India will expand an adolescent health initiative in 10 districts with a combined population of 19 million where the age of marriage and first pregnancy is low and reproductive health status is poor. Through the Institute of Health Management Pachod’s Safe Adolescent Transition and Health Initiative, based on a MacArthur-funded pilot project, local women are trained to monitor married adolescents in their community and help them obtain reproductive health care. Regular visits to the young women represent a “surveillance system” that underlies the project’s interventions, including identifying pregnancy at an early stage and ensuring access to appropriate and timely health services.