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Dr Zarka Riaz sits behind her desk at the Family Health Model Clinic (FHMC) set up by Rahnuma Family Planning Association of Pakistan (FPAP) in a low-income neighbourhood in Rawalpindi, a city of over two million next to Pakistan’s capital Islamabad. Even on this wet monsoon day, over a dozen women are gathered in the waiting area of the clinic. “Pakistan is experiencing a population explosion, women, especially those from underprivileged and marginalized sections of society are not able to gain access to contraception they so desperately want and need, to make choices for their families,” says Dr Zarka. Dr Zarka is a gynecologist, with a specialization in family planning. She has been working with FPAP for ten years but started working at this clinic 18 months ago. The family clinic is supported as part of the Women’s Integrated Sexual Health (WISH2ACTION) programme funded by the Foreign Commonwealth and Development Office (FCDO), under the strategy to ‘Leave No One Behind’. Across the country – Rahnuma-FPAP works through cluster networks. A pioneering model that brings together public and private specialist sexual and reproductive and health centers within a close radius referral network to ensure women and girls can receive life-changing care. Networks use poverty data mapping to ensure that services are targeted to areas where the population needs them most. "Under WISH we are offering free family planning services, which is extremely important for a low-income area such as this”, explains Dr Zarka. FPAP works in partnership with government and private clinics, community-based distributors, disability organizations and religious and community leaders as part of the clusters. Local pharmacies are also part of these networks and provide condoms and birth-control pills free of cost. Dr Zarka observes that a lot of women worry about unintended pregnancies but are not aware of family planning methods available. Pakistan is the world's fifth-most populous country, home to over 220 million people with an annual fertility rate of 3.6 children per couple. “There are a lot of myths and misconceptions about family planning. In male-dominated societies such as ours, women are often not able to make decisions about their reproductive health, which is why it is essential to engage men and mothers-in-law." Dr Zarka notes that it is becoming increasingly common for women in low-income areas to try to terminate unwanted pregnancies by getting unsafe abortion. “Abortion pills are readily available, and people use the internet to find out ways to abort unwanted pregnancies. However, women often take the wrong dosage and end up with too much bleeding or infections,” she says. “Access to free contraceptives can reduce the need for unsafe abortions, allow women to space their pregnancies and gain autonomy over their health and wellbeing,” she adds. Rahnuma implements the WISH programme across five provinces across the country and through its community awareness work is changing the discourse in Pakistan on family planning and sexual and reproductive health and rights.    

School closures as a response to COVID-19 across the world has impacted education of children. Children and adolescents are spending more time online for virtual classes and to connect with their friends. This pandemic has made digital access necessary, but if misguided, this can be dangerous for young minds. There is an urgent need for parents and guardians to prevent their children from becoming participants of unwanted sexting, internet bullying or other transgressive behaviour. Accurate and responsible information about sex and reproductive issues can prepare children of all ages and enable them to reach out for support. We understand this can be overwhelming. We have put together a useful resource list which includes guides and interactive tools to help you find ways to start the discussion on sex, sexuality, reproduction, and relationships.  All One Curriculum: Guidelines and Activities for a Unified Approach to Sexuality, Gender, HIV, and Human Rights Education https://www.popcouncil.org/research/its-all-one-curriculum-guidelines-and-activities-for-a-unified-approach-to- Planned Parenthood tips for talking about sex with children of all ages ​​​​​​ https://www.plannedparenthood.org/learn/parents/tips-talking https://www.plannedparenthood.org/uploads/filer_public/6e/a4/6ea4bb87-e61e-4b99-a35e-8cf2e2c82a51/20171004-lets-talk-relationships-at-any-age-d01.pdf Videos on myths, consent, reproductive issues and sexuality https://www.ippfen.org/resource/basic-sex-ed-101-can-you-put-condom-banana https://www.youtube.com/watch?v=lM86exl8tIU https://www.youtube.com/watch?v=3MFy7z8isU8 https://www.youtube.com/watch?v=nZjYESyxEEk https://www.youtube.com/watch?v=lInVibdN2GE Improve your knowledge about Comprehensive Sex Education https://www.guttmacher.org/sites/default/files/report_downloads/demystifying-data-handouts_0.pdf Tips for delivering sex-positive workshops for young people; An educator’s guide https://rb.gy/ejii2i IPPF Guide and messaging checklist to communicate effectively with young people https://www.ippf.org/sites/default/files/youth_messaging_checklist.pdf Share IPPF’s popular guide for young people - Healthy, Happy & Hot: A guide to your rights, sexuality, and living with HIV https://www.ippf.org/healthy-happy-and-hot  

World Sexual Health Day 2020 Growing up sex was a forbidden word. Our school curriculum accommodated basic formal sexuality education, but it was never really taught. Conversations about relationships, pleasure, masturbation, intimacy, and sexuality were even more restricted at home. Expression of intimacy and an interest in sexuality were not welcomed at school or home. In this environment, puberty struck as a horrid surprise for me. It became a subject of shame and came with a whole new set of restrictions – from being forbidden to visit a religious place to curfews and diktats over not playing any sport during “those days”. Active denial of love, sexuality, intimacy, and pleasure came in small doses of advice hidden behind the carefully crafted care and teachings of adults. For a 12-year-old girl these were enough to diminish self-confidence and worth. Fifteen years later, as I work on issues of sexual and reproductive rights in South Asia, I find that the high walls restricting young people’s access to conversations about sex and sexuality still exist. Institutions of trust (schools, family, government) continue to stigmatize sexuality and instil the ideal of abstinence till marriage. However, young people are curious and rightly so. Their curious mind use technology, unreliable media sources, erotica, and most of all pornography to find answers. Pornography exposes young minds to violent sexual acts, abusive sexual language and introduces them to negative messages around relationships. A survey in 2014 by Institute for Public Policy Research on Young people, sex and relationships, found that 7 out of 10 young people (typically aged 13-15) said ‘accessing pornography was seen as typical’ while they were at school. Of these young people, about 45 per cent young men and 29 percent young women agreed that ‘pornography helps young people learn about sex’, while 21 percent young men and 40 percent young women also strongly agreed that ‘pornography leads to unrealistic attitudes to sex’. Half as many young men (18 per cent) as young women (37 per cent) also strongly agreed that ‘pornography encourages society to view women as sex objects’. It is dangerous to let the idea of pleasure and sexuality be controlled by and imparted through unreliable mediums. The impact of this exposure is significant on young minds. It often leaves them in a state of confusion, uneasiness and with a future burdened with deeply problematic attitudes towards sex. In Bangladesh, a study done by Haider et. al, found that by age 19, approximately 88 percent of urban adolescent males and 44 percent of rural adolescent males reported premarital sexual intercourse. Differences in experimentation were even greater for girls. 47 percent of 19-year-old urban girls reported they had already experienced sexual intercourse but only 5 percent of their rural counterparts had. It was also observed that approximately 39 percent of male adolescents had sex with commercial sex workers and of them, 56 percent did not use a condom. [1] Moreover, the incidence of abortion was found to be 35 times higher in unmarried adolescents compared to their married counterparts and over a third of young girls aged 13-19 had experienced some form of gendered harassment and unwanted sexual attention.[2]   When the importance of consent, respect and sexual diversity is not understood it leads to abuse of women’s rights and limits the freedom over reproductive and sexual choices. As reported by the UNFPA, one in seven girls in the South Asia region have given birth by the age of 18 (married before their 18th birthday), often in the context of high unmet need for contraception and child marriage. Up to 63% of adolescent pregnancies in the region are unintended, contributing to a significant, although underreported, burden of unsafe abortion. While the importance of sexual health is globally recognized, education to promote it remains a controversial issue. In South Asia, socio-cultural and religious norms strongly shape and restrict the access of young people to sexual and reproductive health information and services. In some countries these norms get legal legitimacy through the prohibitions imposed by national laws and policies. Some of the other factors that play a significant role are low education, gender disparity, early and forced marriages, restricted access to family planning information and services, and legal regulations restricting access to abortion.   Comprehensive sexuality education is an undeniable right of every young person, but it needs to go far beyond the biology of reproduction, birth control, STI’s and HIV. Young people in the region have a desire to know more about sexuality, pleasure and that must be met with active efforts to include those ideas in our education. Asia as a region has some of the most populous countries with higher percentages of younger population in countries such as Afghanistan, Bangladesh, India, Indonesia, Pakistan, Philippines– all have median ages of 30 or younger. We should strive to build a conducive environment supporting young people’s right to a healthy and happy transition into adulthood. Sexuality education should be an integral component of our pedagogy today, it needs to expand its scope- from being limited to sexual and reproductive health information on reproduction, negative health consequences, safety, consent and harassment- and include in its ambit pleasure, love, desire and sexuality. Looking back in time, I realize if I had access to an enabling environment to empower me with comprehensive sex education, I think I would have been better prepared for my life as an adult. ________________________________________________ Roshnee Burma, Youth Officer at South Asia Regional Office of International Planned Parenthood Federation [1] Rob, U., & Mutahara, M. U. (2000). Premarital Sex among Urban Adolescents in Bangladesh. International Quarterly of Community Health Education, 20(1), 103–111. https://doi.org/10.2190/nflm-e0my-q26n-dbvh [2]Burnet Institute, Kennedy, E., Willenberg, L., Mohamed, Y., Baravilala, W., & Sauvarin, J. (2016). Sexual and Reproductive Health of Unmarried Young People in Asia and the Pacific Review of knowledge, behaviours and outcomes. Unfpa. https://doi.org/10.1017/CBO9781107415324.004        

  Acting on the urgency to ensure sustainability of regular Memnber Associations' activities, IPPF SARO promptly designed a bridging fund for business continuity during COVID-19. The report studies the utilization of these business continuity funds from April - June 2020.   Despite the threat of COVID-19, members are are finding ways to provide Sexual and Reproductive Health and Rights through targeted operational hours of clinics, tele-counselling and community outreach in compliance with social distancing norms. Despite these innovations and proactive initiatives, the last three months (April to June 2020) have seen an estimated 60-70 per cent reduction in overall clinic services.    

The unfolding COVID-19 crisis has restricted access to contraception and safe abortion services, with the poorest and most marginalised women and girls being the worst affected. It is important that women continue to have access to safe abortion services during the COVID-19 pandemic. Whether they can access them safely and with dignity depends upon every one of us to rise to the challenge to provide them. During this challenging time, IPPF Member Associations are responding and adapting to this evolving situation and are committed to delivering the services to the women. In order to capture the innovative approaches implemented by Member Associations (MAs) for safe abortion services amid COVID19, interviews were conducted with two MAs from South Asia – Family planning association of India (FPAI) & Rahnuma -Family Planning Association of Pakistan (R-FPAP), on range of topics including Telemedicine, Abortion consultations and Post abortion contraceptive. IPPF team have collated questions and answers (Q&As) which can serve as a practical guidance for those working on Sexual and Reproductive Health and Rights. 

Annual Report of IPPF SARO for 2016

This report summarises highlights of the results achieved during the past three years, findings of the assessment of the project, lessons learnt, challenges faced and outline of what impact it leaves for future in terms of sustainability of these achievements. In responding to address the unmet need of family planning services in the region, IPPF SARO provided 22.8 million services in 2016. Nearly, 38 percent of these services were provided to young people. The project played an important role in demand generation through reaching to young people. Moreover, the values and learnings from the Champions Project were adopted globally in IPPF’s new strategic framework 2016-2022. This will allow IPPF to maintain the momentum, deepen further advocacy efforts through the champions and expanding engagement of support groups.

This political mapping exercise seeks to conduct a situational analysis and understand the policy and programmatic environment pertaining to Sexual and Reproductive Health and Rights (SRHR) in nine countries of the International Planned Parenthood Federation’s (IPPF) South Asia region, namely Afghanistan, Bangladesh, Bhutan, India, Iran, Maldives, Nepal, Pakistan and Sri Lanka. It also aims to identify and prioritize issues of advocacy for SRHR in each of these countries as well as at the regional level and suggest strategies for advocacy on these issues with the government, non-government organizations, civil society organizations (CSO) and other relevant stakeholders. 

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.  

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.