Sexual Health

Stakeholder perspectives on adolescent sexual and reproductive health and rights in Malawi: Barriers, incentives, and opportunities for reform.

TL;DR

Social norms, institutional weaknesses, and gaps between policy commitments and implementation continue to pose significant barriers to adolescents' realisation of their sexual and reproductive health and rights (SRHR) in Malawi, though stakeholders identified reform pathways including expanding domestic financing, improving coordination, and reframing adolescent SRHR as a national development priority.

Key Findings

Structural poverty, restrictive gender norms, and heavy dependence on external donor financing create a fragile foundation for adolescent SRHR programming in Malawi.

  • These three factors were identified through qualitative analysis as interconnected structural barriers.
  • Heavy reliance on external donor financing was identified as a systemic vulnerability undermining sustainability of programming.
  • These findings emerged from 42 key informant interviews and participatory workshops.
  • The combination of these structural factors was found to undermine both service delivery and access.

Early marriage, gender-based violence, and limited access to contraception and comprehensive sexuality education (CSE) undermine adolescents' wellbeing and future opportunities in Malawi.

  • These were identified as key social norm-driven barriers to adolescent SRHR.
  • Restrictive gender norms were found to shape both institutional arrangements and community-level access to services.
  • These barriers were documented through desk review, key informant interviews, and participatory workshops.
  • The findings reflect both policy gaps and implementation failures.

Institutional barriers to adolescent SRHR in Malawi include the absence of dedicated budget lines, weak intersectoral coordination, short-term political incentives, donor-driven programming priorities, and normative resistance from influential faith-based actors.

  • The absence of dedicated budget lines was identified as a structural fiscal barrier limiting sustained programming.
  • Weak intersectoral coordination was identified as impeding coherent service delivery across health and education sectors.
  • Faith-based actors were specifically identified as influential sources of normative resistance to adolescent SRHR programming.
  • Short-term political incentives were found to undermine long-term policy commitment.
  • Donor-driven programming priorities were identified as distorting domestic ownership and sustainability.

Stakeholders identified five key reform pathways for improving adolescent SRHR in Malawi: expanding domestic financing, improving coordination, engaging faith and community structures, institutionalising meaningful youth participation, and reframing adolescent SRHR as a national development priority.

  • These pathways were identified through 42 key informant interviews with government officials, development partners, civil society organisations, and community actors.
  • Participatory inception and validation workshops were used to develop and confirm reform pathways.
  • Advancing reforms was identified as requiring 'sustained political commitment, stronger domestic ownership, and strategies to improve fiscal resilience.'
  • Engaging faith-based and community structures was highlighted as a strategy to address normative resistance.
  • Institutionalising meaningful youth participation was explicitly identified as a distinct reform requirement.

The study used a qualitative design drawing on a desk review, 42 key informant interviews, and participatory inception and validation workshops to examine actor interests, institutional arrangements, and normative contexts shaping adolescent SRHR service delivery in Malawi.

  • Key informants included government officials, development partners, civil society organisations, and community actors.
  • The analytical framework examined how 'actor interests, institutional arrangements, and normative contexts' shaped delivery and access.
  • Participatory workshops served both inception and validation functions in the research process.
  • A desk review was conducted alongside primary data collection.
  • The study was qualitative in nature and did not report quantitative statistical measures.

There are significant gaps between policy commitments and implementation in Malawi that continue to limit adolescents' realisation of their SRHR.

  • Policy-implementation gaps were identified as a persistent and ongoing challenge, not a resolved issue.
  • The gap was found to exist despite formal policy commitments to adolescent SRHR.
  • Social norms and institutional weaknesses were identified as factors sustaining the policy-implementation gap.
  • These findings have implications for both domestic governance and donor programming approaches.

What This Means

This research examines why adolescents in Malawi continue to face serious barriers to accessing sexual and reproductive health services and rights (SRHR), despite existing policies meant to protect them. The study gathered perspectives from 42 key informants — including government officials, international development partners, civil society groups, and community members — as well as through workshops and a review of existing documents. It found that deep-rooted problems like poverty, gender inequality, early marriage, gender-based violence, and limited access to contraception and sexuality education are major obstacles. Importantly, the study also found that Malawi's health and education programs in this area are heavily dependent on international donor funding, which makes them fragile and vulnerable to shifting external priorities. The research identified several institutional problems that compound these social challenges: there are no dedicated government budget lines for adolescent SRHR programs, different sectors of government coordinate poorly with each other, politicians tend to focus on short-term gains rather than long-term health investments, and influential religious organizations often resist programming related to adolescent sexual health. Together, these factors mean that even when good policies exist on paper, they are rarely fully implemented in practice. This research suggests that meaningful progress will require Malawi to increase its own domestic investment in adolescent SRHR rather than relying primarily on external donors, improve coordination between government ministries, find constructive ways to engage religious and community leaders, ensure young people have a genuine voice in shaping programs that affect them, and treat adolescent reproductive health as a core national development issue rather than a peripheral concern. The authors emphasize that these changes will require sustained political will and a stronger sense of national ownership over the problem.

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Citation

George G, Muula A, Chipeta E, Govender K, Mussa R, Mhango P, et al.. (2026). Stakeholder perspectives on adolescent sexual and reproductive health and rights in Malawi: Barriers, incentives, and opportunities for reform.. Global public health. https://doi.org/10.1080/17441692.2026.2685999