Pregnancy and childbirth are high-risk situations, which may seriously affect perinatal health resulting in morbidity and mortality. Poor nutrition in women is associated with a high risk of low birth weight infants who are then at higher risk of morbidity and mortality in the neonatal period or later infancy. Subsequently the same low weight female children will perpetuate the cycle of malnutrition and chronic illnesses.
Obstetric outcomes are also related to nutritional status of women. Reductions have been produced in the maternal morbidity and mortality rates of women by not only improving the medical services but also the nutritional status of women especially in the early years of life.
About 80% of maternal deaths are the results of five direct obstetric causes i.e. haemorrhage, infection, obstructed labour, unsafe abortion and eclampsia.¹ Obstructed labour is more likely to occur among women who were stunted and wasted in childhood. Obstructed labour can lead to haemorrhage, uterine rupture, sepsis and urinary fistulae. It is estimated that anaemia may be responsible for as much as 20% of maternal mortality, particularly in those deaths from haemorrhage and possibly infection.² Anaemia also increases the risk of morbidity and mortality associated with any major surgical intervention including caesarean section. Iron is a component of many enzymes essential for the adequate functioning of brain, muscle and the immune system cells. Iron deficiency develops as the stores in the liver, spleen and bone marrow are depleted alongside insufficient iron intake. Other causes of anaemia in our country include folate deficiency along with malaria and hookworm infestations.
Malnutrition results not only from a deficiency of proteins and energy but also from an inadequate intake of vital minerals and vitamins and often essential fatty acids as well. Infections further compound the deficiency state. Micro-nutrients are needed in tiny quantities in the order of few thousandths of a gram or less each day. They are required for the production of enzymes, hormones and other substances that are required to regulate biological processes leading to growth, activity, development and the functioning of the immune and reproductive systems. All the minerals that the body needs i.e. calcium, phosphorous, iron, zinc, iodine, sodium, potassium and magnesium for example have to come either from the food we eat or from supplements. The body manufactures many of the complex organic molecules it needs from simpler building blocks. However, the minerals and vitamins A, B complex, C and so on are not synthesized.
Zinc promotes normal growth and development. It forms part of the molecular structure of 80 or more known enzymes that work with red blood cells to move carbon dioxide from tissues to lungs. Zinc also helps maintain an effective immune system. Severe zinc deficiency causes growth retardation, diarrhoea, skin lesions, and loss of appetite. Administration of Zinc has been shown to have a therapeutic effect on diarrhoea cases.
Pakistani girls under the age of five years are more likely to be underweight as compared to their brothers irrespective of their urban or rural background. Forty four percent of rural children are underweight as compared to those living in urban areas.3 Sixty-seven million of our population is under the age of eighteen.³ For every two women who end the reproductive period of their life five young women enter the scene. Two out of every five will be severely stunted and anaemic. Four out of these five will deliver in their homes with untrained assistants. This is an emergency, which only becomes apparent when a woman dies. Unfortunately even the death is unrecorded until some person makes a determined effort to make it a statistic. Nevertheless for the individual and the nation the tragedy continues.
In a country where at least 51 percent of the population is food insecure and consumes less than 2,100 kcal per day, anemia is widely prevalent in women.¹
Among non pregnant women, 50.5% were haemoglobin deficient out of which 49.5% were from urban areas and 51% were from rural areas.2 When the data was compared for provinces it was found that 62.1% from Sindh province had deficient haemoglobin followed by Punjab 48.8%, Baluchistan 48.7%, FATA 45.5%, AJK 41.3%, KP 36.3%.² Levels of anaemia are highest amongst women regardless of their number of pregnancies. Amongst pregnant women 48.3 % were zinc deficient; 58.3%, hypocalcaemic and 86.1% were vitamin D deficient.2 Rural Pakistanis report eating meat less often than urban residents. Only four percent of those in rural areas eat meat daily compared to ten percent of those who live in cities.⁴ An additional thirteen percent of rural residents and 39 percent of urban residents eat meat on alternate days.⁴ Rural residents are more likely than urban residents to eat curd more often than once weekly. They are less likely than urban residents to drink milk this often. Deficiencies of micro-nutrients e.g. folic acid, zinc, and iron and calcium are associated with less meat and milk in the diet. Pakistani women and children eat less meat, fruit and eggs.
There is hardly any doubt that women feed the world, as from the first meal of the mother’s milk till the diet at the age of maturity. Mothers, sisters, daughters, wives usually accept their noble role of cooking and giving food to their dependents. Yet it is rare that women are provided with the information as to how healthy food is prepared. Unfortunately it is even more tragic that women and the females are worse off in terms of nutrition in comparison to the male members of the family. This is irrespective of social class in developing countries and is attributed to gender preference. Traditional wisdom is usually overtaken by “convenience foods” and foods of convenience.
Any plans for saving mothers and their babies must include strategies for improving the nutritional status of women and the adolescent girls. This will help save the lives, health and productivity of the mothers and future generations.

References

1. National Health Survey of Pakistan 1990-94, Health Profile of the People of Pakistan. Pakistan Medical Research Council. Islamabad.1997.
2. National Nutrition Survey of Pakistan 2011.
3. The State of the World’s Children. 1998. Unicef. Oxford University Press. New York.
4. UNICEF. Poverty and Children: Lessons of the 90s for least developed countries. New York: UNICEF, 2001.