Beyond where roads end, a nurse is changing lives
A story of people taking control of their futures with contraception
The journey
7:03am. The unforgiving sun is already blazing. A Nigerian nurse in blue scrubs, her hair tied back, is packing equipment into a white Toyota 4x4, making sure her team has everything they need before they set out.
And the journey begins. Nurse Ifeoma – affectionately called ‘Ify’ by her team – stares out the window at the hectic, crowded roads where people are selling things, walking to work or school, zipping past on motorbikes, gathering at markets.
They keep driving.
Over time, the busy streets become increasingly empty, the smooth terrain surrenders to rust-red muddy ground. Manoeuvring around large potholes, rises and dips, the car is jolting and everyone inside it is being tossed around.
As Ify holds on to the door to steady herself, she looks outside at several children around six or seven years old, pumping water into buckets at a community water well. She was their age when she proudly told her father she wanted to be a nurse.
They’re nearing their destination now. The buildings outside have become less structured, made of mud bricks with thatched or corrugated iron roofs. Electricity lines came to an end a while back.
There are many experiences in Ify’s 34 years that she could point to as the reason she’s in this car today, as an MSI nurse about to provide women with contraception.
It could be that she herself wasn’t properly taught about contraception until she was at nursing school. Or perhaps it was seeing her university roommate almost die from having an unsafe abortion, risking it all to end a pregnancy she didn’t want.
It could be that she had to watch her sister, whose husband tragically died soon after they had their sixth child, lose all hope at the reality of caring for her children alone on a meagre wage.
Or maybe it was her first experience with MSI that set her on this path. She was a client, and fondly remembers being treated with warmth and compassion as she received contraception for the first time, a choice that allowed her to finish her nursing qualification and have her three children when she was ready.
But the truth is that Ify feels she was destined to be here, because caring for people comes as naturally to her as breathing air.
"I don’t like my job – I love it. The hardest part is the difficult journeys… crossing rivers, passing through harsh landscapes, travelling kilometres without seeing a soul. Sometimes the car gets stuck in deep mud and we have to dig it out. But once you get there and see smiles on faces, you forget about it."
- Nurse Ify
Two hours after setting off, they arrive at a community. Tucked into surrounding farmland, you’d never have known it existed. Brightly patterned clothing and headscarves are worn by community members who chant and drum to welcome the MSI team, an excitable energy rising among the crowd.
Ify jumps out of the car and starts to dance and pray with them – she’s in her element now. In these communities dancing is a means of connecting, and Ify is not one to shy away. “If you work with me, you have to dance!” she laughs.
The team busy themselves, unloading the vehicle and setting out plastic chairs for clients. Alongside Ify there’s the driver and admin assistant, Michael, and another healthcare provider called Monica. They hand out water and sweet crackers to people who’ve been waiting patiently in the heat.
The building where they’re setting up is a public health facility that doesn’t have the staff or supplies to provide contraceptive options in this area. Long before today, MSI developed a close partnership with the local government, and they work together to curate plans on which communities need services and where MSI can set up.
Sometimes up to 100 people can be waiting to receive services. Today mostly women are gathered, some men and babies too.
Interested faces stare as Ify greets them warmly and reaffirms why MSI is here today: to provide contraceptive choice for anyone who wants it.
"The local government are in full support of what we do. We’re reaching those rural places that, if we didn’t, would not have any reproductive health services. There’s no public infrastructure to make that possible right now. We don’t want people to fall through the cracks."
- Nurse Ify
Galvanising support
Last month, Ify’s colleague Felix visited this same community but not to provide healthcare.
His job is to mobilise communities, to let people know about MSI’s services and the benefits of contraception. He has his work cut out for him.
A lack of sex education here means misconceptions run deep.
Commonly circulating rumours are that contraception will cause lifelong infertility or could drive you mad. People have heard it can cause cancer. Others think it’s only for married people because it will make teenagers promiscuous.
Ify explains that "many believe what a woman wants doesn’t actually matter – it’s up to men to decide how many children they have."
The result is that many women are trapped in a constant cycle of giving birth, and families are having more children than they want or can afford. Ify has met a woman who birthed 18 children (“eight alive, ten buried”). She recalls another who had a mental illness and was locked indoors by her family so she couldn’t leave the house and become pregnant again.
It’s common for her to meet women who fall pregnant just two or three months after giving birth. And without adequate maternity care, there are women dying in their homes. When Ify shares these memories and stories, tears spill down her cheeks.
"Before working for MSI, I didn’t think that a man would refuse his wife the right to use contraception, that he’d simply say ‘no’. I can’t imagine my husband saying that – it's my body so it should be my choice! But it’s common… and these women are suffering in silence."
- Nurse Ify
MSI mobilisers like Felix hold community talks to flip the script. You can find him at town halls, schools and markets, informing people of their modern contraceptive options and busting myths that are holding them back from accessing these services.
He explains in their local language how these choices can help them have the futures they want.
Community members ask questions. They read flyers. And they’re left with the power of knowledge, so they can make up their minds before MSI’s mobile health team arrives to offer services.
Felix explains that holding discussions with groups of men can help them understand and become supportive of their wives’ choices. He finds that once men are properly informed, they’re often happy to champion contraception. They simply didn’t have the right information before.
There’s one thing that is most crucial to Felix’s work: getting the support of local leaders. They have immense influence over their communities, and whether clients show up to receive MSI’s services can be directly related to whether their leader supports reproductive healthcare or not.
In this particular community, Ify and Felix have built a good relationship with the local leader – a man who is deeply supportive of MSI’s work, having witnessed the impact of reproductive healthcare over the years. He warmly welcomes the team today and wants to discuss how they can reach more of the nearby villages. His name is Chief Cosmos and his presence is aptly atmospheric.
Chief Cosmos:
"When reproductive healthcare was not that well known in my area, you could count on your fingertips how many girls went to secondary school.
You see somebody of school age, probably 15 or 16, become pregnant and that hampers their education, their career and dreams. So this generation will become poor and the next generation will become poor, and the next."
"MSI has done a lot for us, carrying its services direct into the villages, direct to the people.
I’m eager to have a community that is more forward-looking than we are now. So I carry the message of reproductive health personally to the hinterland of my community.
When people understand the benefits, they will welcome it with two hands."
It’s not just a lack of education that communities like this are up against.
Ify has lost count of how many times she’s heard the same experience: a woman travels tens of kilometres, sometimes by foot, to her nearest public clinic for contraception. It’s so busy she has to wait all day, and many times she won’t get the chance to be seen at all.
If she’s lucky enough to see a health worker, oftentimes she’ll be told that there are only condoms available – there are no supplies or staff who can provide longer-acting methods. It's such a bad, time-wasting experience that many don’t go back, accepting their fate of not being able to choose when they get pregnant.
Until a nurse like Ify drives into their community with free healthcare options that could change everything.
Women taking power back
Having now set up for the day ahead, Ify finishes a group health talk and a few people ask questions. Everyone has been listening intently, disrupted only by nearby goats bleating and birds chirping in the surrounding forest. The morning humidity has left a sheen on everyone’s faces.
The MSI team starts to welcome people inside for private appointments, so clients can choose a method of contraception that suits them.
Inside is dim, with wooden bench seats and bars on the windows. Brightening the room is a blue briefcase labelled ‘choice kit’ and a small poster on the wall that reads: MSI loves you.
Ify’s first client of the day is Adadechei, a 19-year-old who heard about MSI’s services from village announcements. She has a young boy and dropped out of secondary school to raise him.
This is extremely common here, she explains. “I know a lot of other girls who are 14, 15, 16, that have had to drop out of school, and once they give birth they don’t go back. Most of them just keep on giving birth, just like that.”
Adadechei is here today because she wants to buck this trend. “I really want to go back to school again and get a better life for myself and my child,” she tells Ify.
She talks about wanting to be more financially stable and being able to plan for future pregnancies, but her dream of education is what lights up her face. She’d love to study medicine one day. She wants to make it to university, to make a name for herself, to show her peers there is still life after giving birth.
She discusses her options with Ify, opts for her first contraceptive implant, and leaves with a huge smile, her future wider than before.
“If MSI wasn't here today offering free care, I don't think a lot of us, including myself, would be able to access contraception. First of all, because of the distance. Also, the money to obtain these services – we don’t have it. We’d end up having more children that we don’t want.”
As the day wears on, the MSI team works seamlessly to register clients on the system, support people with services and make sure everyone is heard and respected. This team spends many hours, days and weeks with each other, working and eating together. They describe each other like a second family.
After Adadechei, Ify meets Glory, a 32-year-old mother of nine who wants a break from giving birth. Glory says she’s seen many people that contraception “has favoured”, and that’s why she has come here today. She wants more time to make money and to care for her children.
Next in line is a young woman who hasn’t had any children yet and aims to keep it that way as long as she can.
Ify delivers contraceptive counselling and services with the finesse and quality required of her, and a kindness that is innate. It’s not uncommon for returning clients to ask for her, and for new clients to run back to their houses and bring their friends after their appointments. She describes the joy these women have when they receive her services. Their smiles speak volumes.
At the end of the day the team come together to pack everything up, and even the community leader is pitching in. Of course, Ify finds another opportunity to dance with joyful abandon. “People say are you not tired at the end of the day? Nah, the more you dance, the more energy you have!”
The team hop back in the vehicle to begin the long drive back to their accommodation. They’ll be back here in a few months’ time. But today, they leave knowing that their work has sparked a rippling effect of change and hope for many families.
“We give life-changing choices and we dance!”
A day's work, a lifetime legagy
Ify doesn’t have to wonder if her hard work is changing lives.
She finds the effects of her work all around her. In the teenager who walks past her in school uniform, holding textbooks and laughing with her friends. In the woman who she sees has opened a stall at the local market, pocketing the profits to support her family.
The future is written every day. And the women that Ify has supported with contraception are now writing their own futures.
In Nigeria alone, MSI’s rural outreach programme supported 520,000 people last year across 6,300 communities
boosting the number of people who now have access to modern contraception and with it, new opportunities.
This same impact is true of Ify’s colleagues across her country and the world.
As Ify goes to sleep, MSI health providers like her on the other side of the world are waking up and setting out on their own journeys.
378 mobile health teams in 24 countries speak a variety of different languages and serve their local communities. They’re all determined to create lasting impact for people whose daily lives lack the basic healthcare and choices every one of us deserves.
This work takes extraordinary grit and MSI teams are up for it, day in and day out.
In 2024, MSI teams supported 14 million people in remote communities with contraceptive choice.
More than half of these women and girls didn't know of another way to access contraception - MSI was the only option.
MSI health providers are often welcomed into communities with open arms and curiosity, by people who are trying to live as well as they can in spite of adversity, and who want better for their children.
Some are supported by our mobile health teams. Others receive care at an MSI clinic or by a public health worker who has been trained by MSI.
To meet people with reproductive healthcare and choices is to help them change their lives and carve out new paths for the next generation.
It’s a legacy that Ify is proud to be part of.
“I don't want a day to pass without making a change in someone's life. When people hear my name, I want it to conjure up a good image. I hope they remember that I embraced them, cared for them, treated them with the respect they deserve. Oh – and they can’t forget my dance moves!”
Be part of MSI’s story – and help people change theirs – by supporting the work of mobile outreach teams.
There’s still more than 250 million women who want access to modern contraception, but they’re being left behind. Together, we can reach them.
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