Change the Context Not the Girls: A Critical Analysis of Efforts to Reduce Teenage Pregnancy in Sierra Leone

By Denney, Lisa; Gordon, Rachel et al. | Journal of Research in Gender Studies, January 1, 2017 | Go to article overview

Change the Context Not the Girls: A Critical Analysis of Efforts to Reduce Teenage Pregnancy in Sierra Leone


Denney, Lisa, Gordon, Rachel, Kamara, Aminata, Lebby, Precious, Journal of Research in Gender Studies


Introduction

Reducing high levels of teenage pregnancy has long been a challenge in Sierra Leone. In 2013, the country ranked among the ten nations with the highest rates of teenage pregnancy in the world, with 28% of girls aged 1519 years pregnant or already having had at least one birth (UNFPA, 2015). Nearly 40% of women between the ages of 20 and 24 had their first child before the age of 18 (UNFPA, 2013: 15). The majority of teenagers are sexually active, with a 2013 survey of 3,000 15-to-35-year-old female and male respondents finding that 95% were currently sexually active and half of the sexually active females had their first sexual experience at the age of 16 (Marie Stopes, 2013). The same survey found that only 45% reported using any contraceptive method (Marie Stopes, 2013: 2). A reported increase during the Ebola outbreak raised the profile of teenage pregnancy and led to significant investments of donor resources to address the problem. UNFPA (2015) have since reported that 18,119 girls became pregnant during the Ebola epidemic in Sierra Leone. While there are no concrete figures on pregnancy rates prior to the epidemic with which to compare, this is widely considered to be a significant increase.

Governmental and aid funding to address this challenge has been channeled towards priorities laid out in Sierra Leone's National Strategy for the Reduction of Teenage Pregnancy, launched in 2012 by President Ernest Bai Koroma. This Strategy came to an end in 2015, with a new National Strategy to be developed in 2016. It is therefore an opportune moment to reflect on the nature of the problem of teenage pregnancy in Sierra Leone and efforts to reduce it, and to think creatively about how to move forward with current and new programming. This analysis of the complexities of the issue of teenage pregnancy in Sierra Leone may also be informative for policymakers and practitioners elsewhere in the region and internationally who are grappling with similar issues.

This paper builds on two stages of research in Sierra Leone aimed at examining donor-supported programming around the reduction of teenage pregnancy. It seeks to understand some of the common approaches that donor and non-governmental (NGO) programs have adopted to deal with this problem, and explore how these efforts play out at the local level. The intention is to provide reflections and analysis that can inform the development of the new National Strategy and assist in refining programming to reduce teenage pregnancy. Overwhelmingly, our research finds that there is a need to shift the focus of interventions from changing girls' behavior to changing the contexts in which they are becoming pregnant. That is, much programming to date has focused on encouraging girls to abstain from sex, use contraception, stay in school, and generally make "better" choices. Some important progress has been made as a result - adolescent fertility rates (number of births per 1,000 women ages 15-19) have dropped from 164.5 in 1997 to 125.3 in 2012 (World Bank, 2015). Yet this approach overlooks the fact that girls' behavior and decisions are the outcome of a much wider context, and it is this context that constrains their options and incentivizes girls to make the decisions and behave in the ways that they do. In order to realistically reduce teenage pregnancy, programming must aim to change the circumstances in which girls are making decisions that lead to early pregnancy - not merely to encourage girls to make decisions against the odds. In addition, it must account for and respond to widespread sexual abuse and exploitation of girls, about which girls themselves can make can make essentially no decisions at all. These are not easy tasks, and involve grappling with complex and systemic issues like gendered power relations and relative poverty that puts teenage girls in vulnerable situations. Yet if programming continues to focus overwhelmingly on girls, we are asking those with the least power and resources to carry the burden of change. …

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