As a youth advocate for sexual and reproductive health and rights (SRHR) in Malawi, I have walked the dusty roads of Zomba, Machinga, Mangochi, and Mchinji. In these communities, I have listened to girls pushed out of school by early pregnancy, boys with little knowledge of contraception, and health workers overwhelmed by demand and limited resources.
In 2022, Malawi launched the Youth Friendly Health Services Strategy (2022–2030) to improve access to SRHR services. Yet reality tells a different story. The 2024 Malawi Demographic Survey shows adolescent pregnancy rates at 34% in rural areas, more than double the 15% in urban settings—evidence that access to quality SRHR services remains unequal.
One story that stays with me is Tamala’s (not her real name). Pregnant at 16, she later suffered obstetric complications that led to a fistula and the removal of her uterus due to poor-quality care. She is one of more than 60 adolescent girls treated at Bwaila Fistula Centre after referrals from under-resourced facilities. Instead of accountability, her community focuses on her inability to bear children—highlighting the stigma and silence that continue to harm girls.
Nelly Tsamwa – Youth Accountability Champion , Malawi
Malawi is a signatory to the ESA Ministerial Commitments on health and education, pledging access to comprehensive sexuality education and youth-friendly health services. Yet stories like Tamala’s show how far we still have to go.We must invest in rural health systems, scale up comprehensive sexuality education, strengthen accountability, and meaningfully engage communities. Access to reproductive health care must stop being a privilege and start being a right—because every girl deserves a future free from fear and preventable suffering.
Working alongside youth groups, traditional leaders, and health officials, I have been part of efforts to improve SRHR outcomes—holding community dialogues, training peer educators, and distributing information materials. But progress is slow, and the barriers remain steep. Cultural taboos limit open discussion, health facilities lack trained personnel and supplies, and youth-led initiatives are often sidelined due to “budget constraints.”In Machinga, I met a 15-year-old girl who had never heard of emergency contraception. In Mangochi, health workers reported months-long shortages of condoms and pregnancy test kits. In Zomba, a youth club leader shared how repeated requests for SRHR training were denied. These are not isolated cases; they are clear signs of a system that is not prioritizing its young people.
Call to Action
Tamala’s story must never be repeated. To the Government of Malawi and all SRHR stakeholders, urgent action is needed:
- Invest in rural health infrastructure by equipping clinics with trained personnel, essential equipment, and reliable supply chains.
- Scale up comprehensive sexuality education to empower young people with accurate, age-appropriate information.
- Strengthen accountability mechanisms to address medical negligence and ensure justice for affected girls.
- Engage communities meaningfully, including traditional leaders, parents, and educators, as partners in change.
- Monitor and evaluate the Youth-Friendly Health Services Strategy to identify and address implementation gaps.
The question remains: When will access to quality reproductive health care stop being a privilege and start being a right?
Tamala’s silence is not hers alone—it reflects the voices of a generation waiting to be heard. It is time for the government and stakeholders to listen, act, and fulfil the promises made. Because every girl deserves a future free from fear, stigma, and preventable suffering.
