"These attitudes are a pressure": women with disabilities' perceptions of how stigma shapes their sexual health choices.

Women with disabilities face numerous barriers to achieving sexual health on an equitable basis to others, including stigma about disability and sexuality. Yet, how specific stigmatising beliefs about disability and sexuality influence the choices women with disabilities make about their sexual health has not been studied widely. The present study sought to address this gap in the context of Sierra Leone. Semi-structured interviews were conducted with women with disabilities (N = 32) and women without disabilities (N = 10). Societal stigma of disability linked with witchcraft was seen as a deterrent to accessing sexual and reproductive health services. Stigma about women with disabilities as burdens and about childless women with disabilities as pitiable were perceived as sources of pressure on disabled women's reproductive choices. Concurrently, women with disabilities rejected common stigmatising beliefs held about their lives. Results are discussed in terms of practical implications for healthcare providers and policymakers in Sierra Leone.

The effect of becoming a Fistula Advocate on the recovery of women with Obstetric Fistula in Sierra Leone: A qualitative study.

Engaging women affected by Obstetric Fistula as advocates has been proposed as an effective strategy to raise awareness of the condition. Limited literature exists on the experience of those who become advocates. A model of community education, in Sierra Leone, trained women affected by Obstetric Fistula to become volunteer Fistula Advocates. This study explored Advocates' perception of their role and its influence on their recovery and reintegration. This was a qualitative study, undertaken in Sierra Leone, collecting data from 7 Fistula Advocates and 3 Key Informants (with roles in either clinical or outreach care for women with Obstetric Fistula or training and supervision of Advocates), using semi-structured interviews. Data was subject to a thematic analysis and related to a conceptual framework for mental health recovery. Intrinsic factors motivating Advocates to undertake this role were influenced by psycho-social support received and the possibility for financial independence. Advocates used personal stories in their work to define a new identity, change perceptions and reduce stigma. Benefits associated with the interactions and relationships created through providing and receiving peer support were voiced. Surgical treatment was described as an important factor influencing recovery. The Advocates said economic empowerment helped recovery and reintegration, and the voluntary nature of the Advocate role limited the impact of this. Overall Advocates perceived their role positively, reporting psychological, social, and economic benefits. The complexities of recovery from Obstetric Fistula were highlighted and connections drawn between the treatment of physical symptoms, the socio-cultural context and mental health recovery. They described the role positively influencing existing relationships and initiating supportive, empowering social interactions between women affected by Obstetric Fistula and with Non-Governmental Organisation staff and community members. The study offers insights into the potential for community-based approaches to facilitate access to treatment for sensitive and stigmatising health problems and support recovery.

From commitment to implementation: lessons learnt from the first National Strategy for the Reduction of Teenage Pregnancy in Sierra Leone.

This study provides insight into the extent to which public commitment to reduce teenage pregnancy made by the President of Sierra Leone made the issue a political priority and the factors that facilitated and hindered this. Using historical observations from government and civil society actors who were involved in the formulation and implementation of the country's National Strategy for the Reduction of Teenage Pregnancy (NSRTP), the study presents lessons learnt, with a particular focus on advocacy. It does not examine the extent to which the NSRTP was operationalised and its objectives fulfilled. Findings indicate that the availability of locally relevant data as well as advocacy from international and national NGOs were factors that led to the President's commitment and the development of a national strategy. Whilst continued verbal support from political leaders and administrative mechanisms for implementation assured that teenage pregnancy reduction stayed on the political agenda, the scarcity of resources as well as the necessary diversion of efforts and resources to the Ebola epidemic impeded implementation. Overall, the findings demonstrate that public commitments made by political leaders - starting with President Ernest Bai Koroma's public declaration in 2012 - kick-started efforts to reduce teenage pregnancy in Sierra Leone; and that despite inadequate human and financial resources for the implementation of the NSRTP, actions taken by both the government and partners over time have contributed to tangible progress.