The missing focus on women’s health in the ‘First 1,000 days’ approach to nutrition

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Research snapshot¹

The First 1,000 Days approach emphasises the time between conception and a child’s second birthday as a critical period where adequate nutrition is essential for subsequent healthy growth and development throughout the child’s life. Based on a review of the relevant literature, this commentary explores the First 1,000 Days approach with a maternal lens.

The focus of nutrition-specific and nutrition-sensitive interventions within the first 1,000 days is on child health benefits with very little attention given to maternal nutritional status and health outcomes. Interventions indirectly place emphasis on mothers through interventions to strengthen their nutritional status during pregnancy and lactation, for example, through vitamin and mineral supplementation and multiple micronutrient (MMN) supplementation to reduce the risk of low birthweight (LBW) infants.

However, women’s health indicators are rarely tracked and measured. As an example, the authors highlight a 2017 Cochrane review of MMN supplementation for women during pregnancy which included 16 trials that reported the effects on preterm births and LBW and 15 trials that reported small-for-gestational-age but only five trials that reported maternal anaemia, four trials reporting caesarean section rates, three that reported maternal mortality rates and one trial that reported pre-eclampsia. Other maternal health outcomes (placental abruption, premature rupture of membranes, maternal wellbeing or satisfaction) were not reported by any of the trials. This represents a measurement gap in the evidence base, particularly in health outcomes for women.

The gap in knowledge of the effect of maternal nutrition interventions on women themselves perpetuates the lack of prioritisation and research in this area. Nutritional interventions within the First 1,000 Days approach have not had the expected magnitude of effects on reducing childhood stunting and potentially the lack of attention given to the nutritional status of women has been a contributing factor to this. The authors conclude that there is a need to understand the processes of entrenching poverty and malnutrition between inadequacies in maternal diet, adverse health outcomes for women and contextual factors, with mothers at the centre. 

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