That’s what big sisters are for - MSI Reproductive Choices

Thérèse is an eldest child. She wasn’t lucky enough to have a big sister of her own but considers it a privilege to be one.

In fact, being a big sister to her three brothers isn’t enough. There are other people in her community who need a big sister too. Especially the teenage girls she knows.

In this beachside community in the Democratic Republic of the Congo, girls are navigating the universal experience of puberty and sex. But these topics are cloaked in silence and muddled by myths, making it nearly impossible for them to find and understand the information they desperately seek. Will I get pregnant? How can I stop that? Are my heavy periods normal? If someone abuses me, where do I go for help? Will my life be in danger if I fall pregnant?

Only 1 in 10 adolescent girls in the DRC are using modern contraception. Rates of teenage pregnancy are soaring. Many girls face a future they wouldn’t have chosen for themselves.

That’s where Thérèse comes in.

“In my neighbourhood, lots of girls get pregnant before 18 and life becomes difficult. Becoming an MSI Big Sister was an opportunity for me to help them understand and use the contraceptive methods and support offered by MSI.”

As a Big Sister (Grande Soeur in the French-speaking DRC), Thérèse is employed by MSI to raise awareness among her peers of sexual health and the life-changing benefits of contraception.

Her day starts early – typically at 5am. She prays and does her household chores. Then she prepares her work materials and heads out.

“I find young people by the water, in the hair salon, on the road, at the market or at school, anywhere we can reach them to provide awareness. We speak with students, professionals, and sex workers, generally between 14 and 24 years old. We’ll help every young person we meet.”

At 24 years old, Thérèse has youth on her side. It helps her connect with other young people in a way that older adults typically can’t. The girls call her bestie, they swap stories and phone numbers.

“Being young helps. It allows young people to trust us. We talk about everything! Starting with topics they know like menstrual hygiene opens the door to discussing sexual health without judgement. We can talk about sex, our challenges, things we couldn’t discuss with our parents.”

Once Thérèse finds young people in her community and builds rapport with them, she can help them to understand their options and give them advice. If they want services, she connects them to a local MSI Lady (nurse) who can provide the care they want, from contraception to STI testing and treatment.

Thérèse offers to accompany them to the clinic if they'd like extra support. On a typical day she might accompany five or six girls as they enter the world of reproductive healthcare. Most are choosing to access contraception to avoid pregnancy while they’re still young and dreaming of future avenues they may take.

This small interaction with Thérèse may well have changed the course of their life.

That’s what big sisters are for. A role model and friend – someone with a few more life experiences on their side who can give a listening ear, guide us, and give unwavering support when we don’t know who else to turn to.

The Big Sisters walk along their local beaches in Kalemie DRC, speaking with girls about their reproductive health

Meet Thérèse’s sisters

Thérèse doesn’t serve this community on her own, she shares this work with Esther and Tanya.

Tanya is better known as ‘Yaya’ – locally translating to older sister, a term of respect and endearment. This community is her own, where she was raised and is well-known among her peers.

“They know they can talk freely with me. It stays between us. That’s the kind of relationship we have, and it’s very rewarding to grow with these girls.” 

Tanya grew up with her grandmother and without siblings or parents. She was often alone. Support on her menstruation and sexual health was not forthcoming. No one talked to her about how her body was changing or what it meant to grow up as a young woman.

Today, what she offers to other young people is exactly what she didn’t receive herself. She takes great pride in improving girls' experiences of this turbulent time in life. She sees the bigger picture.

“This is not just about contraception,” she says. “MSI helps save dreams, ambitions, and hope.” 

It’s true that good things come in threes.

The third member of Thérèse and Tanya’s team is 21-year-old Esther. With seven younger siblings, she is well versed in big sister responsibilities.

She’s motivated to help girls get the most out of their education, shaped by her own experience.

“When I started using contraception, I felt free. At that time, I was still a student and I believe it really helped me finish my studies and think about other things.”

Since being involved in MSI’s work in the community, she has started seeing girls have a broader vision beyond marriage and babies. Dreams are wider, more ambitious, and rooted in what they want, not predetermined.

Her hopes for what MSI Big Sisters can achieve are not modest – she wants this generation to “feel saved”. And she wants to be part of it.

The three Big Sisters share their experiences and any challenges they’re facing, sending a message to their shared WhatsApp chat or meeting up in person at the end of the day. If faced with tricky questions or backlash, they also find help from the local MSI nurses and midwives.

All of them work together to serve their community.

The little sisters

These are the young ones supported by the Big Sisters.

At 18, Evodie is a young mother and lives on a farm with her stepfather and small child. “He is a year old. When I got pregnant, it wasn’t by choice.”

She sells juice to make ends meet, feeding her child and covering health costs as best she can. Some days there’s not enough to go around.

She met Big Sister Thérèse on the road.

“Ahh Miss Thérèse! She explained to me what my options were. I was not afraid because I felt like this was someone who wanted to help. I thought family planning sounded really good, because it gives me time until my child grows. I said to her, give me one!”

Thérèse took Evodie to the hospital where she learned more. She chose to get a contraceptive implant that would protect her for five years.

“I’m thankful to have met Miss Thérèse. If she wasn’t here, I would’ve gotten pregnant again. We need to talk about contraception because it helps with many things we didn’t know it could.”

18-year-old Evodie was supported by MSI Big Sister Thérèse

Another young person who crossed paths with the Big Sisters is Adjidja, a student. Before meeting them, using contraception hadn’t even occurred to her. She was always told that family planning methods were for mothers, not young people like her.

“Talking to the Big Sisters changed something for me. Before I met them, I thought as girls we could get pregnant anytime and ruin our lives. But the advice I was given at MSI opened my eyes. I got to know that there are things made to protect my health and my body. Now, even if I do have sex, I feel comfortable knowing I will not get pregnant.”

She speaks about how these services are helping her and her friends “get to our future goals. So our dreams don’t get broken on the way.”

The sisterhood of choosing our futures

In healthcare and social change sectors, we use terms like adolescent strategies, youth-friendly care, social behaviour change, and peer mobilisers. To Thérèse and her community, this is more than a strategy or project. It’s about sisterhood. Women supporting women. Friends lifting up friends.

It’s a network that holds a girl’s hand as she receives the information she needs, makes informed choices for herself, and gets the healthcare that will pave her future.

And it works.

When the Big Sisters approach was just a pilot study in one city in the DRC, there was a 53% uplift in the number of adolescents receiving services from our MSI Ladies.

The Big Sisters were so successful in establishing their visibility and drawing in a wide audience, that they started to be approached by parents asking them to talk to their daughters.

Their success has spurred on an expansion into two provinces, with more MSI Big Sisters being employed. Our latest data shows that where Big Sisters are working, up to half of clients visiting our providers are adolescents – this means many more young people are seeking services than in other places. And it costs £10 or less for every young person reached.

The local government in Kinshasa, DRC’s biggest city, has been convinced. They’ve started implementing and training Big Sisters within the public health system.

In other countries, MSI teams have found similar success with ‘godmothers’ – older women who support people in humanitarian settings, or with engaging families in card games to encourage conversations about reproductive health.

There’s no shortage of community models being trialled by MSI, designed for local needs and realities. All of them with a shared goal of building brighter futures for girls – and for us all.

Thérèse herself puts it best:

“A world where young women are able to take care of themselves, achieve their goals, and be autonomous. That’s the kind of future I want to see.”