Giving women in developing countries access to family planning information and contraceptives is transformative. It not only allows women and girls the opportunity to lead healthier, more productive lives but it’s one of the best investments a country can make in its future. Access to family planning information and contraceptives can change lives. Every woman and girl deserves the chance to determine her own future.

The day I left my parents’ home to start my career at Microsoft, they told me something I’ll never forget. They’d sacrificed a lot to help me pay for college and business school, but as I walked down our front porch steps, they said, “If you decide you want to get married soon and raise a family, that’s fine by us, too.” That was an amazing feeling, to know that the thing my parents wanted most for me was whatever would make me the happiest.



In fact, I wanted to have a career and have a family—when I was ready. I am proud that I was one of the youngest female executives at Microsoft. I am even prouder of my three children. Just as my parents hoped, I have been able to do the things that made me happiest, because I have been able to decide when to have my children. Bill and I love our kids so much, and we’re grateful that we had the option of expressing our love by timing our pregnancies.

When Silper Agandi, a cleaner at the Tupange-supported Migosi Health Center in Kisumu, Kenya, was invited to a training on family planning, she was sure there had been some mistake. "Those things are always for the nurses and doctors only--why would they ever want a sweeper to go to that class?" she asked herself. But the 32-year-old mother of seven is exactly the kind of woman the program hopes to reach. "We learned so much about family planning in those classes," Silper says of the Jhpiego-led urban reproductive health initiative, supported by the Bill and Melinda Gates Foundation. "Everybody had questions--even the nurses! I asked so many. With seven children, I knew I just couldn't manage anymore. I was so tired. But I was fearing that it was going to hurt my body." After attending just two of the series of classes, Silper started using Depo Provera. “Family planning is good. Tupange made me feel like I belong to myself again,’’ she says. “Now that I have taken those classes I tell everybody about family planning. I encourage them to come and talk to our nurses and to choose a method. I show them how well I am, and I tell them that I am not having any problems. Because they can see me with their eyes, they believe me.”

Taking the contraceptive pill enabled my husband and I to decide when to start a family. It also allowed us space out our children, leaving a healthy gap of two years between the caesarian sections that I needed, allowing healing to take place before the next child was conceived. I think this was essential for my own health; maternal wellbeing is essential if children are going to be given a good start in life. Our three children are now in their twenties and, having been to university, they have all embarked on interesting careers.

Six children in 16 years of marriage and Khadiza Begum had little knowledge of family planning. But she was interested in finding out because of her frail and weak condition. A community health worker in her village in the Sylhet district of Bangladesh brought her the information she needed thanks to an initiative funded by the U.S. Agency for International Development and supported by Jhpiego and partners. After the birth of her youngest child, Khadiza successfully practiced the Lactational Amenorrhea Method (LAM) for five months. Then, she became interested in learning about permanent FP methods. With counseling, she chose one. “After giving birth to six children, I got very weak. Now I feel better,’’ she explains. Her husband Mortuza Ahmed concurs: “Taking the permanent family planning method is a blessing for our family. Now we can concentrate on our children in a better way.”

Year after year, nurse-midwife Laureta Ramaj would see the same women return to give birth at Koco Gliozheni Maternity Hospital in Tirana, Albania. She soon discovered that the women had little or no information on how best to plan for their families -- "they just got pregnant." With help from Jhpiego and support from the U.S. Agency for International Development, Ramaj received training in postpartum family planning approaches and opened a family planning resource center on the hospital maternity ward. Said one new mother, Marjola Kupa: “One wishes to have a first baby and a second one, but after that planning is necessary. We do not want more than two children but they may happen. We now have books and materials that will help us not to have regrets later.” According to a review of Jhpiego-initiated family planning services for postpartum women, 92 percent have discussed family planning while in the hospital and 76 percent left the hospital using (or planning to use) the lactational amenorrhea method at the time of discharge.

Next month I will be having my current contraceptive implant removed after having it for three years and will get another put in straight away. It sounds a bit strange to say it but I love my implant. It absolutely works for me and provides stability and security – I don’t have to think about contraception day to day and can just live my life.

After a series of long and difficult home births, Maryam Abubakar found herself pregnant again. This time, however, she decided to seek prenatal care and give birth in a health facility near her home in northern Nigeria. Abubakar had married young-at age 13-and knew little about family planning. Over the years, the babies arrived despite her desire to let more time go by between pregnancies. As part of her care and pregnancy at Sir Muhammad Sanusi Specialist Hospital in Kano, Abubakar and her husband were counseled about family planning methods. The couple -- parents of seven children -- decided on a long-acting or permanent contraceptive method. After undergoing an emergency cesarean section, Abubakar received a tubal ligation. She went home with a healthy baby girl and free from worry that she would be pregnant soon again. "If I had known about this method of family planning," says Maryam, 35, "I would have stopped delivering long ago because I believe quality of life for my children is more important than number of children." The Abubakars are just one of thousands of couples who have received potentially lifesaving family planning information and counseling through the U.S. Agency for International Development (USAID) flagship Maternal and Child Health Integrated Program (MCHIP). An estimated 30,000 women die annually from complications of childbirth in Nigeria.

As an older mom who chose to wait and raise 3 kids after years of travel, study and professional growth - I can't imagine an equally fulfilling life for myself, any other way. My family benefits, I benefit, and that only has positive impact on our community as a whole.



"Choosing" requires access to effective contraception. There is no other way.

My name is Maheshwori. I’m 19 years old. My husband went to India to work. Here, there is no food. No rice, no nothing. Around here, there’s no work.

I am very, very scared about my pregnancy. Everyone has been asking about it, which makes me even more scared. My first child was breach-born and I might just die this time. If I live, I will live. If I die, I will die.

Some said take her to the hospital. Some said drive her down. But how would you get a car without money? In November my daughter was born. I had the baby in our cow shed. For 12 days after the birth, the baby and I were kept in the cow shed. On the 13th day we were allowed out. You can’t take a newborn in the house. God gets angry. You’re better off in the cow shed.

After the birth, I’ll rest for seven days, but then it’s back to work. I have to pound the rice, carry water, cut grass, and chop wood. Life is tough here.

My grandmother is a strict Catholic and so my mother is one of 18 kids in India. My grandfather died when my youngest uncle was invitro still. So my grandma had to take care of 18 kids on her own with no income. My mother also did not believe in contraception and had it not been for several mishaps and miscarriages I too would have been one of 18 kids. However, I married an American who introduced me to the Copper T/Paraguard/IUD which was subsidized in India by the Swedish government. Without the IUD I would be in my grandmother's shoes raising 18 kids on my own...so contraception has helped me make a great choices in family planning. And I have two very wanted kids and no unintended pregnancies like my mother and grandmother.

I work as a technical adviser in Family Planning and Sexual and Gender Based Violence. My role is to support and manage field activities related to interventions.

As a child, I saw women die—neighbors losing mothers, friends losing mothers. It wasn’t until I became an adult, after I finished my studies, that I understood the connection between the early deaths of these women and our society’s endemic problems. Ignorance; illiteracy coupled with the low status of women; weak health due to numerous, close together, and early and late pregnancies; psychological trauma due to gender discrimination; war with its corollary effects on women’s lives; all condemn women to poverty and suffering. Very early on I became obsessed with these issues, which gave me the power to be an activist promoting family planning, optimal birth spacing, and fighting against gender discrimination.

Many girls are victims of tradition. Many are forced to enter into marriage at age 12 or so for dowries, and soon become pregnant. If I hadn’t been schooled by my parents, I would be living in poverty, sadness, and a harsh reality like many of the other women in my country. However, even education could not save me from the damage caused by my lack of rights as a woman. My husband took my children from me when we divorced. He did this just to hurt me, knowing that I would have no way to reclaim them. That’s the root of my compassion for other mothers, and how my own trauma became the healing of others’.

I’ve been able to help women to access the best health care available before, during and after their pregnancies, and perhaps most importantly teach them how to stand up for themselves and their children in order to have the lives that they deserve.

Zainabu lives in Sierra Leone with her husband and nine children. Until recently, they’d never used a modern method of contraception. All too aware of the dangers of repeated pregnancies (one in eight women in Sierra Leone dies during pregnancy and childbirth), Zainabu decided to find out about family planning through the Marie Stopes outreach team, which visits her village each month.

After discussing the different options, including condoms, the pill, and long-acting and permanent methods, she made a life-changing decision and chose a tubal ligation. The procedure took just 25 minutes and was performed under a local anaesthetic.

After the procedure, Zainabu shared her relief: “I’m very happy it’s done. By stopping having children, we’ll be able to give all our attention to the ones we have.”

Yune was 20 when she got married and she became pregnant with her first child almost straight away. After the birth, she confided in a neighbour that she didn’t want to have another child too soon. But she wasn’t sure what she could do. Her neighbour told her about the family planning services she could access at the centre in her compound.

(Yune's story taken by Charlie Shoemaker)

On her first visit to the centre Yune was welcomed by Prudence, the care provider who runs the clinic five days a week. She was counselled on a range of family planning methods and decided upon the injection: “I chose the injection because it lasts for three months. You can’t forget to take it like you can with the pill.” When asked what she’d do if care wasn’t here, she laughed: “it would be the end of the world”.

I'm in my fourth year of postgraduate study, an immense privilege which has enabled me to continue learning while sharing my knowledge with others and gradually coming to the conclusion that I definitely want to spend my life teaching English literature. I'm also in the fourth year of a great relationship; thanks to easy access to contraceptives, I have never had to fear that my professional aspirations could be compromised by unplanned pregnancy and all of the many challenges that might entail. As I hopefully embark on an exciting career, I treasure the security that I can choose whether and when to embark on family life, in the future.

Tigist is a community based distributor in Ethiopia’s capital Addis Ababa. Every day she travels around her community making sure women can access family planning and other vital sexual and reproductive health services. She meets women like Zeitu, a 30 year old mother of four. Zeitu gave birth to her first child at 14 having been sold into marriage. The money Zeitu makes as a seamstress is barely enough to feed the family she has. And she’s adamant that she can’t afford to have anymore children. Tigist’s regular visits mean Zeitu can access contraception and choose the size of her family.

(Tigist's story told by Guy Calaf)

For Mavis and her husband, having access to the right method of contraception was so important they cycled for two hours to visit an outreach clinic where they knew they’d have a range of choices.

Mavis is 35. Married at 25, she and her husband have five children. Their sixth child died shortly after birth. It was then that Mavis found out she was HIV positive and decided she didn’t want to have any more children. While Mavis had been able to access family planning services at a nearer clinic, she wasn’t happy with the range of choices available to her. She was sure about her decision. And she wanted a more long-acting method than her local clinic could provide.

After listening to the options available from the health outreach team during the group counselling session, Mavis chose the implant. And she was able to have it fitted there and then by a trained member of the team. “We are so happy. We’ve been looking for the implant for a long time, and we now know where I can get it.”

(Mavis' story told by Charlie Shoemaker)

Khadeja is 28 and lives with her husband, son and mother-in-law.

Khadeja and her husband met in the garment factory where they both work. After marrying they decided to wait for a year before starting a family, so Khadeja started taking the pill. She was able to get it from a family planning centre run by Marie Stopes International, based in the factory where she works.

Khadeja took the pill until she and her husband decided the time was right to have a child. When she returned to work after having her son she spoke with one of Marie Stopes International’s family planning nurses, decided the pill was the best option for her, and started taking it again.

Because they are able to control the size of their family, Khadeja and her husband have a good quality of life today, and they’re able to plan their family’s future.

“Without the pill we’d have had lots of children by now and it would have been impossible for my husband to support us. Life’s not so tough when you’ve only got one child. Our family is small but we are happy.”

(Khadeja's story told by Susan Schulman)

Ingrid is a mother of seven from a poor neighborhood in Guatemala City. She tried several methods of family planning over the years, but she often experienced unhealthy side effects or could not afford to continue paying for the method long-term. One day, Ingrid when to a clinic information day organized by the Pan-American Social Marketing Organization (PASMO) around family planning education. PASMO counselors talked her through all of her family planning options. Ingrid chose to get the Copper T, a non-hormonal method which prevents pregnancy for up to 10 years. Ingrid’s decision has changed her life. Now she counsels her children about using contraception. “I told my daughter to have two children,” says Ingrid. “Have two until they’re 10 or a certain age, and then decide if you’re going to have more.”

Rose comes from a family of five children. When she was very young, her father left her mother. Since Rose’s mother didn’t have much money, she couldn’t afford to send her children to school. Once Rose finished primary school, which is free in Tanzania, her education came to an end. Rose, now a 30-year-old mother of two daughters, wants more for her children: “I want them to receive a proper education. I don’t want to have a large family I can’t afford to take care of,” she says. About 10 minutes from where Rose lives in Magomeni, Dar es Salaam, is a private health center. One day, she heard that people were coming to the clinic to talk about family planning. The staff at the clinic talked to her about family planning and eased her concerns about side effects. Afterwards, they provided counseling sessions to the women who were interested in a long-acting and reversible contraceptive method, such as an IUD or implant. That day, Rose chose to have an IUD inserted. Rose wants to keep using family planning for a few more years. Then she wants to have a third child. “I feel better when I’m using family planning. I look at my daughters, and all I want is for them to be healthy and educated. I want them to grow up and have a better life,” she says.

I'm lucky to have the advantages of public health care provision, committed medical professionals, and free access to comprehensive contraceptives. My husband and I rely on contraceptives together to live our lives with self-determination and autonomy, and choose our life path as a couple. Contraception empowers us to lead the lives we want to live. As I finish my MSc, Environmental Management, I recognize that too many women and men do not have these advantages. I hope that continues to change. It's in our collective best interests to ensure access to contraceptives is widespread, well funded, supported and protected.



