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Madeleine M. Kunin Headshot

Women and Children's Lives Can Be Saved

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We know how to prevent the 900,000 maternal deaths that occur every year in the world. And one million babies could be saved each year if they had better nutrition and health care.

I learned this and much more while participating in a recent symposium on maternal and child health and nutrition in Emerging Markets at Oxford University. The focus was on Brazil, Russia, India and China.

We know that mothers' and children's deaths can be prevented because there has been remarkable progress doing so. Since 1990, mortality rates for children under five and mothers after childbirth have been cut by 50 percent -- by better nutrition, medical and technological advances and immunization.

It's been well known since the 18th century that optimal child growth is influence by nutrition of mother and child. Babies and young children, who fall below the norm, are labeled stunted. India alone has 17 percent of the world's poor children and 48 percent of those under five are stunted.

Low birth weight and stunting impacts obesity, diabetes, increased cardiovascular risk, and intelligence in later life. But we had thought that nature and nurture were two separate spheres, never to intersect. Not so. I learned a new term at the symposium: epigenetics. Environmental factors, like malnutrition and stress, can change gene expression.

Contrary to our assumptions, not all newborns reach the starting gate in the same condition. Some are small, and most are healthy, but many are not. They are at a disadvantage from the moment they take their first breath.

The question is: when is the best time to break the cycle of deprivation? We know that the first 1,000 days of a baby's life are critical. That is when there is a surge of growth that influences later health, physically, emotionally and mentally. But because we know that a young woman's eggs have been impacted by her environment, the best time to begin is 1,000 days before conception. A healthy adolescent is more likely to give birth later to a healthy baby.

There is hope. For example, one counter-intuitive fact is that there is more variation in height and weight within an ethnic group than among ethnic groups. In other words, given good nutrition, Chinese children will not be shorter than American or Scandinavian children.

There are two obstacles at either end of the spectrum. Malnutrition at one end, and obesity at the other. Obesity itself makes a child vulnerable to a vast array of health risks, similar to malnutrition. Counter-intuitive as it seems, a small, malnourished fetus can develop into an obese adult because the fetus stores up fat cells in self defense.

We simply can't afford to lose future citizens who would contribute to society. But above all, maternal and child health is a question of social justice. We have the ability to save lives in every corner of the world, including our own. There is no good reason not to do so.