Month: May 2019

Transforming How We Advocate for Women’s Nutrition

1,000 Days was born in 2010 out of ground-breaking scientific evidence that found there was a brief but powerful window of opportunity from a woman’s pregnancy to a child’s 2nd birthday to enhance the development and long-term health of individuals and societies. The research showed that investing in proven, cost-effective nutrition interventions in that first 1,000 days can lead to lower child and maternal mortality and healthier moms and babies.

Our organization set out to raise awareness of these findings and focus on improving policies and increasing much-needed resources for nutrition in the 1,000-day window. Research continues to prove that early investments in nutrition provide the foundation for children to develop to their full potential, setting them up for later success in school and the workforce, and reducing a child’s predisposition to obesity and other illnesses later in life.

But here’s something we’ve noticed over the years: at times, the nutrition community has so ardently celebrated the amazing potential impact of investments in the first 1,000 days that discussions of a woman’s nutrition have tended to narrowly focus on the impact her nutrition has on her newborn child. A woman plays an incredibly important and indisputable role in the health and development of her child – but all too often, a woman’s own right to long-term health and nutrition is overlooked.

Nutrition as a step toward gender equality

Women and girls often struggle to access adequate nutrition due to their status in a society.  In fact, they represent 60% of all undernourished people in the world and a recent analysis by UN Women found that two thirds of countries report higher rates of food insecurity for women compared to men. On top of that, women and adolescent girls have special nutritional needs tied to their reproductive health and menstruation. Today, it is estimated that more than one billion women and girls do not have access to the adequate nutrition and healthy diets they need to survive and thrive.

This inequity has deep consequences because investing in a woman’s nutrition not only helps her deliver a healthy baby, it is a basic right for women everywhere to lead healthy and productive lives and in turn, these investments support gender equality. We know that the right nutrition is part of the fight for gender equality because of the impact it has in three key areas—her health, her education and her ability to earn an income:

  • Her health: Proper nutrition during the 1,000-day window can have a significant impact on the health and well-being of a woman. This is especially pertinent during and after pregnancy, a critical period in women’s lives, especially since maternal mortality is still a leading cause of death in low resource settings. Additionally, breastfeeding, which nutrition programming helps promote, protect, and support, is associated with lower risk of heart disease – the leading cause of death among women in the U.S. – as well as breast cancer, ovarian cancer and Type-2 diabetes later in life. There are also benefits beyond the 1000-day window. Women who are well nourished are less susceptible to infectious diseases such as HIV/AIDS, malaria and tuberculosis, and have a lower prevalence of diet-related non-communicable diseases such as diabetes and cardiovascular disease.
  • Her education: An education is key for girls seeking a better future, and one of the most critical investments in a gender equal world. Each year of schooling increases a woman’s earnings by as much as 10-20%, moving many women towards achieving financial independence and closing the gender-based earning gap. While gender disparities in school enrollment have multiple causes, malnutrition and food insecurity can also play a role. In low income countries, the promise of at least one meal provided at school can motivate parents to choose to prioritize education over staying home to work or care for other family members. Further, well-nourished girls are more likely to perform better in school and reach higher levels of education. In India, for example, girls who received school meals showed a 30% higher chance of completing primary school.
  • Her earning potential: And finally, improving nutrition helps increase women’s earning potential. It is well-known that children who are well-nourished in the 1000-day window are more likely to learn better in school and have higher paying jobs – earning 25% more than those without proper nutrients early in life. Proper nutrition can also have an outsized effect on adult women. Eliminating anemia alone could increase adult productivity by up to 17%, helping break the cycle of poverty and malnutrition for the next generation.

We must do more

Many of these returns from nutrition investments on health, education, and earning potential are not unique to women. Good nutrition is fundamental to every person’s ability to live a healthy, productive life. But it is time we acknowledge that gender equality itself is further advanced when women and girls get the nutrition they need, and that a woman’s all-too-often diminished role in society negatively impacts her ability to be well-nourished. We need programs and policies that support all the ways that nutrition helps women achieve what they want – whether it’s a healthy body, high marks in school, or a high-powered career. The focus on women’s nutritional needs has been predominantly oriented towards ensuring that she can provide the best health outcomes for her child, but ensuring women have access to proper nutrition can do even more – it can help her grow her power. We need to start focusing more attention on ensuring that women have access to the right nutrition at every stage of a woman’s life if we want to make a meaningful impact on gender equality.

The State of Moms and Babies

Earlier in May, 1,000 Days hosted a Congressional briefing on the importance of health and nutrition for mothers, babies and young children in the United States and around the world. We were fortunate to work with the Congressional Maternity Care Caucus and the Congressional Baby Caucus on the event. 

To an audience that included staff from Congressional offices, partner organizations and the administration, Members of Congress and panelists spoke about the need to invest and prioritize the well-being of women and children especially during the critical 1,000-day window.  


  • Congresswoman Rosa DeLauro (D-CT) kicked the event off discussing her role as Chairwoman of the Labor, Health and Human Services and Education Appropriations subcommittee, which provides funding for many programs that support moms and young children. As a leader in Congress on issues critical to women, young children and working families, DeLauro spoke to the need to strengthen programs like WIC and invest in maternal and child health services.  
  • Congresswoman Lucille Roybal-Allard (D-CA) told the audience that improving the health outcomes of moms and babies must be a priority in our communities and the halls of Congress. She relayed her efforts to address health inequities in the U.S., including introducing the Newborn Screening Reauthorization Act. Her bill will help expand comprehensive newborn screening programs to identify health conditions early.  
  • Lucy Sullivan, Executive Director of 1,000 Days, moderated the event and provided the audience with an overview of why the first 1,000 days is such a critical time period with a particular focus on how addressing issues like maternal mortality, food insecurity and child stunting begins with strong investments and prioritizing policies that support the health of mothers and young children.
  • Dr. Nicholas Alipui provided the overarching context to why this time period is so foundational to both a child’s development, but also to the ability for communities to thrive. His presentation highlighted for the audience how nutrition impacts a child’s early development and how integrated programs focused on the first thousand days can improve the health of children and communities.
  • Dr. Jessica Nash of Children’s National was the final speaker. She relayed her experience as a pediatrician in Washington D.C. and the barriers her patients and their families face. Highlighting issues from toxic stress, infant mortality and health inequities, Dr. Nash left the audience with an awareness of how these issues impact communities across the U.S., including right here in Washington DC stating “If we are using infant mortality as an indicator of population health, we have some work to do.”

We were honored to host a group of strong advocates who work to support the health of moms and babies and we will continue to engage with policymakers urging them to prioritize brighter futures starting with the first thousand days. 

What All Moms Need This Mother’s Day

With Mother’s Day around the corner, here at 1,000 Days we’ve been thinking about what moms really need. At the top of our list:

  • Quality, affordable health care
  • Time to care for themselves and their babies
  • Good nutrition from healthy foods
  • Support from the community

We’d like to highlight one of these priorities – quality, affordable health care – and the key role that it plays for moms everywhere.

The Importance of Quality, Affordable Health Care

Comprehensive health care is foundational to a woman’s health and well-being before, during and after pregnancy. All women need access to prenatal care, skilled care during childbirth, and care and support in the weeks and months after childbirth. However, too many moms are not getting the care they need. About 6% of women in America receive late or no prenatal care, and as many as 40% of women do not attend a postpartum visit (with lower rates among women with limited resources). In low-income countries around the world, close to two-thirds of pregnant women miss out on the recommended prenatal care visits.

Gaps in access to care or poor quality of care can have tragic consequences. Across the globe, approximately 800 women die from preventable causes related to pregnancy and childbirth every day. In the United States, an estimated 700 women die from these causes each year, and some women are more likely to die than others. The disparities in maternal death are striking, with black women dying at more than 3 times the rate of white women.

The good news is that many maternal deaths can be prevented. Recent data from the Centers for Disease Control and Prevention (CDC) indicate that approximately 3 in 5 pregnancy-related deaths in America are preventable – no matter a woman’s race/ethnicity or whether the death occurs during pregnancy, delivery, or after birth.

Globally, there is a recognition that greater attention to maternal mortality is urgently needed – and nutrition must be part of that discussion. Of the 5 pregnancy complications that account for nearly 75% of all maternal deaths, 3 are related to nutrition (severe bleeding, pre-eclampsia, premature labor) and their risk can be mitigated with better nutrition. It’s critical to strengthen health systems and ensure they are providing women with high impact nutrition interventions before, during and after pregnancy, including multiple micronutrient supplements, diet and nutrition counseling, as well as breastfeeding counseling and support.

In the U.S. and around the globe, we need to do more to ensure that no mother’s life is cut short due to preventable causes.

Advancing a Vision for a Healthier First 1,000 Days

Here at 1,000 Days, we are fighting to make sure all moms get what they need to thrive. One critical part of this is working to increase investments in women’s preconception, prenatal, and postpartum health, with a focus on the most disadvantaged. We believe that every woman should have access to comprehensive health coverage and benefits – no matter who she is or where she lives.

On Mother’s Day and every day, all moms deserve a healthy first 1,000 days. Let’s honor all of the moms in our lives by giving them what they need: quality, affordable health care.

Preventing Surprise Medical Bills During the First 1,000 Days

Few issues can bring the White House, Congress and health care advocates together. But one issue is increasingly receiving strong, bipartisan support: tackling surprise medical bills. This is good news for moms, babies and their families.

What are surprise medical bills?

A surprise medical bill comes when a patient receives services from an out-of-network provider, often through no fault of their own.

Most health plans have a network of health care providers, and it’s cheaper for a patient to use in-network providers. If a patient choses an out-of-network provider, they are responsible for much higher out-of-pocket costs. Some patients will choose to use an out-of-network provider—for example, due to location or because the provider is preferred. When the patient makes the choice to use the out-of-network provider, they do so understanding that they will pay more.

But sometimes, a patient receives a service from an out-of-network provider without realizing it or without consenting. During a health care visit—particularly in a hospital-based setting—multiple health care providers may treat patients, and some of these providers might not be in-network. In this case, patients get treatment from an out-of-network provider through no fault of their own but are still responsible for the higher costs.

How can surprise medical bills affect families during the first 1,000 days?

Many families receive surprise medical bills after childbirth. For example, a woman may choose to deliver her baby at an in-network hospital with an in-network OB-GYN. During her delivery, an anesthesiologist, who is a critical part of the care team, may serve her. But, if the anesthesiologist is out-of-network, the woman will be responsible for the costs of those services.

Sadly, this is a common occurrence. A recent study found that 11% of mothers experienced a surprise out-of-network bill with their first delivery. Not only do those mothers face high and unexpected costs, but they are also more likely to switch from their preferred hospital after receiving a surprise bill.

Whether a patient unknowingly receives the services of an out-of-network anesthesiologist during childbirth or ends up in an out-of-network emergency room during a medical crisis, families shouldn’t have to bear the outrageous costs of out-of-network bills.

What is being done to solve the problem?

Part of a comprehensive solution is up-front transparency about what a patient will pay for the total cost of care. But that’s not enough. Patients should be held harmless from surprise bills and should never have to pay more than their normal in-network cost-sharing requirement for a service.

Many states have worked to address surprise medical bills, and some states have meaningful protections. But most states do not have comprehensive protections against surprise billing, and there is no national policy to protect consumers. This needs to change.

The President and Congressional Leaders have expressed an interest in passing legislation to address surprise medical bills. 1,000 Days urges policymakers to move quickly to ensure that during recovery from childbirth or other medical situations, no one receives a surprise medical bill.

My Time at 1,000 Days Exploring Maternal Health and Nutrition

My passion for maternal health and nutrition began when I volunteered as a local community nutritionist and maternal advocate with the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) program serving women in Palestinian refugee camps. It continued when I set up a clinic to address maternal nutrition, translating the science of nutrition into understandable information about food before, during, and after pregnancy. Today, I am serving as a Global Policy and Advocacy Program Associate Fellow with 1,000 Days.

In this role, I have had wide exposure to issues related to women’s health and nutrition and I found it both important and interesting to learn more about what is still of huge concern in the world of maternal health: maternal mortality. Maternal death can happen while a woman is pregnant, during labor and delivery, or in the 42 days after childbirth or the termination of pregnancy.

Who’s at risk?
Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth with 99% of all maternal deaths occurring in developing countries. While it’s much safer to have a baby today than in the past, it’s still not safe for everyone. Not every woman has access to or can afford regular prenatal care, good nutrition and a skilled health practitioner at her delivery. At the same time, age, race, and the location where you deliver can unfairly determine your chance of survival. See the top 10 countries with the highest maternal mortality rates.

Why Do Women Die?
Poor nutrition before, during and after pregnancy can increase a woman’s risk for complications. Of the five pregnancy complications that account for nearly 75% of all maternal deaths, three are related to nutrition.

1. Severe bleeding (Mostly Postpartum Hemorrhage – PPH)
Every year about 14 million women around the world suffer from PPH. And is not only associated with nearly one quarter of all maternal deaths globally but is also the leading cause of maternal mortality in most low-income countries.

An anemic pregnant woman has a higher risk of experiencing PPH. During pregnancy, the risk of iron deficiency anemia increases as a woman’s body needs to provide nutrients for herself and her child. In fact, anemia still affects 40% of pregnant women worldwide. Interventions that increase iron uptake and stores such as oral iron pills, prenatal vitamins, and diet rich in iron and folic acid such as (leafy veggies, meat and poultry, eggs, etc.) reduce blood loss and infection, and address other micronutrient deficiencies could prevent at least half of all anemia cases.

2. High blood pressure during pregnancy (Pre-eclampsia and Eclampsia )
Eclampsia begins in the placenta, the organ that nourishes the fetus throughout pregnancy and can pose a serious health risk for a woman and her child. Early in pregnancy, new blood vessels develop and evolve to efficiently send blood to the baby through the placenta, but sometimes those blood vessels do not form properly and can cause serious health complications. While causes of eclampsia vary, inadequate diet can further increase a woman’s risk. In populations with low dietary calcium intake WHO recommends a daily calcium supplementation (1.5 g–2.0 g oral elemental calcium) for pregnant women to reduce the risk of pre-eclampsia.

3. Premature labor and Complications from delivery.
Premature labor also has varied causes, including an abnormally low blood volume. This can be prevented with a well-balanced diet rich in a variety of macro- and micronutrients and could significantly decrease premature labors. In addition, there are several promising interventions such as calcium supplementation in women with low calcium intake, iron, zinc, magnesium, and fish oil supplementation.

Key takeaways:
Linking global maternal mortality and nutrition is a clear yet missed opportunity in solving this issue. Advocates must continue to push for:

  • Scaling up high impact nutrition interventions, especially by reducing anemia and addressing calcium deficiencies. Integrating these nutrition-specific interventions into maternal and child health programs should be a priority.
  • A focus on girls and women at all stages of life. There is a need for a much more proactive approach that does not focus solely on women’s nutrition during pregnancy. Good health and nutrition throughout a woman’s life allows her to thrive – and is the key to a healthy pregnancy.
  • The need to extend and strengthen data collection and analysis for women’s nutrition. While more data is important, it is also important to better utilize and analyze existing nutrition data to further understand the relationship between malnutrition and pregnancy complications. Only by doing so we will be better positioned to respond to the needs and priorities of women and girls.
  • A holistic approach that focuses on the importance of delivering good quality care for all. Nutrition outcomes are also improved by integrating water, sanitation, and hygiene (WASH) and other nutrition-sensitive interventions.

As for you readers, you too can join the fight, by lending support to organizations like 1,000 Days that are working to enact lifesaving efforts for nutrition. Although my journey as a fellow with 1,000 Days is coming to an end, I know that a great journey based on the experience I gained here is still ahead of me! I feel privileged to have spent almost a year working with this awesome team of advocates that are fighting for every mom and baby around the world.