Inequalities in early childhood care and development in low/middle-income countries: 2010–2018

Background Inequalities in early childhood development (ECD) tend to persist into adulthood and amplify across the life course. To date, little research on inequalities in early childhood care and development in low/middle-income countries has been available to guide governments, donors and civil so...

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Main Authors: Kai Liu, Günther Fink, Bernadette Daelmans, Zhihui Li, Linda Richter, Chunling Lu, Jorge Cuartas, Dana McCoy
Format: Article
Language:English
Published: BMJ Publishing Group 2020-03-01
Series:BMJ Global Health
Online Access:https://gh.bmj.com/content/5/2/e002314.full
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author Kai Liu
Günther Fink
Bernadette Daelmans
Zhihui Li
Linda Richter
Chunling Lu
Jorge Cuartas
Dana McCoy
author_facet Kai Liu
Günther Fink
Bernadette Daelmans
Zhihui Li
Linda Richter
Chunling Lu
Jorge Cuartas
Dana McCoy
author_sort Kai Liu
collection DOAJ
description Background Inequalities in early childhood development (ECD) tend to persist into adulthood and amplify across the life course. To date, little research on inequalities in early childhood care and development in low/middle-income countries has been available to guide governments, donors and civil society in identifying which young children and families should be targeted by policies and programmes to improve nurturing care that could prevent them from being left behind.Methods Using data from 135 Demographic and Health Surveys and Multiple Indicator Cluster Surveys between 2010 and 2018, we assessed levels and trends of inequalities in exposure to risks of stunting or extreme poverty (under age 5; levels in 85 and trends in 40 countries), early attendance of early care and education programmes (36–59 months; 65 and 17 countries), home stimulation (36–59 months; 62 and 14 countries) and child development according to the Early Childhood Development Index (36–59 months; 60 and 13 countries). Inequalities within countries were measured as the absolute gap in three domains—child gender, household wealth and residential area—and compared across regions and country income groups.Results 63% of children were not exposed to stunting or extreme poverty; 39% of 3–4-year olds attended early care and education; and 69% received a level of reported home stimulation defined as adequate. Sub-Saharan Africa had the lowest proportion of children not exposed to stunting or extreme poverty (45%), attending early care and education (24%) and receiving adequate home stimulation (47%). Substantial gaps in all indicators were found across country income groups, residential areas and household wealth categories. There were no significant reductions in gaps over time for a subset of countries with available data in two survey rounds.Conclusions Available data indicate large inequalities in early experiences and outcomes. Efforts of reducing these inequalities must focus on the poorest families and those living in rural areas in the poorest countries. Improving and applying population-level measurements on ECD in more countries over time are important for ensuring equal opportunities for young children globally.
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spelling doaj-art-e74a0d064aed4d33b9a0e8516be13e2b2025-08-20T02:09:51ZengBMJ Publishing GroupBMJ Global Health2059-79082020-03-015210.1136/bmjgh-2020-002314Inequalities in early childhood care and development in low/middle-income countries: 2010–2018Kai Liu0Günther Fink1Bernadette Daelmans2Zhihui Li3Linda Richter4Chunling Lu5Jorge Cuartas6Dana McCoy7Department of Clinical Laboratory, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, ChinaSwiss Tropical and Public Health Institute, Allschwil, Switzerland5 Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, SwitzerlandDepartment of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USAdistinguished professorDivision of Global Health Equity, Brigham and Womens Hospital/Harvard Medical School, Boston, Massachusetts, USAHarvard Graduate School of Education, Harvard University, Cambridge, Massachusetts, USAHarvard Graduate School of Education, Harvard University, Cambridge, Massachusetts, USABackground Inequalities in early childhood development (ECD) tend to persist into adulthood and amplify across the life course. To date, little research on inequalities in early childhood care and development in low/middle-income countries has been available to guide governments, donors and civil society in identifying which young children and families should be targeted by policies and programmes to improve nurturing care that could prevent them from being left behind.Methods Using data from 135 Demographic and Health Surveys and Multiple Indicator Cluster Surveys between 2010 and 2018, we assessed levels and trends of inequalities in exposure to risks of stunting or extreme poverty (under age 5; levels in 85 and trends in 40 countries), early attendance of early care and education programmes (36–59 months; 65 and 17 countries), home stimulation (36–59 months; 62 and 14 countries) and child development according to the Early Childhood Development Index (36–59 months; 60 and 13 countries). Inequalities within countries were measured as the absolute gap in three domains—child gender, household wealth and residential area—and compared across regions and country income groups.Results 63% of children were not exposed to stunting or extreme poverty; 39% of 3–4-year olds attended early care and education; and 69% received a level of reported home stimulation defined as adequate. Sub-Saharan Africa had the lowest proportion of children not exposed to stunting or extreme poverty (45%), attending early care and education (24%) and receiving adequate home stimulation (47%). Substantial gaps in all indicators were found across country income groups, residential areas and household wealth categories. There were no significant reductions in gaps over time for a subset of countries with available data in two survey rounds.Conclusions Available data indicate large inequalities in early experiences and outcomes. Efforts of reducing these inequalities must focus on the poorest families and those living in rural areas in the poorest countries. Improving and applying population-level measurements on ECD in more countries over time are important for ensuring equal opportunities for young children globally.https://gh.bmj.com/content/5/2/e002314.full
spellingShingle Kai Liu
Günther Fink
Bernadette Daelmans
Zhihui Li
Linda Richter
Chunling Lu
Jorge Cuartas
Dana McCoy
Inequalities in early childhood care and development in low/middle-income countries: 2010–2018
BMJ Global Health
title Inequalities in early childhood care and development in low/middle-income countries: 2010–2018
title_full Inequalities in early childhood care and development in low/middle-income countries: 2010–2018
title_fullStr Inequalities in early childhood care and development in low/middle-income countries: 2010–2018
title_full_unstemmed Inequalities in early childhood care and development in low/middle-income countries: 2010–2018
title_short Inequalities in early childhood care and development in low/middle-income countries: 2010–2018
title_sort inequalities in early childhood care and development in low middle income countries 2010 2018
url https://gh.bmj.com/content/5/2/e002314.full
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