Attended Births End Hunger

Anna Slattery is the Manager of External Affairs at The Hunger Project, a global development organization that transforms the systems of inequity that keep hunger in place.

One year ago, my husband and I were sitting in traffic in the tunnel under Boston, heading to the Labor and Delivery Unit at one of the hospitals downtown. It was my fifth time heading to the hospital in three days — I am somewhat of a chronic worrier and live close enough to the hospital that the team there always told me to come in, just in case.

At every visit I was attended to by a full team of doctors and nurses — arguably some of the best in the world. With their support, finally after that fifth trip, I had a smooth, safe labor experience and our darling baby girl arrived in the world, kicking and screaming.

A woman wearing a blue dress holds her new baby. The baby is swaddled in a white and blue blanket and has a blue bow on her head.
Charlotte and I, about a day after she was born. We were so grateful for all the support the doctors and nurses provided us in those first few days!

Charlotte was one of approximately 383,562 babies born that day. She was also fortunate enough to be among the 80% of births globally that were assisted by a skilled birth attendant. In the United States, 99% of births are attended by trained caretakers. However, only 24% of births in the country of Chad were attended, according to the most recently collected data.

Accredited and trained birth attendants — who range from doctors to doulas to community health workers depending on the context — play a significant role in reducing maternal and newborn mortality around the world. Trained attendants can respond if an emergency arises — both for mom and baby. They are particularly attuned to signs that the baby may need extra support in those first few days of life.

It may come as a surprise, but birth attendants are also key to ending hunger.

Many children born to mothers who are undernourished will likely grow up stunted or with malnutrition themselves. In 2020, 149 million children under age 5 were estimated to be stunted (too short for their age) and 45 million were estimated to be wasted (too thin for their height). Around 45% of deaths among children under age 5 are linked to undernutrition. These conditions are largely preventable, even in communities with high levels of hunger and poverty. Birth attendants are often the first and most capable of taking simple steps to support a new mom and her baby and break the cycle of malnutrition.

First, trained birth attendants often act as advocates for a new mom, intervening in harmful societal and cultural norms that make it difficult for a new mother to feed her baby. In many communities, particularly those with high levels of hunger, women are fed last and least. Some postpartum cultural practices take this one step further. For example, in some parts of Bangladesh, where The Hunger Project offers training to pregnant women and grandmothers about healthy postpartum practices, women traditionally aren’t fed for several days after giving birth. On a trip in 2019, one of my colleagues spoke with a woman who shared that, after the birth of her first child, her husband had to sneak around his mother to bring food to his wife. A birth attendant can play this same role and ensure that the mother is fed adequately, particularly in the first few days after giving birth. This supports the health of the mother and elevates the health of the child as she begins breastfeeding, the next critical step in a child’s wellness immediately after birth.

Breastfeeding is critical for children’s nutrition, particularly in low-income countries. Formulas and breast milk alternatives are expensive and require a clean and consistent water supply to avoid disease. Breast milk is free, clean, provides disease-fighting antibodies and meets all of baby’s nutritional needs — even if the mother’s diet is not ideal. It is one of the best ways to prevent stunting and wasting. Unfortunately, according to UNICEF, only 49% of newborns begin breastfeeding within one hour of birth. In some cultures, breastfeeding can be delayed even longer, intentionally preventing the baby from eating colostrum, the initial milk that is higher in protein than breast milk.

But breastfeeding is tough, particularly those first few days. Midwives and nurses, often the same people who supported a mother through the birthing process, play a critical role in supporting a new mom as she learns to feed her baby. I know from my own experience that I would have quit on day four if not for the support from my nurses and my mother.

A pregnant woman wearing a yellow dress smiles outside of the door to the clinic. The sign behind her reads: Services Offered: OPD, Antenatal, Immunization, HIV Counseling.
Allen from Uganda smiles outside of her local clinic after a prenatal appointment. Allen’s community identified a clinic as a key component of their development and it was built as part of The Hunger Project’s Epicenter Strategy. Photo Credit: Reinier van Oorsouw, 2019

Finally, globally, UNICEF estimates that 54% of newborns are not weighed at birth. This is a simple, yet important step that birth attendants know to take so that the newborn’s health and nutrition can be monitored those first few weeks of life and can help diagnose any feeding issues. From my own experience, monitoring my baby’s weight gain, or lack thereof, was crucial to diagnosing and fixing a feeding issue so that she could get the proper nutrition.

Having a baby of my own has steeled two assertions of mine:

  1. Having a baby really takes a village. Caring for a woman as she becomes a mom, and caring for her new baby, requires the love and support from family, friends and trained healthcare providers.
  2. Every woman, everywhere, has the right to a birthing experience that will set her up for success as she embarks on her journey to motherhood. That means that she has the right to an attended birth, with someone who is trained in labor, delivery and postpartum care.

By increasing the number of women worldwide who have access to healthcare resources before, during and after labor, we can break the cycle of malnourishment and end chronic hunger.

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Reflections on what it will take to sustainably end chronic hunger

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Anna Slattery

Anna Slattery

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