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At the Family Health Model Clinic (FHMC) set up by Rahnuma Family Planning Association of Pakistan (FPAP), mothers and daughters-in-laws wait for a consultation for affordable treatment and medication. At the FHMC, patients are charged only 50 Rupees (0.22 GBP) for a consultation. This is a fraction of what they would pay at a private clinic and less than the cost of travelling to the nearest government hospital. The clinic also has a ‘no-refusal policy’ to ensure those who cannot afford to pay the fee can still receive the care they need. Around 50 patients visit the clinic every day.  For 26-year-old Sehrish Hamid, the clinic is providing essential healthcare services, she is unable to afford elsewhere. “My husband sells scrap metal off a cart and we often struggle to make ends meet,” she says.  In the past, Sehrish frequently got urinary tract infections but could rarely afford to visit a doctor. A few weeks back, a social organizer from the WISH project visited her house and told her about the FHMC, where she was able to get affordable treatment and medication. “The staff here are friendly, and the doctor gives time and attention to each patient. In the past, no doctor took out the time to talk to me about hygiene and explain how recurring infections can be prevented,” she says.  The FHMC operates as a ‘one stop clinic’ offering a range of health services including family planning and screening for cervical cancer and counselling for Sexual Gender Based Violence (SGBV). Many, such as Sehrish come to clinic for one reason but also end up choosing to take up of family planning services.  “I have a three-year-old and want to wait a few years before I have another child. When I came to the clinic, I also found out about family planning methods. I had a lot of questions and concerns that were addressed and allowed me to make a decision about which contraceptives to use,” Sehrish says. 

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

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.”