Overview

• This article explores why out-of-school adolescents remain one of the most overlooked groups in Sexual and Reproductive Health and Rights (SRHR) programming across Africa.
• While many initiatives successfully deliver health education through schools, they often fail to reach girls who have dropped out due to period poverty, early pregnancy, caregiving responsibilities, poverty, or other life circumstances.
• Using the story of Shanice, alongside examples from Girl Power USA’s community-based work, the article highlights the risks faced by out-of-school girls and argues for more intentional, community-driven approaches.
• It also outlines practical recommendations for governments, donors, and civil society organisations to ensure that every adolescent, regardless of whether she is in school, has access to the information and services she needs.

The Missing Girls

Shanice is thirteen years old, from Uganda, and dreams of becoming a doctor. Her parents struggle to keep her in school, but there is one thing they cannot afford: sanitary pads. At first, she missed a few days of school each month. Then a week. Then a month. Eventually, she stopped going altogether.

A girl drops out of school. Suddenly, she disappears, not from her community, but from the programmes designed to protect her.

Across Africa, many Sexual and Reproductive Health and Rights (SRHR) programmes are delivered through schools. While this approach reaches millions of young people, it can end up missing those who are most vulnerable: adolescents who are no longer in the classroom. These girls are not absent from society. They are working in markets, caring for younger siblings, living in children’s homes, navigating early motherhood, or simply trying to get by. Yet they are largely absent from the conversations, data, and funding decisions that shape SRHR initiatives.

This gap is also evident in Rwanda. According to the 2025 Rwanda Demographic and Health Survey, 8% of girls aged 15 to 19 have ever been pregnant, rising from less than 1% at age 15 to 20% by age 19 (National Institute of Statistics of Rwanda, 2025). Yet adolescent health advocates working on the ground, including Viviane, a GSRH specialist and advocate, point to something the data doesn’t explicitly state: a significant number of those girls are not in school. So when health educators arrive, these girls are not included in programme registers.

At Girl Power USA, we see the faces behind these numbers every day. In Kenya, there is a young woman who grew up in a children’s home and is now trying to build her life independently, with no school system to link her to health services. In Lagos, there is a sixteen-year-old girl selling vegetables in the market from dawn until dusk, too exhausted by evening to attend any session organised for her. And there is Shanice in Uganda, who stopped going to school not because she wanted to, but because she had no sanitary pads. One missed week became a month. One month became permanent.

Their stories push us to ask a question we cannot ignore: if SRHR programmes are built primarily around schools, are we shutting out the very girls who need them most?

Why “Out-of-School” Often Means “Out of Sight”

Schools are often the most practical place to reach adolescents. Teachers, school nurses, clubs, and organised timetables give programme designers a ready-made structure for health education. But practical does not always mean equitable.

For every girl receiving SRHR information in a classroom, there is likely another who never had the chance to attend school, who left to care for a sick parent, who works to keep her family afloat, or who became a mother before she could finish her education.

These girls do not miss health sessions because they are unwilling to participate. They miss them because they are simply not where the sessions take place.

Viviane puts it plainly: “We talk about fairness, but we only reach the girls who are already easy to reach. That is not fairness. It is a habit. And it is a habit that keeps resources flowing to girls who face fewer barriers, while the ones carrying the heaviest burdens get nothing.”

If we are serious about ensuring every adolescent can make informed decisions about her health, we need to start by being honest about who we are leaving out.

The Double Danger

Dropping out of school not only affects a girl’s education, but it also exposes her to a wider set of risks. Girls who are out of school face higher rates of early marriage, sexual exploitation, gender-based violence, and unintended pregnancy (Tessema et al., 2022). They are also far less likely to have received reliable information about contraception, consent, menstrual health, or where to go for help. Both problems feed each other.

The consequences can build quickly. What begins as a lack of sanitary pads can grow into something much harder to recover from. A girl misses a few days of school; she falls behind, she feels embarrassed, and withdraws. Eventually, she stops going altogether. Once she is out, she loses not just her education but the health talks, the school nurse, the peer groups, and the menstrual kits that were only ever available inside school gates.

Through our Period Power initiative, we see this pattern again and again. As Viviane puts it, when programmes fail to follow girls beyond the school gate, they are punished twice: “first by the situation that pushed them out, and then by the services that never came looking for them.”

Meeting Girls Where They Are

If SRHR is genuinely a right, then programmes have to reach girls wherever they actually are, not just in places that are convenient to deliver.

At Girl Power USA, community-based approaches have shown real results. We bring health education into orphanages, villages, community centres, and other spaces outside of formal schooling. We look to train people whom those girls already trust: women community leaders, market traders, peer mentors, and local health workers, to build a community-led system that is built with the right context for sustainability.

Timing matters just as much as location. A teenage mother with a young child cannot always make it to a 2 P.M. session. A girl who works in a market all day is not free on a standard weekday schedule. If we want to reach the girls who have been overlooked, we have to be willing to work around their lives, not expect them to rearrange those lives around us.

From Inclusion to Intention

Closing this gap takes more than good intentions. It takes programmes that are deliberately designed to find the girls who are hardest to reach.

Donors need to fund community-based work alongside school-based programmes, and they need to accept that reaching marginalised girls is slower and less straightforward to measure. Governments need to name out-of-school adolescents explicitly in health policies, not as a side note but as a group that deserves dedicated attention and resources. Civil society organisations need to look honestly at who they are not serving and find solutions for that gap.

And every team, before any programme launches, should sit with one question: who is not in the room? That question, taken seriously, tends to point directly to the individuals who need the most support.

SRHR programmes cannot only be built inside classrooms. They have to work in markets, children’s homes, farming communities, places of worship, and every other space where young people are actually living.

The girl selling goods at a roadside stall has the same right to health information as the girl sitting in a school health lesson. The fact that she is harder to reach through existing systems is not her problem. It is ours.

And what about Shanice? The thirteen-year-old girl whose dream of becoming a doctor began to fade when period poverty pushed her out of school. Once she left the classroom, she did not stop being an adolescent. She did not stop needing information, support, or access to health services. Yet the systems designed to reach young people increasingly stopped reaching her.

Shanice’s story is not unique. It is the reality of millions of out-of-school adolescents across Africa whose needs remain invisible because our programmes are often built around where we expect young people to be, rather than where they actually are.

Until girls like Shanice are at the centre of SRHR programming, our work is not finished.

FAQs

1. Why are out-of-school adolescents often excluded from SRHR programmes?

Many SRHR programmes are delivered through schools because they provide an organised environment where large numbers of adolescents can be reached efficiently. However, this approach unintentionally excludes young people who have left school due to poverty, pregnancy, disability, family responsibilities, or other challenges.

2. Who are considered out-of-school adolescents?

Out-of-school adolescents are young people who are not enrolled in formal education. They may have dropped out, never attended school, or completed their education early. Many spend their days working, caring for family members, living in children’s homes, or raising children of their own.

3. Why is reaching out-of-school girls important?

Girls who are out of school often face higher risks of early marriage, unintended pregnancy, gender-based violence, and limited access to reliable health information. Without targeted programmes, they can miss essential SRHR education and services that help protect their health and future opportunities.

4. How does period poverty contribute to school dropout?

When girls cannot afford menstrual products, they may miss school during their periods. Repeated absences can lead to falling behind academically, embarrassment, and eventually dropping out altogether. Once they leave school, they may also lose access to school-based health education and support services.

5. What does the article recommend to improve SRHR access for out-of-school adolescents?

The article recommends expanding community-based SRHR programmes, training trusted community members, delivering services in locations where adolescents already spend time, offering flexible schedules, and ensuring governments and donors intentionally include out-of-school adolescents in policies and funding priorities.

6. What role can communities play in improving adolescent SRHR?

Communities can help by creating safe spaces for health education, supporting peer mentors, engaging community leaders and healthcare workers, reducing stigma around adolescent reproductive health, and connecting vulnerable girls with health services even if they are no longer attending school.

7. How is Girl Power USA addressing this challenge?

Girl Power USA delivers SRHR education beyond schools by working in orphanages, villages, community centres, and other community settings. Through initiatives such as Period Power, the organisation partners with trusted local leaders to reach girls who might otherwise be excluded from traditional school-based programmes.

8. What can policymakers and donors do differently?

Policymakers can explicitly include out-of-school adolescents in national SRHR strategies and allocate resources to reach them. Donors can support community-based programmes alongside school-based initiatives and recognise that reaching the most marginalised adolescents often requires more flexible, long-term investment.