In Ethiopia, getting young people’s attention about sexual and reproductive healthcare is no easy task. But at a youth centre in Jimma, the capital Oromia region, groups of young people are getting vital messages about sexual health and contraception out to their peers through dance, song, and poetry. Student Jumeya Mohammed Amin came here to train as a peer educator for sexual and reproductive health [SRH] three years ago, when she was 14 years old. In her community – a conservative village 20 km outside the city – early marriage and pregnancy was common, and information about SRH practically unheard of. Navigating traditional norms “Girls younger than me at the time were married. The youngest was only nine,” said Amin, who would watch her classmates have to leave their home, school, and playmates behind. In Amin’s community, to opt out of unintended pregnancies involves unsafe abortion methods such as remedies prescribed by traditional healers – which can be fatal. “I know one girl from 10th grade who was 15 years old, and she died from this in 2017,” she said. But Amin’s work educating hundreds of young people each year on sexual health has changed attitudes in her community around early marriage, unplanned pregnancy and the options available to prevent it, she says, with many of her peers now waiting to start becoming sexually active. Tackling high rates of teen pregnancy Oromia has the third highest rate of teenage pregnancy in Ethiopia, after the Afar and Somali regions, says Dessalegn Workineh, who runs the Jimma office of the Family Guidance Association of Ethiopia [FGAE], which is supported by IPPF. “In Oromia, out of this rate of teen pregnancies, almost twenty percent end up in abortion,” he said. The region also has the third lowest uptake of contraceptives among women aged 15 to 49. 17-year-old peer educator Mastewal Ephrem says that the problem comes down to a lack of information. “People don’t know about reproductive health and they need this information about how to manage their family, sex and infections,” she said. Religious and social conservatism make this difficult, especially in poor and rural areas where families receive dowries in the form of money and gifts when their daughters marry. “Because of not having confidence and not talking to people, girls are doing early marriage,” said Ephrem. Poverty and other hardships also push girls out of their family homes early and leave them in precarious situations, where they run a high risk of encountering abuse. “I see girls aged 10, 13 and 15, who live on the streets and take drugs,” said Emebet Bekele, a counsellor working at an IPPF-supported clinic in Jimma that is aimed at helping sex workers. Bekele provides counselling and testing for HIV and STIs. She talks to girls and women about the full range of free and confidential family planning services available at the clinic. “Sometimes we bring them from the streets and we test them. Most of them get pregnant,” she said. She often supports students to get safe abortion care; including girls as young as 13. Taking sexual healthcare to the streets The youth centre reaches a lot of young people in schools and directs them towards the youth centre, where there is a library and many group activities and performances to teach them about SRH. Groups of young people practice and perform short plays and dances about topics such as unsafe sex and STIs here, as well as on the streets, where they draw a crowd. Fourteen-year-old Simret Abiyu has turned what she has learned into SRH-themed poems that she pens and performs to her peers in English, Amharic and Oromo. “Sometimes I get training here and write poems about family planning and the work of FGAE and the development of the country,” she said. Healthcare and advice via the phone University student Nebiyu Ephirem, 26, is a youth leader at the centre. He has been managing the two SRH helplines – located in a quiet back office – since it started in 2017. He answers a lot of calls from young people asking about contraception or their bodies and people dealing with emergencies and tries to answer their questions or refer them to public, private or FGAE clinics across the country. “Culturally, people used not to want to discuss sexual issues. They fear discussing these openly with family, and due to religious beliefs, so people like to call me,” said Ephirem. The youth centre reaches more than 11,000 young people a year through its work at schools, and through outreach clinics located in coffee plantations, where many young people work. Currently, the youth centre uses the helpline, radio adverts and social media to inform people about sexual health. The team hopes that media campaigns can spread the message wider in order to raise awareness about young peoples’ sexual health needs.

Rewda Kedir works as a midwife in a rural area of the Oromia region in southwest Ethiopia. Only 14% of married women are using any method of contraception here.  The government hospital Rewda works in is supported to provide a full range of sexual and reproductive healthcare, which includes providing free contraceptives and comprehensive abortion care. In January 2017, the maternal healthcare clinic faced shortages of contraceptives after the US administration reactivated and expanded the Global Gag Rule, which does not allow any funding to go to organizations associated with providing abortion care. Fortunately in this case, the shortages only lasted a month due to the government of the Netherlands stepping in and matching lost funding. “Before, we had a shortage of contraceptive pills and emergency contraceptives. We would have to give people prescriptions and they would go to private clinics and where they had to pay," Rewda tells us. "When I first came to this clinic, there was a real shortage of people trained in family planning. I was the only one. Now there are many people trained on family planning, and when I’m not here, people can help." "There used to be a shortage of choice and alternatives, and now there are many. And the implant procedures are better because there are newer products that are much smaller so putting them in is less invasive.” Opening a dialogue on contraception  The hospital has been providing medical abortions for six years. “Before, there was no safe abortion," says Rewda. She explains how people would go to 'traditional' healers and then come to the clinic with complications like sepsis, bleeding, anaemia and toxic shock. If they had complications or infections above nine weeks, Rewda and her colleagues would send them to Jimma, the regional capital. "Before, it was very difficult to persuade them to use family planning, and we had to have a lot of conversations. Now, they come 45 days after delivery to speak to us about this and get their babies immunised," she explains. "They want contraceptives to space out their children. Sometimes their husbands don’t like them coming to get family planning so we have to lock their appointment cards away. Their husbands want more children and they think that women who do not keep having their children will go with other men." "More kids, more wealth" Rewda tells us that they've used family counselling to try and persuade men to reconsider their ideas about contraception, by explaining to them that continuously giving birth under unsafe circumstances can affect a woman's health and might lead to maternal death, damage the uterus and lead to long-term complications. "Here, people believe that more kids means more wealth, and religion restricts family planning services. Before, they did not have good training on family planning and abortion. Now, women that have abortions get proper care and the counseling and education has improved. There are still unsafe abortions but they have really reduced. We used to see about 40 a year and now it’s one or two." However, problems still exist. "There are some complications, like irregular bleeding from some contraceptives," Rewda says, and that "women still face conflict with their husbands over family planning and sometimes have to go to court to fight this or divorce them.”

In a room that is bare but for a few beds, Kuzema Abba Naga is resting after giving birth hours before to her tenth child, and now she thinks, her last. Before coming from her village to this remote and rural government health center in the Kebele district to give birth, Naga never knew it was possible to choose when or whether to have a baby. “I am 38 years old and I had my first baby at age 15,” she said. “This is my first baby for eight years.” Naga named the baby Nejat, which translates to ‘liberation’, after giving birth and discovering the contraception options available to her, she decides to have an IUD fitted immediately. Lack of access to contraception in rural areas This is the first time midwife Rewda Kedir has fitted a woman who has just had a baby with an IUD, though it is not uncommon to meet women coming from rural areas who have never heard about family planning. When they do, many are interested in it, even if they have to fight their husbands to use it or they are forced to hide it from them. “They want contraceptives to space out their children,” said Kedir. “Sometimes their husbands don’t like them coming in to get family planning, so we have to lock their appointment cards away. Their husbands want more children and some think that women who do not keep having their children will go with other men,” she said. Kedir says that most women prefer using the contraceptive implants because they feel few side effects, are long-lasting, easy and painless to have fitted and to conceal. “Here, people believe that more kids means more wealth, and religion restricts family planning services,” she said. “Only 28 percent of women aged 15 to 49 use modern contraceptives,” says Dessalegn Workineh, who manages the Family Guidance Association of Ethiopia’s south west area office in Jimma. Expanding contraceptive access in Ethiopia  With support from the Family Planning Association of Ethiopia (FGAE), who work with the Ethiopian government, clinics in remote rural areas like this one can now provide a full range of sexual and reproductive health (SRH) services for free.  Having all the products and services available and under one roof makes it easier to reach people who might really benefit from help with family planning.  In Oromia, 43 percent of women give birth at a health facility. Kedir finds a lot of women coming in for maternal and post-natal health services who she speaks to about family planning, end up staying or returning to get family planning services.   “Before, it was very difficult to persuade people to use family planning and we had to have a lot of conversations. Now, they come 45 days after delivery to speak to us about this when they get their babies immunised,” she said.  Staff at the clinic also provide family counselling to try and encourage men that contraception is a good idea for the whole family. “We tell them that continuously giving birth can affect the mother’s health and might lead to maternal death, damage the uterus and lead to long-term complications,” said Kedir. A number of staff at the clinic have been trained on family planning and can answer queries and deliver services, “So when I’m not here, people can help.” “The implant procedures are better because there are newer products,” said Kedir, who sits next to a handmade poster with the options for contraception glued on that still has the older, match-sized implants and the new, thinner implants. Providing comprehensive abortion care The clinic also provides comprehensive abortion care and for the past six years, medical abortions. This involves taking a pill rather than having vacuum aspiration or surgery, and is helping to stop women turning to unsafe abortion methods. “Before, there was no safe abortion. People would go to traditional healers and then come here with complications like sepsis, bleeding, anaemia and toxic shock,” said Kedir.  “The good thing is that the women that have [safe] abortions get proper care and the counselling and education has improved,” said Kedir. In Ethiopia, these services are vital “to save mothers from dying due to cases of unsafe abortion,” says Workineh. “Working on comprehensive abortion care reduces complications and therefore maternal mortality,” he added. Kedir says women still have to fight their husbands to get access to family planning and cases can end up in court or divorce. But the cases of complications resulting from unsafe abortion have plummeted.  “We used to see about 40 a year. Now it’s one or two,” she said.

Meseret* and Melat*, volunteers Known in their local community as demand creators, Meseret and Melat, from the Family Guidance Association of Ethiopia’s (FGAE) confidential clinic head out to visit sex workers in Jimma town. This group of volunteers are former, or current, sex workers teaching others how to protect themselves from sexually transmitted infections (STIs) and unintended pregnancy. Their work is challenging, and they travel in pairs for safety - their messages are not always welcome. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Meseret* and Melat*, volunteers Meseret and Melat from the Jimma clinic talk to sex workers in their local community about sexual health concerns, as well as provide contraception. “It’s very difficult to convince sex workers to come to the clinic. Some sex workers tend to have no knowledge, even about how to use a condom.” says Meseret. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Melat, volunteer It can be challenging persuading women that the staff at the confidential clinic are friendly towards sex workers and will keep their information private. “When we try to tell people about HIV we can be insulted and told: ‘You are just working for yourself and earn money if you bring us in.’ They sometimes throw stones and sticks at us,” said 25-year-old Melat. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Fantaye, sex worker Getting information and contraception to women often involves going out to find them, such as Fantaye, a sex worker currently living in a rental space in Mekelle. Peer educators focus on areas populated with hotels and bars and broker's houses, where sex workers find clients. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sister Mahader, FGAE Sister Mahader from FGAEs' youth centre talks to sex workers in Mekelle, about sexual health, wellbeing, and various methods of contraception. This outreach takes place weekly where information and advice is given to groups of women, and contraception is provided free of charge. Under threat from the loss of funding from the US Administration, the Jimma clinic has been forced to reduce the range of commodities available to its clients such as sanitary products, soap and water purification tablets. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Hiwot Abera*, sex worker Hiwot* after her appointment at FGAEs confidential clinic in Jimma. The clinic offers free and bespoke healthcare including HIV and STI testing, treatment and counselling, contraceptives and safe abortion care. Many sex workers have experienced stigma and discrimination at other clinics. In contrast, ensuring confidentiality and a safe environment for the women to talk openly is at the heart of FGAEs’ healthcare provision at its clinics.*pseudonymPhotos: ©IPPF/Zacharias Abubeker Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Leias Obed is a registered nurse working with the Vanuatu Family Health Association (VFHA). She’s part of the Emergency Medical Team operating out of Pangi in south Pentecost, as part of the Cyclone Harold response, which hit in April 2020. We caught up with her there. Sexual and reproductive health is a "hidden agenda", she said, putting a positive spin on the phrase. Women often have to hide their sexual and reproductive health issues and concerns, for fear of stigmatization, or even coercion and violence. By joining the relief effort as part of larger joint medical teams capable of addressing numerous concerns for both men and women, the VHFA staff are able to use the opportunities presented to contact potential clients discreetly and without putting them at risk. Informal exposure to skilled medical staff and counsellors is often enough to initiate a process that results in better, more manageable living conditions for women and their families. Unaware of their own pregnancy “We came to central Pentecost,” said Leias, “and we came across many issues affecting women and girls, but it's like I mentioned, it's a 'hidden agenda'. One thing that we found out is that many women have large numbers of children and their spacing is too close together. But they don't see it as a problem. It's not a problem for them." “Some women who became pregnant during the disaster weren't even aware of their status, but when they came to see us, we have pregnancy tests, and when we test them, they're positive. They're pregnant, and a lot of them have family planning needs.” “Their communities are a long long way from accessing facilities like [these] clinics. We go there and we help them understand, about implants that last five years. A lot of them didn't really understand. They didn't know, it but their main issue is family planning.” Information and education for all “During a response we're more concentrated on the issues facing women right now but it's clear there's a need for us to come back. We must come back so that people can come to understand: What exactly is family planning? Why is it important to use contraceptive treatments? “They really don't understand well at all about family planning products.” The information and education process needs to reach everyone, though: “It would be good if we came back. We come back and present small workshops to fathers, chiefs and to communities at large. To young girls, to mothers so they can come to understand.” There’s a need to follow through, she says. “Family planning is an individual right. We won't force anyone to take it. But there's a need. The more we stay with them, the more we explain, then they can begin to change their mind-set. Then they can freely choose to take family planning.”

Globally, the unmet need for contraception remains too high. It’s estimated that 214 million women and girls are not using modern contraception, despite wanting to avoid pregnancy. And this was before the COVID-19 pandemic, which is set to further derail access to contraception for women and girls around the world.  Disrupted supply chains Lockdown measures taken globally to respond to COVID-19 are bringing major disruptions to contraceptive supply chains. Large manufacturers of contraceptives in Asia have had to halt production or operate at reduced capacity, and we may see similar developments in other regions as COVID-19 takes hold.  For example, the world’s largest condom producer – Malaysia’s Karex Bhd – which makes one in every five condoms globally, was forced to close for a week in March and only given permission to reopen at 50% capacity. Production of IUDs in India – a major global producer of IUDs – has come to a standstill with the Indian government also curtailing export of any product containing progesterone, a key component of a number of contraceptives.   In addition to this, the closures of borders and other restrictions imposed in the face of COVID-19 further affect the shipping and distribution of commodities.  Delays in the production and delivery of contraceptive supplies at global and national levels will lead to stockouts of supplies, severely impacting contraceptive access.  Disrupted access Beyond this, at country level, sexual and reproductive health services, staffing and funds may be diverted to support COVID-19 responses, leaving women and girls unable to access contraceptive and other sexual and reproductive health care. Provision of sexual and reproductive health services will also be affected by infection prevention measures, including health workers’ access to personal protective equipment (PPE). Yet, this is just part of the picture. Even where contraceptives are available and continue to be provided through clinics or pharmacies, the impact of COVID-19 on women’s and girls’ lives will curtail their access in multiple other ways. Quarantine measures and mobility restrictions will affect women’s and girls’ ability to seek out contraceptive services. Financial insecurity and additional caregiving burdens brought on by lockdown measures will be further impediments. Marginalized populations will face additional barriers. What’s the impact for our clinics on the ground?  In 2018, we delivered 81.2 million contraceptive services and distributed over 300 million condoms through our Member Associations (MAs). Contraceptive care, either through clinics or outreach programs, makes up the largest portion of our service provision to communities by far.  Now, in the face of the COVID-19 pandemic, we are receiving concerning updates from our MAs who are worried about impacts on supply chains and their ability to operate. 5,633 static and mobile clinics and community-based care outlets have already closed because of the outbreak, across 64 countries. They make up 14% of the total service delivery points IPPF members ran in 2018. For MAs that are still running limited services, an immediate need is PPE.  Where does this leave us?  At IPPF, supporting all our MAs through this pandemic is our priority. We are working to understand the stresses being placed on our MAs and to deliver as much direct support as possible. We actively monitor the impact of COVID-19 on the supply of contraceptives and other sexual and reproductive health commodities, and work with partners and manufacturers to do what we can to meet MAs’ needs – including for PPE – and ensure continued availability of supplies. We are also working to identify opportunities to modernize our service offering to respond to the rapidly changing landscape, with a view to expanding no touch and digital services and self-management of care, and make a strong case for additional resourcing in these challenging times.  And we are calling on others – national governments, donors and international agencies – to recognize sexual and reproductive healthcare, including contraceptive services, as essential in this crisis, and to take measures to address disruptions in supply chains and ensure continued service provision at national level.   If women, girls and marginalized communities cannot access contraceptive care in this crisis, we can expect to see a rise in unintended and forced pregnancies, an increase in sexually transmitted infections, including HIV, and, ultimately, a sharp rise in unsafe abortions. The impacts on women’s and girls’ lives now, and beyond this crisis, will be severe.   

Midwife Sophia Abrafi sits at her desk, sorting her paperwork before another patient comes in looking for family planning services. The 40-year-old midwife welcomes each patient with a warm smile and when she talks, her passion for her work is clear.  At the Mim Health Centre, which is located in the Ahafo Region of Ghana, Abrafi says a sexual and reproductive health and right (SRHR) project through Planned Parenthood Association of Ghana (PPAG) and the Danish Family Planning Association (DFPA) allows her to offer comprehensive SRH services to those in the community, especially young people. Before the project, launched in 2018, she used to have to refer people to a town about 20 minutes away for comprehensive abortion care. She had also seen many women coming in for post abortion care service after trying to self-administer an abortion. “It was causing a lot of harm in this community...those cases were a lot, they will get pregnant, and they themselves will try to abort.”   Providing care & services to young people Through the clinic, she speaks to young people about their sexual and reproductive health and rights. “Those who can’t [abstain] we offer them family planning services, so at least they can complete their schooling.” Offering these services is crucial in Mim, she says, because often young people are not aware of sexual and reproductive health risks.  “Some of them will even get pregnant in the first attempt, so at least explaining to the person what it is, what she should do, or what she should expect in that stage -is very helpful.” She has already seen progress.  “The young ones are coming. If the first one will come and you provide the service, she will go and inform the friends, and the friends will come.” Hairdresser Jennifer Osei, who is waiting to see Abrafi, is a testament to this. She did not learn about family planning at school. After a friend told her about the clinic, she has begun relying on staff like Abrafi to educate her. “I have come to take a family planning injection, it is my first time taking the injection. I have given birth to one child, and I don’t want to have many children now,” she says. Expanding services in Mim The SRHR project is working in three other clinics or health centres in Mim, including at the Ahmadiyya Muslim Hospital. When midwife Sherifa, 28, heard about the SRHR project coming to Mim, she knew it would help her hospital better help the community. The hospital was only offering care for pregnancy complications and did little family planning work. Now, it is supplied with a range of family planning commodities, and the ability to do comprehensive abortion care, as well as education on SRHR. Being able to offer these services especially helps school girls to prevent unintended pregnancies and to continue at school, she says.  Sherifa also already sees success from this project, with young people now coming in for services, education and treatment of STIs. In the long term, she predicts many positive changes. “STI infection rates will decrease, teenage pregnancies will decrease, unsafe abortions and deaths as a result of unsafe abortions will decrease. The young people will now have more information about their sexual life in this community, as a result of the project.”

Factory workers at Mim Cashew, in a small town in rural Ghana, are taking their reproductive health choices into their own hands, thanks to a four-year project rolled out by Planned Parenthood Association Ghana (PPAG) along with the Danish Family Planning Association (DFPA). The project, supported by private funding, focuses on factory workers as well as residents in the township of about 30, 000, where the factory is located. Under the project, health clinic staff in Mim have been supported to provide comprehensive abortion care, a range of different contraception choices and STI treatments as well as information and education. In both the community and the factory, there is a strong focus on SRHR trained peer educators delivering information to their colleagues and peers. An increase in knowledge  So far, the project has yielded positive results - especially a notable increase amongst the workers on SRHR knowledge and access to services - like worker Janet Pinamang, who is a 32-year-old mother of two. She says the SRHR project has been great for her and her colleagues. "I have had a lot of benefits with the project from PPAG. PPAG has educated us on how the process is involved in a lady becoming pregnant. PPAG has also helped us to understand more on drug abuse and about HIV.” She also appreciated the project working in the wider community and helping to address high levels of teenage pregnancy.  "I have seen a lot of change before the coming of PPAG little was known about HIV, and its impacts and how it was contracted - now PPAG has made us know how HIV is spread, how it is gotten and all that. PPAG has also got us to know the benefits of spacing our children." “It has helped me a lot” Pinamang's colleague, Sandra Opoku Agyemang, 27, is a mother of a six-year-old girl called Bridget. Agyemang says before the project came to Mim, she had only heard negative information around family planning. "I heard family planning leads to dizziness, it could lead to fatigue, you won't get a regular flow of menses and all that, and I also heard problems with heart attacks. I had heard of these problems, and I was afraid, so after the coming of PPAG, I went into family planning, and I realised all the things people talked about were not wholly true." Now using family planning herself, she says the future is bright for her, and her family. "It has helped me a lot, without that information I would have given birth to many children, not only Bridget. In the future, I plan to add on two [more children], even with the two I am going to plan."  

When Gifty Anning Agyei was pregnant, her classmates teased her, telling her she should drop out of school. She thought of having an abortion, and at times she says she considered suicide. When her father, Ebenezer Anning Agyei found out about the pregnancy, he was furious and wanted to kick her out of the house and stop supporting her education.  Getting the support she needed But with support from Planned Parenthood Association of Ghana (PPAG) and advice from Ebenezer’s church pastor, Gifty is still in school, and she has a happy baby boy, named after Gifty’s father. Gifty and the baby are living at home, with Gifty’s parents and three of her siblings in Mim, a small town about eight hours drive northwest of Ghana’s capital Accra.  “Despite all those challenges, I thought it was necessary to stay in school. I didn’t want any pregnancy to truncate my future,” Gifty says, while her parents nod in proud support. In this area of Ghana, research conducted in 2018 found young people like Gifty had high sexual and reproduce health and rights (SRHR) challenges, with low comprehensive knowledge of SHRH and concerns about high levels of teenage pregnancy. PPAG, along with the Danish Family Planning Association (DFPA), launched a four-year project in Mim in 2018 aimed to address these issues.  For Gifty, now 17, and her family, this meant support from PPAG, especially from the coordinator of the project in Mim, Abdul- Mumin Abukari. “I met Abdul when I was pregnant. He was very supportive and encouraged me so much even during antenatals he was with me. Through Abdul, PPAG encouraged me so much.” Her mother, Alice, says with support from PPAG her daughter did not have what might have been an unsafe abortion. The parents are also happy that the PPAG project is educating other young people on SRHR and ensuring they have access to services in Mim. Gifty says teenage pregnancy is common in Mim and is glad PPAG is trying to curb the high rates or support those who do give birth to continue their schooling.  “It’s not the end of the road” “PPAG’s assistance is critical. There are so many ladies who when they get into the situation of early pregnancy that is the end of the road, but PPAG has made us know it is only a challenge but not the end of the road.” Gifty’s mum Alice says they see baby Ebenezer as one of their children, who they are raising, for now, so GIfty can continue with her schooling. “In the future, she will take on the responsibly more. Now the work is heavy, that is why we have taken it upon ourselves. In the future, when Gifty is well-employed that responsibility is going to be handed over to her, we will be only playing a supporting role.” Alice also says people in the community have commented on their dedication. “When we are out, people praise us for encouraging our daughter and drawing her closer to us and putting her back to school.” Dad Ebenezer smiles as he looks over at his grandson. “We are very happy now.” When she’s not at school or home with the baby, Gifty is doing an apprenticeship, learning to sew to follow her dream of becoming a fashion designer. For her, despite giving birth so young, she has her sights set on finishing her high school education in 2021 and then heading to higher education. 

As the sun rises each morning, Dorcas Amakyewaa leaves her home she shares with her five children and mother and heads to work at a cashew factory. The factory is on the outskirts of Mim, a town in the Ahafo Region of Ghana. Along the streets of the township, people sell secondhand shoes and clothing or provisions from small, colourfully painted wooden shacks.  “There are so many problems in town, notable among them [young people], teenage pregnancies and drug abuse,” Amakyewaa says, reflecting on the community of about 30,000 in Ghana.       The chance to make a difference  In 2018, Amakyewaa was offered a way to help address these issues in Mim, through a sexual and reproductive health rights (SRHR) project brought to both the cashew factory and the surrounding community, through the Danish Family Planning Association, and Planned Parenthood Association Ghana (PPAG).  Before the project implementation, some staff at the factory were interviewed and surveyed. Findings revealed similar concerns Amakyewaa had, along with the need for comprehensive education, access and information on the right to key SRHR services. The research also found a preference for receiving SRHR information through friends, colleagues or factory health outreach. These findings then led to PPAG training people in the factory to become SRHR peer educators, including Amakyewaa. She now passes on what she has learnt in her training to her colleagues in sessions, where they discuss different SRHR topics. “I guide them to space their births, and I also guide them on the effects of drug abuse.” The project has also increased access to hospitals, she adds. “The people I teach, I have given the numbers of some nurses to them. So that whenever they need the services of the nurses, they call them and meet them straight away.” Access to information One of the women Amakyewaa meets with to discuss sexual and reproductive health is Monica Asare, a mother of two.  “I have had a lot of benefits from PPAG. They teach us as to how to avoid STDs and how to space our childbirth. I teach my child about what we are learning. I never had access to this information; it would have helped me a lot, probably I would have been in school.” Amakyewaa also says she didn’t have access to information and services when she was young. If she had, she says she would not have had a child at 17. She takes the information she has learnt, to share with her children and other young people in the community. When she gets home after work, Amakyewaa’s peer education does not stop, she continues. She also continues her teachings when she gets home. “PPAG’s project has been very helpful to me as a mother. When I go home, previously I was not communicating with my children with issues relating to reproduction.” Her 19-year-old daughter, Stella Akrasi, has also benefitted from her mothers training. “I see it to be good. I always share with my friends give them the importance of family planning. If she teaches me something I will have to go and tell them too” she says.