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There are some years that become a pivotal moment in history - 2020 is one of those. IPPF has never been faced with delivering healthcare in the grip of a global pandemic. Yet our global teams have demonstrated agility, resilience, and creativity putting clients at the heart of our work to ensure the safe delivery of vital care. The pandemic has changed how we work, but not what we do. Here we acknowledge some of our amazing colleagues, clients, and partners as well as events that have shaped 2020. Expanding healthcare for factory staff Sandra is one of a team of women who work at a cashew factory in a small town in rural Ghana. Thanks to a project run in partnership by Planned Parenthood Association Ghana (PPAG) and the Danish Family Planning Association (DFPA) women like Sandra can now access contraceptive and reproductive healthcare during their working day. "It has helped me a lot, without that information I would have given birth to many children.”© IPPF/Natalija Gormalova Share on Twitter Share on Facebook Share via WhatsApp Share via Email Ensuring healthcare provision during the pandemic Malak Dirani, a midwife at the Lebanese Association for Family Health (SALAMA). “My message to healthcare workers across the world is that we are always here for people to secure their health and rights. We are on the frontline; we were always the one who people trust! We are the nation's guiding light during this difficult time, so we can, with our efforts and power support patients, overcome this crisis, and save lives.”© SALAMA Share on Twitter Share on Facebook Share via WhatsApp Share via Email COVID-19 crisis sparks innovation New approaches to reach women with safe abortion care include telemedicine and home-based provision of medical abortion. To ensure that quality abortion care can be provided to women during travel restrictions, the Cameroon National Planning Association for Family Welfare (CAMNAFAW)’s service providers travel to partner clinics in underserved areas and to clients’ homes to provide medical and surgical abortion care. This model of taking safe abortion care closer to women will continue even with easing of travel restrictions, as this has been found to be an effective and acceptable approach to increasing access.© IPPF/Xaume Olleros Share on Twitter Share on Facebook Share via WhatsApp Share via Email Getting creative on social media A watercolour entry for a social media art competition. “With our Youth Network we created an artistic competition on our Facebook and Instagram platforms on issues such as masturbation, menstruation, coming out, female genitalia, pornography. The aim is to enhance creativity and make young people reflect about sexual and reproductive health and rights in a creative way during the pandemic. The aim was also to offer something fun and positive in this difficult time.” Noemi, 24, is the co-founder and coordinator of Santé Sexuelle Suisse/Sexuelle Gesundheit Schweiz's Youth Network. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Delivering healthcare to remote communities in Fiji RFHAF Team in Kadavu performing general health checks after TC Harold. Healthcare provider, Nasi, administers an HPV shot to a client. In early April 2020, the all too familiar destruction of a Tropical Cyclone (TC) – Harold – hit the Solomon Islands, Vanuatu, Fiji and Tonga. One of the worst affected areas was the Eastern part of Fiji. Through support by Department of Foreign Affairs and Trade (DFAT), our Member Association, Reproductive and Family Health Association of Fiji (RFHAF), was quick to respond ensuring access to essential sexual and reproductive healthcare for Kadavu’s women, girls, and vulnerable groups.© IPPF/Rob Rickman Share on Twitter Share on Facebook Share via WhatsApp Share via Email Spotlight on women in leadership Executive Director, Dr Kalpana Apte, of FPA India talks about young people being a primary focus for access to healthcare and information. “Gender equality and equity is a fundamental issue that India must prioritize. India is a country of young people. That is the biggest cohort of people at this time in history. Within this group of young people, adolescent and young girls are the most marginalized group. The face of poverty in India is a young girl. Girls have fewer choices, options and opportunity. The gap between boys and girls in terms of access to sexual and reproductive health services and information is huge. Education, Health and empowerment are the three priorities for young girls.”© IPPF/Anurag Banerjee Share on Twitter Share on Facebook Share via WhatsApp Share via Email Humanitarian Youth Club, Kiribati Theta, 25, is part of the Humanitarian Youth Club set up by the Kiribati Family Health Association in her village. “I have helped the Humanitarian Youth Club to apply for financial grants from the Australian High Commission [for $1,000]. I am recognized as the smartest member who can write in English. We have learned how to design a disaster plan for the community and share our ideas on sexual and reproductive issues such as sexually transmitted infections. We discuss what we can do for the next strong tide, where we can gather as a community. For now, I want to enjoy the chance to be in our own beloved country. I won’t move until the majority have already left. I want my daughter to grow up in the same place I grew up in.”© IPPF/Hannah Maule-Ffinch Share on Twitter Share on Facebook Share via WhatsApp Share via Email Youth-led healthcare through song, dance, and poetry 17-year-old student Jumeya Mohammed Amin has been a ‘change agent’ for her community through the Family Guidance Association of Ethiopia since she was 14. "I wanted to protect girls from violence – like early marriage – and I wanted to change people’s wrong perceptions about sex and sexuality.”©IPPF/ Zacharias Abubeker Share on Twitter Share on Facebook Share via WhatsApp Share via Email Small but mighty: The Pill at 60 2020 marks the 60th anniversary of the game-changing contraceptive pill. For 60 years, “the Pill” has been approved for use in the US market, changing the face of reproductive control for millions of people since. Although taking a few years longer to become widely available to all women, the Pill was the first oral hormonal contraceptive. It allowed women to take real ownership over if and when they had children, and how many they had, giving them control over their lives in a way that had never been seen before.© Jessica Dance Share on Twitter Share on Facebook Share via WhatsApp Share via Email Being part of IPPF: What it means for Profamilia, Colombia Executive Director, Marta Royo. “For Profamilia, the value that the Federation adds is enormous. It gives us the possibility to exchange experiences and knowledge with other associations around the world, enriching our work, and allowing it to advance more quickly and with greater strength. This has allowed us to work with the most vulnerable populations in our country – from advocacy to healthcare service delivery, research, addressing issues as varied as abortion care, contraception and comprehensive sex education. Without this support, thousands of people in Colombia would not have access to any of these services.”© Profamilia Share on Twitter Share on Facebook Share via WhatsApp Share via Email Unprecedented support for women’s right to abortion care in Poland Huge numbers of people took part in protests prompted by the decision of the Constitutional Tribunal to impose a near ban on abortion on 22 October 2020. The ruling struck down the possibility for women to access abortion care on the ground of severe fetal impairment, rejecting what is the most common of the few legal grounds for abortion in the country at present. The demonstrations had a powerful impact, and on 3 November the government announced a delay in implementing its latest court ruling in response to the protests.© Marta Bogdanowicz Spacerowiczka Share on Twitter Share on Facebook Share via WhatsApp Share via Email US Election 2020 The people of the United States voted for change and progress. The reinstatement of the US Global Gag Rule in 2017 has had enormous consequences for women and girls accessing sexual and reproductive healthcare. IPPF calls on President-elect Biden to keep to his word of signing an executive order on his first day in office to repeal the harmful Global Gag Rule (the Mexico City Policy). © J. Smith/USA Share on Twitter Share on Facebook Share via WhatsApp Share via Email 16 Days of Activism Against GBV In humanitarian emergencies, women and girls may be forced to turn to survival sex work as a way of feeding themselves and their families. Without the usual healthcare available and low sexual health understanding, sex is frequently unprotected and violent, exposing them and their clients to sexually transmitted infections, including HIV. In fact, people who engage in sex work experience 10 times higher prevalence of HIV than the general population, with an average of a 12% rate of HIV infection.© Jem Milton Share on Twitter Share on Facebook Share via WhatsApp Share via Email Spotlight on sex and disability Joy & Jake talk sex and more to mark International Day of Persons with Disabilities. Joy and Jake – who are sight/visually-impaired – discuss the highs, lows, and everything in between of navigating sex, sexual health, dating, relationships and sex education, whilst living with a disability.© Bird Lime Media Share on Twitter Share on Facebook Share via WhatsApp Share via Email

“I've heard kids yelling on the street that there was a program to space pregnancies. I've always wanted to do that for the long term. Until then, I'm still trying with the three-month-old pills. Besides, listening to one of the people advertising these services, the address was not very far from my home." Claudine, aged 27, is a sex worker. "In the past, I was wary of 'contraceptive' methods. But once I tried them and I didn't notice any negative impact on my body, I made it a habit in order to not get pregnant". Like all young girls interested in the Women’s Integrated Sexual Health (Lot 1) programme services, Claudine arrives shyly at the center where Association pour le Bien-Etre Familial-Naissances Désirables (ABEF-ND) distributes contraceptive methods. "When I arrived at the center, I thought that there would be no paperwork to do, but I was pleasantly surprised that the organizers want to find out about me and maybe one day they will be able to set up a health centre to follow us regularly," she hopes. In the DRC, few women raise the subject of sexual violence because they are afraid of being rejected and that "poverty sometimes leads us into sex work," she says. "But the consequences are enormous and sometimes harmful. Girls who are not sensitized will have unsafe abortions and catch sexually transmitted infections." Claudine has expectations and hopes regarding this kind of activity: "However, if awareness-raising is regulated, even every three months, we will, I think, have fewer young mothers because they will be more knowledgable about family planning". The WISH project has seen a positive change in women and girls' access to integrated family planning and sexual and reproductive health care. WISH promotes a variety of contraceptive methods and sexual and reproductive health support, ranging from referrals to services for those who need it most.   "I want to feel free in my sexual activities". I have a boyfriend but that doesn't stop me from doing my life. "I make my livelihood as a sex worker and he is a carpenter. That's how we've been trying to make ends meet since we moved to the capital two years ago." "We're going back to the village to take a break, it's not a permanent departure." Claudine and her boyfriend are both from Boende, the capital of the Tshuapa province, in the north-west of the country, 2,285 km from Kinshasa. She was encouraged to move to the capital at the insistence of one of her uncles who had been living there for several years. "The reality is quite different. We have been able to raise enough money to send goods to the village for the past two years. My companion and I will go back there to rest and maybe come back if we get bored in the village again.” “Pakadjuma is a place where almost everyone comes from the village, but it is only here that I see enough interest from associations to sensitize young girls on family planning by distributing condoms to prevent early pregnancies and sexually transmitted diseases. It's all very interesting. It's an opportunity for us and I think it's one of the things I'll miss the most when I go back to the village. I hope to still have friends here who can send me these methods.”

After her parents divorced, the family dissolved and Ruth found herself in Pakadjuma where she rented a small house. "My boyfriend helps me pay the rent," she says. She thought she would continue with school but could not afford it. After a few years of a relationship, Ruth became pregnant, and explain that "it was late to get an abortion, and I didn't want to put my life in danger." "I would have liked to get my bachelor's degree, but I don't regret it; I loved my child right away." Ruth, aged 19, like other young girls, queues up to learn about the different contraceptive methods the WISH programme offers for girls and women living in Pakadjuma. Some of them sign up directly to take them. Others find out and promise to come back after talking with their companions. The Women’s Integrated Sexual Health (WISH Lot 1) programme offers quality integrated sexual and reproductive health services across the Democratic Republic of Congo through IPPF Member, Association pour le Bien-Etre Familial – Naissances Désirables (ABEF-ND). Ruth is trying the service for the first time. She is in favour of receiving a contraceptive method for the next three months. "Some people have discouraged me because they believe that the 5-year method can destroy the body. But before deciding to come here, I asked around with the neighbours who have already tried it. I didn't have any negative experiences." Ruth asked the organizers about the consequences: "They said it's just to protect me so that I don't get pregnant for 3 months and then I can renew if I feel like it.” Ruth feels that many parents do not discuss sexual matters with their children. They probably feel it is inappropriate. Yet, if young girls get pregnant before they are socially stable, it is also due to a lack of guidance and orientation. "This should be a regular initiative," she says. "It's not late to receive sex education but above all to have free contraceptive methods, because I would have preferred a thousand times to buy milk for my baby than to pay for a condom or a Jadelle. Ruth has an 8-month-old baby, "I didn't want this and having many children will be disadvantageous for me especially as I am not yet married". She lives from small businesses and the money to support from her companion. Ruth says she took this contraceptive method without her partner's advice. "Since the birth of our child, we have been abstinent, and that's good. "He encourages me to go back to school, and I think that's what I should do.”

Five years ago, when Arnilda Simango was 13, she started dating a boy from her community, outside Xai-Xai City, in Gaza Province in southern Mozambique. A year later she got pregnant, at his insistence, and he left her shortly after the baby was born. AMODEFA’s youth services offered her counselling and advice throughout her pregnancy and became the network through which she made new friends.  Today, at the age of 18, she is raising her son, with help from her mother and plans to return to school. “When I started dating, I thought I wanted a partner who could take care of me and that could maybe fill the void I felt for not having a father. When I started the relationship with my boyfriend, he insisted that he needed a son because all his friends already had one. I had little space to say no because he threatened to date someone else and I was convinced he was the right person for me. When I got pregnant in 2016, he started behaving strangely. He stopped being affectionate and gave indications that he did not want to be with me anymore. That's when a friend of mine told me that there was a youth center where I could get advice on how to proceed in this situation". The Adolescent and Youth Friendly Services (SAAJ) center, based at the Patrice Lumumba Urban Health Center, on the outskirts of Xai-Xai, is run by AMODEFA and provides HIV testing and treatment, prenatal and postpartum consultations, and other information and services around sexual health and rights. The center is supported by the Women’s Integrated Sexual Health (WISH2ACTION) programme, led by IPPF.   "One day I walked there and received a lot of advice. As I was already 4 to 5 months pregnant, I was advised to open a prenatal form. They did all the follow-up until I gave birth to my son.” "Believe me, being a single mother at 14 was a suffocating experience and it could have been worse if I had not been accompanied by [the SAAJ]. I do not know how to thank them. I practically felt alone without knowing what to do, but I had a lot of advice here and made friends with other girls". Planning for the future  Arnilda dropped out of 7th grade once she became pregnant and helped her mother selling basic goods from a stall in her home. It is from this small business that her mother supports her two children who are still living at home, as well as five grandchildren. Arnilda plans to return to school next year to continue her studies now her son is old enough to stay with his grandmother. Her dream is to be a professional model. Until then she does not want to have another child, so she goes to the SAAJ for family planning purposes. Arnilda says she walks 50 minutes to the center every three months for the contraceptive injection.  "I wanted the implant, but it doesn't settle well with me, so I renew the injection every three months.  I do this because I need to continue studying to have a decent job that allows me to support my son. Next year I will go back to school. "A second child is not in the plans. I still consider myself a minor. Even the first child I only had because at the time I had no one to give me advice and show me the best way. I believed in my ex-boyfriend and today I have this lesson. Today I can say that I have come to my senses, not only from the experience of being a mother, but from everything I learn here [at the SAAJ]. There is no friend of mine who does not know SAAJ. I always advise them to approach here because I know they will have all kinds of counselling and accompaniment.”

At the Family Health Model Clinic (FHMC) set up by Rahnuma Family Planning Association of Pakistan (FPAP), mothers and daughters-in-laws wait for a consultation for affordable treatment and medication. At the FHMC, patients are charged only 50 Rupees (0.22 GBP) for a consultation. This is a fraction of what they would pay at a private clinic and less than the cost of travelling to the nearest government hospital. The clinic also has a ‘no-refusal policy’ to ensure those who cannot afford to pay the fee can still receive the care they need. Around 50 patients visit the clinic every day.  For 26-year-old Sehrish Hamid, the clinic is providing essential healthcare services, she is unable to afford elsewhere. “My husband sells scrap metal off a cart and we often struggle to make ends meet,” she says.  In the past, Sehrish frequently got urinary tract infections but could rarely afford to visit a doctor. A few weeks back, a social organizer from the WISH project visited her house and told her about the FHMC, where she was able to get affordable treatment and medication. “The staff here are friendly, and the doctor gives time and attention to each patient. In the past, no doctor took out the time to talk to me about hygiene and explain how recurring infections can be prevented,” she says.  The FHMC operates as a ‘one stop clinic’ offering a range of health services including family planning and screening for cervical cancer and counselling for Sexual Gender Based Violence (SGBV). Many, such as Sehrish come to clinic for one reason but also end up choosing to take up of family planning services.  “I have a three-year-old and want to wait a few years before I have another child. When I came to the clinic, I also found out about family planning methods. I had a lot of questions and concerns that were addressed and allowed me to make a decision about which contraceptives to use,” Sehrish says. 

Women around the world have faced multiple barriers to accessing safe abortion care during the COVID-19 pandemic including the de-prioritization of sexual and reproductive healthcare, overwhelmed health systems and restrictions on movement. The COVID-19 crisis has sparked innovation among IPPF Member Associations who responded swiftly by developing new approaches to reach women with safe abortion care including telemedicine and home-based provision of medical abortion. Strong evidence generated from this work supports the continuation and strengthening of these approaches beyond the end of the pandemic. Cameroon Cameroon National Planning Association for Family Welfare (CAMNAFAW) To ensure that quality abortion care can be provided to women during travel restrictions, CAMNAFAW’s service providers travel to partner clinics in underserved areas and to clients’ homes to provide medical and surgical abortion care. This model of taking safe abortion care closer to women will continue even with easing of travel restrictions, as this has been found to be an effective and acceptable approach to increasing access.Photo: IPPF/Xaume Olleros/Cameroon Share on Twitter Share on Facebook Share via WhatsApp Share via Email Guinea Association Guinéenne pour le Bien-Etre Familial (AGBEF) Building on lessons learned during the Ebola crisis in Guinea, AGBEF quickly took measures to prevent infection in its clinics to continue providing sexual and reproductive healthcare, including surgical and medical abortion, in a safe environment. AGBEF donated protective materials to communities, including hand-washing stations, face masks and antibacterial gel, alongside messaging on infection prevention. This community visibility reassures clients they can safely attend AGBEF clinics for abortion and contraceptive care.Photo: AGBEF/Guinea Share on Twitter Share on Facebook Share via WhatsApp Share via Email India Family Planning Association of India (FPA India) FPA India and partners advocated to have sexual and reproductive healthcare, including abortion, recognized as essential by the government, which meant FPA India could continue healthcare delivery during the national lockdown. To reduce in-person clinic visits, FPA India established teleconsultation and counselling for abortion care, and is continuing to provide in-clinic care for both medical and surgical abortion. Photo: IPPF/Alison Joyce/India Share on Twitter Share on Facebook Share via WhatsApp Share via Email Nepal Family Planning Association of Nepal (FPAN) FPAN and partners advocated for interim approval of home provision of medical abortion and telemedicine for abortion counselling during COVID-19. FPAN is now implementing these approaches, ensuring continued access to abortion care in Nepal, where many people live in remote locations with limited mobility, which has been further restricted by COVID-19 lockdowns. Photo: FPAN/Nepal Share on Twitter Share on Facebook Share via WhatsApp Share via Email Pakistan Rahnuma – Family Planning Association of Pakistan (Rahnuma-FPAP) Rahnuma-FPAP and partners successfully advocated for the government to class sexual and reproductive healthcare as ‘essential’, which enabled the team to continue providing post-abortion care during the pandemic. Rahnuma-FPAP expanded its telemedicine and home-based provision for menstrual regulation counselling and post-abortion care. These new approaches have ensured continued access to services for clients unable to reach clinics.Photo: Rahnuma-FPAP/Pakistan Share on Twitter Share on Facebook Share via WhatsApp Share via Email Palestine Palestinian Family Planning and Protection Association (PFPPA) In response to the government-mandated closure of its clinics, PFPPA quickly established a toll-free call centre which provides consultations, counselling, referrals and follow-up, including consultation for abortion care through a harm reduction approach, ensuring that women are provided with accurate information. Due to its success, PFPPA is exploring options for continuing this healthcare delivery model beyond the pandemic, with the aim of keeping it free of charge for users.Photo: SAAF/Samar Hazboun/Palestine Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sudan Sudan Family Planning Association (SFPA) Following a nation-wide shutdown in April, SFPA  established  a call centre to increase access to healthcare, including abortion and contraceptive counselling and referrals.  An unexpected outcome of the new call centre is that it has reached an increased number of young women who regularly call to discuss their reproductive health and rights. SFPA  is working  towards institutionalizing this model for continuation beyond the pandemic.Photo: SFPA/Sudan Share on Twitter Share on Facebook Share via WhatsApp Share via Email Togo Association Togolaise pour le Bien-Etre Familial (ATBEF) ATBEF adapted its mobile application ‘Infos Ado Jeunes’, adding a toll-free teleconsultation service for young clients to use to access abortion consultations and pre- and post-abortion counselling. This app has given young clients ongoing access to care when they face challenges travelling to clinics. It has also eased overall client flow in clinics at a time when social distancing is being implemented.Photo: ATBEF/Togo 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

In early April 2020, the all too familiar destruction of a Tropical Cyclone (TC) – Harold – hit the Solomon Islands, Vanuatu, Fiji and Tonga. One of the worst affected areas was the Eastern part of Fiji. Through support by Department of Foreign Affairs and Trade (DFAT), our Member Association, Reproductive and Family Health Association of Fiji (RFHAF), was quick to respond ensuring access to essential sexual and reproductive healthcare for Kadavu’s women, girls, and vulnerable groups. Fiji's vulnerable coastline Fiji’s worst affected area was the Eastern part, with TC Harold bringing destructive storm force winds and storm surge. RFHAF focused its humanitarian response on the local Kadavu population. This remote area proves a challenge to reach for the team with supplies. Share on Twitter Share on Facebook Share via WhatsApp Share via Email RFHAF's humanitarian response team tackle rough terrain National travel restrictions - due to the current COVID-19 pandemic - on all inter island transfers has slowed the response in some areas, including Kadavu. The island of Kadavu is one of the least developed areas of Fiji, the main source of income is substance living (Yaqona). Transport around the island is difficult, with very few roads, no public water system or electricity. The humanitarian team from RFHAF travels by boat and then on foot. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Asenaca, client Kadavu, the biggest island in the Eastern division has the greatest population (10,897). 197 evacuation centres were activated in total, initially hosting over 6,240 people. Many are women of reproductive age, with an estimated 150 currently pregnant. Asenaca learns about breast cancer self-checks from RFHAF’s healthcare provider, Karo. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Nasi, RFHAF healthcare provider The medical mobile team deliver a broad range of healthcare including contraception, information and counselling on sexual health, pregnancy, HIV and STI care and testing. RFHAF Team in Kadavu performing general health checks after TC Harold. Nasi administers a HPV shot to a client. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Kate, client Young women and girls are at the heart of RFHAF’s healthcare provision. Kate walks home with her dignity kit after a health check at the mobile clinic. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Karo, RFHAF healthcare worker RFHAF offers sexual and reproductive healthcare as well as counselling, and referrals for follow up care. Share on Twitter Share on Facebook Share via WhatsApp Share via Email Alidi, RFHAF healthcare worker The team ensures young people in the community are not forgotten and provide information and education on relationships and sexual health and rights. Alidi conducting a session with a local group of young people at Gasele, Kadavu.Photos ©IPPF/Rob Rickman/Fiji Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Seventeen-year-old student Jumeya Mohammed Amin started educating other people about sexual and reproductive health when she was 14 years old. She trained as a ‘change agent’ for her community through the Family Guidance Association of Ethiopia’s south west office in Jimma, the capital of Oromia region. Amin comes from a small, conservative town about 20km outside the city. "I wanted to protect girls from violence – like early marriage – and I wanted to change people’s wrong perceptions about sex and sexuality, because they [men in her community] start having sex with girls at a young age, even with girls as young as nine years old, because of a lack of education." "They suddenly had to act like grown-up women" "Before I started this training I saw the majority of students having sex early and getting pregnant because of a lack of information, and they would have to leave home and school. Boys would be disciplined and if they were seen doing things on campus, expelled. Girls younger than me at the time were married. The youngest was only nine. They would have to go back home and could not play anymore or go to school. They suddenly had to act like grown-up women, like old ladies. They never go back to school after marriage. My teacher chose me for this training and told me about the programme. I like the truth so I was not afraid. I heard about a lot of problems out there during my training and I told myself I had to be strong and go and fight this." "I have a brother and four sisters and I practiced my training on my family first. They were so shocked by what I was saying they were silent. Even on the second day, they said nothing. On the third day, I told them I was going to teach people in schools this, so I asked them why they had stayed silent. They told me that because of cultural and religious issues, people would not accept these ideas and stories, but they gave me permission to go and do it. Because of my efforts, people in my school have not started having sex early and the girls get free sanitary pads through the clubs so they no longer need to stay home during periods." Training hundreds of her peers "I know people in my community who have unplanned pregnancies consult traditional healers [for abortions] and take drugs and they suffer. I know one girl from 10th grade who was 15 years old and died from this in 2017. The healers sometimes use tree leaves in their concoctions.  We tell them where they can go and get different [safe abortion] services. The first round of trainings I did was with 400 students over four months and eight sessions in 2017. Last year, I trained 600 people and this year in the first trimester of school I trained 400. When students finish the course, they want to do it again, and when we forget we have a session, they come and remind me. At school, they call me a teacher. I’d like to be a doctor and this training has really made me want to do that more."

Youth leader Nebiyu Ephirem, 26, has been staffing the phones at a hotline for young people who have questions about sexual and reproductive health (SRH) since it started in 2017 in Ethiopia’s Oromia region.  The helpline has two phones and is free, anonymous and open six days a week. The helpline is aimed at people aged 17-26 who are curious about SRH but are too shy or afraid to ask others about topics such as contraception, menstruation, and diseases.  The hotline also advises people dealing with emergencies following unprotected sex and issues such as unintended pregnancy and concerns over sexually transmitted infections (STIs), by referring people to their nearest clinic.  About 65 to 70 percent of the callers are female. Ephirem also trains other people about SRH and how to educate more young people about this. Being on call for his community  “Most days, I get about 30 to 40 calls and on a Saturday, around 50. People ask about contraceptive methods like pills and emergency contraceptives and depo provera [three-month injectable contraceptive], about the spread of STIs and HIV and how to prevent it, and about menstruation and sanitation. I give my suggestions and then they come and use Family Guidance Association of Ethiopia (FGAE) services, or I refer people to clinics all over the country. There are seven FGAE clinics in this area and dozens of private clinics. Young people need information about STIs before they come to the clinic, and when they want a service they can know where the clinics are. Most of them need information about menstruation and contraception. They fear discussing this openly with family and due to religious beliefs, so people like to call me. Culturally, people used to not want to discuss sexual issues. We took the information from IPPF documents and translated them into the two local languages of Oromia and Amharic, with the help of university lecturers. After four years, even the religious leaders did this training. We have trained university students, teachers and many more people to be trainers and 30 of them graduated. They [the people who dropped out] did not want to hear about the names in the local language of body parts. Most of the ones who stayed were boys and girls, but now we have women doing this. [At first], they were laughing and said: ‘How could you talk like this? It’s shameful. But slowly, they became aware. They now talk to me, they discuss things with their parents, families, even teachers at school and friends.” Lack of sex education  There is no sex education in Ethiopia’s national curriculum but youth groups and activists like Ephirem and his colleagues go into schools and teach people through school clubs. “This year [2019] up to June we trained 16,000 people and reached 517,725 adolescents and young people aged 10 to 24 through the helpline, social media – Facebook, Twitter and YouTube – workshops, radio talk shows and libraries.” A banner in Jimma town promotes the helpline and its number 8155, as does Jimma FM radio.  “The target for reaching people in school was 5,400. We achieved 11,658. The most effective way to reach people is at school. At the coffee plantation sites we reach a lot of people.”  The minimum family size around here is about five and the maximum we see is 10 to 12. In our culture, children are [considered as a sign of] wealth and people think they are blessed [if they have many]. When we go to schools to teach them, there are kids that already have kids. But after we teach them, they generally want to finish education and have kids at 20-25-years-old. We tell people they have to have kids related to the economy and to their incomes and we calculate the costs to feed and educate them. I’m a volunteer here, so it’s mental satisfaction I get from doing this. I get 1000 Ethiopian Birr [roughly USD 30] per month for transport costs. I am also studying marketing at university and want to become a business consultant.”