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Over the past 30 years, more than 60 countries and territories have liberalized their abortion laws. Only four have regressed, including the United States. Abortion rights are increasingly becoming recognized as fundamental human rights for millions of people worldwide. The global landscape of abortion rights continues to evolve in 2024, with new legislation and feminist movements fighting for better access. Let's take a trip around the world to see the latest developments.

“You work with people who have HIV? Why?” That was the question Dr. Gregory Boyce was asked by the young intern that stood before him. He had come to the hospital ward to visit a client who was known to be living with HIV. He approached the intern at the desk and gave his name and designation. The intern looked at him, confused and somewhat amused and asked the question that he has neither forgotten, nor understood to this day.   However, this young intern’s question comes from a mindset that Dr. Boyce is working fervently to change. As Deputy Director of the Medical Research Foundation of Trinidad and Tobago (MRF), Dr. Boyce provides clinical and administrative support to a team of doctors and nurses providing care to their clients who are living with HIV. Due to MRF’s long-standing work in HIV research and healthcare, the Family Planning Association of Trinidad and Tobago (FPATT), has referred many clients to Dr. Boyce and his team, and especially clients from the LGBTI+ community.   Providing specialist care and support  “Persons coming to us from key populations, have very layered needs. They are facing unique challenges in addition to living with the virus. There is still that myth that being HIV positive means that you will positively die. Added to that, there’s the discrimination that the community faces in every aspect of their lives on a daily basis. As a staff, we’ve had to seek special training to guide the way we interact with these clients so that we can meet all their needs appropriately and sensitively,” explains Dr. Boyce.   “Apart from medical interventions which are needed to ensure that our clients continue to live healthy lives, we focus heavily on their psychosocial needs. It’s easy to think that because a client is physically healthy that they are also emotionally healthy. We have clients that won’t leave abusive relationships because they think no one else would accept them. We have other clients that are dealing with long-term medication fatigue because they have been taking pills for over 10 years. With that sometimes comes depression and other drug addictions, which is why it’s necessary for us to maintain open and honest relationships to address those accompanying issues.”  Making HIV a non-issue  Dr Boyce has been committed to providing treatment and care to clients living with HIV for over 20 years. He had worked at the Port of Spain General Hospital after graduating, during which time, medicine for persons living with HIV was expensive and out of reach for many. A few years later, through government programmes, medicine became more affordable, and treatment centres were opening up across the island. However, Dr. Boyce realized that the mortality rate had not changed by much. He wondered why people were still dying from a virus when medicine was easily accessible.   “That first conversation – giving a client the news that they’ve tested positive – is very important. We get to show them that HIV is not an impediment. Most times, with the wrong information, they start to draw up a list of things that they can no longer do, like go after a promotion or start a family. Then they go through life shrunken and unrecognizable, not the person they once were. So to answer that intern’s question about why I work with persons living with HIV: I want to make HIV a non-issue,” he states.    Dr. Boyce hopes to see HIV disclosure become as acceptable as other chronic illnesses such as cancer or diabetes, where an entire family would work towards caring for the affected person, instead of alienating them. He also hopes to see more inclusion and tolerance towards persons living with HIV, especially those within the LGBTI+ community.   “Until a gay or transgender person can walk the streets freely and not be jeered at by passers-by, we still have a long way to go. Until they can access treatment at any public facility without fear or judgment, we have a lot of work to do. It would take a lot of education to change the stigma and discrimination but there is absolutely no reason why another person’s life should be miserable because their expression is different to ours.”   He commends the work of FPATT in upholding the sexual and reproductive health and rights of the LGBTI+ community, through ensuring that they have a safe and non-judgmental environment for treatment and care. He says that the Medical Research Foundation values the great relationship that the two organizations have had for years, even as FPATT works towards becoming its own full-service antiretroviral treatment site for persons living with HIV.    

Public perceptions, a lack of education, and government policies contribute to the barriers and challenges to achieving equality for all. In a country as diverse as Trinidad and Tobago, this is especially acute for certain key populations, including the LGBTI+ community.  For Brandy Rodriguez, Healthcare Navigator at the Family Planning Association of Trinidad and Tobago (FPATT), the struggle is both real and personal. In 1999, Brandy began her transition to womanhood and since 2006 has been working with FPATT in their HIV programme for the LGBTI+ community.    “Back in 2004, very little was said about HIV infection, transmission and prevention. In fact, if there was any information, it was misconstrued and meant to stigmatize the LGBTI+ community. I was fairly new to the transgender community, so I made it a mission to research and find out the truths behind HIV and how I could protect myself. I then felt like I had to share what I found with others who were searching as well,” she said.  Overcoming prejudice and stigma   That’s when FPATT asked Brandy to join their team in educating the LGBTI+ community on the types of healthcare available. Stigma surrounding the community forced many to stay hidden and avoid seeking care. Even if a member of the LGBTI+ community wanted to test for their HIV status, they would never dare to go into a public health centre, because of the fear of being judged by the healthcare professionals.    “It’s a simple case of this. When a transgender or non-binary person walks into a health centre or hospital, and the triage nurse has to fill in a form that asks for gender, the only two options there are male and female. So usually, the non-binary person knows that if they want to access that healthcare, free of judgement, they would have to dress as the gender that would bring less attention. At the end of the day, the healthcare provider does not receive accurate information about the client, and the client doesn’t receive the scope of assessment and treatment that may be necessary. So part of what I do, is to simply accompany the client to the appointment so that it’s a less stressful experience and they don’t feel like they are alone,” says Brandy.   The importance of access to HIV treatment and care Apart from a great lack of healthcare professionals that are willing to treat the LGBTI+ community non-judgementally, the community also lacks social support. Most of the members of the community face barriers to housing and employment, which often means earning a livelihood through sex work. Over 95% of skilled and employable persons within the LGBTI+ community have turned to sex work because they are constantly denied employment within other industries.   “When I began my transition, I was fortunate to have the support of my family; they understood my heart and my need to be my authentic self. Not everyone has that support and so some either migrate or are left homeless because of the fact. Having to work within the sex industry means that they are now at greater risk for HIV or other STIs. My job as an Educator and Navigator is to promote condom use and ensure that they make use of FPATT’s regular HIV testing. If they do test positive, we then have that conversation about U=U, which means that if they [their HIV viral load] are undetectable, they will be untransferable, and then get them to that place of undetectability.”    Brandy explains that being undetectable means that the client’s viral load is suppressed, and they are living healthy lives. The team works hard to ensure clients living with HIV enrol in the FPATT Programme, which supports the importance of adhering to consistent treatment, healthy eating, and rest. As well as testing, the Programme offers sexual and reproductive health education on prevention against STIs and both group and one-to-one sessions to anyone who needs it.  Advocating for support  FPATT has, for many years, advocated for the sexual and reproductive rights of the LGBTI+ community, ensuring that it remains a safe place for HIV testing and counselling. It holds a vision of a world where gender or sexuality are no longer a source of inequality or stigma.   FPATT is poised to become a full-service HIV treatment site, offering antiretroviral treatment as well as psychosocial services for persons affected by HIV. FPATT’s goal is to stop discrimination and stigma against persons living with HIV and ultimately end the spread of HIV within Trinidad and Tobago by 2030.       October 28, 2021 - We celebrate our much beloved colleague Brandy, LGBTQI+ Healthcare Navigator for FPATT and Trinidadian champion of human rights. She has long been a defender of the rights of LGBTQI+ people, and a pioneer in ensuring access to services while fighting stigma and discrimination in the community. We honor her dedication to equality across the Caribbean, her passionate advocacy for Trans rights. The fight continues in her powerful memory.   Conmemoramos a nuestra querida colega Brandy, defensora por la salud LGBTQI+ para FPATT, y referente en Trinidad y Tobago por de los derechos humanos. Ha sido durante mucho tiempo una defensora de los derechos de las personas LGBTQI+, y una pionera en garantizar el acceso a los servicios de salud, al tiempo que luchaba contra el estigma y la discriminación en la comunidad. Honramos su dedicación a la igualdad en todo el Caribe y su apasionada defensa de los derechos de las personas trans. La lucha continúa en su memoria.  

“Selling my body doesn’t make me a bad person, but working as a peer educator has helped enabled me to help many like me.” Hasina is one of the estimated 1,500 sex workers living in Haunman Tekri, a red-light area in Bhiwandi, a town near Mumbai. When her husband passed away six years ago leaving behind a three-year-old daughter, Hasina turned to sex work as her only option to earn money. She admits that it came with a feeling of powerlessness. "You don't choose this trade; it is the result of life circumstances.” She works as a peer educator with PSK, one of the Family Planning Association of India's (FPAI) clinics. "Working with Parivar Swasthya Kedra (PSK), has made me feel less helpless; it's given me some control over my body; the ability to choose whether or not to bring another life into this world.” Building trust through education Hasina has been a peer educator for three years, working within the district to educate other women on safe sex, contraception, and abortion. Hasina admits she was once wary of PSK workers. "I used to think that these workers who insist we use condoms, would only sabotage my clientele. But soon I realized they were only looking out for us." When talking with local women, Hasina advocates the use of contraception but says in the case of an unintended pregnancy, abortion is a viable option. "It's easy to judge us, but many of us have no choice; we simply cannot feed another on just Rs. 400 a day."  Hasina is now the go-to woman in the district when it comes to sexual health. "Since I am one of them, the women trust me." This is the secret behind PSK success; a model where sex workers educate their peers, understanding the complexities and prejudices of their daily lives. "I hope one day I am able to put all of this behind me. But I hope that through PSK I am able to make another woman's life just a little bit safer, a little bit better." Do you want to show your support for women and girls to be free to decide what happens to their body? Pledge your voice to our I Decide campaign,IPPF’s movement for safe abortion access for all. You'll be provided with toolkits on how to talk about abortion and you'll have access to a range of content from personal testimonies to videos explaining the different types of abortion available.

In the district of Gwalior in Madhya Pradesh, the summer season has started and the heat in town is already extreme. Here, the Family Planning Association of India GCACI clinic serves many people living in poverty. In the ten years since the GCACI project started there, the clinic has provided 16,301 women with comprehensive abortion care and 202,758 women with contraceptive services. The two-storey clinic is situated in a residential area and, inside, women queue up to see the counsellors and medical staff. Many are accompanied by link workers who have travelled with them from outlying districts. Neelam Dixit is in charge of the branch. “Most women are from marginalised sections of society and are denied the right to make their own decisions. By the time they visit our clinic, the woman is already a couple of months pregnant”. FPA India’s work is making an impact and Dixit is seeing views change on abortion. “There is a shift in attitude among women since FPAI started providing services. Presently, there is little stigma attached to abortion. Our aim is to provide quality health services at low cost. We create awareness about the consequences of unsafe abortion and train volunteers to be sure women in villages are aware of our clinic.” The clinic has served around 300,000 people from rural and semi-urban populations with comprehensive sexual and reproductive health services, and provides both first- and second-trimester abortion services.   

Konika* Mother of three, Parivar Swasthya Kendra (PSK) client Konika is 20 years old, and the mother of three girls. Like many local young women, she decided to have an abortion when she became pregnant for the fourth time within five years. Citing financial issues as the driving force behind her decision, despite her mother-in-laws desire for her to have another child, hoping this time it would be a boy. Through a neighbour, she approached the PSK clinic in Bhiwandi for an abortion. In Konika’s community, many young women are married and have kids by the time they are 20. Now with PSK, women like Konika have a choice to be pregnant or not. *Name has been changed Share on Twitter Share on Facebook Share via WhatsApp Share via Email Rehkha Parivar Swasthya Kendra (PSK) link worker Family Planning Association of India, works with a network of volunteer link workers, who disseminate information about services available in the PSK clinic, make referrals, and often accompany women to the clinic for support. One of these link workers is Rehkha. Rekha says: "I have been involved with PSK for five years. And today I can proudly say that since the first awareness campaigns, there has been not a single death in the village due to an unsafe abortion." She adds: "These women are my flesh and blood. They know I only want the best for them… Within our communities we spread the message of safe sex and safe abortion through songs and skits which are easily understood. And I think the trick is to include mother-in-laws in our work. We have a high success rate in providing safe abortion care.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Shajahan Parivar Swasthya Kendra (PSK) link worker Shajahan is a link worker in the nearby Muslim district, where women pack into a house in the narrow village lanes to wait to speak to her. She says: "I am a Muslim. In my community, abortion is frowned upon, and contraception is considered a sin. Initially, the women thought I was going against our customs, and the men thought I was a bad influence on their wives. Some of the men in our area even approached my husband and asked him to order me to stop these efforts." But her husband was supportive, telling other men that it was also their responsibility to be part of the process. It took several years, but eventually Shajahan won the trust of the women and men of her area. "Today, every woman in my area comes to me when it concerns matters of sexual health." Share on Twitter Share on Facebook Share via WhatsApp Share via Email Gauri Family Planning Association of India (FPAI) staff Gauri has worked for FPAI for years and remembers hearing about the experiences of women who’d had unsafe abortions. "I had heard first-hand accounts of [unsafe] abortions that left women reeling in pain, suffering permanent infertility. I had also seen the grief in the faces of men whose wives died. So today when I see women leaving us, after an abortion, in perfect health, I feel like I've done something right with my life." Gauri continues: "My work may have started with one area, but I want to reach every corner of the country with FPAI - so that no woman in India becomes a statistic." Share on Twitter Share on Facebook Share via WhatsApp Share via Email Nisha Mother of two At 23, Nisha Boudh is already a mother to two children and severely anaemic. She feels she is in no position to have a third child, but her in-laws are not supportive. Nisha chose to have an abortion at FPAI’s Gwalior clinic. “I have been weak since childhood and, honestly, motherhood has taken a toll on my health. Doctors in other clinics were not willing help me and I would have died had FPAI not come to my rescue. With their doctors’ advice I have now decided to undergo an operation [tubal ligation] as I do not want to conceive. My mother-in-law was upset with my decision but I want to live to see my other children grow,” said Boudh. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Diti* Sex worker Diti is a sex worker living in Kolkata. She says she, "owes her life to PSK". Diti was forced into an early marriage when she was just 12 years old. "Before my body could even develop, my husband was forcing himself upon me." By the age of 20, Diti had five children. Struggling to cope at such an early age, and married to an abusive husband, Diti ran away. "I don't enjoy having sex with strangers, but I need the money." She makes 300 rupees a day ($4 USD). When Diti became pregnant she didn’t want to continue with the pregnancy. "There's no way I can feed a child. Besides, this is no place to bring a child into the world. Another sex worker recommended the PSK clinic.” Diti was worried about visiting the clinic, fearing stigma and discrimination from staff for working as a sex worker. Her experience was vastly different, finding the clinic team to be welcoming, reassuring and supportive. "They treated me like a human being." Share on Twitter Share on Facebook Share via WhatsApp Share via Email Mala Medical officer “The big problem in this part of India is early marriage and pregnancy. Both of which need to be handled very delicately,” says medical officer Mala Tiwari. “Slowly, things are changing as women are becoming aware of their rights. Previously when GCACI did not exist there was very little interaction with the link workers, and they [and the community] feared it was illegal to get an abortion. They did not know they did not need the consent of their husbands and in-laws. They now know, women have a right over their body.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Manju Mother of two, Parivar Swasthya Kendra (PSK) client Manju Rana was forced to marry at fifteen. “I have had two children in eight years of marriage,” she says. “My mother-in-law wanted me to keep having children. She does not understand I would not be able to give them a good education if I had more children. My husband is a driver and we cannot afford to have any more. When I learnt I was pregnant, without taking anyone’s permission, I went with the link worker of my area to the clinic and had an abortion.” Manju adds: “In these affordable clinics we can choose about pregnancy. They also made sure I was counselled, as coming to a decision about abortion is not easy.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email