Stories

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.

"I feel satisfied as a service provider and as a member of the outreach team." Shodunke Mary, 53, has been a midwife from the Local Government Area Council for seven years. Now she is working with PPFN providing family planning counselling and a range of integrated sexual and reproductive health services. In addition, Mary also conducts on the job training to other facilities which are providing services for the PPFN model. "The model used by PPFN is successful because the services we provide are free for those in need, the providers are motivated and the community leaders are also involved in the implementation. Also, the commodities and equipment are always available." As seen above, Mary administers an implant to Bukola Akami, who has one baby. The number of new contraceptive users has dramatically increased by 400,000 in less than a year as a result of PPFN's outreach and service delivery. Yetunde, 26, like Bukola, is a client with a young baby and was also seeking family planning. She says: "I don't want to have another baby in the next three years. I have a lot of things I want to do and I want to have time to take care of my children. My baby is really affecting my work and I always have to leave her with my mother-in-law. I will be recommending PPFN's family planning to my friends so they can also know what to do when they don't want to get pregnant again." The team Read more about the team behind Nigeria's amazing success

"As a child I loved the medical profession so much. I always wanted to go with my aunt to the hospital for her antenatal check-ups. The neat and well-tailored uniform of the health workers always caught my eyes. And I knew one day, I would be wearing one of those uniforms serving my community.” Latifat Balogun explains how her childhood experiences led her to decide to train and work as a Community Health Extension Worker with the Planned Parenthood Federation of Nigeria (PPFN), where she has worked for 20 years. She plays an integral part in delivering a wide range of services to women in her community. Here she is about to treat Zainab Akinsola, 52-years-old, who is waiting to have cervical cancer screening during a PPFN outreach programme at the Eni Ayo clinic in Ibadan, South West Nigeria. As a result of the strong integrated service delivery, non-contraceptive services increased from 42,700 in 2014 to 226,000 in 2015. Latifat's colleague, Adeyinka, is a faith-based health worker who encouraged a friend to undergo cervical cancer screening. "I counselled her and she went for screening, not knowing that she was going to test positive. If it wasn't for PPFN she might have died of cancer. I so nearly lost a friend. So I cannot forget that day. But now my friend is bouncing up and down, so excited about the project! During our last outreach she brought so many people."   The team Read more about the team behind Nigeria's amazing success

"How do I feel about my role? I'm excited!" Emiade Kudirat, 24, is a Community Health Extension Worker doing outreach with the Planned Parenthood Federation of Nigeria (PPFN) for the last 18 months. She specializes in the Sayana Press - a three-month, progestin-only injectable contraceptive favoured for its convenience in administration and portability. "I go from house-to-house to provide health education and introduce family planning services. I do counselling and provision of these services too. The PPFN model can really reduce the mortality rate of women in the community. We're taking the clinic to women at the market, to their homes and to their work." One patient, 24-year-old Bukola Polpoola, says she is happy that her treatment was free and easy. "In my village we don’t have any information about this. At first I was afraid it would stop me from getting pregnant again. I’d heard stories of side effects. I’m a nurse and even I began to wonder about it. But I called the clinic and they counselled me and reassured me.” She talked to her partner before she decided to get an implant. Now, she says, she’d recommend it to anyone. "I would be happy to spread the word in my village. Taking this will help you plan your life. For example, you know that for the next two years you can’t get pregnant and you’ll be able to plan your life properly because an unwanted pregnancy can stop you from getting an education or a job. This removes that fear for a time."   The team Read more about the team behind Nigeria's amazing success

"I find this work very interesting. I love to interact with the women in the markets. And I get to work all day with my 10-month-old baby, Bejide, with me!" Olusula, 40, is a Community Health Extension Worker, conducting outreach for the Planned Parenthood Federation of Nigeria (PPFN). In 2014, PPFN received a one year grant from the Bill & Melinda Gates Foundation through IPPF. The purpose of the grant was to expand family planning and reproductive health services. PPFN used this grant to improve on its current model of service delivery known as the Cluster model. PPFN piloted a successful project over 9 months around family planning. This project exceeded targets significantly and has the potential to be rolled out in Nigeria and other countries. "I refer clients through vouchers to the facility of their choice for long acting and reversible contraceptive methods too", explains Olusula. She works closely with her local community providing information and choice about contraceptive methods. Women and men are able to make informed decisions that ensure suitability to them and their circumstances. Choice promotes convenience and acceptability. "This PPFN outreach and service model will reduce a lot of abortions in our community. It also encourages women to space their children and lets them do the other things they want."   The team Read more about the team behind Nigeria's amazing success

"We capture the data directly into this app. It maps out what the demand will be and ensures that we never run out of those supplies.” Monitoring and evaluation officer, Babatunde, is responsible for ensuring the supply of contraceptives for all the cluster facilities. "My job entails the use of a mobile app built for direct data information capture (DDIC). I created an account for each of the 10 facilities that were under the Clusterplus Model. Before I stock up their store, I audit their supplies and can review their monthly report via the app. I put this into the mobile app as well as the commodities I have supplied them. Every two months, the app will forecast what a particular facility will need based on the contraceptive demand.” "I provided training on the mobile app for the store keepers at the facilities we worked with. All through the nine months of the Clusterplus Project, no facility ever ran out. This meant family planning methods were always available to those that needed them.” Babatunde has developed a wealth of knowledge about family planning and the many methods available. Clients favour long-acting methods Implanol and the IUCD. Two of Babatunde's colleagues Afolabi and Olufemi tell us they have both had some very memorable experiences during their careers as Community Health Extension Workers. Afolabi, 32, says the crux of her work is in breaking down the meaning of family planning to rural communities. "I discovered lots of misconception and misinformation, fears and rumors about family planning. But my job is to educate them on the benefits of family planning and allay their fears. We keep educating them and breaking down the 'walls' they have built around family planning methods, like the false thinking that implants require an operation." "I so much look forward to the outreach sessions. It is a time to help women make better choices that will help them plan for their family and future. The fact that the family planning method is administered free has contributed to its high level of acceptance by the people." "In some of our communities, the people are so poor that they can't feed themselves properly. Let alone to have money for family planning. Poverty is real and not planning your family, escalates the challenges of having a poor quality of life. No money should mean fewer children. But the reverse is the case and poverty goes together with low level of education." Olufemi agrees. "I counselled a woman who I thought was 50-years-old. But I was surprised to find out she was just 29-years-old and had 12 children. The burden and labour of delivering 12 children could be seen all over her". "It was a pathetic case for me. I imagined, how can a 29-year-old have 12 children? We spoke about the different family planning methods available. She decided to have a long term method that will last for five years. "Months later, she called me to thank me. I was so happy knowing that she appreciated it. Because I wondered, how will she raise all those children without a good livelihood? I was glad to have contributed to helping her plan her family." The team Read more about the team behind Nigeria's amazing success

"We saw changes, broke barriers, removed myths. My joy will be to see this approach rolled out across the country. I am to be helping and empowering women in our rural communities to make informed choices about their health." Ambibola is a programme officer for IPPF's Member Association in Nigeria, working on the ambitious Cluster Plus model. “The project was a one-stop shop which brought services together. So a woman could have screening for breast and cervical cancer, counselling and have access to all methods of family planning at the same place. Also if a woman was detected with early stage of cervical cancer, we were able to carry out a curative operation." "Our success is due to our grassroots approach. We asked the communities to nominate the community health workers they would like to work with. These workers go into the community to counsel people about their health issues. This gave the communities a sense of ownership and kept them fully engaged.” "We also held meetings with traditional and religious leaders who then went into the community to tell people about our projects. Now many private centres want to adopt our approach. In these communities the rate of teenage and unwanted pregnancies has gone down, maternal and abortion mortality has also been cut. We were able to take family planning to the doorsteps of the women in our rural communities the ones who needed family planning but couldn't afford it."   The team Read more about the team behind Nigeria's amazing success