First 1,000 Days Of Life: Importance Of Maternal And Child Nutrition During Pregnancy And Up To Two Years Of Age

New Delhi: According to the United Nations Children’s Fund (UNICEF), the first 1,000 days of life – the time spanning between conception and a baby’s second birthday – is a unique period of opportunity when the foundations of optimum health, growth, and neurodevelopment across the lifespan are established. This is the time period when maternal and child nutrition and health can determine the child’s ability to grow. Experts say that poor nutrition in the first 1,000 days cause irreversible damage to a child’s growing brain and body. According to Dhanya Sooraj, Consultant Nutritionist, National Nutrition Mission- Kerala, investments done by governments and individuals towards nutrition for mothers and children during the first 1,000 days will not only give the child a healthy future but will also help the whole nation to grow and prosper.

Also Read: Opinion: Importance Of Maternal Nutrition And Its Inter-generational Impact

However, as per Dr. Charu Dua, Chief Clinical Nutritionist at Max Super Speciality Hospital, Patparganj in East Delhi, in many families, due to a number of cultural reasons and various myths, pregnancies are not disclosed immediately and in a lot of cases, the pregnancy itself gets detected after a month or so. This affects the care and nutrition required by the pregnant woman in the initial stages of pregnancy, thus, upsetting first 1,000 days at the beginning of the pregnancy itself. She says, the early detection a pregnancy is important in order to ensure that the window of opportunity provided by the first 1,000 days is utilised optimally to give a healthy future to the child as well the mother. She highlighted that while some deficiencies can be partly addressed in the later stages of life, the window of opportunity narrows with age, thus, making it difficult for an older child or an adult to manage the health conditions resulting from a deficiency.

Nutrition During The First 270 Days: What Should A Pregnancy Plate Look Like?

According to Dr. Dua, malnutrition can set in the mother’s womb itself. If the mother is not healthy and her Body Mass Index (BMI), which is the first parameter that is evaluated for nutrition screening in a person, is not more than 18.5, then there are extremely high chances that the child will suffer from malnutrition. BMI is calculated using a person’s height and weight. The healthy range of BMI is 18.5 to 24.9. A BMI of 25.0 or more is overweight and a BMI of less than 18.5 is underweight. She said,

If the BMI of a pregnant woman is less than 18.5, we need to work on the mother first to bring her BMI to normal levels as malnutrition and underweight in the early pregnancy are linked with premature birth and low birth weight of the child. For the women who are between BMI 18.5 and 24.9, we just need to add 300 calories to her diet during pregnancy.

Explaining further, Dr. Dua said that the diet of a pregnant woman must include iron which is found in green leafy vegetables and foods rich in Vitamin C such as tomatoes. She added that it must have folic acid, zinc, calcium, vitamin D, and fatty acids which are found in whole-grain cereal, milk, seafood, lentils and nuts. She said,

Iron deficiency is the most common nutritional deficiency among pregnant women even though iron is extremely important for the development of the brain of the child. Thus, during the pregnancy, women who have iron deficiency must be given iron supplementation. There have been many studies which show that iron supplementation beginning in the early stages of pregnancy resulted in significantly better working memory, body functions among children.

According to Ms. Sooraj, along with eating nutrient-dense foods, a pregnant lady must drink at least 10-12 glasses of water. She highly recommends choosing foods with low sugar. While talking about nutrition for pregnant women, she said that a pregnant women’s diet per day should contain the following:

– At least two bowls (250 ml) of cooked green leafy vegetables per day along with other vegetables like ladyfingers or brinjals or beans or any other non-starchy vegetables.
– At least 350 ml of starchy vegetables like potatoes or sweet potatoes or beets or carrots
– At least 75 grams of fish or two full boiled eggs or a three-fourth cup of cooked legumes like Kabuli Chana, Rajma, Matar, Moong Daal, Masoor Daal among other at least twice a day
– At least four chapatis made of wheat/Bajra/Maize or Corn or two bowls (250 ml) cooked rice or ragi
– Use a mix of oils like mustard oil plus groundnut oil or rice bran or coconut oil for cooking
– 250 ml of milk or curd
– At least two seasonal fruits per day
– 10-12 glasses of water

A pregnant woman should eat vegetables, fruits, millets, curd and drink 10-12 glasses of water every day, according to experts

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Nutrition For Lactating Mothers

Dr. Dua says that a lactating mother needs about 600 calories more than non-pregnant and non-lactating women in the first six months when she is practising exclusive breastfeeding and about 500 additional calories after six months till the time she continues to breastfeed. She highlighted that the new mother needs to continue taking iron even after delivery. She says,

Iron is important for breastfeeding mothers. It helps fight Anaemia in the mother as it is the main source to make haemoglobin. Iron also helps to recover the loss of blood during delivery. Moreover, iron aids in the development of the baby’s brain and blood cells.

She further prescribes a breastfeeding mother to also include calcium, Omega-3 fatty acid, vitamin D and protein in her diet every day.

A lactating mother should include calcium, iron, omega-3 fatty acid, vitamin D and protein every day in her diet

To help lactating mother produce more milk and breastfeed better, Dr. Dua prescribes the following six superfoods that are easily available in almost every kitchen- Fennel (Saunf), Aniseed (Starseed), Cumin (Jeera), Carom (Ajwain), Fenugreek (Methi) and Garlic. She said,

In India, herbs such as methi seeds, jeera, ajwain, saunf and garlic are extremely easy to find and affordable. These herbs help in digestion and avoid colic pain in baby along with increasing milk production. Various items can be prepared using these such as goand (edible gum) laddoo, methi laddoo, almond halwa, dried ginger (saunth). However, eat these preparations in moderation as these are high in fat and calories.

Food from the kitchen to help mothers breastfeed better

Dr. Dua further recommends that a breastfeeding mother must drink at least 8-10 glasses of water. She said,

Breastfeeding every 2 to 4 hours can be dehydrating. Thus, make water your best friend. Water will also help in keeping up milk production. A breastfeeding mother can also consume milk, fruit juices and soups.

She suggests that a lactating woman must reduce caffeine intake by cutting down on coffee, tea, cola and chocolate drinks. She also recommends cutting down the consumption of foods that are difficult to digest like fried or extremely fatty foods.

Dr. Dua warns against ‘dieting’ during breastfeeding. She said,

Some women think about reducing the pregnancy weight immediately after giving birth and start eating less. Dieting during breastfeeding can reduce the quantity and quality of the breastmilk. To lose pregnancy weight, women can limit the intake of foods that are high in fat and sugar. Try to incorporate some moderate exercises like walking or some yoga.

Also Read: Opinion: Benefits Of Breastfeeding For Mother And Child And How We Can Promote And Support It

Nutrition For Babies From 0-2 Years

For babies after birth, it is highly recommended that breastfeeding is initiated within the first hour of birth. Followed by this is exclusive breastfeeding in the first six months which is extremely important for the healthy growth of the child. According to experts, breastmilk provides all essential nutrients in the right amount to meet the requirements for the mental and physical growth of a baby. Dr. Dua says that a baby should be fed breastmilk as many times in a day as it demands.

Breastfeeding provides babies with perfect nutrition

According to Dr. Dua, weaning should be started in the seventh month by offering vegetables and fruits to the baby along with breastfeeding as and when required. She said,

Weaning should be started with single vegetables and fruits in puree form.

Over the next 18 months, the diet of the baby has to be modified in order to meet the daily requirements of energy, protein, vitamins, iron, and calcium, among other nutrients, she said.

Some vegetables that can be given to an infant during 6 months to 2 years are- green leafy vegetables, sweet potato, pumpkin and carrots. Some fruits recommended by Dr. Dua that can be given during this period are banana, guava, mango, papaya, mud apple, and custard apple. Dr. Dua further explained that the form of the food given to the baby during this period also needs to be changed gradually from puree to semi-solid to solid.

Some vegetables and fruits for babies from 6 months to 2 years

Dr. Dua highlighted that even though, the baby is being offered various kinds of food, breastfeeding has to be continued for two years and beyond. She said that during 6 months to 8 months, the child should be offered weaning food two to three times a day and during 9 months to 24 months, the child should be offered three to four meals a day along with breastmilk.

How many times should a child be fed in a day?

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How Anganwadi System In India Is Providing Nutritional Security To Mothers And Their Newborns In Rural Areas

According to Basanta Kumar Kar, Recipient of Global Nutrition Leadership Award, ‘Anganwadis’ (courtyard shelters) or child development centres play a vital role in ensuring a better nutritional status of pregnant women, lactating mothers and newborns, especially in the rural areas. Anganwadi system works under the Ministry of Women and Child Development (MWCD) as part of the Integrated Child Development Services (ICDS) programme (now merged under Prime Minister’s Overarching Scheme for Holistic Nutrition). ICDS was launched by MWCD on October 2, 1975, in a bid to tackle malnutrition among all pregnant women, lactating mothers and children in the age group 0-6 years. The services under ICDS include supplementary nutrition, nutrition and health education, health check-ups, immunization and pre-school non-formal education. These services are universal or not limited to any criterion like BPL (Below Poverty Line) and are delivered by Anganwadi workers, Anganwadi helpers, medical officers, ASHA (Accredited Social Health Activist) and ANM (Auxiliary Nurse and Midwife), according to MWCD. As on March 31, 2020, 1.68 crore pregnant women and 6.86 crore children are being catered to at 13.8 lakh Anganwadis across the country, as per the data provided by MWCD in response to a question in Lok Sabha on September 23, 2020.

Services under ICDS along with other health and nutrition related scheme and programmes to improve the nutritional status of children, pregnant women and lactating mothers were merged under the POSHAN Abhiyaan or National Nutrition Mission launched on March 8, 2018 and is majorly implemented by the MWCD in partnership with other ministries like the Ministry of Health and Family Welfare, Ministry of Rural Development, Ministry of Human Resource Development, and others.

According to the Ministry of Women and Child Development, pregnant women and lactating mothers must consume 600 extra calories through supplementary nutrition or nutrient-dense food along with regular food and at least 18-20 grams of protein per day. It also prescribes pregnant women and lactating mothers to nine micronutrients -iron, calcium, folic acid, zinc and vitamins A, B1, B2, B3 and C, in their diet. Anganwadis are required to deliver the nutrition prescribed by MWCD through the distribution of Iron, vitamin and folic acid tables, supplementary nutrition in the form of ready-to-cook daliya or preparations like ladoo or panjiri or cookies and hot meals comprising of regional dishes and staple foods or take-home ration (THR), according to Karthyayani VC, Chairperson, Anganwadi Workers Welfare Association, Kerala.

Also Read: ‘Only Healthy Mothers Can Produce Healthy Offspring,’ Is The Message This Nutrition Warrior Spreads In Her Rajasthan Village

Appreciating the efforts of Kerala government in ensuring nutrition for pregnant women, new mothers and children, Ms. Karthyayani said,

In rural areas of Kerala, Anganwadi Centres are doing well. Along with essential Iron and vitamin tablets, pregnant women and lactating mothers are given hot cooked meals two times in a day- breakfast and lunch that consist of local vegetable, nutrient-dense sambhar and upma or rice. Women and children enrolled in Anganwadis are also provided with special fortified milk. The state government has also started providing special cookies to lactating mothers to help them breastfeed better.

She further said that even when COVID-19 pandemic hit the state and disrupted the functioning of Aganwadis, the workers and helpers made sure that the women and children are provided with Take-Home-Ration for the whole month. She sdded that at many places in the state the Angawadis have started operating again and resumed cooking hot meals which are being delivered at the doorstep of pregnant women and lactating mothers. However, at some places, Anganwadis are still distributing only Take-Home-Ration.

Ms. Karthyayani said that unlike many other states, Kerala motivates its Anganwadi workers by providing them with benefits such as pension, free medical care, over and above their basic salary.

Anita Tiwari, 43-year-old Anganwadi worker in Bauripara Block of Ambikapur District of Chhattisgarh also acknowledged the Chhattisgarh state’s efforts in providing food and nutrition to the women and children under Anganwadis in a timely manner. She said,

I am so proud to say that 5 out of 7 severely acute malnourished (SAM) children in my centre have improved and transitioned to moderate malnutrition and about 10 have moved to normal. This has happened post COVID-19. The government of Chhattisgarh recommends giving eggs to the SAM children and I make sure that all the SAM children in my Angnwadi consume one boiled egg every day. For this, I personally buy eggs daily and go to each of their houses to deliver.

Also Read: Opinion: Thinking Beyond The First 1000 Days Of Life For Maternal And Child Nutrition

Ms. Tiwari further said that as part of supplementary nutrition, pregnant women/lactating mothers and infants from 6 months to 2 years are given four ready-to-cook ‘dailya’ packets every month. One packet lasts for about 6-7 days. While during the pre-COVID times, they were provided with hot cooked meals once a day, this service had to be stopped for about six months. She said,

We started cooking hot meals again in the first week of September, but it was decided by the supervisors that we should continue giving dry ration to the beneficiaries for some more days.

Talking about the disruption of food systems due to COVID-19 induced lockdown, Parvin, 40-year-old Anganwadi worker in Kota, Rajasthan said that Anganwadis were completely shut in the months of April and May and the distribution of food resumed from June. However, she highlighted that during this time, ANMs continued visiting and services like distribution of ORS (Oral Rehydration Salts), Vitamin tablets and Iron tablets and the immunisation services were not disrupted.

While talking about the Anganwadi services in Uttar Pradesh, Neeta Bhatnagar, 50-year-old Anganwadi worker in Moradabad block said that only ready-to-cook ‘daliya’ is being provided to pregnant women, lactating mothers and children. She said,

The daliya alone is not enough to cater to the nutritional needs of the children, pregnant women and new mothers. The state government should take early nutrition seriously, especially when UP is one of the worst states when it comes to maternal and child health. The previous government provided hot meals and fruits also every day but now it just ‘daliya’.

Mr. Kar believes that the pandemic has brought to light the importance of the Take-Home-Ration and thus, it is an opportunity to strengthen the delivery of nutrition to the last mile and transform the country’s nutrition security scenario. He said that the country’s Supplementary Nutrition Programme is one of the largest such initiatives in the world and despite its many flaws, Anganwadis have provided a platform for addressing the rural nutritional outcomes.

Also Read: Community Health Workers Reduce Maternal, Foetal And New-Born Deaths, Study Finds

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.