Empowering girls and women to rise above anemia’s silent threat

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Anemia doesn’t just make you feel tired – it can cause birth defects, neurological problems or even death. Through organizations like Nutrition International, Canada is leading the way to help girls and women around the world live up to their potential

When Dr. Helga Mutasingwa asks groups of girls in her native Tanzania if they sometimes feel tired, dizzy and get headaches, just about everyone puts their hand up. That’s when Dr. Mutasingwa, a physician and volunteer with the World Association of Girl Guides and Girl Scouts, explains that these symptoms can be caused by anemia, and it’s because they’re not getting enough iron in their food.

“Oh, that’s the reason!” the children often say in surprise.

“We eat just to fill our bellies, not for our bodies,” Dr. Mutasingwa says of the local diet in Tanzania, which due to economic restrictions and lack of access is predominantly starchy carbohydrates rather than iron-rich meats and vegetables.

In addition, superstitions – such as the belief that pregnant women should not eat eggs – can influence food choices, Dr. Mutasingwa says.

Societal norms rooted in gender bias further impacts nutrition. “The largest portions [of food] go to the father and son,” she says. “When they are stuffed, that’s when the girls and the mother can eat.”

Dr. Mutasingwa herself became anemic during medical school. Pressed for time and studying at all hours, she would eat affordable street food meals of fried yams or rice, purchasing the cheapest calories she could find. “I’d skip meals. I would not make sure I sat down and have a meal. I couldn’t just eat for the sake of eating,” she recalls.

Now, she’s helping Girl Guides in Tanzania learn about nutrition and spread the word in their local communities about the importance of good nutrition and taking iron and folic acid supplements to reduce anemia. The Girl Powered Nutrition program, developed through a partnership between the World Association of Girl Guides and Girl Scouts and Nutrition International, a global nutrition organization headquartered in Canada, also runs in Madagascar, the Philippines and Sri Lanka. The program includes a Nutrition Badge – an opportunity for girls to gain knowledge about the importance of nutrition and learn how to be advocates for nutrition in their communities.

This grassroots project is just one Nutrition International endeavour focused on improving the lives of girls and women around the globe through nutrition.

Few people realize that more than one billion women, girls and children suffer from anemia, and that nutritional deficiencies devastate health and economies. The World Health Organization estimates that 42 per cent of children less than 5 years of age and 40 per cent of pregnant women worldwide are anemic. An issue of gender equality, anemia holds women back from their full potential to earn, learn and grow. It threatens their education and risks the future of adolescent girls and children.

“It’s a silent global emergency that has no champion,” says Joel Spicer, president and CEO of Nutrition International. That emergency is about to get worse as the COVID-19 pandemic impacts economies, livelihoods, and programs, making it harder for people, especially women and girls, to access health services and nutritious food.

“At a human development level, the pandemic is going to wipe out a lot of hard-won progress,” he says. “It’ll set some countries back more than a decade in terms of population health.”

Malnutrition-related anemia isn’t just about feeling tired, says Mr. Spicer. It’s a serious medical condition causing catastrophic damage that can be prevented.

“It’s a major killer,” he says. Anemia causes 20 per cent of maternal deaths because pregnant women who are anemic have a much higher change of hemorrhaging during childbirth. Babies born to anemic mothers are at risk for premature birth, low birthweight and high mortality rates, plus they can have motor and neurological problems.

Anemia is a leading cause of death for pregnant teenagers and the leading cause of disability for adolescent girls. In pregnancy, it threatens not only a mother’s survival but that of her infant, together with their long-term capacity to learn and earn. Since the beginning of the COVID-19 pandemic, the closure of schools has had devasting impacts on adolescent girls in particular, including a rise of teen pregnancies.

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In 2012, world leaders agreed that addressing anemia was critical to improve maternal, newborn and child health. The World Health Assembly, which is the decision-making body of the World Health Organization, committed to cutting rates in half by 2025 for women of a reproductive age. Despite this global consensus, anemia rates are worsening in many countries

“It’s more important than ever to get the word out about nutrition’s foundational role in health and how women and girls are disproportionately affected,” Mr. Spicer says. Many nations are rolling out new support programs because of the pandemic, so now is the time to get nutrition on the agenda.

Canada is playing a leadership role in advocating for change, he adds. For example, since 2017, an investment of $2.2-million into Nutrition International’s Girl Powered Nutrition program has reached 585,000 girls in four countries, including Tanzania. Over the last 30 years, Canada has led the world in scaling up proven, low-cost, high impact nutrition programming for women and children, and rallying world leaders to do the same.

There are many causes of anemia, but iron deficiency anemia is the most common. Teen girls who are iron deficient can’t concentrate in school. “Anemia can lead to girls leaving school. If they don’t have any skills training, they won’t have decent work, and they won’t have power over their life choices,” says Dr. Selly Kane Wane of the United Nations Population Fund (UNFPA) Senegal.

“We can’t accept it as normal that a billion people in the world don’t have access to their full potential,” says Mr. Spicer. Anemia interventions are high-impact and low-cost, he notes. “If you look at what it costs to fix the problem, this is among the best investments out there.”

Nutrition International’s work is unique in that it brings together health-system and education-based approaches. It combines direct nutrition interventions, such as giving iron-folic acid tablets to women and girls, with antenatal care for pregnant women and new mothers and school-based education programs to improve awareness of the importance of nutrition among adolescent girls.

In Senegal – where more than half of women and girls suffer from anemia – Nutrition International has been working with UNFPA since 2018 to integrate nutrition into existing platforms.

In three rural regions of the country, UNFPA combines its existing reproductive and sexual health programming with nutrition education. The organization also provides women with iron and folate supplements which in addition to preventing anaemia, also help prevent neural tube defects in babies if women become pregnant. Community members help with the program, including bajenu gox, which means godmother in the Wolof language.

“It’s the first time we have integrated nutritional health awareness and iron and folic acid supplementation among adolescents outside of a school in a rural area,” says Dr. Wane.

She says the women in the program seem receptive to learning about nutrition. However, it’s an ongoing challenge to provide a steady supply of supplements. “Senegal doesn’t produce iron or folate supplements,” she says.

It’s a problem that Canada is helping to solve. With a Canadian investment of $1.5-million through Nutrition International, the program has been able to reach more than 389,000 girls and women in Senegal.

Dr. Mutasingwa says the impact of programs like Girl Powered Nutrition is even wider, as girls have spread the word in their local communities and advocated for change, often via affordable ideas. For example, she recalls how one Girl Guide in Tanzania convinced a local school to grow a vegetable garden and use the produce for student lunches.

Another young woman created a research report on the value of iron and folic acid supplementation and was eventually given a role on the community health management team in her region.

“The girls have been inspired,” says Dr. Mutasingwa, who juggles her volunteer work with her day job as a physician. She says she stays motivated by seeing healthy young women around her doing good. “It’s the change that you see in these girls.”

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