A Look at the Lack of Basic Nurturing Care Worldwide for Preschoolers

The first 1,000 days of life are a crucial timeframe in a child’s growth and development. But what about the next 1,000 days? 

Nurturing care is just as important for children aged 3–4, yet it is a period of a child’s life that has largely been understudied by public health and early education researchers. 

A new report from Harvard Graduate School of Education Associate Professor Dana Charles McCoy sheds a harsh light on the inadequate care children around the world are suffering during those formative years, finding that nearly three in four preschool aged children in low- and middle-income countries lack access to the most basic nurturing care. 

Utilizing data collected between 2005 and 2019 on more than 425,000 children living in 104 low- and middle-income countries, the report analyzed access to adequate care based on the Nurturing Care Framework put forth by the WHO, UNICEF, and the World Bank, which looks at children’s access to supports in five areas: responsive caregiving, early learning, safety and security, nutrition, and health. 

McCoy's study, co-authored with University of Nebraska Medical Center's Marcus Waldman, who earned a doctorate at HGSE, and current HGSE doctoral students Jonathan Seiden and Jorge Cuartas, appears in the latest issue of Lancet Child & Adolescent Health. Some of its major findings include: 

• An estimated 181.9 million preschool-age children living in low- and middle-income countries did not receive minimally adequate nurturing care prior to the pandemic. 
• Children from upper middle-income countries are nine times more likely than their peers from low-income countries to receive minimally adequate care.
• Access to nutrition was high, with 86.2% of children showing healthy weight, but all other areas were significantly lower, with just 29.3% of children participating in early childhood care and education services and 29.7% receiving adequate stimulation from fathers and non-maternal caregivers, for example. 

We spoke with McCoy to learn more about the report and what can be done to provide children the support they need. 

You make a point in the paper to stress that this data comes from before the pandemic. Children were already receiving inadequate care, so can we assume that things have only gotten worse? 

I can speculate the situation has gotten far worse the last couple of years. We know from systematic reviews that access to all dimensions of nurturing care has been compromised during the pandemic. For example, we know that 167 million children in this age group lost access to early education and care services between March of 2020 and January of 2021. We know that violence and abuse rate are up, and we know that children’s access to parental stimulation and learning opportunities at home have been compromised due to caregiver stress and mental health problems.   

What sets this new study apart from previous work in the field? 

The history of estimating children’s developmental status on a global scale started in 2007 when the Lancet published their first series on early childhood development and found that 200 million children under age 5 were “failing to reach their developmental potential.” This number had tremendous value in terms of advocating for early childhood investments, but its empirical rigor was questionable. The authors based this estimate on the number of children under age 5 who were living in poverty plus half the number of children that were malnourished, and choosing half was completely arbitrary. We know there are plenty of kids not in poverty and not malnourished who are struggling, and those children weren’t reflected in these numbers. But at the time, these were the best data that were available for understanding children’s needs.

What we wanted to do in this paper was push the field forward and look at the data that are more directly related to a child’s developmental outcomes. We looked at the five areas that come from the Nurturing Care Framework, which are established, scientific areas we know children need to thrive. Our task was to find data to map onto them, and that’s where we came up with 10 specific indicators we used in the study, like adequate stimulation from caregivers, access to learning materials like toys and books in the home, and access to a clean water source. 

The study showed that access to health and nutrition were high while early learning, responsive caregiving, and safety and security were all low. Why was that the case? 

The pattern we’re seeing is consistent with policy efforts of the last 10 and 20 years, which have focused on children’s basic survival needs. A lot of the interventions of the first 1,000 days of life have been focused on reducing infant mortality and improving issues related to malnutrition and infection, but we haven’t met the needs beyond those foundational health areas. The takeaway I have as an educator is that these are the next steps for the field, to tackle the large gaps of these complex educational, learning, and social-emotional needs for kids in this age period. 

How do you hope these findings will push the conversation around policy and practice to start making those steps? 

I’m hoping this study will bring attention to the challenges kids are facing. There’s been a lot of discussion during the pandemic about supporting families with young children, not only in the United States, but globally. How do we leverage that attention into real change, especially when historically, early childhood education has been considered a luxury service for a lot of governments? Substantial investments are needed to support preschool services that are accessible, affordable for families, and high in quality. We also need further investments in high-quality data, monitoring, and research in low- and middle-income countries. There’s a statistic that nearly 90% of children live in a low- or middle-income country, but only 6.8% of child development research is based in those countries. I hope that seeing this work come out of a school of education can put the learning needs of children living in low- and middle-income countries to the forefront of conversations regarding child development research and global policy.