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Spotlight

A selection of stories from across the Federation

2024 trends
Story

What does the year 2024 hold for us?

As the new year begins, we take a look at the trends and challenges ahead for sexual and reproductive health and rights.
Family Planning FPAN
story

| 25 July 2017

Emergency rescue in Kathmandu Valley

For Sharad Kumar Argal, the weeks after April 25 are a time he will never forget. Sharad has been working for FPAN for twenty years, currently as Kathmandu Valley branch manager. When the earthquake struck, the Kathmandu Valley was among the worst affected area in the country. Thousands of people were killed, injured and displaced, and many of the valley’s houses, schools, buildings and historic temples were destroyed or damaged beyond repair. The 2015 earthquake has been a major test for the country, with bureaucracy and alleged abuse hampering reconstruction. But for FPAN, in the days after the quake struck, there was no time to waste. “The first thing we did was to identify the needs of the people,” Sharad says. “We realised people were being deprived of services,” with many clinics and hospitals damaged, closed or overwhelmed by patients. By the second day after the earthquake, we were conducting health camps. All the volunteers and staff came together and made a plan: we identified the most affected areas and went there with mobile services.” The teams divided their work into two categories: first and second level. During the first phase, they offered check ups for those injured and distributed essential items like oral rehydration, medicines, food and water. During the second phase, a few days later, they gave more comprehensive services: the team set up mobile labs to carry out blood tests, provided contraception and dignity kits [sanitary pads etc], and gave antenatal checks and psycho-social counselling. They also set up women- and child-friendly spaces, in partnership with the UN Population Fund and other NGOs. For women, safe spaces to spend time and access support were vital, particularly given how insecure and vulnerable their temporary accommodation was. “Children were very affected with trauma, as well as physically,” says Sharad. “We set up child-friendly spaces where children could come, spend time and play with toys. We even had a tutor to give them education, as well as counsellors.” Today, the work of the FPAN Valley branch office is still heavily affected by the earthquake. Their Bhaktapur clinic was completely destroyed and they now operate out of tiny room in the ancient heart of the city, surrounded by building sites and the sounds of cement mixers, while they await permission from government and community leaders to begin building a new centre. “Most of our service delivery points are still damaged,” says Sharad. “This is the main hindrance to giving services to the people: we want to provide services but due to the lack of space, we often can’t provide the services they want. This is one of the biggest impacts we are still facing.”

Family Planning FPAN
story

| 29 March 2024

Emergency rescue in Kathmandu Valley

For Sharad Kumar Argal, the weeks after April 25 are a time he will never forget. Sharad has been working for FPAN for twenty years, currently as Kathmandu Valley branch manager. When the earthquake struck, the Kathmandu Valley was among the worst affected area in the country. Thousands of people were killed, injured and displaced, and many of the valley’s houses, schools, buildings and historic temples were destroyed or damaged beyond repair. The 2015 earthquake has been a major test for the country, with bureaucracy and alleged abuse hampering reconstruction. But for FPAN, in the days after the quake struck, there was no time to waste. “The first thing we did was to identify the needs of the people,” Sharad says. “We realised people were being deprived of services,” with many clinics and hospitals damaged, closed or overwhelmed by patients. By the second day after the earthquake, we were conducting health camps. All the volunteers and staff came together and made a plan: we identified the most affected areas and went there with mobile services.” The teams divided their work into two categories: first and second level. During the first phase, they offered check ups for those injured and distributed essential items like oral rehydration, medicines, food and water. During the second phase, a few days later, they gave more comprehensive services: the team set up mobile labs to carry out blood tests, provided contraception and dignity kits [sanitary pads etc], and gave antenatal checks and psycho-social counselling. They also set up women- and child-friendly spaces, in partnership with the UN Population Fund and other NGOs. For women, safe spaces to spend time and access support were vital, particularly given how insecure and vulnerable their temporary accommodation was. “Children were very affected with trauma, as well as physically,” says Sharad. “We set up child-friendly spaces where children could come, spend time and play with toys. We even had a tutor to give them education, as well as counsellors.” Today, the work of the FPAN Valley branch office is still heavily affected by the earthquake. Their Bhaktapur clinic was completely destroyed and they now operate out of tiny room in the ancient heart of the city, surrounded by building sites and the sounds of cement mixers, while they await permission from government and community leaders to begin building a new centre. “Most of our service delivery points are still damaged,” says Sharad. “This is the main hindrance to giving services to the people: we want to provide services but due to the lack of space, we often can’t provide the services they want. This is one of the biggest impacts we are still facing.”

Portrait of Binu
story

| 05 July 2017

How cultural traditions affect women’s health

High up in the mountains of central northern Nepal, not far from the Tibetan border, lies the district of Rasuwa. The people here are mainly ethnic Tamang and Sherpa, two indigenous groups with cultural traditions stretching back centuries. But these rich cultural traditions can come hand-in-hand with severe social problems, compounded by entrenched poverty and very low literacy rates. Binu Koraila is a health facility mentor for the Family Planning Association of Nepal (FPAN) in Rasuwa. "Stigma, myths and cultural practices can have a damaging effect on sexual health, family planning and women’s rights", she says. Misconceptions about contraception are widespread. “People think the intrauterine coil will go into the brain or will fall out. They think the contraceptive implant will penetrate into the muscles.” Funeral rites present another problem. “Men who want a vasectomy need permission from their parents,” she explains. “But it’s thought that men who have had vasectomies won’t be able to perform the rituals after their parent’s death: parents think that God won’t accept that, so they don’t allow men to have vasectomies.” The culture here is strongly patriarchal. Among the Tamang, marriage involves boys or men picking out young girls from their communities.Early and forced marriage is widespread among the Tamang. If chosen, the girls have no choice but to get married. “If a boy likes a girl, they can just snatch them and take them to their house,” Binu says. Some girls are as young as 13 years old. “The girls don’t know enough about family planning, so there is a lot of teenage pregnancy.” Early marriage and teenage pregnancy can create all kinds of physical, emotional, social and economic problems for girls and their families. For many, their bodies are not well developed enough for childbirth, and maternal mortality remains a major problem in Nepal, at 258 deaths per 100,000 live births, according to UNFPA data. Their large families also suffer because there is not enough food and money to go around. “Women are the worst affected,” Binu says. Parents and husbands keep strict control of women’s access to contraception. “If they want to use contraception, women tend to need consent from their parents or husbands. “I have seen cases where if a woman gets contraceptive implant services, they get beaten by their father-in-law and husband. One woman asked to have her implant removed because she had been beaten by her husband.” Binu’s role is to deliver sexual health and family planning advice and services to villages across Rasuwa district: “I go to remote places, where people are marginalised and don’t know about family planning.” She also trains government health workers on family planning, and mentors them after they return from training in Kathmandu to Rasuwa. As well as delivering health services, the FPAN team have been working hard to change perceptions. “Recently we had a health camp at Gatland,” she explains. "After two hours of counselling one client requested an IUD. After months there was a rumour in Gatlang that her coil had fallen out. The FPAN volunteer went to the woman’s house and asked if this was true. She said, ‘No, I’m really comfortable with that service.’ After that, the client went door to door and told others how happy she was with it and that they should take it at the next family planning camp. “After four or five months, we went back to the Gatlang camp and at that time another eight women took the IUD.” These numbers might seem small but they are far less so when viewed against the wall of stigma and myth that can obstruct contraception use here, as in so many rural areas of Nepal. The involvement of committed, passionate health mentors and volunteers is vital to show people how important it is to take sexual health and family planning seriously: the benefits are felt not just by women and their families, but by entire communities. Stories Read more stories from Nepal

Portrait of Binu
story

| 29 March 2024

How cultural traditions affect women’s health

High up in the mountains of central northern Nepal, not far from the Tibetan border, lies the district of Rasuwa. The people here are mainly ethnic Tamang and Sherpa, two indigenous groups with cultural traditions stretching back centuries. But these rich cultural traditions can come hand-in-hand with severe social problems, compounded by entrenched poverty and very low literacy rates. Binu Koraila is a health facility mentor for the Family Planning Association of Nepal (FPAN) in Rasuwa. "Stigma, myths and cultural practices can have a damaging effect on sexual health, family planning and women’s rights", she says. Misconceptions about contraception are widespread. “People think the intrauterine coil will go into the brain or will fall out. They think the contraceptive implant will penetrate into the muscles.” Funeral rites present another problem. “Men who want a vasectomy need permission from their parents,” she explains. “But it’s thought that men who have had vasectomies won’t be able to perform the rituals after their parent’s death: parents think that God won’t accept that, so they don’t allow men to have vasectomies.” The culture here is strongly patriarchal. Among the Tamang, marriage involves boys or men picking out young girls from their communities.Early and forced marriage is widespread among the Tamang. If chosen, the girls have no choice but to get married. “If a boy likes a girl, they can just snatch them and take them to their house,” Binu says. Some girls are as young as 13 years old. “The girls don’t know enough about family planning, so there is a lot of teenage pregnancy.” Early marriage and teenage pregnancy can create all kinds of physical, emotional, social and economic problems for girls and their families. For many, their bodies are not well developed enough for childbirth, and maternal mortality remains a major problem in Nepal, at 258 deaths per 100,000 live births, according to UNFPA data. Their large families also suffer because there is not enough food and money to go around. “Women are the worst affected,” Binu says. Parents and husbands keep strict control of women’s access to contraception. “If they want to use contraception, women tend to need consent from their parents or husbands. “I have seen cases where if a woman gets contraceptive implant services, they get beaten by their father-in-law and husband. One woman asked to have her implant removed because she had been beaten by her husband.” Binu’s role is to deliver sexual health and family planning advice and services to villages across Rasuwa district: “I go to remote places, where people are marginalised and don’t know about family planning.” She also trains government health workers on family planning, and mentors them after they return from training in Kathmandu to Rasuwa. As well as delivering health services, the FPAN team have been working hard to change perceptions. “Recently we had a health camp at Gatland,” she explains. "After two hours of counselling one client requested an IUD. After months there was a rumour in Gatlang that her coil had fallen out. The FPAN volunteer went to the woman’s house and asked if this was true. She said, ‘No, I’m really comfortable with that service.’ After that, the client went door to door and told others how happy she was with it and that they should take it at the next family planning camp. “After four or five months, we went back to the Gatlang camp and at that time another eight women took the IUD.” These numbers might seem small but they are far less so when viewed against the wall of stigma and myth that can obstruct contraception use here, as in so many rural areas of Nepal. The involvement of committed, passionate health mentors and volunteers is vital to show people how important it is to take sexual health and family planning seriously: the benefits are felt not just by women and their families, but by entire communities. Stories Read more stories from Nepal

Rita receiving services
story

| 05 July 2017

Battling stigma against sexual and reproductive health and information

“People used to shout at me when I was distributing condoms. ‘You’re not a good girl, you’re not of good character’ they’d say. They called me many bad things.” “But later on, after getting married, whenever I visited those families they came and said: ‘you did a really good job. We realise that now and feel sorry for what we said before.” Rita Chawal is recalling her time as a volunteer for the Family Planning Association of Nepal (FPAN), Nepal’s largest family planning organisation. Her experiences point to the crucial importance of family planning education and support in Nepal, a country still affected by severe maternal and infant mortality rates and poor access to contraception. Poor government services, remote communities, a failing transport network and strict patriarchal structures can make access to family planning and health services a challenge for many people across the country. Services like FPAN’s are vital to reach as many people as possible. Rita is now 32 years old and herself a client of FPAN. She lives with her husband and six-year-old son in Bhaktapur, an ancient temple city, 15 kilometres from the centre of Kathmandu. Before getting married, she spent 10 years working as a family planning youth volunteer for FPAN, running classes on sexual health, safe abortion and contraception. Her time at the organisation set her in good stead for married life: after marrying she approached FPAN right away to get family planning support, antenatal classes, and, later on, contraception. “I had all this knowledge, so I decided to come and take the services,” she says. “I found that the services here were very good.” But Rita is far from the norm. She shudders when she recalls the abuse she received from neighbours and her community when she worked distributing contraception. Stigma still surrounds contraception in many places: for an unmarried young woman like Rita to be distributing condoms was seen as immoral by many, particularly older, people, even in an urban setting like Bhaktapur. Stigma can be even more extreme in rural areas. Across Nepal, rumours about the side effects of different contraceptive devices are also a problem. Attitudes are slowly changing. Rita says people now come to her whenever they have a family planning problem. “I have become a role model for the community,” she says. She herself is now using the contraceptive implant, a decision she arrived at after discussing different options with FPAN volunteers. She has tried different methods. After her son’s birth, she began using the contraceptive injection. “After the injection, I shifted to oral pills for six months, but that didn’t suit me,” she says. “It gave me a headache and made me feel dizzy. So I had a consultation with FPAN and they advised me to use the implant. I use it now and feel really good and safe. It’s been five years now.” This kind of advice and support can transform the lives of entire families in Nepal. Reductions in maternal and infant mortality, sexual health, female empowerment and dignity, and access to safe abortion are just a few of the life-changing benefits that organisations like FPAN can bring. Stories Read more stories from Nepal

Rita receiving services
story

| 29 March 2024

Battling stigma against sexual and reproductive health and information

“People used to shout at me when I was distributing condoms. ‘You’re not a good girl, you’re not of good character’ they’d say. They called me many bad things.” “But later on, after getting married, whenever I visited those families they came and said: ‘you did a really good job. We realise that now and feel sorry for what we said before.” Rita Chawal is recalling her time as a volunteer for the Family Planning Association of Nepal (FPAN), Nepal’s largest family planning organisation. Her experiences point to the crucial importance of family planning education and support in Nepal, a country still affected by severe maternal and infant mortality rates and poor access to contraception. Poor government services, remote communities, a failing transport network and strict patriarchal structures can make access to family planning and health services a challenge for many people across the country. Services like FPAN’s are vital to reach as many people as possible. Rita is now 32 years old and herself a client of FPAN. She lives with her husband and six-year-old son in Bhaktapur, an ancient temple city, 15 kilometres from the centre of Kathmandu. Before getting married, she spent 10 years working as a family planning youth volunteer for FPAN, running classes on sexual health, safe abortion and contraception. Her time at the organisation set her in good stead for married life: after marrying she approached FPAN right away to get family planning support, antenatal classes, and, later on, contraception. “I had all this knowledge, so I decided to come and take the services,” she says. “I found that the services here were very good.” But Rita is far from the norm. She shudders when she recalls the abuse she received from neighbours and her community when she worked distributing contraception. Stigma still surrounds contraception in many places: for an unmarried young woman like Rita to be distributing condoms was seen as immoral by many, particularly older, people, even in an urban setting like Bhaktapur. Stigma can be even more extreme in rural areas. Across Nepal, rumours about the side effects of different contraceptive devices are also a problem. Attitudes are slowly changing. Rita says people now come to her whenever they have a family planning problem. “I have become a role model for the community,” she says. She herself is now using the contraceptive implant, a decision she arrived at after discussing different options with FPAN volunteers. She has tried different methods. After her son’s birth, she began using the contraceptive injection. “After the injection, I shifted to oral pills for six months, but that didn’t suit me,” she says. “It gave me a headache and made me feel dizzy. So I had a consultation with FPAN and they advised me to use the implant. I use it now and feel really good and safe. It’s been five years now.” This kind of advice and support can transform the lives of entire families in Nepal. Reductions in maternal and infant mortality, sexual health, female empowerment and dignity, and access to safe abortion are just a few of the life-changing benefits that organisations like FPAN can bring. Stories Read more stories from Nepal

Portrait of Mona
story

| 05 July 2017

Waiting for an ambulance that never arrives: childbirth without medical help in rural Nepal

“When I was about to give birth, we called for an ambulance or a vehicle to help but even after five hours of calling, no vehicle arrived,” recalls 32-year-old Mona Shrestha. “The birth was difficult. For five hours I had to suffer from delivery complications.” Mona’s story is a familiar one for women in rural Nepal. Like thousands of women across the country, she lives in a small, remote village, at the end of a winding, potholed road. There are no permanent medical facilities or staff based in the village of Bakultar: medical camps occasionally arrive to dispense services, but they are few and far between. Life here is tough. The main livelihood is farming: both men and women toil in the fields during the day, and in the mornings and evenings, women take care of their children and carry out household chores. The nearest birthing centre is an hour’s drive away. Few families can afford to rent a seat in a car, and so are forced to do the journey on foot. For pregnant women walking in the searing heat, this journey can be arduous, even life-threatening. “Fifteen years ago, there was a woman who helped women give birth here, but she’s no longer here,” Mona says. “It’s difficult for women.” Giving birth without medical help can cause severe problems for women and babies, and even death. Infant mortality remains a major problem in Nepal, and maternal mortality is one of the leading causes of death among women. Only 36% of births are attended by a doctor, nurse or midwife.  A traumatic birth can cause long-term physical, psychological, social and economic problems from which women might never recover. Access to contraception and other family planning services, too, involves walking miles to the nearest health clinic. Mona says she used to use the contraceptive injection, but now uses an intrauterine device. Like many villages in Nepal, Bakultar is awash with myths and gossip about the side-effects of contraception. “There are so many side effects to these devices – I’ve heard the coil can cause cancer,” Mona says. “This is why we want to have permanent family planning like sterilisation, for both men and women.” These complaints heard frequently in villages like Bakultar. As well as access to facilities and contraception, people here desperately need access to education on contraception and sexual health and reproductive rights. Misinformation as well as a lack of information are both major problems. “It would be really helpful to have family planning services nearby,” says Mona. Stories Read more stories from Nepal Ask for universal access to contraception!

Portrait of Mona
story

| 29 March 2024

Waiting for an ambulance that never arrives: childbirth without medical help in rural Nepal

“When I was about to give birth, we called for an ambulance or a vehicle to help but even after five hours of calling, no vehicle arrived,” recalls 32-year-old Mona Shrestha. “The birth was difficult. For five hours I had to suffer from delivery complications.” Mona’s story is a familiar one for women in rural Nepal. Like thousands of women across the country, she lives in a small, remote village, at the end of a winding, potholed road. There are no permanent medical facilities or staff based in the village of Bakultar: medical camps occasionally arrive to dispense services, but they are few and far between. Life here is tough. The main livelihood is farming: both men and women toil in the fields during the day, and in the mornings and evenings, women take care of their children and carry out household chores. The nearest birthing centre is an hour’s drive away. Few families can afford to rent a seat in a car, and so are forced to do the journey on foot. For pregnant women walking in the searing heat, this journey can be arduous, even life-threatening. “Fifteen years ago, there was a woman who helped women give birth here, but she’s no longer here,” Mona says. “It’s difficult for women.” Giving birth without medical help can cause severe problems for women and babies, and even death. Infant mortality remains a major problem in Nepal, and maternal mortality is one of the leading causes of death among women. Only 36% of births are attended by a doctor, nurse or midwife.  A traumatic birth can cause long-term physical, psychological, social and economic problems from which women might never recover. Access to contraception and other family planning services, too, involves walking miles to the nearest health clinic. Mona says she used to use the contraceptive injection, but now uses an intrauterine device. Like many villages in Nepal, Bakultar is awash with myths and gossip about the side-effects of contraception. “There are so many side effects to these devices – I’ve heard the coil can cause cancer,” Mona says. “This is why we want to have permanent family planning like sterilisation, for both men and women.” These complaints heard frequently in villages like Bakultar. As well as access to facilities and contraception, people here desperately need access to education on contraception and sexual health and reproductive rights. Misinformation as well as a lack of information are both major problems. “It would be really helpful to have family planning services nearby,” says Mona. Stories Read more stories from Nepal Ask for universal access to contraception!

Pretty Lynn, a sex worker and beneficiary of the Little Mermaids Bureau project, at the LMB office in Kampala, Uganda.
story

| 21 May 2017

A graduate in need turns to sex work

The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Lady Mermaid's Bureau. I am Pretty Lynn, aged 25. I am a sex worker but I went to university. I graduated with a Bachelor's Degree in Tourism in 2013. But now, during the day I’m sleeping and during the night I’m working. That is how my day goes every day. I got into sex work through friends. Okay it is not good but I am earning.  I tried to get a job when I graduated. I have been applying since I graduated in 2013. I’m still applying but I’m not getting anywhere. You know to get jobs in Uganda; you have to know someone there and no one knows me there. To be a sex worker is like a curse. People look at you like, I don’t know, as someone that has no use in society. People look at you in a bad way. They even don’t consider why you are selling. They just see you as the worst thing that can happen in the society. So it is not comfortable, it is really hard but we try and survive. The fact sex working is illegal means you have to hide yourself when you are selling so that police cannot take you. And then you get diseases, men don’t want to pay. When the police come and take us, sometimes they even use us and don’t pay. So it is really hard. They want a free service. Like if they come and take you and pay that would be fair. But they say it is illegal to sell yourself. But they still use you yet they are saying it is illegal. You can’t report the police because there is no evidence.  Abortion and unwanted pregnancies are really common because men don’t want to use condoms and female condoms are really rare and they are expensive. Though at times we get female condoms from Lady Marmaid’s Bureau (LMB) because there are so many of us they can’t keep on giving you them all the time. At times when we get pregnant we use local methods. You can go and use local herbs but it is not safe. One time I used local herbs and I was successful. Then the other time I used Omo washing powder and tea leaves but it was really hard for me. I almost died. I had a friend who died last year from this. But the good thing is that LMB taught us about safe abortion. I have had a safe abortion too. There are some tabs they are called Miso (misoprostol). It costs about fifty thousand shillings (£10 pounds or $20.) It is a lot of money. But if I’m working and I know I’m pregnant, I can say, "this week I’m working for my safe abortion". So if I’m working for twenty thousand, by the end of the week I will have the money. It is expensive compared to Omo at five hundred shillings but that is risky. So if I say I will work this whole week for Miso (misoprostol) it is better. But I'm working and I'm not eating. A project like this one from Lady Mermaid's can help young girls and women. But to take us from sex work, it would really be hard. They would not have enough money to cater for all of us. So what they have to do is to teach us how to protect ourselves, how to defend ourselves. Safe abortion yes. They will just have to sensitise us more about our lives, protection, female condoms and all that. I don't have a boyfriend but maybe when I get money and leave this job I will. But for now, no man would like a woman who sells. No man will bear the wife selling herself. And that will happen only if I get funds, settle somewhere else and become responsible woman. I don’t want this job. I don’t want to be in this business of sex work all the time. I want be married, with my children happily, not selling myself. Stories Read more stories about the amazing success of SAAF in Uganda

Pretty Lynn, a sex worker and beneficiary of the Little Mermaids Bureau project, at the LMB office in Kampala, Uganda.
story

| 29 March 2024

A graduate in need turns to sex work

The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Lady Mermaid's Bureau. I am Pretty Lynn, aged 25. I am a sex worker but I went to university. I graduated with a Bachelor's Degree in Tourism in 2013. But now, during the day I’m sleeping and during the night I’m working. That is how my day goes every day. I got into sex work through friends. Okay it is not good but I am earning.  I tried to get a job when I graduated. I have been applying since I graduated in 2013. I’m still applying but I’m not getting anywhere. You know to get jobs in Uganda; you have to know someone there and no one knows me there. To be a sex worker is like a curse. People look at you like, I don’t know, as someone that has no use in society. People look at you in a bad way. They even don’t consider why you are selling. They just see you as the worst thing that can happen in the society. So it is not comfortable, it is really hard but we try and survive. The fact sex working is illegal means you have to hide yourself when you are selling so that police cannot take you. And then you get diseases, men don’t want to pay. When the police come and take us, sometimes they even use us and don’t pay. So it is really hard. They want a free service. Like if they come and take you and pay that would be fair. But they say it is illegal to sell yourself. But they still use you yet they are saying it is illegal. You can’t report the police because there is no evidence.  Abortion and unwanted pregnancies are really common because men don’t want to use condoms and female condoms are really rare and they are expensive. Though at times we get female condoms from Lady Marmaid’s Bureau (LMB) because there are so many of us they can’t keep on giving you them all the time. At times when we get pregnant we use local methods. You can go and use local herbs but it is not safe. One time I used local herbs and I was successful. Then the other time I used Omo washing powder and tea leaves but it was really hard for me. I almost died. I had a friend who died last year from this. But the good thing is that LMB taught us about safe abortion. I have had a safe abortion too. There are some tabs they are called Miso (misoprostol). It costs about fifty thousand shillings (£10 pounds or $20.) It is a lot of money. But if I’m working and I know I’m pregnant, I can say, "this week I’m working for my safe abortion". So if I’m working for twenty thousand, by the end of the week I will have the money. It is expensive compared to Omo at five hundred shillings but that is risky. So if I say I will work this whole week for Miso (misoprostol) it is better. But I'm working and I'm not eating. A project like this one from Lady Mermaid's can help young girls and women. But to take us from sex work, it would really be hard. They would not have enough money to cater for all of us. So what they have to do is to teach us how to protect ourselves, how to defend ourselves. Safe abortion yes. They will just have to sensitise us more about our lives, protection, female condoms and all that. I don't have a boyfriend but maybe when I get money and leave this job I will. But for now, no man would like a woman who sells. No man will bear the wife selling herself. And that will happen only if I get funds, settle somewhere else and become responsible woman. I don’t want this job. I don’t want to be in this business of sex work all the time. I want be married, with my children happily, not selling myself. Stories Read more stories about the amazing success of SAAF in Uganda

Milly, a teacher and VODA community volunteer, wears a t-shirt advocating for safe abortions in Kasawo, Uganda.
story

| 20 May 2017

Working to stop unsafe abortion for school girls

The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Volunteers for Development Association Uganda (VODA). Unsafe abortion is a huge problem in Uganda with an estimated 400,000 women having an unsafe abortion per year. The law is confusing and unclear, with abortion permitted only under certain circumstances. Post-abortion care is permitted to treat women who have undergone an unsafe abortion, however lack of awareness of the law and stigma surrounding abortion mean that service providers are not always willing to treat patients who arrive seeking care. The VODA project aims to ensure that young women in Uganda are able to lead healthier lives free from unsafe abortion related deaths or complications through reducing abortion stigma in the community, increasing access to abortion-related services and ensuring the providers are trained to provide quality post-abortion care services. I am Helen. I have been a midwife at this small clinic for seven years and I have worked with VODA for four years. Unsafe abortion continues and some schoolgirls are raped. They then go to local herbalists and some of them tell me that they are given emilandira [roots] which they insert inside themselves to rupture the membranes. Some of them even try to induce an abortion by using Omo [douching with detergent or bleach]. At the end of the day they get complications then they land here, so we help them. Unsafe abortion is very common. In one month you can get more than five cases. It is a big problem. We help them, they need to go back to school, and we counsel them. If it is less than 12 weeks, we handle them from here. If they are more than 12 weeks along we refer them to the hospital. Most referrals from VODA are related to unwanted pregnancies, HIV testing, family planning, and youth friendly services. A few parents come for services for their children who are at school. So we counsel them that contraception, other than condoms, will only prevent pregnancy, but you can still get HIV and STIs, so take care. I am Josephine and I work as a midwife at a rural health centre. I deal with pregnant mothers, postnatal mothers, and there are girls who come with problems like unwanted pregnancy. I used to have a negative attitude towards abortion. But then VODA helped us understand the importance of helping someone with the problem because many people were dying in the villages because of unsafe abortion. According to my religion, helping someone to have an abortion was not allowed. But again when you look into it, it’s not good to leave someone to die. So I decided to change my attitude to help people. Post-abortion care has helped many people because these days we don’t have many people in the villages dying because of unsafe abortion. These days I’m proud of what we are doing because before I didn’t know the importance of helping someone with a problem. But these days, since people no longer die, people no longer get problems and I’m proud and happy because we help so many people.   My name is Jonathan. I am married with three children. I have a Bachelor of Social Work and Social Administration. I have worked with VODA as a project officer since 2008. Due to the training that we have done about abortion many people have changed their attitudes and we have helped people to talk about the issue. Most people were against abortion before but they are now realising that if it’s done safely it is important because otherwise many people die from unsafe abortion. I have talked to religious leaders, I have talked to local leaders; I have talked to people of different categories. At first when you approach them, they have a different perception. The health workers were difficult to work with at first. However they knew people were approaching them with the problems of unsafe abortion. Due to religion, communities can be hard against this issue. But after some time we have seen that they have changed their perception toward the issue of safe and unsafe abortion. And now many of them know that in some instances, abortion is inevitable but it should be done in a safe way.   I’m Stevens and I am nurse. We have some clients who come when they have already attempted an unsafe abortion. You find that it is often inevitable. The only solution you have to help those clients is to provide treatment of incomplete abortion as part of post-abortion care. Because of the VODA project there is a very remarkable change in the community. Now, those people who used to have unsafe abortions locally, know where to go for post-abortion care - unlike in the past. I remember a schoolgirl, she was in a very sorry state because she had tried some local remedies to abort. I attended to her and things went well. She went back to school. I feel so proud because that was a big life rescue. A girl like that could have died but now she is alive and I see her carrying on with her studies, I feel so proud. I praise VODA for that encouragement. This service should be legalised because whether they restrict it or not, there is abortion and it is going on. And if it’s not out in the open, so that our people know where to go for such services, it leads to more deaths. Stories Read more stories about the amazing success of SAAF in Uganda

Milly, a teacher and VODA community volunteer, wears a t-shirt advocating for safe abortions in Kasawo, Uganda.
story

| 29 March 2024

Working to stop unsafe abortion for school girls

The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Volunteers for Development Association Uganda (VODA). Unsafe abortion is a huge problem in Uganda with an estimated 400,000 women having an unsafe abortion per year. The law is confusing and unclear, with abortion permitted only under certain circumstances. Post-abortion care is permitted to treat women who have undergone an unsafe abortion, however lack of awareness of the law and stigma surrounding abortion mean that service providers are not always willing to treat patients who arrive seeking care. The VODA project aims to ensure that young women in Uganda are able to lead healthier lives free from unsafe abortion related deaths or complications through reducing abortion stigma in the community, increasing access to abortion-related services and ensuring the providers are trained to provide quality post-abortion care services. I am Helen. I have been a midwife at this small clinic for seven years and I have worked with VODA for four years. Unsafe abortion continues and some schoolgirls are raped. They then go to local herbalists and some of them tell me that they are given emilandira [roots] which they insert inside themselves to rupture the membranes. Some of them even try to induce an abortion by using Omo [douching with detergent or bleach]. At the end of the day they get complications then they land here, so we help them. Unsafe abortion is very common. In one month you can get more than five cases. It is a big problem. We help them, they need to go back to school, and we counsel them. If it is less than 12 weeks, we handle them from here. If they are more than 12 weeks along we refer them to the hospital. Most referrals from VODA are related to unwanted pregnancies, HIV testing, family planning, and youth friendly services. A few parents come for services for their children who are at school. So we counsel them that contraception, other than condoms, will only prevent pregnancy, but you can still get HIV and STIs, so take care. I am Josephine and I work as a midwife at a rural health centre. I deal with pregnant mothers, postnatal mothers, and there are girls who come with problems like unwanted pregnancy. I used to have a negative attitude towards abortion. But then VODA helped us understand the importance of helping someone with the problem because many people were dying in the villages because of unsafe abortion. According to my religion, helping someone to have an abortion was not allowed. But again when you look into it, it’s not good to leave someone to die. So I decided to change my attitude to help people. Post-abortion care has helped many people because these days we don’t have many people in the villages dying because of unsafe abortion. These days I’m proud of what we are doing because before I didn’t know the importance of helping someone with a problem. But these days, since people no longer die, people no longer get problems and I’m proud and happy because we help so many people.   My name is Jonathan. I am married with three children. I have a Bachelor of Social Work and Social Administration. I have worked with VODA as a project officer since 2008. Due to the training that we have done about abortion many people have changed their attitudes and we have helped people to talk about the issue. Most people were against abortion before but they are now realising that if it’s done safely it is important because otherwise many people die from unsafe abortion. I have talked to religious leaders, I have talked to local leaders; I have talked to people of different categories. At first when you approach them, they have a different perception. The health workers were difficult to work with at first. However they knew people were approaching them with the problems of unsafe abortion. Due to religion, communities can be hard against this issue. But after some time we have seen that they have changed their perception toward the issue of safe and unsafe abortion. And now many of them know that in some instances, abortion is inevitable but it should be done in a safe way.   I’m Stevens and I am nurse. We have some clients who come when they have already attempted an unsafe abortion. You find that it is often inevitable. The only solution you have to help those clients is to provide treatment of incomplete abortion as part of post-abortion care. Because of the VODA project there is a very remarkable change in the community. Now, those people who used to have unsafe abortions locally, know where to go for post-abortion care - unlike in the past. I remember a schoolgirl, she was in a very sorry state because she had tried some local remedies to abort. I attended to her and things went well. She went back to school. I feel so proud because that was a big life rescue. A girl like that could have died but now she is alive and I see her carrying on with her studies, I feel so proud. I praise VODA for that encouragement. This service should be legalised because whether they restrict it or not, there is abortion and it is going on. And if it’s not out in the open, so that our people know where to go for such services, it leads to more deaths. Stories Read more stories about the amazing success of SAAF in Uganda

Family Planning FPAN
story

| 25 July 2017

Emergency rescue in Kathmandu Valley

For Sharad Kumar Argal, the weeks after April 25 are a time he will never forget. Sharad has been working for FPAN for twenty years, currently as Kathmandu Valley branch manager. When the earthquake struck, the Kathmandu Valley was among the worst affected area in the country. Thousands of people were killed, injured and displaced, and many of the valley’s houses, schools, buildings and historic temples were destroyed or damaged beyond repair. The 2015 earthquake has been a major test for the country, with bureaucracy and alleged abuse hampering reconstruction. But for FPAN, in the days after the quake struck, there was no time to waste. “The first thing we did was to identify the needs of the people,” Sharad says. “We realised people were being deprived of services,” with many clinics and hospitals damaged, closed or overwhelmed by patients. By the second day after the earthquake, we were conducting health camps. All the volunteers and staff came together and made a plan: we identified the most affected areas and went there with mobile services.” The teams divided their work into two categories: first and second level. During the first phase, they offered check ups for those injured and distributed essential items like oral rehydration, medicines, food and water. During the second phase, a few days later, they gave more comprehensive services: the team set up mobile labs to carry out blood tests, provided contraception and dignity kits [sanitary pads etc], and gave antenatal checks and psycho-social counselling. They also set up women- and child-friendly spaces, in partnership with the UN Population Fund and other NGOs. For women, safe spaces to spend time and access support were vital, particularly given how insecure and vulnerable their temporary accommodation was. “Children were very affected with trauma, as well as physically,” says Sharad. “We set up child-friendly spaces where children could come, spend time and play with toys. We even had a tutor to give them education, as well as counsellors.” Today, the work of the FPAN Valley branch office is still heavily affected by the earthquake. Their Bhaktapur clinic was completely destroyed and they now operate out of tiny room in the ancient heart of the city, surrounded by building sites and the sounds of cement mixers, while they await permission from government and community leaders to begin building a new centre. “Most of our service delivery points are still damaged,” says Sharad. “This is the main hindrance to giving services to the people: we want to provide services but due to the lack of space, we often can’t provide the services they want. This is one of the biggest impacts we are still facing.”

Family Planning FPAN
story

| 29 March 2024

Emergency rescue in Kathmandu Valley

For Sharad Kumar Argal, the weeks after April 25 are a time he will never forget. Sharad has been working for FPAN for twenty years, currently as Kathmandu Valley branch manager. When the earthquake struck, the Kathmandu Valley was among the worst affected area in the country. Thousands of people were killed, injured and displaced, and many of the valley’s houses, schools, buildings and historic temples were destroyed or damaged beyond repair. The 2015 earthquake has been a major test for the country, with bureaucracy and alleged abuse hampering reconstruction. But for FPAN, in the days after the quake struck, there was no time to waste. “The first thing we did was to identify the needs of the people,” Sharad says. “We realised people were being deprived of services,” with many clinics and hospitals damaged, closed or overwhelmed by patients. By the second day after the earthquake, we were conducting health camps. All the volunteers and staff came together and made a plan: we identified the most affected areas and went there with mobile services.” The teams divided their work into two categories: first and second level. During the first phase, they offered check ups for those injured and distributed essential items like oral rehydration, medicines, food and water. During the second phase, a few days later, they gave more comprehensive services: the team set up mobile labs to carry out blood tests, provided contraception and dignity kits [sanitary pads etc], and gave antenatal checks and psycho-social counselling. They also set up women- and child-friendly spaces, in partnership with the UN Population Fund and other NGOs. For women, safe spaces to spend time and access support were vital, particularly given how insecure and vulnerable their temporary accommodation was. “Children were very affected with trauma, as well as physically,” says Sharad. “We set up child-friendly spaces where children could come, spend time and play with toys. We even had a tutor to give them education, as well as counsellors.” Today, the work of the FPAN Valley branch office is still heavily affected by the earthquake. Their Bhaktapur clinic was completely destroyed and they now operate out of tiny room in the ancient heart of the city, surrounded by building sites and the sounds of cement mixers, while they await permission from government and community leaders to begin building a new centre. “Most of our service delivery points are still damaged,” says Sharad. “This is the main hindrance to giving services to the people: we want to provide services but due to the lack of space, we often can’t provide the services they want. This is one of the biggest impacts we are still facing.”

Portrait of Binu
story

| 05 July 2017

How cultural traditions affect women’s health

High up in the mountains of central northern Nepal, not far from the Tibetan border, lies the district of Rasuwa. The people here are mainly ethnic Tamang and Sherpa, two indigenous groups with cultural traditions stretching back centuries. But these rich cultural traditions can come hand-in-hand with severe social problems, compounded by entrenched poverty and very low literacy rates. Binu Koraila is a health facility mentor for the Family Planning Association of Nepal (FPAN) in Rasuwa. "Stigma, myths and cultural practices can have a damaging effect on sexual health, family planning and women’s rights", she says. Misconceptions about contraception are widespread. “People think the intrauterine coil will go into the brain or will fall out. They think the contraceptive implant will penetrate into the muscles.” Funeral rites present another problem. “Men who want a vasectomy need permission from their parents,” she explains. “But it’s thought that men who have had vasectomies won’t be able to perform the rituals after their parent’s death: parents think that God won’t accept that, so they don’t allow men to have vasectomies.” The culture here is strongly patriarchal. Among the Tamang, marriage involves boys or men picking out young girls from their communities.Early and forced marriage is widespread among the Tamang. If chosen, the girls have no choice but to get married. “If a boy likes a girl, they can just snatch them and take them to their house,” Binu says. Some girls are as young as 13 years old. “The girls don’t know enough about family planning, so there is a lot of teenage pregnancy.” Early marriage and teenage pregnancy can create all kinds of physical, emotional, social and economic problems for girls and their families. For many, their bodies are not well developed enough for childbirth, and maternal mortality remains a major problem in Nepal, at 258 deaths per 100,000 live births, according to UNFPA data. Their large families also suffer because there is not enough food and money to go around. “Women are the worst affected,” Binu says. Parents and husbands keep strict control of women’s access to contraception. “If they want to use contraception, women tend to need consent from their parents or husbands. “I have seen cases where if a woman gets contraceptive implant services, they get beaten by their father-in-law and husband. One woman asked to have her implant removed because she had been beaten by her husband.” Binu’s role is to deliver sexual health and family planning advice and services to villages across Rasuwa district: “I go to remote places, where people are marginalised and don’t know about family planning.” She also trains government health workers on family planning, and mentors them after they return from training in Kathmandu to Rasuwa. As well as delivering health services, the FPAN team have been working hard to change perceptions. “Recently we had a health camp at Gatland,” she explains. "After two hours of counselling one client requested an IUD. After months there was a rumour in Gatlang that her coil had fallen out. The FPAN volunteer went to the woman’s house and asked if this was true. She said, ‘No, I’m really comfortable with that service.’ After that, the client went door to door and told others how happy she was with it and that they should take it at the next family planning camp. “After four or five months, we went back to the Gatlang camp and at that time another eight women took the IUD.” These numbers might seem small but they are far less so when viewed against the wall of stigma and myth that can obstruct contraception use here, as in so many rural areas of Nepal. The involvement of committed, passionate health mentors and volunteers is vital to show people how important it is to take sexual health and family planning seriously: the benefits are felt not just by women and their families, but by entire communities. Stories Read more stories from Nepal

Portrait of Binu
story

| 29 March 2024

How cultural traditions affect women’s health

High up in the mountains of central northern Nepal, not far from the Tibetan border, lies the district of Rasuwa. The people here are mainly ethnic Tamang and Sherpa, two indigenous groups with cultural traditions stretching back centuries. But these rich cultural traditions can come hand-in-hand with severe social problems, compounded by entrenched poverty and very low literacy rates. Binu Koraila is a health facility mentor for the Family Planning Association of Nepal (FPAN) in Rasuwa. "Stigma, myths and cultural practices can have a damaging effect on sexual health, family planning and women’s rights", she says. Misconceptions about contraception are widespread. “People think the intrauterine coil will go into the brain or will fall out. They think the contraceptive implant will penetrate into the muscles.” Funeral rites present another problem. “Men who want a vasectomy need permission from their parents,” she explains. “But it’s thought that men who have had vasectomies won’t be able to perform the rituals after their parent’s death: parents think that God won’t accept that, so they don’t allow men to have vasectomies.” The culture here is strongly patriarchal. Among the Tamang, marriage involves boys or men picking out young girls from their communities.Early and forced marriage is widespread among the Tamang. If chosen, the girls have no choice but to get married. “If a boy likes a girl, they can just snatch them and take them to their house,” Binu says. Some girls are as young as 13 years old. “The girls don’t know enough about family planning, so there is a lot of teenage pregnancy.” Early marriage and teenage pregnancy can create all kinds of physical, emotional, social and economic problems for girls and their families. For many, their bodies are not well developed enough for childbirth, and maternal mortality remains a major problem in Nepal, at 258 deaths per 100,000 live births, according to UNFPA data. Their large families also suffer because there is not enough food and money to go around. “Women are the worst affected,” Binu says. Parents and husbands keep strict control of women’s access to contraception. “If they want to use contraception, women tend to need consent from their parents or husbands. “I have seen cases where if a woman gets contraceptive implant services, they get beaten by their father-in-law and husband. One woman asked to have her implant removed because she had been beaten by her husband.” Binu’s role is to deliver sexual health and family planning advice and services to villages across Rasuwa district: “I go to remote places, where people are marginalised and don’t know about family planning.” She also trains government health workers on family planning, and mentors them after they return from training in Kathmandu to Rasuwa. As well as delivering health services, the FPAN team have been working hard to change perceptions. “Recently we had a health camp at Gatland,” she explains. "After two hours of counselling one client requested an IUD. After months there was a rumour in Gatlang that her coil had fallen out. The FPAN volunteer went to the woman’s house and asked if this was true. She said, ‘No, I’m really comfortable with that service.’ After that, the client went door to door and told others how happy she was with it and that they should take it at the next family planning camp. “After four or five months, we went back to the Gatlang camp and at that time another eight women took the IUD.” These numbers might seem small but they are far less so when viewed against the wall of stigma and myth that can obstruct contraception use here, as in so many rural areas of Nepal. The involvement of committed, passionate health mentors and volunteers is vital to show people how important it is to take sexual health and family planning seriously: the benefits are felt not just by women and their families, but by entire communities. Stories Read more stories from Nepal

Rita receiving services
story

| 05 July 2017

Battling stigma against sexual and reproductive health and information

“People used to shout at me when I was distributing condoms. ‘You’re not a good girl, you’re not of good character’ they’d say. They called me many bad things.” “But later on, after getting married, whenever I visited those families they came and said: ‘you did a really good job. We realise that now and feel sorry for what we said before.” Rita Chawal is recalling her time as a volunteer for the Family Planning Association of Nepal (FPAN), Nepal’s largest family planning organisation. Her experiences point to the crucial importance of family planning education and support in Nepal, a country still affected by severe maternal and infant mortality rates and poor access to contraception. Poor government services, remote communities, a failing transport network and strict patriarchal structures can make access to family planning and health services a challenge for many people across the country. Services like FPAN’s are vital to reach as many people as possible. Rita is now 32 years old and herself a client of FPAN. She lives with her husband and six-year-old son in Bhaktapur, an ancient temple city, 15 kilometres from the centre of Kathmandu. Before getting married, she spent 10 years working as a family planning youth volunteer for FPAN, running classes on sexual health, safe abortion and contraception. Her time at the organisation set her in good stead for married life: after marrying she approached FPAN right away to get family planning support, antenatal classes, and, later on, contraception. “I had all this knowledge, so I decided to come and take the services,” she says. “I found that the services here were very good.” But Rita is far from the norm. She shudders when she recalls the abuse she received from neighbours and her community when she worked distributing contraception. Stigma still surrounds contraception in many places: for an unmarried young woman like Rita to be distributing condoms was seen as immoral by many, particularly older, people, even in an urban setting like Bhaktapur. Stigma can be even more extreme in rural areas. Across Nepal, rumours about the side effects of different contraceptive devices are also a problem. Attitudes are slowly changing. Rita says people now come to her whenever they have a family planning problem. “I have become a role model for the community,” she says. She herself is now using the contraceptive implant, a decision she arrived at after discussing different options with FPAN volunteers. She has tried different methods. After her son’s birth, she began using the contraceptive injection. “After the injection, I shifted to oral pills for six months, but that didn’t suit me,” she says. “It gave me a headache and made me feel dizzy. So I had a consultation with FPAN and they advised me to use the implant. I use it now and feel really good and safe. It’s been five years now.” This kind of advice and support can transform the lives of entire families in Nepal. Reductions in maternal and infant mortality, sexual health, female empowerment and dignity, and access to safe abortion are just a few of the life-changing benefits that organisations like FPAN can bring. Stories Read more stories from Nepal

Rita receiving services
story

| 29 March 2024

Battling stigma against sexual and reproductive health and information

“People used to shout at me when I was distributing condoms. ‘You’re not a good girl, you’re not of good character’ they’d say. They called me many bad things.” “But later on, after getting married, whenever I visited those families they came and said: ‘you did a really good job. We realise that now and feel sorry for what we said before.” Rita Chawal is recalling her time as a volunteer for the Family Planning Association of Nepal (FPAN), Nepal’s largest family planning organisation. Her experiences point to the crucial importance of family planning education and support in Nepal, a country still affected by severe maternal and infant mortality rates and poor access to contraception. Poor government services, remote communities, a failing transport network and strict patriarchal structures can make access to family planning and health services a challenge for many people across the country. Services like FPAN’s are vital to reach as many people as possible. Rita is now 32 years old and herself a client of FPAN. She lives with her husband and six-year-old son in Bhaktapur, an ancient temple city, 15 kilometres from the centre of Kathmandu. Before getting married, she spent 10 years working as a family planning youth volunteer for FPAN, running classes on sexual health, safe abortion and contraception. Her time at the organisation set her in good stead for married life: after marrying she approached FPAN right away to get family planning support, antenatal classes, and, later on, contraception. “I had all this knowledge, so I decided to come and take the services,” she says. “I found that the services here were very good.” But Rita is far from the norm. She shudders when she recalls the abuse she received from neighbours and her community when she worked distributing contraception. Stigma still surrounds contraception in many places: for an unmarried young woman like Rita to be distributing condoms was seen as immoral by many, particularly older, people, even in an urban setting like Bhaktapur. Stigma can be even more extreme in rural areas. Across Nepal, rumours about the side effects of different contraceptive devices are also a problem. Attitudes are slowly changing. Rita says people now come to her whenever they have a family planning problem. “I have become a role model for the community,” she says. She herself is now using the contraceptive implant, a decision she arrived at after discussing different options with FPAN volunteers. She has tried different methods. After her son’s birth, she began using the contraceptive injection. “After the injection, I shifted to oral pills for six months, but that didn’t suit me,” she says. “It gave me a headache and made me feel dizzy. So I had a consultation with FPAN and they advised me to use the implant. I use it now and feel really good and safe. It’s been five years now.” This kind of advice and support can transform the lives of entire families in Nepal. Reductions in maternal and infant mortality, sexual health, female empowerment and dignity, and access to safe abortion are just a few of the life-changing benefits that organisations like FPAN can bring. Stories Read more stories from Nepal

Portrait of Mona
story

| 05 July 2017

Waiting for an ambulance that never arrives: childbirth without medical help in rural Nepal

“When I was about to give birth, we called for an ambulance or a vehicle to help but even after five hours of calling, no vehicle arrived,” recalls 32-year-old Mona Shrestha. “The birth was difficult. For five hours I had to suffer from delivery complications.” Mona’s story is a familiar one for women in rural Nepal. Like thousands of women across the country, she lives in a small, remote village, at the end of a winding, potholed road. There are no permanent medical facilities or staff based in the village of Bakultar: medical camps occasionally arrive to dispense services, but they are few and far between. Life here is tough. The main livelihood is farming: both men and women toil in the fields during the day, and in the mornings and evenings, women take care of their children and carry out household chores. The nearest birthing centre is an hour’s drive away. Few families can afford to rent a seat in a car, and so are forced to do the journey on foot. For pregnant women walking in the searing heat, this journey can be arduous, even life-threatening. “Fifteen years ago, there was a woman who helped women give birth here, but she’s no longer here,” Mona says. “It’s difficult for women.” Giving birth without medical help can cause severe problems for women and babies, and even death. Infant mortality remains a major problem in Nepal, and maternal mortality is one of the leading causes of death among women. Only 36% of births are attended by a doctor, nurse or midwife.  A traumatic birth can cause long-term physical, psychological, social and economic problems from which women might never recover. Access to contraception and other family planning services, too, involves walking miles to the nearest health clinic. Mona says she used to use the contraceptive injection, but now uses an intrauterine device. Like many villages in Nepal, Bakultar is awash with myths and gossip about the side-effects of contraception. “There are so many side effects to these devices – I’ve heard the coil can cause cancer,” Mona says. “This is why we want to have permanent family planning like sterilisation, for both men and women.” These complaints heard frequently in villages like Bakultar. As well as access to facilities and contraception, people here desperately need access to education on contraception and sexual health and reproductive rights. Misinformation as well as a lack of information are both major problems. “It would be really helpful to have family planning services nearby,” says Mona. Stories Read more stories from Nepal Ask for universal access to contraception!

Portrait of Mona
story

| 29 March 2024

Waiting for an ambulance that never arrives: childbirth without medical help in rural Nepal

“When I was about to give birth, we called for an ambulance or a vehicle to help but even after five hours of calling, no vehicle arrived,” recalls 32-year-old Mona Shrestha. “The birth was difficult. For five hours I had to suffer from delivery complications.” Mona’s story is a familiar one for women in rural Nepal. Like thousands of women across the country, she lives in a small, remote village, at the end of a winding, potholed road. There are no permanent medical facilities or staff based in the village of Bakultar: medical camps occasionally arrive to dispense services, but they are few and far between. Life here is tough. The main livelihood is farming: both men and women toil in the fields during the day, and in the mornings and evenings, women take care of their children and carry out household chores. The nearest birthing centre is an hour’s drive away. Few families can afford to rent a seat in a car, and so are forced to do the journey on foot. For pregnant women walking in the searing heat, this journey can be arduous, even life-threatening. “Fifteen years ago, there was a woman who helped women give birth here, but she’s no longer here,” Mona says. “It’s difficult for women.” Giving birth without medical help can cause severe problems for women and babies, and even death. Infant mortality remains a major problem in Nepal, and maternal mortality is one of the leading causes of death among women. Only 36% of births are attended by a doctor, nurse or midwife.  A traumatic birth can cause long-term physical, psychological, social and economic problems from which women might never recover. Access to contraception and other family planning services, too, involves walking miles to the nearest health clinic. Mona says she used to use the contraceptive injection, but now uses an intrauterine device. Like many villages in Nepal, Bakultar is awash with myths and gossip about the side-effects of contraception. “There are so many side effects to these devices – I’ve heard the coil can cause cancer,” Mona says. “This is why we want to have permanent family planning like sterilisation, for both men and women.” These complaints heard frequently in villages like Bakultar. As well as access to facilities and contraception, people here desperately need access to education on contraception and sexual health and reproductive rights. Misinformation as well as a lack of information are both major problems. “It would be really helpful to have family planning services nearby,” says Mona. Stories Read more stories from Nepal Ask for universal access to contraception!

Pretty Lynn, a sex worker and beneficiary of the Little Mermaids Bureau project, at the LMB office in Kampala, Uganda.
story

| 21 May 2017

A graduate in need turns to sex work

The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Lady Mermaid's Bureau. I am Pretty Lynn, aged 25. I am a sex worker but I went to university. I graduated with a Bachelor's Degree in Tourism in 2013. But now, during the day I’m sleeping and during the night I’m working. That is how my day goes every day. I got into sex work through friends. Okay it is not good but I am earning.  I tried to get a job when I graduated. I have been applying since I graduated in 2013. I’m still applying but I’m not getting anywhere. You know to get jobs in Uganda; you have to know someone there and no one knows me there. To be a sex worker is like a curse. People look at you like, I don’t know, as someone that has no use in society. People look at you in a bad way. They even don’t consider why you are selling. They just see you as the worst thing that can happen in the society. So it is not comfortable, it is really hard but we try and survive. The fact sex working is illegal means you have to hide yourself when you are selling so that police cannot take you. And then you get diseases, men don’t want to pay. When the police come and take us, sometimes they even use us and don’t pay. So it is really hard. They want a free service. Like if they come and take you and pay that would be fair. But they say it is illegal to sell yourself. But they still use you yet they are saying it is illegal. You can’t report the police because there is no evidence.  Abortion and unwanted pregnancies are really common because men don’t want to use condoms and female condoms are really rare and they are expensive. Though at times we get female condoms from Lady Marmaid’s Bureau (LMB) because there are so many of us they can’t keep on giving you them all the time. At times when we get pregnant we use local methods. You can go and use local herbs but it is not safe. One time I used local herbs and I was successful. Then the other time I used Omo washing powder and tea leaves but it was really hard for me. I almost died. I had a friend who died last year from this. But the good thing is that LMB taught us about safe abortion. I have had a safe abortion too. There are some tabs they are called Miso (misoprostol). It costs about fifty thousand shillings (£10 pounds or $20.) It is a lot of money. But if I’m working and I know I’m pregnant, I can say, "this week I’m working for my safe abortion". So if I’m working for twenty thousand, by the end of the week I will have the money. It is expensive compared to Omo at five hundred shillings but that is risky. So if I say I will work this whole week for Miso (misoprostol) it is better. But I'm working and I'm not eating. A project like this one from Lady Mermaid's can help young girls and women. But to take us from sex work, it would really be hard. They would not have enough money to cater for all of us. So what they have to do is to teach us how to protect ourselves, how to defend ourselves. Safe abortion yes. They will just have to sensitise us more about our lives, protection, female condoms and all that. I don't have a boyfriend but maybe when I get money and leave this job I will. But for now, no man would like a woman who sells. No man will bear the wife selling herself. And that will happen only if I get funds, settle somewhere else and become responsible woman. I don’t want this job. I don’t want to be in this business of sex work all the time. I want be married, with my children happily, not selling myself. Stories Read more stories about the amazing success of SAAF in Uganda

Pretty Lynn, a sex worker and beneficiary of the Little Mermaids Bureau project, at the LMB office in Kampala, Uganda.
story

| 29 March 2024

A graduate in need turns to sex work

The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Lady Mermaid's Bureau. I am Pretty Lynn, aged 25. I am a sex worker but I went to university. I graduated with a Bachelor's Degree in Tourism in 2013. But now, during the day I’m sleeping and during the night I’m working. That is how my day goes every day. I got into sex work through friends. Okay it is not good but I am earning.  I tried to get a job when I graduated. I have been applying since I graduated in 2013. I’m still applying but I’m not getting anywhere. You know to get jobs in Uganda; you have to know someone there and no one knows me there. To be a sex worker is like a curse. People look at you like, I don’t know, as someone that has no use in society. People look at you in a bad way. They even don’t consider why you are selling. They just see you as the worst thing that can happen in the society. So it is not comfortable, it is really hard but we try and survive. The fact sex working is illegal means you have to hide yourself when you are selling so that police cannot take you. And then you get diseases, men don’t want to pay. When the police come and take us, sometimes they even use us and don’t pay. So it is really hard. They want a free service. Like if they come and take you and pay that would be fair. But they say it is illegal to sell yourself. But they still use you yet they are saying it is illegal. You can’t report the police because there is no evidence.  Abortion and unwanted pregnancies are really common because men don’t want to use condoms and female condoms are really rare and they are expensive. Though at times we get female condoms from Lady Marmaid’s Bureau (LMB) because there are so many of us they can’t keep on giving you them all the time. At times when we get pregnant we use local methods. You can go and use local herbs but it is not safe. One time I used local herbs and I was successful. Then the other time I used Omo washing powder and tea leaves but it was really hard for me. I almost died. I had a friend who died last year from this. But the good thing is that LMB taught us about safe abortion. I have had a safe abortion too. There are some tabs they are called Miso (misoprostol). It costs about fifty thousand shillings (£10 pounds or $20.) It is a lot of money. But if I’m working and I know I’m pregnant, I can say, "this week I’m working for my safe abortion". So if I’m working for twenty thousand, by the end of the week I will have the money. It is expensive compared to Omo at five hundred shillings but that is risky. So if I say I will work this whole week for Miso (misoprostol) it is better. But I'm working and I'm not eating. A project like this one from Lady Mermaid's can help young girls and women. But to take us from sex work, it would really be hard. They would not have enough money to cater for all of us. So what they have to do is to teach us how to protect ourselves, how to defend ourselves. Safe abortion yes. They will just have to sensitise us more about our lives, protection, female condoms and all that. I don't have a boyfriend but maybe when I get money and leave this job I will. But for now, no man would like a woman who sells. No man will bear the wife selling herself. And that will happen only if I get funds, settle somewhere else and become responsible woman. I don’t want this job. I don’t want to be in this business of sex work all the time. I want be married, with my children happily, not selling myself. Stories Read more stories about the amazing success of SAAF in Uganda

Milly, a teacher and VODA community volunteer, wears a t-shirt advocating for safe abortions in Kasawo, Uganda.
story

| 20 May 2017

Working to stop unsafe abortion for school girls

The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Volunteers for Development Association Uganda (VODA). Unsafe abortion is a huge problem in Uganda with an estimated 400,000 women having an unsafe abortion per year. The law is confusing and unclear, with abortion permitted only under certain circumstances. Post-abortion care is permitted to treat women who have undergone an unsafe abortion, however lack of awareness of the law and stigma surrounding abortion mean that service providers are not always willing to treat patients who arrive seeking care. The VODA project aims to ensure that young women in Uganda are able to lead healthier lives free from unsafe abortion related deaths or complications through reducing abortion stigma in the community, increasing access to abortion-related services and ensuring the providers are trained to provide quality post-abortion care services. I am Helen. I have been a midwife at this small clinic for seven years and I have worked with VODA for four years. Unsafe abortion continues and some schoolgirls are raped. They then go to local herbalists and some of them tell me that they are given emilandira [roots] which they insert inside themselves to rupture the membranes. Some of them even try to induce an abortion by using Omo [douching with detergent or bleach]. At the end of the day they get complications then they land here, so we help them. Unsafe abortion is very common. In one month you can get more than five cases. It is a big problem. We help them, they need to go back to school, and we counsel them. If it is less than 12 weeks, we handle them from here. If they are more than 12 weeks along we refer them to the hospital. Most referrals from VODA are related to unwanted pregnancies, HIV testing, family planning, and youth friendly services. A few parents come for services for their children who are at school. So we counsel them that contraception, other than condoms, will only prevent pregnancy, but you can still get HIV and STIs, so take care. I am Josephine and I work as a midwife at a rural health centre. I deal with pregnant mothers, postnatal mothers, and there are girls who come with problems like unwanted pregnancy. I used to have a negative attitude towards abortion. But then VODA helped us understand the importance of helping someone with the problem because many people were dying in the villages because of unsafe abortion. According to my religion, helping someone to have an abortion was not allowed. But again when you look into it, it’s not good to leave someone to die. So I decided to change my attitude to help people. Post-abortion care has helped many people because these days we don’t have many people in the villages dying because of unsafe abortion. These days I’m proud of what we are doing because before I didn’t know the importance of helping someone with a problem. But these days, since people no longer die, people no longer get problems and I’m proud and happy because we help so many people.   My name is Jonathan. I am married with three children. I have a Bachelor of Social Work and Social Administration. I have worked with VODA as a project officer since 2008. Due to the training that we have done about abortion many people have changed their attitudes and we have helped people to talk about the issue. Most people were against abortion before but they are now realising that if it’s done safely it is important because otherwise many people die from unsafe abortion. I have talked to religious leaders, I have talked to local leaders; I have talked to people of different categories. At first when you approach them, they have a different perception. The health workers were difficult to work with at first. However they knew people were approaching them with the problems of unsafe abortion. Due to religion, communities can be hard against this issue. But after some time we have seen that they have changed their perception toward the issue of safe and unsafe abortion. And now many of them know that in some instances, abortion is inevitable but it should be done in a safe way.   I’m Stevens and I am nurse. We have some clients who come when they have already attempted an unsafe abortion. You find that it is often inevitable. The only solution you have to help those clients is to provide treatment of incomplete abortion as part of post-abortion care. Because of the VODA project there is a very remarkable change in the community. Now, those people who used to have unsafe abortions locally, know where to go for post-abortion care - unlike in the past. I remember a schoolgirl, she was in a very sorry state because she had tried some local remedies to abort. I attended to her and things went well. She went back to school. I feel so proud because that was a big life rescue. A girl like that could have died but now she is alive and I see her carrying on with her studies, I feel so proud. I praise VODA for that encouragement. This service should be legalised because whether they restrict it or not, there is abortion and it is going on. And if it’s not out in the open, so that our people know where to go for such services, it leads to more deaths. Stories Read more stories about the amazing success of SAAF in Uganda

Milly, a teacher and VODA community volunteer, wears a t-shirt advocating for safe abortions in Kasawo, Uganda.
story

| 29 March 2024

Working to stop unsafe abortion for school girls

The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Volunteers for Development Association Uganda (VODA). Unsafe abortion is a huge problem in Uganda with an estimated 400,000 women having an unsafe abortion per year. The law is confusing and unclear, with abortion permitted only under certain circumstances. Post-abortion care is permitted to treat women who have undergone an unsafe abortion, however lack of awareness of the law and stigma surrounding abortion mean that service providers are not always willing to treat patients who arrive seeking care. The VODA project aims to ensure that young women in Uganda are able to lead healthier lives free from unsafe abortion related deaths or complications through reducing abortion stigma in the community, increasing access to abortion-related services and ensuring the providers are trained to provide quality post-abortion care services. I am Helen. I have been a midwife at this small clinic for seven years and I have worked with VODA for four years. Unsafe abortion continues and some schoolgirls are raped. They then go to local herbalists and some of them tell me that they are given emilandira [roots] which they insert inside themselves to rupture the membranes. Some of them even try to induce an abortion by using Omo [douching with detergent or bleach]. At the end of the day they get complications then they land here, so we help them. Unsafe abortion is very common. In one month you can get more than five cases. It is a big problem. We help them, they need to go back to school, and we counsel them. If it is less than 12 weeks, we handle them from here. If they are more than 12 weeks along we refer them to the hospital. Most referrals from VODA are related to unwanted pregnancies, HIV testing, family planning, and youth friendly services. A few parents come for services for their children who are at school. So we counsel them that contraception, other than condoms, will only prevent pregnancy, but you can still get HIV and STIs, so take care. I am Josephine and I work as a midwife at a rural health centre. I deal with pregnant mothers, postnatal mothers, and there are girls who come with problems like unwanted pregnancy. I used to have a negative attitude towards abortion. But then VODA helped us understand the importance of helping someone with the problem because many people were dying in the villages because of unsafe abortion. According to my religion, helping someone to have an abortion was not allowed. But again when you look into it, it’s not good to leave someone to die. So I decided to change my attitude to help people. Post-abortion care has helped many people because these days we don’t have many people in the villages dying because of unsafe abortion. These days I’m proud of what we are doing because before I didn’t know the importance of helping someone with a problem. But these days, since people no longer die, people no longer get problems and I’m proud and happy because we help so many people.   My name is Jonathan. I am married with three children. I have a Bachelor of Social Work and Social Administration. I have worked with VODA as a project officer since 2008. Due to the training that we have done about abortion many people have changed their attitudes and we have helped people to talk about the issue. Most people were against abortion before but they are now realising that if it’s done safely it is important because otherwise many people die from unsafe abortion. I have talked to religious leaders, I have talked to local leaders; I have talked to people of different categories. At first when you approach them, they have a different perception. The health workers were difficult to work with at first. However they knew people were approaching them with the problems of unsafe abortion. Due to religion, communities can be hard against this issue. But after some time we have seen that they have changed their perception toward the issue of safe and unsafe abortion. And now many of them know that in some instances, abortion is inevitable but it should be done in a safe way.   I’m Stevens and I am nurse. We have some clients who come when they have already attempted an unsafe abortion. You find that it is often inevitable. The only solution you have to help those clients is to provide treatment of incomplete abortion as part of post-abortion care. Because of the VODA project there is a very remarkable change in the community. Now, those people who used to have unsafe abortions locally, know where to go for post-abortion care - unlike in the past. I remember a schoolgirl, she was in a very sorry state because she had tried some local remedies to abort. I attended to her and things went well. She went back to school. I feel so proud because that was a big life rescue. A girl like that could have died but now she is alive and I see her carrying on with her studies, I feel so proud. I praise VODA for that encouragement. This service should be legalised because whether they restrict it or not, there is abortion and it is going on. And if it’s not out in the open, so that our people know where to go for such services, it leads to more deaths. Stories Read more stories about the amazing success of SAAF in Uganda