By Samia Khatun, IPPF WISH Head of Region and Moses Wafula (Reproductive Health of Uganda -RHU) WISH SBCC (Social and Behavioural Change Communication) Advisor In celebration of World Contraception Day, we tell the story of a woman reached through the WISH programme in Uganda, and how this journey has impacted on her and her family. Since 2018 The Women’s Integrated Sexual Health (WISH)[1] programme enhanced access to modern family planning methods for women, especially young people under 20 years of age, people with disabilities, people living in poverty and those living in humanitarian settings.  The programme aims to empower women and girls to make their own choices on shaping their family from how many children to have, to when they would like to have them. Since its inception the WISH2ACTION programme, led by IPPF, covering 15 countries across East and Southern Africa and Asia, provided 25 million years of contraceptive coverage to couples[2], reached over 2.9m new additional users of contraception, of which nearly 16% were under 20 years of age. The modern contraceptive prevalence rate (mCPR) or number of women accessing modern methods of family planning in Uganda for all women stood at 30.4% in 2020. The Government of Uganda has committed to increasing the ability of women who would like to use modern contraceptive to a rate of 39.6% by 2025, WISH is contributing to this effort. Rose’ Road to Determining Her Future Rose* is a 32-year-old woman living in Buyoga village in Ikumbya, a remote village in North-eastern Uganda. Rose is the second wife in a polygamous marriage. She has been married for 16 years and has seven children with her husband. Her eldest child is 14 years old, and the seventh child was just three weeks old at the time we met Rose. The spacing between each of her children is an average of 15 months. “I had not intended to marry so early, but when I was 16 years old, I travelled to another village for holiday where I met my husband. Months later I realised that I was pregnant and got married.” Having six children, she has struggled to provide for her family. Outreach Clinics Rose first learned about healthy birth spacing in 2019 during a WISH outreach in Ikumbya organised by RHU. A Village Health Team (VHT) informed her about the outreach services coming to Buyoga, she would be able to learn more about different contraceptives and to access free services. During this outreach Rose decided to take a three-year implant following comprehensive counselling on the various contraceptive methods available to her. In April 2021, Rose had decided to have her implant removed as she wished to have another baby. Her youngest child then was almost three years old. She got pregnant with her seventh child. Planning for the future The following year in June 2022, RHU re-visited Buyoga village to conduct an outreach clinic. When Rose learned of the visit, she was determined to receive a contraceptive method that would offer her protection for a long period. Provision of family planning after a woman gives birth in Uganda remains sparse, particularly in the first three weeks after birth (with less than 6% of women accessing post-partum contraception) representing a missed opportunity for a woman to protect herself from an unintended pregnancy in the period she is recovering and taking care of a new baby. Rose and her husband opted for the 5-year implant. She explained “I would like to have one more child in the future. After that I might get a permanent method, so that I can then focus on raising my children and give them the best I can.“ Henry Wasswa, the RHU Busoga Coordinator has noted the importance of the WISH intervention in this region particularly for young people, close to 50% of mothers who attend antenatal are below 20 years. “Community dialogues and outreach services provide an opportunity to close the gap for under privileged adolescent girls and young women to make informed choice and decisions. These women often lack access to quality SRHR (Sexual Reproductive Health and Rights) information and access services as facilities are often too far away and too costly to reach,” he says. In Uganda, WISH has been able to reach approximately 2.1 million family planning users, avert over 1.4 million unintended pregnancies and avert more than 2500 maternal deaths[3], representing a £75 million saving in direct healthcare costs. As we mark World Contraception Day it is important to note that many women and girls still do not have adequate access to contraception to prevent unintended pregnancies. While programmes such as WISH have provided vital services, in the long-term more action is needed by Governments to ensure that young girls and women living in poverty are able to access family planning services for free, family planning is offered to all women post-partum and family planning is budgeted for, such that their global commitments are made a reality to improve the lives of women and girls.    *Featured image: a clinician at Reproductive Health Uganda (RHU) For more updates on our work, follow IPPF Africa Region on Facebook, Twitter, Instagram and You Tube. [1] The WISH Programme is split into 2 Lots:  Lot 1 (covering 12 countries in West and Central Africa) and Lot 2 commonly referred to as WISH2ACTION (covering 15 countries in Eastern and Southern Africa + Asia). [2] The estimated protection provided by family planning (FP) methods during a one-year period. [3] This figure is inclusive of all WISH service delivery partners in Uganda not just RHU and is generated using the Impact2 model

Story by Maryanne W. Waweru / Photos by Fortunate Kagumaho IPPF strives to ensure that the rights of all people are protected and upheld, including those of sex workers. Through it's Member Associations, IPPF provides quality healthcare services to this group of vulnerable people. In this article, IPPF Africa Region highlights the work of it's Member Association in Uganda -Reproductive Health Uganda in serving sex workers. We tell this through the experience of Harriet.  24-year-old Harriet* is a sex worker in Uganda’s capital city, Kampala. The mother of one began sex work four years ago, after being introduced to the trade by a childhood friend. “I was idle in my village in Bugiri district, Eastern Uganda. I come from a family of 11 children and my parents, who are peasant farmers, did not have much to provide for us. When my friend told me there were plenty of ways to make money in Kampala and invited me to visit her, I jumped at the opportunity,” says Harriet, who studied up to senior 4 of her secondary education. In Kampala, Harriet would watch with envy as her friend prepared herself every evening to go to work. She would take a shower, apply scented lotion, slip on a tight-fitting dress, apply make-up, put on a pair of clip-on earrings, a glittering necklace and slide into some pumps before leaving the house. She would return in the morning, milk and bread in hand. “With time, I got to learn about the work she did and when she told me it was time for me to join her in ‘bringing milk and bread’, I knew what I was in for,” recalls Harriet. The first time Harriet accompanied her friend to work, it was to a bar. Her friend introduced her to a middle-aged man, then left. “She told me that I was safe with him because he was a friend. The man bought me a meal and several beers. Afterwards, we walked to a lodging a few meters away from the bar where we had sex. In the morning, he gave me 50,000 Ugandan shillings (USD14) before we left the room. It was unbelievable! I was so excited about him giving me that much money just for sex!” says Harriet, as she recalls her debut into the sex trade. From that day, she began accompanying her friend to work every evening. “We would go to bars where she would introduce me to men, who would buy us food and beer before we went to lodgings for sex. With time, I was able to establish my own clientele base.” After eight months, Harriet had saved enough money to move out of her friend’s house and rent her own place. “The money I was making was not bad. At least I did not have to depend on anyone as I was able to feed myself and buy some clothes, lotions, shoes, make-up, and jewelry,” she says. However, Harriet’s work was not without challenges.   “I would frequently get sexually transmitted infections (STIs) since I didn’t always use condoms. Seeking treatment meant spending money, which was expensive. Many times, I would suffer in silence because paying for consultation and drugs meant digging deep into my pockets. I would only seek treatment when the infection was so bad that I could not work,” she says. One day while in the bar sipping on a beer and waiting for a client, a woman approached her. “She told me she was a health worker from an organization called Reproductive Health Uganda (RHU). She gave me information about condoms, pregnancy prevention, HIV and STIs, adding that all these services were offered at RHU at a subsidized cost. She further told me about a programme for sex workers at RHU under the ‘Moonlight Stars’ clinic. Coincidentally, at that very moment I was suffering from an STI, so her reaching out to me could not have come at a better time. Encouraged by her warmth and her friendliness, I opened up, after which she invited me to the clinic the following day, assuring me she would be there to receive me,” recalls Harriet. The following day, Harriet made her way to the RHU Moonlight Star clinic, located in Bwaise, Kawempe division, Kampala, and true to her word, the health worker she’d met the previous day was there to receive her. “She introduced me to the musaawo (clinician) before leaving, assuring me I was in safe hands. After telling her about my work and the problem that had brought me to the clinic, she understood me right away. I didn’t have to explain myself much and I didn’t feel judged or rebuked by her. In other health centers I had visited, some clinicians would make snide remarks about me, asking why I sleep with other women’s husbands. Some would tell me that I could find something better to do with myself such as sell vegetables, while others openly preached to me. Sometimes, other clients would get served before me, yet I had arrived earlier. But I didn’t feel this way with the musaawo at RHU that first day, and the good services I receive have encouraged me to keep returning there. I have referred many of my friends to RHU and they too share similar sentiments. The staff are very professional and always make us feel welcome at their facility, whose services we also find to be very affordable. Even when we don’t have money, the RHU staff never turn us away. They still treat us, something that we have never experienced anywhere else. That’s why we keep going back to RHU,” she says. Harriet says she has learnt a lot about her reproductive health from RHU, including family planning. She is currently on the Jadelle implant as she does not want to get pregnant. “The musaawo told me that the implant would give me protection for five years, though if I wanted to take it out earlier in case I was ready to have a child then I could. I have also learnt about the importance of condoms, and I usually get them from RHU. I never run out of them, because RHU always has them in stock,” she says. Sex workers like Harriet form part of the key populations that RHU targets in their work. Key populations, identified by UNAIDS, includes sex workers, men who have sex with men (MSM) and injecting drug users, all of whom have the highest risk of contracting and transmitting HIV. Their activities are usually criminalized and highly stigmatized, including by healthcare workers, which hinders their access to much-needed prevention, care and treatment services. This increases their vulnerabilities to negative health outcomes. Sex work is criminalized in Uganda. Rhoda Namukwana, the nurse in charge at RHU’s Bwaise Moonlight Star clinic says one of their areas of specialty areas is serving at risk people and key populations. “The Bwaise area consists of densely populated slums that have a high population of sex workers and their clients. We offer a wide range of sexual reproductive services at our clinic, which are highly accessed by sex workers. Our outreach activities involve going to sex workers’ hotspots such as bars, lodgings and popular streets where they congregate, socialize and approach clients. There, we give them information about sexual reproductive health and rights and refer them to our clinics for further management. These venue-based services at sex worker hotspots enhances their access to services, and also helps to address the limitations of clinic-based services,” she says. According to Namukwana, RHU’s range of services targeted at sex workers include: family planning, laboratory services, antenatal and postnatal care, safe abortion services, cervical cancer screening, HIV counseling and testing, and STI treatment, and well as treatment services for minor ailments. Clients also get referred for Pre-exposure prophylaxis (PrEP), which is a course of HIV drugs taken by HIV-negative people to protect them against HIV infections. For clients who test positive for HIV, RHU refers them to its partner health facilities for further management, which includes antiretroviral therapy (ART). “In a day, we serve about 30 clients, mostly women, who include sex workers. A lot of the services are STI related, including those related to HIV testing services.” HIV prevalence among sex workers in Uganda was estimated at 37% in 2015/16, with sex workers and their clients accounting for an estimated 18% of new HIV infections during the same period. (Avert) Since she began sex work four years ago, Harriet remains happy with the services offered at RHU’s Moonlight Stars Clinic. “RHU has been a great partner in my work. The information and services I receive have enabled me to live a healthy life,” says Harriet, who is saving money from her sex work with the hope of starting her own business someday -a bakery. *Name has been changed to protect her identity. Also read related story: Promoting the Human Rights of Sex Workers in Uganda Maryanne W. Waweru is the Communications Officer, IPPF Africa Regional Office. Fortunate Kagumaho is the Communications Coordinator at Reproductive Health Uganda.

  The project aims to provide SRH services to refugees and the most vulnerable and marginalized population in Northern and Central Uganda. Budget:  10,000,000 DKK Donor: DANIDA Timeline: 2 Years ( April 2020-March 2022 ) Project implementation areas: Ouganda Partners: Uganda MOH, Uganda crisis coordination office Key achievements to date: 47,631 persons (73% females and 27% males) aged 10- 49 years of age served with integrated sexual reproductive health services 284,048 SRH services provided Enhanced capacity of 60 community resource persons and 77 health care providers in various SRH and SBCC packages.   Innovative approaches: Working with persons with disabilities to ensure disability-inclusive programming Lessons learned: Cultural diversity, beliefs, and practices significantly undermine how refugees relate.

The Japan Trust Fund (JTF) represents a visionary partnership that began in 2000 between the Government of Japan and IPPF. Together, we invest in programmes that prioritize health equity, gender equality, and human security for all. Traditionally a driving force behind IPPF's efforts to support the integrated HIV prevention programmes of our Member Associations in Africa and Asia, JTF has adjusted to reflect changing global health priorities. We attach importance to universal access to sexual and reproductive health and rights - an essential contributor to universal health coverage and the global development goals.     These projects have transformed the lives of people most vulnerable to HIV and high risk of maternal and child mortality. Equally, it ensures that as a donor, the GOJ’s response to HIV remains people-centred and contributes to human security.      

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/  

The SPRINT Initiative provides one of the most important aspects of humanitarian assistance that is often forgotten when disaster and conflicts strike: access to essential life-saving sexual and reproductive health services. We build capacity of humanitarian workers to deliver essential life-saving sexual and reproductive health services in crisis and post-crisis situations through the delivery of the Minimum Initial Service Package (SRH) for reproductive health in emergencies.   Through funding from the Australian Government's Department of Foreign Affairs and Trade (DFAT) our SPRINT Initiative has brought sexual and reproductive health to the humanitarian agenda, increased capacity and responded to a number of humanitarian emergencies. Australia has funded the SPRINT initiative since 2007 and has supported reaching 1,138,175 people to date and continues to respond to ongoing emergencies.   In each priority country, we work with an IPPF Member Association to coordinate and implement SPRINT activities. Through these partnerships, SPRINT helps strengthen the enabling environment, improve national capacity and provide lifesaving services during times of crisis.   You can read more about the SPRINT Initiative and IPPF Humanitarian’s Programme here.   Australian Government's Department of Foreign Affairs and Trade (DFAT)      Australia's location in the Indo-Pacific provides us with a unique perspective on humanitarian action. Australia is committed to helping partner governments manage crisis response themselves. This is done through building the capacity of the national government and civil society to be able to respond to disaster. DFAT also works with experienced international partners to prepare for and respond to disasters, including other donors, United Nations agencies, the International Red Cross and Red Crescent Movement and non-government organisations.  

IPPF collaborates with UNAIDS and The PACT to implement ACT!2030 (formerly ACT!2015), a youth-led social action initiative which engages young people in 12 countries with advocacy and accountability around the Sustainable Development Goals (SDGs) and other SRHR agreements/frameworks. ACT!2030 was initiated in 2013 as a way to increase youth participation in the negotiations leading up to the adoption of the post-2015 development agenda, and for two years focused on establishing alliances of youth-led and youth-serving organisations in 12 countries across the world. The project is currently in Phase 4, which runs until the end of 2017, and aims to establish youth-led, data-driven accountability mechanisms to ensure youth engagement with the implementation of the SDGs and build an evidence base for advocacy. Ultimately, Phase 4 of ACT!2030 seeks to identify, assess and address key policy barriers to young people’s sexual and reproductive data by using existing data, supplemented by youth-collected data, to advocate and lobby for policy change. This phase involves four main activities: indicator advocacy (persuading decision makers to adopt youth-friendly SRHR and HIV indicators, including on things like comprehensive sexuality education (CSE) and access to youth-friendly services, into national/global reporting mechanisms); evidence gathering (creating national databases on quality of and access to youth-friendly services and CSE); communications (transforming this data and evidence into communications pieces that can be used to advocacy and lobby at national and international level); and global exchange (facilitating global visibility to share advocacy and engagement learnings and increase youth-led accountability in global and regional processes). ACT!2030 is implemented by national alliances of youth organisations in 12 countries: Algeria, Bulgaria, India, Jamaica, Kenya, Mexico, Nigeria, Philippines, South Africa, Uganda, Zambia and Zimbabwe.  

This is the story of Nnambi, a young 14-year-old girl from Uganda who shares her experiences living with HIV. Watch more educative videos by AMAZE here.

  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.

Maka is a satisfied family planning (FP) user from Uganda. She is a mother of eight children living in a polygamous home shared with three co-wives who are raising a total of 23 children in the household. She has been struggling to take care of her eight children with no financial support from her husband. She heard about FP by Women’s Integrated Sexual Health (WISH) Village Health Teams (VHTs) who are trained by WISH humanitarian partner International Rescue Commission, (IRC) and was referred to Koro Health Centre III for further information and services. Maka received comprehensive counselling after which she made an informed choice and settled for tubal ligation. During a home follow-up visit, Maka expressed her satisfaction with the tubal ligation and had not experienced any side effects. She is now a promoter of long acting and permanent FP methods in the community. WISH programme has been working with satisfied users to increase uptake of long acting and permanent methods to poor and marginalised women in Uganda. Incorporating satisfied users in sexual and reproductive health and rights programs is critical because other potential FP users trust them. Satisfied users are working with VHTs and service providers to provide community awareness and dispel myths and misconceptions about FP. They identify potential users of FP and accompany them to the health facilities where they receive comprehensive counselling to enable them to make informed choices on their desired methods of contraception. The IRC has also strengthened the capacity of health workers through training, values clarification and attitude transformation and provides FP commodities to facilities to ensure all FP methods are available on request at the health facilities. Maka reported that she is now able to concentrate on her business which she uses to support her family. She is now a member of a women's savings group and has gained greater credibility among her peers. She can now take good care of her children and pay for their educational needs. Between March 2021 and May 2021, Koro Health Centre III served 14 clients with IUD, 109 implants and 2 with tubal ligation. Out of these, nine clients were identified and referred by Maka to the facility. Featured photo: a team of service providers from Koro HC III during a follow-up home visit to Madam Maka Woko. For more updates on our work, follow IPPF Africa Region on Facebook, Twitter, Instagram and You Tube.