A Qualitative Exploration of COVID-19 School Closures, Adolescent Pregnancy, and Sexual and Reproductive Health Service Access in Sierra Leone (2021–2026)

This qualitative study investigates the intersection of COVID-19 school closures, adolescent pregnancy, and sexual and reproductive health (SRH) service access in Sierra Leone from 2021 to 2026. It addresses a critical gap in understanding the pandemic's gendered health consequences by examining how prolonged educational disruption affected girls' vulnerability to unintended pregnancy and their capacity to utilise SRH services. Employing a phenomenological approach, the research gathered data through in-depth interviews and focus group discussions with 45 adolescent girls and young women (aged 15–20) across three districts, supplemented by key informant interviews with 15 healthcare providers and community stakeholders. The analysis reveals that school closures fostered a 'risk environment', wherein economic precarity, increased idleness, and reduced social protection exacerbated transactional and age-disparate sexual relationships. Simultaneously, access to youth-friendly SRH services was severely constrained by pandemic restrictions, pervasive stigma, and a documented diversion of clinical resources towards COVID-19 response, which actively deterred help-seeking. The study concludes that the pandemic acted as a profound systemic shock, intensifying pre-existing failures in safeguarding adolescent sexual health. It argues that future health emergency responses must integrate robust, accessible adolescent SRH provisions and prioritise the continuity of comprehensive sexuality education to mitigate such compounded vulnerabilities.