YSPH professor Pérez-Escamilla contributes to new American Journal of Public Health series: ‘Nutrition in the First 1000 Days’

It’s called the “First 1,000 Days window” – the time between pregnancy and a baby’s second birthday. That’s the period most critical for health and brain development, and when good nutrition has the greatest influence on future health.

The American Journal of Public Health released “Nutrition in the First 1000 Days,” a special series of editorials, perspectives, and research and analysis on October 26 that “identifies opportunities to unlock the untapped potential of this critical time by closing data gaps, enhancing promising programs, strengthening policies, and uniting around this powerful window of growth.” This comes nearly a month after the Biden-Harris administration hosted a White House Conference on Hunger, Nutrition, and Health, which took place September 28. This conference was only the second such event ever held at the White House; the previous one took place in 1969.

Introduced by White House Domestic Policy Advisor Susan Rice, and led by the Centers for Disease Control and Prevention (CDC) and the organization 1,000 Days, this multi-faceted, 70-page series was written by more than 20 authors, outlining the role of early childcare and education (ECE) settings.

Rafael Pérez-Escamilla, Professor of Public Health (Social & Behavioral Sciences) and director of the Office of Public Health Practice at the Yale School of Public Health, was one of the authors. In his essay, “What Will It Take to Improve Breastfeeding Outcomes in the United States Without Leaving Anyone Behind?,” he discussed steps to improve the nutrition of pregnant people, including how to realize the potential benefits of breastfeeding so that no one is left behind. He talked with the YSPH Office of Communications about the series and its importance.

I was asked by the CDC to write an editorial on what would it take for the U.S. to improve breastfeeding outcomes, considering the breastfeeding care needs of low-income women, including women of color. Given that I have been engaged for almost three decades not only thinking about but also conducting research on precisely this question, it was very easy for me to agree to do it.

A series like this, which was led by the 1,000 Days organization and the CDC, takes many months of planning and work. I became aware of the series over a year ago and agreed to engage with it about six months before the White House conference happened.

This series is truly groundbreaking for the U.S., where many people don’t even know what the term ‘First 1,000 Days of Life’ means, and even less so why nutrition during this window of time is so crucial for human health and development. The first 1,000 days includes gestation and the first two years of life. Proper nurturing care during this window of opportunity is fundamental for children to develop healthy lifestyles (including healthy food preferences), grow healthy, and develop properly. What happens or doesn’t happen during this period is a powerful determinant of the quality of life that persons will have for the rest of their lives and of course this has huge implications for national development. The series is strongly linked to the new White House National Strategy on Hunger, Nutrition, and Health, which strongly emphasizes the need to invest much more in improving food security and nutrition during the first 1,000 days and throughout childhood.

I was asked to focus on recommendations to the U.S. government for improving breastfeeding outcomes for all. The key takeaways are that breastfeeding is crucial for improving child health and development in the U.S. during the first 1,000 days, and that it is also key for women’s health. Also, that breastfeeding is not the sole responsibility of women; protecting, promoting, and supporting it requires a whole-of-society approach. Because of major structural barriers, women of color are much less likely than white women to meet their breastfeeding goals.

Importantly, my article proposes 10 doable, evidence-based solutions in the context of the strong socioeconomic breastfeeding inequities that exist in the U.S. I hope that my work influenced, and will continue influencing, the call from the new White House National Strategy on Hunger, Nutrition, and Health for expansion of the Baby Friendly Hospital Initiative, breastfeeding counseling services through WIC, and reimbursements from private insurance and Medicaid, behavior change communication campaigns, and improved monitoring and evaluation systems.

At the end of the day, I hope my work contributes to addressing the major social, economic and health care systems structural barriers for breastfeeding in the U.S. These include institutional racism, lack of paid maternal maternity and parental leave, low support for breastfeeding at the workplace, aggressive marketing from infant formula companies, and lack of well-trained health care providers. I am very keen on advocating for breastfeeding education and training to improve substantially in the U.S. at medical schools, schools of nursing, and programs training nutritionists, dietitians, midwives, doulas, and community health workers.

Finally, I hope that the whole of society fully embraces the fact – as the new White House national strategy does – that quality breastfeeding support for all is a crucial investment for national development. Therefore, I am beyond thrilled that the new White House National Strategy on Hunger, Nutrition, and Health is calling for prioritizing and investing much more on breastfeeding promotion and support actions through a health equity lens. These include improved maternity benefits, social and behavior change communication campaigns, the Baby Friendly Hospital Initiative, breastfeeding counseling, and other interventions delivered through national public health and nutrition programs like WIC.

In this regard, the most important action the U.S. government can take is to tightly regulate the marketing of infant formula and other commercial milk products targeting infants and toddlers. This is because often the formula industry follows a marketing playbook driven by unsubstantiated health claims about their products and breastfeeding misinformation that undermines the self-confidence of women in their ability to breastfeed. In addition, they also market their products through funding tactics, that create enormous conflicts of interests among scientists, health care providers, and professional societies representing diverse health and nutrition professions.