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Review of Programmatic Responses to Adolescent and Women’s Nutritional Needs in Low and Middle Income Countries

Photo of a woman selling produce at a marketThe 2013 Lancet Series on Maternal and Child Nutrition provided new evidence on the importance of women’s nutrition at the time of conception and during pregnancy, not only to ensure optimal fetal growth and development but also for the health of the mother. The series also identified adolescent girls as a key priority, placing them together with women of reproductive age (WRA) and mothers at the center of nutrition interventions. Currently, there are more than 500 million adolescent girls living in low- and middle-income countries.

This paper is one of two discussion papers commissioned to identify key issues and practices regarding the scientific evidence, and to summarize recent and current programmatic experiences; this paper serves as the second of these papers. The goal of this paper is to review the approaches used, practices promoted, and lessons learned by projects and programs that set out to improve the nutrition of adolescent girls and WRA in low- and middle-income countries. Specifically, it sets out to 1) provide information on global programmatic experiences to improve the nutrition of WRA and 2) summarize inputs, outcomes, and lessons learned from implementers who have or are currently carrying out nutrition programs for WRA.

To gather information, two search strategies were used. First, a review of the literature was conducted covering programs from 2004 through 2014. Second, an online survey was developed and sent to practitioners in the field requesting information during the same time period. Out of 47 persons/institutions contacted, there were a total of 15 survey responses providing detailed programmatic information on eight projects. These survey responses and the review of the literature provided a total of 53 programs.

Priority nutrition practices have been promoted or delivered through a broad range of activities, strategies, and delivery platforms. Capacity building of local organizations/governments (23 percent) and community-based platforms for nutrition education and promotion (21 percent) were used most often while distribution of micronutrients, food, or cash (13 percent) and mass media (8 percent) were used least often. The most commonly promoted nutrition practices were described as improved eating practices (34 percent) followed by the consumption of iron folic acid intake (27 percent), consumption of a diverse diet (17 percent) and purchase/consumption of fortified foods (13 percent). Few programs promoted the consumption of micronutrient supplements (5 percent), intake of amounts of water (3 percent), or consumption of additional food (1 percent) as a priority practice. Out of the 53 programs identified, only nine targeted adolescent girls specifically, and only nine provided data on the effectiveness of the intervention. Detailed information on each program is provided.

Based on the synthesis of the literature findings and survey responses, the following policy-level recommendations are made: 1) address nutrition of adolescent girls and WRA in policies, systems, and guidelines; 2) define adolescence and bring attention to the specific nutritional needs of adolescent girls; 3) disaggregate data by age and gender at the national level; 4) integrate nutrition guidelines into existing adolescent, maternal and child health, prevention of maternal to child transmission of HIV , and other guidelines that address services for WRA; and; 5) streamline and collaborate at all levels. With respect to nutrition programming for adolescent girls and WRA, the paper identified the following: 1) expand upon lessons learned from IFA programs; 2) consider interventions to prevent and address risk factors for nutrition-related noncommunicable diseases (N-RNCDs); 3) identify platforms to address the nutritional needs of women outside of pregnancy and lactation periods; 4) involve women and communities in nutritional program planning; 5) identify opportunities for multisectoral collaborations and program integration; and, 6) address gender norms.

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