Extending the Barker Hypothesis to Enhance Reproductive Rights and Justice

Background: The Barker Hypothesis has driven child health and nutrition public health thinking over the last 15-25 years. This hypothesis posits that reduced fetal growth is a strong determinant of a number of chronic conditions later in life. This and two closely related theories, the thrifty genotype and the thrifty phenotype, offer that eventual chronic health problems are predetermined before birth. Exploration: These hypotheses urge us to consider primarily interuterine conditions. However, studies purported to support this hypothesis often suffer from lack of ability to control for environment and other confounders. Also, since it posits that future health is set in utero, it may discourage or misinform preventive health approaches before or after birth. For example, if one accepts these hypotheses, it would per force limit consideration of maternal reproductive health or child nutrition interventions for lifelong health intervention. Extended Hypothesis: The presentation will propose an improved model based on physiological and developmental evidence arguing for consideration of the preconception period and through the inter-pregnancy interval. For example, the conditions pre-pregnancy are inseparable from the conditions of the fetus. Also, since humans are essentially born immature compared to other mammals, we have evolved such that the postpartum period of care is physiologically inseparable from the pregnancy in many ways. Discussion and Conclusions: Evidence will be presented arguing that the inter-pregnancy mother/child behaviors are equally important, more amenable to intervention, more responsive to rights and justice constructs, and should be included in an extended hypothesis.