Event Summary: How to improve nutrition and health outcomes for adolescent mothers

The health and development community must recognize adolescence as a critical window of opportunity for improving health and education outcomes for adolescent girls and their children, global experts said during a Grand Challenges event.

Much has been written about the need to improve nutrition during a child’s first 1,000 days. During the Grand Challenges event on October 25, experts discussed what happens when the first 1,000 days of a child’s life occur during their mother’s adolescence – often the case in low- and middle-income countries.

For example, 28 percent of girls in Bangladesh give birth before they turn 18. Across sub-Saharan Africa, about 25 percent of girls give birth before turning 18. “We need to wrap our heads around this intersection,” said Purnima Menon, a senior research fellow with the International Food Policy Research Institute (IFPRI). “Adolescent life trajectories intersect with a child’s first 1,000 days.”

Supporting good nutrition for these girls before they become pregnant, during their pregnancies, and after they give birth requires health leaders to leverage a mixture of innovative delivery platforms and sectors. How we support good nutrition for a high-risk, pregnant 13-year-old girl who may still be attending school is very different from how we support good nutrition for a pregnant 18-year-old young woman who may have already left school, said Menon.

In Bangladesh, where the average age of marriage is 16.3, a majority of girls drop out of school after getting married. Many of the girls becoming pregnant are underweight. Research indicates that there is a high risk their children will be stunted. “There are huge consequences, generational consequences,” said Kaosar Afsana, a professor of public health at BRAC University.

At the same time, these girls provide health leaders with a huge opportunity to empower women and improve health and nutrition outcomes generationally.

Afsana offered an example of one program that is providing educational support, life skills training, and livelihoods training to keep adolescent girls in school and stop early marriage and pregnancy – the Balika program in Bangladesh.

Dr. Julie Ruel-Bergeron a nutritionist with the Global Financing Facility said schools offer a delivery-based system that can improve both educational and health outcomes. Dr. Ruel-Bergeron cited Mozambique’s Mobile Health Brigades as a promising school-based intervention. As part of the program, specially trained nurses visit schools four times a year to deliver contraception and other health care to adolescent girls.

“There are efficiencies to be gained by packaging and piggybacking delivery,” said Dr. Ruel-Bergeron. Health packages delivered at school might include vision screenings, deworming, iron and folic acid supplementation, school feeding programs, sex education, WASH initiatives, and nutrition education.

Dr. Caroline Kabiru, who leads the Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health Unit of African Population and Health Research Center in Kenya, offered another potential model – the movement to end female genital mutilation (FGM). Kenya, for example, established an independent agency that brings together disparate stakeholders to address FGM, including the ministries of health and education, as well as women and girls, alongside NGOs. The coalition has been remarkably effective at reducing the practice of FGM.

This cross-sector collaboration, in particular collaboration with the education sector, is key, said Asha George, a professor in the School of Public Health at the University of Western Cape. “The ministry of education is a key partner. Their core business of keeping girls in school contributes to health. If schools want to reach their goal, they need healthy, well- nourished students.” George added: “Just keeping girls in school, is a win.”

Though the experts agreed that this subject area requires greater research and there is a dearth of data even on what girls are eating and what interventions are effective at scale, there are a growing number of resources for health leaders responding to the emerging evidence that adolescent girls present an unparalleled opportunity to empower women and improve their - and their children's - nutrition and health outcomes.

These include what the 2021 Lancet series on adolescent nutrition said was a “rightly emphasis on early childhood nutrition. However, adolescence is an additional important phase of risks and opportunities for healthy nutrition with lifelong and intergenerational consequences. Yet, this age group has been neglected in national and global plans and policies. This series highlights the effect of nutrition on adolescent growth and development, the role the food environment has on food choices, and which strategies and interventions might lead to healthy adolescent nutrition and growth.”

The Global Financing Facility has produced three key briefs on this subject: School Health and Nutrition: Reach and Relevance for Adolescents; Monitoring Adolescent School Health and Nutrition Programs and Interventions Answering The Why, What, Who, and How; and Sustaining Adolescent Health Service Delivery During Prolonged School Closures: Considerations in Light of COVID-19.

Exemplars in Global Health research in Ethiopia, Nepal, Peru also provide insights into how leaders successfully improved education outcomes for girls and also improved their nutrition, delivering reductions in stunting levels for the next generation.