There is an age-old stigma that surrounds sexual and reproductive health and rights in Jamaica. But for youth officer Fiona Francis, her work in the area is making an impact, one person at a time. I will leave here better than I came Francis, 28, joined the Jamaica Family Planning Association (JFPA) in 2017 as a volunteer at the Lenworth Jacobs Clinic. This was made possible through a one-year internship with the Jamaica Social Investment Fund. “I was placed to be a youth officer, which I never had any knowledge of. Upon getting the role I knew there would be challenges. I was not happy. I wanted a place in the food and beverage industry. I thought to myself, ‘what am I doing here? This has nothing to do with my qualifications’. It was ‘baby mother’ business at the clinic, and I can’t manage the drama,” Francis said. But Francis’ perception of JFPA quickly changed when she was introduced to its Youth Advocacy Movement (YAM) and began recruiting members from her own community to join. “I quickly learnt new skills such as social media marketing, logistics skills and administrative skills. In fact, the only thing I can’t do is administer the vaccines. They have provided me with a lot of training here. Right now, I have a Provider Initiative Training and Counselling certificate. I am an HIV tester and counsellor. I volunteer at health fairs and special functions. I will leave here better than I came,” Francis said. Despite the location of the Lenworth Jacobs Clinic being in a challenging area, Francis is adamant her work is to be done, and believes the youth are the vanguards for change. Men feel entitled to their bodies “It’s a volatile area so some clients you have to take a deep breath to deal with them as humans. I am no stranger to the ghetto. I grew up there. The young people will come, and they’ll talk openly about sex. They’ll mention multiple partners. You have to tell them choose two [barrier and hormonal contraception] to be safe, you encourage them to protect themselves,” she said. Many young girls in the community are at risk of sexual grooming, underaged pregnancy, self-harm, and depression. “Sometimes men may lurk after them. There is sexual grooming where men feel entitled to their bodies. A lot are just having sex. They don’t know the consequences or the sickness and potential diseases that can come as a result of unprotected sex.  Many don’t know there are options- like contraceptives. Some don’t know the dangers of multiple sex partners. The challenges are their lifestyle, poverty level, environment, and sex are often transactional to deal with economic struggles,” Francis explained. However, she said YAM has provided a safe space for many young people to learn about, and discuss issues like consent, sexual health and rights, and sexuality to make informed choices But there is a need for more youth volunteers and learned adults to carry the mandate of the JFPA forward. “We need more young people and we definitely need an adult group. Teens can carry the message, but you’re likely to hear parents say, ‘I’ve been through it already’ and not listen. They also need the education YAMs have access to, so they can deal with their children, grandchildren, and educate them about sexual and reproductive health rights. For my first community intervention, a lot of kids came out and had questions to ask. Questions that needed answers. I had to get my colleagues to come and answer,” Francis said. “There’s a lot going through these teenagers’ minds. Through YAM I have developed relationships and become their confidante, so they can call me for anything. The movement is impacting. It helped me with my life and now I can pass it down. YAM can go a long way with the right persons. Whatever we do we do it with fun and education – edutainment,” she said.

‘Are you interested in advocacy and reproductive health and rights?’ These were the words which caught Mario Boothe’s attention and prompted him to sign up to be part of the Jamaica Family Planning Association (JFPA) Youth Advocacy Movement (YAM) five years ago. At the time, Boothe was 22 and fresh out of college, searching for opportunities to gain experience. It’s so much more than sex and condoms “I was on Facebook looking at different things young people can do, and it popped up. I had just left college with an Associate Degree in Hospitality and Tourism Management. I was unemployed and I just wanted to be active, give myself the opportunity to learn and find something I can give my time to and gain from it,” Boothe said. Being no stranger to volunteerism and having a desire to do advocacy, Boothe decided to sign up for YAM to get a new experience and broaden his knowledge base. “It’s so much more than sex and condoms. It’s really human rights and integrated in everything we do. Reproductive health affects the population, it affects your income, your family planning, how people have access to rights. It cuts across men, women, LGBT people and encompasses everything. My love for working with YAM and being an advocate for sexual and reproductive health rights deepened and I could expand further in my outreach,” he said. Now, Boothe has no regrets with his decision as he has gained a second family and a safe space, he can call home. Additionally, YAM has equipped him with skills and given him opportunities he would otherwise not have. “I have done public speaking which has opened lots of doors for me. I have traveled and met with other Caribbean people about issues [around SRHR]. There’s an appreciation for diversity as you deal with lots of people when you go out into communities, so you learn to break down walls and you learn how to communicate with different people,” Boothe said. With YAM, Boothe has delivered projects, presentations with schools and churches, and training sessions in condom use and addressing other sexual health issues. Reluctance to talk about sex But, the greatest challenge to his advocacy is people’s reluctance to talk about sex. “Once they hear sex it’s kind of a behind the door situation with everybody, but they are interested in getting condoms,” he said. “When it comes to that it is breaking taboo in people’s minds and it might not be something people readily accept at the time. LGBT rights, access to condoms and access to reproductive health for young people at a certain age — many people don’t appreciate those things in Jamaica.” Other challenges regarding sexual and reproductive health and rights, Boothe said, include access and misinformation. “Within the framework of the family and giving youth individual rights to access their own reproductive health. So, can they go to a doctor, nurse without worrying if they are old enough or if the doctor or nurse will talk back to the parents? Access is about giving them the knowledge and empowering them to go for what they need. “The stigma is the misinformation. If you’re going to the clinic people automatically assume, you’re doing an HIV/AIDS test or abortion. [So] after the community empowerment, because of the stigma maybe 15 per cent will respond and come to the clinic. The biggest issue is misinformation,” Boothe said, adding that diversification of the content and how messages are shaped could possibly help. To address these issues Boothe wants to see more young people involved in advocacy and helping to push the message of JFPA in a diversified way. “It is a satisfying thing to do both for your own self development and community development. You’re building a network. If you put yourself out there you don’t know what can happen,” he said.

From their inception, cultural barriers and stigma have threatened the work of the Jamaica Family Planning Association (JFPA). Although some myths around family planning are still prevalent, according to one senior healthcare provider at the Beth Jacobs Clinic in St Ann,  there have been some positive shifts. Registered midwife Dorothy Boyd-Brown who first began working with the Association in 1973, said the organization has made its mark and reduced barriers and stigmatizing behavior towards family planning and sexual and reproductive health and rights. Boyd-Brown, head of maternal and child-care/sexual and reproductive healthcare at the Beth Jacobs Clinic said cultural barriers were often seen in families lacking basic knowledge about sexual health. “I remember some time ago a lady beat her daughter the first time she had her period as she believed the only way, she could see her period, is if a man had gone there [if the child was sexually active]. I had to send for her [mother] and have a session with both her and the child as to how a period works. “She apologized to her daughter and said she was sorry. She never had the knowledge and she was happy for places like these where she could come and learn – both parent and child,” Boyd-Brown said. Information sharing is important She also highlights that religious groups once perpetuated stigma, so much so that women feared even walking near the FAMPLAN clinic. “Churchwomen would hide and come, tell their husbands, partners or friend they are going to the doctor as they have a pain in their foot, which nuh guh suh [was not true]. Every minute you would see them looking to see if any church brother or sister came on the premises to see them as they would go back and tell the Minister because they don’t support family planning. But that was in the 90s,” Boyd Brown said. Boyd-Brown says things have changed and the church participates in training sessions about family planning encouraging members to be informed about contraceptive care and their sexual and reproductive health and rights. But despite the wealth of information and forward-thinking of the communities the Beth Jacobs Clinic serves, Boyd-Brown said there are some prevailing myths, which if left unaddressed threaten to repeal the work of the Association. “Information sharing is important, and we try to have brochures on various STIs, and issues around sexual reproductive health and rights. But there are people who still believe ‘sex with a virgin cures’ HIV, plus there are myths around contraceptive use too. We encourage reading. Back in the 70s, 80s, 90s we had a good library where we encouraged people to read, get books, get brochures. That is not so much now,” Boyd-Brown said. Boyd-Brown also faces the challenge of ensuring women continue to access healthcare. “I saw a lady in the market who told me from the last day I did her pap smear she hasn’t done another one. That was five years ago. I had one recently - no pap smear for 14 years. I delivered her last child,” Boyd-Brown said. Despite the challenge, she remains dedicated to the task and shares that her commitment also helps to improve women’s choices. It is Boyd-Brown’s hopes that the once active Mobile Unit with community-based distributors will be reintegrated into JFPA’s healthcare delivery to be able to reach under-served communities.  Boyd-Brown added, “JFPA has made its mark. It will never leave Jamaica or die.”

Trigger warning: this story contains details about sexual assualt Monique* shared with IPPF her experience as a young, disabled woman with a child:  "I was constantly raped by my father. I got pregnant. People thought I shouldn’t and couldn’t raise my son, but now he’s going to one of the best public schools." "I’m a mother. I’m a woman. People seem to think there’s something strange about me wanting to have sex or enjoying it. People with disabilities are made invisible and silent. They need encouragement in gaining confidence and becoming as self sufficient as possible. This programme has given me confidence. I’ll make sure that what I learned I’ll teach to others." In Trinidad and Tobago, many young people face challenges when it comes to accessing sexual and reproductive health services, but young people with disabilities face additional barriers due to stigmatization and social prejudices.  Young people with disabilities are often isolated and lack knowledge about sexual and reproductive health and rights. As a result, they can be vulnerable to sexual abuse. Rates of unplanned pregnancies and sexually transmitted infections are high among young people with disabilities.  In Port of Spain and San Fernando, the Family Planning Association of Trinidad and Tobago (FPATT) set up 'Going Beyond the Walls' – a project to provide HIV testing and counselling to young people with disabilities. It offered a full range of other sexual and reproductive health services, from pap smears through to general counselling. They also organized seminars to sensitize young people to the issues faced by those with disabilities. Over 400 students attended educational sessions about people with disabilities and their sexual rights. Participants said their attitudes towards people with disabilities, and often towards themselves, had shifted significantly as a result of the project. They suggested that what they had learned should be communicated to everyone through campaigns, sensitization exercises and services. *Not her real name/image

Erin from Syracuse, New York, has been a member of the Planned Parenthood Federation of America (PPFA) for several years. She joined PPFA as National Campus Organizer for youth organizing in May 2014. Prior to joining, Erin was a local campus organizer at Syracuse University in New York working closely with Planned Parenthood of Central and Western New York.  Erin graduated from Syracuse University with a B.A. in Policy Studies and Women's and Gender Studies.  “As a member of the LGBTI community and a young person in the United States, I’ve learned first-hand what it means to be on the front lines of fighting for equal rights and access in the Western world. Growing up in the 1990s, when the Defense of Marriage Act was signed into law and in the years that followed, I experienced firsthand what it meant to be a second-class citizen: and it all happened because I was a young, queer woman that decided to come out. Living in the shadows You could say I always knew that I was different, and I think many members of my chosen queer family can relate. Many of us live in the shadows every day out of fear of shame and violence. We have to do better to ensure that young people live in a world without fear from being exactly who they are. Now, I do organizing work with Planned Parenthood Federation of America (PPFA) across the country, and work with young people in the LGBTI community every day. We tirelessly fight for better access to sex education, resources, and health care for all, in every nook of society – from our families, to our schools, to our communities, and with our elected officials. We at the PPFA National Office believe deeply that young people’s experiences, particularly those who live at the margins, should be center to and fuel our mission. For every campaign, for every advocacy and outreach effort, for every education program, we always think about the communities we are serving. Taking charge and standing up Young queer people in the United States are taking charge and standing up for their rights, and in the process, creating healthier communities. They are at the forefront of policy change: in Las Vegas, Nevada, our young advocates are organizing in their communities to pass culturally sound and comprehensive sex education policy; in South Florida, an area with the highest rate of new HIV infections in the United States, young people fought for and passed sex education policy directly impacting their lives. As demographics shift in the United States, young people are ensuring that power shifts along with it. As we continue to grow as a nation and improve resources for young people, we are also creating spaces for young people to take leadership roles and stand up for their communities. We are a generation fighting for our rights today.” The Planned Parenthood Federation of America (PPFA) is a trusted health care provider, an informed educator, a passionate advocate, and a global partner helping similar organizations around the world. Planned Parenthood delivers vital reproductive health care, sex education, and information to millions of women, men, and young people worldwide, including those from the LGBTI community. 

It wasn’t the group meetings, the testing services or the health facilities that attracted Manny Norman, it was the offer of a free subway card and a bite to eat. A friend who was also a substance use told him about the workshops in a basement at a nearby community centre. Manny focused on the subway card which would be worth a few dollars if he sold it on. “I just wanted something to eat,” he says. “I hadn’t eaten in probably 20 hours. And the idea of getting more drugs without stealing sounded good to me.” Thirteen years later and he is still attending the Safety Counts meetings run by Planned Parenthood’s Project Street Beat, and credits them with helping him rebuild a life shattered by drug abuse. At the time, he explains he was neglecting his young family, stealing from them to buy crack cocaine and alcohol. His wife would call the police or lock him out of the home on an almost daily basis. “I was on crack and alcohol, the drugs that led me to dereliction, that led me to stealing, being unmanageable, not responsible, without a care in the world,” he says. “(I) didn’t want to work. I just wanted to feed my drug addiction.” Starting a new life But when he walked into the Safety Counts meetings, he says now, he realised he was among people who understood his life. “They met me where I was at,” he says. “They could tell I was under the influence. They could tell I was hurting, that I wasn’t doing the right thing and they made me feel no less than and no different. They gave me hope to come back the next week.” At first, he just went with the flow, focusing on the food and the subway card, not taking much notice of the services on offer. But eventually, he realised there were other people in the room he had come out the other side and rebuilt their lives. “We talked about harm reduction,” he says. “I could identify with the stories other people were telling. Lying, cheating, stealing, borrowing money knowing you wouldn’t pay it back.” Detox and rehab followed. He used the facilities of the projects mobile medical unit to get himself tested for Hepatitis C and HIV and has managed to stay clean, even training as an HIV outreach worker, and has rebuilt his family life. “It’s a happy home now,” he says. “My daughter got her father back, my wife got her husband back. Most of all I got myself back, thank God.” Without Project Street Beat he says his life would have continued its downward spiral. He would most likely be in prison today. Instead, he works as a supervisor for a cleaning company. And when he bumps into one of his friends from the old days he knows what to do. “When I walk down the street and see someone I know – someone I took drugs with or drank with – I let them know exactly where the mobile might be at,” he said. “I have cards in my pocket I give out to people and let them know this is the new way.” Watch Project Street Beat in action