title: 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.
authors.affiliation: a Mailman School of Public Health , Columbia University , New York , NY , USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Stark
authors.affiliation: a Mailman School of Public Health , Columbia University , New York , NY , USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Tan
authors.affiliation: b School of Population and Public Health , University of British Columbia , Vancouver , BC , Canada.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Muldoon
authors.affiliation: c Department of Anthropology , Columbia University , New York , NY , USA.
authors.forename: Dora
authors.initials: D
authors.lastname: King
authors.affiliation: d United Nations Children's Fund (UNICEF) , Freetown , Sierra Leone.
authors.forename: David F M
authors.initials: DFM
authors.lastname: Lamin
authors.affiliation: e Save the Children UK , London , UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lilley
authors.affiliation: a Mailman School of Public Health , Columbia University , New York , NY , USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Wessells
keywords: Sierra Leone; adolescence; child protection; orphans; sexual and reproductive health