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