Never did she think that a job as Clinic Administrator would lead to a career that would change so many lives, but in 2007, Angelie Chotalal embarked on a path that would also change her life for good. Working at the Family Planning Association of Trinidad and Tobago (FPATT) in her late thirties, Angelie found joy in handling the administrative needs of the clinic, ensuring that the doctors and staff had all the resources to function at full capacity. She held that position for 3 years until she transferred into the vocation of Sessional Nurse, caring for the clients and clinic in a more hands-on role.  For the next 8 years, Angelie would devote her energy into education, becoming a Health and Family Life Education Master Trainer, as well as a Master Trainer in HIV Testing.  It was during this time that she also improved her bilingual skills; a decision that would prepare her for great success in the coming years.  “Hola! Como estás? Te ves bien,” she says as she greets a Venezuelan woman in the waiting area of the clinic. Her compassion is soothing and her smile is contagious. In her current role as Clinic Co-ordinator, Angelie has found herself having to be creative, innovative and still down-to-earth in the planning and execution of programmes for FPATT’s 4 static clinics across the country. The young migrant mothers of the clinic have come to know her as a matriarch, as she frequents the clinic floor always ready to attend to a new concern. “What makes them less than human?” Fleeing political oppression, lack of food and medicine and the downfall of the Venezuelan economy, over 40,000 Venezuelans have migrated to Trinidad to seek safer livelihoods. Many of them work to send most of their income home for the families they had to leave behind. “This here is my heartbeat. The work we do with the migrant community is dear to me because when I hear their stories, I know that there is so much more to be done. They are part of a population that has not received equal treatment. They’ve been put into a situation that they couldn’t expect and their only hope was to flee to this country where basic human rights are being withheld from them. What makes them less than human?” she asks, her visage pained with concern. Despite the influx of Venezuelans, Trinidad and Tobago’s migration policy has offered refugees very little access to healthcare and social services. However, FPATT’s mandate is to ensure that every person living within the borders of Trinidad and Tobago receive equal access to Sexual and Reproductive Healthcare (SRH) and Angelie’s personal mission is to ensure that they receive the best treatment when they come to her clinic.  “In 2018, we started offering healthcare specifically for the migrants. We had to ensure that our staff were compatible with our vision, and it was more than being bilingual; we each had to be genuinely empathetic toward the community we were seeking to serve. We worked to remove bias, xenophobia and other ill perceptions from even our own lives,” she noted. “The community is so close knit, that word of our services spread quickly and very soon our clinic for migrants was up and running. They would come in and see that it was a safe space to share their experiences and we took the time to listen, because they wouldn’t get this safety anywhere else.”  Before the FPATT clinic, migrants who needed SRH healthcare have had to book appointments with private doctors who often charge more than the migrants can afford.  “They work 12 hours a day, 7 days a week, get enough income to take care of their families here and those they’ve left behind. We’ve visited homes that house up to 10 migrant families, but it’s merely a shack with no running water or space to sleep. And then COVID hit,” she pauses pensively. “Incomes disappeared and so did options for housing; many of them were left homeless, so women who were already vulnerable were now being exploited. Imagine, your landlord asks you to pay for your rent with sex and a month later, brings his friends to cash in on the same favour, all because he knows you have nowhere else to live.”  Taking SRH Services online FPATT has offered all their regular healthcare services including gender-based violence counselling, birth control and emergency contraception to the migrant community. When Trinidad and Tobago entered a lockdown due to COVID protocols in 2020, FPATT approached the United Nations Population Fund for sponsorship to launch TeleHealth, an online medical consultation programme specifically for the migrant community. Through TeleHealth, clients are able to book 30-minute consultations with a clinical doctor and have their concerns addressed, ailments diagnosed and medicine prescribed, over WhatsApp video call.   In January 2021, FPATT also hosted a webinar series patterned after IPPF’s One Curriculum but tailored to the needs of the migrant community. The series featured FPATT’s team of clinical staff as well as experts in the fields of nutrition, self-defence and gender-based violence. “The response to both programmes is tremendous. The online access works well for our clients and we have developed such close relationships with them that we would love to expand our healthcare, but funding is often our major issue. We need sponsors to come on board, see how the programmes impact the people and help us continue to serve,” she states.  Ms. Chotalal looks forward to working with the Family Planning Association and helping communities that need their services the most.

Two clients of sexual and reproductive health counseling services agree that trust is one of the most valued aspects. Danitza Gonzales, the 28-year-old personal trainer, came to Inppares on the recommendation of a friend: “I felt great with the counseling. The same doctor gave me all the confidence to be able to tell her my issues and my doubts that are still taboo, she knew how to guide me”. Kiamara Meneses, 25, a sociologist, says that she found out about the institution through Facebook and when she arrived at counseling with her partner she felt confident: “We liked the way the explanation was provided and it was all very clear, so we kept coming back all of 2019, until 2020, because I was considering having a subdermal implant and I came to consult”, she commented. “What I liked the most about the counseling service was that there was no such luck of judging people, which had happened to me in other health facilities, where if I asked for a longer-lasting method, such as an implant or an IUD They put limitations on having children before or things like that. Here I understood that there are no restrictions to use a particular method and that seemed super important to me”, adds Kiamara. Among other aspects that the users highlight is the accessible price and the central location. “The cost seemed adequate to me, in addition to the treatment they gave me. So I stayed. When someone asks me where to go to seek contraceptive counseling or advice, I share the experience I have had, in addition to the fact that the place is very central and the price is very convenient,”says Danitza. “What I mainly like are the services Inppares has, in addition to counseling, the ease of accessing the methods, because they always have campaigns and also the HIV test; in addition to the Future Youth Center; so, it is a fairly comprehensive place and I would definitely recommend it. It contributes a lot to the lives of young people because information empowers. Young women can have a differentiated service that meets their needs, empowers them to make informed decisions about their bodies”, concludes Kiamara.  Danitza agrees that “Services like these have a great impact on the lives of women and men in order to make informed and responsible decisions; they should promote them more in schools and universities”.

Famia Planea Aruba (FPA) saw a gap in the market and developed its online store to better reach clients like Hilyann, a journalist, with an active lifestyle and work schedule.  FPA’s online store is open to members and non-members where they shop for their favorite FPA product in a worry- and hassle-free environment from the comfort of their own home, office, school or even on the go. Being able to order products online saves time and also supports those clients with limited access to transport.  “As a young professional, one of the challenges I often face is balancing my profession with my active lifestyle and practicing self-care. This is why I couldn’t be happier with FPA’s online store”, Hilyann says. The visually appealing online store is available in the local Aruban language, Papiamento. The site has been designed to provide quick access to various contraceptive methods, with supporting information to help clients make choices based on their needs. “It is so convenient and allows me to manage my time more efficiently, making it so much easier to be conscious of the necessary efforts with regards to my reproductive health. Above all, it allows me to focus on my personal goals, all while making the right choices when it comes to family planning”, she adds. Clients can browse a range of products and add their selections to the cart. At the check-out clients fill in their preferred time, date, and location for delivery. A confirmation email will be sent to the client while FPA starts to prepare the order for delivery.  “Shopping on the FPA online store makes me feel very in control and empowered. I hope that more people of all ages take advantage of this service. I hear far too often that people say they don’t have time, nobody has actually, but FPA is there for you. Take control of your sexual and reproductive health, empower yourself, be the boss of your time and your body”.

IPPF is pleased to announce the appointment of Eugenia Lopez Uribe as Regional Director and Dona Da Costa Martinez as Deputy Regional Director of the Americas and Caribbean. They will be based in the Americas and the Caribbean Regional office (ACRO), based in Bogota, Colombia and Port of Spain, Trinidad and Tobago, respectively.  IPPF would like to thank partner organizations for their continuous support during the transition phase, as well as to the IPPF transition team led by Anamaria Bejar who will return to her position as IPPF Global Director of Advocacy. Eugenia López Uribe – IPPF ACRO Regional Director Eugenia is an experienced advocate for gender equality and sexual and reproductive rights, promoting innovation in the delivery of health services from a human rights perspective. She began her professional career as a volunteer with the Gente Joven (Young people) Programme of MEXFAM, IPPF's Mexican member association.  She has worked with rural and indigenous people, adolescents, youth, LGBTQI+ populations, sex workers and women with HIV in Latin America and the Caribbean. For more than a decade she was the executive director of Balance, a sexual and reproductive rights NGO working on regional advocacy in favour of sexual rights. Internationally, Eugenia has engaged on the follow-up of the commitments of International Conference of Population and Development (ICPD), the Beijing Conference on Women’s Rights, the Convention on the Elimination of All Forms of Discrimination against Women - CEDAW and UN General Assembly on AIDS.  She co-founded the Abortion Fund for Social Justice: MARIA, the first initiative of its kind in Latin America. Her experience includes ten years as part of the management team of the Integrated Model of Health Care for Rural Adolescents of the Mexican Social Security Institute - IMMS Oportunidades. Eugenia will be based in Bogotá - Colombia.  Dona Da Costa Martinez – IPPF ACRO Deputy Regional Director Dona began her work in sexual and reproductive health, thirty-five years ago, when she joined the Family Planning Association of Trinidad and Tobago – FPATT in 1985.   In her formative years in the Association, she was responsible for research, planning and evaluation and the development of programmes to ensure the achievement of the Association’s mission.  From 1990 she served as the Deputy Executive Director of the Association before taking on the mantle of Executive Director in 1999.   Under her stewardship, the Association expanded its work in many other areas with a focus on integrating sexual rights in all of its programmes.  This included expansion of its advocacy work in abortion and LGBTQI rights, comprehensive sexuality education, gender-based violence, HIV prevention and ensuring universal access to sexual and reproductive health services to most at risk populations including sex workers and adolescents.   She serves as Co-Chair of the Caribbean Vulnerable Communities Coalition (CVC), is the Chairperson of the Trinidad and Tobago Non-Communicable Diseases Alliance and serves on several other committees at the national, regional and international levels.   Dona is the holder of an Executive Master’s in Business Administration from the Institute of Business, University of the West Indies, Trinidad and Tobago. Dona will be based in Port of Spain.  Under new leadership, IPPF ACRO will continue to provide support and strengthen our Member Associations in the Americas and the Caribbean to ensure they can deliver quality sexual and reproductive healthcare to those in need - no matter what.

The inspiration for delivering comprehensive sexuality education to young people digitally was propelled by the COVID-19 lockdown. Like other frontline healthcare providers, Famia Planea Aruba (FPA) was faced with unforeseen challenges about how to continue reaching their communities. Undeterred, the small team of four embraced the challenge to create, develop, and launch FPA’s first Online Puberty Educational News Program (OPEN).  With a background in marketing and extensive management experience, FPA’s Executive Director Evelyn Yarzagaray, led the project and team to successfully bring the digital platform to life.  “In the last few years, FPA’s in-school Comprehensive Sexuality Education program was growing rapidly, and then all of a sudden we hit a wall; our Island was in complete lockdown and all schools were closed. At first, we were very sad, since we were fully booked for the upcoming few months, and would lose the opportunity to reach thousands of young people”, Evelyn remembers.  Typically, during April and May FPA usually focuses on students between the ages of 11 and 13 and supporting with the transition from elementary school to secondary school. At this age young people are starting to experience changes to their bodies and hormones.  “We were all of a sudden bombarded with parents who started requesting one-on-one counseling sessions for their kids, but due to safety regulations, this was not an easy option. That was when we started looking for a way to reach both parent and child in the safety of their own homes. By converting materials used during our in-person CSE’s we developed an educational video that can be viewed by both parent and child”, says Evelyn The OPEN platform has been designed with a colorful background, emojis, and animation to appeal to its target audience. Users can access valuable information through the FAQ section, international news, and video content such as an interview with a Family Physician.  “The filming and editing were the longest and most difficult part of the entire process, but once it was launched, we immediately saw that is was completely worth it, reaching over 42,000 people on social media”, Evelyn says.   

Accessibility to information and contraceptives has always been a priority for Famia Planea Aruba (FPA), whether through the office, delivery service, or in schools.  For over fifteen years FPA has worked in partnership with one of the largest secondary schools on the island. The FPA team visits the school on a monthly basis to provide guidance, counseling, and contraceptive care to students and to help ensure they stay in school to complete their education.  “One of my first experiences providing comprehensive sex education, with FPA was at the EPB School during my education as a social worker, many years later I still very much enjoy this”, says Richenella, FPA’s Finance and IEC support staff. FPA’s client is at the heart of its healthcare provision. FPA staff work with students to build trust and ensure they feel safe to talk openly. This helps to provide a sense of consistency for the student, as well as efficiency for the team being familiar with specific students and cases. They are better able to notice if something changes, and if a student needs a referral to a medical doctor or other organization for additional treatment. “The consultations are always fun; you get a change of scenery by stepping out of the office. Over the years you see so many faces and still, somehow you manage to remember most of them. After just a few visits you can start to build a profile of most students, you can start to tell who the class clown is, the Mister Popular, the shy one, the loud one, and the one who just wants to take his time to avoid going back to class”, Richenella laughs.  

  Famia Planea Aruba (FPA) places great value on the relationship they have with Adriana, the social worker at EPB San Nicolas School. Adriana is the person who has the most contact with the students, and the one most students turn to when they need help.  “I’ve been the Social Worker at EPB San Nicolas for about fourteen years and have been working with FPA throughout my entire career here. It has always been a pleasure to work with them, they are very accommodating to whatever project we have going on. Each year we have an educational carousel for the first-year students, and we have always been able to count on FPA to provide information to our students. The Comprehensive Sexuality Education program is always fun, informative, and evolving. I, as well as other colleagues, try to catch at least one CSE session each year to see what innovative way the information is presented.” EPB is a secondary vocational school that educates young people from 12 to 18 years. Over the years it has developed a reputation for having challenging students. Adriana knows the students better than most of the teaching staff and is a firm advocate for the continuation of the on-the-spot-consultations, having seen the consequences when this type of care is not offered.  For registered youth under 21 years, the costs of healthcare provision are covered by the national health insurance, however, some students fall outside of the system. “Most of the times you get to have fun with the students, however, every now and then you will come across a heartbreaking case. Since Aruba has so many different migrants, very often you will come across one person who is not insured at the moment, who needs products and can’t afford it and you figure out a way to help”, Adriana says. “For our second, third- and fourth-year students FPA has been collaborating with us to provide a monthly session where the students receive contraceptives and guidance on school grounds. Since around this age, most of our students are already sexually active, we try to help them stay safe in and out of school. The consultations hours have become so popular over the years that as soon as the students see an FPA team member, they immediately assume that they are here to provide them with contraceptives and guidance, even if they are here for some completely different reason that day”, she comments. “The love, patience, and dedication that FPA has shown our students over the years are outstanding. At the beginning of the COVID-19 crisis we had to stop the consultation hours, but thankfully we are now back at it, bigger and better. Due to the collaboration with FPA, we were able to finish out our 2018-2019 school year with no new pregnancies, which was a first for our school. We hope to accomplish this again, now that we can continue our consultations, and keep our kids educated and in school, for as long as we can so they can achieve the best possible future”, Adriana concludes.  

Dr. Stewart McKoy has dedicated his life to ensuring the needs of both men and women are equally represented in the provision of healthcare at the Jamaica Family Planning Association (JFPA). When Dr. McKoy returned to Jamaica from overseas medical studies in the 1980s, the frustration at the failure of many Jamaican males to use contraception was a continuing concern. This led to him making a strong case for vasectomies to be offered as part of JFPA’s contraceptive options. Whilst the initial response from local males was disheartening, Dr. McKoy took the grassroots approach to get the buy-in of males to consider contraception use. Getting men on board “Someone once said it’s only by varied reiteration that unfamiliar truths can be introduced to reluctant minds. We used to go out into the countryside and give talks. In those times, I came down heavily on men. I remember after one talk, when I was finished, the driver of the JFPA van said they [men] didn’t like what I was saying. I saw a bar outside and went, carried them in, and said drinks on me. By the second round they opened up and were receptive,” he said. The reception would form the catalyst he needed to ensure that men, too, benefitted from sexual and reproductive healthcare. Men were choosing vasectomies if they already had children and didn’t plan to have any more. In addition, Dr. McKoy was an instrumental voice in the Men’s Clinic that was formerly operated by JFPA and also encouraged the inclusion of women at the meetings, in order to increase male participation and uptake of healthcare. “When we as men get sick with our prostate it is women who are going to look after us. But we have to put interest in our own self to offset it before it puts us in that situation where we can’t help yourself. It came down to that and the males eventually started coming. The health education got out and men started confiding more in health services,” he said.   It could be a matter of life or death McKoy said it is important that women use contraception and take their sexual and reproductive health seriously. If neglected, Dr McKoy said it could be a matter of life or death. He refers to a case of a young mother who was complacent towards having pap smears and ended up dying a preventable death as a result of cervical cancer. “Over the years I saw the opportunity to do pap smears out of the clinic. The mobile unit gave us access to so many patients. We had persons who neglected to do it. One patient in particular - she was not yet 30 years old. She had three children and after every delivery, she was told by the hospital to do a pap smear. She didn’t do it and eventually got cervical cancer. When she was to do the pap smear, she didn’t come. One morning they brought her and had to lift her up out of the car. At that time doctors said they couldn’t do anything for her,” Dr. McKoy said while fighting back tears. “It wasn’t necessary. We had to go out more to meet people, educate them teach them the importance of sexual and reproductive health.” That experience was his driving force to continue the work in sexual and reproductive healthcare. Dr. McKoy said the message about family planning, sexual and reproductive health must be continued through education in community outreach projects.

Keriann Hurley has worked at the Barbados Family Planning Association (BFPA) for 15 years. She is a social worker and the Manager of Youth Programming, but art is another passion of hers.  A link between art and social work may not seem evident but Keriann explains that combining her passions “helps to fuel the type of interventions I do with the clients.” Keriann is proud that “here at BFPA, our niche and the thing that we do amazingly well, above anyone else I dare say, is how we deal with Sexual and Reproductive Health issues, but that’s not all we do”. “Sexuality and sexual health is only one aspect of your existence”, she says. She is clear that BFPA’s services must consider gender, sexual identity, sexual orientation, mental health, family circumstances and relationships in its service delivery if it is to truly serve the community. There is a real need to provide unhindered access to young people who require services In Barbados, the age of consent is 16 but “there is still the issue of the age of access versus the age of consent.” Keriann explained that there’s no legal framework that prevents young people between 16 and 18 from accessing SRH services; there is the cultural “assumption that they must bring parent/guardian to be seen by a medical professional.” “A young person isn’t just going to show up at a doctor’s office because they think it’s the cool thing to do. There must be a dire reason”, Keriann says, and she adds that many young people do not access services because they fear judgement and punishment. “At BFPA, we don’t turn away anyone” A key task of the BFPA is to facilitate young people’s access to SRH services. BFPA established legally compliant protocols which govern their engagement with young people. Social Workers like Keriann comprehensively assess the personal circumstances of each young person to ensure that they are provided with the appropriate care. “Not every young person has a parent or guardian who will come with them, but should they be turned away if they have a dire need? No, it’s unethical to do that. At BFPA, we don’t turn away anyone”, she says. Sometimes a young person does have an available parent or guardian but fears their reaction to their desire to access SRH services. In these situations, she acts as a mediator to facilitate conversation between the young person and their caretaker. With the years passing, it became clear to Keriann that the challenge is “dealing with age-old issues in new ways. There is nothing new under the sun. However, issues do come back around in new ways”. The significance of certain issues changes with the times. “Just look at social media!” she says, “it also means that information, and misinformation, is easily accessible.” Keriann has seen a shift in societal attitudes towards SRH over the last 5 years. A plus side of the internet, she says, is that the accessibility of information means that society cannot “bury its head in the sand and pretend that young people aren’t sexually exploring.” “The Young Mothers Programme is my baby” In 2011, Keriann started this 10-year programme. The majority of Barbadian households are female-headed and she recognises that empowering young mothers will have a powerful positive impact on society. “These girls come with heavy issues,” Keriann says. Beneficiaries are taught not just parenting skills but life skills. They have access to intensive psychosocial counselling for themselves, partners and family members and vocational training. The Young Mothers Programme has transitioned to online delivery which poses such as lack of devices, electricity or a conducive household environment, and unreliability or absence of internet access. “Suddenly there was a new normal before we could even figure out what that meant”, Keriann says. Online delivery is more tiring, and she admits the difficulty in balancing delivery of a quality programme without an unsustainable psychological cost to herself but is adamant that “it is better to have a meaningful impact on 10 people than surface level engagement with 100”. Keriann believes that “the wealth and health of a society is based on how we take care of the most vulnerable. Working in an organisation whose focus is primarily the most vulnerable is really rewarding”. Keriann shares that social work is one of least financially viable careers in Barbados. “Many months we just try to get by, but the work is really rewarding!” she laughed, “We are here grinding on and doing what we have to do to make sure that we provide quality services to the most vulnerable in our community and not leaving anyone behind”

Dr. Rashida Daisley is the 31-year-old Clinical Director of the Barbados Family Planning Association (BFPA) and is also the president of the Barbados Association of Endometriosis and Polycystic Ovarian Syndrome (BAEP). “I have a passion for working with key populations and that’s what lead me to work at BFPA,” She says and takes pride in BFPA's continued leadership of sexual and reproductive health services in Barbados. Offering a spectrum of gynecological care while also conducting specialized clinics, steadily expanding its practice to include more general services including antenatal care. There is a men’s clinic that addresses both SRH and physical and emotional wellbeing while BFPA’s surgical clinic offers minor surgeries such as hernia repair, lumpectomies, and vasectomies. Despite funding challenges, BFPA has committed to providing critical support to the under-served LGBTQ+ community in Barbados by partnering with NGO - Sexuality, Health and Empowerment (SHE) to provide affordable, high quality and inclusive health services to lesbians, bisexual and queer women, as well as non-binary and transgender persons - an effort spearheaded personally by Dr. Daisley, while also supporting pre-exposure prophylaxis (PrEp) and STI clinics at Equals Barbados, another LBGTQ+ organization on the island.   COVID-19 and filling the gaps Dr. Daisley says she is pleased that clinical services were able to continue throughout the pandemic, unfortunately, COVID-19 has had a devastating impact on Barbados’ economy and society. As a tourism-dependent nation, a large proportion of the Barbadian workforce became unemployed in a very short period which in turn negatively affected the ability of marginalized persons to access basic services or even basic hygiene products. BFPA sought funding and donations to fill this gap and was able to secure funding from international organizations such as UNFPA, as well as donations of sanitary items from the Lady Box Project, a local NGO aimed at ending period poverty.  With funding from IPPF assisting in the provision of services to key populations such as persons living with HIV, men who have sex with men, sex workers, and LGBTQ+ persons. The allocation of funds to provide services to these groups allowed BFPA the financial space to direct its efforts to their other clients. Perhaps surprisingly, a relatively large subset of BFPA’s clients are older persons.  “The majority of people that BFPA interacts with are pretty open but that is probably because the people who seek out BFPA are already open-minded enough to access services at an organization with the words ‘family planning’”, Dr. Daisley laughed, “we do get a lot of referrals.” Perhaps surprisingly, a relatively large subset of BFPA’s clients are older people, many of whom started coming to BFPA as young people, while a small number of older persons do still seek out services because they are sexually active. Unfortunately, they grew up in a social climate where sexual and reproductive health education was virtually non-existent and the work to provide them better access is ongoing.  Dr. Daisley explains that the older population often do not think that they need to see the doctor about their sexual activity because there is no possibility of pregnancy. They are also not aware of the breadth of STI testing available. “When I ask them when was their last STI test, they usually say a few years ago at a health fair.” When probed, many of them disclose that they have only ever been tested for HIV and are not aware of many of the other STIs. In contrast, younger persons tend to have a healthier and more informed approach to sex and sexuality. Dr. Daisley observes that there is an increase in young people coming to be tested with their partners, and she attributes this in part to the important work that the BFPA’s Youth Advocacy Movement has done over the years, and essential to the progress of comprehensive sexual education.