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Document Abstract
Published: 2014

A community-­driven approach to reducing teenage pregnancy in Sierra Leone: midline evaluation brief

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Preliminary evidence from a 2009 global evidence review suggested that community-based child protection mechanisms are likely to be more effective and sustainable if they are linked with formal aspects of the child protection system. To test the value of nonformal-formal linkages, this action research uses a quasi-experimental design to test the effectiveness of a community owned and driven intervention that seeks to reduce teenage pregnancy.

In each of Moyamba and Bombali Districts, there were two clusters of three communities in different but comparable chiefdoms. One cluster was an intervention cluster, whereas the other was a comparison cluster. In the intervention clusters, community members from three villages worked collaboratively to develop an intervention that addressed a child protection concern of their choosing. In both intervention clusters, the communities elected to focus on teen pregnancy, an issue that had been documented as a key concern in previous ethnographic work. The intervention, which was developed by the community, included components on family planning, sexual and reproductive health education, and life skills and was implemented in partnership with NGOs and District Ministry of Health partners.

Using a survey of adolescents (13-19 years of age), this study reports on mid-term (T2) changes in contrast to the baseline (T1) findings: 
  • exposure to the intervention was found to increase with age, and was particularly high among individuals who had a partner but were unmarried. The latter individuals had 1.7 times the odds of  attending a presentation when compared to those who were married
  • between baseline (T1) and T2, the percentage of teenagers aged 15-17 in intervention areas who were willing to ask their partners to use a condom increased by 17.1 percentage points, whereas the control villages  showed a decrease of 6.2 percentage points
  • girls and adolescents under 15 years in intervention areas showed a significant increase in their intention to  use condoms regularly, while the opposite was true in control areas
  • similarly, adolescents who were exposed to the intervention’s programs were nearly twice as likely (1.74 times the odds) to report intending to say no to unwanted sex
  • sexual activity was also found to have increased between T1 and T2 in control  areas,  while  no  increase occurred in intervention areas, suggesting possible signs of impact of the program
Several lessons can be gleaned from these initial findings, which may influence future efforts. First and foremost, data from the T2 survey support  the proposed theory of change with some early evidence of changes in knowledge, attitudes, intentions, and behaviour around sexual health in the intervention communities in Moyamba and Bombali districts.  The findings around behaviour, specifically the intent to turn down unwanted sex and increase condom use, are promising, and point to the importance (and early effectiveness) of peer discussions of these sensitive topics in a comfortable, safe space.
 
In particular, the increased willingness to ask a partner to use a condom and plans to use condoms in people under 18 is encouraging for future rounds of the project. By heightening awareness and shifting social norms in the generation of adolescents who are just becoming sexually active, change may follow in targeted outcome areas including pregnancy.   Combined with the perceived increased access to contraceptives in all areas, there are signs that the intervention is supporting adolescents in the treatment villages to use contraception in early sexual activity.

It is evident that certain groups, particularly those over 18 years, currently have a higher likelihood of accessing  the presentation component of the intervention. While this is a positive development, particularly if high access among unmarried adolescents with a partner indicates a desire to prevent pregnancy before marriage, it may also indicate a need for additional strategies for engaging younger populations. Collectively, and given the short window of time in which it has been active, the findings presented in this brief suggest positive trends and signal that the intervention is moving in the right direction with the potential for a much larger impact in the coming years. 
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A scientific diagram of the circulatory system, painted on a wall in Dubangat Momicha government-run secondary school, in Ethiopia. The mural indicates the main arteries and veins of the heart.

© 2004 Crispin Hughes, Panos Pictures