Child’s first 1 000 days are critical, conference hears

Child’s first 1 000 days are critical, conference hearsThe neonatal care unit at Leratong Hospital. PHOTO: Denvor De Wee/Spotlight

A child’s first 1 000 days  are crucial, paediatrician Dr Elmarie Malek argued in a paper presented at the 10th Child Health Priorities Conference in Potchefstroom over the weekend.

She argued that in this 1 000 days period child health priorities including the Essential Package (primary level maternal and child health, social services and income support, nutrition support, support for primary caregivers and stimulation for early learning) should be lined up in a row.

“This period from conception to 2 years of age is the time when the developing brain is most sensitive to environmental influences both harmful and good,” said Dr Malek.

“Malnutrition, environmental toxins or substances and toxic psychological stress experienced in pregnancy creates raised cortisol levels that reach the unborn baby and can affect brain architecture permanently. So too in the young infant, its genetic potential can be altered,” she said.

“Sensitive maternal care and attention that fosters good attachment and attunement with the baby and provides nurturing care, helps the baby feel safe and curious to learn and reach maximum potential,” Malek said.

1 000 Days Drive

According to Malek the Western Cape government has embarked on a first 1 000 days drive. The aim is to “provide support to 10 000 children and their caregivers during the first 1 000 days of a child’s life – the first known contributor to setting a child on a crime-free path through life”.

The Western Cape government also wants to identify the families most at risk of violence and to roll out parenting programmes that “in similar contexts around the world, have been proven to reduce violence – particularly substance abuse & gender-based violence”, she explained.

“In essence,” said Alan Winde, premier of the Western Cape in a media statement released in September, “the Western Cape will offer a parent and caregiver support package which will include the new road to health book, risk screening and referral [for] mental health and psychosocial support”. It will also include home visits by community health workers to support high risk pregnant women and mothers.

Seven strategies

“The additional knock-on effect of parenting support is violence prevention as per the World Health Organisation’s INSPIRE 7 strategies,” said Dr Malek. The Save the Children Resource Centre website describes INSPIRE as “an evidence-based resource for anyone committed to preventing and responding to violence against children and adolescents”.

It further explains that, “the document presents seven strategies to help countries and communities intensify their focus on prevention programs and services with the greatest potential to reduce violence against children”. The seven strategies include:

  • Law implementation and enforcement
  • norms and values
  • safe environments
  • parent and caregiver support
  • income and economic strengthening
  • response and support services; and
  • education and life skills.

The Western Cape government notes that “research shows that children who benefit from essential first 1 000-day outcomes, can earn up to 20% more as adults versus their counterparts; and [are] more likely to have healthy families themselves”.

Inter-generational violence

Malek’s paper also tackles the inter-generational violence in South Africa. According to the paper, 33% of mothers 20 years and older reported being treated cruelly and beaten by their parents, while 43% are exposed to community violence during pregnancy and 48% experienced violence in their home when their child was under 6 years of age.

According to the paper the key priority interventions include “early identification of at-risk pregnant mothers, children and caregivers at facility and household level”, “relational support for at risk pregnant mothers, caregivers and children through a structured home visitor package by community health workers, and “counselling, mentoring and mental health service capacity enhancement for vulnerable clients and the frontline staff working with them”.