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Over the past 30 years, more than 60 countries and territories have liberalized their abortion laws. Only four have regressed, including the United States. Abortion rights are increasingly becoming recognized as fundamental human rights for millions of people worldwide. The global landscape of abortion rights continues to evolve in 2024, with new legislation and feminist movements fighting for better access. Let's take a trip around the world to see the latest developments.

This World Humanitarian Day we reflect on the incredible work undertaken by our humanitarian response teams over the last 12 months. Last year, IPPF reached approximately 5.5 million people in humanitarian crises through our local Member Associations. This achievement would not have been possible without the dedicated and heroic healthcare teams providing vital sexual and reproductive healthcare in the most fragile humanitarian settings. COVID-19 response in Papua New Guinea Papua New Guinea Family Health Association (PNGFHA) PNGFHA responded to the COVID-19 outbreak in PNG, supported by the Australian government. With access to emergency healthcare facilities now extremely limited, PNGFHA health workers travel to hard-to-reach areas providing sexual and reproductive healthcare to the most marginalized communities.Clients like Vavine Kila receive a consultation at the PNGFHA mobile clinic. Share on Twitter Share on Facebook Share via WhatsApp Share via Email The humanitarian response teams taking healthcare into people's homes in Gaza Palestinian Family Planning and Protection Association (PFPPA) On 10 May 2021, Israel launched airstrikes on the Gaza Strip, killing over 220 people (including women and children) and leaving over 75,000 displaced. At the time, an estimated 87,000 women in the Gaza Strip and nearby areas were pregnant. The PFPPA humanitarian response team visited families in their homes, with each household expected to have four to five women of reproductive age needing healthcare. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Offering holistic care to families in Gaza Palestinian Family Planning and Protection Association (PFPPA) Children account for close to 50% of the population in Gaza. As part of the response, PFPPA youth volunteers entertained the children while their family members received life-saving sexual and reproductive healthcare and psychosocial support by the humanitarian response teams in privacy. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Ensuring ante- and post-natal care in the aftermath of an earthquake in West Sulawesi Indonesia Planned Parenthood Association (IPPA) On 15 January 2021, a 6.2 magnitude earthquake struck the West Sulawesi province in Indonesia leaving over 15,000 displaced, including many pregnant people and nursing mothers.As part of its response efforts, the IPPA set up mobile clinics near the shelters to provide vital ante- and post-natal care. Share on Twitter Share on Facebook Share via WhatsApp Share via Email A super cyclone and a pandemic Family Planning Association of India (FPAI) On 20 May 2020, severe Cyclone Amphan hit the Indian state of West Bengal, affecting millions of people in and around the state capital Kolkata. Emergency crises during the COVID-19 pandemic intensifies the impact of the disaster and puts a strain on health systems and access to sexual and reproductive healthcare.FPAI responded by providing emergency sexual and reproductive healthcare to affected communities, particularly focusing on the most marginalized and vulnerable people including the LGBTI community, sex workers, pregnant women, and survivors of sexual and gender-based violence (SGBV). Share on Twitter Share on Facebook Share via WhatsApp Share via Email Providing healthcare to hardest hit communities after Cyclone Yasa The Reproductive and Family Health Association of Fiji (RFHAF) In mid-December 2020, a category 5 severe Tropical Cyclone Yasa hit the island of Fiji and neighbouring Lau group of Islands. IPPF’s Member Association, RFHAF, was supported by the Australian government to provide life-saving sexual and reproductive healthcare in the hardest hit communities, including counselling on STI risk reduction, first-line support for survivors of SGBV, and contraceptive and ante-natal care. Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Sitting outside Lilongwe Youth Life Centre on a sunny Thursday afternoon, 24-year-old Rodrick is glued to his phone. When asked to show some of his posts, he asks “what do you want to see, Instagram, WhatsApp, Facebook?”    Rodrick and his friends laugh at a post of a smiling cartoon condom fighting off multicoloured STIs.  SheDecides promotes change through social media  Rodrick is a trained Social Media Agent for SheDecides, a movement empowering youth to champion the rights of girls and women to make choices about their lives and bodies and have access to comprehensive sexual and reproductive health education.    “Social networks are developing each and every day, so more young people are now on social media,” explains Rodrick, adding that many young people don’t have access to books to read about sexual and reproductive health and rights.    “It’s better to reach them on social media so they can see it,” says Rodrick, although he admits that many people in Malawi cannot afford internet data bundles on their phones.  He says that he and other Youth Action Movement volunteers try to get out daily posts on social media channels to educate other young people about the issues they are passionate about.    “One day I posted asking why the government of Malawi doesn’t legalize abortion, which I think is not good for the girls because they have their lives to live,” says Rodrick, adding that he believes abortion can keep more girls in education. Rodrick says that while people don’t always agree with him, he enjoys discussing the topic on social media. “People ask ‘are you a real man?’” he laughs.    "I debate so much, and I like that! And sometimes I convince people that what I’m saying is right.” Supporting young people through personal challenges  As well as getting into lively debates on social media, Rodrick says he is often sent private messages by young people who feel they can open up to him as a peer with knowledge about sexual health.    A 16-year-old girl messaged Rodrick on WhatsApp, telling him she had been raped and was pregnant. “I asked her if she was comfortable with the pregnancy and she said no, how can I be comfortable with a pregnancy that I didn’t want to come to me?”    She then asked Rodrick how he could help her with the issue. “I said I will help you, though I’m not the person responsible I’ll take you to the person who is so they can handle that issue.” Rodrick then met up with the girl, who went on to access abortion counselling. He says that the case also went to court, and is awaiting the verdict.  “We always say this thing can be done by a male, and this thing can be done by a female,” says Rodrick, talking about gender inequality and his involvement in SheDecides. “But that’s not right. We’re all humans and should be able to do whatever he or she wants to do.”   

Dressed in a sparkling white medical coat, Alinafe runs one of Family Planning Association of Malawi (FPAM) mobile clinics in the village of Chigude. Under the hot midday sun, she patiently answering the questions of staff, volunteers and clients - all while heavily pregnant herself.  Delivering care to remote communities  “Most NGOs don’t come here because it’s so hard to reach,” she says, as women queue up in neat lines in front of two khaki tents to receive anything from a cervical cancer screening to abortion counselling. Without the mobile clinic, local women risk life-threatening health issues as a result of unsafe abortion or illnesses linked to undiagnosed HIV status. According to the Guttmacher Institute, complications from abortion are the cause of 6–18% of maternal deaths in Malawi.    District Manager Alinafe joined the Family Planning Association of Malawi in 2016, when she was just 20 years old, after going to nursing school and getting her degree in public health. She was one of the team involved in the Linkages project, which provided free family planning care to sex workers in Mzuzu until it was discontinued following the 2017 Global Gag Rule.  Seeing the impact of lost funding on care  “This change has reduced our reach,” Alinafe says, explaining that before the Gag Rule they were reaching sex workers in all four traditional authorities in Mzimba North - now they mostly work in just one. She says this means they are “denying people services which are very important” and without reaching people with sexual and reproductive healthcare, increasing the risk of STIs.    The reduction in healthcare has also led to a breakdown in the trust FPAM had worked to build in communities, gaining support from those in respected positions such as chiefs.    “Important people in the communities have been complaining to us, saying why did you do this? You were here, these things were happening and our people were benefiting a lot but now nothing is good at all,” explains Alinafe.    Still, she is determined to serve her community against the odds - running the outreach clinic funded by Global Affairs Canada five times a week, in four traditional authorities, as well as the FPAM Youth Life Centre in Mzuzu.  “On a serious note, unsafe abortions are happening in this area at a very high rate,” says Alinafe at the FPAM clinic in Chigude. “Talking about abortions is a very important thing. Whether we like it or not, on-the-ground these things are really happening, so we can’t ignore them.”

For Jennipher, who lives in a village outside of Lilongwe, unintended pregnancies amongst young women and girls like her are an everyday reality.    “Girls often speak to me about these issues because they know I come to the Youth Life Centre and that I know a lot about these issues,” explains Jennipher, who wears a baggy white t-shirt and big hoop earrings.    “They are happy to talk to me about these issues because I’m young and also a girl. It’s hard for girls to talk about these issues to their families because they might not believe them,” says Jennipher, who is a Youth Action Movement (YAM) volunteer in her local area, Dowa. “It’s important to teach girls about abortion so they know how to take care of themselves and stop risking their lives,” she adds.  Teaching peers how to avoid unwanted pregnancy  Off the top of her head, Jennipher can think of two close friends who have experienced unwanted pregnancies at a young age. One was just 14 when she fell pregnant and, desperate, had an unsafe abortion. “There was a lot of blood. I helped her by taking her here [to the Youth Life Centre] for treatment. Now she’s quite fine and back at school after recovering,” says Jennipher.    Another friend was 18 when she got pregnant, but ended up keeping her baby. Jennipher says she encouraged her friend to get help at the center “so she could learn a lot of things and maybe get contraception, so she can go back to school again and have a bright future.”    Two years on, her friend is back at school and her mother takes care of the baby while she is studying. “She even joined the Youth Action Movement, so we are together here,” smiles Jennipher.  Passionate about education  These experiences have made Jennipher passionate about educating young women and girls in her community about contraception, with the aim of keeping them safe, healthy, and in school.    As a YAM volunteer she also gets approached by girls who have experienced sexual abuse, often within the family. Another friend of Jennipher’s told her that her sister’s husband wanted to sleep with her.     “In these cases, sometimes the girls choose to be silent for fear that the breadwinner might be arrested and then the family will suffer,” she explains. But with a well-informed peer like Jennipher to confide in, her friend was advised to go to the authorities and to the center for guidance.    Looking to the future, Jennipher says she wants to have two or three children. “That would be enough!” She laughs. She also plans to make a career out of her skill for caring for others. “I want to be a secondary teacher or a nurse. I want to help people.” 

Mary, a 30-year-old sex worker, happily drinks a beer at one of the bars she works at in downtown Lilongwe. Her grin is reflected in the entirely mirrored walls, lit with red and blue neon lights.    Above her, a DJ sat in an elevated booth is playing pumping dancehall while a handful of people around the bar nod and dance along to the music. It’s not even midday yet.    Mary got introduced to the Family Planning Association of Malawi through friends, who invited her to a training session for sex worker ‘peer educators’ on issues related to sexual and reproductive health and rights as part of the Linkages project.    “I learnt about condoms and even female condoms, which I hadn’t heard of before,” remembers Mary.  Life-changing care and support   But the most life-changing care she received was an HIV test, where she learnt that she was positive and began anti-retroviral treatment (ART). “It was hard for me at first, but then I realized I had to start a new life,” says Mary, saying this included being open with her son about her status, who was 15 at the time.    According to UNAIDS 2018 data, 9.2% of adult Malawians are living with HIV. Women and sex workers are disproportionately affected - the same year, 55% of sex workers were estimated to be living with HIV.    Mary says she now feels much healthier and is open with her friends in the sex worker community about her status, also encouraging them to get tested for HIV.  “Linkages brought us all closer together as we became open about these issues with each other,” remembers Mary.  Looking out for other sex workers   As a peer educator, Mary became a go-to person for other sex workers to turn to in cases of sexual assault. “I’ll receive a message from someone who has been assaulted, then call everyone together to discuss the issue, and we’d escort that person to report to police,” says Mary.    During the Linkages project - which was impacted by the Global Gag Rule and abruptly discontinued in 2017 - Mary was given an allowance to travel to different ‘hotspot’ areas. In these bars and lodges, she explains in detail how she would go from room-to-room handing out male and female condoms and showing her peers how to use them.    FPAM healthcare teams would also go directly to the hotspots reaching women with healthcare such as STI testing and abortion counselling. FPAM’s teams know how crucial it is to provide healthcare to their clients ensuring it is non-judgmental and confidential. This is a vital service: Mary says she has had four sex worker friends die as a result of unsafe abortions, and lack of knowledge about post-abortion care.    “Since the project ended, most of us find it difficult to access these services,” says Mary, adding that “New sex workers don’t have the information I have, and without Linkages we’re not able to reach all the hotspot bars in Lilongwe to educate them.”

In 2017, the Family Planning Association of Malawi (FPAM) refused to sign the Global Gag Rule and consequently lost vital US funding forcing lifeline projects such as Linkages, which provided care to sex workers, to close. By signing the GGR policy, FPAM would be going against what it stood for at the heart of its mission – to offer integrated healthcare in one place no matter how remote. “You don’t want a client to have to move from one place to another,” explains Executive Director Donald Makwakwa. FPAM provides integrated care at its Youth Life Centers and outreach clinics, which offer young people who have come to them for condoms other care including abortion, counselling, and STI tests. Committed to abortion care despite loss of funds Donald Makwakwa, Executive Director FPAM “Organizations had to make a choice. We have funding from the US government, do we lose it? Or do we keep it?” says Donald Makwakwa, Executive Director of FPAM, reflecting on the impact of the 2017 Global Gag Rule. FPAM made the decision to lose USAID funding, but along the way lost much more: 40 staff members, its reputation among clients and prospective employees, and momentum in their advocacy work due to some of their allies signing onto the Rule. “When we are talking about family planning, we also believe that we cannot stop talking about abortion because the two are very much related,” says Makwakwa. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sex workers face limited access to care Mary, sex worker The loss of funds brought an abrupt end to FPAM’s Linkages project, which provided tailored healthcare to female sex workers; FPAM’s plans to train staff in all hospitals on delivering care to sex workers were derailed. Mary was a peer educator with the Linkages project and became a go-to person for other women to turn to in cases of sexual assault. “I’ll receive a message from someone who has been assaulted, then call everyone together to discuss the issue, and we’d escort that person to report to the police,” says Mary. “Since the project ended, most of us find it difficult to access these services,” she continues, adding that “new sex workers don’t have the information I have, and without Linkages we’re not able to reach all the hotspot bars in Lilongwe to educate them.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Feeling the impact of the Linkages project *Marianne, sex worker “I wouldn’t be alive today if it wasn’t for Linkages,” says 30-year-old sex worker Marianne simply. When outreach workers in Mzuzu met Marianne at a bar, she says she was having unprotected sex and drinking and smoking heavily. “I was just doing everything that I could think of doing.” In her eyes, the main benefit of Linkages was that it reached everyone in her community - including those who didn’t feel comfortable going to hospitals for care. Marianne says that she now takes pride in keeping herself and her community safe. “With the new information I got, I was protecting my friends by using a condom when a man comes, so that when another woman sleeps with the same man, she won’t get the same infection.”*pseudonym Share on Twitter Share on Facebook Share via WhatsApp Share via Email Re-building healthcare provision through Canadian funding Youth volunteers and FPAM staff set up an outreach clinic in the village of Chigude. Through funding from Global Affairs Canada (GAC) FPAM has been able to rebuild their healthcare provision following the Global Gag Rule. The funding has kept their Youth Life Centres afloat - including supporting Youth Action Movement volunteers - and helped FPAM do what it takes pride in most: delivering vital healthcare in remote areas where no other NGOs have a presence. Makwakwa says that the organization's operations in Mzuzu, northern Malawi, are entirely funded by GAC. “Without that funding, by now we wouldn’t have operations that side of the country, meaning a lot of Malawians would not have had access to sexual and other health services,” he explains. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Leaving no one behind Alinafe Chasowa, District Manager for FPAM Alinafe Chasowa, District Manager for FPAM in Mzuzu, is particularly proud of their outreach clinics which operate across all four traditional authorities in Mzimba North. “Most NGOs don’t come here because it’s so hard to reach,” she says. At an outreach clinic in the village of Chigude, over 100 women line up for the clinic. Because of local taboos around women’s sexuality - and the nearest clinic being a five hour walk away - many women hadn’t received sexual and reproductive healthcare before FPAM came to their area. She says that talking about abortions is “a very important thing” in this area, where there are high rates of unsafe abortion. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Taking control of the future Monica, client Monica, 23, is at a sexual and reproductive health clinic in Chigude, northern Malawi. Her two-month-old baby sleeps peacefully in a sling tied around her shoulder. It’s her third time to the clinic. “It’s very important for me to come here so I don’t get an unwanted pregnancy,” explains Monica, adding that “if that happens, all my plans will be cancelled.” Monica is currently busy preparing to build a house - which would have to be put on hold if she had to care for another child in addition to the two she already has. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Benefitting from integrated healthcare Mariet, client Mariet, 26, came to FPAM’s mobile clinic for the first time and got a cervical cancer screening. Mariet is engaged and has one child. She says she is thinking about using the contraceptive injection because her child is still young and she wants to leave some time before she has another. “Today I’ve learnt about issues of unsafe abortions,” says Mariet. “I can now go home and discuss this with my friends, so they can get the information from me in case they are not comfortable speaking to the health workers,” she explains, adding that many people in her community do not know their HIV status so would benefit from the test the FPAM clinic offers. “All the services are here. Many of my friends have so many children, because the nearest clinic is far. That’s why this outreach is very important for us.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Young volunteers connect their peers to information and contraceptive care Kondwani, Youth Action Movement volunteer In Chigude, a usually quiet rural village in northern Malawi, young people gather around two tables laughing and chatting animatedly. “Most of them have come here for condoms, but I don’t just give them out,” says Kondwani, a 22-year-old Youth Action Movement (YAM) volunteer. “I ask them how do you use a condom? How is it useful to somebody who is using it?” Activities like this in hard-to-reach areas are one of many that the Youth Action Movement delivers across Malawi. Trained and hosted by Youth Life Centers, which provide sexual and reproductive healthcare aimed at youth, the volunteers meet regularly and reach out to their peers in schools, universities, and on social media. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Realities of unwanted pregnancies Jennipher and Sellah, Youth Action Movement volunteers For Jennipher, who lives in a village outside of Lilongwe, unwanted pregnancies amongst young women and girls like her are an everyday reality. “Girls often speak to me about these issues because they know I come to the Youth Life Center and that I know a lot about these issues,” explains Jennipher. “They are happy to talk to me about these issues because I’m young and also a girl. It’s hard for girls to talk about these issues to their families because they might not believe them,” says Jennipher, who is a Youth Action Movement (YAM) volunteer in her local area, Dowa. “It’s important to teach girls about abortion so they know how to take care of themselves and stop risking their lives,” she adds. Share on Twitter Share on Facebook Share via WhatsApp Share via Email SheDecides encourages change through social media Rodrick and Phoebe, Youth Action Movement volunteers & Social Media Agents “Social networks are developing each and every day, so more young people are now on social media,” explains Rodrick, a trained Social Media Agent, adding that many young people don’t have access to books to read about sexual and reproductive health and rights. “It’s better to reach them on social media so they can see it.” He posts daily on social media channels to educate other young people about the issues they are passionate about. “One day I posted asking why the government of Malawi doesn’t legalize abortion, which I think is not good for the girls because they have their lives to live,” says Rodrick, adding that he believes abortion can keep more girls in education. Rodrick says that while people don’t always agree with him, he enjoys discussing the topic online. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Youth help their peers follow their dreams Partson, Youth Action Movement volunteer & Social Media Agent Youth Action Movement Volunteer, Partson, understands the importance of contraceptive access if he and his peers are going to achieve their hopes and dreams. “We encourage young people to use contraception, and also to get help at the Youth Life Centre, so that after the pregnancy they can go back to school,” he says, adding that abortion counselling and post-abortion care are also offered. “We feel proud because we’re helping them to achieve their goals, like school and business,” he says, explaining how members of his youth group at Dowa Youth Life Centre encourage their friends to use its contraceptive and sexual healthcare provisions. “On social media, people ask questions that are more private than face-to-face where they can be shy. They are more free,” says Partson, laughing “we all go through sex, so we have to talk about it!”Photos ©IPPF/Tommy Trenchard/Malawi Share on Twitter Share on Facebook Share via WhatsApp Share via Email

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

Our Member Association, Family Planning Association of Malawi (FPAM), is delivering healthcare through the support of WISH* in Lilongwe and Kasungu with a focus on young women and girls. A bespoke training programme supports community health workers on how to deliver youth-friendly healthcare through outreach to local communities, and especially young women. *The Women’s Integrated Sexual Health (WISH2Action) programme, is funded by the UK Foreign Commonwealth and Development Office (FCDO), under the strategy to ‘Leave No One Behind’. Photographs ©FPAM/Andrew Mkandawire/Malawi Barriers to contraceptive care Young people, particularly girls, face barriers to accessing sexual and reproductive healthcare and contraception due to societal perceptions that they have no need for them. Chiefs and parents in the Lilongwe and Kasungu districts have demonstrated that by working together they are able to meet this need and protect the health and wellbeing of young people in their communities. Their collective approach ensures elders advocate on behalf of the youth in their communities, encouraging them to feel confident in accessing healthcare provision and to counter myths and misconceptions about contraception. Their goal is to reduce the high number of unintended pregnancies and STIs among young people. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Gogo Nakwenda Gogo Nakwenda is respected in her community as a go-to counsellor for young people, advising on sexuality and how to access healthcare. Now nearing her 80s, Nakwneda, talks about different contraception methods, saying that if she was 18 again, she would opt for the five-year implant to ensure her education and future work opportunities. “During our time we used traditional contraception, but I have learned that modern pregnancy and sexually transmitted infections prevention methods are very predictable and give no excuses to protection errors. One can comfortably plan when to have a child and when not to have child.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Lucy, volunteer and parent Lucy believes it is important to educate both parents and young people on the benefits of access to contraception. Lucy talks about how myths and misconceptions remain a barrier for young girls to be able to access contraception, mostly because of fears related to infertility. She is open about her own experiences with contraceptives. “I’m 38, I have used pills, injectables and now I’m now using the IUD and successfully I have given birth to three children and here I am in good health. Who else can lie about modern contraceptives? I usually encourage the young ones to be mindful of their future to avoid any mistake that could be prevented with available contraceptives they can comfortably demand from their community health workers.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Chiefs Sadulira and Chinoko Chiefs in Lilongwe and Kasungu districts are committed and supportive of the promotion of sexual and reproductive healthcare for the young people using the youth clubs they supervise. Chief Sadulira believes this is a crucial time for parents to understand the importance of being open with young people. Connecting them with community health workers who are experienced in counselling and provision of sexual and reproductive healthcare can help reduce unintended pregnancies. “I use community meeting sessions to advise parents who resist or misunderstand why youth should have access to contraceptives, because prevention is better than cure.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Matundu youth club In July 2020, FPAM visited the Lilongwe and Kasungu youth clubs to support sexual and reproductive health behaviour change communication interventions. “Our youth here access condoms from the chairman of Namangwe youth club who is linked to Chiwamba health center, located about 18km from Namangwe. He does all this as a volunteer because the area does not have any community-based distribution agents. And the fact that FPAM is finally here, we are assured that access to cervical cancer screening and contraception services are guaranteed,” says Chief Chinoko. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Ngwangwa Ngwangwa applauded FPAM for bringing youth-targeted outreach clinics to their remote area and requested to increase the frequency of the clinics to reach more youth living in hard-to-reach communities. “My area is big yet is leaning more like an island without a health facility nearby. It takes youth to walk 17km to get to Dzenza hospital, 15km to reach Ngoni health center, and 35km to get to Kabudula community hospital. This gap requires frequent mobile clinics.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Ruth, youth leader Radio and youth clubs are major sources of information on contraception as well as through community discussions and groups. “I first heard about contraception in 2016, when I was 15, from Zodiak and MBC radios. I accessed the Implanon implant that protects for three years from one of the FPAM outreach clinics. In my family we are three girls and all my elder sisters fell pregnant in their teens. I never wanted to get disturbed to complete my secondary school education. And hearing from radios about the benefits of contraception like the ability to complete education made me generate confidence to have an implant to avoid unintended pregnancy.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Banda, vice chair, Youth Action Movement (YAM) The teams of youth leaders have successfully advocated for sexual and reproductive health and rights, creating demand specifically for contraceptive care in their communities. “I engage in contraception discussions slowly by starting with a little probe if girls and young women have ever heard or used contraception before. Later I extend the discussion to give in that the unwanted pregnancy I got was total negligence because access to contraception services was available. I encourage them not to fall into unwanted pregnancy trap when they have all the support and preventative measures around." Share on Twitter Share on Facebook Share via WhatsApp Share via Email Lucy, youth leader Lucy chose a long-acting method of contraception through the FPAM mobile outreach clinic. “My friends discouraged me a lot because they feared a rumor that the IUD drops into the uterus and causes cancer. I gathered courage because I needed a solution that would enable me not to conceive again until my family's economic status improves, and I got the IUD fitted. I feel no problem. This evidence is now a tool I use to teach many girls and women about the benefits of contraception. We are really glad to have FPAM bring a youth-friendly mobile clinic which will support our ground efforts to advocate for youth access to all sexual and reproductive health and rights information and services.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email

“Selling my body doesn’t make me a bad person, but working as a peer educator has helped enabled me to help many like me.” Hasina is one of the estimated 1,500 sex workers living in Haunman Tekri, a red-light area in Bhiwandi, a town near Mumbai. When her husband passed away six years ago leaving behind a three-year-old daughter, Hasina turned to sex work as her only option to earn money. She admits that it came with a feeling of powerlessness. "You don't choose this trade; it is the result of life circumstances.” She works as a peer educator with PSK, one of the Family Planning Association of India's (FPAI) clinics. "Working with Parivar Swasthya Kedra (PSK), has made me feel less helpless; it's given me some control over my body; the ability to choose whether or not to bring another life into this world.” Building trust through education Hasina has been a peer educator for three years, working within the district to educate other women on safe sex, contraception, and abortion. Hasina admits she was once wary of PSK workers. "I used to think that these workers who insist we use condoms, would only sabotage my clientele. But soon I realized they were only looking out for us." When talking with local women, Hasina advocates the use of contraception but says in the case of an unintended pregnancy, abortion is a viable option. "It's easy to judge us, but many of us have no choice; we simply cannot feed another on just Rs. 400 a day."  Hasina is now the go-to woman in the district when it comes to sexual health. "Since I am one of them, the women trust me." This is the secret behind PSK success; a model where sex workers educate their peers, understanding the complexities and prejudices of their daily lives. "I hope one day I am able to put all of this behind me. But I hope that through PSK I am able to make another woman's life just a little bit safer, a little bit better." Do you want to show your support for women and girls to be free to decide what happens to their body? Pledge your voice to our I Decide campaign,IPPF’s movement for safe abortion access for all. You'll be provided with toolkits on how to talk about abortion and you'll have access to a range of content from personal testimonies to videos explaining the different types of abortion available.