A deeper understanding of the challenges confronting 10 to 14-year-olds is urgently needed, and pregnancy prevention and support for very young adolescent mothers must be advanced to the top of the sexual and reproductive health and reproductive rights agenda of governments, development institutions and civil society. It is with this group that the greatest need lies and that the obstacles have been thus far insurmountable. But interventions at this critical stage of their development, characterized by profound physical, cognitive and social changes that occur in puberty, are needed to ensure girls’ safe and healthy transition through adolescence into adulthood.