Within each of these systems, a risk and protective factor framework perspective was used to define characteristics as protective or risk factors that are associated with ASRH outcomes [12,13,18 –21]. The framework posits that there are multiple risk and protective factors that contribute or combine to shape the behaviors and outcomes of adolescents during their develop- ment. Protective factors refer to influences that modify or reduce the probability of a maladaptive outcome. They also increase the likelihood of positive health behaviors or outcomes. In contrast, risk factors are causes of undesirable, negative development outcomes; they generate negative change in or persistent poor behavior or functioning. Risk and protective factors include ele- ments such as characteristics or qualities of individuals, experi- ences, relationships, contexts, and institutions.