Sylvian Musau tackles motherhood while helping youth in her community avoid unwanted pregnancy.

Over half of all sexually active adolescent girls in Kenya who want to delay pregnancy have an unmet need for modern contraception.

Sylvian Musau didn’t know about family planning until she became unexpectedly pregnant at age 20. “I never knew how to face my parents because I saw that I was a failure — a disappointment.” For Sylvian, this concern went beyond her family: Adolescent pregnancy is considered shameful to her Jomvu community, one of the settlements in Mombasa county along the Kenyan coast.

Sylvian knew the judgment wouldn’t stop after giving birth. “So, you don’t know what choice to make,” she admits. “Do you abort, do you keep the child? How will you manage? How will you bring that child up?”

Over half of all sexually active adolescent girls in Kenya who want to delay pregnancy have an unmet need for modern contraception. While the national government has committed to reducing teenage pregnancy rates and released an adolescent sexual and reproductive health policy, the coastal region has been slower to make progress.

PAI grantee Kenya Muslim Youth Development Organization (KMYDO) is changing that by engaging with local government and health officials to address the lack of youth-friendly sexual and reproductive health services and funding in the region. KMYDO is a national organization that inspires grassroots youth activism, strengthens community leadership and supports the growth of family planning advocacy.

During her pregnancy, Sylvian was connected with KMYDO and its community-based partner, the Pwani Youth Network (PYN). This is when PYN staff members taught her about family planning and women’s empowerment. Now as a new mother, Sylvian shares what she learned with young people in Mombasa county.

With support from PYN and KMYDO, Sylvian is teaching her peers how they can prevent pregnancy and HIV infection using contraceptives such as condoms. She also counsels young girls, connecting them to the nearest health clinic; and hosts family planning dialogues with youth groups and religious institutions in person and on social media.

By bringing her daughter Chelsea to events, Sylvian has shown her community what it means to be a young mother. She hopes that speaking openly about her experience will decrease the stigma she faced and also encourage young people to use family planning to prevent unwanted pregnancy.

Seeing her child growing gives Sylvian the “strength to go out there — speak, work and hustle.” In the future, she sees herself as an ambassador who will impact “not only the subcounty, but the whole of Kenya. Because there’s no greater feeling than helping a person who needs it.”

I never had knowledge about contraceptives. I never had a person to mentor or empower me … [Now,] I do share my story … Because there’s no greater feeling than helping a person who needs it.

Sylvian Musau, youth mentor

With financial and technical support from PAI, Observatorio de Mortalidad Materna en México empowers indigenous youth to work with health clinics to ensure providers are giving quality, nondiscriminatory and culturally relevant sexual and reproductive health care.

In 2015, in response to the country’s high teenage pregnancy rate, Mexico established a national strategy designed to strengthen young people’s access to sexual and reproductive health care. However, due to widespread discrimination, indigenous adolescents and youth continue to face significant obstacles accessing birth control and youth-friendly sexual and reproductive health care.

This is certainly the case in Chiapas, the country’s poorest state and home to one of its largest indigenous populations. Compared to young women nationally, adolescent girls in Chiapas have more children on average and have a higher unmet need for birth control. 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.

Observatorio de Mortalidad Materna en México (OMM) is working to change that. With financial and technical support from PAI, OMM created a program that trains indigenous youth to work alongside health clinic staff in Chiapas to ensure that they are providing quality, nondiscriminatory and culturally relevant care. This includes offering sex education materials in indigenous languages and banning the denial of care to young women in traditional dress.

As a citizen monitor, Cecilia Hernández, 16, travels to public health facilities across Chiapas to record how staff treats patients. In one instance, she saw that multiple contraceptive options were unavailable at a clinic. Cecilia knew this inventory was critical and when she asked staff members about it, they told her that the contraceptive methods requested from the Ministry of Health were overdue to arrive.

“This is harder for young people,” she explains, “because they don’t have money, they have a hard time asking for what is [available] and not that many pharmacies sell birth control.”

Social accountability, specifically citizen monitoring, is an important step in providing oversight to Mexico’s relatively decentralized public health system. The evidence OMM’s citizen monitors gather is used to educate the government of Chiapas on how to improve the quality and accessibility of care at the 45 public health facilities serving thousands of indigenous youth and women in the region.

In a region where indigenous people, especially youth, are left out of conversations about their well-being, the work of citizen monitors is helping to broaden those discussions and make sure that health clinics are meeting the pressing needs of the communities they serve. Cecilia and OMM are driving real change in their communities, and PAI is proud to support them in this essential work.

Meeting people in the health centers, getting to learn more about sexual and reproductive health and having the opportunity to travel to other communities — this job is a blessing.

Cecilia Hernández, citizen monitor, OMM

In early 2020, the Ministry of Health announced that family planning services — including a wide range of contraceptive options — would be included in Zambia’s new benefits package.

Countries around the globe are embarking on bold plans to achieve universal health coverage (UHC) and expand affordable health care to citizens. But as history has shown, if advocates are not part of the process, women and girls will be overlooked, and the cost of high-quality sexual and reproductive health services, including contraceptives, will remain a barrier for those who need them most.

Thanks to PAI partner the Centre for Reproductive Health and Education (CRHE), history won’t be repeating itself in Zambia.

When the government of Zambia introduced a new national health insurance initiative in 2018 as part of its UHC reforms, CRHE and PAI mobilized quickly, leveraging our collective strengths to ensure that family planning would be included.

CRHE advocates tapped into their local networks and experience with the Zambian political landscape to gain key intel on the process and timeline. PAI offered a technical analysis of the proposed health insurance plan and advised on the best opportunities to engage decision-makers.

With this analysis in hand, CRHE gathered Zambian family planning advocates and other stakeholders for a workshop. PAI was present to help clarify the policy implications of the new insurance program on sexual and reproductive health and supported attendees as they developed an advocacy strategy. At the end of the two days, members of the coalition left with a robust plan of action.

With PAI’s continued support, CRHE led the coalition as members pursued the advocacy agenda and worked with government decision-makers. In early 2020, their hard work paid off when the Ministry of Health announced that family planning services would be part of the new benefits package. This included a wide range of contraceptive options that would allow women to choose the one that works best for them, from birth control pills to implants, injectables, intrauterine devices and emergency contraception.

The decisions governments are making now around UHC will impact their citizens for years to come. It’s essential that organizations like CRHE are there to advocate for the health needs of women and girls and that PAI can provide them with the tools and resources they need to succeed.

PAI recognizes that advocacy requires a long-term investment and its support of CRHE has helped us achieve many wins for women and girls over the years.

Amos Mwale, executive director, CRHE

Expanding access to legal, comprehensive abortion care in Ethiopia has led to a significant decrease in maternal mortality due to unsafe abortion.

In 2005, Ethiopian advocates and health providers scored a victory for women and girls when they helped secure a more liberal abortion law that decriminalized the procedure and expanded the circumstances under which it is allowed. Improved access to legal, comprehensive abortion care and an increase in the number of people using family planning have led to a decline in maternal deaths from unsafe abortions.

As one reproductive health professional in Ethiopia told PAI, “When [the government] pushed through safe abortion care, women stopped dying.”

The Ethiopian government, public health experts and civil society know that legal, safe abortion care is critical to saving lives. But the Trump-Pence administration’s expanded Global Gag Rule (GGR) undermined Ethiopia’s progress on reducing maternal deaths due to unsafe abortions by cutting out critical providers from receiving U.S. global health funding.

Under the policy, qualified and trusted health professionals are prevented from providing safe and legal abortion services, including giving patients full and accurate information about their pregnancy options. It further blocks advocates from working with their governments to improve national abortion laws and policies.

The GGR forces foreign organizations to choose between receiving U.S. global health funding and providing comprehensive sexual and reproductive health care to the people they serve. This has led to the closure of clinics and mobile outreach programs that are the trusted — and sometimes sole — sources of family planning and other reproductive health services for marginalized groups in Ethiopia, particularly youth and hard-to-reach rural communities.

The GGR has also damaged long-standing partnerships between health care providers and impeded their ability to integrate sexual and reproductive health services with other vital programs, such as nutrition counseling, HIV testing and maternal health screenings.

The United States is the largest global health donor to Ethiopia and has helped build up and strengthen the country’s health systems. But the GGR is rolling back those achievements, including the country’s own domestic efforts to save women’s lives through progressive abortion policies. In our Access Denied reports, PAI has documented the harmful impacts the policy is having in countries like Ethiopia, giving our allies in Congress direct evidence of the policy’s consequences and strengthening the case for its permanent repeal.

When [the government] pushed through safe abortion care, women stopped dying.

Interview from Access Denied Ethiopia