During the 1970’s Aruba’s population was rapidly growing; yet one-third of all pregnancies were unplanned. With the arrival of Famia Planea Aruba (FPA), local communities were able to access health and contraceptive care. For more than 50 years FPA has evolved and adapted its healthcare provision to meet the needs of the growing and changing community. Access to contraception continues to be FPA’s most in demand healthcare provision.  “As a recently graduated Social Worker, I feel it is very important to provide both, men and women, with information and products regarding sexual and reproductive health and rights. We hear far too often that preventing an unwanted pregnancy should be the woman’s responsibility, especially from our male counterparts”, says Lisen, one of the Information, Education, and Communication Support Staff at FPA. During a one-on-one consultation at the FPA office, everyone is provided with information individual to their own needs as well as that of their partner. This information is provided by a trained IEC member of the team.  “I believe in the values of FPA, and that information is the key to health and a prosperous future. When counseling an individual, I try to take time to get to know the person the best I can in what is usually a short period. By building a trust relationship with each client they are more inclined to open up and ask the questions they truly need help with. What for one person might seem a small issue might be something huge for another one when as a counselor you are able to assess each individual, you can achieve so much”, Lisen says. What sets FPA apart from a pharmacy is the integrated care provision. This includes guidance provided with the contraceptives, the individually tailored care for each client, and working in close partnership with family practitioners, midwives and the local general health insurance provider. “There are some clients that you see so often that they almost become like family in a way, as soon as you see them you can already anticipate their needs. I am just 25 years old which means that some of the clients are my age, some older, some younger. Seeing someone you helped out in public and having them greet you or tell you that you did a great job helping them is such a wonderful feeling, I don’t know if I will ever get used to it”, Lisen says.

Accessibility to information and contraceptives has always been a priority for Famia Planea Aruba (FPA), whether through the office, delivery service, or in schools.  For over fifteen years FPA has worked in partnership with one of the largest secondary schools on the island. The FPA team visits the school on a monthly basis to provide guidance, counseling, and contraceptive care to students and to help ensure they stay in school to complete their education.  “One of my first experiences providing comprehensive sex education, with FPA was at the EPB School during my education as a social worker, many years later I still very much enjoy this”, says Richenella, FPA’s Finance and IEC support staff. FPA’s client is at the heart of its healthcare provision. FPA staff work with students to build trust and ensure they feel safe to talk openly. This helps to provide a sense of consistency for the student, as well as efficiency for the team being familiar with specific students and cases. They are better able to notice if something changes, and if a student needs a referral to a medical doctor or other organization for additional treatment. “The consultations are always fun; you get a change of scenery by stepping out of the office. Over the years you see so many faces and still, somehow you manage to remember most of them. After just a few visits you can start to build a profile of most students, you can start to tell who the class clown is, the Mister Popular, the shy one, the loud one, and the one who just wants to take his time to avoid going back to class”, Richenella laughs.  

  Famia Planea Aruba (FPA) places great value on the relationship they have with Adriana, the social worker at EPB San Nicolas School. Adriana is the person who has the most contact with the students, and the one most students turn to when they need help.  “I’ve been the Social Worker at EPB San Nicolas for about fourteen years and have been working with FPA throughout my entire career here. It has always been a pleasure to work with them, they are very accommodating to whatever project we have going on. Each year we have an educational carousel for the first-year students, and we have always been able to count on FPA to provide information to our students. The Comprehensive Sexuality Education program is always fun, informative, and evolving. I, as well as other colleagues, try to catch at least one CSE session each year to see what innovative way the information is presented.” EPB is a secondary vocational school that educates young people from 12 to 18 years. Over the years it has developed a reputation for having challenging students. Adriana knows the students better than most of the teaching staff and is a firm advocate for the continuation of the on-the-spot-consultations, having seen the consequences when this type of care is not offered.  For registered youth under 21 years, the costs of healthcare provision are covered by the national health insurance, however, some students fall outside of the system. “Most of the times you get to have fun with the students, however, every now and then you will come across a heartbreaking case. Since Aruba has so many different migrants, very often you will come across one person who is not insured at the moment, who needs products and can’t afford it and you figure out a way to help”, Adriana says. “For our second, third- and fourth-year students FPA has been collaborating with us to provide a monthly session where the students receive contraceptives and guidance on school grounds. Since around this age, most of our students are already sexually active, we try to help them stay safe in and out of school. The consultations hours have become so popular over the years that as soon as the students see an FPA team member, they immediately assume that they are here to provide them with contraceptives and guidance, even if they are here for some completely different reason that day”, she comments. “The love, patience, and dedication that FPA has shown our students over the years are outstanding. At the beginning of the COVID-19 crisis we had to stop the consultation hours, but thankfully we are now back at it, bigger and better. Due to the collaboration with FPA, we were able to finish out our 2018-2019 school year with no new pregnancies, which was a first for our school. We hope to accomplish this again, now that we can continue our consultations, and keep our kids educated and in school, for as long as we can so they can achieve the best possible future”, Adriana concludes.  

Damara Rasmijn is a data analyst and a member of the Sustainable Development Goals Commission. She started using Famia Planea Aruba’s (FPA) contraceptive delivery service a year ago.  “It definitely has made my life much easier especially when I have a busy schedule. I sometimes clock in at work very early and leave late which makes it difficult for me to personally stop by and buy my products. With the delivery service I simply order my products through the online store and choose the date and time that is most convenient for me”, she says. Damara values the personal service and the convenience of paying by card and choosing a preferred delivery time. “I love this service because sometimes I place an order a few days before and with my busy schedule I forget I ordered it. However, the employees at FPA call to confirm the order on the day of the delivery, which is great because it is like a personal reminder! The best part is that they also have a portable ATM machine. I get my products, guidance and have it delivered to my location, what more can you ask for?”  Damara has shared her positive experience of the convenience of buying products through FPA’s online store recommending it to her colleagues and friends.  “I suggested this service to my colleagues and friends because we all have such hectic lifestyles and are always searching for faster, easier, and more convenient ways to balance our lifestyles. Especially during the COVID-19 pandemic, this service has been a great help for me. Having to adhere to the protocols and restrictions and being a health enthusiast, it was much easier and comfortable for me that FPA provides this service.”  

Famia Planea Aruba’s (FPA) contraceptive delivery service is an added personal touch to its online store. The site is accessible to both members and non-members who can shop in privacy for their contraceptives and schedule a delivery. Orders are delivered by FPA staff with clients having the option to pay cash or debit upon delivery. To ensure a clients’ privacy and confidentiality orders are delivered discreetly. Ghislaine Koeiman, Head of Information, Education, and Communication Support at FPA has been managing the delivery service since it started in August 2018. “Since the start of the delivery service in 2018, our clients were enthusiastic however, the usage started slow. I believe this was due to the unfamiliarity, and people were still in the transition phase to online services. Moreover, clients believed that the delivery transportation would have been in a car completely covered in images of condoms, sperm cells and pills, which made them skeptical of using the service due to embarrassment”, says Ghislaine.  As with any new service comes challenges as well as opportunities. “Some of the challenges we face are the overload of deliveries on one day.” Even though Aruba is a small island and there are traffic jams only at specific hours in the day. “Sometimes I get stuck in traffic and try to rush myself to deliver the products in the time slot and at times I find myself in places that I barely recognize and discover new locations.” “The part I enjoy is the communication with the clients. Building a relationship with the client and vice versa provides a smoother transition of service but also provides the comfort and safe feeling for the client”. Ghislaine says the service often calls for more than the delivery of contraceptive orders, as clients may have questions or need support about their health. FPA’s bespoke healthcare delivery has seen successful growth since it started, with an increase of 115% during 2019 and 170% in 2020. “There has been an immense increase in the service in 2020 due to the pandemic. We already had the service in place, so we just had to fill in the gaps; for example, providing more hours and dates for clients to make use of the service.” <img src="https://tracker.metricool.com/c3po.jpg?hash=8b2b54e62fc802a9ae3ee7903a883415"/>

“One day, when I returned from work, Ms. Glenda and Mr. Martin from ADS Pro-Familia were at my house, I heard what the volunteering was about, regarding the education of the men in the community, how to teach, how to stop machismo, to be less violent, how to give the talks and visit the clients; they also talked about the contraceptive methods, medicines and many things that would change people's lives, the proposal seemed important to me and I accepted since I like to work for my people”, recalls José. Since 2008, male participation in sexual and reproductive healthcare in rural communities has been an integral component of the Community-Based Program (PBC), addressing issues of masculinity, behavior, and access to healthcare. "When I gave the talks on masculinity, they questioned me: 'Why can't you scream at home, if you're the man?' Or 'Who you think you are to say those things?', questions that I also asked myself once", says José. “Thanks to the training I have had and the support of the Pro-Familia staff, I have managed to learn and clarify my doubts. During the process I have had a personal change, I no longer respond if someone seeks me to fight and now, I don’t carry my knife everywhere as I used to, I take care of my own health, I share the responsibilities at home, I take care of my two-year-old son; before volunteering, I thought it was a woman’s job, I didn't do that”, reflects José. Educational activities on sexual and reproductive healthcare remain a challenge. Yet, health promoters can help break down some barriers through counseling for couples and the provision of contractive supplies - especially condoms - and medicines. “I like the communication I have with the Pro-Familia staff and the training reinforcements, they should keep it that way, because it's the way to learn and do things better in the community,” he says. “The change begins with oneself and then transmits it to others. I gather men in talks, make visits to their homes, give guidance on prevention of sexually transmitted infections, family planning and not to be violent”, says José. "Older adult men are more difficult to change." Changing attitudes to contraception  José has seen a change in the attitudes of men in his local community and those small achievements encourage him to keep going. “When men ask me about violence and condom use, I feel encouraged. For example, a co-worker uses a condom and confidently tells me that he does it because he learned from the talks he received, that motivates me to continue guiding towards new masculinities." For male clients who are referred by their local health promoter for a voluntary surgical contraception (VSC) procedure, the care is free of charge thanks to the Community-Based Program’s special fund. José is aware that there is still work to be done; "the issue of vasectomy is difficult with men in the community, the challenges continue." “In the community, young people ‘get to live together at an early age (marital union), maybe I cannot change that, but I can help them to be better people, to respect each other. Just as I changed, so can other men,” says José.