Working to Advance
Health Equity in Africa

Social norms, institutional weaknesses, and gaps between policy commitments and implementation in Malawi continue to pose significant barriers to adolescents’ realisation of their sexual and reproductive health and rights (SRHR). Early marriage, gender-based violence, and limited access to contraception and comprehensive sexuality education (CSE) undermine adolescents’ wellbeing and future opportunities. This qualitative study examines how actor interests, institutional arrangements, and normative contexts shape the delivery of and access to adolescent-friendly health and education services in Malawi. Data were drawn from a desk review, 42 key informant interviews with government officials, development partners, civil society organisations and community actors, and participatory inception and validation workshops. Analysis reveals that structural poverty, restrictive gender norms, and heavy dependence on external donor financing create a fragile foundation for adolescent SRHR programming. Institutional barriers 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. Reform pathways identified by stakeholders included: expanding domestic financing, improving coordination, engaging faith and community structures, institutionalising meaningful youth participation, and reframing adolescent SRHR as a national development priority. Advancing these reforms will require sustained political commitment, stronger domestic ownership, and strategies to improve fiscal resilience.