UCSF

In national policy, international commitments, non-governmental organizations’ program documents, and public health research, adolescent pregnancy increasingly appears as a foregone conclusion: the scope and scale of the problem is taken to be synonymous with its essential nature. In settings such as Sierra Leone, where adolescent pregnancy is extremely common, this simple recitation of statistics is often and easily framed as a crisis demanding public action (Government of Sierra Leone 2018). And, with its associations with weak access to health care, household poverty, gender inequitable norms, there is little question that experiences of adolescent girls in Sierra Leone who become pregnant are characterized by hardship and risk, shaped by weak social and health services, discrimination and social exclusions (Bandiera et al. 2012; Denney et al. 2016; de Koning et al. 2013; Kostelny et al. 2016; Risso-Gil and Finnegan 2015; UNFPA 2011; UNICEF 2013). However, as sociologist Constance Nathanson has argued, “While sexuality and motherhood outside of orthodox familial boundaries are as constant as those boundaries themselves, the meanings attributed to those behaviors and the strategies advocated and implemented in their management have varied with the social and cultural setting in which the behaviors are found” (Nathanson, 1991: 104). These meanings, in turn, carry critical material implications. Drawing on a body of literature that holds social constructions: of gender, adolescence, the nature of adolescent sexuality, and adolescent pregnancy as a social and/or “health” problem, to primary, I explore how the “problem” is currently defined and situated in Sierra Leone. The three papers that comprise my project explore the same general topic, the social construction of “adolescent pregnancy” in Sierra Leone, from three different perspectives. In the first substantive chapter, I analyzed the country’s National Strategy for the Reduction of Adolescent Pregnancy and Child Marriage (2018-2022) and the definition of the “problem” that it uses. In invoking official statistical definitions of a “health” problem, “evidence-based” approaches, girls’ rights, and gendered social processes, the Strategy presents the “problem” as predefined and equated with its official statistical definition. Yet, hostility, discriminatory treatment, and health risks facing pregnant girls appeared intact, as natural consequences of pregnancy itself, while responsibility for “solving” the problem largely resided with girls, families, and rejections of the constraints imposed by “culture,” nebulously defined. In Chapter 3, I drew on focus group discussions (FGDs) conducted with adolescent girls, boys, and young men in a low resource urban setting to gather perspectives on the nature of “adolescent pregnancy.” As part of an individualizing discourse on “adolescence” as a period of achievement marker of girls’ moral failures, interspersed with family shame, and boys’ disobedience. The meaning of contraception appeared to be in flux, potentially accepted as an indication that girls are “planning for the future,” or serious about education, opposed as a marker of either promiscuity, infidelity or challenges to male power over reproduction. In Chapter 4 my data were collected from an adaptation of the Population Council’s Participatory Building Assets Toolkit or “Asset Exercise”(Population Council 2015) with girls, boys, and adults in five rural communities. The Asset Exercise operationalizes human rights discourse on empowerment, centering on the idea exercising a right is contingent on having the resources and skills to do so before it is necessary and uses the question of “what age” girls need each asset to be able to use it when necessary (Kabeer 1999; Population Council 2015). Across discussions, a sex- and age-essentialist view of adolescent girlhood was common, shaping decisions to assign “assets” to adult ages: often too late for them to “use” assets to either effectively carry out gender-conforming social roles, or for a non-normative, more expansive set. Throughout, the constraints imposed by poverty and weak social infrastructure appeared influential in reinforcing the low expectations for girls. Adolescent pregnancy appeared largely as a product of girls’ moral failings in combination with a sexualized social environment that put them “at risk” from early in adolescence.