Book Review: The First 1,000 Days

For more than half a decade, the critical importance of good nutrition during the first 1,000 days of a human being’s life has been widely accepted. It is during this period, which stretches from conception to the second birthday, that the determinants of future health and wellbeing are established. So significant is this window of opportunity that it has given rise to an organization of the same name: 1,000 Days. The Executive Director of 1,000 Days, Lucy Martinez Sullivan, is in fact interviewed in the Day in the Life section of this issue of Sight and Life.


baby being cuddled by mum smiling


An excellent complement to Lucy Martinez Sullivan’s reflections is Roger Thurow’s new publication The First 1,000 Days. A Senior Fellow for Global Agriculture and Food Policy at the Chicago Council on Global Affairs, Thurow was a reporter the Wall Street Journal for 30 years. He is, together with Scott Kilman, the author of Enough: Why the World’s Poorest Starve in an Age of Plenty (which won the Harry Chapin WhyHunger book award) and a recipient of the 2009 Action Against Hunger Humanitarian Award.

Not surprisingly given his background in American journalism, Thurow takes a narrative-based approach to his subject in The First 1,000 Days , focusing on the lives of four pregnant women from different corners of the world: Esther Okwir in rural Uganda, where the infant mortality rate is among the highest in the world; Jessica Saldana, a high school student in a violence-scarred neighborhood of Chicago; Shyamkali, the mother of four girls in a low-caste village in India; and Maria Estella, in Guatemala’s western highlands, where most people are riddled with parasites and mothers can rarely afford the fresh vegetables they farm.


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In the footsteps of Hemingway and Steinbeck

This approach makes Thurow’s latest publication significantly different from much contemporary writing on nutrition and public health, which frequently has a policy-driven, statistics-based line of argumentation. True to the literary tradition that gave us journalist-authors such as Ernest Hemingway and John Steinbeck, Thurow commences his narrative in medias res and sticks closely to the experiences of his four subjects throughout. The fact that he contrasts the poverty of a depressed urban environment in his native Chicago with three settings in the developing world makes his account all the more compelling.


Children eating fast food


“In the second decade of the twenty-first century,” Thurow writes, “one in every four children under the age of five is stunted – about 170 million in total, according to the World Health Organization … A child who is severely stunted is sentenced to a life of underachievement: diminished performance in school, lower productivity and wages in the workplace, more health problems throughout life, and a greater propensity for chronic illnesses such as diabetes and heart disease as an adult. And that life sentence is most often rendered by the time a child is two.”

“A child who is severely stunted is sentenced to a life of underachievement”


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Readers of Sight and Life will be familiar with such reflections, but in Thurow’s prose, they are especially powerful – direct, simple, and free of policy-speak. They are rooted in the actual experience of real women, and we see how Esther, Jessica, Shyamkali and Maria Estella all struggle with their own versions of the same problem. In a Uganda ravaged by the aftermath of the guerrilla operations of the warlord Joseph Kony, Esther dreams that her baby might one day become “a manager or president of a company, if not president of the entire country.” Jessica in Chicago lives in a world in which mothers fill baby bottles with Coca-Cola or Kool-Aid because these soft beverages are cheaper than milk. In a downtrodden village in Uttar Pradesh, Shyamkali struggles with a culture that favors male children over female to the extent that the ratio of females to males in society is declining due to “female infanticide and feticide and the neglect of the wellbeing of daughters.” And in the western highlands of Guatemala, Maria Estella lives in a landscape burgeoning with agricultural produce but in a subset of society that has always been condemned to malnutrition through poverty, disenfranchisement and ignorance: she and her fellow-mothers are astonished when taught how to cook a simple, nutritious potato soup.

Inspiration and heartbreak

Thurow’s narrative accompanies these four women through the first 1,000 days of their children’s lives, charting their progress with stories and insights that are inspiring and heartbreaking by turns. Nutrition education, breastfeeding, cookery classes, good hygiene and sanitary practices, and the consumption of nutrient-rich foods – all these measures can help, but the odds stacked against success are tragically high for the poorest of the poor.


pregnant women in the kitchen


This book details the struggle on the part of just four mothers to make the first 1,000 days work for their infant children, with the aid of people inspired by the Scaling Up Nutrition (SUN) movement, which has been pivotal in its promotion of the concept of the first 1,000 days.  But 360,000 babies were born each day in 2011,  and that figure has increased since then with the constantly accelerating rise in the world’s population. And as Thurow observes in his introduction, “Malnutrition has gone big, it has gone global. A stunted child in Africa is a stunted child everywhere.”

The book ends on a questioning note. “As their 1,000 days came to an end, the moms in Shivgargh, Ongica, Chuicavioc, and Chicago looked upon their children and wondered how they would navigate the next years. Their dreams began in the 1,000 days but they had no end date … For as they grow, it will now be their challenge to finally break the generational cycle of malnutrition, stunting and inequality.” Essential reading for anyone who wants to know what really lies behind the disarmingly simple phrase: “the first 1,000 days.”

Roger Thurow: The First 1,000 Days

Hardcover: 304 pages

Publisher: PublicAffairs (May 3, 2016)

Language: English

ISBN-10: 1610395859

ISBN-13: 978-1610395854

“The First Hundred Days” is available from PublicAffairs

First published in Sight and Life magazine VOL. 30 (2) |2016. (

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