Vital Sexual and Reproductive Health Services provided – by you

199 individuals have received vital help through your PopOffsets funding. The latest report from WINGS in Guatemala shows the life-changing benefits have been given by making simple long term contraception freely available where it currently isn’t. A small amount of donated money can change a families future for the better.

These poor families have had no prior access to contraception and so have had large families as a consequence, putting strains on their health and well-being, as well as adding to environmental pressures.

With a grant of only £5000, 199 women have been supplied with long term contraception meaning they can now continue looking after their existing family without the worry of another pregnancy and child.

I. In October 2015, Pop Offsets generously provided WINGS a grant of £5,000 in support of our project Increasing Access to Contraception in Guatemala. The grant has been spent nearly in full, and therefore we are writing to inform you how these funds have allowed WINGS to increase access to contraception in geographically remote areas through the provision of mobile reproductive health services.

II. Project Summary, Activities, and Results
Guatemala is the most populous country in Central America, and also has the highest total fertility rate in the region, 3.8 children per women. Despite expressing the desire to space or limit subsequent births, 27.6% of sexually active Guatemalan women are not using any form of contraception, a clear indication of unmet need for family planning (OHCHR 2011). In indigenous communities, unmet need for family planning reaches nearly 30% and contributes to women having an average of 4.2 children. Limited public expenditure on healthcare, approximately 2.6% of GDP, exacerbates longstanding inequities and results in highly uneven access to social services among the indigenous Maya. In many of the communities in which we work, over 90% of residents cannot reach a health facility within an hour (UNDP 2005).
WINGS operates two mobile medical units which provide long-acting reversible contraception (LARCs), copper intrauterine devices (IUDs) and subdermal hormonal implants (Jadelle), and rapid cervical cancer screening. Staffed by our team of professional nurses, auxiliary nurses, and drivers, our mobile units travel throughout 12 provinces, scheduling on average 12 mobile clinics per month and in addition coordinate voluntary surgical contraception clinics with our network of stationary partner clinics.
Through August 2016, our mobile medical units have reached 1,950 individuals with vital sexual and reproductive health services through 199 mobile clinics. Our medical teams have distributed 537 copper IUDs, which provide up to 10 years protection, and 1,413 Jadelle subdermal implants, which provide up to 5 years protection. Additionally, the team has performed 426 tubal ligations, 79 vasectomies and 3,295 cervical cancer screenings. Thankfully, only 74 women, or less than 2% of cases, have required cryotherapy treatment for precancerous lesions. In total, WINGS’ mobile units have reached 71% of their annual projection for LARCs, as well as 71% of the annual projection for permanent procedures (tubal ligations and vasectomies). We have seen a positive turn regarding use of the IUD, with an increase in usage of 85% in comparison to the same period of time in 2015. This trend reinforces the effectiveness of using the LARCs First Methodology when presenting contraceptive methods to users.
2
During a recent mobile clinic this August, in the IXIL region of Quiche, we met Petronila. At 24 years old, she has four living children. Weighing only 99 pounds, she presented signs of severe malnutrition, and unfortunately, that means her children are likely malnourished as well. Accompanied by her mother in law, she told WINGS´ nurse Blanca that she came to learn about the screening for cervical cancer, but wasn’t interested in a contraceptive method. However, once inside the examination room, in a whisper, Petronila revealed that in fact she did want a contraceptive method as she didn’t want to have any more children, but her husband does not allow her to use a method, and she was afraid her mother in law would find out and tell her husband. It is quite common in many rural communities where WINGS works to encounter this barrier to access. Men often deny their wives access to contraceptives as it is commonly believed that a large family proves a man’s masculinity, and women use contraception to hide their infidelity or seek revenge on unfaithful spouses.
Blanca explained the various contraceptive methods available to Petronila, and that in cases like hers, the IUD is favorable, as it is undetectable, meaning no one in her family would find out she was using a method. While Petronila thought about her options, she underwent a cervical cancer screening, which unfortunately came out positive for precancerous lesions. She was very scared by the results. It is common for women to think they have cancer and begin to imagine the worst when results are positive. However, Blanca took extra time to sit with Petronila and walk her through the process of treatment with cryotherapy, which can be done on the spot. After roughly an hour, and after recruiting the help of a local health center nurse who committed to following up with Petronila and even to help her speak with her husband, she agreed to undergo cryotherapy treatment and choose the IUD, which will protect her for 10 years against an unintended pregnancy. The community, Santa Avelina Cotzal, where Petronila is from, saw the largest turnout of the three clinics WINGS hosted in the area, with 42 women attending. In Quiché, on average women have 4.1 children, making for the highest departmental fertility rate in Guatemala. WINGS is excited to increase our presence in the department, and make a difference in the lives of women, overcoming the linguistic, cultural, and geographic barriers that exist to accessing services in the area.
Working in close collaboration with our mobile medical units, WINGS network of youth leaders, women and men between ages 14 and 19 trained extensively in sexual and reproductive health information, give
Women from Santa Avelina Cotzal during educational talk.
3
informal and formal talks to other youth in their communities on various sexual and reproductive health topics, in addition to providing referrals for services from our network of volunteer promoters, mobile medical units, and “youth-friendly” clinic spaces. To date, our network consists of 69 youth leaders who have given 1,043 informal talks, 91 formal, in-school talks, and hosted 26 health fairs reaching 7,196 adolescents. Their hard work translates into 261 new adolescent users opting for a LARC and 416 adolescent users opting for short-acting contraception. We have seen an increase of 68% in use of long-acting reversible contraception among 14 to 19 year olds, in comparison to the same period of time in 2015. Of the individuals attending our mobile clinics, 2 in every 10 is an adolescent.
III. Finances
As of August 2016, WINGS has spent 91% of the grant provided by PopOffsets. The remaining £438.90 will be used to partially fund 1 mobile clinic during the month of September, providing 10 women with Jadelle implants, among other services. The executed funds provided 140 women with Jadelle implants, which translates into the prevention of 60 unintended pregnancies, 13 unsafe abortions, 38 live births, and 532 couple years of protection. In addition, women and their families saved £ 1,246.75 ($1,920) in direct healthcare expenditures.

For more information about WINGS, please visit the WINGS website

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A First for Philippines Family Planning

Funding from PopOffsets has provided new Family Planning for the people of Caloocan City in the Philippines. £5,000 of funding through the Population Matters Charity has helped over 100 participants with procedures to give them control over their fertility. There are many challenges to overcome including people in the community who stick to their myths on contraceptive methods despite efforts in the project to provide information and education.

Partnerships have been established with:

  • Caloocan City Health Department for access to the district’s health centers and the barangay health workers assigned there
  • Caloocan Private Midwives Association for assistance in demand generation and service delivery

  • Philippine Society of Reproductive Health Nurses for assistance in community education and service delivery

Here is the latest report:

PERIODIC REPORT

PROJECT TITLE

Bridging the Gap In Family Planning Service Delivery

NAME OF PROPONENT

The Family Planning Organization of the Philippines

NAME AND DESIGNATION OF CONTACT PERSON

Mr Nandy Senoc

Acting Executive Director

ADDRESS OF THE ORGANIZATION

50 Doña Hemady St., New Manila, Quezon City

CONTACT DETAILS OF THE ORGANIZATION

(02) 7217101 / (02) 3588139

fpop1969@yahoo.com, nsenoc_fpop@yahoo.com

PROJECT SITE

Caloocan City, District 2, National Capital Region, Philippines

PROJECT PERIOD

Six (6) months

TOTAL PROJECT COST

Php 1,259,000

AMOUNT REQUESTED

Php 344,000 (£5,000.)

DATE OF SUBMISSION

June, 2016

  1. PROJECT DESCRIPTION

  1. Objectives

  1. To generate demand for family planning services and commodities among the target group through the assistance of barangay(village) health workers and local organizations

  2. To provide family planning services and commodities to the target group

  3. To reach out, at least, 3000 new acceptors of a varied mix of artificial family planning methods

  1. Activities

  1. Conduct of capacity-building on reproductive rights and issues in the local context and introduction on the project for barangay health workers

  2. Establishment of partnerships with local organizations and health facilities for service delivery

  3. Courtesy calls to city and barangay officials

  4. Profiling of the target group

  5. Deployment of motivators to recruit acceptors from among the target group

  6. Conduct of 30 community education sessions on family planning for the target group

  7. Dispensing of commodities such as pills, injectables, condoms, and intra-uterine devices to the target group as counselled by the members of the project team who are medical practitioners

  8. Provision of facility-based services for long acting permanent and reversible FP methods by the project team or partner service providers to specific members of the target group, particularly those who require the said methods as counselled by the project team

  9. Submission of reports to the Regional Office of the Department of Health for the determination of movement in the contraceptive prevalence rate

  1. ACCOMPLISHMENTS

ACTIVITIES CONDUCTED

QUANTITY

TARGET

RESULTS

  1. Project Orientation Meeting

1

1

The meeting was instrumental in bringing together the key actors in the project, specifically 23 barangay health workers who are expected to aid in demand generation and profiling.

  1. Organizing Meetings

2

6

Organizing meetings were used for project monitoring, evaluation, and planning purposes.

  1. Barangay Assemblies

1

3

Barangay assemblies were used to coordinate with and update local officials on the status and results of activities.

  1. Coordination Meetings

3

6

Coordination meetings were used to facilitate collaborations with service providers.

  1. Service Provision of Temporary, Long-Acting, and Permanent Methods

3 bilateral tubal ligation sessions; daily provision of services for temporary and long-acting methods

No specific target. Services are provided as desired by the acceptors.

Services provided yielded a CYP of 327.29.

  1. Community Education Sessions

5

30

A third of the current total number of new acceptors came from the community education sessions.

SERVICE OUTPUT

METHOD

QUANTITY

Non-scalpel vasectomy

1

condoms

28

Natural family planning

0

Pills

35

Injectables

24

Intra-uterine device

2

Bilateral tubal ligation

70

MILESTONES

The successful motivation of one acceptor of services for non-scalpel vasectomy is noteworthy, considering the inherent difficulty of getting males to agree to the procedure. Machismo runs high in the Philippines even with efforts in this project to educate the male population on the real effects of non-scalpel vasectomy.

The sole acceptor reported here agreed to the procedure because he did not want the recovery process entailed in BTL to interfere with his wife’s breastfeeding activities. The acceptor, however, could not be counted on to help motivate his peers as he does not wish to reveal to others that he accepted the procedure.

PARTNERSHIPS ESTABLISHED

  • Caloocan City Health Department for access to the district’s health centers and the barangay health workers assigned therein

  • Caloocan Private Midwives Association for assistance in demand generation and service delivery

  • Philippine Society of Reproductive Health Nurses for assistance in community education and service delivery

  • LuzonHealth for assistance in community education sessions

  • Population Services Pilipinas, Inc. for bilateral tubal ligation services

  1. CHALLENGES AND INNOVATIONS

There are people in the community who stick to their myths on contraceptive methods despite efforts in the project to provide information and education. One example is the resolute resistance to non-scalpel vasectomy. The males commonly invoke a misconception or two and then promptly pass the responsibility to their partners whom they expect to singly use a method. This challenge will be circumnavigated by tapping male organizations or individuals who can endorse non-scalpel vasectomy.

The barangay health workers are indispensable partners in this project. They know the communities very well as they are assigned where they are based. However, their workload is undeniably excessive, and they are underpaid. Demand generation activities highly depend on their availability because project staff may not conduct activities in the communities without them mainly for security reasons. This unavoidable handicap is remedied by tapping local officials to fill in for the barangay health workers. The downside to this, though, is the lack of knowledge on the part of officials as far as potential acceptors and their health history and issues are concerned.

staff

Here are some of the project team members in their white shirts breaking for a photograph with health center staff. The health centers are the focus of the project as the strategy is to collaborate with the health centers in doing demand generation and service delivery. The barangay health workers are based in the health centers, and they help in demand generation. Service delivery, on the other hand, is done in cooperation with the health centers’ midwives and nurses. The project works with 15 health centers in this 2nd district of Caloocan City.

Barangay (Village) Health Workers from eight health centers in the 2nd District of Caloocan City were gathered for an orientation on the project. During the workshop, they were grouped according to the health centers they belong to. They were asked to portray their vision of District 2 as far as reproductive health is concerned by means of illustrations. At the end of the session, the barangay health workers were asked to come in front and sign their groups’ commitment to their agreed vision.

one

This photograph shows the first new acceptor of the project receiving an injectable from one of the project team members. The team was doing its rounds for the first time in one of the barangays of the project site. The patient was promptly screened right outside her home and then taken to the nearest health centre for the administration of the injectable.

A project team member in one of her home visits. Visiting prospective acceptors right at their homes is one of the better ways to reach the women in the community. Most of the women stay at home to take care of their children, leaving them no time and no means to visit the health center for health care services. Team members bring along a bag of commodities to be able to provide counseling and service on the spot. Otherwise, they invite the women as soon as possible to the nearest health center.

patient

Acceptors of free implant and IUD insertion at FPOP’s Metro Manila
clinic waiting for their turn after undergoing FP counseling.

For over a year now, government health facilities are prohibited to
perform implant insertion due to the Temporary Restraining Order
(TRO) issued by the Supreme Court. The Order was issued after anti-choice group filed a petition against the use of implant, claiming that it is abortifacient. Because of the TRO, women who opt for implants are trooping to avail of free implant services by non-government service providers like FPOP.

Fabiola from Guatemala given a better future

In a recent mobile clinic in San Francisco Zapotitlán, we met Fabiola, a 21-year-old mother of three children. Fabiola is one of seven siblings, whose mother sold vegetables in the local market to provide for her children. While her mother was at work, Fabiola was in charge of the house, taking care of her younger siblings, despite being a child herself.

As is the case in many Guatemalan families, nobody ever told Fabiola about birth control. When she was 18, Fabiola had her first child. She struggled because on top of looking out for her younger siblings, she now had her own baby to take care of. At 19, Fabiola had her second child. Today, Fabiola is 21 years old and has three children. Raising her three children has not been easy: 

“Being a mother is a beautiful thing, but sometimes I feel like I can barely manage. I can’t afford to provide my children with everything I’d like to give them, and when they get sick, I can’t sleep because I’m worried about their well-being”.  

Days before the mobile clinic, our Field Supervisor Mylin visited women in San Francisco Zapotitlán to talk about their family planning options and encourage them to attend our mobile clinic. Although Fabiola showed up, she was very nervous about using birth control. In San Francisco, as in many Guatemalan communities, birth control is highly stigmatized. While she was afraid that her community would judge her, Fabiola knew that she could not afford to have more children. After discussing which contraceptive options we could offer her, Fabiola chose the subdermal hormonal implant, which provides up to 5 years of protection. Fabiola shared her gratitude as she now does not have to worry about becoming pregnant and can dedicate all her time to raising her three boys. 

“WINGS is one of the few organizations that has reached out to women in my community. Many of us do not have enough money to go to a big hospital and pay for expensive services. Once I told the nurses I did not have enough money for the implant, they gave it to me for free!”

Visit our main website to donate and find out more about PopOffsets:

http://www.popoffsets.org/

Meet Ana from Guatemala

19 year old Ana Antonieta was one of the first to arrive at our WINGS mobile clinic in Guatemala. She had struggled to access information or contraception in the past which is why she gave birth twice at such a young age. Thanks to funding from PopOffsets, she like many other women in her community, opted for the highly effective Jadelle to delay pregnancy for five years. She can now spend five happy years with her two children without worrying about any unwanted pregnancies.

Read the full story here:

https://popoffsetssite.wordpress.com/2016/04/21/family-planning-help-for-vulnerable-guatemalan-girls/

Visit our main website to donate and find out more about PopOffsets:

http://www.popoffsets.org/

 

Pop Offsets: WINGS Interim Update 2016

 

The latest uplifting report from our chosen charity, Wings, with news of help given to vulnerable girls and women in Guatemala.

Pop Offsets: WINGS Interim Update

In October 2015, Pop Offsets generously provided WINGS with a £ 5,000 ($7,576.50) grant to fund 9 mobile clinics, and provide highly effective long-acting reversible contraceptives (LARCs) to 150 adolescent girls and women in Guatemala. We are writing now to provide Pop Offsets with an update on how these funds are enabling WINGS to increase access to essential family planning and reproductive health services among vulnerable women and girls throughout Guatemala.

Mid 2015, WINGS began the important process of strengthening its service provision by acquiring a second mobile unit and hiring the supporting medical team including a Gynecologist to serve as Medical Director and nurse practitioners to offer services in rural communities. With the second mobile unit equipped and staff trained, our team expanded service provision from 4 to 12 provinces in a 6 month period. Although we originally anticipated providing services in 8 additional provinces, the ongoing instability in the Ministry of Health and corresponding demand from a variety of local and international organizations has driven our team to respond to the needs at the national level.

Organizing at least 9 mobile clinics a month with community organizations and local charities, our team has travelled to remote communities on a daily basis to provide copper intrauterine devices (IUDs) and subdermal hormonal implants (Jadelles), in addition to cervical cancer screening and immediate treatment for precancerous cells with cryotherapy. During each clinic, two nurses provide LARCs to approximately 20 women, but in some instances, the team sees 50 women in a day for a combination of family planning and reproductive health services.

In addition to acquiring the second mobile unit, WINGS also implemented a no cost policy for adolescents under age 20. In Guatemala, 58.1% of young women become pregnant for the first time before age 18, contributing to one of the highest adolescent fertility rates regionally: 92.4 pregnancies per 1,000 women aged 15 to 19 (ECLAC 2014). According to the 2008-2009 National Maternal and Infant Health Survey, only 6.5% of adolescents between ages 15 and 19 currently use a modern contraceptive method (MSPAS et al. 2010). Although the level of use rises to 24.2% in young adults between 20 and 24 years, 25.6% of young women between 15 and 24 expressed an unmet need for family planning, the highest of any age group, implying that various barriers exist to access (MSPAS et al. 2010).

The immense unmet need among young Guatemalan women underscores the lack of accessible and affordable youth-friendly services.

Thus WINGS has moved to an increasingly youth-friendly approach which includes removing economic barriers to services as well as increasing service delivery points throughout the country and implementing a new counselling methodology which takes into account the desires of young women regarding initiation or continuation of childbearing.

Ana Guatemala

19-year-old Ana Antonieta and her two children, pictured, visited our mobile clinic in Morelia, a village in the Western Highlands. Accessible only by a muddy dirt road, our mobile team passed through an overflowing river to reach the mountain roads leading to our clinic location. Because of how hard it is to enter and leave the village, Ana had struggled to access information or contraception in the past which is why she gave birth twice at such a young age. However, when our promoter informed women in Morelia about our upcoming mobile clinic, Ana Antonieta was one of the first to arrive. She like many other women in her community opted for the highly effective Jadelle to delay pregnancy for five years and plans to share her experience with friends and family so that they are able to benefit from these mobile services.

In a recent mobile clinic in San Pedro Limón, a community straddling the border between Alta Verapaz and Quiché, a 12 year old girl arrived with her husband. Although the Guatemalan Congress raised the legal age of marriage from 14 to 18 for girls in November 2015, child marriage remains widespread in many rural impoverished communities where the lack of educational and economic opportunities have impeded a cultural shift away from this practice.

As it is often quite difficult to reach these young brides and ensure that they have access to information and services to make well-informed decisions and delay high-risk pregnancies, our team was impressed that the young couple came on their own to learn about their options. Mobile Unit Coordinator Blanca spoke with them privately about the reproductive risks the young girl might face in pregnancy and provided complete contraceptive counselling in Q’eqchi’, the couple’s native language. Although the couple was not ready at the time, they recently contacted us to inquire about the availability of the smaller copper IUD models which we will provide to the girl in a follow-up clinic.

Claudia Guatemala Wings

Nurse Claudia unloading supplies for the San Limón mobile clinic

The interest of the young couple in the copper IUD is not unique. Rather uptake for this highly effective LARC has been growing in communities we serve. Historically myths and misconceptions about how the contraceptive method worked have deterred women from utilizing the copper IUD. However, our efforts to dispel myths and promote the benefits through community talks and home visits are helping: in a small mobile clinic in Sololá in October 2015, 7 out of 9 women attending opted for a copper IUD. As pictured at right, two of the women in the clinic examine the copper IUD during our pre-clinic talk. Since that October clinic, WINGS has provided a total of 233 IUDs in addition to 849 Jadelle throughout the country. Moreover, our mobile teams continue to build on their initial successes increasing access to LARCs by coordinating additional clinic dates each month and visiting clinic locations up to two weeks in advance to offer informational talks and individual counselling.

We look forward to sharing our advances on this grant in October.

700 unwanted pregnancies avoided in 6 one-day clinics

Kenyan mother and child

PopOffsets has just released figures from its latest Dandelion Africa project, reporting that it helped Kenyan families avoid 700 unwanted pregnancies through six one-day clinics at a cost of just over £5000.

With no availability and means to provide themselves with effective contraception, PopOffsets and Chase Africa provide these desperately needed services, free of charge, together with support and education.

By investing in Family Planning, the families that are helped are no longer under immense stress that large families can bring.  The families are smaller, happier, children are better cared for. They have a brighter future and parents have more time to spare. This then means the environment is under less pressure from larger numbers of people.

Pop Offsets invests in family planning around the world, in the name of people and the planet.

More information on the latest project can be found here: https://popoffsetssite.wordpress.com/2016/01/23/2/

(2869 CYP @ 0.25 per CYP =  717 pregnancies using Guttmacher Institure calculations https://www.guttmacher.org/pubs/2011/01/24/Guttmacher-CYP-Memo.pdf

 

 

Dandelion Africa 2015 report

ChaseAfrica

Report by CHASE Africa to PopOffsets

Grant for 6 one day clinics from September to November 2015

Dandelion Africa has a well-established procedure for operating one day clinics. Key to success is effective mobilisation before the clinic happens.  Many people in rural areas have a negative attitude to family planning and it is essential that Community mobilisers spend enough time in the community trying to dispel the many misconceptions and highlighting all the benefits family planning can bring. The clinic is further publicised with posters displayed around the community and with announcements on the local radio station.

Six one day Clinics were held in the following communities:

Athinai 26th Sept, Lomolo A 16thOct , Oterit 23rd Oct, Lomolo B 5th Nov, MajaniMingi 12th Nov and Alfega on the 26th Nov.

Steve Bown a board member of Population Matters visited Dandelion twice in 2015 seeing a clinic in operation in February in Lomolo B and one in Gaakwen in September. His report on Dandelions activities was very informative and encouraging.

The staff on a one day clinic comprises two doctors, up to three nurses, two mobilisers, and two of Dandelion Africa’s staff to organise the day. Each of the nurses or doctor work from a small pop-up tent to provide privacy for the patient. A range of different services are offered including basic healthcare, family planning counselling, family planning treatment, anti-natal care, HIV/AIDS counselling and testing, cervical screening, immunisation, deworming and a small pharmacy. If any of the patients present with a case that is too serious to be dealt with they referred to the nearest hospital.

The table below gives the results of the family planning element of the six clinics;

Type of family planning Quantity Couple Year Protection
5 year implant, first time 185 703
5 year implant, repeat 60 228
3 year implant,first time 566 1415
3 year implant, repeat 114 285
Depo-provera, first time 355 88
Depo-provera, repeat 163 41
Depo-provera, repeat 163 41
Contraceptive pill 46 3
CYP without condoms 2763
Condoms 12,826 106
Total Couple Year Protection 2869

In our original application we stated that we hoped to achieve a CYP of 2910 without including condoms. If condoms are included this figure was nearly reached but we feel the CYP figure of 2763 still represents very good value for money.

Other clinical results

The most common symptoms which presented were chest infections, indigestion, diarrhoea and backache. Women have to carry heavy loads of water and firewood and backache is a common ailment.

Worms in children are a big problem and to encourage lots of children to attend the clinic hires 2 professional artists/peer educators for the day. They keep the children laughing and running around while their parents attend the clinic. But they also talk to them about other issues such as hygiene, discipline and abstinence.

Children Immunised 128
Children de-wormed 7004
Patients receiving primary health care 2911
HIV/AIDS VCT 553
Number of people testing positive for HIV 17

Budget Report.

The actual spend was slightly higher than was anticipated and this was covered by an under spend from another Dandelion project supported by CHASE.

Details for 6 one day clinics Budget for 6 day clinics. £ Actual for 6 day clinics. £
Medical supplies (FP commodities provided free by MoH)              699 589

 

Outreach, mobilisation and training              279 667
Salaries and other allowances for 5/6 free clinic days           1,157 1366
Materials and publications              471 379
Logistics, implementation, transport, communications, monitoring           2,471 2376
Subtotal           5,077 5377
UK contribution to management @ 8%              406 406
 Total           5,483 5783

Monitoring and Evaluation

Data collection is an important and routine part of every clinic. The data helps Dandelion to understand the needs of the community and plan accordingly. It also helps Dandelion to understand what to focus on in the area e.g. behaviour change and communication based on the number of people who test positive for HIV, or addressing stigma and discrimination depending on the number of people who agree to be tested for HIV.

The data collected is passed on to the Ministry of Health to be included in the compilation of national records.

Across Kenya, especially in urban areas, the acceptance of family planning is rising but there are still many barriers to uptake in rural areas.  Women are often reluctant to discuss what their husbands think about family planning  but in the privacy of the tents the nurses will often get the their patients to talk about the issues they face at home.

Challenges and lessons learned

Dandelion operates in remote rural areas where conflict between communities is quite common leading to security problems. They try and mitigate this by involving the local authorities and getting support from community leaders. Access to these rural areas can also be difficult as the roads are not metalled. In wet weather, what was a relatively easy trip in dry weather, can become very time consuming and sometimes not possible.

In rural areas family planning still has many obstacles to overcome.  Many people still see Children as a sign of wealth hence the reason many women have around 8 children.  Dandelion places great emphasis on engaging with men to discuss the issues surrounding sexual reproductive health. It is still a widely held belief that modern methods of family planning can make you infertile. They try to convince men that by having fewer Children women have more time for productive work. This will mean the whole family will be better off and the children have a much better chance of finishing school. It is estimated that a girl who finishes secondary school will have around half the number of children compared to a girl who does not attend secondary school.

The one day clinics carried out by Dandelion with the generous support of PopOffsets are changing the lives of many families, giving them a chance to escape poverty.