More than half of all adolescent girls in India, 64 million, suffer from anaemia[1]. Anaemia due to iron deficiency can lead to cognitive impairments related to attention span, intelligence and sensory perception functions. Some common signs and symptoms of anaemia include fatigue, weakness, difficulty concentrating, brittle or spooned nails, pale skin, cracks at the sides of the mouth, coldness in the feet and hands, shortness of breath, and, in severe cases, irregular heartbeat. Biologically, women and girls are at a greater risk of iron deficiency as they have much lower iron stores as compared to men and boys and incur additional iron losses during menstruation. Often dietary iron alone cannot meet the body’s iron demands, especially during infancy, adolescence and pregnancy when iron requirements are highest.
Considering the unique nutritional needs of girls, many governments run public health iron supplementation initiatives to support the iron intake among adolescents. Weekly iron and folic acid supplementation (WIFAS) is one intervention recommended by the World Health Organisation (WHO) and is one of the most effective adolescent health and nutrition programs implemented across many countries to help prevent anaemia.
Recognizing the crucial nature of WIFAS interventions, these programs have been initiated through schools in most countries to maximize reach and maintain consistency. A few countries, such as India, also deliver the WIFAS program to out-of-school adolescents using a fixed day approach through the Anganwadi workers. However, since March 2020 with the COVID-19-related restrictions and school closures, this significant adolescent health and nutrition intervention has been impacted drastically.
While the strict lockdowns to curb the spread of the COVID-19 infection worked well for many countries, they also created barriers to access. School closures due to the pandemic have put millions of children, including adolescents, out of school. As per a UNICEF report, in India, almost 1.5 million schools were closed affecting 286 million children, of which 49% are girls[2].
With a large urban-rural divide, gender inequity and unequal access to technology, education has been disrupted. What is more worrisome is that many of these children may not go back to school, due to reduced family incomes. Adolescent girls in developing countries, who often receive meals, WIFAS and nutrition education in school, are now not only missing out on their education but are also facing an increased risk of anaemia at a time when nutrition is of prime importance.
Furthermore, lockdowns have limited transportation resulting in disruptions in supply chains which has led to a shortage of IFA tablets in many countries. Counselling and attempted distribution of IFA tablets through alternate means have also been restricted as frontline health workers are focused on the COVID-19 response. Lack of personal protective equipment (PPE) and the fear of disease transmission among service providers and beneficiaries has further created barriers to access.
Nutrition International, a global organisation committed to delivering proven nutrition interventions to high-need communities, has been working in India for over 20 years to improve survival and health of the vulnerable, especially women, adolescent girls, and young children. During the pandemic, Nutrition International has been supporting the governments of Uttar Pradesh, Gujarat, Madhya Pradesh, Chhattisgarh and West Bengal to streamline the supply of IFA tablets by engaging with frontline health workers and community-based platforms. As a result, in many states, an advance supply of the IFA tablets was provisioned in order to ensure that no adolescent – whether boy or girl, in-school or out-of-school – was left without their WIFAS.
Fueled by these initiatives, after an initial period of decreased WIFAS coverage due to school closures, the trend is now reversing as more and more girls are being reached via community platforms. Central to all these innovations has been the collaboration with local champions, such as village midwives, teachers, health cadres and youth groups, which has proven to be efficient in reaching adolescents. Additional measures such as provisioning of incentives for home visits and adequate supply of PPE can provide the much-needed boost to frontline workers’ efforts to ensure adolescents in their community stay healthy.
As India begins to open up and consider reopening schools, it is important that the government does not overlook the impact of disrupted social protection programs, food distribution schemes, and micronutrient supplementation interventions for those living in vulnerable situations. Investment in nutrition is the need of the hour, as it will help build resilience and immunity to disease, paving the way for global economic recovery and stability.
[1] Aguayo VM, Paintal K, Singh G. The adolescent girls’ anaemia control programme: a decade of programming experience to break the inter-generational cycle of malnutrition in India. Public Health Nutr. 2013;16(9):1667–76.
[2] UNICEF report titled- Remote Learning Reachability Report; Release date: August 2020