Stories

In the mountains of Kumera on Tanna Island, Vanuatu, the village women of Kamahaul normally spend over 10,000 Vatu ($83 USD) to travel to the nearest hospital.  It takes an hour to travel up the steep, rugged, tire-track terrain by car, but it takes two hours by foot - the normal form of commute for villagers.  Alani*, a 22-year-old mother of three, said that after Tropical Cyclones Kevin and Judy hit Vanuatu in March 2023, it has been even harder to travel to the hospital.  “After the cyclone, my crops were destroyed. I usually take my kids with me to the market and sell produce but after the cyclone, I do not have any money. If I have to go to the hospital for my 3-month injectable [contraceptive], I spend 5,000 Vatu one way, then 500 for medicine at hospital then I pay 5,000 Vatu to come back.” This is equivalent to over 100 AUD, which is unaffordable for most people like Alani.   Village spokesperson, Jimmy, said that the community is grateful for the Vanuatu Family Health Association (VFHA) as they are the first medical team to visit the remote community.  “I feel sorry for our mamas, they must spend so much money just to get medicine,” he said. “In our village, we have a lot of young single mothers and most of the time, trucks refuse to come up here because of the bad road. They must walk for two hours just to get to the main road, sometimes whilst pregnant, holding bags and their many children. This is why I invited VFHA to come here, so women don’t have to spend so much money and time just to get health services.”  The outreach programme was part of VFHA’s humanitarian response to the cyclone.  “We’ve been overwhelmed by the testimonies of hardships shared by the women in this community,” said Kalowi Kaltapangm VFHA Programme Manager. “Girls and women should not be paying over 100 AUD just to have access to sexual reproductive health services – it is not right. We thank Australia through DFAT for allowing us to reach more people post-disaster.”  Jimmy added that the community is grateful for the VFHA visit and hopes they set up a clinic in Kumera.  “After Tropical Cyclones Judy and Kevin, we lost about 21 homes across the communities here and most of the food crops are gone. If you travel further, you will still see some families still in tents. People are still rebuilding their lives and it's hard to rebuild if women fall pregnant again.’  The VFHA response team reached a total of 21 communities and more than 3,000 beneficiaries across Tafea Province. This included mobile outreach to 15 communities on Tanna Island, three communities on Futuna and three communities in Aneityum.   

“Very traditional.” These two words are often used to describe the people of Tanna in Vanuatu, one of the most populated islands in the small country in the Pacific.  Between 1 and 5 March 2023, the Vanuatu islands were hit by two consecutive Category 4 cyclones (“Judy” and “Kevin”) with widespread damage to the northwest and northeastern islands. Authorities report that some 250,000 people were affected, representing more than 80 per cent of the population.  Since 28 March, The Vanuatu Family Health Association (VFHA) has been conducting their humanitarian response on Tanna. Team Leader, Enneth Ilaisa, said that they are very surprised by their breakthrough with communities - especially with the men.   “Tanna is known to be very traditional, even in the past it was almost impossible get access to these communities to talk about sex, but now it is slowly changing, and we are surprised. In our recent field visits, we have seen men step forward bringing their wives and even their daughters to get family planning!” says Ilaisa.  Levi, a 47-year-old father, said that he brought his daughter to the VFHA site to get Jadelle [a long-acting contraceptive] because he does not want his daughter to fall pregnant.  “After the cyclones, I saw pregnant mothers walking to the hospitals for check-ups and I told myself that I do not want that for my daughter. I do not want her to suffer if the boy runs away. Some men were talking about VFHA, and I was surprised that even though most were hesitant to get family planning for their daughters because it meant that they were able to have sex, they also did not want their daughters to suffer,” says Levi.   Ilaisa added that they have seen more men step forward due to their work with community chiefs to ensure men attend the information sessions.  “We talk to the men too, we educate them. Then after they go to nakamal (a traditional meeting place in Vanuatu used for gatherings and ceremonies), they tell all the men about what they learnt. I believe because people are still recovering from the cyclones, men have seen the firsthand challenges of women getting pregnant and the hardships of looking after a pregnant woman when you have lost everything after a cyclone. “  31-year-old Rose, from Kumera, said that she is surprised her husband advocated for her to get family planning.   “I can’t thank VFHA enough, my husband, who previously accused me of cheating when I told him I wanted to get family planning, is the same man who now wants me to get family planning. I thank VFHA for also speaking to the men as they are usually the problem when it comes to family planning!” says Rose.  VFHA Programme Manager, Kalowi Kaltapang thanked his hardworking humanitarian team for their perseverance in breaking down barriers of sex in communities, but most importantly, the great support from DFAT in funding the humanitarian response.  “It's always been tricky to engage men in these spaces, but I thank DFAT, IPPF and the hardworking VFHA humanitarian team, who are steadfast in their mission to ensure that everyone has access to SRH services.”    

Girls and women from nearby villages flock to mobile health clinics set up by the Vanuatu Family Health Association (VFHA). The response team from VFHA consists mostly of women, who have already been away from their families for over six weeks. Team Leader, Enneth Ilaisa, mentally prepares her team for the long day ahead.  The 12-member team, consisting of nine women and three men, have been conducting community outreach on Tanna Island, Vanuatu since 28 March 2023, as part of their humanitarian response to Tropical Cyclones Judy and Kevin, which tore through Vanuatu.   “Our team consists of nine mothers who have left their families to provide these essential services to vulnerable communities. When people visit us, we must put on a happy face to make them feel welcome but sometimes it gets hard,” says Ilaisa.  Ilaisa said that the women in the medical team have been away from their homes for so long that their husbands would sometimes be overwhelmed with looking after the children and often would call the women on the team ‘selfish’ for choosing to leave their families.  Sexual and reproductive health nurse, Cindy Mahi, said she sometimes feels bad for leaving her partner alone to look after the children. When she sees clients with their children, she says she feels homesick.  “I call my family every morning, and sometimes my husband complains about me being away – and it really hurts, especially if I hear my children in the background asking when I will be back. I feel so guilty sometimes as a mother!” says Mahi.  Ilaisa added that the stress from leaving their families is compounded by an intense working environment delivering vital sexual and reproductive healthcare to remote communities.  “Our work is such that we leave our accommodation before sunrise and return after sunset. People are very tired and sometimes we are so busy helping clients that we often work through lunch to ensure we help everyone,” says Ilaisa.  Mahi said that these are things people don’t see when they come to receive services.  “When women come to see us for help, we put on a warm smile, but they do not know about the hardships we face. They do not see what is running at the back of our mind.”   Ilaisa said when it comes to the mental health of the team, she ensures she is creating a safe space where her team members can openly share.  “I offer counselling to them, and I encourage them to share the important work that they do in the field with their husbands, so they know exactly what they do. I sit there and listen to them and sometimes we cry together.”  Ilaisa said that apart from counselling, she encourages the mothers to practice self-care by taking the weekend off and making sure they take adequate breaks throughout the day.  “I tell them, if you feel you need to take a break in the middle of work – do it! When we debrief after our field work, we share the numbers of women who received SRH services, and the feeling of accomplishment is what makes our work worthwhile. When we hear these numbers it reminds us of our purpose, it reminds us of why we are here, and for a second, our family problems fade away because we know we are serving a purpose greater than ourselves.” 

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. 

Julie was a midwife with the Ministry of Health for 20 years before she joined the Vanuatu Family Health Association (VFHA) as nurse and project manager for IPPF's SPRINT Initiative response in Vanuatu. When Cyclone Pam hit Vanuatu, the SPRINT Initiative and VHFA started providing life-saving services to the Island, Tanna, which was the population worst affected by the typhoon. Many communities there live remotely, in grass huts, with no immediate access to medical care.  Julie was there with the VFHA team. “When I first came here we used the kitchen to operate from. On my second trip, we created a clinic in our youth centre, and used the nearby health post for clinical procedures. Soon we saw more patients pouring in, which created a huge demand for space." Health conditions are very low. Even before the cyclone hit the island, it was reported that the average mother loses two pregnancies each, in her lifetime. Every person in the village knows at least one mother who has died during child birth. Access and knowledge to family planning is overlooked as traditional practices are used first. As Julie explains, advocating about family planning is a challenge in the area, also for language barriers. “Talking about birth-spacing and talking in the regional dialect of Tanna is a problem. Most of us in Vanuatu speak Bislama, but people here in Tanna aren’t well versed with it. However, we try our level best with all possible methods including sign language and demos to impart knowledge about family planning.” Family planning services are just a part of the IPPF-SPRINT Cyclone Pam response, that also included general health check-up, counselling and awareness about Sexual and Gender Based Violence, maternal care and awareness and prevention of HIV and Sexually Transmitted Infections (STI).