Kate Etue, Director of Communications

There are currently 222 million women worldwide who want access to modern contraception but don't have any way to get it. We know that the healthy timing and spacing of pregnancy can improve the health of both mother and child, but did you realize there was a significant economic benefit to making contraception accessible to women living in extreme poverty? This short video by Population Action International summarizes the economic benefits beautifully.

Lucy Sullivan, Executive Director, 1,000 Days

Last week, 1,000 Days was honored to join with Hope Through Healing Hands and Senator Bill Frist to engage community leaders in Nashville in the effort to improve maternal and child nutrition. With leaders from the faith, business, and academic communities around the table, we examined the issue of poor nutrition around the world and in Tennessee, where one in four children are food-insecure. The gathering of diverse voices—united by their passion to help mothers and children throughout the world—was a unique opportunity to bring greater attention to the issue of poor nutrition early in life and discuss ways that churches, businesses, and individuals can make an impact. 

What became clear is that the importance of good nutrition, right from the start, is universal. Whether a baby is born in Nashville, Tennessee, or Nairobi, Kenya, every child needs basic nutritional building blocks to achieve healthy growth and brain development.   

Poor nutrition—whether measured as hunger, undernourishment, or obesity—is pervasive throughout the world.  Unfortunately, it is also all too pervasive in the US as well. 

As a result, poor nutrition is arguably this generation’s largest public health issue. Globally, nearly half of all childhood deaths worldwide are caused by malnutrition and 165 million children are permanently stunted as a result of chronic undernourishment, leaving them unable to reach their full potential to grow, learn and thrive. In the US, food insecurity and the epidemic of obesity are together fueling a burgeoning health crisis. In the US, about a quarter of preschool children ages 2-5 year are overweight or obese.

Ensuring that children get the right nutrition early in life is one of the most basic yet powerful things we can do to ensure healthier and more prosperous societies. 

There is strong scientific evidence that points to one moment when the quality of a person’s nutrition can shape the foundation of lifelong health and well-being.  It all starts in the first 1,000 days. The 1,000 days between a woman’s pregnancy and her child’s second year of life is a critical window of opportunity when nutrition serves as the foundational building block for a person’s intellectual development, growth and long-term health.  Research shows that a child that is well-nourished early in life is more likely to do better in school, earn more money as an adult and have a lower risk of illnesses such as diabetes and heart disease.  The effects of good nutrition early in life have been estimated to boost economic prosperity as much as 8 percent in terms of GDP gains. 

In this way, improving nutrition for mothers and children during the critical 1,000 day window is one of the most powerful tools we have to unlock greater human and economic potential and help break the cycle of poverty.  It is the reason why the 1,000 Days Partnership was formed and includes over 80 partners working to promote greater action and investment in maternal and young child nutrition.  While the 1,000 Days partnership has helped galvanize much-needed momentum to improve maternal and child nutrition globally, much remains to be done. 

There’s a simple way to get engaged in this conversation. Throughout the month of March, 1,000 Days is hosting an online “March for Nutrition” to raise awareness about the critical role of good nutrition for women and children everywhere. I invite you to join us by sharing your stories and insights on Facebook and Twitter and by following #March4Nutrition.

Kate Etue, Director of Communications

Our mission at the Faith-Based Coalition for Healthy Mothers and Children Worldwide is to create advocates for maternal health, infant and children’s health, and for the healthy timing and spacing of pregnancies for women in developing world. This includes mothers in Africa, India, Mongolia, Guatemala, and everywhere where moms and children are living in extreme poverty. Where 222 million women (mostly married) want access to contraception, but it’s simply not available where they live.

It’s hard for us in the United States to get outside of our own experience when we look at these issues. The debate about domestic healthcare rages on, and it’s difficult for us to separate this from international maternal health. But once we’re able to imagine a daily experience outside our own, the need for advocacy becomes crystal clear.

Photo (c) Unicef

In the country of Niger, for example, 75 percent of girls become child brides. Of course, this is the country that has the highest prevalence of child marriage, but the truth is that young girls—often around eleven years old—are regularly given in marriage across Africa and southeast Asia. When these girls marry, they’re often forced to leave school, stunting their intellectual development and their social growth. They've also frequently not been educated about reproduction, and their young bodies simply are not ready to become mothers, evidenced by the fact that a girl is 10-14 times more likely to die in childbirth if she has her children before the age of 18.

Or consider Beatrice Namulondo. She was 13 when first became a mother, and she had dreams of raising a small family of children. But at age 36 she’s now mother to 17, because she had no access to any kind of contraception. This is compounded by the fact that the women in her village told her timing and spacing her pregnancies to suit the life she dreamed of and to match what she was economically and emotionally prepared to care for would make her weak and unable to work her garden, when the exact opposite is the truth.

But good work is being done to turn the tide, and in countries like Ethiopia the maternal mortality rate is dropping, the country’s GDP is rising, and political leaders believe these things are intimately connected. With Ethiopia’s Health Extension Worker (HEW) program, women and children receive visits from the 38,000 HEWs like Miheret, who travel to hard-to-reach places (like Ethiopia’s border with South Sudan) to administer vaccines, test for diseases like diarrhea or pneumonia, and monitor the hygiene in the home. Women are given access to contraception and maternal care when they do choose to have children. The results are staggering—child mortality has been slashed in half, poverty rates are down, and twice as many children are in school.

If you want to learn what you can do to help more women get access to this kind of life-saving assistance, visit our Faith-Based Coalition for Health Mothers and Children Worldwide page and see what advocacy activities we’re involved in at the moment. Follow us on Twitter @HTHHglobal and on Facebook. We need you!

Jason Axt, MD

The next two weeks I found myself much better able to engage in the hospital system. Now I had learned the names of Benson, Mugo, Humphries all clinical officer or medical officer interns. It became my pleasure on night and weekend call to lead them through surgical triage or procedures. On subsequent calls I was able to help one of the medical officer interns through two chest tube placements. These patients had spontaneous pneumothoraces, but were not in extremis, thus I could take my time and coach the intern through the procedure. By the second placement, Mugo was able to anesthetize the patient appropriately, make the incision, and perform this life saving procedure. He remained a bit tentative, but I had seen vast improvement by this second time. These guys and gals are the front line of the Kenyan medical system, and are seeing patients in isolated places with no surgeons, or even residency trained physicians available. Teaching Mugo to place a chest tube well could benefit multiple Kenyan patients in the future.

We also had opportunity to entertain these learners in our home. We got to learn of some of the struggles they had to overcome. One resident commutes nearly an hour each morning and evening for the benefit of her family. Other interns come from extremely poor or difficult circumstances. The Kenyan health care system relies on these young men and women.

Another sad and challenging case that I encountered was that of D. He is 45 year old man who had been diagnosed with appendicitis over a month prior to my meeting him. He had been taken to theater for an appendectomy at an outlying hospital. When I met him he was post op day 2 and 3 from a second laparotomy for peritonitis and periappendiceal abscess. He had succus pouring from the lateral portion of a “hocky stick” incision. It seems he had been diagnosed with a post appendectomy abscess, and the medical officer (almost certainly not a surgeon) had encountered dense adhesions as he or she had attempted to drain this abscess. The operation had resulted in multiple enterotomies and now enterocutaneous (EC) fistulas. He likely had generalized peritonitis after his first operation or maybe at the time of his first operation. EC fistulas are difficult problems in the United States; here an EC fistula is devastating and likely fatal. We took him to theatre and did a diverting ostomy while closing or resecting the 5 enterotomies or anastomoses that had been left. We placed him on TPN – a rare and expensive resource here. We were unable to close his abdominal fascia, and settled for closing the skin.

He remains alive now 1 ½ weeks later. He remains on TPN after an episode of central line related sepsis and partial opening of his abdominal wound for infection. D. is an example of advanced surgical care done amidst quite austere and resource limited setting. He also is an example of a patient who would have fared much better with initial treatment by a well-trained surgeon. Simple ultrasound guided abscess drainage could have avoided this morbid procedure in this patient, but is available here in a limited fashion. D. remains very grateful for his care and is asking the hospital clergy and medical staff to pray with him and for him. Surgery in Kenya is far different from that at home. Learning to work and teach amidst the resource constraints here has been a stretching and eye opening experience.