The first thousand days: global health and the politics of potential in Khayelitsha, South Africa

This thesis in anthropology examines the logics and implications of the first thousand days project, a global health focus on nutrition interventions in early life. The thousand days between conception and a child's second birthday has emerged as a critical period that determines future health and potential, underpinned by new scientific knowledge in the fields of epigenetics and the Developmental Origins of Health and Disease. Since 2013, the first thousand days focus has directed nutrition policy in over forty countries. Drawing on fourteen months of multi-sited ethnographic fieldwork in Cape Town, I examine the first thousand days as a policy object, as part of perinatal clinical care, and in the everyday contexts of women and children who are the focus of this intervention. I address the forms of value implicit in this global health policy, the practices of measurement, categorisation, audit, and evaluation that constitute the clinical practice of perinatal care, and the alignment of global scientific projects of aspiration and future-making with the local worlds and futures of women and their children in this setting. Khayelitsha, Cape Town's largest informal settlement, is the central field site. Ethnographic data from antenatal clinics and scenes of ordinary life in this setting illustrate how revised scientific notions of risk and heredity embedded in global health interventions come to bear on everyday life in the global South. My findings show how the first thousand days intervention exemplifies the economic, humanitarian, and anticipatory logics of the 'global health' era, and how familiar concepts of vulnerability with distinct histories in African contexts are newly invigorated by emergent science that refocuses attention on the mother-child dyad. Ethnographic attention to the clinical implementation of the nutrition policy package reveals the tensions between paper directives and the actualities of perinatal healthcare in the local context of Khayelitsha. Finally, close work with fifteen women and their families over the course of fourteen months shows how the anticipatory action envisaged by the first thousand days paradigm is at odds with other potentialities that shape perceptions of the future and structure action in the present, most notably the potential for violence. I frame these disjunctures as part of a politics of potential, which extends the reach of governance into the most intimate spaces and simultaneously elides the local potentialities that configure life and the future.