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. 

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.