An innovative community-based mentoring scheme for pregnant adolescent girls in Sierra Leone has been found to save lives, whilst also helping girls return to education.
The pilot trial, published in The Lancet and led by researchers at King's College London in collaboration with local NGO Lifeline Nehemiah Projects (LNP), reduced a combination of maternal and perinatal deaths by almost half (48%). For every 18 girls mentored, one baby's life was saved.
Between July 2022 and November 2023, 673 pregnant girls in twelve communities across five districts of Sierra Leone took part in the trial. Girls were assigned to a local mentor to support them during and after their pregnancy.
The mentors provided vital support for the girls, many of whom faced enormous stigma and family abandonment. They helped the girls access antenatal care, meet other pregnant women, reconnect with family and financially support themselves and their babies.
Girls that have taken part in the project have been able to return to school, pursue vocational training in plumbing, electrical installation, hospitality and tailoring or develop their businesses.
The trial is the first to formally evaluate the impact of the 2YoungLives project and demonstrates that it was feasible to run in rural and urban areas of Sierra Leone. LNP started the scheme in 2017 with just three mentors and nine mentees. By 2021 the scheme had 24 mentors and had mentored over 300 girls, with no maternal deaths.
In 2021, 2YoungLives became part of a larger project called CRIBS , a global health group funded by the National Institute for Health and Care Research (NIHR), which aims to reduce maternal mortality and build research capacity in Sierra Leone.
Dr Cristina Fernandez Turienzo, lead author and a Senior Research Fellow at King's College London, said: "This is the first time we have seen just how powerful a locally developed and led community-based mentoring scheme can be for pregnant adolescent girls and their babies - a clear example of why global health research should focus on local solutions to local problems."
2YoungLives founders Mrs Lucy November and Mangenda Kamara from LNP, are keen to highlight that the clinical results of the trial don't reveal the full extent of the social impact of the scheme.
Lucy November, a Midwife Research Fellow in the Department of Women & Children's Health at King's College London, said: "The trial goes far beyond clinical results, as it has helped these girls to thrive beyond their pregnancy. The business start-up fund provided a sustainable income, allowing them to eat well during pregnancy and saving for their babies. And many of the girls were able to return to school or followed vocational training after giving birth."
Maternal mortality in Sierra Leone has steadily fallen in recent years, from being one of the worst in the world to better than the average rates in sub-Saharan Africa.
However, despite a reduction of almost 40 per cent in the maternal mortality ratio (MMR) from 1,165 per 100,000 live births in 2013 to 443 per 100,000 live births in 2020, Sierra Leone still remains one of the countries with the highest MMR in the world.
And even when mother and baby both survive, poverty and school exclusion mean that girls rarely get back on their pre-pregnancy trajectory with education and its associated economic benefits.
The researchers also recommend capitalising on learning from this pilot study to conduct a larger trial before scaling up in Sierra Leone and elsewhere including high income countries.
Professor Jane Sandall CBE, Professor of Social Science and Women's Health at King's College London, said: "Many of the interventions in the scheme could also have a reciprocal benefit for communities in the UK. In particular, it could help groups of women who are poorly served, maybe they don't speak English or find care hard to access."
