hub: East Africa

As we marked the World Population Day on July 11^th 2025, under the theme “Empowering young people to create the families they want in a fair and hopeful world,” the day invited reflection on a fundamental truth: the health and sustainability of our world depend on women’s and girls’ ability to access their sexual and reproductive health and rights (SRHR).

Every reproductive health journey is rooted in autonomy and dignity, and when those rights are upheld, communities thrive. SRHR is not only a health issue; it’s a powerful lever for gender equity, economic development, and population resilience. Across Africa, women are leading this work, designing solutions, shaping systems, and breaking barriers in some of the most challenging contexts.

At WomenLift Health, we are proud to spotlight two such leaders: Elizabeth Katunga, who is expanding family planning and contraceptive access in underserved communities in Malawi, and Brigid Waliuba, who is advancing SRHR in humanitarian settings in Kenya.

Their leadership reminds us that sustainable population futures are built not only through policy, but the voices, decisions, and actions of women on the frontlines.

What is the Cost of Exclusion When SRHR Services Are Out of Reach?

Elizabeth Katunga: Ensuring access to sexual and reproductive health and rights (SRHR) services is not just a health intervention, it’s a commitment to placing women and girls at the center of development. When they are empowered to make informed choices about their reproductive lives, they are better able to stay in school, participate in the workforce, and shape their communities. SRHR access builds agency, and with it, the potential for long-term social and economic transformation. But when SRHR is neglected, particularly in underserved or remote communities, the ripple effects are profound. Teenage pregnancies rise, unsafe abortions increase, and maternal mortality rates increase. Education systems are strained by dropout rates and overcrowding. Health systems buckle under the pressure of high fertility and limited resources. And entire generations of women are held back by poverty, gender inequality, and unmet potential.

The cost of inaction is more than statistical; it’s personal. It limits futures, deepens inequality, and delays progress on nearly every Sustainable Development Goal, from health and education to gender equality and poverty reduction.

Brigid Waliuba: Unlimited access to sexual and reproductive health and rights (SRHR) services, particularly in underserved, remote, and crisis-affected communities, has deep, cross-cutting impacts. In sub-Saharan Africa, the unmet need for family planning is 26.9%, with only 22% of women of reproductive age and 25% of adolescent girls using modern contraceptives. This contributes to unintended pregnancies, unsafe abortions, and maternal mortality, especially among adolescents. East Africa, for example, has the highest teenage pregnancy rate on the continent at 21.5%, exposing girls to serious complications like obstetric fistula, poor child health outcomes, and a maternal mortality risk of 1 in 39, compared to 1 in 4,700 in industrialized countries. Without access to accurate information and youth-friendly care, these risks remain unacceptably high.  

The ripple effects are felt across sectors. Girls who become pregnant are more likely to drop out of school, limiting their future economic opportunities and reinforcing cycles of poverty. Women without access to contraception or safe abortion services face restricted choices and reduced productivity, placing additional strain on already overstretched public resources, especially in high-growth areas like informal settlements or refugee camps.

Social stigma, gender-based violence, and mental health challenges often go unaddressed, further compounding inequalities. These gaps undermine progress across multiple Sustainable Development Goals (SDGs), from health, education, and gender equality to poverty reduction and climate resilience. Without meaningful investment in SRHR and women’s leadership, population pressures will continue to outpace resources, and sustainable development will remain out of reach for the most vulnerable.

Advancing SRHR through a Human Rights Lens

Elizabeth Katunga: Integrating the Nine Human Rights Standards into SRHR programs ensures services are safe, respectful, and rooted in choice. It means women and girls receive accurate information and confidential care and can make informed decisions without pressure. In humanitarian and remote settings, this approach helps reach the most underserved through mobile clinics, trained providers, and community outreach. When rights are prioritized, trust grows, and so does access. Women are more likely to seek and use SRHR services when they feel respected and heard.

Brigid Waliuba: Applying the human rights principles to SRHR programs ensures services are inclusive, equitable, and responsive, especially in low-resource and humanitarian settings. It means no one is left behind, regardless of gender, age, disability, or location. A rights-based approach strengthens trust and uptake by promoting informed consent, privacy, and non-discrimination. It empowers communities, especially women and girls, to participate in shaping services that reflect their needs and realities. In low-resource settings, this approach helps rebuild disrupted systems with dignity at the core. Mobile clinics, community outreach, and feedback mechanisms make services more accessible and accountable, leading to better outcomes for those most at risk.

Designing Responsive, Accessible SRHR Services

Elizabeth Katunga: Ensuring women and girls can fully exercise their reproductive rights requires bold, people-centered shifts. First, they must be meaningfully included in decision-making, nothing for women and girls without them. Governments need to treat SRHR as a development priority, backed by political will and funding guided by data. Integration with broader health services and investment in self-care options can ease access, especially in hard-to-reach areas. In Malawi, youth-led, community-driven outreach models are proving effective—bringing mobile services to rural communities, reducing transport burdens, and creating safe spaces for young people to access accurate information and make informed choices.

Brigid Waliuba: Real reproductive rights go beyond access; they require bold, inclusive policies that give women and girls true agency over their bodies and lives. This starts with recognizing SRHR as a fundamental human right and embedding it into national health and social protection systems. Services must reach the last mile through mobile outreach, youth-friendly spaces, and trained community health workers, especially in rural, conflict-affected, or underserved areas.

Legal and policy reforms are also essential. Outdated laws that restrict access to contraception or criminalize abortion need urgent review. Programs must address harmful norms by engaging men and boys, prioritizing marginalized groups, and supporting feminist leadership that puts women’s voices at the center of decision-making.

To make these shifts sustainable, governments need to invest, not just financially, but structurally. This means building data systems that track gaps, financing models that protect SRHR even during crises, and accountability mechanisms that empower communities to shape and monitor services. In a world facing rising inequality and climate pressures, reproductive rights must be protected as part of a broader push for justice and resilience.

Putting Choice Within Reach: Centering Women and Girls in SRHR Delivery

Elizabeth Katunga: By bringing SRHR services closer to communities, including in districts like Nkhatabay, Mchinji, Dedza, Balaka, Phalombe, Chiradzulu, Chikwawa, and Mwanza, we reduce common barriers like transport costs and distance, especially for women and girls who often shoulder household responsibilities. This proximity increases access and gives them the space and time to receive clear, accurate information, empowering them to make informed decisions about their reproductive health. We also support youth-led outreach clinics, where young people, including adolescents and girls, organize through their own networks and request SRHR services. This model encourages autonomy from the start, allowing them to take ownership of their health and exercise their reproductive rights with confidence.

Brigid Waliuba: At the International Rescue Committee in Kenya, we ensure our SRHR programs align with national priorities by grounding them in key policies like the Reproductive Health Policy, UHC Policy, and PHC Act. Our technical teams stay up to date with these frameworks, allowing us to integrate program goals into national and county health strategies. We rely on routine data and client feedback to track progress and respond to community needs. Regular reviews with the Ministry of Health and partners help us identify gaps and make evidence-based adjustments that improve service delivery.

In refugee-hosting areas like Turkana and Garissa, we use inclusive, client-centered design, engaging women, girls, and persons with disabilities to shape services that reflect their lived realities. We also prioritize rights-based approaches and safe feedback channels to promote accountability and trust.

Policy and Leadership for a Rights-Based Future

Elizabeth Katunga: To uphold dignity, choice, and rights over the next decade, SRHR service delivery must be more innovative and integrated. We need to reframe SRHR as a multi-sectoral priority, embedded not just in health, but across education, gender, and even agriculture programs to drive broader development outcomes. Expanding mobile outreach clinics and investing in self-care options will be key to reaching women and girls in remote areas while easing the burden on health systems. Digital solutions, like service reminders and on-demand information, can also enhance access, especially for young people navigating their reproductive health journeys.

Brigid Waliuba: We need bold, feminist leadership that challenges structural inequalities and centers dignity, equity, and rights in SRHR policy. Women must be equipped and supported to lead at every level. Governments must prioritize domestic financing for SRHR and move away from donor dependence. Legal reforms, particularly around abortion and adolescent access to contraception, are urgent to remove barriers and stigma. To stay responsive, programs must be grounded in evidence and real community needs. That means stronger data systems, inclusive design, youth-led networks, and cross-sector collaboration to drive lasting, rights-based change.

Mental health remains one of the most pressing yet under-addressed challenges globally, especially among young people. Across the African continent, millions of young people face stressors that deeply affect their mental well-being. To mark the world Mental Health Awareness Month, we sat down with Hildegarde Mukasakindi, Clinical Instructor at Partners In Health in Rwanda and a 2025 WomenLift Health East Africa Global Fellow, to unpack the state of mental health in Africa. Drawing from her work in community-based mental health care, Hildegarde shares timely insights on stigma, resilience, leadership, and how we can collectively create a healthier future.

1. What are some of the primary drivers of mental health challenges among African youth today?

A 2021 study on mental health in Sub-Saharan Africa revealed that one in seven children and adolescents live with mental health problems, and one in ten meet the criteria for psychiatric diagnosis. Further, the prevalence of mental health challenges in adolescents affected by HIV/AIDS, exposure to violence, and poverty stands at 29% for depression, 19.3% for anxiety, 27% for post-traumatic stress (PTS), and 11.6% for suicidality.

Young people who are socio-economically vulnerable—like those experiencing poverty, inadequate access to basic needs, unemployment, exposure to violence and conflict, and orphanhood—are more susceptible to mental health problems. Other vulnerabilities like high social media usage, social pressures, conflict, alcohol and drug abuse, and inadequate access to supportive systems also raise vulnerability that if ignored could develop into mental health challenges. 

2. How have health emergencies such as the COVID-19 pandemic and the climate crisis impacted mental health across the continent?

COVID-19 brought about mass psychological distress, with high rates of mental health challenges including increased anxiety, depression, and insomnia reported during the pandemic. This was not only due to the loss of loved ones and increased economic hardship as a result of job losses, but also because of interventions such as quarantine, social distancing and isolation, which were psychologically draining and exacerbated loneliness, uncertainty, and stress.

The climate crisis causes additional psychological stressors. Eco-anxiety is a chronic fear that aligns with environmental degradation and its impacts, affecting many Africans. Droughts, floods, desertification, and food deficits threaten livelihoods, displace communities, and deepen poverty. These environmental processes fuel uncertainty and despair, undermining resilience and dampening the desire to participate in climate adaptation activities.

Overall, the interconnection of infectious disease, climate change, and socio-economic status creates a cumulative driver of mental health challenges in Africa. Efforts to combat such effects must be multidisciplinary in nature—integrating mental health services and enhancing community resilience, access to basic resources, and support from governments and other stakeholders.

3. How can we address stigma to encourage more open conversations around mental health and improve access to mental health services?

Reduction of stigma at the community level requires a multi-intervention strategy consisting of robust mental health policies, education, community engagement, quality mental health care and empowerment programs.

Skills training in areas such as maintaining health following a diagnosis of mental illness, identifying strengths and goal setting, planning personal recovery, enhancing social skills, confronting stigma and violence, and improving livelihoods can empower those living with mental health disorders.

In addition, the integration of mental health care into national health systems can help deliver support more seamlessly and make it less stigmatizing. If mental health treatment is included as a routine part of care, seeking help becomes normalized and the rights of individuals with mental disorders can be better protected.

Establishing a culture of open communication, increasing access to quality care, and empowering affected persons comprise the key measures towards reducing stigma and improving mental well-being in African societies.

4. Based on your extensive experience in delivering community-based mental health services, how has mental health care in Africa evolved over the past decade?

The past 10 years have been a welcome movement towards more equitable access to mental health care through community-based approaches in Africa. While some African countries have endorsed and implemented policies and programs to integrate mental health into primary health care, challenges around effective implementation, limited resources, inadequate infrastructure and training among medical professionals, together with stigma, persist.

That said, commendable efforts have been made to develop community-based, culturally appropriate, sustainable, cost-effective, and scalable interventions across Africa.

In Rwanda, for example, the Mentorship and Enhanced Supervision at Health Centers for Mental Health (MESH-MH) program, a collaboration between the Ministry of Health and Partners In Health, is aimed at strengthening primary health care by providing treatment of severe and common mental illnesses through community-based care, as per Rwanda’s National Mental Health Policy.

In Ethiopia, an integrated district-level model of delivering mental health care utilizing task-sharing has effectively filled the treatment gap in addressing severe mental disorders in rural environments. In Ghana, Positive Psychology Interventions (PPIs) have been successful implemented in rural settings. In Zimbabwe, psychological intervention with peer support is provided through the Friendship Bench program in rural settings to combat depression.

These are examples of community-level interventions with promising results and effectiveness in meeting mental health needs and yielding positive health outcomes. Scaling up these programs to aid in closing the treatment gap for mental disorders in Africa would make a significant difference to expanding and strengthening mental health care.

5. Africa is home to six of the top ten countries with the highest suicide rates in the world. As a leader in global health, what role do you believe leadership plays in addressing the challenges around mental health in Africa?

Suicide is a critical public health issue that warrants urgent attention. Every 40 seconds someone takes his or her own life, and at least 90% of suicide victims are thought to suffer from a mental disorder, with approximately 60% of them being depressed at the time of death.

Young adults and adolescents aged 15 to 30 years are a high-risk group for suicide, which results from the interaction between biological, genetic, psychological, sociological, cultural, and environmental factors, as well as untreated mental health conditions.

Bold, inclusive, and transformative leadership is required to address the rising suicide rates across Africa. Such leadership should reinforce comprehensive policy reforms that place mental health within the overall agenda of public health, with adequate financing, resource mobilization, and the establishment of culturally appropriate, context-specific mental health services.

In addition, inclusive leadership should involve multiple stakeholders— community leaders, youth, women, and even traditional healers—to tackle the stigma around mental health. Mainstreaming mental health conversations and practice into everyday life fosters trust and ownership by the community. The participatory approach also creates supportive mechanisms that include family, friends, religious groups, community associations, and social networks. Enabling constructive engagement reinforces community resilience and mental well-being.

While such support networks can reduce suicidal risk, they cannot eliminate it. Transformational leadership must transcend ingrained systemic barriers, facilitate early recognition and treatment of mental health disorders, and advocate for the integration of mental health into the broader development agendas. It is also necessary to advocate for data-driven approaches to monitor progress and modify interventions accordingly.

6. You are a strong advocate for community-based mental health care. Can you elaborate on the benefits of this approach and how it can be scaled up effectively?

Community-based mental health care enhances access to services, reduces stigma, improves medication adherence, prevents chronicity of illness, and is cost-effective, especially in low-income settings. They also limit long waiting times and lead to better health outcomes.

In addition, community-based mental health services promote culturally responsive and holistic approaches that enable individuals to receive services in comfortable, familiar environments. Engaging stakeholders from within communities enables frank discussions about mental health, which heightens awareness, acceptability, promotes early detection of mental illnesses, and reduces stigma. Facilitating the provision of care closer to patients’ homes also allows patients to remain close to their families, form meaningful relationships, avoid social isolation, and enhance community ownership and better health outcomes.

Scaling up mental health care in the community requires a multi-faceted approach to develop supportive national policies, build political will, engage communities and allocate funding, which are all critical steps. Prioritizing cost-effective interventions and leveraging data for ongoing improvement all contribute to sustainability of effective mental health care services.

Putting these measures in place can dramatically improve access, limit disparities, and improve mental health outcomes among populations.

7. How can we better engage African youth in mental health advocacy and empower them to be part of the solution?

Integrating mental health education into school curricula and youth programs can increase awareness, enhance knowledge, and promote early help seeking to boost resilience. Providing training and leadership opportunities enables young people to serve as peer educators and advocates, teaching them with a sense of ownership and responsibility.

In today’s digital world, leveraging technology—mobile applications, online support groups, social media—is key to engaging more youth and making mental health conversations more accessible and engaging.

Including the youth as partners in policymaking and program design will also ensure their needs and concerns are heard, resulting in more effective interventions. Through education, youth-friendly forums, and participatory engagement, we can empower the youth to amplify mental health awareness and advocacy and influence systems of care in Africa.

8. Looking ahead, what are your hopes and aspirations for the future of mental health care in Africa, and what steps do you believe are crucial to achieving these goals?

My hope is that mental well-being becomes an integral part of daily life for everyone at every stage of life. Just as we promote exercise and nutrition to improve physical health, we need to foster a culture of mental wellness by empowering individuals from a young age to thrive in spite of adversity and build resilience.

I call for leadership with a ripple effect—policy informing, resource organizing, and community stimulating toward a shared vision of improved mental health resilience and well-being in Africa.

Hildegarde Mukasakindi is a Clinical Instructor for the Mental Health Program at Partners In Health (Rwanda) and a 2025 WomenLift Health global Fellow