy for a woman at risk of unintended pregnancy, has been a part of Bangladesh’s family planning program since 1979. It is allowed up to 10 –12 weeks after a woman’s last menstrual period. Auliya Khatun, a mother of three children, was 40 years old when she found out that she had unintentionally become pregnant again. Khatun says she had heard about family planning services and menstrual regulation services available at the Upzila Health Complex from other women in her small village. She discussed the option of undergoing menstrual regulation with her husband. “My spouse was supportive and he gave me the freedom to come to this decision myself,” Khatun says. “If this service was not available then I would have carried on with the pregnancy. It would have been embarrassing, though,” she explains. “It is embarrassing to have another child at this age.” Khatun, who sometimes assists her husband with work in a local handloom, also cited the financial burden another child would have on her family. “We are facing financial difficulty so it is not possible to have another child.” Khatun says she only experienced mild gastric discomfort after the procedure but felt assured about her recovery due to being able to check-in with doctors at the local health centre. The access to the services and doctors, she says, was a major factor in a smooth and easy recovery. “Since this service was in a government facility I could prevail [through] this and survive,” she says. “It is an important service.”  

Marinho, 30, works as an activista for Amodefa’s Challenge TB programme, bringing treatment to remote villages in the Ribaué district of Nampula. Since August last year he has identified 84 cases of TB in the eight communities in which we works; “75 patients are in treatment at the moment, the rest are recovered,” he says. Before Amodefa started work in Nampula, Marinho says, “people were dying because they couldn’t reach the hospital, but with this programme it is becoming easier because we bring the medication to the patients.” However, lack of transport means it is a challenge for him to keep on top of all his cases. “The distances are far and the few bikes we have are breaking,” Marinho says. Yesterday he travelled 40 km to visit his patients. Some of the communities he visits are up to 50 km away. In the first quarter of this year 1,318 people were tested for TB in the eight districts where Amodefa operates; in the second quarter, 2,106 were tested; and in the third quarter, the number reached 3,154. More than half of these people were diagnosed to have TB. The surge in the number of people going for tests is in a large part due to Amodefa’s ‘Day of the Cough’.  On the 27th of each month teams of activistas and volunteers go into communities, schools and jails to educate people about TB.   Before volunteers had to go from house to house to identify patients, “but now, with the lectures, it’s easy to find people who are TB positive because they are identifying themselves,” says Marinho. Children are particularly receptive to Amodefa’s message, Marinho says. He remembers one woman who had been sick for a long time and her daughter, knowing he was an activist, sought him out. The patient’s initial test for TB came back negative, so she was given alternative medication.  “She took the tablets but she was still sick - she was unable to walk or to eat,” Marinho says.  “We brought her here to the clinic, examined her and she immediately started TB treatment. Now she has started her recovery and is able to sit.” Lessons taught during the ‘Day of the Cough’ means communities are also now taking greater precautions against the disease, he says. Steps such as opening windows, cleaning the house, not eating from one communal bowl, and practising ‘coughing etiquette’ have all helped limit the spread of TB.  “People understand now and are taking serious measures to prevent it,” Marinho says. However, the US decision to withdraw funding from Amodefa following the introduction of the Global Gag Rule , could halt the Challenge TB programme just as it is gaining momentum. “If the programme stops the people will suffer,” says Marinho. “For people who live too far from the hospital to receive treatment, this programme saves their lives. Knowing Amodefa has come to eliminate TB, it can’t stop. If they stop now the TB will get resistant, so we’ve got to keep going, we’ve got to get stronger.”   SUPPORT OUR WORK WITH A DONATION

Antonio Junior Xiranza is 12 years old. He lives with his Aunt Talita Agosto Mujovo, 39, and her three children in Maputo, Mozambique, after his parents both died from HIV-related illnesses. Antonio is HIV positive, something that Talita was able to reveal to him over the course of nine counselling sessions through IPPF Member Association AMODEFA’s Ntyiso programme. When Antonio was sent to Talita in 2015 he had no understanding of his illness. He was severely underweight and wouldn’t take his medication. “I didn’t think he was going to make it,” says Talita. But following AMODEFA’s intervention last year Antonio’s health has improved rapidly and is gaining weight. This is in large part because Antonio, though still young, has chosen to take on the responsibility for managing his illness himself.  “He takes his medication without being told”, says Talita. “If he’s injured he knows the other children can’t touch his wound.” Antonio is still small for his age but says he feels stronger. He is well enough now to attend school regularly and is already thinking about the future; when he grows up he wants to be a fireman.“I am happy about life here,” he says, shyly. Talita says she is “relieved” to see these changes in Antonio. “At first I was not going to say anything. I would have waited until he was 18 to tell him,” Talita says, which would have continued to put pressure on the entire family. “But with the help of the counselling I had through Ntyiso I was able to tell him now.” While Ntyiso was intended to help parents speak more openly about HIV with their children, it has given Talita the confidence to discuss the illness more widely. “I was able to tell my father, who was sick and had a wound, that he should get tested for HIV,” she says. Her father was diagnosed positive and is now in treatment. “Before I wouldn’t have advised people to take the test, I would have just kept quiet,” she says. Read more about AMODEFA's tireless work in Mozambique