New Delhi: It is heartening to see our Honorable Minister Smriti Irani often use the phrase “focus on the first 1000 day” as an effective strategy to fight malnutrition and its multiple forms. But why these 1000 days and what are they? The first 1,000 days can be seen as a combination of five stages/phases – the nine months of pregnancy (antenatal period); birth passage or delivery process (intranatal period); four weeks following birth (neonatal period); 11 months of infancy; and the final chunk post first birthday until two years when the child is weaned from the breast, and transitions to eating solids. All these critical phases of development, if managed well, reduce the risk of falling in the trap of any form of malnutrition. Malnutrition can decrease the economic growth of a nation by 8 per cent due to loss in productivity caused by reduced schooling and cognitive impairments. Estimates suggest that stunted children earn 20 per cent lesser as adults compared to healthy individuals.
Several reasons explain the vulnerability of the first 1000 days: rapid growth and development, high nutritional requirements, greater susceptibility to infections, high sensitivity to programming effects and full dependence on others for care, nutrition, and social interaction. Both adequate overall nutrition (that is the absence of malnutrition) and provision of adequate amounts of key macro and micronutrients during these first 1000 days are necessary for normal brain development. Malnutrition includes both undernutrition (provision of inadequate amounts of macro and/or micronutrients) and also overweight-obesity (provision of excessive calories, often at the expense of others).
According to UNICEF, 50 per cent of the growth failure accrued by two years of age occurs in the womb owing to poor nutrition of the mother. Studies have shown that early macronutrient undernutrition is associated with lower IQ scores, reduced school success, and more behavioral abnormalities. Similarly, prenatal and early infancy iron deficiency is associated with long term and irreversible neurobehavioral damage. Periconceptional folic acid is effective in preventing most neural tube defects. Iodine is essential for the synthesis of thyroid hormone, which is also crucial in neurodevelopment. Deficiency of iodine in pregnant women leads to cretinism in the child with several developmental delays. Iodine deficiency is also associated with reduced performance on IQ tests. Long-chain polyunsaturated fatty acids, which include docosahexaenoic acid and arachidonic acid, are important for normal development of vision and may also affect neurocognitive development. After birth, deficient infant feeding practices, including absent or deficient breastfeeding practices and inappropriate and untimely complementary feeding, together with high rates of diarrhoeal diseases caused by unhygienic environment, lead to undernutrition and stunting. Conversely, if the expectant mother is obese, that also adversely affects her offspring’s health throughout the life span including an increased risk for diabetes and obesity. Fast weight gain after two years of birth is predictive of risk of chronic disease, and this relationship strengthens with age. Maternal obesity is also associated with decreased breastfeeding initiation rates, delayed onset of full milk production, and insufficient milk supply, resulting in a shortened duration of breastfeeding. This in turn may not only impact brain development and cognition but also predispose children to develop non-communicable diseases like heart problems, diabetes, hypertension, among others, in adult life.
The big challenge we face today is that of promoting healthy growth without falling into the obesity trap. This requires all stakeholders to help and contribute in the action plan to prevent malnutrition especially during the first 1000 days. Right from government (programmes/policies), to employers (workplace policies) to healthcare professionals, civil society, private sector and most important, the caregivers – all must be held accountable to provide support towards building a conducive environment for a healthy start. We must bear in mind that direct nutrition interventions (adequately scaled up) can reduce stunting only by 20 per cent; indirect interventions (for example, access to WASH, women empowerment, agriculture) must tackle the remaining 80 per cent.
It is time we remind ourselves of Adam Smith, a Scottish philosopher from 18th century, who rightly said that true wealth of a nation depends in part on the health, nutrition, skills and knowledge of their people. Back then he advocated that poor health and nutrition and lack of education could lower economic productivity. The several schemes operational by the government in several spaces – notably public health, nutrition, agriculture and environment, are duly acknowledged. While each of these offer valuable contributions to child growth and development, none of them alone will address the multiple forms of malnutrition which are lurking and portending the optimal potential of our human capital. Who will we train in Skill India program or reap the benefits for by Swachh Bharat Mission if our human capital gets a compromised start. ‘Beti bachao and beti padhao’ also needs an additional “beti swasth banao” tag and matching action. As public health and nutrition advocates, we like to reinforce life-course approach to nutrition and health. The effects of early adverse experiences especially during the critical 1000 days may result in a lifetime of medical and psychosocial problems, lost academic achievement and productivity, and possible negative impact on the next generation.
(Dr Shweta Khandelwal is Head, Nutrition Research and Additional Professor, Public Health Foundation of India.)
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