“You are too young to have sex…too young to be pregnant….” These are words etched in the echoes of time, often passed from older generations to the younger generations or “Ma2000” as we often call them. Parents speak avoidance but what happens when avoidance eventually becomes experimentation? Just like telling a toddler not to put his hand on a flame – the most you will succeed in doing is making them even more curious…curious enough to touch the flame when your back is turned.
Curiosity, experimentation and then consequences. Now, as we said before, parents and the community preach avoidance so what happens when the flame burns the toddler or in our case, the young women of Lesotho? Those in the rural areas barely have access to SRH education and talking about anything sexually related, including contraceptives, sexually transmitted diseases, pregnancy and others, stigma becomes the order of the day. How do we expect girls, women and people of the LGBTQ+ community to feel free and open enough to seek information on Sexual and Reproductive Health with all the stigma attached to seeking such services?
Let us have a look at infrastructure for one. Do we cater for all persons regardless of their backgrounds including age, disabilities, race or sexual orientation, while observing ethics and principles that include non judgmental attitudes? For instance, men who have sexual relations with other men have countlessly advocated to have inclusive hospitals and clinics where they can feel at ease to share their issues without being stigmatized by other patients and/or doctors and nurses.
The negative outcome of this stigmatization is that it has led to defaulting on medications and treatment for many people, particularly people living with HIV/AIDS. For example, lately, there has been talk about one hospital with an infectious diseases wing and a taxi conversation constantly replays in my head. Two people, a man and a woman, were stating that they would never go to that particular hospital because then everyone would know that they potentially have sexually transmitted diseases or HIV/AIDS. That was their understanding about the infectious diseases wing. That is just how much we lack knowledge on SRHR.
Moving from the issue of high disease prevalence due to either lack of access to information and/or resources, once a girl or woman is pregnant, the chances of maternal and infant mortality gain momentum, especially in the highlands of Lesotho. Why? People who are skilled in delivering SRHR information and services are in shortage. Despite the trainings and capacity building for community healthcare workers to bridge the issue of economic barriers, there is always a gap in information reaching the people who need it most – young people and people in rural areas who are dominated by cultural practices that prohibit use of contraceptives or any talk related to SRHR.
But there is hope, particularly in this digital transition era where technology has a far and wide reach. In the digital age, innovation is transforming how we approach public health, offering new opportunities to address longstanding challenges. One such area where technology holds immense potential is sexual and reproductive health (SRH) education for young women, particularly in low- and middle-income countries (LMICs) where access to healthcare resources can be limited. A recent study in Lesotho testing the use of a digital conversational agent, “Nthabi,” to deliver SRH education provides promising insights into how digital tools can bridge gaps in knowledge and empower young women.
The importance of SRH education for young women cannot be overstated. Unwanted pregnancies, sexually transmitted infections (STIs), and the broader challenges of reproductive health often disproportionately affect young women, especially those in under-resourced settings. In countries like Lesotho, where nearly 70% of young women are students and many remain unmarried, the need for accessible, reliable health education is more urgent than ever.
The trial, which involved 172 young women using Nthabi to learn about family planning, folic acid use, and healthy eating, demonstrates that digital health interventions can be effective in improving knowledge. Participants showed a significant increase in understanding of family planning (a 4.4% improvement in correct responses) and folic acid use (a striking 26.3% increase in correct answers). These findings suggest that Nthabi is not only accessible but also impactful, offering a scalable solution to address the SRH education gap in Lesotho.
What makes Nthabi particularly promising is its adaptability. The system can be accessed on both smartphones and loaned tablets, ensuring that the intervention reaches a wide audience, regardless of device ownership. Additionally, the relatively high engagement with the content—an average of 8.6 interactions per participant signals a level of interest and willingness among young women to learn.
