In the mountains of Kumera on Tanna Island, Vanuatu, the village women of Kamahaul normally spend over 10,000 Vatu ($83 USD) to travel to the nearest hospital.  It takes an hour to travel up the steep, rugged, tire-track terrain by car, but it takes two hours by foot - the normal form of commute for villagers.  Alani*, a 22-year-old mother of three, said that after Tropical Cyclones Kevin and Judy hit Vanuatu in March 2023, it has been even harder to travel to the hospital.  “After the cyclone, my crops were destroyed. I usually take my kids with me to the market and sell produce but after the cyclone, I do not have any money. If I have to go to the hospital for my 3-month injectable [contraceptive], I spend 5,000 Vatu one way, then 500 for medicine at hospital then I pay 5,000 Vatu to come back.” This is equivalent to over 100 AUD, which is unaffordable for most people like Alani.   Village spokesperson, Jimmy, said that the community is grateful for the Vanuatu Family Health Association (VFHA) as they are the first medical team to visit the remote community.  “I feel sorry for our mamas, they must spend so much money just to get medicine,” he said. “In our village, we have a lot of young single mothers and most of the time, trucks refuse to come up here because of the bad road. They must walk for two hours just to get to the main road, sometimes whilst pregnant, holding bags and their many children. This is why I invited VFHA to come here, so women don’t have to spend so much money and time just to get health services.”  The outreach programme was part of VFHA’s humanitarian response to the cyclone.  “We’ve been overwhelmed by the testimonies of hardships shared by the women in this community,” said Kalowi Kaltapangm VFHA Programme Manager. “Girls and women should not be paying over 100 AUD just to have access to sexual reproductive health services – it is not right. We thank Australia through DFAT for allowing us to reach more people post-disaster.”  Jimmy added that the community is grateful for the VFHA visit and hopes they set up a clinic in Kumera.  “After Tropical Cyclones Judy and Kevin, we lost about 21 homes across the communities here and most of the food crops are gone. If you travel further, you will still see some families still in tents. People are still rebuilding their lives and it's hard to rebuild if women fall pregnant again.’  The VFHA response team reached a total of 21 communities and more than 3,000 beneficiaries across Tafea Province. This included mobile outreach to 15 communities on Tanna Island, three communities on Futuna and three communities in Aneityum.   

“Very traditional.” These two words are often used to describe the people of Tanna in Vanuatu, one of the most populated islands in the small country in the Pacific.  Between 1 and 5 March 2023, the Vanuatu islands were hit by two consecutive Category 4 cyclones (“Judy” and “Kevin”) with widespread damage to the northwest and northeastern islands. Authorities report that some 250,000 people were affected, representing more than 80 per cent of the population.  Since 28 March, The Vanuatu Family Health Association (VFHA) has been conducting their humanitarian response on Tanna. Team Leader, Enneth Ilaisa, said that they are very surprised by their breakthrough with communities - especially with the men.   “Tanna is known to be very traditional, even in the past it was almost impossible get access to these communities to talk about sex, but now it is slowly changing, and we are surprised. In our recent field visits, we have seen men step forward bringing their wives and even their daughters to get family planning!” says Ilaisa.  Levi, a 47-year-old father, said that he brought his daughter to the VFHA site to get Jadelle [a long-acting contraceptive] because he does not want his daughter to fall pregnant.  “After the cyclones, I saw pregnant mothers walking to the hospitals for check-ups and I told myself that I do not want that for my daughter. I do not want her to suffer if the boy runs away. Some men were talking about VFHA, and I was surprised that even though most were hesitant to get family planning for their daughters because it meant that they were able to have sex, they also did not want their daughters to suffer,” says Levi.   Ilaisa added that they have seen more men step forward due to their work with community chiefs to ensure men attend the information sessions.  “We talk to the men too, we educate them. Then after they go to nakamal (a traditional meeting place in Vanuatu used for gatherings and ceremonies), they tell all the men about what they learnt. I believe because people are still recovering from the cyclones, men have seen the firsthand challenges of women getting pregnant and the hardships of looking after a pregnant woman when you have lost everything after a cyclone. “  31-year-old Rose, from Kumera, said that she is surprised her husband advocated for her to get family planning.   “I can’t thank VFHA enough, my husband, who previously accused me of cheating when I told him I wanted to get family planning, is the same man who now wants me to get family planning. I thank VFHA for also speaking to the men as they are usually the problem when it comes to family planning!” says Rose.  VFHA Programme Manager, Kalowi Kaltapang thanked his hardworking humanitarian team for their perseverance in breaking down barriers of sex in communities, but most importantly, the great support from DFAT in funding the humanitarian response.  “It's always been tricky to engage men in these spaces, but I thank DFAT, IPPF and the hardworking VFHA humanitarian team, who are steadfast in their mission to ensure that everyone has access to SRH services.”    

Girls and women from nearby villages flock to mobile health clinics set up by the Vanuatu Family Health Association (VFHA). The response team from VFHA consists mostly of women, who have already been away from their families for over six weeks. Team Leader, Enneth Ilaisa, mentally prepares her team for the long day ahead.  The 12-member team, consisting of nine women and three men, have been conducting community outreach on Tanna Island, Vanuatu since 28 March 2023, as part of their humanitarian response to Tropical Cyclones Judy and Kevin, which tore through Vanuatu.   “Our team consists of nine mothers who have left their families to provide these essential services to vulnerable communities. When people visit us, we must put on a happy face to make them feel welcome but sometimes it gets hard,” says Ilaisa.  Ilaisa said that the women in the medical team have been away from their homes for so long that their husbands would sometimes be overwhelmed with looking after the children and often would call the women on the team ‘selfish’ for choosing to leave their families.  Sexual and reproductive health nurse, Cindy Mahi, said she sometimes feels bad for leaving her partner alone to look after the children. When she sees clients with their children, she says she feels homesick.  “I call my family every morning, and sometimes my husband complains about me being away – and it really hurts, especially if I hear my children in the background asking when I will be back. I feel so guilty sometimes as a mother!” says Mahi.  Ilaisa added that the stress from leaving their families is compounded by an intense working environment delivering vital sexual and reproductive healthcare to remote communities.  “Our work is such that we leave our accommodation before sunrise and return after sunset. People are very tired and sometimes we are so busy helping clients that we often work through lunch to ensure we help everyone,” says Ilaisa.  Mahi said that these are things people don’t see when they come to receive services.  “When women come to see us for help, we put on a warm smile, but they do not know about the hardships we face. They do not see what is running at the back of our mind.”   Ilaisa said when it comes to the mental health of the team, she ensures she is creating a safe space where her team members can openly share.  “I offer counselling to them, and I encourage them to share the important work that they do in the field with their husbands, so they know exactly what they do. I sit there and listen to them and sometimes we cry together.”  Ilaisa said that apart from counselling, she encourages the mothers to practice self-care by taking the weekend off and making sure they take adequate breaks throughout the day.  “I tell them, if you feel you need to take a break in the middle of work – do it! When we debrief after our field work, we share the numbers of women who received SRH services, and the feeling of accomplishment is what makes our work worthwhile. When we hear these numbers it reminds us of our purpose, it reminds us of why we are here, and for a second, our family problems fade away because we know we are serving a purpose greater than ourselves.” 

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

Julie was a midwife with the Ministry of Health for 20 years before she joined the Vanuatu Family Health Association (VFHA) as nurse and project manager for IPPF's SPRINT Initiative response in Vanuatu. When Cyclone Pam hit Vanuatu, the SPRINT Initiative and VHFA started providing life-saving services to the Island, Tanna, which was the population worst affected by the typhoon. Many communities there live remotely, in grass huts, with no immediate access to medical care.  Julie was there with the VFHA team. “When I first came here we used the kitchen to operate from. On my second trip, we created a clinic in our youth centre, and used the nearby health post for clinical procedures. Soon we saw more patients pouring in, which created a huge demand for space." Health conditions are very low. Even before the cyclone hit the island, it was reported that the average mother loses two pregnancies each, in her lifetime. Every person in the village knows at least one mother who has died during child birth. Access and knowledge to family planning is overlooked as traditional practices are used first. As Julie explains, advocating about family planning is a challenge in the area, also for language barriers. “Talking about birth-spacing and talking in the regional dialect of Tanna is a problem. Most of us in Vanuatu speak Bislama, but people here in Tanna aren’t well versed with it. However, we try our level best with all possible methods including sign language and demos to impart knowledge about family planning.” Family planning services are just a part of the IPPF-SPRINT Cyclone Pam response, that also included general health check-up, counselling and awareness about Sexual and Gender Based Violence, maternal care and awareness and prevention of HIV and Sexually Transmitted Infections (STI).