A couple of weeks ago GAIN and the World Health Organization (WHO) organised a consultation “Adolescents: Agents of Change for a Well Nourished World”. This was the third in four “stepping stones” towards forging a consensus on promising approaches for programming to improve adolescent nutrition outcomes. The first was hosted by SPRING (a USAID initiative), the second by ENN/London School of Hygiene and Tropical Medicine, the third by GAIN/WHO and the fourth will be in September 2018, hosted by IFAD and Save the Children.
We at GAIN wanted to learn from others as we build on our adolescent nutrition landscape reports and begin working with our partners in Bangladesh, Indonesia, Mozambique and Pakistan to design interventions that are likely to improve the nutrition status of adolescents.
There were 2 key features of the consultation that GAIN and WHO were determined to make happen: (1) we wanted to learn from those outside the nutrition ecosystem who had extensive experience of working with adolescents and (2) we wanted direct and meaningful engagement with adolescents themselves. It would have been much easier not to do this, but much less interesting and legitimate we thought.
We were able to bring in expertise from organisations such as the Shornokishoree Network Foundation (SKNF), Quantum, Restless Development, ONE, Purpose PBC, Ashoka’s Centre for Social and Behaviour Change, and NCDFREE – all of whom work with young people on a regular basis. Also participating were development organisations who are beginning to do more work on adolescent issues such as the Global Finance Facility, the Overseas Development Institute, and the Young Lives Programme. In addition we had key food and nutrition stakeholders: FAO, WFP, IFAD, Save the Children, SPRING, ENN, Concern Worldwide, Nutrition International, Global Affairs Canada, SickKids Hospital, IDRC and the Aga Khan University.
But the x-factor in the consultation was the participation of 10 adolescents from Bangladesh, Indonesia, Pakistan and Zambia. More about them later.
I can’t possibly do justice to the richness of the meeting, but here goes.
Why focus on adolescents?
- There are a lot of adolescents. Asia and Africa are experiencing a youth bulge as their countries go through a demographic transition. In the next 5-10 years we will be at “peak youth” as they hit the labour force and the voting rolls.
- Despite being so prominent in the population numbers, adolescents are virtually invisible in nutrition data and in nutrition programming. We really only have data on 15-19 year old girls. Virtually nothing on girls 10-14 or boys 10-19.
- The data we do have suggests that a very large proportion of adolescents experience at least one form of malnutrition.
- Malnutrition in adolescence affects the development of key brain functions—there is plenty of development going on after the first 1000 days into the 4000 -7000 day period.
- Because the transition from childhood to adolescence carries the promise of more power to make their own decisions, adolescents are catalysts for social change. Whether campaigning for stricter gun control in the USA, the prevention of child marriage or bans on single use plastics, adolescents have enormous potential agency. Adolescents can redefine norms around, say, healthy eating—if we support them in the right way.
What kinds of actions or programmes should be developed?
The specifics are less clear here. But there are some key principles:
First, as Dr. Chandra-Mouli from WHO said, we should stop doing “interventions” we know do not work in this space (e.g. high profile public meetings, and one off trainings).
Second, try to build nutrition into existing policies and programmes that seek to improve the wellbeing of adolescents.
Third, in building nutrition in, do not dilute the existing programs’ ability to talk about really difficult and awkward topics, e.g. on puberty and sexuality.
Fourth, the demand side is vital: find ways to engage with adolescents on their terms—what influences their choices (e.g. taste, convenience, privacy, looks, aspiration, sports, celebrity, superheroes)—but don’t talk explicitly about nutrition (its boring).
Fifth, what can we do to make sure healthy food is available in or near schools (our Zambian adolescents shared some heart-breaking reality about food at school) or in markets (e.g. in Java, where is the healthy fast food that tastes good and is the “cool” thing to buy and eat?)
Finally, strengthen accountability around what powerful stakeholders are or are not doing with or for adolescents, e.g. State of Youth reports, petitions, campaigns, declarations and policy scorecards.
How to design and implement programming?
First and foremost—work with adolescents in a meaningful way. As one participant said, “let them be your guide”. They best understand their reality, the opportunities and limits and how to seize and navigate them. They can help us figure out where they are and how to get there—they will not necessarily be where the programmers want the programming to be.
Second, build the capacity of the adolescents and the rest of us to engage with each other. As one participant said the “peacocks” (adolescents) and the “turtles” (the rest of us) need to work together for change and neither group probably has much experience of doing so. They both need to learn.
Third, like any agents of change, adolescents can achieve more working together (the “power with” multiplying the “power within”). We need to support their organisation, their ability to educate and their ability to agitate.
Finally, we need to let them lead. This is potentially the most challenging aspect because we are so used to being in control. But if adults only view adolescents as instrumental to the former’s goals, they are being exploitative.
So what does all this mean?
Interestingly it seems to me that the adolescent agenda is not plagued by the usual institutional territoriality in development. Not yet anyway. For example, there is no obvious UN agency charged with promoting the rights and wellbeing of this age group. This creates space for duplication, but also for collaboration. Fortunately, we are more in the collaboration space at the moment.
This lack of formalised institutional leadership also gets us into a different but familiar territory, namely that “adolescents are everyone’s business and no one’s responsibility”. And because there is a bit of a vacuum of leadership around adolescent nutrition, many agencies are stepping in, in a coordinated way, and that is encouraging. Now the challenge is for the stepping stones to actually create a path towards significant commitments of resources to adolescent nutrition programs and policy.
We need the UN to come together around the adolescent nutrition agenda and call a meeting in 2019 where member state governments can shape a series of “asks” and turn them into commitments for governments, and all other investors–such as NGOs, research organisations, businesses, development donors–to make.
The one group we don’t have to ask to make commitments is adolescents—they are living their commitment. And if the rest of us do not step up to make commitments to support them, then they may just do it without us. “Never about us without us” may become “if you don’t step up then step away”.
Fortunately, at the consultation, a large number of organisations made commitments that they will report back on publicly in June 2019 – to the adolescents attending the meeting and to everyone else. The commitments do not involve major funding, but they do involve change. And even though some of the commitments probably relate to actions that were going to be undertaken in any case, the most important thing is that the commitments were made public, allowing all of us to monitor them and to assess progress against them.
We are still working on finalising the wider set of specific commitments from the different organisations, but GAIN’s are as follows:
- GAIN will not organize any meeting on adolescent nutrition without meaningful involvement from adolescents
- GAIN will attempt to connect the Indonesian adolescent representatives with the Ministry of Health in Indonesia and set up a dialogue between the adolescents and the Ministry’s representatives
- GAIN will set up or use existing national adolescent networks for meaningful engagement and capacity building in the design phase of adolescent nutrition programs in countries where GAIN is/will be working
Such public pledging is unusual, and I think it happened because the adolescent participants made us not only think about the issues, but to really experience feeling and emotions around the issues. And when thinking and feeling come together, action is inevitable and change is unstoppable. A fire is lit and it cannot be extinguished!