Based in Freetown, Sierra Leone, Gladys Goba has always known her way around a marketplace. The capital city of 1 million people boasts dozens of markets that sell everything from solar-powered flashlights to vegetables to beauty products. But Goba doesn't go there to shop — she goes to markets to educate community members about sexual and reproductive health services.
Working as a nurse and the regional manager of the North West region for Planned Parenthood Sierra Leone (PPSL), Goba’s main goal is to destigmatize contraception in a highly religious and traditional society, where misconceptions are rife.
“People say [contraception is] a sin, it makes you fat, it makes you bleed. They peg every illness to it,” Goba, 46, told Global Citizen.
To combat this kind of misinformation, Goba leads outreach initiatives organized by PPSL. Alongside a team, she sets up temporary labs and clinics in some of Freetown’s most marginalized communities such as the Kroobi slum, Dwarzaka, and Adonkai. These makeshift clinics are set up under a canopy on market days — a different day of the week depending on the community, where people congregate on roadsides to buy and sell goods.
The outreach workers see diverse clientele throughout the day. Men tend to drop by in the mornings, women come in the late afternoon after selling their goods at the market, and youth visit the clinic in the evenings. Although outreach services are meant to wrap up by 7 p.m., workers stay as late as 10 p.m. on some days to provide counselling and other services.
Alongside providing sexual and reproductive health services, PPSL treats minor ailments like malaria and typhoid. Goba explains this is a way to “create demand” for reproductive health services, which people are initially hesitant to enquire about.
“When we do these [general health] tests, people come and flock [to] our clinic. We use this as an opportunity to engage them in sexual and reproductive health issues,” Goba explained.
To tackle stigma and misconceptions about contraception, PPSL has goodwill ambassadors who are traditional, religious, and women community leaders that endorse the organization and its approach to family planning. On outreach days, when Goba is asked questions like whether birth control is permissible by certain religions, she uses a projector in the makeshift clinic to screen a documentary featuring the ambassadors. Their endorsements are highly respected by community members, who Goba says are typically more comfortable with family planning services after watching the documentary.
Goba says that some community members so intentionally seek PPSL’s services, but want to be discreet.
“Sometimes, a woman will come and say 'I want this thing [contraception] fast.' They don’t want counselling or anything like that,” she explained, fearing that the longer they stay at the clinic, the more likely they are to be recognized by someone they know.
Because of this, some people are not comfortable going to the outreach clinic in their own communities, and prefer to seek services in a different community instead.
Goba says a lack of confidentiality amongst health workers also contributes to the stigma.
“If a young woman comes and asks for a condom, women working in the clinic will say, ‘Do you know this young girl? So and so’s daughter? She is sexually active.’ And then everyone will be talking about it,” Goba said, adding that she recently saw a young woman leave the clinic before receiving any services after overhearing nurses gossiping.
At other times, women do not want their spouses to know they are using contraceptives.
“There are some women who leave their client card with us because they don’t want their husbands to see it in their purse or at their home,” Goba said.
In these cases, the client card is kept on file at the clinic.
Since PPSL aims to reach a wide demographic of people, including those who are illiterate, Goba and other health workers find creative ways to keep people informed of their upcoming appointments.
“We tell them they’re due for another appointment two days after Valentine’s Day or they should get their IUD replaced next year on Eid al-Fitr [a Muslim holiday],” the nurse said.
In Freetown, Planned Parenthood runs the Western Region Youth Center, an unconventional centre that provides sexual and reproductive health services. The centre hosts a small film theatre and arcade. Some youth who seek health services go to the clinic under the guise of watching a soccer match, so they will not be judged for being sexually active. This youth centre helps the organization reach its target demographic despite a strong stigma.
"The adolescents don’t want their parents knowing [they are receiving our services] because sex is a taboo. They say, 'I cannot take a [contraceptive] pill because my parents will see me taking it everyday,'"
While they serve adolescents, PPSL is not permitted by the government to provide services to anyone wearing a school uniform — Sierra Leone does not currently have a sexual education curriculum in schools.
“There is a huge information gap,” Goba said. “That’s why there’s a lot of misinformation.”
Planned Parenthood is working with the government to develop a curriculum, which it hopes will roll out in schools nationwide in 2020.
PPSL works alongside programs like UNFPA Supplies, the UN’s program dedicated to increasing access to contraception worldwide with the goal of eliminating maternal deaths, increasing access to family planning, and ending gender-based violence and harmful practices. The cost to do so succesfully by 2030 is estimated to be $264 billion — but UNFPA expects a funding gap of $222 billion.
That is why world leaders like Canada — who is widely praised for its feminist foreign aid agenda — must increase funding to UNFPA Supplies.
A report by the Guttmacher Institute found that the $42.6 million that Canada spent on family planning in 2017/2018 contributed to: 1.4 million women and couples receiving contraceptive services and supplies; 387,000 unintended pregnancies averted; and 1,100 maternal deaths prevented. This data shows the outcomes of investing in women and girls' sexual and reproductive health, and contributes to the UNFPA's 2030 goal of ensuring every person has access to family planning.