Adolescence is a critical window to combat stunting

By Frances Mason of Save the Children and Paul Dorman of Young Lives, @lyoxford

As G7 sherpas gather in Rome this week, another stage is set for world leaders to contribute to ending malnutrition for every last child.

The human and economic consequences of child undernutrition are profound. In the short term, a greater risk of death, illness, lower learning and engagement with school. In the longer term, lower skill development and a greater chance of being poor in adulthood. Then add that to the impact on society (See, for example, DFIDs economic development strategy), with malnutrition costing countries billions of dollars every year in lost productivity and holding back economic development, which affects everyone.

We are not only talking about the crushing starvation, evident in humanitarian crisis such as Yemen and Sudan, but also the day-to-day insufficiency of quality good-food and the prevalence of disease, which result in 200 million young children not fulfilling their development potential.

Good nutrition is the key to unlocking every child’s physical and cognitive potential – we must use any and all opportunities to support and sustain good nutrition for children. The window of opportunity in the first 1,000 days after conception is targeted by many nutrition initiatives.

The good news is, there may be a further window of opportunity: adolescence.

Several arguments have been put forward to suggest this is the case. First, nutritional deprivations during adolescence, when growth is rapid, can have dramatic implications for individual health. And second, for girls and women, these deprivations are likely to be transmitted to their offspring, perpetuating the cycle of disadvantage.

Young Lives and Save the Children have been discussing nutrition during adolescence. Save the Children is keen to explore all the options to help tackle malnutrition, and we have recognised adolescence as a neglected group . Young Lives researchers have explored the extent and implications of post infancy recovery. Now with a longer age span of data, researchers are using the Young Lives study to examine the potential of adolescence as a further ‘critical window’. Initial analysis features in Save the Children’s Unequal Portions report,  and Young lives has just published its full  research paper.

So what’s new? By using unique data, from Ethiopia, India, Peru and Vietnam, collected at several points during the life course, Young Lives has been able to examine the links between a mother’s circumstances with her children’s outcomes.  Two findings are key.

1. Being born to an adolescent stunted mother increases the chance the infant will be stunted by 15 percentage points. While identifying the intergenerational link is not new, showing that this stunting may persist into the child’s adolescent years is. Most of this effect is linked to a mother being chronically malnourished before and during pregnancy, rather than the age she gave birth (worth noting though, that the adolescent mothers here do not tend to be very young adolescents, where the consequences of pregnancy would be most profound). So, improving a mother’s health before pregnancy is in the best interests of her children.
2. Young Lives looked at the circumstances of a second (older) group of girls to see the extent of physical recovery during adolescence. This showed more change than expected. For girls who were shorter than the World Health Organization norm expected at age 12, 40% of the height deficit on average was recovered by the age 19 years. This provides further evidence that growth trajectories remain somewhat maleable during adolescence – and suggests potential to recover during this period from the initial disadvantage of malnutrition. Most of the change seemed to happen between 12 and 15 years, so early adolescence is a particularly promising time.

So what are the implications for policy and programming? The starting point here remains early life investments to get children off to a good start.

But we shouldn’t stop there. Sustaining early gains and recovering early losses are important. These findings imply that investment in adolescent girls’ nutrition, and particularly early adolescence, has potential for improving girls’ nutritional status.

The critical question is, can good programmes bring these improvements about during adolescence? Young Lives research study doesn’t comment here, since it doesn’t evaluate specific interventions. But wider programming experience highlights measures – including social protection, school feeding and micronutrient supplementation alongside interventions such as WASH.  This is an area for careful further investigation in programming and research. Interventions offer a double hope of empowering adolescents and intervening to secure the health of the next generation.

So G7 leaders, as you debate how to deliver your Flagship Initiative on Food Security and Nutrition, please don’t forget the importance of adolescence.