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The Maternal Thread of Life

Mareeg.com-ISLAMABAD – Last month, Oxford University’s Green Templeton College held its annual
Emerging Markets Symposium at Egrove Park. The theme this year was “Maternal and
Child Health and Nutrition.” The final slide of the opening presentation, delivered
by GTC fellow Stephen Kennedy, was a cartoon depicting two young contestants set to
begin a race: one was strong and healthy, while the other was emaciated, shackled,
carrying the baggage of disease, and confronting the massive barrier of
malnutrition. The message was clear: not everyone begins life with the same chance
of success.

Of course, this is not a groundbreaking insight. The impact of factors like poverty,
maternal literacy, sanitation, and housing conditions on children’s health – and, in
turn, on social and economic outcomes – is well documented. The problem is that
these factors are not amenable to isolated public-health interventions. But another,
less widely discussed social determinant – maternal nutrition – could be.

Since Hippocrates, people have been discussing how “nature” and “nurture” interact
to shape a person’s development. Indeed, even in ancient civilizations, adequate
maternal nutrition was considered essential to ensuring future generations’ survival
and prosperity. But poverty and ignorance can thwart even the best intentions.

The consequences of maternal malnutrition are far-reaching, including higher
child-mortality rates, more birth defects, increased susceptibility to infection,
and specific nutritional deficiencies that can lock a child into a vicious cycle of
poor health early in life. Moreover, intrauterine malnutrition can increase the risk
of chronic conditions like obesity, diabetes, and cardiovascular disease during
adulthood.

It is telling that most of the symposium’s 47 participants – influential public- and
private-sector figures from around the world – were unaware of the extent to which a
mother’s nutrition affects her offspring’s wellbeing. They were surprised by
evidence that babies grow in the same way worldwide, as long as they receive the
same care and are not constrained by environmental factors – evidence that
challenged the widely held notion that ethnicity and gender are major determinants
of a child’s development.

This reflects a fundamental failing on the part of the scientific community to relay
relevant data to decision-makers. In fact, upon hearing the evidence, a former
Pakistani prime minister confessed that he would have been more proactive in this
area had he known while he was in office what he knows now.

The meeting’s participants agreed that strong efforts to support pre-conception care
in the context of maternal- and child-health services were vital. After all, if an
adequately nourished mother provides critical health benefits to her offspring
throughout their lives, women can be viewed as the custodians of future generations’
health.

These inter-generational biological connections are particularly pronounced in the
case of female children. The influence of the levels and composition of maternal
nutrition on a female fetus will carry through to adulthood, when she, too, becomes
a mother.

Given how few scientists have recognized the extent to which a woman’s eggs shape
her grandchildren’s prospects, it is not surprising that policymakers remain so
oblivious to the long-term impact of women’s health. But the evidence is clear, and
it demands action.

The good news is that there are solutions. Conditional cash transfers,
text-message-based initiatives, school-based food programs, vitamin-fortification
schemes, and local leadership have all proved effective in improving maternal
nutrition.

Such initiatives should be backed by policies that foster positive nutritional
choices. Compelling policymakers to implement such policies will require a new set
of skills that draws upon lessons from around the world. In Brazil, a television
program on the role that folic-acid supplementation could play in the prevention of
spina bifida (a congenital neural tube defect) immediately grabbed politicians’
attention.

Initiatives aimed at enhancing the public’s knowledge of nutrition are also crucial
– not least because they can motivate citizens to pressure their governments to take
action. To this end, entertainment media like soap operas, which have emerged as
important tools for empowering women in conservative Middle Eastern societies, could
be employed.

Forums like the Emerging Market Symposium can help to bridge the increasingly
obvious gap between science and public policy. But, without strong domestic support
for change, the impact of such meetings is limited. It is time to demand action –
and past time for policymakers to deliver it.

Sania Nishtar is the founder of Heartfile.

Project Syndicate

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