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”

At her desk in the small, quiet office, sits an extraordinary Cuban physician and educator, whose accolades are second to none. Today, she is neither writing nor teaching on the advances in medical science, but rather, she is focused on her mobile phone. Engaged in a video call, she listens attentively to the person with whom she speaks. She shuffles in her chair, only for a brief moment, as if to make herself more comfortable and even more attentive. To Dr. Camejo, this is not just a job, this is her way of being present for a community that is in dire need of her help.   Four days a week, Dr. Mabel Camejo conducts TeleHealth, a telemedicine service initiated by the Family Planning Association of Trinidad and Tobago (FPATT) specifically for the Venezuelan and Cuban migrant communities. Her clients consider this service a god-send, as it allows them to book 30-minute consultations over WhatsApp video call. During the call, Dr. Camejo assesses and diagnoses her clients’ illnesses and prescribes medication if needed. If the client needs to be examined, she refers them to the FPATT clinic for hands- on assessment.    “My patients love it here. Many of them just don’t have the money or time to come in to the clinic for an appointment. If they have to take time off from work and that means no income for the day, but it’s easy when they can pick up the phone and send a message or take a call to get the same advice or treatment,” she notes.   Dr. Camejo recalls how technology has advanced since her practice in Cuba over 10 years ago. “In Cuba, the doctors go to the patient’s home so that we can chat with the whole family about how they can help the patient recover – whether it means reducing stress in the home, or cooking with less salt or sugar. There, we have to be the doctor for the entire family. Here, now in Trinidad, we get to do the same with TeleHealth. On the consultation call, we can address the whole family so that everyone understands the recovery path forward,” she said. “When people need help, you just have to help” With over 30 years of practicing medicine, Dr. Camejo specializes in gynecology, pediatrics and post-natal care but says that most of her migrant clients come in with a much wider range of ailments.  “Breast cancer is one I see very often. Then there is polycystic ovaries, diabetes, vaginal infections and even osteoarthritis. These women have been managing chronic illnesses that need constant and consistent treatment but because they cannot get medicine in Venezuela, they have to leave what they know as home to come here to Trinidad. It’s their only chance to survive,” she lamented.   Current policies in Trinidad and Tobago have prevented the migrants from accessing the public health care system unless they need pre-natal or emergency healthcare, so many of them with existing chronic illnesses have no other choice but to seek private care, which can be almost half of their weekly salary. However, FPATT’s mandate is to fight for equal Sexual and Reproductive Health Rights for all persons living within the nation’s borders and that includes the communities that need it the most.  In January 2020, FPATT launched an 8-module Zoom series for the migrant community that focused on the topics that were most critical to helping them integrate into their new home and culture. The structure was based on the IPPF’s One Curriculum, but designed to suit the needs of Trinidad and Tobago’s unique context. Dr. Camejo spoke from her expertise in Sexual and Reproductive Health, highlighting the use of contraceptives for planned pregnancies and the importance of regular pap smears to reduce the risk of cervical cancer.  “It’s information that they desperately need. They are in a new country, everything is different, including the systems, the culture and the food. They appreciate faces and voices that are familiar, sharing information that could save their lives,” she said. “This is what I love to do as a doctor. Since I was a little girl in Havana, I would watch my father speaking to his clients and he would be so careful with them and they would be so grateful that he came to see them. I feel the same way when I get to share and communicate with my clients. When people need help, you just have to help.” Dr. Mabel Camejo has been with FPATT for over 3 years and looks forward to serving the local Venezuelans and Cubans as long as she can. A migrant herself, she understands the intrinsic and changing needs of this community and continues to help FPATT tailor its services to ensure that equal opportunities in sexual and reproductive healthcare are afforded to all.          

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.

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/