Childhood, interrupted: Are we meeting the needs of adolescent mothers?
Before the next Mother's Day rolls around, 17 million girls under 19 will have given birth. For many governments and development organizations, these young mothers — most of them in low- and middle-income countries — pose two major challenges: their nutrition needs are often not fully understood or prioritized, and they are notoriously hard to reach.
"I suspect that in most situations pregnant and breastfeeding adolescents aren't getting the nutrition they need," says World Food Programme (WFP) Nutrition Deputy Director Dr. Fatiha Terki, who leads the organization's work in adolescent nutrition.
Adolescence, pregnancy and breastfeeding are all stages of life when a woman or girl has increased nutrition needs. When these periods overlap, the nutrient needs compound. This means that the need for nutritious foods is greater for a pregnant teenager than it is for her adult pregnant aunt or her non-pregnant friends.
Although adolescents are moving up on the global agenda, adolescent girls remain particularly vulnerable to all forms of malnutrition. The food they eat needs to provide nutrients to fuel both the child's rapid growth and the mother's unfinished development. They are at a high risk of anaemia, which during pregnancy increases the risk of low-birth weight babies and maternal mortality. And the association between early pregnancy and child stunting has also been widely observed.
Regardless of high nutrient needs, the adolescent girl often eats last and least. WFP Executive Director David Beasley asks us to visualize a typical family dinner. "Imagine a family sitting down for a meal — a father, a mother who's nursing a little baby, a school-aged boy and an adolescent girl. Who has the most on their dinner plate? Maybe Dad, since he's the biggest and has a physically demanding job. Then the boy… Then after that, the two slimmest: Mom and daughter, right?"
In fact, the contrary would make more sense, according to WFP's Fill the Nutrient Gap analysis. At least in terms of nutritional quality, that is the amount and variety of nutrients per bite of food. A pregnant or breastfeeding adolescent girl needs the largest share of nutritious foods in a household.
And since nutritious foods — fresh fruit and vegetables and animal-source food — tend to be more expensive than low-nutrient staples like rice, this translates into price. In short, the adolescent mother's is the most expensive mouth to feed.
Cultural and family dynamics also play a part. Findings from Bridging the Gap, a study carried out in Kenya, Uganda, Guatemala, and Cambodia by WFP and research-based organization Anthrologica, revealed that many unmarried adolescent mothers felt that they were considered a burden on their families, and often received only one portion of food to share between themselves and their children.
When delivering nutrition and health interventions, adolescents are notably hard to reach, as WFP's Director of Nutrition Lauren Landis described: "We know, more or less, that we can find children at schools or new mothers at health clinics. But on any given day, adolescents who've left school are scattered across homes, informal workplaces, gardens, farms and so on. Reaching them is another kettle of fish."
The cultural and UN or government demographic definitions can also present challenges, as they are often not consistent. In some contexts, once a girl has a baby, she is considered to be a woman, even if she is still a teenager. Landis cites the case when adolescent mothers don't attend programmes designed for youth or children: they no longer see themselves as children.
Bridging the gap
The findings from Bridging the Gap revealed that the needs of adolescents vary wildly across contexts, but there are some common threads. "In all four countries we saw that adolescents wanted services brought to them," said Lynnda Kiess, a WFP nutritionist who worked on the study.
"Adolescent mothers need a range of services — from nutrition to health, family planning, prevention of violence and education. But many have busy lives. They don't want to be pulled into six different directions for six different services. For example, can a pregnancy check-up be combined with nutrition education classes?"
Another common finding was that adolescents wanted to be involved in the design of programmes targeting them. "Rather than going ahead and changing the health system, governments, the UN and NGOs should ask the girls how they want to be reached," said Kiess.
WFP is taking steps to better reach adolescents with more tailored programming, says Dr. Terki. "We are committed to supporting adolescents in developing and reaching their full potential," she said. "We have stepped up our efforts recently to address data gaps internally and to develop an engagement strategy for adolescents that involves several sectors."
Yet Kiess stresses that the opportunities to improve nutrition of this vulnerable go beyond traditional development players. The private sector can play a big role, she says, for example, by fortifying rice with vitamins and minerals, or through using social media and new technologies to influence behaviour change. "We should be thinking of how to serve adolescent mothers in partnership, and make sure that nutrition is not being viewed as detached from their other needs."
Kiess is also quick to point out the bigger picture, that one of the most effective ways of preventing malnutrition associated with teenage motherhood is to delay pregnancies in the first place. "One of the most effective things we can do to prevent early pregnancy is to keep girls in school".
WFP's support for school feeding programmes is a way to do just that, as it motivates parents to send their children to school. Often, they include an additional incentive for girls, such as take-home rations, so parents are more inclined to enroll their daughters.
Dr Terki reminds us of the exponential power of investing in adolescent girls. "Improving the nutrition of an adolescent girl is a triple whammy: It will improve her life today, while she's still growing; tomorrow, if she becomes pregnant; and then the life of her child, who will have received the right nutrition at a critical moment. How else do we explain the fact that US$1 invested in nutrition gives a US$16 return? If this was the stock market, you'd have investors flocking."