Experts have called for a paradigm shift from nutrition programs that focus solely on children to ones that also address malnutrition in adolescent girls and pregnant and lactating women. Women in many low- and middle-income countries (LMICs) typically eat a lower quantity and variety of nutritious foods than their male counterparts – even though, at specific stages in the lifecycle, women require more dietary iron than men and more protein when pregnant or breastfeeding. In a recent major review of diet quality in adolescent girls (10-20 years) in a wide range of LMICs, over half of the young women and adolescent girls surveyed were not able to meet their micronutrient needs.
But healthy diets do not ‘just happen’. Meals represent a common human experience which is nevertheless special to time, place and culture. What people actually eat results from a complex set of interconnected production, marketing and retail systems. What is eaten (or not) is influenced by personal preference, purchasing power, knowledge, social and religious norms, accessibility, advertising and constraints linked to available time and space for preparation. At the same time, what is eaten (or not) has a very significant influence on the global burden of disease.
In the global response to the deepening nutrition crisis, many aid agency and public interventions, promoting products such as pills, powders, and Ready to Use Supplementary Foods (RUSFs), have struggled to be effective at large scale, with very low acceptability amongst women of reproductive age (as low as 20%), due to failure to adapt formats, packaging, flavors and delivery models to each population’s socio-cultural context. These rations also have very low availability due to unsustainable and unscalable donor-based financing, and their failure to integrate solutions with local manufacturers and distributors. Multi-sector partnerships that harness market-based approaches can help to address these constraints to sustained scale and effectiveness.