When Laws Become Barriers
The Fight for Adolescent Access to Sexual and Reproductive Health Services in East and Southern Africa
By Francis Maingaila
Lusaka, Zambia24 -- 15-07-2026 -- For many adolescents across East and Southern Africa, seeking healthcare is not always a straightforward journey. Young persons may walk into a clinic looking for help, but instead of receiving care, often meet with questions about their age, parents, or guardians.
"Where are your parents?"
"Why have you come alone?"
For some adolescents, these questions become the first barrier standing between them and the healthcare services needed.
This challenge is at the centre of the Step Up 4 Access Campaign, a regional initiative addressing legal and policy barriers to adolescent sexual and reproductive health and rights (SRHR) services.
Supported under the Regional SRHR Fund by Hivos and partners, the campaign brings together organisations in Kenya, Uganda, Malawi, Zambia, and Zimbabwe to push for clearer, harmonised, rights-based approaches to adolescent healthcare access.
Speaking during a stakeholder engagement meeting in Zambia, Tatenda Songore, Executive Director of Youth Advocates — a Zimbabwe-based organisation working across the region on adolescent health, rights advocacy, emergency response, livelihoods, and youth empowerment — said the campaign was shaped by adolescents' experiences of being denied care because of age restrictions and unclear legal frameworks.
Songore said the organisation's youth helpline, which receives more than 300,000 calls annually from callers in Malawi, Botswana, and Zimbabwe, has repeatedly highlighted one major concern — minors being denied services for lack of parental or guardian consent.
"Many young people walk long distances to health facilities hoping to receive help, only to be told to return with their parents or guardians," — Songore
According to Songore, one of the biggest challenges across the region is the gap between health policies that promote adolescent-friendly services and laws that leave healthcare providers uncertain of their legal standing.
"Service providers are caught between wanting to offer a service and fearing repercussions because of unclear laws," — Songore
This uncertainty can result in adolescents missing opportunities for early treatment, counselling, HIV prevention, contraception, and other essential health services.
For Songore, the issue is not only about laws and policy but about real teenagers affected by these barriers.
He shared the story of a teenage girl abused by her stepfather, who was also the family's breadwinner.
After developing health complications, she visited a local health facility but was asked to return with a parent or guardian before receiving support — yet the person she needed to report was the person she feared, and her mother was afraid to act because the family depended on him financially.
Songore said such cases show how systems requiring parental involvement can unintentionally prevent vulnerable adolescents from accessing healthcare and protection.
"These are realities happening in our communities. They are not just discussions happening in offices," — Songore
He explained that delays in accessing care can affect adolescents' education, economic opportunities, and future wellbeing — a teenager facing unintended pregnancy, a sexually transmitted infection, or violence without timely support may be forced to leave school and fall into a cycle of poverty.
"If a young person is already facing a health challenge, denying them care will not solve the problem. The solution is to provide accurate information, protection, and healthcare support," — Songore
Through legal and policy reviews across the five countries, the Step Up 4 Access Campaign identified gaps between national laws, healthcare policies, and adolescent protection strategies.
It is now advocating for a regional model law and guidelines on adolescent and child access to healthcare, including SRHR services — a framework meant to help countries protect adolescents while giving healthcare workers the confidence to provide necessary care without legal risk.
Songore stressed that improving adolescent access does not mean removing the role of parents, families, or communities, but creating a system that gives youth the support they need while communities continue guiding and protecting the next generation.
"We must ensure that young people are protected, but protection should not become a barrier that prevents them from receiving healthcare," — Songore
Songore also spoke at the event, noting that some adolescents referred to health facilities are turned away for lacking a parent or guardian despite travelling long distances for care — an experience that has driven Youth Advocates to work more closely with partners to identify and address these barriers.
Human rights experts, government officials and civil society organisations have called for stronger systems that enable adolescents to access health services safely, confidentially and without discrimination.
Ms. Lange said adolescent healthcare must uphold rights to dignity, privacy, information, equality and participation, while ensuring young people are involved in decisions affecting their health.
She stressed that HIV testing and other adolescent health services must be inclusive of persons with disabilities and key populations, who are often excluded from health discussions.
Ms. Lange said services should be guided by voluntary participation, informed consent, confidentiality and counselling, adding that stigma remains a major barrier preventing adolescents from accessing HIV prevention and treatment services.
She urged stakeholders to address discriminatory attitudes within communities and health facilities to create safe environments where young people can seek care without fear.
Meanwhile, UNAIDS Zambia HIV Prevention Acceleration Lead Florence Hamahwa called for increased investment in HIV prevention among adolescents and young adults, who continue to account for a significant proportion of new infections.
Ms. Hamahwa said 38 percent of people living with HIV in Zambia are adolescents and young adults, while the country records about 30,000 new infections annually.
She warned that reductions in HIV funding could threaten progress made in prevention and treatment efforts, stressing the need to expand access to youth-friendly prevention options and services.
Hivos Regional SRHR Fund Programme Manager Limpo Chinika called for stronger collaboration among organisations working in adolescent sexual and reproductive health and rights (SRHR).
Ms. Chinika said young people must not only be represented in policy discussions but should be actively involved in designing programmes and policies that affect their lives.
She emphasised that meaningful youth participation is critical to developing solutions that respond to the realities faced by adolescents.
Ms. Phiri said protecting adolescents should not mean denying them access to health services, but ensuring they receive care that is safe, confidential and provided with dignity.
The workshop also received contributions from Zambia Police Headquarters Victim Support Unit representative Edgar Kazembu, who highlighted the importance of protection mechanisms in addressing challenges affecting children and young people.
Stakeholders agreed that improving adolescent access to healthcare requires coordinated efforts among government institutions, civil society organisations, health providers and young people themselves.
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