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Love wins! The fight for marriage equality has seen incredible progress worldwide, with a recent surge in legalizations. Across the world, 36 out of 195 countries have legalized equal marriage: Andorra, Argentina, Australia, Austria, Belgium, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Denmark, Ecuador, Estonia, Finland, France, Germany, Greece, Iceland, Ireland, Luxembourg, Malta, Mexico, the Netherlands, New Zealand, Norway, Portugal, Slovenia, South Africa, Spain, Sweden, Switzerland, Taiwan, the United Kingdom, the United States of America and Uruguay. In 2023, three new countries legalized same-sex marriage (Andorra, Estonia and Slovenia), and three more solidified legislative progress towards decriminalizing same-sex unions: a Japanese court ruled it is unconstitutional for the nation not to legally recognize same-sex unions. And the Supreme Courts of Nepal and Namibia recognized marriages of same-sex couples registered abroad. So marriage equality marches on! Already in 2024, two more countries have said "I do" to equal rights.   According to the Human Rights Campaign Foundation, even more countries could legalize equal marriage in 2024. In particular, the Czech Republic, India, Japan, Nepal and Philippines show signs of growing support for marriage equality. The fight for marriage equality isn't over, but the momentum is undeniable. IPPF stands with those working to make love win everywhere.

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.”

Meseret* and Melat*, volunteers Known in their local community as demand creators, Meseret and Melat, from the Family Guidance Association of Ethiopia’s (FGAE) confidential clinic head out to visit sex workers in Jimma town. This group of volunteers are former, or current, sex workers teaching others how to protect themselves from sexually transmitted infections (STIs) and unintended pregnancy. Their work is challenging, and they travel in pairs for safety - their messages are not always welcome. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Meseret* and Melat*, volunteers Meseret and Melat from the Jimma clinic talk to sex workers in their local community about sexual health concerns, as well as provide contraception. “It’s very difficult to convince sex workers to come to the clinic. Some sex workers tend to have no knowledge, even about how to use a condom.” says Meseret. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Melat, volunteer It can be challenging persuading women that the staff at the confidential clinic are friendly towards sex workers and will keep their information private. “When we try to tell people about HIV we can be insulted and told: ‘You are just working for yourself and earn money if you bring us in.’ They sometimes throw stones and sticks at us,” said 25-year-old Melat. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Fantaye, sex worker Getting information and contraception to women often involves going out to find them, such as Fantaye, a sex worker currently living in a rental space in Mekelle. Peer educators focus on areas populated with hotels and bars and broker's houses, where sex workers find clients. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sister Mahader, FGAE Sister Mahader from FGAEs' youth centre talks to sex workers in Mekelle, about sexual health, wellbeing, and various methods of contraception. This outreach takes place weekly where information and advice is given to groups of women, and contraception is provided free of charge. Under threat from the loss of funding from the US Administration, the Jimma clinic has been forced to reduce the range of commodities available to its clients such as sanitary products, soap and water purification tablets. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Hiwot Abera*, sex worker Hiwot* after her appointment at FGAEs confidential clinic in Jimma. The clinic offers free and bespoke healthcare including HIV and STI testing, treatment and counselling, contraceptives and safe abortion care. Many sex workers have experienced stigma and discrimination at other clinics. In contrast, ensuring confidentiality and a safe environment for the women to talk openly is at the heart of FGAEs’ healthcare provision at its clinics.*pseudonymPhotos: ©IPPF/Zacharias Abubeker Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Emebet Bekele is a former sex worker turned counsellor, who works at the Family Guidance Association of Ethiopia (FGAE) run, confidential clinic in Jimma, Oromia. The clinic was set up in 2014 to help at-risk and underserved populations such as sex workers. The clinic provides free and bespoke services that include HIV and STI testing, treatment and counselling, contraceptives and comprehensive abortion care.  Counselling sex workers In her new role, Emebet counsels others about HIV and treatment with anti-retroviral drugs, follows up with them and monitors their treatment. Emebet tries to be a role model for other girls and women who are sex workers to adopt a healthier lifestyle “The nature of the sex work business is very mobile, and they often go to other places when the coffee harvest is good, so I tell them about referrals and take their phone numbers so I can keep counselling them”. “The difficult thing is sex workers using alcohol and drugs with ARVs [anti-retrovirals], which is not good and also means that they forget to take their medication. The best thing is that I know and understand them because I passed through that life. I know where they live so I can call them and drop medicine at their homes.” Bekele regularly tests sex workers and every month, “a minimum of five out of a hundred, maximum ten” test positive for HIV.  An increase in HIV cases Over the last five years, her reports show an increase in the number of HIV cases due to more sex workers coming in or changing clinics to attend the confidential clinic. Partly because the staff are friendly towards sex workers, who often report facing stigma in other public hospitals or being turned away when staff hear what they do. At the confidential clinic, people can walk-in any time, which better suits the sex worker lifestyle, but crucially, the service is confidential. “The ARV clinics in government hospitals are separate so everyone knows you have HIV. Also, people will see others crying and say that they have HIV,” says Bekele. A shared experience  “I used to be a sex worker, so I have a shared experience with them. When I came to this clinic I taught people about this place and the services and I counsel and train them. I didn’t have any knowledge about sex work so I also got infected. When I got knowledge, I decided I wanted to do something to help others.” “Sometimes clients add extra money for sex without condoms and sometimes sex workers have been drinking and don’t notice their clients have not used condoms. To have sex using a condom usually costs about 300 Ethiopian Birr [roughly USD 7] but it can go as low as 50 Birr [USD 1.20] or 20 Birr [USD 0.50], whereas sex without using a condom costs 200 to 300 Birr more or even up to 1000 Birr [USD 24].” When Bekele was a sex worker, she would take home about 7,000 to 8,000 Birr per month [roughly USD 170 to 190], after paying job-related expenses such as hotels, as well as for substances like alcohol to get through it. As a counsellor, she now gets 2,000 Birr to cover her travel costs.  “I have already stopped and I’m now a model for these girls. I have financial problems but life is much more than money.” “I see girls aged 10, 13 and 15 who live on the streets and take drugs. Sometimes we bring them from the streets and test them. Most of them are pregnant and I help them.” “This project is useful for our country because there aren’t any others helping sex workers and if there are ways to help them, we save many lives and young people. If you teach one sex worker, you teach everyone, from government to university staff and anyone who goes to see them, so I save many lives doing this job.”

In August 2017, weeks of continued and heavy rainfall across Nepal resulted in flash floods and landslides that affected 36 of the 75 districts. Many people lost their homes or were displaced. It was estimated that of those affected, 112,500 were women of reproductive age, including 8,694 pregnant women.  IPPF Humanitarian, through their Member Association, The Family Planning Association of Nepal (FPAN), activated its emergency response system early on. With funding support from the Australian Government, FPAN and IPPF Humanitarian initially mobilised their response in four of the worst affected districts (Sunsari, Saptari, Bardiya, and Dang). Mobile medical camps were established to meet the sexual and reproductive health needs of the affected population, including through the distribution of short and long acting methods of contraception, STI and HIV screening, and GBV referrals. In collaboration with the USAID-SIFPO project, services were then expanded into five more affected districts. IPPF Humanitarian spoke with 21-year old Muna in her home district of Sunsari in Nepal.  “I got married at 16 years old and have two children, a four-year-old girl and two-year-old boy.  In my caste, we get married early, so my parents took me to get an arranged marriage. I was in the 8th class at the time, and returned to school after I got married, but only lasted one year.  My husband works in construction and had to stop working for two weeks when the floods came. When he doesn’t work, he doesn’t get paid, so it’s been very difficult.  A FPAN social worker told me about the mobile medical camp today. I used to be on the three-month injectable but today I changed to the five-year implant in my arm.  When my youngest child was eight months old I found out I was pregnant again. I decided to discontinue that pregnancy, so I took the five small tablets given to me by my neighbourhood doctor. I was two months pregnant at the time.  From this, I had two days bleeding and cramp like pain, and then weakness. I decided to abort that pregnancy because my youngest will still only eight months old, and I didn’t want any more children.  If I had more than two children, it would be very difficult to feed and educate them, and would badly affect my body too. I’m so happy I now don’t have to worry about contraception for another five years.” Want to know more about safe abortion access? Join IPPF'S I Decide movement

Milan Khadka was just ten years old when he lost both his parents to HIV. “When I lost my parents, I used to feel so alone, like I didn’t have anyone in the world,” he says. “Whenever I saw other children getting love from others, I used to feel that I also might get that kind of love if I hadn’t lost my parents.” Like thousands of Nepali children, Milan’s parents left Nepal for India in search of work. Milan grew up in India until he was ten, when his mother died of AIDS-related causes. The family then returned to Nepal, but just eight months later, his father also died, and Milan was left in the care of his grandmother. “After I lost my parents, I went for VCT [voluntary counselling and testing] to check if I had HIV in my body,” Milan says. “After I was diagnosed as HIV positive, slowly all the people in the area found out about my status and there was so much discrimination. My friends at school didn’t want to sit with me and they humiliated and bullied me,” he says. “At home, I had a separate sleeping area and sleeping materials, separate dishes and a separate comb for my hair. I had to sleep alone.” Things began to improve for Milan when he met a local woman called Lakshmi Kunwar. After discovering she was HIV-positive, Lakshmi had dedicated her life to helping people living with HIV in Palpa, working as a community home-based care mobiliser for the Family Planning Association of Nepal (FPAN) and other organisations. Struck by the plight of this small, orphaned boy, Lakshmi spoke to Milan’s family and teachers, who in turn spoke to his school mates. “After she spoke to my teachers, they started to support me,” Milan says. “And after getting information about HIV, my school friends started to like me and share things with me. And they said: ‘Milan has no one in this world, so we are the ones who must be with him. Who knows that what happened to him might not happen to us?” Lakshmi mentored him through school and college, encouraging him in his schoolwork. “Lakshmi is more than my mother,” he says. “My mother only gave birth to me but Lakshmi has looked after me all this time. Even if my mother was alive today, she might not do all the things for me that Lakshmi has done.” Milan went on to become a grade A student, regularly coming top of his class and leaving school with flying colours. Today, twenty-one-year-old Milan lives a busy and fulfilling life, juggling his college studies, his work as a community home-based care (CHBC) mobiliser for FPAN and a burgeoning music career. When not studying for a Bachelor’s of education at university in Tansen, he works as a CHBC mobiliser for FPAN, visiting villages in the area to raise awareness about how to prevent and treat HIV, and to distribute contraception. He also offers support to children living with HIV, explaining to them how he lost his parents and faced discrimination but now leads a happy and successful life. “There are 40 children in this area living with HIV,” he says. “I talk to them, collect information from them and help them get the support they need. And I tell them: ‘If I had given up at that time, I would not be like this now. So you also shouldn’t give up, and you have to live your life.” Watch Milan's story below:      

“Family Planning Association of Nepal is playing a crucial role in protecting the rights of female sex workers in the whole of Nepal” says Jamuna Sitvla, senior programme officer at Family Planning Association of Nepal (FPAN). There are around 40,000 sex workers in Nepal. Around 1,300 are infected with HIV. FPAN is working to increase awareness among sex workers to practice safe sex and to use condoms to protect from HIV. "One challenge is that when female sex workers carry condoms, if the police find the condoms, they criminalise the women. Some of the sex workers have been organised via different organisations in order to protect their rights. Now the Supreme Court has given an a ruling that policemen have to ensure the sexual rights of female sex workers have to be addressed. This decision includes that women can carry condoms: that is their right. The second decision is that sex workers have the right to organise. Some sex workers are afraid of asking heir clients to wear condoms and this increases their risk of contracting HIV but the more confident sex workers are ensuring that their clients wear condoms". "In 2017 there was a huge conference held at FPAN, with sex workers invited as panelists. People had the opportunity to understand the problems they were facing. One of FPAN’s great successes was to invite the criminal department of police, policy makers and sex workers to come under one roof. We gathered them in the FPAN venue and they made a commitment that from now on the female sex workers will be treated with respect, with dignity, will not be criminalised."   Stories Read more stories about our work with people living with HIV

Lakshmi Kunwar married young, at the age of 17. Shortly afterwards, Lakshmi’s husband, who worked as a migrant labourer in India, was diagnosed with HIV and died. “At that time, I was completely unaware of HIV,” Lakshmi says. “My husband had information that if someone is diagnosed with HIV, they will die very soon. So after he was diagnosed, he didn’t eat anything and he became very ill and after six months he died. He gave up.” Lakshmi contracted HIV too, and the early years of living with it were arduous. “It was a huge burden,” she says. “I didn’t want to eat anything so I ate very little. My weight at the time was 44 kilograms. I had different infections in my skin and allergies in her body. It was really a difficult time for me. … I was just waiting for my death. I got support from my home and in-laws but my neighbours started to discriminate against me – like they said HIV may transfer via different insects and parasites like lice.” Dedicating her life to help others Lakshmi’s life began to improve when she came across an organisation in Palpa that offered support to people living with HIV (PLHIV). “They told me that there is medicine for PLHIV which will prolong our lives,” she explains. “They took me to Kathmandu, where I got training and information on HIV and I started taking ARVs [antiretroviral drugs].” In Kathmandu Lakshmi decided that she would dedicate the rest of her life to supporting people living with HIV. “I made a plan that I would come back home [to Palpa], disclose my status and then do social work with other people living with HIV, so that they too may have hope to live. I said to myself: I will live and I will let others living with HIV live”. Stories Read more stories about our work with people living with HIV