When we talk about malnutrition, we often think of a very young child who is not getting enough to eat. The reality in Indonesia, though, is more complex: adolescents are also facing a nutrition crisis.
With 45 million young people between the ages of 10 and 19, Indonesia has one of the largest adolescent populations in the world. Even before COVID-19, they faced a triple burden of malnutrition: the coexisting realities of undernutrition, micronutrient deficiencies and obesity. About a quarter of them are stunted, or too short for their age; around 8 percent are too thin; 15 percent are overweight or obese; and 22 percent of adolescent girls are anemic.
Malnutrition, in all its forms, is detrimental to children’s long-term development – and can even be passed down through generations. Besides poor cognitive performance and low work productivity, anemic adolescent girls, for example, are more likely to become anemic mothers giving birth to low-birthweight babies who are likely to grow stunted. Nearly half of all pregnant mothers in Indonesia are anemic because the food they consume lacks the necessary vitamins and minerals.
Good habits developed during adolescence, such as healthy dietary behavior and physical activity, can last a lifetime and can break the intergenerational cycle of malnutrition. Yet, programs aiming to improve nutrition during these formative years are still too few and far between across the country, and need to be scaled up rapidly.
In a bid to support good nutrition during adolescence, the Government of Indonesia with support from United Nations Children Fund (UNICEF) and other partners have been testing various public health policies and interventions. Since 2016, a national program distributes weekly iron-folic acid supplementation to adolescent girls in schools, based on evidence that supervised iron and folic acid given once a week can help lower the prevalence of anemia in adolescent girls. But coverage is still low.
More recently, a program called Aksi Bergizi (Action on Nutrition) builds on the national program by providing school-going adolescent girls as well as boys with weekly iron and folic acid supplementation, nutrition education sessions and public health messaging to encourage good nutrition habits.
In 2019-2020, results from the Aksi Bergizi program in Klaten, Central Java and Lombok Barat, West Nusa Tenggara, showed improvement in nutrition-related perceptions and key behaviors among adolescents, such as increased iron and folic acid consumption, physical activity and healthy dietary intake. Starting this year, the Aksi Bergizi interventions are expected to be included in the national Sekolah Sehat (Healthy School) program.
COVID-19 has had a devastating impact on programs like Aksi Bergizi. Many nutrition services that adolescents relied on have been severely disrupted, and only 40 percent of puskesmas (community health centers) have been able to distribute iron and folic acid supplementation to adolescent girls during the pandemic.
A UNICEF online survey of more than 6,000 adolescents found that nearly 90 percent girls were not taking these supplements during the pandemic, which could lead to a sharp increase in the number of anemic adolescent girls.
Today, on National Nutrition Day, the health minister is calling for subnational authorities to accelerate efforts in improving adolescent nutrition, especially iron and folic acid supplementation.
This requires a concerted effort from several sectors – health, education, religious affairs and home ministries and the National Development Planning Board (Bappenas) – to mainstream adolescent nutrition into their respective policies, plans, budget, program implementation and monitoring. The private sector also has an important role to play in making available and promoting healthier food options.
Importantly, young people must be empowered to become champions for nutrition. Despite the closures of schools due to COVID-19, many adolescents continue to motivate and support their peers to exercise and eat healthily, in person and through social media.
By engaging adolescents as partners, we can help them navigate the complex food choices they face and make better decisions that will lead to a healthier life.
The writer is UNICEF Indonesia's Country Representative.