The earliest days of a child's development, both in the womb and after birth, are essential to human development and are well within the reach of the development community's ability to address the problem, a House hearing said. “There is perhaps no wiser investment that we could make in the human person than to concentrate on ensuring that sufficient nutrition and health assistance is given during the first 1,000 days of life,” said Rep. Chris Smith (R- N.J), chairman of the House of Representatives’ global health subcommittee, which hosted the March 25 hearing. "We must take a holistic, mother-and-child approach to the problem," he added. The hearing, entitled “The First One Thousand Days: Development Aid Programs to Bolster Health and Nutrition” discussed development from conception to age two and the impact of quality of life in these early stages on further development. Sophia Aguirre, chair of Catholic University of America's Integral Economic Development Management Program, advocated "placing the family at the center" of development solutions. Saying it is a "long-term investment" solution. Aguirre said ensuring "household food access, good health and hygiene conditions, as well as good care and health practices for infant and pregnant mothers" safeguards the ability of future generations to work toward their own development. Failing to guarantee proper nutrition and development in utero and in early childhood, she added, "has been found to be also related to dementia, obesity, hypertension, and diabetes among other illnesses." Aguirre continued, saying these phenomena affect not only "those who suffer them, but it places an economic burden on the family members, communities, and finances of the country to which they belong.” “These burdens can be avoided through investing in effective preventive initiatives.” Aguirre stressed that typically, "these needs are first met in the family," and that aid programs should focus on helping households as a whole: “Healthy families are the key to providing stability during this early stage of life.” Tjada D'Oyen McKenna, an official with the U.S. Agency for International Development, testified as lead witness at the hearing, explaining that malnutrition for mothers and children has long-ranging consequences.  "At least 165 million children worldwide are stunted or have short stature resulting from chronic under-nutrition," McKenna said. "Stunting leads to irreversible cognitive impairment and poor health over the life span. Each year, under-nutrition in all forms is the underlying cause of 3.1 million child deaths, or 45 percent of all child deaths worldwide.” Henry Perry, associate professor at the international health department in the Bloomberg School of Public Health at Johns Hopkins University, said that while the maternal and infant mortality rate around the globe has decreased greatly, "we must recognize that we have a long way to go." Perry encouraged the funding of child survival programs and community education initiatives, improved community-centered strategies, and increased support for the Child Survival and Health Grants Program. Mehret Mandefro, adjunct professor of Health Policy at the Milken Institute School of Public Health at George Washington University, encouraged aid organizations to focus on supporting psychological development and promoting maternal health conditions. "Psychosocial development is often left off the table  in discussions about global child survival," he said. He called on congressmen to consider "the conditions under which pregnant mothers live and give birth," especially how they relate to poverty. “Because we pay insufficient attention to the prenatal and  postpartum  environment,  we  miss  a  huge  opportunity  to  improve the lives of the very people we could help the most.” Smith commented that increasing child and maternal health are "complimentary objectives," not opposed to one another. "Curbing child mortality in the womb and at birth also goes hand-in-hand with reducing maternal mortality," he stated.  "Best practices to radically reduce maternal mortality can and must be life-affirming -- protecting from harm both patients, the mother and the child in the womb."