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The restrictive measures to contain the spread of the deadly COVID-19 virus have made it even more difficult for young people to access essential life-saving sexual and reproductive health and rights (SRHR) services, including comprehensive sexuality education (CSE) and contraception; putting them at greater risk of teenage pregnancies, unsafe abortion, gender-based violence (GBV), sexually transmitted infections (STIs) and HIV. While the lockdowns and other containment measures such as closure of schools and institutions of higher learning have curtailed CSE meetings with peer educators, IPPF’s Member Association in Kenya, Family Health Options Kenya (FHOK)  has been able to continue providing CSE with minimum disruption through its well established WhatsApp mobile application. This has worked particularly well in Kenya which has over 95% mobile phone penetration – one of the highest in Africa – and where many young people have access to smart phones. Besides, WhatsApp is the most popular mobile messaging application in Kenya for young people aged 13 to 24 years because it is affordable, accessible, and easy to use. During the lockdown period from April to end of May, FHOK reached 2,351 youth (1,321 young women and 1,030 young men) with accurate, age appropriate sexuality education and COVID-19 information using this platform, allowing them to not only make informed choices about their sexuality, but also increase their awareness on the COVID-19 pandemic and response. FHOK has successfully used WhatsApp to reach in and out of school youth with CSE since 2016. The approach was started in the urban centres of Mombasa, Nakuru and Mombasa; and in 2018 was expanded to all FHOK’s 10 youth centres across the country. By the beginning of this year, FHOK had 102 trained and active facilitators, 85 active WhatsApp groups and had reached an estimated 13,105 youth in 2019. This approach is now even more crucial due to the COVID-19 pandemic. The facilitators use the FHOK facilitator guide, which is based on the  IPPF CSE curriculum, to deliver structured sessions that covers topics including SRHR and HIV and AIDS; gender; GBV; relationships; youth friendly services; drugs and mental health; life skills; peer education; and advocacy. To ensure that the sessions, held once or twice a week for about two hours, are engaging and interesting, facilitators use e-posters, storytelling and short videos to spur discussions. The mobile platform also provides opportunities for psychosocial support for young people when needed and anonymity is assured for participants when necessary. The facilitators also link participants, who may require additional SRH services, with service providers at an identified clinic or youth centre since FHOK clinics are still open. Supportive community systems and good working relationship with community gatekeepers have made it possible for young people to continue accessing CSE information and nondiscriminatory SRH services during the COVID-19 crisis. For more information about the work of IPPF Africa Region, follow us on Facebook and Twitter.

Cynthia is a young 23 year-old lady from Kenya. She tells us of her experience working on a youth-centered project at Family Health Options Kenya (FHOK). “Before I joined the Access, Services and Knowledge (ASK) project, I had never seen a female condom in my whole life. In fact, before then, I couldn’t even pronounce the words 'vagina' or 'penis'. I was so shy and felt so embarrassed about mentioning these body parts by their actual names. I would refer to them as 'things'. However, after my engagement with the ASK project, including intensive training on issues of adolescent sexual reproductive health by FHOK, I built up my confidence and now I'm able to confidently educate my peers on matters of their sexuality. Today, I speak to the young people in my church about healthy choices, more so those concerning their relationships and sexual health. I also pick condoms from FHOK for distribution among my friends and other young people. I'm not afraid about holding a condom up and explaining its proper use to my peers. Through my engagement with the youth activities at Family Health Options Kenya - FHOK, I am a better informed youth and a champion for sexual reproductive health and rights and this makes me feel proud.” The Access, Services and Knowledge (ASK): ‘What Young People Want, What Young People Need’ was a three year programme that targeted young people in the age group of 10-24 years. The overall objective of the project was to improve the use of SRHR services by young people (10-24 years) through demand creation, provision of youth friendly information and services (including commodities), and ensuring public private partnerships with a greater respect for young people’s sexual rights. It was implemented in the five countries of: Senegal, Uganda, Kenya, Ethiopia and Ghana. Story by FHOK and Maryanne W. Waweru, IPPF Africa Region

By Maryanne W. Waweru Melvin Ouyo is the Hospital Matron at Family Health Options Kenya (FHOK) –Nairobi West clinic. The facility has been implementing the Cervical Cancer Screening and Preventative Therapy (CCSPT) –supported by the International Planned Parenthood Federation (IPPFAR) Africa Region. Melvin shares her experiences with regard to the cervical cancer awareness, mobilization and provision of services during outreach activities. How do you Create Awareness around Cervical Cancer? Melvin: We conduct community outreach activities. We announce our intended ‘cervical cancer camp’ for about three weeks before the activity. We mobilize women through door-door campaigns, distribution of leaflets, announcements in churches, in women’s groups, and in chiefs’ baraza’s. Most of these activities are undertaken by our peer educators and community health volunteers, all of whom have received basic training on cervical cancer. How do you Conduct the Outreach Camps? We station tents in selected areas within the camp venue. Locations for the camps include strategic open fields, churches and classrooms. During the outreaches, we give information on cervical cancer and also provide screening services. Screening helps detect the presence of precancerous lesions in the woman’s cervix. We use the Visual Inspection with Acetic Acid / Lugol’s Iodine tests (VIA/VILI) method for screening. If any precancerous lesions are detected, we then offer the woman cryotherapy treatment, which involves the freezing of abnormal tissues. However, if the woman is found to have advanced precancerous lesions, we refer her to a higher level health facility for further management. Do Women Readily Accept to be Screened for Cervical Cancer? Melvin: Not really. Most women in the community are hesitant about it and ask many questions before they agree to it. Some of the questions asked are: Will I be able to have sex after screening? Will I be able to walk after screening? If the results are positive, does it mean that I have cancer? How long will I have to live? We however offer the woman adequate counselling before she undertakes the test, ensuring she understands the testing procedure and the implications of a negative or positive test result. Why are Some Women Reluctant to Undergo Screening? Melvin: Many fear to test because of the fear of positive results. I have had many women tell me they would rather live in ignorance, rather than find out they have precancerous cells. We however encourage them to test, letting them know that cervical cancer is highly preventable, especially if diagnosed in the early stages. We also notice that women, especially those who have never had children gasp as we explain to them the testing procedure, which includes widening the vagina with a speculum. Because of this fear, some refuse to undertake the test. Interestingly, women who have had children, more so those who had traumatic vaginal births cringe at the thought of a medical instrument being inserted in their vagina. Because of a prior negative birth experience, some refuse to take the test. Unfortunately, we also see cases of women who present with chronic abdominal pain and bleeding. Their cervical cancers are usually at an advanced stage. Many seek hospital treatment late, having held on to the belief that the constant bleeding and ‘chronic stomach ache’ is as a result of bewitching by a jealous neighbour. They spend months taking herbs and local concoctions before eventually coming to us as a last resort. We refer them to higher-level facilities.    Do Women ask about Cervical Cancer Treatment? Melvin: Yes they do. They are curious to know if the treatment is 100 per cent effective and if it will cure them of cancer should screening results turn positive.   Women also ask about the mode of treatment –whether it will be in the form of pills, injections or if it will require hospital admission and for how long. We however inform them of our cryotherapy treatment procedure which is quick and painless. We also let them know that the treatment method is dependent on the extent of the precancerous lesions spread, and the need to refer them for advanced treatment if need be. Do you Involve Men in your Activities? Melvin: Yes we do! Even though our main target population is women, we include men as they are critical determinants to the health and well-being of women. We invite them to listen to the information shared during outreaches, as they too can pass on this information to other women. Whenever couples come together for family planning services or HIV testing in our clinic, we give them information on cervical cancer and the need for the woman to get tested. More often than not, it is actually the men then encourage their wives to undertake a cervical cancer screening test. With the support of their partners, you find many women accepting to get tested, their fears having been allayed. About the Cervical Cancer Screening and Preventative Therapy (CCSPT) Initiative Cervical cancer is the fourth most common cancer in women worldwide. The vast majority of women who suffer cervical cancer in Sub-Saharan Africa seek care when the disease has already advanced and is far beyond the capacity of surgery or other treatment modalities to offer cure. IPPFAR's response to Africa's cancer burden is through the Cervical Cancer Screening and Preventative Therapy initiative, which is aimed at maximizing the number of cancer services offered to women through a validated, low-cost screening and preventative therapy approach. Screening is carried out using Visual Inspection with Acetic Acid (VIA), an evidence-based and affordable alternative approach for cervical cancer screening in low-resource settings. Maryanne W. Waweru is the Communications Officer, IPPFAR For more updates on our work, follow IPPF Africa Region on Facebook and Twitter

The IPPF European Network Regional Director Ms. Caroline Hickson has today paid a courtesy visit to the Executive Director of Family Health Options Kenya (FHOK), Mr. Edward Marienga. FHOK is IPPF’s Member Association in Kenya. Ms. Hickson is on a working visit to the IPPF Africa Regional Office located in Nairobi, Kenya. During the meeting, Mr. Marienga oriented Ms. Hickson on FHOK’s work in the country, whose core focus is the provision of quality sexual reproductive health and services to millions of men, women and young people. FHOK, a local Non-Governmental Organization has been a leading service provider of sexual and reproductive health services in the country for over five decades. With a strong grassroots network, FHOK is present in 14 Counties (out of 47), through its Family Care Medical Centers. Through innovative delivery programming and capacity building, FHOK particularly focuses on young people, marginalized groups, underserved and inaccessible populations in the country. FHOK has a pricing policy that offers affordable, quality and easily accessible services to all. The meeting between Ms. Hickson and Mr. Marienga also acted as an experience-sharing forum between the two parties, where both discussed best SRHR implementation practices. FHOK also showcased its successful business models including its Learning Center and other income-generation ventures, which have greatly contributed to the success and sustainability of the organization over the years. “Our work has also been greatly enhanced by the strong partnerships that we have formed with different stakeholders, chief among them the Government of Kenya. We recognize the invaluable support of the Government in the achievement of our goals, and regularly consult with them on various issues. We also collaborate with them in programme activities, such as cervical cancer screening, testing and treatment, as well as various HIV/AIDS activities –including at the grassroots level. FHOK works with other non-governmental organizations, community-based organizations, faith-based organizations, youth networks and other groups towards the realization of it's goals,” Mr. Marienga added. Other issues that were discussed included effective advocacy strategies in the push for supportive SRHR policies and legislations at local, national and regional levels.   Ms. Hickson commended FHOK for its work, saying that there was plenty to learn from the organization, and which can also be emulated by other Member Associations –including those in Europe. IPPF EN includes 39 Member Associations and collaborating partners in as many countries throughout Europe and Central Asia. The Region reaches from Iceland to Kyrgyzstan and from Russia to Israel, from some of the richest countries in the world to some of the poorest, from donor countries to recipient countries, from long-standing democracies to countries still struggling to find their way.  Learn more about IPPFEN here. Learn more about FHOK here.

One day, while going about her daily activities in her home area in Nakuru, Kenya, 26 year-old Teresia Wangui happened upon a group of people providing medical services. They particularly seemed to be targeting women and since she had a few minutes to spare, she made way to the tent where they were. It was this decision that would save her life –literally. On offer at the medical camp were mobile cervical cancer screening services by the Family Health Options Kenya (FHOK) –Nakuru branch. FHOK is the IPPF Africa Region Member Association in Kenya. “When I approached the tent, I found out that they were offering free cervical cancer screening services, and I decided to get tested too because I felt that I needed to know my status,” says Teresia. It was a decision that paid off because Teresia was found to have pre-cancerous lesions. To help allay the development of these lesions into cervical cancer, she was referred for further treatment - cryotherapy, which is a treatment for abnormal cells on the cervix. Cancer of the cervix is caused by the Human Papillomavirus (HPV) through sexual contact, with most people acquiring the infection shortly after the onset of unprotected sexual contact. However, pre-cancer lesions of the cervix are easily detectable by a trained medical provider. Regular screening tests can lead to early detection and treatment, which makes cervical cancer highly preventable. “Had I not made that split decision to pop into the medical camp by FHOK, I probably would not be here sharing my story with you today. I’m glad that I was able to be screened and receive treatment. I would advise all ladies to go for cervical cancer screening even if you are young and have not had children, since it affects everyone who is sexually active. I would also like to tell my fellow women not to wait for services to be brought to their doorstep. Cervical cancer screening services are also offered in many clinics, so it is your responsibility to undertake regular checks. You are the one responsible for your own health,” she says. Cervical cancer remains a major public health problem in developing countries, especially in Africa where an estimated 53,000 women die of the disease every year, according to the World Health Organization (WHO). In response to this, FHOK implements the Cervical Cancer Screening and Preventative Therapy (CCSPT) Initiative in different parts of the country through its static clinics. The CCSPT Initiative is aimed at improving reproductive health outcomes for women, with specific regard to cervical cancer. The CCPT initiative aims at maximizing the number of cancer services offered to women through a validated, low-cost screening and preventative therapy approach. Screening is carried out using Visual Inspection with Acetic Acid (VIA) -an evidence-based and affordable alternative approach for cervical cancer screening in low-resource settings. The CCSPT initiative offers instant treatment for clients with pre-cancerous lesions using cryotherapy –a method that involves freezing of precancerous lesions. Story by FHOK and Maryanne W. Waweru, IPPF Africa Region

Saturday 27 August 2016, Nairobi, Kenya The IPPF Director General, Mr. Tewodros Melesse has decried the shyness -and sometimes hypocrisy with which issues of Sexual Reproductive Health and Rights (SRHR) are dealt with in Africa, especially by its leaders. “When talking about development, there has always been the tendency to prioritize other issues, but not those of sexuality. Yet, conversations about Africa’s development cannot be meaningful without giving credence to reproductive health rights, and more so those pertaining to girls and women. If we fail to tackle women’s challenges in accessing quality healthcare, then we cannot make progress with regard to women’s empowerment. Sexual Reproductive Health and Rights are fundamental to women’s advancement, and women’s advancement means development for Africa. This must be recognized and prioritized by our African governments,” he said. Mr. Melesse was speaking during an African First Ladies’ seminar titled: ‘Investing in Child and Maternal Health for Social Transformation in Africa: Spotlight on Evidence Based Interventions’. The seminar was organized by the African First Ladies’ attending the sixth Tokyo International Conference on African Development (TICAD VI). In his remarks, Mr. Melesse cited the various impediments to African women’s success, such as early marriages –which leads to many girls ending thier schooling. “With no education, this only creates fertile grounds for her poverty and that of her family. Further, when a woman has no access to family planning information and services, then she is not able to adequately space her births or have the number of desired children, and with many mouths to feed, then this becomes a great challenge for her –only enhancing her poverty status. It also becomes hard for her to gain meaningful employment or sustain a job, more so when she has to take frequent breaks from work to care for her pregnancies or young children. That is the reality, especially in the private sector,” he said. Mr. Melesse said that tackling sexual reproductive health and rights for women is one of the sure ways to elevate the status of African women. “Supporting women’s rights means that we will have more women represented in the higher echelons of power, including in Parliament. It also means that we will have more women who are able to attain a tertiary education status. It will also mean that we will have more women in the employment sector, and more women in entrepreneurship, among other sectors,” he said. Mr. Melesse also recognized some of the progress that has been made with regard to the support of Sexual Reproductive Health and Rights in the continent. “Most African governments have aligned themselves with the stipulations of the Maputo Plan of Action (MPoA), together with the Sustainable Development Goals (SDGs). This progress has to be acknowledged. However, while we have the framework, the key issue is their implementation, where African governments must honor their commitments towards Africa’s development. I must also commend Kenya’s First Lady H.E Margaret Kenyatta for her ‘Beyond Zero Campaign’, which is indeed an example of a noble initiative that can be emulated across the region, as it focuses on women’s health, and especially maternal health,” he said. Mr. Melesse reiterated the fact that health is critical to development, and women’s health is central to this. “We must not be shy to talk about sex and reproductive health. We must have these conversations that will ensure that every African child is wanted, that every African woman is healthy, and that she is a human being whose rights are respected,” he concluded. Other panelists included: Dr. Mustapha Sidiki Kaloko –African Union Commissioner for Social Affairs, Dr. Matshidiso Moeti –Regional Director, WHO Regional Office for Africa, Dr. Seth Berkley, Chief Executive Officer GAVI –the Vaccine Alliance, Ms. Katherine Perry, Country Coordinator (Kenya) U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and a representative of Dr. Babatunde Osotimehin, Executive Director, United Nations Population Fund (UNFPA). The session was moderated by Ms. Julie Gichuru, Kenyan journalist and host of Africa Leadership Dialogues

One of the principles that IPPFAR stands for and champions across the region, is the empowerment of adolescent girls and young women. This it does by implementing, through Member Associations, different programs and projects that are focused on this population. One such initiative is the ‘3E Project’, currently being implemented in the three countries of Malawi, Kenya and Uganda. In these countries, girls and young women aged between 10 – 25 years and who are particularly vulnerable to HIV, as well as those living positively with HIV are empowered to voice their needs and concerns through mentoring activities and through social media. The trained youth advocates play a key role in mobilizing other young women by building their advocacy skills on HIV and Sexual Reproductive Health and Rights (SRHR). This they do through community outreaches, conducting educative sessions in schools, in their neighborhoods, as well as sending out messages on popular social media platforms such as Facebook, Twitter and WhatsApp.   “When women hold key decision-making positions, then they are able to push for the agenda of all women across the country, and advocate for their rights. Since 2015, the 3E project has been on a journey to nurture the leadership skills of adolescent girls and young women, especially in the area of sexual and reproductive health and rights (SRHR),” says Ms. Nathalie Nkoume –IPPFAR’S Gender, Sexual Rights and Advocacy Advisor, who is coordinating the 3E project. To date, the project has trained over 75 young passionate and vibrant girls who continue to raise awareness on different aspects of SRHR among their peers, their parents and the school community (including teachers). These passionate young girls – Africa’s growing leaders, have spearheaded different initiatives in their own communities that are focused on empowering fellow young women and raising their status in society. “We go to schools, colleges and talk to girls in the neighborhood about sexual reproductive health and through this, many girls have come back to us and told us that they have been able to make informed choices about their sexuality because of the information we shared with them,” says Bridget Ndagire from Uganda. 19 year-old Caroline Mulenga from Malawi says that she has been able to refer hundreds of young girls for reproductive health services. “Through the 3E project, I have got to learn of facilities that offer youth-friendly services in my area, and I refer young girls there. Previously, they were reluctant to access SRHR information and services at health centers because they were not as accommodating of their needs. But I have been able to let them know that nowadays, many health providers have been trained on how to effectively handle the sexual reproductive health needs of young people, and I have seen them taking up services,” she says.   Bridget, Caroline and other young advocates trained by the 3E project are now recognized as sources of quality SRHR information in their communities, and continue to raise their voices in different platforms they are invited to –including at the national and regional levels where they raise thier voices and all for the prioritization of the reproductive health needs of young African women. The project has also had an effect on the girls at a personal level.  "Before the project, I was not able to stand up and speak before people. I was afraid and shy. But not anymore. I am happy to say that my engagement with the 3E project has made me more confident, and today I can address a huge gathering of people in my community, where I share with them information on among others: sexual and reproductive health,” says Jacinta Auma from Siaya County in Kenya.  The 3E Project, implemented through the technical assistance of IPPF Africa Region and with financial support from UN Women, has indeed transformed the lives of adolescents and young women in the three countries. Story by Maryanne W. Waweru, IPPF Africa Region.