Evaluating Adolescent Girls' Sexual and Reproductive Health Rights Realization in Malawi

One South is back in Malawi, conducting a rigorous evaluation of Farm Radio International (FRI) new Innovations in Health, Rights, and Development (iHEARD) project funded by Global Affairs Canada. The project aims to dismantle barriers to sexual and reproductive health and rights (SRHR) for adolescent girls and young women in Malawi through:

Increased access to reliable and accurate SRHR information and opportunities for adolescents to put knowledge into practice,
Strengthened capacity and quality of SRHR services for adolescents
Strengthened collaboration and a cross-sectoral approach to advocacy for the sexual and reproductive health of adolescent girls and young women (AGYW)

One South is drawing from its significant experience researching SRHR barriers for marginalized groups in Malawi to design rigorous and contextually relevant mixed methods evaluation tools that can be used to assess the project’s impact, effectiveness, sustainability, and relevance. One South has conducted research in Malawi since 2014, supporting projects which work with marginalized girls, women in sex work, girls at risk of exploitation, LGBTI+ people, and adolescents and youth.

For a project aimed at empowering women and girls, One South has recruited a majority-woman team of enumerators. In line with our sustainability approach and commitment to localizing development research, One South’s collaborative research process strengthens the skills and capacity of Malawian researchers to implement data collection while closely following the intended research design.

Leading the fieldwork is Rose Nyambi, a local researcher with over eight years of experience in implementing applied research for development programs with One South. She recently trained field staff for iHEARD baseline data collection and is thinking ahead to the next stages of the evaluation. Rose recently shared some of the lessons she has learned throughout her research experience that add invaluable practical and cultural insight.

Understanding Context

According to Rose, “The first priority is to understand your target group. So, before you even get to the field, I think it's important to understand how you can interact with [the target group] to build rapport.” This is particularly important when researching sensitive topics which are often culturally difficult to speak about. She emphasizes that when conducting community outreach, it is crucial to consider the stage of the research and the existing relationships the project has with target communities. For a Baseline study, project staff may not be familiar with the context. The target community has also not yet been exposed to awareness raising efforts on the project’s topics, so, it takes extra care to build comfort on both sides, especially with topics like SRHR.

Community Collaboration and Safeguarding

To build relationships with the project’s research populations, Rose is working closely with community focal persons (CFPs). CFPs are community members whose role is to inform the research team about practical considerations like times and locations for interviews that are accessible to the population. CFPs also act as trusted liaisons, conducting initial outreach to potential participants and introducing them to the research.

Entering the research phase, Rose notes that she and her team will keep a close eye on protection issues: “You have to be very careful. I'll give an example of the LGBTI populations. You have to be very careful in terms of where you meet them. Who you are in contact with so that you also don't put them at risk once you leave.” Dealing with the sensitive topic of SRHR comes with risks that are important to think through when planning evaluations.

Barriers and Biases

Although the evaluation is in early stages, Rose shares insights into the potential barriers to SHRH education and healthcare access in Malawi, including cultural taboos, accessibility, and information quality. Young people are often excluded from SHRH health services because of the stigma around youth sexual activity[1]. Rose confirms that this holds true for Malawi, where healthcare is not always adolescent friendly.

Rose also identifies the lack of accurate and age-appropriate information: “We have moved from lack of information to too much information. But it is not the right information. There’s still either misinformation, or lack thereof. Or, in some cases, it’s not tailored for the age groups that are being targeted.” On the bright side, Rose says that Malawian policy is shifting in the right direction with the introduction of SHRH curriculum tailored to difference age levels.

Although Rose’s experience offers helpful insights to the evaluation, she also acknowledges the importance of putting her preconceived notions aside in order to mitigate research bias. “I always think it’s good to have an open mind because, to be honest, I have learned a lot through this process about Malawi, and I think it’s important to make sure you’re aware of your biases so that you have an open mind. Then, you’re able to facilitate the conversation so that [participants] are able to speak,” she explains.

One South’s worked with project stakeholders to develop contextualized and culturally competent measurement approaches while upholding best practice ethical standards for this type of research. One South accounts for both methodological and analytical bias to learn from a diversity of perspectives and best support health and education initiatives. The One South team is excited to continue learning with and from our research partners and research populations to inform impactful programs.

The iHEARD project is implemented by Farm Radio International in partnership with Farm Radio Trust, CODE, Girl Effect, FAWEMA, MaikHanda, Women and Children Frist (WCF), and Banja La Mtsogolo (BLM) in partnership with MSI Choices.

One South has conducted applied research for sexual and reproductive health projects and initiatives in Malawi for a range of organizations, including UNESCO, the Arts and Global Health Centre Africa, and Theatre for a Change.

[1] IN DANGER: UNAIDS Global AIDS Update 2022. (2022). Joint United Nations Program on HIV/AIDS. https://www.unaids.org/en/resources/documents/2022/in-danger-global-aids-update