Stories

Fiona, 28, joined the Jamaica Family Planning Association (FAMPLAN) Lenworth Jacobs Clinic in 2017 as a volunteer through a one-year internship with the Jamaica Social Investment Fund.  “I was placed to be a youth officer, which I never had any knowledge of. Upon getting the role I knew there would be challenges. I was not happy. I wanted a place in the food and beverage industry. I thought to myself, ‘what am I doing here? This has nothing to do with my qualifications’. It was baby mother business at clinic, and I can’t manage the drama,” Fiona says.  Embracing an unexpected opportunity   Fiona’s perception of FAMPLAN quickly changed when she was introduced to its Youth Advocacy Movement (YAM) and began recruiting members from her own community to join.  “I quickly learnt new skills such as social media marketing, logistics skills and administrative skills. In fact, the only thing I can’t do is administer the vaccines. They have provided me with a lot of training here. Right now, I have a Provider Initiative Training and Counselling certificate. I am an HIV tester and counsellor. I volunteer at health fairs and special functions. I will leave here better than I came.”  Working with vulnerable communities   The Lenworth Jacobs Clinic is located in tough neighbourhood in Downtown, Kingston. Fiona says there is vital work to be done, and youth are the vanguards for change.  “It’s a volatile area so some clients you have to take a deep breath to deal with them as humans. I am no stranger to the ghetto. I grew up there. The young people will come, and they’ll talk openly about sex. They’ll mention multiple partners. You have to tell them choose two [barrier and hormonal contraception] to be safe, you encourage them to protect themselves,” she says.  Other challenges that young people face include sexual grooming, teenage pregnancy, and violation of their sexual rights.  “Sometimes men may lurk after them. There is sexual grooming where men feel entitled to their bodies. A lot are just having sex. They don’t know the consequences or the sickness and potential diseases that can come as a result of unprotected sex. Many don’t know there are options - contraceptives. Some don’t know the dangers of multiple sex partners. The challenges are their lifestyle, poverty level, environment, and sex is often transactional to deal with economic struggles,” Fiona explains.  Providing a safe space to young communities   Despite these challenges YAM has provided a safe space for many young people to discuss issues like sexual consent, sexual health and rights, sexuality and provide them with accurate information access to FAMPLAN’s healthcare.  But there remains a need for more youth volunteers, and adults, to support FAMPLAN’s work.   “We need more young people, and we definitely need an adult group. Teens can carry the message, but you’re likely to hear parents say, ‘I’ve been through it already’ and not listen. They also need the education YAMs have access to, so they can deal with their children, grandchildren and educate them about sexual and reproductive health rights. For my first community intervention a lot of kids came out and had questions to ask. Questions that needed answers. I had to get my colleagues to come and answer,” Fiona says.  YAM’s impact goes beyond sexual and reproductive health, as the group has supported many young people on issues of self-harm and depression.  “There’s a lot going through these teenagers’ minds. Through YAM I have developed relationships and become their confidante, so they can call me for anything. The movement is impacting. It helped me with my life and now I can pass it down. YAM can go a far way with the right persons. Whatever we do we do it with fun and education – edutainment.” 

‘Are you interested in advocacy and reproductive health rights?’ These were the words which caught Mario’s attention and prompted him to sign up to be part of the Jamaica Family Planning Association (FAMPLAN) Youth Advocacy Movement (YAM) five years ago. At the time, Mario was 22 and looking for opportunities to gain experience after graduating from college.  From graduate to advocate   “I was on Facebook looking at different things young people can do, and it popped up. I had just left college with an Associate Degree in Hospitality and Tourism Management. I was unemployed and I just wanted to be active, give myself the opportunity to learn and find something I can give my time to and gain from it,” Mario says.  Interested in volunteering and advocacy Mario joined the YAM to get a new experience and broaden his knowledge base. He says he has gained a second family and a safe space; he can call home.  “It’s so much more than sex and condoms. It’s really human rights and integrated in everything we do. Reproductive health affects the population, it affects your income, your family planning, how people have access to rights. It’s cuts across men, women, LGBT people and encompasses everything. My love for working with YAM and being an advocate for sexual and reproductive health rights deepened and I could expand further in my outreach.”  His work with YAM has equipped Mario with skills and given him opportunities he would otherwise not have.  “I have done public speaking which has opened lots of doors for me. I have travelled and met with other Caribbean people about issues [around sexual and reproductive health]. There’s an appreciation for diversity as you deal with lots of people when you go out into communities, so you learn to break down walls and you learn how to communicate with different people.”   Challenging the reluctance to talk about sex   The greatest challenges he faces are people’s reluctance to talk about sex, accessing healthcare, and misinformation.  “Once they hear sex it’s kind of a behind the door situation with everybody, but they are interested in getting condoms. When it comes to that it is breaking taboo in people’s minds and it might not be something people readily accept at the time. LGBT rights, access to condoms and access to reproductive health for young people at a certain age — many people don’t appreciate those things in Jamaica.”  Mario talks about giving youth individual rights to access healthcare. “So, can they go to a doctor, nurse without worrying if they are old enough or if the doctor or nurse will talk back to the parents? Access is about giving them the knowledge and empowering them to go for what they need.”  “The stigma is the misinformation. If you’re going to the clinic people automatically assume, you’re doing an HIV/AIDS test or getting an abortion. [So] after the community empowerment, because of the stigma maybe 15 per cent will respond and come to the clinic. The biggest issue is misinformation,” Mario says, adding that diversification of the content and how messages are shaped could possibly help.  To address these issues, he wants to see more young people involved in advocacy and helping to push FAMPLAN’s messages in a diversified way.  “It is a satisfying thing to do both for your own self development and community development. You’re building a network. If you put yourself out there you don’t know what can happen.”  

Candice, 18, joined the Youth Advocacy Movement (YAM) when she was 15 after being introduced to the group by the Jamaica Family Planning Association’s (FAMPLAN) youth officer, Fiona.  Sharing knowledge with peers   Initially, Candice, saw YAM as a space where she could learn about sexual and reproductive health and rights (SRHR) as there was no information available elsewhere. Candice uses her knowledge and involvement with YAM to educate her peers about their sexual health and rights with hopes that they make informed choices if they choose to engage in sex.  “I’ve seen teenagers get pregnant and it’s based off them never knowing routes they could take to prevent pregnancies. I figured I could play a role by learning it for myself, applying it to myself as well as talk to those around me to somewhat enlighten them about sexual and reproductive health. I just wanted to be able to learn for myself and pass on the knowledge.”  Making positive changes   Candice believes that sexual and reproductive health and rights are not limited to sex, but also about being empowered to make positive changes and choices. Candice has worked with the youth group to use her voice for the voiceless and make a change.  “Seeing young girls divert to wanting more and because their parents were not able to provide, they turn to men. Also, I saw undue pressure being placed on girls to not have sex and that pressure unfortunately caused them to develop creative ways to go out and it so ends up that they were left with an unwanted pregnancy. I was learning not only for myself, but to spread the word.  I learnt I needed to immerse myself in order to be an effective advocate.”  Through her advocacy work, Candice has been to health fairs and spoken to her peers and adults about their sexual and reproductive health and rights. The impact has been positive.  “In my circle I’ve seen people become more aware and more careful. In my teaching, my friends are inspired to join so I am looking to recruit soon,” she said.  Breaking down barriers to contraception use  Candice has faced a number of obstacles, especially around the reservations her peers have to practicing safer sex.  “You can only educate someone, but you can’t force them to do what you’re promoting. You will have different people asking and you explain to them and show them different ways to approach stuff and they will outright be like ‘OK, I am still going to do my thing. This is how I am used to my thing’. So, they accept the information, but are they practicing the information? People are open minded, but it’s just for them to put the open mindedness into action.”  Candice says there are parents who are not open to discussing these issues with their children and it subsequently makes the work more challenging and prohibits access to safer practices and choices.  She believes it would be beneficial for parents to take a more active role in advocating healthy choices. She would also like to see more sexual and reproductive health and rights sessions delivered in schools.  “Implement classes in school that are more detailed than what exists. The current lessons are basic and the most compact you’ll learn is the menstrual cycle. You’re learning enough to do your exam, not apply to real life. If this is in schools, the doctors and clinics may be more open to the reality that younger people are engaging in sex. To prevent unplanned pregnancies be more open.”   “YAM has good intentions. These good intentions are definitely beneficial to the target audience. With more empowerment in the initiative we can move forward and complete the goal on a larger scale.” 

Dr McKoy has committed his life to ensuring equality of healthcare provision for women and men at the Jamaica Family Planning Association (FAMPLAN).  Expanding contraceptive choice   Returning to Jamaica from his overseas medical studies in the 1980s, Dr McKoy was frustrated and concerned at the failure of many Jamaican males to use contraception.  This led him to making a strong case to integrate male sterilization as part of FAMPLAN’s contraceptive care package. Whilst the initial response from local males was disheartening, Dr McKoy took the grassroots approach to get the buy-in of males to consider contraception use.  “Someone once said it’s only by varied reiteration that unfamiliar truths can be introduced to reluctant minds. We used to go out into the countryside and give talks. In those times I came down heavily on men.”   Overcoming these barriers, was the catalyst he needed to ensure that men accessed and benefitted from health and contraceptive care. Men were starting to choose vasectomies if they already had children and had no plans for more.  Encouraging uptake of male healthcare  Dr McKoy was an instrumental voice in the Men’s Clinic that was run by FAMPLAN, encouraging the inclusion of women at the meetings, in order to increase male participation and uptake of healthcare.  “When we as men get sick with our prostate it is women who are going to look after us. But we have to put interest in our own self to offset it before it puts us in that situation where we can’t help yourself. It came down to that and the males eventually started coming. The health education got out and men started being more confident in the health services.”  Health and wellbeing are vital   McKoy advocates the importance of women taking their sexual health seriously and accessing contraceptive care. If neglected, Dr McKoy says it could be a matter of life death.  He recalls a story of a young mother who was complacent towards cervical screenings and sadly died from cervical cancer - a death he says which could have been prevented.  “Over the years I saw the opportunity to do cervical screenings at the clinic. The mobile unit gave us access to so many patients. We had persons who neglected to do it. One patient in particular - she was not yet 30 years old. She had three children and after every delivery she was told by the hospital to get a cervical screening. She didn’t do it and eventually got cervical cancer. When she was to do the cervical screening, she didn’t come. One morning they brought her and had to lift her up out of the car. At that time doctors said they couldn’t do anything for her. It wasn’t necessary. So, we had to go out more to meet people, educate them teach them the importance of sexual and reproductive health.”  That experience was his driving force to continue the work in providing sexual and reproductive healthcare and information through community outreach. 

Cultural barriers and stigma have threatened the work of the Jamaica Family Planning Association (FAMPLAN), but according to one senior healthcare provider at the Beth Jacobs Clinic in St Ann, Jamaica things have taken a positive turn, though some myths around contraceptive care seem to prevail.  Committed to changing perceptions and attitudes   Midwife, Dorothy, is head of maternal and child and sexual and reproductive healthcare at the Beth Jacobs Clinic and first began working with FAMPLAN in 1973.    She says the organization has made its mark and reduced barriers and stigmatizing behaviour towards sexual health and contraceptive care. Cultural barriers were once often seen in families not equipped with basic knowledge about sexual health.  “I remember some time ago a lady beat her daughter the first time she had her period as she believed the only way, she could see her period, is if a man had gone there [if the child was sexually active]. I had to send for her [mother] and have a session with both her and the child as to how a period works. She apologized to her daughter and said she was sorry. She never had the knowledge and she was happy for places like these where she could come and learn – both parent and child.”   Working with religious groups to overcome stigma   Religious groups once perpetuated stigma, so much so that women feared even walking near the FAMPLAN property.  “Church women would hide and come, tell their husbands, partners or friend they are going to the doctor as they have a pain in their foot, which nuh guh suh [was not true]. Every minute you would see them looking to see if any church brother or sister came on the premises to see them as they would go back and tell the Minister because they don’t support family planning. But that was in the 90s.”  Dorothy says that this has changed, and the church now participates in training sessions sexual healthcare and contraceptive choice, encouraging members to be informed about their wellbeing and reproductive rights.  Navigating prevailing myths   Yet despite the wealth of information and forward thinking of the communities the Beth Jacobs Clinic reaches, Dorothy says there are some prevailing myths, which if left unaddressed threaten to repeal the work of FAMPLAN.  “Information sharing is important, and we try to have brochures on STIs, and issues around sexual and reproductive health and rights. But there are people who still believe sex with a virgin cures’ HIV, plus there are myths around contraceptive use too. We encourage reading. Back in the 70s, 80s, 90s we had a good library where we encouraged people to read, get books, get brochures. That is not so much now,” Dorothy says.  Another challenge is ensuring women are consistent with accessing healthcare and contraception. “I saw a lady in the market who told me from the last day I did her pap smear she hasn’t done another one. That was five years ago. I had one recently - no pap smear for 14 years. I delivered her last child,” she says.  Despite these challenges Dorothy remains dedicated and committed to her community knowing her work helps to improve women’s lives through choice. She is confident that the Mobile Unit with community-based distributors will be reintegrated into FAMPLAN healthcare delivery so that they can reach remote communities.  “FAMPLAN has made its mark. It will never leave Jamaica or die.” 

Christan, 26, is committed to helping develop young people to become confident advocates for change.  Christan is the executive assistant at the FAMPLAN Lenworth Jacobs Clinic. Her work overlaps with that of the Youth Action Movement (YAM), helping to foster the transitioning and development of youth into meaningful adults.  Harnessing change through young advocates   “FAMPLAN provides the space or capacity for young persons who they engage on a regular basis to grow — whether through outreach, rap sessions, educational sessions. The organization provides them with an opportunity to grow and build their capacity as it relates to advocating for sexual and reproductive health and rights amongst their other peers,” she said.  Though she has passed on her youth officer baton, Christan, remains connected to YAM and ensures she leads by example. “When you have young adults, who are part of the organization, who lobby and advocate for the rights of other adults like themselves, then, on the other hand, you are going to have young people like Mario, Candice and Fiona who advocate for persons within their age cohort,” she said.  “Transitioning out of the group and working alongside these young folks, I feel as if I can still share some of the realities they share, have one-on-one conversations with them, help them along their journey and also help myself as well, because social connectiveness is an important part of your mental health. This group is very, very, very dear to me.”  Gaining confidence through volunteering   With regards to its impact on her life, Christan said YAM helped her to become more of an extrovert and shaped her confidence. “I was more of an introvert and now I can get up do a wide presentation and engage other people without feeling like I do not have the capacity or expertise to bring across certain issues,” she said.  However, she says that there is still a lot of sensitivity around sexual and reproductive health and rights. This can sometimes limit the conversations YAM is able to have and at times may generate fear among some of the group members.  Turning members into advocates   “There are certain sensitive topics that still present an issue when trying to bring it forward in certain spaces. Other challenges they [YAM members] may face are personal reservations. Although we provide them with the skillset, certain persons are still more reserved and are not able to be engaged in certain spaces. Sometimes they just want to stay in the back and issue flyers or something behind the scenes rather than being upfront.”  But as the main aim of the movement is to develop advocates out of members, Christan’s conviction is helping to strengthen Yam's capacity.  “To advocate you must be able to get up, stand up and speak for the persons who we classify as the voiceless or persons who are vulnerable and marginalised. I think that is one of the limitations as well. Going out and doing an HIV test and having counselling is OK, but as it relates to really standing up and advocating, being able to write a piece and send it to Parliament, being able to make certain submissions like editorial pieces. That needs to be strengthened,” says Christan. 

Sitting outside Lilongwe Youth Life Centre on a sunny Thursday afternoon, 24-year-old Rodrick is glued to his phone. When asked to show some of his posts, he asks “what do you want to see, Instagram, WhatsApp, Facebook?”    Rodrick and his friends laugh at a post of a smiling cartoon condom fighting off multicoloured STIs.  SheDecides promotes change through social media  Rodrick is a trained Social Media Agent for SheDecides, a movement empowering youth to champion the rights of girls and women to make choices about their lives and bodies and have access to comprehensive sexual and reproductive health education.    “Social networks are developing each and every day, so more young people are now on social media,” explains Rodrick, adding that many young people don’t have access to books to read about sexual and reproductive health and rights.    “It’s better to reach them on social media so they can see it,” says Rodrick, although he admits that many people in Malawi cannot afford internet data bundles on their phones.  He says that he and other Youth Action Movement volunteers try to get out daily posts on social media channels to educate other young people about the issues they are passionate about.    “One day I posted asking why the government of Malawi doesn’t legalize abortion, which I think is not good for the girls because they have their lives to live,” says Rodrick, adding that he believes abortion can keep more girls in education. Rodrick says that while people don’t always agree with him, he enjoys discussing the topic on social media. “People ask ‘are you a real man?’” he laughs.    "I debate so much, and I like that! And sometimes I convince people that what I’m saying is right.” Supporting young people through personal challenges  As well as getting into lively debates on social media, Rodrick says he is often sent private messages by young people who feel they can open up to him as a peer with knowledge about sexual health.    A 16-year-old girl messaged Rodrick on WhatsApp, telling him she had been raped and was pregnant. “I asked her if she was comfortable with the pregnancy and she said no, how can I be comfortable with a pregnancy that I didn’t want to come to me?”    She then asked Rodrick how he could help her with the issue. “I said I will help you, though I’m not the person responsible I’ll take you to the person who is so they can handle that issue.” Rodrick then met up with the girl, who went on to access abortion counselling. He says that the case also went to court, and is awaiting the verdict.  “We always say this thing can be done by a male, and this thing can be done by a female,” says Rodrick, talking about gender inequality and his involvement in SheDecides. “But that’s not right. We’re all humans and should be able to do whatever he or she wants to do.”   

Dressed in a sparkling white medical coat, Alinafe runs one of Family Planning Association of Malawi (FPAM) mobile clinics in the village of Chigude. Under the hot midday sun, she patiently answering the questions of staff, volunteers and clients - all while heavily pregnant herself.  Delivering care to remote communities  “Most NGOs don’t come here because it’s so hard to reach,” she says, as women queue up in neat lines in front of two khaki tents to receive anything from a cervical cancer screening to abortion counselling. Without the mobile clinic, local women risk life-threatening health issues as a result of unsafe abortion or illnesses linked to undiagnosed HIV status. According to the Guttmacher Institute, complications from abortion are the cause of 6–18% of maternal deaths in Malawi.    District Manager Alinafe joined the Family Planning Association of Malawi in 2016, when she was just 20 years old, after going to nursing school and getting her degree in public health. She was one of the team involved in the Linkages project, which provided free family planning care to sex workers in Mzuzu until it was discontinued following the 2017 Global Gag Rule.  Seeing the impact of lost funding on care  “This change has reduced our reach,” Alinafe says, explaining that before the Gag Rule they were reaching sex workers in all four traditional authorities in Mzimba North - now they mostly work in just one. She says this means they are “denying people services which are very important” and without reaching people with sexual and reproductive healthcare, increasing the risk of STIs.    The reduction in healthcare has also led to a breakdown in the trust FPAM had worked to build in communities, gaining support from those in respected positions such as chiefs.    “Important people in the communities have been complaining to us, saying why did you do this? You were here, these things were happening and our people were benefiting a lot but now nothing is good at all,” explains Alinafe.    Still, she is determined to serve her community against the odds - running the outreach clinic funded by Global Affairs Canada five times a week, in four traditional authorities, as well as the FPAM Youth Life Centre in Mzuzu.  “On a serious note, unsafe abortions are happening in this area at a very high rate,” says Alinafe at the FPAM clinic in Chigude. “Talking about abortions is a very important thing. Whether we like it or not, on-the-ground these things are really happening, so we can’t ignore them.”

For Jennipher, who lives in a village outside of Lilongwe, unintended pregnancies amongst young women and girls like her are an everyday reality.    “Girls often speak to me about these issues because they know I come to the Youth Life Centre and that I know a lot about these issues,” explains Jennipher, who wears a baggy white t-shirt and big hoop earrings.    “They are happy to talk to me about these issues because I’m young and also a girl. It’s hard for girls to talk about these issues to their families because they might not believe them,” says Jennipher, who is a Youth Action Movement (YAM) volunteer in her local area, Dowa. “It’s important to teach girls about abortion so they know how to take care of themselves and stop risking their lives,” she adds.  Teaching peers how to avoid unwanted pregnancy  Off the top of her head, Jennipher can think of two close friends who have experienced unwanted pregnancies at a young age. One was just 14 when she fell pregnant and, desperate, had an unsafe abortion. “There was a lot of blood. I helped her by taking her here [to the Youth Life Centre] for treatment. Now she’s quite fine and back at school after recovering,” says Jennipher.    Another friend was 18 when she got pregnant, but ended up keeping her baby. Jennipher says she encouraged her friend to get help at the center “so she could learn a lot of things and maybe get contraception, so she can go back to school again and have a bright future.”    Two years on, her friend is back at school and her mother takes care of the baby while she is studying. “She even joined the Youth Action Movement, so we are together here,” smiles Jennipher.  Passionate about education  These experiences have made Jennipher passionate about educating young women and girls in her community about contraception, with the aim of keeping them safe, healthy, and in school.    As a YAM volunteer she also gets approached by girls who have experienced sexual abuse, often within the family. Another friend of Jennipher’s told her that her sister’s husband wanted to sleep with her.     “In these cases, sometimes the girls choose to be silent for fear that the breadwinner might be arrested and then the family will suffer,” she explains. But with a well-informed peer like Jennipher to confide in, her friend was advised to go to the authorities and to the center for guidance.    Looking to the future, Jennipher says she wants to have two or three children. “That would be enough!” She laughs. She also plans to make a career out of her skill for caring for others. “I want to be a secondary teacher or a nurse. I want to help people.” 

Mary, a 30-year-old sex worker, happily drinks a beer at one of the bars she works at in downtown Lilongwe. Her grin is reflected in the entirely mirrored walls, lit with red and blue neon lights.    Above her, a DJ sat in an elevated booth is playing pumping dancehall while a handful of people around the bar nod and dance along to the music. It’s not even midday yet.    Mary got introduced to the Family Planning Association of Malawi through friends, who invited her to a training session for sex worker ‘peer educators’ on issues related to sexual and reproductive health and rights as part of the Linkages project.    “I learnt about condoms and even female condoms, which I hadn’t heard of before,” remembers Mary.  Life-changing care and support   But the most life-changing care she received was an HIV test, where she learnt that she was positive and began anti-retroviral treatment (ART). “It was hard for me at first, but then I realized I had to start a new life,” says Mary, saying this included being open with her son about her status, who was 15 at the time.    According to UNAIDS 2018 data, 9.2% of adult Malawians are living with HIV. Women and sex workers are disproportionately affected - the same year, 55% of sex workers were estimated to be living with HIV.    Mary says she now feels much healthier and is open with her friends in the sex worker community about her status, also encouraging them to get tested for HIV.  “Linkages brought us all closer together as we became open about these issues with each other,” remembers Mary.  Looking out for other sex workers   As a peer educator, Mary became a go-to person for other sex workers to turn to in cases of sexual assault. “I’ll receive a message from someone who has been assaulted, then call everyone together to discuss the issue, and we’d escort that person to report to police,” says Mary.    During the Linkages project - which was impacted by the Global Gag Rule and abruptly discontinued in 2017 - Mary was given an allowance to travel to different ‘hotspot’ areas. In these bars and lodges, she explains in detail how she would go from room-to-room handing out male and female condoms and showing her peers how to use them.    FPAM healthcare teams would also go directly to the hotspots reaching women with healthcare such as STI testing and abortion counselling. FPAM’s teams know how crucial it is to provide healthcare to their clients ensuring it is non-judgmental and confidential. This is a vital service: Mary says she has had four sex worker friends die as a result of unsafe abortions, and lack of knowledge about post-abortion care.    “Since the project ended, most of us find it difficult to access these services,” says Mary, adding that “New sex workers don’t have the information I have, and without Linkages we’re not able to reach all the hotspot bars in Lilongwe to educate them.”