Sierra Leone

Recovering from the Ebola Virus Disease: Rapid assessment of pregnant adolescent girls in Sierra Leone

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Executive Summary

The assessment of adolescent pregnancy in Sierra Leone was undertaken in order to map and identify adolescent girls (aged 10-19 years) who got pregnant during the Ebola crisis, to enable an understanding of the reproductive health needs and wellbeing of adolescent girls in order to inform programming. Pregnancy is one of the leading causes of adolescent deaths in sub-Saharan Africa, where adolescents bear the greatest burden of pregnancy-related morbidity and mortality. The adolescent birth rate in Sierra Leone is higher than average for sub-Saharan Africa. Key factors associated with adolescent pregnancy are age at first sex, early marriage, contraceptive use and education. It is believed that the Ebola crisis that led to the closure of schools and degradation of health systems (Oyedele et al., 2015; Loaiza & Liang, 2013) further led to the increase in teenage pregnancies.

The study surveyed adolescent girls who were pregnant or had recently delivered in the 14 districts of Sierra Leone to assess their health, education and social welfare contexts. Data collection was conducted in July and August 2015 in 12 districts --- Bo, Bombali, Bonthe, Kailahun, Kenema, Kono, Koinadugu, Moyamba, Pujehun, Tonkolili, Western Area Urban, Western Area Rural --- and in two districts (Kambia and Port Loko) in November and December 2015.

A total of 18,119 adolescent girls were included in the final analysis, the majority (58 per cent) were between the ages of 18--19 years, not married (77 per cent) and who had attended formal schooling (at least 80 per cent); however only 9 per cent were currently attending school. Money was cited as the most common barrier to returning to school by 51 per cent of the adolescents whereas only 5 per cent cited the stigma of pregnancy. Among the adolescents who dropped out as a result of the pregnancy, the majority (76 per cent) would have liked to return to school but money was cited as the main hindrance. More than half (57 per cent) of the adolescent girls were pregnant at the time of the survey with most (88 per cent) reporting first-time pregnancies and in their third trimester. A high percentage of 15--17-year-old girls had a first-time pregnancy during the Ebola outbreak period (42 per cent).

The ever use of any kind of family planning was reported by less than a third (31 per cent) of the girls. The overall proportion of antenatal care (ANC) -- at least one visit for adolescent girls that were pregnant or had delivered -- was 15 per cent. The majority (80 per cent) that had delivered did so in a health facility. With regard to care and financial support of the child, the majority (45 per cent) expected financial support and care from the father of the child.

This report is divided into four substantive chapters: chapter one provides the context of adolescent well-being in Sierra Leone in which this assessment is undertaken. It assesses health, social welfare and education as it relates to adolescent pregnancy in the context of Ebola, and explains the rationale for the assessment.

Chapter two details the quantitative data sources and methods of data analysis adopted in the study. It defines the sampling technique, including the research tool and the data analysis. Chapter three presents the results from the data analysed on health as it relates to pregnancy (ANC and postnatal care, site of delivery and family planning), social welfare (marital status, care and financial support of children and the experience of violence) and education (current school enrolment, barriers to schooling, and awareness of and access to learning facilities).

Chapter four is a discussion of the general findings as they relate to adolescent health, social welfare and education among adolescent girls in Sierra Leone, and includes the limitations of the data and recommendations for future studies and actions.