Early childhood is getting a lot of attention lately, especially with the recent Lancet series reemphasizing the importance of early childhood development. The Sustainable Development Goals have endorsed the importance of early childhood development; to this end, the Lancet Early Childhood Development series looks at new scientific evidence for interventions.

Experts from RTI International, one of the leading research organizations on child development in the world, recently authored a chapter on this topic in DCP3. DCP3 is the third of the global series on Disease Control Priorities, going beyond previous efforts by providing a systematic economic evaluation of policy choices affecting the access, uptake, and quality of interventions and delivery platforms for low- and middle-income countries. The chapter discussed here, “Platforms to Reach Children in Early Childhood,” examines the different platforms that help support early childhood development.

We sat down with one of the co-authors, RTI’s Katherine A. Merseth, team leader for early childhood development, to learn more about it.

The chapter refers to nurturing care as a strategy to help children reach their developmental potential. What is nurturing care, and why is it so crucial to development?

Nurturing Care is a conceptual framework that outlines the five core elements that young children need to develop their potential: adequate nutrition; responsive caregiving; quality health care; early learning opportunities; and protection from harm. The scientific community has come to agreement that these are all essential for healthy development, and no single domain is sufficient on its own.

The early childhood period — the first 1,000 days from conception to age 2, in particular — is a time of remarkably complex and rapid growth in the human brain and body. Neuroscience research tells us that there are sensitive windows of brain development, when certain inputs are “expected,” biologically speaking, and their absence can do severe harm. The Nurturing Care framework helps policymakers and the public focus on what children need at this important life stage, and to encourage coordination and integration across programs and services.

It is striking how many of the risk factors to development occur before a child is even born. What risks do you see as most consequential, and what can be done to prevent or mitigate them?

That’s right. Child development begins before a child is born, and much depends on the health and well-being of the mother. For example, maternal diet; maternal alcohol or nicotine use; and maternal stress, depression, and anxiety during pregnancy affect the developing fetus, leading to prematurity, low birth weight, and increased risk for health, developmental, and behavioral challenges throughout life. Brain development begins prior to birth and is impacted by the prenatal environment.

We also believe that this correlation occurs after birth, because mothers who are stressed, depressed, or anxious may not have the emotional capacity to provide the kind of responsive, supportive caregiving that babies need. Lower quality caregiver-child interaction is associated with long-term effects on child brain structure and function. Providing adequate support to mothers of young children should be a public health priority.

The chapter references a meta-analysis which concluded that integrated programs had the greatest impact on cognitive development. How can governments create programs that are less fragmented, and how can NGOs adapt to best support them?

National studies of child development interventions, such as Crece Contigoin Chile, suggest that those that are government-funded and incorporated into existing service delivery platforms are the most impactful. This is likely because governments are best positioned to reach large numbers of children in a sustained way over time, and because governments can coordinate resources across sectors.

One of the topics highlighted in this chapter is the gap in services challenge that exists between the health sector and the education sector. Health systems have many contacts with mothers and young children through post-natal and immunization visits. But after age 2, most children only receive health services to treat an acute illness. Meanwhile, the education system begins providing services at 5 or 6 in most countries.

This leaves a gap between age 2 and age 5, meaning that children have limited contact with services that could monitor their progress and ensure their healthy growth and development.

Government efforts to bridge this gap and improve coordination between the sectors (such as health and education) are essential.

With the addition of a Sustainable Development Goal specifically addressing pre-primary attendance, we’re seeing renewed attention on expansion of early childhood education. What do attendance rates currently look like in low- and middle-income countries, and what work still needs to be done to increase access?

Global rates of pre-primary education enrollment have increased dramatically in the last 15 years, but unfortunately there is a wide range between enrollment rates in high- and low-income countries, and even within countries between high- and low-income communities. Countries that prioritize early education, such as Jamaica, have enrollments above 90 percent.

Worldwide, the Global Partnership for Education reports that 150 million 3- to 5-year old children, including more than 80 percent of the children in low-income countries, receive no early education.

Evidence is clear that pre-primary education improves children’s cognitive development, fine motor, and socio-emotional skills — all of which facilitate the transition to primary school and help children succeed as they advance through school. Given this evidence, it is an urgent priority for low-income countries to increase their pre-primary enrollment rates. In many countries, public funding to add pre-primary classes to government schools is limited, so these countries are seeking alternative means to expand access, such as public-private partnerships.

Ensuring that children receive the nutrition, health care, learning opportunities, responsive caregiving, and protection from harm that they need to reach their developmental potential begins by building capacity within families and extends to national policies and cross-sectoral collaboration. Investments in children and the services to support their development benefits not only children, but families and entire societies.