By BEC members Alisa Phillips (World Vision), Viktorya Sargsyan (World Vision), Katelin Wilton (Save the Children), Julia McGeown (Humanity & Inclusion), and Susan Werner Orrin
It is the right of every young child to experience quality Early Childhood Care and Education (ECCE) from birth to 8 years of age[1]. Yet, according to UNICEF, pre -COVID pandemic data from 196 countries showed that ECCE enrollment for the population of children between age 3 and primary school entry was 54% globally, ranging from 21% in low-income countries to 79% (almost 4 times more) in high-income countries[2]. These income disparities between ECCE access in wealthier countries and the poorest countries also influences child development outcomes. Based on neuroscience we know that the learning and achievement gap can start as early as infancy and continue to widen throughout early childhood if not addressed. Factors such as access to quality early childhood education, nurturing care through positive caregiving, and exposure to stimulating environments play crucial roles in shaping a child's learning trajectory. Quality and inclusive ECE programs whose foundation addresses these factors can improve education, health, employment outcomes and reduce poverty[3].
On this #WorldChildrensDay, we are reminded of the importance of nurturing care for all children as we are witnessing and continue responding to multiple crises (e.g. COVID-19, impacts of climate change) and conflicts directly impacting children across the Globe. This has created increased urgency and the need to invest in evidence-based quality, inclusive, and holistic early childhood development and early childhood education opportunities to provide “Nurturing Care” that supports the whole child. When we refer to “Nurturing Care”, we refer to the 5 integral components including:
Good Health
Adequate Nutrition
Responsive Caregiving
Security and Safety
Opportunities for Early Learning
The focus of these programs is to support every child thriving throughout their childhood, in school and later in life. Investing in systems that support both private and public to uphold the right for children to experience nurturing care from caregivers early in life is one essential aspect of ECCE within the quality care package.
This #WorldChildrensDay we reaffirm the important role that caregivers play in children’s well-being and holistic development. We highlight three examples that emphasize positive caregiving principles and approaches and how these contribute towards whole child outcomes and ensuring children’s right to access quality early childhood care.
Example 1: Save the Children Uganda’s Boost for the Youngest
This program integrates responsive caregiving and early learning into the Mother & Baby Areas (MBAs) which promote breastfeeding and good nutrition among pregnant and lactating women and caregivers of children under two years old. As part of a project to operationalize nurturing care in humanitarian settings in Uganda, MBAs offer a warm and friendly space, with comfortable rocking chairs for breastfeeding mothers; soft, clean mats on the floor where they can rest; toys for the children to play with; and sympathetic staff. Linda (age 5, pictured here) is a member of the MBA intervention where she reports that she has learnt the alphabet, names of different things, counting from 1- 20 and is now speaking English at an early age. Her class performance has improved and she is very active in all class activities, which her family attributes to the time she spent around other children in the MBA when younger.
Example 2: World Vision’s Care and Comfort for Children (3c)[4]
3c was a study (quasi-experimental non-equivalent control group, post-test only) conducted in a humanitarian context to test an integrated positive parenting intervention aligned with the nurturing care framework to determine if different dosages of positive caregiving activities would benefit caregivers and young children in Rwanda’s refugee camps of Mugombwa, Kansi, and Kigeme and host communities compared to standard care. Using a socio-ecological approach and social and behavior change methods mainly through World Vision’s Go Baby Go model, the project deployed:
A high dosage (HD) package that included 12 group sessions and 4 home visits in 9 months and a radio program and delivery of SMS
A low dosage (LD) package that included 4 groups sessions and 2 home visits in 9 months and a radio program and delivery of SMS
A comparison area that received only the radio program
WV together with Sesame Workshop implemented this social and behavior change project around the themes of sensitive and responsive caregiving; nurturing a holistic child development; play-based parenting; WASH social behavior change messaging, child growth (protection from infections, responsive feeding); positive discipline, creating safe home spaces, and protecting from violence; responding to children in crisis via responsive and loving care; father’s engagement; COVID-19; and caregiver self-care.
While the study sought various areas of inquiry, the main objective of the intervention was to strengthen family, caregiving and community environments for children 0-5. Some of the key research questions were:
Will caregivers who receive intervention demonstrate improved caregiving practices for optimal ECD compared to caregivers who receive standard service (radio program only) as indexed by differences in (i) engagement with play activities (ii) quality of learning environment at home (iii) responsive feeding practices?
Will there be a difference between the HD and LD intervention groups in caregiving practices?
World Vision assessed caregiver practices using the UNICEF Multiple Indicator Cluster Survey (MICS) which included how household members over 15 years engaged children in the last 3 days. These members were asked about reading books, looking at pictures together, singing songs, telling stories, taking the child outside of the compound, playing with the child, naming, counting or drawing with the child. They also administered a questionnaire related to responsive feeding practices and to assess the learning environment. While they assessed child outcomes using the Ages and Stages Questionnaire, there was only significant positive movement in the personal social domain among 25–48 month old children, which suggests that there is more we need to learn to create greater impacts for holistic child outcomes. Related to improved caregiver practices the study pointed to several encouraging outcomes. They saw a significant percentage of mothers engaged in either HD (211/67%) or LD (148/62%) showing engagement in early learning and stimulation compared to the control (66/37%). An interesting result was that findings for all play and stimulation items were significant. While NCF principles note the importance of positive caregiving by fathers, their engagement with young children is still a challenge. There was no difference in father engagement with play activities between the groups in any of the items. However, they saw significant outcomes with both HD and LD groups in responsive feeding. It was also encouraging to see that more children had homemade toys in the intervention groups than in the control group (90% HD, 88% LD and 60% control). While they recognize that there were some limitations to the study, in 2 weeks World Vision is conducting a study that will target those children and their caregivers that were in the 3C project to assess the long term effect of parenting projects on outcomes such as child development, school readiness and school academic achievement. They expect that this will further contribute to the evidence-base on holistic child outcomes in humanitarian contexts.
Example 3: Humanity & Inclusion’s Democratic Republic of Congo Program
If caregivers can monitor their child’s development well, this can lead to earlier detection of any difficulties and consequently earlier intervention from services, which leads to better health and education outcomes in the long run.
Caregivers are best placed to observe how their child is developing, but they are often unaware of norms of child development. This leads to delays in seeking specialized help in assessing child development and consequent delays in the access to support for children with developmental delays.
Humanity & Inclusion (HI) implements early childhood development and education projects in countries as diverse as Rwanda, Democratic Republic of Congo (DRC), Egypt, and Jordan. Despite the differences in context, in all these countries a strong importance is given to supporting parents so that they understand more about child development.
For example, in DRC (as shown in this photograph), HI works with community workers who either organize community awareness sessions in key community spaces or one-to-one sessions at home.
Community sessions tackle topics such as child development milestones and how parents can support child development by promoting early learning activities (e.g. creating no-cost early learning materials using recycled materials). The sessions also have a holistic focus, including health and nutrition messages, how to give positive and responsive care, as well as educating parents about “red flags” for which they should seek specialized help and where to do so.
Home visits share the same knowledge and awareness messages but also focus on specific messages based on the individual family’s needs. Therefore, if children are deemed at risk of having developmental delays, or are living in vulnerable households, home visits are the preferred option. This allows for individual care and attention that is so important to caregivers, to allow them to truly promote early childhood development.
This is just one small aspect of the work HI carries out in ECD and early education. In other projects, HI also supports local services too — for example, to ensure that developmental screenings and assessments are implemented following a family centered approach.
In summary, the Boost for the Youngest program (Save the Children), the Care and Comfort for Children program (World Vision), and Humanity & Inclusion’s work in the DRC offer opportunities for us to celebrate and find hope on this #WorldChildrensDay that integrated positive caregiving programs can improve behaviors for caregivers in humanitarian contexts where children are the most vulnerable to strengthen their resiliency and fulfill their right to experience nurturing care.
[1] UNESCO Tashkent Declaration
[2] McCoy et al., 2021
[3] Tashkent Declaration
[4] Sargsyan, V., Tenorio, A., Uwera, M., Gasirikare, A., Habyarimana, J.A., Salcido, J.S., Felner, C., Rasheed, M.A., (2023). The benefits of nurturing care interventions on early child development and care: findings from a quasi-experimental study in a humanitarian setting. BMC Pediatrics.