( November 02, 2019 )
It is a unique period of opportunity when the foundations of optimum health, growth, and neurodevelopment across the lifespan are established.
A third of women of reproductive age in India are undernourished, with a body mass index (BMI) of less than 18.5 kg/m2. It is well known that an undernourished mother inevitably gives birth to an undernourished baby, perpetuating an intergenerational cycle of undernutrition. This raises the question on the days and weeks following childbirth, the postnatal period, and how critical are they? Most maternal and infant deaths occur in the first month after birth, almost half of postnatal maternal deaths occur within the first 24 hours, and 66 per cent occur during the first week. In 2013, 2.8 million new-born died in their first month of life ─ 1 million of these new-born died on the first day.
The first 1,000 days of life is the time spanning roughly between conception and one’s second birthday. It is a unique period of opportunity when the foundations of optimum health, growth, and neurodevelopment across the lifespan are established. While the human brain continues to develop and change throughout life, the most rapid period of brain growth and its period of highest plasticity is in the last trimester of pregnancy and the first two years of life. While all nutrients are important for brain development and function, optimal overall brain development depends on providing sufficient quantities of key nutrients during specific sensitive time periods in these first 1,000 days. But the process of maternal care doesn’t start there.
As it has been seen that undernourished mothers give birth to undernourished babies, inevitably, their personal health and hygiene are of utmost importance, and Anaemia during pregnancy is one of the important factors associated with a number of maternal and foetal complications. It decreases the woman’s reserve to tolerate bleeding either during or after childbirth and makes prone to infections. Among the various causes of anaemia in women, iron deficiency is the most common cause, primarily due to their recurrent menstrual loss and secondary due to poor supply of iron in the diet.
The Government of India’s initiatives like ‘Accredited Social Health Activists’ (ASHAs) under the National Rural Health Mission (NRHM) in villages across the country, and Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) have played a vital role in improving maternal and newborn health in last decade.
The ASHA workers provide information to the community on determinants of health such as nutrition, basic sanitation and hygienic practices, healthy living and working conditions, information on existing health services and the need for timely utilisation of health & family welfare services. RMNCH+A strategy provides a strong platform for delivery of services across the entire continuum of care, ranging from community to various level of the health care system. With the implementation of such programmes, the country has shown real progress in tackling critical health issues for mothers and newborn babies. The progress can be clearly seen in states like Nagaland which recorded the lowest Infant Mortality Rate (IMR) of 7 in India, corresponding to that of Kuwait and Lebanon, followed by Goa (9) and Kerala (10). Close behind were Puducherry (11), Sikkim (12) and Manipur (12).
However, issues still persist and we have a long way ahead. To aid in tackling these issues, innovative ideas are the key. Mothers of infants need essential items like bempu temperature device, baby blanket, baby wrap and cap/socks are required to provide Thermal Care to prevent from Hypothermia. Similarly, hand sanitizer, bar soap, wipes, baby nail cutter, cotton roll and sanitary pads establish hygiene practices, and for diarrhoea management zinc and ORS (Oral Rehydration Solution) are vital. A kit, comprising of such items, in the hands of expecting mothers in underserved areas and raising awareness on right eating habits to up iron levels, will ensure that the mother and newborns are safe and healthy. The focus to hand them in Aspirational districts of 117 districts across all states low on the human development index prepared by Niti Aayog, will help in prevailing efforts.
A closer look also shows us that among Indian states, Madhya Pradesh recorded the most number of deaths of children younger than one (IMR 47) in 2017, followed by Assam (44) and Arunachal Pradesh (42). Madhya Pradesh’s IMR was equivalent to that of the West African country Niger’s, 80 per cent of whose land area lies in the Sahara Desert and which ranked the very last on the United Nations’ Human Development Index in 2018. A combination of innovative efforts and support of state governments to reach the most deserving community will enable efforts to materialise.
Such inventive additions will focus on the health of new mothers and help in reducing child mortality. Health and hygiene is an issue of cross-cutting importance and working with less privileged communities across the country is important. Through a number of initiatives, organisations can weave in behaviour change and give access to the necessary remedies community outreach model.