The health of women and girls is particularly important to national development; however in Sierra Leone, early pregnancy and teenage child bearing serve as a significant hindrance to the health, wellbeing, progress and empowerment of adolescent and young women.
The Government of Sierra Leone’s vision of prosperity is embodied by the country’s Agenda for Prosperity (AfP). The AfP has many priorities, among which is a commitment to improve the health of the country’s youth. To quote President Koroma, “The health of adolescents and young people is pivotal to the prosperity of Sierra Leone, so I have made this a new priority in the Agenda for Prosperity.[1]” The health of women and girls is particularly important to national development; however in Sierra Leone, early pregnancy and teenage child bearing serve as a significant hindrance to the health, wellbeing, progress and empowerment of adolescent and young women. The National Strategy for the Reduction of Teenage Pregnancy (NSRTP) was launched in 2013 to address these issues.The NSRTP paper identified several factors contributing to the high rate of teen pregnancies in Sierra Leone, such as poverty, illiteracy or low levels of education, early or forced marriage, low use of contraceptives and rape.The issue of rape is worthy of particular attention, as it is not unusual for older men to engage in sexual intercourse with young girls. The NSTRP, quoting Wessels (2011) states that “a significant number of older men coerce girls into having sex, and condoms are very seldom used in such violation”[2]. In a paper on the criminal justice system in Sierra Leone, Lamin (2013) states that “Abuse of women, including rape, sexual assault, and sexual slavery, rampant during the war still continues albeit in a moderate form… cases of rape are underreported, and indictments are rare, especially in rural areas. Medical or psychological services for rape victims are still limited, and rape victims cannot afford the medical report needed to file charges.”[3]Communities often shame men into marrying the girls they have impregnated, completely taking away her choice of a husband. According to the 2008 Demographic and Health Survey (DHS), about 35% of teenage mothers have partners that are at least ten years older[4].The DHS also indicated that about 28% of women had engaged in sexual intercourse by age 15, and 26% of women ages 15-19 had already had a birth.This is a cause for national concern; not only is early pregnancy the third most common reason for girls dropping out of school, teenagers also represent about 40% of maternal deaths (MICS 2010). The dropping out and deaths of adolescent girls form a juncture where MamaYe’s goal to promote maternal and newborn survival intersects with the government’s commitment to improve adolescent and youth health.Schools provide an advantageous environment for health interventions, as it is easier to reach girls concentrated in a locale. High drop out rates at younger ages due to pregnancy impedes interventions targeting adolescents that could bolster maternal and newborn survival. For example, the Tetanus Toxoid (TT) Vaccine is administered to young women to reduce chances of neonatal mortality. According to the NSRTP, “many girls decide at an early age that they want to have a baby.[5]” This is reason enough to protect them early with Tetanus Toxoid vaccines to further reduce mortality of these young mothers and their babies. Drop outs due to pregnancy accounts for only 14% of girls reaching upper secondary school levels, as compared to 32% of boys (NSRTP 2013). According to 2012 HMIS data, about 9% of TT vaccines were administered in schools. In addition to theSierra Leone EPI policy (2013) on administration of TT vaccines in schools needing to be strengthened so more vaccinations are given in school, these vaccines need to be administered earlier, so even if drop out occurs as a result of pregnancy, the baby will already be fortified against neonatal tetanus.In conclusion, strategies to reduce teenage maternal mortality and pregnancy in Sierra Leone may look complex but redressing social factors like rape, providing legal, moral and psychological services for rape victims, encouraging male involvement in efforts to reduce teenage pregnancy, and providing tetanus toxoid to in-school teenagers up to TT2 can further eliminate preventable deaths in Sierra Leone thereby facilitating social gains as wished-for by Agenda for Prosperity. MamaYe’s commitment to reducing neonatal mortality harmonizes with national efforts to keep girls in school longer, so they can be reached with life-saving vaccines.[1]GHD (2013). Global Health and Diplomacy. Fall 2013. GHD news.com, p62-65[2]NSRTP (2013). National Strategy for the reduction of Teenage Pregnancy. Sierra Leone Government May 2013[3]Lamin, T. (2013). The Criminal Justice System in Sierra Leone-Issue Paper November 2008 [Online]. Available from:http://ogi.gov.sl/content/criminal-justice-system-sierra-leone-issue-paper-november-2008#sthash.WsX7RPCK.dpuf (Accessed: 20 September 2013).[4]SLDHS (2008). Statistic Sierra Leone and ICF Macro. 2009. Sierra Leone Demographics and Health Survey 2008. Calverton, Maryland, USA: Statistic Sierra Leone (SSL) and ICF Macro [5]NSRTP (2013). National Strategy for the reduction of Teenage Pregnancy. Sierra Leone Government May 2013