Table 2.

A call to action: Specific recommendations for programmers, researchers and policy-makers.

For programme designers and implementers Programme design Understand and programme for VYA heterogeneity and local context – rates of development, life-course and sexual trajectories, access to resources, social visibility. Integrate activities within governmental and NGO structures (e.g. schools and other socio-institutional structures). Consider knowledge, attitudes and skills, and structural factors such as access to health services, resources, safe spaces, infrastructure, e.g. suitable toilets. Recognise the influence of VYAs' wider social networks including peer, family (including in-laws of married VYAs), community and policy-level actors. Pay attention to cultural context when adapting western theories of behaviour change; use theoretical perspectives originating in country contexts, especially anthropological ones. Involve adolescents in programme development using VYA-engaging participatory approaches. Programme implementation Discuss puberty first as a segue-way to broader sexual and life planning education. Identify and rely on whomever VYAs trust for providing SRH information. Consider carefully roles of VYA peers; in some instances, older peer mentors may be more effective. Capitalise on technologies as entry points into the VYA world, such as mobile phones or Internet. Learn from best practices with older adolescents and VYA programming from western-based contexts, for cautious exploration and field-testing elsewhere. Institute holistic health services: “12-year-old check-ins”4 to provide health care, information on legal rights, assets (money, identification papers) and safe haven for queries. Annual community-based “citizenship retreats” or “camps” to share health, learning, gender-transformative experiences. Adopt gender-inclusive approaches for girls and boys, including the following: 1.Mixed-sex sports programmes to model gender-sensitivity for boys; programmes to include girls in non-traditional sports. 2.Vocational training programmes to promote gender equity reflections on advantages and challenges of being both co-providers and co-caretakers. Prioritise curriculum-based programmes – with potential for scalability – accompanied by 1.Community, VYA and parental involvement in programme design. 2.Context-specific curricula incorporating appealing activities and structure, with well-trained facilitators. For researchers and evaluators Research and evaluation themes Analyse existing data-sets on 13- to 15-year olds: identify risk and protective factors and sexual health findings. Promote new data collection on the diversity of VYA experiences over shorter interval periods (1–3 years, instead of 5-year cohorts) and on vulnerability of marginalised or disadvantaged populations. Identify social determinants that predispose VYA to risky behaviour. Prioritise research on onset of puberty, menarche and semenarche (first menstruation and ejaculation) and implications; living arrangements, protection, economic and social network support; schooling; mobility; rites of passage; health status, knowledge and access to services; marriage transition (including early marriage); precocious sexual activity, its contexts and consequences; VYAs' thought processes and changes over time. Support robust operations research and evaluation to build evidence on promising practices. Research and evaluation design Develop guidance on ethical and safety research and educate Institutional Review Boards to facilitate research that protects the safety and rights of VYA in diverse contexts. Use participatory, age-appropriate techniques appropriate to the developmental stage of the interviewee. Identify indicators that reflect developmental stages and gender norm expectations specific to VYAs' day-to-day realities. Employ gender-relational approaches to ensure consideration of the needs and challenges of boys. Research and evaluation implementation Prioritise research in countries with high proportions of VYAs initiating sexual intercourse before the age of 15 and among disadvantaged subgroups of VYAs such as domestic workers, including wider holistic analyses of related risk-taking or coerced behaviours. Have care and patience in listening to VYA responses; they can be eager to talk about themselves but are not as articulate about problems or needs. Involve adolescents in research and evaluation implementation. Be alert to situations of abuse or neglect and make referrals as necessary. Make research and evaluation findings widely available, including negative findings, to allow for gradual standardisation of indicators and research approaches and evidence-informed programme practices. For policy-makers Policy development Use policy development to change prevailing biased images and reflect a more positive impression of VYAs. View VYAs as rights-holders with ability to exercise rights for their own benefit; VYAs need new decision-making powers as rapid changes in technology and globalisation, information and protection offered only by adults will be insufficient. Include a broader developmental approach to VYA policy-making and programmes, encompassing other critical sectors such as labour and employment, education and sports, mental health, social work and human rights. Policy implementation Enforce and monitor application of international conventions on behalf of VYAs. Enact policies that support keeping VYAs in school until at least 15 years of age or longer. Emphasise institutional factors (e.g. influencing schools to make their campuses physically safer places). Track funding and spending on VYAs.

Sources: For programme designers and implementers: Bruce & Chong (2006), ICRW (2010), IRH (2010), Temine and Levine (2009), Palmer (2010).

For researchers and evaluators: Brady (2011), Chong et al. (2006), Dixon-Mueller (2011), IRH (2010), UNAIDS (2004), WHO (2010).

For policy-makers: Bruce and Chong (2006), Dixon-Mueller (2011) and Pathfinder international (2010).