The Government of India's initiative to observe National Safe Motherhood Day on April 11 ' coinciding with Kasturba Gandhi's birth anniversary ' was commendable. Or should we say much required? After all, according to the international White Ribbon Alliance (WRA) for Safe Motherhood, 'Every five minutes one woman in India dies from complications related to pregnancy and childbirth'.

Of course, the government has made efforts to increase access to quality healthcare thorough the National Rural Health Mission (NRHM) 2005-2012 and the RCH II. While the Maternal Mortality Rate in India is 301 per 100,000 live births, experts believe that a number of maternal deaths could be avoided through obstetric intervention, improved health, and proper nutrition. In fact, according to UNICEF, as many as 50 per cent of pregnant women suffer from iron deficiency, or anemia, and this may be responsible for as much as 20 per cent of the maternal deaths.

Malnutrition, of which iron deficiency is a sign, is thus life-threatening to both the pregnant woman and lactating mother. Explains Dr Christina D'Monte, gynecologist, Indian Council of Medical Research (ICMR), "Good nutrition at this time protects the health of the mother and also safeguards the health of the baby. Undernourished mothers are more prone to infections and carry the risk of death during delivery."   

According to the National Family Health Survey (NFHS 3) 2005-06, 57.9 per cent of pregnant women (in the age group of 15-49) in India have some degree of anemia.

Anemia does more than present a pale face, "It affects the intelligence, attention and retention capacity and energy levels, since iron is not just a vital component of hemoglobin. It is an important part of every cell and required for its functioning and for overall growth," explains Dr D'Monte. "During the first trimester of pregnancy even if there is excess vomiting, care should be taken to see that fruits and vegetables form part of the diet - at least in small portions at a time. Proper nutrition is vital at all stages of pregnancy. In the third trimester, when the baby gains weight and fat deposits are being formed under the skin to prepare it for life outside the womb, proper maternal nutrition assumes critical importance." According to Dr D'Monte, hypothermia in infants is very common - even in the warm weather experienced in our country.

During a study conducted between 2001 and 2006 on maternal and child health in urban and rural areas by Nalamdana, a Chennai-based NGO, a large incidence of anemia was found to be prevalent. Nithya Balaji, executive trustee and principal investigator for the project, says, "We wanted to explore whether malnutrition was the result of poverty alone or whether other factors like misconceptions about food practices were also responsible. We found the diets to be heavily dependent on rice and other cereals, with fruits and veggies having a negligible presence. The consumption of milk was very negligible, too."

Explains Balaji, "Adolescent children were targeted specifically since the onset of menarche makes girls particularly vulnerable to anemia. The study revealed that adolescent girls whether working or staying at home were prone to skip breakfast on a routine basis." The NGO conducted awareness campaigns by staging plays in villages, besides enrolling twenty girls in the age group of 15 to 18 years to disseminate information. "The girls were taught the importance of good hygiene and the benefits of consuming seasonal fruits. After a year, most of the girls who had low hemoglobin levels at the start of the study attained normal levels. This was achieved only through counseling. No tablets or supplements were given, " he adds.

Dr D'Monte says that food fads contribute to anemia in young girls, "educating young girls on the importance of taking well-balanced meals can help".

Sheela Krishnaswamy, nutritionist and founder of NICHE, a nutrition consulting firm, says, "Though maternal malnutrition is not as prevalent in urban educated women, as much as it is amongst the rural /semi-urban /urban women with little or no education, there is a chance of iron deficiency in some urban educated women - whose food intake might not be adequate or well-balanced. These women usually belong to the working group and don't have much time to prepare well- balanced meals."

Incidentally, the consequences of maternal malnutrition include retarded growth of babies in the womb, increased risk of diseases, and maternal and infant mortality. Some children could be borne with low birth weight and thus prone to infections (due to low immunity levels), to learning disabilities, to slower growth rates and to an increased risk of mortality. The girl child is particularly vulnerable, with intrauterine malnutrition threatening to make her - in due course of time - another malnourished mother bearing a weak child. Thereby perpetuating a cycle.

So for those women who are soon to deliver a child or are currently nursing their little ones, watch out for symptoms of malnutrition, which, according to Dr D'Monte, could be "Back pain and abdominal cramps, along with extreme tiredness and low concentration levels". Dr Priya Selvaraj, gynecologist, GG Hospital, Chennai, says that malnourishment is reflected as "poor weight gain, easy fatigability and palpitations in the mother and growth restriction in the fetus".

However, eating a nutritious diet could keep malnutrition and, thus, iron deficiency at bay. Elaborates Dr Selvaraj, "Lean meat, as in chicken and fish, are good protein sources in addition to occasional red meat and eggs. Vegetarians need to consume a variety of pulses, grain products, dairy products."

"Anemia can be prevented by eating adequate amounts of green leafy vegetables and dry fruits, along with some vitamin C rich foods like fruits," adds Krishnaswamy,

In a small private study conducted by doctors in Chennai, adolescent children in both higher and lower economic groups were found to be anemic. "The number of anemic adolescent girls was seen to be more or less the same in both groups," says Dr D'Monte.

Targeting young girls and providing information on the importance of a balanced diet can help improve the situation a great deal. "They are the future mothers and if they understand the importance of nutrition in promoting good health, the benefits accrue faster," concludes Balaji.