Youth centers, peer education, and one-off public meetings have generally been ineffective in facilitating young people’s access to sexual and reproductive health (SRH) services, changing their behaviors, or influencing social norms around adolescent SRH. Approaches that have been found to be effective when well implemented, such as comprehensive sexuality education and youth-friendly services, have tended to flounder as they have considerable implementation requirements that are seldom met. For adolescent SRH programs to be effective, we need substantial effort through coordinated and complementary approaches. Unproductive approaches should be abandoned, proven approaches should be implemented with adequate fidelity to those factors that ensure effectiveness, and new approaches should be explored, to include greater attention to prevention science, engagement of the private sector, and expanding access to a wider range of contraceptive methods that respond to adolescents’ needs.

BackgroundIncreasingly, the health and rights of adolescents are being recognized and prioritized on the global agenda. This presents us with a “never-before” opportunity to address adolescent contraception. This is timely, as there are enormous numbers of adolescents who are currently unable to obtain and use contraceptives. From research evidence and programmatic experience, it is clear that we need to do things differently to meet their needs/fulfil their rights.Main bodyIn this commentary, we call for action in several key areas to address adolescents’ persistent inability to obtain and use contraceptives. We must move away from one-size-fits-all approaches, from a ‘condoms-only’ mind set, from separate services for adolescents, from ignoring the appeal of pharmacies and shops, and from one-off-training to make health workers adolescent friendly. Our efforts to expand access to quality contraceptive services to adolescents must be combined with efforts to build their desire and ability to use them, and to do so consistently. In order for these changes to be made, action must be taken on several levels. This includes the formulation of sound national policies and strategies, robust programme implementation with monitoring, regular programmatic reviews, and implementation research. Further, high-quality collection, analysis, and dissemination of data must underlie all of our efforts. As we move ahead, we must also recognize and draw lessons from positive examples of large scale and sustained programmes in countries that have led the way in increasing contraceptive use by adolescents.ConclusionThis unprecedented moment in history gives us a real opportunity to bring about transformational change, particularly when there is so much at stake.

The social, economic, and biological events that mark adolescence profoundly influence and shape future adult lives. Sexual and reproductive health (SRH) services, education, and other social programs are needed to support young people for a healthy start. As adolescents transition into adulthood, SRH programs and services that have skilled health providers, in combination with other social services including comprehensive sexuality education, can help prevent unwanted pregnancies, maternal mortality and morbidity, as well as sexually transmitted infections including HIV/AIDS. Programs and services can also provide counseling to prevent sexual violence and abuse and deal with its consequences. Adolescent SRH programs can be more effective if the demographic diversity of this age group is studied. Vulnerable adolescents should be targeted as priority recipients of youth-friendly SRH and other social support services. Data demonstrate that adolescent girls living in rural areas who are not in school and who are often married as children are vulnerable to maternal mortality and morbidity, unwanted pregnancies, unsafe abortion, HIV infection, and sexual violence and abuse. Building adolescent capacities and opportunities requires programs that support adolescent social, economic, and health assets so that they can contribute socially and economically to their societies. A healthy adolescent population is critical for low-resource countries, where a rising proportion of the population is under 24 years of age. Recommendations for strengthening the effectiveness of SRH programs detailed at the FIGO World Congress in 2009 are discussed.

Digital adaptation kits (DAKs) translate World Health Organization (WHO) guidelines for a health domain area into a package of business process workflows, core data needs, decision-support algorithms, linkages to indicators, and functional requirements that can then be more easily translated into digital systems.n DAKs are part of the suite of tools within the WHO SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) guidelines approach to systematically reinforce clinical, public health, and data recommendations within digital systems.n DAKs serve as a critical step in fulfilling WHO's long-term vision of SMART guidelines for transforming guideline development, delivery, and application in the digital age.A key measure of success will be ensuring countries can adapt the generic DAKs according to their digital ecosystem and aligned to their national health policies.n Collaborations across health program leads, digital health and health information systems focal points, implementers, software developers, and service providers will be critical for the effective use of DAKs within country contexts.

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