FIRST 1,000 DAYS – MATERNAL AND CHILD WELLNESS

Ensuring holistic well-being for mothers and their children during the first 1,000 days and beyond

06 August 2021

From conception up until the age of 2, children develop psychological and physical foundations that can optimise their health, growth and development well into adolescence and adulthood. During the early years, the interaction between mother and child is essential in fostering a stable and healthy relationship between the two, as well as shaping and nurturing the child’s behaviour. It is also a pivotal time for developing language, as well as cognitive and social emotional abilities. Appreciating these interdependent, cyclical and multigenerational effects in turn has impacted the way health and social policies and services are designed.

The third edition of Temasek Shophouse Conversations, held on 7 June 2021, brought together experts from various sectors to share about the symbiotic relationship of a mother and her child in their first 1,000 days.

Acting on a critical developmental window

Every aspect of neurological and biological development is shaped by experiences and exposures during the first 1,000 days. According to Dr Tim Moore, Senior Research Fellow at Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, it begins from the moment of conception as the foetus adapts to the nutritional and emotional environment of the womb throughout pregnancy.

This puts both mother and child in a vulnerable position as emotional factors such as stress and mental health can come with long-term costs to a child, both psychologically and physically.

“We have to start at the very beginning with the child as the starting point, and claim progress to support the child's development. Another consideration is to deliver holistic, multi-layered solutions that address all aspects of the mother and child’s well-being – physical, psychosocial and cognitive,” said Woon Saet Nyoon, Chief Executive of Temasek Foundation Cares.

The Temasek Foundation Integrated Maternal and Child Wellness Hub launched at Punggol Polyclinic, together with KK Women’s and Children’s Hospital (KKH) provides comprehensive care to both mother and child. It provides a structured framework of screening and early intervention services to optimise health from pregnancy, infancy, early childhood to adolescence. It also facilitates integrated care within the community for mothers and their children in areas such as nutrition, development, parenting, and mental health and wellness.

Ensuring support from the outside in

Providing support to maternal and child mental health needs to be a collective effort by family members, friends, colleagues, and ultimately health and social services agencies, as we move towards a holistic system that puts both mother and child at the centre.

“The approach we take is collaborative and strength-based, where we believe that the caregivers want the best for the children and have the skills that will scaffold their children's development,” said Ng Wei Chen, Senior Assistant Director, Home Visitation Programme, KidSTART Singapore.

A programme under the Early Childhood Development Agency, KidSTART provides an ecosystem of health, social and child development support to low-income family parents from the prenatal period until the child is six years old. Areas of support provided by KidSTART allow for holistic care and facilitation throughout the formative years of a child and their mother. KidSTART expanded from the Temasek Foundation KIDS 0-3 Programme piloted earlier with KKH which found evidence-based improvements in family function, parent-child interaction and bonding, child health, birth weight and child development and cognitive ability.

Parenting in difficult times

Head of Mindcare, Jeannie Wan shares that cases are increasing throughout the COVID-19 pandemic of mothers seeking financial and parenting support. Global standard recommendations have also been affected due to pandemic regulations, further impacting maternal mental health. Factors such as increased anxiety and stress due to possible infection, limited social support systems due to safe distancing measures, and disrupted mother-child bonding in mothers confirmed with COVID-19 are just to name a few.

In view of this, MindCare, a mental health division of AMKFSC Community Services, aims to provide wellness support through counselling or home visits to ensure vulnerable families are safe.

“Sometimes, we need to take a more proactive approach as not many could be upfront. It’s also a stigma that comes with asking for help. Asking for help does not mean that I am not a good mother. It’s important to remove the labelling,” Ms Wan explained. Especially in these difficult times, the small things that a friend and family member can do, like a call or message, can go a long way.

Ensuring proper child development is not just about what does and does not happen between mother and child. It is also about having social and systematic support in place to raise public awareness and continued engagement on the topic. Mothers have a special role to play in encouraging other mothers to speak up. As patient advocate and theatre actress, Karen Tan, puts it, “the thing about Singapore and being a Singaporean mother is that we have never been taught to fail”. Ms Tan added, “It does start with mothers who have gone through depression to reach out to other mothers and say it’s okay – instead of waiting for other people to do it. And that passes on to others.”