The Cost of Inaction for Young Children Globally: Workshop Summary (2014)

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The State of the World’s Young Children

Data on the state of the world’s young children highlight several issues: the need to move from survival to development of young children; links among education, health, nutrition, and brain development; the role of caregivers; disparities in access to quality early childhood and primary school education; rates of children who are double orphans; significant levels of child stunting in many areas; and the presence of violence in conflict in children’s lives.

CHILD DEVELOPMENT FROM A GLOBAL PERSPECTIVE¹

Donald Bundy stated that child mortality data show a success story: mortality is declining significantly in almost all regions of the world (United Nations, 2013). While the trend is not strong enough to meet the Millennium Development Goals,² Bundy suggested that now is the time to transition the discussion of early childhood from one of survival to one of development. He also noted that the child mortality rates vary geographically in a significant way; children in sub-Saharan Africa and Southern Asia face a much higher risk of dying prior to age 5 than the rest of the world.

Development is not a continuous process, and Bundy emphasized

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¹ This section summarizes information presented by Donald Bundy, World Bank.

² See http://www.un.org/millenniumgoals/pdf/report-2013/mdg-report-2013-english.pdf for more information (accessed April 22, 2014).

the importance of understanding the age trajectory and specific stages of development. For example, nutrition interventions in the 0 to 8 age period have a larger impact than intervention later on. However, Bundy recommended that the community should also consider the child more broadly and simultaneously consider adolescence, as this time period is also characterized by large physical and emotional development. Areas such as education and schooling as well as nutrition can have significant effects on children’s development.

Education can actually change brain architecture. In fact, schooling enhances fluid intelligence by as much as a half a point per year of education. Overall, Bundy pointed to the Flynn effect (Flynn, 1999), which, put simply, is that people are getting smarter. Data show that the average intelligence quotient (IQ) has been increasing since the 1930s. The clearest data is from northern Europe, which shows a 15 point IQ increase per generation. Bundy cited studies that showed a link between education and neuro-cognitive development (Baker et al., 2012). The result is that several years of basic education cause people to think and reason differently.

Bundy discussed the relationships between education outcomes and interventions in health, nutrition, and education. Interventions in health and nutrition have the same level of impact on access to schooling as education interventions. In other words, policy makers should consider health and nutrition when implementing improvements to education. Bundy remarked that in 2008, the World Bank developed a crisis fund to respond to the financial crisis. Countries asked the World Bank for funding for school meal programs. World Bank analysis has since shown the remarkable scale of school meal programs: 368 million children are fed each day through these programs (Burbano de Lara et al., 2013). Bundy explained that school meal programs should not be considered nutrition programs, but education programs; they are designed both as a social safety net and to support education. This is an overlooked platform that is not usually part of the child development discussion.

In describing the role of caregivers and educators of young children globally, Bundy stated that caregivers in the preprimary environment tend to be teachers, adolescent girls, and parents. The number of teachers and trained caregivers is tiny (close to 60 million total) relative to the number of adolescent girls and mothers (around 2.4 billion total).³ Despite studies showing the benefits of early education, the number of preschool teachers has remained fairly constant over the past 25 years, between 20 to 30 million.⁴

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³ See http://esa.un.org/unpd/wpp/index.htm, and the databases from http://databank.worldbank.org for more information and statistics (accessed April 30, 2014).

⁴ See http://databank.worldbank.org for more information and statistics (accessed April 30, 2014).

Bundy concluded by noting that human rights and the rights of the child are implicit in this discussion. The World Bank also has pragmatic, cost-based reasons for acting as well. Not only does early child development make sense from a human rights perspective, it also makes economic sense.

STATE OF YOUNG CHILDREN IN THE ARAB REGION⁵

Maysoun Chehab focused on the education and health of children in the Arab region, along with the threats that challenge the development of children in the region. She explained that Arab nations began to focus on the welfare of young children in the 1990s, when most Arab nations ratified the Convention of the Rights of the Child. In 2000, the United Nations Educational, Scientific, and Cultural Organization’s (UNESCO’s) Education for All (EFA)⁶ goals and the United Nations’ Millennium Development Goals were released, and most Arab nations also adopted those standards. Around that time, most Arab nations developed early childhood care councils. The demand for the services of these councils remains greater than what is available, and there are large differences in the services across the 22 Arab nations. The focus of these programs tends to remain on treatment rather than intervention or prevention.

Regarding the status of child health and nutrition in the Arab world, Chehab emphasized that malnutrition remains a problem, with 17 percent of young children moderately to severely underweight. While all Arab countries have an immunization program for children under 5 years old, only a few have school health programs in public schools for children ages 3–8 (UNESCO, 2010).

The EFA Goal 1 is to expand and improve comprehensive early childhood care and education, especially for the most vulnerable and disadvantaged children. Chehab noted that preprimary education in Arab nations increased by 8 percent from 1999 to 2011, but it remains the second-lowest enrollment in the world (UNESCO, 2014). She explained that Arab nations have highly unequal access to services. Part of the reason, according to Chehab, is that the region also has the highest share of private preschools, with two-thirds of the total enrollment in private schools. She noted a wide gap in enrollment between the highest-income and lowest-income households. Algeria has the highest share of government programs, and it achieved the largest expansion in enrollment (from 2 percent in 1999 to 75 percent in 2011) as the result of its public reforms (UNESCO, 2014).

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⁵ This section summarizes information presented by Maysoun Chehab, UNESCO.

⁶ See http://www.unesco.org/new/en/education/themes/leading-the-internationalagenda/education-for-all for more information (accessed May 1, 2014).

Therefore, Chehab suggested that Algeria may be considered as a model or case study for other Arab nations.

Chehab explained that the access to education varies in the region. For ages 0 to 3, education is usually privately operated, and enrollment varies by nation. Few services are provided to children under 3, and the programs tend to be of a custodial nature rather than educational. She noted that several nations have specific programs to target children from low socioeconomic backgrounds, and eight countries are involved with developing early childhood strategies in collaboration with UNICEF and other organizations.

Armed conflict is a major barrier to the well-being of young children and one of the most pressing needs in the area. She noted that conflict is not merely at a nation’s borders; it is now internal and affects more civilians. Twelve nations in the Arab region currently have conflict, and, as a result, an increased number of people are displaced. Lebanon, a nation with a population of 4 million, has 1.5 million refugees (UNESCO, 2011).

As a result of conflict and displacement, children’s living conditions have degraded, with many refugees living in tents or outdoors. The school infrastructure is a target itself, and 25 percent of the schools in Syria have been destroyed (UNICEF, 2013b). Many parents do not send their children to school because of safety concerns. Also, the problem of the child soldier remains, with schools as a target for recruitment. The child soldier problem is particularly acute in Sudan. Discretionary funding, intended for education, is being diverted to the military in these nations. Chehab emphasized the need for increased funding for education; currently, education accounts for less than 2 percent of humanitarian aid (UNESCO, 2011).

Chehab concluded with a call to action in three areas:

1. Make early childhood programs a force for peace; work to increase political will and the priority of early childhood development.
2. Increase attention on the transition years (age 6 to 8). Information on children in this age group is limited.
3. Develop a database, accurate statistics, and laboratory studies to provide detailed data that can be communicated to policy makers.

THE DEMOGRAPHIC AND HEALTH SURVEYS (DHS) PROGRAM AND CHILDREN⁷

Sunita Kishor explained that the Demographic and Health Surveys (DHS) program has been continuously funded by the U.S. Agency for International Development (USAID) since 1984. It is a survey-based program that provides countries with technical assistance to collect, analyze, and present data on population health and nutrition. She noted that the DHS mission extends beyond that of many other projects providing survey-related assistance in that its objectives include the facilitation of data use and capacity building, not just the collection and presentation of data.

For its household sample survey operation, the DHS uses a household questionnaire, a woman’s questionnaire, and (often, but not always) a man’s questionnaire. These questionnaires are adapted for context and to address country-specific needs, according to Kishor. The DHS uses scientifically selected samples of households in which all eligible women (and often men) in the household are interviewed. These interviews yield nationally representative data that can be used to identify health, demographic, and nutrition metrics for nationally informed programs so that policy makers can understand what is happening in their country. Kishor posited that the DHS is considered by many as the “gold standard” for providing data and noted that all DHS data are downloadable free from the DHS website in the form of recoded data files that facilitate comparative analyses and in formats that are ready for use by most analytical software programs.

Kishor explained that the DHS includes biological and physical measures mainly for women and children, including height and weight readings for calculating nutrition indicators such as stunting, underweight and wasting, and hemoglobin testing for measuring the prevalence of anemia. In some countries children are also tested for malaria. The DHS often includes HIV testing, but rarely for children. Over the years, the DHS has also included other biomarkers, mostly for adults, in specific countries, including metrics on hepatitis, diabetes, lead, measles, vitamin deficiencies, lipids, and sexually transmitted diseases. The DHS also obtains basic indicators for children, such as birth registration, orphanhood status, early marriage, birth weight, vaccine usage, and prevalence and treatment of diarrhea, fever, and symptoms of respiratory infection.

In terms of data collected from mothers, the program collects information related to child nutrition, such as breastfeeding, other feeding

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⁷ This section summarizes information presented by Sunita Kishor, Demographic and Health Surveys.

practices, and dietary supplementation. The DHS program collects information on education of all household members typically above age 5, and on school attendance ratios and gender parity. It also collects background information on the household, such as sanitation, access to water, fuel usage, smoking, household assets, and mosquito net usage. Kishor noted that the DHS does not directly measure literacy or motor skills for children under 6. Often, where Multiple Indicator Cluster Survey (MICS) data are not available, the DHS helps UNICEF by implementing the MICS module on early childhood development.

In using the data collected by the DHS, Kishor identified areas of significant risk for children. She first showed data for the percentage of children ages 0 to 14 who are double orphans. Most countries in the world have a number that is steady and generally less than 1 percent. However, several African nations, such as Zimbabwe and Lesotho, have much higher rates, in the range of 3 to 6 percent. In some countries, a high proportion of children live with neither parent even though the parents are alive: in many African countries, this proportion is more than 10 percent; and in Namibia and South Africa it is more than 20 percent.

While there has been much progress in primary school attendance, according to Kishor, many countries have less than 30 percent of children ages 6 to 9 attending school. Kishor also presented data on stunting: stunting is declining only very slowly over time, but the level of stunting among children under age 5 remain very high, particularly in sub-Saharan Africa where in several countries more than half of children under 5 are stunted.

Kishor concluded by stating the DHS, whose data can be downloaded for free,⁸ helps to answer questions about infant mortality and maternal mortality in addition to the following questions that address nutrition, health, education, and living conditions:

• Are children age 0 to 4 appropriately fed?
• Are children age 0 to 4 starting life malnourished? Anemic?
• What is the context in which children of any age live?
• Do children live with or without parents?
• Do children live in poverty?
• Do children live in families with no education or literacy?
• Do children live in households where they breathe smoke?
• Do children go to school in an age-appropriate way?
• Are children fully immunized?
• What type health care do children with fever or diarrhea receive?

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⁸ For more information, see http://dhsprogram.com/data (accessed May 1, 2014).