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The first 1000 days

Tuesday, November 7, 2017

A thousand days. Chinese proverb or the start of a Sleeping Beauty story? “Man who study for thousand days forever live like king.” Or, “Ye shall sleep for a thousand days and a thousand nights and be awakened by a kiss of true love.”

A thousand days refers to the period of time between conception and the second birthday of a child ie the pregnancy and the first two years of life.

We now know that Lenin (“Give me four years to teach the children and the seed I have sown will never be uprooted”) and either Aristotle or Francis Xavier, (“Give me a child until he is seven and I will show you the man”) were wrong, although Lenin was a bit closer to the truth.

The first 1000 days of life form the adult.

Despite the quotations about the importance of very early life, this idea is a radical departure from traditional socio-educational belief where the emphasis was on the child after age five. Remarkable really, that people decided to forget those crucial first three years (pregnancy and up to age two), until you remember that the people who take these policy decisions are the ones who know the least about children, except for some half-baked ideas about getting worms from eating too much sugar and the need not to pick up crying babies because “it go spoil dem!” But then we tend to be guided by mediocracy, slacktivism and chillax, do we not?

So world health and development organisations have usually fixated on age five and primary school as milestone targets for intervention. Getting children into school has long been a holy grail of successful development. But ensuring brain development and healthy growth, free of illness, in the first 1,000 days, so children are actually capable of learning once they get to school, has been largely ignored.

The central factor in brain development and health in those pregnancy and post pregnancy days is nutrition and the prevention of infections. The result of this disregard of nutrition for pregnant mothers and their young children is that, worldwide, one in four children under five years of age is stunted, physically, cognitively or both.

Stunting is a life sentence of underachievement. The costs—less education, lower productivity and income, higher health care expenses—surge across society, from individual to family to community to nation to the entire world.

So much so that the World Bank, in a 2006 report, “Repositioning Nutrition as Central to Development”, urgently implored: “The unequivocal choice now is between continuing to fail... or to finally make nutrition central to development so that a wide range of economic and social improvements that depend on nutrition can be realised.”

This year, at the World Bank meetings in Washington DC, finance ministers and bankers acknowledged that investing in “grey matter infrastructure”—the brains of young children—is as important for national and global economic growth as is investing in roads, ports and buildings. PM, please note.

Ending hunger and infection has always been seen as the moral thing to do. Now we know it is also the smart thing to do.

Central to this issue of feeding babies properly and preventing infections to maximise growth and development, is good antenatal care and breastfeeding. Both result in healthier babies and adults with IQs three to five points higher than anyone fed formula. Economists have worked out that not breastfeeding is associated, because of the lower intelligence, with economic losses of about $300 billion annually or 0·49 per cent of world gross national income.

Adequate antenatal care and breastfeeding, not much to ask for, is it? Better than spending TT$700 million on Cancer Centres that do not function or TT$8 billion a year on treating NCDs in hospitals?

For a start, Minister, could we get some comfortable chairs for pregnant women while they are waiting two hours to see overworked nurses at Health Centres?


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