Joining Forces for Accountability
International Planned Parenthood Federation / European Network 146, Rue Royale 1000 Brussels Belgium www.ippfen.org +32 (0)2 250 09 50
International Planned Parenthood Federation / Western Hemisphere Region 125 Maiden Lane, 9th Fl. New York, NY 10038 www.ippfwhr.org (212) 248-6400
The International Planned Parenthood Federation (IPPF) strives for a world in which all women, men and young people have access to the sexual and reproductive health information and services they need; a world in which sexuality is recognized both as a natural and precious aspect of life and as a fundamental right; a world in which choices are fully respected and where stigma and discrimination have no place.
IPPF aims to improve the quality of life of individuals by providing and campaigning for sexual and reproductive health and rights (SRHR) through advocacy and services, especially for poor and vulnerable people. The Federation defends the right of all people to enjoy sexual lives free from ill health, unwanted pregnancy, violence and discrimination. IPPF works to ensure that women are not put at unnecessary risk of injury, illness and death as a result of pregnancy and childbirth, and it supports a woman’s right to choose to terminate her pregnancy legally and safely. IPPF strives to eliminate sexually transmitted infections (STIs) and to reduce the spread and impact of HIV and AIDS.
Photography: Noah Friedman-Rudovsky and Layla Aerts
Five years ago, we set out on an exciting and unique journey. As part of the Millennium Development Goals, governments agreed to ensure universal access to critical reproductive health services such as contraception and care during pregnancy. While we were excited by the prominence that reproductive health had gained in the global development agenda, we also knew what it would take to realize this ambitious goal: strong coalitions of civil society leaders able to hold their governments accountable to their commitments. As such, advocates from two diverse yet strikingly similar regions—Latin America and Eastern Europe/Central Asia—joined forces to do just that. Despite obvious cultural and political differences, both regions emerged from a legacy of disenfranchisement in which citizens had little say into open societies in which the fate of publicly funded social services and safety nets remains insecure. Both regions also shared high levels of inequality and marked resistance to sexual and reproductive health and rights (SRHR), despite abundant
evidence that investments in SRHR lead to better health and economic outcomes. Through Joining Forces for Voice and Accountability —or Voices— these advocates achieved success. Over five years, advocates from 11 countries secured a total of 110 policy changes that expand access to vital sexual and reproductive health services and rights, directly impacting the health and well-being of 62 million individuals. Perhaps most importantly, these advocates developed strong coalitions for SRHR in countries where none existed before. From the Dominican Republic to Kyrgyzstan, new movements dedicated to human rights and civic participation emerged at a time when world leaders are set to create the future global development agenda. Thanks to the Voices project, we will be heard within this agenda. Thanks to the Voices project, we are a stronger movement and a stronger humanity.
© Freddy Willems
Carmen Barroso Regional Director IPPF Western Hemisphere Region
Vicky Claeys Regional Director IPPF European Network
Reproductive Health Alliance Kyrgyzstan (RHAK)
Association XY (XY)
DEVELOPED OR REVAMPED 28 GOVERNMENT ACCOUNTABILITY MECHANISMS Tajik Family Planning Alliance (TFPA) Panamanian Family Planning Association (APLAFA)
SECURED US$58 MILLION IN GOVERNMENT FUNDING FOR SRHR Family Planning Association of Moldova (SPFM)
Center of Investigation, Education and Services (CIES)
FORMED AND/OR STRENGTHENED 75 CIVIL SOCIETY COALITIONS Center of Investigation, Education and Services (CIES) Albanian Center for Population and Development (ACPD)
IMPACTED 62 MILLION PEOPLE DIRECTLY
Kazakh Association for Sexual and Reproductive Health (KMPA)
Peruvian Institute for Responsible Parenthood (INPPARES) Dominican Family Welfare Association (Profamilia)
ACHIEVED 110 POLICY CHANGES
Mexican Family Planning Foundation (Mexfam)
2010’s THE INTERNATIONAL CONFERENCE ON POPULATION AND DEVELOPMENT, CAIRO
UNITED NATIONS MILLENNIUM SUMMIT, NEW YORK
UNITED NATIONS HEADQUARTERS,
2000:
2010:
1994: A total of 179 governments agreed to the ambitious Programme of Action that put the reproductive health and rights of women and young people at the center of global development strategies.
Following the adoption of the United Nations Millennium Declaration, all 189 United Nations member states agreed to alleviate poverty, improve health care (including maternal health), and increase access to education by 2015.
Secretary General Ban Ki-moon launched the Global Strategy for Women’s and Children’s Health.
THE FOURTH WORLD
UNITED NATIONS
CONFERENCE ON WOMEN, BEIJING
HEADQUARTERS, NEW YORK
47TH SESSION OF THE COMMISSION ON POPULATION AND DEVELOPMENT, NEW YORK
1995:
Heads of state added four new targets to the Millennium Development Goals (MDGs), including MDG 5b, which calls on governments to achieve universal access to reproductive health by 2015.
The resulting Platform for Action set time-specific targets for national and international actions to improve women’s health and secure the social, economic, and political empowerment of women.
2005:
NEW YORK
2011: After an overhaul of the UN systems and programs that support women’s rights and health, UN Women, a new UN agency focusing on women, was created.
2012: Governments adopted a groundbreaking resolution that upholds the rights of adolescents and calls for investments in sexuality education and youth-friendly health services. FAMILY PLANNING SUMMIT, LONDON 2012: More than 150 government, civil society, philanthropic and business leaders made a commitment to provide an additional 120 million women and girls in the world’s poorest countries access to voluntary family planning by 2020. 67TH SESSION OF THE UNITED NATIONS GENERAL ASSEMBLY 2013: Special event convened by the President of General Assembly to review the progress made towards the achievement of MDGs and to chart the way forward.
MOLDOVA 2010 The Ministry of Health created a mechanism, the National Coordinating Council, in charge of the implementation of the National Strategy on Reproductive Health. IPPF Member Association SPFM has been the official Council Secretariat, leading its monitoring and evaluation work.
BOSNIA & HERZEGOVINA 2010 The SRHR Strategy was adopted in the Federation of Bosnia & Herzegovina.
PANAMA 2011 The Ministry of Health signed an agreement to incorporate recommendations that emerged from an audit of youth SRHR services conducted by IPPF Member Association APLAFA.
DOMINICAN REPUBLIC 2011 PROFAMILIA secured the approval of the National Plan to Prevent Teenage Pregnancy, which established the Interagency Committee for the Prevention of Teen Pregnancy and a budget allocation US$3 million.
TAJIKISTAN 2011 The government adopted new national standards for safe abortion and post-abortion care. Tools for monitoring and evaluation, as well as a government-funded training module for obstetricians and gynecologists, were subsequently approved in 2012.
MEXICO 2011- 2013 The Mexican Congress earmarked US$34 million for the state-level implementation of the adolescent sexual and reproductive health policy—at a time when health and education budgets were being cut across the board.
ALBANIA 2012 The Ministry of Health approved the first and only policy on comprehensive sexuality education, benefiting more than 500,000 young people.
BOSNIA & HERZEGOVINA 2012 SRHR Policy was adopted by the Republic of Srpska, the second entity of Bosnia & Herzegovina.
PERU 2012 The Constitutional Court decriminalized consensual sexual relations between adolescents after INPPARES collected the signatures needed to challenge the law.
KAZAKHSTAN 2012 The Ministry of Health signed Decree #881, the Roadmap for Strengthening Reproductive Health of Kazakhstan’s Citizens (2011–2015). All regional health departments in the country became responsible for executing the country’s Roadmap.
BOLIVIA 2013 The legislature passed the Youth Law, which ensured universal access to SRHR and benefited more than 2.8 million young people.
KYRGYZSTAN 2013 The Ministry of Health approved a plan of implementation of the National Reproductive Health Strategy to improve the reproductive health of adolescents, expanding access to information, education, and services for more than 1.6 million youth.
We believe that achieving SRHR for all is a moral imperative. We believe adolescents are part of the solution, not the problem. We believe that being solution-oriented and proactive is always better than pointing fingers and making threats. We believe that expertise and tenacity must go hand-in-hand. We believe that we will achieve universal access SRHR in our lifetime—that’s why we’re in it for the long haul.
Advocacy requires constant updating of political maps, policies, and stakeholders. Advocacy always targets decision-makers seeking as political change. Advocacy must be carefully planned, with an adequate amount of time and resources allocated. Advocacy is best accomplished in partnerships with others, at all levels of society. Advocacy ultimately strengthens democracy, governance, and citizenship.
Reduces maternal mortality Prevents unwanted pregnancies Curbs the spread of sexually transmitted infections, including HIV and AIDS Empowers women and girls to exercise their sexual and reproductive rights through greater decision-making powers Builds a more sustainable world for all women, men and young people, regardless of gender, sexual orientation, or social and economic status
Have we done adequate research on the policies we hope to influence? Do we have access to adequate financial and human resources? Do we have access to a wide network of allies and experts? Are our communications and advocacy skills up to par? How will we monitor and evaluate our advocacy efforts?
Citizens hold their governments accountable for commitments they’ve made towards sexual and reproductive health and rights.
Citizens are encouraged to participate in the development of public policies and budget processes, and effectively do so.
Public policies and budgets are better aligned to the SRHR needs of citizens.
Funding and policies for sexual and reproductive health and rights are implemented at all levels of government.
The State fulfills its obligations. Women, men and young people access quality sexual and reproductive health care.
Association XY, IPPF Member Association, achieved a major milestone when, for the first time since the founding of Bosnia & Herzegovina in 1992, two major documents were adopted in both entities: the SRHR Strategy of the Federation of B&H and the SRHR Policy of the Republika Srpska. The documents called for the improvement of the sexual and reproductive health and rights of all citizens, especially youth and marginalized people who faced limited access to information and health services. In a conservative and traditional society, putting this into practice was no easy matter. Association XY worked hard to open taboos around SRHR by mobilizing civil society organizations. A network of 24 organizations in 26 cities across the country was established to advocate with decision makers and the media on behalf of citizens. Young people were welcomed and included in this advocacy work.
Bosnia and Herzegovina is a diverse country with three main constituencies: Bosniaks, Serbs, and Croats. The central government has limited power, and the country comprises two autonomous entities: the Federation of Bosnia & Herzegovina (B&H) and Republika Srpska, each of which holds decision-making power over SRHR issues.
Throughout the process, all participants in the group, called the Network of Youth Friendly Health Centers, received continued education in effective advocacy, strategic planning, networking, political mapping, budgeting, and media appearances. Association XY’s goal was to provide skills that could be sustainably carried through into the implementation phase of the country’s new SRHR platforms. Best of all, young people helped lead the development of the Network’s Strategic Plan through 2017, ensuring that the work will continue well into the future.
Since the collapse of communism, Albania has experienced dramatic political and socioeconomic challenges. The situation has been especially delicate for youth, as the government had failed to implement a strategic platform on their behalf. Vulnerable youth, such as Roma and those out of school, have numerous unmet needs, not the least of which is access to education about sexual and reproductive health and rights. Although sexuality education is compulsory in schools, it is limited in content and hours, and ineffective teaching methodologies and a lack of supportive environments hinder the translation of knowledge into positive behavior change.
IPPF Member Association the Albanian Center for Population and Development (ACPD) successfully advocated for the Ministry of Health to approve the country’s first and only policy specifying models for comprehensive sexuality education for young people. Through ACPD’s efforts, more than half a million young people will now benefit from improved sexuality education.
This victory was directly attributable to the Sexual and Reproductive Health and Rights Coalition, established by ACPD and its colleague organizations. The coalition launched a new dialogue between the Ministry of Health and the Ministry of Education that made it possible to develop the models for CSE. It also signaled a new view of Albanian civil society organizations as groups that have a valuable role to play in the definition of policy and in the development of national strategic planning. The coalition now boasts 31 partners nationwide.
Young people between the ages of 10 and 24 account for more than a third of the Bolivian population. The issues related to their sexual and reproductive health are staggering: Every hour in Bolivia, three teenagers get pregnant. One in five Bolivian youth are unaware of any contraceptive method. Adolescents make up 25% of people living with STIs and HIV-AIDS. Source: Census 2012. National Institute of Statistics, Bolivia (2013)
To address these major challenges, IPPF Member Association, the Center of Investigation, Education and Services (CIES) organized youth groups in five regions to raise awareness of their rights and to build the advocacy skills needed to demand their fulfillment by government actors. The results were astounding: Nearly 500 young people received training on SRHR, social participation, and accountability. The youth contributed to the passage of the National Youth Law, which incorporates sexual and reproductive rights, comprehensive sexual education, and access to youth-friendly services as its cornerstone. Eighteen subnational policies have been enacted to guarantee sexual education and access to health services for adolescents. The Ministry of Health issued a resolution to promote youth participation in the nation’s health system. A national decree was issued to ensure access to the legal system and a fair legal process for young people who are victims of violence. The youth networks ensured that a budget was allocated at a local level to effectively provide these services. Perhaps most telling of all is the palpable feeling among youth leaders that they are now empowered to take part in the construction of Bolivia’s democracy and the development of a rich public life at all levels of government.
The goal of the National Strategy on Reproductive Health (NSRH) in the Republic of Moldova is to improve the reproductive health of the population and to ensure opportunities for citizens to exercise their sexual and reproductive health and rights for the following outcomes: Attaining healthy sexual development and maturity and engaging in safer sexual behaviors Planning for the desired number of children and avoiding sexual and reproductive health–related illness Benefiting from quality services in the event of sexual and reproductive health dysfunctions Avoiding exposure to and suffering from violence and other sexual and reproductive health–related abuse
IPPF Member Association, the Family Planning Association of Moldova (SPFM), demonstrated why advocacy is a long-term proposition. The group played a critical role in holding the government accountable for the implementation of the country’s National Strategy on Reproductive Health—first by advocating for the formation of the National Coordinating Council in charge of the implementation of the country’s National Strategy on Reproductive Health (NSRH), and later by serving as its official secretariat. To ensure that the measures outlined in the national initiative were implemented, SPFM formed a network of civil society organizations (CSOs) active in sexual and reproductive rights, including not only local NGOs but also doctors, nurses, social workers, psychologists, teachers, and representatives of the media. Leading the work of the Coordinating Council, which included representatives from different ministries, SPFM monitored the evaluation of the NSRH implementation with CSO partners and pushed successfully for the approval of new standards for safe abortion by the Ministry of Health. In addition, a new educational curriculum now offers students life-based skills in sexual and reproductive health.
In Panama, youth are routinely denied access to comprehensive sexuality education and health services that meet their real-life
Political mapping analysis—APLAFA first ascertained that the conservative government would make it difficult to advance more progressive policies to reduce unplanned teenage pregnancies. However, in reviewing all existing policies, the group found that there were explicit mentions of the need to provide youth-friendly services (YFS) in public clinics nationally.
needs. As a result, teenage pregnancy rates remain high. Although the government has outlined national health care standards and signed on to several international commitments upholding the right to health care, youth in Panama often encounter a different reality.
IPPF Member Association the Panamanian Family Planning Association (APLAFA) set out to address the perceived lack of quality comprehensive sexual and reproductive health services for youth by conducting a series of “mapping” and “audit” exercises meant to ensure the implementation of a national policy aimed at reducing unplanned teenage pregnancy:
Social audit—APLAFA set out to monitor the implementation of these stated national standards. The organization trained 25 youth as social auditors to visit and assess the YFS of clinics. The auditors found a general failure to provide adequate services. After sharing the results with service providers and government agencies, APLAFA began to see action—both the Ministry of Health and service providers signed an agreement to improve those services. Additionally, they developed guidelines for YFS, which are being implemented by the government in three regions to better meet the needs of nearly 500,000 young people.
of adolescents to exercise their sexual freedom. Although they needed just 5,000 signatures, they collected 10,609 in support, enabling them to present the case. IPPF Member Association The Peruvian Institute for Responsible Parenthood (INPPARES) took a nontraditional approach toward advocating for change in the course of the Voices project. The group mapped the prosecution of teenagers between the ages of 14 and 18 who engaged in consensual sex. Believing that there were sufficient legal arguments against such criminalization, INPPARES led a youth network to reach out to people living in both rural and urban provinces to get their support to file a demand to the Constitutional Court to overturn the criminal code and recognize the right
As a result, on December 12, 2012, the Constitutional Court decriminalized consensual sexual relations between adolescents. But the youth network did not stop there. They began to focus their efforts on holding the government accountable and ensuring that there were policies and budget allocations in place. The group has already achieved multiple successes, including a budget allocation of US$26 million to provide SRH services for youth and the reactivation of the regional health councils to monitor the implementation of youth policies.
In spite of major strides in economic growth and low inflation in recent years, a lack of binding public policies and an insufficient budget have caused an increase in teen pregnancy in Peru. Along with the increase has been a rise in maternal and perinatal deaths and unsafe abortions, as well as higher suicide and dropout rates. At odds with advances in SRHR for youth have been the conservative influence of the Catholic Church and the constantly changing leadership of authorities at the regional level.
Young people and adolescents in Kyrgyzstan represent about 30% of the population. Yet a lack of political will and poorly
IPPF Member Association, the Reproductive Health Alliance of Kyrgyzstan (RHAK), made it a priority to ensure that activities directed at youth would be properly funded through officially endorsed budget allocations in spite of political instability and the resulting economic challenges in the country.
financed health services have meant that the country’s youth have limited up-to-date sexual and reproductive health information and lack of access to service providers. As a result, indicators such as rates of adolescent pregnancy and abortion, STIs, and HIV are very high. For instance, the adolescent birth rate is 31 out of 1,000 women aged 15 to 19.
RHAK devoted a significant amount of its advocacy efforts to meetings with government officials. As a result, the Ministry of Health approved the Plan of Implementation of the National Reproductive Health Strategy, which makes adolescents’ reproductive health, including youth-friendly services and sexual education, a priority. The Plan of Implementation is a practical document that identifies the roles and responsibilities of ministries and civil society organizations, and, importantly, allocates a budget for each activity. According to the Plan of Implementation, the public health care system has the opportunity to establish,
With the support and technical assistance of the Kazakhstan Association on Sexual and Reproductive Health (KMPA), the Ministry of Health of Kazakhstan developed and adopted the Roadmap for Strengthening Reproductive Health (2011–2015) based on the UN Millennium Development Goals. Experienced advocates know that without measurable and adequately funded plans for implementation, the most well-intentioned strategies endorsed at the highest levels will not lead to meaningful change. Through long-term efforts, KMPA was instrumental in the Ministry of Health signing Decree #881, making all regional health departments in the country, as well as the National Medical Holding and other core facilities, responsible for executing the Roadmap. This advocacy included coordinating the work of local NGOs with the benchmarks for SRHR set by international agencies such as UNFPA, UNDP, and the World Health Organization. Significantly, a national budget has also
Source: National data source and UNICEF report card on adolescents (April 2012)
develop, and maintain youth-friendly services using governmental financial resources. As a result, 1,684,500 young people will benefit from improved access to information, education, and services.
Although maternal mortality has decreased dramatically in Kazakhstan in recent years and most women have a skilled attendant at the birth of their children, many challenges remain. A lack of access to information on SRHR is a key impediment for Kazakh citizens, and HIV/AIDS rates are increasing, including among pregnant women.
been allocated to the Roadmap, as well as additional funding provided by local authorities. As a result, more than 4.5 million women of reproductive age—representing 30% of Kazakhstan’s population—have the potential for improved sexual and reproductive health by 2015.
Though lifetime fertility has fallen to 2.6 births per woman in the Dominican Republic, adolescents face limited access to comprehensive sexual and reproductive health services. The adolescent fertility rate remains high, at 98 births per 1,000 women ages 15 to 19, and high rates of unintended pregnancy are still a problem.
Thanks to PROFAMILIA, IPPF Member Association, who successfully secured the approval of the National Plan to Prevent Teenage Pregnancy in 2012, this reality is beginning to change. The group also led the creation of the Interagency Committee for the Prevention of Teen Pregnancy, an accountability mechanism responsible for monitoring the implementation of the plan. This was a major victory, but PROFAMILIA knew that this did not necessarily mean there would be an adequate allocation of government resources to carry out the plan. To counter this reality, PROFAMILIA conducted a costing analysis of the plan and ensured buy-in from government entities, including the Ministries of Health, Education, and Finance. After conducting the analysis, PROFAMILIA was able to identify resources required to reduce teenage pregnancy. The plan, with its associated costs, was endorsed and publicly presented by the vice president in June 2013, and each of the involved ministries agreed to allocate in total almost US$3 million between 2014 and 2016 for the plan’s implementation. PROFAMILIA capitalized on the momentum and political will to take their advocacy one step further. Beginning with the knowledge that youth would not use sexual and reproductive health services that didn’t meet their needs, PROFAMILIA launched a social audit process, replicating the model used by APLAFA in Panama. The audit, which was conducted by young people, included the implementation of a survey for both providers and clients of sexual and reproductive health services and educational programs. The final results of this audit, as well as recommendations, were published and presented to government authorities. As a result, more than 1.9 million youth in the Dominican Republic have access to quality sexual and reproductive health care and information.
Prior to the start of the Voices project in Tajikistan, a national action plan to access safe abortion had been adopted by the government. However, unsafe abortion remained a leading cause of maternal mortality.
IPPF Member Association the Tajik Family Planning Alliance (TFPA) boldly introduced protocols on safe abortion (SA) and post-abortion care (PAC) to put the national plan into practice to ensure high quality abortion care. In order to create an atmosphere conducive to these proposed solutions, including the acceptance of nonsurgical medical abortion, TFPA launched a multifaceted plan. First, TFPA initiated working groups of experts from the government and medical community to create both a learning process and a regulatory framework to ensure the sustainability of the effort. Next, TFPA trained obstetrician-gynecologists in safe abortion methods as well as in post-abortion care. The organization and its CSO partners created informational campaigns to inform women of medical abortion as an option. TFPA was also instrumental in forming a reproductive health coalition, building the members’ influence by offering skills in advocacy, budgeting, and monitoring and evaluation. With these tools in place, the coalition worked with key decision makers to ensure that the training on SA and PAC would be formally included in the country’s public health system. On March 19, 2011, the long-term advocacy paid off with the adoption of a legal framework on safe abortion, including new national standards for safe abortion and post-abortion care. Tools for monitoring and evaluation, as well as a training module included in the curriculum of the Obstetrics and Gynecology Department of the Tajik Medical Training Institute, have subsequently been approved. These new advances allow women of reproductive age (1,839,135 women) access to safe abortion throughout the country.
Although Mexico has one of the largest economies in Latin America, persistent inequality presents major challenges to development.
With more than 50% of the country’s total income held by the wealthiest 20%, access to education, employment, and health services—particularly for youth—remains out of reach for millions. Compounding these challenges is the fact that young people are becoming sexually active at a younger age; however, only an estimated 25% of Mexican youth use contraception the first time they have sex.
For the first time in Mexico’s history, the government has earmarked a specific budget for adolescent sexual and reproductive health. Importantly, accountability mechanisms are in place to monitor its implementation. The IPPF Member Association Mexican Family Planning Foundation (Mexfam) was instrumental in securing this victory, which was achieved through a series of strategic interventions:
Mexfam and its partners advocated for a national action plan for adolescent sexual and reproductive health. The resulting plan, which aimed to ensure universal access to reproductive health and comprehensive sex education, includes state-level guidelines that have led to a substantial increase in SRH services for youth. The Mexican Congress earmarked by law funds (US$8 million in 2011, US$15 million in 2012, and US$11 million in 2013) for the state-level implementation of the adolescent sexual and reproductive health policy—at a time when health and education budgets were being cut across the board. Mexfam secured a clause in the legislation earmarking the funds requiring state governments to report on the usage of funds allocated toward the program. Mexfam also continued to work at the state level to ensure the implementation of this youth policy as well as the proper use of funds. Finally, Mexfam has reactivated accountability bodies (GISR) at both the local and national level to monitor the implementation of the plan and the use of resources.
Over the course of five years, the Voices project made significant—at times even life changing—strides in advancing the sexual and reproductive health and rights of people throughout Latin America, the Caribbean, Eastern and Central Europe and Central Asia. Here is just a sampling of some of the voices of people impacted by our work.
Thanks to institutions such as CIES, Bolivia now has a new generation dedicated to social change. The work generated by teenagers and young adults will not only be of use to policy makers and those responsible for the execution of programs for youth, but also to parents, teachers, social service officials, and the general project. Thank you for helping to achieve this dream.
Deysi Fabiola Almanza, Techincal Deputy Minister for Equal Opportunities
By sending letters and petitions, our group of youth representatives revived the meetings of the Regional Health Council. This made us very happy and is a clear achievement showing what we are capable of.
Vanessa Lopez, Youth Leader, Junin Huancayo (Young Teens, Sexuality and Diversity, JODASEX)
Lack of knowledge is not an exemption from responsibility, especially when it comes to your own health. The work of IPPF and the Kazakhstan Association on Sexual and Reproductive Health caused me to think about taking care of my own sexual and reproductive health in order to save myself for helping others.
Aizhan Toktybekova, medical student and youth volunteer leader
Where were you when I was young? I have learned so much about safe abortion now, and I will definitely tell my daughter-in-law about contraception and medical abortion.
Rosiya Artikova, 60 years old, Dushanbe, Tajikistan
The development of ‘Models for Comprehensive Sexuality Education’ has been one of the most participatory processes in terms of the expertise and involvement of civil society, youth, and the government itself.
Klodjan Rrjepaj, Chief of Cabinet, Ministry of Health
Until the moment when high-level officials recognize the problems youth face in fulfilling their sexual and reproductive health and rights, we will have only talks, but no real decisions. Ministers are now beginning to understand the responsibility they have to their people to commit to SRHR, as it is a core human right.
Tursunbek Akun, The Ombudsman of the Kyrgyz Republic
In a world so full of inequity, where people generally believe that only the adults are right, it’s very hard to find projects like this one that will help one to see oneself as a rights-bearing subject and as a key actor in one’s country’s development.
Yitzy Caballero, a youth leader at APLAFA/Panama
For a young person who begins his or her their sexual life without access to information and services, there can be many lasting consequences. Young people have the right to know how the decisions they make now could impact the rest of their lives, and should have everything they need to exercise their rights with the full support of the state. Esperanza Delgado, Institutional Relations Manager, MEXFAM, Mexico
Working on issues like sexual and reproductive health and women’s rights is a heavy commitment to make. You are constantly revising long-held attitudes and behaviors that perpetuate stereotypes, gender inequality, and discrimination. It’s a tough job, but it’s part of me.
Myrna Flores Chang, Rights and Gender Program Manager, PROFAMILIA, Dominican Republic
The main advice I would give to other advocates is to keep your eyes wide open. Be highly strategic. Identify your allies, as there are many actors who will prioritize their own interests to the detriment of others.
While Peru is considered a middle-income country, inequalities persist. To change this reality, we need to continue investing in and empowering citizens to claim their rights, especially youth, women, and rural and poor communities. Only when citizens are informed and able to demand transparency and accountability will we see real change.
Giovanna Carillo, Project Coordinator, INPPARES, Peru
Rubiela Sanchez, Advocacy Coordinator, APLAFA, Panama
The Voices project helped generate a new process of social participation and advocacy that enables people to take an active role in solving the problems that affect their daily lives. In this way, all people are empowered in the social, economic, cultural, and political spheres and in driving social progress.
Cristiam Espindola, National Advocacy Coordinator, CIES, Bolivia
Through the Voices project, we learned the importance of building continuous and high-quality relationships with government officials and advisors. Decision makers must be reelected and are constantly moving. However, forming connections with their advisors is also key because many stay in those positions for years.
Through the Voices project, I gained confidence. I achieved the goals I set for myself and learned that my opinion and perspective are important in my community and my country. Today, I’m able to influence people, help them recognize a problem, and solve it.
Galina Grebennikova, Executive Director, KMPA, Kazakhstan
Tijana Medvedec, Program Manager, Association XY, Bosnia and Herzegovina
Working on this project was a bit like putting together a puzzle: once you have solved one puzzle—or surpassed one advocacy hurdle—you realize that there is another one waiting for you. But this time, you have the skills you need to complete the next one.
Elda Hallkaj Denaj, Voices Project Coordinator, ACPD, Albania
To respect sexual and reproductive rights today is to open the world for tomorrow. Young people are the future of this open world.
Ludmila Zmuncila, Voices Project Coordinator, SPFM, Moldova
The Voices project has been instrumental in the development of our staff, volunteers, and our whole organization. Voices has also taught me the importance of empowering young people to hold their governments accountable, to claim their rights and demand that they be fulfilled.
Nargis Juraeva, Voices Project Coordinator, TFPA, Tajikistan
There is a Russian proverb that says ‘one man is no man.’ I think this is true for advocacy. Working on this project, I met a lot of good, fair-minded people who are also promoting SRHR in their countries. Together, as a movement, we are a stronger force for change.
Tatiana Popovitskaya, Voices Project Coordinator, RHAK, Kyrgyzstan
Decreased funding for sexual and reproductive health Fewer investments in advocacy, especially at the local and national levels Lack of political will to invest in sexual and reproductive health and rights Lack of government transparency and accountability on these issues Organized opposition to sexual and reproductive health and rights
I am amazed at the number of achievements logged by the Voices project participants over the past five years. They have proven our theory of change and fulfilled the entire cycle by building strong alliances, successfully advocating for progressive policies and budgets for sexual and reproductive health and rights, and strengthening the mechanisms with which advocates can hold their governments accountable. They have showed me what hard work and persistence can achieve, and that seemingly impossible changes are well within our reach when we work as a united and organized front. Thanks to their work, millions of young people in Latin America have better access to sexual and reproductive health services, but I know this is only the beginning of their journey to ensure that every individual has access to the services and rights they need to live autonomous and healthy lives.
Laura Malajovich IPPF/WHR Regional Advocacy Officer
We have the power to create a world in which the rights of every individual are respected and upheld Universal sexual and reproductive health is in our reach — and we know what to do to achieve it The creation of a new global development agenda by governments, civil society, and the United Nations Sharing experience and expertise across geographic regions is leading to the creation of innovative and dynamic approaches Advocacy work promotes more transparent and accountable governments, and ultimately, more democratic societies
It has been beyond inspirational to watch how the Voices project has unfolded over the past five years. The advocates worked in very difficult circumstances: models for civil society engagement either didn’t exist or were just developing, and political instability posed significant challenges at each step of their advocacy plans. Despite these hurdles, these advocates made significant steps forward for sexual and reproductive health and rights in their countries, playing a key role as national experts and helping forge consensus among various stakeholders. Above all, they helped build stronger democracies by activating and training new pockets of skilled and agile advocates to work with civil society and governments. Equally importantly, they have each othier’s support as they continue their work going forward.
Soizick Martin IPPF/EN Senior Programme Advisor
Through the Voices project, IPPF regional offices have produced a series of free, hands-on guides for advocates around the world.
Handbook for Political Analysis and Mapping www.ippfwhr.org/en/political_mapping_handbook
Handbook for Strategic Advocacy Planning www.ippfwhr.org/en/advocacy_planning_manual
Handbook for Budget Analysis and Tracking in Advocacy Projects www.ippfwhr.org/en/resource/handbook-budget-analysis
Monitoring and Evaluation of Advocacy Projects: A Guide for Multi-Taskers www.ippfen.org/en/Resources/Publications/Monitoring+and+Evaluation+of+Advocacy+Projects.htm
Additional Publications www.ippfen.org/en/News/Intl+news/Joining+Forces+for+Voices+and+Accountability+Initiative.htm
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