A model (Figure 1, page 12) is provided for thinking about what the evidence tells us about the ecology of adolescent-parent relationships, including skip-generation or sibling-headed households1, and when adolescents themselves become parents. It allows for innovation and reflexivity, particularly regarding policy implications. The review encompassed academic and grey literature from six countries (Kenya, Malawi, Mozambique, South Africa,Tanzania and Zimbabwe) and from the region as a whole.