“Not all heroes wear a cape. Sometimes they wear pale blue overalls and go from door to door carrying a blue briefcase.”
High up in the Himalayan mountains, along crowded streets in bustling West African towns or resting for a moment in the shade of a tree under the blazing sun. This is where we find the ‘Avon Ladies’ of sexual and reproductive health. A new generation of nurses and midwives who are using their local expertise and entrepreneurial skills to break down barriers to contraceptive access by bringing services to the doorsteps of women in their communities – literally.
Dressed in a light blue uniform with a bright blue briefcase strapped to the back of her motorcycle, or carrying a bulging backpack between mountain towns, she goes from door-to-door to deliver choice to women – wherever they are, and whatever their circumstances. She is an MSI Lady.
While more and more women across the world are using modern methods of contraception, many women are still experiencing restrictions that limit their right to decide whether and when to get pregnant. These barriers can be material, such as finding enough money to pay for services or a lack of trained nurses in the area in which they live. But barriers can also consist of intangible obstacles, such as stigma from the community, or religious and cultural restrictions.
MSI Reproductive Choices is committed to finding new ways of opening up contraceptive access to the 218 million women worldwide who are still experiencing restrictions. One such strategy is MSI Ladies. They are qualified midwives and nurses from the local community, or simply committed women from other walks of life, who are trained and supported by MSI to provide contraceptive services and advice to women in their own homes.
What started as a pilot in a handful of countries ten years ago, has now developed into a network of more than 700 MSI Ladies across 15 countries, providing contraception and safe abortion services to more than half a million women and girls every year.
United by a strong desire to help the women in their communities to access contraceptive information and services, MSI Ladies provide discreet support to women and are fully embedded in the communities they serve. They not only establish close relationships with their clients but tailor services to the unique needs of the local community. Trusted within their communities, they are particularly effective at reaching young and unmarried women and girls who might not feel confident in using traditional clinics.
In Nepal, MSI Ladies spend days on end up in the mountains, walking from village to village, door to door, to enable women and girls in even the most rural areas to determine their own futures.
Imagine living far up in the Himalayas, a one-day trek to your nearest neighbour, and two days to the local health post. Your children are still young, leaving you with two options if you want to talk to a nurse about contraception. Either you carry your children on your back all the way, or you risk another unintended pregnancy. This was the reality for Jun Devi before Durga entered her life.
Durga is an MSI Lady, and she treks for up to ten days to reach women in the most rural communities.
“Sometimes it’s hard. Some roads are steep, there is no water and a risk of landslides so I have to walk carefully. Once I got injured from falling rocks… But I am also very proud of myself. Not everyone would walk seven hours straight, and be away from home for days on end, to bring this service to poor remote communities.
“This job has also allowed me to become independent… It feels good to go to remote villages and I enjoy helping these people who have no other options.”
“In such a remote village like ours we never had these options before. We had to give birth even if we didn’t want to. I’m very glad we have options now.”
Jun Devi, Nepal
MSI Ladies does not only directly benefit the women and girls receiving the service; the programme also empowers the nurses and midwives themselves to enhance their entrepreneurial skills, set up micro-businesses, learn new business skills and increase their profile in the community. It’s the perfect example of women working together to lift each other up.
Doreen became an MSI Lady one year ago. She’s a midwife and already had her own clinic in the outskirts of Kampala, Uganda. She’s a trusted member of her community and every month she helps up to 300 clients to find a contraceptive method that fits their individual needs.
“Before I received the training from MSI and became an MSI Lady, I only had about five family planning clients per month. Now, if I don’t have many clients when I come to the clinic, I take the megaphone and go and sit at the back of the boda boda [motorcycle taxi] and remind people that I’m here for them. Then usually when I come back, there are women there waiting for me.
“I have a bigger income and my well-being is better since becoming an MSI Lady. I like being busy, and I like working hard. So I’m very happy.”