“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. 

“I decided to become a volunteer at Pro-Familia when I heard a talk the staff was giving at the Acajutla City Hall, where they explained what they were doing in the communities with the program, and they invited us to be part of the volunteer service. I liked what I could do with the men in the community. It’s been two and a half years”. Juan Martinez Leons’ role as a promoter of the Community-Based Program of ADS – ProFamilia in El Salvador includes contraceptive care and information, as well as counseling to couples and individuals. He refers clients to public health facilities or Pro-Familia clinics for hormonal contraceptive care.  "I like to work for my community, despite the difficulties, and I help in four more communities for them to have the (contraceptives) methods and medicines," says Juan. “I give talks on the soccer field in front of my house, or I have meetings at my house, my children help me invite men to come and they also learn and admire the work. If I am gone in the future, they will continue with this service”. “When I talk with the men of my community, people's lives change” “I like providing family planning counseling because sometimes men don't like women using anything to prevent pregnancy. When I talk with the men of my community, people's lives change and you see the difference: you no longer see the domination over women, they let women plan, and (the woman) does no longer request the method secretly, although there are still some women who hide from their husbands, that's why we have to continue working on counseling, that awakens them,” Juan says. Home visits and talks with local men cover the importance of their own sexual and reproductive healthcare, including the prevention of STIs and HIV, and especially women and children's health. “In some talks, some men have come out angry and questioned me. Who am I to tell those things?” Juan’s quick response is ‘someone who has learned and who respects people's rights.’ “Now men come to ask for condoms, and even my wife confidently gives the condoms to them, she also supports me”, he says. Some men thank Juan for having “awakened their minds” and encouraging them to change, to respect women and to help at home. “I think I help my community a lot. You wake them up. I like what I do, I like to help. Before there was no promoter and they had women submerged. Little by little that is changing, but only by talking to men is it achieved. I want to continue learning about sexual and reproductive health issues, it never ends. I would like to continue training as we used to before the pandemic, and for Pro-Familia to come more often. Until God tells me, I feel that it is my obligation to attend to men or whoever seeks me to help them, that's what I'm for”.  

“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.”

You know where I get contraceptive pills? I get them in my mailbox. Every three months, I receive a large, white envelope that gives me the freedom to choose when and whether to have a child. I thought about this envelope when I was in the jungle in Peru, where many women live their entire lives with no access to contraceptives. Latin America and the Caribbean has the second highest rate of adolescent pregnancies in the world. Nearly 40% of women become pregnant before the age of twenty, and 1 in 5 births are to adolescent women. If these women could obtain contraceptives as easily as I do, it would not only reduce the estimated 1.2 million unintended pregnancies that occur in the region each year, but also save women's lives. Pregnancy is the leading cause of death for women ages 15-44 years old. So, how do women living in the Peruvian jungle obtain contraceptives? I found out when I visited Stefanie Suclupe, a 24-year-old professional nurse who has one of the toughest jobs in the world. As a volunteer with INPPARES, our local partner in Peru, Stefanie brings basic health services—like contraceptives, pre-natal care, and gynecological consultations—to people living in villages that have no electricity, no potable water, and no cell phone signal. Her journeys can take several hours—or days—but she makes them to ensure that poor and rural women can take advantage of family planning. "The jungle has the highest rates of teen pregnancies and death during childbirth in Peru," said Stefanie. "These are national problems that affect the most vulnerable people. It was a wake-up call for me." Traveling to one of these villages requires taking several different types of transportation. After we took a one-hour flight from Lima, Stefanie and I drove for three hours through verdant mountains and over dusty, pothole-ridden roads, braving hairpin turns and heart-stopping cliffs to reach the small town of Barranquita. From there we took a boat to cross three stingray-infested rivers, hiked over hills, and trekked through sun-beaten papaya fields before finally reaching Grau.  "The first time I walked to Grau, I had to face some of my personal fears, like what I might encounter on the road, the depth of the rivers, and whether I would get lost," Stefanie told me. "But once I arrived in the community, they were so welcoming, and that was a huge motivation for me." While Stefanie unpacked her bag of medical supplies, I chatted with a young woman named Mirca. She told me her first pregnancy was at the age of 13. She had just been married to an older man in the community. When providing care to women like Mirca, Stefanie tactfully talks about family planning, protection from sexually transmitted infections, and gender-based violence. She provides women with information about how to prevent unwanted pregnancies and where they can obtain contraceptives to decide when and whether to have children. These conversations help to ensure that every person Stefanie meets not only has access to the health services they want and need, but also understands their right to make their own choices about their lives.  "The work I do makes me feel really good," said Stefanie. "I can help people change their lives and have better health." I left Peru in awe of and inspired by Stefanie's commitment to increasing access to sexual and reproductive health services in her country. Now, when that white envelope arrives in the mail, I think of Stefanie's courage and tenacity, and I recommit myself to doing what I can to help her bring health care to the poor and isolated Peruvians who need it the most.

This programme addresses critical challenges faced by young women around sexual health and sexuality. It has produced a range of advocacy, education and informational materials to support research, awareness-raising, advocacy and service delivery.    Girls Decide is about the sexual and reproductive health and rights of girls and young women. Around the world, girls aged 10 to 19 account for 23% of all disease associated with pregnancy and childbirth. An estimated 2.5 million have unsafe abortions every year. Worldwide, young women account for 60% of the 5.5 million young people living with HIV and/or AIDS. Girls Decide has produced a range of advocacy, education and informational materials to support work to improve sexual health and rights for girls and young women. These include a series of films on sexual and reproductive health decisions faced by 6 young women in 6 different countries. The films won the prestigious International Video and Communications Award (IVCA). When girls and young women have access to critical lifesaving services and information, and when they are able to make meaningful choices about their life path, they are empowered. Their quality of life improves, as does the well-being of their families and the communities in which they live. Their collective ability to achieve internationally agreed development goals is strengthened. Almost all IPPF Member Associations provide services to young people and 1 in every 3 clients is a young person below the age of 25. All young women and girls are rights-holders and are entitled to sexual and reproductive rights. As a matter of principle, the IPPF Secretariat and Member Associations stand by girls by respecting and fulfilling their right to high quality services; they stand up for girls by supporting them in making their own decisions related to sexuality and pregnancy; they stand for sexual and reproductive rights by addressing the challenges faced by young women and girls at local, national and international levels.

The prohibition of abortion in El Salvador is an example of a direct legal barrier to SRH access. However many of the barriers are indirect, resulting from: conflicting interpretations and perceptions of the law relating to age of consent, parental consent and provision of services prevailing cultural norms, stigma, shame, and taboo around youth sexuality  lack of confidence in confidentiality myths about contraception and lack of accurate education about sexuality lack of positive legal protection of young people’s rights and LGBT rights discretionary and therefore uneven implementation of those protective and facilitative laws that do exist the culture of machismo, gender discrimination and the prevalence of gender-based and sexual violence Includes: Implications for law and policy on a broad range of factors impacting access

Under the Evidence project, IPPF is undertaking innovative research on respecting, protecting and promoting human rights in family planning/reproductive health services and ensuring community voices are part of efforts to improve and strengthen family planning programming. The Evidence Project uses implementation science to improve family planning policies, programs, and practices. Led by the Population Council in partnership with INDEPTH Network, International Planned Parenthood Federation, PATH, Population Reference Bureau, and the project’s University Resource Network, the five-year project (2013–2018) is investigating which strategies work best in improving, expanding, and sustaining family planning services. IPPF is leading on two cross-cutting areas of research. Firstly under the Evidence project, we are undertaking research on how the respect and protection of human rights of women and girls can be instituted and operationalised, and how programs can be held accountable for providing high-quality services. http://evidenceproject.popcouncil.org/technical-areas-and-activities/equity-rights-and-accountability. In order to address the need for indicators and tools for rights based family planning, the Evidence Project has partnered with global experts on human rights and family planning, the International Planned Parenthood Federation’s Sustainable Network Project (SIFPO/IPPF) and with colleagues at Reproductive Health Uganda (RHU) to develop and validate the Rights-Based Family Planning (RBFP) Service Delivery Index in Uganda. This is work is being undertaken in close collaboration with the Economic Policy Research Centre Uganda and University College London.  In addition, we are undertaking a variety of activities that aim to contribute to a deeper knowledge of whether and how the implementation of accountability mechanisms in family planning and reproductive health programs improves clients’ access to and quality of services.   For example, a multi-site case study in Uganda uses process evaluation methodology to explore the implementation of two social accountability programs, aiming to determine what hinders and facilitates engagement at the community level and its translation into improved social accountability processes and reproductive health outcomes.   http://evidenceproject.popcouncil.org/accountability-mechanisms-to-improve-family-planning-and-reproductive-health-programs/