Beyond the Stats

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By Isioma D Okolo, MBChB, DTMH, MRCOG

The Birth Lottery


S(he) was born today, 

Her morrow still yesterday,

In the end, who chooses?

As an obstetrics & gynaecology ( ObGyn) doctor,  I am fascinated by birth and pregnancy. So should you! We share one definite thing in common- we are all affected by pregnancy. Regardless of our sex, fertility choices and ability, we have all arrived on earth via a womb. We had no choice in the decision of when, how, where and to whom we were born. Yet this decision was one of the most important ones in your life. This decision continues to have an impact on who you are today.

The Birth Lottery​ by Isioma Dianne Okolo

What's Your Birth Story?​

We inherit many things from our biological parents, the most obvious being our DNA. Like Lego, these blocks of genetic material are passed on to us in the form of chromosomes, which tells stories of who our parents were, as well as who we may become.


Over three decades ago at midnight on a Tuesday somewhere in Lagos Nigeria, my mother went into labour with her second child. Her pregnancy had been unremarkable until this point, and much easier than her first. This baby changed that with their decision to arrive 7 weeks earlier than expected. Her baby girl was born on a Tuesday at 3 am weighing only 3.5 pounds (1.7kg) at 33 weeks. “Skinny, jaundiced and hairy – like a rat”, my mum would often say. That baby was me.

My mother’s story is not uncommon. Today 1 out of 10 babies are born early or pre-term. Pre-term birth is now the leading cause of death in children under the age of 5 years. Preterm birth can be associated with infection, having twins (or multiple pregnancy), problems with the afterbirth (placenta), medical conditions in the mother (e.g., raised blood pressure and diabetes in pregnancy) and previous history of having a pre-term baby.


My mother had none of these problems. Her biggest concern was that I was so tiny and had to be fattened up. Like many mothers, she persists in this goal till today. She was also worried that she had done something wrong to cause me to be born so early and so small.

You Are (Kind Of) What Your Mother Ate

Pre-term babies are often also born low birth weight. This is commonly because they have not had the full pregnancy to put on enough weight. This may also be related to maternal nutrition. Your mother’s nutritional state at the time you were conceived and during their pregnancy was critical to your health in childhood and adulthood. Extremes of nutrition (over nutrition and under nutrition) challenge healthy pregnancies today.


The womb is the first environment we are exposed to as babies. Our chances of developing conditions such as obesity, diabetes, hypertension and heart disease, and mental health disorders are programmed within the womb, and increased if your mother had any of these conditions during her pregnancy, or was under or overweight. Food is essential to life; it nourishes, gives pleasure, holds memories, identities, culture, and community. Food and nutritional messaging are commonly either negatively framed and/or culturally homogenous. 

The narrative and statistics around poor nutrition weigh heavily on minoritised individuals and communities. 


I use the term minoritised in place of BIPOC, POC, BAME and BME  to recognise that different individuals and communities do not naturally exist as minorities; but instead have been assigned this identity in response to dominant social narratives. ‘Minoritised’ highlights contemporary power imbalances rooted in historical events of slavery, colonisation, and other systems of oppression. Colonisation amongst many things decimated land ownership and extracted cultural identities and ‘capital’. Today, erasure of traditions, and ancestral practice around food manifests as poverty, food insecurity and dietary dependence on processed foods-high in fats, sugars and low in nutrients.

Food Is Capital; Not Everyone Has Cereal for Breakfast

There are multiple ways of knowing when it comes to healthy eating and nutritional practice.


At the Cihuapactli Collective, (Cihuapactli means “women’s medicine” in Nahuatl) food is about cultural restoration, justice, and wellbeing. The collective uses ancestral and traditional knowledge to empower urban indigenous pregnant people from diaspora through cooking workshops, recipe sharing and peer support.


Ronke Ajayi, curator of the platform 9jafoodie, uses wholesome Nigerian traditional recipes and balanced positive nutritional messaging to promote wellbeing and nutritional literacy for Africans in the diaspora.


In Bint Rhoda’s Kitchen, we experience the intersection of food, faith, and Palestinian culture. By focusing on the idea of food as ‘home’, Bint Rhoda promotes healthy food traditions which nourish and connect people to their Middle Eastern roots.


These different food narratives are rooted in traditions overlooked by mainstream nutritional messaging. They positively frame the nutritional values and priorities of minoritised communities over-represented in disparate statistics around health outcomes across the life course. A healthy start is a head start in the lottery of life.


Can we redistribute the ‘capital’ food provides by re-framing diverse positive narratives around nutritional statistics in public health?

In Summary

Our lives begin with a birth lottery, so we are all affected by pregnancy

Food gives you a head start in life; thus it is a powerful capital with which to break the cycle of  
systemic undermining of intergenerational wellbeing

The framing of nutritional messages is as important as the plating of the food; 
we need more culturally inclusive nutritional interventions and narratives 
which centre around what diverse groups of pregnant people truly value in their dinner.


In my pieces, I use the terms:

  • girls, women, womxn, pregnant people and birthing people to refer to some of the reproductive health experiences of individuals assigned female at birth 

  • minoritised in place of BIPOC( Black, Indigenous & people of color), POC ( people of color), BAME (Black, Asian & Minority Ethnic)  and BME  ( Black & Minority Ethnic) to recognise that different individuals and communities do not naturally exist as minorities; but instead have been assigned this identity in response to dominant social narratives. ‘Minoritised’ highlights contemporary power imbalances rooted in historical events of slavery, colonisation, and other systems of oppression.

Sneak Peek to Our Next Piece:

What do periods, plastic coffee cups and poverty have in common? ( The answer is not the letter ‘P’)


  1. Preterm birth [Internet]. [cited 2021 Sep 21]. Available from: https://www.who.int/news-room/fact-sheets/detail/preterm-birth

  2. Preterm Birth | Maternal and Infant Health | Reproductive Health | CDC [Internet]. 2020 [cited 2021 Sep 21]. Available from: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm
  3. Sookoian S, Gianotti TF, Burgueño AL, Pirola CJ. Fetal metabolic programming and epigenetic modifications: a systems biology approach. Pediatr Res. 2013 Apr;73(2):531–42.
  4. Crespi BJ. Why and How Imprinted Genes Drive Fetal Programming. Frontiers in Endocrinology. 2020;10:940.
  5. Nutrition of Women and Adolescent Girls: Why It Matters [Internet]. PRB. [cited 2021 Sep 21]. Available from: https://www.prb.org/resources/nutrition-of-women-and-adolescent-girls-why-it-matters/
  6. Heslehurst N, Vieira R, Akhter Z, et al. The association between maternal body mass index and child obesity: A systematic review and meta-analysis. PLOS Med. 2019;16(6):e1002817. doi:10.1371/journal.pmed.1002817

  7. Gaillard R, Santos S, Duijts L, Felix JF. Childhood Health Consequences of Maternal Obesity during Pregnancy: A Narrative Review. Ann Nutr Metab. 2016;69(3-4):171-180. doi:10.1159/00045307

  8. Polinski KJ. Maternal Obesity, Gestational Weight Gain, and Asthma in Offspring. Prev Chronic Dis. 2017;14. doi:10.5888/pcd14.170196

  9. Chang E, Hafner H, Varghese M, et al. Programming effects of maternal and gestational obesity on offspring metabolism and metabolic inflammation. Sci Rep. 2019;9(1):16027. doi:10.1038/s41598-019-52583-x

  10. What We Do [Internet]. Cihuapactli Collective. [cited 2021 Sep 21]. Available from: https://www.cihuapactlicollective.org/what-we-do
  11. 9jafoodie | Nigerian Food Recipes [Internet]. 9jafoodie | Nigerian Food Recipes. [cited 2021 Sep 21]. Available from: https://9jafoodie.com
  12. Jessica. Bint Rhoda’s Kitchen: Palestinian Rice Stuffing, or As My Mother Calls It . . . [Internet]. Bint Rhoda’s Kitchen. 2016 [cited 2021 Sep 21]. Available from: http://bintrhodaskitchen.blogspot.com/2016/02/palestinian-rice-stuffing-or-as-my.html

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The Birth Lottery​ by Isioma Dianne Okolo

We had no say in the decision of when, how, where and to whom we were born. Yet this was one of the most important decisions in our lives, which continues to impact us today.

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