The maternal thread of life

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 and President of the NGO think tank Heartfile. Copyright: Project Syndicate.