Holistic approach imperative to end malnutrition and gender inequality among adolescents

Professor S M Abdul Motin Laskor

Director, Directorate of Secondary and Higher Education, Rangpur Region, Rangpur

Under an MoU with the Directorate of Secondary and Higher Education (DHSE), the JANO project is working with the schools in Rangpur and Nilphamari districts. JANO has set an example in terms of activating students for nutrition gardening which should be replicated all over Bangladesh. A nation cannot thrive without meeting the nutrition requirements of its citizens. If Bangladesh has to make an international presence, we must focus on nutrition with greater importance. Government and development partners must work shoulder to shoulder to achieve this target. I had the chance to go to school just immediately after the independence of Bangladesh. Even at that time, the Father of the Nation, Bangabandhu Sheikh Mujibur Rahman, emphasized on school gardening and seeds were provided to us for plantation at school and home. Now, the time has come to realize the dream of the Father of Nation to make Bangladesh a healthy nation, meeting the nutrition demand of all. We must not forget that we have 50 million adolescents and youths in our country; if we fail to ensure nutrition for them, we will never be able to be recognized both nationally and internationally.

Afroz Mahal

Director, Programme Management and Implementation

Plan International Bangladesh

The once in lifetime opportunity for Bangladesh having benefit of demographic dividend where 32% of the country's population are below 30 years of age and 21% of them are adolescents. It indicates that collectively we should grab and maximize the huge potential to build the nation for the better. So civil society needs to act fast and collaborate with the government to transform this large workforce and grow their potential at large. Bangladesh has demonstrated tremendous achievement in various indicators of the SDGs. However, many reasons, including the adverse impact of COVID-19, has affected the progress, especially to fulfill the gender equity indicator. There exist certain normative and stereotyped practices such as harmful gender norms and roles prevailing in society where women's role only limit to childcare and household chores. Women giving birth to children is a significant responsibility and sometimes it puts them in a life-threatening situation due to ignorance and undervalued position in the family and society. Even in our subconscious mind, we often practice unequal treatment when it comes to girl and boy children. In Bangladesh, we have many policies and plans that guide us on what to do to eliminate this discrimination. If we go through the Government's Nutrition Action Plan, we will see nutrition has been defined as a cross-cutting agenda for different sectoral interventions and is not confined to health only. In collaboration with the Directorate of Secondary and Higher Education (DHSE), Plan Bangladesh has implemented the GEMS curriculum in 1004 schools and madrasas, which is playing a role in terms of developing knowledge on gender equity and adolescent health. Plan International has a global target to empower 200 million girls who will act as change-makers. As this project approach to end, we plan to have a series of consultations with various stakeholders for their thoughts and suggestions that will help us in shaping our current and future work as part of organizational commitment.

Dr. Md. Shahid Uz Zaman

Founder and Executive Director, ESDO

Eco-Social Development Organization or ESDO is the implementing partner of the JANO project. Three indicators are important to consider when we think about food and nutrition security: access, availability, and utility. The beauty of the JANO project is that it has touched upon all these three aspects. There are many good lessons learned from the JANO project which should be scaled up. JANO has created an evidence-based outcome and it has been possible due to the support extended by the relevant government department. We need to focus on the sustainability of the successes related to gender awareness, adolescent health and nutrition produced by JANO project and for this, more policy advocacy is necessary at different levels.

Md Ashik Billah

Head of the Central and Northern Region Programme

Plan International Bangladesh

JANO has created some positive evidence in terms of how we can address the challenge of food security and the global food crisis. The fundamental concept of JANO is to promote awareness on adolescent health, nutrition and gender equality and to enhance the learning to practice in day-to-day life. JANO has focused on 'nutrition gardening' in households and schools. Department of Agriculture Extension (DAE) has some designated persons like; Sub-Assistant Agriculture Officer (SAAO) who works at union level and can be engaged with project activities to sustain these kinds of unique activities. JANO also initiated the adolescent corner at school, which becomes a learning center for adolescent girls and boys on many important issues related to their adolescent period and it can be scaled up by the government all over Bangladesh.

Mohammad Faiz Kawsar

Project Manager-JANO

Plan International Bangladesh

JANO project is playing a supporting role to the government of Bangladesh to achieve our country's nutrition goals and targets associated with the SDGs of the Bangladesh Government. Care Bangladesh, Plan International Bangladesh and Eco-Social Development Organization (ESDO) are implementing JANO project in a consortium with the funding of the European Union and co-funding by Austrian Development Cooperation. JANO is playing the supporting role in Rangpur and Nilphamari districts with twenty-two ministries of the government working on achieving nutrition targets in Bangladesh. Knowledge and awareness are being raised and strengthened within communities in areas to contribute to ending malnutrition of children under five years of age, together with addressing the nutritional needs of Pregnant and Lactating Women (PLW) and adolescent girls, to increase the awareness of appropriate hygiene behaviour, and adoption of nutrition-sensitive, nutrition specific services and climate-smart-agriculture techniques. The project is contributing to the government system to implement the Second National Plan of Action for Nutrition (NPAN 2). JANO has produced a number of successes such as climate-smart vegetable gardening, adolescent corners in schools and Union Health and Family Welfare Centre (UH&FWC), theatre for development for community etc. One key feature of the JANO project is Gender Equity Movement in Schools (GEMS) curriculum which has been implemented in 297 secondary schools and madrasas in JANO project districts. The good thing is that GEMS in schools will now be scaled up all over Bangladesh. We, therefore, must be careful how this concept can be successfully implemented to make effective results. JANO has initiated vegetable gardening (climate-smart garden) in 331 schools from project working areas. JANO is working with the Nutrition Coordination Committees so that they implement effective nutritional programmes within their regions. The private sector is also seen as a major systemic partner as JANO is motivating and encouraging businesses to invest in local markets. The project provided support to Bangladesh National Nutrition Council (BNNC) to develop the web-based nutrition activity monitoring platform. Now this is under countrywide scaleup. Women and girls are at the centre of JANO activities that adhere to a gender-transformational approach for a gender-equal environment. JANO has successfully introduced co-curricular activities such as karate self-defense training that boosted the confidence of the adolescents. Moreover, JANO has shown tremendous success in making students and adolescents interested in gardening and agriculture as a means to meet nutritional needs.

Md Akhtaruzzaman

Deputy Director, Secondary

and Higher Education, Rangpur Region, Rangpur

Nutrition garden is an excellent innovation of this project which enabled the students to gain knowledge on climate-smart agriculture and they are practicing the learning in daily life. Child marriage is still a big concern in many schools, including government schools. Along with adolescent corners and school gardening activities, JANO's intervention in reducing child marriage will also be great. The modality and best practice can be replicated in other schools in the country. And all adolescent girls must get iron-folic acid tablets or iron supplements. The Gender Equity Movement in Schools (GEMS) curriculum implementation at the school and madrasa level is one of the successful interventions of JANO project for the education system.

Dr. Shamim Ahmed

Civil Surgeon, Rangpur

Achieving nutrition targets needs multidimensional coordination and there is no alternative to it. Nutrition is not a business of any given ministry. Without multisectoral and multi-ministerial coordination, it will not be possible to achieve sustainable nutrition goals. 22 ministries have been assigned by the government, and district, sub-district, and union parishad level coordination committees are formed to carry out nutrition activities. Political commitment and public awareness are also very important to end malnutrition. The Constitution of Bangladesh (18.2) mentions that the State shall regard raising the level of nutrition and improving public health as among its primary duties. The development partners have a role to play in advancing the coordination among different government stakeholders for improving results. JANO project is playing a vital role with the government for nutrition-related activities, especially the function of the Union Development Coordination Committee (UDCC), Upazila Nutrition Coordination Committee (UNCC) and District Nutrition Coordination Committee (DNCC) to effectively implement the Nutrition Action Plan under Rangpur and Nilphamari Districts including standard practices of the government system. JANO is a good example of joint implementation with the government with an integrated approach.

Md. Shafiqul Islam

District Education Officer, Nilphamari

There are 216 schools in Nilphamari districts where JANO project activities are being implemented. Under the nutrition governance project, some selected teachers from these schools have been provided with training on adolescent nutrition, health and gender awareness with the great collaboration of the Department of Secondary and Higher Education (DSHE) & National Curriculum and Textbook Board (NCTB). We have observed that teachers have become more sensitized and careful about adolescent nutrition, health and gender awareness after receiving the training. The school garden turned into an interesting and enjoyable learning activity that makes the students happy, hyperactive and conscious about their health and nutrition. They are practicing their learning at home and sharing it with others which is more efficient in terms of spreading knowledge and awareness.

Shegufta Nasrin

Assistant Teacher, Afan Ullah High School, Rangpur

I started working with the JANO project in 2019. The objectives of the project interested me a lot. While working on the project, I came to realize that JANO is considering a holistic approach to address nutrition, considering health and gender awareness within it. Mental and physical health are closely associated with nutrition and gender equity. I worked as a master trainer of the Gender Equity Movement in Schools (GEMS) initiative under JANO and educated students about adolescent nutrition and health, cleanliness, menstrual hygiene, and helped them prepare a food and diet chart to follow to ensure nutritional requirements. Since each school has a physical instructor/teacher, and a new subject named health protection is being introduced in 2023, the concept of GEMS can be implemented all over Bangladesh.

Md. Shamimur Rahman

Additional Deputy Director

Department of Agricultural Extension, Rangpur

Adolescent nutrition, health and gender awareness is a highly important issue for Bangladesh to address. Schools are an essential medium because if we can help aware our students about the knowledge and importance of adolescent nutrition, health and gender awareness, there will be a high-level positive impact in the long run. The reality is that students are not very interested in learning about nutrition, which causes a lack of knowledge. Parents are also equally ignorant. We, as guardians, have an additional responsibility to learn and educate our children about nutrition. Each family should have a food chart and a person should eat 200-250 grams of vegetables and 100-150 grams of fruits per day It is mandatory, but we do not follow it. We need to disseminate this kind of knowledge among our students and parents through schools.

ATM Nazmul Huda

Assistant Director, Family Planning, Rangpur

Despite our efforts, Bangladesh's achievements in various nutrition indicators are quite low in comparison to many poor countries, including several African countries. Stunting results from chronic malnutrition, which retards linear growth, whereas wasting results from inadequate nutrition over a shorter period, and underweight encompasses both stunting and wasting. Family Planning and JANO are working together to address these challenges. With the support of the JANO project, the Directorate General of Family Planning (DGFP) has provided training to Family Planning health workers on adolescent nutrition, health, and gender awareness. Family Planning Department has a School health education module which has been developed in consultation with various agencies, including the DGFP. In our Union Health & Family Welfare Centre (UH&FWC) premises, we have adolescent corners and based on availability, we provide sanitary napkins and iron folic acid tablets. However, we have limited human resources which we need to overcome to perform better.

Antora Roy

Adolescent Representative

I was unaware of the importance of nutrition, reproductive health, and safety before. Then JANO came and initiated adolescent corners and GEMS sessions in school with the support of the school authority. Now, we can discuss our issues and problems in the adolescent corners and learn about adolescent health and changes. The female adolescents in our community did not know about the use of sanitary napkins during the menstrual period, but now, many of us know about the importance of using sanitary napkins and the risks of using unsafe clothes/napkins. JANO also has Theatre for Development Shows, which educated us about the negative consequences of child marriage, the importance of menstrual hygiene, reproductive health etc. JANO project initiative has contributed to building my knowledge and confidence. Now I am confident to apply my learnings on vegetable gardening at the household level, able to support other adolescents in calculating individual BMI calculation, balance diet and food hygiene.

Md Mosaraf Hossain

Assistant Inspector

Bangladesh Madrasa Education Board, Rangpur

Educational Institutions play a big part in addressing concerns with adolescents, health, nutrition, hygiene, and gender. Although the curricula and environments of various educational institutions vary, it is crucial to consider the context and circumstances of Madrasha Education in Bangladesh. For instance, female madrasah instructors might be more engaged in the SRHR concerns of adolescent girls. However, if the adolescence corners can be established in all the madrasas, they will play an important role in promoting knowledge on adolescent nutrition, health and gender awareness among the students.

Md. Anisur Rahman

Manager-Capacity Building

JANO Project, Care Bangladesh

JANO project has gathered lots of experience. Apart from school-going adolescents, JANO has also extensively worked for out-of-school adolescents as they cannot avail many of the services provided in the schools. A budget is needed for school or nutrition gardening, and the existing multisectoral committees at the district and sub-district levels should think about how to find the budget for this practice from government sources. If adolescent corners can be established in all areas, they can significantly contribute to the life of adolescents from these areas.

Tajnim Ferdous

In-Charge, NGOs & Foreign Missions, The Daily Star

Several important recommendations have come up from the discussion. One of the most important things discussed here is students can learn about adolescent nutrition, health and gender issues from the schools, which is very effective. This is something that should not remain confined to the JANO working areas but all over Bangladesh if we want to reap the advantages of demographic dividends in the coming decades. Taking steps to end child marriage is another important task that we must consider while dealing with malnutrition, as child marriage and malnutrition are inexplicably associated with each other. Ensuring the availability of iron and folic acid tablets for adolescents is required. Given that nutrition needs a multisectoral approach and initiatives, it should be considered from education, livelihood, health and social protection perspectives.

Key Recommended Action

♦ A holistic approach should be taken to meet the nutritional needs of adolescents.

♦ Adolescent school-goers should have basic knowledge and information on Adolescent health, nutrition, and gender equity.

♦ Iron folic acid tablets or iron supplements should be provided to all adolescent girls through the government system.

♦ The concept of school/nutrition gardening should be scaled up across Bangladesh in the education system.

♦ More engagement of the agriculture department to promote and establish school vegetable gardens.

♦ Arable land can be used to grow fresh and nutritious vegetables at home to meet daily nutrition needs.

♦ Effective coordination and partnership of government, non-government and other relevant stakeholders can be proved as the most effective way to promote adolescent-friendly health facilities.

♦ Concerted effort is needed to ensure the menstrual and health hygiene of adolescent girls.

♦ Gender equity must be promoted and practiced through curriculum and educational institutions in order to have an impact at the family, household, and community levels.

♦ Parents and guardians should be provided with the proper knowledge on nutritional values, adolescent health, and hygiene which will be helpful to guide their adolescents.