“One day, when I returned from work, Ms. Glenda and Mr. Martin from ADS Pro-Familia were at my house, I heard what the volunteering was about, regarding the education of the men in the community, how to teach, how to stop machismo, to be less violent, how to give the talks and visit the clients; they also talked about the contraceptive methods, medicines and many things that would change people's lives, the proposal seemed important to me and I accepted since I like to work for my people”, recalls José. Since 2008, male participation in sexual and reproductive healthcare in rural communities has been an integral component of the Community-Based Program (PBC), addressing issues of masculinity, behavior, and access to healthcare. "When I gave the talks on masculinity, they questioned me: 'Why can't you scream at home, if you're the man?' Or 'Who you think you are to say those things?', questions that I also asked myself once", says José. “Thanks to the training I have had and the support of the Pro-Familia staff, I have managed to learn and clarify my doubts. During the process I have had a personal change, I no longer respond if someone seeks me to fight and now, I don’t carry my knife everywhere as I used to, I take care of my own health, I share the responsibilities at home, I take care of my two-year-old son; before volunteering, I thought it was a woman’s job, I didn't do that”, reflects José. Educational activities on sexual and reproductive healthcare remain a challenge. Yet, health promoters can help break down some barriers through counseling for couples and the provision of contractive supplies - especially condoms - and medicines. “I like the communication I have with the Pro-Familia staff and the training reinforcements, they should keep it that way, because it's the way to learn and do things better in the community,” he says. “The change begins with oneself and then transmits it to others. I gather men in talks, make visits to their homes, give guidance on prevention of sexually transmitted infections, family planning and not to be violent”, says José. "Older adult men are more difficult to change." Changing attitudes to contraception  José has seen a change in the attitudes of men in his local community and those small achievements encourage him to keep going. “When men ask me about violence and condom use, I feel encouraged. For example, a co-worker uses a condom and confidently tells me that he does it because he learned from the talks he received, that motivates me to continue guiding towards new masculinities." For male clients who are referred by their local health promoter for a voluntary surgical contraception (VSC) procedure, the care is free of charge thanks to the Community-Based Program’s special fund. José is aware that there is still work to be done; "the issue of vasectomy is difficult with men in the community, the challenges continue." “In the community, young people ‘get to live together at an early age (marital union), maybe I cannot change that, but I can help them to be better people, to respect each other. Just as I changed, so can other men,” says José.  

“I am a volunteer promoter by inheritance. First, my mother volunteered with Pro-Familia for 15 years, she resigned because she had to go to the United States. I learned to volunteer since I was little because I saw how my mother did it”, Alicia recalls. Alicia Hernández Monge, 43, remembers that with her mother leaving the country, the community spent some years without a volunteer health promoter. In those years, women came to her to encourage her to re-establish contact with Pro-Familia so the program would resume in the Santo Domingo village, one and a half hours outside of San Salvador.  In the absence of a local public health facility, Alicia decided to become a volunteer health promoter to support her community. “When my mother left, I agreed to collaborate just to promote the cervical screening clinic, but Pro-Familia suggested that I be a volunteer, like my mother, and I accepted. Today, it’s been two years. They have trained me at home on sexual and reproductive health issues, counseling, home visits, and the use of brochures, and I also learned to inject, with all that I do a better job in my community, especially with women”, says Alicia. Alicia is an entrepreneur with a strong spirit of care towards her family and community. Every day she attends her small business that provides the community with basic products.  “I help change people's lives; the women are happy and grateful because they no longer go to Guazapa to buy contraceptive methods. Pro-Familia trains me and I coordinate with other institutions in the community, such as the church, to help people”, she says.  Alicia says that counseling is the most important part of her work. “Counselling is very important, women learn to use (contraceptive) methods and stop thinking that it is a sin, I help them to understand that family planning is a right. (…) I had a case of a client where the husband was the one who decided which method to use and make her changed very often (contraceptive method) because he wanted her to lose weight; one day I explained to him about the benefits of using only one family planning method, the effects of changing very often on her menstruation and that she had the right to decide whether or not to change, and that the weight could be due to other reasons. He understood and thanked me for taking the time to speak to him; from that day on the client keeps one family planning method and the husband respects her decision,” she says. Alicia dreams of having a larger place for her clients, or have a table to administer the injectable, but despite the limited space, she enjoys her work. "I like it and I am happy to know that I can help, many users come at night to pick up their methods because they work out of the house and I take care of them with great pleasure, when they miss their appointment, I look after them, I speak to them by phone or I send them a WhatsApp message", she ends. They prefer her for the confidence she brings Ruth Séfora Manzano has known Alicia for several years before she had children. “I like Alicia because she is a respectful person, she likes to help people, she gives me confidence, and you can trust your personal things to her because she doesn't tell anyone, she looked after me when I got pregnant and she also cares about my daughter, she guides me on how taking care of myself and the baby, she is a kind person, that's why I plan with her, and if I need other medicines I also buy them from her. I also like it because it is close to my house, she gives me the shots, and I don't have to go elsewhere, I am grateful for her help and Pro-Familia´s."

“I remember that I joined Pro-Familia on July 1, 2011, I had many fears and questions at that time, because I did not know about sexual and reproductive health issues, and had no experience working with contraceptive methods, it was something completely new for me, but I really wanted to learn,” says Elga, 34. Elga is one of the Community Health Workers (CHW) in the ADS - Profamilia Community-Based Program team. She remembers when she first started her training, she felt that her role was small and unimportant; but over time she learned and gained in confidence, understanding the positive impact she was having in the local communities. “I found the reason to live, I found a purpose: knowing people’s situations, their difficult situations, that is special for me. Feeling they miss me when they spend days without seeing me because I am in different communities, that is something important, it means they value my work,” she comments excitedly. Elga believes that she has gained a lot personally. “I have learned a lot about women's rights; I apply everything about sexual and reproductive health in my personal life, I do not allow abuse by my partner and I teach my son to respect people. I learned to use contraception for my own benefit,” she says. Communication was very difficult for Elga, she considered herself shy and was very quiet. Today she talks with people, in front of large groups of students in schools, expresses her ideas, and provides counseling. “I enjoy what I do, I prepare to visit the volunteer promoters, to train them and resolve any doubts or questions that arise, they are very intelligent, and I intend to have the best volunteers. I enjoy visiting families in the community, having the opportunity to give family planning counseling, work on the prevention of cervical and breast cancer, work with young people, help them to change their lives, to find new paths, free from violence, just as I found my purpose,” she says. She admires the work of Pro-Familia, as no other organization has permanent programs and subsidized healthcare, which is of enormous benefit to the local community. Elga has seen many clients since she started volunteering. She recalls encouraging a woman to come to the cervical screening clinic: “The lady had never had a cervical screening. I gave her counseling and a referral so that she could come to the ADS / Pro-Familia clinic. Her result was cervical dysplasia – level 1, I followed her until she received the treatment; now, every time she sees me, she thanks me for guiding her and inviting her to the clinic,” she says with joy. She also remembers the first time she suggested a vasectomy to a client. “First, I made the reference to the woman client, but because of health reasons she could not be sterilized, and she was very sad because using hormonal methods also affected her health; I decided to give counseling to the client's partner, who agreed to a vasectomy. The intervention was successful, and he is well, grateful to me and to Pro-Familia”, she recalls. The issues of sexual and reproductive health and contraceptive care are still taboo in many communities. Changing attitudes in order to improve the lives of individuals and families remain a vital focus. Counseling is key to recognizing that health and contraceptive care are fundamental rights, and to eliminate myths and beliefs that prohibit the use of contraception. Volunteers like Elga remain integral to this process in order to bring about change for the future. 

Manuela was sentenced to 30 years in prison for aggravated homicide after suffering an emergency that resulted in pregnancy loss. She died imprisoned 2 years later, after receiving inadequate medical care. Manuela fue condenada a 30 años de prisión por homicidio agravado tras sufrir una emergencia que le hizo perder el embarazo. Murió encarcelada 2 años después, tras recibir una atención médica inadecuada. 

“I started as a Pro-Family Health Promoter (PSP, in Spanish) 30 years ago. I received a visit from Pro-Familia staff on several occasions, I was very interested in what I could do to help in my community as a volunteer. I was trained in sexual and reproductive health issues, and in the technique of injecting (contraceptives)”, says Juana Margoth. Through the community-based Pro-Family Health Promoter program, the Salvadoran Demographic Association (ADS / Pro-Familia) has been providing sexual and reproductive healthcare to local communities since 1974. Today, the program currently has around 900 health promoters across El Salvador. Reaching under-served communities with contraceptive care and information lies at the heart of the program’s mission. In the absence of healthcare from the Ministry of Health in Hacienda El Edén, Sonsonate, Juana provides care to four villages in the surrounding area. “I make visits in the communities to the clients I already have, to see if they are okay with the (contraceptive) method and to receive new clients, sometimes even the same clients tell me that there is someone who needs a visit. I like that they look to me to help them. I give confidence to the clients, to their partners too, I have clients since 2, 5 or 6 years ago. (…) There is a lot of need, so I am here, until God wants it”, she says. Juana receives a quarterly supply of contraceptives that she distributes at low prices to the women in her community. “I like that women know that I am here to help them, also to give advice and understand each people's problem; (to help them) to plan their family, and I like the fact that they want to do it with me,” she says. Providing counseling to clients on contraceptive methods so that they understand the different types and can make an informed choice is a crucial part of her role. “In other places - she says - they only give the contraceptive methods to women and do not explain (it’s use)”. In addition to the community-based program, Pro-Familia supports the network of promoters to help respond to emergencies. When natural disasters occur, Pro-Familia conducts a survey of needs and responds with support for reconstruction and food supplies. “I have a lot to thank Pro-Familia for, I have learned and continue to learn with them, they are always there when I need to know something when I run out of contraceptives and without medications (for the program); I am also grateful because I have my prefabricated house thanks to Pro-Familia who helped me when the earthquake of 2001 happened”, she says. I feel confident with her Yaneth Aguilar knew Juana Margoth and felt confident in choosing the injectable as her preferred contraceptive method. “With my husband, we agreed to put myself in control with her, she is kind, and she pays attention. If she were not here, I would surely have two more children. I feel confident with her. I don't like going to the health unit, because I have to spend the whole day, and sometimes they don't treat me well." Veronica Moran also received contraceptive care and information from Juana. “Margoth has changed our life, mine and my family’s, I have been planning with her for 8 years, she is kind and always has the method I use. When I have doubts, I ask her with confidence, without shame, and I can go to her house at any time, she is always there. I don't like going to the health unit, because I spend a lot (of money), and sometimes they don't have contraceptives; nowadays, with the pandemic, we have her close and she never stopped treating me, it is very helpful in our community." Brenda Martinez has been a client of Juana’s for two years. “She is the person that we know has (contraceptive) methods in the community, where Pap tests to prevent cancer are done, where we buy medicines, where you can always ask. When I was born, she was already a promoter; I couldn't be in another place planning, she is a very good person, kind, and she is always helping us in whatever way.”

When Blanca started as a volunteer, she committed to her new role with enthusiasm, thinking about how the women of La Loma village would benefit from being able to access contraceptive methods close to home. “Many women walk up to an hour and a half from the villages of the Guazapa hill, to receive family planning services or to receive counseling,” Blanca Edith Mendoza Ramos, 61, says proudly. Her house is a cozy and special place for the clients. “I have been a Pro-Familia volunteer for 29 years, when I started, I had already had my five children, I was busy at home, but when the Pro-Familia staff explained to me about working in my community, I trusted It was important to support women. I have learned a lot and I continue to do so, I have received training that helps me to be a better person, to have knowledge and to give good advice; I have received many people from Pro-Familia in these years, and always with great responsibility”, she says. To ensure her clients’ confidentiality, Blanca has created a private room with a sofa where she provides counseling and administers injectable contraceptive methods. By creating a private space, Blanca has built up trust in the community and women prefer to go to her for contraception and advice. “I am proud to help in my community, I visit clients to see if they have any side effects when they do not come to receive their method, or to know if they are well or to recruit new clients who are encouraged to use a family planning method because their families are already very large”, comments Blanqui, as she is known in her community. The public health facility provides free healthcare, however, women from other local communities prefer to see Blanca because she is closer and offers confidential personalized care. “The Health Unit is not close, so women prefer to plan with me, they come with confidence to apply their method. On their first visit, I ask them a few questions about their health, and if everything is okay, they plan with me. I think that family planning is important for the spacing of the children and that it is not only the use of methods but also communication with the couple”, reflects Blanca. The poverty and patriarchy in these communities present many challenges, including domestic violence, multiple partners, and miscarriage that require a sensitive approach to provision of healthcare and information. Volunteers like Blanca are supported to deal with these challenges through training provided by the Community-Based Program staff. Volunteers develop skills to use referral systems, coordinate with local institutions, such as the Ministry of Public Health, other NGOs, such as the Feminist Women's Collective, the Institute for Research, Training, and Development of Women (IMU), which provide support for cases of violence or care in cases of miscarriage. This approach is integral to the provision of healthcare and support in the communities. The team of volunteers helps to reduce violence and femicides in order to improve the quality of life for women and families. “People in the community tell me that they are grateful for the care I give them, and I will continue to change what I can to improve people's lives. I will continue to make home visits, give counseling because it is a need, women need someone that understands them and helps them. Pro-Familia is part of my life, being a volunteer is something special, I have learned a lot, and the most important thing is that I can help others”, says Blanca. Respect and comfort Blanca is often recommended by her clients. María Ofelia, or Felita, as she likes to be called, comments that “a friend from the community recommended that I visit the Blanqui, I already had two children, one 4-years-old and another 11-year-old. I still remember with deep sadness the moment I looked for her, it was my last pregnancy, and I lost my daughter. Blanqui received me with affection, respect, and comfort, she understood what I was going through, she guided me, and I made the decision to plan until now. I’ve been using the two-month injection for 4 years." María Ofelia says that although she can go to the social security check-up, she prefers to go to Blanca because of the confidence she gives her, “she always takes care of me, and the prices are low, I can pay it, because in other places the methods (contraceptives) are more expensive.”

Jamaica Family Planning Association (JFPA), is the brainchild of May Farquharson and Amy Bailey. Both women established what became the Caribbean and Jamaica’s first contraceptive initiative, The Jamaica Birth Control League, - in Kingston, which later became the Jamaica Family Planning League. By the 1950s, Dr Lenworth Jacobs and his wife Beth noticed the need for basic sex education within St Ann and would eventually offer their office space for a family planning clinic. In 1956, the organization was renamed the FAMPLAN and became the seventh member of the International Planned Parenthood Federation. The clinic faced resistance from religious groups in the midst of political tensions in Jamaica. Regardless, Dr and Mrs Jacobs with the help of funders, medical personnel, public health nurses and community health aides, persisted and ensured the development and continuity of the organization. But it is the recollection of registered midwife Dorothy Boyd-Brown, of the early days of FAMPLAN, which will leave you hanging on to every word as she tells the story about the glory days of family planning in Jamaica. “I came on to FAMPLAN in 1973 as a volunteer. I was the nurse in charge of maternal and child health at the St Ann’s Bay Health Centre. I got very interested because at the time they had a vibrant youth programme where you would go to schools, churches, other organisations and encourage persons to use contraceptives and other services that we offer like tubal ligation, vasectomy and other things. I wanted to know what this organization was about, so I served as a volunteer until 1977,” Boyd-Brown said. Boyd-Brown is proud to see FAMPLAN develop and grow to provide access to healthcare to over 100 rural communities and hard to reach populations in and around St Ann. “It’s how you were able as a nurse to help others. You had a mobile unit and trust me I enjoyed the mobile unit, going up into the hills,” she said. “They always seem to upgrade the services they offer and have effective communication around the populace in the surrounding communities.” Boyd-Brown lamented on the Community-based Distributors (CBD) Programme, which was huge in the 1970s. The CBDs responsibility was spreading the message of family planning through contraceptive demonstrations, condom distribution, and community-based talks to increase awareness. The impact of the work led to long-term contraception methods like tubal ligation and vasectomy being offered through a special clinic, in addition to hormonal contraception methods. While women were open to the various contraceptives available, there was still a lot of reluctance from men towards family planning. In response, Dr Stewart McKoy pursued the introduction of vasectomy as an alternative contraceptive method. This was, however, met with strong opposition from the Rastafarian community and men who believed in having as many children as possible. “When I came back to St Ann, I was introduced to the Beth Jacobs Clinic. I came and had a whole lot to do here…I was also trained in laparoscopic tubal ligations and when Professor Hugh Wynter heard I was down here he gave me a laparoscope and said start. Therein began the laparoscopic tubal ligation. There were times we did one in 15 minutes. We got so proficient,” Dr McKoy said, pointing out that the fostering of patient-doctor relationships served to bridge the gap between residents and FAMPLAN and led to greater reception of the services. Overtime the work within the community grew and partnerships with other organizations resulted in increased screening for cervical, breast, and prostate cancers, as well as testing for sexually transmitted infections. “You’re able to help a lot of people, even people who don’t come here. I am able to present the information to my schools, to my churches. They are still getting the information and they know what to do,” Boyd Brown said. The team remains committed to spreading the message of contraceptive care and health and wellbeing. “I feel good to get up in the mornings and I look forward to coming here as I know people are depending on the services offered, and they are depending on me,” Nurse Boyd-Brown said. Dr McKoy added: “When I drive in here my thoughts are that I’m home, after all these years it’s good to be back, see familiar faces like Boyd-Brown and continue the work.”

Candice Taylor, 18, joined the Jamaica Family Planning Association (JFPA) Youth Advocacy Movement (YAM) at age 15 after youth officer Fiona Francis introduced her to the group. Initially, Taylor saw YAM as the only place where she could learn about sexual and reproductive health and rights. Today, Taylor uses her knowledge and involvement with YAM to educate her peers about SRHR with hopes that they make more informed choices if they choose to engage in sex. “I’ve seen teenagers get pregnant and it’s based off them never knowing routes they could take to prevent pregnancies. I figured I could play a role by learning it for myself, applying it to myself as well as talk to those around me to somewhat enlighten them about SRHR. I just wanted to be able to learn for myself and pass on the knowledge,” she said. Taylor’s experience with YAM made her realize that  SRHR is not limited to sex, but also about being empowered to make positive changes towards their health and wellbeing. Taylor wanted to be a voice for others and contribute to positive change. “Seeing young girls divert to wanting more and because their parents were not able to provide, they turn to men. Also, I saw undue pressure being placed on girls to not have sex and that pressure, unfortunately, caused them to develop creative ways to go out and it so ends up that were left with an unwanted pregnancy. I was learning not only for myself, but to spread the word.  I learned I needed to immerse myself in order to be an effective advocate,” she said. Taylor has been to health fairs, spoken to her peers and adults about their sexual and reproductive health. The impact has been great. “In my circle, I’ve seen people become more aware and more careful. In my teaching, my friends are inspired to join so I am looking to recruit soon,” she said. Other positive elements of her involvement in YAM include the opportunities she has received which include holiday jobs and being part of official training courses on sexual and reproductive health and rights. However, she has faced challenges especially around a lack of contraceptive use among her peers. Putting the open-mindedness into action “You can only educate someone, but you can’t force them to do what you’re promoting. You will have different people asking and you explain to them and show them different ways to approach stuff and they will outright be like ‘OK, I am still going to do my thing. This is how I am used to my thing’. So, they accept the information, but are they practicing the information? People are open minded, but it’s just for them to put the open mindedness into action,” Taylor explained. In addition, Taylor said there are parents who are not open to discussing sexual and reproductive health with their children making it more challenging for young people to access contraception. She suggests that parents either be involved in the advocacy or interventions that target them be implemented. Taylor also expressed a desire to see more detailed classes around sexual and reproductive healthcare in schools. “Implement classes in school that are more detailed than what exists. The current lessons are basic and the most you’ll learn is the menstrual cycle. You’re learning enough to do your exam, not apply to real life. If this is in schools, the doctors and clinics may be more open to the reality that younger people are engaging in sex. To prevent unplanned pregnancies be more open,” Taylor said. She added: “YAM has good intentions. These good intentions are definitely beneficial to the target audience. With more empowerment in the initiative we can move forward and complete the goal on a larger scale.”  

The International Planned Parenthood Federation (IPPF) welcomes the news of President Biden’s decision to keep his promise and repeal the harmful Global Gag Rule (GGR) - also known as the Mexico City Policy.    Since its expanded reintroduction in 2017 by the previous administration, the Global Gag Rule has contributed to an increase in unintended and high-risk pregnancies, unsafe abortions – culminating in unnecessary maternal deaths. For IPPF, 53 healthcare projects in 32 countries were impacted by GGR, with some Member Associations losing up to 60% of their funding.   IPPF’s Director-General, Dr Alvaro Bermejo said:    “I welcome the decision by President Biden to repeal the Global Gag Rule.   “The expanded reintroduction of the gag was callously designed to deny women the right to decide what happens to their body. Whilst we know this policy is intended as a tool to attack abortion care by the anti-choice movement, not only has it led to reproductive coercion, it has cut deeper into healthcare provision: from HIV prevention programs to maternal health to contraceptive access – no one was spared the fallout of this policy.     “What lies ahead of us is years of work to undo the harm caused by Global Gag Rule, and to build back a better and stronger relationship with the U.S. – one where our work is not under threat from future anti-sexual and reproductive health administrations. To protect the rights of future generations of women and girls, we ask that the Biden-Harris administration take the necessary steps to permanently repeal the Global Gag Rule. Without a permanent repeal, the global gag remains a constant threat to women, girls, youth and marginalized communities. Reproductive rights, bodily autonomy and the human right to decide what happens to your body cannot be at the mercy of a pen stroke.     “IPPF looks on with hope and welcomes the opportunity to work closely with the Biden-Harris administration to protect and advance sexual and reproductive healthcare for all.”   And President and CEO, Planned Parenthood Federation of America, Alexis McGill Johnson said:  “Over the past four years, the United States didn’t just fail to support global reproductive health care access — it actively blocked it. Today, we applaud the beginning of a new chapter, as the Biden-Harris administration puts an end to the devastating global gag rule, which has prevented millions of people around the world from receiving essential health care. We look forward to working alongside the administration and Congress to pass the Global HER Act, to permanently protect access to sexual and reproductive health care across the globe from changes in White House political control. It is long past time that the United States proudly declares to the world that reproductive rights are human rights.”     IPPF would like to thank the international community who stepped in and stepped up to help fill the funding gap that was left by the Global Gag Rule. Together, we will continue to fight and deliver sexual and reproductive health and rights.   For media inquiries please contact [email protected] (+44) 2079398227 

The Japan Trust Fund (JTF) represents a visionary partnership that began in 2000 between the Government of Japan and IPPF. Together, we invest in programmes that prioritize health equity, gender equality, and human security for all. Traditionally a driving force behind IPPF's efforts to support the integrated HIV prevention programmes of our Member Associations in Africa and Asia, JTF has adjusted to reflect changing global health priorities. We attach importance to universal access to sexual and reproductive health and rights - an essential contributor to universal health coverage and the global development goals.     These projects have transformed the lives of people most vulnerable to HIV and high risk of maternal and child mortality. Equally, it ensures that as a donor, the GOJ’s response to HIV remains people-centred and contributes to human security.