Stories

Fiona, 28, joined the Jamaica Family Planning Association (FAMPLAN) Lenworth Jacobs Clinic in 2017 as a volunteer through a one-year internship with the Jamaica Social Investment Fund.  “I was placed to be a youth officer, which I never had any knowledge of. Upon getting the role I knew there would be challenges. I was not happy. I wanted a place in the food and beverage industry. I thought to myself, ‘what am I doing here? This has nothing to do with my qualifications’. It was baby mother business at clinic, and I can’t manage the drama,” Fiona says.  Embracing an unexpected opportunity   Fiona’s perception of FAMPLAN quickly changed when she was introduced to its Youth Advocacy Movement (YAM) and began recruiting members from her own community to join.  “I quickly learnt new skills such as social media marketing, logistics skills and administrative skills. In fact, the only thing I can’t do is administer the vaccines. They have provided me with a lot of training here. Right now, I have a Provider Initiative Training and Counselling certificate. I am an HIV tester and counsellor. I volunteer at health fairs and special functions. I will leave here better than I came.”  Working with vulnerable communities   The Lenworth Jacobs Clinic is located in tough neighbourhood in Downtown, Kingston. Fiona says there is vital work to be done, and youth are the vanguards for change.  “It’s a volatile area so some clients you have to take a deep breath to deal with them as humans. I am no stranger to the ghetto. I grew up there. The young people will come, and they’ll talk openly about sex. They’ll mention multiple partners. You have to tell them choose two [barrier and hormonal contraception] to be safe, you encourage them to protect themselves,” she says.  Other challenges that young people face include sexual grooming, teenage pregnancy, and violation of their sexual rights.  “Sometimes men may lurk after them. There is sexual grooming where men feel entitled to their bodies. A lot are just having sex. They don’t know the consequences or the sickness and potential diseases that can come as a result of unprotected sex. Many don’t know there are options - contraceptives. Some don’t know the dangers of multiple sex partners. The challenges are their lifestyle, poverty level, environment, and sex is often transactional to deal with economic struggles,” Fiona explains.  Providing a safe space to young communities   Despite these challenges YAM has provided a safe space for many young people to discuss issues like sexual consent, sexual health and rights, sexuality and provide them with accurate information access to FAMPLAN’s healthcare.  But there remains a need for more youth volunteers, and adults, to support FAMPLAN’s work.   “We need more young people, and we definitely need an adult group. Teens can carry the message, but you’re likely to hear parents say, ‘I’ve been through it already’ and not listen. They also need the education YAMs have access to, so they can deal with their children, grandchildren and educate them about sexual and reproductive health rights. For my first community intervention a lot of kids came out and had questions to ask. Questions that needed answers. I had to get my colleagues to come and answer,” Fiona says.  YAM’s impact goes beyond sexual and reproductive health, as the group has supported many young people on issues of self-harm and depression.  “There’s a lot going through these teenagers’ minds. Through YAM I have developed relationships and become their confidante, so they can call me for anything. The movement is impacting. It helped me with my life and now I can pass it down. YAM can go a far way with the right persons. Whatever we do we do it with fun and education – edutainment.” 

‘Are you interested in advocacy and reproductive health rights?’ These were the words which caught Mario’s attention and prompted him to sign up to be part of the Jamaica Family Planning Association (FAMPLAN) Youth Advocacy Movement (YAM) five years ago. At the time, Mario was 22 and looking for opportunities to gain experience after graduating from college.  From graduate to advocate   “I was on Facebook looking at different things young people can do, and it popped up. I had just left college with an Associate Degree in Hospitality and Tourism Management. I was unemployed and I just wanted to be active, give myself the opportunity to learn and find something I can give my time to and gain from it,” Mario says.  Interested in volunteering and advocacy Mario joined the YAM to get a new experience and broaden his knowledge base. He says he has gained a second family and a safe space; he can call home.  “It’s so much more than sex and condoms. It’s really human rights and integrated in everything we do. Reproductive health affects the population, it affects your income, your family planning, how people have access to rights. It’s cuts across men, women, LGBT people and encompasses everything. My love for working with YAM and being an advocate for sexual and reproductive health rights deepened and I could expand further in my outreach.”  His work with YAM has equipped Mario with skills and given him opportunities he would otherwise not have.  “I have done public speaking which has opened lots of doors for me. I have travelled and met with other Caribbean people about issues [around sexual and reproductive health]. There’s an appreciation for diversity as you deal with lots of people when you go out into communities, so you learn to break down walls and you learn how to communicate with different people.”   Challenging the reluctance to talk about sex   The greatest challenges he faces are people’s reluctance to talk about sex, accessing healthcare, and misinformation.  “Once they hear sex it’s kind of a behind the door situation with everybody, but they are interested in getting condoms. When it comes to that it is breaking taboo in people’s minds and it might not be something people readily accept at the time. LGBT rights, access to condoms and access to reproductive health for young people at a certain age — many people don’t appreciate those things in Jamaica.”  Mario talks about giving youth individual rights to access healthcare. “So, can they go to a doctor, nurse without worrying if they are old enough or if the doctor or nurse will talk back to the parents? Access is about giving them the knowledge and empowering them to go for what they need.”  “The stigma is the misinformation. If you’re going to the clinic people automatically assume, you’re doing an HIV/AIDS test or getting an abortion. [So] after the community empowerment, because of the stigma maybe 15 per cent will respond and come to the clinic. The biggest issue is misinformation,” Mario says, adding that diversification of the content and how messages are shaped could possibly help.  To address these issues, he wants to see more young people involved in advocacy and helping to push FAMPLAN’s messages in a diversified way.  “It is a satisfying thing to do both for your own self development and community development. You’re building a network. If you put yourself out there you don’t know what can happen.”  

Candice, 18, joined the Youth Advocacy Movement (YAM) when she was 15 after being introduced to the group by the Jamaica Family Planning Association’s (FAMPLAN) youth officer, Fiona.  Sharing knowledge with peers   Initially, Candice, saw YAM as a space where she could learn about sexual and reproductive health and rights (SRHR) as there was no information available elsewhere. Candice uses her knowledge and involvement with YAM to educate her peers about their sexual health and rights with hopes that they make informed choices if they choose to engage in sex.  “I’ve seen teenagers get pregnant and it’s based off them never knowing routes they could take to prevent pregnancies. I figured I could play a role by learning it for myself, applying it to myself as well as talk to those around me to somewhat enlighten them about sexual and reproductive health. I just wanted to be able to learn for myself and pass on the knowledge.”  Making positive changes   Candice believes that sexual and reproductive health and rights are not limited to sex, but also about being empowered to make positive changes and choices. Candice has worked with the youth group to use her voice for the voiceless and make a change.  “Seeing young girls divert to wanting more and because their parents were not able to provide, they turn to men. Also, I saw undue pressure being placed on girls to not have sex and that pressure unfortunately caused them to develop creative ways to go out and it so ends up that they were left with an unwanted pregnancy. I was learning not only for myself, but to spread the word.  I learnt I needed to immerse myself in order to be an effective advocate.”  Through her advocacy work, Candice has been to health fairs and spoken to her peers and adults about their sexual and reproductive health and rights. The impact has been positive.  “In my circle I’ve seen people become more aware and more careful. In my teaching, my friends are inspired to join so I am looking to recruit soon,” she said.  Breaking down barriers to contraception use  Candice has faced a number of obstacles, especially around the reservations her peers have to practicing safer sex.  “You can only educate someone, but you can’t force them to do what you’re promoting. You will have different people asking and you explain to them and show them different ways to approach stuff and they will outright be like ‘OK, I am still going to do my thing. This is how I am used to my thing’. So, they accept the information, but are they practicing the information? People are open minded, but it’s just for them to put the open mindedness into action.”  Candice says there are parents who are not open to discussing these issues with their children and it subsequently makes the work more challenging and prohibits access to safer practices and choices.  She believes it would be beneficial for parents to take a more active role in advocating healthy choices. She would also like to see more sexual and reproductive health and rights sessions delivered in schools.  “Implement classes in school that are more detailed than what exists. The current lessons are basic and the most compact you’ll learn is the menstrual cycle. You’re learning enough to do your exam, not apply to real life. If this is in schools, the doctors and clinics may be more open to the reality that younger people are engaging in sex. To prevent unplanned pregnancies be more open.”   “YAM has good intentions. These good intentions are definitely beneficial to the target audience. With more empowerment in the initiative we can move forward and complete the goal on a larger scale.” 

Dr McKoy has committed his life to ensuring equality of healthcare provision for women and men at the Jamaica Family Planning Association (FAMPLAN).  Expanding contraceptive choice   Returning to Jamaica from his overseas medical studies in the 1980s, Dr McKoy was frustrated and concerned at the failure of many Jamaican males to use contraception.  This led him to making a strong case to integrate male sterilization as part of FAMPLAN’s contraceptive care package. Whilst the initial response from local males was disheartening, Dr McKoy took the grassroots approach to get the buy-in of males to consider contraception use.  “Someone once said it’s only by varied reiteration that unfamiliar truths can be introduced to reluctant minds. We used to go out into the countryside and give talks. In those times I came down heavily on men.”   Overcoming these barriers, was the catalyst he needed to ensure that men accessed and benefitted from health and contraceptive care. Men were starting to choose vasectomies if they already had children and had no plans for more.  Encouraging uptake of male healthcare  Dr McKoy was an instrumental voice in the Men’s Clinic that was run by FAMPLAN, encouraging the inclusion of women at the meetings, in order to increase male participation and uptake of healthcare.  “When we as men get sick with our prostate it is women who are going to look after us. But we have to put interest in our own self to offset it before it puts us in that situation where we can’t help yourself. It came down to that and the males eventually started coming. The health education got out and men started being more confident in the health services.”  Health and wellbeing are vital   McKoy advocates the importance of women taking their sexual health seriously and accessing contraceptive care. If neglected, Dr McKoy says it could be a matter of life death.  He recalls a story of a young mother who was complacent towards cervical screenings and sadly died from cervical cancer - a death he says which could have been prevented.  “Over the years I saw the opportunity to do cervical screenings at the clinic. The mobile unit gave us access to so many patients. We had persons who neglected to do it. One patient in particular - she was not yet 30 years old. She had three children and after every delivery she was told by the hospital to get a cervical screening. She didn’t do it and eventually got cervical cancer. When she was to do the cervical screening, she didn’t come. One morning they brought her and had to lift her up out of the car. At that time doctors said they couldn’t do anything for her. It wasn’t necessary. So, we had to go out more to meet people, educate them teach them the importance of sexual and reproductive health.”  That experience was his driving force to continue the work in providing sexual and reproductive healthcare and information through community outreach. 

Cultural barriers and stigma have threatened the work of the Jamaica Family Planning Association (FAMPLAN), but according to one senior healthcare provider at the Beth Jacobs Clinic in St Ann, Jamaica things have taken a positive turn, though some myths around contraceptive care seem to prevail.  Committed to changing perceptions and attitudes   Midwife, Dorothy, is head of maternal and child and sexual and reproductive healthcare at the Beth Jacobs Clinic and first began working with FAMPLAN in 1973.    She says the organization has made its mark and reduced barriers and stigmatizing behaviour towards sexual health and contraceptive care. Cultural barriers were once often seen in families not equipped with basic knowledge about sexual health.  “I remember some time ago a lady beat her daughter the first time she had her period as she believed the only way, she could see her period, is if a man had gone there [if the child was sexually active]. I had to send for her [mother] and have a session with both her and the child as to how a period works. She apologized to her daughter and said she was sorry. She never had the knowledge and she was happy for places like these where she could come and learn – both parent and child.”   Working with religious groups to overcome stigma   Religious groups once perpetuated stigma, so much so that women feared even walking near the FAMPLAN property.  “Church women would hide and come, tell their husbands, partners or friend they are going to the doctor as they have a pain in their foot, which nuh guh suh [was not true]. Every minute you would see them looking to see if any church brother or sister came on the premises to see them as they would go back and tell the Minister because they don’t support family planning. But that was in the 90s.”  Dorothy says that this has changed, and the church now participates in training sessions sexual healthcare and contraceptive choice, encouraging members to be informed about their wellbeing and reproductive rights.  Navigating prevailing myths   Yet despite the wealth of information and forward thinking of the communities the Beth Jacobs Clinic reaches, Dorothy says there are some prevailing myths, which if left unaddressed threaten to repeal the work of FAMPLAN.  “Information sharing is important, and we try to have brochures on STIs, and issues around sexual and reproductive health and rights. But there are people who still believe sex with a virgin cures’ HIV, plus there are myths around contraceptive use too. We encourage reading. Back in the 70s, 80s, 90s we had a good library where we encouraged people to read, get books, get brochures. That is not so much now,” Dorothy says.  Another challenge is ensuring women are consistent with accessing healthcare and contraception. “I saw a lady in the market who told me from the last day I did her pap smear she hasn’t done another one. That was five years ago. I had one recently - no pap smear for 14 years. I delivered her last child,” she says.  Despite these challenges Dorothy remains dedicated and committed to her community knowing her work helps to improve women’s lives through choice. She is confident that the Mobile Unit with community-based distributors will be reintegrated into FAMPLAN healthcare delivery so that they can reach remote communities.  “FAMPLAN has made its mark. It will never leave Jamaica or die.” 

Christan, 26, is committed to helping develop young people to become confident advocates for change.  Christan is the executive assistant at the FAMPLAN Lenworth Jacobs Clinic. Her work overlaps with that of the Youth Action Movement (YAM), helping to foster the transitioning and development of youth into meaningful adults.  Harnessing change through young advocates   “FAMPLAN provides the space or capacity for young persons who they engage on a regular basis to grow — whether through outreach, rap sessions, educational sessions. The organization provides them with an opportunity to grow and build their capacity as it relates to advocating for sexual and reproductive health and rights amongst their other peers,” she said.  Though she has passed on her youth officer baton, Christan, remains connected to YAM and ensures she leads by example. “When you have young adults, who are part of the organization, who lobby and advocate for the rights of other adults like themselves, then, on the other hand, you are going to have young people like Mario, Candice and Fiona who advocate for persons within their age cohort,” she said.  “Transitioning out of the group and working alongside these young folks, I feel as if I can still share some of the realities they share, have one-on-one conversations with them, help them along their journey and also help myself as well, because social connectiveness is an important part of your mental health. This group is very, very, very dear to me.”  Gaining confidence through volunteering   With regards to its impact on her life, Christan said YAM helped her to become more of an extrovert and shaped her confidence. “I was more of an introvert and now I can get up do a wide presentation and engage other people without feeling like I do not have the capacity or expertise to bring across certain issues,” she said.  However, she says that there is still a lot of sensitivity around sexual and reproductive health and rights. This can sometimes limit the conversations YAM is able to have and at times may generate fear among some of the group members.  Turning members into advocates   “There are certain sensitive topics that still present an issue when trying to bring it forward in certain spaces. Other challenges they [YAM members] may face are personal reservations. Although we provide them with the skillset, certain persons are still more reserved and are not able to be engaged in certain spaces. Sometimes they just want to stay in the back and issue flyers or something behind the scenes rather than being upfront.”  But as the main aim of the movement is to develop advocates out of members, Christan’s conviction is helping to strengthen Yam's capacity.  “To advocate you must be able to get up, stand up and speak for the persons who we classify as the voiceless or persons who are vulnerable and marginalised. I think that is one of the limitations as well. Going out and doing an HIV test and having counselling is OK, but as it relates to really standing up and advocating, being able to write a piece and send it to Parliament, being able to make certain submissions like editorial pieces. That needs to be strengthened,” says Christan. 

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.”