Start with the smallest possible mother. This probably means that she was malnourished in her own childhood. Any extra food she may receive during pregnancy will be used to fuel her own metabolism and to make good her own chronic energy deficiency rather than to nourish the child in her womb.
If the diet of the mother-to-be is inadequate and unvaried, and she continues to do heavy work, then this will sharply increase the chances of the baby being born with low birth weight. At this point, the mother's anaemia can be almost taken for granted. Frequent illness, malaria, reproductive tract infections, mental and physical abuse, and exposure to smoke from domestic fires and cigarettes will further increase the possibility of premature birth and low birth weight.
When the baby is born, the malnutrition of the mother may reduce the micronutrients in her breastmilk. Delaying the start of breastfeeding for 48 hours will further reduce the supply and also prevent the infant from receiving colostrum, the yellowish fluid which precedes normal breastmilk and protects against infection.
From now on, breastfeeding either infrequently or not at all will deny the child both the best possible food and a source of protection against common infections. If the child is instead fed from an unsterilized bottle using milk powder overdiluted with unsafe water, then a self-reinforcing cycle of poor growth and frequent infection will be set up.
Photo: However much a mother may love her children, it is all but impossible for her to provide high-quality child care if she herself is poor and oppressed, illiterate and uninformed, anaemic and unhealthy...©
Introducing solid foods too early, especially if the food is a watery gruel with little energy value, will further increase the risk of infection and growth faltering. If the child is also kept away from health centres and vaccination points, then this too will increase the likelihood of frequent infection, giving the child little time to recover properly and catch up on growth in between episodes of disease. Measles and diarrhoeal disease, in particular, are sure to take away the child's appetite and cause growth to falter, especially if it is part of the culture to refuse food to a child who has an infection or withhold fluids from a child who has diarrhoea.
The process will be accelerated if the child's immediate environment is unhygienic, especially if there is neither safe water nor sanitation.
If the mother continues to eat last and least, she may have insufficient fat reserves to breastfeed adequately and very little energy for looking after her child. If she also has six or seven other children to look after, no help from her husband or partner, and a job outside the home, then this will make it virtually impossible for her to give the kind of care and attention that all small children need if they are to develop properly.