In early April 2020, the all too familiar destruction of a Tropical Cyclone (TC) – Harold – hit the Solomon Islands, Vanuatu, Fiji and Tonga. One of the worst affected areas was the Eastern part of Fiji. Through support by Department of Foreign Affairs and Trade (DFAT), our Member Association, Reproductive and Family Health Association of Fiji (RFHAF), was quick to respond ensuring access to essential sexual and reproductive healthcare for Kadavu’s women, girls, and vulnerable groups. Fiji's vulnerable coastline Fiji’s worst affected area was the Eastern part, with TC Harold bringing destructive storm force winds and storm surge. RFHAF focused its humanitarian response on the local Kadavu population. This remote area proves a challenge to reach for the team with supplies. Share on Twitter Share on Facebook Share via WhatsApp Share via Email RFHAF's humanitarian response team tackle rough terrain National travel restrictions - due to the current COVID-19 pandemic - on all inter island transfers has slowed the response in some areas, including Kadavu. The island of Kadavu is one of the least developed areas of Fiji, the main source of income is substance living (Yaqona). Transport around the island is difficult, with very few roads, no public water system or electricity. The humanitarian team from RFHAF travels by boat and then on foot. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Asenaca, client Kadavu, the biggest island in the Eastern division has the greatest population (10,897). 197 evacuation centres were activated in total, initially hosting over 6,240 people. Many are women of reproductive age, with an estimated 150 currently pregnant. Asenaca learns about breast cancer self-checks from RFHAF’s healthcare provider, Karo. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Nasi, RFHAF healthcare provider The medical mobile team deliver a broad range of healthcare including contraception, information and counselling on sexual health, pregnancy, HIV and STI care and testing. RFHAF Team in Kadavu performing general health checks after TC Harold. Nasi administers a HPV shot to a client. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Kate, client Young women and girls are at the heart of RFHAF’s healthcare provision. Kate walks home with her dignity kit after a health check at the mobile clinic. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Karo, RFHAF healthcare worker RFHAF offers sexual and reproductive healthcare as well as counselling, and referrals for follow up care. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Alidi, RFHAF healthcare worker The team ensures young people in the community are not forgotten and provide information and education on relationships and sexual health and rights. Alidi conducting a session with a local group of young people at Gasele, Kadavu.Photos ©IPPF/Rob Rickman/Fiji Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Humanitarian crises Largely brought on by sudden onset and slow-onset natural disasters, humanitarian crises are increasingly prevalent in the Pacific. During responses to humanitarian crises in the Pacific, sexual and reproductive healthcare is often under-prioritised and under-resourced. As a result, women and girls of reproductive age and vulnerable and marginalized groups are disproportionately affected and facing increased health and psychosocial risks. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Fragile environments Low topography, rising sea levels and insufficient fresh water supply leaves Kiribati’s population vulnerable to the effects of the climate crisis. The fragility of the outer islands of Kiribati during natural disasters is compounded by their geographic isolation, which makes transportation and communication during post-disaster relief and response both expensive and difficult. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Coastal exposure The majority of the population of 115,000 people live a subsistence lifestyle. Communities are geographically dispersed across 33 atolls covering 3.5 million square kilometres in the central Pacific Ocean. The population and infrastructure within Kiribati are largely concentrated on the coast, where communities face increased exposure to climate threats and natural hazards such as tsunamis, earthquakes, king tides, flooding, droughts, and occasionally cyclones. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Takaria, leader and youth organizer in the Tebikenikua community Takaria will be running to be a Member of Parliament in Kiribati in 2020. “I assist the youth with family problems and family planning and disasters. In our community there are unforeseen pregnancies, domestic violence, and disasters such as high tide waters and strong winds, which can also affect this community. The Kiribati Family Health Association (KFHA) is the key point for us with outreach and training so people in this community know how to prevent and treat STIs, etc. They all know where the KFHA clinic is and that they can get counselling or services there. The problem now is you can’t survive with the sea rise levels. I want all members of my community to live better and have better health and peace.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Susan*, sex worker Susan receives care at the Kiribati Family Health Association (KFHA) including a pap smear. Susan*, 28, is a sex worker from the town of Betio on the main island of Kiribati. Originally from an outlying island, she moved into Tarawa to seek work. Unable to find employment that would fulfill her dream of sending money back to her two children, she was introduced to sex work. With other sex workers, she regularly travels out to the large cargo ships from China, Philippines and Korea anchored off the coast of Kiribati. Despite her new income, she still can’t speak with her children or see them due to the restrictive costs involved of travel between islands.*pseudonym Share on Twitter Share on Facebook Share via WhatsApp Share via Email Theta, 25-year-old mother and youth volunteer Theta is part of the Humanitarian Youth Club set up by the Kiribati Family Health Association in her village. “We face a lot of situations here, one of them is disasters and the second is unemployment and school drop out with our youth. I have helped the Humanitarian Youth Club to apply for financial grants from the Australian High Commission [for $1,000] I am recognized as the smartest member who can write in English. We have learned how to design a disaster plan for the community and share our ideas on sexual and reproductive issues such as STIs. We discuss what we can do for the next strong tide, where we can gather as a community and what we can do if even the maneabe (town hall) floods? If the tide and wind is too strong, we need to go to another safer place, such as another community’s town hall. For now, I want to enjoy the chance to be in our own beloved country. I won’t move until the majority have already left. I want my daughter to grow up in the same place I grew up in.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Beitau, youth volunteer Beitau is the Chairperson of the Humanitarian Youth Club. “I was lucky to be selected as Chairperson as the Humanitarian Youth Club. I feel like I get more respect from the community now I am in this position. I would love advanced training on leadership now, to further assist the club. As I am the Chairperson of the HYC, my main target is to help people during a disaster. I have attended training through KFHA. What I took from this is that when a disaster strikes, we have to do our best for pregnant women, small children and people with disabilities. They more vulnerable and less able to survive a disaster.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Abe, youth officer Abe was involved with KFHA since 2012. “I was inspired by what they KFHA was doing and the issues they were addressing that affects youth. I was surprised to see how many young people come to the clinic as they are affected by STIs, HIV and teenage pregnancy. The lack of education here is a big problem, most people here have a lot of children and yet can’t afford to send them to school. Sexual and reproductive health is our responsibility and we must talk about it with young people. Climate change affects many countries, but Kiribati is small and low lying. I used to go visit a very nice beach with a lot of nice trees and plants. Now, the trees are gone, and the waves have taken over, and the houses have disappeared so no one can build there. In my role as a youth worker and activist, I tell people to fight climate change: to grow more mangroves, to clean up the beach, because we love our Kiribati.”©IPPF/Hannah Maule-Ffinch/Kiribati Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Healthcare providers in their PPE Lebanon Association for Family Health (SALAMA) “After the extension of the general mobilization and in order to provide the services to the most in need population, we decided to re-open the clinic. For this purpose, we are developing a plan for the work during the next weeks, taking into consideration the protocols and procedures taken in Lebanon. This will include an isolation room before the consultation and an assessment of the patient’s status and any symptoms that may relate to the coronavirus. In addition to all the precaution procedures including separation, our clinic was sterilized by a specialized company.”Lina Sabra, the Executive Director of the Lebanese Association for Family Health (SALAMA) Share on Twitter Share on Facebook Share via WhatsApp Share via Email Youth volunteers sort through medical donations China Family Planning Association The China Youth Network set up a donation working group and with the support of the China Family Planning Association and Hubei Family Planning Association, they received donations of menstruation supplies, and medical equipment. By March they had successfully donated 5,680 sanitary towels, 3,280 medical face shields, 1,200 hand disinfectants, 925 disposable beddings, 500 air disinfectants and some medical machines to 87 hospitals in Hubei Province. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Erbol, 17, is the chair of the youth committee of the Issyk-Kul branch Reproductive Health Alliance of Kyrgyzstan “At the present time we are using Instagram with detailed information about our organization and articles on sexual and reproductive health issues. We found new technologies and approaches to organize online meetings with the youth volunteers and planning of future branch activities through Zoom. It is planned to consider additional options in creation of channels on Telegram and Twitter because they are very popular among young people.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Healthcare providers put together hygiene kits for local communities Family Planning Association of Sri Lanka FPA Sri Lanka assembled 5,000 hygiene kits to be distributed to promote and enable frequent hand washing, personal hygiene and menstrual hygiene among vulnerable women and girls with limited incomes. These women and girls include mothers, widows with children, families who care for a member living with a disability, and women and girls living in slums during lockdown in high-risk areas for COVID-19. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Healthcare outreach teams distribute contraception and hygiene kits Family Health Association Iran “To reduce the number of visits to our clinics, we made some changes in the way we deliver services. We provide counselling services through online systems and creating different groups for clients to provide online educational training about COVID-19 for them, as well as some components of life skills and SGBV. For the vulnerable groups including sex workers and substance users we distribute contraceptives, COVID-19 preventive packages, and food through the outreach team instead of static clinics.”Zahra Fathi, Executive Director of the Family Health Association Iran (FHA Iran) Share on Twitter Share on Facebook Share via WhatsApp Share via Email Outreach teams sanitize people's homes in remote communities Sudan Family Planning Association Staff at the Sudan Family Planning Association conduct outreach work in local communities, including offering to sanitize people's homes. Remote areas in Sudan with no medical services will be affected with discontinued mobile clinics services. Access to all family planning, antenatal care, and postnatal care services will be affected due to restricted movement. Sudan, as will many other countries, will be impacted by any decrease in activity in the supply chain for healthcare supplies. Share on Twitter Share on Facebook Share via WhatsApp Share via Email A watercolour entry for a social media art competition Santé Sexuelle Suisse/Sexuelle Gesundheit Schweiz “With our Youth Network we created an artistic competition on our FB and Instagram platforms on issues such as masturbation, menstruation, coming out, female genitalia, pornography. The aim is to enhance creativity and make young people reflect about sexual and reproductive health and rights in a creative way during the corona pandemic. The aim was also to offer something fun and positive in this difficult time.”Noemi, 24, is the co-founder and coordinator of Santé Sexuelle Suisse/Sexuelle Gesundheit Schweiz's youth network. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Volunteers make hand sanitizer kits at a SFPA clinic. Syria Family Planning Association When the lockdown was announced SFPA had to stop running their mobile clinics but recently resumed this service. To keep the health facilities open they implemented a new shift rota for staff. The clinics are also following an extremely high-standard of sterilization procedures in all facilities to reduce the risk of catching or spreading coronavirus. SFPA started using social media to spread information on COVID-19. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Belmar Franceshi, Executive Director Asociacion Civil de Planificacion Familiar “The work we do is very important – despite being in our homes, we continue to work, research and look for alternatives to serve the hundreds of people who daily seek our services. It is one more challenge that we must face and will strengthen our actions, our interventions and the activities we carry out daily with communities, women and girls.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Enusring client and staff safety with PPE Family Planning Organisation of the Philippines The Family Planning Organisation of the Philippines (FPOP) is working safely with PPE equipment to ensure uninterrupted access to antenatal care and family planning methods for women and young girls through their clinics. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Delivering essential healthcare to women Family Planning Association of Nepal With PPE and hygiene kits FPAN’s healthcare providers can safely engage in delivering essential care to communities, including counselling, contraception methods, safe abortion, HIV/STI care, obstetrics and gynaecology care and sexual and gender-based violence support. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Reaching local communities Family Health Association Bangladesh FPAB key health workers have continued to provide essential sexual and reproductive healthcare in local communities during COVID-19. Share on Twitter Share on Facebook Share via WhatsApp Share via Email

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

In May 2017, flash flooding in Sri Lanka triggered landslides resulting in many people losing their homes, forcing them to seek shelter in camps. IPPF’s member association the Family Planning Association of Sri Lanka (FPASL) assisted those affected and provided health camps with the support of IPPF Humanitarian. Chathurika Jayalath, a youth volunteer for FPASL, took part in the response. Chathurika is a 24-year-old student from Kegalle, a large town about 80 km from Colombo, and she has been working with FPASL for the last three years. She started out as a youth volunteer and recently became a member of the Youth Technical Advisory Committee. During her engagement with FPASL, Chathurika has learned about sexual and reproductive health and rights (SRHR) and gender issues and has organized workshops on similar topics in her own community. In fact, she runs a youth club at her university to inform her peers about SRHR.  Shortly after the floods began, Chathurika received a WhatsApp message from FPASL where they called for youth volunteers to take part in the response.  “I wanted to volunteer during the response,” Chathurika told us. “As a university student I didn’t have money to donate so I figured I could contribute with my strength instead. I volunteered in the health camp. There, I assisted the medical staff with basic things such mobilizing affected people, making sure they queued up when seeking health care and packed medicine.” Ongoing SRHR needs, even in a crisis Chathurika is keen to learn more about humanitarian work. She received training with FPASL on the needs of people in humanitarian settings in which she and other trainees were presented with different case studies. “There was particularly one story that struck me. We were told that when the flash floods came, women fled without anything, they fled with the only pair of clothes they were wearing,” recalls Chathurika. “When they reached the camp, they received donated water and food. Some of them got their period while living in the camp. They did not have any sanitary pads nor additional cloths. Some of them even fled without underwear. This story made me realize that people’s SRHR needs don’t disappear just because there is a crisis.” Youth empowerment is important to Chathurika and she would like to continue this work while learning more about development and humanitarian work. She is a firm believer “that young people can contribute. Through my own experience I have seen that it is possible.”   

In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. “When I lost my job as service delivery manager [at PPAZ USAID's Open Doors project], I felt like a part of me had died, I’m very passionate about this. I look forward to seeing a day where everybody will be free to access health services without stigma and discrimination, especially public health facilities. That’s what I’d like to see, [I] want to see integrated services, being provided to key populations, without stigma and discrimination, and fear of being arrested." The Global Gag Rule The reinstatement of the ‘Global Gag Rule’ resulted in the termination of Planned Parenthood Association of Zambia grant for the USAID Open Doors being terminated.  Chipili says “We didn’t expect its implementation to come with the termination of the grants suddenly. We thought that we were going to be given time, a year, one year to work and complete the project and hand over to the partner that was going to take over the responsibilities that Planned Parenthood Association of Zambia handled.” The termination of the project means progress that has been made, especially the work done to help reduce the number of HIV and STIs cases among the key populations will be undone. Progress, that is desperately needed to meet Zambia’s targets on HIV reduction. “We are losing precious time. We have got targets to meet as a nation, we need to ensure that by 2020 we reach the 90/90 goals, set by UNAIDS, and also the country has a broader vision of eliminating the threat of HIV, HIV as a public threat by 2030. So if we have such stumbling blocks, then the targets might not be met.  And then these key populations are also linked with the general population, we have men who sex with men, they also have partners, some of them are married, and if we don’t get into their networks, HIV and STIs will end up in the general population, therefore putting everybody at risk." Other impacts have been the increased vulnerability and the lost investment of peer promoters from the key populations and loss of safety and security that was provided by the organization.  Loss of safety and security “For safety and security, key populations cannot freely go to facilities they don’t know very well. The clinic setup was the most ideal set up for them. No one would question them, because this is open to everybody. But now what the project is doing, they are renting houses, the USAID is renting houses where they are providing services, so a house is very different from a clinic, that also affects the element of sustainability. The element of sustainability has also been lost because PPAZ has been here for a long time, since 1972, so we were hoping that the project was going to build the capacity for PPAZ to continue providing services to key populations that are free from stigma and discrimination. That has been lost. To me it’s a lost opportunity.” The Zambia National AIDS/HIV Strategic Framework for 2017 to 2021, bears a strong emphasis on leaving no one behind when it comes to stopping the HIV/AIDS epidemic. “No one should be left behind, if we are to reduce HIV infections to zero, if this is not done, the dream, the vision will not be achieved, we cannot afford to start pointing fingers, we have to use the public health approach and eliminate the risk of HIV infection amidst our people”.