'It's now or now': African ASRHR youth leaders demand a future where girls have power over their bodies

Liz Lum and Faith Malenga are part of a growing movement of youth leaders determined to reframe what adolescent sexual and reproductive health and rights (ASRHR) can look like, with young people leading the way.

As youth advisors for Adolescent Sexual and Reproductive Health and Rights Exemplars project (ASHER), a collaboration between the African Institute for Development Policy (AFIDEP) and Exemplars in Global Health, Malenga and Lum are helping spotlight what works in ASRHR – and why.

The ASHER project, launched at the Women Deliver 2023 Conference, seeks to better understand progress in adolescent health by studying countries that have made significant improvements in ASRHR outcomes, particularly reductions in adolescent fertility rates between 2000 and 2017, while accounting for national education levels. By analyzing both adolescent fertility trends and related ASRHR outcomes, ASHER aims to surface the policies and programs that helped these positive outlier countries succeed and share those lessons with others.

ASHER focuses on six exemplar countries – Cameroon, Ghana, India, Malawi, Nepal, and Rwanda – and has embedded youth leadership at every level. Two youth advisors have been engaged from each country, with three also serving on the project’s technical advisory group. Both Lum and Malenga bring lived experience and deep grassroots expertise to their roles – Malenga from Malawi and Lum from Cameroon – alongside research insight and policy acumen in a field where young voices are too often sidelined. “Girls need power over their bodies,” says Lum. “We need information and the freedom to make choices.”

In this conversation, the two reflect on the ASHER project’s findings, how countries can better support youth-friendly services, and what it takes to ensure that young people aren’t just included in the conversation but shaping it.

Could you please introduce yourselves and share your roles, affiliated organizations, and relationship with Exemplars in Global Health?

Lum: My name is Liz Lum. I'm a passionate sexual and reproductive health and rights advocate and girls' rights activist. I've been at the forefront of this fight for over seven years now, and through my journey, I have worked with different organizations, championing girls' rights, designing programs, and even leading grant-making for a few years. Currently, I serve as the Pan-African hub organizer for the Me Too International Global Network, where I support organizations across the continent to build their capacity in handling sexual and gender-based violence, supporting survivors, and strengthening their networks. I'm also proud to serve as a youth advisor with Exemplars in Global Health, under the ASHER project, where I've spent the last two years helping to use research from across continents to advance sexual and reproductive health.

Malenga: My name is Faith Malenga. I'm a proud development enthusiast from Malawi. I'm interested in youth development and I work across different sectors, one of them being the health sector, and I'm interested in issues related to adolescent sexual and reproductive health. I work with Youth Wave Malawi as the youth inclusion and engagement officer. It's a youth-based organization. I've also been honored to serve as the national youth advisor for adolescent sexual and reproductive health here in Malawi. I've been part of this sector for over seven years now and it has really been an exciting journey.

What inspired you to become involved in advocating for ASRHR, and what motivates you to pursue this work?

Lum: I would say it all began with two deeply personal experiences that woke me up to the realities of our bodies as girls and our power over them. The first is – I got my period as a nine-year-old, which was much earlier than what I'd been told [it would be] in school or by my caregivers. The classroom taught me that it would happen around 12, after breast development, but I had no breasts yet. But then I got a period, and no one around me believed that it could be my period. So I bled on my underwear for three days straight while everyone speculated about what it might be. I felt lost, confused, and very ashamed.

And then about a year later, I watched my best friend, who was barely 12 – she was Muslim – forced out of school into marriage. In her family's eyes, the fact that she had gotten her period that year meant she was mature enough to get married. I was devastated. I kept asking, ‘What can I do to make sure that other girls don't go through this?’ And the answer became very clear. Girls need power over their bodies; we need information and the freedom to make choices. Adolescent sexual reproductive health and rights are the starting point for that power. When adolescent girls and young women can manage their sexuality, understand their rights, and protect their bodies, they can make informed decisions and teach others to do the same.

Malenga: My inspiration for my involvement in adolescent sexual and reproductive health [was] spurred when I was younger. It was a very personal experience – I was walking down the street with my father and I remember meeting one of his friends. He had questioned him to say, 'Oh, this is your first born?' They were having a conversation, and he said, 'Oh, yes, she's my first born.' I quote, in his words, he said, 'You have not yet given birth, because as a man, you're supposed to have a son first, before you start having girls.' It really challenged me and it left a lot of questions because, by then, I was in primary school and it awakened something deeper in me, to say, 'What is it that women do not have, but men have, and why should we have a discussion about men being more important than women?' I have always lived to just show that, as a woman, I have power. As a woman, I can do whatever a man can do.

Given the shifting landscape in global health funding, what do you think is the role of youth leaders in navigating these challenges and continuing to drive ASRHR progress in these countries and beyond?

Lum: I think as young people, as young leaders, this is our moment. The world needs young people now more than ever. First, as youth leaders, we need to step up, leave the back of the class, and come to the front as active architects of solutions, not just beneficiaries. Yes, the aid cuts are a harsh reality, but we've been underfunded and under-resourced even before now, even before the cuts came. Young people and youth organizations, we have been underfunded and under-resourced, especially grassroots youth organizations. Yet, we've always found a way to serve our communities. That resilience, for me, is our strength. We have a critical role in innovating, in co-creating solutions, and holding systems accountable. We must push for intergenerational collaboration and learning to ensure that our voices are not an afterthought, but that they're actually embedded in the design right up to execution. I also feel like, as youth leaders, there is a need for us to amplify the urgency, to show our governments and other global partners that investing in young people is not optional. It is essential to sustain progress.

Malenga: This is a global challenge. We know that, in terms of health financing, there's been a significant shift. As young people, we have lived experiences, but we also focus on local realities. What I mean is, donor funding does not stop whatever we experience in our communities. Therefore, it should not stop our role as young leaders taking action in protecting other young people. As young people right now, we need to act. Our role is to continue advocating if we're in advocacy. Our role is to ensure that other young people get the information they need to protect themselves from sexual and reproductive health issues that arise from a lack of information and awareness.

What are some of the ways governments and organizations in Malawi and Cameroon could effectively engage young people and adolescents in this work?

Lum: It's well established: there is a need to engage young people now. It's now or now. Governments in our countries could do this in four ways. First, they need to acknowledge that, as young people, we are experts of our lived realities, so they need to engage with us as partners – not as subordinates, not as mere beneficiaries, but as partners. The second thing is they need to go beyond tokenism and build meaningful participation into programs where young people are part of the solution-building, rather than simply checking a box. The third thing is to fund grassroots initiatives. The global aid cuts really exposed how much support our governments and countries were genuinely putting into adolescent sexual and reproductive health. It exposed how significant the gap in this funding was. We need more resources directed at youth organizations to scale up our efforts, especially in underserved communities. As we have established, before the aid cuts, we were underfunded, but we were still operating and providing help to our communities and offering solutions. What we need now is all hands on deck to scale up our solutions. Lastly, we need our governments to ensure that policies are implemented in practice and not just on paper, opening the doors for young people to monitor, evaluate, and influence policies at every stage.

Malenga: We say nothing for young people without young people. The question should be – how do you talk about issues involving young people when young people are not at the table to discuss the things they are experiencing? I would like to see meaningful youth engagement in anything and everything involving young people. That is the first thing our government and organizations can do – say that if young people are at the table, we're not just there as beneficiaries but as co-creators. If we're developing policies, we should have input, and we need to be allowed to say something.

Second, we should also talk about financing. A lot of initiatives by young people are not funded how they should be. That's why there are gaps in terms of support going toward young people, particularly to vulnerable groups like young women and adolescent girls.

Finally, we should also talk about capacity strengthening. We have the skills. We know what we're supposed to do, but what we have is not enough to take us to the next level or help us do more than we are already doing. We know that governments have experienced people. We know most civil society organizations have experienced people. We need them to share their experiences with us by capacitating young people to say, 'OK, in terms of advocacy, this is how we are supposed to run advocacy.' The 20 years of experience they have, we do not have. We know that with the skills we have, we can build on that, and we can do better.

Both of you fill an important role on the EGH ASHER project. Could you talk about what you've learned through this research, particularly anything you found surprising or inspiring?

Lum: The purpose of the project for me, it's about picking apart success stories of countries and helping other countries to use those secrets for good. Throughout this research and studying the results from all of the exemplar countries, what really stood out for me was that while most of the countries actually used similar strategies to advance adolescent sexual and reproductive health and rights, what made the difference was how they implemented them. I'm looking at school-based programs. I'm looking at policies. All of the exemplar countries actually did these things. It was also about accountability. It involved grassroots communities and young people in program design and implementation, including as peer educators.

Countries that did this actually had better results. Another big lesson for me as an advocate is that I was trained to look at gaps in care, to look for things that aren't there. This research also taught me that to look at what is working is another solution. Looking at what is working and building from there – because sometimes, progress is hiding in plain sight. And by focusing on the positive outliers, we can replicate successful models and accelerate change faster.

Malenga: What stood out for me during the research is two components. First of all – comparing the different countries that were part of the research. It was really interesting to find out that the issues that we keep on talking about are not only in Malawi. That's when I realized that we need global action, because when you look at Cameroon, Malawi, Nepal and India, they're talking about funding issues. That's something that really captured my attention and made me realize, 'Oh, these are not just national issues, but they're also happening globally, in the global context.'

Secondly, for Malawi, what really stood out for me was seeing the desire and the need for young people to access accurate sexual and reproductive health information in a safe and conducive environment. I realized that we underestimate environment as a key factor for adolescents to access sexual and reproductive health. But through the research, I saw their desires and I saw the need to say, 'We want a judgment-free environment. We want a safe environment to access services.'

What stands out for you about the similarities and differences between Malawi and Cameroon's respective approaches? What do you think the two countries could learn from each other?

Lum: Cameroon has a lot to learn from Malawi – it stands out for its youth-friendly health services. For instance, by 2020, 60% of health facilities in Malawi offered youth-friendly health services, which is huge. This is a key indicator of progress in adolescent sexual and reproductive health and rights. The fact that young people can go to a health center and meet staff who understand them and provide solutions that meet their needs, is key. This success wasn't accidental. Malawi prioritized proper planning, community involvement, constant evaluation, and feedback loops. They didn't just check the box on global policies – they followed through with tangible, local action.

Malenga: I've also personally learned a lot from Cameroon. One thing that has really stood out for me is how resourceful and informed young people are in terms of sexual and reproductive health issues. It has really been interesting for me to ask, 'How do we understand issues of advocacy?'

A very good example is Liz herself. For me, the way she advocates – her passion and how deeply she engages – is something we as a nation can learn from. To say, 'Yes, we are youth advocates, but are we doing enough? What more can we do?' Yes, we have the policies. Yes, the youth corners are there. Everything else is there, but as young people, are we doing enough? I think it's something we can learn from.

Secondly, I also noticed a digital aspect in Cameroon. We don't really have a dedicated digital platform beyond social media campaigns. We haven’t deeply explored digitizing adolescent sexual and reproductive health issues. This is also something we could learn from as well.

What do you perceive as the biggest challenges young people face in accessing ASRHR services in your community? How does that align or differ with other communities in your country or different countries in the region?

Lum: In Cameroon, we are bilingual. We speak both English and French, which already creates a divide regarding who can access accurate information and from where. Also, we have a violent, armed conflict that has been going on for the last seven years. In Cameroon, especially in conflict-affected regions, young people face enormous barriers [to accessing ASRHR]. Even with efforts like adolescent wellness centers or health rights organizations working in these communities, the conflict makes access unpredictable and difficult due to sudden lockdowns and insecurity. We also saw that teenage pregnancy rates skyrocketed in conflict areas. Young people in Cameroon also struggle with stigma, misinformation, and inadequate youth-friendly services, especially in rural settings. Talking about sex education is not a conversation we’re expected to have. In some religious areas, you find beliefs like, 'We don't believe in contraceptives,' or 'We don't believe in discussing sexual and reproductive health.' As an advocate, I remember being 13 years old and trying to teach older people – including grandpas and grandmas – about sex education. I remember their reaction when I wrote the word 'sex' on a chart and turned it over – people called me spoiled and an abomination for knowing that word. This misinformation and stigma around even talking about sexual issues prevents young people from accessing sexual and reproductive health information and services when and where they’re supposed to.

Malenga: One issue we have is the stigma [around ASRHR] and the attitudes of service providers. For many young people, whenever they want to access sexual and reproductive health services, the first question they encounter is, 'How old are you?' The next questions are, 'Where is your mom? Where's your dad? Do your parents know you're having sex?' You expect professionalism from service providers – maintaining confidentiality, providing quality services, and not questioning the client. This is one of the most significant issues I've encountered. Not just in my community, but in Malawi as a whole.

How do socioeconomic factors such as education and income wealth influence young people's ability to access ASRHR services in Malawi and Cameroon? How could those factors be addressed by program and policy development?

Lum: Young people in poor and marginalized communities can't always afford to travel to health centers, let alone pay for services. Every program and policy needs to be designed with equity in mind. For example, we need to bring services closer to people. In Cameroon, each region has a regional hospital where most services are concentrated. Local health centers, which are cheaper and more accessible, are where young people usually find themselves. However, the kind of information that is destigmatized, relevant, and free from bias isn't available in these centers, so sometimes they don't even go.

Regarding socioeconomic factors affecting program and policy development, we could look at providing subsidies or free services for marginalized groups. In conflict-affected regions, there is almost zero economic activity. Any financial resources families or young people have are not prioritized for sexual and reproductive health information. Instead, there are informal solutions, like using certain herbs or rituals to avoid pregnancy or disease. Providing subsidies or free services for these groups is essential. Additionally, we cannot overemphasize using schools, peer networks, and digital platforms to spread information about sexual and reproductive health, rights, and resources. This is where young people are. If we want accurate and proper information to reach them, we need to be present in the spaces they occupy – schools, peer networks, and digital platforms.

Malenga: One thing I've personally observed is that working with people in urban areas differs from working with people in rural areas. There are language barriers and cultural contexts. In urban areas, most of the population attends school, whereas in rural areas, many young people stay at home and don't attend school. Socioeconomic status significantly influences who receives services, information, and how they receive them. This is an opportunity for our government to translate policies into accessible reforms. For example, I've reviewed many of our policies, and they're all in English.

Consider someone in a rural community and you're talking with them about ASRHR strategies for adolescent girls and women's health, but they can't read or understand English. How will we reach them? Translation should extend beyond our native language, Chichewa. We can use plays, podcasts, and radio programs to ensure messages reach people effectively. Otherwise, we're only creating policies for people who already understand, not those living the experiences we aim to address.

Editor's Note: For more information about Adolescent Sexual and Reproductive Health and Rights, visit Exemplars in Global Health.