Nutritional needs in girls and boys are very high during adolescence (ages 15–19). Adolescent girls, in particular, have unique and increased micronutrient requirements which if not met can lead to an impaired growth not just of self, but also of their babies if they become pregnant in the future.
The most widespread micronutrient disorder among girls in India is anaemia caused by iron deficiency. According to the latest fifth round of National Family Health Survey (NFHS-5), the anaemia in adolescent girls increased to 59.1% from 54.1% in NFHS-4, while the Iron Folic Acid (IFA) supplementation coverage among adolescents remains low at 26.2%1. This impairs their motor and cognitive development, adversely affects their immune system predisposing them to increased risk of infections and disease, causes fatigue and limits their productivity. Anaemic mothers are predisposed to an increased risk of maternal and infant mortality, give birth to malnourished children, and thus perpetuates the inter-generational cycle of malnutrition. It is crucial to break this vicious cycle during adolescence.
The government of India has exhibited its commitment to fighting anaemia with the launch of weekly iron and folic acid supplementation (WIFS) followed by the Rashtriya Kishor Swasthya Karyakram which is now an integral part of the Anaemia Mukt Bharat campaign. However, these initiatives received a major setback when the COVID-19 pandemic hit the country.
Schools serve as the primary delivery platform for many food and nutrition programs – from mid-day meals to weekly iron and folic acid supplementation to nutrition education. With schools being shut indefinitely, services at Anganwadi centres being disrupted and the frontline health workers being diverted towards COVID-19 management, the health and nutrition of millions of adolescent girls is at risk. These girls are facing an increased risk of anaemia at a time when energy and a strong immune system are paramount. If the nutrition of adolescent girls is not addressed now, the effects of these disruptions will be evident in the months and years to come with a likely increase in anaemia and rise in malnutrition.
It is a bitter reality that due to the economic distress many marginalized girls may have to drop out of school to contribute to domestic responsibilities and family income or even be married off early. Already ~23% of women in India are married young2, of which 6.8% experience their first pregnancy before turning 183. Even though, these numbers have improved in comparison to NFHS-4, we are yet to see the complete aftermath of pandemic and its effect on the cycle of malnutrition.
The pandemic is not the sole reason for all worries. There are multiple barriers in the implementation of the ongoing government schemes such as interrupted access to WIFS services, unavailability of iron and folic acid supplements, and the prevailing social norms that impede women and girls from accessing health and nutrition services.
Strengthening supply chains by developing detailed distribution plans, regularly monitoring stocks at schools and Anganwadi centres, and establishing benchmarks for re-ordering supplements can aid in addressing the unavailability of supplies. Improved training of healthcare and school staff on correct reporting can help in monitoring and reviewing the program. The use of digital tools such as app-based reporting and telemonitoring can aid in fastening the process of gathering information, reviewing it and taking corrective actions. With access to smartphones becoming universal, the popular WhatsApp application can be used to deliver digital messages in regional languages to promote nutrition education.
Additionally, adolescents can be engaged in decision-making and health and nutrition campaigns. A case in point is Madhya Pradesh and Uttar Pradesh where Nutrition International has involved adolescent champions in discussions at the gram sabha, during village health and nutrition days and in webinars to deliberate on issues related to dietary diversity, anaemia and adolescent nutrition. This has resulted in a better understanding of nutrition issues among the youth and their willingness to address them.
As a resilience measure, many states have already started working to bring back the vigor of the anaemia control program. They have involved frontline workers in door-to-door delivery of monthly IFA supplies and trained peer educators known as Sathiyas for counselling and monitoring compliance. However, it is crucial to provide the frontliners with adequate personal protective equipment to ensure continuity of community-based initiatives amidst the pandemic.
As attention and resources are devoted to stemming the damage of COVID-19, policy makers cannot overlook its disproportionate impact on women and girls. Addressing the malnutrition crisis would require more than just strengthening the public health system. A multi-sectoral approach involving the youth and community is needed. Overcoming the systemic barriers now, more than ever, is essential to ensuring that we come out of this global pandemic stronger, more resilient and ready to build a better future for all.
Dr. Ameet Babre is the National Program Manager–Health Systems for India at Nutrition International.