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Bulgaria

Articles by Bulgaria

Youth Voices, Youth Choices youth group
01 June 2023

Youth Voices, Youth Choices

Young people and groups with vulnerabilities in the Western Balkans face a great many barriers to accessing sexual and reproductive healthcare. Throughout the COVID-19 pandemic, they bore the brunt of additional obstacles to accessing information, support and care. COVID-19 demonstrated how fragile national health systems are and highlighted countries’ unpreparedness to deal with health emergencies. But it also stimulated creativity by civil society and other actors to counter these barriers, with digital outreach and support playing an expanding, crucial role. Youth Voices, Youth Choices is a project dedicated to learning from the COVID-19 experience in the Western Balkans to ensure sexual and reproductive health services, information and education become more accessible and youth-friendly in the long term, especially for marginalised groups. Running from 2020 until 2023, it brings together IPPF members and partners in Albania, Bosnia and Herzegovina, Bulgaria, North Macedonia and Kosovo, supported by IPPF EN’s Regional Office. Project partners have conducted research into the impact of the pandemic on young people’s SRH needs and access to services and information, and the role of integrated digital services, with a focus on communities living in remote areas and unfavourable social conditions. They are sharing good practices and empowering young people as campaigners and advocates using digital and offline education tools. And working in multi-stakeholder partnerships, they are developing policy recommendations to support advocacy and youth-led campaigns for stronger health systems and increased access to care, in and beyond emergency situations. In October 2022, IPPF EN launched a set of regional policy recommendations based on our research into how the pandemic affected young people. All partners also created national recommendations. Collectively, we built upon these through regional and national advocacy campaigns and actions. Check out our YVYC resources page! Take a look at our series of interviews carried out by young people with their peers on how COVID affected their access to SRHR information, education and care, and their vision for the future. RESEARCH REPORT  As a basis for this work, in 2021 and early 2022, we conducted a study to provide us with a clearer picture of the impact of the pandemic on young people’s SRHR. The data was published in a series of reports presenting the findings of the study, carried out by and among youth in five Balkan countries. The reports, available for download below, document young people’s SRH needs and experiences and the perspectives of healthcare providers and other relevant stakeholders on these needs. They also capture the latter’s needs as they deliver services, information and education to young people, building on their experience of COVID-19. POLICY RECOMMENDATIONS In October 2022, IPPF EN launched a set of regional policy recommendations that call on decision-makers to listen to young people and uphold their SRHR as they build back health and social systems in the wake of the pandemic. Presented at the European Parliament on 26 October by youth advocates and experts, with the support of MEP Fred Matić, the recommendations were developed by a group of specialists who came together to develop a blueprint for designing systems that prioritise access to youth-friendly SRH care, and better support of young people’s health and well-being. The policy recommendations are available for download below. The policy recommendations were used to set advocacy priorities for further actions and campaigning. YOUTH VOICES Young people are at the heart of this work: as researchers, as members of the expert groups that developed policy recommendations, and as advocates and campaigners for change. They were also in the lead at the 'Healthy Youth – Healthy Future' multi-stakeholder meeting in Tirana in spring 2023, where youth representatives and staff from our partner organisations came together with decision-makers and experts from the field - see Tirana joint declaration on protecting the health and social wellbeing of young people. The young participants presented advocacy campaigns carried out at regional and national levels, and shared their needs and experiences at an event held in the Albanian parliament. For more information about this work, please contact us at: [email protected]           This work is funded by MSD for Mothers.

YVYC illustration young people advocating
25 October 2022

"It would make a real difference if we could be open with health professionals about what really concerns us."

We spoke to young people from the Western Balkans about how their access to sexual and reproductive health and rights was affected by the COVID pandemic, and asked them about their vision for re-designing a more youth-friendly future in which young people can flourish.  Alex is a 19-year-old LGBTIQ girl, studying at university in Blagoevgrad, Bulgaria. As a peer educator, she supports other young people to learn and develop crucial life skills relating to their sexual and reproductive health.   Alex, describe your experience of access to SRHR* education, information and care before and during COVID.  My access to sexual and reproductive healthcare before COVID was relatively normal, for example a gynaecologist visit, but during the pandemic, it was rather harder to go because I had to present a negative COVID test to be examined. At some point, in-person consultations with doctors were extremely limited, unless it was with reference to COVID or life-threatening - so regular check-ups were not really happening. I didn’t receive any adequate sexuality education either before or during the pandemic. The only time sexual health was discussed in my 12 years of schooling was back in elementary school and it only included only a talk with the girls on menstrual pads and periods. I believe online information became more accessible because of COVID. As a result of the limited consultations with professionals, more people sought answers on the Internet. Of course, we must keep in mind that information has to be checked carefully. Also, reliable information in Bulgarian is very limited.   Did anything change for the better during the pandemic in terms of access to SRHR? I suppose more information regarding SRHR became available online because of the huge demand. A good thing is that the information is still relevant today even though COVID is no longer an urgent crisis. Personally, I got into the habit of looking for answers myself and checking if the source was reliable or not. Other than that, I would not say that COVID had any positives.   What was the biggest challenge to young people’s SRHR during the pandemic? How could decision-makers/medical professionals have removed this obstacle?   One of the biggest problems was the misleading and unreliable sources of information about sexual and reproductive health. In addition, adequate information is mostly in English. I believe a fact-checking system to verify all factual information could be helpful in preventing the spread of misinformation. I faced that problem when I and other 3 friends conducted a few educational workshops on the topic of comprehensive sexuality education. While putting together the information we needed, we came across numerous invalid data and false statements.   What lessons should governments and professionals who work with youth learn from the pandemic about how to look after young people’s health and wellbeing in a crisis?   From what I have seen, many adults do not seem to understand the burden this crisis has had on us and therefore neglect our mental health. Affordable and regular psychologist appointments should be a priority. There is this stigma around mental health that you seek help only if you are “not normal”. That is completely false and puts our generation under pressure and makes us not take proper care of our well-being (which often includes going to a psychologist). Also, many of the professionals (both teachers and medical practitioners) were sharing their personal and controversial opinion on the pandemic and vaccinations which has to be limited. A personal experience I had was when I went to get vaccinated and my GP would not allow me to, saying that it was unnecessary and even “dangerous”.   What is your number 1 recommendation on what is needed to make services more youth-friendly? What difference would this make in the life of a young person like you? More young and inclusive professionals working in the sphere are needed. For example, many of my female peers insist that female gynecologists examine them. LGBT+ inclusivity is also important, as currently many of us cannot share a key part of our life neither with a gynecologist nor a psychologist. The difference would be that we will be more open and share what really concerns us so we can seek adequate help. It is much easier to talk to someone close to your age or background.   What helped you to become engaged as an activist? How has this experience been so far? The idea that I can do something about the desperate need for a change and make my voice heard was what helped me get involved. So far, I mostly enjoy working with other young people and seeing them as determined and hopeful as I am. Every new idea has been welcomed with enthusiasm and encouragement by many of my peers, which makes it clear that youngsters are looking forward to a change and improvement. However, as I mentioned, we held several workshops about comprehensive sexuality education and we faced many obstacles. The project was very scarcely funded, which made it very hard to implement properly and exactly how we have envisioned it. Also, finding people to attend the workshops was fairly hard as well and we could not get any support from our teachers and school staff. They did not welcome the idea because the topics of sexual health and LGBT+ inclusivity are still taboo in our society - so they were scared of how the parents would react. On the other hand, the people that came to the workshops had very encouraging feedback and even a demand for more similar events. * SRHR = sexual and reproductive health and rights Interview conducted by Viktoria Nikolova, a member of the regional youth group of the IPPF EN project Youth Voices, Youth Choices, funded by MSD for Mothers

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08 April 2022

Working with the Roma community and local actors for reproductive freedom

In the Balkans, IPPF members are working hand-in-hand with diverse networks of actors from within and around Roma communities. This work was shaped as the My Body, My Rights project. Our common goal is to strengthen girls’ lifelong reproductive freedom and tackle some of the deep-rooted, systemic obstacles that prevent people - especially women and youth - from living safer and healthier lives. How? By increasing access to care, creating supporting contexts for choice and advocating for investment. Our work is community-driven and based on fostering local partnerships. At the heart of this collective action are Roma volunteers, girls and boys, health mediators and local NGOs, leading grassroots change and advocating for their own unique communities. Doctors, community nurses and teachers are working with them to help deliver lasting impact. And some decision-makers are stepping up and beginning to make much-needed investments in more equitable access to reproductive healthcare. We are proud to share highlights of our work, recommendations to decision-makers and resources for further reading. Explore our new microsite!   

Youth Voices, Youth Choices research report front cover
30 March 2022

Youth access to SRH information, education and care in the Balkans in COVID times

COVID-19 created the largest health and socio-economic crisis of our generation. Many health systems were pushed to the brink by restrictive measures rushed in to respond to the pandemic, resulting in the deprioritisation of some existing healthcare services. In almost all European countries, COVID-19 had a negative impact on the delivery of vital sexual and reproductive healthcare, including maternal health and family planning, for women and groups that face barriers to accessing care, including young people. The pandemic also uncovered weaknesses within our systems and exposed the fact that countries are not adequately prepared to deal with health emergencies. To help bring about positive change for young people, IPPF European Network is working to strengthen healthcare systems through the project Youth Voices, Youth Choices, and to remove all kinds of barriers preventing youth from accessing essential care in five Balkan countries: Albania; Bosnia & Herzegovina; Bulgaria, Kosovo and North Macedonia. We are focusing particularly on the needs of those living in remote areas, as well as those from communities that face challenging social conditions, such as the Roma. POLICY RECOMMENDATIONS In October 2022, IPPF EN launched a set of regional policy recommendations that call on decision-makers to listen to young people and uphold their SRHR as they build back health and social systems in the wake of the pandemic. Presented at the European Parliament on 26 October by youth advocates and experts, with the support of MEP Fred Matić, the recommendations were developed by a group of specialists who came together to develop a blueprint for designing systems that prioritise access to youth-friendly SRH care, and better support of young people’s health and well-being. The policy recommendations are available for download below. RESEARCH REPORT  As a basis for this work, in 2021 and early 2022, we conducted a study to provide us with a clearer picture of the impact of the pandemic on young people’s SRHR. The data was published in a series of reports presenting the findings of the study, carried out by and among youth in five Balkan countries. The reports, available for download below, document young people’s SRH needs and experiences and the perspectives of healthcare providers and other relevant stakeholders on these needs. They also capture the latter’s needs as they deliver services, information and education to young people, building on their experience of COVID-19. YOUTH VOICES Young people are at the heart of this work. They were part of the teams that carried out the research presented in the reports below. They participated in the expert groups that developed our regional recommendations for policy change (below) at national and regional level, and they are being supported and empowered to advocate for these changes. Youth were also in the lead at our 'Healthy Youth – Healthy Future' multi-stakeholder meeting in Tirana in spring 2023, where together with staff from our partner organisations they held discussions with decision-makers and experts from the field, concluding with the signing of a joint declaration on protecting the health and social wellbeing of young people during and beyond moments of crisis - available for download below.     Young people also carried out a series of interviews among their peers to share stories of how the pandemic affected their access to SRHR, and what their vision is for a more youth-friendly future that listens to the younger generations and upholds their SRHR.

vaska--smiling--with--bg.jpg
20 September 2021

My friends think I’m crazy, because I only have one child. But I know I can decide when to have another. Vaska's Story

“I got married quite early, when I was 17. A year and a half later I got pregnant and had a baby girl. Now she is 18 months old. My husband started a job in the city in a company which is popular among Roma people, and I stayed home to look after our child.  Last year I met Valya, the health mediator. She told me they organize meetings, and she invited me to take part in a women’s group. Initially I didn’t know what we would do, but it was interesting as there were other women like me. During these meetings we spoke very often about contraception in general, and especially about IUDs. The women shared what they had heard and what they knew about them. It was strange, but most of them said that IUDs harm women’s health. I also understood that the men are worried about their wives’ health and that that’s why they don’t approve of contraception. I heard women say other things as well, like you can still get pregnant with an IUD, that you may gain weight, that IUDs move in the body, and so on and so forth.  One day, during a meeting, we spoke again about contraception, and more precisely, what we thought was a good family size. People had different views. I personally think that it is not so much about the number of children as it is about being able to make sure you have everything you need - clothes, food, the possibility to educate them. Everyone should take these issues into consideration before having children.  I thought more often about myself and my family. We didn’t have high incomes and we could barely afford our bills. Our daughter was a baby and it was challenge to provide for her. My husband and I started to talk about it, and I started to think about getting an IUD. That’s why six months ago I decided to have one fitted, and I feel fine. It isn’t painful and I haven’t gained weight. My friends think I’m crazy, because I only have one child. But I know that I’ll be able to decide when to have another one.” When vulnerable communities, volunteers and professionals unite for reproductive freedom, they are a powerful force for change. Watch Vaska’s story and others in our short film about the amazing work our members in Bulgaria, Romania and Serbia are doing to support the lifelong reproductive health and safety of Roma girls, women and young people.

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27 September 2021

My Body, My Rights - short film

When vulnerable communities, volunteers and professionals unite for reproductive freedom, they are a powerful force for change. Our short film features five stories that show how IPPF members in Bulgaria, Romania and Serbia are supporting the lifelong reproductive health and safety of Roma girls, women and young people, working on the multiple fronts necessary to improve access and uptake of quality family planning and maternal health care. Learn more about the My Body, My Rights project here. 

Serbia roma community worker
14 January 2022

My Body, My Rights

My Body, My Rights is a three-year project supporting the lifelong reproductive health and freedom of Roma girls, by improving access and uptake of quality maternal and family planning healthcare for vulnerable communities in Bulgaria, Romania and Serbia. We are working holistically on the multiple fronts necessary to bring about lasting change. At the heart of the project lies participation by Roma people themselves, particularly the young. IPPF members in Bulgaria, Romania and Serbia are working in intersectional partnerships to empower girls and boys to become leaders in educating and informing their peers about sexual and reproductive health and rights, and in driving change for their community through advocacy. Relationship and sexuality education is vital for increasing support for gender equality and reproductive freedom among young Roma people, while awareness-raising in their communities is increasing the acceptability of modern contraceptives. Project partners are also training primary health care providers to update their technical knowledge and skills related to family planning in line with best practice and international standards, sensitising them to Roma health needs and to how stigma and discriminatory attitudes towards the Roma and young people negatively affect the quality of care they receive. Roma health mediators are our bridge between communities and healthcare providers. The project is also targeting decision-makers, carrying out advocacy for stronger political commitment to quality family planning care for communities often left behind.   Our members are using innovative approaches such as the development of an app to promote contraceptive acceptability. This work is coordinated by IPPF EN’s regional office, implemented by our national members in Bulgaria, Romania and Serbia, and funded by MSD for Mothers. Explore our project microsite!

COVID-19 and SRHR
09 July 2021

COVID-19 IPPF innovation and best practice

The COVID-19 pandemic has had a profound impact on access to and enjoyment of sexual and reproductive health services and rights. While families, couples and individuals have faced intense pressure and hardship as a result of the pandemic, life-saving sexual and reproductive health (SRH) services and supplies, including sexual and gender-based violence services, have become scarce and/or inaccessible. Existing socioeconomic inequalities have been exacerbated, especially as they pertain to girls, women and marginalised groups.  As nationally owned and locally operated health service providers, IPPF Member Associations (MAs) remain committed to their communities and the people within them. In this Case Study series, we share progress, learning and innovation that has occurred within MAs over the course of the pandemic. The case studies cover: telemedicine for abortion in the COVID-19 context, SGBV response in COVID-19, adapting sexuality education in COVID-19 through digitalisation, and leaving no one behind, especially marginalised populations. Take a look at the above Case Studies from Bulgaria, Estonia, Serbia and Ireland. 

Young woman and contraceptive methods
26 September 2020

Making contraceptive freedom a reality in vulnerable communities

Today is World Contraception Day – a day for raising awareness about contraceptive care. It might seem surprising that we still need to raise awareness - isn’t everyone in Europe using modern contraception nowadays? Unfortunately, the answer is no. In Romania, Bulgaria and Serbia, for example, less than half of women use a modern method. Many women and girls from the poorest and most socially excluded communities in the Balkans rely on withdrawal. Contraceptive use is hugely influenced by myths and misinformation about hormonal contraception. This can be tackled by raising awareness and providing accurate information, which is exactly what we are doing in Roma communities in these countries. With support from the communities, our local partners are training and building essential life skills among Roma women and men to enable them to act as points of contact for their friends, children, neighbours and family. And this approach is bearing fruit. Last year, I visited Kosharnik, a neighbourhood in the city of Montana in the north of Bulgaria, where 6000 Roma have settled. 600 of them live in extreme poverty, without running water or electricity. They form a ‘ghetto within the ghetto’. Many have no income and struggle to survive. Contraception is a life-changer for women living in this neighbourhood. One young woman living here told us that local sessions organised by a health mediator from the community had convinced her of the advantages of contraceptive care. She had married at 17 and now, three years and one child later, had decided after careful consideration with her husband what was right for her: “One day, we spoke again.. about what is a good number of children in a family... I thought more about me and my family. We didn’t have a high income and could barely pay our bills. Our daughter was a baby and it was challenge to look after her. With my husband we started to discuss it, and I started to think about getting an IUD... That’s how six months ago I decided to have one fitted… My friends told me I’m crazy, they said I only have one child. But I know that I can decide myself when to have another, and that I’ll do so consciously.” Raising awareness is just part of the solution. Roma women and girls face many more hurdles to get the family planning services they need. Many are uninsured, which makes contraceptive care costly, so we support them to get health insurance. Often, it takes hours to reach healthcare services on public transport, so most women can’t even make the trip. That is why our Bulgarian partner collaborates with a doctor who visits the nearby community health center to provide contraceptive care free-of-charge. We encourage and even push doctors to get out of their consultation rooms and provide information, counselling and even services in the communities. This simple intervention boosts access for women and girls, but crucially also opens the eyes of the doctors, helping to change their perceptions and attitudes towards Roma people. In the words of one Serbian doctor: “This field work teaches me that we have to act like a human, to take the time to listen, ask and help”. Social norms and expectations are another reason that the uptake of contraceptive care is very low. Why would a young girl ask for contraception if she’s not even supposed to have sex before marriage? Or why would a teenage couple use contraception if they just got married and are expected to start a family as soon as possible ? Why would a man propose to his wife to use a condom – is he cheating on her? Young people and their communities need to talk - not just about contraception, but about sex, sexuality, relationships, gender, consent, and more! That’s why we support teachers, local nurses, health mediators and young people to build these essential life skills in their children and peers. Young people and children love the relationships and sexuality education sessions and even the adults we have trained get excited seeing the children’s enthusiasm. A community nurse in Romania told us: “This has helped us to see that more can be done... You realise that for a young girl of 11 or a young boy of 12, questions like "how to use a condom" or "what happens when you have sex with a girl on her period", are clearly taboo, and they have no one to talk to about these things because in their families it’s seen as shameful.... But we're trying to move forward and explain that it’s not bad to talk about these things..." Our work in the Balkans with some of Europe’s most vulnerable communities brings home just how much contraceptive care still changes and saves lives in Europe. It also highlights that making contraceptive freedom a reality for everyone requires civil society, decision-makers and care providers to unite as a team, with and for local communities. Above all, political commitment is needed to ensure all women can live safe and dignified reproductive lives. --- Marieka Vandewiele is a Senior Programme Advisor at IPPF EN's Regional Office.  You can read more about this work here.

Sexuality Education in Bulgaria
02 December 2014

How sexuality education is empowering young people with learning disabilities in Bulgaria

The town of Kazanlak, at the foot of the Balkan Mountains, is the centre of Bulgaria’s famous rose oil industry. Maria Gineva and Veska Marakjieva run four centres there for young people with special needs, including learning disabilities. Both have taken part in training sessions on sexuality education organised by IPPF’s Bulgarian member association BFPA as part of the ‘Keep me Safe’ project. Maria tells the story of a teenage couple with learning disabilities who were in love. “They didn’t really know about sex, about how it worked, and how to protect themselves. So we started to work with them, discussing sexuality, feelings and how and where it’s appropriate to express them. “Previously they had been kissing all the time in public spaces. After these sessions we agreed on rules on where they could go, and gave them a private space. Their parents hadn’t talked to them at all about sex. We spoke to the parents too, to encourage them to speak to their children and respect their need for space. The project is helping us find the right way to talk to these young people.” Maria and Veska believe that the project can make real changes to the lives of young people with learning disabilities by equipping them and their parents, as well as others involved in their care, to navigate the tricky waters of puberty and developing sexuality. Before Keep Me Safe, explains Veska, “we didn’t focus on these issues, even though the young people were literally growing up before our eyes.” The staff of the centers had tried instinctively to talk to them about issues like personal boundaries and masturbation in communal spaces, and there was some work on preventing sexual abuse. “But we hadn’t thought of it as something where we needed a concrete policy,” adds Maria. This has now changed, and a new policy is being rolled out. It is clear from the experiences of Maria and Veska and other professionals caring for young people with learning disabilities in Bulgaria that parents have a crucial role to play in empowering them when it comes to sexuality and prevention of sexual abuse. But this is also an extremely difficult subject to broach in a country where discussing sexuality in general is taboo, and sexuality education for mainstream children is woefully inadequate. Reactions from parents of young people with learning disabilities to the prospect of sexuality education workshops have ranged from questioning the need to discuss sex with their children, to embarrassment, curiosity and gratitude. One mother who attended a BFPA workshop in the town of Lovech described herself as “very happy – this will give me the confidence to talk to my son about these issues. He is 21. Before he didn’t know who he could talk to when he was in love, he was looking for information on the internet.” Veska, herself the mother of a child with a learning disability, recalls the first session she ran with parents. “We advised them to try and give their children more privacy, and stop hugging them like they are toddlers when some of them are 30 years old. We tried to make them understand that this puts their children at risk because they think hugging all the time is the norm.” She laughs as she adds that she is trying to get into the habit of just kissing her son on the cheek. “The impact on the young people themselves can be greater happiness,” says BFPA Executive Director Radosveta Stamenkova, when asked what the project will mean in the longer term. She has been pleasantly surprised by the strong demand from organisations involved in the direct care of these youngsters, travelling with the BFPA team to different towns around the country to lead additional workshops. Radosveta believes that Keep me Safe’s visual tools with their simple language can also be useful for reaching out to other vulnerable groups, e.g. younger children in the mainstream, new waves of refugees escaping conflict in the Middle East, and Bulgaria’s Roma community, of which 20% is illiterate. Veska confirms that in Kazanlak, which has a large Roma population, the project is already being used more broadly: “We did several sessions with teenage mums, mainly Roma, and we realised that they just didn’t know their own bodies at all, didn’t know the risks of early pregnancy, could not make a proper assessment of healthy behaviour and risks.” But a recurring theme in conversations with all those who are excited about the potential of Keep me Safe in Bulgaria is the lack of mandatory comprehensive sexuality education in mainstream schools. “We have been fighting for this for 20 years. It pains me physically that it is still not there,” adds Radosveta, citing a recent case that reached notoriety when a teenage mother in Kazanlak dumped her baby in a dustbin. When the media interviewed an adolescent boy who went to the same school and asked him to name one sexually transmitted infection, he said “Ebola”. --- Keep me Safe is a two-year project that aims to empower young people with learning disabilities across Europe to protect themselves against sexual abuse and violence. It is funded by the European Commission Daphne III Programme. You can read more about the work in Bulgaria here.

Youth Voices, Youth Choices youth group
01 June 2023

Youth Voices, Youth Choices

Young people and groups with vulnerabilities in the Western Balkans face a great many barriers to accessing sexual and reproductive healthcare. Throughout the COVID-19 pandemic, they bore the brunt of additional obstacles to accessing information, support and care. COVID-19 demonstrated how fragile national health systems are and highlighted countries’ unpreparedness to deal with health emergencies. But it also stimulated creativity by civil society and other actors to counter these barriers, with digital outreach and support playing an expanding, crucial role. Youth Voices, Youth Choices is a project dedicated to learning from the COVID-19 experience in the Western Balkans to ensure sexual and reproductive health services, information and education become more accessible and youth-friendly in the long term, especially for marginalised groups. Running from 2020 until 2023, it brings together IPPF members and partners in Albania, Bosnia and Herzegovina, Bulgaria, North Macedonia and Kosovo, supported by IPPF EN’s Regional Office. Project partners have conducted research into the impact of the pandemic on young people’s SRH needs and access to services and information, and the role of integrated digital services, with a focus on communities living in remote areas and unfavourable social conditions. They are sharing good practices and empowering young people as campaigners and advocates using digital and offline education tools. And working in multi-stakeholder partnerships, they are developing policy recommendations to support advocacy and youth-led campaigns for stronger health systems and increased access to care, in and beyond emergency situations. In October 2022, IPPF EN launched a set of regional policy recommendations based on our research into how the pandemic affected young people. All partners also created national recommendations. Collectively, we built upon these through regional and national advocacy campaigns and actions. Check out our YVYC resources page! Take a look at our series of interviews carried out by young people with their peers on how COVID affected their access to SRHR information, education and care, and their vision for the future. RESEARCH REPORT  As a basis for this work, in 2021 and early 2022, we conducted a study to provide us with a clearer picture of the impact of the pandemic on young people’s SRHR. The data was published in a series of reports presenting the findings of the study, carried out by and among youth in five Balkan countries. The reports, available for download below, document young people’s SRH needs and experiences and the perspectives of healthcare providers and other relevant stakeholders on these needs. They also capture the latter’s needs as they deliver services, information and education to young people, building on their experience of COVID-19. POLICY RECOMMENDATIONS In October 2022, IPPF EN launched a set of regional policy recommendations that call on decision-makers to listen to young people and uphold their SRHR as they build back health and social systems in the wake of the pandemic. Presented at the European Parliament on 26 October by youth advocates and experts, with the support of MEP Fred Matić, the recommendations were developed by a group of specialists who came together to develop a blueprint for designing systems that prioritise access to youth-friendly SRH care, and better support of young people’s health and well-being. The policy recommendations are available for download below. The policy recommendations were used to set advocacy priorities for further actions and campaigning. YOUTH VOICES Young people are at the heart of this work: as researchers, as members of the expert groups that developed policy recommendations, and as advocates and campaigners for change. They were also in the lead at the 'Healthy Youth – Healthy Future' multi-stakeholder meeting in Tirana in spring 2023, where youth representatives and staff from our partner organisations came together with decision-makers and experts from the field - see Tirana joint declaration on protecting the health and social wellbeing of young people. The young participants presented advocacy campaigns carried out at regional and national levels, and shared their needs and experiences at an event held in the Albanian parliament. For more information about this work, please contact us at: [email protected]           This work is funded by MSD for Mothers.

YVYC illustration young people advocating
25 October 2022

"It would make a real difference if we could be open with health professionals about what really concerns us."

We spoke to young people from the Western Balkans about how their access to sexual and reproductive health and rights was affected by the COVID pandemic, and asked them about their vision for re-designing a more youth-friendly future in which young people can flourish.  Alex is a 19-year-old LGBTIQ girl, studying at university in Blagoevgrad, Bulgaria. As a peer educator, she supports other young people to learn and develop crucial life skills relating to their sexual and reproductive health.   Alex, describe your experience of access to SRHR* education, information and care before and during COVID.  My access to sexual and reproductive healthcare before COVID was relatively normal, for example a gynaecologist visit, but during the pandemic, it was rather harder to go because I had to present a negative COVID test to be examined. At some point, in-person consultations with doctors were extremely limited, unless it was with reference to COVID or life-threatening - so regular check-ups were not really happening. I didn’t receive any adequate sexuality education either before or during the pandemic. The only time sexual health was discussed in my 12 years of schooling was back in elementary school and it only included only a talk with the girls on menstrual pads and periods. I believe online information became more accessible because of COVID. As a result of the limited consultations with professionals, more people sought answers on the Internet. Of course, we must keep in mind that information has to be checked carefully. Also, reliable information in Bulgarian is very limited.   Did anything change for the better during the pandemic in terms of access to SRHR? I suppose more information regarding SRHR became available online because of the huge demand. A good thing is that the information is still relevant today even though COVID is no longer an urgent crisis. Personally, I got into the habit of looking for answers myself and checking if the source was reliable or not. Other than that, I would not say that COVID had any positives.   What was the biggest challenge to young people’s SRHR during the pandemic? How could decision-makers/medical professionals have removed this obstacle?   One of the biggest problems was the misleading and unreliable sources of information about sexual and reproductive health. In addition, adequate information is mostly in English. I believe a fact-checking system to verify all factual information could be helpful in preventing the spread of misinformation. I faced that problem when I and other 3 friends conducted a few educational workshops on the topic of comprehensive sexuality education. While putting together the information we needed, we came across numerous invalid data and false statements.   What lessons should governments and professionals who work with youth learn from the pandemic about how to look after young people’s health and wellbeing in a crisis?   From what I have seen, many adults do not seem to understand the burden this crisis has had on us and therefore neglect our mental health. Affordable and regular psychologist appointments should be a priority. There is this stigma around mental health that you seek help only if you are “not normal”. That is completely false and puts our generation under pressure and makes us not take proper care of our well-being (which often includes going to a psychologist). Also, many of the professionals (both teachers and medical practitioners) were sharing their personal and controversial opinion on the pandemic and vaccinations which has to be limited. A personal experience I had was when I went to get vaccinated and my GP would not allow me to, saying that it was unnecessary and even “dangerous”.   What is your number 1 recommendation on what is needed to make services more youth-friendly? What difference would this make in the life of a young person like you? More young and inclusive professionals working in the sphere are needed. For example, many of my female peers insist that female gynecologists examine them. LGBT+ inclusivity is also important, as currently many of us cannot share a key part of our life neither with a gynecologist nor a psychologist. The difference would be that we will be more open and share what really concerns us so we can seek adequate help. It is much easier to talk to someone close to your age or background.   What helped you to become engaged as an activist? How has this experience been so far? The idea that I can do something about the desperate need for a change and make my voice heard was what helped me get involved. So far, I mostly enjoy working with other young people and seeing them as determined and hopeful as I am. Every new idea has been welcomed with enthusiasm and encouragement by many of my peers, which makes it clear that youngsters are looking forward to a change and improvement. However, as I mentioned, we held several workshops about comprehensive sexuality education and we faced many obstacles. The project was very scarcely funded, which made it very hard to implement properly and exactly how we have envisioned it. Also, finding people to attend the workshops was fairly hard as well and we could not get any support from our teachers and school staff. They did not welcome the idea because the topics of sexual health and LGBT+ inclusivity are still taboo in our society - so they were scared of how the parents would react. On the other hand, the people that came to the workshops had very encouraging feedback and even a demand for more similar events. * SRHR = sexual and reproductive health and rights Interview conducted by Viktoria Nikolova, a member of the regional youth group of the IPPF EN project Youth Voices, Youth Choices, funded by MSD for Mothers

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08 April 2022

Working with the Roma community and local actors for reproductive freedom

In the Balkans, IPPF members are working hand-in-hand with diverse networks of actors from within and around Roma communities. This work was shaped as the My Body, My Rights project. Our common goal is to strengthen girls’ lifelong reproductive freedom and tackle some of the deep-rooted, systemic obstacles that prevent people - especially women and youth - from living safer and healthier lives. How? By increasing access to care, creating supporting contexts for choice and advocating for investment. Our work is community-driven and based on fostering local partnerships. At the heart of this collective action are Roma volunteers, girls and boys, health mediators and local NGOs, leading grassroots change and advocating for their own unique communities. Doctors, community nurses and teachers are working with them to help deliver lasting impact. And some decision-makers are stepping up and beginning to make much-needed investments in more equitable access to reproductive healthcare. We are proud to share highlights of our work, recommendations to decision-makers and resources for further reading. Explore our new microsite!   

Youth Voices, Youth Choices research report front cover
30 March 2022

Youth access to SRH information, education and care in the Balkans in COVID times

COVID-19 created the largest health and socio-economic crisis of our generation. Many health systems were pushed to the brink by restrictive measures rushed in to respond to the pandemic, resulting in the deprioritisation of some existing healthcare services. In almost all European countries, COVID-19 had a negative impact on the delivery of vital sexual and reproductive healthcare, including maternal health and family planning, for women and groups that face barriers to accessing care, including young people. The pandemic also uncovered weaknesses within our systems and exposed the fact that countries are not adequately prepared to deal with health emergencies. To help bring about positive change for young people, IPPF European Network is working to strengthen healthcare systems through the project Youth Voices, Youth Choices, and to remove all kinds of barriers preventing youth from accessing essential care in five Balkan countries: Albania; Bosnia & Herzegovina; Bulgaria, Kosovo and North Macedonia. We are focusing particularly on the needs of those living in remote areas, as well as those from communities that face challenging social conditions, such as the Roma. POLICY RECOMMENDATIONS In October 2022, IPPF EN launched a set of regional policy recommendations that call on decision-makers to listen to young people and uphold their SRHR as they build back health and social systems in the wake of the pandemic. Presented at the European Parliament on 26 October by youth advocates and experts, with the support of MEP Fred Matić, the recommendations were developed by a group of specialists who came together to develop a blueprint for designing systems that prioritise access to youth-friendly SRH care, and better support of young people’s health and well-being. The policy recommendations are available for download below. RESEARCH REPORT  As a basis for this work, in 2021 and early 2022, we conducted a study to provide us with a clearer picture of the impact of the pandemic on young people’s SRHR. The data was published in a series of reports presenting the findings of the study, carried out by and among youth in five Balkan countries. The reports, available for download below, document young people’s SRH needs and experiences and the perspectives of healthcare providers and other relevant stakeholders on these needs. They also capture the latter’s needs as they deliver services, information and education to young people, building on their experience of COVID-19. YOUTH VOICES Young people are at the heart of this work. They were part of the teams that carried out the research presented in the reports below. They participated in the expert groups that developed our regional recommendations for policy change (below) at national and regional level, and they are being supported and empowered to advocate for these changes. Youth were also in the lead at our 'Healthy Youth – Healthy Future' multi-stakeholder meeting in Tirana in spring 2023, where together with staff from our partner organisations they held discussions with decision-makers and experts from the field, concluding with the signing of a joint declaration on protecting the health and social wellbeing of young people during and beyond moments of crisis - available for download below.     Young people also carried out a series of interviews among their peers to share stories of how the pandemic affected their access to SRHR, and what their vision is for a more youth-friendly future that listens to the younger generations and upholds their SRHR.

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20 September 2021

My friends think I’m crazy, because I only have one child. But I know I can decide when to have another. Vaska's Story

“I got married quite early, when I was 17. A year and a half later I got pregnant and had a baby girl. Now she is 18 months old. My husband started a job in the city in a company which is popular among Roma people, and I stayed home to look after our child.  Last year I met Valya, the health mediator. She told me they organize meetings, and she invited me to take part in a women’s group. Initially I didn’t know what we would do, but it was interesting as there were other women like me. During these meetings we spoke very often about contraception in general, and especially about IUDs. The women shared what they had heard and what they knew about them. It was strange, but most of them said that IUDs harm women’s health. I also understood that the men are worried about their wives’ health and that that’s why they don’t approve of contraception. I heard women say other things as well, like you can still get pregnant with an IUD, that you may gain weight, that IUDs move in the body, and so on and so forth.  One day, during a meeting, we spoke again about contraception, and more precisely, what we thought was a good family size. People had different views. I personally think that it is not so much about the number of children as it is about being able to make sure you have everything you need - clothes, food, the possibility to educate them. Everyone should take these issues into consideration before having children.  I thought more often about myself and my family. We didn’t have high incomes and we could barely afford our bills. Our daughter was a baby and it was challenge to provide for her. My husband and I started to talk about it, and I started to think about getting an IUD. That’s why six months ago I decided to have one fitted, and I feel fine. It isn’t painful and I haven’t gained weight. My friends think I’m crazy, because I only have one child. But I know that I’ll be able to decide when to have another one.” When vulnerable communities, volunteers and professionals unite for reproductive freedom, they are a powerful force for change. Watch Vaska’s story and others in our short film about the amazing work our members in Bulgaria, Romania and Serbia are doing to support the lifelong reproductive health and safety of Roma girls, women and young people.

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27 September 2021

My Body, My Rights - short film

When vulnerable communities, volunteers and professionals unite for reproductive freedom, they are a powerful force for change. Our short film features five stories that show how IPPF members in Bulgaria, Romania and Serbia are supporting the lifelong reproductive health and safety of Roma girls, women and young people, working on the multiple fronts necessary to improve access and uptake of quality family planning and maternal health care. Learn more about the My Body, My Rights project here. 

Serbia roma community worker
14 January 2022

My Body, My Rights

My Body, My Rights is a three-year project supporting the lifelong reproductive health and freedom of Roma girls, by improving access and uptake of quality maternal and family planning healthcare for vulnerable communities in Bulgaria, Romania and Serbia. We are working holistically on the multiple fronts necessary to bring about lasting change. At the heart of the project lies participation by Roma people themselves, particularly the young. IPPF members in Bulgaria, Romania and Serbia are working in intersectional partnerships to empower girls and boys to become leaders in educating and informing their peers about sexual and reproductive health and rights, and in driving change for their community through advocacy. Relationship and sexuality education is vital for increasing support for gender equality and reproductive freedom among young Roma people, while awareness-raising in their communities is increasing the acceptability of modern contraceptives. Project partners are also training primary health care providers to update their technical knowledge and skills related to family planning in line with best practice and international standards, sensitising them to Roma health needs and to how stigma and discriminatory attitudes towards the Roma and young people negatively affect the quality of care they receive. Roma health mediators are our bridge between communities and healthcare providers. The project is also targeting decision-makers, carrying out advocacy for stronger political commitment to quality family planning care for communities often left behind.   Our members are using innovative approaches such as the development of an app to promote contraceptive acceptability. This work is coordinated by IPPF EN’s regional office, implemented by our national members in Bulgaria, Romania and Serbia, and funded by MSD for Mothers. Explore our project microsite!

COVID-19 and SRHR
09 July 2021

COVID-19 IPPF innovation and best practice

The COVID-19 pandemic has had a profound impact on access to and enjoyment of sexual and reproductive health services and rights. While families, couples and individuals have faced intense pressure and hardship as a result of the pandemic, life-saving sexual and reproductive health (SRH) services and supplies, including sexual and gender-based violence services, have become scarce and/or inaccessible. Existing socioeconomic inequalities have been exacerbated, especially as they pertain to girls, women and marginalised groups.  As nationally owned and locally operated health service providers, IPPF Member Associations (MAs) remain committed to their communities and the people within them. In this Case Study series, we share progress, learning and innovation that has occurred within MAs over the course of the pandemic. The case studies cover: telemedicine for abortion in the COVID-19 context, SGBV response in COVID-19, adapting sexuality education in COVID-19 through digitalisation, and leaving no one behind, especially marginalised populations. Take a look at the above Case Studies from Bulgaria, Estonia, Serbia and Ireland. 

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26 September 2020

Making contraceptive freedom a reality in vulnerable communities

Today is World Contraception Day – a day for raising awareness about contraceptive care. It might seem surprising that we still need to raise awareness - isn’t everyone in Europe using modern contraception nowadays? Unfortunately, the answer is no. In Romania, Bulgaria and Serbia, for example, less than half of women use a modern method. Many women and girls from the poorest and most socially excluded communities in the Balkans rely on withdrawal. Contraceptive use is hugely influenced by myths and misinformation about hormonal contraception. This can be tackled by raising awareness and providing accurate information, which is exactly what we are doing in Roma communities in these countries. With support from the communities, our local partners are training and building essential life skills among Roma women and men to enable them to act as points of contact for their friends, children, neighbours and family. And this approach is bearing fruit. Last year, I visited Kosharnik, a neighbourhood in the city of Montana in the north of Bulgaria, where 6000 Roma have settled. 600 of them live in extreme poverty, without running water or electricity. They form a ‘ghetto within the ghetto’. Many have no income and struggle to survive. Contraception is a life-changer for women living in this neighbourhood. One young woman living here told us that local sessions organised by a health mediator from the community had convinced her of the advantages of contraceptive care. She had married at 17 and now, three years and one child later, had decided after careful consideration with her husband what was right for her: “One day, we spoke again.. about what is a good number of children in a family... I thought more about me and my family. We didn’t have a high income and could barely pay our bills. Our daughter was a baby and it was challenge to look after her. With my husband we started to discuss it, and I started to think about getting an IUD... That’s how six months ago I decided to have one fitted… My friends told me I’m crazy, they said I only have one child. But I know that I can decide myself when to have another, and that I’ll do so consciously.” Raising awareness is just part of the solution. Roma women and girls face many more hurdles to get the family planning services they need. Many are uninsured, which makes contraceptive care costly, so we support them to get health insurance. Often, it takes hours to reach healthcare services on public transport, so most women can’t even make the trip. That is why our Bulgarian partner collaborates with a doctor who visits the nearby community health center to provide contraceptive care free-of-charge. We encourage and even push doctors to get out of their consultation rooms and provide information, counselling and even services in the communities. This simple intervention boosts access for women and girls, but crucially also opens the eyes of the doctors, helping to change their perceptions and attitudes towards Roma people. In the words of one Serbian doctor: “This field work teaches me that we have to act like a human, to take the time to listen, ask and help”. Social norms and expectations are another reason that the uptake of contraceptive care is very low. Why would a young girl ask for contraception if she’s not even supposed to have sex before marriage? Or why would a teenage couple use contraception if they just got married and are expected to start a family as soon as possible ? Why would a man propose to his wife to use a condom – is he cheating on her? Young people and their communities need to talk - not just about contraception, but about sex, sexuality, relationships, gender, consent, and more! That’s why we support teachers, local nurses, health mediators and young people to build these essential life skills in their children and peers. Young people and children love the relationships and sexuality education sessions and even the adults we have trained get excited seeing the children’s enthusiasm. A community nurse in Romania told us: “This has helped us to see that more can be done... You realise that for a young girl of 11 or a young boy of 12, questions like "how to use a condom" or "what happens when you have sex with a girl on her period", are clearly taboo, and they have no one to talk to about these things because in their families it’s seen as shameful.... But we're trying to move forward and explain that it’s not bad to talk about these things..." Our work in the Balkans with some of Europe’s most vulnerable communities brings home just how much contraceptive care still changes and saves lives in Europe. It also highlights that making contraceptive freedom a reality for everyone requires civil society, decision-makers and care providers to unite as a team, with and for local communities. Above all, political commitment is needed to ensure all women can live safe and dignified reproductive lives. --- Marieka Vandewiele is a Senior Programme Advisor at IPPF EN's Regional Office.  You can read more about this work here.

Sexuality Education in Bulgaria
02 December 2014

How sexuality education is empowering young people with learning disabilities in Bulgaria

The town of Kazanlak, at the foot of the Balkan Mountains, is the centre of Bulgaria’s famous rose oil industry. Maria Gineva and Veska Marakjieva run four centres there for young people with special needs, including learning disabilities. Both have taken part in training sessions on sexuality education organised by IPPF’s Bulgarian member association BFPA as part of the ‘Keep me Safe’ project. Maria tells the story of a teenage couple with learning disabilities who were in love. “They didn’t really know about sex, about how it worked, and how to protect themselves. So we started to work with them, discussing sexuality, feelings and how and where it’s appropriate to express them. “Previously they had been kissing all the time in public spaces. After these sessions we agreed on rules on where they could go, and gave them a private space. Their parents hadn’t talked to them at all about sex. We spoke to the parents too, to encourage them to speak to their children and respect their need for space. The project is helping us find the right way to talk to these young people.” Maria and Veska believe that the project can make real changes to the lives of young people with learning disabilities by equipping them and their parents, as well as others involved in their care, to navigate the tricky waters of puberty and developing sexuality. Before Keep Me Safe, explains Veska, “we didn’t focus on these issues, even though the young people were literally growing up before our eyes.” The staff of the centers had tried instinctively to talk to them about issues like personal boundaries and masturbation in communal spaces, and there was some work on preventing sexual abuse. “But we hadn’t thought of it as something where we needed a concrete policy,” adds Maria. This has now changed, and a new policy is being rolled out. It is clear from the experiences of Maria and Veska and other professionals caring for young people with learning disabilities in Bulgaria that parents have a crucial role to play in empowering them when it comes to sexuality and prevention of sexual abuse. But this is also an extremely difficult subject to broach in a country where discussing sexuality in general is taboo, and sexuality education for mainstream children is woefully inadequate. Reactions from parents of young people with learning disabilities to the prospect of sexuality education workshops have ranged from questioning the need to discuss sex with their children, to embarrassment, curiosity and gratitude. One mother who attended a BFPA workshop in the town of Lovech described herself as “very happy – this will give me the confidence to talk to my son about these issues. He is 21. Before he didn’t know who he could talk to when he was in love, he was looking for information on the internet.” Veska, herself the mother of a child with a learning disability, recalls the first session she ran with parents. “We advised them to try and give their children more privacy, and stop hugging them like they are toddlers when some of them are 30 years old. We tried to make them understand that this puts their children at risk because they think hugging all the time is the norm.” She laughs as she adds that she is trying to get into the habit of just kissing her son on the cheek. “The impact on the young people themselves can be greater happiness,” says BFPA Executive Director Radosveta Stamenkova, when asked what the project will mean in the longer term. She has been pleasantly surprised by the strong demand from organisations involved in the direct care of these youngsters, travelling with the BFPA team to different towns around the country to lead additional workshops. Radosveta believes that Keep me Safe’s visual tools with their simple language can also be useful for reaching out to other vulnerable groups, e.g. younger children in the mainstream, new waves of refugees escaping conflict in the Middle East, and Bulgaria’s Roma community, of which 20% is illiterate. Veska confirms that in Kazanlak, which has a large Roma population, the project is already being used more broadly: “We did several sessions with teenage mums, mainly Roma, and we realised that they just didn’t know their own bodies at all, didn’t know the risks of early pregnancy, could not make a proper assessment of healthy behaviour and risks.” But a recurring theme in conversations with all those who are excited about the potential of Keep me Safe in Bulgaria is the lack of mandatory comprehensive sexuality education in mainstream schools. “We have been fighting for this for 20 years. It pains me physically that it is still not there,” adds Radosveta, citing a recent case that reached notoriety when a teenage mother in Kazanlak dumped her baby in a dustbin. When the media interviewed an adolescent boy who went to the same school and asked him to name one sexually transmitted infection, he said “Ebola”. --- Keep me Safe is a two-year project that aims to empower young people with learning disabilities across Europe to protect themselves against sexual abuse and violence. It is funded by the European Commission Daphne III Programme. You can read more about the work in Bulgaria here.