Mother and child health:
The child’s first 1000 days (approximately from conception to the second birthday) are very crucial for the baby’s healthy growth and development. This period is important for the development of the body, brain, metabolism, and immune system. The brain of the child develops in the first 1000 days. Children’s brains can create thousands of new neural connections every second during this period. Achieving mental and physical health is a lifetime foundation. Insufficient nutrition in the first thousand days will lead to irreparable damage to a child’s developing brain and body. The health and proper nutrition of the mother during the first trimester will impact these thousand days for the child’s growth and development. Several nutrients are important for the pregnancy-induced growth of the brain. These are specific lipids, protein, folate, zinc, iodine, iron, and copper. The children receiving proper nutrition in this period are likely to be born healthy. They have a reduced risk of developing illnesses and disorders such as obesity and type 2 diabetes. Post-birth, the child gets its nutrition from the mother through breastfeeding. Therefore, the undernutrition of the mother, not only affect her but also the offspring.
Women’s nutrition matters:
The above discussion underscores the importance of Mother’s nutrition. Securing a proper, nutritious, safe, and affordable diet is fundamental to a woman’s health, survival, and well-being. This should be thorough in all the stages like adolescence, preconception, pregnancy, and breastfeeding. For the rapid physical growth and development of adolescents, there is a requirement for a high amount of protein, micronutrients, and energy. Prior to pregnancy, women need nutritious diets to protect their health and to have sufficient reserves to protect pregnancy. During pregnancy, there is an increased need for an extra 300 Kcal / day. There is an extra need for dietary requirements to support foetus growth and development. The need for nutrients, like protein, vitamins and minerals such as folate, iron, and calcium, is also increased. For lactating mothers, in addition to a nutritious diet extra energy needs of 640 Kcal /day exclusively for women who are breastfeeding.
Despite understanding the need for good nutrition amongst women, there is a prevalence of all types of malnutrition affecting millions of women globally. This includes underweight, short stature, anaemia and overweight. Globally 170 million (9.1%) are underweight, and 610 million (32.5%) are overweight. Overweight or obesity has increased over the last three decades. 7% of women in low- and middle-income countries are of short stature, which is a consequence of malnutrition. There is a deficiency of key micronutrients like iron, folate, vitamin B12 and D, iodine, and zinc. This is regardless of whether they are underweight, overweight, or normal weight. Anaemia affects less than one-third or 571 million women globally.
Consequences of malnutrition:
All sorts of malnutrition have serious consequences on women’s health and well-being. Underweight and overweight women face the risk of gestational diabetes, hypertension, preeclampsia, caesarean section, and poor pregnancy and breastfeeding outcomes. Underweight or overweight mothers may lead to small for gestational age (SGA) or large for gestational (LGA) age births. SGA children are those whose birth weight is less than 10% of the weight of their gestational age mates. Among many reasons, the main cause is malnourished mothers during pregnancy. LGA baby is a new-born who weighs more than 90% of the new-borns of the same gestational age at birth. The main cause for this may be the mother has diabetes or is obese. Maternal malnutrition may result in Low-Birth-Weight babies (LBW). Each year 20 million LBW babies are born. Malnutrition before and during pregnancy can result in stunting, wasting and micronutrient deficiencies in babies. This may lead to negative consequences like impaired growth and development and learning readiness in childhood to chronic diseases in adulthood. Deficiencies in essential vitamins and minerals like iron, iodine, and Calcium may lead to miscarriage, stillbirths, LBW, congenital defects, infant mortality, impaired cognitive development, and cardiometabolic risks in adult life. Pregnant adolescent girls, the majority of whom are from low- and middle-income countries have special needs. They face malnutrition because they are still growing, and they have difficulty accessing nutritious foods because of unkind cultural / gender norms.
Causes of poor nutrition in women:
This is because of a variety of factors including the limited availability of safe, affordable, and nutritious foods. Also limited access to nutrition services, limited knowledge of pre-natal nutrition care and harmful gender norms are some other factors. All over the world, women’s diets are lacking in diversity with limited intake of vegetables, dairy, meat, and fruits. This problem is not unique to low- and middle-income countries; it exists in High-Income-Counties too. The diets are deficient in folate, iron, and vitamin D. Latest trend of switching over from home-cooked food to ready-to-eat foods has resulted in their own problems with nutrition. Poor health, water, and sanitation services lead to infection and disease for women and children. Meagre access to health care practices at household, community and societal levels also leads to poor nutrition.
Our country has its typical unique issues and problems. As discussed, earlier energy needs of pregnant and lactating mothers are higher because of the deposition of tissue and secretion of milk. The ICMR’s RDA is higher than recommended by WHO/FAO/UNO for energy needs. Basal Metabolic Rate (BMR) is 5% lower than that of WHO/FAO/UNO. The reasons are undernutrition with low body weight and low mass index, Lower protein turnover, and Differences in the proportion of muscle and viscera. Additional energy requirements during pregnancy and lactation are the same in ICMR and WHO recommendations, which is 300 Kcal in pregnancy and an average of 500 Kcal in lactation. Upper-income group women have less physical activity during pregnancy and have a daily consumption of 2000 – 2500 Kcal per day. This is similar to that of developed countries. Daily energy intake in the low-income group in urban and rural areas is between 1200 -1600 Kcal. However, low-income group women in urban areas still do household work and moderate activity and remain active during pregnancy. Women in rural areas spend more energy on household chores like fetching water or firewood from distance, and also if required need to work on farms. Therefore, there is no deterioration of their maternal nutritional status.
Rural women form a major workforce for socio-economic reasons in our country and cannot be stopped working during pregnancy. Therefore, in order to meet the energy gap and nutrition needs they will have to be given Food Supplements. This is given through Aanganwadis. Studies on supplementation reveal positive outcomes during pregnancy like improvement in birth weight and reduction in prematurity rate. The problem of middle and higher income is different. They have knowledge about nutrition through reading and mass media. They have good antenatal care. They eat traditionally recommended energy-rich foods as well as modern balanced nutritional foods. With less physical activity, they have excessive weight gain at the end of pregnancy and lactation. Subsequent efforts to reduce weight are futile. With this afterwards, they face other health problems.
Women’s health and nutrition at all the stages viz. adolescence, pregnancy, and lactation is very important. Their status of health decides the health of their children. Good health and development of a child make him grow as a healthy adult.