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No Nation Can Rise Above the Level of Its Women and Ultimately Its Children: The Legacy of Leonora Cohen and Belinda Barnes
Essay Submitted by Allan D. Lieberman, M.D., for The Lancet's Annual Wakley Prize
Leonora Cohen was one of England's famous suffragettes who fought for the right of women to vote but more importantly for motherhood. She believed "Every child has a right to be well born and no nation can rise above the level of its women." She inspired a host of politicians to recognize good food as essential for the health of individuals, nations, the next generation, and above all, women preparing for pregnancy.
England became home to one of the first community programs for preconception care. The program was pioneered in our generation by Belinda Barnes, a mother and a nursery nurse, who saw a need to fulfill Leonora Cohen's legacy of helping mothers to give birth to healthier infants, and therefore ultimately healthier children and adults.
Ms. Barnes envisioned a better way of developing healthier babies and surrounded herself with many creative scientific thinkers including Humphrey Osmond, Abram Hoffer, Theron Randolph, and members of the McCarrison Society. Reading the pioneer works of Weston Price, Frank Pottinger, and Roger Williams convinced her even more of the importance of nutrition in optimizing fertility and giving birth to a healthy baby. From the research of England's Ellen Grant, she learned about the adverse effects of the contraceptive pill on hormone levels and fertility, and incorporated natural family planning into the program to avoid these effects. Grant's experience was the basis for adding testing and treatment for urogenital infections, which were found in 69 percent of the preconception program's population.
It was Margaret and Arthur Wynn who contributed greatly to the science of preconception by publishing their treatise, The Case for Preconception Care of Men and Women. They formulated and answered the following profound questions:
1) Can a couple do things before conception that may improve their chances of having a healthy baby?
2) Does the health of a couple before conception matter?
3) Does the health of a father really affect the outcome of pregnancy?
4) Are there hazards in everyday life that may jeopardize a couple's chances of having a healthy baby?
5) What is the evidence that there are periods of susceptibility for damage to the sperm and ova before and around the time of conception?
Their treatise, with 517 references, laid the scientific foundation for Ms. Barnes and Foresight's Preconception Care Program. Ms. Barnes once said, "Foresight was not invented-it grew. It appeared like an oak tree out of an acorn."
Science, however, took a different direction when in 1992 D.J.P. Barker edited the book, Fetal and Infant Origins of Adult Disease, published by the British Medical Journal. On page 1 Barker summarized his results: "The general theme was that factors affecting the fetus and the young have long lasting effects and are important causes of later diseases." Few had ever heard of England's epidemiologist Barker, but on September 23, 1999, Newsweek magazine in America had a picture on the cover of Peter Nathanielsz and a full article on his just-published book, Life in the Womb, The Origin of Health and Disease. His book was described as "a revolution in the making." Nathanielsz hypothesized that "the way we enter this world may determine how we will leave it."
Despite the importance of these two works, they failed to recognize what Ms. Barnes and her consultants knew: it is the 100 days prior to conception that determines the health and future of a newborn baby and not just the nine months of gestation.
The decline in health in Western nations has reached critical proportion. The mortality from cancer, heart disease, and stroke alone is overwhelming, but the morbidity of everyday health concerns such as obesity, diabetes, depression, and learning and behavioral disorders, are of equal concern. Where do we in developed countries begin to reduce this morbidity and mortality? Despite increasing expenditure of money in health care, little change in outcome has occurred, suggesting we are going in the wrong direction. Preconception and prenatal care may be the new direction we are looking for-logically and logistically beginning at the very beginning.
Imagine being able to reduce infant morbidity and mortality to almost zero. Those were the statistics reported by England's Foresight Preconception Program based upon 367 couples, with 327 conceiving and 327 babies being born. There were no premature births, no miscarriages, no birth weights below 5 pounds 7 ounces, no congenital malformations, and no need for neonatal intensive care. Of further significance, 86 percent of infertile couples conceived. These statistics were so unbelievable that the British Journal of Medicine refused to publish Ms. Barnes' and her clinical team's paper outlining how they achieved their results.
A few physicians in America were also astounded and asked for more data. The new report was based upon 721 couples, yielding the same results except that 91 percent of infertile couples conceived and delivered normal, healthy babies. The majority of couples enrolled in Foresight's program were infertile, yet of the 91 percent who conceived there were only two sets of twins and one set of triplets. In contrast, where assisted reproductive technologies (ART) are employed, multiple births occur on average in 51 percent of conceptions and are associated with high risk of premature and low birth weight babies. Compared to the 86 to 91 percent success rate for infertile Foresight couples, the best rate for singleton births with ART is about 23 percent.
How did this preconception program produce such unbelievable results? Surprisingly, both in England and here in America, most in the medical profession or health care agencies were simply not interested. How can nations turn their backs on such data when the morbidity, mortality, and cost of providing medical services are so staggering? And what will it take to get the attention of everyone who would benefit?
Perhaps Foresight's accomplishments could not be appreciated, as physicians had no frame of reference with which to compare. Would it change their minds if they knew that the British national average for 376 couples was 92 miscarriages, 5 stillbirths, 11 malformations, and 33 premature by weight babies, as opposed to almost none for the 327 Foresight babies?
Even if so few seemed to care, it behooves us to tell the story of how Foresight accomplished their success. Eight major areas of concern were addressed: nutrition, mineral levels, social poisons (alcohol, tobacco and drugs), natural family planning, genitourinary infections, allergies, and the body burden of toxic metals and chemicals.
The overall nutrition of both the mother and father was paramount. The diet had to be adequate and regular with no missed meals during the 14 days before conception. The follicular phase of the menstrual cycle is highly sensitive to maternal nutrition, affecting the next generation from its early development even before conception. A healthy ovarian follicle may increase in mass by more than 2000 times during the first 14 days of the menstrual cycle and before ovulation. If maternal nutrition is inadequate to supply the ovum during its long journey beginning after ovulation, the luggage may be inadequate for the first stages of the journey. Foresight taught that high protein foods had the highest correlation with many of the other essential nutrients including vitamins, minerals, and essential fatty acids, and 73 grams of protein daily was found to be optimal for pregnancy. A diet of organically grown whole foods, providing a broad balance of nutrients, was stressed for both the mother and father.
Experience dictated that any deficiencies could not be adequately corrected after conception, emphasizing Foresight's concentration on the 100 days prior to conception. They preached that normal healthy babies come from normal, healthy parents. Foresight learned how to use a simple hair analysis to test for toxic heavy metals as well as essential minerals. Deficiencies were corrected and toxic excesses reduced. Ms. Barnes emphasized the importance of the zinc/copper ratio, explaining that onset of labor correlates with a rising copper level and restoration of the zinc level occurs when most mammals (excluding humans) eat the zinc-enriched placenta as part of the birthing process. Zinc supplementation for new mothers became a routine part of the program.
None of the eight areas addressed in Foresight's program was new to modern medicine. What was new was the timing of their application, in both the father and the mother, 100 days prior to conception as well as during the nine months of gestation. Great attention was given to the father's contribution to the outcome of pregnancy. Koller, in his book Riskofaktoren Der Schwangerschaft, showed that smoking by the father, even when the mother did not smoke, was associated with an increased rate of early and late miscarriage, preterm birth, low birth weight, perinatal death, and the occurrence of severe congenital malformations. Foresight corrected risk factors in both parents, enhancing the success rate of their preconception program.
The legacy of Leonora Cohen and Belinda Barnes was to teach us how to reduce infertility and maternal and infant morbidity and mortality through the application of preconception care, and in so doing to increase the health and welfare of children and adults. Theirs is a sublimely simple solution for the reduction of health care costs, for "No nation can rise above the level of its women," and ultimately its children.
For more information about The Center's Preconception Program, call (843) 572-1600 and ask to speak with our New Patient Coordinator, or see Having a Baby-100 Days Can Make a Difference.
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