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Sitting outside Lilongwe Youth Life Centre on a sunny Thursday afternoon, 24-year-old Rodrick is glued to his phone. When asked to show some of his posts, he asks “what do you want to see, Instagram, WhatsApp, Facebook?”    Rodrick and his friends laugh at a post of a smiling cartoon condom fighting off multicoloured STIs.  SheDecides promotes change through social media  Rodrick is a trained Social Media Agent for SheDecides, a movement empowering youth to champion the rights of girls and women to make choices about their lives and bodies and have access to comprehensive sexual and reproductive health education.    “Social networks are developing each and every day, so more young people are now on social media,” explains Rodrick, adding that many young people don’t have access to books to read about sexual and reproductive health and rights.    “It’s better to reach them on social media so they can see it,” says Rodrick, although he admits that many people in Malawi cannot afford internet data bundles on their phones.  He says that he and other Youth Action Movement volunteers try to get out daily posts on social media channels to educate other young people about the issues they are passionate about.    “One day I posted asking why the government of Malawi doesn’t legalize abortion, which I think is not good for the girls because they have their lives to live,” says Rodrick, adding that he believes abortion can keep more girls in education. Rodrick says that while people don’t always agree with him, he enjoys discussing the topic on social media. “People ask ‘are you a real man?’” he laughs.    "I debate so much, and I like that! And sometimes I convince people that what I’m saying is right.” Supporting young people through personal challenges  As well as getting into lively debates on social media, Rodrick says he is often sent private messages by young people who feel they can open up to him as a peer with knowledge about sexual health.    A 16-year-old girl messaged Rodrick on WhatsApp, telling him she had been raped and was pregnant. “I asked her if she was comfortable with the pregnancy and she said no, how can I be comfortable with a pregnancy that I didn’t want to come to me?”    She then asked Rodrick how he could help her with the issue. “I said I will help you, though I’m not the person responsible I’ll take you to the person who is so they can handle that issue.” Rodrick then met up with the girl, who went on to access abortion counselling. He says that the case also went to court, and is awaiting the verdict.  “We always say this thing can be done by a male, and this thing can be done by a female,” says Rodrick, talking about gender inequality and his involvement in SheDecides. “But that’s not right. We’re all humans and should be able to do whatever he or she wants to do.”   

Dressed in a sparkling white medical coat, Alinafe runs one of Family Planning Association of Malawi (FPAM) mobile clinics in the village of Chigude. Under the hot midday sun, she patiently answering the questions of staff, volunteers and clients - all while heavily pregnant herself.  Delivering care to remote communities  “Most NGOs don’t come here because it’s so hard to reach,” she says, as women queue up in neat lines in front of two khaki tents to receive anything from a cervical cancer screening to abortion counselling. Without the mobile clinic, local women risk life-threatening health issues as a result of unsafe abortion or illnesses linked to undiagnosed HIV status. According to the Guttmacher Institute, complications from abortion are the cause of 6–18% of maternal deaths in Malawi.    District Manager Alinafe joined the Family Planning Association of Malawi in 2016, when she was just 20 years old, after going to nursing school and getting her degree in public health. She was one of the team involved in the Linkages project, which provided free family planning care to sex workers in Mzuzu until it was discontinued following the 2017 Global Gag Rule.  Seeing the impact of lost funding on care  “This change has reduced our reach,” Alinafe says, explaining that before the Gag Rule they were reaching sex workers in all four traditional authorities in Mzimba North - now they mostly work in just one. She says this means they are “denying people services which are very important” and without reaching people with sexual and reproductive healthcare, increasing the risk of STIs.    The reduction in healthcare has also led to a breakdown in the trust FPAM had worked to build in communities, gaining support from those in respected positions such as chiefs.    “Important people in the communities have been complaining to us, saying why did you do this? You were here, these things were happening and our people were benefiting a lot but now nothing is good at all,” explains Alinafe.    Still, she is determined to serve her community against the odds - running the outreach clinic funded by Global Affairs Canada five times a week, in four traditional authorities, as well as the FPAM Youth Life Centre in Mzuzu.  “On a serious note, unsafe abortions are happening in this area at a very high rate,” says Alinafe at the FPAM clinic in Chigude. “Talking about abortions is a very important thing. Whether we like it or not, on-the-ground these things are really happening, so we can’t ignore them.”

For Jennipher, who lives in a village outside of Lilongwe, unintended pregnancies amongst young women and girls like her are an everyday reality.    “Girls often speak to me about these issues because they know I come to the Youth Life Centre and that I know a lot about these issues,” explains Jennipher, who wears a baggy white t-shirt and big hoop earrings.    “They are happy to talk to me about these issues because I’m young and also a girl. It’s hard for girls to talk about these issues to their families because they might not believe them,” says Jennipher, who is a Youth Action Movement (YAM) volunteer in her local area, Dowa. “It’s important to teach girls about abortion so they know how to take care of themselves and stop risking their lives,” she adds.  Teaching peers how to avoid unwanted pregnancy  Off the top of her head, Jennipher can think of two close friends who have experienced unwanted pregnancies at a young age. One was just 14 when she fell pregnant and, desperate, had an unsafe abortion. “There was a lot of blood. I helped her by taking her here [to the Youth Life Centre] for treatment. Now she’s quite fine and back at school after recovering,” says Jennipher.    Another friend was 18 when she got pregnant, but ended up keeping her baby. Jennipher says she encouraged her friend to get help at the center “so she could learn a lot of things and maybe get contraception, so she can go back to school again and have a bright future.”    Two years on, her friend is back at school and her mother takes care of the baby while she is studying. “She even joined the Youth Action Movement, so we are together here,” smiles Jennipher.  Passionate about education  These experiences have made Jennipher passionate about educating young women and girls in her community about contraception, with the aim of keeping them safe, healthy, and in school.    As a YAM volunteer she also gets approached by girls who have experienced sexual abuse, often within the family. Another friend of Jennipher’s told her that her sister’s husband wanted to sleep with her.     “In these cases, sometimes the girls choose to be silent for fear that the breadwinner might be arrested and then the family will suffer,” she explains. But with a well-informed peer like Jennipher to confide in, her friend was advised to go to the authorities and to the center for guidance.    Looking to the future, Jennipher says she wants to have two or three children. “That would be enough!” She laughs. She also plans to make a career out of her skill for caring for others. “I want to be a secondary teacher or a nurse. I want to help people.” 

Mary, a 30-year-old sex worker, happily drinks a beer at one of the bars she works at in downtown Lilongwe. Her grin is reflected in the entirely mirrored walls, lit with red and blue neon lights.    Above her, a DJ sat in an elevated booth is playing pumping dancehall while a handful of people around the bar nod and dance along to the music. It’s not even midday yet.    Mary got introduced to the Family Planning Association of Malawi through friends, who invited her to a training session for sex worker ‘peer educators’ on issues related to sexual and reproductive health and rights as part of the Linkages project.    “I learnt about condoms and even female condoms, which I hadn’t heard of before,” remembers Mary.  Life-changing care and support   But the most life-changing care she received was an HIV test, where she learnt that she was positive and began anti-retroviral treatment (ART). “It was hard for me at first, but then I realized I had to start a new life,” says Mary, saying this included being open with her son about her status, who was 15 at the time.    According to UNAIDS 2018 data, 9.2% of adult Malawians are living with HIV. Women and sex workers are disproportionately affected - the same year, 55% of sex workers were estimated to be living with HIV.    Mary says she now feels much healthier and is open with her friends in the sex worker community about her status, also encouraging them to get tested for HIV.  “Linkages brought us all closer together as we became open about these issues with each other,” remembers Mary.  Looking out for other sex workers   As a peer educator, Mary became a go-to person for other sex workers to turn to in cases of sexual assault. “I’ll receive a message from someone who has been assaulted, then call everyone together to discuss the issue, and we’d escort that person to report to police,” says Mary.    During the Linkages project - which was impacted by the Global Gag Rule and abruptly discontinued in 2017 - Mary was given an allowance to travel to different ‘hotspot’ areas. In these bars and lodges, she explains in detail how she would go from room-to-room handing out male and female condoms and showing her peers how to use them.    FPAM healthcare teams would also go directly to the hotspots reaching women with healthcare such as STI testing and abortion counselling. FPAM’s teams know how crucial it is to provide healthcare to their clients ensuring it is non-judgmental and confidential. This is a vital service: Mary says she has had four sex worker friends die as a result of unsafe abortions, and lack of knowledge about post-abortion care.    “Since the project ended, most of us find it difficult to access these services,” says Mary, adding that “New sex workers don’t have the information I have, and without Linkages we’re not able to reach all the hotspot bars in Lilongwe to educate them.”

In 2017, the Family Planning Association of Malawi (FPAM) refused to sign the Global Gag Rule and consequently lost vital US funding forcing lifeline projects such as Linkages, which provided care to sex workers, to close. By signing the GGR policy, FPAM would be going against what it stood for at the heart of its mission – to offer integrated healthcare in one place no matter how remote. “You don’t want a client to have to move from one place to another,” explains Executive Director Donald Makwakwa. FPAM provides integrated care at its Youth Life Centers and outreach clinics, which offer young people who have come to them for condoms other care including abortion, counselling, and STI tests. Committed to abortion care despite loss of funds Donald Makwakwa, Executive Director FPAM “Organizations had to make a choice. We have funding from the US government, do we lose it? Or do we keep it?” says Donald Makwakwa, Executive Director of FPAM, reflecting on the impact of the 2017 Global Gag Rule. FPAM made the decision to lose USAID funding, but along the way lost much more: 40 staff members, its reputation among clients and prospective employees, and momentum in their advocacy work due to some of their allies signing onto the Rule. “When we are talking about family planning, we also believe that we cannot stop talking about abortion because the two are very much related,” says Makwakwa. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sex workers face limited access to care Mary, sex worker The loss of funds brought an abrupt end to FPAM’s Linkages project, which provided tailored healthcare to female sex workers; FPAM’s plans to train staff in all hospitals on delivering care to sex workers were derailed. Mary was a peer educator with the Linkages project and became a go-to person for other women to turn to in cases of sexual assault. “I’ll receive a message from someone who has been assaulted, then call everyone together to discuss the issue, and we’d escort that person to report to the police,” says Mary. “Since the project ended, most of us find it difficult to access these services,” she continues, adding that “new sex workers don’t have the information I have, and without Linkages we’re not able to reach all the hotspot bars in Lilongwe to educate them.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Feeling the impact of the Linkages project *Marianne, sex worker “I wouldn’t be alive today if it wasn’t for Linkages,” says 30-year-old sex worker Marianne simply. When outreach workers in Mzuzu met Marianne at a bar, she says she was having unprotected sex and drinking and smoking heavily. “I was just doing everything that I could think of doing.” In her eyes, the main benefit of Linkages was that it reached everyone in her community - including those who didn’t feel comfortable going to hospitals for care. Marianne says that she now takes pride in keeping herself and her community safe. “With the new information I got, I was protecting my friends by using a condom when a man comes, so that when another woman sleeps with the same man, she won’t get the same infection.”*pseudonym Share on Twitter Share on Facebook Share via WhatsApp Share via Email Re-building healthcare provision through Canadian funding Youth volunteers and FPAM staff set up an outreach clinic in the village of Chigude. Through funding from Global Affairs Canada (GAC) FPAM has been able to rebuild their healthcare provision following the Global Gag Rule. The funding has kept their Youth Life Centres afloat - including supporting Youth Action Movement volunteers - and helped FPAM do what it takes pride in most: delivering vital healthcare in remote areas where no other NGOs have a presence. Makwakwa says that the organization's operations in Mzuzu, northern Malawi, are entirely funded by GAC. “Without that funding, by now we wouldn’t have operations that side of the country, meaning a lot of Malawians would not have had access to sexual and other health services,” he explains. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Leaving no one behind Alinafe Chasowa, District Manager for FPAM Alinafe Chasowa, District Manager for FPAM in Mzuzu, is particularly proud of their outreach clinics which operate across all four traditional authorities in Mzimba North. “Most NGOs don’t come here because it’s so hard to reach,” she says. At an outreach clinic in the village of Chigude, over 100 women line up for the clinic. Because of local taboos around women’s sexuality - and the nearest clinic being a five hour walk away - many women hadn’t received sexual and reproductive healthcare before FPAM came to their area. She says that talking about abortions is “a very important thing” in this area, where there are high rates of unsafe abortion. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Taking control of the future Monica, client Monica, 23, is at a sexual and reproductive health clinic in Chigude, northern Malawi. Her two-month-old baby sleeps peacefully in a sling tied around her shoulder. It’s her third time to the clinic. “It’s very important for me to come here so I don’t get an unwanted pregnancy,” explains Monica, adding that “if that happens, all my plans will be cancelled.” Monica is currently busy preparing to build a house - which would have to be put on hold if she had to care for another child in addition to the two she already has. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Benefitting from integrated healthcare Mariet, client Mariet, 26, came to FPAM’s mobile clinic for the first time and got a cervical cancer screening. Mariet is engaged and has one child. She says she is thinking about using the contraceptive injection because her child is still young and she wants to leave some time before she has another. “Today I’ve learnt about issues of unsafe abortions,” says Mariet. “I can now go home and discuss this with my friends, so they can get the information from me in case they are not comfortable speaking to the health workers,” she explains, adding that many people in her community do not know their HIV status so would benefit from the test the FPAM clinic offers. “All the services are here. Many of my friends have so many children, because the nearest clinic is far. That’s why this outreach is very important for us.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Young volunteers connect their peers to information and contraceptive care Kondwani, Youth Action Movement volunteer In Chigude, a usually quiet rural village in northern Malawi, young people gather around two tables laughing and chatting animatedly. “Most of them have come here for condoms, but I don’t just give them out,” says Kondwani, a 22-year-old Youth Action Movement (YAM) volunteer. “I ask them how do you use a condom? How is it useful to somebody who is using it?” Activities like this in hard-to-reach areas are one of many that the Youth Action Movement delivers across Malawi. Trained and hosted by Youth Life Centers, which provide sexual and reproductive healthcare aimed at youth, the volunteers meet regularly and reach out to their peers in schools, universities, and on social media. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Realities of unwanted pregnancies Jennipher and Sellah, Youth Action Movement volunteers For Jennipher, who lives in a village outside of Lilongwe, unwanted pregnancies amongst young women and girls like her are an everyday reality. “Girls often speak to me about these issues because they know I come to the Youth Life Center and that I know a lot about these issues,” explains Jennipher. “They are happy to talk to me about these issues because I’m young and also a girl. It’s hard for girls to talk about these issues to their families because they might not believe them,” says Jennipher, who is a Youth Action Movement (YAM) volunteer in her local area, Dowa. “It’s important to teach girls about abortion so they know how to take care of themselves and stop risking their lives,” she adds. Share on Twitter Share on Facebook Share via WhatsApp Share via Email SheDecides encourages change through social media Rodrick and Phoebe, Youth Action Movement volunteers & Social Media Agents “Social networks are developing each and every day, so more young people are now on social media,” explains Rodrick, a trained Social Media Agent, adding that many young people don’t have access to books to read about sexual and reproductive health and rights. “It’s better to reach them on social media so they can see it.” He posts daily on social media channels to educate other young people about the issues they are passionate about. “One day I posted asking why the government of Malawi doesn’t legalize abortion, which I think is not good for the girls because they have their lives to live,” says Rodrick, adding that he believes abortion can keep more girls in education. Rodrick says that while people don’t always agree with him, he enjoys discussing the topic online. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Youth help their peers follow their dreams Partson, Youth Action Movement volunteer & Social Media Agent Youth Action Movement Volunteer, Partson, understands the importance of contraceptive access if he and his peers are going to achieve their hopes and dreams. “We encourage young people to use contraception, and also to get help at the Youth Life Centre, so that after the pregnancy they can go back to school,” he says, adding that abortion counselling and post-abortion care are also offered. “We feel proud because we’re helping them to achieve their goals, like school and business,” he says, explaining how members of his youth group at Dowa Youth Life Centre encourage their friends to use its contraceptive and sexual healthcare provisions. “On social media, people ask questions that are more private than face-to-face where they can be shy. They are more free,” says Partson, laughing “we all go through sex, so we have to talk about it!”Photos ©IPPF/Tommy Trenchard/Malawi Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Our Member Association, Family Planning Association of Malawi (FPAM), is delivering healthcare through the support of WISH* in Lilongwe and Kasungu with a focus on young women and girls. A bespoke training programme supports community health workers on how to deliver youth-friendly healthcare through outreach to local communities, and especially young women. *The Women’s Integrated Sexual Health (WISH2Action) programme, is funded by the UK Foreign Commonwealth and Development Office (FCDO), under the strategy to ‘Leave No One Behind’. Photographs ©FPAM/Andrew Mkandawire/Malawi Barriers to contraceptive care Young people, particularly girls, face barriers to accessing sexual and reproductive healthcare and contraception due to societal perceptions that they have no need for them. Chiefs and parents in the Lilongwe and Kasungu districts have demonstrated that by working together they are able to meet this need and protect the health and wellbeing of young people in their communities. Their collective approach ensures elders advocate on behalf of the youth in their communities, encouraging them to feel confident in accessing healthcare provision and to counter myths and misconceptions about contraception. Their goal is to reduce the high number of unintended pregnancies and STIs among young people. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Gogo Nakwenda Gogo Nakwenda is respected in her community as a go-to counsellor for young people, advising on sexuality and how to access healthcare. Now nearing her 80s, Nakwneda, talks about different contraception methods, saying that if she was 18 again, she would opt for the five-year implant to ensure her education and future work opportunities. “During our time we used traditional contraception, but I have learned that modern pregnancy and sexually transmitted infections prevention methods are very predictable and give no excuses to protection errors. One can comfortably plan when to have a child and when not to have child.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Lucy, volunteer and parent Lucy believes it is important to educate both parents and young people on the benefits of access to contraception. Lucy talks about how myths and misconceptions remain a barrier for young girls to be able to access contraception, mostly because of fears related to infertility. She is open about her own experiences with contraceptives. “I’m 38, I have used pills, injectables and now I’m now using the IUD and successfully I have given birth to three children and here I am in good health. Who else can lie about modern contraceptives? I usually encourage the young ones to be mindful of their future to avoid any mistake that could be prevented with available contraceptives they can comfortably demand from their community health workers.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Chiefs Sadulira and Chinoko Chiefs in Lilongwe and Kasungu districts are committed and supportive of the promotion of sexual and reproductive healthcare for the young people using the youth clubs they supervise. Chief Sadulira believes this is a crucial time for parents to understand the importance of being open with young people. Connecting them with community health workers who are experienced in counselling and provision of sexual and reproductive healthcare can help reduce unintended pregnancies. “I use community meeting sessions to advise parents who resist or misunderstand why youth should have access to contraceptives, because prevention is better than cure.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Matundu youth club In July 2020, FPAM visited the Lilongwe and Kasungu youth clubs to support sexual and reproductive health behaviour change communication interventions. “Our youth here access condoms from the chairman of Namangwe youth club who is linked to Chiwamba health center, located about 18km from Namangwe. He does all this as a volunteer because the area does not have any community-based distribution agents. And the fact that FPAM is finally here, we are assured that access to cervical cancer screening and contraception services are guaranteed,” says Chief Chinoko. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Ngwangwa Ngwangwa applauded FPAM for bringing youth-targeted outreach clinics to their remote area and requested to increase the frequency of the clinics to reach more youth living in hard-to-reach communities. “My area is big yet is leaning more like an island without a health facility nearby. It takes youth to walk 17km to get to Dzenza hospital, 15km to reach Ngoni health center, and 35km to get to Kabudula community hospital. This gap requires frequent mobile clinics.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Ruth, youth leader Radio and youth clubs are major sources of information on contraception as well as through community discussions and groups. “I first heard about contraception in 2016, when I was 15, from Zodiak and MBC radios. I accessed the Implanon implant that protects for three years from one of the FPAM outreach clinics. In my family we are three girls and all my elder sisters fell pregnant in their teens. I never wanted to get disturbed to complete my secondary school education. And hearing from radios about the benefits of contraception like the ability to complete education made me generate confidence to have an implant to avoid unintended pregnancy.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email Banda, vice chair, Youth Action Movement (YAM) The teams of youth leaders have successfully advocated for sexual and reproductive health and rights, creating demand specifically for contraceptive care in their communities. “I engage in contraception discussions slowly by starting with a little probe if girls and young women have ever heard or used contraception before. Later I extend the discussion to give in that the unwanted pregnancy I got was total negligence because access to contraception services was available. I encourage them not to fall into unwanted pregnancy trap when they have all the support and preventative measures around." Share on Twitter Share on Facebook Share via WhatsApp Share via Email Lucy, youth leader Lucy chose a long-acting method of contraception through the FPAM mobile outreach clinic. “My friends discouraged me a lot because they feared a rumor that the IUD drops into the uterus and causes cancer. I gathered courage because I needed a solution that would enable me not to conceive again until my family's economic status improves, and I got the IUD fitted. I feel no problem. This evidence is now a tool I use to teach many girls and women about the benefits of contraception. We are really glad to have FPAM bring a youth-friendly mobile clinic which will support our ground efforts to advocate for youth access to all sexual and reproductive health and rights information and services.” Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Amina is a peer educator trained by Family Planning Association of Malawi’s (FPAM) Linkages project. “I am a HIV positive sex worker and a peer educator,” she says. “I have 51 other sex workers in my care, I inform them on testing and treatment, also about STI treatment and condom use. I teach about the disadvantages of sharing ART (anti-retroviral therapy) and encourage them to go for tuberculosis testing if they are coughing.” Another educator called Cecilia adds: “I reached out to 60 female sex workers. We are all friends and they trust me. I refer them to services and we address abuse by the police. They rape us and steal our money but through the project, we can follow up since the project has access to the managers of the police.” Basic sexual health information Her colleague Florence says: “It also helped that the rogue and vagabond law was repealed.” The law was a permanent curfew, giving the police the power to round up, fine or jail anybody who was on the streets after eight o’clock at night. Lucy, also a peer educator, says part of the work is giving basic information. “I teach my friends on HIV and GBV (gender-based violence),” she explains. “And I teach how to use condoms and lubricants and how to persuade clients to use condoms. I also talk about family planning. Many female sex workers do not know they need it.” “The project helped me with condoms and I shared that with others,” says another client of the programme, Angela. “Through the project, I got tested for HIV and treated for STIs. I also encourage pregnant sex workers to go for pre-natal care so that they do not infect their babies. It is the first time that an organisation like FPAM worked with us. We got respected within the community because we are knowledgeable.” In the year the Linkages project ran, 627 female sex workers were supported in getting tested for HIV, the initiation of anti-retroviral treatment and therapy adherence. 2,700 women were referred to services and many more received information. The HIV prevalence rate among female sex workers went down from 77% to 62%. Global Gag Rule effects FPAM’s Linkages project was phased out in 2016 due to the Global Gag Rule. The effects are keenly felt amongst those who benefitted from the project: Amina says: “Many stopped taking medication. Healthcare facilities are not for us. I sing in a church choir, which is important to me. If they find out what I do, they will throw me out.” “My family thinks I work at a filling station at night,” says Lucy. Cecilia adds: “This project has to come back, please bring it back. If not, we will all die early.”

It used to take Matilda Meke-Banda six hours on her motorbike along dirt roads to reach two remote districts and deliver sexual and reproductive health (SRH) services. In this part of southern Malawi, Machinga, family planning uptake is low, and the fertility rate, at 6.6, is the highest in the country. The Family Planning Association of Malawi, known as FPAM, runs a clinic in the town of Liwonde and it’s from here that Matilda travelled out six times a month. “We have established six watch groups, they are trained to address SRH issues in the community,” she explains. Luc Simon is the chair of one of those groups.  “We teach about Family Planning,” he says. “We encourage parents and young people to go for HIV testing. We address forced early marriages, talk to parents and children to save a lot of young people.” And there are a lot of myths to dispel about family planning. Elizabeth Katunga is head of family planning in the district hospital in Machinga: “Family Planning is not very much accepted by the communities. Many women hide the use of contraceptives,” she says. “Injectables are most popular, easy to hide. We have cases here where husbands upon discovery of an implant take a knife and cut it out. It is not that people want big families per se but it is the misconceptions about contraceptives.” FPAM’s projects are based at the Youth Life clinic in Liwonde. The clinic offers integrated services: Family planning, HIV services, STI screening, cervical cancer screening and general healthcare (such as malaria). This joined-up approach has been effective says FPAM’s executive director Thoko Mbendera: “In government health facilities, you have different days, and long queues always, for family planning, for HIV, for general health, which is a challenge if the clinic is a 20 km walk away.There are privacy issues.” But now, FPAM’s services are being cut because of the Global Gag Rule (GGR), mobile clinics are grounded, and there are fears that much progress will be undone. Some of FPAM’s rural clients explain how the Watch Groups work in their community. “It starts with me as a man,” says group member George Mpemba. “We are examples on how to live with our wives. We are non-judgemental; we embark on a mutual learning process. Our meetings are not hearings, but a normal chat, there is laughing and talking. After the discussion we evaluate together and make an action plan.” Katherine, went to the group for help: “There was violence in my marriage; my husband forced himself on me even if I was tired from working in the field. When I complained there was trouble. He did not provide even the bedding. “He is a fisherman and he makes a lot of cash which he used to buy beer but nothing for us.I overheard a watch group meeting once and I realised there was a solution. They talked to him and made him realise that what he was doing was violence and against the law. It was ignorance.Things are better now, he brings money home, sex is consensual and sometimes he helps with household chores.”

It is 9.00pm in Lilongwe, the capital of Malawi , the fish market is one of the “hotspots” where the Family Planning Association of Malawi’s (FPAM) opens its trailer doors to  sex workers, a “key population” in the fight against HIV. Thoko Mbendera is the Executive Director of FPAM: “Key populations are groups whose needs you have to address if you ever want to bring down HIV prevalence in the general population. Sex workers clearly need help here: the HIV prevalence rate among them is 77% while among the general population it is 10.2%.” The clinic offers STI screening, family planning, HIV testing, tuberculosis (TBC) testing and cervical cancer screening. Outside, peer educators distribute condoms and talk to waiting clients. Thoko Mbendera says: “This group does not (have) access the public health sector, it is simple not an option for women who do not disclose what they do to anyone, so in the Linkages program we reach out to the hot spots at night.” Florence Mushani, is the coordinator of Linkages: “In the project we trained 63 peer educators. They are HIV positive; they approach their colleagues with information and advice. Our goal is the 90-90-90 target meaning 90% of sex workers know their status, 90% of HIV positive women are on anti-retroviral treatment (ART), and 90% of the women on ARTs will be virally suppressed. We also trained 21 peer navigators; they support others to adhere to therapy. We pay them a small stipend of 25 dollars a month, we expect a lot of them.” Tusekele Mwakasungula is FPAM’s Programs Manager: “The goal of the peer educators training is to build up the person,” he says. And it shows: these women are no shy victims of an unjust society, they are self-confident and outspoken, determined to improve the situation of female sex workers.” FPAM’s Linkages project was phased out in 2016 due to the Global Gag Rule.