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Resilient Women Resilient World 2019 Annual Report

Dear Pathfinders and partners worldwide,

Women's sexual and reproductive health and rights are human rights. Honoring those rights is essential to empowering women and girls and improving the health of our planet.

We have made great progress over the past several decades in empowering women to make the most important decisions of their lives — if or when to marry and start a family — but we still have so much work to do.

More than 200 million women around the world who do not wish to become pregnant are not using contraception. More than 800 women die each day from preventable causes related to pregnancy and childbirth.

Over the past year, we have seen dangerous policies enacted to exacerbate these challenges and restrict sexual and reproductive rights — limiting the control millions of women and girls have over their own bodies and putting their health and lives at risk. Pathfinder remains steadfast in its commitment to stand up to these restrictive policies and to support women and girls in reaching their greatest potential.

Women who reach their greatest potential are poised to help save our planet. Women and girls, when they have reproductive autonomy, stay in school, overcome harmful social and gender norms that hold them back, can become leaders, change-makers, and innovators.

Through our population, health, and environment programs in East Africa, we have watched this transformation over and over. These programs engage entire communities — men and boys, traditional and religious leaders, health care professionals and community health workers, business owners, and school administrators — to support women and girls to reach their full potentials. The result is empowered women.

Empowered women propose and carry out solutions to reducing our carbon footprint and making their communities healthier. Empowered women help encourage other women and entire communities to adopt sustainable agricultural practices, to start environmentally friendly businesses, to cook with energy-saving stoves, to plant trees, and to use contraception. Through their leadership, they make their families and communities more resilient to shocks from climate and poverty.

As a pioneer and leader in the field of sexual and reproductive health and rights, Pathfinder is committed to partnering with individuals, faith-based and non-governmental organizations, the private sector, and governments that have missions aligned with our own — to increase our planet's resiliency through the resiliency and contributions of healthy women and girls.

I invite you to join us.

Yours,

Lois Quam

President & Chief Executive Officer

Comprehensive sexual and reproductive health care is a human right.

We honor and support every woman's right to comprehensive sexual and reproductive health care. This means access to modern contraception, safe abortion, and post-abortion care; care before, during, and after pregnancy; and the prevention and treatment of cervical cancer, HIV, and other sexually transmitted infections. High-quality sexual and reproductive health care is crucial to empowering women and girls around the world and making them more resilient.

India

Over the past year, more than 11,000 women have voluntarily adopted injectable contraceptives through Salaamti-supported health facilities in Haryana.

Injectable contraceptives are one of the most popular ways to prevent pregnancy around the world, but until recently, women in India could not access them. In 2016, the Salaamiti project introduced injectables for the first time in India through public health facilities in four districts of Haryana state. Through a partnership with the Haryana state government, Salaamti has been scaled up to seven districts in Haryana.

Donor: Bill & Melinda Gates Foundation

Tanzania

Since January of 2018, more than 63,000 women and girls have received a contraceptive through the Your Decision, Your Tomorrow project.

The Your Decision, Your Tomorrow project provides rural communities in Shinyanga, Tanzania, with a full range of contraceptive options — including long-acting methods like intrauterine devices and implants — through existing immunization outreach clinics. Since women already go to the immunization clinics to have their children vaccinated, it is a practical place to offer them contraceptives.

Donor: The Erik E. and Edith H. Bergstrom Foundation

A majority of the 20 million unsafe and often fatal abortions every year can be attributed to the fact that abortion remains illegal and unregulated in many countries.

Through our Resonance project — launched in October of 2018 — we are creating coalitions for safe abortion advocacy across Côte d’Ivoire, Burkina Faso, and Democratic Republic of the Congo.

Donor: AmplifyChange (a pooled fund supported by a group of European donors)

Over the past year, Pathfinder has supported the screening of 4,127 women in Ethiopia and treatment for those who screened positive for precancerous lesions.

Cervical cancer is a leading killer of women in Africa, even though it is completely preventable. Pathfinder led Ethiopia's first pilot cervical cancer prevention and control project, Addis Tesfa, from 2009-2015. Our Enhancing Cervical Cancer Secondary Prevention through Screening and Treatment project continues to assist the Ethiopian government with scaling up the program nationally and advancing screening and treatment protocols.

Donor: PEPFAR

From January to June of 2019, 13,416 HIV-positive individuals were re-initiated on ART.

Pathfinder began working this year in three of Mozambique's provinces — Sofala, Manica, and Gaza — to lead the Strengthening Adherence and Retention of Patients in Treatment for HIV and TB through Community Interventions project. The project increases the number of people living with HIV who adhere to life- saving antiretroviral treatment (ART). This means reaching HIV-positive individuals who may have received ART at a health facility but stopped their treatment for various reasons — stigma and discrimination, distance to the health facility and lack of money to pay for transport, and stock-outs of medicines — and getting them back on treatment.

Donor: Global Fund — Center for Collaboration in Global Health

Adolescents and youth are our partners and our promise for a better future.

Because far too many adolescents still cannot access modern contraception — due to discrimination, stigma, and lack of information — complications from pregnancy and childbirth remain a leading killer of adolescent girls globally. We reach adolescents and youth with information, support, and care that allows them to grow into healthy, productive, resilient adults. This includes helping them to delay pregnancies until they are ready through access to youth-friendly contraceptive, abortion and post-abortion care services; increasing gender equity by transforming negative perceptions and practices that hold girls and boys back; and reaching young married women and couples with sexual and reproductive health information and services.

Junt@s Mozambique

"In relation to adolescent pregnancies, we can say that this is a successful story. Since we are working with the boys and girls, we haven't registered any case of pregnancy. I am sure the (project) activities are influencing." - Mentor Teacher, Maputo Province

Junt@s engages entire communities to support adolescent health and well-being. Girls and boys from primary and secondary schools participate in discussions about sexual and reproductive health and gender equality, including the merits of delaying marriage and pregnancy. School corners host health providers who offer contraceptive information and services to adolescents, and local health clinics offer contraceptive methods, HIV counseling and testing, safe abortion care, and gender-based violence services. Police ensure that gender-based violence cases are martialed through the judicial system. Parents and neighbors support the adolescents in their lives to make healthy decisions and succeed.

Donor: Royal Norwegian Embassy

From January to June of 2019, more than 70,000 adolescent boys and girls have participated in discussions about sexual and reproductive health and gender at their schools.

Naya Qadam Pakistan

"Naya Qadam gave me the opportunity to step outside my house for the first time and interact with the outside world. Not only has it increased my self-confidence, but also provided me the goals I need to work towards in life." —Zubaria Latif, Youth Champion, Nawabshah

Although many reproductive health programs have sought to delay early pregnancies and early marriage among adolescent girls, fewer have focused on encouraging young women who have already become pregnant to delay and space subsequent pregnancies. Naya Qadam operates in six districts of Pakistan's Sindh and Punjab provinces to increase the access of young women, ages 15 to 24, to high-quality post-pregnancy and post-abortion family planning including a full range of contraceptive options. These are opportune times to engage young women in contraceptive counseling — when they are already at the health facility. This approach has included building the capacity of health providers, lady health workers, community midwives, lady health visitors, and youth champions to educate people about, refer, or offer these services.

Donor: Bill & Melinda Gates Foundation

Naya Qadam has trained more than 1,200 public and private providers in postpartum and post- abortion family planning service provision.

Act With Her Ethiopia

One girl reported that she "was considering myself less than men... but it's wrong. I can do what boys do."

A girl's ability to make positive choices and to benefit from key health, education, and economic opportunities throughout her life is closely linked to how gender norms are perpetuated in her society and how others view her worth, her rights, and her future. Act with Her partners with adolescent girls and boys, families, communities, and the systems girls rely on to increase adolescent empowerment and gender equity in societies where girls are typically disempowered. Mentor-led groups in the Amhara, Oromia, and Afar regions help girls and boys to fulfill their right to education, bodily integrity, health, psychosocial well-being, voice, agency, and economic empowerment.

Donor: Bill & Melinda Gates

Pathfinder is driven by the conviction that all people, regardless of where they live, have the right to decide whether and when to have children, to exist free from fear and stigma, and to lead the lives they choose.

We collaborate closely with our partners around the world to offer life-saving reproductive and maternal and newborn care, integrate health and environment work to address the holistic needs of communities, and reach the most vulnerable populations, including those who have been displaced due to conflict and natural disaster.

Bangladesh

Since August 2017, an estimated 745,000 Rohingya people from Myanmar fled to Bangladesh to escape extreme atrocities and volatility in Rakhine state. Pathfinder has supported our local partner, Research Training and Management International, to provide critical sexual and reproductive health services to the Rohingya in Camp 22 of Cox's Bazaar, Bangladesh, and to the growing number of Rohingya in host communities of Teknaf Upazilla.

These gender-responsive sexual and reproductive heath services include contraception, menstrual regulation care, and gender-based violence prevention and response services essential to the health of these displaced populations.

Children in a refugee camp in Bangladesh

Nigeria

Between 2016 and 2019, 66% fewer women and 44% fewer newborns died from complications during childbirth in Cross River State's health facilities than during a previous comparable period.

Through a suite of evidence-based interventions and upgrades to health facilities, the Saving Mothers, Giving Life Program in Cross River State, Nigeria, drastically reduced the number of mothers and newborns dying from complications during childbirth.

Pathfinder engaged communities and strengthened health systems to transport women to health facilities in time for delivery, trained health providers to offer life-saving services, and equipped health facilities for safe deliveries.

"In Nigeria, midwives often deliver babies using their cell phone flashlights," said Dr Farouk Jega, Pathfinder's country director in Nigeria. "But not anymore."

Through our partnership with We Care Solar, 150 health facilities received solar suitcases to power them up. "Without it. emergency obstetric and newborn care couldn't have been done in the night." said Dr. Jega.

Donor: USAID and Merck for Mothers

General Hospital Ogoja, Cross River State

Mozambique

Cyclone Idai — one of the worst tropical storms on record in the Southern Hemisphere — struck Mozambique in late March. Given our strong partnership with the Government of Mozambique and development partners in the country, we were able to assist with the recovery effort in Sofala and Cabo Delgado, two hard hit regions.

After the cyclone hit, Pathfinder:

Deployed emergency services beyond the scope of family planning, which included supporting an estimated 43,000 expecting mothers in flood-affected areas.

Assisted with distributing 900,000 oral cholera vaccines to prevent an outbreak and further crisis.

Partnered with peer organizations to curb the spread of malaria from stagnant flood waters.

Made repairs to health centers and provided crucial support for women, children, and families affected by the storm.

Provided fuel, cars, and solar lamps so that health care could continue despite crippled infrastructure.

Population, Health, and Environment

Population, health, and environment programs support women to lead resilient communities.

Pathfinder's population, health, and environment (PHE) approach addresses some of the most pressing issues affecting rural, vulnerable populations: the effects of climate change, food security, nutrition, livelihoods, sexual and reproductive health and rights, and gender inequities. Our PHE programs support women to be innovators and change-makers who build resilient communities that can thrive through the most formidable global challenges — including climate change

We do this by supporting women and girls to make the most important decisions about their lives and their bodies, receive quality health care, get an education, earn an income, and manage natural resources sustainably.

"I'm tremendously proud of the Jane Goodall Institute's community-centered conservation work in Tanzania over nearly 25 years and I am delighted about the news of our new initiative. It will make such a difference in our partnership with local communities and our efforts to protect wildlife and habitats in the region." —Dr. Jane Goodall, Founder, Jane Goodall Institute.

Pathfinder began partnering with the Jane Goodall Institute this year, launching a comunity-centered conservation program in western Tanzania. The program seeks to protect endangered chimpanzee populations and their habitats while encouraging sustainably managed natural resources and increasing communtities' access to sexual and reproductive health care.

Donor: USAID

Over the past seven years, Pathfinder has played a catalytic role in advancing PHE programs in East Africa. Two major initiatives have been Pathfinder's PHE Learning Lab and the Health of People and Environment in the Lake Victoria Basin (HoPE-LVB) project. Together with our PHE projects in Tanzania, these initiatives have led to governments adopting PHE policies and dedicating resources to PHE programs, and to regional support for extending PHE models across East Africa.

Donor: Margaret A. Cargill Philanthropies & John Swift

Zinder, Niger, is in the Sahel — a place that is extremely susceptible to climate-induced shocks. In partnership with a resilience organization, the Evidence to Action/Resilience in the Sahel Enhanced (RISE) project trained conservation farming groups to encourage the use of family planning services and community-based distributors of family planning services to provide information on conservation farming techniques, water, sanitation, hygiene, and nutrition.

14 female community-based distributors who learned how to apply conservation farming techniques reported doubling their harvests and attracting the interest of other women in adopting these techniques.

Donor: USAID

Thank you for your commitment.

Our Donors

To my fellow Pathfinder supporters,

Pathfinder has always been at the forefront of advancing sexual and reproductive health and rights in the countries where we work. For more than 60 years, we have worked hand in hand with communities and the public health systems that serve them to allow women, men, and young people to be resilient in the face of even the most formidable obstacles. Pathfinder remains steadfast in its commitment to continuing this work, despite the formidable challenges we face.

Throughout our history, we have seen shifts in politics, technologies, global health priorities, and the environment, which have required us to shift the way we operate. One thing that has not changed, however, is the locally driven nature of our programs. Our programs ensure that the local communities we serve are not only recipients of our programs — that they are the solution.

Of our more than 1,200 staff around the world, almost 90 percent work in the countries they know and love. They grew up with the customs and systems in which they operate, hearing about the hopes and desires of the people they reach. They make us ideally positioned to influence the harmful social and gender norms that continue to hold women and girls back and to strengthen the public systems that out partner communities rely on.

Being insiders allows us to run programs like Act with Her in Ethiopia and Junt@s in Mozambique. These programs combat harmful gender norms that hold girls back and make them believe they are less capable than boys.

These programs not only engage adolescent boys and girls in transformative discussions, they engage entire communities and systems to support their health, education, and growth. Through these programs, we are giving girls the power to believe in themselves, and boys the power to support them in their beliefs.

As an Ethiopian girl told an Act with Her mentor: "I can do what boys do."

Empowering women and girls and investing in them as leaders and role models is crucial to the future trajectory of our planet.

I've watched over the past decade as Pathfinder's population, health, and environment (PHE) programs have invested in women and girls to drive the health of entire communities and ecosystems, and how effective this approach has been. It has fostered gender equity, mitigated the effects of climate change, increased food security, and improved nutrition in some of the most vulnerable communities on this planet.

Our partners have taken notice too. That's why the three countries where we have led our biggest PHE programs — Kenya, Tanzania, and Uganda — have all adopted national PHE policies. That's why the Jane Goodall Institute is working with us on a program in western Tanzania that seeks to protect endangered chimpanzees while supporting women and girls to exercise their right to reproductive autonomy and sustainably manage natural resources.

The world is rapidly changing. Investing in women and girls is a moral imperative, but also a strategy to mitigate the effects of climate change and lead us on a path toward a better tomorrow. please join us in ensuring Pathfinder can continue to uplift women and girls around the world. Our world depends on it.

Roslyn Watson

Board Chairperson

Financial Highlights

For the year ending June 30, 2019

The information presented above is drawn from Pathfinder International's financial statements, audited by CBIZ, Inc., and Mayer Hoffman McCann P.C. They are available upon request or at pathfinder.org/financials. Pathfinder International receives Charity Navigator's highest rating for accountability and transparency.

*Estimates for maternal deaths averted, unintended pregnancies averted, direct health care costs saved, and unsafe abortions averted are calculated with Marie Stopes international's Impact Calculator 2 v3 using data on contraceptive commodities from 35 projects in 13 countries.