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Adolescent Health

To design and test interventions that hold promise for delaying the timing of first birth among married adolescents (ages 15-19) in Niger and Bangladesh.

You may find facilitator’s guides and other implementation resources from IMAGINE here.


Ninety percent of adolescent pregnancies in the global South are to married girls, and complications from pregnancy and childbirth are a leading cause of death among this population. Empowering adolescents to delay the timing of their first pregnancy can result in positive health and economic outcomes, such as healthy pregnancies and infants, completing their education, and economic prosperity. Unfortunately, married adolescent girls face numerous social and structural barriers that impact their ability to delay childbearing.


IMAGINE uses a holistic approach that combines education on reproductive health, business skills, and life skills for married and unmarried adolescent girls and husbands, as well as health provider training on adolescent and youth-friendly health services, community dialogue sessions to address harmful social norms impacting adolescent childbearing, and income-generating opportunities so that motherhood is not girls’ only option. Activities are designed to inform and equip girls while engaging families and communities and influencing systems to create a better environment for girls to exercise their rights and make decisions about their health and lives.

of adolescent pregnancies in the global South are to married girls

Program achievements

  • Treatment groups in both countries reported greater use of health services, social and economic mobility, and income-generating activities than respondents in the control group.
  • In Bangladesh, over half of respondents in both the treatment group (54.9%) and the control group (54.4%) are currently using a modern method of contraception.
  • In Niger, more respondents in the treatment group (29.4%) reported currently using contraception (17.7% control). The use of modern contraceptive method was also higher among the treatment (24.7%) than the control group (13.6%).
  • In both countries, respondents who have given birth had higher rates of contraceptive use than those who have not given birth.
  • In Bangladesh, the treatment group, compared to the control group, showed statistically significantly greater improvements in knowledge on a variety of topics like pregnancy risk, family planning use, delaying childbirth, and income generation. They also showed a statistically significant decline in their belief of family planning myths.
  • In Niger, there was substantial impact on contraceptive use and girls’ agency. Respondents in the treatment group, compared to the control group, showed a decline in beliefs in family planning myths. At the same time, they showed more self-determination to visit a health facility and to engage in economic activities.

The importance of IMAGINE

Married adolescents are often neglected by development and health programs, which tend to focus on either preventing child marriage or meeting the reproductive health needs of adult women. IMAGINE is addressing this gap by testing a comprehensive adolescent empowerment package aimed at building married girls’ capacity and agency to make decisions about their lives. The project addresses the social and structural barriers that impede their ability to pursue alternative futures to early motherhood.


IMAGINE Overview

This brief provides an overview of the IMAGINE project, which is currently testing holistic interventions that hold promise at supporting the healthy timing of first birth among married adolescents in Niger and Bangladesh. Available in English and French.

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IMAGINE Evaluations

This link encompasses analysis and findings on the IMAGINE project on a diversity of areas such as qualitative, cost effectiveness, and economic-related evaluations, as well as an endline report.

Read the reports on CARE Evaluations

IMAGINE Intervention Components

An IMAGINE project brief broken down by the different intervention components: girls’ collectives, livelihoods training, health worker transformation, couples counseling and couples events, fada groups, and community reflective dialogues.

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Reflective Dialogues for Health Workers: Family Planning Counseling and Adolescent and Youth Friendly Services

This manual, for facility- and community-based health workers, combines reflective dialogue sessions around social and gender norms with technical training in family planning counseling for adolescent clients. It also contains exercises to support the creation of individual and health facility-based action plans in order to better meet adolescents’ sexual and reproductive health needs. Available in French and English. Also available in Bengali by request.

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Peer-reviewed: Understanding individual, family and community perspectives on delaying early birth among adolescent girls: findings from a formative evaluation in rural Bangladesh

Researchers examined the underlying social, individual and structural factors influencing married girls’ early first birth and participation in alternative opportunities (such as education or economic pursuits) in Bangladesh.

Read the report on BMC Women's Health

Peer-reviewed: “It is a thing that depends on God”: barriers to delaying first birth and pursuing alternative futures among newly married adolescent girls in Niger

In July of 2017, researchers conducted in-depth interviews with a non-probability sample of community members in three communes of Zinder Region, Niger.

Read the report on NCBI