Growing up GREAT! Implementation Guide

Adolescents face a unique set of challenges in living healthy and productive lives. Inequitable
gender norms and gender-based violence (GBV) limit women’s and girls’ access to information
and services. Social norms create barriers to sexual and reproductive health (SRH) information as
well, prohibiting discussion of sensitive topics like sexuality and contraception with adolescents,
especially those who are young and/or unmarried. When combined with supply-side challenges
such as limited method mix, lack of trained providers, and provider bias in serving adolescent
clients, these norms contribute to a deeply unsupportive environment for adolescent sexual and
reproductive health (ASRH).

Until recently, very young adolescents (VYAs) have not been prioritized in global health
programming. Early adolescence is generally a healthy age and therefore an opportunity for
health promotion and prevention of negative SRH outcomes. However, because most VYAs have
not yet begun their reproductive lives, most ASRH programs focus on older adolescents who
have experienced the onset of puberty and already have urgent health needs related to sexual
health and contraception. Yet early adolescence is a period of rapid growth and development
during which VYAs experience rapid physiological changes while also learning to navigate shifting
societal expectations about their behavior and roles. As such, ASRH programs for this age group
provide an unparalleled opportunity to capitalize on the protective potential of early intervention
and multiply health benefits by equipping VYAs with information, developing their skills, and
connecting them with services so that they can understand and avoid risky health behaviors and
seek care proactively. Likewise, programs that support VYAs to explore and shift harmful gender
and social norms before they are internalized during this formative stage may decrease adverse
health outcomes during early adolescence and throughout the life course.

Growing Up GREAT! addresses the persistent challenge of poor ASRH by intervening early with
VYAs 10–14 years to address barriers that contribute to undesirable ASRH outcomes.
The intervention employs social norm theory to develop a scalable intervention that supports
VYAs and their communities to question and break down entrenched social barriers to ASRH.

Growing Up GREAT! integrates many of the key attributes that make norms-focused
interventions successful.1 A central tenet of this approach is its socio-ecological design, which
acknowledges the many actors at different levels who can influence attitudes, perceptions and
decisions about VYAs’ health. Efforts to create lasting normative change must include these
actors—parents, caregivers, teachers and influential community members—who are
responsible for engendering a supportive normative environment for change. Growing Up
GREAT! intentionally engages numerous community groups in reflective dialogue about topics
related to ASRH and connects VYAs to services.

It also creates opportunities for critical reflection within peer groups that go beyond
outreach and messaging. Discussions in VYA clubs and during caregiver testimonial videos and
community reflection sessions allow participants to explore and question existing norms within
safe spaces and challenge them to engage others in this reflection through a process called
organized diffusion. Organized diffusion ensures that new ideas and ways of thinking spread
beyond participants into the wider community, which is crucial in overcoming social barriers
and realizing normative change. Importantly, this process also encourages communication
between VYAs and their caregivers by proactively creating opportunities for exchange and
mutual learning