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Condoms have come a long way since the days of being fashioned from animal intestines (surprise: these are still a thing). They now come in all shapes and sizes – from textured to pre-lubricated to novelty glow-in-the-dark condoms – so there is something for almost everyone. That also means the ‘they don’t feel good’ excuse is no longer a reason not to use one! Why should I use a condom? Condoms have existed in some form or other for thousands of years, and were usually made from animal intestines – thankfully we have moved on since then (although lambskin condoms are still available but aren’t as effective as latex condoms at protecting you against STIs). Condoms are the only form of contraception that can protect you from HIV and STIs and are 87-98% effective for an external (male) condom and 79-95% effective for an internal (female) condom. Using a condom alongside another form of contraception (for example an IUD or the Pill) is the best way to protect against unintended pregnancy. With so many to choose from, we have listed five different types of condoms that you may want to consider the next time you’re getting intimate. 1.The latex condom Let’s start with the male latex condom. It comes in a smooth finish, non-lubricated and a number of sizes. It can be up to 98% effective when used correctly. For non-lubricated latex condoms it is recommended that you use a water-based lube as oil-based lubes can cause tears in the condom, which would bring the effectiveness of the condom down to about 0%. 2. The non-latex condom For those who have latex allergies, non-latex condoms are an alternative but are more likely to break than latex condoms, making them slightly less effective than latex condoms. Most non-latex condoms are made from polyurethane or polyisoprene, but you can also find ‘lambskin’ alternatives, made from lamb cecum, which is the pouch located at the beginning of a lamb’s large intestine! 3. The lubricated condom Whilst lubricated condoms come (obviously) pre-lubricated, the amount of lubrication used may not be enough for you and your partner. It is always advised to use extra water- or silicon-based lube. And remember, never use an oil-based lube with latex condoms. 4. The internal condom Previously known as the ‘female condom’, the internal condom can be used for both vaginal and anal sex. The effectiveness of the internal condom can vary depending on how often it is used. The effectiveness of the internal condom can range from 79% to 95% depending on use. Most internal condoms are non-latex and no, doubling up on an external and internal condom does not increase effectiveness – in fact, it’s strongly advised not to use both of these condoms at the same time as this may cause them to rip. 5. The textured condom Said to increase pleasure, textured condoms come in a variety of textures, from ribbed to dotted to anatomic (a mixture of both). The best way to find out if they work for you is to experiment with your partner or partners!

We can all agree that a lot has happened in 2020 – but let’s not forget that this year also marks the 60th anniversary of the game-changing contraceptive pill. For 60 years, “the Pill” has been approved for use in the US market, changing the face of reproductive control for millions of people since.  Although taking a few years longer to become widely available to all women, the Pill was the first oral hormonal contraceptive – and the massive impact of this tiny pill cannot be understated.  It allowed women to take real ownership over if and when they had children, and how many they had, giving them control over their lives in a way that had never been seen before. As a by-product, the Pill also enabled its users to make freer choices about other aspects of their lives, such as their careers, education, and sexual habits, and we can see why it remains one of the most popular forms of contraceptive to-date.  How it works The way the Pill works is that this hormonally active medication is usually taken on a daily basis. They contain either two hormones combined (progestogen and estrogen) or a single hormone (progestogen), and they generally work by suppressing ovulation, and causing a thickening of the cervical mucus, blocking sperm penetration. The Pill is 92-99% effective, offering continuous protection against unintended pregnancy when used consistently and correctly. It also produces regular and shorter periods (and frequently a decrease in menstrual cramps), and it can protect against ovarian and endometrial cancer, ectopic pregnancies and infections of the fallopian tubes. Possible side effects include nausea, breast tenderness, mild headaches, weight gain or loss. Very rarely, it can lead to serious health risks (e.g. blood clots, heart attack, and stroke), and risks are higher for women over 35 years who smoke. It’s important to note that the Pill does not protect against sexually transmitted infections (STIs, including HIV). To protect against STIs, an internal or external condom must be used. Learn more about how the Pill works.  What next? For years, many people have been calling for a “male Pill”, due to the limited number of contraceptive options available to men beyond condoms and a vasectomy. This often places undue pressure on women or people with uteruses to be “in charge” of contraception – although it is important to note that it is, in fact, everyone’s responsibility. Research is ongoing into contraceptive solutions for men, including pills, injections and gels, but so far none have made it to public use.  Thus the Pill remains one of the most trusted and widely-used forms of hormonal contraception, and in the troubling face of challenges to reproductive freedoms, we truly hope that this vital component of healthcare remains freely available to all who want and need it. 

Oral contraceptives (the pill) are hormonally active pills which are usually taken by women on a daily basis. They contain either two hormones combined (progestogen and estrogen) or a single hormone (progestogen). Combined oral contraceptives suppress ovulation. Progestogen-only contraceptives also suppress ovulation in about half of women (they are slightly less effective). Both types cause a thickening of the cervical mucus, blocking sperm penetration. Oral contraceptives are 92 - 99% effective. A woman can decide to start taking the pill if she is sexually active or planning to become sexually active and is certain she is not pregnant. Some pills are taken daily for 21 days and stopped for 7 days before starting a new package. Other kinds are taken continuously for 28-day cycles. Oral contraceptives should be taken in order, at a convenient and consistent time each day. They are appropriate for women who are willing to use a method that requires action daily and who will be able to obtain supplies on a continuous basis. The pill offers continuous protection against pregnancy, it produces regular and shorter periods (and frequently a decrease in menstrual cramps), and it protects against ovarian and endometrial cancer, ectopic pregnancies and infections of the fallopian tubes. Possible side effects include nausea, breast tenderness, mild headaches, weight gain or loss. Very rarely, it can lead to serious health risks (e.g. blood clots, heart attack, and stroke). Risks are higher for women over 35 years who smoke. The pill does NOT protect against sexually transmitted infections (STIs, including HIV). To protect against STIs, a male or female condom must be used.   Myth: There is a risk of birth defects Some women who seek family planning incorrectly believe that using COCs will cause birth defects in their babies. Fact: Good evidence shows that COCs will not cause birth defects and will not otherwise harm the fetus if a woman becomes pregnant while taking COCs or accidentally starts to take COCs when she already pregnant. Myth: The contraceptive pill can cause cancer Some women who seek family planning believe that combined oral contraceptives (COCs) cause cancers such as breast cancer, uterine cancer, and ovarian cancer. Fact: The use of combined oral contraceptives (COCs) is proven to decrease the risk of two gynecological cancers (ovarian and endometrial). It is difficult to know the effect of COC use on breast cancer and cervical cancer. The possibly increased risks that have been recorded in some studies are not large enough to outweigh benefits or to change current practice. Use of COCs helps protect women from two kinds of cancers—cancer of the ovaries and cancer of the lining of the uterus (endometrial cancer). This protection continues for 15 or more years after stopping use. Breast cancer Research findings about COCs and breast cancer are difficult to interpret. In studies, breast cancer is slightly more common among women using COCs and those who have used COCs in the past 10 years than among other women. Scientists do not know whether or not COCs actually caused the slight increase in breast cancers. It is possible that the cancers were already there before COC use but were found sooner in COC users. Both COC users and women who do not use COCs can have breast cancer. Cervical cancer Cervical cancer is caused by certain types of human papillomavirus (HPV). HPV is a common STI that usually clears on its own without treatment, but sometimes persists. Use of COCs for five years of more appears to speed up the development of persistent HPV infection into cervical cancer. The number of cervical cancers associated with COC use is thought to be very small. If cervical screening is available, providers can advise COC users—and all other women—to be screened every three years (or as national guidelines recommend) to detect precancerous changes in the cervix, which can be removed. Myth: You will experience general health problems Some women believe that COCs cause hair loss (alopecia), asthma, and headaches. Fact: A woman may experience short term side affects associated with use of combined oral contraceptive (COCs), including changes in bleeding patterns, headaches, and nausea. However such side effects are not a sign of illness, and usually stop within the first few months of using COCs. For a woman whose side effects persist, give her a different COC formulation. In women who are otherwise well, COC use may be continued for many years as there are no adverse effects related to long-term use. In fact, there are also long-term non-contraceptive health benefits of using COCs as they: Help protect against cancer of the lining of the uterus (endometrial cancer) Help protect against cancer of the ovaries Help protect against symptomatic pelvic inflammatory disease May help protect against ovarian cysts May help protect against iron-deficiency anemia Reduce menstrual cramps Reduce menstrual bleeding problems Reduce ovulation pain Reduce excess hair on face or body Reduce symptoms of polycystic ovarian syndrome Reduce symptoms of endometriosis Myth: There is confusion about how often and when to take the pill Some women who seek family planning are misinformed about how often or when they should take the pill. Fact: A woman can start using COCs any time she wants if she is reasonably certain that she is not pregnant. To be reasonably certain a client is not pregnant, providers can use the Pregnancy Checklist. If a client is starting her pack of pills within five days after the start of her menstrual period, there is no need for a backup method as she is immediately protected from pregnancy. If she starts COCs more than five days after the start of her menstrual period, she can start them any time it is reasonably certain she is not pregnant. She will need to use a "back up" method of contraception, such as a male or female condom, for the first seven days of taking pills to ensure protection from pregnancy. The effectiveness of oral contraception depends on a regular intake of the hormones contained in the pill. Therefore pills must be taken daily, until the pack is empty. Although the specific time of day does not matter, the pills should be taken at the same time every day to reduce side effects and to help women remember to take their pills more consistently. The client should be advised not to interrupt taking the pills before a pack is finished, even if she does not have sexual intercourse. If the pills are taken correctly, the client will always start a new pack on the same day of the week. If a client is taking pills from a 21-pill pack, she will wait seven days after taking the last pill in the pack before beginning a new pack. If a client is taking pills from a 28-pill pack, she will take the next pill from the next pack on the very next day. Women do not need to take a “rest” from COCs after taking them for a time. There is no evidence that taking a “rest” is helpful. In fact, taking a”rest” from COCs can lead to unintended pregnancy. COCs can safely be used for many years without having to stop taking them periodically. Myth: There is a risk of infertility, or a delayed return to fertility Women who seek family planning may incorrectly believe that using COCs will cause a long delay in conceiving or prevent them from being able to have children in the future. Fact: The combined oral contraceptive (COC) does not cause infertility. This is true regardless of how long a woman has taken the pill, the number of children the woman has had, or the age of the woman. In fact, some of the non-contraceptive benefits of the pill include preserving fertility by offering protection against pelvic inflammatory disease, endometriosis, and ectopic pregnancy. There is no evidence that COCs delay a woman's return to fertility after she stops taking them. Women who stop using COCs can become pregnant as quickly as women who stop using non-hormonal methods. Myth: Contraceptive pills can get absorbed into the wrong part of the body Many women who seek family planning incorrectly believe that COCs accumulate in the body and cause diseases and tumors, or get stored in the stomach, ovaries, or uterus and form stones. Fact: After the pills are swallowed, they dissolve in the digestive system, and the hormones they contain are absorbed into the bloodstream. After they produce their contraceptive effect, the hormones are metabolised in the liver and gut and are then eliminated from the body. They do not accumulate in the body anywhere. Myth: Contraceptive pills encourage 'promiscuity' Some clients who seek family planning wrongly believe that the pill encourages infidelity, promiscuity, or prostitution in women. Fact: There is no evidence that COCs affect women’s sexual behavior. The evidence on contraception in general shows that sexual behavior is unrelated to contraceptive use. In fact, using contraception shows responsible behavior in order to avoid unintended pregnancy and sexually transmitted infections. Myth: There will be an impact sexual desire and pleasure Some clients who seek family planning may believe that COCs reduce sexual pleasure or interest in sex (loss of libido) or that they cause frigidity in women. Fact: There is no evidence that COCs affect a woman's sex drive. Although some women using the pill have reported either an increase or decrease in sexual interest and performance, it is difficult to say whether such changes are a result of COCs or other life events. Myth: You will experience weight changes Some clients believe that COCs cause women to gain or lose weight. Fact: Most women do not gain or lose weight as a result of COC use. A woman's weight may fluctuate naturally due to changes in age or life circumstance. Because changes in weight are common, many women attribute their natural weight gain or loss to the use of COCs. Although a very small number of COC users may report weight change following COC use, studies have found that, on average, COCs do not affect weight. A few women experience sudden changes in weight when using COCs. These changes reverse after they stop taking COCs. It is not known why these women respond to COCs this way.

Leias Obed is a registered nurse working with the Vanuatu Family Health Association (VFHA). She’s part of the Emergency Medical Team operating out of Pangi in south Pentecost, as part of the Cyclone Harold response, which hit in April 2020. We caught up with her there. Sexual and reproductive health is a "hidden agenda", she said, putting a positive spin on the phrase. Women often have to hide their sexual and reproductive health issues and concerns, for fear of stigmatization, or even coercion and violence. By joining the relief effort as part of larger joint medical teams capable of addressing numerous concerns for both men and women, the VHFA staff are able to use the opportunities presented to contact potential clients discreetly and without putting them at risk. Informal exposure to skilled medical staff and counsellors is often enough to initiate a process that results in better, more manageable living conditions for women and their families. Unaware of their own pregnancy “We came to central Pentecost,” said Leias, “and we came across many issues affecting women and girls, but it's like I mentioned, it's a 'hidden agenda'. One thing that we found out is that many women have large numbers of children and their spacing is too close together. But they don't see it as a problem. It's not a problem for them." “Some women who became pregnant during the disaster weren't even aware of their status, but when they came to see us, we have pregnancy tests, and when we test them, they're positive. They're pregnant, and a lot of them have family planning needs.” “Their communities are a long long way from accessing facilities like [these] clinics. We go there and we help them understand, about implants that last five years. A lot of them didn't really understand. They didn't know, it but their main issue is family planning.” Information and education for all “During a response we're more concentrated on the issues facing women right now but it's clear there's a need for us to come back. We must come back so that people can come to understand: What exactly is family planning? Why is it important to use contraceptive treatments? “They really don't understand well at all about family planning products.” The information and education process needs to reach everyone, though: “It would be good if we came back. We come back and present small workshops to fathers, chiefs and to communities at large. To young girls, to mothers so they can come to understand.” There’s a need to follow through, she says. “Family planning is an individual right. We won't force anyone to take it. But there's a need. The more we stay with them, the more we explain, then they can begin to change their mind-set. Then they can freely choose to take family planning.”

Globally, the unmet need for contraception remains too high. It’s estimated that 214 million women and girls are not using modern contraception, despite wanting to avoid pregnancy. And this was before the COVID-19 pandemic, which is set to further derail access to contraception for women and girls around the world. Disrupted supply chains Lockdown measures taken globally to respond to COVID-19 are bringing major disruptions to contraceptive supply chains. Large manufacturers of contraceptives in Asia have had to halt production or operate at reduced capacity, and we may see similar developments in other regions as COVID-19 takes hold. For example, the world’s largest condom producer – Malaysia’s Karex Bhd – which makes one in every five condoms globally, was forced to close for a week in March and only given permission to reopen at 50% capacity. Production of IUDs in India – a major global producer of IUDs – has come to a standstill with the Indian government also curtailing export of any product containing progesterone, a key component of a number of contraceptives. In addition to this, the closures of borders and other restrictions imposed in the face of COVID-19 further affect the shipping and distribution of commodities. Delays in the production and delivery of contraceptive supplies at global and national levels will lead to stockouts of supplies, severely impacting contraceptive access. Disrupted access Beyond this, at country level, sexual and reproductive health services, staffing and funds may be diverted to support COVID-19 responses, leaving women and girls unable to access contraceptive and other sexual and reproductive health care. Provision of sexual and reproductive health services will also be affected by infection prevention measures, including health workers’ access to personal protective equipment (PPE). Yet, this is just part of the picture. Even where contraceptives are available and continue to be provided through clinics or pharmacies, the impact of COVID-19 on women’s and girls’ lives will curtail their access in multiple other ways. Quarantine measures and mobility restrictions will affect women’s and girls’ ability to seek out contraceptive services. Financial insecurity and additional caregiving burdens brought on by lockdown measures will be further impediments. Marginalized populations will face additional barriers. What’s the impact for our clinics on the ground? In 2018, we delivered 81.2 million contraceptive services and distributed over 300 million condoms through our Member Associations (MAs). Contraceptive care, either through clinics or outreach programs, makes up the largest portion of our service provision to communities by far. Now, in the face of the COVID-19 pandemic, we are receiving concerning updates from our MAs who are worried about impacts on supply chains and their ability to operate. 5,633 static and mobile clinics and community-based care outlets have already closed because of the outbreak, across 64 countries. They make up 14% of the total service delivery points IPPF members ran in 2018. For MAs that are still running limited services, an immediate need is PPE. Where does this leave us? At IPPF, supporting all our MAs through this pandemic is our priority. We are working to understand the stresses being placed on our MAs and to deliver as much direct support as possible. We actively monitor the impact of COVID-19 on the supply of contraceptives and other sexual and reproductive health commodities, and work with partners and manufacturers to do what we can to meet MAs’ needs – including for PPE – and ensure continued availability of supplies. We are also working to identify opportunities to modernize our service offering to respond to the rapidly changing landscape, with a view to expanding no touch and digital services and self-management of care, and make a strong case for additional resourcing in these challenging times. And we are calling on others – national governments, donors and international agencies – to recognize sexual and reproductive healthcare, including contraceptive services, as essential in this crisis, and to take measures to address disruptions in supply chains and ensure continued service provision at national level. If women, girls and marginalized communities cannot access contraceptive care in this crisis, we can expect to see a rise in unintended and forced pregnancies, an increase in sexually transmitted infections, including HIV, and, ultimately, a sharp rise in unsafe abortions. The impacts on women’s and girls’ lives now, and beyond this crisis, will be severe.

The Solomon Islands government took a significant step in addressing the family planning service delivery programme in the country by strengthening partnership with the civil society. In its latest move, the Ministry of Health and Medical Services tapped Solomon Islands Planned Parenthood Association (SIPPA), an IPPF member association, to be the CSO focal point to help mobilize the civil society sector towards the achievement of Solomon Islands’ FP2020 target. The Solomon Islands failed to reach the national target for contraceptive rate set in 2015. The target of 55% CPR is double the current rate of 27% which has stayed at that rate for about a decade. The high unmet need can be attributed to various factors, which include: young people’s lack of information to make the right choices; women, men, and youth’s lack of access to FP services and commodities; lack of skilled staff and health service providers. By bringing SIPPA into the action, the Government of Solomon Islands will benefit from IPPF’s and SIPPA’s strong youth program, data collection, management, and analysis infrastructure, and technical expertise in comprehensive sexuality education and HIV/STI program. The commitments made on behalf of the Government of Solomon Islands on July 11, 2012 are (1) to make family planning a priority under the reproductive health program section of the government National Health Strategic Plan for 2006-2015 and (2) to make men partners in all reproductive health issues, including voluntary family planning.  

The decision by China to relax its one-child policy is an important step towards realising reproductive health and rights for all its citizens, the International Planned Parenthood Federation (IPPF) said today. Earlier this year, within a month of taking office, the Premier of China, Li Keqiang, met with IPPF’s Director General Tewodros Melesse and Naomi Seboni, IPPF President.  During this visit, the delegation also met separately, with Vice Premier Liu Yangdong. Mr Melesse said: “During my meeting with Vice Premier madam Yangdong , she endorsed IPPF’s Sexual and Reproductive Health and Rights (SRHR),Vision 2020. I saw this as a strong signal that some of the change we’ve been supporting for many years, might be on its way. “IPPF’s Vision 2020 was launched at the UN earlier this year and aims for a world in which everyone can realise their SRHR rights by 2020. “The announcement from China’s new leadership is a significant step towards this vision. The decision will improve the rights of many people across China and is a positive sign for future changes.” IPPF is a global advocate for SRHR and a leading service provider working across the world. Its 152 Member Associations include the Chinese Family Planning Association (CFPA). CFPA director of international co-operation, Madam Hong Ping, added: “This is good news because people in China will have increased choices in this key area of their lives.”  Image: Ed Jones/AFP/Getty Images

The Government of Solomon Islands agreed to cooperate with International Planned Parenthood Federation (IPPF) this week to advance the work on sexual and reproductive health and rights (SRHR) across its provinces. The Prime Minister announced its commitment to improve SRHR for all by 2020 and a partnership role with IPPF. In the first of a series of meetings between Ministers and high level government officials across the Pacific and Australia this month, IPPF Director General and Acting Solomon Islands Prime Minister Hon. Manasseh Maelanga brokered a partnership which will see the Federation designated as an executing agency on behalf of the Government of the Solomon Islands to advance sexual and reproductive health and rights of all people across the provinces. IPPF Director General, Tewodros Melesse said:  “This is a great step for the Government and IPPF. Our Member Association, Solomon Islands Planned Parenthood Association, has been working diligently to improve the lives of people across the Solomon Islands through a range of much needed services. Through this extensive partnership arrangement we can take that work to the next level to improve access, increase the range and quality of Government services and integrate our expertise to better the lives of people across the Solomon Islands.  This focus will ensure services reach those who are poor, marginalized and socially excluded and wherever there is a need”. IPPF’s Member Association - Solomon Islands Planned Parenthood Association will work closely with the Government to convene meetings across provinces with national ministries, non-governmental and faith based groups and medical associations to advise and prepare a budgeted action plan to help realize sexual and reproductive health and rights for all by 2020. The cooperation will see IPPF play a large role in supporting and representing the interests of the Solomon Islands with key international multilateral and bilateral donors, including the African-Caribbean-Pacific Group of States to support the implementation of these plans, to strengthen sexual and reproductive health and rights.  

This programme addresses critical challenges faced by young women around sexual health and sexuality. It has produced a range of advocacy, education and informational materials to support research, awareness-raising, advocacy and service delivery.  Girls Decide is about the sexual and reproductive health and rights of girls and young women. Around the world, girls aged 10 to 19 account for 23% of all disease associated with pregnancy and childbirth. An estimated 2.5 million have unsafe abortions every year. Worldwide, young women account for 60% of the 5.5 million young people living with HIV and/or AIDS. Girls Decide has produced a range of advocacy, education and informational materials to support work to improve sexual health and rights for girls and young women. These include a series of films on sexual and reproductive health decisions faced by 6 young women in 6 different countries. The films won the prestigious International Video and Communications Award (IVCA). When girls and young women have access to critical lifesaving services and information, and when they are able to make meaningful choices about their life path, they are empowered. Their quality of life improves, as does the well-being of their families and the communities in which they live. Their collective ability to achieve internationally agreed development goals is strengthened. Almost all IPPF Member Associations provide services to young people and 1 in every 3 clients is a young person below the age of 25. All young women and girls are rights-holders and are entitled to sexual and reproductive rights.

The Happy Planet Index has declared Vanuatu Archipelago ‘the happiest place on earth’ with its picturesque shoreline and friendly people. But unfortunately, Vanuatu - the Land Eternal- is a country with one of the highest disaster risks in the world. On Friday 13th of March 2015 cyclone PAM hit Vanuatu's southern provinces of Shefa and Tafea, causing widespread devastation. International Planned Parenthood Federation (IPPF), through its SPRINT initiative (supported by DFAT of Australian government), immediately responded providing life-saving reproductive health services with the help of its Member Association- Vanuatu Family Health Association (VFHA). The VFHA team, with Vanuatu Ministry of Health and United Nation Population Fund (UNFPA), established medical and reproductive health camps in the islands (North Tanna, Epi, North Efate) and remote villages. After the cyclone struck, the island people were left without any access to healthcare, leaving pregnant women especially vulnerable. Around the world, it is estimated that 60% of maternal deaths and 45% of newborn deaths take place in fragile contexts. So, many of these Vanuatu women and their babies are at high risk of maternal and neonatal morbidity and mortality. Furthermore, violence against women and girls is a growing social and economic issue in Vanuatu. The Vanuatu National Prevalence Study of 2010 reports that at least 60 % of the women experience physical or sexual violence and 30% experience childhood sexual abuse while under the age of 15 years. During a crisis situation, this violence is exacerbated. Aditi Ghosh, Acting Director, IPPF-SPRINT joined the VFHA team on their mission to the devastated Tanna Island. “The journey to Tanna was along a long, rocky mud track through deserted woodland, called the land of wild horses. Finally, after two hours, we reached a small village called Launatke, which had a few thatched houses scattered around the forest. We were welcomed warmly by locals. They sang a cyclone Pam song for us in local Launatke tribal language “the power of the storm was so strong that it destroyed everything…”. The VFHA team had turned a youth centre into a medical clinic. We listened to people telling us about the hardships they had faced during the cyclone. Julia, a young women in early 20’s– a mother of four, told us that she conceived her second baby immediately after she stopped breast feeding her first and the same pattern was repeated with the following two pregnancies. Her youngest child was five months old and she was worried she would get pregnant again …… but the cyclone gave her the opportunity get advice from the VFHA nurses. Now, she said, she can focus on taking care of her four young children without the fear of an unexpected pregnancy. We heard many similar stories throughout the afternoon. Next morning, we woke to thundering rain and a blanket of thick fog. We were headed for Labasilis village – a three hour trek through hills and forest. The medicine and supplies were packed in a waterproof bag and we set off - a team of seven including two doctors and two nurses. Keeping balance in slippery mud was a real challenge, everyone decided to walk barefoot for better grip. I was relieved to learn that Tanna doesn’t have poisonous insects or snakes. On our way, a team member told us that pregnant women have to be carried along this road, and then taken by truck the nearest clinic. How do these women survive through this journey? Not surprising that most women prefer to deliver at the village with the help of local (and untrained) birth attendants. No sterilized knives to cut the umbilical cord, instead they use sharpened bamboo. We heard an amazing story of resiliance .. like the one about the woman who while working on her field suddenly felt labor pains. She came back home, delivered on her own, covered the baby with a cloth at home and returned to the field to finish her work. After two hours we reached Loeala vama. I could see a few makeshift tarpaulin houses, a few damaged thatched houses. After providing some quick services in that village, we continued our walk along the slippery road towards our destination.   The fog has become thicker now, covering the whole area. It was difficult to see even the team members ahead of me. Finally, after another hour of we reached our final destination – Labasilis village. There was an UNICEF tent, where we started to set up our outreach medical camp. Though it was an open tent, we partitioned a corner with a cloth for privacy. Soon I could see a stream of people coming towards us, over the hills. I was told that the surrounding villages had been informed about today’s camp and permission to visit given by the village chiefs. That day we saw more than 190 clients – treating a range of ailments from cold, fever, wounds, pneumonia to pregnancy tests, newborn, antenatal and postnatal check-ups, plus family planning counseling and services. We saw many young parents- many with four or more children. Someone joked that here boys will have babies before they have beards. We could see for ourselves, how true that was. I also noticed a young shy pregnant woman, with small baby on her lap, who quietly asked the nurse if she could talk to her in private. Her name was Natalie. She had been prescribed Jadelle (Long Acting Reversible Contraception), when she visited the clinic two months ago. But, when she returned to her village, people scared her by saying the medicine was for wild horses and somehow they removed the Jadelle implant from her arm. And now she is again pregnant, unwillingly. Heading back to the airport in the pouring rain I thought about wild horses, old wives tales and how Natalie will cope with her new pregnancy.