They come to us at night, under the cover of darkness. During the day it’s too risky. Too many eyes and people talk. So we set up and wait, passing time by watching the sun slowly set.
Soon enough, there's a knock on the door and the women quietly enter the clinic while their husbands keep watch in the dark.
One talks of her failure to access family planning at her local health centre because the nurse was from her village.
“If I went to her, I knew my family and community would find out the same day that I have gone looking for family planning,” she says.
“Using modern family planning methods is against the social and religious beliefs of my family and community. I cannot risk it.”
Another walked two villages over with her husband only to turn back – scared of the social stigma – after discovering the nurse on duty was married to a man from her husband’s village.
“Natural family planning is the only (socially) acceptable method, but it is hard to keep track using this method,” she tells us.
“I just want to rest, I'm tired, my body is tired. I don't want to get pregnant again.”
Similar stories are shared with our team as we work through the night. They are like those of many women and couples who seek support from Marie Stopes Papua New Guinea (MSPNG) across the country.
The women leave for their homes and grateful hugs are exchanged along with baskets of garden food. By now, the moon is halfway across the sky and as they become distant shadows in the night, we realise it will be dawn when they reach their villages.
The underlying message is clear – sometimes a woman’s need for family planning is not hindered by the lack of access to services, but the pressures of cultural and social beliefs.
Addressing the pressures that prevent men and women from accessing family planning or sexual and reproductive healthcare is complicated.
It is a challenge faced everyday by Roseylita Opa, the Western Highlands outreach coordinator for MSPNG.
MSPNG is the leading family planning and sexual and reproductive health service provider and conducts outreaches across the country with support from the Papua New Guinea-Australia Partnership.
“Any discussion related to sex or sexual and reproductive health is not something that we freely or openly discuss within our homes especially with our children,” she says.
“There is this shame and stigma surrounding a health service that is basically no different to other healthcare services.”
Roseylita believes this stems from the misconception that talking to children at an early age about sex will encourage them to become sexually active.
“I used to believe that as well until I began working with MSPNG,” says the 34-year-old.
“Since then, I’ve met so many women and young girls who end up having one child after the other simply because they did not know about family planning.
“For many of these women, MSPNG’s outreach clinic is the first time they are exposed to sexual and reproductive health services.”
Roseylita is a staunch advocate of empowering women through family planning and spent the last six years supporting and educating men and women in the rural communities of Jiwaka, Western Highlands and Simbu on the importance of planning and spacing children adequately.
“Back in the village and even in our cities too, ordinary Papua New Guineans do not understand what women empowerment is or that access to family planning is a basic human right,” she continues.
“You go into a village and start talking about women’s sexual and reproductive health rights and you may as well be speaking in a foreign language.
“We have to say it in a way that our men and women will understand. We have to say it in a way that does not upset or insult the communities we visit. And that is what we do.”
A common approach used by Roseylita and other MSPNG outreach teams is using practical examples that are relatable to everyday people.
“We talk to the young men and fathers about the growing shortage of land, the increase in price of goods and services, school fees, lack of a steady income, the distance they must travel to access basic services,” she says.
“The women know these struggles all too well. Often it is the men that need convincing because of course, our society is deeply rooted in the belief that man is the head of the family.”
According to the recent Demographic Health Survey 2016-18 conducted by the National Statistics Office, one in six births in PNG are not wanted at the time of conception. The report further states that the more children a woman has, the more likely that a birth is unwanted.
Roseylita says family planning is all about providing women and men with the choice to decide when to start a family and the number of children they would like to have.
“The emphasis is on women because 90 percent of the childrearing responsibilities lay with the mother, but that does not mean men do not have a role to play when it comes to family planning.”
The mother of five believes that with greater awareness about sexual and reproductive health, more women and girls will be empowered to take control of their bodies, lives and futures.
“You cannot say a woman is fully empowered if she has no control over her body,” she stresses.
“Family planning and women empowerment are interrelated. The only way we can break the stigma around sexual and reproductive health issues is through education.”
Despite the challenges, Roseylita and the MSPNG outreach teams remain committed to ensuring PNG women have access to quality and affordable family planning services.
“Whether she lives in the village or city, whatever her marital status, regardless of whether she is in school or working or at home – every woman should have the power to choose when and whether to have a child.”