This examination of changes in adolescent fertility emphasizes the changing social context within which adolescent childbearing takes place.

Since the end of the civil conflict in 2002, Sierra Leone has worked hard on rebuilding its health and social system. Although progress has been made in reducing maternal mortality, the number of women who die as a result of complications during pregnancy and/or childbirth is still one of the highest in the world. The high number of pregnant girls and teenage mothers has severe health and social consequences and contributes to the problem of maternal mortality in Sierra Leone. KIT and partners in Sierra Leone and the Netherlands have joined forces with the Government of Sierra Leone to investigate and address teenage pregnancy through knowledge sharing capacity building and the development of interventions. This work is carried out within the Public Private Partnership (PPP) Sierra Leone, one of the programs that make up the MDG5 Meshwork for improving Maternal Health*. This report includes the justification, methodology, results and recommendations of a qualitative study interviewing teenage girls who were pregnant or had been pregnant, and focus group discussions with their peers, elders and leaders in various communities in Moyamba, Kailahun, Kambia and Bo. The report describes the stories of the girls who became pregnant, the reasons for their pregnancy and the consequences of their pregnancy for them, their family and the man/boy who impregnated the girl. These stories were used in the training of health workers and for the development of a community education strategy. The report formulates implications and recommendations for further policy and strategy development for adolescent sexual and reproductive health in Sierra Leone. The latter are also based on the outcomes of a discussion of implications during a dissemination meeting of the results in Sierra Leone. *Part of the knowledge strengthening component of the MDG5 Meshwork Public Private Partnerships Programme for the improvement of Maternal Health in Sierra Leone.

This book challenges orthodox public perspectives on reproduction. It relies on participant observation, field censuses, interviews, and use of official demographic, epidemiological, and health statistics.