Despite clear evidence on what works to support improvements in ASRH outcomes, taking impactful programming to scale is rarely straightforward. This brief draws on experiences from the A360 and Connect projects in Ethiopia, Nigeria, Kenya, Bangladesh, and Tanzania to explore the difficult—but necessary—trade-off questions implementers face when designing for both impact and scale: 

• Do we invest in demand creation or in strengthening service delivery? 

• Do we keep interventions simple to facilitate scale—or intervene deeply to mitigate root causes?  

• Whose goals do we prioritize—government or donor? 

• Do we prioritize reaching the groups most impacted by inequities—or use a more broad approach to reach all? 

These and other trade-offs determine whether programs remain impactful at scale—or risk becoming scalable but ineffective. We hope this resource sparks reflection and conversation on how to build adolescent family planning programs that are not only effective, but lasting.