The nutrition and health of the mother before and during pregnancy affect the baby's birthweight, how well the baby grows and the baby's chances of survival. A healthy, well-nourished woman has a good chance of having a healthy pregnancy, which increases her chances of having a healthy baby. A healthy baby has a better chance of growing into a healthy child and then growing into a healthy adult.
Infant mortality rates and birthweight are both internationally accepted indicators of the nutritional status of a population. The nutrition and health of the mother prior to and during pregnancy has an impact on the birthweight and infant growth and survival of her baby.
Low birthweight may be due to:
Low birthweight babies may be long and thin (asymmetrically small) which suggests normal nutrition early in pregnancy but the diet has been inadequate in the final trimester. Alternatively, it suggests that the infant is preterm. Symmetrically small babies tend to reflect more generalised undernutrition of the mother throughout pregnancy.
Lower birthweight - long term consequences Infants with lower birthweight are more likely to die or have problems early in life than infants with birthweights of around 3.5kg. At the other end of the spectrum, very heavy infants are also likely to suffer problems, especially if their mothers had diabetes during pregnancy. More recently, Barker and colleagues have proposed that, in addition to the well known short-term influences in early life, lower birthweight has long-term influences on the development of chronic diseases in adulthood, including diabetes.
Mackerras 1998:1
Low birthweight (weighing less than 2 500 grams at birth) and premature delivery are both more common in the Aboriginal population than in the non-Aboriginal population. A report 'Mothers and Babies 1995' showed that 12.9 per cent of Aboriginal live births were in the low birthweight category compared with 5.6 per cent of non-Aboriginal live births. It was also reported that 12.4 per cent of Aboriginal mothers reportedly delivered a premature infant compared with 6.2 per cent of non-Aboriginal mothers (d'Espaignet et al 1997:vii,7).
A study on maternal nutritional status and its impact on birthweight carried out in the Top End (Rae 1989) showed that the following maternal risk factors were strongly associated with low birthweight and IUGR:
Rae's study was used as the basis for the development of the Strong Women, Strong Babies, Strong Culture (SWSBSC) project which was implemented initially in three communities (see the description of the program in this chapter). Results of an evaluation after four years showed there had been a decline in the prevalence of low birthweight. There was also an increase in mean birthweight over time in the three communities. An increase in maternal weight gain and a reduction in preterm births were found to account for about half of the increase in birthweight (Mackerras 1998:61).
Most Aboriginal women breast feed their babies. About 96 per cent of Aboriginal mothers breast feed their babies from birth. About 93 per cent of Aboriginal mothers are still breast feeding their six month old babies (Rae 1994:40).
A woman's nutritional needs are increased while she is breast feeding.
Maternal nutrition Unsupplemented human milk is all that is required to sustain growth and good nutrition for the first six months of life in the babies of well-nourished mothers, who have produced foetuses with optimal stores, who have themselves laid down adequate nutritional reserves, including subcutaneous fat, in pregnancy, and who are well fed during lactation.
Jelliffe and Jelliffe 1978:79-80
Currently in the Northern Territory, many young Aboriginal mothers:
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See Rae (1989) and Mackerras (1998) for more information |
At this time, it is safer to assume that breast milk may not sustain the healthy growth of a baby after four months of age. It is recommended that other foods be given, in addition to breast milk, from four months of age. However, poor maternal nutrition and/or growth faltering in the infant are not reasons for switching from breast feeding to artificial feeding.
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Encourage and support mothers to improve their nutrition and to ensure that their babies get some food as well as breast milk | |
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Refer to the 'Growth Assessment and Action' in this chapter |
Reviews of international studies (for example, Pelletier et al 1993) suggest that any malnutrition or growth faltering is important. There is an increased risk of death and illness with decreasing weight-for-age and/or height-for-age.
The Road to Health Chart was developed to assist with the growth monitoring of infants 0-3 years of age. The Chart emphasises the relationship between the direction of growth and that risk or danger is associated with no weight gain or any weight loss.
The Chart is based on the National Centre for Health Statistics (NCHS) growth reference data for children. By using international growth reference data, we can compare how different groups of children are growing. For example, we can compare the growth of children in one region of the NT to another region or the growth of Aboriginal children with non-Aboriginal children.
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See 'Improving the growth and development of young children' in Section 2 |
Over the years there have been many surveys done in communities. Still, we do not have an overall picture of childhood malnutrition on a Northern Territory-wide basis.
In remote areas, the commonly observed growth pattern of Aboriginal infants and young children is:
First 4-6 months satisfactory growth in both boys and girls 6-18 months slower overall gains in weight and length, periods of weight loss, associated with illness periods of no apparent weight gain 18-24 months growth resumes
Based on Thurley 1993:1-11
Example of a common growth pattern in remote Aboriginal infants
In the Top End, studies show that there is a high level of malnutrition among Aboriginal children. Doctors have estimated that the minimum prevalence of malnutrition (defined as either a weight-for-age or length-for-age below the 3rd centile) is 20 per cent in children below two years of age (Ruben & Walker 1995a:401). These doctors have also observed that "up to 90% of young Aboriginal children in many remote communities are below average weight" (Ruben and Walker 1995b:445). Community based growth data from the Katherine area supports the finding that malnutrition is a serious problem in Aboriginal communities (Muller et al 1995:445).
Poor growth can be associated with :
The following cycle often leads to poor growth during childhood:
by Heather Grieve
While a child is recovering from illness, there is a catch-up growth period. To regain lost weight, the child requires a much higher intake of energy (calories) and protein.
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Ask a nutritionist to advise you about which foods to recommend to the child's carers. Foods should be energy rich and high in protein and available in most community stores |
The chronic diseases of type II, non-insulin dependent diabetes, heart disease and renal disease share underlying causative factors including poor nutrition. These diseases (along with hypertension and chronic airways disease) are major causes of the high rates of morbidity and mortality in Aboriginal people (Plant et al 1995).
The origins of these chronic diseases are believed to be set or 'biologically programmed' in utero and early childhood through low birthweight, malnutrition and repeated childhood infections. It may also be the case "that throughout the life course exposures and insults gradually accumulate through episodes of illness, adverse environmental conditions and behaviours increasing the risk of chronic disease and mortality" (Kuh & Ben-Shlomo 1997:6). Such behaviours include poor nutritional intake, lack of physical activity and substance misuse.
A recent study of renal disease among Aboriginal populations in the Top End of the Northern Territory (Hoy et al 1997) has shown that increased body weight, hypertension and lack of physical activity can add to pre-existing risk and increase the chances of serious adult disease. These chronic diseases and their underlying factors are potentially preventable (Territory Health Services 1998b).
Over the last century and particularly the last 20 to 30 years, there have been major changes to the living and cultural practices of Aboriginal people. The dietary changes have already been described. Many people now live in a semi-urban environment that gives less chance for the level of activity which was part of traditional living. Lack of physical activity and dietary changes, accompanied by social disruption and increased levels of stress, mean that more people are overweight or obese and suffer from the chronic conditions described above (Scrimgeour et al 1997:1).
In the first National Aboriginal and Torres Strait Islander Survey, 36 per cent of Aboriginal males and 29 per cent of Aboriginal females were found to be overweight (Body Mass Index 25.00 to 29.99) compared with the combined all-Australian figure for males and females of 37 per cent (Cunningham & Mackerras 1998:21; Australian Bureau of Statistics & Commonwealth Department of Health and Family Services 1997).
Twenty-five
per cent of Aboriginal males and 29 per cent of Aboriginal females were found to be obese
(Body Mass Index greater 30.00 and greater). The combined all-Australians figure for males
and females was 18 per cent (Cunningham & Mackerras 1998:22; Australian Bureau of
Statistics & Commonwealth Department of Health and Family Services 1997).
Several studies throughout the Northern Territory (for example, Knight 1992 and Urapuntja Health Service Aboriginal Corporation 1990) have identified a high prevalence of abdominal obesity (body fat around the waist or an 'apple shape' as opposed to body fat mainly around the hips or a 'pear shape'). Abdominal obesity is particularly associated with diabetes, heart disease and high blood pressure.
Controlling obesity through improving nutrition and increasing physical activity is important for preventing chronic diseases. However, it is extremely important to note that many Aboriginal women under 20 years of age are underweight when they have children and need to gain some weight.
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See Section 2 for strategies that work for improving people's nutritional status | |
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See Alcohol and Other Drugs chapter for ways to reduce smoking and alcohol misuse | |