“Our girls need to see a path to the future” --perspectives on sexual and reproductive health information among adolescent girls, guardians, and initiation counselors in Mulanje district, Malawi

Abstract

BackgroundMalawi has one of the highest adolescent pregnancy rates worldwide; at 141 births/1000 girls it is 3-fold higher than the global average. Adolescent pregnancy contributes to poor maternal and neonatal outcomes, school dropout, and poverty. In preparation for an information, education, and communication (IEC) intervention to reduce unintended pregnancy among adolescent girls, formative research was conducted to understand how and what sexual and reproductive health (SRH) information is shared with girls in southern, rural Malawi, and perceptions of such information among key informants.MethodsForty semi-structured interviews were conducted with three participant groups: adolescent girls (n = 18), mothers/female guardians (M/FGs) of adolescent girls (n = 12), and leaders of initiation rites (n = 10). Interviews were conducted in 15 villages. Data were analyzed and coded using Dedoose 7.5.ResultsParticipants widely acknowledged both the health risks and the general social unacceptability of early childbearing, yet adolescent pregnancy is common in the region. Respondents also acknowledged the importance of female school completion and the norm that pregnancy usually marks the end of a girl’s education. Unprotected transactional sex was reported to be common and driven by poverty. Initiation rites were described as prevalent and often encourage girls to practice sex at puberty. Contraceptives, and even condoms, were reportedly discouraged for adolescents due to concerns about inappropriateness for nulliparous and young girls and misconceptions about side effects. Adolescent respondents also noted barriers to accessing condoms and contraceptives. M/FGs were described as gatekeepers to SRH information and services, and many parents reported delaying SRH discussions until after sexual debut due to concerns about encouraging sexual activity. Adolescent and M/FG participants expressed a desire for role models or “outside experts” to provide SRH education and to promote an alternate vision to adolescent motherhood.ConclusionTo improve SRH outcomes for adolescent girls, it is critical to engage key stakeholders and create an enabling environment so that girls can effectively act on the IEC they receive. Initiation counselors remain entrenched information sources; efforts to provide them with training on accurate SRH messaging could leverage an existing channel. Engaging parents, especially mothers, is crucial to encourage earlier SRH education and to gain their acceptance of adolescent access to SRH services. Also important is mobilizing the broader community of influencers in support of girls’ SRH and vision for a healthier future. Sensitization messages focusing on the health, educational and economic benefits of preventing early pregnancy may overcome misconceptions about and barriers to contraceptive use. Finally, fostering girls’ aspirations for school completion and jobs and other income generating opportunities via role models can encourage an alternative to adolescent motherhood. Ultimately, poverty and gen...

The role of community leaders on adolescent HIV and Sexual Reproductive Health and Rights in Mulanje, Malawi

“…This is in agreement with what our study has found as there were mixed feelings among the community leaders about advising adolescents on SRH issues. This has also been reported in another study done in Mulanje, whereby, many of initiation counsellors claimed not to encourage girls to practice sex intercourse but at the same time they reported knowing others who do that [17]. Therefore, our study ascertain the claims made by other studies on adolescents when it comes to addressing SRH and HIV issues.…”

Enabling and hindering factors of health surveillance assistants’ roles in the provision of contraceptive services in Mangochi, Malawi

“…Although many youth indicated that the age of the HSA makes no difference to them, some study participants mentioned that young people prefer to be assisted by younger health workers. Research shows that young people like to discuss issues around sexual and reproductive health with peers or young role models [31,32], but young CBDAs seemed to be scarce in the three study areas. Further research should explore collaboration between HSAs and this voluntary cadre in providing youth-friendly services.…”

Being dragged into adulthood? Young people’s agency concerning sex, relationships and marriage in Malawi, Mozambique and Zambia

“…Young people's and adults' notions about adulthood were related to readiness for sex and relationships. The transition from child to adulthood was supported by initiation ceremonies (Nash et al 2019;Frederico, Arnaldo, and Ma ungue 2017). Some young people reported that curiosity or desire made them start sex and relationships.…”