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Nearly 16 million children in this country don't always have access to the food they need. A growing body of research indicates, the younger they are, the more serious the long-term impact can be, a key concern, making sure the very youngest and pregnant women are getting the proper nutrition.
Starting in 2010, a program under the health care reform law made that idea more of a possibility in many states.
Hari Sreenivasan has our report on one effort in Northern Arkansas.
Tori Moon always thought life on her own would look different than this. At 20, she lives in a budget motel in Harrison, Arkansas, eats donated food when it's available and is now several months pregnant. Without much family in the area and a fiancé who works long hours, she spends much of her time feeling alone.
It was really hard for me to make friends, being pregnant, because we live in the Bible Belt, and a lot of people around here don't believe in being pregnant before marriage.
But Moon can count on at least one person dropping by regularly.
Every other week, Deena Tougaw sits down with Moon to discuss ways of staying healthy during pregnancy.
DEENA TOUGAW, Circle of Life: I want you to write down what you eat for breakfast, snack, lunch, snack, dinner, snack.
They talk about how that can translate into long-term benefits for her child.
Tougaw runs the Circle of Life program in Northern Arkansas. It's one of many home visiting projects throughout the nation that received a big financial boost under the Affordable Care Act to bring basic preventative services directly to low-income families.
And the two things that you marked that you don't get any of would be your dark green or orange-yellow vegetables.
And, quite often, that includes lessons on how to eat better when resources are slim.
In places like Harrison, a town of about 13,000 in the Ozark Mountains, the barriers to good health for mothers and children can be steep. Poverty and teen pregnancy rates here are among the highest in the nation, and a trip to the store for fruits and vegetables is often a long one.
That's why Tougaw and her staff use a portion of their $140,000 budget to drive Moon and others to the grocery store when necessary.
Why don't you go ahead and grab you a bag if you like them?
There are currently 38 new or expecting mothers enrolled in the program, and without this kind of help, most would face what the government calls severe food insecurity.
So do you just eat cucumbers? You just slice them up and eat them? OK.
And then I put them in the salads, too.
Oh good. OK. So why don't you grab you several?
Moon now knows that women who skip meals or don't eat the right foods may be at greater risk for labor troubles and birth defects. And she takes that seriously, because her first daughter, who was born when Moon was a high school senior, had a rare complication that left the baby's intestines and stomach outside the body. Given the expensive treatment needed for the baby's survival, Moon decided to give her up for adoption.
There's all different kinds of things that can cause the birth defect that she had. But when I look back at the situation when I was pregnant with her, I wasn't able to make ends meet with my food stamps. I wasn't able to get as many fruits — fruits and vegetables. I wasn't able to do all that all the time.
For other families in crisis, the long-term impacts of malnutrition can be more subtle, but just as devastating.
Two hours South of Harrison, at Arkansas Children's Hospital in Little Rock, Dr. Patrick Casey has been studying the effects of diet on child health for several decades.
DR. PATRICK CASEY, Arkansas Children’s Hospital:
Are you clear on the — adding the material into the formula?
And, since the '90s, he's been pooling his findings with doctors in other parts of the country through the Boston-based group Children's Health Watch.
DR. PATRICK CASEY:
There's no doubt that food insecurity is associated with poorer general health and well-being, more hospitalizations, lower developmental achievements in preschool children. Iron-deficiency anemia has been found to be more common.
But there's also research emerging that indicates the domino effect may start much earlier, that malnutrition during pregnancy can have consequences that last a lifetime for children.
On one hand, babies born to underweight mothers stand a good chance of being too small themselves, which increases the odds for developmental delays and a variety of chronic conditions later in life. But the other extreme is also common, where a woman gains too much weight because she only has access to cheap and unhealthy foods.
An overweight mother is more likely to deliver a heavy newborn, and a heavy newborn has a much greater statistical likelihood of being obese as they grow older, or having hypertension and associated medical problems.
Officials say producing better outcomes boils down to a simple calculation, aggressively target at-risk groups like teens with information on how to have a healthy baby and take it to them where they are, including their classrooms.
At Mills High School on the outskirts of Little Rock, upwards of 10 girls become pregnant each school year. This winter, seniors Isaria Jackson and Keroshi Hendricks are among them. Jackson says she was pretty clueless when she first went to the school nurse for help.
She was asking me what was wrong, what was wrong with me. And I just finally just came out and just told her. And then she was like, OK. Well, then she sat down, and she went and got out the book, and this nutrition book that we have.
It's the best thing for you, as well as the baby — for your baby.
School nurse Rae Rice considers herself the first line of defense for these girls.
I wanted to first talk to you all about being here at Mills and being pregnant.
So she will remind them early and often that their child's future depends in many ways on their own eating habits, and that when their kids start school themselves in a few years…
Start out with nine. Now, how many pieces were sold?
… they will be better off in almost every way if they received the nutritional base they needed. They will find it easier to concentrate, get along with others, and, down the line, finish school on time.
Developmentally, what has he started doing that's been new?
Which is why Deena Tougaw says aggressive interventions for at-risk families save society money in the long-run, even if they do involve some up-front costs for programs like hers.
Whenever you feed him, does he watch you?
In the Circle of Life program, home visits continue through a child's third birthday to ensure developmental milestones are being met and to take early action if they're not.
On this day, baby Isaiah is learning to follow a moving target. But his mom, 17-year-old Jessie Sprinkles, is learning just as much about what to feed him as he grows up. Food is a tough topic for Sprinkles. It hasn't always been plentiful in her house, and when it's there, she often binges on the cheap stuff she knows is bad for her. But she wants better for her son.
I do, because, you know, I don't want him to eat like me and be — gain a bunch of weight like I did and stuff when I was a kid, so…
Sprinkles says she has a lot to learn and even more to do to meet that goal. But she now has a better idea of the steps to take and a new reason to try.
The NewsHour's Jason Kane produced this segment with the support of the Dennis A. Hunt Fund for Health Journalism and the National Health Journalism Fellowship, programs of the USC Annenberg School of Journalism's California Endowment Health Journalism Fellowships.
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