NUTRITION INTERNATIONAL’S WORK TO IMPROVE NUTRITION FORADOLESCENT GIRLS

Improving Adolescent NutritionAfter infancy, adolescence (10-19 years of age) is the most rapid period of growth with the highest nutritional needs, providing a second window of opportunity for catch up growth. Until recently, the health and nutrition of adolescents has been neglected in global and national investment, and policy and programming in developing countries.

Iron deficiency anaemia is now recognized as the number one cause of lost disability adjusted life years (DALYs) in adolescent girls globally. Anaemia has three major consequences for adolescent girls: (i) decreased school performance; (ii) loss of productivity; and (iii) decreased current and future reproductive health.

Weekly Iron and Folic Acid Supplementation (WIFAS) is one of the limited examples of nutrition interventions with proven effectiveness to impact adolescent girls, as evidenced through previous anaemia reduction programs in the Asia region. Despite this WHO recommendation, the policy environment for WIFAS remains a challenge as only India has operationalized WIFAS, with many other countries without guidelines or policies, or with guidelines that are not being implemented.

Access to education for females is one of the best long term strategies to improving nutrition, yet several gendered barriers are faced in attending schools. Girls have described low social support for female attendance, menstrual hygiene management barriers, inadequate WASH, early marriage, pregnancy, personal safety and economic constraints of families. Even when girls are in school, anaemia can further hold them back from academic achievement, and potential future economic empowerment.

Introduction

Gender Equality, Girls’ Empowerment & Youth InclusionWomen and girls can only have equal opportunities to earn, learn and grow when they have adequate nutrition. Nutrition International (NI) believes that gender equality and nutrition need to be addressed universally, rather than within the silos of each Sustainable Development Goal. Men and boys are part of the solution to advancing gender equality. When it comes to policy and programs, we follow the approach of “nothing about her without her”. NI works with adolescents in the design, implementation and evaluation of interventions, and also supports adolescent girls to be empowered advocates for their own health and nutrition.

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Kenya

Tanzania

IndiaSenegal

Ethiopia

Bangladesh

Indonesia

Madagascar

Philippines

Sri LankaNigeria

WIFAS programming*:

Right StartNLIFTMITRA Youth

* Stripes indicate multiple funding sourcesdefines by colors above

Pakistan

Program ApproachNI aims to reduce anaemia in adolescent girls through WIFAS, and to help girls feel empowered through nutrition counselling and education, as part of health education. Adolescent boys are part of the nutrition education and may receive supplements in contexts where their anaemia is high.

NI is providing technical and financial support to ministries of Health and of Education, with the collaboration of local partners, to develop and implement enabling policies and programs for adolescent nutrition:

• Demonstration projects have identified effective delivery channels for reaching adolescent girls in-school and out-of-school with WIFAS and nutrition education and counselling.

• Guidance on the scale-up of the most cost effective strategies within the education and health system, as well as considerations for approaches for the hard-to-reach.

• Support for supply, delivery and stock monitoring will be provided to ministries at regional and national level.

• Building capacity, training and supporting teachers, health workers and primary providers in delivering WIFAS and nutrition education and counselling.

• Behaviour Change Intervention strategies are being designed and implemented to address the specific needs of adolescent girls, adolescent boys, parents, teachers, health workers and community influencers.

• Support to develop and integrate adolescent nutrition curriculum for both boys and girls at school, linking in key themes of menstrual hygiene management, puberty, and sexual reproductive health.

At a global level NI is collaborating with global partners to raise the profile of adolescent nutrition, highlight the data gaps for decision makers to understand the current situation, and to work with partners such as UNICEF in market shaping for the availability of WIFAS.

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Overview by Country: Nutrition Education & Weekly Iron Folic Acid Supplementation

EthiopiaPotential reach: 965,000Platform: In-school delivery, and out-of-school delivery through health posts and organized outreach sessions by health extension workers and women development team leadersPartners include: Ministry of Health; Ministry of Education; Addis Ababa University School of Public Health; and regional and woreda health and education bureaus and offices

IndiaPotential reach: 4.8 millionPlatform: In-school delivery, and out-of-school delivery through outreach (Anganwadi) centers Partners include: Ministry of Women and Child Development; Department of Health and Family Welfare; State Education departments; UNICEF state offices; and Implementing partners in each state (Uttar Pradesh and Madhya Pradesh- Gorakhpur Environmental Action Group; Madhya Pradesh- Debate Trust and Centre for Integrated Development; Gujarat- Deepak Foundation; Chhattisgarh- TRIOs Development Support Private Limited)

IndonesiaPotential reach: 2.8 millionPlatform: In-school deliveryPartners include: Ministry of Health, Ministry of Education and Culture, and Ministry of Religious Affairs at National, Provincial, and District levels

KenyaPotential reach: 810,000Platform: In-school delivery, and out-of-school delivery through community based distributionPartners include: Ministry of Health; Ministry of Education; and Population Services Kenya

PakistanPotential reach: 20,000Platform: In-school deliveryPartners include: Ministry of National Health Services, Regulation and Coordination; Ministry of Federal Education and Professional Training

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SenegalPotential reach: 1.2 millionPlatform: In-school deliveryPartners include: Ministry of Education; Ministry of Health; and Cellule de Lutte Contre la Malnutrition (CLM)

TanzaniaPotential reach: 100,000Platform: In-school delivery, and out-of-school delivery through health facilities Partners include: Ministry of Health, Community Development, Gender, Elderly and Children; Ministry of Education and Vocational Training; Tanzania Food and Nutrition Centre; Tanzania Food and Drug Authority; Medical Store Department; Amref Health Africa; and Local Government Authorities, particularly the education authority

Innovative Approaches through NLIFT Nutrition Leverage and Influence for Transformation (NLIFT) is a pioneering initiative that seeks to integrate proven nutrition interventions into existing development platforms that do not already focus on nutrition. With this approach, Nutrition International aims to reduce missed opportunities and expand the reach of effective nutrition interventions to ultimately improve health and nutrition outcomes and the economic future in Asia and Africa. With a 25 million dollar anchor investment provided by the Government of Canada through Global Affairs Canada, this initiative collaborates with exciting newcomers to the nutrition landscape — leveraging their resources to reach vulnerable people, especially women and adolescent girls. The goal to improve nutrition and support women’s equality and empowerment is interwoven into each investment

Overview by Project

Girl Effect SpringsterCountry: IndonesiaPotential reach: 4.8 millionPlatform: Mobile/social mediaPartners include: Girl Effect/Springster; Percolate Galactic; Praekelt.org Project: Through Springster, Girl Effect’s global mobile platform, marginalized and vulnerable girls are connected to each other and the relevant content, services, tips and advice they need to achieve their full potential. With support from NLIFT, Girl Effect will create evidence-based and age appropriate content on nutrition to be shared through Springster to adolescent girls in Indonesia.

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Integrated Nutrition & Deworming Program: Improving Adolescent Health & NutritionCountry: BangladeshPotential reach: 15.000Platform: In-school deliveryPartners include: Ministry of Health and Family Welfare; Ministry of Education; Children Without Worms Project: Large-scale demonstration project that delivers an integrated package of interventions: WIFAS for adolescent girls to reduce anaemia, deworming treatment for adolescent girls and boys, and nutrition and health education to improve adolescents’ access to information, knowledge, attitudes, and practices regarding health, nutrition, and hygiene. Behaviour change interventions support all aspects of the intervention. Lessons learned from this program model will inform policy recommendations for consideration to scale up nationwide.

UNFPA Nigeria: Working Together for Better Family Planning and NutritionCountry: NigeriaPotential reach: 25,000 vulnerable adolescent girlsPlatform: Integration into UNFPA’s large-scale Sexual and Reproductive Health platformPartners include: UNFPA Nigeria; Adolescent Girls Initiative Project: Access to contraceptives allows women, couples and especially young people to exercise their rights to reproductive health including family planning. UNFPA has multiple programs that reach adolescent girls and women of reproductive age. The AGI supports retention of girls in school as a way to delay the age of marriage and consequently, the age of first pregnancy. Girls are enrolled in safe spaces and receive numeracy and literacy classes, and negotiation and communication skills, in addition to the sexual and reproductive health education they already receive. This partnership will integrate nutrition education into this package, expanding intake and demand for nutrition interventions through leveraging with various UNFPA programs.

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UNFPA Senegal: Integrating Nutrition into Reproductive Health Services for Women and Adolescent GirlsCountry: SenegalPotential reach: 31,000 adolescent girls, and 190,000 women of reproductive agePlatform: Integration into UNFPA’s Supplies program, specifically outreach strategies and community-based interventions for out-of-school adolescent girls and women of reproductive agePartners include: Ministry of Health and Social Action; UNFPA Senegal Project: Making reproductive health commodities available and accessible empowers women and young people, increases gender equality, improves nutritional status of women and girls, and enables them to exercise their reproductive rights. This initiative aims to increase knowledge, attitudes and practices on iron and folic acid supplementation and healthy eating among adolescent girls and women of reproduction age, and also seeks to increase intake of WIFAS among out-of-school adolescent girls. The project will focus on integrating nutrition into family planning/reproductive health, and adolescent program interventions at the primary care level, including communities. This partnership will also conduct a landscape analysis to assess the feasibility of introducing WIFA supplements into the UNFPA procurement portfolio for routine family planning services.

WAGGGS Girl Powered Nutrition ProgrammeCountry: Bangladesh, Madagascar, Philippines, Sri Lanka, TanzaniaPotential reach: 585,000Platform: Non-formal education platform both in- and out-of-schoolPartners include: World Association of Girl Guides and Girl Scouts; Girl Scouts of the Philippines; Girl Guides Associations in Bangladesh, Madagascar, Sri Lanka and Tanzania Project: With support from NLIFT, WAGGGS developed an educational nutrition badge curriculum, which will be piloted in five countries where malnutrition is a major problem. To earn the Girl Powered Nutrition Badge, girls will reach out to their communities to share nutrition knowledge. They will mobilize efforts to implement projects that will increase girls’ access to better nutrition. WAGGGS will capture and disseminate lessons learned from the curriculum to influence decision makers at a national and global level. Girl Guides and Girl Scouts are part of co-creation teams, empowering them to design the program, create the curriculum, implement actions, and monitor the results of their actions. The Girl Powered Nutrition Badge is complementary to the existing YUNGA Nutrition Challenge badge, which can allow girls to continue to deepen their knowledge of nutrition.

AboutNutritionInternationalFounded in 1992, Nutrition International is a global organization dedicated to delivering proven nutrition interventions to those who need them most. Working in partnership with countries, donors and implementers, our experts conduct cutting-edge nutrition research, support critical policy formulation, and integrate nutrition into broader development programs. In more than 60 countries, primarily in Asia and Africa, Nutrition International nourishes people to nourish life.

ContactMarion RocheSenior Technical Advisor,Adolescents’ & Women’s Health & Nutrition

mroche@NutritionIntl.org

www.NutritionIntl.org

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