[Congressional Record Volume 160, Number 50 (Friday, March 28, 2014)]
[Extensions of Remarks]
[Pages E467-E468]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      THE FIRST ONE THOUSAND DAYS

                                 ______
                                 

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                         Friday, March 28, 2014

  Mr. SMITH of New Jersey. Mr. Speaker, this week I convened a 
subcommittee hearing entitled The First One Thousand Days: Development 
Aid Programs to Bolster Health and Nutrition.
   There is perhaps no wiser investment that we could make in the human 
person than to concentrate on ensuring that sufficient nutrition and 
health assistance is given during the first one thousand days of life: 
A thousand days that begins with conception, continues throughout 
pregnancy, includes the milestone of birth and then finishes at roughly 
the second birthday of the child.
   Consider this: According to the United Nations Children's Fund 
(UNICEF), 6.6 million children died before reaching their fifth 
birthday in 2012; an average of roughly 18,000 daily deaths among 
children under five years old. Among the factors contributing to such a 
grim tally are malnutrition, obstructed newborn breathing, pneumonia, 
and diarrhea. All these, and other causes, are ones which we are 
capable of addressing, if we apply resources and political will to the 
problem.
   The hearing I held complements various hearings our Global Health 
Subcommittee has held over the past several years. It was inspired in 
part by what I experienced at the UN Millennium Development Goals 
Summit in New York in September 2010.
   There I had the privilege of participating in an extraordinary 
roundtable meeting of First Ladies of African nations that concluded 
with the signing of a declaration to end maternal and child 
malnutrition, with particular emphasis on ``the first 1000 days in the 
life of a child from the moment of conception.'' The roundtable focused 
on that great killer of children, malnutrition.
   The roundtable concluded that undernutrition alone remains ``one of 
the world's most serious, but least-addressed problems--killing an 
estimated 3.5 million children annually.'' In other words, food 
insecurity is a plague which ravages our future, ending the lives of 
little boys and little girls throughout the developing world well 
before their time. The roundtable also pointed out that 60 percent of 
the world's chronically hungry are women.
   According to the Global Alliance for Improved Nutrition, or GAIN, 
cosponsor of the roundtable, malnutrition's most devastating impact is 
actually in the womb, often causing death or significant mental and 
physical disability to the precious life of an unborn child.
   Children who do not receive adequate nutrition in utero are more 
likely to experience lifelong cognitive and physical deficiencies, such 
as stunting. UNICEF estimates that one in four children worldwide is 
stunted due to lack of adequate nutrition.
   Children who are chronically undernourished within the first two 
years of their lives also

[[Page E468]]

often have impaired immune systems that are incapable of protecting 
them against life-threatening ailments, such as pneumonia and malaria. 
Adults who were stunted as children face increased risk of developing 
chronic diseases, such as diabetes, hypertension, and heart disease. 
Mothers who were malnourished as girls are 40% more likely to die 
during childbirth, experience debilitating complications like obstetric 
fistula, and deliver children who perish before reaching age five.
   We must take a holistic, mother-and-child approach to the problem.
   By helping women throughout pregnancy receive adequate nutrition and 
supplemental micronutrients--such as iodine, Vitamin A, and folic 
acid--and ensuring that they are well-fed while nursing, both children 
and mothers thrive.
   In addition to addressing undernutrition, there are a number of 
other interventions that can make an impact. About 44% of all under-
five deaths occur within the first month of life, during the neonatal 
period. Among newborns the greatest threats to survival are prematurity 
and failure to breathe at birth, known as birth asphyxia. Following the 
neonatal period through the first five years of life, child survival is 
imperiled primarily by pneumonia and diarrhea.
   The solutions are often readily at hand. Most neonatal deaths can be 
prevented at little to no expense with neonatal resuscitation, prompt 
administration of antibiotics, and nutrition supplementation. 
Inexpensive interventions like oral rehydration salts (ORS), which cost 
$0.05-0.10 per dose, are also effective in curbing diarrheal deaths.
   Nor must we ever pit the survival of the child against that of the 
mother, as both are complementary objectives. Curbing child mortality 
in the womb and at birth also goes hand-in-hand with reducing maternal 
mortality.
   Best practices to radically reduce maternal mortality can and must 
be life-affirming--protecting from harm both patients, the mother and 
the child in the womb. Of course, we have known for more than 60 years 
what actually saves women's lives: skilled birth attendants, treatment 
to stop hemorrhages, access to safe blood, emergency obstetric care, 
antibiotics, repair of fistulas, adequate nutrition, and pre-and post-
natal care.
   Political will is absolutely essential to address this problem and 
to make sure it is adequately resourced. It is one thing that I hope 
this hearing will bring to light, that such interventions in the first 
1000 days of life is not only morally imperative but also cost 
effective.
   One group of Nobel Laureate economic experts ranked efforts to 
address undernutrition as the single most cost-effective investment in 
foreign aid. The economists concluded that each dollar spent on 
reducing undernutrition could yield a $30 benefit.
   One other thing I hope this hearing will highlight is the importance 
of Faith Based Organizations in fighting this battle, and to underscore 
the need for our aid programs to work with such organizations. We will 
hear from representatives from two such organizations, Food for the 
Hungry and World Vision, to discuss their insights.
   Faith Based Organizations play an absolutely critical role in places 
such as Africa, which one can say is a Faith Based Continent. Matthew 
25--``when I was hungry, you gave me food, when I was thirsty, you gave 
me drink, when I was naked, you clothed me''--inspires these and other 
great organizations such as Catholic Relief Services, just as it 
inspires the work of this subcommittee.
   For example, in 2004, along with my colleague on the Foreign Affairs 
Committee, Ileana Ros-Lehtinen, I sponsored an obstetric fistula 
resolution, seeking to address one debilitating factor that wreaks 
havoc on the lives of mothers and their children. The following year I 
was able to amend the Foreign Relations Authorization Act to fund 
twelve centers in the developing world to treat and prevent obstetric 
fistula, as well as to provide funding for skilled-birth attendants. 
Importantly, I was also able to remove restrictive language from the 
original bill that would have prohibited faith-based hospitals in the 
developing world from receiving funding. Again, I must stress, that it 
is these faith based organizations that are doing yeoman's work on the 
ground to address child and mother mortality, and they must be 
supported.
   In this Congress I introduced H.R. 3525, the International 
Hydrocephalus Treatment and Training Act. Hydrocephalus, or ``water on 
the brain,'' is a disease which affects three to five out of every 1000 
newborns in developing countries, who are either born with it or 
acquire it due to neonatal infections in the first few months of life. 
For such children, it is often a death sentence. Doctors--assuming 
there is even a doctor around--often do not know how to treat it.
   Moreover, if they do treat and use the traditional surgical 
procedure which requires the life-long use of a shunt, such shunts 
often become infected, leading to death a few years later.
   Our bill would train doctors in Africa in a new and proven technique 
which does not require a shunt and is effective in at least two thirds 
of the cases of infants with hydrocephalus. It is ideally suited to 
conditions in the developing world. The amount required to make a 
difference in the lives of these children and their parents is 
relatively little--an estimated $15 million over 5 years. I invite my 
colleagues who are present here to join in co-sponsoring this 
legislation, as one way to address the problem of child mortality.
   Initiatives such as these are ones which should gather support 
across the political aisle--they are life-affirming, and can save the 
life of both mother and child. We have common ground here.
   By addressing health during the first 1000 days of life, beginning 
at conception, we help ensure that over the next 25,000 days--or 
whatever the number is that our Creator has allotted--our brothers and 
sisters the world over can best reach their potential, leading 
fulfilled lives of health, vigor, and dignity.

                          ____________________