Imagine a world where adolescent girls are left out of conversations, invisible in datasets, and underserved by programs intended to meet their sexual and reproductive health (SHR) needs. In many parts of the world, including across West Africa and the Middle East, this is reality. The sexual and reproductive choices and trajectories of women, girls — as well as men and boys — are navigated in the shadows, rather than being understood, heard, seen, and served by the health systems meant to support them.

Across West Africa and the Middle East, locally based researchers funded by the International Development Research Centre (IDRC) worked to flip this script. Known as the Cedar Cohort, 16 researchers from 11 countries used implementation research to generate real-world evidence steeped in local context, grounded in community processes, and positioned to influence change.

Results across the cohort are captured in 11 papers released in the new journal supplement, Context matters: Real-world evidence and impact for better sexual and reproductive health in West Africa and the Middle East.  

From Strategy to Reality: The Know-Do Gap

While many governments and agencies have robust sexual and reproductive health and rights (SRHR) policies and guidelines, translating these into effective on-the-ground programs remains a challenge. This gap — between what we know works and what happens on the ground — is what researchers call the “know-do gap.”

Cedar Cohort researchers embraced implementation research to close this gap.

Asking questions like “how,” “for whom,” and “in what context” interventions work in real life, the teams designed and implemented interventions to address SRH challenges adolescents are facing today – and which will continue to shape their life trajectories.

Take, for instance, the use of community radio in Kenya to create opportunities for families to talk about gender norms and SRH. Or efforts in to Ghana co-develop peer education programs based on what adolescents themselves said they needed. In the Gambia, researchers worked with local leaders to challenge early marriage practices, resulting in measurable changes in attitudes and increasing the age of marriage.

Health Information Systems That Reflect Everyone

If we can’t see a problem, we can’t solve it. Far too often, health information systems in low- and middle-income countries leave out adolescents and other groups experiencing multiple vulnerabilities and barriers to access SHR information and services, especially in crisis settings.

In Jordan, researchers helped integrate siloed reproductive health data into a unified digital registry, improving continuity of care for pregnant women. In the West Bank, a comprehensive mapping of adolescent health services filled a major evidence gap in a region facing a humanitarian crisis.

“By prioritizing feasible and context-relevant indicators, our work laid the groundwork for a unified adolescent health monitoring framework in the West Bank—one that reflects both the needs on the ground and the realities of data collection in a fragmented system.” – Aisha Shalash, Researcher at Birzeit University

The message is clear: locally relevant health information systems, designed with and for communities, are crucial to equitable health systems.

Gender and Relationships Matter

While adolescent girls face distinct SRH challenges — such as early marriage, unplanned pregnancy, and sexual violence — gender equality must be seen as a broader societal issue. Projects in the Cedar Cohort explored the power of gender-transformative approaches, working with both boys and girls, and looking closely at how power, access, and social norms affect young people’s ability to make informed choices.

In Ghana, for example, researchers found that economic independence and social norms shaped boys’ and girls’ use of condoms. These findings underscored the need for intersectional, life-skills-based interventions that build agency and support healthy relationships.

Community-Led, Context-Specific, and Scalable

A central insight from the Cedar Cohort is this: Change happens when communities lead. The most promising solutions were those rooted in local partnerships, built on trust, and flexible enough to adapt to shifting contexts — whether due to political instability, pandemics, or social resistance.

By embedding research in real-world settings, and working with those most affected, these projects created pathways for scalable and sustainable interventions.

So, What Are the Takeaways?

• There is no single solution to improving adolescent SRHR. It requires locally rooted, gender-transformative, data-informed, and system-integrated strategies.
• Implementation research is a powerful tool for closing the know-do gap, bridging the distance between policy ambitions and lived realities.
• Data systems must be designed to reflect everyone’s realities, especially those who have been historically excluded.
• And above all, meaningful change starts by listening to and investing in the leadership of local actors, especially young people.

The Cedar Cohort offers context-rich and compelling examples for how to move from policy to practice, from global goals to grassroots action. At a time when progress is both critical and precarious, it is precisely this kind of work that lights the way forward.

A Way Forward

As we look ahead to the final stretch of the Sustainable Development Goals, we’re reminded that progress on adolescent health and rights won’t come from technical fixes or policy prescriptions alone — but from integrated, community-based, and multisectoral efforts that are locally led, equity-driven, and gender-transformative.

The Cedar Cohort demonstrates what’s possible when we center actions around community voices, value and support local knowledge, and invest in the systems — data, policies, and people — that support healthy transitions to adulthood for all adolescents, especially those often left behind.