5th UK Implementation Science Research Conference

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2 Young Lives: Mentoring scheme for pregnant adolescent girls in Sierra Leone

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PRESENter

Cristina Fernandez Turienzo

Photo_Cristina_Fernandez

presenter biography

Cristina is a postdoctoral research fellow at the Department of Women and Children’s Health (Faculty of Life Sciences and Medicine, King’s College London) with more than 15 years of clinical and research experience in a wide range of international settings. She has experience in clinical research of tropical and infectious diseases, complex interventions in maternal health, clinical trials and mixed methods implementation research.

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background

Sierra Leone (SL) has one of the highest maternal mortality rates in the world. Adolescent girls are particularly vulnerable, many times belong to disadvantaged communities usually driven by poverty, lack of education & employment opportunities. In 2015, a household survey conducted in Easter Freetown showed an adolescent maternal mortality of 1 in 102, and a following qualitative study found important contributing factors such as a) vulnerability to adolescent pregnancy: not living with birth family, sex for water/grades/school fees, criminal justice system, availability & accessibility of contraception and abortion; and b) vulnerability to death when pregnant: neglect, abandonment; being cared for by a non-parental adult, delayed care seeking, obstetric risks (i.e. bleeding, eclampsia, infections), socio-economic factors. Cross-cutting :Gendered social norms for sexual behaviour.
In 2017, 2YoungLives (2YLs) was developed as an upstream solution to maternal/perinatal mortality for adolescent girls and their babies. Pregnant girls are supported by mentors to: attend antenatal care and deliver at facilities; re-establish family connections’ have practical advice about childbirth, parenting, health-seeking behaviour, contraception; run small business; and re-engage with school or start vocational learning. After a small-scale pilot across 4 districts over 4 years, 2YLs has mentored over 200 girls with no maternal deaths and 8% perinatal loss. Girls report close loving relationships with their mentors, and a sense of agency and wellbeing from the educational and socio-economic elements of the scheme.

MEthod

As part of the NIHR CRIBS group that started in 2021, we are carrying out a hybrid type 2, pilot cluster RCT in 12 areas (both rural + urban) to assess the feasibility of 2YLs in new communities and inform procedures for a larger scale up programme. A mixed methods process evaluation will explore context, implementation (i.e. acceptability, fidelity, adoption, sustainability), mechanisms, & experiences of care, health & wellbeing.

results

We believe 2YLs directly addresses some key government priorities (e.g., Radical Inclusion policy, National Strategy for the reduction of adolescent pregnancy and child marriage) with a community-run, sustainable intervention which complements statutory services such as free maternity care and free secondary education. Pilot data confirms it has potential to save lives and promote wellbeing of adolescent girls and babies in Sierra Leone.

Conclusion

KCL and the University of Sierra Leone, with support from in country collaborators, have partnered to build maternal health implementation and evaluation research and expertise where it is needed most. We believe close partnership and planning will promote uptake & success, strengthen institutional capacity & create a platform for advancement in health projects and services, across all cadres of maternal health provider.