Download Global Reproductive Health Diaries

Global Reproductive Health Diaries (GRHD) illustrates challenges women, men and providers from around the globe face in regards to pregnancy and HIV/STI prevention.  GRHD is a series of vignettes based on stories from real women to help raise awareness around reproductive health needs and the need for technologies and strategies that address the spectrum of risks faced by women.

While the stories below represent experiences of real women and men from around the globe, the names of the characters and the illustrations depicted here are fiction.

Sohni, age 30, India

“People are afraid of getting pregnant because there is this real fear of unsafe delivery. Mothers really can die in childbirth; my sister, Roshni, died while delivering her fifth baby in just seven years. I am married with two children. My husband wants more children, so he doesn’t think we need to use contraception. I want to have more children, but I want to space them out; it will be safer for all of us. I don’t think I am at risk for AIDS, but I can’t be sure; my husband travels a lot and is often out late for ‘work’. I know he would be angry if I asked him to get tested. I wish there was something that could protect me, and my family, against unintended pregnancy and diseases.”

Helene, age 33, Ivory Coast

“I have six children, and that is enough. I go to the local health center to get the Depo injection so that I won’t become pregnant again. That is what I have to focus on, not getting pregnant. I don’t feel comfortable asking my husband to wear condoms because he doesn’t like them, and he asks me why? I know he is with other women, but he denies it. I can control when I get pregnant, but don’t know what to do about other infections.”

Lian, age 28, China

“My husband and I are moving into the city with our 2-year-old son, Minsheng. My husband got a job at a factory and I will help my cousins at their restaurant. We don’t want to have another child and I have heard from friends about chlamydia being common in the city and I am nervous. I think my husband has always been loyal to me, but I am unsure about what may happen when we move. He would be against using a condom because we are married. I wish there was a way I could avoid pregnancy and keep from getting Chlamydia or something else.”

Gabriela, age 31, Guatemala

“I have HIV, but have received good treatment that has allowed me to stay healthy. I am dating a nice guy who is very supportive of me. I am so nervous about giving him HIV, so I ask him to use condoms. I can tell that he does not like it and I admit that a couple times we didn’t use protection. We have been lucky those times, but I have always been afraid afterwards. I think someday we would like to have a family, but not now. I wish there was an easier way to keep from getting pregnant and protect him from my HIV, but all we have are condoms.”

Rachel, age 23, USA

“Ever since I became sexually active, I’ve had to deal with some partners trying to convince me that we don’t need to use a condom. And sometimes, I have been swayed. I’m lucky that I never had to deal with the consequences of that decision. I can’t imagine how many women out there don’t feel comfortable insisting on using a condom—guys can be persuasive. I mean, your safety should come first, but in the moment, it doesn’t always.”

Lauren, age 19, Wisconsin, USA

“It’s my first year in college, so I’m incredibly busy and a little overwhelmed. It’s not a good time to be in a long-term relationship, but it’s nice to have a warm body to sleep next to sometimes. I mean, it’s not very often or with very many guys, and I always know them well and trust them. I really care about being safe. I tried going on the pill, but it doesn’t prevent against STDs and it made me gain weight, so I stopped using it. And the guys will wear condoms, but they don’t usually like it. Those two methods, condoms and the pill, are really the only two methods that people my age use and talk about. I want something else that I can really rely on, but right now I’m not really sure what that could be.”

Lydia, age 48, Russia

“I was a young woman in the 1980s in the Soviet Union, coming of age in a time when contraception was essentially unavailable, and the result was that abortion became a widely-used method of contraception. I knew people who were having many abortions or who were getting diseases because they weren’t using protection. Abortions became frighteningly more normal than they should have been, even for married women who sometimes used abortion as a means of family planning. And I had one, too, when I was twenty-two years old, young and husband-less and not realizing the emotional realities of it. I am thankful that times are changing, but I still worry constantly for my daughters who are growing up so quickly. It’s not about being pro-choice or pro-life; I think we should all be able to agree that safe and easily accessible methods of protection—from unwanted pregnancy and from STDs—are extremely important.”

Clarissa, age 68. Ohio, USA

“People don’t want to think about grandparents having sex. Well, I’ve been divorced for a while, and I’ve had boyfriends. But protection is not something I feel very comfortable talking about with them or even to my doctor who is so much younger than I am. And since people seem to be focused on unwanted pregnancies, boyfriends tend to think of protection as a problem of the past since we can no longer get pregnant. But—there are still diseases. It makes me worry, but it’s hard to address that worry openly.”

Justine, age 27, New York, USA

“My biggest concern right now is protection against STDs. If you get an STD, you have to live with it and that’s hard enough, but then there’s the possibility that you won’t be able to live with it. I worry about pregnancy too, of course, but I’m not a teenager and I’m in a steady relationship, so it’s not my biggest worry. Still, if you’re a kid and you get pregnant—well, then that’s it. You have no choice but to stop your childhood short and grow up. I knew more than one girl who got pregnant around the age of twelve or thirteen. There’s so much more life to live—they’re practically babies themselves and then they have to raise one. So a good prevention technology is going to have to prevent against both STDs and pregnancy, and its gotta be easy, because people start earlier and earlier, and regardless of age, you just can’t trust that people are being as careful as they should.”

Akissa, age 27, South Africa

“Too many people around me are infected with HIV, and it makes me worry. I have a boyfriend in the city. We live far apart and only see each other about once a month, so—I am not sure who else he may have been with. Once I tried to tell him that I was worried about getting HIV, and other diseases, too. He only got upset, and he accused me of being with other men, but I remain faithful to him even when it is not easy to do so. I have stopped worrying about diseases because I have no choice. And we don’t ever talk about this kind of stuff anymore. No one does. I have two children, and I know that soon enough they will be older and then they will be at risk, and that scares me so much. But what can I do?”

Jack, age 20, Oregon, USA

“I’ve been with my girlfriend for about a year now, and we’re still trying to find a method that will work for us. I care as much as she does about protection, and I want to take part in figuring this out. She was on the pill at first, but she didn’t like the way it made her body feel. We even talked about an IUD but she doesn’t feel comfortable either talking about it with her parents or getting one without them knowing. And we keep meaning to get tested, just in case, but we still haven’t gotten around to it. So I wear condoms, of course, but I’m sick of them. Wouldn’t it be cool if there were something else that is not a condom, but is just as easy?”

Amy, age 26, Massachusetts, USA

“I first became aware of STDs when I was eighteen; I never used condoms, and I got Chlamydia. It was a reality check that came too late to be preventative. At least Chlamydia is something that’s fixable if you catch it early, which, luckily enough, was the case for me. Of course, since then I’ve been really responsible; I’ve been on the pill for years even though I don’t really like the way it makes my body feel. And I’ve always used condoms, too. I have a steady boyfriend now, and he never wanted to use them. He hates them and says they take away the sensation, but I always made him use one until we both got tested. But the only reason I was so forceful about it was because I had this horrific, real-life experience when I was only eighteen. And if I hadn’t? Who knows if I would still be this responsible.”

Susan, age 46, California, USA

“I’ve been divorced for twelve years, and whenever I’m with a guy now, I ask him if he’s clean—and not everyone does ask—and then I just have to trust him. I was with this guy and he was like “I’m clean, I’m clean,” so we stopped using a condom. Well weeks later, I came to find out through conversation that he had also been with another woman the entire time we’d been seeing each other, and they hadn’t been using protection either. I mean, he and I had never talked about being exclusive, but—I thought we were. And the other woman he was seeing thought they were too, and she freaked out because it was her first relationship after her divorce. So he and I both got tested right away, and we’re fine, but still, it’s scary. You can be as responsible as you want, but at some point, you’re going to trust someone—and you should trust people—but there will always be some risk to that.”

From the Field: Clinicians and Researchers

Marjan, age 43, Iran

“I work at a clinic in Iran. Once we had a woman come in who had eight children, and both she and her husband were not ready for more, at least not yet. She wasn’t sure how to prevent unwanted pregnancy, so we gave her a supply of condoms to bring home for her husband. A few months after that visit, her husband showed up, complaining of horrible stomach pains. We did some scans and decided we had to operate. What we found was incredible—hundreds of condoms in his intestines. Astonished, we realized that neither husband nor wife knew how to use the condoms, so he had been swallowing them with water. The necessity of taking the time to carefully explain, and in this case demonstrate, how to use existing prevention methods for family planning and STIs was never more apparent than at that moment. The reality was that neither this woman nor her husband had ever seen, let alone used, condoms. When it comes to people’s health and protection, you should never assume anything.”

Ben, age 39, Kenya

“I spend time in a clinic in Western Kenya. I see these women come in, most of whom are HIV infected, and I hear their stories. And I know that it is possible to actually bring down the level of new HIV infections around the world to near zero, and it is possible to empower women to take control of their health. What we’re trying to do is to make the easy choice the healthy choice. A woman should be able to go to her local shop and choose a product that suits her best—ideally there would be a multitude of products—that would either prevent HIV, bacterial vaginosis, and other STIs as well as prevent pregnancy or only prevent STIs if she was trying to get pregnant. These products will take time to get on the market—maybe a decade or more—but what we care about is just that they get there and start making a difference.”

If you or someone you know has experienced challenges accessing prevention for sexually transmitted infections (STIs) and/or adequate family planning/contraception or if you have personal experience as a clinician, share your own story by sending an email to info@cami-health.org. Please include your age and geographic location; we will keep your personal identity confidential. Feel free to send in a question, and we will do our best to respond to all questions in the discussion section.