Nourishing Hope? Changes in Malnutrition and Changes in Girls' Aspirations - Evidence From the Suaahara II Adolescent Girls Panel in Nepal

Madjdian, Dónya S.; Talsma, Elise F.; Vaandrager, Lenneke; Gupta, Aman Sen; Geest, Judith M.J. van de; Koelen, Maria; Cunningham, Kenda


Purpose: Malnutrition is a pressing public health challenge in South Asia with adverse consequences for adolescent girls' well-being and, potentially, aspirations as drivers of developmental progress. This study aimed to investigate associations between changes in malnutrition and changes in girls' aspirations in key life domains.
Methods: We analyzed two-period panel data from the Suaahara II Adolescent Girls Panel (10–19 years) in Nepal (2018–2019, n = 613). Height, weight, blood samples, 24-hour dietary recalls, and indicators of girls' educational, occupational, marital, and fertility aspirations were collected. Height-for-age z-scores, body mass index–for-age z-scores, hemoglobin concentration (Hb g/dL), and dietary diversity scores for women were calculated. Through cluster-robust fixed-effects regressions, we examined whether changes in thinness (body mass index–for-age z-scores < −2 standard deviation), anemia (Hb <115 g/L nonpregnant <11 years; Hb <120 g/L nonpregnant >12 years; Hb <110 g/L pregnant), and reaching minimum dietary diversity for women were associated with changes in educational, marital, or fertility aspirations.
Results: A change from thinness to no thinness increased girls' aspired ages of having a first child by 2.77 years (standard error [SE] 1.22, p = .025). A change from anemia to no anemia increased girls' aspired years of education by .54 (SE .27, p = .044). This association was stronger for postmenarche girls (b −.62, SE .29, p = .035). No associations were found between changes in minimum dietary diversity for women and any of the aspirations.
Conclusions: Thinness and anemia were negatively associated with adolescent girls' aspirations in domains of fertility and education. Multisectoral integrated policies and programs that improve adolescent nutritional status and diets have the potential to foster adolescent girls' aspirations and thereby increase their future potential.