Health and Healthcare Systems

Sierra Leone trials new ways to cut teen pregnancy

Mariatu Sesay, 15, smiles as she carries her daughter Nadia while she walks outside her house in the countryside village of Sierra Leone  July 11, 2019. REUTERS/Cooper Inveen - RC18D8F12EE0

Every year, 21 million girls aged 15 to 19 become pregnant in developing countries. Image: REUTERS/Cooper Inveen

Nellie Peyton
Journalist, Reuters Foundation
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Umu Bangura was 16 when she got pregnant by a man who gave her money and told her he loved her, but soon after disappeared - a crisis faced by many young mothers in the West African nation, which has one of the world's highest adolescent birth rates.

The Sierra Leonean teenager hid her pregnancy for three months, long enough to pass her high school exams with top marks, and then left home, knowing her family would shun her.

"No one tried to reach me. It seemed like, 'She is gone. Let us just forget her'," she said, recalling how for years she moved from place to place, sometimes homeless, selling rice or doing housework to support herself and the baby.

"When I gave birth to my baby, I cried a lot because I didn't have any single thing for her." Bangura, now 22 years old, told the Thomson Reuters Foundation.

Some 21 million girls aged 15 to 19 become pregnant in developing countries each year, and complications during pregnancy and childbirth are the leading cause of death for this age group worldwide, according to the World Health Organization.

Although the global adolescent birth rate has declined in the last two decades, the number of teen pregnancies is set to rise, it says, because the world's population is growing.

Sierra Leone had the 13th highest rate of teenage pregnancy globally in 2017, with 113 births per 1,000 adolescents, more than 10 times the rate in Europe, according to the World Bank.

Pregnancy - driven by low education, poverty and abuse - often precedes child marriage in Sierra Leone, unlike in other African countries with similarly high rates. Girls who become pregnant are typically married off or thrown out.

While the government and charities have been trying to reduce teenage pregnancy for years - promoting birth control and empowering girls - some researchers are testing new approaches that seek to change broader attitudes and family roles as well.

"It's all well and good to educate girls about availability of contraceptives or healthcare services," said Lisa Denney, a researcher at the London-based Overseas Development Institute (ODI) think-tank.

"But this isn't fundamentally a problem of lack of knowledge. It's actually about power relations and girls' lack of agency over their own lives."

ODI is working with three international aid agencies on trial programmes aiming to change attitudes around sex and gender that drive teenage pregnancy in Sierra Leone - discussing it not only with girls but with parents, men and boys too.

Fatmata, 20, holds her twin daughters outside her home in Susan's Bay, Freetown, Sierra Leone. July 24, 2019.
Fatmata, 20, holds her twin daughters outside her home in Susan's Bay, Freetown, Sierra Leone. Image: Reuters Foundation/Nellie Peyton


Sierra Leone, one of the poorest countries in the world, holds fairly liberal views on premarital sex. Relationships between young girls and older men who provide money, clothes or food are common.

But teens who get pregnant are often disowned by their parents, who believe they wasted their money educating daughters who now have no prospects.

"Pregnancy is the ultimate shame," said Regina Bash-Taqi, head of the Institute for Development, a Sierra Leonean consultancy which is working with ODI.

A 2013 government survey in Sierra Leone found that three in 10 girls aged 15 to 19 were pregnant or had given birth, while two in 10 were married.

Girls in rural areas are more likely to marry, while many single mothers in the capital city, Freetown, fend for themselves with little support, said aid workers.

Pregnant girls were banned from school in 2015. The law is being challenged in West Africa's regional court, though some locals said most pregnant teens drop out of school anyway due to stigma and the need to support themselves.

In the Freetown slum of Susan's Bay 17-year-old Adja cradled her baby in a shack in the rain.

"My parents said I should go stay with the father, but I didn't want to live with him," said Adja, who declined to give her full name. "It was just a mistake."

She was forced to leave home and now sells corn cobs by the roadside, living with an older sister who provides only a place to sleep.

Adja is training to be a tailor through a scheme run by international charity Save the Children, which has helped about 300 young mothers in Freetown to either return to school, start a business or learn a trade.

"My daughter's responsibility is solely on me," she said.

The one-year-old project has worked well so far, said the charity, but reaches only a fraction of those in need.

"We preach to parents to encourage their children to back to school after they give birth," said Mohamed Kargbo, a representative of the National Secretariat for the Reduction of Teenage Pregnancy, which coordinates charities' activities.

"Most of them will shun their children and they will end up on the streets and get pregnant again."

Fatmata, 20, is pictured with her aunt and two daughters outside their home in Susan's Bay, Freetown, Sierra Leone. July 24, 2019.
Fatmata, 20, is pictured with her aunt and two daughters outside their home in Susan's Bay, Freetown, Sierra Leone. Image: Thomson Reuters Foundation/Nellie Peyton
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High hopes

The rate of teenage pregnancy is declining in Sierra Leone, but not fast enough, said Bash-Taqi of the Institute for Development, who advised the government on a new strategy published last year.

"We're doing the same things and we're plateau-ing, so we need to take it to the next level now," she said.

Key to this is learning more about beliefs and behaviours that drive teen pregnancy, such as why mothers who know their daughters are having sex do not teach them about birth control but then get angry if they fall pregnant, she said.

Bash-Taqi and ODI are working with three projects over the next year to see what they discover and how to integrate new ideas into large-scale programmes.

Save the Children is training young people to examine how social norms influence their behaviour, and how to change them - for example the fact that rape and sexual assault are treated less seriously than other crimes.

Concern Worldwide is looking at the motivations and beliefs of men and boys, while the International Rescue Committee is focusing on girls' role in family decision-making, which is generally minimal.

"I have very high hopes, but a lot is resting on how much work we do," Bash-Taqi said.

Bangura has managed to turn her life around after her difficult entry into motherhood. Six years on, she is working for a development agency helping teenage mothers, studying for a computer science degree and has reconciled with her parents.

"We need to keep talking to teenage mothers," Bangura said, crediting her success to a friend who told her life was not over because she was pregnant and she could still pursue a career.

"If they sit at home alone, they will feel like nothing."

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