What it’s like to work in family planning and SRHR right now

Exhausting. A struggle. Burn out. Risky. These were the words practitioners operating globally in the family planning and sexual and reproductive health and rights, or SRHR, space used to describe what it’s like to currently do so, especially in the wake of the U.S. Supreme Court’s decision to overturn Roe v. Wade earlier this year. But determination, anger, and a sense of responsibility are what keep many of them going, according to those Devex spoke to on the sidelines of the International Conference on Family Planning in Pattaya, Thailand, in mid-November. “Working in this space is extremely exhausting and requires a certain level of resilience,” said Dr. Angela Akol, regional director of Ipas Africa Alliance, which works to increase access to safe abortions and contraception. Long fraught with taboos and charged with emotion, the controversy around family planning and SRHR services bubbled over onto the global stage when the constitutional right to abortion in the U.S. was diminished. Consequently, access to safe abortion services in certain states is now limited or even outlawed while groups contend with the idea that contraception could be next. “We know the same actors — they’re deeply misogynist, they’re deeply anti-LGBT — are also coming for the same efforts to provide contraception because contraception is about freedom and they’re ultimately against the freedom of women, children, poor people, people of color, and they’re invested in their own power,” Beth Schlachter, interim director of global advocacy and the U.S. representative for the International Planned Parenthood Federation, said at an ICFP press conference. Against this backdrop, a more vocal abortion rights and SRHR debate is taking place that is being felt in tangible ways by those working on the issues, and not just in the U.S. “With the recent changes in the U.S. context, people feel it's more okay now to level attacks against people who are working on abortion and contraception,” said Akol, who is based in Nairobi, Kenya. “Some days you're minding your own business, it’s a Tuesday morning, and someone puts out a Tweet saying Ipas and IPPF are promoters of abortion and you're the lead of that organization and you normally walk home from work.” But working in this space has always come with a security risk, said Katy Mayall, director of strategic initiatives at the Center for Reproductive Rights, explaining that it’s something her organization takes seriously and that some colleagues, depending on location, experience more than others. “There are colleagues I have who can’t talk to their families about the work that they do, there are partners I work with who don’t want their photos taken because they don’t want people knowing they do this work and they have to take extreme security measures,” said Mayall. That opposition, Akol warned, can come in different forms. “Sometimes it's your church leader, sometimes it's your neighbor, sometimes it’s the ministry of health,” she said, adding that it’s not uncommon to stop being invited to meetings. When you are invited, “you have to look around and see who's in the room before you introduce yourself and that's not a comfortable space.” “With the recent changes in the U.S. context, people feel it's more okay now to level attacks against people who are working on abortion and contraception.” --— Dr. Angela Akol, regional director, Ipas Africa Alliance In the past, Ipas staff members and health workers have been attacked, Akol said, which is why the organization makes provisions for safeguarding its workers and their families. For example, rapid response teams of activists and lawyers are able to quickly arrive on the scene. “It's very easy to say ‘hey, what you're doing is wrong and what she's doing is within the law’ and then they back off,” Akol said. If traveling to a place that’s considered higher risk, such as Mali or Burkina Faso, staff working for nonprofit DKT International — a private provider of family planning and reproductive health products and services — don’t deviate from the capital and work with an agency to develop security policies and protocol, explained Nedjma Benzekri, its regional director for Francophone West and Central Africa. And at the ICFP conference in Thailand, where around 3,500 delegates gathered for four days in what is the world’s largest scientific conference on family planning and reproductive health, security was a big consideration. The ICFP Secretariat shared that it worked in “close consultation” with the Johns Hopkins Global Health Securities and Johns Hopkins Office of Institutional Equity teams as well as the Thai government to ensure safety. Secret service, due to the presence of high-ranking government officials and heads of state, it said, were also in attendance as were medical services. A mental toll The constant pushback, barriers to progress, and backlash that comes with this work can take a mental toll on advocates. “For a lot of us, there’s always this constant struggle working on an issue which, in many contexts, is so contentious,” Mayall said. “The victories are extreme highs but the losses are extreme lows.” That’s felt even among those who don’t work in the field. Mexico-based Michell Mor has been working in family planning for seven years and is the senior manager of digital strategy and innovations at Women First Digital, a collection of online platforms that provide information and counseling services on safe abortion, contraception, and SRHR. When she began working in this space, she explained that it was easy to disseminate information on social media but “little by little, the panorama has changed,” with evolving decisions by tech and media platforms on how they display certain types of content having a big impact. On Facebook, with content that is “women’s health-related,” more work is involved in getting the context accessible and visible, Mor said. This battle to reach key populations with information and navigate the censorship requires constant visual and language creativity and can lead to burnout, she explained. “Especially last year … it felt like every week Google was updating something differently so we were not able to advance on our digital strategy,” she said. “Everyone in the communications department was feeling so tired and they felt their work wasn’t reaching the people who needed to be reached.” Social justice movements are, however, increasingly more cognisant of self-care to prevent burnout, Mayall said. “I think that’s been incredibly salient in the abortion rights community in particular.” For Benzekri, who has worked in family planning for six years and is based in Senegal where abortion is illegal at any stage, self-care means adhering to a strict work-life balance as well as “loving what you do.” “I’m practicing a lot of sports,” she said. This helps in managing the frustrations around what she calls “slow progress” in the space. There’s also the knowledge, Mor said, that this work is valuable. “If not us, who is going to do it?” she asked. “We’re competing against the anti-choice [movement] who are investing in fake news websites [and] there are people who believe [in] that, so you need to keep on competing.” The U.S. decision, in Mayall’s view, has only served to deepen people’s commitments to abortion rights, and rather than turn people away from the sector, it’s brought in new advocates. “This community is strong … together we know what works, we know who's against this, we know how to fight that, and ultimately we will prevail,” Schlachter said. “We know we’re in this for the long haul.”