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. 

The Ethiopian Orthodox Church (EOC) comprises 43.5% of the population, or almost half.  After that, Muslim communities make up 33.9% of the population. In the minority, Protestant denominations comprise 18.6%. And finally, there are a few other traditional religions at 2.6%, and Catholics at less than 1%. The EOC has a long, rich cultural history in Ethiopia. It was a part of the Coptic Orthodox Church until 1959 when it was granted its own patriarch. It is a hierarchical religion with archbishops and bishops worldwide.

In the Tigray region, there exist a host of monolithic churches, or churches hewn out of one single rock. There is a community of churches in Lalibela that are famous rock churches, but there are a few in Mekele as well. We visited one on the outskirts of town while there.

Perhaps most famously, in the town of Axum, The Chapel of the Tablet at the Church of Our Lady Mary of Zion claims to house the original Ark of the Covenant with the Ten Commandments as held by Moses.

In Mekele, we were able to visit with both an Eastern Orthodox Priest, Keshi Gebre Tsadkan, as well as staff from the St. Frumentius Abba Selama Kessate, Berhan Theological College Mekelle including Mr. Tesfaye Hadera, Dean; Mr. Mekonnen Tesfay, Vice Dean; and Mr. Assefa Reda’e, Bible for Development Coordinator.

Knowing that there are over 500,000 Ethiopian Orthodox Priests throughout the nation of Ethiopia, there is an embedded potential arm of the culture to support and educate citizens about access to health care. Before he died in 2012, the former Patriarch Abune Paulos urged Ethiopians to seek not only “holy water” to heal HIV/AIDS, but he also encouraged his followers to adhere to their regimen of anti-retroviral medications. This was a crucial message for people living with HIV/AIDS to seek proper care and treatment.

In the same way, priests serving as “godfathers” to families throughout the country have the opportunity to educate families about the importance of women’s health, antenatal care, and family planning. This being said, the situation is made complex by the current stigma that still surround issues of sexuality.  The statistics show little participation in pre-marital sex in Ethiopia, probably due to the average age of 16 for marriage for girls. Yet, girls typically marry older men who want children immediately. The gatekeepers of the community including ethnic leaders, mothers-in-law, and religious leaders tend to support the husband in the wish for families. Thus, the highest unmet need for contraception in the country is for young married girls between the ages of 15-19 at 30% as of 2011.

However, some priests are aiding in the destigmatization of family planning in their communities, such as Gebretsadkan. He shared that he goes with his wife to the Health Post to demonstrate his support for her choice of contraception. As a “godfather,” he advises many husbands and families on how to better time and space pregnancies, encouraging contraception, as a life saving mechanism in some cases.

When I asked about his theological position supporting family planning, he asked, is it not a sin to not be able to provide food, clean water, and clothing for your own children? To allow your children to suffer from hunger, malnutrition, and potential disease because you cannot support them? Isn’t it better to take advantage of the knowledge that family planning allows for healthier deliveries, births, newborns and children properly timed and spaced as well as a more stable family economically?

Similarly, in speaking with the Dean and Professors of the Seminary, they too argued that in fact Ethiopia had accomplished the request to “Be fruitful and multiply the earth,” as noted in Genesis. Now, it was time to rethink the health of mothers, children, and families with access to family planning.

The St. Frumentius Abba Selama Kessate, Berhan Theological College Mekelle partnered with UNFPA and Population Council to create a “Developmental Bible.” This book, printed in Amharic, held 365 different devotions with Scripture related to development and health issues. The Scripture correlated with issues such as HIV/AIDS, maternal and child health, infectious disease, hunger, malnutrition, and family planning.

These books are the basis of a “Developmental Bible” course at the Seminary for formal training of priests as well as an informal training for current priests through workshops. At the end of the training, they receive the books to use in their communities in devotion and worship. These Developmental Bibles have been disseminated throughout the nation.

Some argue that the religious leaders pose a barrier to family planning. Others contend that the support of religious leaders has been helpful from HIV/AIDS awareness and education to family planning. We conclude that due to the pastoral, rural nature of the country, that likely there is much work to be done to educate and encourage priests to urge their followers to seek information and services to improve maternal and child health, including family planning.

In every village, there is a priest or an imam or a pastor. If these religious leaders were incentivized to promote awareness and education of health care opportunities, like family planning, the religious communities could also be a powerful arm mobilizing the nation to achieve MDG5, improving maternal health.