Adolescence is a critical window. For girls, especially, it is a period of rapid growth, hormonal changes and the beginning of reproductive maturity. Adequate nutrition during this time does more supports growth and helps shape lifelong health, cognitive development, school attendance and future economic potential.
In India, where a large portion of the population is under 20, investing in adolescent nutrition is not just a matter of social welfare but also a national development priority.
However, for many adolescent girls in rural, tribal or marginalised communities, the reality is grim: iron deficiency, anaemia, lack of dietary variety and low awareness of nutritional health. This makes adolescent nutrition a pressing public health and social equity challenge.
National-level schemes (like iron–folic acid distribution, mid-day meals) play an essential role, but they are often inadequate when applied with a generic, “one-size-fits-all” lens. What’s needed is a region-specific “playbook” — one that adapts to local food cultures, resource constraints, gender norms and health system strengths.
Why Adolescent Girl Nutrition Matters for India’s Development
According to NFHS-5, adolescent girls aged 15-19 are critical to breaking the intergenerational cycle of malnutrition. Yet, nearly a quarter of them remain underweight, reflecting far-reaching consequences for the country’s economic and development trajectory.
Malnourished adolescent girls often grow into adults with lower productivity, weaker immune systems and reduced learning capacity, which can impact India’s human capital growth and its ability to harness the demographic dividend. The implications are even more severe when adolescent girls become young mothers. Malnutrition during adolescence increases the risk of maternal mortality, leads to low-birthweight infants and perpetuates chronic undernutrition in the next generation, particularly in states with high teenage pregnancy rates. Nutrition for adolescent girls is also closely linked to gender equality. Improved nourishment results in better school attendance, delays early marriage and enhances future economic participation. Ultimately, investing in the nutrition of adolescent girls pays developmental dividends at every stage of their lives.
However, given India’s population diversity, the challenges and solutions related to adolescent girl nutrition cannot be uniform across states. Socio-cultural norms, geography, tribal status, climate, food availability and levels of urbanisation differ dramatically across regions. Hence, it is essential to have a region-specific approach towards nutrition.
Region-specific approach to nutrition
In northern states such as Uttar Pradesh, Rajasthan, Haryana, Himachal Pradesh and Jammu & Kashmir, gender norms, harsh winters and high anaemia prevalence combine to create specific vulnerabilities for adolescent girls. In Uttar Pradesh, nearly 66 per cent of its teenage girls report anaemia, and adding to that is the social issue of early marriage, resulting in a widening nutritional gap during adolescence. Furthermore, Himalayan states face challenges due to their cold climates, which limit access to fresh produce, making it difficult to achieve micronutrient-rich diets. Addressing these issues requires locally relevant solutions such as winter-resilient community nutrition initiatives, the cultivation of iron-rich crops in kitchen gardens, stronger school-based supplementation programmes and mobile health services for remote mountain communities.
In contrast, eastern and northeastern states such as Odisha, Jharkhand, West Bengal, Assam, Manipur and Nagaland fight a different set of challenges. High tribal populations often live in geographically isolated areas where access to healthcare and nutrition services is limited. Jharkhand and Bengal have seasonal migration of labourers, disrupting schooling of young girls and interrupting access to government schemes. Extreme weather events such as floods in Assam routinely affect food supply systems. States like Odisha and Jharkhand report high levels of stunting and severe anaemia, reflecting deep-rooted food insecurity.
Solutions that work in these regions must be grounded in local food cultures, such as millet-based and forest-based diets traditionally consumed by tribal communities. Strengthening hostel-based nutrition for adolescent migrant girls, developing flood-resilient health services and supporting women-led self-help groups to produce take-home rations can significantly improve nutrition outcomes in these areas.
The western region, comprising Maharashtra, Gujarat, Goa and western Rajasthan, faces the dual burden of malnutrition. Urban areas in Maharashtra and Gujarat have been reporting rising obesity levels among adolescent girls, driven by processed food consumption and sedentary lifestyles. At the same time, rural pockets continue to struggle with undernutrition and anaemia. This urban-rural divide necessitates a dual approach that simultaneously addresses micronutrient deficiencies and obesity through school-based nutrition education, regular screenings and dietary counselling.
In industrial belts of Maharashtra, where school dropout rates among adolescent girls remain high, particularly due to household labour demands, nutrition programmes must be tightly woven into school retention efforts. Locally grown crops, nutri-gardens in drought-prone villages and partnerships with municipal authorities to regulate school canteen nutrition are regionally relevant strategies for this zone.
Southern states, such as Tamil Nadu, Kerala, Karnataka, Andhra Pradesh and Telangana, present a comparatively better institutional framework, with stronger public health infrastructure and a broader reach of schemes like ICDS and Midday Meals. However, pockets of micronutrient deficiency persist, especially in disadvantaged districts within Tamil Nadu, Telangana and North Karnataka. The region is also witnessing a steady rise in adolescent obesity, especially among girls from middle-income families who face academic pressure, irregular eating habits and reduced physical activity. Southern states thus require interventions focused on food fortification, strengthening school meals, awareness campaigns to reduce ultra-processed foods and integrating mental health with nutrition counselling in schools. These areas also stand to benefit from precise micro-nutrition mapping to identify underserved communities within otherwise high-performing states.
A region-specific national playbook for India must stand on five strong pillars.
1. The first is strengthening institutional delivery systems such as ICDS, Midday Meals and school health programmes. These platforms cover millions of adolescent girls, but their quality varies significantly across regions. Standardising monitoring systems, improving supply chains, diversifying food procurement to include local produce and ensuring mandatory micronutrient supplementation can provide an equitable foundation.
2. The second pillar is recognising India’s cultural and dietary diversity as a strength rather than a barrier. Each region has locally available, nutrient-rich foods—ranging from coastal fish-based diets to tribal millet-based meals—that must be integrated into nutrition plans. Standardised diets are neither cost-effective nor culturally acceptable across India’s diverse landscape.
3. The third pillar involves transforming community behaviour through social change, particularly among mothers, teachers and peer groups. Nutrition in India is highly gendered, with girls often eating last and least within households. Changing this requires sustained community engagement, mother–daughter sessions, father-inclusive dialogues and peer support groups in schools.
4. The fourth pillar focuses on strengthening the health system so that frameworks and policies reach adolescents. Regular anaemia screening, functional menstrual hygiene rooms in schools, affordable sanitary products produced by women-led groups and specialised training for frontline workers on adolescent nutrition are essential for impactful interventions.
5. The fifth and final pillar emphasises the integration of nutrition with education and social protection systems. Malnutrition cannot be addressed in isolation; it is intertwined with school dropout, early marriage, mobility constraints and household poverty. Convergence between departments can enable innovations such as conditional cash transfers to delay early marriage, scholarships tied to school attendance and free transportation for girls in remote regions.
Nutrition for Adolescent Girls
Applying these pillars in practical state-level strategies could fundamentally shift outcomes. For instance, Uttar Pradesh can prioritise tackling anaemia through community and school-based campaigns, while Odisha may focus on integrating tribal diets and migration-sensitive services. Maharashtra could address both obesity and undernutrition through a combined urban-rural strategy and Tamil Nadu may emphasise micronutrient fortification alongside mental health–nutrition integration. Each state requires a customised plan based on geography, culture, food availability, social norms and infrastructure.
The economic rationale for adolescent nutrition is equally compelling. Evidence from the World Bank suggests that every dollar invested in nutrition yields sixteen dollars in financial returns. Because teenage girls sit at a transformative stage of life, the multiplier effect of improved nutrition is reflected in higher educational attainment, delayed marriage, improved maternal health, increased lifetime earnings and healthier future generations. A region-specific adolescent nutrition playbook is not a cost but an economic and developmental investment that India cannot afford to postpone.
Role of civil society and Smile Foundation
In this regard, civil society organisations play a critical role in operationalising these ideas at the grassroots level. While the government remains focused on creating large-scale frameworks, it is the duty of community organisations to translate them into local solutions tailored for local needs. Smile Foundation’s work offers powerful insights into how this can be done.
Through initiatives such as Project Poshan, nutrition counselling for adolescent girls, and community mobilisation efforts, the Foundation demonstrates how locally available foods and culturally relevant practices can be integrated into daily diets. Its mobile health units under the Smile-on-Wheels programme take nutrition awareness and health services to remote regions that public systems struggle to reach. School health programmes, under initiatives like Swabhiman, link anaemia screening, menstrual hygiene awareness, and adolescent counselling, showing the value of integrating social norms, health services, and food practices. These models embody precisely the regional, community-led approach India needs to adopt at scale.
