The first 500 days of life: policies to support maternal nutrition

Abstract

Background: From conception to 6 months of age, an infant is entirely dependent for its nutrition on the mother: via the placenta and then ideally via exclusive breastfeeding. This period of 15 months Á about 500 days Á is the most important and vulnerable in a child's life: it must be protected through policies supporting maternal nutrition and health. Those addressing nutritional status are discussed here. Objective and design: This paper aims to summarize research on policies and programs to protect women's nutrition in order to improve birth outcomes in low-and middle-income countries, based on studies of efficacy from the literature, and on effectiveness, globally and in selected countries involving in-depth data collection in communities in Ethiopia, India and Northern Nigeria. Results of this research have been published in the academic literature (more than 30 papers). The conclusions now need to be advocated to policy-makers. Results: The priority problems addressed are: intrauterine growth restriction (IUGR), women's anemia, thinness, and stunting. The priority interventions that need to be widely expanded for women before and during pregnancy, are: supplementation with ironÁfolic acid or multiple micronutrients; expanding coverage of iodine fortification of salt particularly to remote areas and the poorest populations; targeted provision of balanced protein energy supplements when significant resources are available; reducing teenage pregnancies; increasing interpregnancy intervals through family planning programs; and building on conditional cash transfer programs, both to provide resources and as a platform for public education. All these have known efficacy but are of inadequate coverage and resourcing. The next steps are to overcome barriers to wide implementation, without which targets for maternal and child health and nutrition (e.g. by WHO) are unlikely to be met, especially in the poorest countries. Conclusions: This agenda requires policy decisions both at Ministry and donor levels, and throughout the administrative system. Evidence-based interventions are established as a basis for these decisions, there are clear advocacy messages, and there are no scientific reasons for delay.

Prevalence of Chronic Malnutrition (Stunting) and Determinant Factors among Children Aged 0-23 Months in Western Ethiopia: A Cross-Sectional Study

“…The other studies also strongly recommended that the optimal nutrition of children under two years of age, it is considered important that they be exclusively breastfed for the first 6 months before being given complementary food [26]. In many studies, it is indicated that duration of exclusive breastfeeding (>6 months) and the age for starting complementary feeding is significantly associated with higher weight, length, and lower probability of stunting, wasting and infections [26][27][28][29]. This could be due to lack of essential nutrients from the breast milk during the first six months of life and later.…”

Socioeconomic determinants of malnutrition among mothers in the Amoron’i Mania region of Madagascar: a cross-sectional study

“…A child's development depends entirely on the mother's nutritional status during fetal life and the first six months of life [2]. Current knowledge shows the adverse effects of maternal malnutrition on their health and that of their children [3].…”

Characterisation of anaemia and associated factors among infants and pre-schoolers from rural India

“…The implications for child health and development with respect to an anaemic caregiver have also been recognised (38) . Therefore, prevention strategies should target adolescent girls and women of reproductive age to eliminate or reduce the burden of anaemia before entering into the higher nutritional demands of pregnancy (39)(40)(41) . A continuum in interventions is required during the reproductive period for the benefit to reach the offspring.…”