This post was written by Sophie Theis and Jowel Choufani.

Adolescence is the period of development which begins at puberty and ends at adulthood. At 1.2 billion, there has never been a larger group of young people aged 10–19 living as there is today, and the majority live in low and middle-income countries (LMICs) (Black et al., 2013).  

Adolescence is commonly divided into three developmental periods: early adolescence (10–14 years of age) which is dominated by pubertal development and sexual maturation, late adolescence (15–19 years of age) which exhibits pubertal maturation though in a less pronounced form, and young adulthood (20–24 years of age) where adult roles and responsibilities are assumed (Patton et al., 2016).

There is growing interest in adolescent nutrition as a means to improve the health of women and future generations. Adolescence is a critical window for interventions to influence long-term health outcomes, including the health of women during pregnancy, which in turn affects the health of future generations (Das et al., 2017). Nutritional and development interventions that focus on adolescence have high rates of return due to improved health, nutrition, and cognition, which lead to improved physical, reproductive, cognitive and economic performance in later years (Ruel and Alderman, 2013).  Moreover, adolescent nutrition can contribute to the Global Food Security Strategy Objective 3, a well-nourished population and our cross-cutting intermediate result (IR) 4 increased youth empowerment and livelihoods. 

In addition to investing in adolescents for future well-being, this population increasingly experiences the double burden of malnutrition. Rates of overweight and obesity among adolescents are on the rise. Globally, about one third of adolescents are overweight and/or obese, while almost 10% of younger adolescent girls (13-15 years) are too thin for their age and height. Moreover, micronutrient deficiencies are common (especially iron, iodine and vitamin A), and iron-deficiency anemia is among the top five causes of disability-adjusted life years (DALYs;  a measure of the years of healthy life lost due to ill health, disability or premature death) (Patton et al., 2016). Addressing these different, yet co-existing, forms of malnutrition requires a combination of approaches to get at their underlying determinants.

Recognizing the importance of multi-sectoral interventions for nutrition, integrated, nutrition-sensitive agricultural programs are increasingly common. Designed to leverage several pathways through which agricultural livelihoods can influence rural producers’ diets and nutrition, these programs have mostly targeted adults. Many have had the goal of shifting adults’ behavior to ensure maternal nutrition, and to meet the nutritional needs of children during the first two years of life (i.e. the first 1,000 days).

Programs that target parental/guardian behavior change may already be affecting adolescent nutrition, but this approach does not address all factors affecting adolescent eating patterns and behaviors. These could be broadly classified as personal factors, including attitudes, beliefs, food and preferences; environmental factors, including family, friends, peer networks, school, and social and cultural norms; and macrosystem factors, including food availability, food production, distribution systems, mass media, and advertising campaigns (Moreno et al., 2010; Story and Stang, 2005).

By refocusing activities and measuring implications for adolescents, nutrition-sensitive agricultural interventions can help maximize their positive impacts and mitigate possible risks for adolescent health and nutrition. Potential approaches could include:

• Discuss and model equitable gender norms. Adolescence is a critical window in which gender-based identities – and risks – begin to coalesce. Activities that shift household and community attitudes towards gender equality can expand opportunities for adolescent girls, avoid risks like child marriage, early pregnancy, and sexually transmitted infections, and increase adolescent boys’ support for gender equity. For example, a household methodology approach could be used to engage families to reflect critically on the distribution of household chores and food allocation among family members as a way to question and alleviate bias against girls.
• Expand the scope of adults’ nutrition education to reinforce the importance of adolescent health and nutrition. This can include discussion of other factors that affect adolescent health over which parents/guardians have significant influence, including delaying marriage and staying in school.
• Extend nutrition education to adolescents. Nutrition education in agricultural programs typically target adult caregivers. However, reaching adolescents directly could equip young people with critical knowledge prior to reproductive age, connect them with mentors, and create safe spaces to build social capital and confidence. In addition, they already play important care roles for younger siblings, and learning about the importance of nutrition early can reinforce messages for when they have their own children. 
• Leverage economic alternatives to mitigate risk. Livelihoods programs can provide crucial economic support that make it possible for families to pay school fees for adolescents and avoid pulling children out of school for agricultural and/or household labor. However, families have to value this, and risks associated with school attendance for adolescents need to be addressed.
• Strengthen adolescents’ economic agency to enable them to exercise choice. Girlhood is a high-risk time, with threats of gender-based violence, child marriage, early pregnancy, and increased risk of HIV/AIDS. One program found that vulnerable girls in Kenya and Uganda have money and want to save it. With financial institutions in-country, they created group-based financial services for girls, with weekly meetings with a female mentor and financial, health, and life skills education, to strengthen girls’ goal-setting and agency to avoid risk behaviors. Similar savings activities could be integrated into adolescent health promotion to reinforce risk prevention and potentially link to adolescents’ roles in their family’s agricultural business.  

These strategies work in synergy to extend the benefits of integrated agriculture-nutrition programs to adolescents. Along with the above, all programs should make plans to mitigate and monitor the risk that the intervention increases child labor, gender-based violence, domestic work burden for adolescents, or exposure to agro-chemicals and contaminated water.

An additional challenge is that many youth or adolescent-focused activities end up disproportionately serving adolescent boys. It can be harder to reach girls, given intertwined factors of domestic work burden, restricted mobility, risks of travel, and greater difficulty securing support of a parent/guardian. Multi-level approaches – those that engage both adolescents and their parents/guardians and other gatekeepers – can help align behavior change  (Haberland et al., 2018). Longer-term evaluations assessing the effectiveness of youth and adolescent-oriented approaches on health and wellbeing are needed to inform the design of future interventions.

Multi-sectoral livelihood programs can have a powerful influence on the enabling environment for adolescent nutrition and health. Investments in the health and nutrition for this age group, and especially for adolescent girls, will pay off over their lifetimes and future generations.

References:

Black, R.E., Victora, C.G., Walker, S.P., Bhutta, Z.A., Christian, P., de Onis, M., Ezzati, M., Grantham-McGregor, S., Katz, J., Martorell, R., Uauy, R., Maternal and Child Nutrition Study Group, 2013. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet (London, England) 382, 427–51. https://doi.org/10.1016/S0140-6736(13)60937-X

Das, J.K., Salam, R.A., Thornburg, K.L., Prentice, A.M., Campisi, S., Lassi, Z.S., Koletzko, B., Bhutta, Z.A., 2017. Nutrition in adolescents: physiology, metabolism, and nutritional needs. Ann. N. Y. Acad. Sci. 1393, 21–33. https://doi.org/10.1111/nyas.13330

Haberland, N.A., McCarthy, K.J., Brady, M., 2018. Insights and Evidence Gaps in Girl-Centered Programming: A Systematic Review, GIRL Center Research Brief No. 3. New York.

Moreno, L.A., Rodríguez, G., Fleta, J., Bueno-Lozano, M., Lázaro, A., Bueno, G., 2010. Trends of Dietary Habits in Adolescents. Crit. Rev. Food Sci. Nutr. 50, 106–112. https://doi.org/10.1080/10408390903467480

Patton, G.C., Sawyer, S.M., Santelli, J.S., Ross, D.A., Afifi, R., Allen, N.B., Arora, M., Azzopardi, P., Baldwin, W., Bonell, C., Kakuma, R., Kennedy, E., Mahon, J., McGovern, T., Mokdad, A.H., Patel, V., Petroni, S., Reavley, N., Taiwo, K., Waldfogel, J., Wickremarathne, D., Barroso, C., Bhutta, Z., Fatusi, A.O., Mattoo, A., Diers, J., Fang, J., Ferguson, J., Ssewamala, F., Viner, R.M., 2016. Our future: a Lancet commission on adolescent health and wellbeing. Lancet 387, 2423–2478. https://doi.org/10.1016/S0140-6736(16)00579-1

Ruel, M.T., Alderman, H., 2013. Maternal and Child Nutrition 3 Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?, www.thelancet.com. https://doi.org/10.1016/S0140-6736(13)60843-0

Story, M., Stang, J., 2005. Understanding adolescent eating behaviors., in: Story, M., Stang, J. (Eds.), Guidelines for Adolescent Nutrition Services. Center for Leadership, Education and Training in Maternal and ChildNutrition, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, pp. 9–19.

This post was written by Sophie Thies, Senior Research Analyst, IFPRI, Gender, Climate Change, And Nutrition Integration Initiative (GCAN)  ; Jowel Choufani , Research Analyst, IFPRI