This briefing paper sets out the need for a rethink in the way programmes seek to tackle startlingly high teen pregnancy rates in Sierra Leone. The findings emerge from the report, Change the context not the girls: Improving efforts to reduce teenage pregnancy, in Sierra Leone. The central argument is that the current programming emphasis on changing girls’ behaviour treats teenage pregnancy as the responsibility of girls. If rates are to fall, then programmes to address teen pregnancy should understand – and tailor their efforts to address – the different types of sexual experiences through which girls are getting pregnant and the wider contexts that shape their actions. To that end, five recommendations are proposed.