Pioneers of the first 1,000-day window of life

Addressing malnutrition is key to laying a solid foundation for human development. Optimal maternal nutrition and infant and young child feeding are the most effective set of interventions to reduce childhood death and illness, prevent malnutrition, determine cognitive development, and ultimately enable child productivity. adult life. Specifically, the first 1,000 days of life, i.e. from conception to the first two years of a child’s life, are critical as this phase presents a critical window of opportunity to ensure growth. , development, child survival and optimal health and nutrition throughout life. In fact, 80% of brain development takes place during the first 1,000 days of life.

To address the persistent and high burden of malnutrition, India has undertaken several policy and programmatic efforts including the flagship program, Prime Minister’s Comprehensive Holistic Food Program (POSHAN) Abhiyaan (launched in April 2018) under under the Ministry of Women and Child Development. (MWCD). Its overarching goal is to improve nutrition outcomes by focusing on capacity building, improving service delivery, community mobilization and engagement, use of technology, and inter-ministerial convergent planning and review. /interdepartmental. In addition, increased emphasis was placed on documenting coverage of interventions in the first 1,000 days, such as pregnancy registration, antenatal check-up and exclusive breastfeeding, compared to the situation in 2015- 2016.

Evidence-based interventions are essential

Evidence tells us that to bring about change in nutrition outcomes, evidence-based interventions must be delivered with coverage, continuity (in the first 1000 days of life and across distribution channels), intensity (multiple interactions), high quality and fairness. Women’s health and nutritional status, including weight and hemoglobin, age at conception, and levels of multiple micronutrients during the periconception period, are critical determinants of infant health. child.

The importance of preconception care, that is care before pregnancy, is recognized. In 2018, the Ministry of Health and Family Welfare worked with Maharashtra and UNICEF to introduce the first-ever primary health care innovation program aimed at promoting women’s health during the period of preconception, in Peth and Sinnar blocks of Nashik district, Maharashtra. During the program, which was completed in 27 months, it was found that promoting the health of adolescent girls and women not only promotes newborn health, but also prevents low birth weight, premature births and newborn deaths. Its success led it to be extended to several districts in the state.

All of these interventions are carried out to the last mile by the frontline workforce network: Accredited Social Health Activists (ASHA), Auxiliary Nurse Midwives (ANM) and Anganwadi Workers (AWW) ), which play a key role in empowering the community on health planning and action. In many geographic areas, they are the only point of access to basic nutrition and other health services. They are essential for promoting healthy practices, providing on-the-ground support and improving awareness.

In Uttar Pradesh

For example, during Poshan Pakhwdaa in March 2022, in a remote village in Uttar Pradesh, all families with children under the age of two were able to overcome age-old fears and misconceptions and have their children weighed at the anganwadi center after multiple and continuous efforts on the part of the AWW, supported by the supervisor. Mothers and other relatives such as grandmothers and also fathers have been enlightened about the benefits of regular weight measurement. Men, especially fathers, also play a very important role in ensuring maternal and newborn health (MNH). They can influence behaviors and good practices around MNH within their households and communities. Studies show that mothers are 1.5 times more likely to receive prenatal care in the first trimester when fathers are involved during pregnancy.

Back to the story. The AWW and the supervisor found support in the panchayat pradhan which had organized a community level meeting a day before the start of Poshan Pakhwada. All men, women, AWW, ASHA, teachers and community elders were involved in raising awareness of the benefits of weight measurement, early detection of malnourished children and ensuring the weighing of all eligible young children.

Read also: How to fight against malnutrition

Similarly, supervisors in a block in Unnao district (Uttar Pradesh) ensured that AWWs not only received growth monitoring devices but were also trained to measure and record body weight precisely. Community mobilization meetings to ensure coverage of all eligible children were also held.

These stories of change from Uttar Pradesh that were led by frontline workers and their supervisors resonate with the joint efforts of AWW and ASHA workers in a remote village on the Nepal border, who ensure regular weighing of each child each month to detect deficiencies early in growth. .

The impetus to strengthen the nutrition system focuses on regular skills, supportive supervision and motivation of frontline workers to deliver contextualized, targeted and quality nutrition and health services. These, along with data-driven reviews, should be prioritized and maintained at the program level. Because of their deep understanding of local issues and needs, their contribution to community health is far greater. It is crucial to empower our frontline workers who drive change at the last mile.

Dr. Dinesh Baswal is Lead MNCH and Chief of Party Saksham MNCH Accelerator supported by USAID (South Asia Hub). He is also a former Deputy Commissioner for Maternal Health, Department of Health and Family Welfare