Improving adolescent health and nutrition in South Asia
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r346 (Published 03 March 2025) Cite this as: BMJ 2025;388:r346Read the collection: Tackling the triple burden of adolescent girls’ malnutrition
- Zulfiqar A Bhutta,, founding director1 2,
- Drishti Sharma,, researcher3,
- Sohana Shafique,, project coordinator4,
- Khakerah Rashidi, national lead health and nutrition5
- 1Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
- 2Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- 3IAVI India Regional Office, Gurugram, India
- 4Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- 5Aga Khan Foundation, Afghanistan
- Correspondence to: Z A Bhutta zulfiqar.bhutta{at}sickkids.ca
Roughly half of the population in South Asia is under 18 years of age, with a staggering 350 million adolescents living in the South Asia region.1 A large proportion of adolescent girls are married, and almost a fifth give birth before they are 18. The health and nutrition of adolescent girls is strongly influenced by gender discrimination and sociocultural traditions influencing adolescent marriage, lack of access to education and health services, and exposure to sexual and domestic violence.2 Concurrent prevalence of undernutrition and emergence of overweight and obesity is notable across several countries in South Asia, with a recent assessment showing that Pakistan had the highest rates of change.3
A new BMJ Collection (www.bmj.com/collections/nourishing-south-asia), led by the South Asia regional office of Unicef and Deakin University in Australia, highlights the alarming state of health and nutrition for adolescents in South Asia, with persisting high rates of undernutrition,4 poorly regulated food environments affecting the rise in overweight and obesity,5 and systematic exclusion of girls and gender norms in the region that underlie persistent patterns of undernutrition and anaemia.6 Analysis of data on 14 107 adolescent mothers from India’s fourth National Family Health Survey (2015-16) showed that they were significantly more undernourished than adult mothers and had lower rates of education, empowerment, and poorer access to health services.7 Not surprisingly, children born to adolescent mothers had significantly lower Z scores for length or height-for-age (mean difference −0.53 SD), weight-for-age (−0.40 SD), and weight-for-length or height (−0.16 SD) than children born to adult women. These findings are reflective of the specific nutritional and physiological needs of adolescents8 and the negative consequences of children having children. The long term consequences of adverse birth outcomes and the excess of small vulnerable infants born to undernourished adolescents are notable and intergenerational. With adolescent births accounting for almost a quarter of all mothers assessed in India’s fourth national survey,7 this alone is the largest impediment to human capital in South Asia.
The reasons for the marginalisation of adolescents and neglect of adolescent nutrition in South Asia are manifold. In Bangladesh, the rapid rise of overweight and obesity, often concurrent with persistent undernutrition and anaemia among marginalised populations, have notable gender dimensions and are related to changes in dietary patterns and limited opportunities for mobility among adolescent girls.9 Nowhere is this more notable than in Afghanistan, where educational opportunities for girls have been officially curtailed over the past 2.5 years.
Acting on the evidence
As highlighted in the collection,4 opportunities for addressing the health and nutrition of adolescents are plentiful and it is time for concerted action in the region. The global evidence on effective interventions to meet adolescent nutritional needs is strong and underscores the importance of addressing social determinants and entrenched gender inequities, as well as direct nutrition interventions through appropriate supplementation and fortification strategies.10 The best strategy to reach adolescents, especially younger adolescent girls, is through a continuum of services using school health and community platforms,1112 emphasising the need for cross sectoral initiatives involving health and education services as well as social protection programmes.
The policy and regulatory frameworks affecting food environments and exposure to inappropriate marketing of ultraprocessed foods are fast emerging as public health priorities in developing economies, and with the rapid rise in access to mobile phones and social media influences, adolescents face additional risks globally.13 Adolescent health and nutrition services therefore have to be protected from the undue influences of a largely unregulated private sector and egregious marketing strategies. Banning mobile phone use for children and adolescents in schools is one such measure. Although a ban is extreme, evidence is growing that reducing screen time improves physical activity and reduces sedentary behaviours, all essential for preventing overweight and obesity among adolescents globally.14 Robust research is also needed to fill several gaps related to epidemiology, information on drivers, and the links between adolescent nutrition, mental health, and environmental factors.
These measures by national governments need to be complemented by strategies at regional level and concerted oversight by agencies such as Unicef and the World Health Organization. The efforts of the Unicef Regional Office for South Asia to highlight the need for a holistic strategy for addressing adolescent health and nutrition, especially for girls, are laudable and must now be followed up by action within countries, as well as monitoring and evaluation platforms with consistent tracking of indicators and targets. As indicated, these require action across various sectors and not just health departments or programmes. Addressing social and commercial determinants of adolescent health and nutrition consistently across the region must become a policy and programme imperative.15 Several global meetings this year, such as the Nutrition for Growth Summit in March 2025 and Scaling Up Nutrition in November, offer an opportunity for spurring action.
Footnotes
Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare.
Provenance and peer review: Commissioned; externally peer reviewed.
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