Malnutrition is a pervasive burden, contributing to 50% of preventable child mortality, and reducing a surviving child’s ability to reach their full potential. In recent years, there has been renewed intensity from the global development community to target children with essential nutrition interventions in the critical first 1,000 days of life. While a healthy start is essential, such a targeted focus risks missing other critical development windows to ensure that a healthy child becomes a healthy adult. A particular challenge is the emerging adolescent girl agenda, where little progress has been made to meet the critical and unique health and nutrition needs of this vulnerable age-group.
Anemia is one of the most widespread malnutrition conditions in the world, and particularly in South Asia where an estimated 47% of non-pregnant women are anemic . Adolescent girls are particularly vulnerable to anemia, which has been associated with reduced cognitive and motor development, fatigue, and negative impacts on productivity and lifetime earnings. In India, about 56% of adolescent girls are estimated to be anemic .
Adolescent girls at risk for anemia need a suite of nutrition interventions, including weekly supplementation with iron and folic acid, as well as nutritional education, access to clean water and sanitation, and a diverse diet.
Both countries with high burdens and their donor partners must invest more in adolescent nutrition. Less than 1% of global aid goes toward total nutrition, and just over 2% of government spending in low and middle-income countries is allocated towards fighting malnutrition, primarily for pregnant women and children ,  Few governments include adolescent nutrition within their health and educational policies and programs . Similarly, global policies and norms rarely highlight the importance of maintaining proper nutrition in adolescence. Although Target 2.2 for the Sustainable Development Goals mentions the importance of considering the nutritional needs of adolescent girls, all the indicators for this target focus on children under the age of five.
Countries and donors need to include adolescent girls in their strategic plans and allocate funds for the needed interventions appropriately. Adolescent girls are a difficult population to reach since they do not have regular encounters with the health system; other channels than health clinics, such as schools and girls clubs, may be more effective. This will require coordination and multi-sectoral cooperation, which is itself challenging, but has big potential payoffs in terms of impact and efficiency. Already, organizations like Nutrition International , WFP , and UNFPA  are prioritizing nutrition interventions for adolescents, and other organizations working to safeguard women and child health should do more to ensure that no one is left behind.
Ending anemia in adolescent girls will not be easy, but has large direct and indirect payoffs. Protecting the nutritional status of adolescent girls through education and dietary diversity has knock-on effects by reducing the risks of pregnancy and delivery, low birth-weight, and child mortality. Ensuring that adolescent girls have sufficient iron to support growth safeguards the cognitive, economic, and developmental potential of both current and future generations.
 Stevens GA, Finucane MM, De-Regil LM, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. The Lancet Global Health. 2013;1(1):e16-e25. doi:10.1016/S2214-109X(13)70001-9.
 Bill & Melinda Gates Foundation. Nutrition strategy overview. Accessed at: https://www.gatesfoundation.org/What-We-Do/Global-Development/Nutrition
 International Food and Policy Research Institute. Global Nutrition Report. 2016.
 Save the Children. Adolescent Nutrition: Policy and programming in SUN+ Countries 2015. Accessed at: https://www.savethechildren.org.uk/sites/default/files/images/Adolescent_Nutrition.pdf.
 Nutrition International. Women & girls’ nutrition. Accessed at: https://www.nutritionintl.org/what-we-do/by-programs/women-girls-nutrition/
 World Food Program. Nutrition at the World Food Programme: A Focus on Adolescents. Accessed at: http://documents.wfp.org/stellent/groups/public/documents/communications/wfp269725.pdf
 UNFPA. Nutrition International and UNFPA partner to improve women and adolescent girls’ health. Accessed at: https://www.unfpa.org/press/nutrition-international-and-unfpa-partner-improve-women-and-adolescent-girls%E2%80%99-health.
Shan Soe-Lin, Robert Hecht ,
Lindsey Hiebert and Kelly Flanagan
Pharos Global Health Advisors