Beyond Recipients: Adolescent Girls as Active Agents in Reproductive Health

Empowering adolescent girls as active agents in reproductive health ensures informed choices and sustainable change.

[This text was written jointly by Anna Lucas, Coordinator of the Maternal, Child and Reproductive Health Initiative, Clara Menéndez, Research Professor, Director of the Maternal, Child and Reproductive Health Initiative and Programme, and Cristina Enguita, Assistant Research Professor at ISGlobal.]

Adolescent Girls at the Center of Health Decision-Making

Promoting adolescent girls engagement in health decisions enables them to gain critical knowledge, develop life skills, and cultivate positive attitudes toward their sexual and reproductive health. When girls have opportunities to be vocal and involved - through group discussions, peer education, and leadership in advocacy- they are more likely to make informed choices, avoid risky behaviors, and demand services that meet their unique needs.

From Beneficiaries to Co-Creators in Reproductive Health

Moving beyond seeing adolescent girls as mere beneficiaries is vital to position them as co-creators, and advocates in reproductive health research and programming and offer adolescents the chance to discuss openly with peers, researchers, health workers, and teachers allowing them to ask questions, express concerns, and support each other in decision-making. Their voices can contribute to inform and shape policies and services, making interventions more culturally relevant, acceptable and responsive to their lived experiences.

When girls have opportunities to be vocal and involved - through group discussions, peer education, and leadership in advocacy- they are more likely to make informed choices, avoid risky behaviors, and demand services that meet their unique needs

Facilitating adolescent involvement can also help de-stigmatize reproductive health issues and reduce harmful practices. Sustainable improvement in adolescent reproductive health relies on supporting girls to act as change-makers within their families, schools, and communities. This requires creating safe environments for self-expression, involving girls in research and program design, and training them to advocate for their rights.

HPV Vaccination and the Case of Sierra Leone

Vaccination against the human papillomavirus (HPV) -that prevents cervical cancer and is aimed primarily at the group of girls between 9-14 years of age per the WHO recommendation- is an intervention where their voices must be heard.

Vaccination against the human papillomavirus (HPV) -aimed primarily at the group of girls between 9-14 years of age per the WHO recommendation- is an intervention where their voices must be heard

In Sierra Leone -as in most low-income countries- cervical cancer, primarily caused by persistent HPV infection, remains a major health challenge. It is the second most common cancer among women and a leading cause of mortality, with approximately 372 deaths each year. The HPV vaccine, introduced in Sierra Leone in 2022 as a key preventative measure, saw early success but uptake subsequently dramatically declined. To ensure cervical cancer elimination targets are met in Sierra Leone, and as the next vaccination campaign expands to older adolescent girls (11-18 years old), understanding the factors influencing uptake is vital.

Understanding Barriers to HPV Vaccine Uptake

Studies investigating the reasons behind low HPV vaccination coverage have indicated structural barriers, including weak health systems, often heavily reliant on external support, limited vaccine supply, geographic inaccessibility, and low school enrolment as the main factors. In addition, uptake-related challenges such as misinformation and mistrust – such as concerns about fertility and vaccine safety but in the case of Sierra Leone also shaped by experiences with past disease outbreaks, especially Ebola-, stigma and socio-cultural beliefs and scrutiny around sexual and reproductive health may influence perceptions of the HPV vaccine and the health seeking behaviors of adolescents and young women. Thus, understanding their views is key for mitigation.

Insights from the SHARE Project

Within the framework of the SHARE project, a mixed-methods formative research evaluation has been recently conducted in Sierra Leone to examine adolescent’s knowledge and awareness of sexual and reproductive health, cervical cancer, HPV, and the HPV vaccine, and to understand the behavioral, social, and structural factors shaping HPV vaccine decision-making. Findings from the study will inform recommendations for a more sustainable, culturally sensitive HPV vaccine campaign.

It is key to include adolescent girls as active participants and prioritize a whole-community engagement approach to ensure effective, sustainable vaccine uptake

Most adolescent girls enrolled in the study showed a generally positive view of the vaccine, perceiving it as effective and trustworthy. However, fear and concerns remained as a barrier to uptake. Knowledge of HPV, cervical cancer and the HPV vaccine and awareness were uneven, shaped by both informal and formal sources, allowing myths, misconceptions and stigma to persist. Girls perceived peers and caregivers as both enablers and barriers to uptake. Teachers, healthcare workers, and adolescents themselves were identified as key engagement figures. A desire for increased community-wide sensitization and vaccine administration was expressed. Among the structural barriers perceived by girls were potential costs, distance, and poor communication infrastructure. In Sierra Leone, HPV vaccine uptake is shaped by an array of factors that can work in favour or against its acceptance and, therefore, its coverage. In this context, it is key to include adolescent girls as active participants and prioritize a whole-community engagement approach to ensure effective, sustainable vaccine uptake.

A Whole-Community Approach for Sustainable Change

On the International Day of the Girl Child, we reaffirm the need to recognize them as active agents in shaping their own reproductive health outcomes, rather than passive recipients of interventions. Their engagement is central to ensuring health programs are effective, sustainable, and respectful of their autonomy and evolving capacities.