“THE STRESS IS ALL ABOUT SEX” Conceptualisations of intimate relationships amongst school attending youth in Sierra Leone

Abstract

Background Sierra Leone (SL) has persistently high levels of adolescent pregnancy and reducing this is a priority. Data that captures the experience of young people (YP) and the decisions that they make about sexual and reproductive health (SRH) is required to help inform education and public health interventions. Objectives This study aims to establish how YP at school in SL understand their rights and responsibilities around sex and relationships, and to find out what the facilitators and barriers to making positive decisions in this area are, with a view to informing locally developed SRH programs. Methods An adapted version of the Participatory Ethnographic Evaluation and Research (PEER) approach was used to involve the YP throughout the research process. Six male and six female students were trained in research methods and met in gender group sessions (GGS) to develop the tools for data collection. Each then interviewed 3 friends and fed these interviews back to the visiting researcher in debriefing sessions. Initial findings were discussed with the participants in GGS for clarification and interpretation. Key informant interviews and notes from the GGS also contributed to the data set. Results Evidence demonstrated the pervasive nature of gender inequalities between the groups. Expectations of the communities and pressure to achieve at school weighed heavily on the young women, and yet the power in relationships remained decisively with the young men. While romantic notions of “good” relationships and the acknowledgement of the benefits of equality were commonplace, sex was referred to negatively by both genders. It was described as a tool of control, with transactional sex and “sexual harassment” portrayed as normal. Relationships were kept secret from all but trusted friends, and the stresses that were associated with navigating them were vividly described as physical and mental illness. Anxiety surrounded pregnancy and there was strong pressure to abort in secret despite the danger this entails. There was no mention of contraception. Conclusion The study demonstrates the need to consider the broad social context when considering SRH interventions. Messages about risks create anxiety amongst females in school, but structural factors significantly limit their ability to influence outcomes. This study suggests the need to work with boys, men and the wider community to share the burden of responsibility, improve knowledge and develop strategies for change.