Why the First 1,000 Days Matter:
Nutrition, Development, and Survival
The first 1,000 days of life — from conception to just after a child’s second birthday – are arguably the most important period in the human lifespan. This window is foundational for physical growth, cognitive development, immune resilience, and even emotional well-being and attachment. Yet, in many parts of the world, and particularly South Africa and its surrounds, this vital period is often overlooked in public health interventions, policy priorities, and social support systems.
The consequences are profound. Suboptimal nutrition and care during this period contribute to high rates of stunting, developmental delays, and avoidable child deaths. These outcomes are not only deeply tragic; they are preventable.
Global Consensus: The First 1,000 Days Set the Lifelong Trajectory
The science around the first 1,000 days is clear and compelling. A child’s brain grows faster during this time than at any other stage of life, forming up to one million new neural connections every second.[1] The nutritional status of the mother during conception and pregnancy, the quality of care at birth, and the infant’s access to adequate nutrition in the first two years all influence long-term outcomes — from educational achievement to economic productivity.
This understanding has been embraced by global health authorities. The World Health Organisation (WHO) and UNICEF both advocate strongly for integrated interventions during this window, including maternal nutritional support, exclusive breastfeeding for the first six months, appropriate complementary feeding, and early developmental stimulation. [2]
Other peer group low-and-middle income countries like Peru, Rwanda, and Bangladesh have achieved measurable progress by implementing national multi-sectoral strategies focused on this timeline. For instance, Peru reduced its stunting rate from over 28% in 2008 to under 13% by 2016 through targeted early-life nutrition and maternal health programmes. [3]
South Africa: A case of Good Intentions, Uneven Implementation
South Africa is not without its strengths. The National Food and Nutrition Security Plan (2018–2023) explicitly highlights the importance of early childhood nutrition. We’ve implemented the Baby-Friendly Hospital Initiative (BFHI) in many state, and private facilities, and community health workers play a critical role in maternal and child outreach. The Child Support Grant (CSG) provides some much-needed economic relief to poor households with young children.
However, implementation is inconsistent, and its impact is diluted by systemic challenges. According to the South African Demographic and Health Survey (SADHS), only about 32% of infants under six months are exclusively breastfed.[4]Stunting remains high at 27% — a figure that has unfortunately persisted for over a decade, especially in rural and low-income areas.[5]
Furthermore, maternal malnutrition continues to affect pregnancy outcomes, including preterm birth and low birth weight. These, in turn, increase neonatal vulnerability and the likelihood of long-term developmental complications. In many cases, pregnant women in under-resourced communities struggle to access nutrient-rich foods, antenatal supplementation, or accurate health information and timeous access to emergency medical care.
What’s Missing: A Proactive, Integrated Approach
What becomes clear is that while the framework exists, we are often addressing symptoms rather than causes. Most interventions are reactive – focused on managing malnutrition or catching up on developmental delays once they have already occurred. Instead, we must shift towards a preventive approach, anchored in the first 1,000 days.
This means:
- Expanding early antenatal care access, especially in rural and informal communities, ensuring every pregnancy is monitored, nourished, and supported from the outset.
- Strengthening maternal nutrition programmes with food supplementation, iron and folate support, and nutrition education tailored to local diets.
- Enhancing breastfeeding support, including workplace protections, lactation-friendly public facilities, and peer support groups.
- Equipping community health workers with the tools and training to identify risks early and educate caregivers meaningfully.
- Improving cross-sector collaboration between health, agriculture, education, and social development departments to address the structural roots of undernutrition.
In other words, we must build a system where every woman is supported during pregnancy, every child receives a strong nutritional start, and every family is empowered with knowledge and resources.
The Role of Society: Shifting the Narrative
The first 1,000 days are not just a medical issue. They are a social, economic, and moral priority. Addressing them requires changing the way we talk about nutrition and survival. Too often, malnutrition is framed as a personal failure – of the mother, the household, the community. But in reality, it reflects broader structural inequities.
Household food insecurity, gender inequality, inadequate maternity leave policies, and poor access to clean water and sanitation all directly affect a child’s ability to thrive. Nutrition should not be framed as a matter of individual choice alone; it is deeply embedded in the systems that govern people’s lives.
A Call to Action
The first 1,000 days are a once-in-a-lifetime opportunity. If we get it right, we can reduce the burden of disease, improve educational outcomes, and create a healthier, more equitable society. If we get it wrong, we sentence another generation to the downstream effects of underdevelopment, poor health, and lost potential.
South Africa has both the knowledge and the tools to lead in this space. What remains is the political will, the integrated effort, and the shared understanding that this is not just about survival – it’s about investing in the future of our nation.
The time to act is now.
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Footnotes:
- Centre on the Developing Child. (2007). The Science of Early Childhood Development. Harvard University.
- World Health Organization (2020). Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals.
- World Bank. (2017). Reducing Stunting in Peru: A Decade of Success.
- South Africa Demographic and Health Survey 2016. National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC), and ICF.
- UNICEF South Africa. (2023). Nutrition Country Profile: South Africa.
- National Library of Medicine (2024). Preventing Stunting in South African Children Under 5: Evaluating the Combined Impacts of Maternal Characteristics and Low Socioeconomic Conditions.
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