January 26, 2023

By: Dr. Justine Kavle and Mr. Joseph Gaithuma

Originally published by Maternal Health Task Force. 

Why is the 1,000-day window critical for nutrition, health & well-being for women & children?

The first 1,000 days refers to the period from conception until 2 years of age- a period of rapid growth and development for children. Ensuring mothers & infants are well-nourished during this window of opportunity has a profound impact on a child’s ability to grow, develop, learn and thrive. The Dietary Guidelines for Americans, 2020–2025 encouragingly focuses on the 1,000-day window, for the first time, with federal recommendations on dietary intake for pregnant, lactating women, infants and toddlers in the United States (US).

Why is maternal nutrition important in the United States? What are the key issues?

Maternal mortality rates in the US are among the highest among high-income countries and point to glaring racial and ethnic disparities. Healthy eating during pregnancy and postpartum is a cornerstone of maternal health, positive birth outcomes and helps meet women’s nutritional needs during breastfeeding – yet there are gaps in women’s and providers’ knowledge and practice that need to be addressed in programs and policy in the US. Experiences from the global health community can lend insight into ensuring quality maternal health services in the US, including the areas of medical education, counseling on maternal nutrition and pregnancy weight gain, and community engagement. Reflections from our paper in the American Journal of Public Health special series “Opportunities to Strengthen Women’s Nutrition Within Maternal Health Service Delivery: Reflections From Global Health Implementation” highlights four considerations for women’s nutrition across the continuum of care (pregnancy, childbirth, and the postnatal period) in the US:

1. Better Integrate Nutrition Within Pre-service Curricula and Continuing Medical Education Ensuring medical school graduates have appropriate evidence-based training via alternative learning models such as in-site and virtual modalities is critical. Equipping health providers with knowledge, skillsets, and continuing education can help motivate providers and improve the quality of nutrition-health services delivered to women, as in Guatemala’s Diplomado, a maternal and child nutrition course.
2. Strengthen Maternal Nutrition Counseling as Part of Routine Preventive Care Recent data show that 10% to 43% of US pregnant women have inadequate dietary intakes of iron, folate, vitamins A, D, E, and calcium. Moreover, health provider advice on diet, weight gain, and physical activity during pregnancy is often too generalized or vague. More attention is needed on the training and application of  WHO Antenatal Care (ANC) guidelinesand Quality of Care Standards to improve counseling content and quality delivered through a cultural, racial/ethnic, and socioeconomic inequities lens.
3. Ensure Quality Counseling on Pregnancy Weight Gain Weight gain counseling is often not delivered with the desired quality and/or consistency. Advice is often targeted to overweight & obese pregnant women, while women who are black or socioeconomically disadvantaged are less likely to receive weight gain information. Equipping health providers with skills to respectfully discuss weight gain progress achieved during ANC in relation to pre-pregnancy body mass index, dietary intake and physical activity is needed.
4. Engage women and their communities Consider women’s groups and participatory strategies which provide social support for dietary diversity and breastfeeding. Community doula programs can also foster linkages with local champions at partner hospitals and provide peer-to-peer doula mentorship.

How does the series build up on the White House Strategy on Health and Nutrition?

The American Journal of Public Health special series provides evidence to propel the whole society approach delineated in the White House Conference on Hunger, Nutrition and Health. This requires meaningful engagement from public health nutritionists, community-based organizations, and academic institutions to equip health providers with skillsets to provide culturally congruent care, counselling, and support for women’s nutrition in the US.

What actions should be taken moving forward regarding women’s nutrition in the US?

Here are three ways to address women’s nutrition in the US:

• Tailor maternal nutrition counselling to Black, Indigenous Communities of Color that lack exposure or access to action-oriented, culturally resonant nutrition advice
• Engage public health nutritionists, community-based organizations, and academic institutions to equip health providers with skillsets to provide culturally congruent care counselling and support for women’s nutrition- a whole society approach
• Conjoin efforts on maternal nutrition with breastfeeding/baby-friendly hospital initiatives (BFHI), community doula /outreach programs to improve quality ANC and PNC

Visit our Kavle Consulting, LLC web page for more information on our work & research around nutrition program implementation.

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