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.

“The first time I met Chariette [a peer educator for the Cameroon National Planning Association for Family Welfare] was at Sunday football, around four years ago. She was invited by the organizer to come and talk to us when the match was over. We were all men but she wasn’t intimidated and she handled the stupid jokes well.  We stayed in touch and then one day I realized I had an STI. It’s a little taboo and I didn’t want to talk about it. I bought some drugs at the local market but they didn’t have any effect. I called Chariette and we discussed what had happened. She told me to come to the CAMNAFAW clinic and I did, where I spoke about my problem and they gave me proper drugs to get rid of it. That day, I decided to become a peer educator myself. There are a lot of guys who are suffering but too scared to speak out. Above all, men are scared of talking about STIs.  I now work in schools and youth groups, especially sports teams. They will insist they don’t have anything wrong but every Sunday since then I have gone round the teams and chatted with them.  I speak about pregnancy as well. It’s the guys who push women to have sex without a condom and also to have an abortion afterwards. I help to raise awareness of why we have to protect ourselves. It’s hard to recruit people to become peer educators because we are volunteers. It’s not easy to persuade people to change their ways. The view from a lot of churches is very strict and centers on abstinence. The young men want to be macho.” Hervé Tchuigwa Djiya is a peer educator for the Cameroon National Planning Association for Family Welfare (CAMNAFAW)

“Chariette was my neighbor. We lived next door to each other. She often organized group information sessions in the neighbourhood to talk about sexually transmitted infections (STIs) and early pregnancy, and unintended pregnancies as well.  When I started attending her sessions I was in a bit of unstable relationship. My life was chaotic. My boyfriend didn’t like using protection and we told each other that as we loved each other we weren’t taking any risks. Once I caught something and I was itching a lot. My boyfriend told me that I must have caught it in a public toilet. I trusted him and I didn’t realize I could catch something. When I started listening to Chariette it opened my eyes and I realized I was running big risks. As we aren’t married and we are still studying, we shouldn’t have an unintended pregnancy. What would we do? She told me about sexually transmitted infections as well. I tried to talk to my boyfriend about it but he didn’t want to hear about it, especially about using condoms. I asked for a private session with Chariette for him, and she spoke to us both and he finally understood. Today we have a much more stable sex life and we aren’t running those risks anymore. He learned how to use a condom. After attending her sessions, I was able to save a friend with Chariette’s help. This friend tried to perform an abortion herself and she was bleeding everywhere. I remembered that Chariette told me about the Cameroon National Planning Association for Family Welfare clinic, so I called her and asked how she could be admitted. She was able to receive post-abortion care but if I hadn’t known Chariette I don’t know what would have happened. I have brothers and I have helped them to change too. I’ve helped them to adopt a healthier sex life. There is HIV around and it’s scary.” Gertrude Zouakeu Noutcha, 29, is a student and peer educator for the Cameroon National Planning Association for Family Welfare (CAMNAFAW)

Women and girls in Palestine face a number of difficulties and challenges. The ongoing conflict and lack of sitting government as well as high unemployment, has led to poverty and inequality, while an increasingly conservative society and traditionally patriarchal culture has led to increased gender-inequality and lack of access to sexual and reproductive healthcare. The current abortion law unfairly pushes women to risk their lives and health to attempt to end their unwanted pregnancies in unsafe ways. In this context, the Palestinian Family Planning and Protection Agency (PFPPA) has been working since 1964, to provide sexual and reproductive healthcare and advocate for women’s rights. Having received two grants from Safe Abortion Action Fund (SAAF) since 2014, they have been working on the lack of access to safe abortion in the country with a focus on increasing their provision of abortion-related services and advocating at community and national level for changes to the abortion law. My name is Fatima, I am a midwife and have worked with PFPPA for 18 years in the Halhul clinic in Palestine.   PFPPA has had a great impact on me personally as well as the community as a whole. I experienced violence in my marriage but when I joined the organization I learned the meaning of violence and I realized that I didn’t have to put up with it and could make decisions for myself. This was a turning point in my life. My life changed 180 degrees, thank God, and my husband stopped being violent.  Society & acceptance Since I have worked here, I have seen changes in society’s acceptance of sexual and reproductive health issues and I feel that more people are supporting us. They can be women, religious personalities or young volunteers. One of the proudest moments of my work has been working with a young man who was training to be a peer educator, he was violent, especially with his sister. From the very start of the training, he was against the issues that we were presenting, however, he started to understand our issues. I also met his mother and she thanked me for the change that happened in his life. She came to say that he is now helping in the house - washing dishes and doing other tasks that he would have thought were just for women before.  The challenges that we face are a misunderstanding of religion, negative traditions and customs, as well as the political situation in Palestine with the occupation, the walls, the checkpoints as well as the economic situation. We work on issues that will take many years to witness any change due to the negative traditions and customs.  Harm reduction & abortion care We have recently started implementing a harm reduction approach to abortion care. I remember one woman who was 44 years old and divorced. She came to the clinic and was seven weeks pregnant. Her face was pale and tired...I felt that all the problems were on her shoulders. She was looking for a saviour. We supported her with harm reduction information and afterwards provided information on post-abortion contraception. After one or two months she sent a message thanking me, saying that we had saved her life, I was really happy about that.  There are also cases of women that come here, maybe they took pills or they did something that made them bleed. They don’t tell you what they did but I can detect if I think an abortion happened. If it is an incomplete abortion, we explain how to take the treatment and we follow up with support.  Unsafe methods  Women in our communities use many unsafe methods to try to end pregnancies. They drink special teas or chlorine. They jump off things or ask their children to jump on them. They sometimes put suppositories made from Arabic medicinal herbs into the cervix. Although it is common, deaths are not registered as linked to unsafe abortion but are probably registered as maternal deaths.  When the society says that abortion is haram (forbidden), they don’t take into consideration the issues and these women in need. Imagine if we had safe abortion services at the hospitals, we would not see these issues at all. There are women who would choose abortion for reasons like their age, their health, social issues and psychological issues. There are women themselves who say “I will die if I complete this pregnancy”. I am passionate about the work that I do. I advocate for these issues everywhere I go, on the bus, during weddings and with friends and family, wherever I go. That is why the Safe Abortion Action Fund (SAAF) funded project is so important. I have learned a lot about advocacy and campaigning, how we manage legal advocacy and how to work with decision-makers. We have run events to mark International Safe Abortion Day with groups of women gathered here in the centre and with decision-makers and volunteers. Read more stories from SAAF in Palestine

Women and girls in Palestine face a number of difficulties and challenges. The ongoing conflict and lack of sitting government as well as high unemployment, has led to poverty and inequality, while an increasingly conservative society and traditionally patriarchal culture has led to increased gender-inequality and lack of access to sexual and reproductive healthcare. The current abortion law unfairly pushes women to risk their lives and health to attempt to end their unwanted pregnancies in unsafe ways. In this context, the Palestinian Family Planning and Protection Agency (PFPPA) has been working since 1964, to provide sexual and reproductive healthcare and advocate for women’s rights. Having received two grants from Safe Abortion Action Fund (SAAF) since 2014, they have been working on the lack of access to safe abortion in the country with a focus on increasing their provision of abortion-related services and advocating at community and national level for changes to the abortion law.  My name is Amani and I am 24 years old. I live with my parents in Bethlehem in the West Bank and I work as a midwife in a family hospital in Jerusalem as well as a peer education volunteer with the Palestinian Family Planning and Protection Agency.  Working in schools Part of my role as a volunteer involves going to schools and doing presentations about early-marriage, family planning and gender-based violence. Even though sex outside of marriage is taboo, it does happen. However, it is very hard for unmarried people to access contraception as the culture is so restrictive, especially here in Hebron. When they need contraception, the man usually goes by himself or they look online.  When we go to schools and talk to students about the subject of sexual health, the students want to know more because at home it is a taboo to talk about such things. We get many questions about issues such as masturbation or what causes pregnancy. They just know that it happens when men and women are together, they do not know how it happens. So people may ask a question like: ‘if I touch somebody, if I stand near someone or kiss them will I get pregnant?’ Abortion is still a taboo The students don’t normally ask about abortion as it is such a taboo. I do know that unsafe abortion happens though, for example my grandmother tried to end her pregnancy once. She was forty-five years old and had six children already. She did not know any way of not getting pregnant or safely ending the pregnancy. She told me that she drank liquids and jumped from the stairs, taking a great risk. She really didn’t want to be pregnant again and tried hard to end it but it did not work.  I am very proud that as a peer educator I have expanded my knowledge on many issues, including how to provide harm reduction information to women so that they can reduce risks of unsafe abortion and not do what my grandmother did in case they don’t want to be pregnant.   Once I met with a woman who already had six children, she was tired of having children but her husband wanted to have more so we visited them at home and through conversation, the husband understood the need, so she was able to access an IUD. Here we work a lot with women, we change them, we speak with them, they change their opinions, they become decision-makers and they leave the clinic as different people.  Read more stories from SAAF in Palestine

Women and girls in Palestine face a number of difficulties and challenges. The ongoing conflict and lack of sitting government as well as high unemployment, has led to poverty and inequality, while an increasingly conservative society and traditionally patriarchal culture has led to increased gender-inequality and lack of access to sexual and reproductive healthcare. The current abortion law unfairly pushes women to risk their lives and health to attempt to end their unwanted pregnancies in unsafe ways. In this context, the Palestinian Family Planning and Protection Agency (PFPPA) has been working since 1964, to provide sexual and reproductive healthcare and advocate for women’s rights. Having received two grants from Safe Abortion Action Fund (SAAF) since 2014, they have been working on the lack of access to safe abortion in the country with a focus on increasing their provision of abortion-related services and advocating at community and national level for changes to the abortion law.  My name is Khawla*, I am 42 years old and I am a midwife and university lecturer. I have been married for 10 years and have three children, two boys and a girl. I have multiple health issues and a number of hereditary conditions in my family. I first became involved with PFPPA through my work, having taken many trainings with them about issues such as early marriage, gender-based violence, sexual health and safe abortion. Then last year I accidentally became pregnant myself. My youngest child was just two years old, I had a new job at the time and was suffering with a number of health issues that would make another pregnancy dangerous for me.  Unintended pregnancy When I read that the pregnancy test was positive, it was a very hard time. I started crying – I felt like the world was very black – it was the end of my life. I would kill myself, if I didn’t end this pregnancy. So I came to PFPPA and they treated me as a client. I met with the social worker, midwife and doctor and, since the pregnancy was risk to my life and I was very weak and bleeding when I reached them they were able to prescribe the tablets. These pills are highly regulated and restricted here and not all pharmacists stock them but I was able to access them with the prescription and they worked. PFPPA provided follow up afterwards helping me to find an effective long-acting family planning method. Even though I knew about the different methods, they discussed them all with me to ensure that they would be appropriate for my health.  Even though the law allows abortion in cases of risks to health of the woman, you need to get permission from the religious leaders and they are very hard to convince. I took my case to them and, despite my health issues, they refused despite it being very early in the pregnancy, before the ensoulment and is allowed according to Islam. The public hospital will not perform it unless they receive the permission from the religious leaders and they don’t give it despite what the religious rules say.  Stigma & access From my experience the situation in relation to abortion in Palestine is very hard. There are many women who get pregnant who did not plan it and it’s not the time for the pregnancy. The door is closed to them from the public health system. I have started to campaign on this issue now, I talk to the students in my course about how we can solve this problem. I think the stigma is very difficult. I never thought I would be in this situation, I talked a lot about it before but when you are in the situation, it is totally different.  I really appreciated the help given from the PFPPA team, particularly the psychological support. When I felt bad, they helped me to see that I was doing the right thing and it was my right. Read more stories from SAAF in Palestine *Not her real name