“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

“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!

Cyclone Winston, which devastated Fiji, was the strongest to ever hit the South Pacific. IPPF’s humanitarian response there was carried out with our Member Association, the Reproductive & Family Health Association of Fiji, and is part of our SPRINT Initiative, funded by the Australian Government. Despite its flourishing international tourism industry, Fiji remains a deeply conservative and traditional society, bound by long-held rules on culture and conduct. In particular, any discussion about sex and sexuality is taboo: including talk of sex, condoms, pregnancy and sexually transmitted infections. Given Fiji’s relatively high rate of teen pregnancy (36 in 1000 in the 15-19 age group, according to UNFPA 2016 statistics), it is an issue of growing concern. It falls upon the village headman to provide guidance on how the issue is tackled: and when there is one who is progressive and not afraid to discuss taboo topics, it augers well for the sexual health of the entire community. Sevuama Sevutia is one such leader. The deputy headman of Naiserelegai village is a proud advocate of condom-use, telling the young people of the village that it is vital to wear them to prevent pregnancy. “My experiences, I share with the kids,” says Sevuama. “I tell the children, get to that stage of knowing what the sexual relationship is all about. Please look after yourself and if you have a problem, with the young boys or if someone is giving you the wrong advice, please tell people. It’s my job to tell them, to call their mother, their father.” “Nowadays, as the education level rises, we have to open up. But in the village, in the olden days, when people would see condoms they would say, 'no no, don’t talk about that'. But I am encouraging them to open up.” His children, too, are encouraged to be open. “I tell them, this is a condom,” he says, brandishing an imaginary condom. “Safe sex. If you want to have sex, use a condom. Use the condom! And protect yourself from the other things.” Sevuama, 53, a former marine engineer, spent decades in Suva before returning to his bayside home village of Naiserelegai. He was in the city at the time of the cyclone but managed to get back three or four days later when the roads had re-opened. He found his home damaged but intact and his five children safe, but much of the village destroyed and his wife still in shock. He received a small amount of money from the government to help fix his roof. Earlier this year, he, along with other men in the village, participated in IPPF information sessions on male sexual health and fertility, which he described as very helpful in complementing and reinforcing his existing knowledge. “We had a lot of questions, like mostly for the man, something might have happened to them during a difficult time. All this information helps the communities.” Stories Read more stories about our work in Fiji after the Cyclone Winston

At the end of a long day, Anicia, closes the clinic with praise for her colleagues who never turn anyone away. "We open at 8am. From 8am we will be receiving a variety of clients for different services - whether post-abortion care, whether antenatal care - we have to give them all the services. We may end up to 10pm, because we'll never chase our clients, we'll never close the place when we have a client inside. People come when they have no hope. You receive them, and you give them hope by treating them properly and giving them quality services. The client gets better and will never forget you. And follow them up on the phone. "How are you doing?" It's good for us to know that they're doing well. Others even tell us 'The way you handle us, we love it so much'." Follow a day in the life of our team and clients in Gulu, Uganda 07:00 08:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 22:00 Prev Next 7am: The team prepare for the long day ahead "Every year tens of thousands of Ugandans come to our clinic. Everyone is welcome. Here are just a few of the people that we served in one day last month." READ MORE 8am: Nancy, 19, becomes a volunteer "I was suffering but when I came here, I was treated and I got better. Now I'm inspired to volunteer here" READ MORE 9am: Monica, 25, a sex worker's story "I am sex working. I came here for Hepatitis B testing and also counselling. I have so many personal problems, but here….they’re so caring." READ MORE 10am: Jane, 23, saved by family planning "After multiple miscarriages, family planning here has helped me a lot. I'm glad we've been able to space the number of children we've had. I am not growing old, I am fresh." READ MORE 11am: Vicky, handling disabilities "I'm deaf so accessing services is hard, but here they really try to speak in sign language." READ MORE 12pm: Dorcus, first time patient "This is the first time I've ever come here, I like the service. They give good counselling so I recommend coming." READ MORE 1pm: Christine, 45, a grandmother's tale of living with HIV "I am living with HIV and had HPV. They treated me and now I'm free of cervical cancer." READ MORE 2pm: Lilian, struggling mother of six with sickle cell " I have sickle cell disease and so do all my children. I want to have my tube removed so that I don't get pregnant again but I don't know if my husband will allow it." READ MORE 3pm: Brenda and Francis get fertility treatments "Fertility treatment is a sensitive issue in Uganda but they help us a lot and we get proper treatment." READ MORE 4pm: Joyce, 25, repected regardless of her disability "I realised that at this place they don't segregate. Us people with disabilities have challenges at the main hospitals. You go there, people around look at you as if you are not a human being and you don't fall sick." READ MORE 5pm: Mobile clinic provides outreach services to remote villages "Our outreach to remote communities is a 'one-stop-centre'. We give family planning, vaccines for HPV, malaria, and Hepatitis B, HIV testing and more." READ MORE 22pm: Still giving the last client our very best "Together, we have great teamwork. Sometimes we're still working up to 10pm because we never chase out our clients. We’ll never close the place when we have a client inside. People come when they have no hope." READ MORE

Every Thursday a team from RHU Gulu district provides a mobile outreach clinic in Atega village in the Omoro district in Northern Uganda. The outreach team goes out into this poor, remote area which would otherwise not have access to sexual and reproductive health services. The night before the outreach clinic RHU driver, Robert Nyeko and Godfrey Bedimot load up tents, chairs, medical equipment and supplies. The clinic needs to be set up and by 7am ready to receive clients from 8am. The outreach clinic provides a range of services including diagnosis, testing and treatment, family planning such as fitting implants, providing condoms and HPV vaccines. Laboratory technician, Denis Bongonyinge carries out testing for malaria, Hepatitis B, HIV/AIDS, pneumonia and other infections. Other members of the team provide immunisations and vaccinations. Typically men, women and children start arriving at the clinic by 7:30am. Two volunteers are on hand to direct them to the appropriate place to get the services they need. Some clients need a range of services. At 8am service provider, Anicia Filda, popularly known a 'Mama' in the community is ready with her team to start the day. There are now more than 200 clients waiting to be seen; with more people arriving to join the long queues. The longest queue is for the immunisation and vaccination services. The majority have come for either the Hepatitis B vaccine, which is a big threat in this community. Priority is given to the many young girls lining up for the Human Papilloma Virus (HPV) vaccine. Denis Bongonyinge takes blood samples for rapid tests for malaria, HIV, HPV and a range of other infections. Each client carries an exercise book where Denis records their results which is then taken to the staff giving out prescriptions. 32-year-Robert Otim pushes his bicycle to the outreach clinic. The single father has ridden 10 kilometres with his two young children. He lost his wife to Hepatitis B when their daughter was just six months. His four-year-old son was born prematurely and is now disabled. He has come today for his last Hepatitis B immunisation. His children need to be vaccinated as well as treated for malaria and coughs. Looking at the long queue, he says he doubts whether he will get the service today but he is lucky as one of the team who once treated his son, Geoffrey, notices Robert and they are given priority for treatment and prescriptions. Already by midday, one of the teams delivering minor surgeries, postnatal services, family planning and post abortion care have seen 47 mothers. This is almost the same as the number of clients they would treat at the Gulu Clinic during a normal day. Anicia Filda sends the driver to collect more supplies from the clinic; the stock is starting to run low because demand is so high There is no break for the team. Samuel Kedi, the only clinician at the outreach camp stands up, and picks up a bottle of water from his backpack for a quick drink before continuing with the next client. The clinic continues to see clients well into the evening. The outreach clinic is scheduled to finish by 5pm but Anicia says there is not one day they have closed on time: “We cannot close when clients are still lining up. It’s the same at the clinic in Gulu,” she says. As the clinic draws to a close for the day, the teams complete their report which records details of the numbers clients served, the types of services delivered and supplies of stock. It has been another busy but successful day for Anicia and her team. Provision of integrated services in such remote areas is vital for the local community; many men, women and children would not be able to receive the types of treatment and care that RHU works diligently to provide. Follow a day in the life of our team and clients in Gulu, Uganda 07:00 08:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 22:00 Prev Next 7am: The team prepare for the long day ahead "Every year tens of thousands of Ugandans come to our clinic. Everyone is welcome. Here are just a few of the people that we served in one day last month." READ MORE 8am: Nancy, 19, becomes a volunteer "I was suffering but when I came here, I was treated and I got better. Now I'm inspired to volunteer here" READ MORE 9am: Monica, 25, a sex worker's story "I am sex working. I came here for Hepatitis B testing and also counselling. I have so many personal problems, but here….they’re so caring." READ MORE 10am: Jane, 23, saved by family planning "After multiple miscarriages, family planning here has helped me a lot. I'm glad we've been able to space the number of children we've had. I am not growing old, I am fresh." READ MORE 11am: Vicky, handling disabilities "I'm deaf so accessing services is hard, but here they really try to speak in sign language." READ MORE 12pm: Dorcus, first time patient "This is the first time I've ever come here, I like the service. They give good counselling so I recommend coming." READ MORE 1pm: Christine, 45, a grandmother's tale of living with HIV "I am living with HIV and had HPV. They treated me and now I'm free of cervical cancer." READ MORE 2pm: Lilian, struggling mother of six with sickle cell " I have sickle cell disease and so do all my children. I want to have my tube removed so that I don't get pregnant again but I don't know if my husband will allow it." READ MORE 3pm: Brenda and Francis get fertility treatments "Fertility treatment is a sensitive issue in Uganda but they help us a lot and we get proper treatment." READ MORE 4pm: Joyce, 25, repected regardless of her disability "I realised that at this place they don't segregate. Us people with disabilities have challenges at the main hospitals. You go there, people around look at you as if you are not a human being and you don't fall sick." READ MORE 5pm: Mobile clinic provides outreach services to remote villages "Our outreach to remote communities is a 'one-stop-centre'. We give family planning, vaccines for HPV, malaria, and Hepatitis B, HIV testing and more." READ MORE 22pm: Still giving the last client our very best "Together, we have great teamwork. Sometimes we're still working up to 10pm because we never chase out our clients. We’ll never close the place when we have a client inside. People come when they have no hope." READ MORE

Joyce Auma, 25, is a business administration graduate currently working as a data clerk with Gulu Women with Disabilities Union.  The union has partnered with Reproductive Health Uganda to extend sexual and reproductive health services to women living with disabilities in Gulu and neighbouring districts in Acholi. Joyce, who lost the use of her legs in childhood, is one of the women with disabilities that normally receive services at Gulu Clinic. “I found out about RHU because they are our partners at Gulu Women with Disability Union. I first came to the clinic to test for HIV and other STIs. We also receive their other services like family planning and cancer screening to people with disabilities.” “The first time I came here I was warmly welcomed. They're very good at talking to the youth. Though the place was new for me, I was given service as if it was not my first time.” Says Joyce. "Us people with disabilities have challenges at the main hospitals. People around look at you as if you are not a human being and you don’t fall sick.” Joyce has since been a regular client of RHU for HIV testing, cancer screening and other diseases. She says her status exposes her to many risks of infection which has to be regularly checked for. “I always come here for testing, there is also cancer screening. They don’t segregate me because of my disability. They give you the services you need.”  Follow a day in the life of our team and clients in Gulu, Uganda 07:00 08:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 22:00 Prev Next 7am: The team prepare for the long day ahead "Every year tens of thousands of Ugandans come to our clinic. Everyone is welcome. Here are just a few of the people that we served in one day last month." READ MORE 8am: Nancy, 19, becomes a volunteer "I was suffering but when I came here, I was treated and I got better. Now I'm inspired to volunteer here" READ MORE 9am: Monica, 25, a sex worker's story "I am sex working. I came here for Hepatitis B testing and also counselling. I have so many personal problems, but here….they’re so caring." READ MORE 10am: Jane, 23, saved by family planning "After multiple miscarriages, family planning here has helped me a lot. I'm glad we've been able to space the number of children we've had. I am not growing old, I am fresh." READ MORE 11am: Vicky, handling disabilities "I'm deaf so accessing services is hard, but here they really try to speak in sign language." READ MORE 12pm: Dorcus, first time patient "This is the first time I've ever come here, I like the service. They give good counselling so I recommend coming." READ MORE 1pm: Christine, 45, a grandmother's tale of living with HIV "I am living with HIV and had HPV. They treated me and now I'm free of cervical cancer." READ MORE 2pm: Lilian, struggling mother of six with sickle cell " I have sickle cell disease and so do all my children. I want to have my tube removed so that I don't get pregnant again but I don't know if my husband will allow it." READ MORE 3pm: Brenda and Francis get fertility treatments "Fertility treatment is a sensitive issue in Uganda but they help us a lot and we get proper treatment." READ MORE 4pm: Joyce, 25, repected regardless of her disability "I realised that at this place they don't segregate. Us people with disabilities have challenges at the main hospitals. You go there, people around look at you as if you are not a human being and you don't fall sick." READ MORE 5pm: Mobile clinic provides outreach services to remote villages "Our outreach to remote communities is a 'one-stop-centre'. We give family planning, vaccines for HPV, malaria, and Hepatitis B, HIV testing and more." READ MORE 22pm: Still giving the last client our very best "Together, we have great teamwork. Sometimes we're still working up to 10pm because we never chase out our clients. We’ll never close the place when we have a client inside. People come when they have no hope." READ MORE