This paper explores how context and actors influence processes and content efforts to co-create gender transformative primary health care systems for adolescents in West Africa and draws out lessons for co-creation of effective adolescent mental, sexual, and reproductive health and rights (AMSRHR) interventions in low and middle income countries. The study design was a multicountry case study with the case defined as “processes, context, actors and content of co-creation of gender-transformative adolescent mental, sexual, and reproductive health interventions”. Data are from mixed qualitative sources in two research phases:

a situational/context analysis and co-creation/data validation workshops. Findings reveal that while national AMSRHR policies promote gender-sensitive approaches, actual programmes remain largely gender-neutral or gender-blind. Important considerations in co-creating AMSRHR interventions include how to effectively engage powerful stakeholders with diverse positions, pay attention to gendered power imbalances in co-creation processes, and raise critical consciousness of complex AMSRHR issues through non-threatening, participatory approaches.