People with paid jobs are joyful when a month comes to its end because it signifies an influx of cash into their bank accounts and pockets. But for some women and girls, the end of the month stirs anxiety because they’re thinking about their next period, and if they can afford their menstrual hygiene products if it arrives before they get paid.  In Malawi – where almost half of the population lives below the poverty line and 25 in every 100 people live in extreme poverty – only a few girls and women can afford sanitary pads. Too embarrassed to go to school Menstruation, lasting about five days, requires an average of K600 ($0.74 USD) worth of pads a month for most. That money is too much for some girls, such as Lilongwe-based Prudence Chavula, who recalls with apprehension the first days of her periods when she would use rags to keep the flow in check.  “I was nine years old when I started menstruating. Back then, my parents could not afford to buy the pads every month, so I had to use shreds of old pieces of fabric,” Prudence explains. She says it was embarrassing going to school while having her periods since the rags could easily leak and produce a bad smell. Prudence concedes it is not easy for many girls and women from low-income families to afford sanitary products. Thus, she says, they opt for alternatives which are usually unhygienic and hazardous to their health, sometimes leading to urinary tract infections.

In a landmark verdict today, the High Court of Malindi has ruled that safe abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers, for seeking or offering such services, is completely illegal. Specifically, the Court ruled that: Abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers seeking or offering such services is illegal. Protecting access to abortion impacts vital Constitutional values, including dignity, autonomy, equality, and bodily integrity. Criminalizing abortion under Penal Code without Constitutional statutory framework is an impairment to the enjoyment of women’s reproductive right. For years, women and girls in Kenya have faced sustained and pervasive discrimination hampering their access to seeking reproductive healthcare services; the 1963 Penal Code criminalizes all abortion care, including those allowed under the Constitution 2010, which guarantees the right to healthcare, including access to reproductive health services. The Constitution only permits safe abortion if in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is at risk/in danger. The court case in question, filed in November 2020, involved PAK, a minor 16 years of age from Kilifi County. PAK experienced complications during pregnancy and immediately sought medical care at a nearby clinic where a trained clinical officer attended to her. Upon examining her, the clinical officer determined that she had lost the pregnancy and proceeded to provide her with essential and life-saving post-abortion care. Policy officers stormed the clinic, in the midst of the treatment, stopping the medical procedure and confiscating PAK’s treatment records. They then proceeded to illegally arrest both PAK and the clinical officer. Both were taken to Ganze Police Patrol Base where PAK was not allowed to access further medical care for the next two days and was forced to sign a statement which was contrary to PAK’s description of the events. The police also forced PAK to undergo another detailed medical examination at Kilifi County Hospital to obtain evidence to prove the alleged offence of abortion. The clinical officer was detained for one week while PAK was remanded to a juvenile remand for more than a month, whilst she and her family sought to secure the cash bail for her release. The Malindi High Court has further directed the Parliament to enact an abortion law and public policy framework that aligns with the Kenyan Constitution. Additionally, the Court has confirmed that communication between a patient and the healthcare provider is confidential, which is guaranteed and protected under the Constitution and other enabling laws, save for where the disclosure is consented to by the patient or is in the public interest in line with the limitations as provided for in the Constitution. In its decision, the Court also ruled that PAK was recovering from medical procedure and police did not have the medical qualifications to determine and confirm that she was medically-fit to leave the clinic, regardless of her admission status at the clinic. Additionally, the Court found that PAK’s arrest was inhuman and degrading, and being a minor, she ought not to have been interrogated without legal representation. Marie-Evelyne Petrus-Barry, Africa Regional Director from the International Planned Parenthood Federation, said: “We are absolutely delighted to hear this news and applaud the High Court of Malindi's ruling confirming that abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers for seeking or offering such services is illegal. We are also very pleased to hear that the Court has directed Parliament to enact an abortion law and public policy framework that aligns with the Constitution. This is a victory for women and girls not only in Kenya, but across Africa! Access to quality abortion is essential to guarantee the health and reproductive rights of women and girls everywhere. At IPPF, we are committed to reducing the number of deaths of women and girls who are forced to turn to unsafe abortion methods for fear of arrests and harassment. We will continue to supply and support safe and legal abortion services and care for women and girls everywhere.” The petitioners were represented by the Center for Reproductive Rights a network of reproductive health providers whose member was the second petitioner in this case and a collaborative partner of IPPF. The advocates were Martin Onyango, Head of Legal Strategies for Africa, and Prudence Mutiso, Legal Advisor for Africa. Nelly Munyasia, Executive Director of Reproductive Health Network Kenya (RHNK), , welcomed the court’s decision: “Many qualified reproductive healthcare practitioners continue to be arrested, detained, and prosecuted for providing legal medical care. The court’s decision confirms that prosecution against health providers cannot hold where the prosecution has not established that; the health professional in question was unqualified to conduct the procedure; the life or health of the woman was not in danger or the woman was not in need of emergency treatment,” Ms. Munyasia said. Evelyne Opondo, Senior Regional Director for Africa at Center for Reproductive Rights said: “Today’s victory is for all women, girls, and healthcare providers who have been treated as criminals for seeking and providing abortion care. The court has vindicated our position by affirming that forcing a woman to carry an unwanted pregnancy to term or to seek out an unsafe abortion is a gross violation of her rights to privacy and bodily autonomy. Further, the continued restrictive abortion laws inhibit quality improvement possible to protect women with unintended pregnancies.” Center fact sheet: “The Impact of the Misalignment Between Kenya’s Constitution and the Penal Code on Access to Reproductive Health Care”

In a landmark verdict today, the High Court of Malindi has ruled that safe abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers, for seeking or offering such services, is completely illegal. Specifically, the Court ruled that: Abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers seeking or offering such services is illegal. Protecting access to abortion impacts vital Constitutional values, including dignity, autonomy, equality, and bodily integrity. Criminalizing abortion under Penal Code without Constitutional statutory framework is an impairment to the enjoyment of women’s reproductive right. For years, women and girls in Kenya have faced sustained and pervasive discrimination hampering their access to seeking reproductive healthcare services; the 1963 Penal Code criminalizes all abortion care, including those allowed under the Constitution 2010, which guarantees the right to healthcare, including access to reproductive health services. The Constitution only permits safe abortion if in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is at risk/in danger. The court case in question, filed in November 2020, involved PAK, a minor 16 years of age from Kilifi County. PAK experienced complications during pregnancy and immediately sought medical care at a nearby clinic where a trained clinical officer attended to her. Upon examining her, the clinical officer determined that she had lost the pregnancy and proceeded to provide her with essential and life-saving post-abortion care. Policy officers stormed the clinic, in the midst of the treatment, stopping the medical procedure and confiscating PAK’s treatment records. They then proceeded to illegally arrest both PAK and the clinical officer. Both were taken to Ganze Police Patrol Base where PAK was not allowed to access further medical care for the next two days and was forced to sign a statement which was contrary to PAK’s description of the events. The police also forced PAK to undergo another detailed medical examination at Kilifi County Hospital to obtain evidence to prove the alleged offence of abortion. The clinical officer was detained for one week while PAK was remanded to a juvenile remand for more than a month, whilst she and her family sought to secure the cash bail for her release. The Malindi High Court has further directed the Parliament to enact an abortion law and public policy framework that aligns with the Kenyan Constitution. Additionally, the Court has confirmed that communication between a patient and the healthcare provider is confidential, which is guaranteed and protected under the Constitution and other enabling laws, save for where the disclosure is consented to by the patient or is in the public interest in line with the limitations as provided for in the Constitution. In its decision, the Court also ruled that PAK was recovering from medical procedure and police did not have the medical qualifications to determine and confirm that she was medically-fit to leave the clinic, regardless of her admission status at the clinic. Additionally, the Court found that PAK’s arrest was inhuman and degrading, and being a minor, she ought not to have been interrogated without legal representation. Marie-Evelyne Petrus-Barry, Africa Regional Director from the International Planned Parenthood Federation, said: “We are absolutely delighted to hear this news and applaud the High Court of Malindi's ruling confirming that abortion care is a fundamental right under the Constitution of Kenya and that arbitrary arrests and prosecution of patients and healthcare providers for seeking or offering such services is illegal. We are also very pleased to hear that the Court has directed Parliament to enact an abortion law and public policy framework that aligns with the Constitution. This is a victory for women and girls not only in Kenya, but across Africa! Access to quality abortion is essential to guarantee the health and reproductive rights of women and girls everywhere. At IPPF, we are committed to reducing the number of deaths of women and girls who are forced to turn to unsafe abortion methods for fear of arrests and harassment. We will continue to supply and support safe and legal abortion services and care for women and girls everywhere.” The petitioners were represented by the Center for Reproductive Rights a network of reproductive health providers whose member was the second petitioner in this case and a collaborative partner of IPPF. The advocates were Martin Onyango, Head of Legal Strategies for Africa, and Prudence Mutiso, Legal Advisor for Africa. Nelly Munyasia, Executive Director of Reproductive Health Network Kenya (RHNK), , welcomed the court’s decision: “Many qualified reproductive healthcare practitioners continue to be arrested, detained, and prosecuted for providing legal medical care. The court’s decision confirms that prosecution against health providers cannot hold where the prosecution has not established that; the health professional in question was unqualified to conduct the procedure; the life or health of the woman was not in danger or the woman was not in need of emergency treatment,” Ms. Munyasia said. Evelyne Opondo, Senior Regional Director for Africa at Center for Reproductive Rights said: “Today’s victory is for all women, girls, and healthcare providers who have been treated as criminals for seeking and providing abortion care. The court has vindicated our position by affirming that forcing a woman to carry an unwanted pregnancy to term or to seek out an unsafe abortion is a gross violation of her rights to privacy and bodily autonomy. Further, the continued restrictive abortion laws inhibit quality improvement possible to protect women with unintended pregnancies.” Center fact sheet: “The Impact of the Misalignment Between Kenya’s Constitution and the Penal Code on Access to Reproductive Health Care”

IPPF · Podcast: Dr. Rania on the frontlines of delivering global humanitarian responses “I recall the first humanitarian crisis that I was part of was in 1988, flooding in Sudan,” said Dr. Rania Abdalla Abu Elhassan, IPPF’s Regional Humanitarian Advisor for the Arab World and Africa Regions. “I was still very young, I was wondering how those tents had arrived, how this food is distributed... my understanding of disasters was very fragile. But that really opened my eyes.”  With lived experience of humanitarian crises, Dr. Rania offers an important perspective in her work as a medical doctor and a frontline humanitarian responder. Over her 20-year career as an obstetrician and gynecologist in Sudan and with national and international NGOs, she has provided lifesaving sexual and reproductive health care to women and girls in emergencies around the world.   For this year’s International Women’s Day, Dr. Rania spoke about how she got involved in humanitarian work, the barriers and opportunities facing women in the sector, and what she will do her new role at IPPF to ensure sexual and reproductive health needs are not overlooked amid growing global humanitarian needs.   “There is always a counter argument when it comes to women’s sexual and reproductive health in male dominated communities,” she said. “It is a very shaky idea for the dominance of the male figure. But we are not arguing from a religious perspective. We are speaking about facts. We want to make it safer and easier for women [to access their sexual and reproductive health] because we don't want to lose those women.”  With a master's degree in public health, as well as diplomas in humanitarian assistance and in gender advocacy, Dr. Rania applies a holistic approach to her work. Still, she has faced numerous barriers as a woman in the humanitarian sector, and she says that more needs to be done to ensure gender equity at all levels of humanitarian response.   “There is an unspoken consensus in some humanitarian organizations that females cannot perform like males,” she said. “I have been working with all male medical doctors in a warzone, and their assumption is that this is a warzone... This is a man’s place, it's not a woman place. But we must prepare for gender balance and gender parity prior to the crisis. Because if something was not existing before the crisis, you cannot implement it after a crisis.”   Hear more from Dr. Rania in this podcast.

Dr Gisele Nyamalibu is a local health worker in the Democratic Republic of Congo (DRC), currently leading the humanitarian response in Bukavu following the volcanic eruption in Goma. Driven by her passion to provide crucial sexual and reproductive healthcare (SRH), she spends her time servicing the refugee community. We spoke to her about why representation and localization are vital in SRH service delivery. A dedicated advocate of sexual and reproductive health and rights (SRHR), Dr Nyamalibu has observed the many complexities in SRHR service delivery for refugee women. In 2015, while working as a health supervisor in a Burundi refugee camp in Kavimvira, she witnessed flaws in the implementation of aid where SRHR needs were “not taken into account.” “Sometimes sexual and reproductive services are not a priority according to the actors who intervene in this sector, and for me, I found that it’s an aspect that is being neglected. Perhaps it’s not seen as a priority, and yet it really is.” A unique insight into the needs of the vulnerable Years of experience working with refugee women and children in camps has given Dr Nyamalibu insight into the reproductive healthcare needs of vulnerable displaced women. “There were cases of young girls who were raped in the refugee camps, and others who became pregnant in the camps. There were women who did not know how to control their fertility and who did not know how to plan their birth and became pregnant in the camps. A woman comes as a refugee, in a difficult situation with children, and gets pregnant in the camp because there was no family planning service.” The DRC-born medical doctor was drawn to SRHR to bridge the gap in service delivery. “There was no service to deal with cases of rape and sexual abuse that occurred among refugees, and from that I said to myself: no, this is a sector that many actors ignore but which is really important.”

In a major win for women’s reproductive rights, Ghana’s National Health Insurance Program has expanded to include free long-term contraception from 1 January 2022. The move will allow millions of women of reproductive age who are already covered by national health insurance to avoid paying out of pocket for family planning methods such as the implant, coil and injections. It comes after a two-year pilot study found that including family planning services in health benefits packages resulted in a greater uptake of long-term contraception and future government savings in direct care costs.   “We are excited that at long last, long-term family planning methods are included in the National Health Insurance Scheme,” said Abena Adubea Amoah, the Executive Director of the Planned Parenthood of Ghana (PPAG), an IPPF Member Association. “This means long time peace of mind for women, girls and their families with potential positive impact on their health and economic life.”   Tackling deep-rooted barriers to healthcare In late 2021, the government of Ghana launched a year-long campaign aimed at raising awareness of and preventing maternal deaths in line with Goal 3: Good Health and Wellbeing of the United Nations Sustainable Development Goals. The role of family planning in reducing preventable maternal death is well documented, with unsafe abortion being one of the leading causes. Yet, Ghana is a country where deep-rooted cultural norms and structural barriers perpetuate poor sexual and reproductive health, including high risks of maternal mortality, high numbers of sexually transmitted infections and low levels of contraceptive use. Despite making important progress in recent years, Ghana’s maternal mortality ratio is 308 per 100,000 live births, which is still well above the SDG target of less than 70 deaths per 100,000 live births by 2030.   PPAG will play an important role in supporting the government in its campaign to prevent maternal deaths and disabilities. Since 1967, PPAG has provided the people of Ghana with family planning services as well as maternal and child health care, infertility management, and voluntary counselling and testing for sexually transmitted infections including HIV and AIDS. With over 100 staff members, a team of 1,000 volunteers, and 300 peer educators, PPAG is well-positioned to deliver health services and programmes through permanent and mobile clinics in urban and rural communities across the country. The association's Youth Action Team, comprised of over 810 young people, leads a number of educational and awareness-raising activities at 1000 community-based service points across the country. 

The Get Up, Speak Out! initiative works with and for young people to overcome barriers such as unequal gender norms, negative attitudes towards sexuality, taboos about sex, menstruation, and abortion. Empowering youth communities - especially girls and young women - with information and knowledge about sexual and reproductive health, and the provision of access to health and contraceptive care, is at the heart of the initiative. Get Up, Speak Out! is an international initiative developed by a consortium of partners including IPPF, Rutgers, CHOICE for Youth & Sexuality, Dance4Life, Simavi, and Aidsfonds, with support from the Dutch Ministry of Foreign Affairs.

Understanding the challenges that people living with a disability face when accessing sexual and reproductive healthcare (SRH), and ensuring their rights are upheld, sits at the heart of Fianakaviana Sambatras’ (FISA) mission to reach vulnerable groups. Often on the fringes of Madagascan society, and classified as a vulnerable group, people living with a disability are one of FISA’s priority client groups. Through expansion of their delivery networks, FISA provides safe, confidential, and accessible integrated SRH to people living with a disability.  Barriers to inclusive healthcare  Often, FISA’s clients have a lack of awareness about their sexual and reproductive rights where to go for their healthcare - for example, limited access to information through disability-friendly locations and leaflets and posters creates a barrier to vital information unless adapted for visually impaired and blind people. Other challenges include communication for deaf clients, who in some cases may not be accompanied by a companion to assist them. In some instances, FISA learned that women living with a disability were forced by their families to have an abortion or undergo tubal sterilization during a caesarean delivery without their consent, further reinforcing stigma and stereotypical attitudes towards disability.    Understanding the needs of the client FISA’s experience with providing care to people living with a disability has led to a greater understanding of their clients’ needs. Provision of improved integrated healthcare delivery includes allowing for longer appointment times to give the correct level of support, which is especially important for counselling and consultations.  FISA offers free consultations to people living with a disability and prioritizes young people ensuring they can access youth-friendly care. The team also run sessions using sign language to raise awareness on sexual and reproductive health and rights and to provide information about the different contraceptive methods available, such as the IUD and pill. FISA encourages people living with a disability to participate in events such as International Women’s Day to help make their voices heard, to advocate for their rights, and to collaborate on the development of a comprehensive sexuality education guide through a series of workshops. Designing and delivering disability-inclusive healthcare FISA has adapted its healthcare delivery to be disability-inclusive and to raise awareness of, and advocate for, the sexual and reproductive rights of people living with a disability. Critical to providing healthcare is safeguarding access to comprehensive sexuality education for young people living with disabilities that are specific to their needs. Providing information resources in Braille, using diverse pictures, and training healthcare workers to be able to communicate using sign language makes FISA a go-to place for healthcare for people living with a disability. Clients are made to feel welcome and safe with FISA’s qualified healthcare team and accessible facilities.  “Our Member Association in Madagascar plays a leading role in ensuring that persons with disabilities have access to high-quality and integrated sexual and reproductive healthcare. Their work is a good example of our mission to provide care to the most vulnerable, underserved, and often marginalized members of our communities. Integrated disability-inclusive healthcare delivery strategies that are adapted to our beneficiaries’ needs remain a priority in our work on the African continent”, says Marie-Evelyne-Petrus-Barry, IPPF Africa Regional Director. FISA enables its clients, and especially young people and women, living with a disability to feel empowered to make their own decisions concerning their bodies, wellbeing, and SRH.