2024-11-26 15:21:00
We now know that a child’s first 1,000 days, from pregnancy until the age of two, are crucial for their development. Recent data from Lancet notably, a leading medical journal, which focuses on low- and middle-income countries, suggests that the next 1,000 days, between 2 and 5 years, would be equally important.
The first 1,000 days of a child’s life – during pregnancy and the months leading up to their second birthday – are a critical period. Expectant mothers need quality prenatal care. The better their physical and mental health, the more likely they are to give birth to a healthy baby and be able to raise it for the first two years of life.
A large number of data show that what happens during this time has lifelong effects on a person’s health, growth and well-being.
Less attention has been paid to the “next 1,000 days,” when children are between 2 and 5 years old. But experts in public health and child development know that this is also a crucial time. During this period, there is an opportunity to build on the investments made in the first 1,000 days and get children who did not receive the help they needed earlier in their lives back on track, so to prepare them for school, as well as for a healthy childhood and adolescence.
The Lancetone of the world’s leading medical journals, just launched a series of articles on the “next 1,000 days”, continuing the previous series of 2007, 2011 et 2016 on early childhood development. As a public health and early childhood development specialist, I led this series, in collaboration with experts from around the world, to highlight the latest science on this crucial time in children’s lives. We have particularly focused on low- and middle-income countries.
We wanted to highlight the latest available data on the next 1,000 days: why they are important, what influences the development of children in this age group, which programs are implemented and which work, when children are falling behind and what is the cost of not investing.
Over the next 1,000 days, young children’s development is shaped by a range of factors. This includes physical health, developmental delays and disabilities, nutrition, education, exposure to violence, mental health of caregivers, father involvement, environment linked to care and education during early childhood, and exposure to pollution and climate change. The Covid-19 pandemic has amplified many of the risks associated with these factors, making reducing these risks more urgent than ever.
Why are the next 1,000 days important?
Between the ages of 2 and 5, children progress rapidly in a range of areas: cognitive development and self-regulation, as well as social, emotional, motor, linguistic and numerical skills.
Olesia Bilkei/Shutterstock
Between the ages of 2 and 5, children progress rapidly in a range of areas: cognitive development and self-regulation, as well as social, emotional, motor, linguistic and numerical skills. Of course, children develop these skills at different rates and in their own ways. Promoting development in these areas places young children on a path to health, development and education.
These pathways are shaped by the quality of care in five areas: health, nutrition, so-called adapted or responsive care, safety and early learning. Essentially, this nurturing care (also called primary care, Editor’s note) are what children need to thrive. The chart below shows how these dimensions relate to healthy development for this age group, as well as the policies and programs that are important in guiding their growth.
Health, safety, so-called adapted or responsive care, early learning and nutrition are the primary care that children aged 2 to 5 need to thrive. Source: The Conversation Africa, CC BY-NC-ND
Low and middle income countries: focus on their situation
A previous series of Lancet on early childhood development reported that approximately 250 million children under the age of 5 in low- and middle-income countries were at risk of not reaching their development potential.
Of the more recent data of the new series indicate that in these countries, only 62 million children aged 3 and 4 (25%) are currently receiving the care they need to thrive. Nearly 182 million children are therefore exposed to risks that compromise their development.
Access to adequate care varies systematically from one region to another. In sub-Saharan Africa, this figure is only 7.9%. For children in low- and middle-income countries in Europe and Central Asia, it was 68%.
We also found that fewer than one in three children in low- and middle-income countries are developmentally challenged or protected from corporal punishment. Only 39% of them have access to care and education programs dedicated to early childhood. Children who benefited from early learning support and appropriate care were approximately two years ahead in their development compared to their peers who did not benefit from it.
Overall, it is clear that young children in low- and middle-income countries are not adequately supported by programs that promote development between ages 2 and 5. One of the reasons to explain this situation is the fact that early childhood development programs designed for this age group – as detailed in academic journal publications between 1990 and 2020 – are mainly implemented in countries high-income Westerners; 44% of programs are implemented in the United States.
Only 5% of published programs have been implemented in low- and lower-middle-income countries. These results highlight the gap between the regions of the world where these programs are most needed and the areas where they are implemented.
This publication bias in favor of high-income Western countries has been critical elsewhere and, although there are signs of developments in the right direction, much remains to be done to address the fact that most of the world’s child population is under-represented in research.
Different sectors must work together
As part of the series Lancetwe have identified recommendations that concern different sectors such as health, preschool education, child protection and social assistance.
Firstly, these sectors need to work together rather than in isolation.
Second, programs (ideally through cross-sector partnerships) that aim to help these children thrive should not be limited to risk reduction, such as violence prevention. So-called “protective” factors that protect children from these risks, such as the mental well-being of parents, are also essential.
Third, programs must be of high quality and adapted to the context.
Finally, it is crucial to consider equity and inclusion. The most vulnerable children must be able to benefit from equal programs.
A relevant investment
More and more data show that programs for children in the “next 1,000 days” have both short- and long-term benefits. These include quality early childhood care and education programs, parenting education programs, cash transfers and nutrition interventions. These programs can be combined to produce greater benefits.
The cost of early childhood education and care services varies considerably between countries. However, relative to national incomes, these costs are generally low. In low- and middle-income countries, the estimated cost of one year of early childhood care and education, provided to all children over the next 1,000 days, would be less than 1% of GDP. The potential benefits are on average 8 to 19 times greater than the cost of actually implementing these programs in these countries.
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