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alnutrition and unhealthy lifestyle habits are said to be among the main causes of the high prevalence of anemia among adolescent girls, but not so much among their male peers.

As they reach puberty, girls are naturally prone to anemia, as they lose a significant amount of blood during their monthly menstruation cycle, which lowers their red blood cell count to lower-than-normal levels.

In addition to biological factors, bad eating habits caused by self-consciousness about body image and other social pressures have worsened cases of anemia among teenage girls.

Yoga Devaira, a member of the Indonesian Pediatricians Association (IDAI), said female teenagers were exposed to unhealthy lifestyles and extreme dieting due to low confidence and peer pressure.

“They want to be tall and thin like Barbie dolls or the celebrities they see on TV. [...] Some of them go an extra mile to lose weight. For example, they might eat only a banana or fast all day to try and lose weight instantly,” she said. “Bad eating habits cause [teenage girls] to lose some important nutritional intake, such as iron. Not only do they become malnourished, but also anemic.”

The government is giving extra attention to addressing anemia among adolescent girls. According to data from the 2013 Basic Health Research, the prevalence of anemia among girls of 15 to 18 was 23 percent, higher than the 12 percent rate of anemia among boys of the same age group.

Anemia decreases immunity, concentration and productivity. The condition also poses further health issues in girls, as it increases the risk of complications during adolescent pregnancy, and if they chose to carry the baby to full term, anemia could also lead to other complications such as preterm deliveries, low birth weight and increased risk of maternal mortality. These complications also increase the risks of malnutrition for the child.

For example, the Health Ministry recorded that maternal mortality due to severe bleeding during childbirth, which was often caused by anemia, remained at 32 percent in 2017.

Meanwhile, national figures showed that 37 percent of pregnant women were anemic in 2013, compared to 23 percent of women of reproductive age who were not pregnant.

The Ministry of National Development Planning (BAPPENAS) and the United Nations Children’s Fund (UNICEF) said in a 2017 joint report that the prevalence of anemia among pregnant women had increased from 25 percent in 2007.

“If a woman is anemic when she conceives, her nutrition, and that of her child, will be further compromised. Therefore, it is important to track the prevalence of anemia among women of reproductive age,” the report concluded.

To address the issue, the Health Ministry has been distributing supplements to stimulate red blood cell production since 2015 through community health centers for female students at junior and senior high schools. The students are scheduled to take the supplement once a week during school hours.

However, Eni Gustina, the ministry’s head of health promotion, said the goal to distribute the supplements to all female students in the country was hampered by the limited budget for the program.

“We have covered 30 percent of schools across Indonesia and have targeted 50 percent coverage by 2019. We will do so gradually,” Eni recently told The Jakarta Post.

She also emphasized the roles families played in encouraging a healthy diet.

“What [the girls] eat from their plate every day is the most important thing. They must have a healthy diet that is high in iron to fight anemia. And young students must be given this information [for] when they have their own children later,” she said.