Why India’s future lies in her children’s first 1000 days? | Job Zachariah & Dr Vignesh Devraj, MD
Author Name:Dr. Vignesh Devraj
Youtube Channel Url:https://www.youtube.com/@drvigneshdevraj
Youtube Video URL:https://www.youtube.com/watch?v=geVXW4x-e0g
Title: Why India’s future lies in her children’s first 1000 days? | Job Zachariah & Dr Vignesh Devraj, MD
Author Name: Dr. Vignesh Devraj
Description: The first 1,000 days of a child’s life, from conception to the second birthday, are often described as a critical window of opportunity. During this period, nutrition, health, care and the environment around a child can influence their development and future wellbeing.
In this episode of Ayurvedic Healing & Beyond, Dr Vignesh Devraj is joined by Job Zachariah, who has spent many years working with UNICEF across different parts of India on child health, nutrition, education, sanitation and protection.
They explore why the first 1,000 days matter and the nine key practices that parents, families and communities can focus on during this period, including maternal and child anaemia, breastfeeding, complementary feeding, malnutrition, immunisation, sanitation, safe water, handwashing, nurturing care and maternal education.
Job also shares his experiences of taking these messages to families through doctors, health workers, community initiatives and a programme developed with the IMA in Kerala.
Episode Highlights
The First 1,000 Days
The Nine Key Practices
Breastfeeding & Nutrition
Immunisation & Sanitation
Nurturing Care & Stimulation
The Role Of Family
Reaching More Families
Timestamps
00:00 – 14:20 – Why The First 1,000 Days Matter
14:20 – 29:00 – The Nine Key Practices
29:00 – 48:00 – Nutrition, Breastfeeding & Immunisation
48:00 – 57:00 – Sanitation, Water & Handwashing
57:00 – 1:03:00 – Nurturing Care & Family
1:03:00 – 1:07:55 – Taking The Message Forward
TEDx TALK WITH DR VIGNESH DEVRAJ
In his recent TEDx talk, Dr Vignesh Devraj shares a personal story from his childhood and explores how our emotions, relationships, work, experiences and environment can influence health. He also reflects on the Ayurvedic concept of Swasta and staying connected to our authentic selves.
Watch Dr Vignesh Devraj’s TEDx Talk - • Learning to listen to the body | Vignesh D...
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Learn More About The 14-Day Ayurvedic Metabolic Reset -https://sitaramretreat.com/ayurvedic-...
About Job Zachariah
Job Zachariah has spent many years working with UNICEF across different parts of India, focusing on child health, nutrition, education, sanitation and protection.
About Dr Vignesh Devraj
Dr Vignesh Devraj is a fourth-generation Ayurvedic physician and the founder of Sitaram Retreat, Kerala, a space for authentic healing. He is a committed practitioner and researcher of Panchakarma.
One-on-one Ayurvedic consultation:
https://calendly.com/drvignesh/30-min...
BALANCING THE MIGHTY VATA – ONLINE COURSE NOW AVAILABLE
Vata governs Prana, the nervous system, movement and emotional well-being. This comprehensive online course includes over 6 hours of practical teachings, downloadable notes and tools that can be integrated into everyday life.
Link: https://vigneshdevraj.com/balancing-t...
For further information, kindly visit: www.vigneshdevraj.com and www.sitaramretreat.com/
Instagram – @sitarambeachretreat | @vigneshdevraj
Twitter – @VigneshDevraj
Disclaimer: The content discussed in these episodes should not be used as medical advice or as a substitute for professional medical care.
Transcript:
(00:00) What was this first thousand days? Where did this whole concept came about? >> I would say this is one of the biggest discovery in human life and it is called the window of opportunity. So your character, your behavior, your attitude is also decided in your childhood. Mostly childhood diseases happens in this first 10,000 days.
(00:19) In India for example about six lakh babies die before seeing the first birth. This 1,000 days happens in the life of a person how many times? Only once. India's destiny and future is written the first 1,000 days of a baby and you can be part of it. At least we can reach this message directly to these mothers or pregnant mothers who are going to be conceived or who are having young children below 2 years.
(00:48) In today's episode, let's talk about the most underrated phase in a human's journey. The first thousand days and the profound influence it has on a person's life. These thousand days begin from conception [music] and extend through the first two years of a child's life. They're often described as a critical window of opportunity [music] where nutrition, health, care, and the environment around a child can influence development and [music] future well-being.
(01:15) To explore this, I have invited Mr. Job Sakura who has spent many years working in the top levels of UNICEF across different parts of India on child health, nutrition, education, sanitization and protection. We will begin by understanding why the first thousand days matter and how this [music] period can influence areas ranging from survival and childhood diseases to growth, brain development and even aspects of adult health.
(01:40) The first thousand days happen only once. So let's explore why this window matters. what can be done during this time and how small everyday actions can contribute to the health and development of the next generation. [music] I hope you'll enjoy this episode. Now we go to Mr. Job Sakura. Sir, it's an honor to have you.
(02:00) You know the last time I met you during the TEDex talk that you were giving on the first thousand days. >> So when I [clears throat] heard this, I was very keen to have you in my podcast. >> So you you said that you were chief of staffs in different parts of UNICEF. You are you're heading a department in UNICEF.
(02:16) Can you explain more what you do what you did in the past >> and uh I want to get into that first thousand days of your baby that story. >> Yeah, UNICEF as you know stands for the welfare of the children and the women. So I was heading the UNICEF offices in different states in across India. I was chief of India Kerala and Tamil Nadu office the Chhattisgarh Jakand >> Bihar Orisa different different offices.
(02:40) The main work of UNICEF is the to see the to improve the to help the government to improve the health, education, nutrition, sanitation, protection aspects of children. That was my work in the last uh 15 20 years. >> So tell me what was this first thousand days? Where did this whole concept came about? >> It's very new.
(03:01) >> When you say very new, how >> Yeah. You cannot attribute to a partic particular person who found out. I would say this is one of the biggest discovery in human life. >> Um, Lancet had issued a series of article on child health, child nutrition, maternal nutrition in the last 20 years and in the process of issuing of those article each article as you know Lanc said each article has got 250 to 300 uh citations.
(03:32) It's based on one article is based on 250 30 and they realize it somehow came out that 1,000 days is so critical in the life of a person. >> The first 10,000 >> first 10,000 days is the most critical came out is emerged like that. So it's not a a person who found out uh I would say that a person had found out he would have worthy for to give a Nobel Prize for medicine or peace for this finding.
(03:58) >> So we don't know who it is but it just accumulate. emerged. So it's so there is no particular person you can attribute to. He is the person who found out that first 10,000 days is important critical in the life of a person. So tell us about what is this first,000 days and what are the you know the key parts of this.
(04:16) >> Yeah. The first 10,000 days decides or influences at least so many things. First is it survival of the child itself >> is decided. And by the way, first 10,000 days, is it from the date of birth or from the date the mother finds out? >> Yeah, thank you for asking that one. This one first 10,000 days is formed 270 days of pregnancy.
(04:41) 365 days of the first birthday, >> 365 of the second birthday. So from conception to the second birthday that 270 + 365 + 365 forms the >> first 1,000 days and it is called the window of opportunity. So whatever you need to do, you need to do in the first 10,000 days. And the Lancet study says the damage caused by inaction >> is irreversible.
(05:09) >> Opportunity is just like opening a window and if you don't do it, the window is closed after 1,000 days and it may little open during adolescent period and to close within one or two years. >> Sir, so what are the key areas? So the it decides too many areas too huge I mean it will take hours to dis explain.
(05:30) First is the survival itself. >> In India for example about six lakh babies die before seeing the first birthday. So this first 1,000 days a baby survives the first 10,000 days then the survival rate is very high. >> So that is the first one. Second one, first 10,000 days is the period of diseases.
(05:53) All mostly childhood diseases happens in the first 10,000 days. Basically, the most important childhood diseases are pneumonia and diarrhea. They are the killer number one and two about onethird of the children die because of pneumonia and diarrhea. So all the diseases third thing the even your adult adult life diseases >> is also influenced in this decided almost you can say like for example your heart disease um hypertension >> um diabetes these are all predetermined during this period >> I see >> in great way the influences even your adult life diseases also
(06:30) >> fourth area is regarding the your height >> the standing >> first 1,000 days is the period when the standing happens >> and in India standing is very high. 36%age of the children in India are standard. What >> can you explain what is standard? >> Standard means you know they don't gain uh the height required for that age.
(06:51) >> So who has got a a a chart? >> Yes. >> It maps the height as per the age that is called the WHO growth standard height. And if you are not achieving the height as per the that one then you are called standard. >> Now standing has two impact. One is that by standing your height will reduce. Second one that is the height reducing reduction is not very important.
(07:18) Your brain will be standard. Your brain development will be affected. So when your brain development affect affected then you will not be performing well in studies. Then you will not get a better job. then your income will be so that the entire cycle will affect >> so rest of the life is impacted >> impacted so therefore so even in Kerala 23%age of children are stunned but who is aware about it and who what do you have to do about it is also unknown so another the ma normally we call it as malnutrition but malnutrition has got I
(07:52) mean two three different different words so and malnutrition is also the cause for 69%age of the Child death the root cause of 69% of the child death as per Lancet is malnutrition. >> I see. >> So that is a major issue that that happens in the first 10,000 days. >> Malnutrition does not happens after first 10,000 days.
(08:14) >> That is when whatever happens and whatever the adverse effects happens in the first 10,000 days then is the as I explained the height that is a corollery to the the point on standing >> your height will be reduced. So many people many people think this is controversial and uh this is not this is exaggerated.
(08:36) How come? I mean know general belief is that height is decided by her or racial or genetic partially it may be true but the new evidence is telling there is a major one huge study by the Imperial College London >> Bandam study it says height is basically influenced by environmental and nutritional factors not much of the hereditary factors.
(09:02) M >> second proof of that one is the who growth standards it is uniform that what that chart they are preparing is uniform they use every pediatrician in America or Africa or India or Australia use same chart if it were different for different racial groups and different countries they would have developed a different so they did a research 20 years research and they came out if things are happening in the first 10,000 days the height gained by a person is same.
(09:33) Now another example for this one I mean for this it is not hereditary is for example the Chinese people >> there are a lot of studies they're considered to be very short people now they are very tall and they play a large number of people play in the NBA American basketball where you need to have 6 ft minimum height >> so and same thing is there is another study on the um second generation Indian-Americans children all boys are 6 feet and above even around us if you look around Our children are taller than parents and grandparents. How does it
(10:06) how did it happen? Definitely the environmental factors are happen are affecting. There is another study Indian study called HPS Sachida. So he found that the height of children have increased by 5 to 8 cm in the in this present generation. How did it increase? If it was >> hereditary then how did it increase? So there's a increasing evidence to show that height is decided I mean greatly decided I mean definitely her the genetics may be playing there are dominant genetics for example in my my mine is a dominant genetic of height so
(10:45) even if my children marry a short person pikmi is probably having that number is very less >> 95%age is not the dominant height is not determined by their genes coming to again a corollary thing is you know Even your income, how much salary you will, how much income you will earn in your adult life is also influencing this kind of this is also you know u opening thing.
(11:10) >> So so you mentioned about the four things so far of the first 10,000 >> importance. >> Yeah. So what are the the next ones >> that is one is the income. >> Okay. >> The income of your future income is also decided in this first 10,000 days. Again people will ask how but it is very simple.
(11:29) Bhu 10,000 days if you're standard your IQ will be less >> you will your studies will be poor then your qualification will be less then you will get a not a very highly placed jobs so your income will be less so there is a there are many studies to support that one which is called a grandam study grandam study says a standard child will lose 22%age of the income >> so and if an ordinary person gets 100 a standard child will get only 78 rupees M >> there is another study called the Timotei Jed study which is a recent study which says that each additional
(12:04) inch increase will give you $789 increase in salary which means >> the height >> height each inch uh which if you convert in a very crude form if a 5T person gets 30,000 rupees a 6 ft person is likely to get 40,000 rupees there's a Brazil study which says that each inch will increase your income by 2%age. >> Mhm.
(12:28) >> So there are lot of studies again but it is a simple corollery. It is actually height is not the determining factor in this income. It actually no role actually it is because your standard your qualifications are less then you get lesser salary. M >> so the that is the another one which is also your character your behavior your attitude is also decided in your childhood >> because the first >> first 1000 days whatever experience the child goes the love affection care this is called the serve and return theory so
(13:07) child develops serve and return just like in the tennis serve and return >> when child faces a particular set of experiences it responds with that one in the adult life. So stress your attitude to life behavior to a great extent it is decided in this first 10,000 days. There are again there are a lot of studies one major study is the Harvard center for child development is called BIP study CDC center for disease control.
(13:39) There is another study they all confirm and validate that your it may not be the entirely it may not be decided but to great way it is your charact your uh behavior attitude is decided in the first 10,000 days another one is major so ninth point is regarding your the GDP of the country is also decided influenced not decided I would not say it is also simple if the quality of the human capital developed in the first 10,000 days is good then your GDP will go down.
(14:15) For example, because of anemia, we are losing 4%age of our GDP. Because of malnutrition, we lose 6%age of the GDP. Because of poor sanitation, we lose another 6%age. Before lack of stimulation and care losses 3%. So about 15 20% of your GDP is lost because of lack of certain things not do inaction in first 10,000 days country loses about 15 to 20%.
(14:44) Let us con very conservatively think 15%age only. You know what's the EGS GDP? I don't know how to even say it. It is 350 lakh cr. >> So it is 35 followed by 13 zeros. M >> now 15%age of is is 52 lakh cr will and if this 52 lakh cr is divided by to given to every Indian citizen 140 cr people each person will get 40,000 rupees which means if if he had done everything properly every Indian would have got 40,000 rupees per year >> so this is the impact of this first 1,000 days so you must have heard this saying that the destiny of India is
(15:27) written written in each classroom. I would say the destiny of India is written in the first 10,000 days. Certainly the destiny >> destiny of the entire planet also the cost >> besides the destiny and the future of the child is also decided in this first 10,000 days. So the parents and the family and the society has got a huge role first to understand this first importance of first 10,000 days.
(15:54) Earlier we talked about the research and how the the lancet and how this idea came. Unfortunately since it is very new this has not percolated down reached the people to whom this is more critical. Who are the people who are critical? The mother, parents and the family members. It has not gone to them.
(16:16) So thank you for giving this opportunity because this is a platform at least we can reach this message directly to this mothers or pregnant mothers who are going to be conceived or who are having young children below 2 years after 2 years the window is closed. So at least up to 2 years they can still do something. So thank you for giving this opportunity to disseminate this critical information to the people.
(16:44) Sir, I'm a father of a six-month-old. So I think >> so. Then I will then I will ask you a few questions please. >> I mean coming from this background I will ask you a few questions. First question was your wife anemic >> before even conceiving. >> Yeah that was sorted much before that. >> No but how do you know? >> I mean we tested the blood >> when Okay.
(17:10) So but 67%age of the women are anemic. So you are an exception. Second one did you give your child this in India keralite must have happened five four vaccinations have you given four vaccinations to your child >> uh to my >> the birth >> one and a half months 2 and 1/2 months 3 and 1/2 months 9 months five vaccinations have to be and along with it nine doses of vitamin A I'm sure vitamin A is not given in I mean most of the places >> so he must have your son must have missed daughter daughter daughter must have missed this vitamin A. Another question
(17:46) I want to ask is regarding the whether have you compared do you have a chart of this who growth standard >> no you you normally in hospitals they give the weight versus height >> yeah that is true >> but what I'm talking is there are three charts >> one is weight how much weight you are gaining as per your age this most this one most important is the what is the height of the Maybe as per the chart >> as per the age that one have you charted >> that we are charting >> you have charted so that means you are you you are almost following most of the
(18:27) nine things nine tips nine talismen which a parent should do in the first let me ask me you one thing how many people in your family do the queen or doing gaga or tell stories or play with them. Not the mother and father alone. How many members in your family are doing play with them, smile at them, hug them, kiss them, um do the gaga, cooing, um looking at them, singing to them, telling stories to them, play with them.
(19:05) How many of them are doing it? >> So it's a huge family. So there's a lot of people who will come and do that. >> Yeah. So, so that means you are see this one you this is a picture I always show. >> So this is Mark Zuckerberg >> founder of this book. >> When his daughter was born >> u at when the daughter was one week old >> he was reading a book on quantum physics.
(19:35) Now quantum physics is the most complex science and he was reading this book to this baby of seven days. M >> now I don't think the baby will understand anything on the quantum physics it can never and we have I mean in our puranas there are many stories the story of >> abimemenu being taught on when he was on the boom on the how to break the chakra vuha we we know that story what is happening is not the they will not understand anything which is said but it affects their brain development you know in our brain 700 to 1,000 neural connections are made in 1 second.
(20:16) >> I'm not I didn't say minute 1 second. 700 to 1,000 neural connection happen that builds the brain. >> So when we are doing the stimulation which I mentioned the examples I gave care that that builds the architecture of the brain of the child. So therefore that one stimulation is very very very important >> in this first 10,00 days.
(20:41) >> So so uh I just want to sum up what are the nine concerns of the first 10,000 days and then before we go into the solutions can we just sum up sum? >> Yeah yeah so to sum it up there are nine reasons why 1 1000 first 1000 days is important. First one is the survival of the child.
(21:02) The survival of the child is decided or influenced in the first 1,00 days. >> If the child survives that 1,00 days, then baby is have got a higher life expectancy. Second one is >> is diseases. >> It's a time of diseases childhood. That's why we call a childhood disease mainly diarrhea and pneumonia. >> We in the UNICEF we call them as killer number one and killer number two just like in films.
(21:28) and they account for onethird of all child death is accounted by. So that that happens in that 10,00 days. Third one is the adult diseases. Adult diseases is greatly influenced and decided in this first 10,000 days. >> Uh like heart diseases, diabetes, hypertension, they are all pre-decided to great may not be in all cases to great extent decided in this 10,000 days.
(21:56) Fourth thing which is decided in first 10,000 days is standing >> that we mentioned >> 80%age of the standing happens in first 10,000 days. After 1,000 days there is no standing or malnutrition. You can say underweight or obese but malnutrition the technical definition of standing happens only in the first 10,000 days and there is a consequence of it.
(22:18) Fifth one is a corollary uh to that one is the height uh height of a person is a greatly decided because the uh when you are standard then your height is reduced your IQ is also reduced. Sixth one is the brain development again is a corollary to the standing when you are uh bra when you are standard your brain is de then the cognitive and emotional development affects then your it affects your studies.
(22:47) Seventh one is your the income again is a corollery to the standing I mean when you are standard >> it impacts your eighth one is your uh attitude and behavior >> is greatly influenced by the experiences the child under goes in the first 10,000 days >> how you uh your decision making your leadership your analytical thinking all so your how do you manage your stress all in a great way influenced in the first 1000 days and Last ninth point is the GDP of the country.
(23:18) >> GDP of the country is influenced during this 10,000 days because if if n during the first 1,000 days baby is taken care of India would increase at least by 15 or 20%age. M. >> So these are the nine things uh nine factors why the the first 10,000 days so critical in the life of not only the baby or the family or the community even the nation.
(23:47) >> So now let's go to the solutions for this. How does a let's say a couple planning to have a baby like in Ayurveda we say that at the time they decide to have the a child a couple at that time they should start changing their lifestyle they should start doing therapies like pancha karma as a part of the preparation and then from the conception it's a uh there is a protocol also so now coming to all the concerns that you mentioned let's talk about the solutions for that if somebody's listening to that what should all they keep in mind for
(24:19) both the mother and the father. >> Yeah. I would like to give a is a talisman. I'll call it as a talisman of nine tips >> to be done in this knowing why it is 1,00 days is important is of it's not much value. Of course it's a value but >> how it can be in practice what we can do there are nine things.
(24:40) First is >> the anemia of the mothers >> that has to be addressed to be prevented. Not only enemy of the mothers, the children and also the girls. Enemy of the bloods, the iron store in the blood is just like a bank account. >> It is not created on a particular day over the years. The bank deposit. So it has to be addressed even in the adolescent period.
(25:06) >> In India 67%age of the children are anemic. >> This is the latest NFHS study. It's not an old study. This is about 2 years old and uh uh about 59%age of the adolescent girls are anemic and about 57% of the pregnant women are also enemy. So that have to be addressed that is the biggest this is a I would say the one two challenges India faces is one is anemia and malnutrition.
(25:33) >> Now this can be addressed. Now what is the consequence of this one? Because of the anemia the baby is likely to be preterm before 37 weeks. uh baby is likely to be LBW that means below 2.5 kg baby can the mortality rate of the both mother and is very high it can lead to malnutrition it can lead to uh diseases there's a entire cycle will start when the mother is enemy so it has got a lot and definitely the 3%age of our GDP is lost just because of enemy of women so that is the now the con how to prevent it is very easy first thing eat iron
(26:13) rich food. So if you are a non-vegetarian eat fish and meat if you are a vegetarian take more pulses and leafy vegetables minga things like that. That is the first one. Second strategy is to eat rice and wheat from the ration shop. M >> if you eat the second one there will be no anemia because last 3 years a government of India has added fortified our ration with iron.
(26:42) >> So if you look into your rice there's a pellets kernels in the same shape of a is added into your rice. So it has got rice. So if you're regularly taking the ration rice then you may not like you may not get any. Third thing is you can take the IFA tablet or iron tablets. Now iron tablets are given across India in all schools up to 12th standard >> but many of the places this iron tablets are not given.
(27:15) So no wonder 69%age of the children in India are enemy. So these are the three things and one important thing now we have coffee in front of us. uh after taking food never take coffee or tea. This is fashionable because it inhibits the absorption of iron in the body. You can instead you can take orange or amla or even lemon you take then it increases the absorption.
(27:41) So that's the anemia. So the mother should not have mother and children should not have anemia. Second one is a mother's the maternal nutrition and health which is simple in Kerala it may not be an issue but it's an issue in the other parts of India where mother should get a nutritious food uh should at least have four health checkup should have micronutrients basically zinc iron and um the vitamin A and D then worm infestation Kerala I think this is a fairly taken care of.
(28:21) So that is very important because if mother is mother's nutrition and health is poor that leads to pre-term delivery and also the LBW babies. So it's very important. So that is the second and >> LBW means low birth >> low birth weight a low birth weight means 2 and a half kg. So it's not a big issue but in India it's a big issue. In India 18%age of the children born have less than 2.
(28:49) 5 kg even now >> and about 12%age of the children are uh delivered pre-term delivery and that delivery children born pre-term it has high risk of death 35%age of the reason for neonal death is because of the pre-term complication. >> So that's very important. Third point is is regarding that the their childhood period taking care of the children in the neurotal period and taking care of their diseases is very the third tip it's fairly done in Kerala but not maybe in India first thing is regarding the preventing the LBW and uh pre-term that
(29:30) if the mother is has got nutrit nutritious food and healthy then probably it may not happen in Kerala therefore the LBW and the pre-term cases are very less. >> Second one is the management and the treatment of diseases >> especially diarrhea and pneumonia. One >> one episode of diarrhea is sufficient from for a baby from healthy baby to go to red in the chart malnourished one episode is sufficient.
(30:00) So that treatment is luckily in our immunization system I would say the immunization system in the government it's much stronger than what is happening in the private hospitals. So in the government system there is rota virus which is one of the element which is causing the diarrhea. There is already inbuilt vaccination is being given so that those babies will not have diarrhea.
(30:25) So the episodes of diarrhea in India has reduced substantially. Pneumonia also there is again a vaccination is there built into numokcoal vaccination is built into the governmental system in private different hospitals follow different systems. >> So but these two diseases have to be managed and sometimes they need the treatment in a special newborn care unit which is called essence use.
(30:49) So the treatment of the so children are required and then also the the neurotal period the 28 first 28 days there's a theory in in child death uh 23 of the child >> first 28 days after birth >> after birth that is called neortal period there is a theory there is a what do you call equation >> 23 of all child deaths below 5 years happens in the first year >> okay >> 23 of death of first year happens in the First 28 days 23 of all deaths of 28 days happens in the first week.
(31:25) 23 of all deaths of 7 days happens in the first day. Like that there's a theory. >> So 28 days is a very critical period. >> So that 28 days it has to be seen if you just give mother's milk breastfeeding and kangaroo care. Kangaroo care is not practiced. >> You mean the kangaroo? Kangoo care means just keep the baby close to your chest.
(31:47) >> Not only by mother, by father, by brother. If you do that one, it is as good as an SNC unit where you that what do you call that system where light and everything is much more effective. It was found out in the South America. M >> so if you do breastfeeding and kangaroo care kangaroo skin care that is sufficient for this 28 days.
(32:16) The one research says that you know the this breastfeeding alone uh will prevent about 22%age of the neonal deaths. Breastfeeding exclusive breastfeeding only breastfeeding prevents 22%age of the neonal deaths means death during the first 28 days can be prevented. These are the the child care things. So there are three things we have covered.
(32:35) Then we come to the issue of the the most important thing. The fourth one is the breastfeeding. There are three things to be done related to breastfeeding. The baby has to be fed with mother's milk within 1 hour. >> Second baby should be given only mother's milk in in the first 6 months. Not even a drop of water or a milk or honey.
(33:01) And third from sixth month baby has to be initiated into semi- solid food from sixth month. Now these are very simple and you will think this is very high but you will be surprised to know that only 42%age of the mothers give the mother's milk in the first 1 hour only 42%age and it is declining >> I think if new survey happens going by the practice now it will be showing and the exclusive breastfeeding happens only in 64 4 percentage and the complimentary feeding the proper complimentary feeding with the quality is happening only 11 months. Everybody initiates
(33:46) semi-olid food from 6 month but it has to be with the frequency and quality. There is a there is a theory and there is a tiranga color food to be given. There are multi frequencies to be given. So doing complimentary feeding as per requirement only 11%age of the mothers are doing and because so that is a very gray area in the development of the child >> and then on top of it now we hear a big issue is has emerged that hospitals and pregnant women sorry the nursing mothers are saying they don't have a milk >> milk has stopped
(34:26) and this is reverberating across India Yeah. No milk. The other milk is the mother's milk is >> I think across different parts of the world too >> maybe different parts. And if millions of years mothers have been feeding their babies with breast milk, how come all of a sudden in the last 10 years it has stopped coming? Yeah.
(34:48) Has anything happened? I don't know. >> So this is a major obstacle in this nine tips which are talking about this. We have to overcome this and we have to ensure breastfeeding within 1 hour 6 months only mother's milk and initiating quality complimentary feeding from 6 months. This is very critical. Now by doing this one there are benefits for both baby and for the mother.
(35:18) For babies we know this is the first vaccination. Mother's milk is considered to be the first vaccination of the baby. It protects against all diseases and infections. It also uh develops the brain development about 10 to 15% breastfed children have 10 to 15 percentage IQ more than the non breastfed children. >> So it has a lot of and it addresses the malnutrition.
(35:44) If a baby is given breast milk for 6 months that baby will never be malnourished. >> There will be no standing at that period. Only mother's milk is requ. So there are a lot of benefits for the baby. Much more benefits are there for the mothers. First it is they can reduce their weight very fast and come into shape.
(36:06) If you are breastfeeding, it protects them against many diseases which they may have like many cancers, ovarian, breast, uh chest cancers can be pre will not be there if they are breastfeeding. Same thing with the heart diseases and the um hypertension. And this is almost breastfeeding is just like a contraceptive. >> It delays next delivery at least for 7 9 months it works like a a contraceptive and it develops a bond with the child.
(36:35) >> Mhm. >> So for mother has got a and it also have I mean the mothers after delivery recovers very fast >> and the postpartum hemorrhage chances are very less because blood immediately stops. Uh so there are lot of benefits for but despite this benefits and despite the wisdom of not centuries millenniums we are going back to something which is wrong which is giving babies with mother milk formulas.
(37:10) In fact, India is one of the countries who have pre prohibited prescribing any milk products, formula products to a child below 6 months is punishable in India. A doctor cannot prescribe give this formula. The doctor can never give. He will be sentenced for two years. We have formulated this rule in 1970s. >> So no doctor will write.
(37:37) But you go around the pharmaceutical shops the >> I mean if you go to any uh local pharmacy one of the first things that you will see breastfeeding substitutes like >> will be there. >> So in 2000 UNICEF and WHO launched this huge program across the world called baby friendly hospital. >> Mhm.
(38:02) And Kerala was the first state in the world which was declared as baby friendly hospital state. Uh that time there was about 400 or 450 odd maternity hospitals were there. So all of them were bound by the 10 rules uh to get that certificate. all of them got and they displayed it and one of the criteria was that they will not promote milk substitutes and formulas and they will not store them in their pharmacy >> and I do not know what is the situation now and we are now it's a retrograde we had progressed a lot and now in the breastfeeding we are back to
(38:43) >> but sometimes you know at the time the breast milk is not coming >> what do they do then The so my question doctor what was happening about some 100 years back have you heard any story any your grandmother saying that I didn't have a breast milk so I had to those incidents are rare it may happen I'm not saying you know there are certain incidents sometimes you have to depend upon milk substitutes for example if the mother dies or the mother is sick or something happens like that probably in extreme cases so the nipple is broken
(39:18) So there are extreme cases maybe 1 percentage 2 percentage we have not heard about those cases about 100 years back or 50 years back. So those in instances can be there then formula products can be prescribed. So that's one area the the breastfeeding is one that is the fourth point I think it's coming into the fourth point and uh fifth point is regarding the preventing of malotation.
(39:47) I as I mentioned earlier biggest challenge India is facing is malnutrition and anemia >> and nobody knows about it in India 36% onethird of the children is stunned >> one/ird so you imagine >> when we are talking about demographic dividend if one/ird of the youth is standard how can they contribute to the economy or the the growth of the This is now a few years back it was much higher.
(40:23) So that standing that malnutrition is again preventable consequence we know the death of child the diseases brain brain stunting cognitive development affected poor studies that we know I'm not going to that we have repeatedly said those consequences it can be very easily prevented first thing is if there's a breastfeeding there will be no malnutrition or standing second one if you're treating the diseases as I explained one disease can bring you to malnutrition.
(40:54) So management of tree luckily we have got now medicines and strategies to deal with the diseases. >> Mhm. >> And third one is if you're using u safe water and sanitation. So I'll come to that point. So that is regarding the malnutrition and it is a doable thing. And fifth one is regarding the full immunization.
(41:15) That means that I think by in India by and large 77%age of the children are getting full immunization. Full imunization means a child needs to be vaccinated five times in the first 9 months. Birth one and a half months, 2 and 1/2 months, 3 and 1/2 months, 9 months. So that five times have to be given and nine times vitamin A have to be given every 6 months up to 5 years.
(41:43) Then worm infestation tablets have to be given twice in a year. So if this is done now the immunization program of government of India prevents 14 defects and deficiencies and the infections >> and it also prevents most of the vaccinereventable diseases are now prevented. So you don't hear about people children dying about any any diseases which is vaccinereventable is almost nil now.
(42:14) Same with I mean the vitamin A vitamin A can reduce dosage can reduce about I mean 11 percentage of the all cost child mortality by 11 they have the study in UP huge study it says that it can be prevented same thing with the wor infestation l fortunately in India it's well covered but even now including in Kerala 24%age of the children are not fully immunized they may be taking one or two vaccinations Full imunization means full package have to be taken.
(42:48) So that is not happening. Now after that one so that is the this this was the uh sixth point. Seventh point is regarding sanitation that everybody should be using toilet not only at your home your village also >> and everybody wash hands with soap before eating food and after defecation and use safe water.
(43:16) Now coming to the first point of sanitary toilet use it has improved after the the government of India's huge program of con free construction of toilets across it has improved now one gram of feces has got 100 billion viruses and bacteria one gram so even if everybody in your house is using toilet and somebody in your neighbor is not using it a fly will come from there and can sit on your food then all advantage of having sanitation is lost.
(43:50) >> So it's very important and once that is there it creates a diseases for the children this 1,000 days if the baby is there it affects that baby. >> Mhm. >> So therefore this is very important and fortunately the coverage people using uh toilet is has increased but still it is not 100%age.
(44:13) Second one is regarding safe water um using I mean right now again by the JJM program by and large the safe water is reaching but that's also safe water is another reason for the important initiative during the first 1000 days. Third one is the most important but simple but most important is if I ask you a personal question I would say did you wash your hands before eating breakfast today with soap? M >> did you wash your hands with soap? Everybody hands two things have to be done.
(44:49) Wash hands with soap before eating food and after going to toilet. >> Now many people because of our toiletry practice the feces the micro or micro part of the feces is in our hand. We are touching the faces because of our toiletry practice. And if you don't wash our hands now for example if I had not washed my hands after going to toilet my hand will have 100 cr not 100 100 cr bacteria and viruses disease causing bacteria and viruses will be in my hand although it looks clean >> it's microscopic >> microscopic so and even if you wash hands also it's not I mean not you're
(45:32) not safe suppose your maid or your mean friend who comes to your home and then you touches here that is sufficient and you touch there finished. So the entire population not only you but the entire population around the child have to see that they don't they wash their hands with soap.
(45:52) It's one of the symbol the the statistic says that only 74%age of the people wash hands with soap after defecation and only 34%age wash hands with soap soap before eating food. that is very less that's one of the reason for so sanitation and this is a huge and the not doing this one not only it I mean affects the baby because of that one the world bank study says one country can lose 6% of the GDP just by not following this three principles of sanitation safe water and washing hands with soap everybody wash hands with hands But not
(46:37) with soap. >> So just normal water is not enough. You need to put the soap and rinse it like a surgeon >> because there are grease and oily will stuck in. Some people use with the mud. In north India I have seen people washing with telling me that they have washed their hands with the mud and ash is not good enough.
(46:55) >> Of course one lakh will go. So you have got 10 cr bacteria. One lakh will go. But remaining whatever 99 lakh 99 >> and what about hand sanitizer? >> Hand sanitizer is also equally effective but then that is expensive. So we don't have to soap or I mean need not be very expensive soap.
(47:16) Even the soap which you use some earlier time the using the washing clothes even that is sufficient. >> So hand sanitizer is expensive. We don't recommend hand sanitizer because I mean definitely there are chemicals are involved. Of course, I mean when you are traveling, there are certain situations where you cannot wash your hands with soap and water.
(47:34) So I always tell there is a paraphrasing one sentence. One soap, one mug of water can change the world. >> One soap, one mug of water can change the world. It is so simple but it can reduce the diseases, it can reduce malnutrition, it can increase GDP of the country. It's so simple. So that's regarding >> there was a debate uh like a group of people were saying the reason for human longevity that increased is because of vaccination.
(48:08) >> Another uh group said that is partially true. The real reason is sanitization. Sanitization is the real cause for enhanced longevity that we see today. Exactly correct. It's not vaccination. I mean vaccination could >> maybe contributing but the sanitation when we say sanitation three elements are there >> sanitation safe water washing >> these three things have contributed much more than any immunization and you we can see around now it in India I mean earlier I mean about 10 years back 50%age of the people in India were open
(48:44) defecating defecating in the open and now it has reduced maybe only 10 or 20 percentage even our Trains were I mean we found out even in states where everybody was using toilet one person was not using that toilet and that person was spreading it across that geography >> you know who train so entire for example if entire Kerala everybody is using toilet but a train runs across which is defecating of course not the train >> yeah I mean it falls on the track >> but now So that also has been now the most of the trains in India realizing
(49:25) the rail railways realizing that they are the biggest defecator of India >> they are defecating daily not normal person will defecate only once they are defecating every second >> so realizing that one they are now bio toilets are there in most trains so they are not defecating uh so that is one of the major you're right that is one of the reasons Why we have been able to arrest the diseases and the malnutrition to great extent is this one and uh next point.
(50:01) So the next point is regarding this is the one area where nurturing care and stimulating children >> which I explained the brain that the this is considered to be a women's affair >> normally playing with the children and go doing cooing with them or gaga and that doing is a women's area and men or other members in the family um is probably when the child is grown up to one year or something they will start play and everything but the new sign says that you need to interact and with the child by whatever ways I mean you can sing a song tell a story read
(50:46) mahabharat or classical songs you can sing you can play you can look at the eyes you can do the you can do whatever I mean you engage with the child as much as possible. I mean listen to music, show them music, classical music, tell them stories. That's what the case I was telling about this this where I mean you know he was reading quantum physics.
(51:10) I mean you know nobody ever thinks that you know the child when grows up will remember all the whatever was told to her on quantum physics she will remember. She's not going to remember. But her brain has been stimulated. As I said earlier, 1,000 neural connections are made in the brain in every second >> and that is the ar that forms the architecture of the brain.
(51:35) Brain develops. So that stimulation the family members have got a bigger role probably that is getting restricted because of the um nuclear families only two father and mother. So the opportunity for we want diverse engagement >> the engagement of parents will be in one level engagement of a grandparents is another level telling old story so and they may not have time so all the time if you can do with the babies that the best thing so the parents have to find ways even the nuclear families they have to find ways probably they can play
(52:12) classical music they can show them some classical dances or I mean things like that. So they have to find their own ways to substitute what is there in the joint family system and then the menfolk >> the for example the grandfather or I mean brothers or uncles they normally don't do the stimulation with the I mean limited so they have to engage the baby much more another area is the I mean know the ninth point regarding to be done I mean in Carolina it may not be relevant is really the the there's a strong connection between the child's
(52:54) development and the maternal education. >> So mother have to be at least educated. In UNICEF we say that girls education is the magic bullet for women empowerment and human development and social development. One magic bullet if you have that is the girls education. There strong linkages there.
(53:17) So girls have to be educated at least up to 18 years. So in in other parts some in our it's increasing the percentage of the girls attending schools in the higher secondary schools are now increasing but earlier it was just less than 40%age. Second one, the mother should not be a child bride >> because um teenage pregnancy is very dangerous.
(53:43) Dangerous for the mother as well as for the uh child also. the the the risk for the maternal the risk for death is about 40 times higher than the normal child and then it leads to pre-term delivery LBW baby system malnutrition the entire cycle it is a cycle actually it will start so these are the nine things to be done now one important three points I want to reiterate this 1,000 days happens in the life of a How many times? Only once.
(54:20) >> 1,000 days happens only once in your life. >> Unless you believe in rebirth. [laughter] >> Then you can do again. So only can you not spend some time to do this nine tips. First point. Second point is your inaction. If you are not doing anything, the damage caused because of that inaction >> is irreversible.
(54:48) >> Irreversible. And after 1,000 days, if you start doing all this stimulating and everything, >> it may not have the same impact. >> It very less impact. Third thing, this all the nine tips we have mentioned, it does not involve much expenditure. Everything is free. Breastfeeding is free.
(55:10) Washing hands with soap of course if you need a soap or >> not so expensive >> expensive even the immunization is fully free the of course if you're not going to the private hospitals the government system every month in north India I don't know how organized it is in north India it's very or India has got 10 lakh villages in every village every village every month one&m goes and does the immunization every village >> mm M >> it's so organized it's free they will the asha worker I mean if they don't come ashawa worker will pak they will catch them and bring
(55:51) >> so system is and no expenditure and their cold storage system potency is much organized >> I mean straight from the cold storage the special equipments are not all the vaccines cannot be different vaccines have got different temperature and it has to be kept in that temperature otherwise the potency is lost.
(56:14) So they have the vaccine baggage is there. So the system is welloiled machinery is there. So you have to so these are the three points once in a lifetime and once you lose that opportunity it is gone forever and third it is thing another point is regarding when you are investing your time energy on doing these nine tips then you are shaping the future of this child >> and the nation >> but yes that is the point you are also shaping the future and the destiny of India.
(56:53) M >> so I would say which I mentioned to doctor earlier this rephrase that that sentence India's destiny is written in its classrooms right but I will also add India's destiny and future is written in the first 1,000 days of a baby and you can be part of it >> I think there is so much to learn and I really wish every mother and father you know who are about to have a child and also going through the first two years of their child listens to this and follow this protocol and it's it's quite interesting I mean when you go to a
(57:31) doctor when you go to pediatricians I mean they ask some basic questions but I really wish you know this kind of information comes to us in a very systematic manner like you know so many information comes to us but I wish this kind of information is what really needs to be spread. We made an attempt. So I realized that if I say this nine things.
(57:54) So I was telling you an instance my brother is a doctor well-known doctor and in a family get together I was >> what doctor is he? >> He's a cardiologist >> and he's a he reads a lot. I don't think this is >> and his children are also doctors. So in my family get together I was mentioning about this first 10,000 days and every and the importance of first nine days.
(58:17) they were all questioning me. So I said it's all WHO, UNICEF, Lancet based on the information. So this knowledge so I thought if I say I am telling government I mean when I was in working in UNICEF I'm telling the health workers that means there is an asha in every village there is an&m who goes to the village every month and there is also this anganari worker.
(58:44) So I we are working through them presuming they will transfer this knowledge to the pregnant mothers and the family members and it may not happen. So I thought I had a brilliant idea. Idea was brilliant but implementation was very poor. >> I thought if doctors prescribe it just like a medicine in western countries it is called green prescription.
(59:07) So doctors they do this and cut like this. So I thought if any mother of a child or a child comes to a doctor he should prescribe one of these nine tips in the so probably the child is having a diarrhea. >> So the they go to the doctor and doctor will be prescribing some medicine along with it if he cut and write ensure exclusive breastfeeding.
(59:37) So I thought if they write it will be a good idea. Then I realized they are not going to write it. So I developed a seal. So they don't have to write it. >> Just put the seal >> seal. So we worked with the IMA in Kerala and this program was launched by the former chief. This program was launched with IMA um that they will prescribe doctors will prescribe these nine practices and tell also.
(1:00:06) So because then there is a more credibility and it was launched in a function with the former chief minister >> and we provided the seals some doctors must have I mean done it but coming to your point there is increased requirement if by everyone talking about it doctors health workers family members it has to be disseminated widely and it has to reach The most who is the person who is most interested in the growth of the child is the mother, father and their family members.
(1:00:48) It has to be directly go to them. So I asked a doctor why are you not prescribing and telling? So he said first of all there's no time. A patient comes for a particular disease or whatever prescribe whatever is required medicine or something we don't have time to counel and talk to them tell about these nine tips we don't have time and partially it is correct >> probably we need to create so in another state I created another method this is one experiment I did when I was chief of UNICEF in Tamiladu and Kerala and we
(1:01:21) launched a program with the IMI and Kerala government In another state I did another strategy. Realizing that doctors is not going to um tell all these nine tips, I developed another method. So after seeing the doctor in a Ph, uh we engaged another person. >> Mhm. >> It's a health worker. It's engaged by us, paid by us.
(1:01:50) So the doctor will say after seeing okay, you please go to this room number 12 also as a for a checkup. And when the mother goes to that room actually it's nothing as checkup they give some of the points not all the nine points together only one point will be taken for example maybe breastfeeding or maybe on anemia one point is taken but that is it's a quick fix because it's not a part of the government system.
(1:02:16) M >> so if the doctor does not have a time so anyway the the crux of the problem is we have to reach this message to as many people as possible and since this is a very very new is only 10 years old people did not know about 1000 days about 10 years back >> mhm >> and what needs to be done is also scattered >> the way I have said nine things and everything it's not written anywhere >> this nine things can be expanded to 11 things 21 things content is same you can increase the points but what needs to be done is same
(1:02:53) >> and it's not rocket science it's very bas >> it's not rocket science it's a basic common sense >> I think the future definitely okay future of every nation future of all human being survival >> it all comes down here >> definitely and uh yeah yeah definitely and it is improving I mean you know we can I was mentioning about the height of >> the people you look around I mean no research is required.
(1:03:17) You look around your own relatives, your own friends, their children are growing taller. How come? And they are uh probably there we don't have any study on the change in the IQ a life cycle studies we don't have. Uh definitely their brain development must have gone up. Definitely we don't have any research to show it.
(1:03:39) Definitely it is improving but much more scope if you are taking care of the in India taking care of the malnutrition, anemia, breastfeeding, the stimulation and the safe water issue because these are all neglected and underrated issues in my family. Uh we have mine is a very big family. So about 30 35 people gather in every function. We we occasional.
(1:04:07) So last time when lenji was served I looked how many people are washing hands before eating food. Out of 35 three people washed hands. >> But none wash with soap. Everybody wash with water. This is a situation. You go to a hotel everybody wash with hand. I mean in the the restroom there's a big rush but all of them are washing hands mostly with soap only after food >> some oils in fact I would say that there's no need to wash I mean even if you don't wash your hands after eating food no problem but what is more important is in fact in another state I
(1:04:52) did this experiment that we went to all restaurants and wrote their wash hands meaning the table we provided a sticker u wash your hands before ordering wash your hands with soap before ordering food it may I mean these are all multiple strategies and multiple ways we need to address one way a doctor's prescribing is one way media through I have written several articles that's one way hotels approaching the hotels I have also tried the marriage, the events, the weddings.
(1:05:32) I have not seen so far anyone washing hands with soap before entering to the the wedding reception >> and never see forget about washing with soap even with water is not there but everybody rushes to the wash area for after food. In fact, it is not required [laughter] even if you do. So this realization that I mean the way I explained that how much we cannot see that money you know when I explained one feces one gram of feces is having thousand billion notion cr how many surro zeros I do not know this is creating viruses and bacteria and
(1:06:12) pathogens they have and our hands we do not know >> it's quite fascinating very small small habits when you can incorporate it goes a long way in the quality of your life. Correct. Thank you so much sir. It was a very deep conversation. I think you have a lot to share and uh I wish that you know we can spread this information more and more and so that people's longevity and the quality of children and the quality of our conscious living goes up.
(1:06:42) Thank you so much for giving this opportunity because we need multiple opportunities like this. So to reach this message to the people and that will lead to a better India, >> a better youth and a better life, more happiness, success in their life. All will happen if we can do this small simple nine things in first,000 [music] days.
(1:07:07) >> Thank you so much sir. Thank you. Thank you.
Author Name:Dr. Vignesh Devraj
Youtube Channel Url:https://www.youtube.com/@drvigneshdevraj
Youtube Video URL:https://www.youtube.com/watch?v=geVXW4x-e0g
Title: Why India’s future lies in her children’s first 1000 days? | Job Zachariah & Dr Vignesh Devraj, MD
Author Name: Dr. Vignesh Devraj
Description: The first 1,000 days of a child’s life, from conception to the second birthday, are often described as a critical window of opportunity. During this period, nutrition, health, care and the environment around a child can influence their development and future wellbeing.
In this episode of Ayurvedic Healing & Beyond, Dr Vignesh Devraj is joined by Job Zachariah, who has spent many years working with UNICEF across different parts of India on child health, nutrition, education, sanitation and protection.
They explore why the first 1,000 days matter and the nine key practices that parents, families and communities can focus on during this period, including maternal and child anaemia, breastfeeding, complementary feeding, malnutrition, immunisation, sanitation, safe water, handwashing, nurturing care and maternal education.
Job also shares his experiences of taking these messages to families through doctors, health workers, community initiatives and a programme developed with the IMA in Kerala.
Episode Highlights
The First 1,000 Days
The Nine Key Practices
Breastfeeding & Nutrition
Immunisation & Sanitation
Nurturing Care & Stimulation
The Role Of Family
Reaching More Families
Timestamps
00:00 – 14:20 – Why The First 1,000 Days Matter
14:20 – 29:00 – The Nine Key Practices
29:00 – 48:00 – Nutrition, Breastfeeding & Immunisation
48:00 – 57:00 – Sanitation, Water & Handwashing
57:00 – 1:03:00 – Nurturing Care & Family
1:03:00 – 1:07:55 – Taking The Message Forward
TEDx TALK WITH DR VIGNESH DEVRAJ
In his recent TEDx talk, Dr Vignesh Devraj shares a personal story from his childhood and explores how our emotions, relationships, work, experiences and environment can influence health. He also reflects on the Ayurvedic concept of Swasta and staying connected to our authentic selves.
Watch Dr Vignesh Devraj’s TEDx Talk - • Learning to listen to the body | Vignesh D...
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Weight management can involve more than simply changing what you eat. The 14-Day Ayurvedic Metabolic Reset at Sitaram brings together personalised Ayurvedic consultations, therapies, nutrition, movement and lifestyle practices within a structured retreat environment.
The programme offers an opportunity to step away from your usual routine and create space to focus on digestion, metabolism and daily rhythms through personalised Ayurvedic care.
Learn More About The 14-Day Ayurvedic Metabolic Reset -https://sitaramretreat.com/ayurvedic-...
About Job Zachariah
Job Zachariah has spent many years working with UNICEF across different parts of India, focusing on child health, nutrition, education, sanitation and protection.
About Dr Vignesh Devraj
Dr Vignesh Devraj is a fourth-generation Ayurvedic physician and the founder of Sitaram Retreat, Kerala, a space for authentic healing. He is a committed practitioner and researcher of Panchakarma.
One-on-one Ayurvedic consultation:
https://calendly.com/drvignesh/30-min...
BALANCING THE MIGHTY VATA – ONLINE COURSE NOW AVAILABLE
Vata governs Prana, the nervous system, movement and emotional well-being. This comprehensive online course includes over 6 hours of practical teachings, downloadable notes and tools that can be integrated into everyday life.
Link: https://vigneshdevraj.com/balancing-t...
For further information, kindly visit: www.vigneshdevraj.com and www.sitaramretreat.com/
Instagram – @sitarambeachretreat | @vigneshdevraj
Twitter – @VigneshDevraj
Disclaimer: The content discussed in these episodes should not be used as medical advice or as a substitute for professional medical care.
Transcript:
(00:00) What was this first thousand days? Where did this whole concept came about? >> I would say this is one of the biggest discovery in human life and it is called the window of opportunity. So your character, your behavior, your attitude is also decided in your childhood. Mostly childhood diseases happens in this first 10,000 days.
(00:19) In India for example about six lakh babies die before seeing the first birth. This 1,000 days happens in the life of a person how many times? Only once. India's destiny and future is written the first 1,000 days of a baby and you can be part of it. At least we can reach this message directly to these mothers or pregnant mothers who are going to be conceived or who are having young children below 2 years.
(00:48) In today's episode, let's talk about the most underrated phase in a human's journey. The first thousand days and the profound influence it has on a person's life. These thousand days begin from conception [music] and extend through the first two years of a child's life. They're often described as a critical window of opportunity [music] where nutrition, health, care, and the environment around a child can influence development and [music] future well-being.
(01:15) To explore this, I have invited Mr. Job Sakura who has spent many years working in the top levels of UNICEF across different parts of India on child health, nutrition, education, sanitization and protection. We will begin by understanding why the first thousand days matter and how this [music] period can influence areas ranging from survival and childhood diseases to growth, brain development and even aspects of adult health.
(01:40) The first thousand days happen only once. So let's explore why this window matters. what can be done during this time and how small everyday actions can contribute to the health and development of the next generation. [music] I hope you'll enjoy this episode. Now we go to Mr. Job Sakura. Sir, it's an honor to have you.
(02:00) You know the last time I met you during the TEDex talk that you were giving on the first thousand days. >> So when I [clears throat] heard this, I was very keen to have you in my podcast. >> So you you said that you were chief of staffs in different parts of UNICEF. You are you're heading a department in UNICEF.
(02:16) Can you explain more what you do what you did in the past >> and uh I want to get into that first thousand days of your baby that story. >> Yeah, UNICEF as you know stands for the welfare of the children and the women. So I was heading the UNICEF offices in different states in across India. I was chief of India Kerala and Tamil Nadu office the Chhattisgarh Jakand >> Bihar Orisa different different offices.
(02:40) The main work of UNICEF is the to see the to improve the to help the government to improve the health, education, nutrition, sanitation, protection aspects of children. That was my work in the last uh 15 20 years. >> So tell me what was this first thousand days? Where did this whole concept came about? >> It's very new.
(03:01) >> When you say very new, how >> Yeah. You cannot attribute to a partic particular person who found out. I would say this is one of the biggest discovery in human life. >> Um, Lancet had issued a series of article on child health, child nutrition, maternal nutrition in the last 20 years and in the process of issuing of those article each article as you know Lanc said each article has got 250 to 300 uh citations.
(03:32) It's based on one article is based on 250 30 and they realize it somehow came out that 1,000 days is so critical in the life of a person. >> The first 10,000 >> first 10,000 days is the most critical came out is emerged like that. So it's not a a person who found out uh I would say that a person had found out he would have worthy for to give a Nobel Prize for medicine or peace for this finding.
(03:58) >> So we don't know who it is but it just accumulate. emerged. So it's so there is no particular person you can attribute to. He is the person who found out that first 10,000 days is important critical in the life of a person. So tell us about what is this first,000 days and what are the you know the key parts of this.
(04:16) >> Yeah. The first 10,000 days decides or influences at least so many things. First is it survival of the child itself >> is decided. And by the way, first 10,000 days, is it from the date of birth or from the date the mother finds out? >> Yeah, thank you for asking that one. This one first 10,000 days is formed 270 days of pregnancy.
(04:41) 365 days of the first birthday, >> 365 of the second birthday. So from conception to the second birthday that 270 + 365 + 365 forms the >> first 1,000 days and it is called the window of opportunity. So whatever you need to do, you need to do in the first 10,000 days. And the Lancet study says the damage caused by inaction >> is irreversible.
(05:09) >> Opportunity is just like opening a window and if you don't do it, the window is closed after 1,000 days and it may little open during adolescent period and to close within one or two years. >> Sir, so what are the key areas? So the it decides too many areas too huge I mean it will take hours to dis explain.
(05:30) First is the survival itself. >> In India for example about six lakh babies die before seeing the first birthday. So this first 1,000 days a baby survives the first 10,000 days then the survival rate is very high. >> So that is the first one. Second one, first 10,000 days is the period of diseases.
(05:53) All mostly childhood diseases happens in the first 10,000 days. Basically, the most important childhood diseases are pneumonia and diarrhea. They are the killer number one and two about onethird of the children die because of pneumonia and diarrhea. So all the diseases third thing the even your adult adult life diseases >> is also influenced in this decided almost you can say like for example your heart disease um hypertension >> um diabetes these are all predetermined during this period >> I see >> in great way the influences even your adult life diseases also
(06:30) >> fourth area is regarding the your height >> the standing >> first 1,000 days is the period when the standing happens >> and in India standing is very high. 36%age of the children in India are standard. What >> can you explain what is standard? >> Standard means you know they don't gain uh the height required for that age.
(06:51) >> So who has got a a a chart? >> Yes. >> It maps the height as per the age that is called the WHO growth standard height. And if you are not achieving the height as per the that one then you are called standard. >> Now standing has two impact. One is that by standing your height will reduce. Second one that is the height reducing reduction is not very important.
(07:18) Your brain will be standard. Your brain development will be affected. So when your brain development affect affected then you will not be performing well in studies. Then you will not get a better job. then your income will be so that the entire cycle will affect >> so rest of the life is impacted >> impacted so therefore so even in Kerala 23%age of children are stunned but who is aware about it and who what do you have to do about it is also unknown so another the ma normally we call it as malnutrition but malnutrition has got I
(07:52) mean two three different different words so and malnutrition is also the cause for 69%age of the Child death the root cause of 69% of the child death as per Lancet is malnutrition. >> I see. >> So that is a major issue that that happens in the first 10,000 days. >> Malnutrition does not happens after first 10,000 days.
(08:14) >> That is when whatever happens and whatever the adverse effects happens in the first 10,000 days then is the as I explained the height that is a corollery to the the point on standing >> your height will be reduced. So many people many people think this is controversial and uh this is not this is exaggerated.
(08:36) How come? I mean know general belief is that height is decided by her or racial or genetic partially it may be true but the new evidence is telling there is a major one huge study by the Imperial College London >> Bandam study it says height is basically influenced by environmental and nutritional factors not much of the hereditary factors.
(09:02) M >> second proof of that one is the who growth standards it is uniform that what that chart they are preparing is uniform they use every pediatrician in America or Africa or India or Australia use same chart if it were different for different racial groups and different countries they would have developed a different so they did a research 20 years research and they came out if things are happening in the first 10,000 days the height gained by a person is same.
(09:33) Now another example for this one I mean for this it is not hereditary is for example the Chinese people >> there are a lot of studies they're considered to be very short people now they are very tall and they play a large number of people play in the NBA American basketball where you need to have 6 ft minimum height >> so and same thing is there is another study on the um second generation Indian-Americans children all boys are 6 feet and above even around us if you look around Our children are taller than parents and grandparents. How does it
(10:06) how did it happen? Definitely the environmental factors are happen are affecting. There is another study Indian study called HPS Sachida. So he found that the height of children have increased by 5 to 8 cm in the in this present generation. How did it increase? If it was >> hereditary then how did it increase? So there's a increasing evidence to show that height is decided I mean greatly decided I mean definitely her the genetics may be playing there are dominant genetics for example in my my mine is a dominant genetic of height so
(10:45) even if my children marry a short person pikmi is probably having that number is very less >> 95%age is not the dominant height is not determined by their genes coming to again a corollary thing is you know Even your income, how much salary you will, how much income you will earn in your adult life is also influencing this kind of this is also you know u opening thing.
(11:10) >> So so you mentioned about the four things so far of the first 10,000 >> importance. >> Yeah. So what are the the next ones >> that is one is the income. >> Okay. >> The income of your future income is also decided in this first 10,000 days. Again people will ask how but it is very simple.
(11:29) Bhu 10,000 days if you're standard your IQ will be less >> you will your studies will be poor then your qualification will be less then you will get a not a very highly placed jobs so your income will be less so there is a there are many studies to support that one which is called a grandam study grandam study says a standard child will lose 22%age of the income >> so and if an ordinary person gets 100 a standard child will get only 78 rupees M >> there is another study called the Timotei Jed study which is a recent study which says that each additional
(12:04) inch increase will give you $789 increase in salary which means >> the height >> height each inch uh which if you convert in a very crude form if a 5T person gets 30,000 rupees a 6 ft person is likely to get 40,000 rupees there's a Brazil study which says that each inch will increase your income by 2%age. >> Mhm.
(12:28) >> So there are lot of studies again but it is a simple corollery. It is actually height is not the determining factor in this income. It actually no role actually it is because your standard your qualifications are less then you get lesser salary. M >> so the that is the another one which is also your character your behavior your attitude is also decided in your childhood >> because the first >> first 1000 days whatever experience the child goes the love affection care this is called the serve and return theory so
(13:07) child develops serve and return just like in the tennis serve and return >> when child faces a particular set of experiences it responds with that one in the adult life. So stress your attitude to life behavior to a great extent it is decided in this first 10,000 days. There are again there are a lot of studies one major study is the Harvard center for child development is called BIP study CDC center for disease control.
(13:39) There is another study they all confirm and validate that your it may not be the entirely it may not be decided but to great way it is your charact your uh behavior attitude is decided in the first 10,000 days another one is major so ninth point is regarding your the GDP of the country is also decided influenced not decided I would not say it is also simple if the quality of the human capital developed in the first 10,000 days is good then your GDP will go down.
(14:15) For example, because of anemia, we are losing 4%age of our GDP. Because of malnutrition, we lose 6%age of the GDP. Because of poor sanitation, we lose another 6%age. Before lack of stimulation and care losses 3%. So about 15 20% of your GDP is lost because of lack of certain things not do inaction in first 10,000 days country loses about 15 to 20%.
(14:44) Let us con very conservatively think 15%age only. You know what's the EGS GDP? I don't know how to even say it. It is 350 lakh cr. >> So it is 35 followed by 13 zeros. M >> now 15%age of is is 52 lakh cr will and if this 52 lakh cr is divided by to given to every Indian citizen 140 cr people each person will get 40,000 rupees which means if if he had done everything properly every Indian would have got 40,000 rupees per year >> so this is the impact of this first 1,000 days so you must have heard this saying that the destiny of India is
(15:27) written written in each classroom. I would say the destiny of India is written in the first 10,000 days. Certainly the destiny >> destiny of the entire planet also the cost >> besides the destiny and the future of the child is also decided in this first 10,000 days. So the parents and the family and the society has got a huge role first to understand this first importance of first 10,000 days.
(15:54) Earlier we talked about the research and how the the lancet and how this idea came. Unfortunately since it is very new this has not percolated down reached the people to whom this is more critical. Who are the people who are critical? The mother, parents and the family members. It has not gone to them.
(16:16) So thank you for giving this opportunity because this is a platform at least we can reach this message directly to this mothers or pregnant mothers who are going to be conceived or who are having young children below 2 years after 2 years the window is closed. So at least up to 2 years they can still do something. So thank you for giving this opportunity to disseminate this critical information to the people.
(16:44) Sir, I'm a father of a six-month-old. So I think >> so. Then I will then I will ask you a few questions please. >> I mean coming from this background I will ask you a few questions. First question was your wife anemic >> before even conceiving. >> Yeah that was sorted much before that. >> No but how do you know? >> I mean we tested the blood >> when Okay.
(17:10) So but 67%age of the women are anemic. So you are an exception. Second one did you give your child this in India keralite must have happened five four vaccinations have you given four vaccinations to your child >> uh to my >> the birth >> one and a half months 2 and 1/2 months 3 and 1/2 months 9 months five vaccinations have to be and along with it nine doses of vitamin A I'm sure vitamin A is not given in I mean most of the places >> so he must have your son must have missed daughter daughter daughter must have missed this vitamin A. Another question
(17:46) I want to ask is regarding the whether have you compared do you have a chart of this who growth standard >> no you you normally in hospitals they give the weight versus height >> yeah that is true >> but what I'm talking is there are three charts >> one is weight how much weight you are gaining as per your age this most this one most important is the what is the height of the Maybe as per the chart >> as per the age that one have you charted >> that we are charting >> you have charted so that means you are you you are almost following most of the
(18:27) nine things nine tips nine talismen which a parent should do in the first let me ask me you one thing how many people in your family do the queen or doing gaga or tell stories or play with them. Not the mother and father alone. How many members in your family are doing play with them, smile at them, hug them, kiss them, um do the gaga, cooing, um looking at them, singing to them, telling stories to them, play with them.
(19:05) How many of them are doing it? >> So it's a huge family. So there's a lot of people who will come and do that. >> Yeah. So, so that means you are see this one you this is a picture I always show. >> So this is Mark Zuckerberg >> founder of this book. >> When his daughter was born >> u at when the daughter was one week old >> he was reading a book on quantum physics.
(19:35) Now quantum physics is the most complex science and he was reading this book to this baby of seven days. M >> now I don't think the baby will understand anything on the quantum physics it can never and we have I mean in our puranas there are many stories the story of >> abimemenu being taught on when he was on the boom on the how to break the chakra vuha we we know that story what is happening is not the they will not understand anything which is said but it affects their brain development you know in our brain 700 to 1,000 neural connections are made in 1 second.
(20:16) >> I'm not I didn't say minute 1 second. 700 to 1,000 neural connection happen that builds the brain. >> So when we are doing the stimulation which I mentioned the examples I gave care that that builds the architecture of the brain of the child. So therefore that one stimulation is very very very important >> in this first 10,00 days.
(20:41) >> So so uh I just want to sum up what are the nine concerns of the first 10,000 days and then before we go into the solutions can we just sum up sum? >> Yeah yeah so to sum it up there are nine reasons why 1 1000 first 1000 days is important. First one is the survival of the child.
(21:02) The survival of the child is decided or influenced in the first 1,00 days. >> If the child survives that 1,00 days, then baby is have got a higher life expectancy. Second one is >> is diseases. >> It's a time of diseases childhood. That's why we call a childhood disease mainly diarrhea and pneumonia. >> We in the UNICEF we call them as killer number one and killer number two just like in films.
(21:28) and they account for onethird of all child death is accounted by. So that that happens in that 10,00 days. Third one is the adult diseases. Adult diseases is greatly influenced and decided in this first 10,000 days. >> Uh like heart diseases, diabetes, hypertension, they are all pre-decided to great may not be in all cases to great extent decided in this 10,000 days.
(21:56) Fourth thing which is decided in first 10,000 days is standing >> that we mentioned >> 80%age of the standing happens in first 10,000 days. After 1,000 days there is no standing or malnutrition. You can say underweight or obese but malnutrition the technical definition of standing happens only in the first 10,000 days and there is a consequence of it.
(22:18) Fifth one is a corollary uh to that one is the height uh height of a person is a greatly decided because the uh when you are standard then your height is reduced your IQ is also reduced. Sixth one is the brain development again is a corollary to the standing when you are uh bra when you are standard your brain is de then the cognitive and emotional development affects then your it affects your studies.
(22:47) Seventh one is your the income again is a corollery to the standing I mean when you are standard >> it impacts your eighth one is your uh attitude and behavior >> is greatly influenced by the experiences the child under goes in the first 10,000 days >> how you uh your decision making your leadership your analytical thinking all so your how do you manage your stress all in a great way influenced in the first 1000 days and Last ninth point is the GDP of the country.
(23:18) >> GDP of the country is influenced during this 10,000 days because if if n during the first 1,000 days baby is taken care of India would increase at least by 15 or 20%age. M. >> So these are the nine things uh nine factors why the the first 10,000 days so critical in the life of not only the baby or the family or the community even the nation.
(23:47) >> So now let's go to the solutions for this. How does a let's say a couple planning to have a baby like in Ayurveda we say that at the time they decide to have the a child a couple at that time they should start changing their lifestyle they should start doing therapies like pancha karma as a part of the preparation and then from the conception it's a uh there is a protocol also so now coming to all the concerns that you mentioned let's talk about the solutions for that if somebody's listening to that what should all they keep in mind for
(24:19) both the mother and the father. >> Yeah. I would like to give a is a talisman. I'll call it as a talisman of nine tips >> to be done in this knowing why it is 1,00 days is important is of it's not much value. Of course it's a value but >> how it can be in practice what we can do there are nine things.
(24:40) First is >> the anemia of the mothers >> that has to be addressed to be prevented. Not only enemy of the mothers, the children and also the girls. Enemy of the bloods, the iron store in the blood is just like a bank account. >> It is not created on a particular day over the years. The bank deposit. So it has to be addressed even in the adolescent period.
(25:06) >> In India 67%age of the children are anemic. >> This is the latest NFHS study. It's not an old study. This is about 2 years old and uh uh about 59%age of the adolescent girls are anemic and about 57% of the pregnant women are also enemy. So that have to be addressed that is the biggest this is a I would say the one two challenges India faces is one is anemia and malnutrition.
(25:33) >> Now this can be addressed. Now what is the consequence of this one? Because of the anemia the baby is likely to be preterm before 37 weeks. uh baby is likely to be LBW that means below 2.5 kg baby can the mortality rate of the both mother and is very high it can lead to malnutrition it can lead to uh diseases there's a entire cycle will start when the mother is enemy so it has got a lot and definitely the 3%age of our GDP is lost just because of enemy of women so that is the now the con how to prevent it is very easy first thing eat iron
(26:13) rich food. So if you are a non-vegetarian eat fish and meat if you are a vegetarian take more pulses and leafy vegetables minga things like that. That is the first one. Second strategy is to eat rice and wheat from the ration shop. M >> if you eat the second one there will be no anemia because last 3 years a government of India has added fortified our ration with iron.
(26:42) >> So if you look into your rice there's a pellets kernels in the same shape of a is added into your rice. So it has got rice. So if you're regularly taking the ration rice then you may not like you may not get any. Third thing is you can take the IFA tablet or iron tablets. Now iron tablets are given across India in all schools up to 12th standard >> but many of the places this iron tablets are not given.
(27:15) So no wonder 69%age of the children in India are enemy. So these are the three things and one important thing now we have coffee in front of us. uh after taking food never take coffee or tea. This is fashionable because it inhibits the absorption of iron in the body. You can instead you can take orange or amla or even lemon you take then it increases the absorption.
(27:41) So that's the anemia. So the mother should not have mother and children should not have anemia. Second one is a mother's the maternal nutrition and health which is simple in Kerala it may not be an issue but it's an issue in the other parts of India where mother should get a nutritious food uh should at least have four health checkup should have micronutrients basically zinc iron and um the vitamin A and D then worm infestation Kerala I think this is a fairly taken care of.
(28:21) So that is very important because if mother is mother's nutrition and health is poor that leads to pre-term delivery and also the LBW babies. So it's very important. So that is the second and >> LBW means low birth >> low birth weight a low birth weight means 2 and a half kg. So it's not a big issue but in India it's a big issue. In India 18%age of the children born have less than 2.
(28:49) 5 kg even now >> and about 12%age of the children are uh delivered pre-term delivery and that delivery children born pre-term it has high risk of death 35%age of the reason for neonal death is because of the pre-term complication. >> So that's very important. Third point is is regarding that the their childhood period taking care of the children in the neurotal period and taking care of their diseases is very the third tip it's fairly done in Kerala but not maybe in India first thing is regarding the preventing the LBW and uh pre-term that
(29:30) if the mother is has got nutrit nutritious food and healthy then probably it may not happen in Kerala therefore the LBW and the pre-term cases are very less. >> Second one is the management and the treatment of diseases >> especially diarrhea and pneumonia. One >> one episode of diarrhea is sufficient from for a baby from healthy baby to go to red in the chart malnourished one episode is sufficient.
(30:00) So that treatment is luckily in our immunization system I would say the immunization system in the government it's much stronger than what is happening in the private hospitals. So in the government system there is rota virus which is one of the element which is causing the diarrhea. There is already inbuilt vaccination is being given so that those babies will not have diarrhea.
(30:25) So the episodes of diarrhea in India has reduced substantially. Pneumonia also there is again a vaccination is there built into numokcoal vaccination is built into the governmental system in private different hospitals follow different systems. >> So but these two diseases have to be managed and sometimes they need the treatment in a special newborn care unit which is called essence use.
(30:49) So the treatment of the so children are required and then also the the neurotal period the 28 first 28 days there's a theory in in child death uh 23 of the child >> first 28 days after birth >> after birth that is called neortal period there is a theory there is a what do you call equation >> 23 of all child deaths below 5 years happens in the first year >> okay >> 23 of death of first year happens in the First 28 days 23 of all deaths of 28 days happens in the first week.
(31:25) 23 of all deaths of 7 days happens in the first day. Like that there's a theory. >> So 28 days is a very critical period. >> So that 28 days it has to be seen if you just give mother's milk breastfeeding and kangaroo care. Kangaroo care is not practiced. >> You mean the kangaroo? Kangoo care means just keep the baby close to your chest.
(31:47) >> Not only by mother, by father, by brother. If you do that one, it is as good as an SNC unit where you that what do you call that system where light and everything is much more effective. It was found out in the South America. M >> so if you do breastfeeding and kangaroo care kangaroo skin care that is sufficient for this 28 days.
(32:16) The one research says that you know the this breastfeeding alone uh will prevent about 22%age of the neonal deaths. Breastfeeding exclusive breastfeeding only breastfeeding prevents 22%age of the neonal deaths means death during the first 28 days can be prevented. These are the the child care things. So there are three things we have covered.
(32:35) Then we come to the issue of the the most important thing. The fourth one is the breastfeeding. There are three things to be done related to breastfeeding. The baby has to be fed with mother's milk within 1 hour. >> Second baby should be given only mother's milk in in the first 6 months. Not even a drop of water or a milk or honey.
(33:01) And third from sixth month baby has to be initiated into semi- solid food from sixth month. Now these are very simple and you will think this is very high but you will be surprised to know that only 42%age of the mothers give the mother's milk in the first 1 hour only 42%age and it is declining >> I think if new survey happens going by the practice now it will be showing and the exclusive breastfeeding happens only in 64 4 percentage and the complimentary feeding the proper complimentary feeding with the quality is happening only 11 months. Everybody initiates
(33:46) semi-olid food from 6 month but it has to be with the frequency and quality. There is a there is a theory and there is a tiranga color food to be given. There are multi frequencies to be given. So doing complimentary feeding as per requirement only 11%age of the mothers are doing and because so that is a very gray area in the development of the child >> and then on top of it now we hear a big issue is has emerged that hospitals and pregnant women sorry the nursing mothers are saying they don't have a milk >> milk has stopped
(34:26) and this is reverberating across India Yeah. No milk. The other milk is the mother's milk is >> I think across different parts of the world too >> maybe different parts. And if millions of years mothers have been feeding their babies with breast milk, how come all of a sudden in the last 10 years it has stopped coming? Yeah.
(34:48) Has anything happened? I don't know. >> So this is a major obstacle in this nine tips which are talking about this. We have to overcome this and we have to ensure breastfeeding within 1 hour 6 months only mother's milk and initiating quality complimentary feeding from 6 months. This is very critical. Now by doing this one there are benefits for both baby and for the mother.
(35:18) For babies we know this is the first vaccination. Mother's milk is considered to be the first vaccination of the baby. It protects against all diseases and infections. It also uh develops the brain development about 10 to 15% breastfed children have 10 to 15 percentage IQ more than the non breastfed children. >> So it has a lot of and it addresses the malnutrition.
(35:44) If a baby is given breast milk for 6 months that baby will never be malnourished. >> There will be no standing at that period. Only mother's milk is requ. So there are a lot of benefits for the baby. Much more benefits are there for the mothers. First it is they can reduce their weight very fast and come into shape.
(36:06) If you are breastfeeding, it protects them against many diseases which they may have like many cancers, ovarian, breast, uh chest cancers can be pre will not be there if they are breastfeeding. Same thing with the heart diseases and the um hypertension. And this is almost breastfeeding is just like a contraceptive. >> It delays next delivery at least for 7 9 months it works like a a contraceptive and it develops a bond with the child.
(36:35) >> Mhm. >> So for mother has got a and it also have I mean the mothers after delivery recovers very fast >> and the postpartum hemorrhage chances are very less because blood immediately stops. Uh so there are lot of benefits for but despite this benefits and despite the wisdom of not centuries millenniums we are going back to something which is wrong which is giving babies with mother milk formulas.
(37:10) In fact, India is one of the countries who have pre prohibited prescribing any milk products, formula products to a child below 6 months is punishable in India. A doctor cannot prescribe give this formula. The doctor can never give. He will be sentenced for two years. We have formulated this rule in 1970s. >> So no doctor will write.
(37:37) But you go around the pharmaceutical shops the >> I mean if you go to any uh local pharmacy one of the first things that you will see breastfeeding substitutes like >> will be there. >> So in 2000 UNICEF and WHO launched this huge program across the world called baby friendly hospital. >> Mhm.
(38:02) And Kerala was the first state in the world which was declared as baby friendly hospital state. Uh that time there was about 400 or 450 odd maternity hospitals were there. So all of them were bound by the 10 rules uh to get that certificate. all of them got and they displayed it and one of the criteria was that they will not promote milk substitutes and formulas and they will not store them in their pharmacy >> and I do not know what is the situation now and we are now it's a retrograde we had progressed a lot and now in the breastfeeding we are back to
(38:43) >> but sometimes you know at the time the breast milk is not coming >> what do they do then The so my question doctor what was happening about some 100 years back have you heard any story any your grandmother saying that I didn't have a breast milk so I had to those incidents are rare it may happen I'm not saying you know there are certain incidents sometimes you have to depend upon milk substitutes for example if the mother dies or the mother is sick or something happens like that probably in extreme cases so the nipple is broken
(39:18) So there are extreme cases maybe 1 percentage 2 percentage we have not heard about those cases about 100 years back or 50 years back. So those in instances can be there then formula products can be prescribed. So that's one area the the breastfeeding is one that is the fourth point I think it's coming into the fourth point and uh fifth point is regarding the preventing of malotation.
(39:47) I as I mentioned earlier biggest challenge India is facing is malnutrition and anemia >> and nobody knows about it in India 36% onethird of the children is stunned >> one/ird so you imagine >> when we are talking about demographic dividend if one/ird of the youth is standard how can they contribute to the economy or the the growth of the This is now a few years back it was much higher.
(40:23) So that standing that malnutrition is again preventable consequence we know the death of child the diseases brain brain stunting cognitive development affected poor studies that we know I'm not going to that we have repeatedly said those consequences it can be very easily prevented first thing is if there's a breastfeeding there will be no malnutrition or standing second one if you're treating the diseases as I explained one disease can bring you to malnutrition.
(40:54) So management of tree luckily we have got now medicines and strategies to deal with the diseases. >> Mhm. >> And third one is if you're using u safe water and sanitation. So I'll come to that point. So that is regarding the malnutrition and it is a doable thing. And fifth one is regarding the full immunization.
(41:15) That means that I think by in India by and large 77%age of the children are getting full immunization. Full imunization means a child needs to be vaccinated five times in the first 9 months. Birth one and a half months, 2 and 1/2 months, 3 and 1/2 months, 9 months. So that five times have to be given and nine times vitamin A have to be given every 6 months up to 5 years.
(41:43) Then worm infestation tablets have to be given twice in a year. So if this is done now the immunization program of government of India prevents 14 defects and deficiencies and the infections >> and it also prevents most of the vaccinereventable diseases are now prevented. So you don't hear about people children dying about any any diseases which is vaccinereventable is almost nil now.
(42:14) Same with I mean the vitamin A vitamin A can reduce dosage can reduce about I mean 11 percentage of the all cost child mortality by 11 they have the study in UP huge study it says that it can be prevented same thing with the wor infestation l fortunately in India it's well covered but even now including in Kerala 24%age of the children are not fully immunized they may be taking one or two vaccinations Full imunization means full package have to be taken.
(42:48) So that is not happening. Now after that one so that is the this this was the uh sixth point. Seventh point is regarding sanitation that everybody should be using toilet not only at your home your village also >> and everybody wash hands with soap before eating food and after defecation and use safe water.
(43:16) Now coming to the first point of sanitary toilet use it has improved after the the government of India's huge program of con free construction of toilets across it has improved now one gram of feces has got 100 billion viruses and bacteria one gram so even if everybody in your house is using toilet and somebody in your neighbor is not using it a fly will come from there and can sit on your food then all advantage of having sanitation is lost.
(43:50) >> So it's very important and once that is there it creates a diseases for the children this 1,000 days if the baby is there it affects that baby. >> Mhm. >> So therefore this is very important and fortunately the coverage people using uh toilet is has increased but still it is not 100%age.
(44:13) Second one is regarding safe water um using I mean right now again by the JJM program by and large the safe water is reaching but that's also safe water is another reason for the important initiative during the first 1000 days. Third one is the most important but simple but most important is if I ask you a personal question I would say did you wash your hands before eating breakfast today with soap? M >> did you wash your hands with soap? Everybody hands two things have to be done.
(44:49) Wash hands with soap before eating food and after going to toilet. >> Now many people because of our toiletry practice the feces the micro or micro part of the feces is in our hand. We are touching the faces because of our toiletry practice. And if you don't wash our hands now for example if I had not washed my hands after going to toilet my hand will have 100 cr not 100 100 cr bacteria and viruses disease causing bacteria and viruses will be in my hand although it looks clean >> it's microscopic >> microscopic so and even if you wash hands also it's not I mean not you're
(45:32) not safe suppose your maid or your mean friend who comes to your home and then you touches here that is sufficient and you touch there finished. So the entire population not only you but the entire population around the child have to see that they don't they wash their hands with soap.
(45:52) It's one of the symbol the the statistic says that only 74%age of the people wash hands with soap after defecation and only 34%age wash hands with soap soap before eating food. that is very less that's one of the reason for so sanitation and this is a huge and the not doing this one not only it I mean affects the baby because of that one the world bank study says one country can lose 6% of the GDP just by not following this three principles of sanitation safe water and washing hands with soap everybody wash hands with hands But not
(46:37) with soap. >> So just normal water is not enough. You need to put the soap and rinse it like a surgeon >> because there are grease and oily will stuck in. Some people use with the mud. In north India I have seen people washing with telling me that they have washed their hands with the mud and ash is not good enough.
(46:55) >> Of course one lakh will go. So you have got 10 cr bacteria. One lakh will go. But remaining whatever 99 lakh 99 >> and what about hand sanitizer? >> Hand sanitizer is also equally effective but then that is expensive. So we don't have to soap or I mean need not be very expensive soap.
(47:16) Even the soap which you use some earlier time the using the washing clothes even that is sufficient. >> So hand sanitizer is expensive. We don't recommend hand sanitizer because I mean definitely there are chemicals are involved. Of course, I mean when you are traveling, there are certain situations where you cannot wash your hands with soap and water.
(47:34) So I always tell there is a paraphrasing one sentence. One soap, one mug of water can change the world. >> One soap, one mug of water can change the world. It is so simple but it can reduce the diseases, it can reduce malnutrition, it can increase GDP of the country. It's so simple. So that's regarding >> there was a debate uh like a group of people were saying the reason for human longevity that increased is because of vaccination.
(48:08) >> Another uh group said that is partially true. The real reason is sanitization. Sanitization is the real cause for enhanced longevity that we see today. Exactly correct. It's not vaccination. I mean vaccination could >> maybe contributing but the sanitation when we say sanitation three elements are there >> sanitation safe water washing >> these three things have contributed much more than any immunization and you we can see around now it in India I mean earlier I mean about 10 years back 50%age of the people in India were open
(48:44) defecating defecating in the open and now it has reduced maybe only 10 or 20 percentage even our Trains were I mean we found out even in states where everybody was using toilet one person was not using that toilet and that person was spreading it across that geography >> you know who train so entire for example if entire Kerala everybody is using toilet but a train runs across which is defecating of course not the train >> yeah I mean it falls on the track >> but now So that also has been now the most of the trains in India realizing
(49:25) the rail railways realizing that they are the biggest defecator of India >> they are defecating daily not normal person will defecate only once they are defecating every second >> so realizing that one they are now bio toilets are there in most trains so they are not defecating uh so that is one of the major you're right that is one of the reasons Why we have been able to arrest the diseases and the malnutrition to great extent is this one and uh next point.
(50:01) So the next point is regarding this is the one area where nurturing care and stimulating children >> which I explained the brain that the this is considered to be a women's affair >> normally playing with the children and go doing cooing with them or gaga and that doing is a women's area and men or other members in the family um is probably when the child is grown up to one year or something they will start play and everything but the new sign says that you need to interact and with the child by whatever ways I mean you can sing a song tell a story read
(50:46) mahabharat or classical songs you can sing you can play you can look at the eyes you can do the you can do whatever I mean you engage with the child as much as possible. I mean listen to music, show them music, classical music, tell them stories. That's what the case I was telling about this this where I mean you know he was reading quantum physics.
(51:10) I mean you know nobody ever thinks that you know the child when grows up will remember all the whatever was told to her on quantum physics she will remember. She's not going to remember. But her brain has been stimulated. As I said earlier, 1,000 neural connections are made in the brain in every second >> and that is the ar that forms the architecture of the brain.
(51:35) Brain develops. So that stimulation the family members have got a bigger role probably that is getting restricted because of the um nuclear families only two father and mother. So the opportunity for we want diverse engagement >> the engagement of parents will be in one level engagement of a grandparents is another level telling old story so and they may not have time so all the time if you can do with the babies that the best thing so the parents have to find ways even the nuclear families they have to find ways probably they can play
(52:12) classical music they can show them some classical dances or I mean things like that. So they have to find their own ways to substitute what is there in the joint family system and then the menfolk >> the for example the grandfather or I mean brothers or uncles they normally don't do the stimulation with the I mean limited so they have to engage the baby much more another area is the I mean know the ninth point regarding to be done I mean in Carolina it may not be relevant is really the the there's a strong connection between the child's
(52:54) development and the maternal education. >> So mother have to be at least educated. In UNICEF we say that girls education is the magic bullet for women empowerment and human development and social development. One magic bullet if you have that is the girls education. There strong linkages there.
(53:17) So girls have to be educated at least up to 18 years. So in in other parts some in our it's increasing the percentage of the girls attending schools in the higher secondary schools are now increasing but earlier it was just less than 40%age. Second one, the mother should not be a child bride >> because um teenage pregnancy is very dangerous.
(53:43) Dangerous for the mother as well as for the uh child also. the the the risk for the maternal the risk for death is about 40 times higher than the normal child and then it leads to pre-term delivery LBW baby system malnutrition the entire cycle it is a cycle actually it will start so these are the nine things to be done now one important three points I want to reiterate this 1,000 days happens in the life of a How many times? Only once.
(54:20) >> 1,000 days happens only once in your life. >> Unless you believe in rebirth. [laughter] >> Then you can do again. So only can you not spend some time to do this nine tips. First point. Second point is your inaction. If you are not doing anything, the damage caused because of that inaction >> is irreversible.
(54:48) >> Irreversible. And after 1,000 days, if you start doing all this stimulating and everything, >> it may not have the same impact. >> It very less impact. Third thing, this all the nine tips we have mentioned, it does not involve much expenditure. Everything is free. Breastfeeding is free.
(55:10) Washing hands with soap of course if you need a soap or >> not so expensive >> expensive even the immunization is fully free the of course if you're not going to the private hospitals the government system every month in north India I don't know how organized it is in north India it's very or India has got 10 lakh villages in every village every village every month one&m goes and does the immunization every village >> mm M >> it's so organized it's free they will the asha worker I mean if they don't come ashawa worker will pak they will catch them and bring
(55:51) >> so system is and no expenditure and their cold storage system potency is much organized >> I mean straight from the cold storage the special equipments are not all the vaccines cannot be different vaccines have got different temperature and it has to be kept in that temperature otherwise the potency is lost.
(56:14) So they have the vaccine baggage is there. So the system is welloiled machinery is there. So you have to so these are the three points once in a lifetime and once you lose that opportunity it is gone forever and third it is thing another point is regarding when you are investing your time energy on doing these nine tips then you are shaping the future of this child >> and the nation >> but yes that is the point you are also shaping the future and the destiny of India.
(56:53) M >> so I would say which I mentioned to doctor earlier this rephrase that that sentence India's destiny is written in its classrooms right but I will also add India's destiny and future is written in the first 1,000 days of a baby and you can be part of it >> I think there is so much to learn and I really wish every mother and father you know who are about to have a child and also going through the first two years of their child listens to this and follow this protocol and it's it's quite interesting I mean when you go to a
(57:31) doctor when you go to pediatricians I mean they ask some basic questions but I really wish you know this kind of information comes to us in a very systematic manner like you know so many information comes to us but I wish this kind of information is what really needs to be spread. We made an attempt. So I realized that if I say this nine things.
(57:54) So I was telling you an instance my brother is a doctor well-known doctor and in a family get together I was >> what doctor is he? >> He's a cardiologist >> and he's a he reads a lot. I don't think this is >> and his children are also doctors. So in my family get together I was mentioning about this first 10,000 days and every and the importance of first nine days.
(58:17) they were all questioning me. So I said it's all WHO, UNICEF, Lancet based on the information. So this knowledge so I thought if I say I am telling government I mean when I was in working in UNICEF I'm telling the health workers that means there is an asha in every village there is an&m who goes to the village every month and there is also this anganari worker.
(58:44) So I we are working through them presuming they will transfer this knowledge to the pregnant mothers and the family members and it may not happen. So I thought I had a brilliant idea. Idea was brilliant but implementation was very poor. >> I thought if doctors prescribe it just like a medicine in western countries it is called green prescription.
(59:07) So doctors they do this and cut like this. So I thought if any mother of a child or a child comes to a doctor he should prescribe one of these nine tips in the so probably the child is having a diarrhea. >> So the they go to the doctor and doctor will be prescribing some medicine along with it if he cut and write ensure exclusive breastfeeding.
(59:37) So I thought if they write it will be a good idea. Then I realized they are not going to write it. So I developed a seal. So they don't have to write it. >> Just put the seal >> seal. So we worked with the IMA in Kerala and this program was launched by the former chief. This program was launched with IMA um that they will prescribe doctors will prescribe these nine practices and tell also.
(1:00:06) So because then there is a more credibility and it was launched in a function with the former chief minister >> and we provided the seals some doctors must have I mean done it but coming to your point there is increased requirement if by everyone talking about it doctors health workers family members it has to be disseminated widely and it has to reach The most who is the person who is most interested in the growth of the child is the mother, father and their family members.
(1:00:48) It has to be directly go to them. So I asked a doctor why are you not prescribing and telling? So he said first of all there's no time. A patient comes for a particular disease or whatever prescribe whatever is required medicine or something we don't have time to counel and talk to them tell about these nine tips we don't have time and partially it is correct >> probably we need to create so in another state I created another method this is one experiment I did when I was chief of UNICEF in Tamiladu and Kerala and we
(1:01:21) launched a program with the IMI and Kerala government In another state I did another strategy. Realizing that doctors is not going to um tell all these nine tips, I developed another method. So after seeing the doctor in a Ph, uh we engaged another person. >> Mhm. >> It's a health worker. It's engaged by us, paid by us.
(1:01:50) So the doctor will say after seeing okay, you please go to this room number 12 also as a for a checkup. And when the mother goes to that room actually it's nothing as checkup they give some of the points not all the nine points together only one point will be taken for example maybe breastfeeding or maybe on anemia one point is taken but that is it's a quick fix because it's not a part of the government system.
(1:02:16) M >> so if the doctor does not have a time so anyway the the crux of the problem is we have to reach this message to as many people as possible and since this is a very very new is only 10 years old people did not know about 1000 days about 10 years back >> mhm >> and what needs to be done is also scattered >> the way I have said nine things and everything it's not written anywhere >> this nine things can be expanded to 11 things 21 things content is same you can increase the points but what needs to be done is same
(1:02:53) >> and it's not rocket science it's very bas >> it's not rocket science it's a basic common sense >> I think the future definitely okay future of every nation future of all human being survival >> it all comes down here >> definitely and uh yeah yeah definitely and it is improving I mean you know we can I was mentioning about the height of >> the people you look around I mean no research is required.
(1:03:17) You look around your own relatives, your own friends, their children are growing taller. How come? And they are uh probably there we don't have any study on the change in the IQ a life cycle studies we don't have. Uh definitely their brain development must have gone up. Definitely we don't have any research to show it.
(1:03:39) Definitely it is improving but much more scope if you are taking care of the in India taking care of the malnutrition, anemia, breastfeeding, the stimulation and the safe water issue because these are all neglected and underrated issues in my family. Uh we have mine is a very big family. So about 30 35 people gather in every function. We we occasional.
(1:04:07) So last time when lenji was served I looked how many people are washing hands before eating food. Out of 35 three people washed hands. >> But none wash with soap. Everybody wash with water. This is a situation. You go to a hotel everybody wash with hand. I mean in the the restroom there's a big rush but all of them are washing hands mostly with soap only after food >> some oils in fact I would say that there's no need to wash I mean even if you don't wash your hands after eating food no problem but what is more important is in fact in another state I
(1:04:52) did this experiment that we went to all restaurants and wrote their wash hands meaning the table we provided a sticker u wash your hands before ordering wash your hands with soap before ordering food it may I mean these are all multiple strategies and multiple ways we need to address one way a doctor's prescribing is one way media through I have written several articles that's one way hotels approaching the hotels I have also tried the marriage, the events, the weddings.
(1:05:32) I have not seen so far anyone washing hands with soap before entering to the the wedding reception >> and never see forget about washing with soap even with water is not there but everybody rushes to the wash area for after food. In fact, it is not required [laughter] even if you do. So this realization that I mean the way I explained that how much we cannot see that money you know when I explained one feces one gram of feces is having thousand billion notion cr how many surro zeros I do not know this is creating viruses and bacteria and
(1:06:12) pathogens they have and our hands we do not know >> it's quite fascinating very small small habits when you can incorporate it goes a long way in the quality of your life. Correct. Thank you so much sir. It was a very deep conversation. I think you have a lot to share and uh I wish that you know we can spread this information more and more and so that people's longevity and the quality of children and the quality of our conscious living goes up.
(1:06:42) Thank you so much for giving this opportunity because we need multiple opportunities like this. So to reach this message to the people and that will lead to a better India, >> a better youth and a better life, more happiness, success in their life. All will happen if we can do this small simple nine things in first,000 [music] days.
(1:07:07) >> Thank you so much sir. Thank you. Thank you.
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