Review: The First 1,000 Days: A Crucial Time for Mothers and Children—and the World

Most people have heard the parable of the woman who gives birth in a rice paddy, then straps her newborn to her back and goes right back to work. The fable has many purposes: to state that women’s bodies are built for childbirth; to admonish women who prefer pain relief during birth, or who bemoan a lack of paid maternity leave; and to idealize the simplicity of a life far removed from our own, whether by time or geography.

The real stories are much less romantic; a point made evident in Roger Thurow’s latest book, The First 1,000 Days: A Crucial Time for Mothers and Children—and the World.

The first 1,000 days span from the beginning of pregnancy until the child turns 2. As readers will learn, it’s a delicate window during which illness and poor nutrition can completely undermine the future of any child. With a quarter of the world’s children under 5 stunted—too short and underweight for their age, almost always accompanied by cognitive deficiencies—we have a real global crisis on our hands. Survival rates for infants have been improving steadily, but the difference between surviving and thriving depends largely on the quality of nutrition during the first 1,000 days.    

Thurow takes us through the pregnancies, births and first two years of several families in Uganda, India, Guatemala and Chicago. Not surprisingly, the babies and children most at risk live in developing countries, particularly in rural areas. But even the United States isn’t exempt from childhood malnutrition. The author’s aim is to explore how much difference interventions targeting the first 1,000 days can make in the lives of those most at risk.

Working for Heifer International, and as a mother who has made it through the first 1,000 days twice, I was eager to read this book. How would my experiences compare to the women in the book? What were our strongest commonalities?

The short answer? To mother is to worry.

All of the women chronicled by Thurow faced a slew of worries: how to afford the nutritious fruits and vegetables they needed to eat to nourish the life developing inside them, how to avoid illness while pregnant, how to survive labor and delivery, and how to keep their babies well. Following along with their stories, it is hard not to feel like the odds are stacked against them.

Each mother featured in the book receives interventions in one form or another: nutrition classes, dietary supplements, ultra-nutritious varieties of sweet potatoes and beans, subsidized food, information on improved hygiene practices, instruction on the importance and mechanics of breastfeeding.

At birth, my youngest daughter required resuscitation. Had I delivered her in Uganda, where only half of the health facilitates have neonatal resuscitation capabilities, her odds at surviving would have been the flip of a coin.

Even still, the obstacles they face are unlike anything I’ve dealt with. At birth, my youngest daughter required resuscitation. Had I delivered her in Uganda, where only half of the health facilitates have neonatal resuscitation capabilities, her odds at surviving would have been the flip of a coin. I’ve never once worried that all my work at feeding myself and my baby a nutritious diet could be undone by a case of dysentery. I worried about SIDS, but not malaria.

I found it difficult, at times, to not feel frustrated and hopeless on behalf of these mothers and the millions of others in the same circumstances. Even with all of the interventions, the gains made in the first 1,000 days can be so easily lost by age 9. The problem with safety nets is that they have holes and are prone to being dropped.

What I wanted most was to see more empowerment for the mothers. Yes, they were empowered with knowledge on better nutrition, but most of them had very little control over their ability to access nutritious foods. A mother’s power to secure a better future for her children can only be so strong in a community entrenched in poverty, lacking electricity, with poor roads and violence to contend with.

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It isn’t until the epilogue that Thurow really hits on it: multidimensional development. For a better future for all, every family needs solid nutrition in the first 1,000 days, plus electricity, clean water, improved sanitation and overall infrastructure. Ultimately, families have to be able to provide for themselves in an environment that is conducive to thriving. Otherwise, all the hard work is for naught.

It’s easy to read a book like The First 1,000 Days and be overcome with worry. I’m worried for the mothers, for their children, for their communities, for humanity. I think it’s important to remember that the antidote to worry can oftentimes be action. When I start agonizing over the state of things, whether it’s childhood malnutrition or polar ice caps melting, I try to look for an action I can take, even if it feels so far removed from the actual problem. What have you done to make the world a better place today?