Policy Implications of Addressing Young Adolescents with an Integrated Nutrition, Hygiene and Reproductive Health Intervention: Evidence from Rural Uttar Pradesh

Objective: To demonstrate the need for integrated interventions for young adolescents in rural Uttar Pradesh for long term health benefits in maternal and infant health. Background Uttar Pradesh (UP) has a high maternal mortality ratio and infant mortality rate. More than half (59 percent) of women aged 20-24 years marry before 18 years (NFHS-3). UP is home to 17.2 million adolescent girls. Nutrition and RH programs for in-school adolescents are vertical. Methods The data are part of a baseline assessment for a randomized cluster trial in 30 rural schools in Hardoi district, UP. Baseline data were collected in 2010 from 1195 girls (grades 6-8). Results The nutritional status of the girls is poor. The rate of stunting (< median-2 sd) increased with each year, with 49.4 percent 15 year old girls being stunted compared to 25.8 percent girls at 11 yrs. About 48 percent girls reported they had not consumed any protein rich food a day prior to the survey and only 2.7 percent had consumed green leafy vegetables. Menstrual problems were reported by 63 percent of the girls and 6.5 percent reported symptoms of reproductive tract infections; 71 percent learnt about menstruation after their menses had begun. Handwashing with soap: after defecation – 70 percent, before eating – 13.9 percent, before cooking - 5 percent. Conclusions There is a need to simultaneously improve nutrition, hygiene and reproductive health behaviors in young adolescents. Starting with young adolescents is a first step to building healthy communities in Uttar Pradesh.