Atlantic Fellows for Health Equity brings together health professionals from around the world and across disciplines to build leaders, combat disparities and create community. Its mission is to develop global leaders who not only understand the roots of health inequities but also have the skills and courage to create more equitable organizations and communities.
Each year, fellows share their reflections through Equity Talks — short presentations that highlight their leadership journey and learning during the fellowship. We are proud to bring some of these insights to the BMJ Leader Blog audience.
The blog below was written by Madalitso Juwayeyi, a 2025 Atlantic Fellow for Health Equity.
To watch the recording of this talk, click here.
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I grew up in Chinsapo, one of the most under-resourced communities in Malawi’s capital city. Like many girls in my community, I was surrounded by traditions that shaped what it meant to become a woman long before I understood their consequences.
Growing up, there was an initiation ceremony in my community. In Chichewa, we call it Chinamwali. Chinamwali is for young girls ages nine to 15.
I remember being a child and wanting to go for Chinamwali. Every year, I would tell my parents that I wanted to go, and every year they would say, “Next year, next year, next year.” But next year never came.
The reason I wanted to go for Chinamwali was simple. When the girls came out of Chinamwali, they were given money. As a child, I wanted that money so much.
As I grew older, I realized that Chinamwali was not as joyful and happy as I had thought. Girls were taken out of the community and into the bush for three weeks. And the lessons they were learning there were very different from what I imagined.
At Chinamwali, girls were taught how to please a man, how to aspire to marriage, and how to be better women based on how the community defined a “better woman.” I later learned that because of these lessons, many girls would come out and want to practice what they had learned. This made them more vulnerable to teenage pregnancy, child marriage, HIV and sexual exploitation.
It was when I got to college that I learned about sexual and reproductive health and rights, and about the concept of feminism. That is when I realized that the “no” I was getting from my parents was not them lying to me. It was protection.
I remember learning about feminism in class and thinking about my father, who raised girls and sent them to school. When I went home, I told him, “Dad, you are a feminist.” He said, “No, I’m not. What is that?”
What he did not know was that by sending us to school, he was challenging systems that had, for so long, made women believe they were less than, that they belonged in the kitchen and nowhere else.
I was lucky. I had parents who believed in education and big sisters who served as my role models. But I realized that most girls in my community did not have the same privilege.
That is what birthed a dream in me. In Malawi, a dream is called lotto. My lotto was to be a role model for girls. I wanted to be the big sister for the girls in my community.
When I finished university, I co-founded FACT Malawi, a youth-led organization that advances access to sexual and reproductive health. Our first funding came from the Gates Foundation in 2018.
At that time in Malawi, there was a movement challenging cultural systems and traditional practices. When we received that funding, I was excited to be part of that movement.
Our first project was to change the curriculum for Chinamwali. We reduced it from three weeks to three days. We introduced feminism and sexual and reproductive health into the curriculum. We made sure it only happened during school holidays so that no girl had to miss school because of Chinamwali.
We also partnered with community leaders because at that time, the concept of sexual and reproductive health was still new. We trained them, and we taught young people to advocate for their own sexual rights. We signed memoranda of understanding with ten community leaders to change negative attitudes toward sexual and reproductive health.
In 2020, we received funding from HIVOS. Through this work, we realized that while we were advocating for youth-friendly sexual and reproductive health services, hospitals were not actually providing youth-friendly care. For young people, these spaces were more youth-frightening than youth-friendly.
Young people would go to hospitals and meet older women, like the ones they saw at church, who would ask them questions like, “What are you doing here?” These are the kinds of questions communities like to ask young people.
So we decided to establish youth-friendly centers, where young people could offer services to other young people.
Through this work, we identified another challenge: the increasing rates of HIV among adolescent girls aged 19-24. When we looked deeper, we found that many of these girls were in relationships with “blessers” — older men, known globally as sugar daddies.
These relationships were driven by poverty and the desire for a “better life.” But they involved older men in their forties and fifties having sexual relationships with teenage girls. There was no power to negotiate for safe sex. That is why HIV rates continued to rise.
We partnered with UNAIDS and took HIV testing services directly to universities. Across five universities in Blantyre, we tested 5,000 young people. We distributed condoms and launched a campaign using Gen Z language that went viral. Many young couples aged 16 to 18 came for HIV testing before engaging in sexual relationships.
But my dream was not finished.
While I was excited about the grassroots impact, I wanted to do more beyond my community and in Malawi. That is when the Atlantic Fellowship came into my life.
Through the fellowship, I learned about health inequities I had never considered and lessons about systems, transformation and leadership. I realized that the problems we face in Malawi are not different from those being addressed elsewhere in the world.
At that moment, I knew my dream was no longer mine alone.
Even as the global funding landscape became more uncertain, especially for women’s health, the fellowship reminded me that we are not fighting alone. We are fighting for the next generation, for our nieces and children, and for a world that is better than the one we inherited.
As I move forward in this journey, with a strong back and an open heart, I believe that change is possible.
Author
Madalitso Juwayeyi
Madalitso Juwayeyi co-founded Forum for AIDS Counselling and Training (FACT-Malawi) the Health Equity and Policy Initiative (HEAPI), a youth-led organization dedicated to empowering young people using a peer-to-peer model. She is a Senior Atlantic Fellow for Health Equity.
Declaration of Interests
No interests to declare