Meggie Mwoka,Anthony Idowu Ajayi, Grace Kibunja, Collins Cheruiyot, Ramatou Ouedraogo, Kenneth Juma, Emmy Kageha Igonya, Winnie Opondo, Emmanuel Otukpa, Caroline Kabiru, Boniface Ayanbekongshie Ushie
One of the obstacles to domesticating and operationalising continental commitments that promote adolescent sexual and reproductive health and rights (SRHR) in sub-Saharan Africa (SSA) is the lack of stakeholder-driven research or inputs in setting the research agenda.
This commentary describes a cocreation initiative that engaged strategic stakeholders to identify key policy goals and research priorities necessary to advance continental and subregional advocacy around adolescent SRHR in SSA.
The development of the cocreated regional research agenda encompassed three phases: (1) a landscape analysis involving the mapping of existing research and research priorities on adolescent SRHR in SSA; (2) a 2-day cocreation workshop with regional and subregional SRHR policy, advocacy and research actors; and (3) a validation exercise where stakeholders reviewed and confirmed the research priorities.
The emerging adolescent SRHR policy goals centered on policy and law reforms to end child marriage, implement sexuality education in and out of schools, and universal access to comprehensive and integrated sexual and reproductive health (SRH) services for adolescents.
The main research priorities focused on understanding the needs and service access of vulnerable adolescent populations; implementation research on the delivery of comprehensive sexuality education and adolescent-friendly SRH services; understanding the impact of child marriage on health and well-being; and the analysis of legal and policy provisions addressing the age of consent to SRH services for adolescents.
Various stakeholders, including funders and researchers, will find this research agenda useful in improving adolescent SRHR in SSA.
The sub-Saharan Africa (SSA) region has one of the poorest adolescent sexual and reproductive health (SRH) indicators, and a multiplicity of structural and sociocultural factors contribute to these poor adolescent SRH outcomes. Prevailing sociocultural and religious beliefs characterise adolescent sexuality as a taboo. As a result, interventions or policies aiming to improve adolescent SRH outcomes face significant opposition. Additionally, vague and restrictive regulations on the right to privacy, confidentiality and informed consent to accessing SRH services limit the provision and access to SRH services to adolescents.
Regional commitments on sexual and reproductive health and rights (SRHR), such as the ground-breaking Maputo Protocol, have explicitly recognised adolescents' right to youth-friendly SRH services, comprehensive sexuality education (CSE), safe abortion and postabortion care. Although most countries in SSA have ratified the Maputo Protocol, domestication and operationalisation remain slow. Also, where it is domesticated, poor prioritisation and resource allocation towards adolescent SRH programming, poor knowledge of the laws and policies by adolescents, services providers, communities, and societal barriers hinder effective implementation.
Regional and subregional policy and advocacy actors require robust empirical evidence to facilitate domestication of the continental commitments on adolescent SRHR. In response to the expressed evidence needs, the African Population and Health Research Center (APHRC), under the auspices of the Challenging the Politics of Social Exclusion project, undertook a research agenda-setting process. The APHRC brought together multiple stakeholders to identify the evidence gaps hampering progress in adolescent SRH, comprehensive abortion care and the inclusion of sexual and gender minorities. This undertaking was in recognition that evidence is a critical lever in policy development and implementation. The cocreated research agenda seeks to bridge the gap between policy actors and researchers and facilitate mutually beneficial agendas. This commentary describes the agenda cocreation process and highlights the evidence priorities that stakeholders identified as critical to policy and advocacy processes around adolescent SRH.