Comprehensive Health Options through Innovative Community Engagement (CHOICE)
The Project
The Comprehensive Health Options through Innovative Community Engagement (CHOICE) is a gender transformative project that aims to increase the realization of Sexual and Reproductive Health and Rights (SRHR) by those experiencing poverty and marginalization, particularly women, adolescent girls, and persons of diverse sexual orientations, gender identities and expressions and sex characteristics (SOGIESC) in Malawi, Zambia and Zimbabwe.
The project will be implemented by Oxfam, in collaboration with 13 implementing partners.
CHOICE focuses on building resilient, integrated communities and health systems to better address women and girls’ needs and ensure access to neglected areas of SRHR such as comprehensive contraceptive care (CCC), comprehensive abortion care (PAC), comprehensive sexuality education (CSE) and youth friendly sexual and reproductive health (SRH) services.
The project works at multiple levels—individual, community, institutional, and societal—and aims to reduce gender inequality and discrimination, and contributes to poverty reduction. When SRHR needs of Adolescent Girls and Young Women (AGYW) are met, they can participate equally in economic and social activities, paving the way for sustainable, inclusive development.
Women and girls in all their diversity around the world have access to the quality health services they need. CHOICE is committed to supporting comprehensive SRHR. This approach means that all individuals have the rights, knowledge, and means to make decisions and access services concerning their reproductive lives and sexuality, free from criminalization, coercion, discrimination and violence. This includes the promotion and protection of LGBTQI+ rights and the right to safe and legal abortion and post abortion care.
Reach
The project will directly reach 150,809 people, 74% of which is women and AGYW. AGYW are highly represented because they face major challenges accessing SRH information and services, and are more subject to negative social and health outcomes.
CHOICE will also indirectly reach 603,236 people. The project will take an intersectional approach to combat discrimination across identity factors, including a particular focus on SOGIESC. Project teams will target specific rural and urban communities with greatest needs, and will adopt a comprehensive approach to public engagement and national advocacy activities.
The Context
Health systems in Malawi, Zambia, and Zimbabwe have limited capacity to deliver quality sexual and reproductive health (SRH) information and services. They are less prepared to anticipate, respond to, and recover from potential stressors such as extreme weather events, pandemics, and weak governance. The COVID-19 pandemic has further highlighted weaknesses in these countries' health systems, including acceptability, quality, accessibility, availability of vital SRHR information and services to women, girls, adolescents, and persons of diverse SOGIESC. This, combined with fear, stigma, and harmful social norms, results in worsened SRH outcomes such as maternal and infant mortality, unsafe abortions, and gender-based violence (GBV).
The COVID-19 pandemic also required SRH practitioners to be innovative to meet population needs, particularly those of women and girls in humanitarian settings. This involved context-specific approaches that engage communities in decision-making.
Issues at a Glance:
Unmet family planning needs:
- 13% in Malawi
- 15.9% in Zambia
- 8.5% in Zimbabwe
Adolescent pregnancy rates:
- 136 per 1,000 adolescent girls aged 15–19 in Malawi
- 135 per 1,000 adolescent girls aged 15–19 in Zambia
- 108 per 1,000 adolescent girls aged 15–19 in Zimbabwe
HIV prevalence rates:
- 6.7% in Malawi
- 9.8% in Zambia
- 10.5% in Zimbabwe
HIV rates are higher among adolescent girls and young women than boys and young men.
Child, early, and forced marriages (CEFM):
- 38% of adolescent girls in Malawi
- 29% in Zambia
- 34% in Zimbabwe
CEFM is a precursor to adolescent pregnancy and increased adolescent birth rates.
Maternal Mortality Rate (MMR):
The MMR in the region is significantly higher than the Sustainable Development Goal (SDG) target of 70 deaths per 100,000 live births by 2030:
- 225 per 100,000 in Malawi
- 85 per 100,000 in Zambia
- 358 per 100,000 in Zimbabwe
Restrictive abortion laws:
All three countries have restrictive abortion laws that limit women and girls' bodily autonomy and put them at high risk of unsafe abortions. Unsafe abortions account for:
- 7% of maternal deaths in Malawi
- 25% of maternal deaths in Zimbabwe
- 30% of maternal deaths in Zambia
The Partners
Malawi:
- Family Planning Association of Malawi (FPAM)
- Centre for Alternatives for Victimized Women and Children (CAVWOC)
- Point of Progress (POP)
- Village Reach (VR)
Zambia:
- Planned Parenthood Association of Zambia (PPAZ)
- Women in Law and Development in Africa (WiLDAF)
- Young Women's Christian Association (YWCA)
- SafAIDS
Zimbabwe:
- Population Services Zimbabwe (MSI Reproductive Choices) (PSZ-MSI)
- SAYWHAT
- MUSASA
Ipas, a leader in sustainable abortion programming, will implement activities across the three countries in Southern Africa.
Canada:
- Dignity Network Canada (DNC)
The project will be implemented in Balaka and Lilongwe districts in Malawi; Chibombo, Chisamba, Itezhi-Tezhi and Namwala in Zambia; and Harare, Nyabira (Zvimba), Gokwe South, Sanyati (Kadoma), Mutare, Beitbridge and Gwanda districts in Zimbabwe.
DETAILS
Location:
- Malawi
- Zambia
- Zimbabwe
- Canada
Duration:
7 years, 2025-2032
Thanks to our Partners:
View Partners
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This project is undertaken with the financial support of the Government of Canada, provided through Global Affairs Canada, and the generous Canadian public.
