S.V. Subramanian

S.V. Subramanian

Breaking the cycle of undernourished women giving birth to low-birthweight babies

August 30, 2012 – Nutritional support in first thousand days of child’s life critical to development

Despite gains in economic growth, education, and life expectancy in India in recent years, over half of Indian children have stunted (low height for age) and/or are underweight. Children who are stunted fall below two standard deviations on a distribution of height-for-age. Even in the Indian state, Kerala, where income has more than tripled over the past decade or so and most are educated, immunized, and have safe drinking water, and women generally receive prenatal care, 25% of the children are shorter than they normally would be for their age.

“If we are going to save the children, we better have a plan for their sustained growth, otherwise they are trapped in the intergenerational cycle of deprivation,” S V Subramanian, professor of population health and geography at Harvard School of Public Health (HSPH), told an audience in FXB G-13. His August 14, 2012, lecture, “Linked Lives: Intergenerational Influences on Health in Low and Middle Income Countries,” was the final talk in this summer’s Hot Topics lecture series.

Subramanian described numerous studies that he and others have conducted showing that India, like many low- to middle-income countries, is caught in a cycle of undernourished women giving birth to low-birthweight babies. The babies generally grow up to be underweight adults, often with reduced mental capabilities, and susceptibility to disease and premature death.

When height up, mortality down

Women’s height is known to be a predictor of an offspring’s chances of survival and also their growth patterns in infancy and childhood, Subramanian said. “As height goes up, mortality goes down,” he said. In one study of 54 countries by Subramanian and colleagues, women’s height fell in 14 countries, all in Africa, and stayed the same in 21, including four South American nations. There was a near universal and consistent patterning in height with disadvantaged women being shorter in 52 of the 54 low- and middle-income countries studied. “The situation for the next 20 years is not looking bright,” Subramanian said.

While height is 60-70% inherited, good nutrition very early in life is critical. “Nutrition improvement in the first three to four years of life makes the difference,” he said. Some countries, including India, try to intervene by providing meals to children when they attend school. But this is too late to counter stunting. “It’s the first thousand days that count,” Subramanian said.

Misplaced policy focus

Subramanian said health policymakers, including the developers of the United Nation’s Millennium Development Goals, need to switch the emphasis from education to nutritional policy to meet the urgent need to increase nutritional intake in the poor. “For the poorest nations, it would take 25-27 years of education to reduce mortality. It will never happen,” he said.

“We need a focused, intergenerational health approach as opposed to an indirect focus on education. We have to get to homes of parents with new babies and deliver nutrition. If you wait until the child is in school, it’s too late,” said Subramanian.“We want to move away from a ‘survival agenda’ to a ‘growth agenda.’”

View the lecture

Learn more

Women’s Height Declining in Many Low-Income Countries (HSPH feature)

Economic Growth Fails to Remedy Undernutrition in India’s Children (HSPH feature)

Overweight Primarily a Problem Among Wealthier Women in Low- to Middle-income Countries (HSPH press release)

–Marge Dwyer

photo: Aubrey LaMedica