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PAI envisions a world where all people have access to high quality, affordable and comprehensive sexual and reproductive health care.
For more than 50 years, we have worked towards this goal, confronting whatever obstacles stand between women and girls and the sexual and reproductive health care they need and deserve. As attacks on reproductive rights have intensified, and global commitment to justice and equity has become paramount, our work remains guided by our values.
Our unwavering commitment to global reproductive rights is grounded in:
Innovation. Empowerment. Inclusion. Accountability.
These four organizational values guide our work every day. They help us decide how we support those we serve and how we work responsibly and effectively to advocate for real change in the lives of women and girls.
Innovation helps PAI adapt to an ever-changing environment and find solutions to new and expanded threats like the Global Gag Rule.
Empowerment provides our local partners in countries like Kenya, Zambia, Mexico and Indonesia with the financial support and strategic guidance they need to be their own values-driven advocates.
Inclusion drives us to honor the differing perspectives of our partners, listen to our colleagues and understand that there is more than one way to achieve success.
Accountability ensures that together with our partners, we guarantee that policymakers follow through on their commitments.
In the United States and around the world, 2018 was a year of challenges—but also a year of victories. From the global rise of the #MeToo movement to the U.S. midterm elections, we have witnessed the impact of these changes on our work and how our advocacy affects the rest of the world. In this report, we reflect on what brought us here and what will move us forward in the year to come.
Drawing on our values has made us bolder in our leadership and humbler in our partnerships. We have become even more strategic in our programs and efficient in our operations.
We have focused on what motivates us every day to support and protect the rights of women and girls, globally. This report reflects our commitment to what we value and how those values shape our work.
Because values-driven advocacy is not just about achieving our goal—it’s about doing so with integrity.
President and CEO
Our mission demands us to be strategic, imaginative and opportunistic as we pursue the change we want for women and girls around the world.
Challenging global political environments require us to be nimble and proactive to yield positive outcomes for women and girls.
In 2018, this was best exemplified by our ongoing effort to push back against the destructive Global Gag Rule, which forces organizations to choose between receiving U.S. global health assistance and providing comprehensive sexual and reproductive health care.
As the Global Gag Rule’s effects deepened around the world, PAI remained committed to helping clinicians, advocates and policymakers navigate this policy. Key to the long-term strategy to permanently end the Global Gag Rule is our work documenting the policy’s impact on health care providers and the women and girls who depend on them.
Unfortunately, the policy is so complex and its effects are so wide-ranging that many policymakers are not yet fully aware of its impact. Recognizing that media coverage can help educate and elevate the need for country- and donor-driven action, PAI has employed a media strategy that simultaneously engages journalists in the U.S. and in the Global South at the national, regional and district levels to ensure the greatest visibility for this crisis.
In addition to ongoing media education and engagement, in 2018 we brought journalists together for roundtable discussions in Europe, as well as East and West Africa.
I hadn’t heard any mention of the Global Gag Rule. When I received the invitation [to the workshop], it led me to start searching and I turned to the Togolese Family Welfare Association and asked whether they knew about it and are feeling any impact. I found out there is real impact. The organization told me that all of a sudden, all funding that came from USAID was cut off. Those who suffer are grassroots beneficiaries. I realized after this research there is need to talk about this issue.”
Radio Broadcaster, Togo
Our goal was simple: to ensure that journalists fully understood the policy and the harms that it would inflict on the health systems of countries receiving U.S. global health assistance.
To humanize the impact, we connected journalists with partners affected by the Global Gag Rule. At the same time, we highlighted to partners how strategic engagement with journalists can amplify their own advocacy efforts, helping to create a global community using a diverse range of tools to fight back against this harmful policy.
Because of PAI’s targeted global media roundtables, journalists have produced powerful stories on the Global Gag Rule in:
Kenya, Ethiopia, Malawi, Togo, Senegal, Benin, Mauritania, United Kingdom and United States.
PAI staff and partners have been featured in media outlets including:
VOA Africa News Tonight, The Washington Post, Deutsche Welle and BBC World Service Radio.
The agency, initiative and priorities of the people we serve drive how we make a difference in the world.
PAI believes that finding local solutions to the challenges women and girls face to their reproductive health and rights creates lasting change, and helps countries become less reliant on foreign aid.
Our work begins and ends with partnership. It is informed and guided by our partners and the most pressing policy and advocacy needs from their perspective. Our work is responsive to their demands for change and visibility as well as their desire for country ownership.
The Women Promotion Centre (WPC) is one of our partners that took their advocacy and leadership to the next level in 2018. And they did it on their own terms.
Led by young women, the nonprofit works in Kenya to improve young people’s access to sexual and reproductive health services.
Since it’s taboo to discuss these issues in public, most young people get information from their peers—and it’s often inaccurate. At the same time, these youth, especially young women and girls, often endure hostile attitudes from health care providers, as well as condemnation by religious and community leaders if they use contraceptives.
That all began to change in 2018 thanks to the work of WPC. With support from PAI over the past three years, the group has made critical breakthroughs in transforming attitudes and advancing young people’s right to access sexual and reproductive health care.
Young people are less likely to embrace and accept policies if they feel they are not part of them. Therefore, there is a great need for young people to be meaningfully engaged in policy discussions so their voices can be heard and included. This improves youth ownership, success and uptake of policies.”
Program Manager, Women Promotion Centre, Kenya
PAI worked with WPC to craft and refine their advocacy strategy and provided guidance as they turned their strategy into action. This included spearheading an advocacy campaign to implement a new national adolescent sexual and reproductive health policy.
WPC convened policymakers, religious leaders and reproductive health advocates to support the creation of youth health centers in Nairobi and throughout Kenya. The voices and experiences of young people were central to WPC’s effort.
The outcome? The shared dialogue among influencers boosted political support for the youth centers and positioned WPC as a strong youth- and women-led organization making needed change. And WPC’s advocacy led to a new taskforce that is now fast-tracking the implementation of Kenya’s national adolescent sexual and reproductive health policy.
The Women Promotion Centre held
17 roundtable discussions
with young people and local decision-makers on the sexual and reproductive health needs of adolescents and youth, resulting in the government fast-tracking the creation of youth centers throughout Kenya.
We honor the different perspectives of our partners and encourage shared learning, fresh ideas and new insights to ensure that all voices are heard.
PAI’s advocacy zeroes in on improving policies and increasing funding related to sexual and reproductive health. To make this strategy globally successful, we seek partners in the Global South that approach the work of our movement from different angles and include voices not always heard in conversations about sexual and reproductive health and rights.
One such partner is Observatorio de Mortalidad Materna (OMM) based in Chiapas, Mexico—one of the country’s poorest states and home to one of its largest indigenous populations, with 12 federally recognized ethnicities. OMM focuses on improving sexual and reproductive health care through evidence generation and public policy monitoring.
PAI’s work with OMM is in the highlands in Chiapas with the Tzotzil and Tzeltal Maya, where deep discrimination and inequality among indigenous adolescents and youth undermine their right to access sexual and reproductive health care and drive high teenage pregnancy rates.
Part of OMM’s work is equipping indigenous youth with the skills to monitor Chiapas’ health clinics. The goal? To make sure providers are giving quality, nondiscriminatory and culturally relevant care that is aligned with a national strategy to prevent teenage pregnancy.
To achieve this, PAI worked with OMM to craft an advocacy strategy that ensures national policies include the needs of indigenous adolescents and youth. It also holds health providers accountable for delivering those services in culturally appropriate ways.
This includes facilities offering sex education materials in indigenous languages and banning the denial of care to young women in traditional dress.
How? By training indigenous young people like 28-year-old Maruch Hernandez to become citizen monitors at their local clinics.
Last year, Maruch and her partner Juana visited public health clinics in 11 communities. While there, they documented whether young people were able to access the health care they desired, as well as the availability of contraceptive supplies and medicines to treat sexually transmitted infections. They also noted if clinics had long queues, forcing patients to wait for hours.
It’s important for youth to participate. It’s how you learn. It’s how one day, if something happens to me or happens to someone I know, and I need to go to a clinic, I’ll be able to know what I need. If I hadn’t done this work, I wouldn’t know anything.”
Juana Jiménez Guzman
Health Promoter, Observatorio de Mortalidad Materna, Chiapas, Mexico
The evidence gathered by Maruch and other citizen monitors showed that teenage pregnancy in the highlands is directly related to persistent difficulties in accessing contraceptives.
This evidence is now being used to educate the newly elected government of Chiapas on how to improve the quality and accessibility of care at the 48 public health facilities serving over 40,000 indigenous youth and 20,000 indigenous women in the region.
For Maruch, who also teaches workshops about sexual and reproductive health and rights, serving as a health promoter is a chance to equip youth in her community with critical information to choose their own futures. This is especially true for girls, who are often forced to marry young and have no say in decisions about their reproductive health.
Observatorio de Mortalidad Materna trained
10 indigenous Tzotzil and Tzeltal youth
to conduct citizen monitoring at
48 public health facilities
to assess the quality of care provided to patients.
We trust and support our global partners’ abilities to drive change in their communities by holding policymakers, service providers and individuals accountable for their decisions and actions.
For PAI, accountability means fulfilling the promises we have made to women and girls—especially the most vulnerable. That requires ensuring earmarked funding is spent and policies are implemented by officials, clinicians and communities after they are passed and adopted.
In Uttar Pradesh, India, PAI partner SAHAYOG plays an important role in translating policies meant to empower women and girls to accountability at the community level. Through our partnership, SAHAYOG was able to expand Ek Saath—their initiative that engages men in rural communities to tackle harmful gender norms, reduce gender-based violence and foster shared responsibility for family planning among men and women.
In Uttar Pradesh’s Chandauli village, as in many communities, deeply entrenched patriarchal gender norms make it difficult for women and their husbands to talk about contraception and sexuality and the need for women and girls to have the same social and economic opportunities as men.
Female community volunteers deliver contraception and discuss such matters with women. However, many men remain uninformed about family planning. As key household decision-makers, their ignorance often creates barriers around the usage of birth control and other reproductive health needs.
But now, Ek Saath is providing a space for men to learn from their peers about condoms and vasectomies, as well as contraceptive methods for women. And the approach is helping dismantle long-standing norms and transform men’s behavior and attitudes.
My wife and I had five children in three years because we didn’t know about family planning. I realized my wife was overstretched. She had no time between caring for the children and housework. The children were also cranky and acting up. So, I started taking more of an active role with them and helping around the house. Now our relationship as a family has improved. My children love me more and trust me to take care of them even when my wife is out.”
Husband in Chandauli village, India
Since being involved in the initiative, men have been inspired to become more involved with housework and taking care of their children. The rate of violence in Chandauli—and specifically, violence against women—has decreased. And more girls are staying in school.
In 2018, Ek Saath held
17 community-level meetings
with 330 women and 580 men.
The meetings were also attended by
210 government officials and 80 journalists
resulting in 70 articles published in local newspapers.
The past two years have brought unrelenting attacks on the reproductive rights of women and girls around the world. In the face of these attacks, we have kept focused and held true to our guiding values.
These values have led PAI through triumphs, like when a young woman in Nairobi, Kenya can access the birth control she wants, and moments of heartbreak, like when the Global Gag Rule is expanded, causing more women and girls to lose access to critical sexual and reproductive health care. Our core convictions keep us evolving and propel us forward, smarter and more committed after every win and every loss.
Without these values, we cannot create a better future for women and girls.
As we anticipate another unpredictable year due to the current political climate, we will continue to lean into our values for direction, focus and energy to accomplish our shared vision.
PAI doesn’t tell [partners] what to do; they give them the opportunity to do it better. To me, that’s just the right way. It often takes a lot longer, but it is the way to make lasting change.”
We will seek innovative ways to elevate the devasting impact of the Global Gag Rule and build support on Capitol Hill for its permanent repeal.
We will provide the financial resources and strategic guidance that empower our more than 70 partners across the Global South to create change in their communities.
We will foster inclusive relationships with our partners as we work together to improve the health and autonomy of women and girls.
And with our partners and supporters, we will hold policymakers accountable for their commitments and actions.
Together—with our partners and with you—we will create a world where women and girls have the quality reproductive health care they deserve.