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Why the first 1000 days are crucial for children all over the world

By Amy Cooper

From the start of pregnancy through to a child’s second birthday, the clock is ticking on a crucial window of opportunity: the first 1,000 days. We now know wellbeing, nutrition and care in this period of life, more than any other, has a profound impact on a future adult, their eventual children – and even wider society.

“Not a year goes by where we don’t learn more and more about the importance of the first 1000 days of a child’s life,” says Australian Medical Association president, Michael Gannon. “They are critical in setting up a human being for good health for the rest of their days.”

This window of opportunity exists for every baby, regardless of birthplace, background, race and religion. The challenge, especially in disadvantaged regions, is ensuring that this precious moment isn’t lost forever. While the effects of a good first 1000 days are transformative, the implications of a bad one are dire and, sadly, irreversible.


In the beginning

The first 1000 days begin at conception, and a mother’s health is key. She needs nutritious food with all the right micronutrients for optimum wellbeing for her and the baby, clean water, basic health services and health education. Optimum nutrition in the womb is essential to reduce the risk of disease in later life, and the fetus is at risk if the mother lacks essential nutrients for brain, bone and organ development.

Here in Australia, a mum-to-be can access a nationwide network of free resources, choosing from a range of public and private care options including midwives, doctors or obstetrician. She’ll receive regular health checks and guidance about pregnancy nutrition and lifestyle. She might be advised to take helpful supplements such as folate, her weight will be monitored and she’ll be encouraged to exercise regularly and eat good fresh food, stay hydrated and sleep well. She’ll have every reason to anticipate her baby’s first 1000 days will begin with a safe, happy pregnancy and birth – with available support if things don’t go to plan.

In other places, the story of a new life begins very differently.

“Fortunately we live in a part of the world where the expectation is that women will survive their birth, for a start,” says Gannon. “There are 40 countries where being pregnant, you literally take your life in your hands.”

Several of those countries are in East Africa, a region suffering a hunger crisis declared by the United Nations as the worst humanitarian crisis since World War II.

Here, news of a pregnancy can be far from happy. A woman in South Sudan, Kenya, Ethiopia, or Somalia is very likely to be one of 25.5 million East African people facing extreme food and water shortages, and her baby on course to join the region’s 850,000 critically malnourished children under the age of five.

She might have endured a devastating combination of physical hardship and emotional trauma, like Lomukuny, from Kenya’s Turkana County, where drought has robbed people of life’s basic necessities.

After cattle thieves stole her family’s livestock – their only food source – and killed her husband, Lomukuny and her four children under 12 are alone and desperate. To survive, the heavily pregnant mum, malnourished and sick, must take them all on a 30-kilometre walk to the nearest health clinic.

Her baby, Akusi, starts her first 1000 days with two strikes against her: a starving mother, and no father. She’s born severely malnourished and fails to thrive, but she’s one of the lucky ones pulled back from the brink by the clinic’s ready-to-use therapeutic food (RUTF) supplied by World Vision through the World Food Program. Without it, says World Vision nutritionist June Cherutich, “she would have died of dehydration or diarrhoea. Akusi would have just slept into death.”

Lomukuny is also given food. The family is safe for now, but their future is still unclear. Supplies of RUTF are low and the demand is overwhelming. There is also little relief for Lomukuny’s emotional trauma, which is just as problematic for young Akusi. A mother’s mental wellbeing is considered so crucial to a baby’s first 1000 days that in Australia, a new Federal Government initiative will provide all pregnant women with access to free mental health assessments during and after pregnancy from this November. “Healthy mothers who are functioning well are more likely to take good care of their babies,” says Gannon. Tragically, Lomukuny’s story is commonplace in her part of the world.

Mother’s milk

Breastfeeding in the first six months of life provides babies the perfect nutrition for healthy growth and brain development, and protection against life-threatening illnesses. Feeding isn’t always easy and in Australia, new mums may need support from midwives, doctors and lactation consultants to master the new skill. A breastfeeding Aussie mum will be advised to stay extremely well hydrated and boost her nutritious calorie intake by about 400-500 calories a day. Dietary variety, she’ll be told, will change the flavour of her milk and help prepare her baby for the introduction of solid food at six months.

In a South Sudan refugee reception centre, new mum Amandru and her baby Sumaya are struggling with breastfeeding. The little one constantly tries to suck, crying when she fails. Amandru has no milk. It’s been more than seven days since she was last able to breastfeed Sumaya.

The mother and her three children are among the 30 per cent of the country’s population severely malnourished by famine, and they have walked for four weeks to seek safety and food. They survived along the way by sharing just one handful of peanuts per day. Amandru is exhausted beyond speech, and hasn’t eaten nearly enough to make milk.

Across Kenya, Ethiopia and Somalia, the situation is equally critical. “The drought has seen a drastic rise in the number of children and mothers who don’t have enough to eat,” says nurse Muna Omar, who leads World Vision’s childhood nutrition programme in Somaliland. “Women are not producing enough breast milk to adequately provide for their children. It’s one of the reasons we’ve seen this malnutrition crisis.”


The immunity effect

A healthy mum’s disease-fighting antibodies transfer to her baby during pregnancy and remain in action for several months after birth. Breastfeeding adds another powerful and ‘bespoke’ level of protection, passing on a mother’s individual immunities to her baby, and Aussie mothers are educated to further shield their newborn’s delicate immune system with good hygiene habits. A nationwide free vaccination schedule protects against killers such as diphtheria, whooping cough and hepatitis B.

For new mums in drought-crippled Somalia, hygiene is often not an option. A lack of clean water supply precipitates outbreaks of deadly communicable diseases such as cholera and acute watery diarrhoea, and the little ones’ immune systems, weakened by malnutrition, can’t protect them. These diseases can wipe out a young family in weeks, and heavy seasonal rains spread the devastation. In the most recent figures reported by the World Health Organisation, 71,663 cases have been counted, including more than 1,098 deaths.


The future

With a healthy first 1000 days, any baby can hope to flourish and later pass the same gift to her own children, contributing to a bigger picture of ongoing nationwide health and prosperity.

For babies affected by malnutrition during that critical period, the future looks very different. They will grow up with permanent stunting, which means they’re smaller than well-nourished children and likely to battle irreversible cognitive and emotional challenges. These young people will be less prepared for the job market and earn lower wages than those without stunting.

With 40 per cent of children in sub-Saharan Africa growing up stunted by malnutrition, the wider implications for their homelands are troubling: reduced economic productivity due to a shortage of physically and mentally robust young people. Countries with high levels of malnutrition, trapped in a vicious cycle of hunger, struggle to prosper as disadvantages are passed from generation to generation.

In any country, those first 1000 days are precious. In the world’s hungriest regions, they’re priceless.



World Vision is working to save lives and create long-term change in communities affected by the East Africa hunger crisis. By sponsoring a child in East Africa, you can help relieve their suffering and help their communities become more resilient to disaster. 500 East African children are in critical need. Sponsor now.