Stories

"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. 

Midwife Sophia Abrafi sits at her desk, sorting her paperwork before another patient comes in looking for family planning services. The 40-year-old midwife welcomes each patient with a warm smile and when she talks, her passion for her work is clear.  At the Mim Health Centre, which is located in the Ahafo Region of Ghana, Abrafi says a sexual and reproductive health and right (SRHR) project through Planned Parenthood Association of Ghana (PPAG) and the Danish Family Planning Association (DFPA) allows her to offer comprehensive SRH services to those in the community, especially young people. Before the project, launched in 2018, she used to have to refer people to a town about 20 minutes away for comprehensive abortion care. She had also seen many women coming in for post abortion care service after trying to self-administer an abortion. “It was causing a lot of harm in this community...those cases were a lot, they will get pregnant, and they themselves will try to abort.”   Providing care & services to young people Through the clinic, she speaks to young people about their sexual and reproductive health and rights. “Those who can’t [abstain] we offer them family planning services, so at least they can complete their schooling.” Offering these services is crucial in Mim, she says, because often young people are not aware of sexual and reproductive health risks.  “Some of them will even get pregnant in the first attempt, so at least explaining to the person what it is, what she should do, or what she should expect in that stage -is very helpful.” She has already seen progress.  “The young ones are coming. If the first one will come and you provide the service, she will go and inform the friends, and the friends will come.” Hairdresser Jennifer Osei, who is waiting to see Abrafi, is a testament to this. She did not learn about family planning at school. After a friend told her about the clinic, she has begun relying on staff like Abrafi to educate her. “I have come to take a family planning injection, it is my first time taking the injection. I have given birth to one child, and I don’t want to have many children now,” she says. Expanding services in Mim The SRHR project is working in three other clinics or health centres in Mim, including at the Ahmadiyya Muslim Hospital. When midwife Sherifa, 28, heard about the SRHR project coming to Mim, she knew it would help her hospital better help the community. The hospital was only offering care for pregnancy complications and did little family planning work. Now, it is supplied with a range of family planning commodities, and the ability to do comprehensive abortion care, as well as education on SRHR. Being able to offer these services especially helps school girls to prevent unintended pregnancies and to continue at school, she says.  Sherifa also already sees success from this project, with young people now coming in for services, education and treatment of STIs. In the long term, she predicts many positive changes. “STI infection rates will decrease, teenage pregnancies will decrease, unsafe abortions and deaths as a result of unsafe abortions will decrease. The young people will now have more information about their sexual life in this community, as a result of the project.”

Factory workers at Mim Cashew, in a small town in rural Ghana, are taking their reproductive health choices into their own hands, thanks to a four-year project rolled out by Planned Parenthood Association Ghana (PPAG) along with the Danish Family Planning Association (DFPA). The project, supported by private funding, focuses on factory workers as well as residents in the township of about 30, 000, where the factory is located. Under the project, health clinic staff in Mim have been supported to provide comprehensive abortion care, a range of different contraception choices and STI treatments as well as information and education. In both the community and the factory, there is a strong focus on SRHR trained peer educators delivering information to their colleagues and peers. An increase in knowledge  So far, the project has yielded positive results - especially a notable increase amongst the workers on SRHR knowledge and access to services - like worker Janet Pinamang, who is a 32-year-old mother of two. She says the SRHR project has been great for her and her colleagues. "I have had a lot of benefits with the project from PPAG. PPAG has educated us on how the process is involved in a lady becoming pregnant. PPAG has also helped us to understand more on drug abuse and about HIV.” She also appreciated the project working in the wider community and helping to address high levels of teenage pregnancy.  "I have seen a lot of change before the coming of PPAG little was known about HIV, and its impacts and how it was contracted - now PPAG has made us know how HIV is spread, how it is gotten and all that. PPAG has also got us to know the benefits of spacing our children." “It has helped me a lot” Pinamang's colleague, Sandra Opoku Agyemang, 27, is a mother of a six-year-old girl called Bridget. Agyemang says before the project came to Mim, she had only heard negative information around family planning. "I heard family planning leads to dizziness, it could lead to fatigue, you won't get a regular flow of menses and all that, and I also heard problems with heart attacks. I had heard of these problems, and I was afraid, so after the coming of PPAG, I went into family planning, and I realised all the things people talked about were not wholly true." Now using family planning herself, she says the future is bright for her, and her family. "It has helped me a lot, without that information I would have given birth to many children, not only Bridget. In the future, I plan to add on two [more children], even with the two I am going to plan."  

When Gifty Anning Agyei was pregnant, her classmates teased her, telling her she should drop out of school. She thought of having an abortion, and at times she says she considered suicide. When her father, Ebenezer Anning Agyei found out about the pregnancy, he was furious and wanted to kick her out of the house and stop supporting her education.  Getting the support she needed But with support from Planned Parenthood Association of Ghana (PPAG) and advice from Ebenezer’s church pastor, Gifty is still in school, and she has a happy baby boy, named after Gifty’s father. Gifty and the baby are living at home, with Gifty’s parents and three of her siblings in Mim, a small town about eight hours drive northwest of Ghana’s capital Accra.  “Despite all those challenges, I thought it was necessary to stay in school. I didn’t want any pregnancy to truncate my future,” Gifty says, while her parents nod in proud support. In this area of Ghana, research conducted in 2018 found young people like Gifty had high sexual and reproduce health and rights (SRHR) challenges, with low comprehensive knowledge of SHRH and concerns about high levels of teenage pregnancy. PPAG, along with the Danish Family Planning Association (DFPA), launched a four-year project in Mim in 2018 aimed to address these issues.  For Gifty, now 17, and her family, this meant support from PPAG, especially from the coordinator of the project in Mim, Abdul- Mumin Abukari. “I met Abdul when I was pregnant. He was very supportive and encouraged me so much even during antenatals he was with me. Through Abdul, PPAG encouraged me so much.” Her mother, Alice, says with support from PPAG her daughter did not have what might have been an unsafe abortion. The parents are also happy that the PPAG project is educating other young people on SRHR and ensuring they have access to services in Mim. Gifty says teenage pregnancy is common in Mim and is glad PPAG is trying to curb the high rates or support those who do give birth to continue their schooling.  “It’s not the end of the road” “PPAG’s assistance is critical. There are so many ladies who when they get into the situation of early pregnancy that is the end of the road, but PPAG has made us know it is only a challenge but not the end of the road.” Gifty’s mum Alice says they see baby Ebenezer as one of their children, who they are raising, for now, so GIfty can continue with her schooling. “In the future, she will take on the responsibly more. Now the work is heavy, that is why we have taken it upon ourselves. In the future, when Gifty is well-employed that responsibility is going to be handed over to her, we will be only playing a supporting role.” Alice also says people in the community have commented on their dedication. “When we are out, people praise us for encouraging our daughter and drawing her closer to us and putting her back to school.” Dad Ebenezer smiles as he looks over at his grandson. “We are very happy now.” When she’s not at school or home with the baby, Gifty is doing an apprenticeship, learning to sew to follow her dream of becoming a fashion designer. For her, despite giving birth so young, she has her sights set on finishing her high school education in 2021 and then heading to higher education. 

As the sun rises each morning, Dorcas Amakyewaa leaves her home she shares with her five children and mother and heads to work at a cashew factory. The factory is on the outskirts of Mim, a town in the Ahafo Region of Ghana. Along the streets of the township, people sell secondhand shoes and clothing or provisions from small, colourfully painted wooden shacks.  “There are so many problems in town, notable among them [young people], teenage pregnancies and drug abuse,” Amakyewaa says, reflecting on the community of about 30,000 in Ghana.       The chance to make a difference  In 2018, Amakyewaa was offered a way to help address these issues in Mim, through a sexual and reproductive health rights (SRHR) project brought to both the cashew factory and the surrounding community, through the Danish Family Planning Association, and Planned Parenthood Association Ghana (PPAG).  Before the project implementation, some staff at the factory were interviewed and surveyed. Findings revealed similar concerns Amakyewaa had, along with the need for comprehensive education, access and information on the right to key SRHR services. The research also found a preference for receiving SRHR information through friends, colleagues or factory health outreach. These findings then led to PPAG training people in the factory to become SRHR peer educators, including Amakyewaa. She now passes on what she has learnt in her training to her colleagues in sessions, where they discuss different SRHR topics. “I guide them to space their births, and I also guide them on the effects of drug abuse.” The project has also increased access to hospitals, she adds. “The people I teach, I have given the numbers of some nurses to them. So that whenever they need the services of the nurses, they call them and meet them straight away.” Access to information One of the women Amakyewaa meets with to discuss sexual and reproductive health is Monica Asare, a mother of two.  “I have had a lot of benefits from PPAG. They teach us as to how to avoid STDs and how to space our childbirth. I teach my child about what we are learning. I never had access to this information; it would have helped me a lot, probably I would have been in school.” Amakyewaa also says she didn’t have access to information and services when she was young. If she had, she says she would not have had a child at 17. She takes the information she has learnt, to share with her children and other young people in the community. When she gets home after work, Amakyewaa’s peer education does not stop, she continues. She also continues her teachings when she gets home. “PPAG’s project has been very helpful to me as a mother. When I go home, previously I was not communicating with my children with issues relating to reproduction.” Her 19-year-old daughter, Stella Akrasi, has also benefitted from her mothers training. “I see it to be good. I always share with my friends give them the importance of family planning. If she teaches me something I will have to go and tell them too” she says.