By Sylvia Ekponimo, Project Advisor, Stand Up for SRHR Approximately one out of four women in Mozambique experience physical or sexual violence during their lifetime, with one in two girls marrying before the age of 18. During the COVID 19 pandemic, reports revealed an exacerbated experience faced by women and girls in the country. With healthcare providers being most likely the first point of contact a survivor would have, it is essential that they are equipped to screen, identify and clinically manage GBV cases, while referring survivors to the relevant authorities where applicable. Numerous structural obstacles and cultural practices hinder individuals from accessing essential health services, particularly those addressing sexual violence and abuse. When survivors navigate these challenges and make it to a clinic, service providers must be adequately prepared to address their needs. It is against this backdrop that IPPF’s Member Association in Mozambique, AMODEFA, supported a 3-day training from 20 to 22 March 2024, on Sexual and Gender-Based Violence (SGBV) for healthcare workers providing care in select health facilities. The training was organized within the framework of the Stand Up project, a multi-stakeholder, multi-country initiative that contributes to the increased enjoyment of sexual and reproductive health and rights. The training’s objective was to equip and increase healthcare providers’ knowledge on SGBV topics and strengthen their capacities and skills in responding and providing SGBV-related services to adolescents and young women. The training also aimed at disseminating appropriate SGBV documentation and providing referrals for complementary non-clinical services, such as psycho-social support and legal redress. With participants ranging from nurses, GBV focal persons, data entry officers, and representatives from other Stand Up partners (Ophenta & LAMBDA), the training addressed harmful social norms, beliefs, attitudes, values, and harmful behaviors that contribute to SGBV. To foster ownership and sustainability, the Nampula District Director of Health, Women and Social Welfare as well as representatives from the Prosecutor’s office and Provincial Health Services were also in attendance. Other topics addressed included human rights, with a special focus on children and women's rights; the perception of sexuality and sexual and reproductive rights as fundamental to access quality SRH services; legislations on GBV, legal instruments that safeguard survivors’ rights to protection, access to justice, and access to clinical services. Additionally, there were sessions to review methodologies in addressing SGBV cases such as information gathering equipment, reporting standards and referrals of SGBV cases by health centers; and the data capturing tools for recording, reporting, and referring cases of SGBV services at the health centers. To learn more about the Stand Up project click here.                 

On 16 August 2023, Japanese House of Representatives member Dr Toshiko Abe visited head office and the Adolescent and Youth Friendly Services Centre of IPPF’s Member Association in Mozambique, the Associação Moçambicana para Desenvolvimento da Família (AMODEFA). Dr Abe visited one of AMODEFA’s eight youth centres in a particularly marginalised and high poverty density area, where youth friendly health services is difficult to reach for the local youth who need them most. Their youth centre functions as the hub of youth target activities such as provision of a range of services from HIV testing and treatment to SRHR counselling and other information and services around sexual health and rights. In 2022, 23.57 % of AMODEFA’s family planning services were provided to clients under 20 years. AMODEFA was established in 1989 and has been IPPF’s Full Member Association since 2010. It is an independent, non-profit, and non-governmental association working in 10 provinces in Mozambique. As the leading service provider in Mozambique, AMODEFA provides comprehensive and diverse sexual and reproductive health, including that related to SGBV. Their focus is on vulnerable people such as women, girls, people with disabilities.  

  Stand Up for SRHR (Stand Up) is a 6.5-year multi-stakeholder, multi-country initiative that contributes to the increased enjoyment of sexual and reproductive health and rights (SRHR) by adolescent girls and young women (10-29 years), other women of reproductive age (30+ years), and men and boys, in strategically selected Mozambican and Ugandan districts. IPPF Africa Region and its Member Associations - Reproductive Health Uganda (RHU) and Associação Moçambicana para Desenvolvimento da Família (AMODEFA) are responsible for the component of the project which aims to strengthen knowledge and capacity of service providers and healthcare facilities to improve the provision of comprehensive sexual reproductive health (SRH) information and services. Donor: Global Affairs Canada Partners: OXFAM – Consortium Lead, The Guttmacher Institute (SRHR research and Policy), Action Canada (SRHT public engagement in Canada) Implementing MAs: Uganda (RHU), Mozambique (AMODEFA) Duration: 3 December 2021 – 31 October 2027 (6 years) Total IPPF Budget: CAD $5,867,063 IPPF Implementation Location: Uganda - West Nile Northern districts (Nebbi, Terego, Madi-Okollo, and Arua) and Eastern Uganda districts (Mayuge and Namayingo). Mozambique - Northern coastal province of Nampula: Nampula City, Nacala, and Mecuburi. Key achievements to date: Agreement signed with Oxfam Canada in December 2021 Project Implementation Plan finalized in May 2022 Established 6 (Mozambique-4; Uganda-2) service provision clusters (local groupings of health service delivery points) to ensure availability of coordinated, comprehensive services Trained 318 (Mozambique-64; Uganda-254) health service providers to provide contraceptives to young people including provision of Long-Acting Reversible Contraceptives (LARCs). Sensitized 250 (Mozambique-18; Uganda-232) ​health workers including service providers and community health workers (CHWs) on delivery of youth-friendly, non-discriminatory services. Trained 158 (Mozambique-20; Uganda-138) health professionals trained on sexual and gender-based violence (SGBV) and safeguarding practices and policies. Reached 7,098 adolescent girls and young women (AGYW) reached Sexual and Reproductive Health and Rights (SRHR) trainings and awareness activities.

Rostina Pedro Cumbane is a 35 year-old person living with disability (PLWD) and single mother of three children aged 8, 10 and 13 years. She lives in Maputo, Mozambique’s capital city, and plaits women’s hair in a room in her house - her family’s sole income.  Widowed five years ago, Rostina says that while she has been dating, she is yet to find someone she wants to settle down with. Since she doesn't want to have an unplanned pregnancy, she has been going to Associação Moçambicana para Desenvolvimento da Família (AMODEFA), the local IPPF Member Association health center for family planning services, run as part of  the Women's Integrated Sexual Health (WISH2ACTION) program, which is funded by the UK Government under the ethos of ‘Leaving No One Behind’.  The WISH2ACTION programme offers integrated and inclusive family planning and sexual and reproductive health (SRH) services to marginalised and hard to reach populations: the poor, youth under 20, and persons living with disability.  Hearing impaired since birth, Rostina accesses a wide range of services at the AMODEFA clinic in Maputo. Recently, she undertook a HIV test and received a top-up of family planning pills during her regular scheduled appointment.   "I’m leaving here happy because the result (from the HIV test) is negative. This means that the protective measures I have been taking are working," said Rostina, through nurse Rufina Joaquim who interpreted her sign language.   Rostina additionally requested for male condoms to give her partner should he forget to bring some at their next encounter.   "I am very strict about this because I don’t want to have any more children unless it's with a person I trust entirely and with whom I and can make future plans with," said Rostina. "For now, my priority is to educate my children.”   Rostina expresses gratitude towards AMODEFA and recommends that the organization’s services be expanded to other parts of the country where they can reach more women with disabilities, who oftentimes are victims of violence but are not always able to express themselves. SRH Challenges for Persons Living with Disability Some of the SRH challenges that AMODEFA has observed regarding PLWDs’ access to services include: the lack of public health policies that support their access to SRH services, stigma and discrimination (including at facility level) of those who seek services, as well as poor infrastructure at service delivery points, which makes it especially difficult for PLWDs to access these services. From AMODEFA’s experience and subsequent recommendations, it is important to involve Organizations of Persons with Disabilities (OPDs) in inclusive sexual reproductive health and rights (SRHR) capacity building initiatives. This would increase healthcare workers’ outreach to PLWDs and would also help PLWDs learn more about SRH services and their availability. AMODEFA continues to scale up SRH services by facilitating awareness-raising sessions and dialogues on family planning myths and misconceptions, more so among persons living with physical disability and those who are hearing-impaired. Also read: "My Attitude Towards Persons with Disabilities is Different Now"-Mazza, Ethiopia. For more updates on our work, follow IPPF Africa Region on Facebook, Twitter, Instagram and You Tube.

When COVID-19 lockdown measures were put in place in Mozambique due to COVID-19, it led to great challenges, among them people’s difficult access to health facilities where they would receive sexual reproductive health (SRH) services and related information. To continue meeting the needs of its clients, IPPF’s Member Association in the country, Associação Moçambicana para Desenvolvimento da Família (AMODEFA) changed strategy and began using mass media more intensively to reach the masses with much-needed information on COVID-19 and SRHR. Radio proved to be a powerful medium with a wider reach covering both urban and rural populations in Mozambique. With many broadcasts produced in local languages, radio particularly appeals to huge masses, including the illiterate populations in rural areas. AMODEFA has partnered with local radio stations (including community radio stations) such as FORCUM (Forum of Community Radios), Radio Mozambique, Radio Cidade, Radio Indico-89.5, Voice Coop - FM 101.7 and Radio Maxaquene. AMODEFA is involved in the production of interactive programmes that addressed SRH needs in the context of COVID-19. Experts For the successful production of the programmes, AMODEFA undertakes continuous training of the radio producers and presenters on different issues surrounding sexual reproductive health and rights (SRHR). This helps them better package the broadcasts. AMODEFA also avails experts who are interviewed during the shows. These range from doctors, nurses, gender and human rights activists, community health workers and HIV/AIDS counselors. Before an AMODEFA-produced show airs, promos are done days in advance. These are done through radio announcements to inform listeners about the intended broadcasts and help them prepare for the show. The programmes are aired either early in the morning or in the afternoon and are very interactive in nature. They allow for question and answer sessions, which increases participant engagement. Most of the questions from listeners surround about where and how to access family planning and other SRH services from AMODEFA and other health facilities during the pandemic, especially with movement restrictions. While the cost of producing and broadcasting the programmes is high, AMODEFA relies on partnerships, good will and the memorandum of understanding they signed with the stations. For more information about the work of IPPF Africa Region, follow us on Facebook and Twitter.

On the evening of 14 March 2019, Cyclone Idai made landfall in the city of Beira in central Mozambique. With wind speeds of 185 kilometers per hour, it was the largest cyclone on record to hit the Southern Hemisphere and Africa. The impact was devastating, leading to the loss of life and extensive damage to infrastructure – not only in Mozambique, but in Malawi, Madagascar and Zimbabwe. In Mozambique alone, more than 130,000 people had to seek shelter in the 136 accommodation centers (emergency tented camps) that were set up across the county. The situation was dire, and the Mozambican government had to call for assistance to rebuild crucial infrastructure like health, transport and communications. The Associação Moçambicana para Desenvolvimento da Família (AMODEFA), IPPF’s Member Association in Mozambique, responded in the most affected areas of Mozambique, including Beira, Tete, Chiomoio and Zambezia. AMODEFA is still there providing sexual and reproductive awareness and services.  A committed volunteer  None of this would have been possible without the help of volunteers like Emerson Chaves, a clinical psychologist. Emerson is stationed in Chimoio, Manica Province. He is a passionate 29-year-old with a desire to offer psychosocial support to his community. Emerson performs his work with dedication as part of AMODEFA’s emergency response team to Cyclone Idai.  “The people of Chimoio were unable to seek for help after the disaster,” Emerson said. “Trying to survive had become a priority as opposed to seeking health services. Most people will not come for services unless we talk to them first.” Emerson’s work is not without its challenges. He works within a community that has deep-rooted cultural traditions that make talking about sex difficult. Yet his work involves sensitizing people about sexual and reproductive health and rights (SRHR), both at the health facility and within the community. This work is especially targeted at women and girls, who are disproportionately affected by issues of displacement. Emergency situations leave girls and young women vulnerable and at a higher risk of sexual exploitation and forced marriage, and they lack basic health services including sexual and reproductive healthcare. These circumstances increase the need for accurate information and quality services on family planning and reproductive health. “Due to the cultural background, I have to approach the topic in a special way and sensitize my community about sexual and reproductive health and rights,” Emerson points out.  Tackling gender-based violence  He shared his experience dealing with cases of gender-based violence; Emerson said the norm in many communities is that the family of a girl that is sexually assaulted receives a ‘bride price’ from the perpetrator’s family. This is usually done as a negotiation between the families. Once this takes place, the case does not get reported to the authorities – if one reports the case the ‘bride price’ is taken away. Many cases of gender-based violence are not reported because of these types of cultural barriers. Fortunately, the IPPF Humanitarian response was able to utilize the Minimum Initial Service Package (MISP), a set of life-saving activities to be implemented at the onset of every humanitarian crisis. MISP focuses on areas such as preventing sexual violence and maternal and infant mortality, and reducing the transmission of HIV, Through AMODEFA, IPPF rolled out the MISP in the affected areas where more than 130,000 people had been displaced, reaching 9,983 people in total, and 3,350 people with sexual and reproductive health (SRH) services. For IPPF, protecting the SRHR of communities and delivering the necessary SRH services in these humanitarian settings is the main objective.  A day with Emerson Emerson beings his day with a plan at the health facility. He has a choice to visit either of six facilities in his area: Motocoma, Chipinda Umue, Inchope, Zembe, Marera or Macate. At these facilities, Emerson receives clients who have been referred from community mobilizers to seek psychosocial support. On Saturdays, he is out with the community mobilizers to sensitize the community on SRHR. He begins with the group sessions then conducts door-to-door visits. The psychosocial care that people need in humanitarian settings is unique – especially when SRHR are concerned. “People in the community are not aware that the facility is offering services,” he said. “They still think that it is closed after the disaster. It is my duty to give correct and updated information on the situation about health services. The community needs to be aware that we are offering services, especially the community members who need SRH services at this time.” 

On the evening of 14 March 2019, Cyclone Idai collided with the city of Beira in central Mozambique. With wind speeds of 185 kilometres per hour, it was the largest cyclone on record to hit the Southern Hemisphere and Africa. The impact was devastating, leading to the loss of life and extensive damage to infrastructure – not only in Mozambique, but in Malawi, Madagascar and Zimbabwe.  In Mozambique alone, more than 130,000 people had to seek shelter in the 136 accommodation centers (emergency tented camps) that were set up across the country. The situation was dire, and the Mozambican government had to call for assistance to rebuild infrastructure like healthcare systems, transport and communication that has been damaged. Continued access to healthcare had to be a top priority due to the challenges displaced people face. Supporting those in the eye of the storm The Associação Moçambicana para Desenvolvimento da Família (AMODEFA), our member association in Mozambique, is reigniting a glimmer of hope lives of the people in the most affected areas including Beira, Tete, Chiomoio and Zambezia.  Since that fateful day in March, AMODEFA has touched the lives of people who were literally in the eye of the storm. Zaida Chivange, a nurse with AMODEFA, has been an important part of the efforts to help affected communities. She is part of a three-person team in an ambulance which, when we spoke to her, was winding through the busy outskirts of Tete. Ferrying the team to Chimbondi Accommodation Center, which is now home to over 500 families whose homes and lives were shattered by Cyclone Idai. They are now living in tents spread across a woodland savannah with scattered baobabs - where they are at greater risk of contracting communicable diseases. The need for basic healthcare services has increased significantly since the setting has heightened the chances of contracting communicable diseases.  Eager to start helping Zaida is eager to begin her day at the Center. This is because she is aware of the healthcare needs of the community in this hard-to-reach area. They arrive at the Accommodation Centre, to provide critical life-saving services to the people who were affected living at Chimbondi.  Zaida’s station is the AMODEFA clinic, which is a large green tent. Right outside the tent is a makeshift bench where two clients who had just arrived are seated. Zaida exchanges greetings with the two ladies and smiles as opens the wooden door of the tent. Her smile is so contagious that the two clients could not help but smile back. She proceeds to set up the space to receive her first clients of the day. Rays of hope It is outstanding just how Zaida goes about her work with exemplary ease despite the setting. One of the clients she welcomes is a mother-of-one in her twenties who had not heard of family planning before. Zaida requests to show her the various forms of contraception available. The young woman is intrigued by how Zaida displays the contraceptive methods. She opts for the long-term method. After a few minutes of minor surgery, the woman walks out with a contraceptive that will last her a few years.  Staff members like Zaida demonstrate that AMODEFA’s response not only ensures that the dignity of the people living in humanitarian settings is restored, it also gives them a ray of hope that the future is better by providing freedom of choice.

Albertina Machaieie has been working with HIV patients for Amodefa for 38 years and is their longest serving nurse. “I’m going to work forever,” she says. “I like helping people, that’s why I do this job.” Albertina heads up Amodefa’s home care programme which provides medical, nutritional and emotional support to HIV positive patients living in the poorest suburbs of Maputo, the capital of Mozambique. She has seen a dramatic change in attitudes to HIV in the 19 years she has been running the service. In the past she had to hide her car and would visit her patients anonymously. “People feared HIV so they feared me coming to them,” she says.Now people welcome her into the community as a friend and will direct new patients to her. “They call us ‘Muhanyisse’”, which means saviour in the local language Shangaan, she says. Albertina and another nurse work with a large team of volunteers, or ‘activistas’, most of whom are also HIV positive. As well as delivering medication and food to patients and performing health examinations, an important part of Amodefa’s work is continuing to change attitudes towards HIV. “The homecare project encompasses everything,” she says. “It’s not just treatment for illness, we also work with the mind – people need to change their mindset.” She and the activistas give lectures in the community to raise awareness of HIV, and also offer counselling to patients, many of whom find it difficult to accept their HIV positive status. “Husbands and wives stop understanding each other when one is living in denial of HIV,” says Albertina. “They blame the illness on witchcraft.” In other cases, those carrying the virus are scared to tell their families for fear of being rejected. “There are many stories of family members, particularly of wives, who have found they are HIV positive and partners have threatened to leave,” she says. “But when Amodefa has stepped in and advocated, the husband has stayed.” This holistic approach to its homecare has been so effective that medical and psychology students have come from Brazil, the US and Mexico to Mozambique to study the programme and to learn from Albertina’s experience. “I am the library for Amodefa,” she jokes. Over the course of her career Albertina has worked with many challenging cases – particularly men. “Women are more open to treatment because they want to get better so they can care for their children,” she says, “but men often won’t seek help until their health has severely deteriorated.” She recalls one case where a woman tested positive for HIV while she was pregnant. She told her husband to get tested but he refused, and he also prevented his wife from taking any treatment. As a result her baby was born HIV positive - as were her second and third born. “With her last child she started taking the treatment without her husband’s knowledge and the baby was born without HIV,” says Albertina. “This man now says, ‘People, you need to be open – I have three positive children and it is my fault because I would not accept the truth.’” “Children who are HIV positive and don’t know often abandon their medication because they are tired of taking the drugs,” says Albertina. “Ntyiso teaches the importance of taking the medicine. When they are aware of their status, they start taking the medicine normally.” Albertina worked with ten families during the pilot phase of the programme. “Already I have seen great changes in the children, it shows why this project of revelation is so important.” The Ntiyso is a pilot project implemented in Maputo City and it has its focus on disclosure of the HIV + status to adolescents. It targets mothers, parents and caregivers of adolescents. The main activities are: Education and training of Mothers, Parents and caregivers of adolescents to reveal HIV+ status to their adolescents. Due to the Global Gag Rule this project lost its funding and was forced to close. Read more about AMODEFA's tireless work in Mozambique