The First 1000 Days: delivering for mothers, children and societies

by Rachel Toku Appiah, Graça Machel Trust
Tuesday, 17 May 2016 07:58 GMT

In this 2014 file photo a mother feeds her two year old daughter at her house in Islamabad, Pakistan. REUTERS/Sara Farid

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* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

Proper nutrition, especially in the first 1,000 days, can be a significant game-changer for governments as they finalize their investment-cases to help achieve their SDG targets

Malnutrition is the underlying cause of nearly half of all under-5 deaths each year, which translates into a staggering loss of approximately three million young lives. It is primarily caused by poor feeding practices – such as inadequate breastfeeding and nutrient-poor diets early in life – poor sanitation and infections. Malnutrition straddles both protein-energy malnutrition (hunger) and micronutrient deficiencies (hidden hunger), and particularly affects hundreds of millions of pregnant women and young children. This leads to a lifetime of ill-health and unrealized human potential. Additionally, the effects of malnutrition span generations and further propagate cycles of hunger and poverty in already impoverished countries.

Stunting is the primary manifestation of malnutrition. It is irreversible, and is associated with low immunity to disease as well as lifelong health and cognitive impairments, which further lead to reduced school performance in children and economic productivity in adults. Unfortunately, the rates of stunting are abysmally high around the world, especially in developing countries. As per UNICEF, in 2014, just under one in four children under 5 years of age worldwide was stunted. Notably, developing countries in South Asia, Eastern and Southern Africa, and West and Central Africa have the highest prevalence of stunting. Without a doubt, this poses a serious threat to their recent upturn in economic growth and human development.

Anaemia, frequently caused by the deficiency of iron, folate, vitamin B12 and vitamin A, is another grim example of malnutrition. As per the World Health Organization (WHO), it contributes to 20% of all maternal deaths. In developing countries, one in every two pregnant women and about 40% of preschool children are estimated to be anaemic.

However, the good news is that we have exceedingly simple yet powerful solutions that can make all the difference in the quality of life and health for women and children. Science has established that the first 1,000 days of a child’s life affect the overall health outcomes later on in life. This initial period of a child’s life dictates the immunity to disease, brain development and physical growth through the life-course. Stretching between the start of the pregnancy and when a child reaches the age of two, this critical window demands the right nutrition so that the mother can carry a safe pregnancy and the child can start her/his journey on a strong footing.  It’s safe to say that maternal health and survival, children’s growth and cognitive development, and the education outcomes and economic productivity of individuals and societies hinge significantly on this 1,000 days period.

The Lancet Maternal and Child Nutrition Series 2013 proposes a package of ten proven, low-cost nutrition interventions  that are designed to specifically address undernutrition and micronutrient deficiencies in women of reproductive age, pregnant women, neonates, infants, and children. These include some critical interventions focused on the 1,000 days period, such as nutrient supplementation before, during, and after pregnancy, breastfeeding (including early initiation, exclusive breastfeeding for six months, and continued breastfeeding), complementary feeding, and management of severe acute malnutrition (SAM) and moderate acute malnutrition.

Specifically, interventions such as breastfeeding have been proven to be critical to child survival. Research has shown that infants who are exclusively breastfed are more likely to thrive physically and mentally, and have a more productive adulthood. Other estimates show that increasing optimal breastfeeding alone could save nearly 8,20,000 lives. 

Since we already know what works, it is imperative that governments focus on these first 1,000 days and invest in the above-mentioned nutrition interventions. This can improve the nutritional and health status of women and children and reap enormous social dividends.

Beyond the obvious improvements in human health, there is also a strong economic case for governments to invest in nutrition. A recent study shows that every dollar spent by a country in improving nutrition in the first 1,000 days of a child’s life can yield a return of US$45, and in some cases as much as US$166 in better health and economic productivity. That’s hundreds of millions of dollars saved from loss of productivity and disease treatment costs that could go towards educating more children and investing in other economically productive sectors.

These findings add to the already impressive wall of evidence that supports the case for investing in nutrition during the first 1,000 days.

In order for countries to meet their nutrition and development targets set forth in the World Health Assembly Global Nutrition Targets 2025 and Sustainable Development Goals (SDGs) 2016-2030, the national governments will need to ramp up their commitment and efforts. Robust data, sufficient financing, effective delivery, reducing gender and access-based inequities, and a strong focus on measuring results can enable the national governments to leverage the first 1,000 days to deliver nutrition-direct and nutrition-sensitive interventions to target populations and improve their health outcomes, especially those of girls and women of reproductive age and children. 

The programmatic and supportive components that can specifically help improve the coverage of nutrition interventions include hiring and training frontline health workers (FHW) to help remote communities access proper nutrition and medical care, and introducing gender-sensitive systems and policies such as adequate maternity leave entitlements, workplace interventions, and counselling and educational programmes to help achieve reductions in inequities.

Traditionally, nutrition has been a neglected area, and there is an urgent need to not just use the existing funds more efficiently and effectively, but also increase the overall domestic financial envelope to fund key nutrition strategies and interventions.

From saving lives to ending poverty to fuelling economic growth, proper nutrition, especially in the first 1,000 days, can be a significant game-changer for governments as they finalize their investment-cases to help achieve their SDG targets. It’s a fortuitous window of opportunity that our policymakers must fully leverage if they want to build healthy, thriving and happy societies. The cost of not doing so, in lives lost and in dollars, is far too high.

Rachel is the Nutrition Program Manager at Graça Machel Trust. The Trust is engaged in advocacy for nutrition at a global level through the SDGs, and at a regional level through the Southern Africa Development Community (SADC) to develop, adopt and implement policies that will improve the nutritional status of pregnant women and infants in Southern Africa.