Empowering adolescent girls as active agents in reproductive health guarantees informed decisions and sustainable change.
[Texto elaborado conjuntamente por Anna Lucas, coordinadora de la Iniciativa de Salud Materna, Infantil y Reproductiva; Clara Menéndez, Research Professor y directora de la Iniciativa y del Programa de Salud Materna, Infantil y Reproductiva; y Cristina Enguita, Assistant Research Professor en ISGlobal.]
Adolescents at the center of health decision-making.
Promote the adolescent participation in health-related decisions It allows them to acquire fundamental knowledge, develop life skills and cultivate positive attitudes towards their sexual and reproductive health. If girls have opportunities to express themselves and participate—through methodologies such as participation in focus groups, peer education, and leading advocacy activities—they are more likely to make informed decisions, avoid risky behaviors, and demand services that respond to their specific needs.
From beneficiaries to co-creators in reproductive health
Overcome vision Seeing adolescents as mere beneficiaries is essential to position them as co-creators and defenders of their interests both in research and in the definition of reproductive health programs. Offering adolescent girls the opportunity to engage in open dialogue with their peers, researchers, healthcare staff, and teachers allows them to ask questions, express concerns, and support each other in making decisions. Their voices can help inform and shape policies and services, making interventions more culturally relevant, acceptable and sensitive to their lived experiences.
If girls have opportunities to express themselves and participate, they are more likely to make informed decisions, avoid risky behaviors, and demand services that respond to their specific needs.
Facilitating the participation of adolescent girls can also help reduce the stigma of both reproductive health issues and harmful practices. Sustainable improvement in reproductive health in adolescence largely involves supporting girls to act as agents of change within their families, schools and communities. This requires creating safe environments for personal expression, involving them in the design of research and programs, and training them to defend their rights.
Vaccination against human papillomavirus (HPV) and the case of Sierra Leone
Vaccination against human papillomavirus (HPV) —which prevents cervical cancer and is mainly aimed at girls between 9 and 14 years old, according to the recommendations of the World Health Organization (WHO)— is an intervention in which their voices must be heard.
Vaccination against human papillomavirus (HPV), aimed mainly at girls between 9 and 14 years old, according to WHO recommendations, is an intervention in which their voices must be heard.
In Sierra LeoneAs in most low-income countries, cervical cancer, mainly caused by persistent HPV infection, remains a notable health problem. It is the second most common cancer among women and one of the main causes of mortality, with approximately 372 deaths each year. The introduction of the HPV vaccine in Sierra Leone in 2022as a key preventive measure, was an initial success, but its coverage subsequently reduced considerably. To achieve the Cervical cancer elimination goals.And as the next vaccination campaign approaches, which will be expanded to older adolescents (11 to 18 years old), it is essential to understand the factors that influence its acceptance.
Understanding the barriers to HPV vaccination
Studies investigating the causes of low HPV vaccine coverage have identified structural barriersamong them fragile health systems – often very dependent on external support – a limited supply of vaccines, geographical access difficulties and low schooling. Furthermore, challenges such as disinformation and the distrust —including concerns about fertility and vaccine safety, influenced in the case of Sierra Leone by previous experiences with epidemic outbreaks, especially Ebola—, along with the stigma and the sociocultural beliefs around sexual and reproductive health, can influence the perception of the vaccine and health care-seeking behaviors among adolescents and young women. Therefore, understanding their points of view is key to designing an effective response.
Lessons from the SHARE project
Under the SHARE project, a mixed methodology formative evaluation was recently carried out in Sierra Leone to examine adolescent girls’ knowledge and awareness of sexual and reproductive health, cervical cancer, HPV and the HPV vaccine. Also searched understand the behavioral, social and structural factors that influence vaccination decision-making. The results of the study will guide recommendations for a more sustainable and culturally sensible vaccination campaign.
It is essential to include adolescents as active participants and prioritize a community-wide approach to ensure effective and sustainable vaccination.
The majority of adolescents participating in the study showed a generally positive perception of the vaccine, considering it effective and reliable. However, fears and doubts continue to represent a barrier to acceptance. Knowledge and awareness about HPV, cervical cancer, and the vaccine are uneven—influenced by both formal and informal sources—perpetuating myths, misunderstandings and stigmas. Girls perceive their peers and caregivers as both facilitators and obstacles to vaccination. Teachers, health workers and adolescents themselves are identified as key figures for involvement, and greater community awareness is required as well as expanding the administration of the vaccine.
Between the structural barriers perceived by girls There are possible costs, distance and poor communication strategy. In Sierra Leone, HPV vaccine uptake is determined by a number of factors that may support or hinder its uptake and therefore coverage. In this context, it is essential to include adolescents as active participants and prioritize a community-wide approach to ensure effective and sustainable vaccination.
A community approach for sustainable change
In it World Girl’s DayWe reaffirm the need to recognize them as active agents in the construction of their own reproductive health, and not as passive recipients of interventions.. Your involvement is essential. to ensure that health programs are effective, sustainable and respectful of their autonomy and developing capacities.
