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

The interventions during the adolescence phase of 13-18 years of the life of women are extremely important to achieve better maternal and child nutritional health outcomes

Opinion: Thinking Beyond The First 1000 Days Of Life

The first 1000 days of life have become a reference point for the nutritional health of the children. A number of interventions are designed and prescribed in the form of maternal nutrition recommendations during the time of pregnancy and in the form of Infant and Young Child Feeding (IYCF) practices for two years of time since the birth of the child. The interventions, which are based on extensive research and evidence, serve very well provided the pregnant woman is well aware of the practices to be followed right from the day one of her pregnancy, she is at the appropriate age to sustain a happy pregnancy, is emotionally in a secured state of mind, is in sound nutritional framework, has a good knowledge base about the service support system available to her and has sufficient understanding of the mother and child care.

Also Read: Opinion: Breastfeeding A Must To Fortify The ‘First Thousand Days’ Of Your Baby

This is but seldom a case. The first 1000 days of life start from the day of conception. However, the pregnancies do not generally get disclosed immediately due to a number of cultural reasons and to add to this the service delivery network also generally miss out on the early identification of pregnancies. In India, the median number of months of pregnancy at the time of the first visit for Antenatal Check-up (ANC) is 3.5 months (NFHS 2015-16) indicating that there is already a loss of three to four months of the first 1000 days. The whole concept of the first 1000 days gets dismantled right at the beginning of the pregnancy. Moreover, to add to the problems, many of the women do still get married before the legal age and do have early pregnancies. Many of these women do fall short of desirable nutritional status at the time of conception. This is evident by the fact that 28 per cent of women in the age group of 18-29 years do get married before 18 years, 8 per cent of the adolescent girls in the age bracket of 15-19 years do have pregnancies, 23 per cent of women aged 15-49 years have Body Mass Index (BMI) less than the normal 18.5 kg/m2 and more than 50 per cent of the pregnant women are in anaemic conditions (NFHS 2015-16). It is evident that many of the pregnancies go through a compromised state which compels us to deliberate on a larger question that do we need to think beyond the first 1000 days of life.

Also Read: Expert Blog: Why Is The Focus On First 1000 Days From Health Perspective Of Mother And Child?

It emphasises in no uncertain terms that to achieve the best out of the practices recommended to be followed during the first 1000 days of life, we need to program and prioritise the interventions during about 2000 days of adolescence before conception. The evidences from the Indian Human Development Survey, 2005 show that the mean age at menarche among Indian women is 13.76 years. Hence, the interventions during the adolescence phase of 13-18 years of the life of women are extremely important to achieve better maternal and child nutritional health outcomes. This period of adolescence, when growth and development is on accelerated pedestal, is an early window of opportunity to make a positive impact on the nutrition status of women and children.

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

Adolescents can play an important role in improving the health and nutrition status of the family and the community. The girls in this age group may prove to be the important change agents and can contribute as a significant link to break the intergenerational cycles of malnutrition.

However, the available information indicates that girls drop out of school at a young age and get into drudgery and unpaid family and farm work. They generally have very limited access to any sort of skill development and hence almost negligible job opportunities. Their labour force participation is minimal leading to almost nil income lines, affecting adversely their contribution to decision making in the family or in the community. It leads to early age marriages and then early pregnancies. Along with this, sets in multiple forms of malnutrition like wasting, stunting, underweight, micronutrient deficiencies and anaemia in these adolescents. The pregnancies set in this milieu are often compromised in following the prescriptions for the first 1000 days affecting adversely the nutritional outcomes in the children.

Also Read: Expert Blog: Five Superfoods Every Lactating Mother Should Consume

We, therefore, need to invest heavily and extensively into the adolescence phase of the life cycle of women to empower them appropriately to enable them to make informed and rational decisions about themselves and their families. The prescriptions are simple but need commitment and willpower to implement. Adolescent girls need to be in school for a longer period to grow and learn in a safe and gender balance environment. They should be educated extensively on life skills whereby they can develop resilience to fight difficult situations. Education will make them aware of their rights and the support structure available to ensure their protection. Additionally, it will also enable them to learn about nuances and the meanings of good health and good nutrition as well as the health and nutrition service delivery structure available at their disposal. They may further be imparted the market-driven skills as per their aptitude and aspirations in the sectors for which opportunities exist in their vicinity. Education and skilling of this sort would empower them socially and economically. A girl so empowered with a sound knowledge base and strong decision making abilities in all probability would be able to delay the age at marriage and age at pregnancy, to make informed decisions about birth orders and gaps in pregnancies, and would be better equipped to appreciate and receive the services available to her. These girls would be appropriately placed to follow the practices recommended during pre-conception period, during pregnancy and during childcare days. It should help in realizing the true potential of the first 1000 days of life. Investment in adolescent girls is a high priority need of the time. We need to think of and focus on these critical 2000 days of life, to get better outcomes of the first 1000 days of life.

Also Read: National Nutrition Month: Benefits Of Eating Locally Produced Nutritious Foods At Complementary Feeding Stage

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

Dr. Dinesh Kumar Saxena

 

Dr. Dinesh Kumar Saxena, Director General of State Nutrition Mission  (SNM), Government of Jharkhand.

Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

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World

24,24,98,327Cases
20,40,54,102Active
3,35,14,449Recovered
49,29,776Deaths
Coronavirus has spread to 195 countries. The total confirmed cases worldwide are 24,24,98,327 and 49,29,776 have died; 20,40,54,102 are active cases and 3,35,14,449 have recovered as on October 22, 2021 at 5:24 am.

India

3,41,43,236 15,786Cases
1,75,7453,086Active
3,35,14,449 18,641Recovered
4,53,042 231Deaths
In India, there are 3,41,43,236 confirmed cases including 4,53,042 deaths. The number of active cases is 1,75,745 and 3,35,14,449 have recovered as on October 22, 2021 at 2:30 am.

State Details

State Cases Active Recovered Deaths
Maharashtra

65,98,218 1,573

27,899 1,434

64,30,394 2,968

1,39,925 39

Kerala

48,88,523 8,733

82,093 1,240

47,79,228 9,855

27,202 118

Karnataka

29,84,849 365

9,017 86

29,37,848 443

37,984 8

Tamil Nadu

26,91,797 1,164

13,790 268

26,42,039 1,412

35,968 20

Andhra Pradesh

20,62,303 493

5,500 66

20,42,476 552

14,327 7

Uttar Pradesh

17,10,068 10

107 5

16,87,062 14

22,899 1

West Bengal

15,83,646 833

7,535 44

15,57,090 775

19,021 14

Delhi

14,39,488 22

311 1

14,14,087 21

25,090

Odisha

10,37,056 524

4,336 51

10,24,422 573

8,298 2

Chhattisgarh

10,05,773 38

206 21

9,91,995 16

13,572 1

Rajasthan

9,54,395 2

36 2

9,45,405 4

8,954

Gujarat

8,26,353 13

156 20

8,16,110 33

10,087

Madhya Pradesh

7,92,721 12

88 6

7,82,110 6

10,523

Haryana

7,71,125 9

131 2

7,60,945 11

10,049

Bihar

7,26,042 6

30 0

7,16,351 6

9,661

Telangana

6,69,739 183

3,967 1

6,61,829 183

3,943 1

Assam

6,07,811 384

3,762 152

5,98,087 228

5,962 4

Punjab

6,02,135 22

226 6

5,85,358 27

16,551 1

Jharkhand

3,48,526 40

166 24

3,43,225 16

5,135

Uttarakhand

3,43,787 14

176 0

3,36,213 14

7,398

Jammu And Kashmir

3,31,386 87

814 14

3,26,143 73

4,429

Himachal Pradesh

2,22,138 202

1,452 58

2,16,955 140

3,731 4

Goa

1,77,765 59

618 21

1,73,790 35

3,357 3

Puducherry

1,27,564 43

454 7

1,25,258 50

1,852

Manipur

1,23,051 81

1,346 14

1,19,800 94

1,905 1

Mizoram

1,15,944 737

10,034 229

1,05,510 962

400 4

Tripura

84,369 18

105 10

83,448 8

816

Meghalaya

83,210 52

735 26

81,034 76

1,441 2

Chandigarh

65,315 3

26 2

64,469 1

820

Arunachal Pradesh

55,065 22

140 2

54,645 20

280

Sikkim

31,819 19

185 10

31,241 9

393

Nagaland

31,670 11

250 5

30,743 15

677 1

Ladakh

20,896 10

43 9

20,645 1

208

Dadra And Nagar Haveli

10,678 2

4 2

10,670

4

Lakshadweep

10,365

0 0

10,314

51

Andaman And Nicobar Islands

7,646

7 0

7,510

129

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1 Comment

1 Comment

  1. Dr Raj Bhandari

    October 3, 2020 at 2:02 pm

    The article is very relevant to target interventions during the pre conception period eg folate supplements can reduce the incidence of Neural tube defects if started early. Anemia can be considered a proxy indicator of multiple micronutrient def. Therefore all cases of anemia must be treated with therapeutic IFA. Other issues like reproductive health services and counseling must be readily accessible. A life skill program at school level will empower them to take informed and responsible decision.

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