Family structure and sexual and reproductive health outcomes among adolescents in rural Sierra Leone

Abstract

Orphanhood is common in sub-Saharan Africa, and is a critical issue shaping global assistance for children. Care arrangements for children are often fluid, and many ‘orphaned’ children have a surviving biological parent. This study examines the protective effects of family-level factors on early sex and pregnancy in rural Sierra Leone. A survey of 530 adolescents in 2 districts in Sierra Leone was analysed to evaluate associations between living arrangement and orphanhood on recent sexual activity and pregnancies out of wedlock. After controlling for confounders, living with one's mother (AOR = 0.46, 95% CI: 0.22–1.00) and living with both parents (AOR = 0.36, 95% CI: 0.17–0.73) were protective against recent sexual activity. Orphan status was not significantly associated with recent sexual activity. Among 164 sexually active adolescents, neither living arrangement nor orphanhood was associated with pregnancy. This study demonstrates the protective effect of living with a surviving biological parent to delay early sexual debut. Once an adolescent becomes sexually active; however, living arrangement is not associated with the risk of pregnancy out of wedlock. The findings suggest that supporting family connectedness and preventing unnecessary family separation may benefit at least some aspects of adolescent sexual and reproductive health in Sierra Leone.

Keywords:

• Sierra Leone
• adolescence
• sexual and reproductive health
• orphans
• child protection

Acknowledgements

The authors gratefully acknowledge UNICEF Sierra Leone, Plan International Sierra Leone, World Vision Sierra Leone and an anonymous donor for their financial support for this phase of work.

Disclosure statement

The authors declare that they have not financial interest in and no financial conflict with the subject matter or materials discussed in this paper. Columbia University Medical Center Institutional Review Board approval reference: AAAB7134.

Notes

1. The Interagency Learning Initiative is a multi-year learning project bringing together several international agencies working in child protection. The initiative is coordinated by Save the Children and led technically by Columbia University. The reports of the initiative are available at http://www.childprotectionforum.org.

2. Within Sierra Leone, the Ministry of Social Welfare, Gender and Children's Affairs is the main government body responsible for child protection. An evaluation of the strength of the child protection system in Sierra Leone was undertaken in 2010 and can be accessed at http://www.unicef.org/wcaro/english/Child_Protection_Systems_Sierra_Leone_Report.pdf