75 per cent of children in low- and middle-income countries are not receiving the care they need, new global study shows
A new series featuring the work of a University of Wollongong (UOW) early childhood expert has shined a light on the 'next 1,000 days', a window of opportunity between the ages of two and five that is crucial to a child's development.
Published in The Lancet overnight (Monday 18 November GMT), the two-part series builds on the foundation of the first 1,000 days, a concept that was developed to highlight the enormous potential and vulnerability of the initial two years of a child's life, about the impact this has on their ability to grow, learn and thrive.
'Early Childhood Development and the Next 1,000 Days', co-authored by Distinguished Professor Anthony Okely, from UOW's School of Social Sciences, focuses on the importance of nurturing care of children at an early age, encompassing overall health, nutrition, safety, security, learning, and responsive care-giving.
It brings together experts from around the world, including contributions from researchers at Harvard University, Stanford University, and New York University in the United States, University College London and Newcastle University in the United Kingdom, the University of the Witwatersrand in South Africa, and UOW in Australia.
The series encompasses two complementary papers; the first paper illustrates the impact on children's wellbeing and development while the second summarises the benefits and costs of key strategies that can support children's development.
The research revealed that in low-income and middle-income countries, almost three quarters of all children aged three or four years old – approximately 181.9 million children – do not have access to adequate nurturing care, putting at risk their healthy development.
Professor Okely, who is Co-Director of the WHO Collaborating Centre on Children's Food, Nutrition and Physical Activity at UOW, said these statistics were startling and showed that more needed to be done to ensure children are not falling through the cracks at an early age.
"The evidence shows that the transition to the next 1,000 days is vital to providing the foundations of health and development that will shape the trajectory of a child's life and wellbeing," Professor Okely said.
"Yet the evidence is clear that for many children, that level of nurturing care is not there.
"In the first 1,000 days, from pregnancy through to the age of two, children receive strong intervention from health services, however, in the next 1,000 days, that direct regular contact with health or education services drops off. In low- and middle-income countries, fewer than one in three children aged three or four attend early childhood programs, despite evidence that they improve children's development.
"There are many risks to children's health, wellbeing, and development, including physical punishment of the child, suboptimal diets, poor caregiver mental health, exposure to pollution and climate change."
Distinguished Professor Tony Okely. Photo: Paul Jones
Professor Okely said interventions in early childhood care and education, and in parenting, would have a tremendous impact on the development and wellbeing of children in low- and middle-income countries.
"In high-income Western countries, we can see the impact and importance of early childhood interventions, but the research shows that only five per cent of these have been implemented in low-and middle-income countries. These children are the most vulnerable, but they are not receiving the support they need to learn, grow, and thrive.
"A minimum package of one year of early childhood care and education for all children would cost less than 0.15 per cent of current gross domestic product for low-income and middle-income countries, and the benefits of that far outweigh the costs. Children deserve the best start in life, at what is a minimal cost.
"The next 1,000 days is the ideal window to improve children's developmental outcomes. But it demands a multifaceted approach, which includes parental education programs, nutritional intervention, high-quality early childhood care, financial support for vulnerable caregivers, and promotion of healthy behaviours. If we can get this right, we can improve the short-term and long-term cognitive and academic outcomes for these children."
The series authors recommend that policymakers around the world, but particularly those in low- and middle-income countries, invest in the next 1000 days.
The emphasis, Professor Okely said, should be placed on increasing access to high-quality early childhood education and care, including adequately paid and trained teachers, reasonable teacher-student ratios, child-centred play, evidence-based curricula, and warm, stimulating, and responsive classroom interactions.
"We know the importance of the first 1000 days. Now we need to give the same level of attention and care to the next 1,000 days to ensure children all over the world have what they need to learn, grow, and thrive," he said. "This is an urgent issue, an issue of equality and inclusion, that will determine the developmental trajectory of hundreds of millions of children throughout the world. The cost of not acting is just too high."
About the research
The series 'Early Childhood Development and the Next 1,000 Days' was published in The Lancet.
Paper one, 'The next 1,000 days: Building on early investments for the health and development of young children', features co-authors Catherine E Draper, Aisha K Yousafzai, Dana C McCoy, Jorge Cuartas, Jelena Obradović, Sunil Bhopal, Jane Fisher, Joshua Jeong, Sonja Klingberg, Kate Milner, Lauren Pisani, Aditi Roy, Jonathan Seiden, Christopher R. Sudfeld, Stephanie V. Wrottesley, Günther Fink, Milagros Nores, Mark S Tremblay, and Anthony D Okely.
Paper two, 'The cost of not investing in the next 1000 days: implications for policy and practice', features co-authors Milagros Nores, Claudia Vazquez, Emily Gustafsson-Wright, Sarah Osborne, Jorge Cuartas, Mark J Lambiris, Dana C McCoy, Florencia Lopez-Boo, Jere Behrman, Raquel Bernal, Catherine E Draper, Anthony D Okely, Mark S Tremblay, Aisha K Yousafzai, Joan Lombardi, and Günther Fink.
