“A world of hope for adolescent girls” – Olive’s story

This is the fourth and final blog in a series sharing personal family planning stories from around the world – presented by CARE and Girls’ Globe in the lead up to the 2018 International Conference on Family Planning. Catch up on the whole series with stories from HawaParmila, and Oun Srey Leak.

Rwanda has made significant strides in empowering women and girls and ensuring they have access to affordable healthcare, including access to family planning.

Access to contraception has steadily increased from 17% in 2005 to 53% in 2015.

The government has decentralized and subsidized healthcare to ensure the most remote areas are reached and the most vulnerable communities can access services. However, the biggest unmet need for family planning is predominantly among young and unmarried women. In 2016 alone, 17,000 girls reportedly became pregnant before turning 18!

In 2016, the Government of Rwanda began providing comprehensive sexuality education in schools, however there is still a long way to go to ensure teachers are equipped with the skills and information needed to engage in age-appropriate, open and honest conversations with students.

I work for CARE in Rwanda, where I advocate for increased access to age-appropriate, integrated sexual and reproductive health services, rights, and education for in-school and out-of-school adolescent girls. Although the country has made notable progress in promoting women’s and girls’ rights in recent years, teenage pregnancies have continued to rise, leading to dire socio-economic and health consequences for Rwandan girls.

A few weeks ago, I attended an information session for young women in Kigali where a medical doctor explained available methods of contraception. I realised then that there is a lot young people do not know. But it made me wonder…

If the youth of Kigali don’t know how to prevent pregnancy or to take care of their sexual and reproductive health, what about women and girls who reside in rural areas where access to information and services is still a challenge – even a luxury?

In my time at CARE, I have seen the tremendous work the organisation is doing around the world to increase demand for sexual and reproductive health information and services, including contraception. Much of our work focuses on addressing underlying causes of poverty and vulnerability and helping communities to challenge harmful and negative socio-cultural norms that hinder women and girls from enjoying their rights and reaching their development potential.

Two weeks ago, I met a group of adolescent girls in Karongi District, Western Rwanda, where CARE is implementing the Better Environment for Education (BEE) project to increase chances of girls staying in school. During my visit, the girls talked to me about the various problems that they faced, including unwanted and early pregnancy. As I listened to their stories, I wondered whether we are doing enough to address these issues.

One particular 17-year-old stood out to me. As she narrated her story with teary eyes, she recalled the difficult time she went through when she found out she was pregnant, and described how she was abandoned by her family. She felt she had failed them and failed herself. At some point she was forced to quit school to raise her infant. But when the BEE project began, she decided to join one of the clubs and suddenly found hope. According to her, the clubs have provided a space and a voice for girls to talk and to get accurate and comprehensive sexuality education.

Although the local health centre is just a few metres away from the school and provides condoms and other contraceptive methods, young people in Karongi told me they feel judged and shamed when they go there to seek services that they are entitled to. The BEE project aims to address this as well by giving adolescent girls a platform to dialogue with the school administration and local leaders to express their needs.

Studies have shown adolescents are increasingly becoming sexually active before they turn 18 and this is a reality we should not ignore. Too often, in countries like Rwanda, adolescent girls do not have information regarding their changing bodies or sexuality in general.

Adolescent pregnancy undermines a girl’s ability to exercise her rights to education, health, and autonomy. It’s not only a health issue, but a human rights and development one too. 

I believe that CARE’s integrated approach to empowering adolescent girls, including economic empowerment through savings clubs, sexuality education, addressing gender-based violence and engaging power holders such as parents, boys, school administration officers, and local leaders is powerful in ensuring the problem is addressed from all sides. I have no doubt that this will bring about transformation in the lives of girls and their communities.

We have no more time to lose.

“Now I Use Contraception” – Oun Srey Leak’s Story

This is the third blog in a 4-part series sharing personal family planning stories from around the world – presented by CARE and Girls’ Globe in the lead up to the 2018 International Conference on Family Planning. Catch up on the whole series with stories from HawaParmila, and Olive.

Oun Srey Leak, a 26-year-old mother of one, navigates her way to work on a crowded street in Phnom Penh, Cambodia. She has worked in the Gladpeer garment factory for five years.

The garment industry is a huge part of Cambodia’s economy, employing over 700,000 workers. About 90% of these workers are women.

Srey Leak, like many of her colleagues, moved to Phnom Penh from a less populous area of Cambodia in search of job opportunities. She met her husband and shortly after became pregnant with their daughter.

Photo by GMB Films

“After I got married, I heard using contraception could stop us from being able to have children in the future. So, that’s why I decided to have a child soon after I got married. Two months after the wedding, I got pregnant,” Srey Leak explained.

Although half of female garment workers report being sexually active, less than a third of them use modern contraceptives.

Just as soon as Srey Leak became a new mom, she was faced with the demand to return to the garment factory. “After the birth, I needed to get back to work. So, I took my daughter to my mother back in the province. I am now far away from my child because I don’t have time to take care of her.”

Srey Leak’s story is not atypical. Most Cambodian garment factories operate six days a week, eight hours a day, and workers are often paid based on the outputs they produce, rather than the time they put in. Taking time off to go to the doctor may cost them more income than they can afford to lose, and there are limited health providers and pharmacies operating on Sundays when the factories are closed.

For the past five years, CARE has been working in garment factories to help women like Srey Leak make healthy decisions. Chat! is a package of activities that reaches women inside factories, where they spend most of their time. The innovative package includes sessions providing information on various sexual and reproductive health topics.

Srey Leak welcomed the opportunity to take control of her health. “One day, CARE came to invite workers to join a short training. They showed me short films about understanding the different types of contraception, safe abortion, and the ways in which we can avoid unplanned pregnancies.”

The sessions are paired with videos that feature fictional characters, in which the women can relate to and identify real health challenges. There is also an app that provides interactive quizzes and activities that are tailored specifically for garment workers, to facilitate ongoing learning.

After she learnt about the various modern contraceptive methods available to her, Srey Leak decided to start using oral contraceptives.

“I now take the contraceptive pill every day. If I’d known about this method before, I could have used it before falling pregnant,” she shared. “For me, after I joined CARE’s training, it changed my life. Now I use contraception and I have a greater understanding. So, it means I can have enough money for my next child.”

Chat! is supported by the Australian government’s Partnering to Save Lives (PSL) initiative and the Cambodian Ministry of Health in an alliance to reduce maternal and newborn mortality in Cambodia. Workers who participated are twice as likely to use modern family planning methods and health services. Factory managers have reported increased productivity and reduced absenteeism within their workers.

Learn more about CARE Cambodia’s garment factory work here, and read an interview with Chat! co-founders Maly Man and Julia Battle.

“Why should women have all the responsibility for family planning?” – Parmila’s Story

This is the second blog in a 4-part series sharing personal family planning stories from around the world – presented by CARE and Girls’ Globe in the lead up to the 2018 International Conference on Family Planning. Catch up on the whole series with stories from HawaOun Srey Leak, and Olive.

When it comes to family planning, women in India (and in the rest of the world) are expected to do the work. This reality is consistent across the various methods of contraception, but the disparity between the sexes is especially obvious when it comes to permanent contraception, or sterilization. For each man who opted for a vasectomy between 2016-2017 in India, 52 women got tubectomies.

The 1:52 ratio is striking, especially when you consider that vasectomies are cheaper, less invasive, carry a lower risk of infection, and have a quicker healing time than the female equivalent.

In recent decades, the procedure has been improved with the advent of the no-scalpel vasectomy (NSV), which boasts an even quicker healing time and lower risk of infection.

For couples who do not want to have any (or any more) children, the NSV can be a great option, and one frontline health worker in India has made it her personal mission to increase uptake in her community.

Photo by CARE

This is Parmila Devi with her husband, Bigan Sahni.

Parmila is an ASHA (Accredited Social Health Activist) in Bihar, one of the most populous states in India. She learned about NSVs as part of the ASHA family planning training, and she immediately decided it was the best option for her family.

“Why should women have all the responsibility for family planning?” she wondered.

“The first thing I did after becoming an ASHA worker was to convince my husband to undergo a vasectomy,” said Parmila. Bigan “thought she had lost her senses” at first, but eventually came around to the idea.

The procedure was a success, and Parmila began to tell her clients about her husband’s experience. She attempted to address concerns and correct myths and misconceptions prevalent in the community.

“Some men think [a vasectomy] would affect their sex drive or their ability to enjoy sex. Some also feel it would make them physically weak, which is not the case,” one state health official explained. Many women shared the same fears for their husbands.

ASHAs typically work most closely with women and children, but because Parmila wanted men in her community to understand the benefits of NSV, she talked to them as well.

“‘Ab ee mardo ken a chori!’ (She will not even leave the men alone!) the people in the households I visited in the early days would say.”

Bigan supports his wife’s efforts, and occasionally they make house calls together and he counsels the husband while Parmila talks to the wife. Gradually, people in her community have become more accepting of NSV as a viable method of permanent contraception.

Parmila received an award from the health minister of Bihar, Mangal Pandi, for motivating 43 men to get NSVs in 2017. Her goal for 2018 is to increase that number to 100, and so far, she’s over halfway there.

Given the volume of accurate information and quality family planning methods available now to individuals, we should be working to ensure this information and these services reach women and men.

There is no reason women should have to bear all of the burden for family planning and contraception in this day and age. Fortunately, there are activists like Parmila in this world to remind us of that, and to push us to be better.

Learn more about CARE’s work in Bihar here.

This case study was collected by Gaurav Masih, MPH candidate at Indian Institute of Public Health – Gandhinagar.

“All men should let their wives start family planning” – Hawa’s Story

This is the first blog in a 4-part series sharing personal family planning stories from around the world – presented by CARE and Girls’ Globe in the lead up to the 2018 International Conference on Family Planning. Catch up on the whole series with stories from Parmila, Oun Srey Leak, and Olive.

Under the hot sun of Maiduguri, Nigeria, 23-year-old Hawa Ngoma is fanning herself with the end of her black hijab (a full head-and-body cloak that most Nigerian Muslim women wear) while sitting under the shade of a tree outside of a health clinic.

Hawa is married and has a five-year-old daughter and a two-year-old son. Her husband, Ali, is an ambulance driver for a United Nations project. Hawa came to this particular clinic after Ali learned about family planning from a midwife who works with him and heard that CARE was offering it here for free. “When my husband heard and saw the benefits of the family planning from his work, he asked me to start family planning and get counseled by this particular midwife.”

CARE Nigeria is providing much needed facility and outreach-based models of sexual and reproductive health service delivery in the most hard-to-reach areas in Northeast Nigeria. Over 250,000 women and girls most severely affected by the crisis have been reached with services including pre- and post-natal care, family planning, HIV testing, health education and post- abortion care.

“When I came to the health center, the midwife explained all the different contraceptive methods to me and how to use them, the good parts and the bad.” Hawa shared. When I came to the clinic, she was really welcoming and warm and took all her time to explain everything to me and gave me the chance to ask as many questions as I wanted and did not feel annoyed at all. This made me want to come back and visit again when the time to change the implant had
come.”

Hawa wanted to find the right method that fit her body and lifestyle, and something Ali would like as well. “I wanted to go for the pill, but my husband told me it makes you grow fat and he loves the way I am already, so I tried the shots. I loved the shots, but I decided to go for the implant because it lasts three years and this will help me rest and not worry about it for that period of time.”

Although Ali now understands the benefits of family planning and supports Hawa using contraceptives, that was not always the case. “After our first daughter was born, he refused to let me start family planning.” At this time, Ali lived in a different town from Hawa for his work. “My husband did not want to hear about family planning and since he was not living with us, it
was easy not to get pregnant. After we started living together, I got pregnant right away and gave birth to a baby girl who died a few days later. Then, because I was not using contraceptives, I got pregnant 40 days after the death of my baby.”

Hawa’s second and third pregnancies were difficult. “For my last two pregnancies, I lost a lot of blood and lost consciousness. After the second one, I had a blood pressure issue,” Hawa explained. “After my second pregnancy, I was introduced to family planning but my husband was against it. I guess the difficulties and challenges we faced during my third pregnancy made him realize it was a mistake not to space births.”

Although acceptance of family planning is growing in her community, many men still do not approve of it. Hawa sees that as a problem. “I’d like to tell men that they should let their wives start family planning as it reduces the risk of suffering and allows them to give birth to healthy babies. It gives you the time to rest and to give a better upbringing to your children instead of having a baby sucking on your breast, one on your back and the other one bothering you for being hungry or because they have messed their pants!”

Hawa hopes to be able to go back to school, find a job, and be financially independent. She wants to grow as a woman and give her children a better education and to raise them to be good people who will help others.

Learn more about CARE’s work in Nigeria here.