In a cramped room in the Tonkolili District of Sierra Leone, adolescent girls squeeze onto plastic chairs, some having walked for miles, to speak openly about subjects their mothers were never permitted to discuss: menstruation, contraception, and consent. For these young women, the Adolescent Friendly Centre has become a sanctuary where their voices are heard, their questions answered, and their futures reshaped.
A lifeline in a land of silence
Many of the girls who attend the centre come from communities where early marriage remains the expectation, education is frequently abandoned, and silence about their own bodies is enforced from childhood. Thirty per cent of girls in Sierra Leone marry or enter unions before turning 18, according to national data, while a 2015 survey showed nearly 40 per cent were married before reaching that age. The Prohibition of Child Marriage Act, passed in 2024, now makes marriage for anyone under 18 a criminal offence and also prohibits cohabitation with a child, but the social pressures that drive the practice remain deeply entrenched, particularly in rural areas.
Mamah, a 21-year-old university student studying mass communications who is also training as a journalist through the centre, described the transformation it has brought. “Growing up, all I knew is that when someone said ‘let’s do this’, I’d say ‘okay’,” she said. “Most parents don’t have time to sit with their daughters and tell them what to avoid. If this centre didn’t exist, it would be a problem for girls. Not having this centre would lead to more girls dropping out of school, getting pregnant at an early age, being forced into early marriage, not knowing their rights, when to say no and when to give consent.”
Inside the centre’s two cramped rooms, adolescents crowd around three ageing computers, often sharing in pairs while others wait their turn for lessons on sexual health, life skills and technology. Staff say the growing number of young people seeking help has stretched the building beyond capacity, with only one shared toilet serving the centre. The centre was originally opened in 2019 by Médecins Sans Frontières (MSF) Holland to tackle rising rates of teenage pregnancy and unsafe abortions. MSF formally handed the centre to Plan International in March 2025, but full services did not resume until September, leaving a six-month gap during which adolescents in Tonkolili had nowhere to go for reproductive health support.
Abdulai Tunkara, who runs the centre for Plan International, described adolescents arriving with information about sexual health that is wrong and sometimes dangerous: girls believing menstruation means they are “unclean”, or young people relying on misinformation from peers about contraception. Many, he said, have no money for menstrual products or family planning services and are reluctant to seek help from formal health facilities where they would have to pay. At the centre, counselling, STI treatment and family planning advice are free. Young people have started bringing friends and younger siblings with them.
The knowledge gap and its deadly consequences
The scale of the crisis the centre is trying to address is stark. Up to 40 per cent of maternal deaths in Sierra Leone occur among teenagers. More than a third of women aged 20 to 24 gave birth before age 18, and 10 per cent gave birth before age 16. The lifetime risk of maternal death is one in 52, with this risk believed to be even greater for adolescents. More than two-thirds of maternal deaths result from haemorrhage, hypertension, and sepsis, while roughly a third are linked to unsafe abortions, particularly among adolescents. Data from 2019 indicated that 22.1 per cent of female adolescents were experiencing teenage pregnancy, with 17.8 per cent having already given birth. More recent figures suggest 28 per cent of girls aged 15-19 are either pregnant or already mothers. In 2020, the maternal mortality ratio stood at 442.8 deaths per 100,000 live births. Pregnancy complications are the leading cause of death for girls aged 15-19, and in Freetown, up to one in ten teenage girls may die in childbirth. Unsafe abortions account for approximately 10 per cent of all maternal deaths and nearly a third of adolescent maternal deaths.
Mariatu Fofanah, a 59-year-old pastor and teacher, is one of 30 school principals in her district and the only woman. At meetings of the district’s school leaders, she said, the room greets itself as “gentlemen”, but she has learnt to say: “I am here.” Fofanah was 14 when her uncles told her father she was already too old and should be married. She did not bow to the pressure, but knows what that pressure costs most girls. “Here, parents don’t guide their children about their bodies. Menstruation is not handled at all. If they are lucky, parents mention one or two things in passing,” she said. In the community, she explained, menstruation is treated as contamination. Some who are on their periods are considered unclean and some stop going to school altogether. She recalled: “When I was young, I asked my mother if babies came out of the belly button. She laughed and told me a proverb.”
That knowledge gap is what the centre is trying to close, both clinically and socially. Amida, a 13-year-old who attends the centre after school, said girls in her community were once expected to remain at home while boys were educated. “Now, both boys and girls can go to school and a girl has a right to choose her partner for herself,” she said. She hopes to become a teacher one day because there are so few female teachers in her community. Fatmata, 29, who works with a community organisation that partners closely with the centre, knows how unusual that aspiration still is. Her elder sister was married at 15, her other sister at 17. “In my community, they believe that for girls, marriage is better than education. With marriage, it is believed you bring more dignity to your family,” she said. She went to university anyway, with her mother selling goods to cover her fees. She is now pursuing a degree in business administration and hopes to complete a master’s. “I wanted to show girls in the community that no matter what circumstance you are facing, whether you are poor or rich, you just need to pursue an education,” she said.
Funding in the balance
Despite the centre’s evident impact, its future is precarious. Funding for the centre, from a foundation, is secured only until spring 2028, and the broader picture for health aid in Sierra Leone is worsening. Sierra Leone’s Ministry of Health cannot sustain the centre alone, staff and activists say.
The UK government’s own Equalities Impact Assessment suggests Britain is likely to stop delivering aid programmes with health objectives in Sierra Leone altogether. A £35 million grant for maternal and newborn health, part of the “Saving Lives in Sierra Leone Phase 3” programme, is being slashed to under £1 million by 2027. This reduction is part of a broader UK plan to cut its global development budget by 40 per cent. The Foreign, Commonwealth and Development Office has indicated that bilateral health programmes are being de-prioritised in favour of in-country refugee costs and multilateral commitments. The FCDO’s own equality impact assessment suggests that reductions in education spending in Sierra Leone are likely to have adverse impacts on children.
US aid cuts have also hit hard. In 2024, the US provided $3.2 million to Sierra Leone’s reproductive health sector, which was about 14 per cent of the country’s overall reproductive health funding. The US Agency for International Development cancelled 83 per cent of its contracts, leading to a $45 million reduction in health projects focused on maternal, child, and adolescent health in Sierra Leone. UNICEF has warned that the funding reductions risk disrupting essential services, with the potential closure of clinics and suspension of vital prenatal and postnatal programmes increasing the risk of life-threatening complications during childbirth. The MSF decision to withdraw from Sierra Leone altogether in early 2025 came just as Donald Trump was slashing the US aid budget and reproductive health funding, and as the world faced multiple crises including wars in Gaza, Ukraine and South Sudan, and a hunger crisis across swathes of Africa. During the Ebola crisis, teenage pregnancy rates in Sierra Leone reportedly rose by an estimated 50 per cent, with extreme poverty leading girls to engage in transactional sex for basic necessities.
A 2021 act allows pregnant girls to return to school, but barriers to education persist, driven by poverty and social pressure for early marriage. Tunkara’s fear is that the centre becomes a story about what once existed, rather than what could still be possible. “What if we reach a point where there is no funding to run free family planning and free STI treatment?” he asked. “What would be the fate of the adolescents? Where can they get the money to afford this?”
