a (re)productive year

With assignments in six different countries throughout the world, PSI has filled up at least a terabyte’s worth of hard drive space in RAW and video files for me this year and has kept me busy enough to fall behind on my blogging. While Population Services International has programs in a number of areas in global health, I’ve primarily been documenting their reproductive health and HIV/AIDS prevention programs along with the lives of the women who have been helped. All of the following were taken in Mali, Cameroon, Vietnam, and Cambodia.

Above, Kono Cecile receives a hormonal implant in her arm at a clinic in Yaounde, Cameroon. The implant will prevent her from having children in the next five years and allow her to concentrate on better raising the children she already has.

Banconi is a crowded suburb in Mali’s capital, Bamako. Mariam Sangare, shown above at her children’s bath time, had 13 pregnancies before deciding to start using family planning. Sadly, only nine of her children have survived. Mariam and her husband live with seven of their children and her sister-in-law in a one room apartment not far from the clinic where she received her hormonal implant.

Above, Mrs. Djomo Odette is a PSI trained midwife who counsels women in Yaounde, Cameroon about family planning options ranging from the intrauterine device, to condoms, to hormonal injections and implants. Many PSI-sponsored clinics like that of Mrs. Djomo’s in Yaounde offer one open day each month, where women can attend and receive contraception courtesy of the NGO.

Above, Safo is a village 15km outside Bamako, Mali. While family planning services are difficult to come by in the capital, they’re almost unheard of in rural areas, where, on the average, fertility rates are much higher than in cities.

Most women in Mali must seek family planning services in secret or risk retribution from their husbands, often in the form of beatings or even divorce. Children are prized in Mali’s conservative Muslim culture, where men often have more than one wife. However, as women begin to have a greater presence among the country’s workforce, it becomes difficult to earn a living while looking after multiple children. In addition to the economic deterrents, women are also aware of health risks associated with bearing children.

“I’ve never talked about family planning with my husband. If he knew I came to the clinic today to get an implant he’d be very, very angry. He’ll either divorce me, chase me out of our house, or make me come back to the clinic to have it removed,” says an anonymous woman I interviewed. “I need to be able to space my children so I can continue doing my hairdressing without having to look after babies all the time. That way I can continue to make enough money to continue supporting my mother because that’s what I have to do.”

Open days similar to those held in Africa are held in reproductive health clinics across Cambodia as well. Below and above, providers in the city of Kampong Cham prepare for an IUD insertion. In Cambodia PSI has established the Sun Quality franchise of health care providers in order that consumers can differentiate between well run and poorer quality clinics. The 83 Sun Quality providers across Cambodia receive consistent training, monitoring and support in order to maintain higher standards.

In Vietnam and Cambodia the HIV/AIDS infection rate is disproportionately high in the sex industry. While prostitution is illegal in both countries, it is widely accepted and tolerated. Above, a man ascends the staircase of a brothel in Hanoi, Vietnam. As shown below, PSI works in such brothels by forming relationships with their owners and educating them about condom use for the their workers.

PSI also targets clients by sending IPCs (Interpersonal Communicators) to bars and restaurants frequented by sex workers. In these personal encounters the dangers of HIV and prevention methods are openly discussed between the would-be client and the IPC. Below, IPCs talk with young men at a bar in Phnom Penh, Cambodia.