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Bendu Alliou sits with her infant daughter outside the hospital in Kailahun, eastern Sierra Leone

Dizzy and sweating, 15-year-old Isatu Koroma sits with her eyes closed in the maternity ward in Sierra Leone where she has spent the last 10 days, as her tiny little daughter begins to cry.

Koroma badly needs blood after a complicated delivery �鶹APP� relatives are expected to donate here but none has visited, also leaving the nurses to pay for her to eat.

Health workers in the west African country are battling a teenage pregnancy epidemic that peaked when the Ebola crisis was at its height late in 2014. They say it shows no sign of slowing.

Ward sister Josephine Samba describes the girl�鶹APP�s pregnancy as �鶹APP�an accident�鶹APP�, whispering that Koroma�鶹APP�s own mother died two months after she was born as she cajoles her into breastfeeding the as yet unnamed baby.

Schoolgirls are so regularly admitted to Princess Christian Maternity Hospital (PCMH) in Freetown that they attract little attention.��

Coyness about discussing sex in Sierra Leone veils the fact that during many teenagers were raped or forced to have sex for money to contribute to household expenses, according to research by several children�鶹APP�s charities and United Nations agencies.

�鶹APP�There were a lot more (teen pregnancies) during the Ebola breakout. Most of them were at home. There was no school, so everything was just upside down,�鶹APP� Samba says.

After Sierra Leone announced its first Ebola cases in May 2014, schools were closed and movement severely restricted, leaving girls more vulnerable to abuse.��

Isatu, a young mother of twins, waits for her children to get vaccinations at the Princess Christian Maternity Hospital in Freetown. She faces the complications of an early pregnancy and the difficulties of a complex journey back to school

Since then the has counted more than 18,000 teenage pregnancies, with the number of pregnant girls up by 65% in certain districts.

Internationally recognised as the country with the world�鶹APP�s highest maternal mortality rate, at 1360 deaths per 100,000 live births, Sierra Leone could ill afford the blow to its health system that Ebola dealt, diverting resources and staff away from maternal health.

The result is thousands of girls who will never live to become women, as UNFPA estimates that 40% of all maternal deaths occur among those under 18.

A lack of birth control and conservative abortion laws mean that many girls, upon realising they are pregnant and fearing they will be forced to drop out of school, attempt to abort with drugs or seek out backstreet providers who employ methods such as bicycle spokes to terminate pregnancies.

Louise Nordstrom, a Swedish midwife working on a UNFPA training programme for birth attendants at the hospital, described a recent, typical case of a young student who arrived at PCMH with severe stomach pains.

�鶹APP�You could see she was in agony. I asked her if she knew she was pregnant,�鶹APP� Nordstrom said, keeping one eye on a screaming woman waiting to be taken to theatre for an emergency caesarian section.

�鶹APP�Soon after she went to pee in a bed pan and out came the dead foetus. It was very obvious she had been taking some drugs at home; she knew she was pregnant; she was afraid and didn�鶹APP�t want to have the baby so she induced an abortion herself.�鶹APP�

Many girls wait until it�鶹APP�s far too late before seeking hospital care, says Alimamy Philip Koroma (no relation to the teenage mother), one of Sierra Leone�鶹APP�s pre-eminent obstetric and gynaecology specialists.

Schoolgirl Eliane with her son Eric Picture: Amnesty International

�鶹APP�Some of them don�鶹APP�t even come to the antenatal clinic, they stay at home because of fear of their (school) colleagues seeing them,�鶹APP� he told AFP.

�鶹APP�Sometimes their pelvis is not prepared enough to have a child,�鶹APP� he said, also referring to haemorrhage and septicaemia as particular risks for girls arriving after attempting unsafe abortions.

In this difficult context, Mohammed El Hassein, reproductive health specialist at��UNFPA, said the three priorities were to improve progress in the uptake of family planning, bolster the image of midwives and ensure access to emergency obstetric care.

But the problem is particularly entrenched among young people.

�鶹APP�We are trying to train the (contraception) providers to be youth-friendly,�鶹APP� he told AFP.

And for those who survive childbirth, life choices are restricted.��

The government has only recently and many of those who do lack the support they need.

�鶹APP�Before the reopening of school the child was very small and on breast milk. There was no one to take care of her except me,�鶹APP� said Neima Foday, 19, speaking to AFP in the town of Kailahun with 13-month-old baby Ishmail on her knee.

�鶹APP�I�鶹APP�m a bit worried because my friends are attending school and I�鶹APP�m not,�鶹APP� she said, adding that without an education she knew money would always be a problem.

Asked if Ishmail�鶹APP�s father was contributing to his son�鶹APP�s upkeep, Foday shook her head.

�鶹APP�I haven�鶹APP�t seen him since I told him I was pregnant,�鶹APP� she said.

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