Multiple studies show that adolescence is a nutritionally demanding phase of life. Even though both adolescent boys and girls face emotional changes during puberty, girls face more physiological demands and thus require a higher intake of macro and micro nutrients. Susceptibility of adolescent girls to anaemia is 40% compared to boys at 18%. This is why promoting dietary diversity is crucial during adolescence, as dietary habits are in the formative stage and evidence shows that behaviour imbibed during adolescence has a higher chance of being continued in adult life. Ensuring appropriate nutrition for adolescent girls is also paramount considering the inter-generational impact it has on combating malnutrition.
Focus on girls
The National Family Health Survey (NFHS)-5 data (2019-20) show an increase in anaemia among adolescent girls by 5% when compared to NFHS-4. The Comprehensive National Nutrition Survey 2019 shows that even before the pandemic, consumption of diverse food groups among adolescents was low. The fallout of COVID-19 has further worsened dietary diversity, especially of women, adolescents and children. A study by the Tata-Cornell Institute for Agriculture and Nutrition showed that women’s dietary diversity in India declined by 42% during COVID-19 lockdowns as they consumed fewer fruits, vegetables, and eggs. The lockdowns also led to the loss of mid-day meals and interruptions in Weekly Iron Folic Acid Supplementation (WIFS) and nutrition education in schools for adolescent girls. This was compounded by challenges in providing nutrition services to out-of-school adolescent girls which further increased their vulnerability to poor nutrition outcomes. Adolescence is the window of opportunity where practices of dietary diversity can be built to correct nutritional deficiencies and replenish the body with much-needed nutrients, especially for girls. There are a few recommendations that emerge on strengthening the diets of adolescent girls in India.
First, along with continued service delivery of WIFS, the government’s health and nutrition policies need to emphasise on strong compliance to diverse diets and physical activities. This includes locally sourced fruits and vegetables, seasonal diets, and the inclusion of millets. This further needs to be supplemented by strengthened nutrition counselling for adolescent girls through community workers’ home visits, by building a strong ecosystem in schools to promote healthy habits and diets, virtual counselling, and comprehensive nutrition counselling through community-based events and Village Health, Sanitation and Nutrition Days.
We need to promote good nutrition among adolescents through Nutri-Smart schools (building kitchen gardens in schools), which are already being implemented in some States. Such initiatives will increase awareness, improve availability, and accessibility to diverse foods groups.
Second, as service delivery platforms to tap adolescents, we need to also think beyond schools, as the diverse plates are first set at home. Young girls need to be equipped with accurate information about adequate and appropriate diets so that they can act as change agents for their families, community, and peer groups. Further, food diversification is required to be complemented with reformative steps such as the recent amendment of increasing the legal age of marriage for women from 18 years to 21 years. However, for such legislation to have the best impact, it is equally crucial to ensure that girls remain in school or formal education, their safety is ensured, and their health and nutrition are prioritised. Only then can such measures provide opportunities for girls to improve their nutritional and health outcomes.
Micro nutrient deficiencies
Third, the adolescent’s nutritional status is related to the burden of multiple micro nutrient deficiencies. Currently, 80% of adolescents suffer ‘hidden hunger’ due to micro nutrient deficiencies. The trend is more prevalent in girls as they already suffer multiple nutritional deprivations. We need to strengthen our policy initiatives to address deficiencies of not just iron and folic acid, but also vitamin B12, vitamin D, and zinc.
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Lastly, the POSHAN Abhiyaan (now Mission POSHAN 2.0) strongly integrates the aspect of under-nutrition and anaemia among women, girls, and children. However, the design needs to be inclusive of the growing risk of non-communicable diseases and obesity among adolescents. Given that over 10% of adolescents are overweight in 12 States of India, strict action plans need to be devised against the sale and advertisement of unhealthy foods and beverages.
Ameet Babre is National Program Manager-Health Systems for India; Smitha Chekanath Parambath is the State Representative, Gujarat, at the Nutrition International
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