The Adolescents Health Indicators

The adolescent
health indicators
recommended by the Global
Action for Measurement of
Adolescent health
Guidance for monitoring adolescent health
at country, regional and global levels
The adolescent
health indicators
recommended by the Global
Action for Measurement of
Adolescent health
Guidance for monitoring adolescent health
at country, regional and global levels
ii
The adolescent health indicators recommended by the Global Action for Measurement of Adolescent health: guidance
for monitoring adolescent health at country, regional and global levels
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The Adolescent Health Indicators recommended by the Global Action for Measurement of Adolescent health iii
Contents
Document at a glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iv
Forewords. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x
Executive summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.2 Scope and purpose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.3 Main audience and intended use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2. Indicator selection process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.1 Step 1: Identification of core measurement areas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.2 Step 2: Scoping review of adolescent health indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.3 Step 3: Selection of draft adolescent health indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.4 Step 4: Assessment, harmonization and database review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.5 Step 5: Refinement and finalization of the indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3. The indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
3.1 Policies, programmes and laws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.2 Systems performance and interventions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.3 Social, cultural, economic, educational and environmental health determinants . . . . . . 21
3.4 Health behaviours and risks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.5 Subjective well-being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
3.6 Health outcomes and conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
4. Measurement principles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
4.1 Holistic approach and interdisciplinary collaboration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
4.2 Adolescent engagement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
4.3 Consideration of context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
4.4 Ethical considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
4.5 Equity, inclusivity and representativeness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
4.6 Disaggregation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5. From indicators to action. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
5.1 Data mapping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
5.2 Data use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
5.3 Critical success factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
5.4 Call to action. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
6. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
iv
This document is an interactive guide for the uniform collection, compilation, reporting, and use of adolescent health
data. See the details of each section below and click on the blocks to jump to the relevant section.
1 Introduction
A snapshot of the adolescent

health measurement
2 Indicator selection process
The selection process was systematic, participatory and included five steps:
1. Identification of core
measurement areas
4. Assessment, harmonization
and database review
landscape and why we need 2. Scoping review of indicators 5. Refinement and finalization of
a set of priority indicators for selected core areas the indicators
and harmonized standards. 3. Selection of draft indicators
3 The indicators
The Global Action for Measurement
of Adolescent health (GAMA) has
recommended 47 indicators within Policies,
3.1
Systems
3.2
six domains:
programmes and performance and
laws interventions
3.3 3.4
Social, cultural, economic, educational Health behaviours

and environmental health determinants and risks
Subjective
3.5
Health outcomes
3.6
4 Measurement principles
An outline of key measurement
principles, applicable to all indicators,
including the involvement of
adolescents, ethical considerations and
well-being and conditions recommended disaggregation.
5 From indicators to action

How the GAMA-recommended indicators
can be used to identify priorities, allocate
resources, monitor and evaluate programmes,
6 References
and advocate for adolescent health.

Click to jump
to section
v
Forewords
Adolescence is a time of significant physical and emotional change that requires tailored health
approaches. Historically, the world has lacked comprehensive indicators for adolescent health, which has
hindered the effective development of age-specific policies and interventions.
That’s the long-standing gap in global health data that this resource aims to fill. The indicators
recommended by the Global Action for Measurement of Adolescent health (GAMA) offer a consensus Introduction
framework to guide global efforts to improve adolescent health, as one more step on the road towards
universal health coverage.
Process
The GAMA-recommended indicators represent a unique, multi-year collaboration between the World Health
Organization (WHO) and seven United Nations (UN) agencies, aimed at harmonizing the measurement of
adolescent health globally. These indicators were selected to be integrated into national health monitoring Domains:
systems, providing a foundation upon which policies and programmes can be built and evaluated.
The inclusive process to select these indicators has drawn on other previous and current work to measure Policies
adolescent health, and has been grounded in both scientific rigour and feasibility, based on real-life
assessment in Member States. The indicators fill a critical gap, offering a nuanced lens to assess adolescent Systems
health that goes beyond traditional health data. With these indicators, countries can benchmark progress,
identify priorities for action and allocate resources effectively, guiding adolescents towards a healthier future.
Determinants
This work is a powerful tool for policy-makers and partners to promote, provide and protect the health of
adolescents, and give them the best chance of a healthy adulthood. It is a commitment not only to track Behaviours
health, but also to transform it. We see these indicators as the keystones in the arch of global adolescent
health, bearing the weight of our aspirations and the hopes of future generations. Well-being
WHO is committed to supporting countries to implement these indicators, as part of our shared work to
enhance the health and well-being of adolescents worldwide. Outcomes
Principles
Dr Tedros Adhanom Ghebreyesus

Director-General Action
World Health Organization
References
The Partnership for Maternal, Newborn and Child Health (PMNCH) is delighted to collaborate on The
adolescent health indicators recommended by the Global Action for Measurement of Adolescent health:
guidance for monitoring adolescent health at country, regional and global levels.
For a long time, adolescents and their needs have received insufficient attention. Advancing an agenda for
adolescent well-being demands timely and robust data for effective advocacy, policy development and
programme monitoring. The GAMA-recommended indicators respond decisively to a crucial gap in health
data, providing a necessary foundation for measuring improved adolescent health outcomes.
WHO and PMNCH, alongside the other UN H6+ agencies have jointly established an Expert Consultative
Group to work towards enhancing adolescent well-being measurement based on the Adolescent Well-being
Framework and its five interconnected domains. The aim is to develop a measurement approach applicable
at the country, regional and global levels. This collaborative effort marks a significant step in tracking and
enhancing the health and well-being of adolescents. Such initiatives, complemented by PMNCH’s Agenda
for Action for Adolescents under the 1.8 billion Young People for Change campaign, are paramount for a
thorough understanding of adolescents’ well-being, addressing their specific needs and measuring impact
in an efficient and timely manner.
Rt. Hon. Helen Clark
Board Chair
Partnership for Maternal, Newborn and Child Health
vi
To improve the health of our adolescents, we need to understand where prioritization and interventions
are needed. I welcome the publication of this guidance, which offers concrete recommendations to help
strengthen comprehensive monitoring of adolescent health.
Adolescents face multiple challenges in accessing health services, including age-based discrimination
and exclusion from services. By engaging with adolescents themselves in the spirit of equity and
inclusion, by working across sectors and by disaggregating data, we can create better, more effective
programs that meet the diverse needs of adolescents. This is in line with the commitments made in the
2021 United Nations Political Declaration on HIV and AIDS, which includes the importance of addressing
inequalities and structural barriers that limit access to services.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) is committed to supporting countries in
their HIV data collection and analysis through the Global AIDS Monitoring process. Evidence-informed
investment is key to improving the lives and health of our adolescents and of future generations. This
report lights the way forward.
Introduction
Winnie Byanyima
Executive Director
Process Joint United Nations Programme on HIV/AIDS
Domains: Adolescence is a critical period for acquiring essential life skills, knowledge and competencies, which
significantly influence lifelong health and education outcomes. We are therefore delighted to collaborate
Policies with WHO and other UN partners in the Global Action for Measurement of Adolescent health (GAMA).
The GAMA-recommended indicators address the knowledge and accountability gap in adolescent
Systems
health, serving as a foundation for informed policy-making and effective programming. Our joint effort
focuses on harmonizing health measurement initiatives at local, national and global levels, recognizing
Determinants the importance of integrating these indicators into national systems, and thereby reducing data
collection burdens and promoting consistency in data comparability.
Behaviours
This collaboration aligns with the commitment of the United Nations Educational, Scientific and Cultural
Well-being Organization (UNESCO) to promote education for health and well-being, recognizing that informed and
healthy adolescents are key to sustainable development and to fully realize their right to education.
Outcomes This joint initiative marks a significant step towards a holistic approach to measuring adolescent health,
guiding global efforts to nurture a healthier, better educated, and thriving future generation.
Principles Stefania Giannini
Assistant Director-General for Education
United Nations Educational, Scientific and Cultural Organization
Action
Globally, 1.3 billion adolescents stand at the threshold of adulthood. Their future is the world’s future.
References
Progress toward sustainable development depends on the investments we make in the health, well-being
and empowerment of adolescents today. Targeted investments can yield significant social and economic
returns, which is why comprehensive, age-specific health indicators are so important: They can reveal
valuable data and information on where to focus interventions so that no one is left behind.
The United Nations Population Fund (UNFPA) welcomes the indicators recommended by the Global Action
for Measurement of Adolescent health (GAMA) because data is essential for designing and investing in
effective programmes that fully support the health and well-being of adolescents. The GAMA-recommended
indicators provide a comprehensive set of measures covering a wide range of adolescent health issues,
including physical health, mental health, sexual and reproductive health, and social well-being.
Better data on adolescent health is key to unlocking the promise of the International Conference on
Population and Development Programme of Action, as we mark its 30th anniversary this year, and to
delivering on the goals enshrined in the 2030 Agenda for Sustainable Development.
We urge stakeholders to embrace the use of the GAMA-recommended indicators to improve the health
and well-being of adolescents today and the prospects of future generations for a healthier tomorrow.
Natalia Kanem
Executive Director
United Nations Population Fund
vii
Adolescence is a time of transformation, marked by opportunities for growth. But the transitional nature
of adolescence also exposes young people to an array of challenges. This generation of adolescents,
the largest ever, faces enormous complexities ranging from conflict and climate change to poverty and
global pandemics.
Historically, a gap in data on adolescents has impeded our understanding of the dynamic physical and
emotional developments that adolescents experience and hindered our ability to tailor policies and
interventions effectively.
The United Nations Children’s Fund (UNICEF) is a steadfast advocate for the rights and development
of adolescents and is committed to ensuring that no adolescent is left behind. At the forefront of this
commitment is UNICEF’s flagship household survey technical assistance programme, Multiple Indicator
Cluster Surveys (MICS), which serves as a cornerstone to support countries on the measurement of
adolescent health. Additionally, the Measuring Mental Health Among Adolescents and Young People
at the Population Level (MMAPP) initiative fills voids in reliable data and tools concerning adolescent
mental health. Introduction
The continuous collaboration between governments, UNICEF, and partner agencies around the MICS
implementation, and the integration of MMAPP into the broader GAMA framework, ensures the alignment Process
of adolescent health measurement and is a pivotal step towards a healthier future for adolescents
worldwide. This guidance serves as a call to action for policy-makers and health systems to prioritize Domains:
adolescent health, not just in tracking but in transforming outcomes that include mental health and well-
being. The comprehensive approach taken in this document acknowledges the complexity of adolescent
Policies
development and the need for support systems that address mental health challenges. Together, let us
ensure that every young person has the opportunity to thrive not just in body but also in mind and spirit.
Systems
Catherine Russell
Executive Director Determinants
United Nations Children’s Fund
Behaviours
The World Bank Group is committed to addressing adolescent health as a critical component of
Well-being
overall public health and development efforts. Adolescence is a pivotal stage of life, characterized by
significant physical, emotional and social changes, and holds the key to unlocking a future of well-being
Outcomes
and prosperity for generations to come. Investments we make today will produce the dividends of a
healthier, more equitable tomorrow with long-term benefits for individuals, communities and societies.
Principles
The World Bank Group’s multifaceted approach to adolescent health is characterized by a strong
commitment to policy and programme support, capacity-building, advocacy and partnerships. It
Action
underscores the importance of integrating these efforts with broader development goals to create
impact that transcends the health sector. Integral to our strategy is the collaboration with the Global
Financing Facility for Women, Children and Adolescents, with its laser focus on reproductive, maternal, References
newborn, child and adolescent health.
To track progress and inform policy decisions, we place special emphasis on improving data collection
and measurement related to adolescent health outcomes. This is best done by advocating for and
using standardized indicators, such as those recommended by the Global Action for Measurement of
Adolescent health (GAMA).
Using these indicators can ensure greater transparency and accountability, help identify gaps, direct
resources to key priorities and support better policy decisions at country level. This will help prioritize
adolescent health not only as a moral imperative but as a strategic investment in our collective future.
Together, we can build health systems that are not only responsive but also resilient, ensuring that
young people receive the health services they need to thrive.
Dr Juan Pablo Uribe

Global Director, Health, Nutrition and Population
Director, Global Financing Facility
The World Bank Group
viii
Acknowledgments
The World Health Organization (WHO) is grateful (HPR), Theresa Diaz (MCA), Titus Divala (WHO
to all those who contributed to this document. consultant), Katrin Engelhardt (NFS), Alexandra
Fleischmann (MSD), Anna Kågesten (formerly
Introduction
WHO consultant), Elizabeth Katwan (MCA), Sarah
Leadership
Keogh (WHO consultant), Dzmitry Krupchanka
Regina Guthold of the WHO Department of
Process (MSD), Gerard Lopez (MCA), David Meddings
Maternal, Newborn, Child and Adolescent Health
(SDH), Ann-Beth Moller (SRH), Jane Rowley (HHS),
and Ageing (MCA) and Andrew Marsh, WHO
Lynnmarie Sardinha (SRH) and Nhan Tran (SDH).
Domains: consultant, coordinated the development of this
guidance document.
Policies WHO regional staff
WHO acknowledges the contributions and
Writing team
Systems facilitation of country communication of
The lead writers were Regina Guthold, Andrew
Geoffrey Bisoborwa (WHO Regional Office for
Marsh, Holly Newby, WHO consultant, and
Determinants Africa), Sonja Caffe (WHO Regional Office for the
Simone Storey, independent consultant.
Americas), Rajesh Khanna (WHO Regional Office
Behaviours for South-East Asia), Aigul Kuttumuratova (WHO
WHO contributors and reviewers Regional Office for Europe), Oscar San Roman
Well-being WHO headquarters staff and consultants (WHO Regional Office for the Americas), Ogusa
Shibata (WHO Regional Office for the Western
Outcomes WHO is grateful for the contributions of the focal Pacific), Khalid Siddeeg (WHO Regional Office for
points for the Global Action for Measurement the Eastern Mediterranean), and Martin Weber
Principles of Adolescent health (GAMA) nominated by (WHO Regional Office for Europe). WHO also
WHO headquarter departments: Wole Ameyan acknowledges the contributions of Symplice
(Global HIV, Hepatitis and STI Programmes Mbola Mbassi (formerly of the WHO Regional
Action Office for Africa), Rajesh Mehta (formerly of the
(HHS)), Sheri Bastien (Sexual and Reproductive
Health and Research (SRH)), Paul Bloem WHO Regional Office for South-East Asia) and
References (Immunization, Vaccines and Biologicals), Nittita Prasopa-Plaizier (formerly of the WHO
Marie Noel Brune Drisse (Environment, Climate Regional Office for the Western Pacific).
Change and Health), Stephanie Burrows (Social
Determinants of Health (SDH)), Tarun Dua WHO country office staff and country collaborators
(Mental Health and Substance Use (MSD)),
Meleckidzedeck Khayesi (SDH), Wahyu Retno WHO is grateful to the staff and local collaborators
(Annet) Mahanani (Data and Analytics (DNA)), of the WHO country offices in Armenia, Colombia,
Anshu Mohan (Partnership for Maternal, Côte d’Ivoire, Democratic Republic of the Congo,
Newborn and Child Health), Leanne Riley Guatemala, Guinea, India, Lesotho, Malaysia,
(Noncommunicable Diseases, Rehabilitation and Nigeria, Pakistan, Timor-Leste, Togo, the United
Disability (NCD)), Kuntal Saha (Nutrition and Republic of Tanzania, and Zimbabwe for their
Food Safety (NFS)) and Chiara Servili (MSD). participation in the feasibility study and indicator
selection process.
WHO also acknowledges the input of other
WHO staff and consultants: Avni Amin (SRH),
Valentina Baltag (MCA), Prerna Banati (MCA), Contributors and reviewers from
Anshu Banerjee (MCA), Elaine Borghi (NFS), Fiona United Nations agencies
Bull (Health Promotion (HPR)), Marcelo Cardona WHO is grateful for the contributions of
(formerly WHO consultant), Alison Commar members of the GAMA United Nations (UN)
ix
Steering Committee and other contributors Kann (Independent consultant, United States of
from partner UN agencies: Parviz Abduvahobov America), Sunil Mehra (Mamta Health Institute
(UNESCO), Tashrik Ahmed (UNICEF), Sameera Al for Mother and Child, India), Elizabeth Saewyc
Tuwaijri (World Bank Group), Victoria Bendaud (University of British Columbia, Canada), Kun
(UNAIDS), Savvy Brar (UNICEF), Liliana Carvajal Tang (Tsinghua University, China), Dakshitha
Velez (UNICEF), Nazneen Damji (UN Women), Wickremarathne (FP2030, Malaysia) and Diana
Howard Friedman (UNFPA), Brendan Hayes Yeung (Johns Hopkins Bloomberg School of
(World Bank Group), Gabriel Lara Ibarra (World Public Health, United States of America).
Bank Group) and Ilaria Schibba (World Food
Programme). Other contributors and reviewers
WHO is grateful for the contributions of Carlo

External contributors and reviewers Cafiero (Food and Agriculture Organization of the
GAMA Advisory Group United Nations), Carolin Ekman (independent
Introduction
consultant), Debra Jackson (London School
WHO thanks the members of the GAMA Advisory of Hygiene & Tropical Medicine), Mary-Anne
Group for their contributions: Emmanuel Land (independent consultant), Thérèse Mahon Process
Adebayo (University of Ibadan, Nigeria), Peter (WaterAid), Dennis Mazingi (The George Institute
Azzopardi (University of Melbourne, Australia), for Global Health), Yemi Okwaraji (London School
Domains:
Mariame Gueye Ba (University Cheikh Anta of Hygiene & Tropical Medicine), Margie Peden
Diop, Senegal), Krishna Bose (Johns Hopkins (The George Institute for Global Health), and
Marni Sommer (Columbia University Mailman Policies
Bloomberg School of Public Health, United
States of America), Saeed Dastgiri (Tabriz School of Public Health).
Systems
University of Medical Sciences, Islamic Republic
of Iran), Lucy Fagan (UN Major Group for Children
and Youth, United Kingdom of Great Britain and Administrative support Determinants
Northern Ireland), Jane Ferguson (Independent WHO thanks Gersende Moyse for the
administrative support. Behaviours
consultant, Switzerland), Charity Giyava (Women
Deliver, Zimbabwe), Joanna Inchley (University
Well-being
of Glasgow, United Kingdom of Great Britain
and Northern Ireland), Ann Hagell (Association Financial support
WHO acknowledges the financial support Outcomes
for Young People’s Health, United Kingdom
of Great Britain and Northern Ireland), Laura provided by the Bill & Melinda Gates Foundation.
Principles
Action
References
x
Abbreviations
AA-HA! Accelerated Action for the Health MICS Multiple Indicator Cluster Surveys
of Adolescents
MICS7 Multiple Indicator Cluster Surveys,
Introduction BMI body mass index 7th round
Process
CRVS civil registration and vital statistics MMAPP Measuring Mental Health Among
Adolescents and Young People at
DHS Demographic and Health Surveys the Population Level
Domains:
DSM-5 Diagnostic and Statistical Manual PPP purchasing power parity
Policies of Mental Disorders, 5th Edition
SD standard deviation
GAMA Global Action for Measurement of
Systems
Adolescent health SDG Sustainable Development Goal
Determinants
G-SHPPS Global School Health Policies and SRMNCAH Sexual, Reproductive, Maternal,
Practices Survey Newborn, Child and Adolescent
Behaviours
Health
GSHS Global school-based Student
Well-being
Health Survey STI sexually transmitted infection
Outcomes HBSC Health Behaviour in School-aged UN United Nations

Children
Principles UNAIDS Joint United Nations Programme
HMIS health management information on HIV/AIDS
system
Action UNESCO United Nations Educational,
HPV human papillomavirus Scientific and Cultural
References Organization
HSV-2 herpes simplex virus 2
UNFPA United Nations Population Fund
ICD International Statistical
Classification of Diseases and UNICEF United Nations Children’s Fund
Related Health Problems
UN Women United Nations Entity for Gender
ICD-11 International Classification of Equality and the Empowerment of
Diseases, 11th revision Women
IRTEC International Registry for Trauma VACS Violence Against Children and
and Emergency Care Youth Surveys
ISCED International Standard WHO World Health Organization

Classification of Education
xi
Executive summary
Adolescence is a critical stage in life for physical, six domains: programmes, policies and laws;
cognitive and emotional development, shaping systems performance and interventions;
future health and well-being. Comprehensive social, cultural, economic, educational and
Introduction
measurement of adolescent health is essential to environmental health determinants; health
prioritize health issues, guide interventions and behaviours and risks; subjective well-being;
track progress. However, global, regional and and health outcomes and conditions. For each Process
national adolescent health measurement has indicator, this guidance document provides a
historically been inconsistent and incomplete. rationale for selection and measurement details.
Domains:
The Global Action for Measurement of Adolescent Measurement principles applicable to all
health (GAMA) Advisory Group has been indicators, such as involvement of adolescents, Policies
established by the World Health Organization ethical considerations and recommended
(WHO) in collaboration with United Nations (UN) disaggregation, are also outlined. Systems
partners to support efforts to focus adolescent
health measurement on the most important The indicators are intended to guide policy and Determinants
issues and to improve alignment across different programming for adolescents, and to assist in
measurement initiatives. identifying topics in which more detailed health Behaviours
assessments and additional programming
This document presents a list of 47 indicators are needed. The last chapter in this guidance Well-being
recommended by GAMA for measurement of document describes how this can be done,
adolescent health. The systematic, participatory based on the approach suggested in the Outcomes
indicator selection process included five steps: Accelerated Action for the Health of Adolescents
identification of core measurement areas; a (AA-HA!) guidance. Principles
scoping review of adolescent health indicators for
selected core areas; selection of draft indicators; The present document is intended to be used as
further assessments of the draft indicators for a reference. Its consistent use will not only ensure Action
implementation feasibility in countries, alignment better focus of collection efforts for adolescent
with survey programmes and global data health data, but also bring uniformity to the References
availability; and refinement and finalization of the way countries, as well as regional and global
indicators based on these assessments. stakeholders, collect, compile, report and use the
most important information to guide action for
These 47 indicators are applicable to all the improvement of the health of adolescents.
adolescent population subgroups and span
Camp for refugees from Tigray, Ethiopia - August 2022. © WHO/Ala Kheir
1
1. Introduction
2 The adolescent health indicators recommended by the Global Action for Measurement of Adolescent health
open call, members were selected through a

1.1 Background competitive process based on their technical
expertise. The selection ensured sex and
Importance of adolescent health geographical balance within the group as well
measurement as coverage of knowledge across the main
About 1.3 billion (16%) of the world’s population adolescent health issues.
are adolescents, defined as those aged
10–19 years. The vast majority of this population The objectives of GAMA’s work are:
currently lives in low- and middle-income
• to provide technical guidance to WHO,
countries, where the number of adolescents is
partner UN agencies and other relevant
projected to continue to grow (1).
measurement groups to define a set of
priority adolescent health indicators, for
Investing in the health of adolescents is crucial
the purpose of harmonizing efforts around
Introduction
for their current and lifelong well-being, and will
adolescent health measurement and
not only benefit individuals but also contribute
reporting; and
to building healthier, better-educated and
Process prosperous communities and societies. By
• to promote harmonized guidance
prioritizing adolescent health, we empower
for adolescent health measurement
Domains: young people to reach their full potential,
that supports countries and technical
positively impacting the future of public health
organizations in the collection of useful data
and societal progress (2).
Policies to track progress in the improvement of
Tracking progress in adolescent health requires adolescent health (5).
Systems
consistent measurement of the most important
programmes, policies, laws and interventions, GAMA has built a network of partners, including
Determinants
as well as determinants, behaviours, risks and global, regional and national adolescent health
outcomes. However, the adolescent health measurement stakeholders, to advance the
Behaviours
measurement landscape has historically been work towards these objectives and exchange
inconsistent and incomplete, with many different recent measurement developments. Additional
Well-being
indicators being used across countries and by information is available on the GAMA website.1
various measurement groups. This has led to
Outcomes
unnecessary duplication of work in some areas
and measurement gaps in others (3). 1.2 Scope and purpose
Principles
This guidance document details a list of
indicators that are recommended for the
Action The Global Action for Measurement of measurement of adolescent health in all
Adolescent health (GAMA) countries and all adolescent population
References In 2018, the World Health Organization (WHO) subgroups. This includes younger (10–14 years)
established the GAMA Advisory Group to improve and older (15–19 years) adolescents of all
global, regional and national adolescent health genders, adolescents in and out of school,
measurement and focus efforts on the most adolescents in humanitarian settings,
important issues. This was done with the support adolescents living with disability, ethnic
of seven other United Nations (UN) agencies: and religious minorities, migrants and
the Joint United Nations Programme on HIV/ institutionalized adolescents.
AIDS (UNAIDS), the United Nations Educational,
Scientific and Cultural Organization (UNESCO), The indicators included in this document relate
the United Nations Population Fund (UNFPA), to six domains derived from existing frameworks
the United Nations Children’s Fund (UNICEF), UN relevant to adolescent health measurement (6):
Women, the World Bank Group, and the World
Food Programme (4). • policies, programmes and laws:
includes country-level indicators on
The GAMA Advisory Group consists of 16 policies, programmes and laws relevant to
members, including 4 young experts, from 12 adolescent health (7, 8);
countries across all WHO regions. Following an
1
The Global Action for Measurement of Adolescent health (GAMA): https://www.who.int/groups/the-global-action-for-
measurement-of-adolescent-health
1. Introduction 3
• systems performance and interventions: • Adolescent well-being indicators promoted

includes indicators on health service by the Adolescent Well-being Measurement
coverage for adolescents (8); Expert Consultative Group (16);
• social, cultural, economic, educational • INSPIRE indicator guidance and results

and environmental health determinants: framework – ending violence against
includes indicators on factors impacting children: how to define and measure change
population health and health equity (9); (17); and
• health behaviours and risks: includes • Core list of action-oriented indicators for child
indicators on modifiable behaviours and risks unintentional injury prevention (18).
that impact the health of adolescents (10);
• subjective well-being: includes indicators

pertaining to connectedness (11); and
1.3 Main audience and Introduction
intended use Process

• health outcomes and conditions: includes
indicators directly relating to the adolescent The target audience of this guidance document is
mortality and morbidity burden (12). stakeholders involved in collecting, interpreting Domains:
and using data related to adolescent health. More
The number of adolescent health indicators specifically, this document is intended for: Policies
has been purposefully limited to focus on the
most important health issues adolescents face, • governments, in particular adolescent Systems
minimize the reporting burden and facilitate health stakeholders within ministries
the measurement and use of these indicators of health and other relevant ministries, Determinants
in countries. The indicators presented here are policy-makers, programme managers and
intended to guide policy and programming statistical offices, including those reporting Behaviours
for adolescents and to assist in identifying on the Sustainable Development Goals
areas where further and more detailed health (SDGs); Well-being
assessments are needed.
• developers, managers and implementers of Outcomes
This list of indicators recommended by GAMA surveys and studies relevant to adolescent
will enable countries to get a comprehensive health; Principles
picture of the health of their adolescents and
contributing factors. Existing topic-specific • international and national organizations
indicator lists may be used to complement Action
working with and for adolescents; and
this list of adolescent health indicators where
additional information is required. Notably, the • researchers and academic institutions References
GAMA-recommended indicator list includes at working on adolescent health.
least one indicator from each of the following
topic-specific indicator lists: This guidance is intended to be used as
a reference document. Its consistent use
• Measuring Mental Health Among will ensure better focus and alignment of
Adolescents and Young People at the adolescent health data collection efforts. It will
Population Level (MMAPP) (13); help countries, as well as regional and global
stakeholders, to uniformly collect, compile,
• Priority list of indicators for girls’ menstrual report and use the most important information
health and hygiene: technical guidance for to guide action for the improvement of the health
national monitoring (14); of adolescents.
• Making every school a health-promoting

school: global standards and indicators (15);
Homa Bay County, Kenya - 28 March, 2018: John, 14 during a exam at Ober Boys Boarding (Secondary). He is a visually
impaired student at this educational institution, located near the Victoria Lake, which is a pioneer in Kenya supporting
kids with visual impairments. © WHO/NOOR /Sebastian Liste
5
2. Indicator selection
process
The set of GAMA-recommended indicators presented in this document were selected through a five-step
process (Fig. 1).
Fig. 1. Selection process for the GAMA-recommended indicators
STEP Identification 33 core measurement areas
1 of core
measurement
areas
identified by assessing:
• young people’s perspectives
• priorities in countries
• adolescent mortality and morbidity
burden
Introduction • topics included in global/regional
measurement initiatives
Process
STEP Scoping
2
Review of 16 global/regional
Domains: measurement initiatives identified review of
413 adolescent health indicators adolescent
Policies health
indicators
Systems
Determinants
STEP Selection
3
Indicators selected in 5 steps:
Behaviours of draft • definition of selection criteria
adolescent • scoring of all indicators identified in
Well-being health Step 2
indicators • review of scoring and preliminary
Outcomes draft list of indicators
• public feedback through online
survey
Principles • review of feedback and finalization
of draft list
Action
12-country study of data STEP Assessment,
4
availability and indicators’ harmonization
References
perceived relevance, acceptability and database
and feasibility review
Comparison with indicators
in global initiatives and
multi-country survey programmes
Review of indicator data

availability in global databases
STEP Indicators finalised in 2 steps:
5
Refinement
and • Step 4 findings reviewed with
finalization topic-specific working groups to
of the reach preliminary recommendations
indicators • consolidated recommendations
reviewed during 10th GAMA
meeting and indicator list finalized
2. Indicator selection process 7
2.1 Step 1: survey in English, French and Spanish; and review

of stakeholder feedback and finalization of the
Identification of core draft indicator list (19).
measurement areas
A set of 33 core measurement areas for
2.4 Step 4: Assessment,
adolescent health were identified through a
systematic assessment of four key inputs: young
harmonization and
people’s perspectives; priorities in countries; the
adolescent mortality and morbidity burden; and
database review
topics included in 16 identified global or regional The draft list of indicators was assessed through
adolescent health measurement initiatives (6). three separate activities undertaken in parallel:
a 12-country study of data availability and of Introduction
perceived relevance, acceptability and feasibility
2.2 Step 2: Scoping of implementing the draft indicators at the
country level (20); a comparison of alignment Process
review of adolescent between the draft indicators and similar

indicators included in global initiatives and Domains:
health indicators selected multi-country survey programmes (21);
and a review of indicator data in global databases.
Policies
The 16 measurement initiatives mentioned in
Step 1 were re-reviewed alongside the resulting
2.5 Step 5: Refinement

33 core measurement areas. All indicators Systems
addressing at least one of the core measurement

areas and overlapping with the adolescent age
range (10–19 years) were extracted along with
and finalization of the Determinants
their metadata, producing a list of 413 adolescent

health indicators (3).
indicators Behaviours
Findings from Step 4 were discussed among Well-being

topic-specific working groups. Group members
2.3 Step 3: Selection of provided their inputs through an online survey
and these inputs were reviewed during one
Outcomes
draft adolescent health virtual meeting per working group to arrive

at preliminary recommendations. These
Principles
indicators recommendations were compiled and presented

Action
during the 10th GAMA meeting (September 2023,
A draft list of adolescent health indicators was Geneva), during which final recommendations
compiled according to a structured five-step were agreed and the list of indicators was References
approach: definition of indicator selection finalized (22).
criteria; scoring of the 413 indicators identified
by GAMA advisors during Step 2; review of With new evidence and measurement
scoring results and development of a draft list of methodologies becoming available, these indicators
indicators; collection of public feedback on the will be periodically reviewed and updated.
draft list through an online public stakeholder
Students wearing face masks at the Tika Vidyashram government school in Kathmandu. © WHO/Tom Pietrasik
9
3. The indicators
This chapter provides an overview of the 47 educational and environmental health

indicators, followed by detailed information determinants”, which present the overall context
about each. Two types of indicators are of adolescent health.
presented in this document:
“Health behaviours and risks”, “subjective well-
• Core indicators are the most essential for being” and “health outcomes and conditions”
measuring the health of all adolescents are the domains containing those indicators
globally. related to the actual health status of adolescents.
Within each domain, indicators are grouped
• Additional indicators are those provided thematically.
for settings2 where further detail within a
subject would add value and resources for Each indicator table provides metadata – the
data collection and reporting are available. technical information needed to understand
each of the indicators. The metadata have
Introduction Table 1 lists the 47 core and additional been developed to support alignment in
indicators, organized into the six domains, data collection and use, and address key
Process and includes the unit of measurement for each inconsistencies identified in the scoping review
indicator. of adolescent health indicators (3).
Domains: The indicator tables below start with those in Fig. 2 provides an overview of the structure used
the domain “policies, programmes and laws” to organize the metadata in the indicator tables
Policies as the fundamental building blocks for national and explains the different elements.
action, followed by “systems performance and
Systems interventions” and “social, cultural, economic,
Determinants
2
Here, “setting” is defined as a country or regional context and a “subject” is a health or health-related topic.
Behaviours
Well-being
Outcomes
Principles
Action
References
Cambodia: Disability inclusion in health – October-November 2023. © WHO/Miguel Jeronimo

3. The indicators 11
Table 1. Overview of the GAMA-recommended indicators

Data
Domain collection level Indicators Indicator type
National adolescent health programme
Policies,
National standards for adolescent health service delivery Core
programmes Government/
and laws national Health service user fee exemptions for adolescents Additional
Legal restrictions for accessing health services
Health services use
Systems Individual Human papillomavirus (HPV) vaccine coverage Core
performance Additional
Comprehensive school health services
and
School Schools offering HIV and sexuality education
interventions
Adolescent population proportion
Social, School completion
cultural, Foundational learning skills Introduction
economic, Povertya Core
educational and Individual Additional
Food insecurity Process
environmental
health Sexual and reproductive health decision-making among
older female adolescents
determinants Domains:
Adolescents not in education, employment or training
Overweight and obesity
Health Thinness Policies
behaviours Vegetable and fruit consumption
and risks Sugar-sweetened beverage consumption Systems
Physical activity
Heavy episodic drinking Determinants
Alcohol use
Tobacco use Behaviours
Electronic cigarette use
Cannabis use Core Well-being
Individual First sex by age 15 Additional
Pre-menarche menstruation awareness Outcomes
Contraceptive use at last sex (modern method)
Condom use at last sex Principles
Demand for family planning satisfied (modern method)
Skilled birth attendance
Action
Bullying
Physical violence
Contact sexual violence References
Sexual violence by age 18
Someone to talk to about problems Core
Subjective Individual
well-being Positive family relationships Additional
Adolescent mortality rate (all-cause)

Health Adolescent mortality rate (cause-specific)
outcomes and Adolescent birth rate
conditions HIV prevalence
Sexual transmitted infection (STI) incidence Core
Individual
Injury hospitalization rate (cause-specific) Additional
Anaemia
Suicide attempt
Depression/anxiety symptoms
Care seeking for depression/anxiety
Note: Core indicators are the most essential for measuring the health of all adolescents globally. Additional indicators are those provided
for settings where further detail within a subject would add value and resources for data collection and reporting are available.
a
This indicator is reported at the individual level using household data on income (or consumption).
Fig. 2. Overview of indicator metadata structure
The indicators fall into one of two 1. Core indicators are 2. Additional indicators are those
categories, as indicated by the the most essential for provided for settings where further
following labels: measuring the health of detail within a subject would
all adolescents globally. add value and resources for data
collection and reporting are available.
Domain title
Indicator (short name) Core indicator Additional indicator
Introduction Indicator name

For use in the adolescent health context. Adding a
Indicator short name reference to “adolescent” may be considered in a
Description
Process
broader context.
Definition
Domains:
The upper portion (numerator) and lower portion
Numerator (denominator) of a fraction. For some indicators
Policies
(such as those around national policies), only a
Denominator numerator is specified.
Systems
Rationale
Determinants
Justification for why this indicator is important
Behaviours and recommended
Well-being
Most of the indicators are based on data collected
directly from individuals. Some indicator data
Outcomes Data collection level are collected directly from schools or national
governments.
Principles
Preferred data source Specified data sources include:
Action • Ongoing routine • Population-based
Measurement
information sources: surveys

Other possible data • Health • Non-population-
References
source(s) management based, periodic
information information sources:
systems • National policy
• Civil registration surveys
Method of
and vital statistics • School policy
measurement • Population surveys
registers • School censuses
Disaggregation An overview of key methodological points about

how the indicator is measured
Comments
Recommended disaggregation dimensions,
typically sex and 5-year age groups although
Additional information for disaggregation by additional characteristics is
understanding or using the suggested for selected indicators
indicator
3.1 Policies, programmes and laws
Policies, programmes and laws

National adolescent health programme Core indicator
Indicator name Existence of an operational national adolescent health programme

Indicator short name National adolescent health programme
Definition The country has a national adolescent health programme with at
Description
least one designated full-time person and a regular government Introduction

budget allocation to support the programme.
Numerator The country reports the existence of a national adolescent health
Process
programme with at least one designated full-time person and a
regular government budget allocation to support the programme.
Denominator Not applicable Domains:
A national programme with sufficient resources is necessary to identify national and

Rationale
subnational priorities and implementation strategies.a Policies
Systems
Data collection level Government/national
Preferred data source Policy survey Determinants
Other possible data None recommended

Behaviours
source(s)
Measurement
Method of measurement Calculating this indicator requires country-reported data on Well-being

the existence of a national adolescent health programme with
follow-up questions probing on staffing and regular budget Outcomes
allocation. At the global level, these data are periodically
collected through the WHO Sexual, Reproductive, Maternal,
Principles
Newborn, Child and Adolescent Health Policy Survey.b
Disaggregation No standard disaggregation recommended
Action
An adolescent health programme may be stand-alone or integrated with other programmes.
Comments
The requirement of a single full-time person may be satisfied by multiple individuals sharing a
position. References
a
Global accelerated action for the health of adolescents (AA-HA!): guidance to support country implementation,
second edition. Geneva: World Health Organization; 2023 (https://iris.who.int/handle/10665/373300, accessed
2 February 2024).
b
Katwan E, Bisoborwa G, Butron-Riveros B, Bychkov S, Dadji K, Fedkina N et al. Creating a global legal and
policy database and document repository: challenges and lessons learned from the World Health Organization
Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey. Int J Health Policy Manag.
2022;11(11):2415–21. doi:10.34172/ijhpm.2021.153.

National standards for adolescent health service delivery Core indicator
Indicator name Existence of national standards for delivery of health services to

adolescents
Indicator short name National standards for adolescent health service delivery
Definition The country has national standards for delivery of health services
Description
specifically for adolescents that include a clearly defined,

comprehensive package of health services, the implementation of
which has been monitored.
Numerator The country reports the existence of national standards for
delivery of health services to adolescents that include a clearly
defined, comprehensive package of health services, the
Introduction
implementation of which has been monitored.
Denominator Not applicable
Process
National standards for adolescent health service delivery help to ensure the basic health needs
Rationale
of adolescents are met.a WHO promotes a standards-driven approach to improve the quality of
Domains: health services.b, c Many countries have moved towards a standards-driven approach to improve
the quality of care for adolescents, guided by the WHO/UNAIDS Global standards for quality of
Policies health-care services for adolescents,c yet few regularly monitor them.b
Systems
Preferred data source Policy survey
Determinants Other possible data None recommended
source(s)
Measurement
Behaviours Method of measurement Calculating this indicator requires country-reported data on

the existence of standards for the delivery of health services to
Well-being adolescents with follow-up questions on monitoring activities
and the inclusion of a comprehensive package of health services.
Outcomes At the global level, these data are periodically collected through
the WHO Sexual, Reproductive, Maternal, Newborn, Child and
Adolescent Health Policy Survey.d
Principles
A list of currently recommended adolescent services and interventions is included within Global
Comments
Action
accelerated action for the health of adolescents (AA-HA!).b
References
a
Nair M, Baltag V, Bose K, Boschi-Pinto C, Lambrechts T, Mathai M. Improving the quality of health care services for
adolescents, globally: a standards-driven approach. J Adolesc Health. 2015;57(3):288–98.
b
2 February 2024).
c
Global standards for quality health-care services for adolescents: a guide to implement a standards-driven approach
to improve the quality of health care services for adolescents. Geneva: World Health Organization; 2015 (https://iris.
who.int/handle/10665/183935, accessed 2 February 2024).
d
2022;11(11):2415–21. doi:10.34172/ijhpm.2021.153.

Health service user fee exemptions for adolescents Additional indicator
Indicator name Existence of a national policy exempting adolescents from user

fees for outpatient care visits in the public sector
Indicator short name Health service user fee exemptions for adolescents
Definition The existence of a national policy exempting adolescents from
Description
user fees for outpatient care visits in the public sector

Numerator Yes = All adolescents are exempted from user fees for outpatient
care visits.
Partial = Selected adolescent population groups are exempted
from user fees for outpatient care visits.
No = Adolescents are not exempted from user fees for outpatient
Introduction
care visits.
Denominator Not applicable
Process
Financial barriers can prevent adolescents from accessing health services because
Rationale
adolescents are less likely to be covered by insurance and/or able to pay out-of-pocket
Domains:
costs for health services.a, b Health service user fee exemptions can increase access to health
services for adolescents seeking care in public-sector facilities.
Policies
Preferred data source Policy survey Systems

source(s) Determinants
Measurement
Method of measurement Calculating this indicator requires country-reported data on the

Behaviours
existence of a national policy exempting adolescents from user
fees for outpatient care visits with follow-up questions asking
Well-being
whether the exemption applies to all adolescents or only to
specific subgroups. At the global level, these data are periodically
Outcomes
collected through the WHO Sexual, Reproductive, Maternal,
Newborn, Child and Adolescent Health Policy Survey.c
Disaggregation No standard disaggregation recommended Principles
No additional comments
Comments
Action
References
a
Adolescent health: the missing population in universal health coverage. Geneva: World Health Organization; 2019
(https://pmnch.who.int/resources/publications/m/item/adolescent-health---the-missing-population-in-universal-
health-coverage, accessed 8 February 2024).
b
2 February 2024).
c
2022;11(11):2415–21. doi:10.34172/ijhpm.2021.153.

Legal restrictions for accessing health services Additional indicator
Indicator name Absence of a legal age limit for adolescents to provide consent for
specified adolescent health services without spousal, parental or legal
guardian consent
Indicator short name Legal restrictions for accessing health services
Definition The absence of a legal age limit to allow married and unmarried
adolescents to provide consent for specified adolescent health services
Description
(that is, contraceptive services except sterilization, emergency

contraception, HIV testing and counselling services, HIV care and
treatment, harm reduction interventions for injecting drug users, and
mental health services) without spousal, parental or legal guardian
Introduction consent
Numerator The country reports no legal age limit for married or unmarried
Process adolescents to provide consent to all specified services without
spousal and/or parental/legal consent, respectively.
Domains: Denominator Not applicable
Requirements for parental or legal guardian consent can lead to breaches in confidentiality and
Rationale
Policies can be barriers for adolescents to access health services, such as testing and treatment for HIV or
obtaining contraception.a In measuring the absence of mandatory third-party authorizations for
health services, this indicator provides insight into adolescents’ autonomy regarding their health.b, c
Systems
Determinants Preferred data source Policy survey
Behaviours Other possible data None recommended

Measurement
source(s)
Well-being Method of Calculating this indicator requires country-reported data on the
measurement existence of a legal age limit for adolescents to obtain specified
Outcomes health services, assessed separately among married and unmarried
adolescents. At the global level, these data are periodically collected
through the WHO Sexual, Reproductive, Maternal, Newborn, Child and
Principles
Adolescent Health Policy Survey.d
Disaggregation Marital status
Action
Comments
References
a
Global accelerated action for the health of adolescents (AA-HA!): guidance to support country implementation, second
edition. Geneva: World Health Organization; 2023 (https://iris.who.int/handle/10665/373300, accessed 2 February 2024).
b
c
Assessing and supporting adolescents’ capacity for autonomous decision-making in health care settings: a tool for
health-care providers. Geneva: World Health Organization; 2021 (https://iris.who.int/handle/10665/350208, accessed
2 February 2024).
d
2022;11(11):2415–21. doi:10.34172/ijhpm.2021.153.
3.2 Systems performance and

interventions
Systems performance and interventions
Health services use Core indicator
Indicator name Proportion of adolescents who received a health service during the
past 12 months
Indicator short name Health services use
Description
Definition Proportion of adolescents (10–19 years) who received a health service

from a health provider during the past 12 months Introduction
Numerator Number of adolescents (10–19 years) who received a health service
from a health provider during the past 12 months Process
Denominator Total number of adolescents (10–19 years)
This indicator measures the proportion of adolescents that are using health services and Domains:
Rationale
receiving care. Adolescence is a critical time for developing healthy behaviours and providing
preventive care; therefore, WHO encourages regular use of health services and routine data
Policies
collection of their use.a, b
Data collection level Individual Systems
Preferred data source Population-based survey

Determinants
Other possible data Health management information system (HMIS)
source(s)
Behaviours
Measurement
Method of Data on both health services received and population are required for
measurement this indicator. Surveys can ask a question whether any health service Well-being
was received during the 12 months preceding the survey and then
record the source(s) of the service, which will allow for disaggregation Outcomes
by type of facility. In the case of the use of administrative data, care
should be taken to consider the health services that may be excluded,
such as private facilities, as well as the source of the population data. Principles
Disaggregation Age group (10–14, 15–19 years); sex. Disaggregation by type of facility
may be considered. Action
For this indicator, a health provider includes a doctor, nurse, midwife, community health worker,
or pharmacist. Traditional healers and herbalists are not included. The health service may References
be provided in a health facility that is either stand-alone or integrated within a school setting
Comments
(for example, school health clinic) and the facility may be in any health sector (public, private,
other). When using administrative data, it may be necessary to obtain data from sectors other
than health to reflect the range of facility types and sectors where adolescents’ visits occur, for
example, through the education sector. Whenever data are combined across multiple sources,
care should be taken to avoid double counting.
For more information on the delivery of health services to adolescents, see Global accelerated
action for the health of adolescents (AA-HA!).c
a
b
Pocket book of primary health care for children and adolescents: guidelines for health promotion, disease
prevention and management from the newborn period to adolescence. Copenhagen: World Health Organization.
Regional Office for Europe; 2022 (https://iris.who.int/handle/10665/352485, accessed 2 February 2024).
c
second edition. Geneva: World Health Organization; 2023 (https://iris.who.int/handle/10665/373300, accessed 2
February 2024).
Human papillomavirus (HPV) vaccine coverage Core indicator
Indicator name Proportion of target population covered by human

papillomavirus (HPV) vaccine (last dose in schedule)
Indicator short name Human papillomavirus (HPV) vaccine coverage
Description
Definition Proportion of the target population who have received the final
dose of HPV vaccine
Numerator Number of adolescents in the target population who have
received the final dose of HPV vaccine
Denominator Total number of adolescents in the target population
HPV is a common sexually transmitted infection and can lead to cancer.a Vaccination against
Rationale
Introduction high-risk strains of HPV can prevent infection and the development of HPV-related cancers.a
Vaccination is most effective when completed before the initiation of sexual activity; therefore,
guidelines focus on younger adolescents.b
Process
Data collection level Individual

Domains:
Preferred data source Health management information system (HMIS)
Other possible data Population-based survey
Policies
source(s)
Measurement
Systems
Method of measurement Calculation of this indicator from administrative sources requires
that vaccination status is reported at the level of the individual
adolescent, so that full vaccination coverage can be derived for
Determinants
the numerator, and that an accurate population estimate can be
derived from another source. Surveys can ask those adolescents
Behaviours
who should have received the final dose in the schedule if they
have ever received the HPV vaccination and, if so, how many
Well-being
doses they have received.
Outcomes Disaggregation Sex

WHO guidelines recommend all girls aged 9–14 years be vaccinated as the primary target
population.c If feasible, WHO recommends extending vaccination to secondary target populations,
Principles
Comments
including females aged 15 years and older, boys, older males, or men who have sex with men.c
The target population for this indicator should be defined according to each country’s national
Action immunization schedule. WHO estimates of HPV immunization coverage can be found on the
interactive immunization dashboard.d
For guidance on measuring this indicator using health facility data, see Analysis and use of facility
References
data: guidance for maternal, newborn, child and adolescent health programme managers.e
a
Cervical cancer. Geneva: World Health Organization; 2023 (https://www.who.int/news-room/fact-sheets/detail/
cervical-cancer, accessed 2 February 2024).
b
WHO recommendations on adolescent sexual and reproductive health and rights. Geneva: World Health
Organization; 2018 (https://iris.who.int/handle/10665/275374, accessed 8 February 2024).
c
Human papillomavirus vaccines: WHO position paper (2022 update). Geneva: World Health Organization; 2022
(https://iris.who.int/handle/10665/365350, accessed 2 February 2024).
d
HPV immunization coverage estimates among primary target cohort (9-14 years old girls) (%) [online database].
Geneva: World Health Organization; 2024 (https://www.who.int/data/gho/data/indicators/indicator-details/GHO/
girls-aged-15-years-old-that-received-the-recommended-doses-of-hpv-vaccine, accessed 3 April 2024).
e
Analysis and use of health facility data: guidance for maternal, newborn, child and adolescent health programme
managers. Geneva: World Health Organization; 2023 (https://iris.who.int/handle/10665/373826, accessed 2 February
2024).
Comprehensive school health services Additional indicator
Indicator name Proportion of schools that offer comprehensive school health

services
Indicator short name Comprehensive school health services
Definition Proportion of schools that offer comprehensive school health
services, defined as school health services addressing at least four
of the following health areas relevant to their student population:
positive health and development; unintentional injury; violence;
sexual and reproductive health including HIV; communicable
Description
disease; noncommunicable disease, sensory functions, physical

disability, oral health, nutrition and physical activity; and mental
health, substance use and self-harm Introduction
Numerator Number of schools that offer school health services that address
at least four of the following health areas: positive health Process
and development; unintentional injury; violence; sexual and
reproductive health including HIV; communicable disease;
Domains:
noncommunicable disease, sensory functions, physical disability,
oral health, nutrition and physical activity; and mental health,
substance use and self-harm Policies
Denominator Total number of schools

Systems
Most countries have some form of school health services, but many programmes are not
Rationale
comprehensive.a Mental health promotion, prevention of substance use, violence and

Determinants
unintentional injury, and addressing chronic conditions are often omitted. Comprehensive
school health services increase the accessibility of health services to school-going adolescents
Behaviours
by reducing cost, transportation challenges and location barriers.b, c
Data collection level School Well-being
Preferred data source Policy survey
Outcomes
Measurement
source(s)
Method of measurement This indicator is calculated using data collected directly from Principles
schools, either through a questionnaire and/or key informant
interviews, on which health and nutrition services are provided at Action
the school.
Disaggregation Disaggregation by schooling level (primary, lower secondary, upper
References
secondary) may be considered.
Education systems vary across countries. The International Standard Classification of Education
Comments
(ISCED)d can be used to produce internationally comparable estimates by schooling level.

WHO guideline on school health servicesb provides more information relevant to this indicator.
a
Ready to learn and thrive: what you need to know about the global report on school health and nutrition. Paris:
United Nations Educational, Scientific and Cultural Organization; 2023 (https://www.unesco.org/en/articles/ready-
learn-and-thrive-what-you-need-know-about-global-report-school-health-and-nutrition, accessed 2 February 2024).
b
WHO guideline on school health services. Geneva: World Health Organization; 2021 (https://iris.who.int/
handle/10665/341910, accessed 8 February 2024).
c
Making every school a health-promoting school: global standards and indicators. World Health Organization and
United Nations Educational, Scientific and Cultural Organization; 2021 (https://iris.who.int/handle/10665/341907,
accessed 8 February 2024).
d
International Standard Classification of Education (ISCED) [website]. Paris: United Nations Educational, Scientific
and Cultural Organization; 2024 (https://uis.unesco.org/en/topic/international-standard-classification-education-
isced, accessed 2 February 2024).
Schools offering HIV and sexuality education Additional indicator
Indicator name Proportion of schools that offer life skills-based HIV and sexuality
education
Indicator short name Schools offering HIV and sexuality education
Definition Proportion of schools that offer life skills-based HIV and sexuality
education (that is, education on life skills, sexual and reproductive
health/sexuality, and HIV transmission and prevention)
Numerator Annual school census: Number of schools that teach all three of the following
within the formal curriculum or as part of extracurricular activities: generic
Description
life skills (for example, decision-making/communications/refusal skills),

sexual and reproductive health/sexuality education (for example, teaching
Introduction
on human growth and development, family life, reproductive health,
contraception, sexual abuse, sexually transmitted infections (STIs)), and
Process HIV transmission and prevention
Global School Health Policies and Practices Survey (G-SHPPS).a Number of
schools that teach sexual and reproductive health and HIV transmission,
Domains:
prevention and treatment and at least one of the following topics:
interpersonal communication, decision-making, problem-solving,
Policies goal-setting, refusal, coping or stress management
Denominator Total number of schools
Systems
Life skills-based education on HIV, STIs and pregnancy can help adolescents to make healthy decisions
Rationale
Determinants
about their sexual behaviour and relationships.b This can have a positive effect on their sexual health,
including delayed sexual debut, reduced number of sexual partners and increased condom use.
Behaviours
Data collection level School
Well-being Preferred data source Policy survey
Other possible data Annual school census
Measurement
Outcomes source(s)
Method of This indicator is based on feedback from principals through school-based
Principles measurement surveys or annual school censuses. Regardless of the data source, schools
need to report the following three topics were covered during the previous
or current academic year: generic life skills, sexual reproductive health/
Action
sexuality education, and HIV transmission and prevention.
Disaggregation Schooling level (primary, lower secondary, upper secondary)
References
Education systems vary across countries. The International Standard Classification of Education
Comments
(ISCED)c can be used to produce internationally comparable estimates by schooling level.

For more information, refer to the metadata for SDG thematic indicator 4.7.2d and the
International technical guidance on sexuality education.e
a
Global school health policies and practices survey. Geneva: World Health Organization; 2023 (https://www.who.int/
teams/noncommunicable-diseases/surveillance/systems-tools/global-school-health-policies-and-practices-survey,
b
Measuring the education sector response to HIV and AIDS: guidelines for the construction and use of core indicators.
Paris: United Nations Educational, Scientific and Cultural Organization; 2013 (https://unesdoc.unesco.org/
ark:/48223/pf0000223028, accessed 2 February 2024).
c
d
SDG 4 Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. Paris:
United Nations Educational, Scientific and Cultural Organization; 2021 (https://tcg.uis.unesco.org/wp-content/
uploads/sites/4/2021/09/Metadata-4.7.2.pdf, accessed 2 February 2024).
e
International technical guidance on sexuality education: an evidence-informed approach. Paris: United Nations
Educational, Scientific and Cultural Organization; 2018 (https://unesdoc.unesco.org/ark:/48223/pf0000260770,
3.3 Social, cultural, economic, educational

and environmental health determinants
Social, cultural, economic, educational and environmental health determinants
Adolescent population proportion Core indicator
Indicator name Proportion of total population that are adolescents

Indicator short name Adolescent population proportion
Description
Definition Proportion of the total population in a country that are

adolescents (10–19 years)
Numerator Number of adolescents (10–19 years) in a country Introduction
Denominator Total population in the same country
Knowledge of the proportion of adolescents in a country facilitates the prioritization of health Process
Rationale
resources and adequate allocation to meet adolescents’ health needs. The total adolescent
population, which provides the numerator for calculating adolescent population proportion, is
also a useful input in the calculation of indicators where the population size is required, such as Domains:
‘Adolescent mortality rate’ (‘all-cause’ and ‘cause-specific’).a
Data collection level Individual Policies
Preferred data source Population register

Systems
Other possible data Population-based survey; census
Measurement
source(s)
Determinants
Method of measurement Calculating this indicator requires data on the entire population
of a country by age. Countries with a population register Behaviours
obtain these data on an ongoing basis. In the case of surveys or
censuses, these data can be based on a direct question on age, a Well-being
question on date of birth, or a combination of both, which allows
for cross-verification. Outcomes
Disaggregation Age group (10–14, 15–19 years); sex
Official United Nations country- and region-level population estimates and projections are
Comments
Principles
available in the World Population Prospects population estimates and projections.b
Action
References
a
Azzopardi P, Kennedy E, Patton G. Data and indicators to measure adolescent health, social development and well-
being. Innocenti Research Brief, no. 2017-04. Innocenti, Florence: United Nations Children’s Fund Office of Research;
2017 (https://www.unicef-irc.org/publications/876-data-and-indicators-to-measure-adolescent-health-social-
development-and-well-being.html, accessed 8 February 2024).
b
World population prospects 2022. New York: United Nations Department of Economic and Social Affairs Population
Division; 2022 (https://population.un.org/wpp, accessed 2 February 2024).

School completion Core indicator
Indicator name Proportions of adolescents and young people who have completed
primary, lower secondary and upper secondary school
Indicator short name School completion
Definition Proportion of adolescents and young people aged 3–5 years
Description
above the intended age for the last grade of each level of
education who have completed that grade
Numerator Number of adolescents and young people aged 3–5 years above
the intended age for the last grade of each level of education who
have completed that grade
Introduction Denominator Total number of adolescents and young people aged 3–5 years
above the intended age for the last grade of each level of
education
Process
Higher educational attainment has been associated with increased cognitive development,
Rationale
improved mental health and lower risk of noncommunicable diseases later in life.a
Domains:
Policies Data collection level Individual

Systems Other possible data None recommended
Measurement
source(s)
Determinants
Method of measurement Calculating this indicator requires data on the highest level
of education and/or grade completed. The indicator can then
Behaviours be calculated according to the national educational system
or, for international comparability, the International Standard
Well-being Classification of Education (ISCED).b
Disaggregation Schooling level (primary, lower secondary, upper secondary); sex
Outcomes
The target population for this indicator is determined based on schooling level and includes
both adolescents and young people to account for those who complete schooling after the
Comments
Principles
intended age for the respective level. The SDG indicator metadata define the intended age for
the last grade of each education level as, “the age at which pupils would enter the grade if they
Action had started school at the official primary entrance age, had studied full time and had progressed
without repeating or skipping a grade”. For more information on this indicator, refer to SDG 4
indicator metadata (indicator 4.1.2).c
References
a
Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB et al. Our future: a Lancet commission on adolescent
health and wellbeing. Lancet. 2016;387:2423–78. doi:10.1016/S0140-6736(16)00579-1.
b
c
SDG indicator metadata (Indicator 4.1.2). New York: United Nations; 2022 (https://unstats.un.org/sdgs/metadata/
files/Metadata-04-01-02.pdf, accessed 2 February 2024).

Foundational learning skills Additional indicator
Indicator name Proportion of adolescents and young people at the end of

primary and at the end of lower secondary achieving at least a
minimum proficiency level in (i) reading and (ii) mathematics
Indicator short name Foundational learning skills
Definition Proportion of adolescents and young people at the end of
Description
primary education and at the end of lower secondary education

who achieve at least a minimum proficiency level in (i) reading
and (ii) mathematics
Numerator Number of adolescents and young people at the end of primary
education and at the end of lower secondary education
Introduction
achieving at least a minimum proficiency level in (i) reading and
(ii) mathematics
Denominator Total number of adolescents and young people at the end of Process
primary education and at the end of lower secondary education
Foundational learning skills have been associated with improved economic status, health Domains:
Rationale
literacy and behaviours, living in healthier neighbourhoods, and other social and psychological
benefits, whereas low literacy has been associated with poorer health outcomes.a Policies

Other possible data None recommended Determinants
Measurement
source(s)
Behaviours
Method of measurement Calculating this indicator requires the direct assessment of
reading and mathematics skills. Individual results should then be
compared to the global minimum proficiency levels established Well-being
for each subject and schooling level.
Outcomes
Disaggregation Schooling level (end of primary, end of lower secondary); subject
(reading, mathematics); sex
Principles
Where assessments of learning outcomes are administered within the school system, as is often
Comments
the case, out-of-school adolescents will be excluded from the calculation of this indicator.
For more information on this indicator, refer to SDG indicator metadata (indicator 4.1.1).b Action
References
a
DeWalt DA, Pignone MP. Reading is fundamental: the relationship between literacy and health. Archives of Internal
Medicine. 2005;165(17):1943–4. doi:10.1001/archinte.165.17.1943.
b

Poverty Core indicator
Indicator name Proportion of adolescents who live below the poverty line
Indicator short name Poverty
Definition Proportion of adolescents (10–19 years) who live in households with
income below the nationally established poverty line
Description
Alternate: Proportion of adolescents (10–19 years) who live in

households with income below the international poverty line
Numerator Number of adolescents (10–19 years) who live in households with
income below the nationally established poverty line
Alternate: Number of adolescents (10–19 years) who live in households
with income below the international poverty line
Introduction
Poverty is a significant contributor to the global burden of disease.a Adolescents living below the
Process
poverty line are more likely to experience negative health effects, such as food insecurity and
Rationale
poor mental health.b Using the national poverty line provides a measure of poverty that is more
Domains: consistent with country-specific circumstances and is likely to be more informative for country-
specific programming.c The alternative use of an international poverty line (such as $2.15 per
Policies person per day in 2017 purchasing power parity (PPP)d) can bring the additional advantage of
cross-country comparability.
Systems Data collection level Household
Determinants Other possible data None recommended
source(s)
Behaviours
Method of Calculating this indicator requires data on household income (or
Measurement
measurement consumption) and the existence of a national poverty line. Poverty

Well-being
lines are typically expressed in per capita or adult equivalence
terms and the proper adjustment should be done for households’
Outcomes
income (or consumption). Where no national poverty line has been
established, the international poverty line may be used.e Household
Principles data are then compared with the respective poverty line to determine
household poverty status. Further computation is necessary to
determine the proportion of adolescents living in households below
Action
the respective poverty line.
References
For more information on the SDG indicators providing the basis for this indicator, see the metadata
Comments
for SDG indicators 1.2.1 (national poverty line)c and 1.1.1 (international poverty line),f which assess
poverty among the entire population. For additional discussion of measuring poverty among
younger ages, see the United Nations Children’s Fund Briefing note #2: Child poverty.g
a
Coates MM, Ezzati M, Robles Aguilar G, Kwan GF, Vigo D, Mocumbi AO et al. Burden of disease among the world’s
poorest billion people: an expert-informed secondary analysis of Global Burden of Disease estimates. PLoS One.
2021;16(8):e0253073. doi:10.1371/journal.pone.0253073.
b
Díaz Y, Hessel P, Avendano M, Evans-Lacko S. Multidimensional poverty and adolescent mental health: unpacking the
relationship. Social Science & Medicine. 2022;311:115324. doi:10.1016/j.socscimed.2022.115324.
c
SDG indicator metadata (Indicator 1.2.1). New York: United Nations; 2023 (https://unstats.un.org/sdgs/
metadata/files/Metadata-01-02-01.pdf, accessed 2 February 2024).
d
Fact sheet: An adjustment to global poverty lines. Washington, DC: The World Bank Group; 2022 (https://www.
worldbank.org/en/news/factsheet/2022/05/02/fact-sheet-an-adjustment-to-global-poverty-lines,
e
Poverty and inequality platform [dashboard]. Washington, DC: The World Bank Group; 2024 (https://pip.worldbank.
org/home, accessed 8 February 2024.)
f
SDG Indicator metadata (Indicator 1.1.1). New York: United Nations; 2023 (https://unstats.un.org/sdgs/metadata/
files/Metadata-01-01-01b.pdf, accessed 2 February 2024).
g
Using data to achieve the Sustainable Development Goals (SDGs) for children [United Nations Children’s Fund
(UNICEF) database]. New York: UNICEF; 2023 (https://data.unicef.org/sdgs, accessed 2 February 2024).

Food insecurity Core indicator
Indicator name Proportion of adolescents who went hungry most of the time or
always during the past 30 days because there was not enough
food in their home
Indicator short name Food insecurity
Description
Definition Proportion of adolescents (10–19 years) who went hungry most of

the time or always during the past 30 days because there was not
enough food in their home
Numerator Number of adolescents (10–19 years) who reported going hungry
most of the time or always during the past 30 days
Denominator Total number of adolescents (10–19 years) Introduction
Experiencing food insecurity during adolescence is associated with various nutritional
deficiencies and negative impacts on health, growth and development.a The direct reporting of
Rationale
Process
food insecurity is considered more appropriate for measuring a specific subpopulation, such as
adolescents, than a household measure that may not account for intrahousehold differences in
experiences of food insecurity.b Food insecurity has also been negatively associated with overall Domains:
adolescent mental health.c

Systems
Measurement

source(s)
Determinants
Method of measurement The calculation of this indicator is based on self-reported
experience of hunger, specifically due to inadequate household Behaviours
food supply, during the 30 days preceding data collection.
Disaggregation Age group (10–14, 15–19 years); sex Well-being
Comments
Outcomes
Principles
a
Dush JL. Adolescent food insecurity: a review of contextual and behavioral factors. Public Health Nurs. Action
2020;37(3):327–38. doi:10.1111/phn.12708.
b
Fram MS, Nguyen HT, Frongillo EA. Food insecurity among adolescent students from 95 countries is associated References
with diet, behavior, and health, and associations differ by student age and sex. Current Developments in Nutrition.
2022;6(3):nzac024. doi:10.1093/cdn/nzac024.
c
Elgar FJ, Sen A, Gariépy G, Pickett W, Davison C, Georgiades K et al. Food insecurity, state fragility and youth mental
health: a global perspective. SSM – Population Health. 2021;14:100764. doi:10.1016/j.ssmph.2021.100764.

Sexual and reproductive health decision-making among older female
adolescents Core indicator
Indicator name Proportion of older female adolescents who make their own
informed decisions regarding sexual relations, contraceptive use and
reproductive health care
Indicator short name Sexual and reproductive health decision-making among older
female adolescents
Definition Proportion of older female adolescents (15–19 years) who are
married or in union and who make their own decision on all
three selected areas; that is, they can say no to sexual intercourse
Description
Introduction with their husband or partner, they can decide on their use of
contraception, and they can decide on their own health care
Process
Numerator Number of older female adolescents (15–19 years) who are married
or in union:
• who can say “no” to sex; and
Domains: • for whom the decision on contraception is not mainly made by
the husband/partner or someone else; and
Policies • for whom the decision on health care for themselves is not
usually made by the husband/partner or someone else
Systems Denominator Total number of older female adolescents (15–19 years) who are
married or in union
Determinants
This indicator reflects the sexual and reproductive health autonomy of older female adolescents
Rationale
who are married or in union. Being able to make their own decisions regarding sexual relations,
Behaviours
contraceptive use and reproductive health care rather than under the influence of their partner
or in-laws can demonstrate the older female adolescent’s empowerment. This can also denote a
Well-being
country’s legal framework regarding the empowerment of women and girls.a
Outcomes
Principles Other possible data None recommended
source(s)
Method of The calculation of this indicator is based on three separate questions
Action
Measurement
measurement asked of female respondents who are either married or in union:

1. Can the respondent say no to her husband/partner if she does
References not want to have sexual intercourse?
2. Who usually makes the decision to use contraception?
3. Who usually makes the decision about health care for the
respondent?
In the case of the last two questions, the respondent is counted in
the numerator if she makes the decision either alone or jointly with
her husband or partner.
Where relevant, countries may choose to also report on each empowerment question
Comments
separately. For more information on this indicator, refer to SDG indicator metadata
(indicator 5.6.1).b
a
Ensure universal access to sexual and reproductive health and reproductive rights. New York: United Nations
Population Fund; 2020 (https://www.unfpa.org/sdg-5-6, accessed 2 February 2024).
b

Adolescents not in education, employment or training Core indicator
Indicator name Proportion of older adolescents not in education, employment or

training
Indicator short name Adolescents not in education, employment or training
Description
Definition Proportion of older adolescents (15–19 years) not in education,

employment or training
Numerator Number of older adolescents (15–19 years) not in education,
employment or training
Denominator Total number of older adolescents (15–19 years)
Older adolescents not in education, employment or training are a vulnerable population
Rationale
associated with a higher likelihood of poorer health, smoking and being left out of Introduction
employment.a, b
Process
Domains:
Measurement
source(s)
Policies
Method of measurement Calculating this indicator requires data on adolescents’
participation in formal or non-formal education, employment
Systems
status, and involvement in vocational/technical training.
Adolescents not participating in any of the above are classified as
Determinants
not in education, employment or training.
Disaggregation Sex Behaviours
This indicator is an adolescent-specific age disaggregation of SDG indicator 8.6.1, the target
population of which also includes ages 20–24 years,c and should be interpreted alongside other Well-being
education indicators.
Comments
Education systems vary across countries, as do definitions of employment and vocational Outcomes
and technical training. Calculating this indicator in a consistent way across time and countries
requires alignment with standardized definitions. The SDG indicator metadata provides
Principles
definitions of education according to the International Standard Classification of Education
(ISCED),d as well as definitions of employment and training that can be used across different
country settings.c Action
References
a
Chandler RF, Santos Lozada AR. Health status among NEET adolescents and young adults in the United States,
2016–2018. SSM – Population Health. 2021;14:100814. doi:10.1016/j.ssmph.2021.100814.
b
World report on child labour 2015: paving the way to decent work for young people. Geneva: International Labour
Organization; 2015 (https://www.ilo.org/ipec/Informationresources/WCMS_358969/lang--en/index.htm, accessed
2 February 2024).
c
d
3.4 Health behaviours and risks
Health behaviours and risks

Overweight and obesity Core indicator
Indicator name Prevalence of overweight and obesity among adolescents

Indicator short name Overweight and obesity
Definition Proportion of adolescents (10–19 years) whose body mass index
Description
(BMI) was ≥ + 1 standard deviation (SD) (overweight) and ≥ +2 SDs

Introduction (obese) from the median BMI, according to WHO growth reference
standards for respective age and sex
Process Numerator Number of adolescents (10–19 years) whose BMI was ≥ +1 SD
(overweight) and ≥ +2 SDs (obese) from the median BMI according
to WHO growth reference standards for respective age and sex
Domains:
Overweight and obesity are risk factors for various noncommunicable diseases, such as
Rationale
Policies
cardiovascular diseases, diabetes, musculoskeletal disorders and some cancers.a Overweight
adolescents are more likely to experience obesity, disability and premature death in adulthood.b
Systems

Determinants
Measurement
source(s)
Well-being Method of The calculation of this indicator requires data on height and weight,
measurement together with the age and sex of the corresponding individual. BMI
Outcomes is calculated as a function of an individual’s height and weight and
is compared to WHO growth reference standards for the respective
Principles
age and sex to determine weight status.c
Disaggregation Age group (10–14, 15–19 years); sex; weight status (overweight,
obese)
Action
BMI is calculated by dividing weight in kilograms by height in metres squared (kg/m2). To obtain
valid anthropometric data at the population level, it is necessary to have specially trained
Comments
References staff using standardized equipment and methods. WHO and the United Nations Children’s
Fund (UNICEF) have produced detailed recommendations for anthropometric data collection,
analysis and reporting among children aged under 5 years, much of which is applicable to
any age group.d For more information on BMI weight status cut-offs, refer to the WHO growth
reference standards.d
a
Lister NB, Baur LA, Felix JF, Hill AJ, Marcus C, Reinehr T et al. Child and adolescent obesity. Nat Rev Dis Primers.
2023;9(1):24. doi:10.1038/s41572-023-00435-4.
b
Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C et al. Global, regional and national prevalence of
overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of
Disease Study 2013. Lancet. 2014;384:766–81. doi:10.1016/S0140-6736(14)60460-8.
c
BMI-for-age (5–19 years). Geneva: World Health Organization; 2007 (https://www.who.int/tools/growth-reference-
data-for-5to19-years/indicators/bmi-for-age, accessed 2 February 2024).
d
Recommendations for data collection, analysis and reporting on anthropometric indicators in children under
5 years old. Geneva: World Health Organization and the United Nations Children’s Fund; 2019 (https://iris.who.int/

Thinness Core indicator
Indicator name Prevalence of thinness among adolescents

Indicator short name Thinness
Definition Proportion of adolescents (10–19 years) whose body mass index
Description
(BMI) was < –2 SDs from the median BMI, according to WHO
growth reference standards for the respective age and sex
Numerator Number of adolescents (10–19 years) whose BMI was
< –2 standard deviations (SDs) from the median BMI according to
WHO growth reference standards for the respective age and sex
Thinness can have various health consequences for adolescents, such as musculoskeletal Introduction
Rationale
growth, the timing of puberty, immunity and neurodevelopment.a While thinness can often be
attributed to socioeconomic factors, it can also be caused by psychological conditions, such as
Process
anorexia nervosa, which can negatively impact mental and physical health and contribute to
premature mortality.b
Data collection level Individual Domains:

Policies
Measurement
source(s)
Systems
Method of measurement The calculation of this indicator requires data on height and
weight, together with the age and sex of the corresponding
Determinants
individual. BMI is calculated as a function of an individual’s height
and weight and is compared to WHO growth reference standards
Behaviours
for the respective age and sex to determine weight status.c
BMI is calculated by dividing weight in kilograms by height in metres squared (kg/m ). Beyond
2
the < –2 SDs cut-off in this indicator, there are additional cut-offs for assessment of adolescent Outcomes
Comments
nutritional status. For example, < –3 SDs from the median BMI is interpreted as severe thinness.d
To obtain valid anthropometric data at the population level, it is necessary to have specially
Principles
trained staff using standardized equipment and methods. WHO and UNICEF have produced
detailed recommendations for anthropometric data collection, analysis and reporting among
children under age five, much of which is applicable to any age group.d Action
References
a
Norris SA, Frongillo EA, Black MM, Dong Y, Fall C, Lampl M et al. Nutrition in adolescent growth and development.
Lancet. 2022;399(10320):172–84. doi:10.1016/S0140-6736(21)01590-7.
b
Neale J, Hudson LD. Anorexia nervosa in adolescents. Br J Hosp Med (Lond). 2020;81(6):1–8. doi:10.12968/
hmed.2020.0099.
c
BMI-for-age (5–19 years). Geneva: World Health Organization; 2007 (https://www.who.int/tools/growth-reference-
data-for-5to19-years/indicators/bmi-for-age, accessed 2 February 2024).
d
Recommendations for data collection, analysis and reporting on anthropometric indicators in children under
5 years old. Geneva: World Health Organization and the United Nations Children’s Fund; 2019 (https://iris.who.int/

Vegetable and fruit consumption Core indicator
Indicator name Proportion of adolescents who consumed at least 5 servings of

vegetables and fruits per day during the past 7 days
Indicator short name Vegetable and fruit consumption
Description
Definition Proportion of adolescents (10–19 years) who consumed at least

5 servings of vegetables and fruits per day during the past 7 days
Numerator Number of adolescents (10–19 years) who consumed at least
5 servings of vegetables and fruits per day during the past 7 days
Adequate nutrition is important for healthy growth during adolescence.a Eating a balanced diet
Rationale
Introduction with sufficient consumption of fruits and vegetables supports immunity and alertness, as well
as the intake of necessary minerals, vitamins and dietary fibre. Furthermore, eating adequate
vegetables and fruits can reduce the risk of developing malnutrition, metabolic syndrome, and
Process
other noncommunicable diseases.b, c
Domains:
Policies Other possible data None recommended
Measurement
source(s)
Systems Method of measurement The calculation of this indicator requires data on the recent
consumption of vegetables and fruits, typically obtained through
Determinants respondent self-report. It is recommended to separately measure
the consumption of vegetables and fruits, probing for the amount
Behaviours of each consumed by presenting examples, and to then combine
the results to calculate this indicator.
Well-being Disaggregation Age group (10–14, 15–19 years); sex
Comments
WHO recommends consuming at least 5 servings (that is, 400 grams) of vegetables and fruits
Outcomes
per day.d Vegetable and fruit consumption is highly dependent on the local environment;
country-specific examples should be developed with local nutrition experts.
Principles
Action a
Das JK, Salam RA, Thornburg KL, Prentice AM, Campisi S, Lassi ZS et al. Nutrition in adolescents: physiology,
metabolism, and nutritional needs. Ann N Y Acad Sci. 2017;1393(1):21–33. doi:10.1111/nyas.13330.
b
Tian Y, Su L, Wang J, Duan X, Jiang X. Fruit and vegetable consumption and risk of the metabolic syndrome: a meta-
References
analysis. Public Health Nutr. 2018;21(4):756–65. doi:10.1017/S136898001700310X.
c
Vereecken C, Pedersen TP, Ojala K, Krølner R, Dzielska A, Ahluwalia N et al. Fruit and vegetable consumption trends
among adolescents from 2002 to 2010 in 33 countries. Eur J Public Health. 2015;25(suppl2):16–9. doi:10.1093/
eurpub/ckv012.
d
Carbohydrate intake for adults and children: WHO guideline. Geneva: World Health Organization; 2023 (https://iris.

Sugar-sweetened beverage consumption Additional indicator
Indicator name Proportion of adolescents who consumed sugar-sweetened

beverages one or more times per day during the past 7 days
Indicator short name Sugar-sweetened beverage consumption
Description
Definition Proportion of adolescents (10–19 years) who consumed

sugar-sweetened beverages one or more times per day during
the past 7 days
Numerator Number of adolescents (10–19 years) who consumed
sugar-sweetened beverages one or more times per day during
the past 7 days
Denominator Total number of adolescents (10–19 years) Introduction
High consumption of sugar-sweetened beverages in adolescence is associated with poor diet
Rationale
quality, obesity, dental caries and metabolic disorders.a, b Globally, adolescents have been found
Process
to be high consumers of sugar-sweetened beverages.c
Data collection level Individual Domains:

Policies
source(s)
Systems
Method of measurement The calculation of this indicator requires data on the
Measurement
consumption of sugar-sweetened beverages during the

Determinants
past 7 days. Current approaches focus on the self-reported
consumption of specific beverage types, such as carbonated
Behaviours
soft drinks, which may only partially reflect consumption of
the broader category of sugar-sweetened beverages. Further
Well-being
methodological work is required to explore approaches that
would assess consumption of the full range of sugar-sweetened
beverages. Outcomes

Principles
Sugar-sweetened beverages are defined as all types of non-alcoholic beverages containing
free sugars, including carbonated and non-carbonated soft drinks, fruit and vegetable juices
Comments
and drinks, nectars, liquid and powder concentrates, flavoured waters, vitamin waters, energy Action
and sports drinks, ready-to-drink teas, ready-to-drink coffees, flavoured milks and milk-based
drinks, and plant-based milk substitutes.d While no guideline specific to sugar-sweetened
References
beverages currently exists, WHO recommends that free sugars account for no more than 10% of
daily energy intake.e
a
Hardy LL, Bell J, Bauman A, Mihrshahi S. Association between adolescents’ consumption of total and different types
of sugar-sweetened beverages with oral health impacts and weight status. Aust N Z J Public Health. 2018;42(1):22–6.
doi:10.1111/1753-6405.12749.
b
Bleich SN, Vercammen KA. The negative impact of sugar-sweetened beverages on children’s health: an update of the
literature. BMC Obesity. 2018;(5):6. doi:10.1186/s40608-017-0178-9.
c
Rosinger A, Herrick K, Gahche J, Park S. Sugar-sweetened beverage consumption among US youth, 2011–2014. NCHS
Data Brief. 2017;(271):1–8.
d
Fiscal policies to promote healthy diets: policy brief. Geneva: World Health Organization; 2022 (https://iris.who.int/
e
Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation, Geneva,
28 January – 1 February 2002. Geneva: World Health Organization; 2002 (https://iris.who.int/handle/10665/42665,

Physical activity Core indicator
Indicator name Proportion of adolescents who accumulated an average of at least

60 minutes of moderate- to vigorous-intensity physical activity
per day during the past 7 days
Indicator short name Physical activity
Description
Definition Proportion of adolescents (10–19 years) who accumulated an

average of at least 60 minutes of moderate- to vigorous-intensity
physical activity per day during the past 7 days
Numerator Number of adolescents (10–19 years) who accumulated
an average of at least 60 minutes per day of moderate- to
vigorous-intensity physical activity during the past 7 days
Introduction
Physical activity is associated with various health benefits for adolescents, such as improved
Process
Rationale
fitness, cardiometabolic health, bone health, cognitive outcomes and mental health.a However,
most adolescents do not achieve adequate physical activity, especially female adolescents,
Domains: making it difficult to achieve the target of a 15% relative reduction in the global prevalence of
physical inactivity by 2030 as stated in the Global action plan on physical activity 2018–2030.b, c
Systems
source(s)
Measurement
Determinants
Method of measurement Calculating this indicator requires information on the
accumulation of moderate- to vigorous-intensity physical activity
Behaviours
during the reference period. These data may be obtained through
device-based measurement (for example, via accelerometer/
Well-being
movement sensor) or through respondent self-report, which may
be supported with the use of show cards with country-relevant
Outcomes
examples of different types of physical activities.
Principles
The WHO guidelines on physical activity and sedentary behaviour provide more detailed
Comments
information about recommended physical activity.a

Action
References
a
WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization; 2020 (https://iris.
b
Guthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: a pooled
analysis of 298 population-based surveys with 1.6 million participants. Lancet Child Adolesc Health. 2020;4(1):23–35.
doi:10.1016/S2352-4642(19)30323-2.
c
Global action plan on physical activity 2018–2030: more active people for a healthier world. Geneva: World Health

Heavy episodic drinking Core indicator
Indicator name Past 30 day prevalence of heavy episodic drinking among

adolescents
Indicator short name Heavy episodic drinking
Description

six alcoholic drinks on one or more days during the past 30 days
Numerator Number of adolescents (10–19 years) who consumed at least six
alcoholic drinks on one or more days during the past 30 days
Heavy episodic drinking among adolescents can have negative effects on attention, memory
Rationale
and central nervous system development, and has been associated with an increased risk of Introduction
violence (victimization and perpetration), injuries and premature death.a, b, c
Process
Domains:
source(s)
Policies
Method of measurement This indicator is based on self-reported consumption of alcoholic
drinks during the 30 days preceding the survey. Questions
Measurement
Systems
on alcohol consumption may include examples of alcoholic
beverages and what constitutes a drink for each (such as a
Determinants
bottle of beer, a shot of spirits). Respondents who report having
consumed at least one alcoholic beverage during the 30 days
Behaviours
preceding the survey can be asked the maximum number
of drinks they had on a single day. It is recommended that
data collection for this indicator obtain the exact number of Well-being
alcoholic drinks consumed so that alternative thresholds may be
considered where relevant. Outcomes

Principles
A standard alcoholic drink is typically a glass of wine, a bottle of beer, a small glass of liquor or
Comments
a mixed drink. This indicator uses the same threshold of six alcoholic drinks for all adolescents,
regardless of sex, age or other characteristic. For guidance on measuring standard alcoholic Action
drinks, see Brief intervention for hazardous and harmful drinking.d
References
a
White A, Hingson R. The burden of alcohol use: excessive alcohol consumption and related consequences among
college students. Alcohol Res. 2014;35(2):201–18 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3908712/,
b
Feldstein Ewing SW, Sakhardande A, Blakemore S-J. The effect of alcohol consumption on the adolescent brain: a
systematic review of MRI and fMRI studies of alcohol-using youth. Neuroimage Clin. 2014;5:420–37. doi:10.1016/j.
nicl.2014.06.011.
c
Jones RM, Van Den Bree M, Zammit S, Taylor PJ. Change in the relationship between drinking alcohol and risk
of violence among adolescents and young adults: a nationally representative longitudinal study. Alcohol and
Alcoholism. 2020;55(4):439–47. doi:10.1093/alcalc/agaa020.
d
Babor TF, Higgins-Biddle JC. Brief intervention for hazardous and harmful drinking: a manual for use in primary care.
Geneva: World Health Organization; 2001 (https://iris.who.int/handle/10665/67210, accessed 8 February 2024).

Alcohol use Additional indicator
Indicator name Past 30 day prevalence of alcohol use among adolescents

Indicator short name Alcohol use
Description

one alcoholic drink during the past 30 days
Numerator Number of adolescents (10–19 years) who consumed at least one
alcoholic drink during the past 30 days
Alcohol use among adolescents can have negative effects on attention, memory and central
Rationale
nervous system development and has been associated with an increased risk of violence,
Introduction injuries, premature death.a, b Early initiation of alcohol use has been linked to heavy episodic
drinking and alcohol misuse in adulthood.c, d
Process Data collection level Individual
Domains: Other possible data None recommended
Measurement
source(s)
Policies Method of measurement This indicator is based on self-reported consumption of any
alcoholic drink during the 30 days preceding the survey.
Systems Questions on alcohol consumption may include examples of
alcoholic beverages and what constitutes a drink for each (such
Determinants as a bottle of beer, a shot of spirits).
Behaviours
A standard alcoholic drink is typically a glass of wine, a bottle of beer, a small glass of liquor or
Comments
a mixed drink. For guidance on measuring standard alcoholic drinks, see Brief Intervention for
Well-being
Hazardous and Harmful Drinking.e
Outcomes
Principles a
White A, Hingson R. The burden of alcohol use: excessive alcohol consumption and related consequences among
college students. Alcohol Res. 2014;35(2):201–18 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3908712/,
Action b
Feldstein Ewing SW, Sakhardande A, Blakemore S-J. The effect of alcohol consumption on the adolescent brain: a
systematic review of MRI and fMRI studies of alcohol-using youth. Neuroimage Clin. 2014;5:420–37. doi:10.1016/j.
nicl.2014.06.011.
References c
Conegundes LSO, Valente JY, Martins CB, Andreoni S, Sanchez ZM. Binge drinking and frequent or heavy drinking
among adolescents: prevalence and associated factors. J Pediatr (Rio J). 2020;96(2):193–201. doi:10.1016/j.
jped.2018.08.005.
d
Jones RM, Van Den Bree M, Zammit S, Taylor PJ. Change in the relationship between drinking alcohol and risk
of violence among adolescents and young adults: a nationally representative longitudinal study. Alcohol and
Alcoholism. 2020;55(4):439–47. doi:10.1093/alcalc/agaa020.
e
Babor TF, Higgins-Biddle JC. Brief intervention for hazardous and harmful drinking: a manual for use in primary care.

Tobacco use Core indicator
Indicator name Past 30 day prevalence of tobacco use among adolescents

Indicator short name Tobacco use
Description
Definition Proportion of adolescents (10–19 years) who used tobacco on one

or more days during the past 30 days
Numerator Number of adolescents (10–19 years) who used tobacco on one or
more days during the past 30 days
The use of both smoked and smokeless tobacco products has been linked to increased mortality
Rationale
and morbidity, including asthma, bronchitis and other pulmonary conditions.a Furthermore,
initiation of smoking tobacco use during adolescence is associated with regular tobacco use into Introduction
adulthood.b
Data collection level Individual Process

Other possible data None recommended Domains:
Measurement
source(s)
Method of measurement The calculation of this indicator is based on self-reported use of Policies
both smoked and smokeless tobacco products. To improve recall,
specific types of smoked and smokeless tobacco can be asked Systems
about individually, including any country-specific examples.
Disaggregation Age group (10–14, 15–19 years); sex; type of tobacco used (that is, Determinants
cigarettes, other smoking tobacco, smokeless tobacco)
Tobacco use includes use of cigarettes, other smoked tobacco products and smokeless tobacco Behaviours
Comments
products, and includes both daily and nondaily use.c Current tobacco use does not include use
of electronic cigarettes. Well-being
Outcomes
a
Reitsma MB, Fullman N, Ng M, Salama JS, Abajobir A, Abate KH et al. Smoking prevalence and attributable disease Principles
burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study
2015. Lancet. 2017;389:1885–906. doi:10.1016/S0140-6736(17)30819-X.
b
Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M et al. Global, regional, and national Action
comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters
of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet.
2015;386(10010):2287–323. doi:10.1016/S0140-6736(15)00128-2. References
c
WHO global report on trends in prevalence of tobacco use 2000–2025, third edition. Geneva: World Health

Electronic cigarette use Additional indicator
Indicator name Past 30 day prevalence of electronic cigarette use among

adolescents
Indicator short name Electronic cigarette use
Description
Definition Proportion of adolescents (10–19 years) who used electronic

cigarettes on one or more days during the past 30 days
Numerator Number of adolescents (10–19 years) who used electronic
cigarettes on one or more days during the past 30 days
Electronic cigarettes (e-cigarettes) may or may not include nicotine (but do not contain tobacco)
Rationale
Introduction and typically also include additives, flavours, and chemicals with potentially toxic health
effects.a The use of nicotine-containing e-cigarettes during adolescence is associated with
nicotine dependence, respiratory conditions, poor oral health and negative effects on mental
Process
health. The use of e-cigarettes may also be associated with tobacco use in adulthood.b
Domains:
Measurement
Policies
source(s)
Systems
Method of measurement The calculation of this indicator is based on self-reported use of
e-cigarettes. Given that e-cigarettes are known by many names
and are available in different forms, questions should begin with
Determinants
a country-specific description and question wording should
reflect the country-specific terminology.
Behaviours
Well-being See WHO report on the global tobacco epidemic, 2019 for more information on e-cigarettes.a
Comments
Outcomes
Principles
a
WHO report on the global tobacco epidemic, 2019: offer help to quit tobacco use. Geneva: World Health
Action Organization; 2019 (https://iris.who.int/handle/10665/326043, accessed 2 February 2024).
b
Livingston JA, Chen C-H, Kwon M, Park E. Physical and mental health outcomes associated with adolescent
e-cigarette use. J Pediatr Nurs. 2022;64:1–17. doi:10.1016/j.pedn.2022.01.006.
References

Cannabis use Core indicator
Indicator name Past 30 day prevalence of cannabis use among adolescents

Indicator short name Cannabis use
Description
Definition Proportion of adolescents (10–19 years) who used cannabis

during the past 30 days
Numerator Number of adolescents (10–19 years) who used cannabis on one
or more days during the past 30 days
Cannabis is the most widely used psychoactive substance among adolescents.a Its use during
Rationale
adolescence has been linked to mental health conditions, such as depression and anxiety,b and
an increased likelihood of harmful substance use.c Introduction

Measurement

source(s)
Method of measurement This indicator is based on self-reported cannabis use during the Policies
30 days preceding the survey. Any questions on cannabis use
should include terms, including slang expressions, commonly Systems
used in the country.
Disaggregation Age group (10–14, 15–19 years); sex Determinants
There is a risk of underreporting, particularly in contexts where cannabis is illegal and/or there is
Comments
Behaviours
stigma surrounding its use.
Well-being
Outcomes
a
Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the future national results on adolescent
drug use: overview of key findings, 2011. Ann Arbor: Institute for Social Research, The University of Michigan; 2012
(https://eric.ed.gov/?id=ED529133, accessed 8 February 2024). Principles
b
Hengartner MP, Angst J, Ajdacic-Gross V, Rössler W. Cannabis use during adolescence and the occurrence of
depression, suicidality and anxiety disorder across adulthood: findings from a longitudinal cohort study over Action
30 years. J Affect Disord. 2020;272:98–103. doi:10.1016/j.jad.2020.03.126.
c
Taylor M, Collin SM, Munafò MR, MacLeod J, Hickman M, Heron J. Patterns of cannabis use during adolescence and
their association with harmful substance use behaviour: findings from a UK birth cohort. J Epidemiol Community References
Health. 2017;71(8):764–70. doi:10.1136/jech-2016-208503.

First sex by age 15 Core indicator
Indicator name Proportion of adolescents who had their first sexual intercourse
before 15 years of age
Indicator short name First sex by age 15
Description
Definition Proportion of older adolescents (15–19 years) who had their first
sexual intercourse before 15 years of age
Numerator Number of older adolescents (15–19 years) who had their first
sexual intercourse before 15 years of age
Denominator Total number of older adolescents (15–19 years)
The early onset of sexual activity is associated with an increased risk of STIs and unintended
Rationale
Introduction pregnancy.a Adolescents have been found to have a low utilization of contraceptives.b
Process
Domains:
Measurement
source(s)
Policies
Method of measurement The calculation of this indicator requires data on age at first
sexual intercourse. To obtain these data, it is necessary to
Systems
establish whether the respondent has ever had sex. If so,
respondents are asked at what age they had sexual intercourse
Determinants
for the first time.
Behaviours Disaggregation Sex
Estimates can be biased if a population has a tendency to either overreport or underreport
Comments
Well-being sexual activity.
Outcomes
Principles a
Magnusson BM, Crandall A, Evans K. Early sexual debut and risky sex in young adults: the role of low self-control.
BMC Public Health. 2019;19(1):1483. doi:10.1186/s12889-019-7734-9.
Action
b
Kalamar AM, Tunçalp Ö, Hindin MJ. Developing strategies to address contraceptive needs of adolescents: exploring
patterns of use among sexually active adolescents in 46 low- and middle-income countries. Contraception.
2018;98(1):36–40. doi:10.1016/j.contraception.2018.03.016.
References

Pre-menarche menstruation awareness Additional indicator
Indicator name Proportion of female adolescents who know about menstruation

before menarche
Indicator short name Pre-menarche menstruation awareness
Description
Definition Proportion of post-menarchal female adolescents (10–19 years)

who were aware of menstruation before menarche
Numerator Number of post-menarchal female adolescents (10–19 years) who
knew about menstruation before their first menstrual period
Denominator Total number of post-menarchal female adolescents (10–19 years)
Lacking awareness of menstruation before their first menstrual period can negatively affect an
Rationale
individual’s attitudes around menstruation, potentially leading to low self-esteem and feelings Introduction
of shame.a Menstruation can affect school attendance and sexual and reproductive health, so it
is important for females to be aware and feel prepared before experiencing menarche.b
Process
Preferred data source Population-based survey Domains:
Measurement

source(s) Policies
Method of measurement The calculation of this indicator is based on self-reporting of
having knowledge about menstruation before having a first Systems
period.
Disaggregation Age group (10–14, 15–19 years) Determinants
This is intended to assess the lowest level of knowledge regarding menstruation; that is, that
Comments
Behaviours
respondents knew what was happening to them when they first saw bleeding and/or were
aware that this was something that would happen to them.
Well-being
More information on this indicator can be found in the Priority list of indicators for girls’
menstrual health and hygiene: technical guidance for national monitoring.c
Outcomes
a
Puberty education & menstrual hygiene management. Paris: United Nations Educational, Scientific and Cultural
Principles
Organization; 2014 (https://unesdoc.unesco.org/ark:/48223/pf0000226792, accessed 2 February 2024).
b
Sommer M, Sutherland C, Chandra-Mouli V. Putting menarche and girls into the global population health agenda.
Reprod Health. 2015;12(1). doi:10.1186/s12978-015-0009-8. Action
c
Priority list of indicators for girls’ menstrual health and hygiene: technical guidance for national monitoring. New
York: Global MHH Monitoring Group. Columbia University; 2022 (https://www.publichealth.columbia.edu/file/8002/
download?token=AViwoc5e, accessed 2 February 2024). References

Contraceptive use at last sex (modern method) Core indicator
Indicator name Proportion of adolescents who used contraception (modern

method) at last sexual intercourse
Indicator short name Contraceptive use at last sex (modern method)
Description
Definition Proportion of adolescents (10–19 years) who used any modern

method of contraception the last time they had sexual intercourse
Numerator Number of adolescents (10–19 years) who used a modern method
of contraception at last sexual intercourse
Denominator Total number of adolescents (10–19 years) who have had sexual
intercourse
Introduction Not using a modern contraceptive method is linked to increased likelihood of unintended
Rationale
pregnancy and not using a condom is linked to increased likelihood of transmission of sexually
transmitted infections (STIs).a
Process

Domains:
Measurement

Policies source(s)
Method of measurement Respondents who report having had sexual intercourse are
Systems
asked about contraceptive use at last sex, specifically whether a
contraceptive method was used and, if so, which one(s).
Determinants
Disaggregation Age group (10–14, 15–19 years); sex. Additional disaggregation by
Behaviours
method used and marital status may be considered.
Modern methods include female sterilization, male sterilization, oral contraceptive pill,
Comments
Well-being intrauterine device, injectables, implants, male condom, female condom, diaphragm,
contraceptive foam, contraceptive jelly, lactational amenorrhea method, standard days method,
Outcomes and emergency contraception.
For more information on each of the methods, please refer to Family planning: a global handbook
for providers.b
Principles
a
Contraception: evidence brief. Geneva: World Health Organization; 2019 (https://iris.who.int/handle/10665/329884,
Action
b
Family planning: a global handbook for providers, 2022 edition. Geneva: World Health Organization; 2022 (https://
References www.who.int/publications/i/item/9780999203705, accessed 2 February 2024).

Condom use at last sex Core indicator
Indicator name Proportion of adolescents who used a condom at last sexual

intercourse
Indicator short name Condom use at last sex
Description
Definition Proportion of adolescents (10–19 years) who used a condom the

last time they had sexual intercourse
Numerator Number of adolescents (10–19 years) who used a condom at last
sexual intercourse
Denominator Total number of adolescents (10–19 years) who have had sexual
intercourse
Condom use is protective against pregnancy and transmission of sexually transmitted Introduction
Rationale
infections (STIs).a This indicator measures condom use at the most recent sexual intercourse
and can be understood as a proxy measure of current use.
Process

Domains:
Measurement

Policies
source(s)
Method of measurement Respondents who report having had sexual intercourse are
Systems
asked about contraceptive use at last sex, specifically whether a
contraceptive method was used and probing for condom use if
Determinants
not spontaneously mentioned.
Disaggregation Age group (10–14, 15–19 years); sex Behaviours
Estimates can be biased if a population has a tendency to either overreport or underreport
Comments
sexual activity. Well-being
Outcomes
Principles
a
Condoms. Geneva: World Health Organization; 2023 (https://www.who.int/news-room/fact-sheets/detail/condoms,
Action
References

Demand for family planning satisfied (modern method) Core indicator
Indicator name Proportion of older female adolescents who have their demand
for family planning satisfied with modern methods
Indicator short name Demand for family planning satisfied (modern method)
Definition Proportion of older female adolescents (15–19 years) currently
using a modern method of contraception among those who
Description
desire either to have no (additional) children or to postpone

pregnancy
Numerator Number of older female adolescents (15–19 years) currently
using, or whose sexual partner is currently using, at least one
modern contraceptive method
Introduction
Denominator Total number of older female adolescents (15–19 years) with
demand for family planning (the sum of contraceptive prevalence
Process (any method) and the unmet need for family planning)
Unintended pregnancies, closely spaced pregnancies and being pregnant at a young age can
Rationale
Domains: have various negative health effects as well as socioeconomic consequences.a
Policies
Systems Preferred data source Population-based survey
Measurement
Determinants source(s)
Method of measurement The calculation of this indicator is based on a series of questions
Behaviours
to ascertain modern contraceptive use and fertility intentions, as
well as related parameters such as pregnancy status, postpartum
Well-being amenorrhea and infecundity.
Disaggregation Disaggregation by marital status may be considered, together
Outcomes
with other disaggregation dimensions.
Modern methods include female sterilization, male sterilization, oral contraceptive pill,
Comments
Principles
intrauterine device, injectables, implants, male condom, female condom, diaphragm,
contraceptive foam, contraceptive jelly, lactational amenorrhea method, standard days method,
Action and emergency contraception.
For more information on this indicator, refer to SDG indicator metadata (indicator 3.7.1).a
References
a

Skilled birth attendance Core indicator
Indicator name Proportion of live births to female adolescents attended by skilled
health personnel
Indicator short name Skilled birth attendance
Description
Definition Proportion of live births to female adolescents (10–19 years)

attended by skilled health personnel
Numerator Number of live births to female adolescents (10–19 years)
attended by skilled health personnel at the time of childbirth
Denominator Total number of live births to female adolescents (10–19 years)
Skilled birth attendance is linked to the prevention of childbirth complications and reducing
Rationale
maternal and perinatal mortality and morbidity.a Introduction
Process
Domains:
Measurement
source(s)
Policies
Method of measurement This indicator is based on data obtained from female respondents
on all their pregnancies resulting in a live birth, with a subsequent
question asking who attended the delivery of each live birth in the Systems
2–3 years preceding the survey, which informs the classification of
“skilled”. Determinants
Disaggregation Age group (10–14, 15–19 years)

Behaviours
The standard calculation for this indicator is based on data from the 2–3 years preceding the
Comments
survey. Some data collection methods also obtain data on stillbirths, allowing for the calculation Well-being
of this indicator based on all births, both live and stillborn.
For more information, refer to the joint statement on skilled health personnel by WHO, UNFPA,
Outcomes
UNICEF, ICM, ICN, FIGO and IPA.b
FIGO: International Federation of Gynecology and Obstetrics; ICM: International Confederation of Midwives; ICN: Principles
International Council of Nurses; IPA: International Pediatric Association; UNFPA: United Nations Population Fund;
UNICEF: United Nations Children’s Fund; WHO: World Health Organization.
Action
a
Budu E, Chattu VK, Ahinkorah BO, Seidu A-A, Mohammed A, Tetteh JK et al. Early age at first childbirth and References
skilled birth attendance during delivery among young women in sub-Saharan Africa. BMC Pregnancy Childbirth.
2021;21:834. doi:10.1186/s12884-021-04280-9.
b
Definition of skilled health personnel providing care during childbirth: the 2018 joint statement by WHO, UNFPA,
UNICEF, ICM, ICN, FIGO and IPA. Geneva: World Health Organization; 2018 (https://iris.who.int/handle/10665/272818,

Bullying Core indicator
Indicator name Proportion of adolescents who experienced bullying during the

past 12 months
Indicator short name Bullying
Description
Definition Proportion of adolescents who experienced bullying during the

past 12 months
Numerator Number of adolescents (10–19 years) who experienced bullying
during the past 12 months
Bullying, both in-person and online, is highly prevalent and negatively impacts health,
Rationale
Introduction particularly mental health.a Experiencing bullying has been linked to depression, anxiety and
suicidality, with the potential for these effects to last into adulthood.b
Process
Domains:
source(s)
Policies
Measurement
Method of measurement The calculation of this indicator is based on self-reported

experience of bullying during the year preceding the survey. To
Systems
improve validity, a description of bullying should be provided,
followed by questions specific to different types of bullying,
Determinants
including in-person and cyber-bullying.
Behaviours Disaggregation Age group (10–14, 15–19 years); sex; type of bullying (that is,
in-person versus digital bullying/cyber-bullying). Additional
Well-being
disaggregation by perpetrator or whether bullying was physical,
sexual or emotional may be considered.
Outcomes Bullying may occur in person or online (cyber-bullying) and is defined as unwanted, aggressive
Comments
behaviour by a peer or a group of peers who are neither siblings nor in a romantic relationship
with the victim.c Bullying involves a repeated pattern of physical, psychological or social
Principles
aggression likely to cause harm, and often takes place in schools and other settings where
children gather, as well as online.
Action
a
Armitage R. Bullying in children: impact on child health. BMJ Paediatr Open. 2021;5(1):e000939. doi:10.1136/
References bmjpo-2020-000939.
b
Copeland WE, Wolke D, Angold A, Costello EJ. Adult psychiatric outcomes of bullying and being bullied by peers in
childhood and adolescence. JAMA Psychiatry. 2013;70:419–26. doi:10.1001/jamapsychiatry.2013.504.
c
INSPIRE indicator guidance and results framework – ending violence against children: how to define and measure
change. New York: United Nations Children’s Fund; 2018 (https://www.who.int/publications/m/item/inspire-
indicator-guidance-and-results-framework, accessed 2 February 2024).

Physical violence Core indicator
Indicator name Proportion of adolescents who experienced physical violence

during the past 12 months
Indicator short name Physical violence
Description
Definition Proportion of adolescents (10–19 years) who experienced

physical violence (excluding sexual violence) during the past
12 months
Numerator Number of adolescents (10–19 years) who experienced physical
violence (excluding sexual violence) during the past 12 months
Adolescents who experience physical violence are at increased risk of physical harm, including Introduction
Rationale
injury and death. Furthermore, there can be various negative mental health effects of
experiencing violence, such as depression, anxiety and suicidality.a
Process

Domains:
Policies
source(s)
Measurement
Method of measurement This indicator is based on self-reported experience of physical

Systems
violence. These data may be obtained by asking a single question
after describing what constitutes a physical attack. It is possible
Determinants
to obtain more detailed information through a series of questions
determining whether specific people (intimate partners, peers,
Behaviours
adult relatives, etc.) perpetrated specific types of physical
violence against the respondent during the preceding year.
Well-being
Physical violence includes both physical attacks perpetrated by one or more people and fights
Comments
Outcomes
between peers. Slapping, hitting, beating and burning are all examples of physical violence, as is
using a weapon, such as a knife or a gun. Physical violence is a subset of violence as defined by
Principles
WHO, which includes both the threatened and actual intentional use of physical force or power.b
Action
a
Global status report on preventing violence against children 2020. Geneva: World Health Organization; 2020 (https://
iris.who.int/handle/10665/332394, accessed 2 February 2024).
References
b
International classification of violence against children (ICVAC). New York: United Nations Children’s Fund;
2023 (https://data.unicef.org/resources/international-classification-of-violence-against-children, accessed
2 February 2024).

Contact sexual violence Core indicator
Indicator name Proportion of adolescents who experienced contact sexual

violence during the past 12 months
Indicator short name Contact sexual violence
Definition Proportion of adolescents (10–19 years) who experienced sexual
Description
violence involving physical contact (that is, forced, pressured or

coerced (completed) sex; attempted (but not completed) forced,
coerced or pressured sex; or unwanted, non-consensual sexual
touch) during the past 12 months
Numerator Number of adolescents (10–19 years) who experienced contact
sexual violence during the past 12 months
Introduction
Experiencing contact sexual violence can have various negative effects on adolescents’ health.
Rationale
Process
There are physical effects, such as injury, disability, sexually transmitted infections (STIs) and
unintended pregnancy, as well as a negative impact on mental health and school performance.a
Domains:
Policies Preferred data source Population-based survey
Measurement
Systems source(s)
Method of measurement This indicator is based on self-reported experience of contact
Determinants
sexual violence during the preceding year. Ideally measurement
should be based on a series of questions covering different types
Behaviours
of contact sexual violence including forced and pressured sex
(whether completed or not) and unwanted touching.
Well-being
Outcomes Sexual violence may take many forms. The items included within this indicator represent the
Comments
subset of sexual violence involving physical contact, which would exclude forms of sexual
violence such as, for example, verbal sexual harassment and online sexual abuse. The INSPIRE
Principles
indicator guidanceb provides more information on different types of sexual violence. Incidents of
contact sexual violence are likely to be underreported due to stigma.
Action
a
Clarke V, Goddard A, Wellings K, Hirve R, Casanovas M, Bewley S et al. Medium-term health and social outcomes
References in adolescents following sexual assault: a prospective mixed-methods cohort study. Soc Psychiatry Psychiatr
Epidemiol. 2023;58:1777–933. doi:10.1007/s00127-021-02127-4.
b
INSPIRE indicator guidance and results framework – ending violence against children: how to define and measure
change. New York: United Nations Children’s Fund; 2018 (https://www.who.int/publications/m/item/inspire-
indicator-guidance-and-results-framework, accessed 2 February 2024).

Sexual violence by age 18 Additional indicator
Indicator name Proportion of young women and men who experienced sexual
violence by age 18
Indicator short name Sexual violence by age 18
Description
Definition Proportion of young women and men (18–29 years) who

experienced sexual violence by age 18
Numerator Number of young women and men (18–29 years) who reported
experiencing any sexual violence by age 18
Denominator Total number of young women and men (18–29 years)
Experiencing sexual violence can have various effects on adolescents’ health. There are
Rationale
physical effects, such as injury, disability, sexually transmitted infections (STIs) and unintended Introduction
pregnancy, as well as a negative impact on mental health and school performance.a
Process
Domains:
Measurement
source(s)
Policies
Method of measurement Ideally, calculation of this indicator is based on a set of questions
that specifically ask about different forms of sexual violence Systems
including, for example, forced and pressured sex (whether
completed or not), unwanted touching, and online sexual abuse
Determinants
and exploitation.
Disaggregation Age group at victimization (< 10, 10–14, 15–17 years); sex Behaviours
Because “sexual violence” is a broad term encompassing diverse forms of both contact and
non-contact sexual victimization, different sets of questions are used by different cross-country Well-being
Comments
survey programmes, some more detailed than others. Until data collection methods become
more standardized, it is necessary for survey questions to be based on a specific operational Outcomes
definition and for the resulting data to be interpreted accordingly. For more information on this
indicator and a detailed definition of sexual violence, refer to SDG indicator metadata (indicator
Principles
16.2.3).b This indicator can be used when it is not possible to assess the preferred indicator of
contact sexual violence experience during the past 12 months.
Action
a
Clarke V, Goddard A, Wellings K, Hirve R, Casanovas M, Bewley S et al. Medium-term health and social outcomes
in adolescents following sexual assault: a prospective mixed-methods cohort study. Soc Psychiatry Psychiatr References
Epidemiol. 2023;58:1777–933. doi:10.1007/s00127-021-02127-4.
b
3.5 Subjective well-being
Subjective well-being
Someone to talk to about problems Core indicator
Indicator name Proportion of adolescents with someone to talk to when they have a
worry or problem
Indicator short name Someone to talk to about problems
Description
Definition Proportion of adolescents (10–19 years) who talked to someone during

Introduction the past month when they had a worry or problem related to difficult
feelings and experiences
Process Numerator Number of adolescents (10–19 years) who reported having talked to
someone during the past month when they had a worry or problem
related to difficult feelings and experiences
Domains:
Having someone to talk to about worries or problems can play a supportive role in an
Rationale
Policies
adolescent’s mental health.a Many mental health conditions in adulthood begin during
adolescence,b so it is important to encourage adolescents to engage in preventive measures.
Systems

Determinants
source(s)
Measurement
Well-being Method of The GAMA-recommended indicator is based on the specially developed

measurement Measuring Mental Health Among Adolescents and Young People at the
Outcomes Population Level (MMAPP) tool, which has undergone cross-country
validation for this age group.c Following a series of questions pertaining
Principles to challenging feelings and experiences, the respondent is asked if they
spoke with anyone about those sorts of problems or worries in the
preceding month.
Action
This indicator was developed by the MMAPP initiativec, d as part of an indicator package on the
Comments
References mental health of adolescents and young people. MMAPP is available as a module in round 7 of
the Multiple Indicator Cluster Surveys (MICS7) but can also be used as a stand-alone tool.e
a
Guidelines on mental health promotive and preventive interventions for adolescents: helping adolescents thrive.
b
Jones PB. Adult mental health disorders and their age at onset. The British Journal of Psychiatry. Supplement.
2013;54:s5–10. doi:10.1192/bjp.bp.112.119164.
c
Measuring mental health for adolescents and young people at the population level [UNICEF Data topic]. New York:
United Nations Children’s Fund; 2023 (https://data.unicef.org/topic/child-health/mental-health/mmap, accessed
2 February 2024).
d
Carvajal-Velez L, Harris Requejo J, Ahs JW, Idele P, Adewuya A, Cappa C et al. Increasing data and understanding of
adolescent mental health worldwide: UNICEF’s measurement of mental health among adolescents at the population
level initiative. J Adolesc Health. 2023;72(1S):S12–4. doi:10.1016/j.jadohealth.2021.03.019.
e
Multiple Indicator Cluster Surveys (MICS) [website]. New York: United Nations Children’s Fund; 2024 (https://mics.
unicef.org, accessed 2 February 2024).
Subjective well-being
Positive family relationships Additional indicator
Indicator name Proportion of adolescents reporting positive family relationships

Indicator short name Positive family relationships
Description
Definition Proportion of adolescents (10–19 years) reporting positive family

relationships
Numerator Number of adolescents (10–19 years) reporting positive family
relationships
Positive family relationships can play an important role in supporting adolescents’ healthy
Rationale
development and mental health.a Support through positive family relationships during
adolescence are protective for mental and physical health and are associated with better Introduction
educational outcomes and lower levels of risk behaviours.a
source(s)
Measurement
Method of measurement There are various validated measures of positive family Policies
relationships, but the family support subscale of the
Multidimensional Scale of Perceived Social Supportb is Systems
recommended. In this subscale, each of four items is coded on
a 7-point Likert scale from ‘Very strongly disagree’ = 1 to ‘Very Determinants
strongly agree’ = 7. A mean score of 5.5 or above on the subscale
is classified as ‘high family support’ reflecting positive family Behaviours
relationships.
Positive family relationships represent the extent to which adolescents feel connected to,
Comments
and supported by, their parents or other family members. It reflects positive affection in Outcomes
the relationship an adolescent has with their parents/family and the extent to which family
members are sensitive and responsive to the adolescent’s needs. Principles
More information on the Multidimensional Scale of Perceived Social Support is provided in
Zimet, Powell, Farley, Werkman & Berkoff.b
Action
a
Chen P, Harris KM. Association of positive family relationships with mental health trajectories from adolescence to
midlife. JAMA Pediatr. 2019;173(12):e193336. doi:10.1001/jamapediatrics.2019.3336. References
b
Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the Multidimensional Scale
of Perceived Social Support. J Pers Assess. 1990;55(3–4):610–7. doi:10.1080/00223891.1990.9674095.
3.6 Health outcomes and conditions
Health outcomes and conditions
Adolescent mortality rate (all-cause) Core indicator
Indicator name Adolescent mortality rate (all-cause)

Indicator short name Adolescent mortality rate (all-cause)
Description
Definition Number of deaths among adolescents (10–19 years) per 100 000
adolescent population
Introduction Numerator Number of deaths among adolescents (10–19 years) during a
given year x 100 000
Process Denominator Total number of adolescents (10–19 years) during the same year
Adolescent mortality rate is an important measure of population health and can identify
Rationale
informative trends. In the absence of a complete death registration system, data availability on
Domains:
adolescent mortality rates is generally poorer than child mortality rates, so there is a need to
improve data availability.a
Policies
Systems Preferred data source Civil registration and vital statistics (CRVS)
Other possible data Population-based survey; population census; sample registration
Determinants source(s) system
Method of measurement To calculate this indicator, age-specific data on both deaths and
Measurement
Behaviours
population are needed. In the case of CRVS, the numerator is based
on deaths of persons aged 10–19 years during a specified period
Well-being
(for example, the preceding calendar year) and calculated per
100 000 of the estimated/enumerated population aged 10–19
Outcomes years from a different source, such as a population register or a
population projection from a census. In the case of surveys and
Principles censuses, data on both deaths and population are available from
the same source. Data on deaths are based on retrospective recall.
Action
Population-based surveys and censuses can employ both direct and indirect methods to
Comments
provide mortality rates.

References
Estimates of mortality can vary by data source and calculation method. WHO’s Global Health
Estimates present comparable country estimates on an annual basis.b
a
Levels and trends in child mortality – report 2022: estimates developed by the United Nations Inter-agency Group for
Child Mortality Estimation. New York: United Nations Children’s Fund; 2022 (https://data.unicef.org/resources/levels-
and-trends-in-child-mortality/, accessed 9 February 2024).
b
Global health estimates [website]. Geneva: World Health Organization; 2020 (https://www.who.int/data/global-
health-estimates, accessed 2 February 2024).
Adolescent mortality rate (cause-specific) Core indicator
Indicator name Adolescent mortality rate (cause-specific)

Indicator short name Adolescent mortality rate (cause-specific)
Definition Number of deaths among adolescents (10–19 years) per 100 000
adolescent population, by specified causes, including priority
causes of adolescent death globally (that is, cardiovascular
Description
disease, drowning, diarrhoeal diseases, HIV/AIDS, interpersonal

violence, lower respiratory infections, malaria, maternal
conditions, meningitis, neoplasms, road traffic injury, self-harm
and tuberculosis) and other causes determined by the national
context
Introduction
Numerator Number of deaths among adolescents (10–19 years) due to
specified causes during a given year x 100 000
Denominator Total number of adolescents (10–19 years) during the same year Process
Causes of mortality change across the lifespan and adolescents have a specific profile of
Rationale
common causes of mortality, with a generally higher proportion of injury as a cause of death Domains:
compared to other age groups.a This indicator includes priority age- and sex-specific causes of
mortality. Improved data collection on mortality causes can encourage targeted action through Policies
national policies and programmes.
Preferred data source Civil registration and vital statistics (CRVS)
Other possible data Population-based survey; health management information Determinants
source(s) system (HMIS); sample registration system
Behaviours
Method of measurement To calculate this indicator, age-specific data on both cause of
death and population are needed. CRVS, surveillance and HMIS Well-being
can provide cause-specific deaths of persons aged 10–19 years
Measurement
during a specified period (for example, the preceding calendar Outcomes

year), but the estimated/enumerated population aged 10–19 years
would come from a different source, such as a population register
or a population projection from a census. Cause-specific death Principles
data may also be obtained from population-based surveys with
verbal autopsies; these surveys also provide the required data for Action
the denominator.
Disaggregation Age group (10–14, 15–19 years); sex; cause (cardiovascular
References
disease, drowning, diarrhoeal diseases, HIV/AIDS, interpersonal
violence, lower respiratory infections, malaria, maternal
conditions, meningitis, neoplasms, road traffic injury, self-harm
and tuberculosis)
Estimates of cause of death can vary by data source and calculation method. WHO’s Global
Comments
Health Estimates present comparable country estimates on an annual basis.b
a
Strong KL, Pedersen J, Johansson EW, Cao B, Diaz T, Guthold R et al. Patterns and trends in causes of child
and adolescent mortality 2000–2016: setting the scene for child health redesign. BMJ Glob Health. 2021 Mar
1;6(3):e004760. doi:10.1136/bmjgh-2020-004760.
b
Global health estimates [website]. Geneva: World Health Organization; 2020 (https://www.who.int/data/global-
health-estimates, accessed 2 February 2024).
Adolescent birth rate Core indicator
Indicator name Adolescent birth rate

Indicator short name Adolescent birth rate
Description
Definition Number of live births to female adolescents per 1 000 female

adolescents
Numerator Number of live births to female adolescents (10–19 years) during
a given year x 1 000
Denominator Total number of female adolescents (10–19 years) during the
same year
Adolescent pregnancy and birth can negatively affect health outcomes for both the adolescent
Rationale
Introduction and baby.a
Process
Preferred data source Civil registration and vital statistics (CRVS)
Domains:
Other possible data Population-based survey; population census
source(s)
Policies
Method of measurement To calculate this indicator, data on both births and female
Measurement
population are needed. In the case of CRVS, the numerator is

Systems
based on births that have been registered during a specified
period (for example, the preceding calendar year) and calculated
Determinants
over a denominator of estimated/enumerated women from a
different source, such as a population projection from a census. In
Behaviours
the case of surveys and censuses, data on both births and female
population are available from the same source. Data on births are
Well-being based on retrospective recall.
Disaggregation Age group (10–14, 15–19 years)
Outcomes
Data for this indicator are routinely collected for adolescents aged 15–19 years, but data
Comments
collection for adolescents aged 10–14 years is also recommended.

Principles
Action
a
Vobecká J. UNECE monitoring framework for the ICPD programme of action beyond 2014. United Nations Economic
References
Commission for Europe; 2018 (https://eeca.unfpa.org/en/publications/unece-monitoring-framework-icpd-
programme-action-beyond-2014, accessed 9 February 2024).
HIV prevalence Core indicator
Indicator name Proportion of adolescents living with HIV

Description
Indicator short name HIV prevalence

Definition Proportion of adolescents (10–19 years) living with HIV
Numerator Number of adolescents (10–19 years) living with HIV
HIV infection can have profoundly negative effects on health if left untreated. Adolescents
accounted for 10% of new HIV infections in 2022.a While HIV incidence, the rate of new HIV
infections over time, is a more sensitive measure of the current state of the epidemic and
changes in incidence can be more directly interpreted as reflecting success of interventions, it is
Rationale
difficult and costly to measure. HIV prevalence among adolescents has been used as a proxy for Introduction
new HIV infections among this age group.b
Many adolescents living with HIV have limited access to needed services and are less likely
Process
to seek out HIV testing and to start and adhere to recommended treatment.b Furthermore,
adolescents living with HIV commonly experience mental health problems associated with HIV-
related stigma and discrimination.c Domains:
Preferred data source Population-based survey Policies

Measurement
Systems
source(s)
Method of measurement HIV serology can be included in population-based surveys to
Determinants
obtain estimates of prevalence in the general population. Data
from other sources are typically representative of a specific
Behaviours
population subgroup, such as people who are pregnant, inject
drugs or are sex workers, and should be interpreted accordingly.
Well-being
Interpretation of this indicator can be facilitated by examining related HIV indicators, including
Comments
Outcomes
HIV incidence and the proportion of adolescents living with HIV among the total population
living with HIV. Modelled estimates of the number of adolescents living with HIV are produced
Principles
annually at the country and global levels. For more information, see UNAIDS data.d
Action
a
HIV estimates with uncertainty bounds 1990–present. UNAIDS; 2023 (https://www.unaids.org/en/resources/
documents/2023/HIV_estimates_with_uncertainty_bounds_1990-present, accessed 18 February 2024).
References
b
Adolescent friendly health services for adolescents living with HIV: from theory to practice. Geneva: World Health
c
Dessauvagie AS, Jörns-Presentati A, Napp AK, Stein DJ, Jonker D, Breet E et al. The prevalence of mental health
problems in sub-Saharan adolescents living with HIV: a systematic review. Global Mental Health. 2020;7:e29.
doi:10.1017/gmh.2020.18.
d
UNAIDS data [website]. Geneva: Joint United Nations Programme on HIV/AIDS; 2024 (https://www.unaids.org/en/
topic/data, accessed 2 February 2024).
Sexually transmitted infection (STI) incidence Core indicator
Indicator name Incidence rate of new cases of sexually transmitted infections

(STIs) among adolescents
Indicator short name Sexually transmitted infection (STI) incidence
Definition Number of new cases of specified STIs (that is, syphilis,
Description
gonorrhoea, chlamydia and herpes simplex virus 2 (HSV-2))

among adolescents (10–19 years) per 100 000 adolescent
population during a year
Numerator Number of new cases of specified STIs (that is, syphilis,
gonorrhoea, chlamydia, and HSV-2) among adolescents
(10–19 years) during a given year x 100 000
Introduction
Denominator Total number of adolescents (10–19 years) during the same
year
Process
Adolescents are at increased risk of contracting STIs and experiencing negative health effects.a
Rationale
Furthermore, there is limited data on STI incidence in adolescents, so it is important to address

Domains: this data gap for better prevention and treatment programmes. This indicator measures
specified STIs based on those that are most common among adolescents.
Systems
Measurement
Other possible data Population-based survey

Determinants source(s)
Method of measurement Measurement methods differ between STIs, but incidence may
Behaviours be calculated based on case reports.
Disaggregation Age group (10–14, 15–19 years); sex; type of STI (that is, syphilis,
Well-being
gonorrhoea, chlamydia, and HSV-2)
This indicator may miss out on asymptomatic infections where health care was not sought. Even
Outcomes
Comments
countries with strong health systems may have challenges calculating this indicator, because
data may be collected routinely only among certain key population groups; for example,
Principles pregnant women or sex workers. Thus, available country-level data, regardless of data source,
must be interpreted with an understanding of their specific operational definitions as they are
Action most likely not representative of the general population.
References a
Shannon CL, Klausner JD. The growing epidemic of sexually transmitted infections in adolescents: a neglected
population. Curr Opin Pediatr. 2018;30(1):137. doi:10.1097/MOP.0000000000000578.
Injury hospitalization rate (cause-specific) Core indicator
Indicator name Adolescent injury hospitalization rate due to specified causes

Indicator short name Injury hospitalization rate (cause-specific)
Definition Number of hospitalized cases of specific types of injuries (that
is, road traffic injuries, fire-related burns, poisonings, falls,
Description
and drowning) among adolescents (10–19 years) per 100 000

adolescent population during a year
Numerator Number of hospitalized cases of a specific type of injuries (that
is, road traffic injuries, fire-related burns, poisonings, falls, and
drowning) among adolescents (10–19 years) during a given year
x 100 000
Introduction
Denominator Total number of adolescents (10–19 years) during the same year
Injuries are the highest cause of morbidity and mortality among adolescents.a Understanding
Process
Rationale
the burden of serious injury resulting in hospitalization can help to inform preventive measures
to improve adolescent health.a This indicator measures specified types of injuries like road
traffic accidents, crashes, fire-related burns and falls, based on what are most common among Domains:
adolescents.
Systems
source(s)
Determinants
Method of measurement Calculating this indicator requires information on the final
Measurement
disposition of an injured patient from hospital-based trauma

Behaviours
registries (as part of the core minimum dataset), hospital ward
admission records or national health information systems.
Well-being
These data are routinely collated centrally and stratified by age
and cause groupings (International Statistical Classification
Outcomes
of Diseases and Related Health Problems (ICD) coded ) for the
specified period.
Disaggregation Age group (10–14, 15–19 years); sex; injury type (road traffic Principles
injuries, fire-related burns, poisoning, falls, and drowning)
The types of injuries listed here were selected according to their burden of disease, ease of Action
Comments
collection and relevance to health system capacity as well as integration with the existing
WHO International Registry for Trauma and Emergency Care (IRTEC) initiative.b Reporting of
References
additional injury types may be considered based on the national and regional context. For
guidance on measuring this indicator using health facility data, see Analysis and use of facility
data: guidance for maternal, newborn, child and adolescent health programme managers.c
a
Sleet DA, Ballesteros MF, Borse NN. A review of unintentional injuries in adolescents. Annu Rev Public
Health. 2010;31:195–212. doi:10.1146/annurev.publhealth.012809.103616.
b
WHO International Registry for Trauma and Emergency Care. Geneva: World Health Organization; 2018 (https://www.
who.int/news/item/01-11-2018-who-international-registry-for-trauma-and-emergency-care, accessed 2 February
2024).
c
Analysis and use of health facility data: guidance for maternal, newborn, child and adolescent health programme
managers. Geneva: World Health Organization; 2023 (https://iris.who.int/handle/10665/373826, accessed 2 February
2024).
Anaemia Core indicator
Indicator name Prevalence of anaemia among adolescents

Indicator short name Anaemia
Description
Definition Proportion of adolescents (10–19 years) who have a haemoglobin

level below the relevant WHO threshold
Numerator Number of adolescents (10–19 years) who have a haemoglobin
level less than the relevant WHO threshold
Lacking sufficient iron (anaemia) can have negative health consequences, especially for
Rationale
adolescents, who depend on a variety of vitamins and minerals for healthy growth and
Introduction development.a Furthermore, menstruating adolescents are at higher risk of anaemia due to
repeated loss of blood. This indicator measures anaemia according to relevant WHO thresholds
and recommendations.b
Process
Domains:
source(s)
Measurement
Policies
Method of measurement The calculation of this indicator requires data on capillary or
Systems
venous blood haemoglobin level recorded in grams per decilitre
(g/dL) to one decimal point. Classification of anaemia should be
made with respect to the appropriate WHO thresholdb given an
Determinants
adolescent’s age, sex and other relevant characteristics, including
pregnancy status, smoking and residential elevation above sea
Behaviours
level.
Well-being Disaggregation Age group (10–14, 15–19 years); sex
The cut-offs for anaemia diagnosis vary with sex, age and other characteristics (for example,
Comments
Outcomes pregnancy, smoking status). See the corresponding WHO guidance for additional information on
anaemia and the relevant cut-offs.b
Principles
Action a
Wiafe MA, Ayenu J, Eli-Cophie D. A review of the risk factors for iron deficiency anaemia among adolescents in
developing countries. Anemia. 2023;6406286. doi:10.1155/2023/6406286.
b
Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. Geneva: World Health
References
Suicide attempt Core indicator
Indicator name Proportion of adolescents who report a suicide attempt during

the past 12 months
Indicator short name Suicide attempt
Description
Definition Proportion of adolescents (10–19 years) who reported a suicide

attempt during the past 12 months
Numerator Number of adolescents (10–19 years) who reported a suicide
attempt during the past 12 months
Suicide is one of the most common causes of mortality in adolescents globally.a There are
Rationale
various suicide risk factors, one of which is a previous suicide attempt.a Introduction
Process
Domains:
Measurement
source(s)
Policies
Method of measurement The recommended method to obtain information is to ask
whether any actions have been taken with the intention of ending
Systems
one’s life. For example, “In the past 12 months, did you try to
harm yourself with the intention or desire to end your life? For
Determinants
example, by taking poison, hanging yourself, jumping off a cliff or
bridge, or throwing yourself in front of a moving car?”
Behaviours
A suicide attempt refers to non-fatal suicidal behaviour. For an expanded discussion of Well-being
Comments
terminology and related measurement implications, see Practice manual for established and
maintaining surveillance systems for suicide attempts and self-harm.b Outcomes
Due to stigma and illegality in some countries, suicide attempts may be underreported and data
quality may be low.c
Principles
a
Shain B, Braverman PK, Adelman WP, Alderman EM, Breuner CC, Levine DA et al. Suicide and suicide attempts in Action
adolescents. Pediatrics. 2016;138(1):e20161420. doi:10.1542/peds.2016-1420.
b
Practice manual for establishing and maintaining surveillance systems for suicide attempts and self-harm. World
Health Organization; 2016 (https://iris.who.int/handle/10665/208895, accessed 2 February 2024) References
c
Suicide. Geneva: World Health Organization; 2023 (https://www.who.int/news-room/fact-sheets/detail/suicide,
Depression/anxiety symptoms Core indicator
Indicator name Proportion of adolescents who report symptoms of depression

and/or anxiety during the past 2 weeks
Indicator short name Depression/anxiety symptoms
Description
Definition Proportion of adolescents (10–19 years) with symptoms of

depression and/or anxiety during the past 2 weeks
Numerator Number of adolescents (10–19 years) with symptoms of
depression and/or anxiety
Symptoms of depression and/or anxiety can have various health and social consequences for
Rationale
Introduction adolescents. Many adolescents experience symptoms of depression and/or anxiety but may
not receive adequate support.a Improved data collection and data quality can help in targeting
interventions.
Process
Domains: Preferred data source Population-based survey
Policies source(s)
Method of measurement Among the different methodologies for assessing depression
Measurement
Systems and anxiety is the specially developed Measuring Mental Health

Among Adolescents and Young People at the Population Level
Determinants (MMAPP) tool, which has undergone cross-country validation for
this age group.a Calculating the indicator is based on a short set of
Behaviours screening questions that do not ask about depression or anxiety
directly and instead ask about various symptoms during the
Well-being previous 2 weeks, followed by additional questions to determine
who would meet the threshold of a clinical diagnosis.
Outcomes Disaggregation Age group (10–14, 15–19 years); sex
This indicator was developed by the MMAPP initiativea, b to assess and monitor overall burden
Comments
Principles of a major depressive episode or anxiety disorder based on a level of symptoms consistent
with clinical diagnosis according to the Diagnostic and statistical manual of mental disorders,
fifth edition (DSM-5) and International Classification of Diseases 11th Revision (ICD-11). MMAPP is
Action
available as a module in round 7 of the Multiple Indicator Cluster Surveys (MICS7) but can also
be used as a stand-alone tool.c
References
a
2 February 2024).
b
c
Care seeking for depression/anxiety Additional indicator
Indicator name Proportion of adolescents with symptoms of depression

and/or anxiety who report contact with a health professional
or counsellor for their mental health symptoms
Indicator short name Care seeking for depression/anxiety
Description
Definition Proportion of adolescents (10–19 years) with symptoms of

depression and/or anxiety who had contact with a health
professional or counsellor for their mental health care
Numerator Number of adolescents (10–19 years) with symptoms of
depression and/or anxiety who had contact with a health
professional or counsellor for mental health care
Introduction
Denominator Total number of adolescents (10–19 years) with symptoms of
depression and/or anxiety
Process
If symptoms of depression and/or anxiety are left untreated, these symptoms can persist and
Rationale
worsen into adulthood.a Despite many adolescents experiencing depression and/or anxiety
symptoms, few receive treatment and care.b This indicator can inform interventions to reach Domains:
adolescents who are not seeking care and support.
Systems
source(s)
Determinants
Method of measurement The GAMA-recommended indicator is based on the specially
developed Measuring Mental Health Among Adolescents and
Measurement
Behaviours
Young People at the Population Level (MMAPP) tool, which has
undergone cross-country validation for this age group.c The
Well-being
tool begins by asking a series of questions to identify those with
symptoms of anxiety and/or depression in the 2 weeks preceding
Outcomes
the survey. These data are required for the denominator. The
numerator is derived from additional questions on whether the
respondent talked with anyone about those kinds of problems Principles
or worries in the past month and, if so, who, which allows for
identifying contact with a health professional or counsellor.
Action
This indicator was developed by the MMAPP initiativec, d as part of an indicator package on the
Comments
References
mental health of adolescents and young people. MMAPP is available as a module in round 7 of
the Multiple Indicator Cluster Surveys (MICS7) but can also be used as a stand-alone tool.e
The month time range for the numerator is to give a longer time frame for care seeking for
adolescents who report recent symptoms.
a
Siegel RS, Dickstein DP. Anxiety in adolescents: update on its diagnosis and treatment for primary care providers.
Adolescent Health, Medicine and Therapeutics. 2012;3:1–16. doi:10.2147/AHMT.S7597.
b
Merikangas KR, He J, Burstein M, Swendsen J, Avenevoli S, Case B et al. Service utilization for lifetime mental
disorders in US adolescents: results of the National Comorbidity Survey–Adolescent Supplement (NCS–A). J Am Acad
Child Adolesc Psychiatry. 2011;50(1):32–45. doi:10.1016/j.jaac.2010.10.006.
c
2 February 2024).
d
e
Shivaratri Festival in Pushkar, India. © WHO/Diego Rodriguez
61
4. Measurement
principles
4.1 Holistic approach assessments that disregard crucial nuances,

leading to ineffective or inaccessible health
and interdisciplinary care solutions. Only by integrating contextual
considerations into health measurement does it
collaboration become possible to craft relevant, sensitive and
tailored interventions that resonate with diverse
Adolescent health measurement should adolescent populations, ultimately fostering
encompass a comprehensive view, rather better health outcomes and reducing disparities.
than focusing solely on one aspect. It should In practical terms, while the indicators presented
consider physical, mental, emotional, social in this document are relevant to adolescents in
and developmental aspects. Collaboration all contexts, the application of the recommended
between various disciplines, such as medicine, measurement guidance may vary in different
psychology, sociology, education and public contexts. For instance, when measuring physical
health, is crucial for a holistic understanding and activity, examples of typical local and culturally
Introduction
a broader perspective of adolescent health (7). appropriate activities embedded in the question
text or included in show cards can be different in
Process different contexts.
4.2 Adolescent
Domains:
engagement 4.4 Ethical
Policies Adolescents’ active engagement in health
measurement, interpretation and use of
considerations
Systems results is paramount because of their unique
Privacy and confidentiality
perspectives and experiences and evolving
Maintaining privacy and confidentiality in
Determinants health needs. Involving adolescents in these
adolescent health measurement is crucial
processes not only acknowledges their agency
to foster trust, honesty and openness in
Behaviours and autonomy, but also facilitates the accurate
communication. Adolescents often face sensitive
capture of their diverse realities and concerns.
Well-being
health issues that they may be hesitant to discuss
By actively participating, adolescents can
openly, especially if confidentiality is not assured.
offer invaluable insights into their health
Outcomes
Respecting their privacy ensures a safe space for
priorities, behaviours and challenges, enabling
adolescents to share personal health information
a more comprehensive understanding of their
without fear of judgement or repercussions.
Principles well-being. Moreover, their involvement fosters
Upholding confidentiality encourages candour,
a sense of ownership and empowerment,
allowing for a more accurate assessment of the
encouraging greater honesty, trust and openness
Action adolescent’s health needs and behaviours. It also
in sharing sensitive health information, thereby
promotes a sense of respect for their autonomy
facilitating the development of more effective
and rights, ultimately strengthening the integrity
References and adolescent-centred health interventions
of health measurement and the effectiveness
and policies (23).
of subsequent interventions tailored to their
specific needs (25).
4.3 Consideration of
context Informed consent and assent
Obtaining informed consent from legal guardians
Adolescent health measurement must consider as appropriate as well as assent from adolescents
the broader social, environmental and cultural is a fundamental requirement for ethical health
context young people live in because these measurement, ensuring adolescents and their
elements profoundly shape beliefs, behaviours guardians understand the purpose, risks and
and perceptions surrounding health and benefits. Obtaining informed consent and assent
well-being (24). The context a person lives in involves providing clear and understandable
significantly influences their attitudes towards information, allowing adolescents (and their
health practices, health care utilization and legal guardians as appropriate) to make
responses to health interventions. Failing to voluntary and informed decisions about
account for cultural diversity and social and participating in health measurement (25).
environmental factors can result in inadequate
4. Measurement principles 63
Respect for autonomy

Recognizing adolescents’ autonomy involves
4.6 Disaggregation
acknowledging their right to make decisions Disaggregation is a powerful way to enhance the
about their health when they have the capacity to insight that data can provide. While averages
do so. Respecting their choices fosters a sense of for the entire adolescent population are useful
empowerment and dignity (25). summary measures and can be easy to track and
communicate, they may also obscure patterns
that are relevant to programming and equity
Minimizing harm considerations.
Ethical measurement ensures that the benefits
of the assessment outweigh potential risks For all applicable indicators, standard
and that any potential physical, emotional or disaggregation by sex and by 5-year age
psychological harm to adolescents is minimized. groups (specifically, 10–14 and 15–19 years) is
This includes avoiding invasive procedures as proposed (27). This is considered the minimum
Introduction
much as possible and providing support for any disaggregation useful for programming and
distress resulting from the measurement process advocacy. Disaggregation by additional
(24, 26). characteristics is recommended for selected Process
indicators as described in the relevant indicator
tables in Chapter 3. Domains:
4.5 Equity, inclusivity Further disaggregation may be both beneficial

Policies
and representativeness and necessary in some contexts; however, it is
important to select disaggregation dimensions
carefully. It is not possible to disaggregate Systems
In practice, it is not always easy to ensure
complete representativeness of samples in all data by all the dimensions that might be
of interest – each disaggregation dimension Determinants
adolescent health measurement. For example,
while school surveys provide an opportunity has implications in terms of time, effort and
money, for both generation and use of the Behaviours
to sample many adolescents efficiently, their
representativeness of the adolescent population data. Furthermore, certain disaggregation
dimensions (for example, ethnicity, migration Well-being
depends on school enrolment and attendance.
Similarly, household surveys may also fail to status, sexual orientation) may be socially or
politically sensitive. Consequently, thoughtful Outcomes
capture marginalized adolescents, including
migrants, institutionalized or homeless consideration is required when planning
adolescents, or adolescents in conflict settings. disaggregation in data collection and use (28, 29). Principles
As much as possible, adolescent health Reflecting that both the availability of

Action
measurement must prioritize equity and disaggregated data and the specific
inclusivity to ensure fair, representative and measurement methodologies can vary by
comprehensive assessments for all young data source, the following non-exhaustive list References
individuals. Achieving health equity means describes additional characteristics that are
acknowledging and addressing disparities, commonly available for general disaggregation.
providing equal opportunities for participation,
• Age: Data are often collected by single
and accounting for diverse needs among
year of age, which means that beyond the
adolescents, irrespective of their backgrounds,
recommended 5-year age groups, data
abilities or geographical locations. Making health
may additionally be disaggregated by
measurements accessible and inclusive involves
other age groupings; for example, those
removing barriers – be they financial, cultural, or
corresponding to levels of schooling.
geographical – that might hinder some groups or
individuals from participating fully. By promoting
• Sex: While collecting data on binary sex
equity and inclusivity, health measurement can
(male/female) is a common practice of most
better capture the diverse health experiences and
large-scale data collection efforts, collecting
challenges faced by adolescents, leading to more
data on gender identity is still relatively
tailored and effective interventions that address
uncommon and is lacking international
the specific needs of all individuals within this
standards (30).
population group (26).
• Residence: Urban/rural residence and • household wealth/poverty or a proxy such

subnational regional residence are commonly as household food security;
used to disaggregate data; other residential
classifications may be available depending • vulnerable population status, including
on the context (for example, peri-urban, adolescents with a disability, specific ethnic
urban slum, refugee camp; lower subnational groups, migrants (but, as noted above, the
administrative levels). desire to have more information should be
balanced against potential harms); and
• Marital status: Disaggregation of data by
marital status can be particularly meaningful • living situation, such as living on own
for some topics; for example, sexual and versus living with family (including family
reproductive health. It is often possible to characteristics such as family size and
determine marital status, whereas data nuclear versus extended family households,
Introduction on cohabitation may be less commonly and potentially orphanhood status and
available, depending on the context. foster care arrangements).
Process
Depending on the data source, additional Notably, in some cases multiple levels of
disaggregation dimensions may be available in disaggregation may be both relevant and feasible.
Domains: some contexts, including:
Policies • schooling status, such as current schooling

status (in-school, out-of-school) and level of
Systems education;
Determinants
Behaviours
Well-being
Outcomes
Principles
Action
References
Jilda Mazira receiving her Pfizer COVID-19 vaccination, Palorinya Refugee Settlement, Uganda.
© UNICEF/UN0660689/Rutherford
65
5. From indicators
to action
The GAMA-recommended adolescent health Step 2: Compile data for the

indicators provide a foundation for identifying GAMA-recommended indicators
priorities, allocating adequate resources, Once data sources have been identified, the
monitoring and evaluating programmes, corresponding GAMA-recommended indicators
and advocating for this critical population. can be populated. Care should be taken to
These 47 indicators reflect universal aspects identify any differences between the details
of adolescent health and are a basis for (for example, numerator, denominator) of the
comprehensive measurement, even as countries available data and the details specified in the
may need to consider additional topics relevant corresponding GAMA-recommended indicator
to their own contexts. Translating a list of (as described in the indicator tables in Chapter
indicators into action requires a collaborative 3 of this document). Even subtle differences can
effort that includes identifying existing affect how the data should be interpreted and
data, filling identified gaps and leveraging used. Where a GAMA-recommended indicator
opportunities to use the data to effect change. cannot be calculated as specified from the
Introduction
source data, but a similar indicator exists, it may
be possible, especially in the short term, to use it
Process
5.1 Data mapping as a proxy for the GAMA-recommended indicator.
All countries have data related to adolescent Beyond age and sex disaggregation, which
Domains:
health, even if those data are limited or vary from should be a routine component of the
GAMA recommendations (for example, by not GAMA-recommended indicators whenever
Policies covering the entire age range of 10–19 years). possible, it is important to take note of other
The starting point for implementing the possible disaggregation dimensions to better
Systems GAMA-recommended indicators is understanding understand variation across specific subgroups
what data are already available at the country of the adolescent population (see Section 4.6).
Determinants level and where gaps exist.
Behaviours
Step 3: Determine data gaps
Well-being
Step 1: Identify all relevant data After existing data for the GAMA-recommended
sources indicators have been compiled, indicators with
Outcomes Multiple data sources are needed to populate no data can be identified and steps taken to
the set of GAMA-recommended indicators. It is fill the data gaps. Importantly, although it is
important to identify which data sources exist in a recommended that all 47 adolescent health
Principles
country and understand the basic characteristics indicators be measured, countries may need
of each source, including the target population, to prioritize filling those data gaps that relate
Action the method of data collection, and the timing and to national priorities and that are the most
frequency of data collection and tabulation. feasible to implement because, for example,
References they can be easily incorporated into existing
Understanding the coverage of the adolescent data collection systems.
population in the data sources is critically
important. Are all adolescents of all ages (that is, Notably, population-based surveys are the
10–19 years) included? Do subpopulations exist most common data source across the set of
that might be systematically excluded from the GAMA-recommended indicators, representing
data source, such as those who are out of school the preferred data source for 34 indicators
or who are not legal residents of the country? and providing another possible source of
Can the data be disaggregated by age and sex data for 7 indicators. This means routinely
at a minimum? In the case of a survey, has the implemented population-based surveys that
sample been scientifically selected and is it large include adolescents are critically important for
enough to produce accurate and representative understanding their health.
estimates?
Table 2 provides an overview of the coverage

of GAMA-recommended indicators by selected
global survey programmes.
5. From indicators to action 67
Table 2. Current measurement of the GAMA-recommended indicators among selected global survey programmes
Indicator
Domain SRMNCAH Policy Survey type
Policies, National adolescent health programme Health service user fee exemptions for adolescents Core
programmes and laws National standards for adolescent health service delivery Legal restrictions for accessing health services Additional
Introduction
DHS MICS VACS GSHS HBSC
Systems Human papillomavirus (HPV) vaccine Human papillomavirus (HPV) vaccine Human papillomavirus (HPV) Core
coverage coverage vaccine coverage Process
performance and Additional
interventions
Adolescent population proportion Adolescent population proportion Food insecurity Core
Domains:
Social, cultural, School completion School completion Additional
economic, educational
and environmental Sexual and reproductive health Sexual and reproductive health
health determinants decision-making among older female decision-making among older female Policies
adolescents adolescents
Adolescents not in education,
employment or training Systems
Overweight and obesity Alcohol use Condom use at Overweight and obesity Overweight and obesity Core
last sex Determinants
Health Thinness Tobacco use Thinness Thinness Additional
behaviours Alcohol use Physical violence Heavy episodic drinking Cannabis use
First sex by age 15
and risks Contact sexual Behaviours
First sex by age 15 Pre-menarche menstruation Alcohol use Condom use at last sex
violence
Contraceptive use at last sex (modern awareness Tobacco use
method) Condom use at last sex Electronic cigarette use Well-being
Condom use at last sex Demand for family planning satisfied Cannabis use
Demand for family planning satisfied (modern method) First sex by age 15 Outcomes
(modern method) Skilled birth attendance Condom use at last sex
Skilled birth attendance
Bullying
Physical violence Principles
Physical violence
Contact sexual violence
Sexual violence by age 18 Action
Someone to talk to about problems Someone to talk to about Positive family Core
Subjective problems relationships Additional
well-being References
Adolescent birth rate Adolescent birth rate Suicide attempt Core

Health Additional
HIV prevalence Suicide attempt
outcomes and
conditions Anaemia Depression/anxiety symptoms
Care seeking for depression/anxiety
DHS: The Demographic and Health Surveys Program; GSHS: Global school- Notes: For each of the six selected survey programmes, the table presents Core indicators are the most essential for measuring the health of all
based Student Health Survey; HBSC: Health Behaviour in School-aged the indicators from the GAMA-recommended indicator set that are adolescents globally. Additional indicators are those provided for settings
Children study; MICS: Multiple Indicator Cluster Surveys programme; measured by the survey programme, even if the age range varies from the where further detail within a subject would add value and resources for data
SRMNCAH: Sexual, reproductive, maternal, newborn, child and adolescent GAMA recommendation. collection and reporting are available.
health; VACS: Violence Against Children and Youth Surveys. Source: Marsh AD et al. 2024 (22)
5.2 Data use practices for governments to systematically

plan and implement adolescent health and
Mapping the GAMA-recommended indicators well-being programmes, the foundation of
is just the starting point. The indicators can which is the evidence-based identification of
only support advances in adolescent health priorities (7). Fig. 3 presents AA-HA!’s structured
and well-being if they are used. Embedding approach to national priority-setting through a
the GAMA-recommended indicators into key three-step process.
national processes and country efforts to
advance adolescent programming will ensure Due to their broad topical scope, the
ongoing and consistent use. While monitoring GAMA-recommended indicators are an
all indicators presented in this document is ideal resource to inform the prioritization
recommended to comprehensively assess process. Beyond the minimum disaggregation
adolescent health, a country may choose to dimensions specified in the indicator tables in
initially elevate a subset of indicators depending this document, further disaggregation of data,
Introduction if feasible, can provide an evidence base for
on the national context and priorities.
equity-conscious programming. Notably, using
Process the GAMA-recommended indicators will provide
consistency in measurement over time, enabling
Setting adolescent health countries to monitor trends and periodically
Domains: programming priorities reassess their priorities.
The Global Accelerated Action for the Health of
Policies Adolescents (AA-HA!) guidance lays out good
Systems
Fig. 3. Three-step process for setting priorities for adolescent health programming
Determinants
Behaviours
1 2 3
STEP STEP STEP
Well-being
Needs Landscape
assessment analysis Setting priorities
Outcomes
To identify which health Of existing policies, Considering the urgency, frequency,
Principles determinants, behaviours programmes and laws, scale and consequences of particular
and risks, outcomes and capacity and resources burdens, the existence of effective,
conditions have the greatest within the country, as appropriate, and acceptable
Action
impact on adolescent health well as a review of current interventions to reduce them, the
and well-being, both among global and local guidance needs of vulnerable adolescents,
References adolescents in general and on evidence-based and the availability of resources and
among the most vulnerable interventions capacity to implement or expand
priority interventions equitably
Source: Adapted from WHO 2023 (7)
Informing strategic plans have been used in the past. If a plan or strategic
Incorporating the GAMA-recommended document already has indicators that are similar
indicators into national health strategies, plans but not identical to the GAMA-recommended
and actions, and into the mechanisms to monitor indicators, examination of the data will be needed
and evaluate them, will support consistent to understand the differences and work towards
tracking of progress. To do this will involve alignment. Going through this review process will
reviewing national priorities to understand also facilitate appropriate target-setting using the
which GAMA-recommended indicators can be GAMA-recommended indicators.
most useful, as well as identifying indicators that
5. From indicators to action 69
Strengthening advocacy Stakeholder involvement

The adolescent health indicators recommended Multisectoral collaboration is vital to the
by GAMA provide a common framework for measurement of adolescent health and
assembling key evidence on adolescent well-being. Adolescent programming needs to
health. Using a shared set of indicators ensures include different sectors; for example, health,
comparability across time and across different education and employment need to work
parts of a country. This means that messaging together. The data for GAMA-recommended
can be clearer and more focused, especially for indicators may come from a variety of different
political leaders, administrators of adolescent national data producers, such as the national
services (such as schools) and other non-technical statistical office, the ministry of health or
audiences. It is also easier for all champions of the ministry of education. This means that
adolescent well-being, regardless of their level identifying, convening and collaborating with
of data expertise, to become familiar with a the relevant stakeholders is essential. It is
few important indicators and consistently refer also important to consider the role of donors; Introduction
to them. Notably, a common set of indicators ensuring they are a part of discussions around
facilitates intercountry comparisons, a powerful data production and use can facilitate their own
tool for political advocacy and experience sharing. adoption of the indicators. Process
“
Domains:
5.3 Critical success The most powerful
factors gains for adolescent
Policies
Adolescent engagement
well-being result from Systems
Adolescents and their advocates have an important multisectoral action.” Determinants

role in implementing the GAMA-recommended
indicators. Although data collection and analysis WHO 2023 (7)
Behaviours
are highly technical and require advanced
training, the participation of adolescents and Sufficient data infrastructure
Well-being
their advocates in setting programming and Beyond the indicator mapping outlined in
measurement priorities is crucial and they can be Section 5.1, all countries should review their
Outcomes
both champions for and users of data. Steps should current adolescent health data infrastructure,
be taken to ensure inclusive participation so the including shortfalls in data-related processes.
Considering the larger system supporting data Principles
diversity of all adolescents is represented.
“
collection and use – including how different
parts of the system interact and how data are Action
Countries should ensure (or are not) being used – can help clarify areas
that require strengthening. All countries should
that adolescents’ expectations identify areas for improvement and determine References
and perspectives are heard the steps to address them. A part of this process
will be clarifying what, if any, additional financial,
in national programming technical or organizational resources are
needed in working towards full availability of
processes. Adolescent comprehensive adolescent health data.
leadership and participation
should be institutionalized and
actively supported during the
design, implementation and
[monitoring and evaluation]
of programmes for adolescent
health and well-being.”
WHO 2023 (7)
5.4 Call to action This includes providing technical assistance for

the implementation and use of the indicators and
Our current understanding of adolescent health related data and promoting further alignment of
is limited by the lack of comprehensive data. This regional and global measurement efforts with the
chapter describes how countries can address recommendations presented in this document.
this by using the GAMA-recommended indicators
to identify and subsequently fill important data Faced with multiple complex challenges, like
gaps. It also outlines the importance of using the reemergence of global pandemics and
readily available information for these indicators intensifying humanitarian crises, adolescents
to drive action to improve adolescent health. The have shown themselves as effective mobilizers
process to do so is based on the well-established and agents of change within their communities
approach outlined in the AA-HA! guidance and and beyond. As they continue rising to meet the
requires bold engagement of a broad range of challenges of this generation and the next, our
national stakeholders, including adolescents collective resilience depends on their ability to
Introduction be and stay healthy. We call on partners to invest
themselves. International actors, including WHO,
other UN agencies and measurement groups, now in adolescent health and its measurement –
Process must support countries with these endeavours. there will be no better time.
Domains:
Policies
Systems
Determinants
Behaviours
Well-being
Outcomes
Principles
Action
References
Members of Art-Blast collective at the Youth Leadership and Development Center in Soledad, Colombia.
© UNICEF/ UN0849332/Elba Bayona
6. References 71
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References
World Health Organization
Department of Maternal, Newborn, Child
and Adolescent Health and Ageing
Avenue Appia 20
CH-1211 Geneva 27
Switzerland
gama@who.int
https://www.who.int/teams/maternal-newborn-child-
adolescent-health-and-ageing

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The adolescent

ISBN 978-92-4-009219-8 (electronic version)

© World Health Organization 2024

Cataloguing-in-Publication (CIP) data. CIP data are available at https://iris.who.int/.

Sales, rights and licensing. To purchase WHO publications, see https://www.who.int/publications/book-orders. To

Design and layout by Lushomo

Cover photo credit: © UNICEF/UN0849335/Elba Bayona

A snapshot of the adolescent

Social, cultural, economic, educational Health behaviours

5 From indicators to action

and advocate for adolescent health.

Dr Tedros Adhanom Ghebreyesus

Dr Juan Pablo Uribe

WHO is grateful for the contributions of Carlo

Outcomes HBSC Health Behaviour in School-aged UN United Nations

ISCED International Standard WHO World Health Organization

open call, members were selected through a

• systems performance and interventions: • Adolescent well-being indicators promoted

• social, cultural, economic, educational • INSPIRE indicator guidance and results

• subjective well-being: includes indicators

intended use Process

• Making every school a health-promoting

Fig. 1. Selection process for the GAMA-recommended indicators

STEP Identification 33 core measurement areas

Review of indicator data

STEP Indicators finalised in 2 steps:

2.1 Step 1: survey in English, French and Spanish; and review

review of adolescent between the draft indicators and similar

2.5 Step 5: Refinement

addressing at least one of the core measurement

their metadata, producing a list of 413 adolescent

Findings from Step 4 were discussed among Well-being

draft adolescent health virtual meeting per working group to arrive

indicators recommendations were compiled and presented

This chapter provides an overview of the 47 educational and environmental health

Cambodia: Disability inclusion in health – October-November 2023. © WHO/Miguel Jeronimo

Table 1. Overview of the GAMA-recommended indicators

Adolescent mortality rate (all-cause)

Fig. 2. Overview of indicator metadata structure

Indicator (short name) Core indicator Additional indicator

Introduction Indicator name

information sources: surveys

Disaggregation An overview of key methodological points about

3.1 Policies, programmes and laws

Policies, programmes and laws

Indicator name Existence of an operational national adolescent health programme

least one designated full-time person and a regular government Introduction

A national programme with sufficient resources is necessary to identify national and

subnational priorities and implementation strategies.a Policies

Other possible data None recommended

Method of measurement Calculating this indicator requires country-reported data on Well-being

Policies, programmes and laws

Indicator name Existence of national standards for delivery of health services to

specifically for adolescents that include a clearly defined,

Behaviours Method of measurement Calculating this indicator requires country-reported data on

Policies, programmes and laws

Indicator name Existence of a national policy exempting adolescents from user

user fees for outpatient care visits in the public sector

Other possible data None recommended

Method of measurement Calculating this indicator requires country-reported data on the

Outcomes HBSC Health Behaviour in School-aged UN United Nations

ISCED International Standard WHO World Health Organization