THE NOURISHING EFFECT

A mother and child at
an outpatient clinic in
the Southern Region
of Ethiopia.
Nena Terrell/USAID Ethiopia
now widely accepted by the medical establishment. 53 The eponymous “Barker hypothesis,”
also known as the “fetal programming hypothesis,” says that children of mothers who are
undernourished during pregnancy and grow up in a postnatal environment of food scarcity
are “programmed” to become obese in adulthood. If they make a dietary transition to oils,
sugars, and animal products in adulthood, most will still not be able to afford the kinds
of foods that promote good health. In South Africa, where four in 10 adults are obese, a
family whose income is among the bottom third of national incomes would need to spend
30 percent more to achieve a “healthy diet.” 54 But these families barely earn enough to meet
minimum food needs.
To Barker, what should be done is neither complicated nor expensive. A child’s health at
birth is most often a reflection of his or her mother’s health and nutritional status. It is fruitless
to try to improve the health of a child while neglecting the mother; moreover, pregnancy
is too late to truly break the cycle of intergenerational malnutrition. Thus, Barker said, “The
greatest gift we could give the next generation is to improve the nutrition and growth of girls
and young women.” 55
Investing in Global Health Systems
Each year hunger and malnutrition contribute to the deaths of tens of thousands of
women in childbirth. 56 In addition to the tragedy of so many young women dying of
preventable causes, maternal mortality lowers the odds of infant survival as well. In one
study of 90 babies who survived labor and delivery when their mothers did not, less than
one-third lived to celebrate their first birthday. This is primarily because babies without
mothers are deprived of breastmilk, an infant’s main source of nutrition. In addition to
providing numerous well-documented health benefits, breastfeeding is also the most affordable
feeding option. 57
Ninety-nine percent of all
maternal deaths occur in developing
countries, making maternal
mortality the most inequitably
distributed health indicator in
the world. 58 The rural maternal
mortality rate is 2.5 times that of
the urban rate. 59 Figure 3.6 shows
the differences in access to skilled
health personnel in rural and
urban areas of developing regions.
A higher total maternal mortality
rate in a country also usually
signals a wider disparity between
rural and urban areas.
“Women are not dying because
of untreatable disease,” explained
Mahmoud Fathalla, former head
of the International Federation of
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