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Profiles

Prerna Banati

Deputy Director a.i. (Former title)

Prerna Banati has served as Chief of Programmes and Planning at the UNICEF Office of Research – Innocenti since 2012. Prior to this, she was a Takemi Fellow in the Department of Global Health and Population at Harvard University. She has previously led work on Program Effectiveness at the Global Fund to fight AIDS, TB and Malaria and conducted epidemiological modeling as part of the Global Burden of Disease project based at WHO. Prior to this, she was based in South Africa leading research on community HIV prevention for independent NGOs and has published in the fields of HIV prevention, reproductive health, migration and health, aid architecture, health financing and environmental risk. Before her work in Africa, Prerna worked for a multinational consulting company in Boston in the field of quantitative human health risk assessment. She has a Ph.D. from the University of Cambridge.

Publications

Child and Adolescent Mental Health and Psychosocial Wellbeing Across the Life Course: Towards an Integrated Conceptual Framework for Research and Evidence Generation
Publication

Child and Adolescent Mental Health and Psychosocial Wellbeing Across the Life Course: Towards an Integrated Conceptual Framework for Research and Evidence Generation

Mental health conditions affect about 1 in 7 adolescents globally. In the context of COVID-19, the importance of mental health and psychosocial support for all has been undoubtedly confirmed. Despite the increased attention to mental health issues, there is a dearth of evidence on what determines child and adolescent mental health, who is most at risk, and what works to foster mental health across contexts, cultures and distinct population groups. This conceptual framework aims to inform research on child and adolescent mental health. It incorporates children’s developmental stages and the dynamic environment in which they live and grow. Informed by a review of existing theoretical frameworks on mental health and child development, this framework integrates elements of the socio-ecological model; the life course approach; the social determinants of health approach; and Innocenti Report Card’s Worlds of Influence Framework. Combining diverse aspects of these frameworks and approaches, we propose an integrated model to guide UNICEF’s research in this area.
Mind Matters: Lessons from past crises for child and adolescent mental health during COVID-19
Publication

Mind Matters: Lessons from past crises for child and adolescent mental health during COVID-19

COVID-19 is a crisis like no other in modern times. It has reached every population and community. While the evidence base is still nascent, this report looks at the impacts of disasters and past epidemics – such as Ebola, HIV, SARS/MERS and Zika – on child and adolescent mental health and psychosocial wellbeing, and examines how these insights can guide policies and progammes to support children, their families and communities during the current pandemic.
Adolescent girls’ potential to disrupt the gender socialization process: Evidence from Plan International UK’s longitudinal cohort study, ‘Real Choices, Real Lives’
Publication

Adolescent girls’ potential to disrupt the gender socialization process: Evidence from Plan International UK’s longitudinal cohort study, ‘Real Choices, Real Lives’

This brief discusses findings from Plan International UK’s ‘Real Choices, Real Lives’ report, which explores factors in adolescent girls’ lives across Benin, Togo and Uganda that may influence them to ‘accept’ or ‘disrupt’ the gender socialization process. The brief focuses on one of a handful of qualitative longitudinal studies addressing the challenges of gender norms in low- and middle-income country settings, providing crucial evidence in these countries to address Sustainable Development Goal 5 on achieving gender equality.
Handbook of Adolescent Development Research and Its Impact on Global Policy
Publication

Handbook of Adolescent Development Research and Its Impact on Global Policy

Of 1.2 billion adolescents in the world today, 90% live in low- and middle-income countries. These adolescents not only face many challenges but also represent a resource to be cultivated through educational opportunities and vocational training to move them toward economic independence, through initiatives to improve reproductive health, and through positive interpersonal relationships to help them avoid risky behaviors and make positive decisions about their futures. This volume tackles the challenges and promise of adolescence by presenting cutting-edge research on adolescent social, emotional, behavioral, cognitive, and physical development; promising programs from different countries to promote adolescents’ positive development; and policies that can advance adolescents’ rights within the framework of international initiatives, such as the Convention on the Rights of the Child and Sustainable Development Goals, which are guiding the international development agenda through 2030. This volume seeks to provide actionable strategies for policymakers and practitioners working with adolescents. Disconnects between national-level policies and local services, as well as lack of continuity with early childhood responses, present a significant challenge to ensuring a coherent approach for adolescents. Increasingly, adolescent participation and demands for rights-based approaches are seen and often unfortunately conflated with violence. This volume adopts a positive framing of adolescence, representing young people as opportunities rather than threats, and a valued investment both at individual and societal levels, contributing to a positive shift in discourses around young people.

Blogs

Time to ramp up psychosocial support for adolescents in crisis settings
Blog

Time to ramp up psychosocial support for adolescents in crisis settings

Globally, the increase in humanitarian crises, protracted conflicts, displacement, violence, terrorism, disease outbreaks, natural disasters and climate change is putting children and adolescents at significant risk of mental and emotional ill-health.Around a quarter of the world’s 1.8 billion young people live in areas affected by armed conflict and organised violence. Yet for most adolescents, rather than getting caught up in violent extremism, violence manifests in their everyday lives: at school at home, when accessing health care and other services, and when spending time with peers – all of which can affect their mental health. These exposures risk fracturing young people’s aspirations and identities and limiting their future opportunities.Two things worry me: the night and war. I worry about everyone in my family. I am afraid to even leave the house."  – 14-year-old girl, Gaza StripIf this alone were not enough to spur urgent action, there is an economic imperative too: unless young people receive the psychosocial support they need, mental health disorders that emerge before adulthood can cost 10 times more to deal with than those that emerge later in life.Adversity and toxic stress lead to poor (gendered) psychosocial outcomesAdolescent biology and neural wiring create a natural adaptability to learning and innovation but also make adolescents vulnerable to shocks and trauma. The emerging science confirms the plasticity of the brain and the importance of the social and economic environment in shaping adolescents’ behaviours and responses.Gender disparities in mental health are substantial (almost twice as many girls than boys report symptoms between the ages of 13 and 15) and increase with age. Early adversities and social factors (such as girls being expected to care for other family members) may put girls at greater risk of depression and anxiety. Evidence shows that girls from low- and middle-income countries (LMICs) experience a range of adversities such as gender-based violence (GBV), school dropout and child marriage.Sexual and gender-based violence has also been linked to higher rates of depression and anxiety among adolescent girls, with social media opening up potential new avenues for bullying and sexual harassment. Social norms also increase girls’ risk: compared to boys, they lack the free time to play and ‘be’ that is critical for young people to develop identity, self-esteem and broader well-being.Amadou, age 15, a young shepherd from Mali's northern region of Kidal, was caught in a raid by the security forces, put in prison and interrogated on suspicion of being associated with armed groups. He's now at a UNICEF-supported center for children like him in Bamako. This is a detail of his drawing of his memories of home, which show him riding a camel. Bamako, Mali, June 2019.In Mali, for example, a shocking 96% of girls and women report being survivors of some type of GBV. Almost one-fifth (19%) of reported cases were rape, 21% were sexual assaults (including female genital mutilation), 20% were physical violence, 17% psychosocial violence, 14% denial of access to resources, and 9% were child marriage. Of all cases, 60% were reported by girls. Yet government support services are thinly spread and often not functional.Vulnerable adolescent girls such as child brides or adolescent mothers are often overlooked in research, though these girls are often at greater risk of mental health disorders (including suicide attempts. Adolescent mothers are more prone to postnatal depression than older mothers, yet their needs are rarely addressed in service provision.Boys also face gendered expectations, though different from those experienced by girls. Early adversity (including inequality and social factors) may increase anti-social behavior and exacerbate hyperactivity and other mental health problems. A study in Mexico (Gonzalez-Foretez 2015) shows that while adolescent girls have higher rates of depression, boys may face different risks, attempting to mask the symptoms of depression through high-risk behaviours such as alcohol or drug use, or violence. High-risk behaviours among adolescent boys also emerged as a key finding in the Gender and Adolescence: Global Evidence (GAGE) research programme in Gaza following the 2014 Israeli–Gaza war and protracted siege of the Gaza Strip.Cumulative and compound exposures create cycles of disadvantageEvidence clearly demonstrates that the risk of psychosocial problems among children and adolescents is exacerbated when they are exposed to chronic stressors, such as everyday violence, insecurity or poverty. The damage wrought by conflict – especially protracted conflict – can steeply reverse development gains, and inequalities intensify as adolescents grow older, leading to poorer employment and earnings, and poorer outcomes for themselves and the next generation.Mariam Barry, 14 years old, and Rokiyatou Barry, 11 years old, both displaced children, discuss their exercises in the UNICEF-provided tent that acts as their temporary learning space. Official IDP camp of Socoura, Mopti region, in central Mali, April 2019.Tapping into adolescent resilienceEvidence highlights that adolescence is also a time when young girls and boys can develop resilience, changing what they do and how they behave to be better equipped to handle adversity. In recent years, this has led to recognition of the positive role that young people can play as agents of peace and security, prompting some development and humanitarian actors to re-orient their approaches toward greater participation and engagement by adolescents.Yet the evidence suggests there are also gendered patterns to adolescent coping strategies. Girls are seemingly more likely to find ways to address their emotions (e.g. through talking to family members or friends, taking part in group therapy sessions, or turning to art or extra study), whereas boys are more likely to resort to negative strategies that mask difficult emotions.Agenda for adolescent mental health in crisis settingsAs the global community looks to develop an aspirational agenda of mental health for all in line with SDG3, it’s time to ensure that adolescents’ needs are no longer invisible. To ensure that those living in conflict-affected settings are not left behind, an action agenda for adolescents’ mental health should include:Investment in a minimum package of interventions that includes: access to safe spaces; opportunities to interact with peers; life skills curricula focusing on interpersonal communication and emotional resilience; accessible reporting and referral pathways; and adequately resourced case worker support.Support for community-based models of prevention and response that focus on addressing underlying stigma associated with mental health.Strengthening the evidence base on the social determinants of mental health in young people to inform context-appropriate, actionable and scalable approaches.Changes in how we assess mental health interventions to better capture age- and gender-specific dimensions. About the authors: Dr Banati is Regional Advisor for Adolescent Development and Gender at UNICEF and former Deputy Director at UNICEF Innocenti; Dr Jones is Principal Research Fellow, Gender, Equality and Social Inclusion, Overseas Development Institute and Director of the Gender and Adolescence: Global Evidence (GAGE) research programme.
Turning the tide together on mental ill health for children
Blog

Turning the tide together on mental ill health for children

In some way, mental ill health has touched everyone. The statistics are alarming, and by some accounts constitute a public health emergency. Today, around 10-20 per cent of all children and adolescents suffer from some type of mental health disorder and mental health conditions account for around 16 per cent of the global burden of disease and injury among adolescents. Worldwide depression is among the leading causes of disability among young people and suicides are the third leading cause of death among adolescents worldwide, and the second among 15-19-year-old adolescent girls. Fifty percent of mental health conditions arise before the age of 14, and 75 per cent by the mid-20s. Given the age-sensitive nature of predictors, early life investment makes good sense. However, globally relatively small sums have been allocated, with an estimate of less than 1 per cent of national health budgets in low-income countries being devoted to mental health. Yet the economic cost of mental health is enormous, amounting to around 4 per cent of GDP. Evidence supports early investment -- if left untreated, it is estimated that mental health disorders which emerge before adulthood can impose a health cost 10 times higher than those that emerge later in life. mental health disorders which emerge before adulthood can impose a health cost 10 times higher than those that emerge later in life.Emerging evidence indicates that the prevalence of mental ill-health is growing. Issues such as climate change, environmental degradation, unplanned and rapid urbanization, migration, demographic transition, youth unemployment, and technological leaps are implicated. These may have profound impacts on the minds of children and young people. Yet we know very little today about how to manage or harness these changes to improve the mental wellbeing of children. The 2018 Lancet Commission report compellingly illustrated the value of addressing mental health to advance a number of sustainable development goals. This suggests that effective mental health interventions may be potential development accelerators – with provisions that lead to progress across multiple SDGs. In the context of shrinking fiscal space, this makes it a highly desirable area of investment. Rafeya Akhter Moni, 14, plays a game with friends at a UNICEF-supported Adolescent Club near her home in Dhaka’s Duaripara slum. Twice each week Moni and 35-40 other young people have the opportunity to get together and be ordinary teenagers in a safe space.More work is needed to examine the state-of-the-art evidence, and the corresponding programmatic and policy responses on children’s mental health in the first decade of life, beginning in utero, through the first five years, and then into middle childhood (5-9 years). The evidence agenda is clear: we need to look at the latest findings from neuroscience; the overall prevalence and spread of mental ill health across ages and geographies; causes and contributing factors; and methods of preventing and treating mental ill health. These are all important parts of the puzzle, and critical to the response effort. Adolescence is a critically important stage of life when many of the mental health conditions prevalent in adulthood first manifest, and also the most challenging time for those entrusted with the care and protection of young people to reach them with solutions. Addressing the mental health of our children is imperative. Greater leadership and political commitment on policy, research and implementation is needed to turn the tide and advance healthy minds and healthy bodies of children and young people. A dedicated global plan or alliance through a shared value partnership for the mental health of children and young people is long overdue. On November 7 – 9 2019, UNICEF and WHO will convene a conference co-chaired by UNICEF’s Executive Director Henrietta H. Fore and WHO’s Director General Tedros Adhanom Ghebreyesus. The Inaugural Leading Minds for Children and Young People conference will focus on advancing the global agenda on mental health in children. This first year will bring together a broad array of the world’s thought leaders and decison makers – from academia, business, civil society, government, international development, philanthropy and of course, children and young people – to accelerate global progress to respond to this neglected issue. This will be the start of a critical conversation about what is needed to ensure children grow up with ‘healthy minds and healthy bodies.’ Throughout, the focus will be on the scale of the challenge and the proven and promising solutions to meet it. The conference’s final session will conclude with a deep dive into the pathways that global actors can take to tackle the issue of child and youth mental health. Crucially the voices of children living in challenging situations will be central. Sessions will be co-designed and run with and by the Youth Leaders of the conference. We need to understand and listen to them: their emotions, fears, coping strategies, and hopes. We need to engage with how they cope, what they do to support others, and what must be done for young people themselves to feel supported and thrive in a complex world.   Priscilla Idele is Director of the UNICEF Office of Research – Innocenti; Prerna Banati is former Deputy Director at UNICEF Innocenti and currently UNICEF Regional Advisor on Adolescent Development and Gender; David Anthony is Chief of Strategy and Policy at UNICEF Innocenti.
Unleashing the Potential of Social Protection for Adolescent Girls and Women
Blog

Unleashing the Potential of Social Protection for Adolescent Girls and Women

On March 12th 2019, UNICEF will co-host a side event to the sixty-third Commission on the Status of Women, together with the UK’s Department for International Development and GAGE Consortium managed by ODI, to share evidence and policy approaches to strengthen gender equality outcomes of social protection programmes, with a particular focus on adolescents and the safe transition to adulthood. Well-designed social protection can address risks and vulnerabilities across the life-course for girls and women, yet so often gender and age inequalities are not considered in social protection systems. Social protection is failing to deliver on this potential – missing the opportunity to benefit the most marginalized girls and women and risks widening inequalities even further. More work and investment is needed to make gender- and adolescent-responsive social protection a reality. Life-course risks and vulnerabilities are influenced by genderWomen and girls face multiple barriers throughout their lives, such as limited access to basic services in education, health and nutrition; limited resources and assets including land and finance; and limited economic, social and political opportunities. Because they lack equal access to resources and assets, women and girls are less able to fully develop their capabilities, and ability to manage and mitigate the effects of risks and vulnerabilities. Women and girls face specific risks in different stages of their lives – adolescence, pregnancy and child birth – that are related to their biological sex as well as to entrenched gender norms that discriminate against them in diverse ways. For instance, more women and girls die before birth, in childhood, and during reproductive years than men and boys. Women and girls shoulder the greatest responsibility for unpaid care and domestic work – amounting to around 2.5 times more time than men. This limits their opportunities to access an education and take on paid work, and makes them more vulnerable to the impacts of poverty. This unpaid care and domestic work differentials between females and males start early in the life course and persist throughout their lives. This unpaid care and domestic work differentials between females and males start early in the life course and persist throughout their lives. Globally girls aged five to nine engage in household chores for an average of almost four hours per week, while girls aged ten to 14 years old spend around nine hours per week Unpaid care and domestic work among adolescents: staggering statistics55050%2/3  Girls under 15 spend 550 million hours every day on household chores, 160 million more hours than boys  Girls 10-14 spend 50% more of their time on household chores than boysOf children performing household chores for 21 hours or more per week are girls  Adolescence is a transformative period to address gender inequalities and break cycles of life-course and intergenerational transmission of inequalitiesAdolescence is a period of life during which transformative change can be accelerated, and more equitable outcomes can be achieved for both girls and boys. It is a profound period of biological and psychosocial development when gender dynamics, relations, beliefs and norms consolidate for life. While children discover their gender and sexuality in their first years of life, it is during puberty and adolescence that gender starts to play a more defining role in their lives. Differentiations between females and males start to widen and become more entrenched, particularly roles within households, and in their relations with family members, peers and in their intimate communities. Yet adolescence is a formative stage of life, and interventions have shown to have an effect on modifying behaviours and outcomes, making this period a unique one for intervening through programmes and policies.vii Recent studies, including from low- and middle-income countries, suggest that this period could be a second window of opportunity in the life-course – where there is the opportunity not only to catch up and redress earlier negative experiences, but also to ensure that previous investments are not lost when children enter adolescence and face new risks and vulnerabilities. Tapping on this window of opportunity is particularly important - there are 1.2 billion adolescents worldwide, of which 90 percent live in low- and middle-income services, at risk of poverty, exclusion and vulnerabilities. Evidence demonstrates positive impacts of social protection programmes on adolescent well-beingEvidence suggests that social protection systems  play a crucial role in lifting children and adolescents out of poverty and improving their well-being. These programmes can act as buffers against shocks, minimizing use of negative coping strategies such as withdrawing children from schools, sending them to work, or selling productive assets such as livestock. Governments have recognised this potential, and in the past two decades, many countries across Asia and the Pacific, Africa, Latin America and the Caribbean, and the Middle East, have designed or expanded social protection programmes to families with children. Many of these programmes have been cash transfers to families with children, either unconditional or conditional onto certain behaviours such as school enrolment or attendance and visits to health centres for check-ups. Some countries have also established a path of progressive universalization of cash transfers, such as Argentina ix. Evaluations of these programmes have shown some positive results – ranging from school enrolment or even attendance, improved nutrition, reduced risky behaviours such as unsafe sex, multiple partners and early sexual debut for girls. For instance, the Zomba cash transfer in Malawi, which targeted girls aged 13-22 for two years, showed strong impacts on school participation by facilitating girls returning to school, as well as reducing early marriages and pregnancies, reducing risky sexual behaviours and HIV infection – although all these positive impacts lasted only for the short-to-medium term. The Malawi Social Cash Transfer Programme and the Zambia Multiple Category Targeted Grant, both government-run unconditional cash transfers targeted to ultra-poor, rural and labour-constrained households, have also demonstrated reductions in poverty and improved schooling outcomes among youth, although no effects on early unions or teen pregnancy were demonstrated. Despite this expansion, only 35 percent of children or adolescents on average across the globe have access to any form of social protection. And there are significant regional disparities: 87 per cent of children in Europe and Central Asia and 66 per cent in the Americas receive benefits; however only 28 per cent of children in Asia and the Pacific and 16 per cent in Africa. A gender and life-cycle lens is needed to strengthen social protection programmes to improve adolescent well-beingMany programmes are not designed with gender dynamics in mind and others are either targeted at younger children, or at adult women and households more generally. Research in eight countries between 2009 and 2012 found very little or no attention to gender considerations in most social protection programmes. While some studies have found that cash transfers can have a positive impact on women’s economic empowerment by increasing women’s economic participation, few studies have systematically assessed the influence of design features on gender outcomes. Moreover many programmes, by identifying women as the transfer recipients, either as beneficiaries themselves or on behalf of their children, have at times unwittingly perpetuated the stereotype of women as primary caregivers. Among the few adolescent-targeted social protection programmes that have tackled child marriage as a primary objective, there is limited efficacy and sometimes even unintended negative effects. And in the case of humanitarian and conflict-affected contexts, while the risks of child marriage and coerced transactional sex are high, we also have very limited evidence on the efficacy of social protection programming. The absence of both gender and adolescent-responsive approaches creates a gap in adequate coverage throughout the life-cycle and across a range of risks, compounding vulnerabilities, increasing exclusion and perpetuating cycles of inequity. Much promise exists in new approaches to respond to adolescent and gender vulnerabilities by looking at social protection in conjunction with other social and economic policies, including infrastructure, health systems, education systems, and labour market systems. This article was written by Prerna Banati, UNICEF Office of Research – Innocenti, Elena Camilletti, UNICEF Office of Research – Innocenti, Roopa Hinton, UK Department for International Development (DfID), Shreyasi Jha, UNICEF Programme Division, Nicola Jones, ODI-GAGE, Muriel Kahane, ODI-GAGE, Atif Khurshid, UNICEF Programme Division. Read more about the event.    
Three windows of opportunity - Using science to inform programming for adolescents and young people
Blog

Three windows of opportunity - Using science to inform programming for adolescents and young people

With the launch of Generation Unlimited,  UNICEF has assumed global leadership to advance the quality of life for children in the second decade. Yet many programs designed for young people, including by UNICEF, are not framed by well-developed theories of the developmental process.Recent scientific discoveries and studies demonstrate that adolescence is a critical or sensitive period, a time in life during which adverse events and exposures can have great impact. Scientific advances can provide actionable insights into windows of opportunity during which policies and programs can have a positive impact on lifetime trajectories.The three windows of opportunity in adolescence, inspired by our 2018 Oxford Handbook of Adolescent Development Research and its Impact on Global Policy,  is a framework, firmly rooted in the evidence, and drawing from the developmental and social science literature, that can help to steer how we design programs, conduct research and advocate on behalf of adolescents and young people. Download the Handbook of Adolescent Development Research and Its Impact on Global PolicyAdolescence is a UNIQUE window, with experiences and exposures that happen only during this period of life. Think about the start of menstruation, the final growth spurt, breast development, these are all examples of unique events occurring during this time of life. Undeniably the biological expressions of puberty are a turning point at the transition into adolescence.Neuroscientific advances now clearly show the plasticity of the adolescent brain, with unique developments of the prefrontal cortex during this period of life. During adolescence, the brain undergoes a process of synaptic elimination or pruning, during which frequently used connections are strengthened while others are eliminated. This process ensures that the remaining synaptic circuits are more efficient. Adolescence is therefore a unique moment to acquire new skills. For instance, research by Janacsek and colleagues (2012) on implicit sequence learning across the lifespan (between four and 85 years of age) suggests that sensitivity to acquiring new skills is significantly more effective until early adolescence (12 years old), than later in life. Yet too many skills-building programs begin after this age.This period is also unique in that we see gender differences emerge. While this might vary across cultures, many societies codify social norms for girls and boys during this period. These lead to an emergence of behaviours and practices which can instill gender inequalities, which may interact with other forms of disadvantage and accumulate. Evidence shows that many children assume care and domestic responsibilities from an early age, with an increasingly gendered pattern as children mature into adolescents. UNICEF estimates from MICS and DHS suggest that girls aged ten to 14 years old spend around nine hours per week on these activities, more than their male peers and more than double the 5-9 years old age group. Analysis of time use data from Malawi[1] shows that while in early adolescence, differences between girls and boys are small, 19-year-old girls undertake two hours of care work a day, while boys only half an hour. This gendered difference persists until females reach 60 years old, when physical limitations for sometimes demanding care work curtail it. Based on data collected for the impact evaluation of the Malawi Social Cash Transfer program. Generated by Jacobus de Hoop. Gender-transformative interventions, and those addressing gender norms, can be particularly impactful in this window, when gender norms are being internalized and consolidated.Adolescence as a unique window of opportunity The experiences of adolescence – biological, neurological and social –  occur uniquely during this period of life.Adolescence occurs at the interface of biology and society. Puberty, secondary sexual characteristics, and brain development – interact with social and structural phenomena around adolescents’ lives, including their relations with peers, parents and siblings, and non-family adultsGender-based discrimination, norms and stereotypes can intensify with puberty and adolescence There is also what some are calling a SECOND or catch up window. This is a window that provides an opportunity to redress gaps in exposures and vulnerabilities experienced in early childhood. We know not all children born during the MDGs benefitted equally from MDG gains. Many of these children are now entering adolescence. A re-prioritized set of actions that advance progress for the most vulnerable can help redress the gaps, creating a ‘second window’ of opportunity to leave no child behind.Increasingly this evidence of a catch-up window is emerging – but more studies are needed to understand when to intervene, and which factors can be leveraged to ensure that full advantage can be taken of this potential second window of opportunity to improve child wellbeing.Evidence from a longitudinal study of childhood and poverty has recently shown that some stunting might be reversible, and catch up growth possible. In the study, around 50% of children stunted at year 1 were no longer stunted at year 8 in the absence of intervention, suggesting accelerated growth after the first 1000 days can occur. Unsurprisingly, catch-up growth depends on the degree of stunting experienced during infancy. This has significant implications for nutritional programming for adolescents. Height for age and height for weight indicators have long been recognized as being associated with outcomes across the board, and indicative of outcomes in a number of other wellbeing domains. For instance, stunting[2] is associated with long-lasting harmful consequences, including diminished mental ability and learning capacity, poor school performance in childhood.Adolescence as a second window of opportunityThe possibility of catch-up growth is an amazing finding that has the potential to revolutionize how we develop programs and policies for young people.While the optimal growth needs for a child are best received in the first 1000 days, extending attention to the first 1000 weeks would allow policymakers and practitioners to intervene to leave no child behind.More research is needed on what, beyond growth, might benefit from a second chance – such as impacts on cognition. Finally, adolescence is also a window into OUR FUTURES. Here the impacts of intervening during this period can be seen to endure, as adolescents age into their adult lives and for future cohorts of their children. Health professionals are well aware of the life time benefits of positive health behaviours (for instance, physical activity and healthy diet) instilled during adolescence. This ability to create lifetime habits is also well known to cigarette manufacturers and the Food and Beverage industry (‘Big Food’).It is also a period during which vulnerabilities and stressors can strongly hit with severe consequences for adolescent futures. Portrait and colleagues (2011) analyzed data from the Amsterdam Longitudinal Aging Study to understand the effects of early life exposure to the Dutch famine (during the winter of 1944-45) on the prevalence of heart diseases, peripheral arterial diseases and diabetes mellitus at ages 60–76. The authors found that across four age classes (0-1 years old; 2-5 years old; 6-10 years old; and 11-14 years old), the exposure to severe undernutrition at ages 11–14 was the most significantly associated with a higher probability of developing diabetes mellitus and/or peripheral arterial diseases among women aged 60–76. Evidence from Falconi and colleagues, using cohort mortality data in France (1816-1919), England and Wales (1841-1919), and Sweden (1861-1919), also demonstrates that early adolescence is a sensitive developmental period for males; with findings suggesting that stressors experienced during the ages of 10-14 are related to shorter life spans.Importantly, the impact of stressors on an individual are cumulative, making it difficult to catch up once young people fall behind. Research in Vietnam has shown a considerably high share of children in the bottom quintile in mathematics scores at age 12 had left school by age 15, further limiting their life chances. Investments in education and learning for primary- and secondary-age children is crucial to ensure long-term well-being. to have positive effects at individual and household levels on their future annual earnings, decreased lifetime fertility rate and increased labour market participation, as well as on their children’s well-being and human capital.The window into our futures includes recognizing intergenerational impacts, which are evident for the next generation of children born to this cohort. For instance, interventions to improve the nutritional status of pregnant adolescents – for example through the provision of micronutrient supplementation and of nutritional education sessions – result in a statistically significant improvement in mean birth weight, reduced low birth weight rates, and preterm birth.Adolescence as a third window of opportunity Adolescence is a critical period responsive to effective interventions (or on the contrary, to stressors and adversities) that can have impacts on lifetime trajectories, and for the next generation.“Investments in adolescent health and wellbeing are some of the best that can be made, resulting in a 10-fold economic benefit”, and vital to achieve the SDGs Our approach to programming now needs new focus. With the new Generation Unlimited partnership, this conceptual approach can help researchers and practitioners, including UNICEF and policymakers, conceptualize adolescence in its interlinkages with other generations and life-course periods, to ensure synergies and effectiveness in the design and delivery of programs and policies.The criticality of the first 1000 days remains, but to ensure the best for the future of society, science now obligates us to extend our reach to the first 1000 weeks of life. The conceptualization of adolescence through a three-window opportunity approach highlights life-course and gender perspectives on adolescence – and reminds us to consider this period of life for its unique, catch up, lifetime and intergenerational significance.  Prerna Banati, PhD, is chief of programs at UNICEF’s Office of Research — Innocenti. Her research focuses on the social and structural forces that are among the most fundamental determinants of poor well- being among children. She was a Takemi Fellow in the Department of Global Health and Population at Harvard University and has previously worked at the Global Fund to fight AIDS, TB, and Malaria and at the World Health Organization (WHO). Before WHO, she was based in South Africa, leading research on community HIV prevention, and has published in the fields of HIV prevention, reproductive health, health systems, and financing.Elena Camilletti supports the Office of Research – Innocenti’s work on adolescence and gender. She conducts research on adolescent girls and unpaid care and domestic work, gender norms, legal and policy frameworks for adolescent well-being, mental health and sexual reproductive health, and cost analyses in low- and middle-income countries. Before joining the Office of Research – Innocenti, she worked for the ILO, the Red Cross / Red Crescent Climate Centre, Oxford Policy Management Ltd and UNRISD. Elena holds a Master of Science in Emerging Economies and Inclusive Development from King’s College London and a Bachelor’s Degree in International Relations and Diplomatic Affairs from the University of Bologna. You can follow here on twitter @elenacml.[1] Based on data collected for the impact evaluation of the Malawi Social Cash Transfer program. See more at https://transfer.cpc.unc.edu/?page_id=196[2] Number of under-fives falling below minus 2 standard deviations (moderate and severe) and minus 3 standard deviations (severe) from the median height-for-age of the reference* population, out of the total number of children under 5 years old in the surveyed population. See more at https://data.unicef.org/topic/nutrition/malnutrition/

Journal articles

Is longitudinal research the best response to the ‘post-truth’ order?
Journal Article

We Are All in This Together: COVID-19 and a Call to Action for Mental Health of Children and Adolescents

Is longitudinal research the best response to the ‘post-truth’ order?
Journal Article

Children’s Roles in Social Reproduction: reexamining the discourse on care through a child lens