After long having been excluded from major global efforts to improve nutrition, adolescents are finally getting some attention.
The Sustainable Development Goals (SDGs), adopted in 2015 by the United Nations to guide the global development agenda, specifically target improving the nutrition of adolescent girls. And adolescent nutrition is on the agenda of this week’s World Health Assembly in a big way.
“What’s different now is there’s a much broader focus on adolescents in the SDGs, in the broader economic, social development arena,” said Lynnda Kiess, a senior program adviser on nutrition with the World Food Program. “We’re seeing adolescents as the future. They’re the ones carrying the SDGs and the effects of whether we reach them or not.”
Experts say this new focus is overdue. In addition to undoing the work of efforts like the 1,000 Days campaign, which has made significant progress in improving nutrition in the first thousand days of life, malnutrition undermines the physical and cognitive development happening as young people continue to grow. That has implications for their ability to thrive, but also for their future children, helping to perpetuate a cycle of malnutrition.
But experts caution there is still a long way to go before this new attention translates into results.
Dr. Zulfiqar Bhutta, an expert on global child health, said there were many reasons that adolescents – traditionally defined as the age group between 10 and 19 – have been overlooked.
The Millennium Development Goals, launched by the United Nations in 2000, were the first attempt to truly set global development priorities. Their primary objective, Bhutta said, was to reduce mortality, which meant their focus was largely on the most vulnerable populations, particularly children and pregnant women.
“It’s not very surprising that adolescents were not considered or included in that discourse,” he said, as they are generally perceived to have lower health risks than most groups. That ignores, Bhutta said, the fact that poor nutrition at an early age can have lifelong consequences, especially for young women who go on to become pregnant.
In a report for the Annals of the New York Academy of Sciences, Bhutta and other researchers noted, “A focus on young girls is also crucial because their health and nutritional status before as well as during pregnancy also influences fetal growth and newborn health.”
In many ways malnutrition among adolescents is more complicated to tackle than within other age groups. As the new report being released at the World Health Assembly highlights, the experience of adolescence is so varied across and even within countries. Prepared by Anthrologica, a research organization that specializes in applied anthropology in global health, and the World Food Program, the report, which was funded by Unilever, underscores that adolescence covers people at a variety of different ages and circumstances. That represents a significant hurdle for policymakers looking to tackle the issue.
There was also a problem of simply not knowing the extent of the problem. There is little data on malnutrition within adolescents, particularly in low- and middle-income countries, either because no one has been looking for it or because information on adolescents hasn’t been specifically drawn out from the data that has been gathered.
All of these hurdles remain in place, despite the new attention for adolescent nutrition, which has slowed the actual implementation of programs, Bhutta said.
“Greater attention on adolescents is greater attention, but it’s not translated into meaningful programs or implementation of interventions on the ground,” he said.
Experts are hopeful that is about to change though, pointing to places like Kenya, where programs for adolescents are at the center of the country’s development strategy. And as they encourage more policymakers to follow suit, they are drawing on the research that does exist, even as they work to supplement it and to design programs that can effectively take on the under-recognized problem.
Eager for Engagement
For Juliet Bedford, the founder and director of Anthrologica, some key lessons to emerge from the 18 months of engaging adolescents in Kenya, Uganda, Cambodia and Guatemala about malnutrition were about how to create programs that they would respond to. The first thing policymakers should know, she said, is that young people are eager to be engaged on the subject.
“It was surprising to the degree that it happened,” she said. “There was a level of consensus between different adolescents. Not just adolescents within one social group or ethnicity in any one country, but across the whole study.”
And they had specific advice for policymakers on how to make those programs effective: Share information that is based on realistic experiences, make it entertaining and speak to them in a language that was both culturally and contextually appropriate.
Bedford said this offered important guidance about looking beyond just social media to other points of contact who might be able to engage adolescents in a way they would respond to.
This is a reversal of the traditional approaches that do exist, Kiess said. “I still feel that the programming around adolescents is top down. This study really helps it being much more bottom-up driven.”
When it comes to adolescent malnutrition, as with many nutrition efforts, there is also a recognition that for programs to be effective and affordable, programs need to be multi-sectoral. Bhutta pointed to the obvious links between adolescent malnutrition and keeping girls in school and providing more information on sexual and reproductive health. Both interventions would offer opportunities for integrating nutritional guidance.
Moving forward, Kiess said it will be important to consider “what already exists programmatically and how do we include a nutrition component to those existing structures. In other contexts where [adolescents] are not being engaged, we need to start engaging them.”