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.  

Famia Planea Aruba’s (FPA) contraceptive delivery service is an added personal touch to its online store. The site is accessible to both members and non-members who can shop in privacy for their contraceptives and schedule a delivery. Orders are delivered by FPA staff with clients having the option to pay cash or debit upon delivery. To ensure a clients’ privacy and confidentiality orders are delivered discreetly. Ghislaine Koeiman, Head of Information, Education, and Communication Support at FPA has been managing the delivery service since it started in August 2018. “Since the start of the delivery service in 2018, our clients were enthusiastic however, the usage started slow. I believe this was due to the unfamiliarity, and people were still in the transition phase to online services. Moreover, clients believed that the delivery transportation would have been in a car completely covered in images of condoms, sperm cells and pills, which made them skeptical of using the service due to embarrassment”, says Ghislaine.  As with any new service comes challenges as well as opportunities. “Some of the challenges we face are the overload of deliveries on one day.” Even though Aruba is a small island and there are traffic jams only at specific hours in the day. “Sometimes I get stuck in traffic and try to rush myself to deliver the products in the time slot and at times I find myself in places that I barely recognize and discover new locations.” “The part I enjoy is the communication with the clients. Building a relationship with the client and vice versa provides a smoother transition of service but also provides the comfort and safe feeling for the client”. Ghislaine says the service often calls for more than the delivery of contraceptive orders, as clients may have questions or need support about their health. FPA’s bespoke healthcare delivery has seen successful growth since it started, with an increase of 115% during 2019 and 170% in 2020. “There has been an immense increase in the service in 2020 due to the pandemic. We already had the service in place, so we just had to fill in the gaps; for example, providing more hours and dates for clients to make use of the service.” <img src="https://tracker.metricool.com/c3po.jpg?hash=8b2b54e62fc802a9ae3ee7903a883415"/>

“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.