Across South Asia, there are 659 million children -- more children than in any other region globally -- currently at risk and disproportionately affected by humanitarian crises. Climate-driven disasters such as droughts, floods, cyclones and other extreme weather events plague the region at an increasing rate. The impacts of these and other events are further compounded by ongoing public health emergencies and political and economic instability, making it increasingly challenging to meet children's basic needs.
Nutrition is one major area of mounting concern.
UNICEF works with partners all across South Asia in an effort to reduce malnutrition and improve overall nutrition, by strengthening nutrition support and related services. Meeting specific nutritional needs of women and girls is one important area of focus. Every year, over 40 million women in South Asia become pregnant while dealing with one or more nutritional risks -- threatening their own health as well as the health of their child's.
Here are some of the ways UNICEF is helping to drive progress against these issues, by advocating for, or helping to develop and implement, some key strategies in partnership with country governments.
Related: Undernourished and Overlooked: New Report Reveals Global Nutrition Crisis for Women and Girls
In Afghanistan, 1 in 3 girls aged 10 to 19 suffer from anemia, or iron deficiency. The condition is prevalent among women or reproductive age in the country as well.
To address this, UNICEF helped launch a community-based program to deliver iron and folic acid supplements to girls at home with the help of community health workers. Launching in 2021 in five provinces, the program has since been scaled to all 34 provinces. By the end of 2023, the program had reached 58 percent of all girls in Afghanistan, including those in remote locations.
UNICEF continues to work with partners to increase the program's impact -- refining the process for procuring the tablets, developing guidelines on nutrition counseling for the community health workers, assisting local organizations with delivery and establishing online platforms for coverage reporting and monitoring.
A separate program UNICEF advocated to introduce has made multiple micronutrient supplements more widely available to pregnant women in the country. MMS tablets contain a number of nutrients, in addition to iron, that are considered essential for maternal health. The women receive the supplements during their routine antenatal visits to a health care facility.
In 2023, almost 350,000 pregnant women in Afghanistan received a full course of the supplements.
Providing the supplements is a priority intervention for UNICEF in a number of other countries as well, including Nepal, Mongolia, Myanmar, Pakistan, the Philippines and Sri Lanka.
In Bangladesh, where anemia affects roughly half of all pregnant women and about 42 percent of women of reproductive age, UNICEF supports a pilot program managed by the Ministry of Health and Family Welfare that includes providing the supplements along with dietary counseling and regular monitoring of weight gain during pregnancy, an important indicator.
After UNICEF advocated for further investments by the government, thousands more health service providers across two dozen districts were trained in nutrition service delivery and nutrition counseling.
Back in 2014, in Bhutan's eastern district of Samdrup Jongkhar, two children died and 34 children were hospitalized due to an outbreak of peripheral neuropathy, a condition caused by vitamin B12 deficiency. A subsequent study revealed a high prevalence of vitamin B12 deficiency among boarding school children, with over 90 percent deficient in thiamine and 64 percent deficient in cobalamin.
In response, the government, with UNICEF support, began providing school meals to public school students containing more protein, fruits and vegetables, and rice fortified with essential vitamins and nutrients, along with iron and folic acid supplements. By 2023, 60 percent of adolescents were being reached with these interventions, and reports of peripheral neuropathy outbreaks have decreased.
In 2018, the Comprehensive National Nutrition Survey across India showed that 1 in 5 girls aged 10 to 19 suffered from at least three micronutrient deficiencies and were underweight. The study also showed that due to an increase in screen time, sedentary lifestyles and the consumption of unhealthy foods, more girls in this age group were overweight, and obesity rates were on the rise.
To combat this, the government of India turned to its school-based nutrition programming, launching interventions that include screenings and referrals for undernutrition and anemia, weekly iron and folic acid supplementation, biannual deworming, fortified foods in school lunches, safe drinking water and age-appropriate education on nutrition, hygiene and health.
In 2019, the National Council of Education Research and Training introduced 11 new training modules for teachers to further expand nutrition-related instruction. UNICEF helped develop the content for the modules and is assisting with their phased rollout to public secondary schools across India.
In Pakistan, UNICEF supports government efforts to strengthen community-based social and behavior change programs to combat undernutrition and anemia in women of reproductive age. A pilot initiative launched in 2023 provides one-on-one nutrition counseling and community engagement as a way to raise awareness of the problem and how to address it.
So far, over 100,000 mothers have received maternal nutrition support, and another 66,000 mothers and families have been reached through a door-to-door approach and through community support group sessions.
UNICEF found that the quality of meals, nutrition services and education varied widely from school to school in Nepal, leaving gaps and creating an inequitable experience for girls in the country. In some cases, the marketing practices of food manufacturers were encouraging school administrators to serve nutrient-poor, ultra-processed foods during meals.
In 2022, the country's Ministry of Education, Science and Technology and Ministry of Health and Population -- with support from UNICEF -- developed the National Health and Nutrition Midday Meal Guidelines for School-Age Children. These guidelines set standards across Nepal for nutritious and safe meals in pre-primary and primary schools, with a focus on utilizing local foods and restricting the use of ultra-processed options.
Almost 29,000 schools across 753 municipalities have implemented the guidelines so far, reaching about 640,000 children.
UNICEF was also instrumental in the successful piloting of an adolescent engagement toolkit to increase buy-in for implementing and improving the school nutrition curriculum. In some regions, local governments have taken things a step further, prohibiting the sale and distribution of unhealthy foods within a 50-meter radius of schools.
Read the UNICEF report, Progress and Promise: Nourishing Girls and Women in South Asia. For a global perspective, see the UNICEF 2023 report, Undernourished and Overlooked: A Global Nutrition Crisis in Adolescent Girls and Women.
Learn more about how UNICEF combats malnutrition globally.