Adolescent Health

World Vision recognizes that adolescents face a variety of challenges that impact their ability to thrive:

• Around 1.1 million adolescents die of preventable causes every year. Millions more suffer from injury, sexual and mental abuse, and ill health.
• Adolescent girls ages 15 to 19 face the added risk of morbidity and mortality due to complications during pregnancy and childbirth. Twelve million girls in that range — and at least 777,000 girls under 15 — give birth each year in developing regions. The leading cause of death for girls ages 15 to 19 globally is complications from pregnancy and childbirth.
• Child marriage (marriage before the age of 18) limits children’s abilities to reach their full potential, as they drop out of school prematurely; are at a much higher risk of complications related to early pregnancy, childbearing, and motherhood; and are at risk of intimate partner violence.

However, targeted comprehensive investments and opportunities in adolescent health — including education, socioeconomic development, and the prevention of violence — offer a chance for adolescents to flourish and become productive adults.

To address the physical, social, and mental health of adolescents, World Vision programming co-invests in education and keeping girls in schools, which may translate into reductions in early sexual debut and unintended pregnancies among adolescent girls. We also promote supportive parenting and communities, including activities that engage men and boys in livelihoods, HIV and AIDS prevention, and the prevention of forced child marriages. Additionally, improving WASH in schools leads to girls’ retention by allowing for dignified and safe menstrual hygiene management.

World Vision’s adolescent programming consists of intersectional and crosscutting interventions and approaches described below that seek outcomes in child protection, education, health, gender equality and social inclusion, and economic well-being. Adolescent health requires the intersection of these holistic approaches, which together work to address communities’ needs, and support and promote young people’s health and cognitive, social, emotional, and spiritual development.

Following are some examples of our holistic adolescent programming:

• Interpersonal Psychotherapy for Groups is an evidence-based mental health and psychosocial support group therapy intervention for 12- to 19-year-olds. It reduces symptoms of depression (and has shown some indications of being beneficial to reducing anxiety and harmful substance use, including alcohol) by improving the quality of the participants’ social and interpersonal functioning.
• Common Elements Treatment Approach is an evidence-based mental health intervention that is delivered in the community by laypeople and is used to address common mental health problems for adolescents and adults. World Vision, in partnership with Johns Hopkins University, piloted this model in secondary schools in India.
• Citizen Voice and Action (CVA) strengthens adolescents’ participation in decision-making, improves social accountability and local advocacy, and facilitates dialogue between communities and government to improve services (like education and child protection services) that impact the daily lives of adolescents and their families. As adolescents are often direct users of basic services, they play a powerful role in the CVA community meetings, often raising topics adults will not raise.
• Menstrual hygiene management includes providing separate latrines for girls in schools, safe disposal and/or water and soap stations for washing menstrual hygiene products, training adolescents to make reusable sanitary pads, and cultivating positive knowledge and behaviors toward menstrual health.
• Village Savings and Loans facilitate savings and access to small loans and instills hope by enabling adolescents to plan, cope with household emergencies, develop their livelihoods, and invest in their health, education, and economic well-being.
• Early Warning System tracks performance, attendance, and behavior at school and refers adolescent girls at risk for dropping out to a school-community accountability group that intervenes to keep girls in school.
• Channels of Hope mobilizes faith leaders and faith communities to meaningfully address (in contextually appropriate ways) gender and gender-based violence in its various forms in local communities.
• Psychological first aid (PFA) provides immediate support to an individual who is showing signs of psychosocial distress. When trained in PFA, helpers can offer PFA to children and adults following emergency situations, disclosure of abuse (e.g., child abuse, sexual- and gender-based violence), or at any point in time if a person is distressed. A facilitator’s manual and PFA manual are available in multiple languages. All staff working with children or families affected by violence should be trained in PFA skills.
• Girls Clubs are established at the community level to engage 30 to 50 girls ages 14 to 24 to build resilience and reduce risk of HIV infection and other vulnerabilities. These clubs are located in communities to reach out to schools and schoolgirls in need of adolescent services. Health information, promotion, and skills building are provided at the Girls Club activities.

The HIV epidemic disproportionately affects adolescent girls and young women (AGYW). Across the globe in 2023, an estimated 1.5 million adolescents (10-19 years old) were living with HIV and 140,000 were newly infected. U.N. AIDS statistics indicate that in sub-Saharan Africa, AGYW are more than twice as likely to acquire HIV as their male counterparts due to gender-related factors, including harmful gender norms and taboos related to sexuality. However, keeping girls in school is one key way to help prevent child marriage, pregnancy, and gender-based violence — and reduce their risk of HIV infection.

Uganda: Strengthening School-Community Accountability for Girls’ Education (SAGE)
The SAGE program was a two-year U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)-funded project implemented by World Vision and managed by John Snow Research and Training, Inc. Through SAGE, a component of the Determined, Resilient, Empowered, AIDS-free and Safe (DREAMS) project, World Vision implemented activities that aimed to reduce school dropouts and HIV infections among 38,750 AGYW in 151 secondary schools across 10 districts with some of the highest levels of dropouts and HIV infections.

The project implemented two adolescent-led, adult-supported innovations: 1) early warning system (EWS) and 2) stay in school committees (SISCs). The project trained school and community stakeholders, established AGYW-led SISCs in schools, and changed student attendance norms by promoting adolescent leadership and community action to reduce dropouts. The SISC uses the EWS to track school attendance, behavior, and performance. SAGE’s innovative combination approach also helped shift social norms and practices around girls’ education, violence against children, reproductive health, and positive discipline.

According to the endline survey findings, the percentage of AGYW who were absent from school for at least a month in a term during the last 12-month period dropped by 2.5 percentage points between baseline (12.7%) and endline (10.2%). Further, SAGE monitoring data reported an increase of girls retained in school at the end of the project (44,351), at 99.7% in 2019 (compared to 88.5% in 2016). For HIV status, the percentage of AGYW ages 15 to 19 who tested for HIV in the last 12 months and know their status increased by 3.8 points in the intervention/treatment areas, from 92.5% at baseline in 2017 to 96.3% at endline in 2018. The findings suggest that the combined EWS and SISC approaches are a potentially effective intervention to identifying girls at risk of dropping out of school, mitigating the causes of dropout, and potentially decreasing risky behaviors and reducing risk of HIV infection.

Kenya and Bangladesh: Big Dream to End Child Marriage 
World Vision is committed to a future where no child is subjected to female genital mutilation (FGM) or child marriage. Through our Big Dream to End Child Marriage program, we work to ensure all children grow up in safe, supportive families and communities—free from violence and harmful practices. In the first half of fiscal year 2025, we expanded this work beyond Kenya into Bangladesh, aiming to help more girls complete their education, strengthen family livelihoods, and break the cycle of child marriage.

Our five-pillar approach focuses on:

• Changing harmful social norms and behaviors
• Expanding access to education and life skills for girls
• Empowering families economically
• Reducing water and sanitation barriers to education
• Strengthening local child protection systems

We work with faith leaders, parents, and other community influencers to change mindsets and ease the financial pressures that often drive child marriage. For girls already at risk, we help ensure access to education and healthcare. Economic empowerment is a key part of the solution: when families are financially stable and resilient, the pressure to marry off young girls for a bride price is reduced. World Vision supports this shift by training farmers, improving market access for high-value crops, and strengthening savings groups so families can increase income and access financial services.