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“I've heard kids yelling on the street that there was a program to space pregnancies. I've always wanted to do that for the long term. Until then, I'm still trying with the three-month-old pills. Besides, listening to one of the people advertising these services, the address was not very far from my home." Claudine, aged 27, is a sex worker. "In the past, I was wary of 'contraceptive' methods. But once I tried them and I didn't notice any negative impact on my body, I made it a habit in order to not get pregnant". Like all young girls interested in the Women’s Integrated Sexual Health (Lot 1) programme services, Claudine arrives shyly at the center where Association pour le Bien-Etre Familial-Naissances Désirables (ABEF-ND) distributes contraceptive methods. "When I arrived at the center, I thought that there would be no paperwork to do, but I was pleasantly surprised that the organizers want to find out about me and maybe one day they will be able to set up a health centre to follow us regularly," she hopes. In the DRC, few women raise the subject of sexual violence because they are afraid of being rejected and that "poverty sometimes leads us into sex work," she says. "But the consequences are enormous and sometimes harmful. Girls who are not sensitized will have unsafe abortions and catch sexually transmitted infections." Claudine has expectations and hopes regarding this kind of activity: "However, if awareness-raising is regulated, even every three months, we will, I think, have fewer young mothers because they will be more knowledgable about family planning". The WISH project has seen a positive change in women and girls' access to integrated family planning and sexual and reproductive health care. WISH promotes a variety of contraceptive methods and sexual and reproductive health support, ranging from referrals to services for those who need it most.   "I want to feel free in my sexual activities". I have a boyfriend but that doesn't stop me from doing my life. "I make my livelihood as a sex worker and he is a carpenter. That's how we've been trying to make ends meet since we moved to the capital two years ago." "We're going back to the village to take a break, it's not a permanent departure." Claudine and her boyfriend are both from Boende, the capital of the Tshuapa province, in the north-west of the country, 2,285 km from Kinshasa. She was encouraged to move to the capital at the insistence of one of her uncles who had been living there for several years. "The reality is quite different. We have been able to raise enough money to send goods to the village for the past two years. My companion and I will go back there to rest and maybe come back if we get bored in the village again.” “Pakadjuma is a place where almost everyone comes from the village, but it is only here that I see enough interest from associations to sensitize young girls on family planning by distributing condoms to prevent early pregnancies and sexually transmitted diseases. It's all very interesting. It's an opportunity for us and I think it's one of the things I'll miss the most when I go back to the village. I hope to still have friends here who can send me these methods.”

After her parents divorced, the family dissolved and Ruth found herself in Pakadjuma where she rented a small house. "My boyfriend helps me pay the rent," she says. She thought she would continue with school but could not afford it. After a few years of a relationship, Ruth became pregnant, and explain that "it was late to get an abortion, and I didn't want to put my life in danger." "I would have liked to get my bachelor's degree, but I don't regret it; I loved my child right away." Ruth, aged 19, like other young girls, queues up to learn about the different contraceptive methods the WISH programme offers for girls and women living in Pakadjuma. Some of them sign up directly to take them. Others find out and promise to come back after talking with their companions. The Women’s Integrated Sexual Health (WISH Lot 1) programme offers quality integrated sexual and reproductive health services across the Democratic Republic of Congo through IPPF Member, Association pour le Bien-Etre Familial – Naissances Désirables (ABEF-ND). Ruth is trying the service for the first time. She is in favour of receiving a contraceptive method for the next three months. "Some people have discouraged me because they believe that the 5-year method can destroy the body. But before deciding to come here, I asked around with the neighbours who have already tried it. I didn't have any negative experiences." Ruth asked the organizers about the consequences: "They said it's just to protect me so that I don't get pregnant for 3 months and then I can renew if I feel like it.” Ruth feels that many parents do not discuss sexual matters with their children. They probably feel it is inappropriate. Yet, if young girls get pregnant before they are socially stable, it is also due to a lack of guidance and orientation. "This should be a regular initiative," she says. "It's not late to receive sex education but above all to have free contraceptive methods, because I would have preferred a thousand times to buy milk for my baby than to pay for a condom or a Jadelle. Ruth has an 8-month-old baby, "I didn't want this and having many children will be disadvantageous for me especially as I am not yet married". She lives from small businesses and the money to support from her companion. Ruth says she took this contraceptive method without her partner's advice. "Since the birth of our child, we have been abstinent, and that's good. "He encourages me to go back to school, and I think that's what I should do.”

Midwife Sophia Abrafi sits at her desk, sorting her paperwork before another patient comes in looking for family planning services. The 40-year-old midwife welcomes each patient with a warm smile and when she talks, her passion for her work is clear.  At the Mim Health Centre, which is located in the Ahafo Region of Ghana, Abrafi says a sexual and reproductive health and right (SRHR) project through Planned Parenthood Association of Ghana (PPAG) and the Danish Family Planning Association (DFPA) allows her to offer comprehensive SRH services to those in the community, especially young people. Before the project, launched in 2018, she used to have to refer people to a town about 20 minutes away for comprehensive abortion care. She had also seen many women coming in for post abortion care service after trying to self-administer an abortion. “It was causing a lot of harm in this community...those cases were a lot, they will get pregnant, and they themselves will try to abort.”   Providing care & services to young people Through the clinic, she speaks to young people about their sexual and reproductive health and rights. “Those who can’t [abstain] we offer them family planning services, so at least they can complete their schooling.” Offering these services is crucial in Mim, she says, because often young people are not aware of sexual and reproductive health risks.  “Some of them will even get pregnant in the first attempt, so at least explaining to the person what it is, what she should do, or what she should expect in that stage -is very helpful.” She has already seen progress.  “The young ones are coming. If the first one will come and you provide the service, she will go and inform the friends, and the friends will come.” Hairdresser Jennifer Osei, who is waiting to see Abrafi, is a testament to this. She did not learn about family planning at school. After a friend told her about the clinic, she has begun relying on staff like Abrafi to educate her. “I have come to take a family planning injection, it is my first time taking the injection. I have given birth to one child, and I don’t want to have many children now,” she says. Expanding services in Mim The SRHR project is working in three other clinics or health centres in Mim, including at the Ahmadiyya Muslim Hospital. When midwife Sherifa, 28, heard about the SRHR project coming to Mim, she knew it would help her hospital better help the community. The hospital was only offering care for pregnancy complications and did little family planning work. Now, it is supplied with a range of family planning commodities, and the ability to do comprehensive abortion care, as well as education on SRHR. Being able to offer these services especially helps school girls to prevent unintended pregnancies and to continue at school, she says.  Sherifa also already sees success from this project, with young people now coming in for services, education and treatment of STIs. In the long term, she predicts many positive changes. “STI infection rates will decrease, teenage pregnancies will decrease, unsafe abortions and deaths as a result of unsafe abortions will decrease. The young people will now have more information about their sexual life in this community, as a result of the project.”

Factory workers at Mim Cashew, in a small town in rural Ghana, are taking their reproductive health choices into their own hands, thanks to a four-year project rolled out by Planned Parenthood Association Ghana (PPAG) along with the Danish Family Planning Association (DFPA). The project, supported by private funding, focuses on factory workers as well as residents in the township of about 30, 000, where the factory is located. Under the project, health clinic staff in Mim have been supported to provide comprehensive abortion care, a range of different contraception choices and STI treatments as well as information and education. In both the community and the factory, there is a strong focus on SRHR trained peer educators delivering information to their colleagues and peers. An increase in knowledge  So far, the project has yielded positive results - especially a notable increase amongst the workers on SRHR knowledge and access to services - like worker Janet Pinamang, who is a 32-year-old mother of two. She says the SRHR project has been great for her and her colleagues. "I have had a lot of benefits with the project from PPAG. PPAG has educated us on how the process is involved in a lady becoming pregnant. PPAG has also helped us to understand more on drug abuse and about HIV.” She also appreciated the project working in the wider community and helping to address high levels of teenage pregnancy.  "I have seen a lot of change before the coming of PPAG little was known about HIV, and its impacts and how it was contracted - now PPAG has made us know how HIV is spread, how it is gotten and all that. PPAG has also got us to know the benefits of spacing our children." “It has helped me a lot” Pinamang's colleague, Sandra Opoku Agyemang, 27, is a mother of a six-year-old girl called Bridget. Agyemang says before the project came to Mim, she had only heard negative information around family planning. "I heard family planning leads to dizziness, it could lead to fatigue, you won't get a regular flow of menses and all that, and I also heard problems with heart attacks. I had heard of these problems, and I was afraid, so after the coming of PPAG, I went into family planning, and I realised all the things people talked about were not wholly true." Now using family planning herself, she says the future is bright for her, and her family. "It has helped me a lot, without that information I would have given birth to many children, not only Bridget. In the future, I plan to add on two [more children], even with the two I am going to plan."  

When Gifty Anning Agyei was pregnant, her classmates teased her, telling her she should drop out of school. She thought of having an abortion, and at times she says she considered suicide. When her father, Ebenezer Anning Agyei found out about the pregnancy, he was furious and wanted to kick her out of the house and stop supporting her education.  Getting the support she needed But with support from Planned Parenthood Association of Ghana (PPAG) and advice from Ebenezer’s church pastor, Gifty is still in school, and she has a happy baby boy, named after Gifty’s father. Gifty and the baby are living at home, with Gifty’s parents and three of her siblings in Mim, a small town about eight hours drive northwest of Ghana’s capital Accra.  “Despite all those challenges, I thought it was necessary to stay in school. I didn’t want any pregnancy to truncate my future,” Gifty says, while her parents nod in proud support. In this area of Ghana, research conducted in 2018 found young people like Gifty had high sexual and reproduce health and rights (SRHR) challenges, with low comprehensive knowledge of SHRH and concerns about high levels of teenage pregnancy. PPAG, along with the Danish Family Planning Association (DFPA), launched a four-year project in Mim in 2018 aimed to address these issues.  For Gifty, now 17, and her family, this meant support from PPAG, especially from the coordinator of the project in Mim, Abdul- Mumin Abukari. “I met Abdul when I was pregnant. He was very supportive and encouraged me so much even during antenatals he was with me. Through Abdul, PPAG encouraged me so much.” Her mother, Alice, says with support from PPAG her daughter did not have what might have been an unsafe abortion. The parents are also happy that the PPAG project is educating other young people on SRHR and ensuring they have access to services in Mim. Gifty says teenage pregnancy is common in Mim and is glad PPAG is trying to curb the high rates or support those who do give birth to continue their schooling.  “It’s not the end of the road” “PPAG’s assistance is critical. There are so many ladies who when they get into the situation of early pregnancy that is the end of the road, but PPAG has made us know it is only a challenge but not the end of the road.” Gifty’s mum Alice says they see baby Ebenezer as one of their children, who they are raising, for now, so GIfty can continue with her schooling. “In the future, she will take on the responsibly more. Now the work is heavy, that is why we have taken it upon ourselves. In the future, when Gifty is well-employed that responsibility is going to be handed over to her, we will be only playing a supporting role.” Alice also says people in the community have commented on their dedication. “When we are out, people praise us for encouraging our daughter and drawing her closer to us and putting her back to school.” Dad Ebenezer smiles as he looks over at his grandson. “We are very happy now.” When she’s not at school or home with the baby, Gifty is doing an apprenticeship, learning to sew to follow her dream of becoming a fashion designer. For her, despite giving birth so young, she has her sights set on finishing her high school education in 2021 and then heading to higher education. 

As the sun rises each morning, Dorcas Amakyewaa leaves her home she shares with her five children and mother and heads to work at a cashew factory. The factory is on the outskirts of Mim, a town in the Ahafo Region of Ghana. Along the streets of the township, people sell secondhand shoes and clothing or provisions from small, colourfully painted wooden shacks.  “There are so many problems in town, notable among them [young people], teenage pregnancies and drug abuse,” Amakyewaa says, reflecting on the community of about 30,000 in Ghana.       The chance to make a difference  In 2018, Amakyewaa was offered a way to help address these issues in Mim, through a sexual and reproductive health rights (SRHR) project brought to both the cashew factory and the surrounding community, through the Danish Family Planning Association, and Planned Parenthood Association Ghana (PPAG).  Before the project implementation, some staff at the factory were interviewed and surveyed. Findings revealed similar concerns Amakyewaa had, along with the need for comprehensive education, access and information on the right to key SRHR services. The research also found a preference for receiving SRHR information through friends, colleagues or factory health outreach. These findings then led to PPAG training people in the factory to become SRHR peer educators, including Amakyewaa. She now passes on what she has learnt in her training to her colleagues in sessions, where they discuss different SRHR topics. “I guide them to space their births, and I also guide them on the effects of drug abuse.” The project has also increased access to hospitals, she adds. “The people I teach, I have given the numbers of some nurses to them. So that whenever they need the services of the nurses, they call them and meet them straight away.” Access to information One of the women Amakyewaa meets with to discuss sexual and reproductive health is Monica Asare, a mother of two.  “I have had a lot of benefits from PPAG. They teach us as to how to avoid STDs and how to space our childbirth. I teach my child about what we are learning. I never had access to this information; it would have helped me a lot, probably I would have been in school.” Amakyewaa also says she didn’t have access to information and services when she was young. If she had, she says she would not have had a child at 17. She takes the information she has learnt, to share with her children and other young people in the community. When she gets home after work, Amakyewaa’s peer education does not stop, she continues. She also continues her teachings when she gets home. “PPAG’s project has been very helpful to me as a mother. When I go home, previously I was not communicating with my children with issues relating to reproduction.” Her 19-year-old daughter, Stella Akrasi, has also benefitted from her mothers training. “I see it to be good. I always share with my friends give them the importance of family planning. If she teaches me something I will have to go and tell them too” she says.