From using revenues from a condom catalog to fund family planning programming to fighting laws that restricted contraceptive advertisement, Phil Harvey was a trail blazer. He was a visionary and “serial founder” who co-founded three organizations that expanded reproductive rights and choices for women globally – Population Services International (PSI), Marie Stopes (now MSI Reproductive Choices) and DKT International.

Phil forever changed the landscape of global health and social justice. In the year since his passing, his legacy lives on. We asked the CEOs of the three organizations he co-founded – PSI, MSI, and DKT – to reflect on Phil’s legacy and what he would do to work towards the United Nation’s SDG goals.

A VISIONARY RULEBREAKER WHO TRANSFORMED GLOBAL HEALTH

Karl Hofmann, PSI

Phil Harvey was a visionary rulebreaker who transformed global health’s landscape. He championed personal freedom, he advanced civil liberties, and he believed in supporting consumers everywhere to take their health and lives into their hands. Phil’s legacy inspires PSI’s people-powered approach, our commitment to people’s right to make their own health decisions and our ability to break from tradition and chart a new course – with and for the people we serve.

To achieve the SDGs, Phil would break the rules. From his mail-order condom business to his social marketing roots, Phil showed us the power of doing development differently. He knew that the best solutions for people started with themselves: listening to people’s voices, and meeting their needs. Phil would be innovating to find ways to enhance the individual as the agent of our progress. And he would avoid conferences.

WHEN HE SPOKE, YOU FELT COMPELLED TO LISTEN

Simon Cooke, MSI

Phil’s contribution to global health cannot be overestimated. From the early days, his mission was to provide affordable contraception to anyone who wanted it, and to normalize the idea that sex could be for pleasure. Through his actions, and the organizations he founded, hundreds of millions of [people] have benefitted from the high-quality contraceptive products and services these organizations distribute and provide, and in so doing, many taboos and barriers have been broken. Phil also put his money where his mouth was and invested his own time and funds to promote and defend individual reproductive rights. With his emphasis on accountability and measurement, he ensured that progress was measured in people served and results, not effort expended. Phil was a man of few words, but when he spoke, you felt compelled to listen.

If Phil were in charge of achieving the SDGs (a task, by the way, I am sure he would not want to take on) he would probably take the responsibility away from many of the organizations tasked with trying to deliver them today. He would consider them to be ill-equipped to deliver results, too self-interested, and unaccountable for their delivery. I am sure he would prefer to engage more private sector actors, and he might, for example, look to distribute cash directly to the poorest so that they could find their own solutions.

THE WORLD IS A MUCH BETTER PLACE BECAUSE OF PHIL HARVEY

Christopher Purdy, DKT

Phil was a pioneering, iconoclastic, optimistic big thinker. An unassuming and quiet champion of freedom, Phil’s ideas, work, and philanthropy have touched the lives of millions of people all over the world.  Furthermore, his fingerprints have impacted multiple organizations and thousands of professionals who work in the field of reproductive health. The world is a much better place because of Phil Harvey.

Phil was always happy on the outside looking in, providing contrarian thinking to solving the world’s problems. His approach to most issues, including those tackled by the SDGs, was to deeply trust individuals to solve their own problems when given sufficient agency, education, and resources. Phil believed that empowering people, without the confines of institutional oversights, helped them unleash their potential through civic and private life.

Finding quality sexual and reproductive health and rights (SRHR) services can be difficult for any teenager, but for deaf adolescents, it can be nearly impossible. VSO, who works to ensure quality health and well-being for all adolescents and youth in Rwanda, supports deaf adolescents in accessing SRHR education and care. Sintha Chiumia, VSO’s Regional Media and Communications Officer sat with VSO Rwanda volunteer Brown Niyonsaba to learn more.

VSO: Tell us about yourself and your work with VSO Rwanda

Brown Niyonsaba: I am 35 years old. I live in Kigali, Rwanda, and I am deaf.

While I was born hearing, I got sick with meningitis after one year and became deaf; my sister is also deaf. After starting at a “normal” school, I eventually moved to a specialized school for deaf children. I am proud to have graduated from Adventist University of Central Africa.

As a young person living in Rwanda, I noticed that many deaf women and girls in my community do not have SRHR education. Some are single mothers. Every person should have access to the SRHR services they need, no matter their abilities, and I feel quite privileged to volunteer with VSO Rwanda and help my peers access SRH information and services through a project called Imbere Heza (Bright Futures).

VSO: What were the barriers to accessing SRH care and education for the deaf community?

BN: Many deaf people do not have national identity cards and Community Based Health Insurance (mutuelle de sante), so they are not able to access health services in Rwanda. For those who can, communication is a major barrier between deaf people and healthcare professionals. Most healthcare professionals in Rwanda do not know sign language. When deaf people go to a health centre, they need a sign language translator to help explain why they are there and the services they need. As deaf people, we did not have the privacy that many need when accessing SRHR services.

It is also rare to find translators at health centers; as a result, health workers have to guess instead of interpreting exactly what a deaf patient needs. Without a translator, health providers are also unable to inform deaf patients about the different SRHR services and adequately support them in their family planning goals.

With these challenges, out of frustration, some deaf people stop going to health centres entirely.

Without sign language, parents and families also don’t know how to share SRHR information with deaf adolescents and youth. This leads to feelings of discrimination among deaf youth and limits their access to critical SRHR information and care.

VSO: What drew you to the Imbere Heza project, and how are you expanding SRHR access for people who are deaf?

BN: All people with disabilities should have quality SRHR education and care. As a deaf person, I live the challenges of navigating health systems that are built for the hearing community. That’s why I chose to volunteer for VSO’s Imbere Heza, a project expanding SRH access for people who are deaf – like myself.

I work in the Nyagatare District in Rwanda’s Eastern province, where 5.3 percent of people live with disabilities. Under the project, I and other volunteers help young people and adolescents to understand SRHR, including family planning issues. We train nurses, midwives, community health workers, receptionists, deaf peers, and other national volunteers on Rwandan sign language. We also train them on how to interact with and support deaf youth.

As volunteers, we support healthcare workers to understand the SRHR issues faced by deaf youth, and we support deaf peer educators to deliver SRHR sessions within their communities. To support deaf youth at home, we train parents and families on sign language so they can communicate easily.

VSO: What has the project achieved? What changes have you seen among young people who are deaf, and the health workers who serve them?

BN: I started volunteering in December 2017. Together with other national volunteers, we have trained 87 nurses, 50 deaf peer educators, and 700 community health workers. The people I have mentored have reached more than 1,100 deaf adolescents and youth. Through our community mobilization efforts, we have reached over 16,000 young people through small and one on one outreach sessions.

Since I and other VSO volunteers started working, we have noticed that there is awareness among health workers, government leaders, families of the deaf, and community members. When we train deaf youth on their SRHR, they are no longer afraid; they go to health centres with more confidence. Some deaf people now have IDs and insurance. They can access family planning services and can communicate their needs to health professionals.

Community Health Workers can give deaf youth SRH information and nurses we have trained can communicate using sign language. Receptionists welcome deaf people in the health centers and deaf people feel more confident in the quality of family planning services they receive.

Our work has led to an increase in SRHR knowledge and uptake of related services, in particular, there has been increase in information about reproductive health and contraceptive choice and improved uptake of modern contraceptive methods.

VSO: Your work to date has catalyzed tremendous impact. What do you hope to achieve five years from now?

BN: My desire is to train more people through the Imbere Heza project. Those trained should use the knowledge to help train others and pay it forward. I want to help all deaf people access the SRH care they need and make health systems more accommodating of those with disabilities.

Learn more about VSO Rwanda here.

By Sarah Odwong, Strategic Communications Manager, PSI Uganda

As part of outreach efforts, Population Services International (PSI) Uganda partnered with the Pan-African edutainment series Kyaddala, It’s Real to bring the topic of self-injectable contraceptives to the mainstream.

Since it launched in October 2019, Kyaddala, It’s Real weaves in stories that resonate with young people across Uganda and the many gatekeepers they have to engage with as they navigate various challenges in their daily lives, from relationships and career guidance to concerns around gender-based violence and unplanned pregnancies. The show’s inaugural season featured realistic storylines with characters overcoming sexual abuse, pursuing their dream while juggling major responsibilities, facing HIV stigma, forced into an arranged marriage, and exploring love and sex. The first season garnered 5 million TV viewers and captivated nearly 1 million users across social media.

Capitalizing on the show’s popularity, PSI Uganda, through the Delivering Innovation in Self Care (DISC) project collaborated with Reach a Hand Uganda (RAHU) to produce the second season of Kyaddala, It’s Real. Marketed towards a 15–24 age audience, the program offers a unique opportunity to make the self-inject journey, including the decision-making stage, real and relatable to audiences through the show’s characters.

DISCOVERING YOUR POWER THROUGH SELF-INJECT

With funding from the Children’s Investment Fund Foundation (CIFF) that DISC is working to support women—particularly urban mothers and young women aged 20-24 years—to take more control over their sexual and reproductive health (SRH), including addressing their unmet needs and barriers to access of modern contraception.

Beginning with contraceptive self-injection, DISC aims to demonstrate that self-care is a viable cornerstone of SRH. By providing a way for women to have increased voice, choice and agency over their health, self-care offers the Ugandan health system a new and critical partner: consumers themselves. Leveraging consumer insights from users and healthcare providers, DISC is fostering local innovation and local capacity to increase voluntary uptake and continuation of self-injectable contraceptives.

Further, DISC seeks to help build the right environment so that a woman can confidently walk into her neighborhood pharmacy or clinic, or use her phone, to access high-quality products and information that meet her needs for self-care, including self-injectable contraception.

Information is therefore necessary for consumers to start and complete the entire self-injection journey. To this end, several episodes of Kyaddala Season 2 spotlight self-inject contraception and self-care through the experience of Shamim, a newly married first-year university student. She is an ambitious young woman who desires to complete her university education and to build a career before having children. She is not ready to get pregnant. When she shares her fears with a friend, she is introduced to self-inject contraception. Viewers will see Shamim trying to balance her dreams with what is expected of her and see her tapping into her power to go after her dreams. And, through the character of Hajji, viewers will see the importance of male support in the self-care journey. The benefits of the method are visibly highlighted throughout the season—namely that self-injection is safe, effective, easy to use, long lasting, reversible, does not interfere with sex, and can be used by breastfeeding women. The storyline will also address the fact that self-injection can be administered in the privacy of one’s home or where they feel most comfortable, can be discontinued without a provider’s help, and one can keep several doses and reduce the number of trips to the health facility to get subsequent doses—thus enabling users to prevent unplanned pregnancies and pursue their dreams without worry.

Through Kyaddala, DISC has access to a wider platform to encourage information-seeking behavior among the project’s target group (who are part of the show’s primary audience). The edutainment series will increase women’s sense of agency, support women in linking to the healthcare system and provide a new channel for initiation and training. Also, it presents an additional touchpoint to reach the self-inject consumer. Kyaddala provides a direct avenue to drive clients from intent to usage of self-inject contraception.

The much-anticipated second season of Kyaddala started on March 4^th, 2022. Episodes are broadcast on NBS TV during Friday night peak time (8-9 pm EAT) and will run till May 20^th, 2022. The estimated audience reach for the show is 10-12 million viewers. The series is also expected to stream on Netflix, Sauti Plus TV and some DSTV channels.

“EDUTAINMENT” HAS BECOME A GAME-CHANGER

Across Uganda, 28% of currently married women and 32% of sexually active unmarried women have an unmet need for family planning. Data from the Guttmacher Institute (2019) show serious gaps in sexual and reproductive health services for adolescent women in Uganda. For example, an estimated 648,000 women aged 15–19 in Uganda are sexually active and do not want a child in the next two years. However, among this group, more than 60% have an unmet need for modern contraception, meaning that they either use no contraceptive method or use a traditional method of contraception. Approximately half of all pregnancies among women aged 15–19 in Uganda are unintended, totaling an estimated 214,000 unintended pregnancies each year. The overwhelming majority (88%) of these pregnancies occur among adolescents with an unmet need for modern contraception (FP 2030). In a country where the fertility rate stands at 5.4 children, the impetus remains to resolve the gaps in serving Ugandan women and girls with the tools and information to take more control of their sexual and reproductive health.

Educational entertainment or “edutainment” has become a game changer. From films to television shows, entertainment media is increasingly used to generate awareness and change perceptions around a variety of sensitive topics, including sexual and reproductive health and rights, and can carry the potential of providing life-saving information to tackle some of the most pressing health problems.

By Nandita Bajaj, Executive Director, Population Balance 

As a young girl growing up in a traditional patriarchal culture in India, I had a surprising proclivity toward unconventional interests: airplanes, mechanical toys and comfortable practical clothes—a quality that, thanks to my family, was lovingly nourished. My family moved to Canada when I was 16-years-old, and even through the process of acclimating to the new environment, my confidence in my ability to choose my own paths—non-traditional as some of those were—remained intact. From aerospace engineering to teaching, and from solo traveling to being in an interracial relationship, I felt that I was afforded a high degree of autonomy to choose a path that was meaningful for me.  

But through this unique journey into my late twenties, the one path that I believed was an inevitability was that of motherhood.  

I had never given it any thought because it’s just what I knew I had to do, even though I had never felt any inkling toward that path. It’s what I had grown up learning and seeing all around me—in school, in books, in movies, and at work—the narrative that having children was a natural rite of passage into adulthood. It wasn’t until my partner (now, husband) and I started discussing our future plans that the subject of kids came up. We were both minimalists and environmentally conscious, and he asked me how I would feel about not having children. I told him I didn’t understand what he meant! “Don’t we have to?” He told me it was up to us whatever we chose to do in alignment with our values. I was 28-years-old. To learn that I could choose not to have children was the most joyful and liberating thing I had ever heard; it was a moment of profound awakening for me, one that determined the path for the rest of my life. 

Fast forward 10 years; I decided to take a sabbatical to pursue my graduate studies at the Institute for Humane Education at Antioch University. This degree was my opportunity to dive more deeply into pronatalism, a set of social, cultural, patriarchal, religious, political, and economic pressures placed on people to have children, regardless of what we truly desire. My research revealed to me that pronatalist pressures are the water in which we swim, so ubiquitous that for many of us, myself among them, it’s difficult to even discern what we truly desire.  

Pronatalist discourse ranges from pressures for children or grandchildren exerted by family members, to religious messaging that greatly influences family size decisions while stigmatizing the single, childfree and childless, to political restrictions on contraceptive use and abortion bans. Reproductive decision making is powerfully shaped by conformity with pronatalist social norms most often upheld by patriarchal religious and community leaders, as well as by politicians with economic, nationalist, or military interests in the foreground. Whatever the reason, pronatalism’s chief characteristic is that it reduces people to reproductive vessels for external demographic goals. Reproductive control through coercion, whether to limit reproduction or promote it, is a violation of reproductive autonomy and has no place in our sexual and reproductive health and rights (SRHR) work. Pronatalism, as I was uncovering in my research, is also at the heart of our unchecked population growth, growth that relies on those with the least degree of personal or reproductive autonomy. In addition to undermining reproductive agency, pronatalism plays a tremendous role in jeopardizing planetary health, including all the incredible plant and animal species that exist along with us. 

Three years of research gave birth to what is now the only course of its kind in the world that draws the connection between pronatalism, anthropocentrism, and overpopulation. Pronatalism and Overpopulation: The Personal, Cultural, and Global Implications of Having a Child is an online, discussion-based, graduate course open to anyone in the world interested in exploring these intersectional and multi-faceted global issues. There’s nothing more gratifying than to see the sense of liberation that young people express when given the opportunity to make free and informed family choices for themselves, their families, and the planet—including how they define ‘family.’ As one student noted, “This course was paradigm-shifting: unpacking pronatalism has given me a revolutionary lens through which to consider my own life choices, but also to understand everything going on in the world, from overpopulation, to climate change, to the oppression of women and other marginalized groups.” 

Having also recently become the Executive Director of the non-profit Population Balance, I inherited The Overpopulation Podcast as one of our programs. Featuring experts covering topics ranging from mobile vasectomies and unconventional families to ecological economics and climate restoration, the podcast has now become one of our top-performing offerings, ranking in the top two percent out of all podcasts globally. Our brilliant interview with Thailand’s ‘Condom King’ Mechai Viravaidya was not only a career highlight for me, but also what inspired me to attend and present at the ICFP2022 conference to meet one of my heroes in person. 

For more information about these initiatives and more, go to www.populationbalance.org.  

____ 

Nandita Bajaj is the Executive Director of Population Balance, where she also co-hosts The Overpopulation Podcast. As faculty with the Institute for Humane Education at Antioch University, Nandita teaches two courses – Human Rights as well as Pronatalism and Overpopulation. Previously, she worked in the areas of Aerospace Engineering and secondary school education. She was born and raised in India and has lived in Toronto, Canada for over 20 years. 

By James Ayers, Deputy Director, Safe Abortion Programming, PSI Global

The global anti-choice movement weaponizes stigma as a strategy for restricting access to safe abortions. By spreading disinformation and villainizing those who receive and support abortion care, this movement aims to make abortion unthinkable— not just illegal.

The good news: storytelling strategies can combat the shame – if the stories are tailored to the audiences we are trying to reach.

Let’s dig in.

THE #STOPTHEJUDGEMENT CAMPAIGN

Over the past few years, PSI has been working to better understand abortion stigma, reviewing existing literature, consulting with subject matter experts, and conducting original research, including media audits, qualitative research, and online pilots. 

We have learned that storytelling tailored to target populations can drive change. Campaigns that have been effective in the Global North like Shout Your Abortion and We Testify are powerful and effective for their Northern audiences, but the stories shared may not resonate with Global Southern audiences because they are not catered to their social and cultural contexts. For example, messages framed around human rights will be less persuasive with groups that prioritize communal rights over those of the individual. 

To test this hypothesis, PSI is working with 13 social media nano- and micro-influencers from Lagos, Nigeria to understand their impact in addressing abortion stigma. By incorporating themes and language that have proven effective in combating abortion stigma, the influencers describe how their personal attitudes about abortion have evolved over time. Each influencer is passionate about fighting abortion stigma through storytelling; they all have something powerful to say. PSI is simply helping to amplify their stories.

Using these testimonials, PSI aims to test the effectiveness of an online storytelling intervention to address abortion stigma through a “Stop The Judgement” campaign. PSI uses Facebook to socialize the campaign in Nigeria. At the same time, PSI is exploring opportunities to share these stories via alternative social media platforms and offline channels. After all, people have stories to tell. We just need to give them the platform to do so.

OUR TWO CENTS (AND A LOT OF RESEARCH) ABOUT ABORTION STIGMA

Abortion stigma – the condemnation of or discrimination against people involved with the procedure – is a significant barrier to safe abortion care.  The blame and shame too often associated with abortion drives women to prioritize secrecy over safety when deciding how to terminate a pregnancy, and it dissuades health care providers from offering this essential health service. 

Abortion stigma can be challenging to combat because:

• Effective stigma-busting strategies identified by the pro-choice global health rely on interpersonal one-on-one or small group conversations and are difficult to facilitate within large populations.
• Abortion stigma is associated with societal gender roles that situate women’s primary role in life as a mother and caregiver.
• It is also rooted in common false beliefs, such as abortion being physically or emotionally dangerous.
• And it is linked to the concept of fetal personhood – which is not rooted in scientific fact, but, rather, is a religious or philosophical idea.

This is where PSI comes in.  

WHAT’S NEXT

While minimizing the impact of abortion stigma can be a challenge, it is essential in order to protect access to safe abortion. Women should have the right to choose what to do with their bodies. This is only possible if they are free of the blame, shame, and violence associated with abortion stigma. PSI will continue working to understand abortion stigma and the strategies most effective in working to address it on a larger scale.

While PSI works to find large-scale interventions to address stigma, we’re looking to you for support too. How can you fight abortion stigma in your communities – and help to #stopthejudgement, once and for all?

By Sandy Garçon, Founding Director of the Self-Care Trailblazer Group and Senior Communications Manager, Practice Areas, PSI

Four years ago, Population Services International (PSI) convened several key partners to form the Self-Care Trailblazer Group (SCTG). We gathered on the margins of what would become the last pre-COVID International Conference on Family Planning (ICFP). We were undoubtedly on the precipice of a fundamental shift in global health and could not know then how the world would embrace self-care in unprecedented ways.

By the following year, the World Health Organization (WHO) published its first Consolidated Guideline on Self-Care, promoting autonomy and agency as vital components in safeguarding public health. Then in 2020, an unprecedented pandemic brought health systems to the brink of collapse across the globe. Amid worldwide lockdowns, self-care solutions became critically important for people to stay healthy while sheltering at home.

While self-care is an old concept, new medical devices and approaches and the rapid growth in digital technologies are converging in exciting and innovative ways that impact how we use, access, and make our health decisions. And although many of these interventions – HIV self-testing, self-injectable contraception, HPV self-sampling, medication abortion – have become staples of health programming, there were few policy frameworks to back them up.

In establishing the SCTG, PSI and partners – with the support of the Children’s Investment Fund Foundation and the William & Flora Hewlett Foundation – seek to use the groundwork laid by the WHO to foster the enabling environment to make self-care accessible to all. 

Even before COVID-19, the WHO estimated that less than half of the world’s population has access to basic and essential healthcare services – and that there will be a shortage of 18 million health workers by 2030. More than ever, we require creative solutions to rebuilding health systems – including self-care.

It’s important to note that self-care is not a replacement for health systems. Mounting evidence shows that it is an essential part of a complete healthcare package. We in the SCTG believe self-care makes health systems more equitable and efficient, which is especially important as we rebuild following the onset of the COVID-19 pandemic. This is particularly true in the sphere of sexual and reproductive health and rights (SRHR) where stigma abounds and privacy is critical.

Women and girls are often disadvantaged at a disproportionate rate to men concerning access to information and quality health products and services. Self-care aims to redress this balance, enabling an equal, practical environment for everyone to access the SRHR care they require. As such, self-care is an integral tool to reach the 214 million women and girls around the world who have an unmet need for contraception.

The SCTG brings together a diverse group of partners with a decades-long history of expanding options for family planning. The power of our collective action contributes to self-care issue salience by leveraging global communications and advocacy, advancing a learning agenda to inform policy development, and producing “global goods” to strengthen the evidence base for self-care that goes beyond single interventions. At the country level, SCTG National Self-Care Networks, incorporating diverse and strategic public, private, and civil society voices, have successfully supported the development of national self-care guidelines in Nigeria, Uganda, Senegal, and more recently, Kenya. 

It’s true that self-care has received greater attention and relevance in recent years. Gone are the days when even the most seasoned global health practitioner would conjure images of (predominantly) white women doing yoga or on a spa day at the first mention of self-care. But the work is far from over and we continue to learn and grow.

Since that first meeting at ICFP, we expanded our membership to garner diverse perspectives, experiences, and expertise. Our new members added to our ability to position and promote self-care and broadened our scope beyond purely SRHR interventions, affording greater geographic and sectoral diversity. Currently, 60% of SCTG members come from the Global South. Our members play a crucial role in mitigating the small pockets of opposition to self-care that still exist while also helping advance national policies and practices, and working with providers to better integrate self-care into their work. 

There is a critical opportunity to chart a new frontier in healthcare and work towards universal health coverage (UHC) by strengthening the policy and regulatory environment for self-care interventions and ensuring it is included as an essential part of UHC services, policies, and programming. Ensuring affordable and functional basic health coverage for all calls for us to develop health systems that put people at the heart of healthcare and more control in individuals’ hands.

Are you interested in the Self-Care Trailblazer Group?

• Visit www.selfcaretrailblazers.org to learn more about self-care and our work. 

• If you are not already a member, we encourage you to join the coalition and any (or all) the SCTG working groups. To submit your membership application, please fill out this form. We are stronger when we join forces and work together!

• Sign up for the SCTG monthly newsletter! If you want to receive communications from the SCTG about all things self-care, subscribe to our monthly newsletter.
• Check us out on Twitter and Instagram, and follow us for the latest self-care news.

By Laura Ramos Tomás, Sexuality Educator and Founder, TabuTabu

The year was 1990, and Salt-N-Peppa gifted the world with a song that told us to talk about sex. 32 years later and, thankfully, spaces like the International Conference on Family Planning (ICFP) exist for professionals to talk about all things sexual and reproductive health and rights (SRHR).

But much to Salt-N-Peppa’s disappointment, the reality stands that sex(uality) remains taboo for  people worldwide – and the implications are far-reaching and undeniable.

I launched TabuTabu in 2020 after four years of working with survivors of trafficking, sex workers, and youth and young mothers living in social vulnerability across Latin America. TabuTabu materialized from a series of very meaningful exchanges that highlighted the role of taboos at the intersection of poverty, lack of access to quality education, and gender and social inequalities:

• the conversation with a 12-year-old in a village in Central America who had just gotten her first period and anxiously believed this meant she was now ready to be a mother;
• the look of a young boy who was acting up in class as a way of coping with the sexual abuse he was enduring at home;
• the surprise of a sexually active 20-something-year-old vulva-owner when she found out that her urine did not come out of her vagina;
• the emancipated explanation of a sex worker who had recently learned that even as an undocumented immigrant, she has human rights and the police are not entitled to take advantage of her.

These and many more impactful exchanges highlighted the far-reaching impacts of taboos around sexuality, and the importance of contextually relevant comprehensive sexuality education.

Taboos are upheld by silence, and in TabuTabu’s experience, often the hardest part of dismantling a taboo is the very beginning: starting the first conversation can be really challenging, because it involves standing up to years, and often generations of silence, shame and, ultimately, fear. Conversations can happen internally, with oneself, as well as between people. It is through these latter interpersonal interactions that a mass shift in perspective can happen: It takes Community to lift the shame and guilt and judgment around taboos. It takes Community to detaboo.

At ICFP2022’s LIVE Stage on November 16 at 05:15 PM Pattaya City Time, I’ll be exploring, together with the ICFP community, which taboos must be tackled as a priority. By jointly breaking the silence, we’ll be demonstrating how to actively dismantle unhelpful taboos around sexuality and SRHR. You too can TabuTabu – join us as we make Salt-N-Peppa proud!

Mechai Viravaidya, known as Thailand’s “Condom King,” has committed his life to improving family planning services and reducing poverty throughout Southeast Asia. He has worked to build community-based sexual and reproductive health services, rural education and poverty alleviation programs, and HIV/AIDS preventive care for over 45 years.

As the founder and chair of the Population and Community Development Association (PDA), Viravaidya is a leader in localized development in Thailand and all of Southeast Asia. We asked the Condom King about his approach to family planning and community development, its impact in Thailand, and how we can use his learnings to achieve universal health coverage (UHC).

Learn more below.

How have you worked to transform health, development, and education in Thailand? 

Beginning in 1974, my colleagues and I have been on a five-journey endeavor to make Thailand a better, healthier place.

1. Reduce births by improving access to family planning services.
2. Reduce deaths from HIV/AIDS through HIV health system strengthening and prevention.
3. Reduce our financial dependence on donors and advance locally-rooted social enterprises.
4. Reduce poverty by partnering urban companies with rural villages.
5. Improve access to education by building lifelong learning centers that act as social and economic hubs for surrounding communities.

To accomplish this, we rely on our guiding principles to take no as a question, to be innovative, to empower our target audience, and to ensure that everything we do is sustainable.

Tell us about the Bamboo School and how it informs your work moving forward.

By building the Bamboo School, a secondary boarding school for students from Thailand, Cambodia, Myanmar, Laos, and Vietnam, we consolidated the most successful and significant elements of our five journeys. To encourage community engagement and reduce poverty, our students and their families pay their school fees by contributing 800 hours of service and planting 800 trees.

The students are heavily involved in the daily planning and future direction of the school. The Student Government helps to support school budgeting, all purchases, the interview and selection of incoming students and teachers, and overall school activities. As part of our five journeys, we make sure to prioritize sexual and reproductive health education, business skills, and food security strategies to set our students and their families up for success.   

I am grateful for the recognition we have gotten since starting the Bamboo School. The United Nations Population Fund (UNFPA) said that “The Mechai Bamboo School is one of the world’s most innovative schools. The UNFPA recognizes the work and philosophy of the Bamboo School in addressing inequalities in all contexts: gender, socioeconomic, access to health and public goods, and so on – that all human beings, in particular women and girls, have an equal chance at fulfilling their potential.”

My only regret is that I did not start the Bamboo School sooner.

How has your impact spread beyond the students and communities of the Bamboo School?

Schools throughout Thailand have implemented the Bamboo School’s revolutionary approach to education. Hundreds of rural schools heard about our community-based learning curriculum and soon after, asked us to help them implement it in their own schools.

We helped to introduce a more dynamic and relevant approach to education by including programs such as a poverty eradication farm, business skill classes, and sex education. We also helped small schools establish microcredit savings and loan funds and helped assist them in becoming community lifelong learning centers.

We have been fortunate to acquire some funding for this work, which we call the Partnership School Project, in 204 schools. There are several hundred rural government schools also seeking our support and we have recently started helping Cambodian schools on the Thai border to start the Partnership School Project.

The Thai Senate Standing Committee on Poverty Eradication and Inequality Reduction has given its strong support for widespread expansion of our work and stressed that this is how we can reform the Thai education system. 

What does localized development mean to you and what will it take to achieve UHC?

In rural settings, community members must play a prominent role in improving the quality of their lives and communities. For many years, we facilitated the Village Development Partnership where we get support and participation from companies to work with poor village communities. In all such projects, a gender balanced village development committee is elected to determine the social and business training requirements to accompany a microcredit savings and loan fund called the School and Village Development Fund.

More than 200 of these so-called banks have been established and loans are made available to student’s parents and community members.

To achieve UHC, schools must play an important role in providing health education and services in their communities. When community members are aware of strategies to improve access to healthcare, they are better equipped to advocate for their health and the government is more likely to allocate resources to sustain community-level health systems.

By Michelle Schaner, DKT International

When Innocent Grant was just 18 years old, he started school to become a doctor. As part of his education, he was sent to his home region in Southern Tanzania to do fieldwork in rural clinics. It was in these remote, under-resourced clinics that Grant says he first became aware of the perils women face in seeking access to safe abortion.

“I had a patient lose their life,” Grant said. “It gave me so many sad moments. Access to safe abortion is a right – it’s a human right to be promoted. Many women go through silent infections and we only detect things later …if we deny women access to safe abortion we are putting them in a position where they access unsafe abortions and it will never end,” he said. 

It is not uncommon for a young doctor like Innocent to witness suffering as part of his medical training, but what makes Grant unique is that he took action. 

After graduation, he sought out an organization called Young and Alive in Tanzania – a youth-led organization working to promote sexual and reproductive health and rights in Tanzania. He now serves as the head of programs at Young and Alive and started Contraceptive Conversations – a Facebook page and digital forum that integrates pleasure-based, sex-positive discussions and conversations for Tanzanian youth.

“Whenever you integrate sex-positive discussions, (young people) start sharing their stories and sharing their ideas,” he said. “We realized there is a big value in promoting sex-positive conversations.”

Grant is one of three winners of the $10,000 Phil Harvey Innovation Award at this year’s International Conference on Family Planning (ICFP). Phil Harvey passed away this past year at the age of 83. Harvey was a serial entrepreneur who founded three of the world’s most impactful sexual and reproductive healthcare organizations: PSI, MSI and DKT International. The three winners for this year’s inaugural award were chosen because they embody Harvey’s legacy of entrepreneurialism and impact. Grant, along with his fellow winners, Laura Ramos Tomás and Tushar Singh Bodwal, will use the $10,000 award to further develop their projects in their respective countries, Brazil and India, receiving technical support for two years as they complete their projects.

The ideas that sparked these award-winning projects are technology-based, they share a desire to unleash conversations around sex and sexuality, and were seeded by those who developed them years before they began. This was how Ana Autoestima (Ana Self-Esteem), a virtual, pleasure-focused, sexuality education messaging service came to life in Brazil. Ana, a virtual character, is the brain-child of Laura Ramos Tomás, founder of the sexuality education non-profit organization Tabu Tabu. 

Tomas founded Tabu Tabu in 2020 after years of working and volunteering in SRHR organizations in Central and South America. Ana’s existence, she said, was a process of co-creation with fifteen local women in Rio’s favelas, (shanty towns) communities in the northern periphery of Rio de Janeiro where Tomás has worked for the past three years.  Ana is a friend, Tomas said, that women can contact to join a WhatsApp group where they can share information about sex and sexuality that is developed with a great deal of intention to be shame, stigma and taboo-free, and safe.

The adult women Tomás works with are part of conversation circles she began in the favelas , which provide a space to talk about the women’s sex lives in a new way, focusing on their pleasure, their choices, their needs..

“(The conversations) are pleasure-based and puts them first – puts their needs first,” she said. “It’s about what it means to be a woman and be a sexual being and it speaks to them so much more than leading with ‘you don’t want to get pregnant’.”

In India, Tushar Singh Bodwal began his career working as a district officer with the Indian government and, like Innocent Grant in Tanzania, was sent to a rural village in Punjab where he worked on projects related to education. He was tasked with developing health education campaigns for both men and women about menstrual hygiene. It was through this experience, he said, that he became sensitized to the stigma women face related to their bodies. 

“When you increase conversations around (menstrual hygiene) and encourage them to have this conversation with their mothers, this becomes a new norm. Male members become sensitized…it was a beautiful step towards sensitizing communities as a whole and building an empathetic lens,” he said.

After two years working with the government, Bodwal went to work for The Good Business Lab, a non-profit labor organization that uses rigorous research methods to find common ground between worker wellbeing and business interests. It was through his work at The Good Business Lab that Bodwal became interested in gig-economy workers and formulated an idea – Why not partner with companies to provide gig-economy workers, many of whom are women, with an onboarding platform where they access information about their health and wellness?

Bodwal will work with two gig-platform owners, Urban Company and Awign, to start an awareness-building project, accessible through the companies’ apps, to create onboarding training materials for these gig-economy platforms on issues such as sexual harrasment, sexuality, and contraception.

“We want to iIdentify potential areas where women would drop out,” Bodwal said. “Are there more complaints being filed? … There is no training on prevention of sexual harrassment, no training on gender sensitization, no intent to increase participation for women or others, so we are designing a unique SHR program that empowers women gig workers and want to know whether it helps increase their retention and care in the industry.”

The money awarded through the Phil Harvey Innovation Award will also fund an evaluation examining how The Good Business Lab’s program with gig economy workers affects SRHR-related knowledge, attitudes, behavior, and overall well-being. 

The three winners of the Phil Harvey Innovation Award have worked to identify SRHR challenges in their communities and are taking action to build sustainable solutions. It was Phil Harvey’s dream to help every person access quality, affordable family planning services and sexual health information and it is young entrepreneurs like Grant, Tomás, and Bodwal that help make this dream a reality.

For more information, contact Michelle Schaner – [email protected], +13304128270