The cultural expectation of sex and judgmental attitude toward unmarried girls seeking reproductive health services are major hindrances to increasing adolescents’ access to sexual and reproductive health information and services in Malawi.
This is according to a report by the African Population and Health Research Center (APHRC) in a country where about one in three new annual HIV infections (12,500 out of 36,000) occur among adolescents and young people aged 15–24 years, and close to three-quarters of these new infections are among girls.
Additionally, about one in seven adolescent girls aged 15–19 years have already given birth or are pregnant, posing risks to their health and development. The risk of maternal deaths is three times higher among adolescent girls compared to young women aged 20 years and older with adolescent girls accounting for close to 30 percent of all maternal deaths.
Malawi has a population of approximately 18 million people, with about five million aged 15 to 24.
The study dubbed Increasing Adolescents’ Access to Sexual and Reproductive Health Information and Services in Malawi: A Problem Driven Political Economy Analysis 2020 sought to assess relevant policies and the prevalent socioeconomic conditions affecting the delivery of comprehensive sexuality education (CSE) and broader sexual and reproductive health (SRH) services to adolescents in the country.
Toward this end, it found that despite the progress the country has made toward improving sexual and reproductive health, young people continue to face barriers in accessing SRH services.
For instance, the cultural expectation of saving sex for marriage persists, hindering unmarried young people from seeking services.
Further, misinformation about contraceptive effectiveness and side effects results in poor utilization, especially among unmarried young people. As a consequence, many adolescents are exposed to early, unintended pregnancies.
Even with significant investment in youth-friendly services, judgmental attitudes of providers towards unmarried girls accessing contraceptives persists and negatively influence uptake. Health facilities are considered unfriendly for adolescents living with disabilities or who identify as sexual minorities.
Laws and policies have also been mentioned as hindrances to access to sexual and reproductive health in Malawi.
Case in point, national laws remain nonaligned to international and regional human rights instruments and standards – regardless of whether signed or ratified. Malawi’s law does not explicitly address the minimum age of consent for contraception,
In addition, the Ministry of Education’s 100-meter rule, which states that there is no contraceptive distribution or availability within 100 meters of schools, is also at odds with the Ministry of Health’s goal of making contraceptives accessible to young people. It is also against school policy for children to be carrying condoms, and schools are opposed to facilitating access to contraceptives on their premises.
Out-of-school adolescents are further compromised as they are not exposed to comprehensive sexuality education (CSE); the majority of these adolescents reside in rural and underserved areas, making accessing health services more challenging.
Although the government is supportive of CSE, implementation has been hindered by several challenges. For example, there remains opposition from some religious and traditional authorities. Conservative opposition to CSE has slowed progress towards a more comprehensive approach to sexuality education in schools the report noted.
Further, the ‘deafening silence’ surrounding sexuality matters, as reported coupled with the lack of a strongly organized and vocal civil society, may explain why public debate on CSE is limited. The slow adoption of a comprehensive approach has been compounded by the education sector’s focus on value-based and prevention-based education, with teachers lacking the skills and resources to deliver on the policy objectives.
To mitigate this problem, the report suggests that a strong and experienced civil society that includes youth-led and women-led groups, can effectively promote CSE and better access to SRH services for adolescents, even in the face of opposition.
Malawi has CSOs working on SRH-related issues that are experienced and engaged, and in many cases, have worked on this issue for decades, giving them needed authenticity and legitimacy for working at the community level were recommended to spearhead SRH campaigns targeting adolescents.