Stories

There are some years that become a pivotal moment in history - 2020 is one of those. IPPF has never been faced with delivering healthcare in the grip of a global pandemic. Yet our global teams have demonstrated agility, resilience, and creativity putting clients at the heart of our work to ensure the safe delivery of vital care. The pandemic has changed how we work, but not what we do. Here we acknowledge some of our amazing colleagues, clients, and partners as well as events that have shaped 2020. Expanding healthcare for factory staff Sandra is one of a team of women who work at a cashew factory in a small town in rural Ghana. Thanks to a project run in partnership by Planned Parenthood Association Ghana (PPAG) and the Danish Family Planning Association (DFPA) women like Sandra can now access contraceptive and reproductive healthcare during their working day. "It has helped me a lot, without that information I would have given birth to many children.”© IPPF/Natalija Gormalova Share on Twitter Share on Facebook Share via WhatsApp Share via Email Ensuring healthcare provision during the pandemic Malak Dirani, a midwife at the Lebanese Association for Family Health (SALAMA). “My message to healthcare workers across the world is that we are always here for people to secure their health and rights. We are on the frontline; we were always the one who people trust! We are the nation's guiding light during this difficult time, so we can, with our efforts and power support patients, overcome this crisis, and save lives.”© SALAMA Share on Twitter Share on Facebook Share via WhatsApp Share via Email COVID-19 crisis sparks innovation New approaches to reach women with safe abortion care include telemedicine and home-based provision of medical abortion. To ensure that quality abortion care can be provided to women during travel restrictions, the Cameroon National Planning Association for Family Welfare (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.© IPPF/Xaume Olleros Share on Twitter Share on Facebook Share via WhatsApp Share via Email Getting creative on social media A watercolour entry for a social media art competition. “With our Youth Network we created an artistic competition on our Facebook and Instagram platforms on issues such as masturbation, menstruation, coming out, female genitalia, pornography. The aim is to enhance creativity and make young people reflect about sexual and reproductive health and rights in a creative way during the pandemic. The aim was also to offer something fun and positive in this difficult time.” Noemi, 24, is the co-founder and coordinator of Santé Sexuelle Suisse/Sexuelle Gesundheit Schweiz's Youth Network. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Delivering healthcare to remote communities in Fiji RFHAF Team in Kadavu performing general health checks after TC Harold. Healthcare provider, Nasi, administers an HPV shot to a client. In early April 2020, the all too familiar destruction of a Tropical Cyclone (TC) – Harold – hit the Solomon Islands, Vanuatu, Fiji and Tonga. One of the worst affected areas was the Eastern part of Fiji. Through support by Department of Foreign Affairs and Trade (DFAT), our Member Association, Reproductive and Family Health Association of Fiji (RFHAF), was quick to respond ensuring access to essential sexual and reproductive healthcare for Kadavu’s women, girls, and vulnerable groups.© IPPF/Rob Rickman Share on Twitter Share on Facebook Share via WhatsApp Share via Email Spotlight on women in leadership Executive Director, Dr Kalpana Apte, of FPA India talks about young people being a primary focus for access to healthcare and information. “Gender equality and equity is a fundamental issue that India must prioritize. India is a country of young people. That is the biggest cohort of people at this time in history. Within this group of young people, adolescent and young girls are the most marginalized group. The face of poverty in India is a young girl. Girls have fewer choices, options and opportunity. The gap between boys and girls in terms of access to sexual and reproductive health services and information is huge. Education, Health and empowerment are the three priorities for young girls.”© IPPF/Anurag Banerjee Share on Twitter Share on Facebook Share via WhatsApp Share via Email Humanitarian Youth Club, Kiribati Theta, 25, is part of the Humanitarian Youth Club set up by the Kiribati Family Health Association in her village. “I have helped the Humanitarian Youth Club to apply for financial grants from the Australian High Commission [for $1,000]. I am recognized as the smartest member who can write in English. We have learned how to design a disaster plan for the community and share our ideas on sexual and reproductive issues such as sexually transmitted infections. We discuss what we can do for the next strong tide, where we can gather as a community. For now, I want to enjoy the chance to be in our own beloved country. I won’t move until the majority have already left. I want my daughter to grow up in the same place I grew up in.”© IPPF/Hannah Maule-Ffinch Share on Twitter Share on Facebook Share via WhatsApp Share via Email Youth-led healthcare through song, dance, and poetry 17-year-old student Jumeya Mohammed Amin has been a ‘change agent’ for her community through the Family Guidance Association of Ethiopia since she was 14. "I wanted to protect girls from violence – like early marriage – and I wanted to change people’s wrong perceptions about sex and sexuality.”©IPPF/ Zacharias Abubeker Share on Twitter Share on Facebook Share via WhatsApp Share via Email Small but mighty: The Pill at 60 2020 marks the 60th anniversary of the game-changing contraceptive pill. For 60 years, “the Pill” has been approved for use in the US market, changing the face of reproductive control for millions of people since. Although taking a few years longer to become widely available to all women, the Pill was the first oral hormonal contraceptive. It allowed women to take real ownership over if and when they had children, and how many they had, giving them control over their lives in a way that had never been seen before.© Jessica Dance Share on Twitter Share on Facebook Share via WhatsApp Share via Email Being part of IPPF: What it means for Profamilia, Colombia Executive Director, Marta Royo. “For Profamilia, the value that the Federation adds is enormous. It gives us the possibility to exchange experiences and knowledge with other associations around the world, enriching our work, and allowing it to advance more quickly and with greater strength. This has allowed us to work with the most vulnerable populations in our country – from advocacy to healthcare service delivery, research, addressing issues as varied as abortion care, contraception and comprehensive sex education. Without this support, thousands of people in Colombia would not have access to any of these services.”© Profamilia Share on Twitter Share on Facebook Share via WhatsApp Share via Email Unprecedented support for women’s right to abortion care in Poland Huge numbers of people took part in protests prompted by the decision of the Constitutional Tribunal to impose a near ban on abortion on 22 October 2020. The ruling struck down the possibility for women to access abortion care on the ground of severe fetal impairment, rejecting what is the most common of the few legal grounds for abortion in the country at present. The demonstrations had a powerful impact, and on 3 November the government announced a delay in implementing its latest court ruling in response to the protests.© Marta Bogdanowicz Spacerowiczka Share on Twitter Share on Facebook Share via WhatsApp Share via Email US Election 2020 The people of the United States voted for change and progress. The reinstatement of the US Global Gag Rule in 2017 has had enormous consequences for women and girls accessing sexual and reproductive healthcare. IPPF calls on President-elect Biden to keep to his word of signing an executive order on his first day in office to repeal the harmful Global Gag Rule (the Mexico City Policy). © J. Smith/USA Share on Twitter Share on Facebook Share via WhatsApp Share via Email 16 Days of Activism Against GBV In humanitarian emergencies, women and girls may be forced to turn to survival sex work as a way of feeding themselves and their families. Without the usual healthcare available and low sexual health understanding, sex is frequently unprotected and violent, exposing them and their clients to sexually transmitted infections, including HIV. In fact, people who engage in sex work experience 10 times higher prevalence of HIV than the general population, with an average of a 12% rate of HIV infection.© Jem Milton Share on Twitter Share on Facebook Share via WhatsApp Share via Email Spotlight on sex and disability Joy & Jake talk sex and more to mark International Day of Persons with Disabilities. Joy and Jake – who are sight/visually-impaired – discuss the highs, lows, and everything in between of navigating sex, sexual health, dating, relationships and sex education, whilst living with a disability.© Bird Lime Media Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Seventeen-year-old student Jumeya Mohammed Amin started educating other people about sexual and reproductive health when she was 14 years old. She trained as a ‘change agent’ for her community through the Family Guidance Association of Ethiopia’s south west office in Jimma, the capital of Oromia region. Amin comes from a small, conservative town about 20km outside the city. "I wanted to protect girls from violence – like early marriage – and I wanted to change people’s wrong perceptions about sex and sexuality, because they [men in her community] start having sex with girls at a young age, even with girls as young as nine years old, because of a lack of education." "They suddenly had to act like grown-up women" "Before I started this training I saw the majority of students having sex early and getting pregnant because of a lack of information, and they would have to leave home and school. Boys would be disciplined and if they were seen doing things on campus, expelled. Girls younger than me at the time were married. The youngest was only nine. They would have to go back home and could not play anymore or go to school. They suddenly had to act like grown-up women, like old ladies. They never go back to school after marriage. My teacher chose me for this training and told me about the programme. I like the truth so I was not afraid. I heard about a lot of problems out there during my training and I told myself I had to be strong and go and fight this." "I have a brother and four sisters and I practiced my training on my family first. They were so shocked by what I was saying they were silent. Even on the second day, they said nothing. On the third day, I told them I was going to teach people in schools this, so I asked them why they had stayed silent. They told me that because of cultural and religious issues, people would not accept these ideas and stories, but they gave me permission to go and do it. Because of my efforts, people in my school have not started having sex early and the girls get free sanitary pads through the clubs so they no longer need to stay home during periods." Training hundreds of her peers "I know people in my community who have unplanned pregnancies consult traditional healers [for abortions] and take drugs and they suffer. I know one girl from 10th grade who was 15 years old and died from this in 2017. The healers sometimes use tree leaves in their concoctions.  We tell them where they can go and get different [safe abortion] services. The first round of trainings I did was with 400 students over four months and eight sessions in 2017. Last year, I trained 600 people and this year in the first trimester of school I trained 400. When students finish the course, they want to do it again, and when we forget we have a session, they come and remind me. At school, they call me a teacher. I’d like to be a doctor and this training has really made me want to do that more."

Youth leader Nebiyu Ephirem, 26, has been staffing the phones at a hotline for young people who have questions about sexual and reproductive health (SRH) since it started in 2017 in Ethiopia’s Oromia region.  The helpline has two phones and is free, anonymous and open six days a week. The helpline is aimed at people aged 17-26 who are curious about SRH but are too shy or afraid to ask others about topics such as contraception, menstruation, and diseases.  The hotline also advises people dealing with emergencies following unprotected sex and issues such as unintended pregnancy and concerns over sexually transmitted infections (STIs), by referring people to their nearest clinic.  About 65 to 70 percent of the callers are female. Ephirem also trains other people about SRH and how to educate more young people about this. Being on call for his community  “Most days, I get about 30 to 40 calls and on a Saturday, around 50. People ask about contraceptive methods like pills and emergency contraceptives and depo provera [three-month injectable contraceptive], about the spread of STIs and HIV and how to prevent it, and about menstruation and sanitation. I give my suggestions and then they come and use Family Guidance Association of Ethiopia (FGAE) services, or I refer people to clinics all over the country. There are seven FGAE clinics in this area and dozens of private clinics. Young people need information about STIs before they come to the clinic, and when they want a service they can know where the clinics are. Most of them need information about menstruation and contraception. They fear discussing this openly with family and due to religious beliefs, so people like to call me. Culturally, people used to not want to discuss sexual issues. We took the information from IPPF documents and translated them into the two local languages of Oromia and Amharic, with the help of university lecturers. After four years, even the religious leaders did this training. We have trained university students, teachers and many more people to be trainers and 30 of them graduated. They [the people who dropped out] did not want to hear about the names in the local language of body parts. Most of the ones who stayed were boys and girls, but now we have women doing this. [At first], they were laughing and said: ‘How could you talk like this? It’s shameful. But slowly, they became aware. They now talk to me, they discuss things with their parents, families, even teachers at school and friends.” Lack of sex education  There is no sex education in Ethiopia’s national curriculum but youth groups and activists like Ephirem and his colleagues go into schools and teach people through school clubs. “This year [2019] up to June we trained 16,000 people and reached 517,725 adolescents and young people aged 10 to 24 through the helpline, social media – Facebook, Twitter and YouTube – workshops, radio talk shows and libraries.” A banner in Jimma town promotes the helpline and its number 8155, as does Jimma FM radio.  “The target for reaching people in school was 5,400. We achieved 11,658. The most effective way to reach people is at school. At the coffee plantation sites we reach a lot of people.”  The minimum family size around here is about five and the maximum we see is 10 to 12. In our culture, children are [considered as a sign of] wealth and people think they are blessed [if they have many]. When we go to schools to teach them, there are kids that already have kids. But after we teach them, they generally want to finish education and have kids at 20-25-years-old. We tell people they have to have kids related to the economy and to their incomes and we calculate the costs to feed and educate them. I’m a volunteer here, so it’s mental satisfaction I get from doing this. I get 1000 Ethiopian Birr [roughly USD 30] per month for transport costs. I am also studying marketing at university and want to become a business consultant.”

Rewda Kedir works as a midwife in a rural area of the Oromia region in southwest Ethiopia. Only 14% of married women are using any method of contraception here.  The government hospital Rewda works in is supported to provide a full range of sexual and reproductive healthcare, which includes providing free contraceptives and comprehensive abortion care. In January 2017, the maternal healthcare clinic faced shortages of contraceptives after the US administration reactivated and expanded the Global Gag Rule, which does not allow any funding to go to organizations associated with providing abortion care. Fortunately in this case, the shortages only lasted a month due to the government of the Netherlands stepping in and matching lost funding. “Before, we had a shortage of contraceptive pills and emergency contraceptives. We would have to give people prescriptions and they would go to private clinics and where they had to pay," Rewda tells us. "When I first came to this clinic, there was a real shortage of people trained in family planning. I was the only one. Now there are many people trained on family planning, and when I’m not here, people can help." "There used to be a shortage of choice and alternatives, and now there are many. And the implant procedures are better because there are newer products that are much smaller so putting them in is less invasive.” Opening a dialogue on contraception  The hospital has been providing medical abortions for six years. “Before, there was no safe abortion," says Rewda. She explains how people would go to 'traditional' healers and then come to the clinic with complications like sepsis, bleeding, anaemia and toxic shock. If they had complications or infections above nine weeks, Rewda and her colleagues would send them to Jimma, the regional capital. "Before, it was very difficult to persuade them to use family planning, and we had to have a lot of conversations. Now, they come 45 days after delivery to speak to us about this and get their babies immunised," she explains. "They want contraceptives to space out their children. Sometimes their husbands don’t like them coming to get family planning so we have to lock their appointment cards away. Their husbands want more children and they think that women who do not keep having their children will go with other men." "More kids, more wealth" Rewda tells us that they've used family counselling to try and persuade men to reconsider their ideas about contraception, by explaining to them that continuously giving birth under unsafe circumstances can affect a woman's health and might lead to maternal death, damage the uterus and lead to long-term complications. "Here, people believe that more kids means more wealth, and religion restricts family planning services. Before, they did not have good training on family planning and abortion. Now, women that have abortions get proper care and the counseling and education has improved. There are still unsafe abortions but they have really reduced. We used to see about 40 a year and now it’s one or two." However, problems still exist. "There are some complications, like irregular bleeding from some contraceptives," Rewda says, and that "women still face conflict with their husbands over family planning and sometimes have to go to court to fight this or divorce them.”

Emebet Bekele is a former sex worker turned counsellor, who works at the Family Guidance Association of Ethiopia (FGAE) run, confidential clinic in Jimma, Oromia. The clinic was set up in 2014 to help at-risk and underserved populations such as sex workers. The clinic provides free and bespoke services that include HIV and STI testing, treatment and counselling, contraceptives and comprehensive abortion care.  Counselling sex workers In her new role, Emebet counsels others about HIV and treatment with anti-retroviral drugs, follows up with them and monitors their treatment. Emebet tries to be a role model for other girls and women who are sex workers to adopt a healthier lifestyle “The nature of the sex work business is very mobile, and they often go to other places when the coffee harvest is good, so I tell them about referrals and take their phone numbers so I can keep counselling them”. “The difficult thing is sex workers using alcohol and drugs with ARVs [anti-retrovirals], which is not good and also means that they forget to take their medication. The best thing is that I know and understand them because I passed through that life. I know where they live so I can call them and drop medicine at their homes.” Bekele regularly tests sex workers and every month, “a minimum of five out of a hundred, maximum ten” test positive for HIV.  An increase in HIV cases Over the last five years, her reports show an increase in the number of HIV cases due to more sex workers coming in or changing clinics to attend the confidential clinic. Partly because the staff are friendly towards sex workers, who often report facing stigma in other public hospitals or being turned away when staff hear what they do. At the confidential clinic, people can walk-in any time, which better suits the sex worker lifestyle, but crucially, the service is confidential. “The ARV clinics in government hospitals are separate so everyone knows you have HIV. Also, people will see others crying and say that they have HIV,” says Bekele. A shared experience  “I used to be a sex worker, so I have a shared experience with them. When I came to this clinic I taught people about this place and the services and I counsel and train them. I didn’t have any knowledge about sex work so I also got infected. When I got knowledge, I decided I wanted to do something to help others.” “Sometimes clients add extra money for sex without condoms and sometimes sex workers have been drinking and don’t notice their clients have not used condoms. To have sex using a condom usually costs about 300 Ethiopian Birr [roughly USD 7] but it can go as low as 50 Birr [USD 1.20] or 20 Birr [USD 0.50], whereas sex without using a condom costs 200 to 300 Birr more or even up to 1000 Birr [USD 24].” When Bekele was a sex worker, she would take home about 7,000 to 8,000 Birr per month [roughly USD 170 to 190], after paying job-related expenses such as hotels, as well as for substances like alcohol to get through it. As a counsellor, she now gets 2,000 Birr to cover her travel costs.  “I have already stopped and I’m now a model for these girls. I have financial problems but life is much more than money.” “I see girls aged 10, 13 and 15 who live on the streets and take drugs. Sometimes we bring them from the streets and test them. Most of them are pregnant and I help them.” “This project is useful for our country because there aren’t any others helping sex workers and if there are ways to help them, we save many lives and young people. If you teach one sex worker, you teach everyone, from government to university staff and anyone who goes to see them, so I save many lives doing this job.”

Senegal’s IPPF Member Association, Association Sénégalaise pour le Bien-Etre Familial (ASBEF) ran two clinics in the capital, Dakar, until funding was cut in 2017 due to the reinstatement of the Global Gag Rule (GGR) by the US administration. The ASBEF clinic in the struggling suburb of Guediawaye was forced to close as a result of the GGR, leaving just the main headquarters in the heart of the city.    The GGR prohibits foreign non-governmental organizations (NGOs) who receive US assistance from providing abortion care services, even with the NGO’s non-US funds. Abortion is illegal in Senegal except when three doctors agree the procedure is required to save a mother’s life.  ASBEF applied for emergency funds and now offers an alternative service to the population of Guediawaye, offering sexual and reproductive health services through pop-up clinics.   Asba Hann is the president of the Guediawaye chapter of IPPF’s Africa region youth action movement. She explains how the Global Gag Rule (GGR) cuts have deprived youth of a space to ask questions about their sexuality and seek advice on contraception.  “Since the closure of the clinic, the nature of our advocacy has changed. We encounter a lot more problems in our area, above all from young people and women asking for services. ASBEF (Association Sénégalaise pour le Bien-Etre Familial) was a little bit less expensive for them and in this suburb there is a lot of poverty.   Our facilities as volunteers also closed. We offer information to young people but since the closure of the clinic and our space they no longer get it in the same way, because they used to come and visit us.   We still do activities but it’s difficult to get the information out, so young people worry about their sexual health and can’t get the confirmation needed for their questions.   Young people don’t want to be seen going to a pharmacy and getting contraception, at risk of being seen by members of the community. They preferred seeing a midwife, discreetly, and to obtain their contraception privately. Young people often also can’t afford the contraception in the clinics and pharmacies.  It would be much easier for us to have a specific place to hold events with the midwives who could then explain things to young people. A lot of the teenagers here still aren’t connected to the internet and active on social media. Others work all day and can’t look at their phones, and announcements get lost when they look at all their messages at night. Being on the ground is the best way for us to connect to young people.” 

Senegal’s IPPF Member Association, Association Sénégalaise pour le Bien-Etre Familial (ASBEF) ran two clinics in the capital, Dakar, until funding was cut in 2017 due to the reinstatement of the Global Gag Rule (GGR) by the US administration. The ASBEF clinic in the struggling suburb of Guediawaye was forced to close as a result of the GGR, leaving just the main headquarters in the heart of the city.   The GGR prohibits foreign non-governmental organizations (NGOs) who receive US assistance from providing abortion care services, even with the NGO’s non-US funds. Abortion is illegal in Senegal except when three doctors agree the procedure is required to save a mother’s life.  ASBEF applied for emergency funds and now offers an alternative service to the population of Guediawaye, offering sexual and reproductive health services through pop-up clinics.   Betty Guèye is a midwife who used to live in Guediawaye but moved to Dakar after the closure of the clinic in the suburb of Senegal’s capital following global gag rule (GGR) funding cuts. She describes the effects of the closure and how Association Sénégalaise pour le Bien-Etre Familial (ASBEF) staff try to maximise the reduced service they still offer.  “Since the clinic closed in this town everything has been very difficult. The majority of Senegalese are poor and we are losing clients because they cannot access the main clinic in Dakar. If they have an appointment on a Monday, after the weekend they won’t have the 200 francs (35 US cents) needed for the bus, and they will wait until Tuesday or Wednesday to come even though they are in pain.   The clinic was of huge benefit to the community of Guediawaye and the surrounding suburbs as well. What we see now is that women wait until pain or infections are at a more advanced stage before they visit us in Dakar. Another effect is that if they need to update their contraception they will exceed the date required for the new injection or pill and then get pregnant as a result.  In addition, raising awareness of sexual health in schools and neighbourhoods is a key part of our work. Religion and the lack of openness in the parent-child relationship inhibit these conversations in Senegal, and so young people don’t tell their parents when they have sexual health problems. We were very present in this area and now we only appear much more rarely in their lives, which has had negative consequences for the health of our young people.  If we were still there as before, there would be fewer teenage pregnancies as well, with the advice and contraception that we provide.  However, we hand out medication, we care for the community and we educate them when we can, when we are here and we have the money to do so. Our prices remain the same and they are competitive compared with the private clinics and pharmacies in the area.   Young people will tell you that they are closer to the midwives and nurses here than to their parents. They can tell them anything. If a girl tells me she has had sex I can give her the morning after pill, but if she goes to the local health center she may feel she is being watched by her neighbours.” Ndeye Yacine Touré is a midwife who regularly fields calls from young women in Guediawaye seeking advice on their sexual health, and who no longer know where to turn. The closure of the Association Sénégalaise pour le Bien-Etre Familial (ASBEF) clinic in their area has left them seeking often desperate solutions to the taboo of having a child outside of marriage.  “Many of our colleagues lost their jobs, and these were people who were supporting their families. It was a loss for the area as a whole, because this is a very poor neighbourhood where people don’t have many options in life. ASBEF Guediawaye was their main source of help because they came here for consultations but also for confidential advice.  The services we offer at ASBEF are special, in a way, especially in the area of family planning. Women were at ease at the clinic, but since then there is a gap in their lives. The patients call us day and night wanting advice, asking how to find the main clinic in Dakar. Some say they no longer get check-ups or seek help because they lack the money to go elsewhere. Others say they miss certain midwives or nurses.  We make use of emergency funds in several ways. We do pop-up events. I also give them my number and tell them how to get to the clinic in central Dakar, and reassure them that it will all be confidential and that they can seek treatment there.  In Senegal, a girl having sex outside marriage isn’t accepted. Some young women were taking contraception secretly, but since the closure of the clinic it’s no longer possible. Some of them got pregnant as a result. They don’t want to bump into their mother at the public clinic so they just stop taking contraception. In Senegal, a girl having sex outside marriage isn’t accepted. The impact on young people is particularly serious. Some tell me they know they have a sexually transmitted infection but they are too afraid to go to the hospital and get it treated.  Before they could talk to us and tell us that they had sex, and we could help them. They have to hide now and some seek unsafe abortions. ”  

Senegal’s IPPF Member Association, Association Sénégalaise pour le Bien-Etre Familial (ASBEF) ran two clinics in the capital, Dakar, until funding was cut in 2017 due to the reinstatement of the Global Gag Rule (GGR) by the US administration. The ASBEF clinic in the struggling suburb of Guediawaye was forced to close as a result of the GGR, leaving just the main headquarters in the heart of the city.   The GGR prohibits foreign non-governmental organizations (NGOs) who receive US assistance from providing abortion care services, even with the NGO’s non-US funds. Abortion is illegal in Senegal except when three doctors agree the procedure is required to save a mother’s life.  ASBEF applied for emergency funds and now offers an alternative service to the population of Guediawaye, offering sexual and reproductive health services through pop-up clinics. Maguette Mbow, a 33-year-old homemaker, describes how the closure of Association Sénégalaise pour le Bien-Etre Familial clinic in Guediawaye, a suburb of Dakar, has affected her, and explains the difficulties with the alternative providers available. She spoke about how the closure of her local clinic has impacted her life at a pop-up clinic set up for the day at a school in Guediawaye.  “I heard that ASBEF (Association Sénégalaise pour le Bien-Etre Familial),  was doing consultations here today and I dropped everything at home to come. There was a clinic here in Guediawaye but we don’t have it anymore.  I’m here for family planning because that’s what I used to get at the clinic; it was their strong point. I take the Pill and I came to change the type I take, but the midwife advised me today to keep taking the same one. I’ve used the pill between my pregnancies. I have two children aged 2 and 6, but for now I’m not sure if I want a third child.   When the clinic closed, I started going to the public facilities instead. There is always an enormous queue. You can get there in the morning and wait until 3pm for a consultation. (The closure) has affected everyone here very seriously. All my friends and family went to ASBEF Guediawaye, but now we are in the other public and private clinics receiving a really poor service.  I had all of my pre-natal care at ASBEF and when I was younger I used the services for young people as well. They helped me take the morning after pill a few times and that really left its mark on me. They are great with young people; they are knowledgeable and really good with teenagers. There are still taboos surrounding sexuality in Senegal but they know how to handle them.  These days, when ASBEF come to Guediawaye they have to set up in different places each time. It’s a bit annoying because if you know a place well and it’s full of well-trained people who you know personally, you feel more at ease. I would like things to go back to how they were before, and for the clinic to reopen. I would also have liked to send my children there one day when the time came, to benefit from the same service.  Sometimes I travel right into Dakar for a consultation at the ASBEF headquarters, but often I don’t have the money.” Fatou Bimtou Diop, 20, is a final year student at Lycée Seydina Limamou Laye in Guediawaye. She explains why the closure of the Association Sénégalaise pour le Bien-Etre Familial clinic in her area in 2017 means she no longer regularly seeks advice on her sexual health.  “I came here today for a consultation. I haven’t been for two years because the clinic closed. I don’t know why that happened but I would really like that decision to be reversed.   Yes, there are other clinics here but I don’t feel as relaxed as with ASBEF (Association Sénégalaise pour le Bien-Etre Familial). I used to feel really at ease because there were other young people like me there. In the other clinics I know I might see someone’s mother or my aunties and it worries me too much.   They explained things well and the set-up felt secure. We could talk about the intimate problems that were affecting us to the ASBEF staff. I went because I have really painful periods, for example. Sometimes I wouldn’t have the nerve to ask certain questions but my friends who went to the ASBEF clinic would ask and then tell me the responses that they got.  These days we end up talking a lot about girls who are 14,15 years old who are pregnant. When the ASBEF clinic was there it was really rare to see a girl that young with a baby but now it happens very frequently. A friend’s younger sister has a little boy now and she had to have a caesarian section because she’s younger than us.  The clinic in Dakar is too far away. I have to go to school during the day so I can’t take the time off. I came to the session today at school and it was good to discuss my problems, but it took quite a long time to get seen by a midwife.”  Ngouye Cissé, a 30-year-old woman who gave birth to her first child in her early teens, but who has since used regular contraception provided by ASBEF (Association Sénégalaise pour le Bien-Etre Familial). She visits the association’s pop-up clinics whenever they are in Guediawaye.  “I used to attend the clinic regularly and then one day I didn’t know what happened. The clinic just shut down.  Senegal’s economic situation is difficult and we don’t have a lot of money. The fees for a consultation are quite expensive, but when ASBEF does come into the community it’s free.  I most recently visited the pop-up clinic because I was having some vaginal discharge and I didn’t know why. The midwife took care of me and gave me some advice and medication.   Before I came here for my check-up, the public hospital was asking me to do a lot of tests and I was afraid I had some kind of terrible disease. But when I came to the ASBEF midwife simply listened to me, explained what I had, and then gave me the right medication straight away. I feel really relieved.  I’m divorced and I have three boys. I had pre-natal care with ASBEF for the first two pregnancies, but with the third, my 2-year-old son, I had to go to a public hospital. The experiences couldn’t be more different. First, there is a big difference in price, as ASBEF is much cheaper. Also, at the ASBEF clinic we are really listened to. The midwife explains things and gives me information. We can talk about our problems openly and without fear, unlike in other health centers.  What I see now that the clinic has closed is a lot more pregnant young girls, problems with STIs and in order to get treatment we have to go to the public and private clinics.   When people hear that ASBEF is back in town there is a huge rush to get a consultation, because the need is there but people don’t know where else to go. Unfortunately, the transport to go to the clinic in Dakar costs a lot of money for us that we don’t have. Some households don’t even have enough to eat.  There isn’t a huge difference between the consultations in the old clinic and the pop-up events that ASBEF organize. They still listen to you properly and it’s well organized. It just takes longer to get seen.” Moudel Bassoum, a 22-year student studying NGO management in Dakar, explains why she has been unable to replace the welcome and care she received at the now closed Association Sénégalaise pour le Bien-Etre Familial clinic in her hometown of Guediawaye, but still makes us of the pop-up clinic when it is available.  “I used to go to the clinic regularly but since it closed, we only see the staff rarely around here. I came with my friends today for a free check-up. I told the whole neighbourhood that ASBEF (Association Sénégalaise pour le Bien-Etre Familial) were doing a pop-up clinic today so that they could come for free consultations.  It’s not easy to get to the main clinic in Dakar for us. The effects of the closure are numerous, especially on young people. It helped us so much but now I hear a lot more about teenage pregnancies and STIs, not to mention girls trying to abort pregnancies by themselves. When my friend had an infection she went all the way into Dakar for the consultation because the public clinic is more expensive. I would much rather talk to a woman about this type of problem and at the public clinic you don’t get to pick who you talk to. You have to say everything in front of everyone.  I don’t think the service we receive since the closure is different when the ASBEF clinic set up here for the day, but the staff are usually not the same and it’s less frequent. It’s free so when they do come there are a lot of people. I would really like the clinic to be re-established when I have a baby one day. I want that welcome, and to know that they will listen to you.”