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Kate Grant is CEO of The Fistula Foundation, a nonprofit that works to end the suffering caused by the childbirth injury of obstetric fistula. Follow the organization online on Twitter and on Facebook.

Gul lives in Afghanistan. At the age of 13, she became the second wife of a much older man. One year later, Gul was pregnant. When the time came for her to deliver her baby, Gul endured three excruciating days of prolonged obstructed labor. With no doctors or clinics near her home, the only “treatment” she received during labor was a sacrificial sheepskin laid over her belly. The baby did not survive.

Afterward, Gul found that she could not control her urine. What Gul thought was an illness was actually the childbirth injury of obstetric fistula, an injury caused by prolonged obstructed labor. Fistula is preventable when a woman has access to emergency medical intervention, such as a C-section, and curable only through a fistula repair surgery that costs as little as $450.

Gul suffered 12 years of incontinence and shame before learning of CURE International Hospital in Kabul. She and her husband rode a bus for four days to get to the hospital, but it was worth the trip: Gul’s surgery was successful and she was no longer incontinent.

My organization, The Fistula Foundation, works with pioneering organizations like CURE International Hospital to fund treatment for women who are suffering the misery and shame that accompanies obstetric fistula. Too often, these women are actually girls like Gul, who give birth too early in life, before their bodies have fully matured.

Most of us want to do something to help girls like Gul, but it can be hard to figure out how to help when Gul and other women suffering from obstetric fistula live so far away, in cultures we don’t always understand. But what if you could do something right now to help heal girls and women with fistula in the developing world? And what if helping was as simple as playing a game?

Today, it is. Half the Sky Movement: The Game launches today on Facebook. It’s the next phase in the Half the Sky Movement, a call to action to end the oppression of women and girls worldwide, centered around the book and documentary film of the same name by Pulitzer Prize winning journalists Nicholas Kristof and Sheryl WuDunn. In the game, players progress through a series of quests and stories related to challenges that real-world women and girls face, through examples provided by The Fistula Foundation and the six other NGO partners featured in the game: GEMS, Heifer International, United Nations Foundation, ONE, Room to Read and World Vision.

The game gives all of us an opportunity to learn more about problems affecting women in the developing world, such as obstetric fistula. It also empowers us with a chance to act online for real-world change offline, thanks to our long-term partner, Johnson & Johnson, which has committed $250,000 to support surgeries for women in the developing world through this game.

So, for perhaps the first time in history, you can help a woman with fistula, like Gul, get the surgery she desperately needs – simply by playing a game.

This post, written by Amy Babchek from the Nike Foundation, originally appeared on the Girl Effect website and is available here.

Girls are finally on the agenda for family planning pledges, but misinformation about their needs and behavior stops girls getting access to the advice and resources they need for family planning. Amy Babcheck from the Nike Foundation is myth-busting.

At this year’s London Summit on Family Planning, global leaders pledged funds and resources for an additional 120 million women and girls by 2020. That’s right—girls. Adolescent girls and young women represent 26 million, or 20 percent, of that total, and that’s a major breakthrough.

Adolescent girls and young women in developing countries haven’t always been included when it comes to meeting family planning needs. Why? Because they become entangled in religious, political and cultural arguments, many of which are myths, yet still widely believed. Here are some of the worst…

MYTH: The world knows a lot about the situation of adolescent girls under the age of 15 when it comes to early sexual activity and early childbearing.

TRUTH: Publicly available information on the situation of very young adolescent girls ages 10-14 years is limited. Yet we know from secondary analysis that in 14 sub-Saharan African countries, 15 percent or more of girls reported having sex before their 15th birthday. And that’s just those who reported—the number is likely to be higher. A substantial proportion of sexual encounters involving very young adolescents are forced or coerced.

Want more details? Investing when it counts

MYTH: Adolescent girls understand their body, menstrual cycle, conception and contraception.

TRUTH: Cultural barriers make correct information about puberty and reproductive health and contraceptives inaccessible. Girls often feel shame and humiliation about their menstrual cycle, so even when they do know where or whom to ask questions, they don’t. This also affects their contraceptive use and ability to plan pregnancy. Because adolescent girls don’t understand their body well, they also don’t understand how they become pregnant or how to prevent pregnancy.

Want more details? Charting the future; Girls decide: choices on sex and pregnancy

MYTH: Adolescent girls who have correct information about and access to family planning (contraception) begin having sex earlier, and have more partners.

TRUTH: Girls who have access to information and contraception have a later age at sexual debut, are less likely to experience coerced sex (if they have built social assets), and are more likely to use contraception when they do have sex.

Want more details? Start with a girl: a new agenda for global health

MYTH (that we often hear from girls): Contraception makes girls infertile, gain weight, grow facial hair and/or get cancer.

TRUTH: Most contraception has no effect on girls’ fertility; some medically intensive methods (such as IUD, implants, etc.) need to be properly administered by a trained medical provider to be safe for girls and women.

Want more details? World Contraception Day: myths, rumours and rubbish

MYTH: All modern contraceptive methods work for adolescent girls.

TRUTH: Permanent sterilization is not an option. And girls want contraceptive methods that they can control, that they can keep very private and that are longer acting —but not permanent. Sex for girls is often out of their control, and when they can’t negotiate condom use to protect them from disease, they at least want to be protected from unwanted pregnancy. Girls don’t want to be seen acquiring or using contraceptives because, whether married or not, using contraceptives goes against cultural norms (girls shouldn’t have sex out of wedlock and should want babies once they are married). Girls often don’t have the means to regularly acquire contraceptives.

Want more details? Start with a girl: a new agenda for global health

MYTH: Girls who do access contraceptives are adequately informed about how to use them.

TRUTH: Girls often have misinformation or misunderstanding about how to properly use contraceptive methods, with the pill being among the most misunderstood.

Want more details? Facts on the sexual and reproductive health of adolescent women in the developing world

Commit your resources to girls and young women, the untapped accelerators of economic development, and by 2020 you will have unleashed the girl effect through access to contraceptives and family planning.

 

Call to Action:  The Sino-implant (II) Initiative was recently selected as a finalist for the Katerva Award in the Human Development Category. Click here to vote for the project for the People’s Choice Award. Deadline is January 29, 2013.

Markus Steiner is a senior epidemiologist at FHI 360 and project director for the Sino-implant (II) initiative. Heather Vahdat is an associate scientist at FHI 360, where she serves as project manager for the Sino-implant (II) initiative. Kate Rademacher is a senior technical officer at FHI 360 and serves as the strategic partnership manager for the Sino-implant (II) initiative.

All women benefit from access to longer-acting contraceptive methods. From a mother living in a rural village with limited access to health care services to a young woman living in an urban center who is focused on completing her education and starting a career.  The peace of mind, independence, and continuous contraceptive protection that comes with a long-acting method is priceless. 

Contraceptive implants are a vital commodity in the spectrum of contraceptive choice. They provide discrete, long-term pregnancy prevention without the need for a pelvic exam, which has been shown to be a barrier to uptake of intrauterine devices (IUDs) for many women. Contraceptive implants are a popular method in developing countries; however, until recently, the high cost of implants has been a barrier to access.

The Sino-implant (II) initiative has been at the forefront of helping to reduce the cost of implants in resource-constrained settings.  Manufactured by Shanghai Dahua Pharmaceutical Co., Ltd., Sino-implant (II) is a low-cost, highly effective contraceptive implant currently labeled for four years of use that is available for approximately US $8 per unit. Through the initiative, which is led by FHI 360 with funding from the Bill & Melinda Gates Foundation, Sino-implant (II) has been registered in 22 countries in Sub-Saharan Africa, Asia, and Latin America since 2008.

Sino-implant (II) entered the international contraceptive market as a game-changing product. Through a network of dedicated distribution partners, Sino-implant (II) has been introduced through in-country programs and provided an opportunity to diversify the contraceptive commodity stock. The lower price of Sino-implant (II) has meant that cost savings could be used to support larger procurements of contraceptive implants, other health commodities, training, or other program needs.

So what is the “So What?” of the cost savings offered by Sino-implant (II)? 

  • More than 870,000 units of Sino-implant (II) have been distributed
  • US $10.4 million in cost savings have been generated when compared to buying similar, more expensive implants
  • According to the Marie Stopes International Impact Calculator, the procurement of 870,00 units of Sino-implant (II) can prevent: 
    • 1.2 million unintended pregnancies
    • 150,000 abortions
    • 3,500 maternal deaths

Recently, Sino-implant (II) (marketed in parts of Africa, Asia, and Latin America under trade names including Zarin, Femplant, Trust, and Simplant) was selected as a finalist for the Katerva Award in the Human Development Category. Click here to vote for the project for the People’s Choice Award.   Voting began on January 14and runs through January 29, 2013. For more information on the Katerva award or Sino-implant (II) initiative, visit: http://katerva.org/2012-nominees/sino-implant-ii/

A Note from the IYWG: Among adolescents who have access to contraception, poor compliance, inconsistent use, and discontinuation are common and often result in unintended pregnancy. Longer-acting family planning methods—including contraceptive implants—provide more effective coverage than shorter-acting methods such as Depo-Provera and oral contraceptives (OCs). According to the World Health Organization, implants are safe and appropriate for adolescents. Implants are discreet, easy to use, and effective for 3-5 years without any need for resupply or regular action by the user. In addition, implants remove the challenge of user compliance and therefore have a very low failure rate. Researchers estimate that if 20 percent of the 17.6 million women using OCs and Depo in sub-Saharan Africa who wanted long-term protection switched to implants, more than 1.8 million unintended pregnancies could be averted over a five-year period.

This post, written by Joy Cunningham, originally appeared on the FHI 360 “Degrees” blog and can be accessed here.

Many of us who spend our time in the youth sexual and reproductive health (YSRH) world don’t often cross paths with those in the business of economic empowerment and livelihoods programs for young people. Although both worlds are aware of the converging paths, funding streams generally keep us operating on parallel roads. Therefore, I was pleased to facilitate a panel session this morning at the conference: “Exploring the Intersection of Adolescent Girls’ Reproductive Health and Economic Empowerment.” During a lively session, panelists shared their experiences with both issues for girls. Some of the themes were:

  •  Even though we are aware of the problem, the data on SRH and economic empowerment for girls, taken together for developing countries, is shocking. The rates of HIV, maternal mortality and morbidity, poverty and isolation paint a dismal picture for girls.
  • Programs that target girls and adults in the community, with messages on both SRH and economic empowerment, are showing some successes. There’s more to learn, but results are encouraging.
  • Models that incorporate peer education and work with girls on SRH and economic empowerment show positive results: the Tesfa program led by the International Center for Research on Women, the Siyakha Nentsha program in South Africa led by Population Council, and a program by Restless Development in Northern Uganda all included a peer education component.
  • Reducing social isolation seems key for increasing both SRH and economic outcomes for girls. Girls need access to other girls for many reasons, but importantly, to give them an outlet to talk about themselves: their ideas, dreams and goals.
  • It’s important to work with the adults, not just the girls. Teachers, parents and faith leaders all play roles in girls’ lives, and we need to get them on board with difficult topics. Sex and money are not easy to discuss with young people, and the adults need to build their skills to do it.

Today’s session initiated some vital discussion about next steps. It’s my hope that the two worlds of SRH and economic empowerment for young people will start to cross more often and begin to operate more closely together. This year’s conference is an encouraging step toward that. Look for more information on this topic, including a research brief and e-forum, by visiting the Interagency Youth Working Group website.

This video and the post below were developed by Pathfinder International and originally appeared on their blog on July 23, 2012.

Can you imagine walking 18 miles to get contraceptives? Or being told your clinic is out of stock? It seems absurd right? But in many countries, this happens every day. Doctors are overworked, under supported, and stressed out. Women struggle to care for their large families and access the services they need, sometimes waiting hours, even overnight to visit a clinic.

We try to make it funny in this video but the reality is no joke. Choice matters about if, when, and how often to have children; choice matters about getting tested for and STI or HIV; choice about sexual and reproductive health matters for all women, everywhere.

If you agree, share this video today! The more people who understand the issues, the more voices we have calling for change.

Even here in the United States, we see barriers to reproductive choice. However, oftentimes those barriers are even more challenging in developing countries. Shannon Wu, one of our donors said, “Most women in America have access to knowledge and health care when it comes to their sexual and reproductive life. But in other parts of the world, women’s health is almost always the last thing to be discussed or taken care of, if at all.”

 Right now more than 222 million women want, but lack access to contraceptives. One woman dies every 90 seconds during pregnancy or childbirth because she lacks access to maternal care. And HIV is the number one cause of death for women of reproductive age in the developing world.

If you want to change these numbers, and improve the lives of women, take a simple action now: share the video. Help start an important conversation with your friends, family, girlfriends, boyfriends, husbands, wives, colleagues that reproductive health care is no joke. Choice matters.

We’d love to know what you think of the video. Did it remind you of the reproductive health care issue that drives you to make a difference?  Use the comments below and thank you for sharing!

A note from the IYWG

Young people face multiple negative sexual and reproductive outcomes including unintended pregnancy, HIV and other sexually transmitted infections, and maternal mortality and morbidity.  Each year, lack of access to family planning services leads to approximately 7.4 million unintended pregnancies among adolescents, and each year nearly 70,000 women between the ages of 15 and 19 die in childbirth.  Preventing unintended pregnancies among adolescents would reduce the number of maternal deaths as well as improve educational and employment opportunities for young women.  To learn more about young people and contraceptive,s view our blog archive for contraceptives posts or our topic page on Contraceptive Options for Young People.

“The Stories Behind the Statistics” is a series we developed for the Gates Foundation blog, “Impatient Optimists.” The following post is the first in our three-part series on contraception. The original post, located on “Impatient Optimists,” is available here.

Over the past couple of months, in our Stories Behind the Statistics series, we shared with readers the overwhelming rate of adolescent pregnancy and its devastating effect on the lives of girls. One of the commitments made on July 11, 2012 at the Family Planning Summit was to increase access to contraceptives for young women and girls.  These global commitments could not be timelier in a world where approximately 16 million girls between the ages of 15 and 19 give birth each year; one million die or suffer serious injury or disease as a result of pregnancy; and millions more face discrimination in their communities, are forced to drop-out of school, and face social isolation as a result of unplanned or unintended pregnancy.

It is estimated that as many as half of all pregnancies worldwide are unintended and a disproportionate amount of unintended pregnancies occur among young, unmarried girls who often lack access to contraception. Approximately 85-95 percent of sexually active young women who do not use contraceptives become pregnant within one year of initiating intercourse.

In some regions of the world, such as sub-Saharan Africa, South-central Asia, and Southeast Asia the unmet need for contraception among adolescents is as high as 68 percent.  Young people face multiple barriers to accessing contraceptives including lack of information, social stigma, provider bias, lack of confidentiality, and policy restrictions.

Lack of information about contraceptives, and myths related to side effects, are commonly reported by young people as reasons for not using contraceptives.  Young people need information, skills, and products to make informed decisions about how they can protect themselves from pregnancy in a way that is consistent with their own values. Young people also face multiple medical and institutional barriers to receiving contraceptive services, including provider bias, parental consent restrictions, notification laws, and unnecessary medical tests such as pelvic exams.

In many societies, young women have limited control over their contraceptive choice. Often they do not have the power to negotiate contraceptive use with their partners; their family planning decisions might be made for them by parents, partners, spouses, or in-laws. Married adolescents face particular barriers to contraceptive access including increased societal pressure to have children, fear of their spouse, or lack of transportation to health services.

Fulfilling the unmet need for family planning among adolescents could prevent an estimated 7.4 million unintended pregnancies.  Preventing unintended pregnancies among adolescents would reduce the number of maternal deaths as well as improve educational and employment opportunities for young women.  Expanding young people’s access to contraceptives means giving girls and young women the choice to determine their own future.

In the next two posts of this series we will hear from two young people–one from Zimbabwe and one from the United States– about why contraceptive access is important to them.

“The Stories Behind the Statistics” is a series we developed for the Gates Foundation blog, “Impatient Optimists.” The following post is the third in our three-part series on adolescent pregnancy. The original post, located on “Impatient Optimists,” is available here.

Gaj Bahadur Gurung works as the program coordinator for the National Federation of Women Living with HIV and AIDS in Nepal.

For a young girl in Nepal or South Asia, pregnancy can be disastrous. If it occurs outside the context of marriage, it will bring her disgrace and might lead to expulsion from her family and school. The young woman may be perceived as deviant in the community and will be considered a curse for her family.

Young women have little choice or control over contraceptives. For unmarried young girls in South Asia, male condoms are their only contraceptive option. Yet, patriarchal gender roles and norms make it difficult or impossible for girls to negotiate condom use with a male partner and often inhibit girls from even buying condoms or other types of contraception.

A lack of appropriate information also contributes to adolescent pregnancy. Parents rarely discuss sexual and reproductive health with their children, and the school curriculum has outdated and inadequate information. In spite of the attempts by nongovernmental organizations to disseminate information, some people are difficult to reach, especially low-income girls in mobile populations.

Early marriage is another major contributor to pregnancy among adolescents. Early marriage is quite normal in this culture, and once married, a young woman is expected to give birth to prove her family’s honor. Once a young married woman becomes pregnant, she receives tons of affection, but often she drops out of school, becomes more economically dependent on her family, and has less social interaction.

Policies and programs must both help prevent early and unintended pregnancy (for married and unmarried women) and mitigate the negative consequences for girls who do become pregnant. Programs should provide young women access to, control over, and informed choice about sexual and maternal health services. Youth-friendly maternity services with easy access for young girls would minimize health risks to mother and baby during pregnancy, delivery, and the post-delivery period.

At yesterday’s landmark Family Planning Summit, hosted by the UK Government and the Bill & Melinda Gates Foundation and UNFPA, global leaders from national governments, donor organizations, civil society, the private sector, and the research and development community committed to increasing contraceptive access for 120 million women and girls by 2020.  The commitments made at this unprecedented event also included sustaining access for the approximately 260 million women who currently use contraceptives and aim to deliver contraceptives, information, and services to a total of 380 million women and girls by 2020. The government of Malawi committed to increasing the rate of contraceptive use by 60% by 2020, with specific focus on young women ages 15-24. Malawi also committed to raising the legal age of marriage to 18 and improving youth sexual reproductive health programs.

These global commitments are crucial to addressing the critical need for contraception among adolescents globally. In developing countries, approximately one-third of adolescent girls give birth before they turn 20. It is estimated that as many as 50 percent of pregnancies worldwide are unintended and a disproportionate amount of unintended pregnancies occur among young, unmarried girls who often lack access to contraception. Approximately 85 to 95 percent of sexually active young women who do not use contraceptives become pregnant within one year of initiating intercourse.  The unmet need for contraception among adolescents is as high as 68% in some regions, such as sub-Saharan Africa, South-central Asia, and Southeast Asia. 

Fulfilling the unmet need for family planning among adolescents could prevent an estimated 7.4 million unintended pregnancies.  Preventing unintended pregnancies among adolescents would reduce the number of maternal deaths as well as improve educational and employment opportunities for young women.  Thus, the commitments made yesterday have the promise to vastly improve the health and lives of millions of young people globally.

To learn more about the family planning commitments made at yesterday’s summit, read the DFID and Bill & Melinda Gates Foundation press release

 

 

This post is the introduction to a monthly series of posts, Stories Behind the Statistics, produced by the IYWG for the Gates Foundation. The original post is available on the Gates Foundation blog, Impatient Optimists.

For many women, receiving a positive pregnancy test can be one of the happiest moments of their lives; for an adolescent it can be terrifying. Approximately 16 million girls between the ages of 15 and 19 give birth each year and, in developing countries, approximately one-third of adolescent girls give birth before their 20th birthday. The social impacts of pregnancy on adolescent girls can be devastating: girls who become pregnant often face discrimination within their communities, drop out of school, and are sometimes forced into early marriage. Girls who become pregnant are more likely to have a lower income and have more children at shorter intervals throughout their lifetime. In contrast, young women who avoid unintended pregnancy are more likely to stay in school; participate in the work force; and have healthier, better-educated children.

Not only does pregnancy during adolescence have negative social impacts, it poses significant risks to the health and lives of young women. Pregnancy in adolescence is life-threatening for many.  Childbirth-related complications are the number one cause of death among girls ages 15-19.  Pregnancy during adolescence also increases the risk of anemia, postpartum hemorrhage, prolonged obstructed labor, obstetric fistula, malnutrition, and mental health disorders, including depression.

Many factors—such as poverty, gender inequality, lack of education, and early marriage—place adolescent girls at high risk of early or unintended pregnancy. But, unintended and early pregnancy is preventable. Interventions to help girls stay in school and delay marriage can have numerous positive effects on the lives of young women, including decreasing their risk of unintended pregnancy. Proven interventions such as comprehensive sex education for both in-school and out-of-school youth, as well as improved access to contraception (including condoms), can vastly reduce high rates of pregnancy among this age group.

The next two blog entries in this series, published on Impatient Optimists next week, written by young people living in Zimbabwe and Nepal, will provide first-hand accounts of the challenges many adolescents who become pregnant face. These two authors will share the stories behind these striking statistics.

To learn more about adolescent pregnancy visit the Interagency Youth Working Group’s “Adolescent Pregnancy” topic page.

 Are you inspired to act on behalf of women and girls who deserve the opportunity to determine their own futures and who desperately need access to family planning education and contraceptives? Look for ongoing information about, and ways to pledge support for, the upcoming Family Planning Summit on July 11, 2012. The Summit is being hosted by the Gates Foundation and the UK’s Department for International Development (DFID). It will address the unmet need for the 120 million women who, over the next eight years, will want contraceptives but won’t have access to them unless we invest in women and girls and put family planning front and center on the global agenda. Join the conversation with @gatesfoundation and check Impatient Optimists regularly for details.

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“The Stories Behind the Statistics” is a series we put together for the Gates Foundation blog, “Impatient Optimists.” The following post is the first in this three part series. The original post, located on “Impatient Optimists,” is available here.

By the end of today, 2,500 young people will become infected with HIV and 1,400 girls and women will die in childbirth.

These are alarming statistics. Half of the world’s population is under 25 and nine out of ten young people live in developing countries, where they face profound challenges, such as high rates of early marriage, unintended pregnancy, HIV and other sexually transmitted infections, and maternal mortality and morbidity. 

Young people account for almost one-quarter of all people living with HIV, and nearly 60 percent all HIV-positive young people are female.  The number of young people living with HIV is rising as children who are pertinently infected gain access to life-prolonging ARV treatment and new infections among youth continue. Young people living with HIV are just as sexually active or curious as other teens, yet they are seldom offered information or support about their emerging sexuality or their reproductive choices. Furthermore, they may be less inclined than their peers to access reproductive health services due to fear of stigma and judgment from their providers. There is a vital need to address the sexual and reproductive health needs of this population.

Young women face a dual challenge: in addition the threat of HIV, pregnancy is one of the most significant threats to the health of adolescent females. 

Approximately 16 million girls between the ages of 15 and 19 give birth each year and, in developing countries, approximately one-third of adolescent girls give birth before their 20th birthday.  An unintended pregnancy can be a difficult experience for any women, and can be especially upsetting for an unmarried adolescent. 

Adolescent pregnancy is life-threatening for many girls. Childbirth-related complications are the number one cause of death among girls ages 15-19. Fortunately, unintended pregnancy and adolescent maternal mortality are preventable; yet in some regions of the world the unmet contraceptive need among adolescents is as high as 68 percent.  This lack of access to family planning services leads to approximately 7.4 million unintended adolescent pregnancies each year.

Ensuring that young people’s reproductive health needs are met has never been more critical.  In 2011, the IYWG developed a set of programming and strategy recommendations to improve youth sexual and reproductive health. The document was created with the input of both professionals in the field of youth sexual and reproductive health and young people themselves. The purpose of these recommendations is to inform programing and guide investment at international, country, and local levels. 

The 2,500 young people who will become infected with HIV and the 1,400 girls and women who will die in childbirth today represent more than striking statistics: each of these numbers represents a young person whose fate could be different if provided with access to reproductive health services. 

The IYWG recommendations are meant to accomplish more than simply lowering statistics; we want them to help improve young people’s quality of life. In this short series, we will share the stories of two young people who have experienced first-hand the sexual and reproductive health challenges young people around the world face every day.

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This blog is brought to you by the Interagency Youth Working Group (IYWG) with financial assistance from the U.S. Agency for International Development and the U.S. President's Emergency Plan for AIDS Relief. The content is managed by FHI, which functions as the secretariat for the IYWG.
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