In recognition that children living in conflict-affected environments are particularly vulnerable to being left behind, SDG Target 16.2, which focuses specifically on protection, also focuses specifically on ending all forms of violence against children. While the target does not focus on early childhood specifically, negative experiences, such as exposure to conflict or violence, have been shown to slow down and alter brain development, thereby affecting how a child grows and learns. In low and middle income countries with data it is estimated that 80% of children aged two to four years old are violently disciplined (UNICEF, 2017b). Added to this is the susceptibility to being born into conflict. In 2015 for instance it was estimated that 16 million babies were born into conflict. In Syria, for instance, one in three children aged under the age of six are estimated to have been born into and continue to live in a conflict-ridden environment (Theirworld, 2017). Yet despite this, a review by Theirworld in 2016 indicates that just 10 out of 38 2016 Humanitarian Response Plans, Flash Appeals and Refugee Response Plans made any mention of ECD, early childhood education or similar ECD terminology (Theirworld, 2016)
The definition of what period of a child’s life constitutes ECD can differ between stakeholders. For the purposes of this paper, we are particularly interested in investments relevant for children from birth until the age of five years old or the point before they enter primary education. The cross-sectoral focus of ECD indicates that in order for interventions to have the potential to mitigate many of the negative consequences of poverty, they need to be multi-dimensional in nature and dress four key domains: cognitive development, linguistic development, socio-economic development and physical well-being and growth (Naudeau et al., 2011). Addressing these domains requires a cross-sectoral approach which spans a range of sectors, including a need for investments for under-fives in the areas of play, education, health, nutrition, sanitation and social protection (Sayre et al., 2013):
Play: Play is an important part of a child’s early development, which helps their brains develop and for language and communication skills to grow. Play can be divided into five types, with each serving a broad purpose as far as development is concerned: these are physical play, play with objects, symbolic play, socio-dramatic play and games with rules (Whitebread, 2012). Approximately 90% of brain development occurs by age five with the frequency of play and communication in these early years of a child’s life having long-term consequences for a child’s learning, physical and mental health later on in life. One study in Jamaica, where health workers engaged with poor toddlers and supported mothers to encourage play, found these participants were more likely to do better in school and have better social skills than their counterparts who did not benefit from this intervention (Gertler and Heckman, 2014).
Education: Interventions in pre-primary education are among some of the most cost effective interventions governments and donors can make both for reducing inequalities and improving social and economic outcomes (Zubairi and Rose, 2017). One study simulated the impact on increasing pre-school enrolment. In 73 countries it found that if pre-primary school enrolment was increased to 25% or 50% in each low and middle income country, for every one dollar invested in quality pre-primary education there would be a benefit-to-cost ratio of between US$6.4 and US$17.6 (Engle et al., 2011). And yet, just 15% of 5-6 year olds in low income countries were enrolled in pre-primary education programmes, compared to 82% for 5-6 year olds in high income countries. Moreover, children from the poorest households are the least likely to enrol onto pre-primary education programmes (Zubairi and Rose, 2017). Yet, there is strong evidence that access to quality pre-primary education can give some of the most disadvantaged children the best start in life and later on in the education cycle. In Mozambique, rural children who had attended pre-school were 24% more likely to enrol in primary school and show improved cognitive abilities compared to their peers who had not enrolled (Martinez et al., 2012). The latest statistics indicate that pre-primary education continues to remain under-funded within total education spending. In 2016 donors disbursed just 0.7% of direct aid to education for spending on pre-primary education (OECD-DAC, 2017, in Zubairi and Rose, 2017).
Health: Investment in childhood interventions are deemed to be amongst some of the most cost-effective with respect to improving the number of ‘Disability Adjusted Life Years’ (DALYs), that is addressing the sum of years of productive life lost due to premature mortality and disability. Between 2008 and 2015 the share of DALYs bourne by children under the age of 15 declined from 41% to 28%. This reduction is largely attributed to a decline in deaths among children under the age of five years old (WHO, 2018a). Despite under-five mortality having decreased, 5.6 million children under the age of five are estimated to have died globally in 2016 (WHO, 2018b). Infectious diseases are the single most important cause of these deaths and they not only have an impact on child survival but also later growth and development (Woodhead, 2014). Studies of children aged five years or younger who are infected with HIV, for example, in low and middle income countries indicates they have much lower motor and mental development scores than their non-infected peers (Walker et al., 2011).
Nutrition: There are strong links between nutrition and cognitive, physical and emotional development. Globally, malnutrition disproportionately affects under-fives. Looking at the causes of under-fives deaths, undernutrition is estimated to contribute to a third of all global under-five deaths. It is estimated that globally, 155 million children younger than age five have stunted growth because of poor or inadequate nutrition and health care (UNICEF et al., 2017). Deficiencies in nutrition in early childhood can lead to a number of problems, including decreasing the immunity from infection and ability to recover from illness (UNICEF, 2017b). This can lead to problems for children developing in other areas; iron-deficiency anaemia is associated with poorer cognitive, motor and social-emotional development (Walker et al., 2011). A randomised trial in Guatemala showed benefits to reading comprehension and reasoning amongst 25-42 year olds for those who had nutritional supplements from birth to 24 months (Stein et al., 2008). For an investment of US$100 per child in developing countries, one study estimates that chronic under-nutrition could be reduced by 36% (Hoddinott et al., 2012).
Sanitation: Globally it is estimated that 3 in 10 people (2.1 billion) lack access to water facilities at home, while 6 in 10 people (4.5 billion) lack access to safe sanitation facilities. While this puts the health of all people at risk, children under the age of five years are particularly at risk from diseases such as diarrhoea which cause the deaths of 361,000 under the age of five years old each year (WHO and UNICEF, 2017). The impact of insanitary living conditions, which can lead to diarrhoea episodes and other diseases, can have a direct impact on schooling; studies in Brazil show positive correlations between diarrhoea episodes before age 2 and late school entry and school performance (Lorntz et al., 2006). Interventions which target improved water and sanitation have been found to be strongly associated with both improved growth and cognitive outcomes. In India for instance, the installation of pit latrines during the first year of a child’s life – as part of the Total Sanitation Campaign – was found to improve their literacy levels (Spears, 2013).
As Table 2 indicates, a holistic approach is required through various cross-sectoral interventions at different stages of a child’s life up until they turn age 5. ECD investments must be sequenced to ensure an integrated approach which meets all the needs a child has in relation to their cognitive and social development, health and nutrition needs. ECD investments must also be comprehensive in order to achieve the immediate and later desired economic and social benefits that can be achieved, as is well-documented through these various interventions.