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Green Templeton College | Oxford

Fifty leading medical scientists, economists and other experts are challenging the governments of 22 emerging market economies to accept new scientific findings and take a fresh, longer-term perspective on social investment in the health and nutrition of women and children.

Participants in the Green Templeton College Emerging Markets Symposium (EMS) are calling for strategies that improve women's quality of life throughout the life course, recognising that good nutrition in early life, adolescence and the reproductive years is a key factor influencing national social and economic development.

They acknowledge that emerging market countries have committed resources and programmes to tackle chronic problems of maternal and child health, with many achieving substantial advances. These are reflected in national declines in maternal and child mortality, yet there remains in these countries a great deal to do.

The international experts identify the need for new nutritional policies to stem the linked epidemics of child stunting and obesity, and for new elements to be incorporated into their health policies based on new scientific findings.

They warn that the costs of inaction are considerable as evidence emerges that very early life deficiencies in nutrition and care can have lifelong, possibly irreversible, effects on learning achievement, physical stature and earning potential. These in turn impact on longer term national prosperity and growth.

Emerging Markets Symposium Chairman and former Prime Minister of Pakistan, Shaukat Aziz, said: "Emerging markets cannot expect to sustain growth, create cohesive societies or achieve political stability if they do not address festering problems of maternal and child health and poor nutrition throughout the life cycle".

According to studies presented at the 2014 Emerging Markets Symposium, there is now stronger evidence than ever before about the importance of good maternal nutrition before and during pregnancy, and of exclusive breastfeeding in the first six months of life. The first 1000 days of life (i.e. from conception until age two) are crucial as they can permanently affect future physical and cognitive development:

  • A ground-breaking international project (INTERGROWTH-21st), funded by the Gates Foundation, has found that under optimal conditions babies born in any country - including emerging markets - can enjoy the same prospects for growth and development. The INTERGROWTH-21st team presented their preliminary findings, which showed that fetal growth is determined more by the social, economic, nutritional and environmental conditions of the mother before and during pregnancy, rather than her ethnic origin.
  • New developments in epigenetics show that environmental factors, such as a poor diet in pregnancy, can alter how fetal genes behave, influencing how the baby develops. A recent review of the effect of nutrition during early life drew attention to environmental factors such as nutrient deficiencies affecting the regulation of genes in the embryo. These changes persist into adulthood leading to increased risks of diabetes, hypertension and cardiovascular disease and can have a lasting effect on subsequent generations.
  • Negative effects on infant cognition and physical development lead to decreased work productivity in adult life - a three-decade study showed that Guatemalan men who were exposed to better nutrition in the womb and early life went on to secure higher hourly wages than those who were not.
  • Patterns of growth and metabolism established in the first 1000 days of life (i.e. from conception until age two) determine how well an individual grows in the future. Children who are short for their age at two years are unlikely to reach their height potential and will remain short as adults. The wrong type of nutrition in this crucial 1000 day window is also more likely to result in individuals being overweight and obese.

Symposium members are urging governments to strengthen their commitment to existing maternal and child health programmes by adopting a range of measures, which include:

  1. Boosting women's empowerment
  2. Tackling women's nutrition
  3. Standardising health care for mothers and newborns so that it complies with best evidence
  4. Adopting a new global indicator at birth, in line with those used in childhood, to capture differences in population-level nutritional and environmental exposures during pregnancy, and
  5. Considering the causes and consequences of unplanned and unwanted pregnancies (including sexual violence, abortion, lack of sex education, poor access to contraception, insufficient family spacing and childbearing at too early an age).

The Emerging Markets Symposium heard that, for the first time in history, there will soon be a measure of optimal growth from conception until age 5, valid for babies and children from all ethnic groups in all countries. The bar can then be set to define the ideal growth to be achieved in pregnancy and the early newborn period, against which all populations can be compared.

The INTERGROWTH-21st findings, which will be submitted for publication soon, complement the widely-used World Health Organization (WHO) optimal child growth charts for children 0 to 5 years of age, derived from the Multi-Growth Reference Study (MGRS) published in 2006.  Data from the two conceptually identical studies have validated the hypothesis that if mothers are healthy at the start of pregnancy, live in environments free from external constraints on growth, have access to regular evidence-based care and breast feed, children around the world will have similar growth patterns from conception until age 5.

These studies not only provide evidence on the conditions required to achieve optimal growth but, importantly for policy makers, also demonstrate that significant improvements are achievable within a generation. The challenge remains how best to reach the most vulnerable women, such as urban slum dwellers, remote and rural communities, marginalised ethnic and indigenous groups, migrant workers and displaced people.

Nutritional problems are complex and governments will need to consider how to improve maternal and child health and nutrition through agricultural production and food supply. In many emerging markets, high calorie, low nutrient foods are now affordable and widely available, replacing traditional diets and resulting in increasing numbers of overweight and obese women entering pregnancy. These women are at greater risk of complications such as preeclampsia and gestational diabetes, which can have subsequent negative lifelong effects for mother and baby.  As nations transition from low- to middle-income, nutritional solutions cannot focus only on increasing caloric intake: a greater emphasis is needed on nutritious and balanced foods.

The Emerging Markets Symposium experts recognise the challenge goes beyond governments, requiring multi-sectoral partnerships with industry, academic and voluntary sectors to address these issues. Enlightened leadership will be essential if policies and programmes with short-term costs but yielding longer-term payoffs are to succeed.
EMS Chair Shaukat Aziz and the Principal of Green Templeton College, Sir David Watson, are writing to the heads of government of 22 emerging market countries, drawing their attention to the new evidence and pointing out that action is needed now to assure future generations of more flourishing lives.


More information about the Emerging Markets Symposium

More information about INTERGROWTH-21st

Emerging Market Countries are Argentina, Brazil, Chile, China, Colombia, Egypt, Hungary, India, Indonesia, Jordan, Malaysia, Mexico, Pakistan, Peru, Philippines, Poland, Russia, South Africa, Thailand, Tunisia, Turkey.