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"One day, when I returned from work, Ms. Glenda and Mr. Martin from Pro-Familia were at my house. I heard what the volunteering was about, regarding the education of the men in the community, how to teach how to stop machismo, to be less violent, how to give the talks and visit the clients. They also talked about the contraceptive methods, medicines and many things that would change people's lives. The proposal seemed important to me and I accepted, since I like to work for my people," recalls José.  In 2008, the Asociación Demográfica Salvadoreña (Pro-Familia) developed a project focusing on sexual and reproductive health and the active participation of men in rural areas. It concentrated specifically on the integration of male participation in sexual and reproductive healthcare. Since 2014, the project has been integrated into the Community-Based Programme as part of the provision of healthcare for rural men.  "When I gave the talks on masculinities, they questioned me: 'Why can't you scream at home, if you're the man?' Or 'who do you think you are to say those things?', questions that I also asked myself once", says José. "Thanks to the training I have had and the support of the Pro-Familia staff, I have managed to learn and clarify my doubts. I take care of my own health, I share the responsibilities at home, I take care of my two-year-old son – before volunteering, I thought it was a woman’s job, I didn't do that."  Ensuring access to information and contraception   Educational activities in sexual and reproductive health remain a challenge, but Pro-Familia is committed to delivering their strategy. The role of the health promoter is to advocate – with other men – the use of contraception, counselling couples, and providing supplies (especially condoms) and medicines.   "I like the communication I have with the Pro-Familia staff, and the training reinforcements – they should keep it that way, because it's the way to learn and do things better in the community," he says.  "The change begins with oneself and then transmits it to others. I gather men in talks, make visits to their homes, give guidance on prevention of sexually- transmitted infections, on family planning, and how not to be violent", says José. "Older adult men are more difficult to change."  Increasing contraceptive use among men   José has seen the positive change among men in his community and those small achievements encourage him to keep going. "When men ask me about violence and condom use, I feel encouraged. For example: a co-worker uses a condom and confidently tells me that he does it because he learned from the talks he received, that motivates me to continue guiding towards new masculinities."  The Community-Based Program has a special fund for clients who are referred by promoters for a voluntary surgical contraception (VSC) procedure, so the service is free of charge for clients. In this regard, José is aware that there is still work to be done: "The issue of vasectomy is difficult with men in the community, the challenges continue."  "In the community, young people 'get to live together' [marital union] at an early age. Maybe I cannot change that, but I can help them to be better people, to respect each other. Just as I changed, so can other men," says José. 

"I decided to become a volunteer at Pro-Familia when I heard a talk the staff were giving at the Acajutla City Hall, where they explained what they were doing in the communities with the program, and they invited us to be part of the volunteer service. I liked what I could do with the men in the community. It’s been two-and-a-half years." Juan Martinez Leon is a volunteer with the Asociación Demográfica Salvadoreña (ADS/Pro-Familia) community-based programme. Juan’s remit is broad, working mainly with men to provide information on contraceptive methods and counselling to individuals and couples. He also provides contraceptive methods including the Pill, injectables and, especially, condoms. For some hormonal contraceptive methods, Juan refers his clients to Pro-Familia clinics or other public health facilities. Putting community first "I like to work for my community, despite the difficulties, and I help in four more communities for them to have the [contraceptive] methods and medicines, because they come to get me," says Juan. "I give talks on the soccer field in front of my house or I have meetings at my house. My children help me invite men to come and they also learn and admire the work." Juan visits clients at home and organizes talks – mainly with other men – to promote the importance of contraceptive use, and women and children's health. The importance of men’s health and their family group is a key element in Juan's role as a health promoter. “I like providing family planning counselling, because sometimes men don't like women using anything to prevent pregnancy. When I talk with the men of my community, people's lives change and you see the difference: you no longer see the domination over women, they let women plan, and [the woman] no longer requests the method secretly – although there are still some women who hide from their husbands. That's why we have to continue working on counselling, that's what awakens them." Changing behaviour and attitudes Juan runs informative talks on reproductive health and the prevention of STIs and HIV. "In some talks, some men have come out angry and questioned me. Who am I to tell those things? ‘Someone who has learned and who respects people's rights,’ I tell them. Now men come to ask for condoms, and even my wife confidently gives the condoms to them. She also supports me." Some men thank Juan for having "awakened their minds", and encouraged them to change to respect women and to help at home. “I think I help my community a lot. You wake them up. I like what I do, I like to help. Before there was no promoter and they had women submerged. Little by little that is changing, but only by talking to men is it achieved. I want to continue learning about sexual and reproductive health issues, it never ends. I would like to continue in training as we used to before the pandemic, and for Pro-Familia to come more often. Until God tells me, I feel that it is my obligation to attend to men or whoever seeks me to help them. That's what I'm for.”

"I started as a Pro-Family Health Promoter 30 years ago. I received a visit from Pro-Familia staff on several occasions and I was very interested in what I could do to help in my community as a volunteer, so I accepted. I was trained in sexual and reproductive health issues, and in the technique of injecting [contraceptives]", says Juana Margoth.  Since 1974, the Asociación Demográfica Salvadoreña (ADS/Pro-Familia), has been providing sexual and reproductive healthcare to marginalized communities in rural and peri-urban areas. Through their Pro-Family Health Promoter and community-based programme, the Pro-Familia teams provide information and contraceptive care and supplies to vulnerable populations. Today, the programme has around 900 health promoters throughout El Salvador.  Building relationships and trust   Juana Margoth is one of these health promoters who provides care across four local villages in Hacienda El Edén, in Sonsonate, where the Ministry of Health does not have a presence.   "I like that women know that I am here to help them, also to give advice and understand each person's problem; [to help them] to plan their family, and I like the fact that they want to do it with me," she says.  She receives a quarterly supply of contraceptives that she distributes at low prices to the women in her community.  "I make visits in the communities to the clients I already have, to see if they are okay with the [contraceptive] method, and to receive new clients. Sometimes even the same clients tell me that there is someone who needs a visit. I like that they look to me to help them – I give confidence to the clients, to their partners too. I have clients since two, five or six years ago. There is a lot of need, so I am here, until God wants it." Providing contraceptive advice Juana Margoth also highlights the importance of guiding women and men, providing counselling to clients so that they understand the different methods and contraception, and how to use it: "In other places they only give the contraceptive methods to women and do not explain [on its use]." Veronica has been a regular client of Juana Margoth’s for eight years, receiving counselling and contraceptives. "Margoth has changed our life, mine and my family’s, I have been planning with her for eight years, she is kind and always has the method I use. When I have doubts, I ask her with confidence, without shame, and I can go to her house at any time, she is always there. I don't like going to the health unit, because it costs a lot of money, and sometimes they don't have contraceptives; nowadays, with the pandemic, we have Margoth close and she never stopped treating me, it is very helpful in our community."  Responding to humanitarian disasters   As well as the community-based programme, Pro-Familia supports the network of volunteer promoter's humanitarian crises, such as natural disasters. Pro-Familia conducts a survey of needs and responds with support for reconstruction, healthcare, and food security.  "I have a lot to thank Pro-Familia for. I have learned and continue to learn with them, they are always there when I need to know something, when I run out of contraceptives and without medications [for the program]; I am also grateful because I have my prefabricated house thanks to Pro-Familia who helped me when the earthquake of 2001 happened, several years ago."

"I remember that I joined Pro-Familia on July 1, 2011. I had many fears and questions at that time, because I did not know about sexual and reproductive health issues, and had no experience working with contraceptive methods. It was something completely new for me, but I really wanted to learn," says Elga.  Elga is one of the Community Health Workers in the Asociación Demográfica Salvadoreña’s (Pro-Familia) Community-Based Program team. She remembers that when she first started her training, she felt that her role was small and unimportant – but over the time she learned and gained in confidence, understanding the positive impact she was having in the local communities.  "I found the reason to live, I found a purpose: knowing people’s situations, their difficult situations, that is special for me. Feeling they miss me when they spend days without seeing me because I am in different communities, that is something important, it means they value my work."  Sharing knowledge and experience   Elga believes that she has gained a lot personally. "I have learned a lot about women's rights; I apply everything about sexual and reproductive health in my personal life, I do not allow abuse by my partner and I teach my son to respect people. I learned to use contraception for my own benefit," she says.  Communication was very difficult for Elga. She considered herself shy and was very quiet. Today she talks with people, in front of large groups of students in schools, expresses her ideas and provides counselling.  "I enjoy what I do, I prepare to visit the volunteer promoters, to train them and resolve any doubts or questions that arise. They are very intelligent, and I intend to have the best volunteers. I enjoy visiting families in the community, having the opportunity to give family planning counselling, work on the prevention of cervical and breast cancer, work with young people, help them to change their lives, to find new paths, free from violence, just as I found my purpose."  Communities benefit from access to care  She admires the work of Pro-Familia, as no other organization has permanent programs and subsidized healthcare, which is of enormous benefit to the local community.  Elga has seen many clients since she started volunteering. She recalls encouraging a woman to come to the cervical screening clinic: "The lady had never had a cervical screening. I gave her counselling and a referral so that she could come to the Pro-Familia clinic. Her result was cervical dysplasia – level 1, I followed her until she received the treatment. Now, every time she sees me, she thanks me for guiding her and inviting her to the clinic," Elga says with joy.  She also remembers the first time she suggested a vasectomy to a client. "First, I made the reference to the women client, but because of health reasons she could not be sterilized, and she was very sad because using hormonal methods also affected her health. So I decided to give counselling to the client's partner, who agreed to a vasectomy. The intervention was successful, and he is well, and grateful to me and to Pro-Familia", she recalls.  The issues of sexual and reproductive health and contraceptive care are still taboo in many communities. Changing attitudes to improve the lives of individuals and families remain a vital focus. Counselling is key to recognizing that health and contraceptive care are fundamental rights, and to eliminate myths and beliefs that prohibit the use of contraception. Volunteers like Elga remain integral to this process to bring about positive change for the future. 

"I am a volunteer health promoter by inheritance. First, my mother volunteered with Pro-Familia for 15 years, when she resigned to go to the United States. I learned to volunteer when I was little, because I saw how my mother did it", Alicia recalls.  The community spent some years without a volunteer health promoter after Alicia’s mother left. During that time, women came to Alicia to encourage her to contact the Asociación Demográfica Salvadoreña’s (ADS/Pro-Familia)to bring back the programme to the Santo Domingo village, 90 minutes outside of San Salvador. In the absence of a local public health facility, Alicia decided to become a Pro-Familia volunteer to support her community.  "When my mother left, I agreed to collaborate just to promote the cervical screening clinic, but Pro-Familia suggested that I be a volunteer, like my mother, and I accepted. Today, it’s been two years. They have trained me at home on sexual and reproductive health issues, counselling, home visits and the use of brochures, and I also learned to inject." Changing people’s lives   Alicia is an entrepreneur with a strong spirit of care towards her family and community. Every day she attends her small business that provides the community with basic products.   "I help change people's lives; the women are happy and grateful, because they no longer go to Guazapa to buy contraceptive methods. Pro-Familia trains me and I coordinate with other institutions in the community – such as the church – to help people", she says.   Alicia says that counselling is a crucial part of her work: "Counselling is very important, women learn to use [contraceptive] methods and stop thinking that it is a sin. I help them to understand that family planning is a right. I had a case of a client where the husband was the one who decided which method to use and make her change it very often. One day I explained to him about the benefits of using only one family planning method, the effects of changing very often on her menstruation and that she had the right to decide whether or not to change. He understood and thanked me for taking the time to speak to him; from that day on the client keeps one family planning method and the husband respects her decision." Alicia dreams of having a larger place for her clients, or to have a table to administer the injectable, but despite the limited space she enjoys her work. "I like it and I am happy to know that I can help. Many users come at night to pick up their methods because they work out of house and I take care of them with great pleasure, when they miss their appointment, I look after them, I speak to them by phone or I send them a WhatsApp message."  Ensuring trust and confidence       Ruth Séfora Manzano has known Alicia for several years before she had children."I like Alicia because she is a respectful person, she likes to help people, she gives me confidence, and you can trust your personal things to her because she doesn't tell anyone. She looked after me when I got pregnant and she also cares about my daughter. She guides me on how taking care of myself and the baby – she is a kind person, that's why I plan with her, and if I need other medicines I also buy them from her. I also like it because it is close to my house. She gives me the shots, and I don't have to go elsewhere – I am grateful for her help and Pro-Familia's." 

When Blanca started volunteering with the Asociación Demográfica Salvadoreña’s (ADS/Pro-Familia), she committed to her new role with enthusiasm. Her thoughts were about how the women of La Loma village would benefit from being able to access contraceptive methods close to home.  "Many women walk up to an hour-and-a-half from the villages of the Guazapa Hill to receive family planning services, or to receive counselling," 61-year-old Blanca Edith Mendoza Ramos says proudly.   Her house is a cosy and special place for the clients. "I have been a Pro-Familia volunteer for 29 years. When I started, I had already had my five children. I was busy at home, but when the Pro-Familia staff explained to me about working in my community, I trusted it was important to support women. I have learned a lot and I continue to do so. I have received training that helps me to be a better person, to have knowledge and to give good advice; I have received many people from Pro-Familia in these years, and always with great responsibility", she says.  A confidential and cosy place    To ensure her clients’ confidentiality, Blanca has created a private room with a sofa where she provides counselling and administers injectable contraceptive methods. By creating a private space, Blanca has built up trust in the community and women prefer to go to her for contraception and advice.  "I am proud to help in my community. I visit clients to see if they have any side effects, when they do not come to receive their method, to know if they are well, or to recruit new clients who are encouraged to use a family planning method, because their families are already very large." Although the public health facility provides free healthcare, women from other local communities prefer to see Blanca because she is closer and offers confidential personalized care.   "The Health Unit is not close, so women prefer to plan with me. They come with confidence to apply their method. On their first visit, I ask them a few questions about their health, and if everything is okay, they plan with me. I think that family planning is important for the spacing of the children and that it is not only the use of methods, but also communication with the couple", reflects Blanca. 

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.”