The early years of adolescence, from age 10-14, mark a critical time in individual development and growth as well as one of the most important opportunities for instilling healthy behaviors that will promote lifelong well-being. Boys and girls are confronted with unique opportunities as very young adolescents (VYAs) as the gender socialization process begins to take place and they internalize both positive and negative cultural messages of what it means to be a man or a woman, solidify soft skills, and begin their adolescent development towards adult social skills. In low- and middle-income settings, VYAs face additional changes beyond intense physical, hormonal, cognitive, and social adjustments and the formation of one's identity. Challenges include strict power hierarchies, lack of voice in their own health and well-being, lack of resources and access to information and education, all of which link to lack of agency. These can result in early marriage, school dropout, early childbearing, and poverty, which interact to shape short-term and long-term health beyond early adolescence.

Fertility and body awareness education can make a big difference for boys and girls, but studies show that most VYAs lack the knowledge and skills to reduce associated risks of puberty including unplanned pregnancy and sexually transmitted infections. Girls are often especially vulnerable to negative puberty- and reproductive health-related outcomes like early pregnancy (e.g., misunderstanding of menstrual cycles) or sexual violence victimization (e.g., harmful cultural norms like certain initiation rites). Among VYA girls who have had sex, very early pregnancy can occur as well and is often unplanned. Sex is often a non-consensual experience for VYAs. Programs that provide VYAs with information and build gender awareness and skills in areas such as self-advocacy, while concurrently addressing adults and community institutions, can be a highly effective approach to promote an enabling environment and sustaining health-related behaviors such as contraceptive use self-efficacy, nutrition education, and medically accurate information about sexuality, consent, or infectious disease risk. Many VYAs are not yet sexually active and have not solidified harmful behaviors or norms; thus, intervening with youth at this stage provides a window of opportunity that is less available later. Among those who have had sex, coercion and unwanted sex are common. Sexual violence is a key concern for VYAs of all genders.

VYAs also benefit from developing physical and psychological wellness skills to promote lifelong health and reduce the likelihood of adult illnesses. Mental health disorders like depression and anxiety can often manifest in early adolescence and correlate with early school dropout, risk-taking behaviors, poor physical health, and early death from suicide or other causes. Early adolescence is also an ideal time to promote healthy eating and exercise habits, discourage the use of tobacco, and develop resilience to social facilitators of harmful use of drugs or alcohol. VYA mental health has been highlighted by the COVID-19 pandemic, specifically related to the effects of isolation and depression, though the evidence for what works in this area is still emerging. School- or community-based prevention programs targeting VYAs are especially effective for health promotion, but VYAs in low- and middle-income settings are not systematically prioritized. The World Health Organization acknowledges that VYAs are neglected both in research and in action; the following list contains key examples of what has worked for VYAs, though many gaps still remain.

 

Body literacy and fertility awareness

Summaries of what works (e.g., Systematic Literature Reviews)

Adolescents and family planning: what the evidence shows

This report synthesizes a review of the literature to identify barriers to adolescents’ access to and use of family planning services, programmatic approaches for increasing access and uptake of those services, gaps in the evidence that require further research, and areas that are ripe for future investment.

School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents 

This Cochrane Collaboration review of the scientific literature summarizes the current evidence on preventing sexually transmitted infections (STIs) and pregnancy in adolescents; many of the included articles describe research specifically performed with VYAs or with mixed-age adolescent populations around the world. (2016)

What does not work in adolescent sexual and reproductive health: a review of evidence on interventions commonly accepted as best practices 

This systematic literature review highlights many presumed best practices that do not work because of content, delivery method, or dosage (intensity) issues and discusses the global implications of ineffective aspects of adolescent sexual and reproductive health (SRH) programming, including for VYAs. (2015)

A forgotten group during humanitarian crises: a systematic review of sexual and reproductive health interventions for young people including adolescents in humanitarian settings

This systematic review identifies historic and recent interventions that have been attempted with global adolescents using age- and gender-targeted approaches, as well as highlighting gaps in the current knowledge base. (2019)

Resource libraries and tools

Very Young Adolescent (VYA) Sexual and Reproductive Health Resource Library 

This toolkit from K4H “is for program managers, educators, health workers, advocates, researchers and policy makers committed to making a difference in the lives of very young adolescents (girls and boys between the ages of 10-14). The toolkit offers resources which address the unique developmental, cognitive, and social opportunities and challenges facing this age group. It provides links to examples of successful programs, research results, curricula, advocacy materials, and other resources useful for working with VYAs.” (2018)

Very Young Adolescent Sexual and Reproductive Health and Gender Program Design Guide 

This Save the Children Resource guide “is a decision-making tool to help those designing and adapting SRH and gender programming for VYAs. As the focus on VYAs grows and programming for this critical age group expands, it is important to learn from what has already been done. Future programs must endeavor to build on the existing evidence in order to catalyze further innovation and learning, rather than repetition or duplication. To achieve that goal, this guide was developed as an evidence-informed resource based on the most current evidence and experience on VYA SRH and gender programming.” (2019)

Highlighted interventions and research from the past 10 years

The Effect of a Theory of Planned Behavior-based Educational Intervention on Sexual and Reproductive Health in Iranian Adolescent Girls: A Randomized Controlled Trial 

This educational intervention with girls 12-16 found a reduction in high-risk sexual behaviors compared to girls receiving standard education. (2017)

Wezesha Vijana Girls’ Advancement Program (GAP) East Africa (Kenya and Tanzania) Outcomes Report

This report highlights findings from Asante Africa Foundation’s Girls’ Advancement Program, which aimed to keep  vulnerable young adolescent girls in school, build their knowledge around reproductive health and body literacy as well as develop their social assets. (2017)

Sexual health of very young adolescents in South Western Uganda: a cross-sectional assessment of sexual knowledge and behavior

This article presents findings from a study focused on assessing reproductive health behavior and knowledge, and information-seeking behaviors among very young adolescents in Uganda. The results indicated that reproductive knowledge was low among VYAs and that sexual risk-taking behavior was high among sexually active VYAs. (2018).

The Sexual and Reproductive Health Needs of Very Young Adolescents Aged 10–14 in Developing Countries: What Does the Evidence Show?

This [Guttmacher] report draws on analyses of national survey data and literature review results to provide an overview of the evidence on key aspects of sexual and reproductive health among very young adolescents aged 10–14 living in developing regions. (2017)

Reaching Very Young Adolescents (VYAs): Advancing Program, Research and Evaluation Practices 

This USAID document is the culmination of a five-day meeting that took place in June 2010 to understand programming and research needs for very young adolescents. (2010)

Investing in Very Young Adolescents' Sexual and Reproductive Health 

This article makes the case for investing in very young adolescents (VYAs) through a detailed description of the specific challenges this age group faces, a review of existing evidence about the efficacy of programming efforts focused on VYAs (2014). 

Investing When it Counts: Reviewing the Evidence and Charting a Course of Research and Action for Very Young Adolescents 

This report reviews the state of the knowledge on the situation and needs of very young adolescents (VYAs) globally, the key social and contextual influences in their lives, the impact of programs working with VYAs, and develops recommendations for further research and programming with this especially vulnerable group (2016).

Advancing Promising Program and Research/ Evaluation Practices for Evidence-based Programs Reaching Very Young Adolescents: A Review of the Literature 

This paper reviews and describes research practices and program interventions addressing the reproductive health needs of VYAs and identifies promising program components and research/evaluation practices (2010).

 

Puberty and menstruation

Summaries of what works (e.g., Systematic Literature Reviews)

Puberty and menstruation knowledge among young adolescents in low-and middle-income countries: a scoping review 

This systematic review presents evidence on girls’ knowledge about and experiences of puberty and menstruation in LMICs. The review found that younger adolescents are under- prepared for puberty and menstruation. The evidence base on very young adolescents’ experiences and the impact of puberty or menstruation interventions and education remains scant. (2019)

Resource libraries and tools

Menstrual hygiene matters: A resource for improving menstrual hygiene around the world 

Save the Children’s resource on menstrual hygiene that supports the development of context-specific information for improving practices for women and girls in lower- and middle-income countries, including communities, schools, and emergencies. (2012)

Highlighted interventions and research from the past 10 years

Menstruation and the Cycle of Poverty: A Cluster Quasi-Randomised Control Trial of Sanitary Pad and Puberty Education Provision in Uganda 

Results of this trial “support the hypothesized positive impact of providing sanitary pads or puberty education for girls’ school attendance in a developing country context.” However, authors also highlight limitations to be expected in similar work, such as poor participant retention and deviations from the intervention protocol. (2016)

Transitions into puberty and access to sexual and reproductive health information in two humanitarian settings: a cross-sectional survey of very young adolescents from Somalia and Myanmar

This paper details findings from a quantitative survey conducted in humanitarian settings in Ethiopia and Thailand to explore the sexual and reproductive health needs and risks of displaced refugee and migrant VYAs. Survey results found that the Somali and Myanmar VYAs were not receiving information on puberty and menstrual hygiene management they need to understand transitions into adolescence. (2017)

 

Physical and mental health promotion

Summaries of what works (e.g., Systematic Literature Reviews)

School-Based Interventions Going Beyond Health Education to Promote Adolescent Health: Systematic Review of Reviews 

This review identifies a large, scoping body of literature on various whole-school health interventions that are effective in preventing teenage pregnancy, smoking, and bullying. (2016).

Resource libraries and tools

Gender and regional inequalities in adolescent economic empowerment 

This policy note from the Gender and Adolescence: Global Evidence (GAGE) consortium describes their findings that “despite increasingly high economic aspirations, adolescents continue to have few affordable opportunities to develop market-appropriate skills and limited access to assets and resources. As a result, many young people are effectively trapped in exploitative work with very limited, if any, safety nets or social protection.” (2019)

Sexual and Reproductive Health in Early and Later Adolescence: DHS Data on Youth Age 10-19 

This report presents DHS data on adolescent sexual and reproductive health indicators in the areas of marriage, sexual activity, contraceptive use, fertility, maternal health, and gender-based violence of younger (10-14 years) and older adolescents (15-19 years). The findings reveal that reproductive events rarely occur during early adolescence. (2017)

Highlighted interventions from the past 10 years

Young Adolescents in the Time of COVID: Findings from Around the World 

The Global Early Adolescent Study (GEAS) is producing COVID-19-specific content on VYAs via country fact sheets.

Evaluation of the Effectiveness of a Three-Year, Teacher-Led Healthy Lifestyle Program on Eating Behaviors Among Adolescents Living in Day School Hostels in Malaysia 

This large experimental study found that a healthy lifestyle program reduced meal-skipping in VYAs and describes the educational module that was used. (2018)

Culturally grounded mother–daughter communication focused intervention for Thai female adolescents 

This pilot intervention found improvements in sexual risk communication, improvements in perceived relationship control, and ability to prevent sexual risk, among other positive outcomes for VYA girls to reduce the risk of early pregnancy through a culturally-grounded approach. (2018)

The impact of education programs on smoking prevention: a randomized controlled trial among 11 to 14 year olds in Aceh, Indonesia 

This large experimental study found that both health- and religious-school-based education on smoking improved knowledge and attitudes on smoking prevention for VYAs of any gender. (2013)

Do restrictive gender attitudes and norms influence physical and mental health during very young Adolescence? 

Evidence from Bangladesh and Ethiopia. Baseline findings on gender attitudes at the individual level and gender norms at the community level and physical and mental health in Bangladesh and Ethiopia from the GAGE program are presented in this paper. The analyses demonstrate that restrictive gender attitudes and norms are drivers of physical health and mental health among VYAs, and VYAs are particularly vulnerable to them. (2019)

 

Social and gender norms and related vulnerabilities

Summaries of what works (e.g., Systematic Literature Reviews)

Understanding Factors that Shape Gender Attitudes in Early Adolescence Globally: A Mixed-Methods Systematic Review

This review explores “factors that shape gender attitudes in early adolescence across different cultural settings globally” and provides evidence that “programs to promote equitable gender attitudes, thus, need to move beyond a focus on individuals to target their interpersonal relationships and wider social environments.” (2016)

A systematic meta-review of evaluations of youth violence prevention programs: Common and divergent findings from 25 years of meta-analyses and systematic reviews 

This large-scale review highlights the best evidence for youth violence prevention approaches, including for VYAs, over several decades. It includes reviews of the literature ranging from aggression to school bullying and suicide risk. (2012)

Demographic perspectives of female genital mutilation

This report from UNFPA “looks at FGM through the lens of population dynamics and the demographic dividend, based on current evidence and data. It offers quantitative information that both supports evidence-based programming, and frames financial implications for Member States and international donors.” (2015)

Resource libraries and tools

Very Young Adolescence 2.0: A curriculum to promote gender equality and sexual and reproductive health 

Promundo’s 12- week curriculum is designed to help very young adolescent girls and boys challenge gender inequalities, norms as well as explore health issues and redefine what it means to be a young girl or boy. The curriculum consists of interactive activities, group discussions and projects. (2018)

Highlighted interventions and research from the past 10 years

Act with Her: Working with Very Young Adolescent Girls and Boys: Perspectives from the Frontline 

This brief synthesizes findings from monitoring data collected from the local implementation team and very young adolescents engaged in Pathfinder International’s Act With Her program currently being implemented in Ethiopia. Key insights from this research demonstrate that VYAs are eager to learn, VYAs can be meaningfully engaged in monitoring, evaluation, and learning and connecting with VYAs requires an appropriate and sensitive approach. (2020)

Learning to Be Gendered: Gender Socialization in Early Adolescence Among Urban Poor in Delhi, India, and Shanghai, China 

This study discusses and compares the gender socialization process among early adolescents in two Global Early Adolescent Study (GEAS) settings—New Delhi, India and Shanghai, China. The findings illustrate the influential role that parents, extended family members, and peers play in instilling gender-related behaviors and traditional gender roles. The study also highlights the gender role differentials between girls and boys as they enter adolescence. (2017)

Parent-child sexual and reproductive health communication among very young adolescents in Korogocho informal settlement in Nairobi, Kenya 

This qualitative study explores parent- adolescent communication around reproductive health matters in Nairobi, Kenya. Key insights from this research point to the need for addressing barriers which impede effective communication between parents and adolescents to improve VYAs reproductive health outcomes. (2020)

Developmental Assets and Sexual and Reproductive Health among 10 to 14 Year Olds in Uganda 

Findings from a research study conducted by Georgetown University’s Institute for Reproductive Health and the Search Institute in Uganda that examined the link between the personal and social strengths and assets of VYAs and how these are related to sexual and reproductive health variables. (2014)  

Adolescent Girls In Crisis: Voices From The Sahel 

This research study details the impact that the crisis in the Sahel region has had on the lives of VYAs and older adolescents. The findings highlight the adolescent girls’ heightened vulnerabilities in crisis contexts and the imperative for integrated programming to address adolescent girls’ needs. (2020)

Married very young adolescent girls in Niger at greatest risk of lifetime male partner reproductive coercion and sexual violence 

This paper discusses findings from baseline analyses of a cluster-randomized controlled trial assessing the impact of the Reaching Married Adolescents intervention on uptake of modern family planning, gender equity attitudes, and intimate partner violence among married adolescent girls aged 13–14, 15–16, and 17–19 and their husbands in Dosso region, Niger. (2020)

Girl Empower Impact Evaluation Mentoring and Cash Transfer Intervention to Promote Adolescent Well-being in Liberia 

This impact evaluation report on the International Rescue Committee’s (IRC) Girl Empower program implemented in Nimba County, Liberia presents the program’s effects on schooling and SRH outcomes among adolescent girls aged 13-14. The findings demonstrated reductions in child marriage, risky sexual behaviors, and positive changes in gender attitudes. (2018)

Gender-norms, violence and adolescence: Exploring how gender norms are associated with experiences of childhood violence among young adolescents in Ethiopia

Using data from the GAGE study, the analyses presented in this paper examined the effects of gender attitudes and norms at the individual, household and community levels on childhood violence among young adolescents in Ethiopia. The results demonstrate that “community norms are significantly associated with experiences of household violence.” (2020)

The Global Early Adolescent Study Special Supplement to the Journal of Adolescent Health 

“The work in this supplement fills these important gaps in the literature. The Global Early Adolescent Study focuses on developmental issues of younger adolescents, age 10 to 14 years, in 15 different high-, middle-, and low-income countries across the world. Equally importantly, this study focuses on adolescents within low-income settings in each of these countries, to capture relatively unexplored contexts for gender identity development. As some of the first work to emerge from this important study of early adolescence, the papers in this supplement offer a fascinating look into key aspects of development during the intensification of gender socialization and gender roles that occurs around puberty. This study is being undertaken in two phases, with the first designed as an exploratory qualitative examination of how gender is experienced across the various settings, identifying cross-cutting themes, and the second phase intended to incorporate a longitudinal quantitative design. (2017)” Additional information about the Global Early Adolescent Study (GEAS) can be found at https://www.geastudy.org/

Growing up Great! Baseline report

Growing up GREAT! (GUG!) is a multi-level intervention for very young adolescents (VYAs), their parents and caregivers and other influential community members through the USAID-funded Passages Project. It uses an ecological approach to provide information and address social and gender norms related to reproductive health and wellbeing at each of these levels, with the goal of improving both in-school 3 and out-of-school VYAs’ voluntary family planning and reproductive health care outcomes in later adolescence. Specifically, GUG! aims to increase: 1. VYAs’ knowledge of puberty and reproductive development 2. VYAs’ and parents’ gender-equitable behaviors 3. Use of family planning and other reproductive health care among VYAs as they age into older adolescence. This report presents findings from baseline data collection. (2018)

CHOICES, VOICES, AND PROMISES

In 2009, Save the Children International Nepal developed the CHOICES intervention, which targeted very young adolescents (VYAs) with the goal of changing gender norms, attitudes, and behaviors and increasing support for more egalitarian relationships between boys and girls. Evaluation results indicated significant improvements for those participating, leading to the development of a further curriculum, PROMISES, which began implementation in 2011. In contract to CHOICES, PROMISES targeted the general community where CHOICES was implemented with the goal of influencing the broader environment. The positive impact of both programs led to the development of VOICES, an approach that uses the voices of mothers and fathers through testimonials to influence change in other parents in the community. Information on each of the pieces of this integrated program can be found through the links below.

Evaluation of Choices 
CHOICES curriculum (English)
PROMISES curriculum (English)
VOICES guide