World Health Organization · 2025 edition · 112 pages
Evidence-based recommendations to prevent child marriage and improve adolescent contraceptive access in LMICs
- Issuer
- World Health Organization
- Edition
- 2025 edition
- Audience
- Policy-makers, programme managers in government and NGOs, technical and funding agencies; secondary: health workers, researchers, professional associations, advocacy groups, young professionals
- Evidence
- GRADE-rated recommendations based on systematic reviews; good practice statements based on expert consensus and indirect evidence
- Reviewed
- 15 Oct 2026 · GMJ
What this guideline says
GMJ summary
This 2025 WHO guideline updates the 2011 edition and provides evidence-based recommendations to reduce adolescent pregnancy and improve reproductive outcomes in low- and middle-income countries. The guideline focuses on two priority areas: preventing child marriage and responding to the needs of married girls, and increasing access to, uptake of, and continued use of contraception among adolescents.
The guideline includes six recommendations and three good practice statements on child marriage prevention, emphasizing multi-component approaches including girls’ empowerment, community engagement, conditional incentives tied to school attendance, removal of barriers to 12 years of quality education, economic empowerment, and age-at-marriage laws consistent with human rights standards. It also includes two recommendations and four good practice statements on contraceptive access, highlighting gender-transformative behaviour change interventions, self-care approaches (self-injection, over-the-counter pills, extended pill supply), reduction of financial barriers, and digital health interventions.
All recommendations were developed using the GRADE methodology by a multidisciplinary Guideline Development Group. The guideline emphasizes equity, meaningful adolescent engagement, and the need for gender-synchronized approaches that engage boys, men, families, and communities alongside interventions targeting girls directly.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Implement interventions to empower girls by building their knowledge, skills, assets and social networks to prevent child marriage (conditional recommendation, low-certainty evidence)
- Engage parents/guardians, boys and men, and broader community to create gender-equitable environments supporting delayed marriage (conditional recommendation, low-certainty evidence)
- Offer conditional financial incentives tied to school attendance and/or remaining unmarried as part of social protection for girls at highest risk (conditional recommendation, moderate-certainty evidence)
- Implement interventions to ensure girls complete 12 years of quality education by removing gender-related barriers (strong recommendation, moderate-certainty evidence)
- Implement economic empowerment interventions to improve girls' financial literacy, access to savings, and employment skills (strong recommendation, moderate-certainty evidence)
- Implement gender-transformative behaviour change interventions to strengthen adolescents' contraceptive decision-making ability (strong recommendation, moderate-certainty evidence)
- Make self-administered injectable contraception, over-the-counter oral contraceptive pills and emergency contraception available without prescription (strong recommendations, moderate to very-low-certainty evidence)
- Provide up to one year's supply of oral contraceptive pills depending on the woman's preference and anticipated use
Summary of recommendations on preventing child marriage
Table extracted from the guideline
| Recommendation | Strength | Evidence certainty |
|---|---|---|
| Implement interventions to empower girls by building their knowledge, skills, assets and social networks | Conditional | Low |
| Engage parents/guardians, boys and men, and broader community to create gender-equitable environment | Conditional | Low |
| Offer conditional incentives (conditioned on school attendance and/or remaining unmarried) | Conditional | Moderate |
| Implement interventions to remove gender-related barriers to education and ensure 12 years of quality education | Strong | Moderate |
| Implement interventions for economic empowerment of girls | Strong | Moderate |
| Formulate and implement laws restricting marriage before age 18 | Conditional | Very low |
Source: World Health Organization, Guideline on preventing early pregnancy and poor reproductive outcomes among adolescents in low- and middle-income countries. Reproduced in summary form.
What changed in this edition
Versus the previous edition
- 2011 edition covered six outcomes; 2025 update focuses on two: preventing child marriage and improving contraceptive access (other areas now covered by separate WHO guidelines)
- Introduction of good practice statements: three on child marriage, four on contraceptive access (2011 edition did not include this recommendation type)
- Change from strong to conditional recommendation on empowering girls to prevent child marriage due to very low certainty of effects and marked intervention heterogeneity
- Change from strong to conditional recommendation on influencing family and community norms due to low to very low certainty of evidence
- New PICO questions on responding to needs of married girls, meaningful engagement of adolescents, digital health interventions, and explicit reference to self-care
- Inclusion of External Review Group comprising country teams from six WHO regions (Argentina, Bangladesh, Burkina Faso, Republic of Moldova, Philippines, Yemen)
- Research recommendations removed from this edition as separate linked research priority-setting exercises are underway
From the guideline
Verbatim
“Adolescents who give birth face higher risks of maternal and infant mortality compared with older women, while early pregnancies can restrict adolescents' choices, limiting their educational and economic prospects.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked extensively on health systems strengthening in the South Caucasus, I recognize that this guideline addresses persistent challenges in our region where adolescent pregnancy rates remain above the European average and where gender norms continue to restrict girls' autonomy. For Georgian clinicians, I would emphasize the strong recommendation to implement gender-transformative behaviour change interventions and the self-care approaches that could extend contraceptive access beyond our urban centres where youth-friendly services are concentrated. However, we must acknowledge a realistic implementation caveat: the conditional recommendation on financial incentives, while supported by moderate-certainty evidence, would require substantial political will and fiscal commitment in a context where social protection systems are still developing and where programmes must demonstrate sustainability beyond donor funding cycles. The guideline's emphasis on coherent legal frameworks is particularly relevant as Georgia continues to harmonize its laws on age of consent, marriage, and access to sexual and reproductive health services.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 15 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guideline addresses critical regional challenges. While Georgia has made progress in adolescent health through its Universal Health Coverage programme (since 2013) and reproductive health services, adolescent pregnancy and early marriage remain concerns, particularly in rural areas and among vulnerable populations. The recommendations on ensuring 12 years of quality education align with Georgia’s education policies but require strengthened implementation to address gender-related barriers. The self-care interventions (over-the-counter emergency contraception, self-administered injectables) could expand access in underserved areas with limited health workforce. National programmes should assess the feasibility of conditional incentive schemes within existing social protection frameworks, ensure contraceptive services are youth-friendly and accessible regardless of marital status, and harmonize laws on age of marriage (currently 18 with exceptions at 16) with consent to sexual activity and access to SRH services. Digital health interventions may be particularly relevant given high mobile phone penetration in the region, though cultural sensitivities around adolescent sexuality require careful contextualization of behaviour change interventions.
Questions this guideline answers
Quick answers
What types of interventions are most effective at preventing child marriage?
Multi-component interventions show the most promise, particularly those combining: empowerment of girls through building knowledge and skills; removal of barriers to 12 years of quality education; economic empowerment including financial literacy and employment skills; conditional incentives tied to school attendance and/or remaining unmarried; and engagement of families, communities, boys and men to shift gender norms. Single-component interventions are less effective.
Should financial incentives to prevent child marriage be conditional or unconditional?
The evidence suggests conditional incentives are more effective than unconditional ones. Incentives should be conditioned on girls' school attendance and/or remaining unmarried. In settings where marriage precludes school attendance, school attendance may serve as a reasonable proxy for remaining unmarried. However, the scalability and sustainability of financial incentive programmes must be carefully considered before implementation.
What self-care contraceptive interventions does WHO recommend for adolescents?
WHO strongly recommends making self-administered injectable contraception (e.g., subcutaneous DMPA) available as an additional delivery approach; making oral contraceptive pills available over-the-counter without prescription; making emergency contraceptive pills available over-the-counter without prescription; and providing up to one year's supply of pills depending on preference. These recommendations apply to adolescents as there is no medical reason to withhold any contraceptive method recommended for adults.
How should married adolescent girls' needs be addressed differently?
Married girls remain an overlooked population despite their heightened vulnerabilities. WHO recommends that efforts to address the needs and rights of women and girls should recognize and address the specific needs of ever-married girls and those in formal or informal unions. This includes tailoring maternal health services, addressing domestic violence risk, supporting girls' autonomy in contraceptive decision-making, and ensuring access to education re-entry, economic opportunities, and mental health support.
Related on GMJ
Interconnected resources
Dictionary of Public Health
GMJ News coverage
Quality & accreditation
Other guidelines on this topic
- Guideline on preventing early pregnancy and poor reproductive outcomes among adolescents in low- and middle-income countries – Web Annex: Evidence base
- Guideline on the prevention of female genital mutilation and clinical management of complications
- Recommendations on the management of sickle-cell disease during pregnancy, childbirth and the interpregnancy period
- Recommendations on the delivery of health services for the prevention and care of sexually transmitted infections
- Abortion care guideline, 2nd edition
- Issuer
- World Health Organization
- Type
- Guideline
- Edition
- 2025 edition
- Replaces
- WHO guidelines on preventing early pregnancy and poor reproductive health outcomes among adolescents in developing countries, 2011
- Status
- Current
- Published
- 2025-04-23
- Languages
- English
- Scope
- Prevention of child marriage and improvement of access to contraception among adolescents aged 10–19 years in low- and middle-income countries
- Audience
- Policy-makers, programme managers in government and NGOs, technical and funding agencies; secondary: health workers, researchers, professional associations, advocacy groups, young professionals
- Pages
- 112
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 9789240104105
- Evidence
- GRADE-rated recommendations based on systematic reviews; good practice statements based on expert consensus and indirect evidence
- Next review
- Not specified; decision on future updates will be based on assessment of need; living guideline approach under consideration
- Record history
- Created 15 Oct 2026 · updated 15 Oct 2026 · next check Apr 2027
WHO guideline on preventing early pregnancy and poor reproductive outcomes among adolescents in low- and middle-income countries. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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