Nourishing hope: Adolescent nutrition and aspirations in Nepal

Research output: Thesisinternal PhD, WU

Abstract

Background

Adolescence is a dynamic life stage characterized by rapid physical, social, and psychological growth. During adolescence, individuals start aspiring for their future lives. Adolescents’ aspirations are hypothesized to being drivers of well-being and development through steering positive and healthy behaviors. Nutrition is another building block of adolescents’ current and future health, well-being, and development. Adolescence is thus an important window of opportunity to set the stage for future health and development. Investments in adolescent nutrition not only enables growth and foster healthy behavior, it also leads progress in areas of education, occupation, and family formation, potentially through aspirations. Presently, adolescent malnutrition remains a pressing challenge in Low-and Middle-Income Countries (LMICs) and particularly in South-Asia. Malnutrition prevents adolescents, and notably girls, from reaching their full developmental potential. An understanding of the associations between nutrition, diets, and adolescents’ aspirations for their future lives - the so-called “nutrition-aspirations nexus” – remains, however, limited.

Aim

The overall aim of this thesis is to improve the understanding of the context-specific multilevel drivers of undernutrition during adolescence in LMICs, and specifically in Nepal. Additionally, it aims to explore the nature of, and relationships between Nepalese adolescent girls’ nutrition and their aspirations in key life domains of education, occupation, family formation, health and nutrition, to contribute to integrated efforts that optimize adolescent girls’ nutritional and developmental outcomes in important life domains.

The following objectives are addressed:

1. To synthesize the evidence on the sociocultural and economic determinants and consequences associated with undernutrition and micronutrient deficiencies among adolescents in LMICs.

2. To examine which sociocultural and economic factors influence undernutrition (stunting and thinness) amongst adolescent boys and girls aged 10–19 years in Nepal.

3. To explore which non-nutritional-related factors are associated with Nepalese adolescent girls’ aspirations in domains of education, occupation, family formation, health, and nutrition.

4. To advance the understanding of Nepalese adolescent girls’ aspirations related to school, work, family life, food, and health and explore factors that influence adolescent girls’ aspirations.

5. To examine the associations between malnutrition and Nepalese adolescent girls’ aspirations related to important life domains of education, occupation, and family formation, and to investigate any changes in these associations, over time.

Methods

This study adopts a mixed-methods research approach which includes: a systematic narrative literature review for objective 1; cross-sectional surveys for objectives 2 and 3; qualitative in-depth interviews, complemented with creative elicitation techniques for objective 4; and panel surveys for objective 5.

Results

Chapter 2 of this study provides a starting base for studying the associations between adolescent nutrition and aspirations by indicating important research gaps. Findings of this review show that there is fragmented evidence on factors influencing undernutrition on both individual and household levels, such as age, sex, birth order, religion, educational attainment, working and marital status, or hygiene practices. Moreover, only few studies investigate factors at the broader societal or environmental level, including seasonality or geographic residence. Even fewer studies investigated the consequences of undernutrition during adolescence, which were mostly limited to associations of (under)nutrition with educational attainment or cognitive skills.

Chapter 3 zooms in on Nepal and provides a comprehensive overview of the individual, household, and community (macro-level) sociocultural and economic factors that are associated with stunting and thinness amongst adolescent boys and girls. Findings showed suboptimal growth environments for adolescents in Nepal as indicated by stunting and thinness prevalence, and that there is no one-size-fits-all approach to address undernutrition. Stunting was associated with the male sex, older age, marital status, religion, caste/ethnicity, nutritional knowledge, parental occupation and education, household wealth, and geographical location. Thinness was associated with the male sex, younger age, marital status, religion, caste/ethnicity, hosuehold wealth, maternal education, and paternal occupation. Effect sizes however differed between sexes and age groups.

In chapter 4, the nature of younger versus older adolescent girls’ aspirations in domains of education, occupation, marriage, fertility, health and nutrition, and their determinants at the individual, household and community-level were explored using data from the Suaahara II Adolescent Girls Panel in Nepal. Findings showed a rather positive picture, with many girls aspiring high. Household wealth, self-efficacy, age, school-status, caste/ethnicity, household size, household head highest completed level of education, and agro-ecological zone of residence were all associated with aspirations, although variations were found in the extent to which factors were associated with the different aspirations. One implication of this study is that keeping girls in school and preventing early marriage are key to fostering girls’ aspirations.

Chapter 5 dives deeper into girls’ aspirations in two districts of Western Nepal. Great differences were found between younger, older and married adolescent girls or young women. Findings overall showed a shift from holding (sometimes overly) high aspirations, to navigating aspirations and expectations, to lowering aspirations and feelings of resignation, with age and upon specific life events (i.e., dropping out of school, marriage, having a child). Results showed how aspirations are embedded within time and place, shaped under the influence of others, and increasingly restricting gendered sociocultural norms.

The final chapter supports the “nutrition-aspirations nexus” by providing provided initial evidence for the hypothesis that good nutrition would have the potential to foster girls’ aspirations. Analyses revealed associations between changes in thinness and fertility aspirations, and changes in anemia and educational aspirations, using unique panel data from Nepal. The latter association only held for post-menarche girls. Other analyses showed associations between height-for-age and educational aspirations, and hemoglobin and occupational aspirations and fertility aspirations. Overall, this chapter underscores the importance of investing in adolescent nutrition to grow aspirations.

Conclusion

This study addresses some important research gaps on adolescent nutrition in LMICs and in Nepal, adolescent girls’ aspirations in Nepal, and the nutrition-aspirations nexus. Main conclusions are that 1) neither nutrition nor aspirations develop in isolation; 2) adolescence is not just one uniform phase of the life course; 3) adolescent nutrition and aspirations are always shaped in interaction with important others and under social influence; and 4) findings support the nutrition-aspirations nexus and that good nutrition would have the potential to nourish adolescent girls’ aspirations.

 

Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Wageningen University
Supervisors/Advisors
  • Vaandrager, Lenneke, Promotor
  • Koelen, Maria, Promotor
  • Talsma, Elise, Co-promotor
Award date10 Sep 2021
Place of PublicationWageningen
Publisher
Print ISBNs9789463958417
DOIs
Publication statusPublished - 2021

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