Last month, a high powered technical Symposium on maternal and child health concluded at the flooded Oxford University Egrove Park with a message that can be captured in just one Cartoon. Projected as the last slide of Stephen Kennedy, the opening speaker’s presentation, the cartoon was framed in the setting of a racing track with a burly man announcing commencement. The two contestants were in stark contrast. One, a healthy boy, all set to roll. The other, an emaciated child in shackles carrying the baggage of disease was confronted by the huge barrier of malnutrition. The point being made was simple. Not everyone in life starts with an equal chance.
We have known this all along. The impact of poverty, per-capita income, maternal literacy, sanitation and housing conditions on child health are well established. But these social determinants are not amenable to isolated and specific public heath interventions. By contrast, another cause of the setback children endure could be relatively more responsive to targeted interventions. Perhaps that is why the focus of the discussions at the Symposium kept gravitating towards maternal nutrition. Since the time of Hippocrates we have known that ‘nature’ and ‘nurture’ interact. In most cultures the notion of feeding mothers well, is predicated on that belief. But impoverishment and ignorance often stand in the way of nourishing mothers adequately. Maternal malnutrition can be a double-edged sword for the child. On the one hand, it can lead to higher death rates, greater susceptibility to infection, specific nutritional deficiencies, pushing the child into the vicious cycle of ill-health early in life. On the other, by resulting in low birth weight, intrauterine malnutrition can lead to obesity, deranged metabolism and greater cardiovascular risk, in later year.
For most policymakers in the select group of 47 participants in the room, the deep significance of mother’s nutrition for the wellbeing of the offspring throughout the life course was new information—they had simply not known that before. A former Prime Minister in the group, confessed he would have been more proactive in this area had he known about this while in office, or if evidence had been conveyed to him. In a way this reflects failure on part of scientists to transform and relay data and evidence into information and messages to levels at which decision making happens.
Evidence presented at the meeting challenged the notion that ethnicity or gender could determine how children grow. Conversely, evidence reviewed emphasized that babies grow in the same way around the world as long as they receive the same optimal care and if ‘environmental constraints’ are overcome. Most saliently, the consensus achieved at the meeting reiterated the need to focus on preconception care in the context of maternal and child health services.
Participants at the meeting emphasized that nutrition of the mother directly affects not just health in the early years but also protects it later in life. Women can therefore be viewed not only the managers of their own health also that of future generations.
These biological and inter-generational connections are most pronounced in the case of a female child. In other words, if a woman is carrying a female fetus, the eggs of the unborn fetus and hence the future offspring of the fetus will be influenced by maternal level of nutrition. Not many of us even in the scientific community have thought about the power of our grandmother’s eggs, let alone policymakers who are remote from scientific evidence, anyway.
Such information needs to be communicated to the decision-making level, because solutions to the problem exist. Conditional cash transfers, text messages in environments of rapidly burgeoning mobile penetration, school feeding programs, fortification schemes and local change agents are known to impact maternal nutrition. But how can we push policymakers to mandate these choices as policy? For that, a completely new set of savvy skills is needed. There are lessons to be learnt from around the world. For example, in Brazil, a television program on Spina Bifida (a congenital neural tube defect) and the role folic acid supplementation could play in prevention, grabbed the attention of politicians immediately. A similar role is being played by soap operas, which have emerged as powerful electronic media tools for women empowerment in conservative Middle Eastern societies. They could play a similar part in convincing the public of the value of nutrition, who are otherwise made to view nutrition as a ‘plate of micronutrients’ through the traditional public service announcement approach.
It is not just the under-nutrition end of the malnutrition spectrum but also the other end that needs to be tackled. Obesity is an equally challenging problem when it comes to children. Both under-nutrition and obesity are pervasive in emerging market countries in a context where growth and prosperity coexist with wide inequities. By providing an annual convening space for policymakers and academics from these countries, the annual Emerging Market Symposium at Oxford is an opportunity to highlight the value of bridging the evidence-policy disconnect. But much more needs to be done as part of domestic policy to institutionalize it.
Dr. Sania Nishtar
Founder & President
The blog above is the original version of the post that appeared on the Project Syndicate, accessible at: http://www.project-syndicate.org/commentary/sania-nishtar-highlights-the-impact-of-women-s-nutrition-on-future-generations–health