Nutritional security: Getting it right in the first 1,000 days

By Sumita Ghosh

The first 1,000 days of human existence are an amazing journey. It begins with conception as a single cell and continues through the embryonic, foetal, and postnatal periods, including infancy and toddlerhood, through a process of rapid, complex and dramatic development & differentiation. A complex, multi-organ system develops with fundamental acquisition of all necessary body functions as well as cognitive and higher brain functions by the second birthday.

The major influences for this rapid physical and mental development are exerted by the genetic environment and the nurturing biological environment of nutrition. Nutrition can also directly modify the gene structure and mediate the expressions of genetic factors. In-fact, new research has shown that even in the pre-conception stage, the role of certain nutrients like folic acid is crucial for neural development. The first 1,000 days play a key role in child brain development. The brain of the term child at birth is only 25{b4bb8ddb70249670c85c66def16f765bd40a90ddaa69bcee7e340d9a7e1b07a9} of the adult brain, whereas by the end of two years, it weighs 72{b4bb8ddb70249670c85c66def16f765bd40a90ddaa69bcee7e340d9a7e1b07a9} of adult brain.

Hence, in these early formative years, good nutrition along with mental stimulation, healthy child rearing practices and adequate healthcare will have a paramount influence on the health and well-being of child in later life. Among these, nutrition in first 1,000 days will have the highest impact on the physical health, cognitive development, academic and intellectual performance of the child.

With a near-8{b4bb8ddb70249670c85c66def16f765bd40a90ddaa69bcee7e340d9a7e1b07a9} teenage pregnancy rate and a high prevalence of anaemia in women, of more that 50{b4bb8ddb70249670c85c66def16f765bd40a90ddaa69bcee7e340d9a7e1b07a9} (NFHS-4), women in India enter pregnancy in a nutritionally-deficient state, a prime reason for deficient nutrition of the child in the first 1,000 days. This results in the high incidence of underweight, wasting and stunting in childhood.

The government of India is implementing strategic, evidence-based interventions with a life-cycle approach for ensuring nutrition in the first 1,000 days by:
• Ensuring in-womb nutritional care,
• Promotion of infant and young child feeding (IYCF) practices in the first two years.

The GoI is implementing a comprehensive programme on anaemia prevention among children, adolescents, women in the reproductive age group, and pregnant and lactating women under Anaemia Mukt Bharat programme. Both, pre-conception and pregnancy periods are covered.

Macronutrients like proteins, carbohydrates and fats, in right quantities, along with adequate calories and balanced proportions, are important. Micronutrients include iron, calcium, copper, folate, zinc, iodine, certain fatty acids, vitamins (especially Vitamin B12, D and A); these are needed for neural system development, morphogenesis, myelination, cognitive functions, intelligence development, etc.

Dietary adequacy and diversity, based on locally-available food and food traditions/habits, are promoted through Supplementary Nutrition Programme for pregnant women, in order to ensure consumption of the main food groups and the micronutrients by inclusion of green leafy vegetables, fresh fruits, proteins. Dairy products, rich in calcium, ensure health of the mother and the foetus growing inside.

Promotion of IYCF practices in first two years of life:
• Initiation of breastfeeding within one hour of birth: Mother’s first yellow milk is vital for baby’s nutrition and protection against infection.
• Exclusive breastfeeding for first six month of life: Critical for growth and development in addition to emotional bonding and protective immunity from diseases.
• Timely introduction of complementary feeding at six month of age: Gradual introduction of solid food in addition to milk-feed when most babies have acquired skills to start complementary feeding.
• Age appropriate foods for children from six months to two years: The quality, quantity, frequency and hygiene, especially hand washing, practices are crucial factors.
• After infancy, babies start exercising increasing autonomy in selection of foods. Wide choice of nutritious foods need be offered to respect their autonomy and to encourage self -feeding behavior.

The way for ward: There is a need to develop a strategic, convergent action plan on nutrition-specific and sensitive areas by all stakeholders. There has to be advocacy for the development and enforcement of law, policies and guidelines on ensuring nutritional security. There is also a need to improving visibility, coverage and quality of the programmes, ensure community participation and involvement of Panchayati Raj Institutions (PRI) and facilitate operational research in existing programmes to find out the gaps and solutions. Replication and scaling up of evidence-based innovations and best practices further established on regional food and food habits are also needed. Apart from this, low coverage areas need to be mapped and strategic plans for these areas to improve the coverage have to be developed.

The economic return for investing in child nutrition always remains high. The cost-benefit ratio of investing in nutritional interventions in a child is estimated to be at 1:16, with a 10{b4bb8ddb70249670c85c66def16f765bd40a90ddaa69bcee7e340d9a7e1b07a9} compounded rate of return (IFPRI 2014).

It is time that we seriously take up issues concerning nutrition in the first 1,000 days.

The author is Additional commissioner
MoHFW