Over ten years ago, researchers in our group from the Summit Institute of Development in Lombok, Lancaster University and the University of California, Davis, Harvard, Georgetown and Deakin Universities, started working with a large medical trial looking at what supplementation is best for pregnant women in the very poor South East Asian island.
Each village on the island was randomly allocated so that pregnant mothers throughout the village got either iron and folic acid or a full range of vitamins and minerals. Local midwives supported the mothers through pregnancy and helped to make sure they all received their supplements, and as much help as possible.
Psychologists from Lancaster and Georgetown looked at mothers’ intellectual, academic and memory abilities and then the team – which grew to include members from Australia as well as the US and the UK – followed up the children’s development at ages 3 and 10.
At all stages the supplements especially helped mothers who had extra nutritional problems. Mothers who took the vitamin and mineral combination, and their children, were better at a variety of skills including complex movements and general intellectual abilities, with different skills coming to the fore at different ages.
When the children were around 10, some groups whose mothers had taken the vitamins and minerals were the equivalent of a whole school year ahead of children whose mothers just took iron and folic acid.
Remember though that mothers in Lombok are at much greater risk than mothers in the West. in most cases, the children who benefitted the most were those whose mothers were underweight or had anaemia. Although some mothers in the West lose weight or are anaemic in pregnancy, the problem is not nearly so severe. This means that these supplements are much less likely to benefit Western children in this way.
We are really pleased that some areas in Lombok are now rolling out this supplement as standard in pregnancy, and the Government of Indonesia is talking about doing the same nationally.
However, current evidence-based medical advice is that folic acid is really important to take in pregnancy, to avoid spina bifida and associated problems – but most other supplements are not likely to benefit well-nourished, Western mothers. And most studies in the West back this up, and do not find such large benefits of vitamin and mineral supplements.
What particularly interested us though was finding that children’s home environment was far more important for their school and intellectual performance than any of the nutritional or health measures – whether we looked at the effects of health problems or the supplements themselves.
Children from poorer homes, and those whose homes were less stimulating, were more likely to do more poorly at school and on our tests of intellectual skills. These effects were separate from each other. This means that families that are very poor (even by the standards of this very poor island) can still provide a more stimulating home where a child can do better at school.
We’ve recommended that stimulation for early childhood development should be a priority in Indonesia too – and the Government is also talking about implementing front line workers in this area. We would like to make this type of recommendation to other countries and charities too – and work I have done with Save the Children should help to take this forward.