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New Series in the American Journal of Public Health Identifies 1,000-Day Window as Untapped Potential to Improve Health of Families

Opportunities, Challenges Identified for Pregnant People and Babies 0-2

(WASHINGTON D.C.) Over the last two decades, science has shown that the 1,000-day window, the time between a pregnancy and the baby’s second birthday, is most critical for brain development and when good nutrition has the greatest influence on future health. Today, on the heels of the first White House Conference on Hunger, Nutrition, and Health in more than 50 years, The American Journal of Public Health released a special series that identifies opportunities to unlock the untapped potential of this critical time by closing data gaps, enhancing promising programs, strengthening policies and uniting around this powerful window of growth.

“Prioritizing the health of babies, younger children, and mothers will reap significant returns on investment, setting the foundation for the health of our nation,” said Ambassador Susan Rice, White House Domestic Policy Advisor, in one of the editorials in the series. “Everyone has a role to play—the private sector; state, local, tribal, and territory governments; civil society; academia; philanthropy; and other partners.”

The 70-page series with more than 15 authors outlines the role of Early Childcare and Education (ECE) settings to strengthen overall support systems for low-income families and influence the healthy growth and development of children; how to improve breastfeeding outcomes without leaving anyone behind; new analysis on COVID’s impact for people who gave birth during the height of the pandemic; investments needed to achieve nutrition security; and new opportunities for pediatricians to better support families in their care with nutrition advice and access.

“This special issue sets the stage for what we know about nutrition in the first 1,000 days in the U.S. and what is needed to move forward. Unfortunately, nutritious foods are not uniformly and equally available to all. This has unique relevance to the first 1,000 days as inequities in childhood growth and development due to poor nutrition can have long-term effects on cognitive development and health throughout that child’s life,” said Dr. Ruth Petersen, MD, MPH, Director of the Division of Nutrition, Physical Activity and Obesity at the Centers for Disease Control and Prevention (CDC), guest editor of the series and an author (R. Petersen).  The series identifies:

  • Gaps in data of nutrition status and eating behaviors through pregnancy, infancy and toddlerhood (H. Hamner), including micronutrient deficiencies such as iron status, which leaves women vulnerable to poor maternal outcomes (M.E. Jefferds).
  • Steps to improve nutrition of pregnant people, including how to realize the potential benefits of breastfeeding so no one is left behind (R. Perez-Escamilla).
  • Impacts of early disparities from historically underserved communities, especially racial disparities that stem from systemic racism in food access, education, housing, health care and employment that have been exacerbated by the COVID-19 pandemic (S. Bleich).
  • Efforts to counter repeated exposure of marketing of unhealthy foods and drinks (J. Harris),  and address overconsumption of ultra-processed food through government policies (J. Krieger).
  •  Opportunities to leverage federal and state programs and policies, such as ECE funding streams, state licensing regulations, state quality improvement programs, and accrediting organizations to strengthen nutrition security in childcare settings. (C. Dooyema).
  • Actions key sectors can take immediately, including childcare, healthcare and the philanthropic sector, as well as policy recommendations for the U.S. government (B. Thomas).  

“What happens in the first 1,000 days sets the foundation for every day that follows. How well or how poorly mothers and children are nourished and cared for during this time has a profound impact on a child’s ability to grow, learn and thrive,” said Blythe Thomas, initiative director of 1,000 Days, an initiative of FHI Solutions. “Achieving nutrition security during the first 1,000 days will ultimately require multisector collaboration, advocacy, and action to fully support families where they live, learn, work, play, and gather. We invite all to join us in prioritizing and realizing the opportunity presented by this AJPH supplement.”

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New Peer-Reviewed Series Reinforces Powerful 1,000-Day Window in U.S.

The “1,000-day window” as an organizing agenda is a new and relatively unknown concept in the United States despite its established role in global health. But, there is opportunity to unite public health communities through the relevant, compelling framework.

We believe further focus on creating the best conditions for families in their 1,000-day window can change the trajectory of the path we’re on. We seek to present a comprehensive picture of the state of the science, research needs, and a policy agenda for optimal maternal and child health in the United States through a dedicated series in the American Journal of Public Health (AJPH).

Three papers were released at 4 p.m. ET September 19, 2022 (and can be found below once published). The full series will be released October 26, 2022 on the AJPH website.

RESEARCH NEWS STORY – The First 1,000 Days: A Window of Opportunity for a Brighter Future for Children

September 20, 2022

The First 1,000 Days: A Window of Opportunity for a Brighter Future for Children

Optimizing federal programs and policies can significantly improve nutritional outcomes in the 1,000-day window—a vital period of development for children

Optimal nutrition between pregnancy and a child’s 2nd birthday (i.e., the first 1,000 days) is critical for the development and long-term health of the child. The 1,000 Days initiative of FHI Solutions aims to improve the health of pregnant people and babies by giving them a healthy start. The 1,000 Days initiative sponsored a new series in the American Journal of Public Health, to publish October 26, 2022, with a pre-release of three papers today.

How can we help create a healthier and more equitable future for all pregnant people and their children? The infant and maternal mortality rates in the US are among the highest of any wealthy country, with glaring racial and ethnic disparities. There is significant room to develop a unifying plan for the right policies and systems to improve nutritional security and well-being for vulnerable families.

A new essay published in the American Journal of Public Health by Dr. Heather Hamner—a health scientist at the Centers for Disease Control and Prevention—reveals numerous gaps between the dietary intake of pregnant people, infants, and toddlers and the US Department of Agriculture and the Department of Health and Human Services’ Dietary Guidelines for Americans, 2020–2025, with race and ethnicity disparities persisting across the spectrum. The average consumption of sugars, saturated fat, and sodium are higher than the recommendations of the Dietary Guidelines. The article also reveals that nearly 75% of infants are not exclusively fed human milk for the first 6 months of their lives and 1 in 3 of them are started on complementary foods (other than human milk or infant formula) before the recommended age. Most children between 12 and 23 months do not consume the recommended amounts of vegetables, dairy, and fruits.

How do we set about addressing these nutritional deficits? The essay states “Advancing efforts related to research and surveillance, programs and communication, and dissemination could help positively, and equitably, influence the health and well-being of mothers and children.” It also outlines a framework by which current federal policies and programs can be strengthened and how access to and participation in programs can be improved.

Another paper in the collection, authored by Blythe Thomas, Initiative Director of 1,000 Days, an initiative of FHI Solutions, points out that a clear plan that unifies maternal and early childhood nutrition policy and systems has eluded implementation in the US. The paper emphasized four sectors where immediate actions can be taken, and where long-term investment can make a significant impact on maternal and child health: early childhood development, health care, philanthropy, and US government relations. “Achieving nutrition security during the first 1000 days will ultimately require multisector collaboration, advocacy, and action to fully support families where they live, learn, work, play, and gather,” says Thomas, in her editorial.

A third paper in the collection—authored by Dr. Kofi Essel, community pediatrician, Children’s’ National Hospital, discusses the limited focus on nutrition-related medical education as a significant constraint on the ability of pediatricians to deliver sound feeding and nutritional guidance during the first 1,000 days. Using examples from the author’s own experience during his pediatric residency, the editorial explains that a paradigm shift on the importance of nutrition and nutrition guidance is important to enhance clinical care. According to Dr. Essel, “This shift requires a collective effort that activates pediatricians to work in cross-sector collaboratives to influence change alongside industry, researchers, and even early childhood educators. It requires pediatricians to use their voices to support local policy that shifts the food landscape, supports national policy that enhances nutrition security for our families, and transforms medical education for current and future providers.”

These three papers are part of a special series, sponsored by 1,000 Days of FHI Solutions, that will appear in AJPH on October 26, 2022. The full series will present the state of science, research needs, and a policy agenda for optimal maternal and child nutrition in the United States. Never before has a journal series brought together papers on these topics during pregnancy, birth, the postpartum period, and early childhood for the US population.

Reference

  Authors                   Titles of original papers                 Journal   Heather C. Hamner, PhD, MS, MPH, Jennifer M. Nelson, MD, MPH, Andrea J. Sharma, PhD, MPH, Maria Elena D. Jefferds, PhD, Carrie Dooyema, MPH, MSN, RN, Rafael Flores-Ayala, DrPH, MApStat, Andrew A. Bremer, MD, PhD, Ashley J. Vargas, PhD, MPH, RDN, Kellie O. Casavale, PhD, RD, Janet M. de Jesus, MS, RD, Eve E. Stoody, PhD, Kelley S. Scanlon, PhD, RD, and Cria G. Perrine, PhDKofi Essel, MD, MPHBlythe Thomas, BS   Improving Nutrition in the First 1000 Days in the United States: A Federal Perspective   The First 1000 Days—A Missed Opportunity for Pediatricians   From Evidence to Action: Uniting Around Nutrition in the 1000-Day Window     American Journal of Public Health
   
DOI         10.2105/AJPH.2022.30706310.2105/AJPH.2022.307028NA
10.2105/AJPH.2022.307028
NA

 

 

Nutrition Bills We Support that Protect Families in their 1,000-day Window

The nutrition that people receive leading up to and throughout their pregnancy, as well as the nutrition their babies receive in the earliest years of life, has a profound impact on a child’s ability to grow, learn, and thrive. This month, in honor of National Nutrition Month and as part of our annual #March4Nutrition campaign, 1,000 Days is highlighting some of the nutrition (including breastfeeding-related) legislation that we support. It is our hope that, with these bills enacted, moms, babies, and their families here in the U.S. and around the world will receive the support and resources they need to begin to build a healthier future.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC):

H.R. 2011 / S. 853, the Wise Investments in our Children (WIC) Act (Rep. Rosa DeLauro, D-CT, and Rep. Jenniffer Gonzalez-Colon, R-PR; Sen. Robert Casey, D-PA, and Sen. Susan Collins, R-ME)

These bills extend WIC eligibility, for women to two years postpartum and allow children to receive benefits through their sixth birthday. It also extends the program certification to two years, which makes it easier for people to continue to receive WIC benefits.

H.R. 4455, the WIC for Kids Act (Rep. Jahana Hayes, D-CT, and Rep. Jenniffer Gonzalez-Colon, R-PR)

This bill makes it easier for families to participate in WIC by providing automatic eligibility to pregnant and postpartum people and children who participate in SNAP, CHIP, Head Start, or Food Distribution Program on Indian Reservations. It also extends postpartum eligibility and aligns family certification windows.

H.R. 6781/ S. 3326, the MODERN WIC Act (Rep. Andy Leven, D-MI, and Rep. Jaime Herrera Beutler, R-WA; Sen. Kirsten Gillibrand, D-NY, and Sen. Roger Marshall, R-KS)

These bills make it easier for families to apply for WIC by revising in-person application requirements to allow for video or telephone certifications. It also allows for remote benefit issuance and provides an annual investment in technology upgrades to support the WIC program.

Child and Adult Care Food Program (CACFP):

S. 1270, the Access to Healthy Food for Young Children Act (Sen. Robert Casey, D-PA)

This bill supports improved nutritional value of meals and snacks in child and adult care settings by increasing CACFP reimbursement values by 10 cents per meal.  It also streamlines paperwork requirements for child care centers in high poverty areas, making it easier for centers to participate in the program and provide nutritious meals and snacks.

H.R. 5919, the Early Childhood Nutrition Improvement Act (Rep. Suzanne Bonamici, D-OR, and Rep. Jaime Herrera Beutler, R-WA)

This bill allows for CACFP providers to serve an additional meal or snack to children in care for a full day and streamlines the certification progress for new providers, expanding access to the program.

 Breastfeeding:

H.R. 3110 / S. 1658, the Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act (Rep. Carolyn Maloney, D-NY, and Rep. Jaime Herrera Beutler, R-WA; Sen. Jeff Merkley, D-OR, and Sen. Lisa Murkowski, R-AK)

These bills would expand access to accommodations for expressing breast milk in the workplace, extending protections in the 2010 Break Time law to 9 million currently excluded workers, including teachers and nurses.

H.R. 804 / S. 248, the Family and Medical Insurance Leave (FAMILY) Act (Rep. Rosa DeLauro, D-CT; Sen. Kirsten Gillibrand, D-NY)

These bills would provide comprehensive paid family and medical leave of up to 12 weeks to all workers in the United States. Categorically recognizing paid leave as a public health imperative, this bill has the potential to transform the lives of moms and babies. As research shows, paid leave supports breastfeeding initiation and duration in a number of ways. For example, a mother is more than twice as likely to stop breastfeeding in the month she returns to work compared to a mother who has not yet returned to work.

Global Malnutrition:

H.R. 4693 / S. 2956 the Global Malnutrition Prevention and Treatment Act of 2021 (Rep. Gregory Meeks, D-NY, Rep. Michael McCaul, R-TX, Rep. Chrissy Houlahan (D-PA), and Rep. Young Kim, R-CA; Sen. Chris Coons, D-DE, Sen. Roger Wicker, R-MS, Sen. Tim Kaine, D-VA, and Sen. John Boozman, R-AR)

These bills will bolster the federal government’s efforts to address global malnutrition and build resilience, particularly as the world continues to respond to and recover from COVID-19 and other global shocks. Additionally, it will authorize USAID to advance targeted interventions to prevent and treat malnutrition around the world, ensure a continued focus on multi-sectoral nutrition programs, and require robust monitoring of these interventions to ensure effective use of taxpayer dollars.

1,000 Days Statement on President’s FY 2023 Budget

This week, the Biden Administration released their budget proposal for fiscal year 2023. While we are thankful for the Administration’s prioritization of investments in programs that support families living in the United States, we are disappointed with their proposed investments in accounts that support global maternal and child health and nutrition.

These investments, both domestically and globally, greatly contribute to the reduction of child mortality and support long-term health, cognitive development, physical growth, and school and work performance later in life. A child’s first 1,000 days are shaped not only by the decisions made by their parents and caregivers, but also by broader societal and economic factors. We are compelled to demonstrate a sense of urgency for policymakers to act during a child’s first 1,000 days, because we know that failure to do so can have lasting, irreversible consequences for children, their families and society.

We were pleased to see significant funding for several 1,000 Days’ key priorities for families living in the United States, including:

  • $6 billion for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), including funding to continue the enhanced Cash Value Benefits for fruits and vegetables and investment in critical research on maternal mortality as well as infant and toddler feeding.
  • $470 million to reduce maternal mortality and morbidity rates, expand maternal health initiatives in rural communities and address the highest rates of perinatal health disparities, including by supporting the perinatal health workforce.
  • Extending and increasing funding for the Maternal, Infant, and Early Childhood Home Visiting Program, which serves families at risk for poor maternal and child health outcomes each year and is proven to reduce disparities in infant mortality.
  • $97 million for the Office of Nutrition Research to advance nutrition science to promote health and reduce the burden of diet-related diseases.

Investments for families outside of the United States fall short. Globally, the FY23 President’s Budget Request of $879.5 billion for Maternal and Child Health and of $150 million for Global Nutrition programs are insufficient and inconsistent with the Administration’s stated priorities. These funding levels are lower than the funding allocated by Congress in the FY22 Omnibus. We are experiencing growing food and nutrition crises that are being exacerbated by global conflict, including in Ukraine, as well as disruptions from the COVID-19 pandemic, and the effects of climate change, which are all driving up food and fertilizer prices and disrupting health services. Now more than ever, we need robust investments in these core health and food security accounts that support fundamental development programming and work to make vulnerable countries more self-reliant and resilient to these unanticipated shocks.

We look forward to working with the Administration and colleagues in Congress to strengthen our FY23 appropriations with stronger global investments including:

  • $300 million in the Global Nutrition Subaccount
  • $1.1 billion for Maternal and Child Health, including $290 million for Gavi and $165 for polio
  • New and additional funding to support the United States’ flagship food security program, Feed the Future

Work at 1,000 Days: Open Positions

1,000 Days leads the fight to build a strong foundation for mothers, children, and families to thrive. The first 1,000 days from pregnancy to age 2 offer a window of opportunity to create a healthier and more equitable future for all pregnant, birthing, postpartum, and parenting people and their children. Join us and help achieve our mission to make health and well-being during the first 1,000 days a policy and funding priority, both in the U.S. and around the world.

The organization is hiring two, full-time, remote positions with office space in the Washington D.C. area available:

Policy and Advocacy Officer (6-8 years experience) The ideal candidate for this position develops, cultivates and leverages great relationships with decision-makers, legislators, fellow nonprofit organizations, policy experts and researchers to deliver on the 1,000 Days’ domestic policy priorities and builds effective coalition efforts and campaigns. The candidate will research, monitor, analyze and respond to federal legislation related to nutrition, paid leave, maternal and child health and healthcare as established in our 2022 Advocacy Agenda. Candidates must be actively interested in working with an organization that is making the needs of vulnerable families a policy and funding priority. The position reports to Solianna Meaza, Director of Policy and Advocacy.

Advocacy and Research Associate (2-4 years experience) The primary role of this candidate is to track and analyze relevant research, reports and policy developments, as well as provide research and writing support around key policies and programs impacting families, including federal nutrition programs, federal dietary guidelines, paid leave and healthcare. The candidate will translate policy and research information for a variety of audiences and produce written materials such as policy briefs, position papers, blog posts, social media posts and reports. The ideal candidate has advanced credentials, such as a Master’s in Public Health, a Registered Dietitian, or similar. The position reports to Blythe Thomas, Initiative Director.

Cultivating a diverse and inclusive team is an essential component of 1,000 Days’ work to advance equity. Candidates of all backgrounds are strongly encouraged to apply. We are committed to fostering a workplace culture that is welcoming and inclusive to staff of different races and backgrounds. We seek to foster an environment where all staff feel a sense of belonging and are affirmed. We actively welcome and value staff with different experiences, backgrounds, attributes, abilities, and perspectives.

We look forward to growing the team of leaders who cares deeply for the health and wellbeing of families here and around the world.

Community Statement on Administrator Samantha Power’s Remarks at the Nutrition for Growth Summit on December 7th, 2021

As organizations committed to ending hunger and improving global health, we echo the Biden Administration’s belief that “By investing in nutrition programs, applying the evidence of what works, and adapting quickly, we can prevent child malnutrition even in the time of COVID, and we can build a healthier world for everyone.”

We commend the U.S. Government’s continued global leadership to combat malnutrition and the commitment that Administrator Power announced to invest up to $11 billion, including $3 billion directed to anticipated humanitarian needs, over the next three years. We look forward to seeing a detailed accounting of the $11 billion by account and fiscal year and hope that this commitment includes new resources outside of existing programs that are working hard to address the skyrocketing food insecurity and nutrition needs around the world. We are grateful to the U.S. Government for bringing much-needed attention to the malnutrition crisis globally. Strong nutrition funding, including new resources, are necessary to save lives and reduce economic impacts and productivity losses.

Eight years after the first Nutrition for Growth Summit, malnutrition remains one of the world’s most pressing but preventable problems. Globally, malnutrition is a leading driver of child death and disability, contributing to 45% of deaths in children under age 5. Rates of malnutrition are reaching nearly unprecedented levels due to the confluence of the COVID-19 pandemic, rising conflict, and the effects of climate change. Researchers warn that this could result in 283,000 more child deaths and an additional 13.6 million children suffering from wasting (low weight for height), the most deadly type of malnutrition. Despite these challenges, we wholeheartedly agree with Administrator Power’s statement that this is “not cause to throw up our hands, but cause to get to work.”

Nutrition programs not only save lives but are considered a best buy in global development. Programming that targets women and children during the critical 1,000 day window from pregnancy to age two offers one of the best returns on investment, with every $1 invested yielding up to $35 in economic returns. We have the proven, cost-effective solutions to save lives, but if we want to stop the growing malnutrition crisis, the U.S. Government will need to continue building on the momentum of today’s announcement, and further increase its funding for this essential investment.

We are thankful for the U.S. Government’s leadership and support to help vulnerable children and families around the world have the chance for a better future. We look forward to continuing to work together to address this critical issue.

Sincerely,
1,000 Days
Action Against Hunger
Alliance to End Hunger
American Academy of Pediatrics
Bread for the World
CARE USA
Catholic Relief Services
Church World Service
Edesia
Food for the Hungry
Global Communities
John Snow, Inc. (JSI)
Medical Impact
Micronutrient Forum
National Cooperative Business Association CLUSA International
RESULTS
Save the Children
The Hunger Project
UNICEF USA
WaterAid America
World Vision US

1,000 Days Statement on Passage of a Continuing Resolution with WIC Benefit Extension

1,000 Days is grateful for the passage of a Continuing Resolution to avoid a lapse in government funding while Congress and the White House work toward resolving a spending plan for FY22. While this stopgap funding does not include necessary increases to a number of vital priorities to improve the health and wellbeing of families in the crucial 1,000-day window, we are grateful for the three-month extension of the WIC Cash Value Benefit (CVB). The increased CVB has improved access to fresh fruits and vegetables for WIC families, leading to better diet quality and improved program satisfaction. This also brings the WIC food package in closer alignment to the 2020 Dietary Guidelines for Americans and prior recommendations from the National Academies of Sciences, Engineering, and Medicine (NASEM). We look forward to continuing to work with partners and champions in Congress to ensure that a final FY22 spending deal extends the CVB increase for the full fiscal year and meets the needs of moms, babies, and families everywhere.

Blythe Thomas
Initiative Director
1,000 Days, an initiative of FHI Solutions

1,000 Days Statement on the White House COVID-19 Summit

Bold action is needed to address the health and economic fallout from COVID-19 and build a better future. Today’s COVID-⁠19 Summit provides an opportunity to expand and enhance efforts for defeating COVID-19 and prioritizing health in the United States and worldwide. Across the world, the pandemic exacerbated existing inequalities and further weakened families’ social safety net. COVID-19 pandemic-related disruptions to food and health systems has led to a devastating rise in severe malnutrition rates around the world. In the United States, significant racial and ethnic disparities in food insecurity which existed before COVID-19 widened in households with children.

The COVID-19 pandemic has hit women and children especially hard, and policies and actions must prioritize this vulnerable group. The 1,000 days between a woman’s pregnancy and her child’s 2nd birthday offer a unique window of opportunity to build healthier and more prosperous futures. The nutrition that mothers and children receive in the 1,000-day window has a profound impact on a child’s ability to grow, learn, and thrive. This has never been more critical than now.

Good nutrition and health services must be at the heart of all COVID-19 pandemic immediate and long-term recovery plans both in the United States and globally. In the U.S., 1,000 Days calls on the U.S Government to support families by passing  comprehensive, universal paid family and medical leave, permanently authorizing the Children’s Health Insurance Program and addressing Medicare coverage gaps. Programs that provided additional resources to families, including the WIC fresh fruits and vegetables Cash Value Benefit and boosted Child Tax Credit, should be extended. There should also be an investment in health equity provisions to address racial and ethnic disparities in maternal and child health outcomes.

The United States has been a long-standing champion of global nutrition programs and life-saving progress has been achieved over the past decade. But without concerted action and additional resources, the world could see a greater rise in child deaths and malnutrition than previously predicted. Increased investment, specifically allocating at least $500 million for nutrition from future COVID supplemental funding, is an immediate action that would help prevent these COVID-related deaths. In addition, we urge the U.S Government to adopt policy measures and make commitments that fully support, protect, and promote exclusive breastfeeding in the first six months of life. Prioritizing the nutritional needs of women, adolescent girls and young children is essential considering the gendered impacts of the COVID pandemic on hunger and malnutrition. We also support the recommendations in the Nourish the Future proposal, sustainable solutions to deploy high-impact interventions at scale, which will not only save children today but promote long-term resilience building and reduced cases of malnutrition for years to come.

Good nutrition, particularly in the 1,000-day window, is critical to building long-term resilience to shocks and overall prosperous and healthy societies. This is a make-or-break year for nutrition and for children and families worldwide and the time to act is now.

Solianna Meaza
Director of Policy and Advocacy, 1,000 Days