2013 Sierra Leone: An Evaluation of Teenage Pregnancy Pilot Projects in Sierra Leone
Author: NASSRIN FARZANEH
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Teenage pregnancy and motherhood has been identified as the second most prevalent child abuse practice in Sierra Leone. It constitutes a national and community-wide problem, with a prevalence of 68 percent pregnancy rate among sexually experienced teenage girls, with a mean age of 15, and 28 percent of teenage boys having caused a pregnancy. While sexually active teenagers had frequent sex (49 percent in the last few months and 44 percent in recent weeks), slightly more than one-third (35 percent) had ever used a condom. Only a small percentage (9.2 percent) of the girls between 15 and 19 who had more than one sexual partner during the last twelve months reported to have used condom the last time they had sex. Moreover, even though about 64 percent of the females between the ages of 15 and 19 know HIV can be transmitted from mother to child, only around 7 percent of sexually active girls within this age group have been tested for HIV and know their results.
As the National Strategy for the Reduction of Teenage Pregnancy states, “Early child bearing and teenage pregnancy is a complex issue with multiple causes and diverse consequences, which requires a large spectrum of interventions. It appears that it cannot be addressed independently from other adolescent and youth sexual and reproductive health (AYSRHR) questions and from economic and social issues.”
The Sierra Leone Out-of-School Study identified ‘high pregnancy rate’ amongst primary and secondary school children as a strong contributing factor as to why school-aged children drop out of school. Teenage pregnancy has serious long-term and wide-ranging consequences – from health complications (for young mother and the baby) to educational attainment and broader socio-economic repercussions. With nearly 48 percent of the total population between 0-17 years of age , prevention and reduction of teenage pregnancy is a national priority.
To address the root causes of teenage pregnancy, UNICEF established partnerships with Child Fund, Save the Children, Council of Churches of Sierra Leone (CCSL), Restless Development, and BRAC to implement five pilot projects in the districts of Bombali, Kennema, Kailahun, Pujuhun, Koinadugu, Kono, and Port Loko with the aim to reduce the prevalence of teenage pregnancy in the country.
The aim of this study is to foster learning about the actors, contexts, and challenges in preventing/reducing teenage pregnancy for the purposes of strategic decision making. It explores the pilot projects’ contribution in producing situational and contextual changes (i.e., gender attitudes and relations, family relations, community relations and commitment, degree of community collaboration, empowerment, access to and utilization of reproductive health services, access to information, etc.) in selected areas in which the projects were implemented. The evaluation attempts to provide this information by comparing differences and changes in outcomes in areas in which the projects were implemented with those that were not. This study does not examine the attribution of individual programs on prevention or reduction of teenage pregnancy; nor does it assess the success or failure of the five projects over one another.
The study employs an outcome mapping evaluation approach. It examines ‘upstream effects’ such as processes that contribute to and influence social change rather than ‘ultimate effects’ of the projects such as reduction in teenage pregnancy.
The study took place in the districts of Port Loko, Kenema, Kailahun, and Pujehun between July and August 2013. In all districts, two communities were selected according to the following criteria:
• One intervention community where at least one of the pilot projects was implemented
• One comparison community where none of the pilot projects was implemented
A total of 726 individuals took part in 79 focus groups led by three teams of interviewers in eight communities in the four districts. Eleven key informant interviews were also conducted by the international consultant. The study employed purposive sampling in the selection of a wide range of focus group participants and key informant interviewees . In both the intervention and comparison areas, the focus groups consisted of: boys and girls (in and out of school); parents/guardians; religious leaders, school management board and committee members, and reproductive health service providers. The key informant interviews included: the Family Support Unit (FSU) of the police; Child Welfare Committee workers; and community leaders including community chiefs.
Six focus group questionnaires, composed of semi-structured questions, were designed to ensure that the objectives of the pilot projects for different target groups and beneficiaries were adequately addressed. The key informant interviews included specific questions regarding the role of the FSU, CWC workers, and community leaders (paramount, section, and local chiefs), general impressions regarding any changes in community knowledge, attitudes, and behavior with regard to teenage pregnancy, and perceptions of barriers in addressing teenage pregnancy.
Findings and Conclusions:
The projects in communities have contributed to raising awareness regarding such issues as the health consequences of early pregnancy.
Although teenage pregnancy is considered an important problem in all communities, active civic engagement and collective cooperation and information sharing including frequent dialogues with the “equitable” involvement of all members and social groups in addressing the root causes of the problem is, for the most part, still missing. Absence of collective efficacy in finding solutions to improve the situation is reflected in the manner in which failure to resolve the problem of teenage pregnancy is attributed to external factors (i.e., poverty, technology, Nigerian pornographic films, dance clubs, Child Rights, and God), as well as “blame shifting” tendencies among girls and boys, fathers and mothers, parents and children, and community leaders and the government.
Notions of childhood and adulthood, tensions surrounding traditional norm and value systems, gender identities (including concepts of manhood and womanhood) and power relations, social status, social exchange, and religious beliefs explain many of the remarks, attitudes and actions that otherwise may appear contradictory, as, for example, when a girl or a boy respects someone who abstains or refuses to have sex until they have finished school, and yet views someone’s rejection of his or her sexual advances as disrespectful. Or, when a parent acknowledges that teenage girls and boys should know about contraceptives, and yet views talking to his/her children about sex and contraceptives as taboo.
Misconceptions about contraceptives continue to reflect lack of proper education on reproductive health and contraception, and religious beliefs. Absence of comprehensive family planning services at the health centres, and/or a sex education syllabus in primary and secondary schools constitute important barriers to use of contraception by teenagers.
• Consider joint programs, and promote sustainable change by unifying the visions and coordinating the work of multiple actors in program design, management, and monitoring, and balancing skewed power relations.
• Conduct bi-yearly or yearly qualitative and quantitative studies (convenience sampling and/or case studies) as a way to monitor change in ‘levels and context of influence’ on behavior, as well as perceptions of project beneficiaries on the effectiveness of program strategies and design and implementation processes in producing the desired outcomes
• Engage in greater community outreach activities in the form of frequent group discussions with girls and boys to obtain a better understanding of their interests and needs to best promote behavior change in the near future.
• Expand training and opportunities in livelihood activities, and offer a wider range of skills to pregnant teenagers, teenage mothers and male drop outs to promote economic empowerment.
• Facilitate out of school girls’ and boy’s control over income from livelihood activities, possibly through youth initiated cooperatives, to encourage trials of marketing and investment schemes and to promote decision-making over how funds are to be used for the family’s livelihood and personal development.
• Provide exposure visits to teenage mothers or pregnant teenagers to income generation projects in other communities and districts, and opportunities to interact with other program beneficiaries for purposes of learning and problem solving regarding finances and savings.
• Advocate for livelihood education/home economics in secondary schools.
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