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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.” 

“I've heard kids yelling on the street that there was a program to space pregnancies. I've always wanted to do that for the long term. Until then, I'm still trying with the three-month-old pills. Besides, listening to one of the people advertising these services, the address was not very far from my home." Claudine, aged 27, is a sex worker. "In the past, I was wary of 'contraceptive' methods. But once I tried them and I didn't notice any negative impact on my body, I made it a habit in order to not get pregnant". Like all young girls interested in the Women’s Integrated Sexual Health (Lot 1) programme services, Claudine arrives shyly at the center where Association pour le Bien-Etre Familial-Naissances Désirables (ABEF-ND) distributes contraceptive methods. "When I arrived at the center, I thought that there would be no paperwork to do, but I was pleasantly surprised that the organizers want to find out about me and maybe one day they will be able to set up a health centre to follow us regularly," she hopes. In the DRC, few women raise the subject of sexual violence because they are afraid of being rejected and that "poverty sometimes leads us into sex work," she says. "But the consequences are enormous and sometimes harmful. Girls who are not sensitized will have unsafe abortions and catch sexually transmitted infections." Claudine has expectations and hopes regarding this kind of activity: "However, if awareness-raising is regulated, even every three months, we will, I think, have fewer young mothers because they will be more knowledgable about family planning". The WISH project has seen a positive change in women and girls' access to integrated family planning and sexual and reproductive health care. WISH promotes a variety of contraceptive methods and sexual and reproductive health support, ranging from referrals to services for those who need it most.   "I want to feel free in my sexual activities". I have a boyfriend but that doesn't stop me from doing my life. "I make my livelihood as a sex worker and he is a carpenter. That's how we've been trying to make ends meet since we moved to the capital two years ago." "We're going back to the village to take a break, it's not a permanent departure." Claudine and her boyfriend are both from Boende, the capital of the Tshuapa province, in the north-west of the country, 2,285 km from Kinshasa. She was encouraged to move to the capital at the insistence of one of her uncles who had been living there for several years. "The reality is quite different. We have been able to raise enough money to send goods to the village for the past two years. My companion and I will go back there to rest and maybe come back if we get bored in the village again.” “Pakadjuma is a place where almost everyone comes from the village, but it is only here that I see enough interest from associations to sensitize young girls on family planning by distributing condoms to prevent early pregnancies and sexually transmitted diseases. It's all very interesting. It's an opportunity for us and I think it's one of the things I'll miss the most when I go back to the village. I hope to still have friends here who can send me these methods.”

After her parents divorced, the family dissolved and Ruth found herself in Pakadjuma where she rented a small house. "My boyfriend helps me pay the rent," she says. She thought she would continue with school but could not afford it. After a few years of a relationship, Ruth became pregnant, and explain that "it was late to get an abortion, and I didn't want to put my life in danger." "I would have liked to get my bachelor's degree, but I don't regret it; I loved my child right away." Ruth, aged 19, like other young girls, queues up to learn about the different contraceptive methods the WISH programme offers for girls and women living in Pakadjuma. Some of them sign up directly to take them. Others find out and promise to come back after talking with their companions. The Women’s Integrated Sexual Health (WISH Lot 1) programme offers quality integrated sexual and reproductive health services across the Democratic Republic of Congo through IPPF Member, Association pour le Bien-Etre Familial – Naissances Désirables (ABEF-ND). Ruth is trying the service for the first time. She is in favour of receiving a contraceptive method for the next three months. "Some people have discouraged me because they believe that the 5-year method can destroy the body. But before deciding to come here, I asked around with the neighbours who have already tried it. I didn't have any negative experiences." Ruth asked the organizers about the consequences: "They said it's just to protect me so that I don't get pregnant for 3 months and then I can renew if I feel like it.” Ruth feels that many parents do not discuss sexual matters with their children. They probably feel it is inappropriate. Yet, if young girls get pregnant before they are socially stable, it is also due to a lack of guidance and orientation. "This should be a regular initiative," she says. "It's not late to receive sex education but above all to have free contraceptive methods, because I would have preferred a thousand times to buy milk for my baby than to pay for a condom or a Jadelle. Ruth has an 8-month-old baby, "I didn't want this and having many children will be disadvantageous for me especially as I am not yet married". She lives from small businesses and the money to support from her companion. Ruth says she took this contraceptive method without her partner's advice. "Since the birth of our child, we have been abstinent, and that's good. "He encourages me to go back to school, and I think that's what I should do.”

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).