THE STATE OF THE WORLD’S CHILDREN 2001

THE STATE OF

THE WORLD’S CHILDREN

2001

The United Nations Children’s Fund (UCEF) ©

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Cover photo:Monica Newton/Peru

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This report has been prepared with the help of many people and organizations, including the followingUNICEF field offices: Angola, Argentina, Benin, Botswana, Brazil, Cameroon, Cape Verde, Colombia,Côte d’Ivoire, Cuba, Democratic Republic of Congo, Ecuador, Egypt, Eritrea, Ethiopia, Ghana,Guatemala, Guyana, India, Iran, Iraq, Jamaica, Jordan, Kenya, Lao People’s Democratic Republic,Liberia, Malawi, Maldives, Mauritius, Mexico, Namibia, Nepal, Nicaragua, Nigeria, Oman, Pakistan,Peru, Philippines, Romania, Sierra Leone, Singapore, South Africa, Sri Lanka, Thailand, the formerYugoslav Republic of Macedonia, Turkey, Uganda, Ukraine, the United Republic of Tanzania,Viet Nam, West Bank and Gaza, Zambia, Zimbabwe.

THE STATE OF

THE WORLD’S CHILDREN

2001

Carol Bellamy, Executive Director,United Nations Children’s Fund

2 The State of the World’s Children 2001

Foreword by Kofi A. Annan, Secretary-General of the United Nations

Our promise to the world’s children by Nelson Mandela and Graça Machel

The State of the World’s Children 2001: Early childhood

What happens during the very earliest years of a child’s life, from birth to age 3, influences how the restof childhood and adolescence unfolds. Yet, this critical time is usually neglected in the policies, pro-grammes and budgets of countries. Drawing on reports from the world over, The State of the World’sChildren 2001 details the daily lives of parents and other caregivers who are striving – in the face of war,poverty and the HIV/AIDS epidemic – to protect the rights and meet the needs of these young children.

Choices to be made: The opening section makes the case for investing in the earliest years ofchildhood, before the age of three, when brain development is most malleable and rights are mostvulnerable. It sets out the options governments have about where and when to make investments toensure that children under three have their rights protected and their needs met. And it introduces theimportance of early childhood development programmes, not only for children, their parents andcaregivers, but for the progress of nations as a whole.

A necessary choice: Attention to the youngest children is most needed where it is most difficult toguarantee: in countries where the seemingly intractable grip of poverty, violence and devastating epidemicsseriously challenge parents’ hopes and dreams for their children. This section argues that early child-care can act as an effective antidote to cycles of violence, conflict, poverty and HIV/AIDS.

The only responsible choice: Parents struggle, often against great odds, to do right by their children.In industrialized and developing countries alike they find advice and aid from informal support networksand community agencies with innovative childcare programmes. The final section describes theseexperiments and experiences and makes the case why, in the long run, investment in ECD pays off.

Contents

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ECD Boxes1. DEFINITION 172. SUCCESSFUL PROGRAMMES 173. NO SINGLE FORMULA 524. THE FIRST STEP 56

Panels1. EARLY BRAIN DEVELOPMENT: A FIRESTORM OF CREATIVITY 142. FAMILIES, CHILD RIGHTS AND PARTICIPATORY RESEARCH IN NEPAL 183. HEALTHY PREGNANCIES: PROTECTING THE RIGHTS OF BOTH WOMEN AND CHILDREN 204. INICIATIVA PAPA: IMPROVING THE LIVES OF CHILDREN, ONE FATHER AT A TIME 225. PATERNITY LEAVE, BATHS AND EVIL SPIRITS 266. GUEST VOICE – THE VORTEX WHERE VALUES ARE WORTHLESS BY ERNESTO SÁBATO 407. RESPECTING THE RIGHTS OF THE INDIAN CHILD 488. GUEST VOICE – CHILD SURVIVAL AND THE AGENCY OF WOMEN BY AMARTYA SEN 58

3Contents

Country profiles1. IN THE RURAL PARISHES OF JAMAICA 252. THE YOUNGEST REFUGEES IN THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA 333. CHILDCARE PRACTICES IN MALAWI 344. EFFECTIVE PARENTING IN TURKEY 395. WAWA WASI FOR WORKING PARENTS IN PERU 546. CONVERGING SERVICES IN THE PHILIPPINES 577. A MEDIA CULTURE IN MALDIVES – FOR AND ABOUT CHILDREN 598. THE IMPORTANCE OF EARLY DETECTION – THE CASE OF JORDAN 60

Text figuresFIGURE 1. BRAIN DEVELOPMENT: SOME CRITICAL PERIODS 12FIGURE 2. THE RIGHTS OF YOUNG CHILDREN 16FIGURE 3. THE SHORT-TERM AND LONG-TERM EFFECTS OF EARLY NUTRITION 20FIGURE 4. EFFECTS OF MATERNAL EXPOSURE TO FAMINE 20FIGURE 5. EARLY INTERVENTION REDUCES THE DISADVANTAGE OF STUNTING 21FIGURE 6. MATERNAL LITERACY AND CHILD DEVELOPMENT 23FIGURE 7. HIV AND MORTALITY AMONG CHILDREN UNDER FIVE YEARS OLD 38FIGURE 8. HAZARDS TO CHILD HEALTH IN THE ENVIRONMENT 42FIGURE 9. THIRD-GRADERS’ SCORES ON MATHEMATICS TESTS 50FIGURE 10. HEAD START PROGRAMME CONCEPTUAL FRAMEWORK 51FIGURE 11. DEBT OVERSHADOWS BASIC SOCIAL SERVICES 55

MapsThree maps illustrating quality of life indicators for early childhood; the link between the status ofwomen and the well-being of children; and the challenges to children’s growth and development.

Statistical tablesEight tables with 193 countries listed alphabetically, regional summaries and world totals, present thelatest data on the well-being of children. Countries are first ranked in descending order of theirestimated 1999 under-five mortality rate, which is then included in each of the following tables:

BASIC INDICATORS 78NUTRITION 82HEALTH 86EDUCATION 90DEMOGRAPHIC INDICATORS 94ECONOMIC INDICATORS 98WOMEN 102RATE OF PROGRESS 108

References 64

Index 112

Glossary 116

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Foreword

The United Nations General Assembly’s Special Session on Children in September 2001will indeed be a special session in several ways. It will have the potential to shape thelives of children and adolescents throughout the world. It will assemble leaders fromgovernments and non-governmental organizations, as well as children and adolescents,

in a model of wide participation and partnership that must be the way of the future in the work ofthe UN. It will agree on a plan of action that must spur the international community to take thesteps needed to realize the rights of every child.

Today, millions of children lead safer, healthier and fuller lives than they did a decade ago –before the adoption of the Convention on the Rights of the Child in 1989 and the WorldSummit for Children in 1990. The same can be said of the progress of millions of women sincethe adoption of the Convention on the Elimination of All Forms of Discrimination againstWomen in 1979. And yet too many children and women still live outside the protection ofsociety. Too many still see their rights abused or threatened.

The Special Session will review progress in meeting the commitments made at the WorldSummit for Children and the obligations entered into with the Convention on the Rights of theChild – the most widely and rapidly ratified human rights treaty in history. It promises to be asobering review. But even more, the Session will look to the future. It will set specific, time-bound targets for the achievement of our main objective over the next decade: protecting andfulfilling the rights of all children and women.

The Session’s agenda has already inspired a remarkable debate around three desired out-comes: every child should have the best possible start in life; every child should receive a good-quality basic education; and every child should have the opportunities to develop his or her fullpotential and contribute to society in meaningful ways. The State of the World’s Children 2001highlights the first of our goals – the best possible start in life for every child, without exception.

The preparations for the Special Session have been imbued with a sense of purpose thatpromises to carry through to the gathering itself. Nearly 1,000 participants from governments,the UN family and international and national civil society have been engaged. Children andadolescents have been among the clearest and most passionate voices.

At local, national and regional levels, these young people have added their perspectives to theassessments of how the world has lived up to its obligations to children. They have spokenabout their own role as agents for change. Many of them will come to New York in September2001 to take part in the Special Session itself. I hope they will be listened to carefully. I hope thatfor them, and for the rest of the world’s children, we will make the Special Session of 2001 thebest possible start to this new millennium.

Kofi A. AnnanSecretary-General of the United Nations


Early childhood

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From Nelson Mandela

My earliest childhood memoriesare of the village of Qunu in therolling hills and green valleysof the Transkei territory in the

south-eastern part of South Africa. Qunu waswhere I spent the happiest years of my boy-hood, surrounded by a family so full ofbabies, children, aunts and uncles that I can-not remember a single waking moment whenI was alone.

There was where my father taught me, bythe way he led his life, the sense of justice that

I have carried with me forthe many decades I havelived. By watching himclosely, I learned to standtall and stand strong formy beliefs.

It was in Qunu that mymother gave me the storiesthat charged my imagina-tion, teaching me kind-ness and generosity as shecooked meals over an openfire and kept me fed andhealthy. From my days as aherd-boy I learned mylove of the countryside, ofopen spaces and the sim-

ple beauties of nature. It was then and therethat I learned to love this earth.

From my boyhood friends I learned dignityand the meaning of honour. From listening toand watching the meetings of tribal elders, Ilearned the importance of democracy and ofgiving everyone a chance to be heard. And Ilearned of my people, the Xhosa nation. Frommy benefactor and guide, the Regent, I learnedthe history of Africa and of the struggle ofAfricans to be free.

It was those very first years that determinedhow the many full years of my long life havebeen lived. Whenever I take a moment to look

back, I feel an immense sense of gratitude tomy father and mother, and to all the peoplewho raised me when I was just a boy andformed me into the man I am today.

That was what I learned as a child. Nowthat I am an old man, it is children whoinspire me.

My dear young people: I see the light inyour eyes, the energy of your bodies and thehope that is in your spirit. I know it is you, notI, who will make the future. It is you, not I,who will fix our wrongs and carry forward allthat is right with the world.

If I could, in good faith, promise you thechildhood I had, I would. If I could promiseyou that every one of your days will be a dayof learning and growing, I would. If I couldpromise that nothing – not war, poverty, notinjustice – will deny you your parents, yourname, your right to live a good childhood andthat such a childhood will lead you to a fulland fruitful life, I would.

But I will only promise you what I know Ican deliver. You have my word that I will con-tinue to take all that I learned in my earliestdays and all that I have learned since then, toprotect your rights. I will work every day inevery way I know to support you as you grow.I will seek out your voices and your opinionsand I will have others hear them too.

From Graça MachelTo the children of the world, in whose namethis report is dedicated, I would like to saythis: You are my life’s work. Fighting for yourdignity and freedom and protection has giventhe best of meaning of my life.

You and I may not know each other, butover the course of my years as a teacher and anactivist, I have learned much about your lives.

I have seen how one year of school changesa child and how years of school transform thatchild’s future. I have watched as the power ofeducation saved families from being poor,

The State of the World’s Children 2001

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Our promise to the

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babies from dying and young girls from livesof servitude. And I have lived long enough tosee a generation of children, armed with edu-cation, lift up a nation.

But at the same time, I have witnessedhow quickly young lives and futures can bedestroyed. I know that war, HIV/AIDS andpoverty, though they hurt everyone, hurt chil-dren most deeply. I know that the safe havensfor young people – your schools, your healthstations – are invaded by thugs. I know thatthe people you treasure and depend on most –your parents, your teachers, your doctors andnurses – are the very same people who aretargeted in conflict or cut down by AIDS.

I have been fortunate to travel the world,seeking out young people to hear of their livesand experiences and many of you have beenkind enough to talk with me. I have heard youspeak about how it feels to have war steal theones you love and destroy your idealism anddreams. I have listened to many young womenwho could not get enough good food to eat,could not go to school nor get the attentionthey deserve. I know how the sting of injusticefeels and the dull pain of realizing that life isnot fair.

And so this is my pledge to you: I promiseto work for your education so you can haveevery opportunity to know your history, toexercise your imagination, to write the storiesof our peoples. I want you to know first-handthe freedom that comes with knowledge andlearning.

I promise to work against war, againstAIDS, against all the unspeakable enemiesthat would deprive you of your parents, yourinnocence, your childhood. I promise to chal-lenge and plead and badger government leadersand business people until you can safely walkout of the door of your home to tend yourflock or fetch a pail of water without fearinglandmines or abduction or harm. And I promisenot to rest until these things are the stuff ofold fairy tales rather than your days’ reality.

You, dear boys and girls, dear young womenand young men, are my most urgent concern.I know what it is like to be given the opportu-nity to excel in life, to be equipped to meetlife’s challenges with a healthy mind and body,to be given the passport to freedom that is aneducation. I want you to experience all this foryourselves.

Early childhood

Joining our voices withthe voices of childrenFrom Nelson Mandela and Graça Machel

To our only children,

We write to you as a mother and a father, as grandparents and

as great-grandparents, as politicians and as activists. You are

the focus of our outrage, just as you are the focus of our hope.

You are our only children, our only link to the future.

Each one of you is your own person, endowed with rights,

worthy of respect and dignity. Each one of you deserves to

have the best possible start in life, to complete a basic educa-

tion of the highest quality, to be allowed to develop your full

potential and provided the opportunities for meaningful par-

ticipation in your communities. And until every one of you,

no matter who you are, enjoys your rights, I, Nelson, and

I, Graça, will not rest. This is our promise.

Please hold us to it.

Nelson Mandela, a Nobel Peace Prize laureate, is the formerPresident of South Africa. Graça Machel, a UN special expert onarmed conflict, is a former Minister of Education in Mozambique.Together, they lead the Global Partnership for Children.

world’s children


ChoicesChoices

9Choices to be made

ost brain development happens before a child reaches threeyears old. Long before many adults even realize what is

happening, the brain cells of a new infant proliferate, synapses crackle and the patterns of a lifetime are established. In a short 36 months, children develop their abilities to think and speak, learnand reason and lay the foundation for their values and social behaviouras adults.

Because these early years are a time of such great change in a young lifeand of such long-lasting influence, ensuring the rights of the child mustbegin at the very start of life. Choices made and actions taken on behalfof children during this critical period affect not only how a child developsbut also how a country progresses.

No reasonable plan for human development can wait idly for the18 years of childhood to pass before taking measures to protect therights of the child. Nor can it waste the most opportune period forintervening in a child’s life, the years from birth to age three.

The time of early childhood should merit the highest-priority attentionwhen responsible governments are making decisions about laws, policies,programmes and money. Yet, tragically both for children and fornations, these are the years that receive the least.

Photo: Newborn twins, born during the floodsin Mozambique in early 2000.UN

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Mto be madeto be made

sounds, commonly called ’motherese’, wouldhelp the baby boy learn to talk.

Once released from the hospital, Priyanthiand her newborn participated in a pro-gramme in which trained volunteers visitedthem in their home. Madusha’s height andweight continued to be monitored. Priyanthialso continued to get support and advice onthe importance of touching, talking andsinging, as well as on bathing and feedingher baby.

Priyanthi’s family is 1 of 22 families fromAmbanganga, a small village about 25 kilo-metres from Matale, involved in a home-based programme carried out by a localNGO called Sithuwama, with UNICEF sup-port. Sithuwama, which means ’raising achild with enjoyment’, promotes early child-hood care, including healthy childcare prac-tices and cognitive stimulation. Its servicesare provided through home-visiting pro-grammes for infants up to three-year-oldsand for pre-schoolers from age three to five.

Through Sri Lanka’s home-based service,Priyanthi learns that good nutrition, homehygiene and sanitation practices and cogni-tive stimulation are all necessary ingredientsfor her children to grow and develop. Now,she is investing the focused time, care andattention that are vital for improving herchildren’s lives. She collects extra firewood toboil water for her children to drink. She findslegumes that add to the nutritional value oftheir meals. She makes certain that they usethe latrine and wash their hands afterwards.

IN SRI LANKA, Priyanthi,a 28-year-old mother in the MataleDistrict, remembers the evening thatshe carried her daughter, Madushika,7 kilometres to the closest medical

facility. It was about five in the late afternoonand almost dark when the small womanbegan her frightful journey with the 18-month-old toddler in her arms struggling forair. Stumbling over the fallen branches andunderbrush cluttering the narrow dirt paths,she heard her daughter’s laborious gaspsgrowing weaker. By 6 p.m., she and thebaby reached the clinic.

The doctor’s words still haunt this womanwith tired eyes and underscore her raceagainst the clock. Had she delayed the trip bya mere 15 minutes, she remembers him say-ing, her baby, whose chest cold had turnedinto pneumonia, would have been dead. HadMadushika, now a healthy five-year-old, beenborn just a decade earlier, without the avail-ability of life-saving drugs, the pneumoniawould have likely won the race.

Priyanthi’s children, Madushika and heryounger brother Madusha, have benefitedfrom Sri Lanka’s system of health servicesand early childcare programmes. Both chil-dren were born in the relative safety of a hos-pital, like nearly 90 per cent of Sri Lankanlive births today. When the young motherwas pregnant with her two-year-old son, shereceived regular health check-ups in the vil-lage clinic and pregnancy advice from thevillage midwife. She learned how talking toher infant during breastfeeding would improvehis mind and body. She learned that cooingand babbling to her child in response to his


Parents and their children ‘play shop’ in Sri Lanka.

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She asks her children their thoughts aboutthe birds chattering overhead during theirbaths in the stream. She takes them to villagehealth days.

Priyanthi, her husband and children livein a small, four-room, cement house withoutelectricity or running water. They sleeptogether on a dirt floor on woven straw mats.The family survives on a little over 2,000rupees (about $27) a month that Priyanthi’shusband earns on a tea plantation.

Sithuwama’s volunteer home visitorshelped Priyanthi figure out how to promoteher children’s psychosocial and cognitivedevelopment without spending muchmoney. The NGO’s volunteers teach her theimportance of play for her children’s physicaland mental well-being. She and her husbandconstructed a playhouse for the children.The airy structure is made from twigs andbranches tied together with pieces of clothand covered with a tarp. Little woodenshelves are filled with colourful boxes,gourds, coconut shells, ceramic bowls, metalcans and flowers they have picked. Throughplay, Madushika and Madusha are learningabout colours, shapes, sizes, labelling andsorting. They are also learning to dreamand imagine.

Priyanthi meets weekly with a programmevolunteer and once a month with a group ofother parents in support sessions. Learningfrom each other, the parents compare notesabout their babies’ height, weight and othermilestones. They review the opportunitiesthroughout the day to engage their childrenin teachable moments – waking up, mealtime,washing and bathing, cooking, visiting, workingoutdoors, playing and getting ready for bed.

Less than a kilometre from Priyanthi’shome is a family not regularly involved inearly childhood care programmes.Wimalarathne, a 33-year-old farmer, explainsthat he recently learned about the home-visiting programme and wants to get hisdaughter, Sasika, involved. When the two-

year-old girl sees strangerscoming towards her house, shebegins to cry. Her seven-year-old brother, Asanka, carries thetiny girl, a frightened toddlerwho clings to her brother, neveruttering a word. Her piercing,dark eyes remain fixated on thestranger who visits. Both chil-dren are uncommunicative.Wimalarathne explains that hischildren are shy but they playwell together.

The father, clearly concerned about hisdaughter’s development, beckons to his wife,Kusumawathi, 30, to get their daughter’sgrowth chart. The graph on the chart showsthe child’s weight and height spirallingdownward from average readings at birth tobelow average as a toddler. Wimalarathnesaid that the doctor is at a loss about herslow growth and has recommended that thefamily become involved with the home-visiting programme.

Two families in the same village, in similarcircumstances, yet the children are so differ-ent. The families in Matale, like millionsthroughout the world, are poor. Most aresubsistence farmers and casual labourerswho work in nearby factories or on teaplantations. Although 99 per cent of thechildren are immunized, almost 40 per centare malnourished. Some families have accessto early childhood care programmes. Manymore do not.

The importance of ages 0-3 years

In the first moments, months and years oflife, every touch, movement and emotion ina young child’s life translates into an explo-sion of electrical and chemical activity in thebrain, as billions of cells are organizingthemselves into networks requiring trillionsof synapses between them (see Panel 1).

11Choices to be made

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These early childhood years are when exper-iences and interactions with parents, familymembers and other adults influence the waya child’s brain develops, with as muchimpact as such factors as adequate nutrition,good health and clean water. And how thechild develops during this period sets thestage for later success in school and thecharacter of adolescence and adulthood.

When infants are held and touched insoothing ways, they tend to thrive. Warm,responsive care seems to have a protectivefunction, to some extent ‘immunizing’ aninfant against the effects of stress experiencedlater in life. But the brain’s malleabilityduring these early years also means thatwhen children do not get the care theyneed, or if they experience starvation,abuse or neglect, their brain developmentmay be compromised (Panel 1).

The effects of what happens duringthe prenatal period and during the earliestmonths and years of a child’s life can lasta lifetime1. All the key ingredients of emo-tional intelligence – confidence, curiosity,intentionality, self-control, relatedness,capacity to communicate and cooperative-ness – that determine how a child learnsand relates in school and in life in general,

depend on the kind of early care he or shereceives from parents, pre-school teachersand caregivers.2 It is, of course, never too latefor children to improve in their health anddevelopment, to learn new skills, overcomefears or change their beliefs.3 But, as is moreoften the case, when children don’t get theright start, they never catch up or reach theirfull potential.

Why invest? The rights of children andthe cause of human development4 are unas-sailable reasons for investing in early child-hood. The neurosciences provide anotherrationale that’s hard to refute as theydemonstrate the influences of the firstthree years on the rest of a child’s life.

In addition5, there are also compellingeconomic arguments: increased productivityover a lifetime and a better standard of livingwhen the child becomes an adult, later cost-savings in remedial education and healthcare and rehabilitation services and higherearnings for parents and caregivers who arefreer to enter the labour force.

And there are social reasons as well: Inter-vening in the very earliest years helps reducethe social and economic disparities and genderinequalities that divide a society and contrib-utes to including those traditionally excluded.

Binocular vision

Emotional control

Habitual ways of responding

Peer social skills

Language

Symbols

Relative quantity

Cognitiveskills:

0 7654321age (years)

Critical period

Critical period wanes

(Adapted from Doherty, 1997)

Source: M. McCain and F. Mustard, Reversing the real brain drain: Early years study, Ontario, April 1999, p. 31.

Figure 1 Brain development: Some critical periods

ments with their opportunities,7 there is apractical problem that must be resolved.Early childhood services do not fall neatlyinto any one sector, as the needs and indivis-ible rights of the young child span the areasof health, nutrition, a safe environment andpsychosocial and cognitive development.Systems are not always in place to keep anintegrated, cross-sectoral approach running.As a result, a government’s responsibility toprovide for children and support theirfamilies easily slips between the lines thatdivide ministries and departments. Seen asthe responsibility of many, providing servicesfor children under the age of three becomesthe responsibility of no one.

Which is all the more reason that govern-ments at all levels must make decisions andtake action if the rights of the child are to berespected and the needs of a country are tobe met. And so must others – civil societyorganizations, the corporate sector, religiousorganizations, non-governmental organiza-tions (NGOs), children and adolescents.Leaders from all parts of society must:

• Make the rights and well-being ofchildren a priority,


And political reasons: A country’s posi-tion in the global economy depends on thecompetencies of its people and those com-petencies are set early in life – before thechild is three years old.6

Choices

Thus, the options before leaders who arestriving to do what’s best for children andbest for their country seem obvious:

Assure that every child, without excep-tion, is registered at birth and starts life safefrom violence, with adequate nutrition,clean water, proper sanitation, primaryhealth care and cognitive and psychosocialstimulation OR fail their moral and legalobligations as set forth in the Conventionon the Rights of the Child.

Support families and communities as theycare for their young children OR abandonthe hope that the next generation will behealthy enough and skilled enough to leada country out of poverty and away fromdestructive disparities of income, educationand opportunity.

Provide the monies necessary to ensureevery child the best possible start in life dur-ing the early childhood years OR perpetuatethe inequities that divide people, compro-mise their well-being and eventually destroysocieties and countries.

Spend what’s needed now to assure thatfamilies have access to basic good-qualityservices they need for their young childrenOR spend more to fix problems later.

These alternatives, although clear-cut,are not always easy to see. Intergenerationalcycles of poverty, disease, violence and discrim-ination are so entrenched in the ways thatlives are lived and societies are organizedthat they seem permanently set in stone,with cycles of hope and change buried underlayers of rock, far from sight and possibility.

But even when governments do recognizethe value of better matching their invest-

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trolled by implacable genes. From thefirst cell division, brain development is adelicate dance between genes and theenvironment. While genes pre-order thesequence of normal development, thequality of that development is shaped byenvironmental factors that affect boththe pregnant and lactating mother andthe young infant. Such factors as ade-quate nutrition, good health, clean waterand a safe environment free from vio-lence, abuse, exploitation and discrimi-nation all contribute to how the braingrows and develops.

The uniqueness of the human brain liesnot only in its size and complexity but alsoin the properties that make it extraordinar-ily interactive with experience. Everytouch, movement and emotion is trans-lated into electrical and chemical activitythat shifts the genetic momentum for-ward, subtly modifying the way a child’sbrain is wired. Human interactions are asimportant to the development of brainconnections as having food to eat, soundsto hear and light by which to see.

Timing is critical There are periods in life when the brainis particularly open to new experiencesand especially able to take advantage ofthem. If these sensitive periods pass bywithout the brain receiving the stimula-tion for which it is primed, opportunitiesfor various kinds of learning may be sub-stantially reduced.

Exactly how critical ‘critical periods’are, and how long the windows of oppor-tunity for specific areas of developmentstay open, is under debate. We knowthat the human brain is malleable andthat its capacity for reorganization con-tinues throughout life and can beenhanced by interventions. But there iswide consensus that during early child-hood the brain is taking shape with aspeed that will never be again equalled.

Developmental prime timeThe brain’s malleability also means thatthere are times when negative experi-ences or the absence of good or appro-priate stimulation are more likely to haveserious and sustained effects. When chil-dren do not get the care they need dur-ing developmental prime times, or if theyexperience starvation, abuse or neglect,their brain development may be compro-mised. Many children living in emergency,displaced or post-conflict situations ex-perience severe trauma and are underexceptional and unresolved stress, con-ditions that are particularly debilitating foryoung children. Only a few synapses fire,while the rest of the brain shuts down.

At these young ages, a shutdown stallsthe motor of development.

Prevention is bestAlthough it is never too late to interveneto improve the quality of a child’s life,


Have you ever observed an infantwatch with heightened anticipa-tion, then squeal with delight as

his mother’s face, hidden behind herhands, suddenly appears? During thisseemingly simple and repetitive game,something quite dramatic is taking placeas thousands of cells in the child’s grow-ing brain respond in a matter of seconds.Some brain cells are ‘turned on’, someexisting connections among brain cellsare strengthened and new connectionsare formed.

With brain connections proliferatingexplosively during the first three years oflife, children are discovering new thingsin virtually every waking moment. Atbirth, a baby has about 100 billion braincells. Most of these cells are not con-nected to each other and cannot func-tion on their own. They must beorganized into networks that require tril-lions of connections or synapsesbetween them.

These connections are miracles ofthe human body, depending partly ongenes and partly on the events of earlylife. Many kinds of experiences affecthow young brains develop, but nothingis more important than early care andnurturing.

A delicate dance A child’s brain is neither a blank slatewaiting for a life story to be written on itnor a hard-wired circuit planned and con-

PANEL 1 Early brain development: A firestorm of creativity

• Create, find and reallocate the resourcesthat are necessary to adequately fundearly childhood care as the first essen-tial step in ensuring the rights of thechild and

• Assign responsibility and accountabilityfor ensuring that every child has thebest possible start in life, as the funda-mental prerequisite for healthy growthand development during school ageand adolescence.

Until society’s leaders step up to theseresponsibilities, the children and adolescentsof this world, and their parents and families,will be left to absorb the effects of poorpublic policy into their private lives, beforepassing them to the next generation. And aslong as a nation allows its public policiesand budget decisions to violate the rights ofchildren and women, there is scant hope ofchanging the realities and futures of childrenor of achieving sustained development. Norwill humanity’s potential be fully realized.

ECD

Programmes built on the fact that there is anindivisibility and unity to the rights of childrenhold the greatest promise for children’s healthand well-being and for that of their familiesand communities (see page 17 for the definitionof ECD). A child grows and develops not in avacuum but in a community, a culture and anation. The most effective ECD programmes(see page 17) are integrated and multidimen-sional, fostering children’s good health andnutrition and their cognitive, social and emo-tional abilities. Reflecting cultural values, thebest of these programmes are deeply rootedwithin families and communities, blendingwhat is known about the best environmentsfor optimal child development with an under-standing of traditional child-rearing practices.

ECD helps build community networksthat can both expand the range of services


early interventions have the most signif-icant effects on children’s developmentand learning. Children’s development canbe enhanced with appropriate, timelyand quality programmes that providepositive experiences for children andsupport for parents. There are a widerange of successful interventions –helping a young mother and father tounderstand the newborn’s signals moreaccurately, for example, reading a storyto a group of toddlers, providing homevisits to new parents.

Lasting imprintsEarly care and nurturing have a decisiveand lasting impact on how children growto adulthood and how they develop theirability to learn and their capacity to regu-late their emotions.

While it is certainly possible to developbasic skills later on, it becomes increas-ingly difficult. Children whose basic needsare not met in infancy and early child-hood are often distrustful and have diffi-culty believing in themselves and inothers. Children who do not receive guid-ance in monitoring or regulating their be-haviour during the early years have agreater chance of being anxious, fright-ened, impulsive and behaviourally disor-ganized when they reach school.

The brain has remarkable capacitiesfor self-protection and recovery. But theloving care and nurture children receivein their first years – or the lack of thesecritical experiences – leave lasting im-prints on young minds.

Photo: These magnetic resonance images(MRIs) of a brain are from a study of twelveyoung children, with a median age of 14-15months, who were treated in a SouthAfrican hospital for infantile malnutrition.The MRI on the left shows various abnormalstructural changes associated with the cere-bral shrinkage that was present in everychild on admission. The image on the right,taken after 90 days of nutritional rehabilita-tion, shows the anatomical recovery thatoccurred in the majority of the children.

Source: Gunston, G.D., et al., ‘Reversible cerebralshrinkage in kwashiorkor: an MRI study’, Archivesof Disease in Childhood 1992; 67:1030-1032, withpermission from BMJ Publishing Group.


Very young children (0-3 years):

• Protection from physical danger

• Adequate nutrition and health care

• Appropriate immunizations

• An adult with whom to form an attachment

• An adult who can understand and respond to their signals

• Things to look at, touch, hear, smell, taste

• Opportunities to explore their world

• Appropriate language stimulation

• Support in acquiring new motor, language and thinking skills

• A chance to develop some independence

• Help in learning how to control their own behaviour

• Opportunities to begin to learn to care for themselves

• Daily opportunities to play with a variety of objects

Pre-school aged children, all of the above, plus:

• Opportunities to develop fine motor skills

• Encouragement of language through talking, being read to, singing

• Activities that will develop a sense of mastery

• Opportunities to learn cooperation, helping, sharing

• Experimentation with pre-writing and pre-reading skills

• Hands-on exploration for learning through action

• Opportunities for taking responsibility and making choices

• Encouragement to develop self-control, cooperation and persistence in completing projects

• Support for their sense of self-worth

• Opportunities for self-expression

• Encouragement of creativity

Children in the early primary grades, all of the above, plus:

• Support in acquiring additional motor, language and thinking skills

• Additional opportunities to develop independence

• Opportunities to become self-reliant in their personal care

• Opportunities to develop a wide variety of skills

• Support for the further development of language through talking,reading, singing

• Activities that will further develop a sense of mastery of a varietyof skills and concepts

• Opportunities to learn cooperation and to help others

• Hands-on manipulation of objects that support learning

• Support in the development of self-control and persistence in completing projects

• Support for their pride in their accomplishments

• Motivation for and reinforcement of academic achievement

Source: Adapted from Coordinators’ Notebook: An international resource for earlychildhood development, The Consultative Group on Early Childhood Care andDevelopment, No. 21, 1997, p. 7.

when needed and respond to emergencies asthey arise. In Indonesia, for example, theBina Keluarga and Balita (BKB) project beganin 1982 as a population, health and nutri-tion programme, monitoring children’sheight and weight and providing nutritiousmeals at local centres. Community women,kaders, were trained in various aspects ofchild development and organized workshopsfor parents and other family members at thenutrition centres. When the economic crisishit the country in 1997, these systems werealready in place. The World Bank loanedIndonesia $21.5 million for the Early ChildDevelopment Project, which included anemergency food component for infants aged6-24 months in Indonesia’s poorest commu-nities, the inpres desa tertinggal, or ‘villagesleft behind’. To protect the infants in thesevillages from the permanent physical andintellectual stunting associated with malnu-trition, plans were made to supply energy,protein and nutrient supplements to morethan a quarter-million infants over a two-year period. Never fully implemented,the project was to rely on the pre-existingvoluntary village health post and theBKB project.8

Parents and communities throughout theworld have created innovative ways of help-ing their children to grow and develop (seeCountry Profiles). They have emphasized theimportance of good hygiene and sanitationpractices, adequate nutrition, proper feedingpractices, immunization, growth monitoring,psychosocial stimulation and early detectionof disabilities and early intervention. In SriLanka, for instance, the home-visiting pro-grammes and pre-schools that focus onstimulation, play, numeracy and literacypreparation have helped young childrenlike Madushika and Madusha shine.

But what works in Sri Lanka will notnecessarily work in Indonesia or Namibia.Investing in early childhood care must beguided by the knowledge that communities

Figure 2 The rights of young children

Photo credits (top to bottom): UNICEF/93-1987/Pirozzi; UNICEF/India/Osan; UNICEF/93-1151/Balaban

are the best architects of successful pro-grammes that match the needs of caregiversand the developmental milestones of youngchildren and also reflect the culture andvalues of families.

In Brazil, for instance, volunteers fromPastoral da Criança (Child Pastorate) aretrained as community health agents. Thesevolunteers, mostly women, visit mothers intheir homes and provide them with infor-mation on family planning, prenatal care,breastfeeding and oral rehydrationtherapy. They monitor babies’ weightsand teach families about the impor-tance of interacting with their youngchildren through cuddling, talkingand singing. Because of theirefforts, communities withPastoral da Criança volunteershave reduced child mortalityby 60 per cent.9

With immunizations andgrowth monitoring as part ofPastoral, some developmen-tal delays and disabilitiesare being prevented. Whenparents are taught about

Definition

The acronym ECD refers to a comprehensiveapproach to policies and programmes for chil-dren from birth to eight years of age, their parents

and caregivers. Its purpose is to protect the child’srights to develop his or her full cognitive, emotional,social and physical potential. Community-basedservices that meet the needs of infants and youngchildren are vital to ECD and they should includeattention to health, nutrition, education and water andenvironmental sanitation in homes and communities.The approach promotes and protects the rights ofthe young child to survival, growth and development.

UNICEF has chosen to focus this report on theearliest years, 0-3, since they are critical to how therest of early childhood unfolds and because theseimportant early years are most often neglected incountries’ policies, programmes and budgets.

Other organizations use the following termi-nology: Early Childhood Care and (Initial) Education(UNESCO); Early Childhood Education and Care (OECD);and Early Childhood Development (World Bank).

expected milestones in a baby’s life, theybecome the first lines of defence for at-riskbabies. When a disability is detected early,young children, especially those from birththrough three years old, are enrolled in com-munity-based early intervention programmesto help them reach their potential. Mothersand fathers learn how to play and interactwith their children at home, helpingthem maintain the progress they make.

Sometimes interventions include notonly services for the child with disabilitiesbut also community education and advocacy,as is the case with the Tadamoun Wa TanmiaAssociation (Solidarity and Development)in Saida (Lebanon), which beganin 1986 with summer clubsand camps for children.In 1992, these expertsin special

Successful programmes1. Incorporate the principles of the Convention on the

Rights of the Child, ensuring non-discrimination, the child’sbest interests, the right to survival and full development andthe participation of children in all matters affecting theirlives.

2. Build on the Convention on the Elimination of All Forms of

Discrimination against Women, recognizing that ensuring women’srights is basic to ensuring child rights.

3. Use the existing strengths of communities, families and social structures, ofpositive child-rearing practices and the strong desire of parents to provide thebest for their children.

4. Have a broad framework, encompassing multidimensional programmes in health,nutrition and the child’s psychosocial and cognitive development.

5. Are developed with and for families, in ways that respect the rights of women andof siblings for schooling and for the enjoyment of their own childhood.

6. Are developed with and for communities, respecting cultural values, building localcapacity, creating ownership and accountability, encouraging unity and strength andenhancing the probability that decisions will be implemented and that the programmewill be sustained.

7. Provide equal access for all children, including girls and those at risk of delayed develop-ment and disabilities.

8. Are flexible and reflect diversity, varying from each other in respect of local and regionalneeds and resources.

9. Meet the highest quality standards.

10. Are cost-effective and sustainable.

Choices to be made 17

E C D

E C D


Children are a bit like chickens –they need to be kept safe, guided,fed and loved,” observed the

grandmother of four young children inthe Nepalese village of Biskundanda,with a touch of irony. In many ways thissimple aphorism captures the funda-mental wisdom of hundreds of millionsof parents throughout the world. Mostmothers and fathers, even without for-mal knowledge of the principles of childdevelopment or the Convention on theRights of the Child, know that their chil-dren have the right to love and protec-tion, good health and nutrition andopportunities to learn.

Yet, according to a recent study inNepal,* many of these same parents, andmany child development experts, tend tounderestimate the significance of parents’day-to-day role in the development of chil-dren’s broader thinking, confidence andskills – those capacities with the greatestsignificance in helping them grow up ableto break the cycle of poverty.

The Nepal study, a model of parti-cipatory research, used a child rightsframework as researchers talked withparents and community leaders aboutthe child-rearing beliefs and practices offamilies in four rural villages. Through struc-tured discussions, the study elicited theinformation needed to develop ECD pro-grammes that are responsive to the

rights of the child and relevant to thecommunities. Its method of collabora-tive dialogue with parents and familieswas as significant for protecting childrights as were its findings.

The circumstances of children inNepal are mixed. On the one hand, childmortality is high, malnutrition is com-mon, sanitation and indoor air quality arepoor, and few children receive more thana few years of formal education. Povertyand the continual struggle for survivalmake it all but impossible to provide ade-quately for children.

On the other, some children flourishdespite the socio-economic odds againstthem. Many village children in Nepal havea clear sense of self-worth and socialresponsibility from the parts they play indoing household chores and agriculturaltasks, such as herding. When the child isyounger, work, play and learning blendseamlessly. Before the chores becomerepetitive and interfere with education,active learning through work is a sourceof pride and satisfaction for children and avaluable opportunity to acquire the com-petence they so desire, as well as therespect of others.

How to explain such ‘positive deviance’?In looking at the subtle and contextualprocesses of children’s development inthe natural environment of the home,the study found that seemingly minor

patterns of parental behaviour andcasual interactions appear to have aninvaluable impact on children’s develop-ment. One mother, for example, onreturning home from a long day’s work,immediately sits down with all of herfour children. She gets them to help hersort the fish she has just caught – all thewhile talking with them about the char-acteristics of the fish, their size, colourand taste. She takes an interest in whatthe children have to say and has evenbrought home a tiny crab for each childso that they can play crab races.

The Nepal study also considered thelarger context of family and village life. Itlooked at the village setting, at social andeconomic realities, at gender and casteissues, at culture and the process ofchange. In many ways the study found nosurprises: Families are naturally con-cerned with all aspects of a child’s life and,on a day-to-day basis, they are most re-sponsible for defending children’s rights.

The big question for ECD initiatives ishow to make them work. The study rec-ommends the adoption of a child rights

PANEL 2 Families, child rights and participatory research in Nepal

from theConvention

on the Rightsof the Child

Article 6

1. States parties recognize that everychild has the inherent right to life.

2. States parties shall ensure to themaximum extent possible the sur-vival and development of the child.

Article 18

2. For the purpose of guaranteeingand promoting the rights set forthin the present Convention, Statesparties shall render appropriateassistance to parents and legalguardians in the performance oftheir child-rearing responsibilitiesand shall ensure the develop-ment of institutions, facilities andservices for the care of children.

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education opened a formal school, Hadicat-as-Salam Centre, to help integrate childrenwith physical and mental disabilities into thecommunity. Recognizing the need for earlyintervention, one of the programmes workswith children between three and eight yearsold. Through games, adaptive sports andcommunity field trips, young children arebecoming more independent. Additionally,the programme provides numerous opportu-nities for children with and without disabili-ties to play and learn together, helping dispelthe myths and stereotypes and remove nega-tive attitudes and biases towards childrenwith special needs.10

As a vehicle for transmitting values, ECDcan be a force for equality and tolerance. Ina crèche in South Africa, the seeds of racialhealing are being sown in an area whereapartheid had previously fostered hatred.In a poor neighbourhood in Johannesburg,tucked in the corner of a park once labelled‘For whites only’, the Impilo Project is pro-viding innovative and comprehensive carefor young children of all races. When ECDworks with parents and communities to fos-ter problem-solving over conflict and accep-tance over intolerance, the groundwork islaid for children to live lives in ways that

Two Macedonianchildren playing in theleaves on the groundsof a UNICEF-supportedinstitution for thosewith mental disabilitiesin Skopje.

framework for assessing how well adults,at the family, community, district andnational levels, are meeting their obliga-tions in ensuring children’s well-being. Anessential component of such an ap-proach is the ongoing dialogue with par-ents and community members on keyissues for children as a basis for action.Many child-rearing practices, both posi-tive and negative, can have a taken-for-granted quality. In responding to theopportunity to reflect on their beliefs anddaily routines and to discuss them withothers, parents begin to take a moreactive, confident role both in reinforcingtheir traditional strengths and in workingtogether to introduce new practices.

Child development experts and fami-lies have a lot to learn from each other.The challenge for those working for childrights is to find the way to accentuatelocal practices and listen to parents’ con-cerns sensitively and cooperatively, andat the same time find ways to addressand debate practices that are at oddswith child rights principles. They muststrike a balance between encouragingtraditions that are good for children whilecontesting those based on caste or gen-der that undermine their rights. Theymust both value the “children are bit likechickens” idea and go beyond it.

*The child-rearing study was a joint initiative of Savethe Children Alliance members (Norway, UK and US)/UNICEF/Seto Gurans National Child DevelopmentServices/City University of New York’s Children’sEnvironments Research Group/Tribhuvan University’sResearch Centre for Educational Innovation andDevelopment.

Choices to be made 19

Photo: A teacher with her young students ata Nepali pre-school. UN

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PANEL 3 Healthy pregnancies: Protecting the rights of both women and children


9

524 26.5 28 30 32

6

7

8

Adult Body Mass Index

Normalweight Overweight Obese as adults

Blo

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glu

cose

mm

ol/l

Born before famine 15

Conceived after famine 15

Famine: late pregnancy 21

Famine: mid pregnancy 14

Famine: early pregnancy 16

Time of maternalexposure to famine

Diabetes orglucose intolerance %

Response to glucose drink(mean 120 min. plasma glucose)

Figure 4 Effects of maternal exposure to famine

Of the many causes of disease,disability and death amongchildren, none cuts a wider

swath with more long-range conse-quences – yet is more easily prevent-able – than maternal ill health duringpregnancy. This toll is not only un-forgivable, it is also unnecessary andcan be avoided through interventionsthat cost a mere $3 per capita per year.

trition – on protein, vitamin A and ironsupplementation or fortification – yieldhigh returns. Eliminating malnutritionamong expectant mothers would re-duce disabilities among their infantsby almost one third. For at-risk infants,early childhood care programmes canhelp prevent disabilities.

Girls and young women must haveeducational opportunities to better pro-vide for their children. Women of allages need to be screened for HIV/AIDSand sexually transmitted infections.Fathers must be included in parenteducation. Communities need cleanwater and sanitation, and societies needthe values and the legislation that createrespect and a non-discriminatory climatefor women.

Ensuring that pregnancies arehealthy clearly can have a profound im-pact on women, children and societyat large. Expectant mothers requireadequate nutrition and good, accessi-ble prenatal, delivery, obstetric andpostnatal care, as well as an environ-ment free of pollutants, exhaustinglabour and extreme stress such asconflict. Investments in maternal nu-

Source: Ending Malnutrition by 2020: An agendafor change in the millennium, final report to theACC/SCN by the Commission on the NutritionChallenges of the 21st Century, February 2000,Figure 3, p. 19; Figure 4, p. 20. Adapted fromA.C.J. Ravelli et al., ‘Glucose tolerance in adultsafter prenatal exposure to famine’, The Lancet,351 (9097) copyrighted by The Lancet, January1998.

Earlynutrition

in utero andchildhood

SHORT TERM

Brain development

Growth and muscle massBody composition

Metabolic programming of glucose, lipids, proteinhormones/receptor/gene

LONG-TERM

Cognitive andeducationalperformance

ImmunityWork capacity

Diabetes,obesity,

heart disease,high blood

pressure, cancer,stroke and aging

Figure 3 The short-term and long-term effects of early nutrition

promote peace within families and societies.In those instances where ECD is devel-

oped with community involvement from theinitial planning phase, the corollary benefitsinclude strong and energized communities.In Nigeria, for example, the Community-level Nutrition Information System forAction (COLNISA) used community analysesto build ‘baby-friendly communities’, linkinghealth facilities and hospitals. Currently,32 communities are working for their chil-dren’s healthy development by promotingexclusive breastfeeding, timely and adequatecomplementary feeding and improvedhousehold sanitation.

A local NGO in Cameroon, Associationpour l’auto-promotion des populations del’Est Cameroun (Association for the Self-promotion of Eastern Cameroon’s People)has created non-formal pre-school educationcentres in the most remote areas ofCameroon’s equatorial forests to reach theBaka pygmy, a traditionally nomad people,in order to prepare their children for school.In more than 60 UNICEF-supported centres,teaching methods have been adapted topygmy culture and language for childrenfrom 0-12 years.

Converging services. There are many entrypoints in existing sectors for ECD programmesthat build on what international agencies,national governments and local communitiesare already doing. For example, while nutri-tion programmes might be focused on goodprenatal care and teaching the importanceof exclusive breastfeeding for the first sixmonths and its continuation for two yearsand beyond, they can also educate mothersabout the importance of early social, emo-tional and cognitive stimulation. In Oman,a network of female community workerswho were originally entrusted with breast-feeding promotion has been trained toadvise mothers on a broadened spectrum ofearly childcare issues. In some countries, thecommunity health system is the entry point

for child development. In other countries,water and sanitation programmes incor-porate ways to assure safe spaces for playand exploration.

One of the most important aspects of ECDis that it can build effectively on what alreadyexists. It is not about reinventing the wheelbut about giving parents and communitiesthe support they need and maximizing exist-ing resources. With health, nutrition, water,sanitation, hygiene, education and child pro-tection programmes already available, it ispossible to integrate or combine these ser-vices to provide for the whole child. Pastoralda Criança is an example of the convergenceof early childhood services through the healthsector. In Colombia, the Project for theImprovement of Education (PROMESA)chose the education sector to integrate ser-vices. In educational programmes, groups ofmothers learn how to stimulate the physicaland intellectual development of their childrenfrom birth to age six.

But before ECD has its chance to succeed,there must be a broadened understanding ofthe rights of children, and the commitmentto spend what must be spent and do whatmust be done to assure that those rightsare realized.


Non-stuntedSupplemented and stimulated

StimulatedSupplemented

Control

Baseline 6 mo 12 mo 18 mo 24 mo

110

105

100

95

90

Dev

elo

pm

ent

qu

oti

ent

Figure 5Early intervention reduces the disadvantage of stunting

Source: S.M. Grantham-McGregor et al., ‘Nutritional supplementation, psychosocial stimulation and mental development of stunted children: The Jamaican study’, The Lancet, 338 (8758), copyrighted by The Lancet, July 1991, pp. 1-5, adapted in Ending Malnutrition by 2020: An agenda for change in the millennium, final report to the ACC/SCN by the Commission on the Nutrition Challenges of the 21st Century, February 2000, p. 10.

PANEL 4 Iniciativa Papa: Improving the lives of children, one father at a time


Every day at noon, without fail, JuanAguirre Quispe picks up his daugh-ter from day care. His large, mus-

cular hand clasps the toddler’s small,delicate fingers as they stroll along,singing songs she learned at the centre.After his hectic morning of work, the 33-year-old father looks forward to thisoasis – time spent jumping, giggling andcuddling with his little girl. He deflectshis friends’ wisecracks about doing“women’s work” with retorts about howthe stories and tickles he shares with hischildren make them smarter. In his heart,he knows that their time spent togetheris also good for him.

“I enjoy our being together. We eattogether, we play and spend more timetogether,” said Mr. Quispe. Reflectingon his life since sharing the care for hischildren, he believes that his marriage isnow stronger. “My wife and I communi-cate more, we show our love and union.”

Mr. Quispe is one of 96,000 Peruvianmen who participate in Iniciativa Papa,an ECD initiative introduced by UNICEFand implemented through pre-school pro-grammes by the Ministry of Education.In its work with men and teenage boys,Iniciativa Papa reinforces the importantroles they play in raising children. Insmall groups led by trained facilitators,fathers discuss the benefits of soundnutrition, clean water, immunizations andcognitive stimulation. Like other coun-tries, such as Jordan and Namibia, Peru’scommitment to its smallest citizens ad-

vocates the giant role offathers in childcare. Menthroughout the world arelearning first-hand how topositively contribute totheir children’s lives.

In Namibia, for instance,community liaison offi-cers captured the atten-tion of villagers by callingfor “fathers’ meetings.”Tapping into the men’scompetitive spirit, theydeveloped a board game,For Fathers Only – FathersInvolved in ECD. The boardhas a series of blocks with

various sketches of men playing with andcaring for children. The object of the gameis to move from the start to the finishbox by drawing a card and answering aquestion, such as “What do childrengain from playing?” After one fatheranswers, the group evaluates his ex-planation. If they agree that he gavea thoughtful and correct response, hemoves his piece forward.

In Jordan, fathers involved in itsBetter Parenting programme meet insmall groups during the evening at com-munity centres or the homes of villageleaders. They learn how to construct playenvironments with material found aroundtheir homes. They talk about how men’saffectionate care – playing, dancing, bath-ing, feeding – helps children develop.

Studies of fatherhood underscoresomething that men who actively par-ticipate in their children’s lives knowviscerally: When men are more thanbreadwinners or disciplinarians in fami-lies, everyone gains. Fathers have alwaysbeen viewed as power-brokers. Butequally important as their economic con-tributions and authority is their influentialrole as nurturers and caregivers.

When fathers nurture their children,not only are the children physicallyhealthier, but they’re also more mentallyacute and emotionally sound. A study ofeight-year-olds in Barbados found thatchildren performed better in school whentheir fathers were actively involved in theirlives – whether or not their fathers lived

with them. Studies in the United Statesshowed that infants with highly engagedfathers scored higher on pre-school intel-ligence tests than infants whose fatherswere less involved. Increased academicscores are not the only benefits providedby a devoted father. When fathers andchildren play, sing and laugh together,there is a greater chance for happy, well-adjusted families.

Since its inception two years ago,Iniciativa Papa has successfully engagedmen and teenagers in evaluating rigid gen-der roles and challenged them to becomearchitects of their children’s future. Besideslearning concrete facts about child de-velopment, the men also confront thevalues that have been passed down fromgeneration to generation. But changinglong-held beliefs about mothers’ andfathers’ roles or their expectations of sonsand daughters is often an uphill battle.

“Machismo is not something thatcan disappear overnight,” says JessicaAvellaneda García, a 24-year-old pro-gramme facilitator. “But there is progress.They seem more willing to communicate,they value women’s work in the housemore and they interact more with theirchildren.”

Rising above old stereotypes, somefathers are learning that singing, story-telling, listening, feeding, cuddling andplaying improve the minds and bodies oftheir sons and daughters. The men alsounderstand the importance of toleranceand tenderness in crafting their children’sself-worth.

“I’ve learned to be more patient,”said Braulio Gálvez Gutiérrez, a fatherwho participates in the teenage group.“These are little children, and you haveto have a lot of patience. That’s why it’sbetter to take advantage of their curios-ity to teach them, so they can learn. I trynot to scream at my son. Now I showhim more my love.”

Photo: Father and son in Guatemala.

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Caring for children = caringfor womenEmphasizing the care of babies and toddlersmeans focusing also on women whose physi-cal and emotional condition influences theirpregnancies and their babies’ development(see Panel 3). Poor prenatal care and malnu-trition in mothers have been linked to lowbirthweight, hearing problems, learning diffi-culties, spina bifida and brain damage inchildren.11 Infants born to underweightmothers are more likely to develop certaindiseases and conditions later as adults,such as diabetes, cardiovascular diseaseand obesity.12

The 1990 World Summit for Childrenrecognized the importance of maternalhealth to children when it called for cuttingmaternal deaths in half by the year 2000.In Vienna in 1993, the World Conferenceon Human Rights reaffirmed that women’srights are human rights, and in 1994 inCairo, the International Conference onPopulation and Development argued thatwomen’s health, including reproductivehealth, was essential for sustainable develop-ment. And at the Fourth World Conferenceon Women held in Beijing in 1995 and atits five-year follow-up in New York, improve-ments in women’s health were identified asone of the action priorities for ensuring gen-der equality, development and peace in the21st century.

Yet today, maternal mortality rates remainhigh. A woman in the developing world is onaverage 40 times more likely than a womanliving in the industrialized world to die fromcomplications of pregnancy and childbirth.13

A study in Bangladesh showed that when awoman dies in childbirth, her surviving babyis 3 to 10 times more likely to die within twoyears than a child who is living with bothparents.14 Shoring up care for mothers wouldprotect children. Recognizing this, UNICEF,the World Health Organization (WHO), theUnited Nations Population Fund (UNFPA)

and the World Bank, along with their manypartners, promote safe motherhood initia-tives throughout the world.

Of course, many cultures understand thisconnection. Bangladesh, for example, estab-lished an annual Safe Motherhood Day,


Health skills

Utilization of services

Reproductive andhealth outcomes(in the grandchildren’sgeneration)

Reproductive and health outcomes(in the child’s generation)

Infant and child mortality

Malnutrition

Fertility (of mother)

Maternal schoolingYears of attendance during childhood and adolescence

Source: R.A. LeVine, S.E. LeVine and B. Schnell ‘Improve the Women: Mass schooling, female literacy and worldwide social change’ (unpublished manuscript), February 2000, fig. 2.

Literacy and language skills(in adulthood)

Reading comprehensionAcademic language

Literacy and language skills of school aged childrenReading comprehensionAcademic language

Utilization of servicesPrenatal care

Immunization

Contraceptive use

Domestic health practices

Health skills(in adulthood)

Understanding health messages

Interacting with health practitioners

Verbal interaction with pre-schoolchildrenFrom 12-60 months of age

Figure 6 Maternal literacy and child development


recognizing that caring for pregnant womenanchors healthy starts for babies. Backed bya mass media campaign, the Government,health care workers andvarious agencies mobilizedto address the social issuesbehind maternal deaths.Bangladesh’s push to providesafe and healthy pregnanciesultimately strengthens thecare of babies.

Educating families aboutthe importance of proper dietand health care for pregnantwomen is also part of ECD,as is educating men abouttheir important roles in caringfor their pregnant wives and nurturing theirchildren (see Panel 4). When fathers, as wellas mothers, are convinced about the supportsrequired for healthy pregnancies and childdevelopment, harmful health practices canbe eliminated.

Women’s gains are children’s gains.If the world fails to honour women’s rights,it will fail to deliver on its responsibilities to

all children. Two areas wherewomen’s rights directly affectchildren are in health andeducation. Infant deaths aresignificantly related to thepoor nutrition and healthof their mothers prior to andduring pregnancy and soonafter the post-partum period.Improved prenatal care formothers saves both women’sand children’s lives. In Africa,most of Asia and in LatinAmerica, women’s increased

school attendance during the later part ofthe 20th century contributed to falling birthand death rates.15

With greater emphasis on ECD, includingcognitive stimulation and social interaction,women’s access to education becomes even

Near the town ofXunyi, in China’sShaanxi Province, awoman spreads soilshe has just unloadedfrom the cart whereher baby now sits.

The best time to

start ensuring

a full life is

as early as

possible.

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more important than before. A study ofGuatemalan women found that the longera mother’s schooling, the more she talkedwith her toddler. In addition, she wasmore likely to take on the role of teacherfor her child.16

But women’s rights are human rights, andECD has benefits for all women, not onlymothers. While gender biases and inequali-ties are deeply rooted in cultural traditions,ECD offers a beginning for correcting genderinequities and improving women’s lives.There is increasing evidence, for example,that services such as parenting programmesfor new fathers and mothers change rela-tions in families and their perceptions ofwhat girls might and can do,17 getting tothe core of gender bias in its early stages.

A cycle of hope and change

There is a strategic approach to realizingthe rights of children and women with greatpotential for cutting through the cycles ofdeprivation, disease, violence and discrimi-nation that currently drain the lives and spiritsof children and adolescents around theglobe. This approach would assure allinfants the best possible chance for theirsurvival, growth and development. It wouldpromise that all children are ready forschool and all schools are ready for children.And it would insist that children and adoles-cents be given the opportunity to participatein and contribute to their societies.

Such an approach is grounded in theknowledge that all stages of child develop-ment are linked and that the best time tostart ensuring a full life is as early as possible.A healthy baby will likely become a physicallyand mentally strong child ready for schooland later learning. That strong child willlikely grow to be a contributing adolescent,more apt to continue with education, delaymarriage, defer childbirth, avoid high-riskpregnancy and later set a sound foundation

In the rural parishesof Jamaica

In Jamaica, where more than 20 per cent of all births are to girls aged15-19, the Roving Caregivers Programme supports teen mothers bycaring for their babies in a demonstration day-care centre while they

attend counselling sessions and academic classes, train for jobs and workon building their self-esteem. In the same settings, there are specialsessions for fathers of the babies and mothers of the teenage girls.

Within their own communities, young parents take part in group meet-ings that provide referrals to health clinics and training and support forincome-generating activities. Together with their peers, they learn aboutreproductive health and the benefits of breastfeeding, good nutrition andenvironmental hygiene and safety.

And in the central rural parishes of the island where the programme islargely based, ‘Roving Caregivers’ walk from home to home workingwith children 0-3 years old and their parents, introducing them to devel-opmentally appropriate childcare practices. ‘Rovers’ are young sec-ondary school graduates from within the community who are engaged inregular, on-going training in child development. Each is assigned about30 families. They help parents be better observers of their child’s devel-opment and create developmentally appropriate home-learning environ-ments. The Roving Caregivers attend bimonthly meetings to report onthe families’ progress, plan activities and prepare training materials. Theparents, caregivers and children themselves produce all of the toys andteaching materials used in the programme.

Part of a multidimensional, non-formal, integrated programme of childdevelopment and parenting education, the Roving Caregivers Programmehas been a collaborative effort of local communities, the Government ofJamaica, UNICEF, the Bernard van Leer Foundation and the Rural FamilySupport Organization since 1992.

Designed to support ‘high risk’ families in meeting the developmental needsof children from birth up to three years, the programme has benefitedover 3,500 children in 700 homes in 25 rural districts and 1,300 childrenin 11 economically depressed inner-city communities.

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amulets, bracelets or tiesas protection against beingpulled from this world.

Whether in industrial-ized cities, on the plainsof Kenya or in the junglesof French Guyana, par-ents face similar respon-sibilities as they try toprotect and shelter theirchildren, secure theirdaily food, keep themclean and healthy andhelp them grow anddevelop. The solutions tothese challenges are asmultiple as the culturesthat produce them. Theyreflect the values andbeliefs of a communitywhile laying the founda-tion for a child’s culturalidentity, a fundamentalright the child enjoys.They also influence thecourse of childhood, ado-lescence and the waychildren will parent whenthey become adults.

Clearly, some tradi-tional practices, such as

food taboos for pregnant women orfemale genital cutting, are harmful toboth mother and child and should bestopped. There are, however, manyother traditional customs of great benefitto the developmental needs of the babyand closer to modern thought on child-rearing than they first seem. In someAfrican and Latin American societies, forexample, tradition requires the confine-ment or a ‘quarantine’ of a mother andher infant for several days or weeks afterbirth. During this time, the mother iscared for by family members and doesnothing but eat, breastfeed and bond withher baby. The wisdom of this practice iscarried over to most industrialized andmany developing countries as motherswho are salaried employees are legallyentitled to maternity leave.

Another example of an effective tradi-tional practice is when mothers in Kenya,New Caledonia and Sumatra fill their

mouth with water and spit-bathe theirbabies to keep them clean. Masai mothersdirect a strong jet of water and Batakmothers in Sumatra and Wayapi mothersin Guyana blow a diffused spray. Whilethe shower techniques vary, all the babiesare washed with warm water.

Infants among the Baule in Côte d’Ivoireare bathed twice a day and scrubbedvigorously, using hot water, soap and avegetable sponge. After the mother haswashed and rinsed him twice, thesqualling baby is put to the breast forcalming. The baby is then massaged, hiships and shoulders stretched and manip-ulated, his head pressed and moulded.He is rubbed with creams, dusted withpowders and daubed with perfumes andkaolin, a soft white clay. During this stageof the toilette the baby is typically calmand wide-eyed. After the ritual is com-pleted the baby – alert, active and awakebut completely calm – is clothed and givento a family member to hold.

In many cultures, carrying a baby isthe natural means for the parents or care-giver to transport the child. It is also ameans of protecting the baby, strength-ening young muscles and providingstimulation. Carried in a sling, a sash, acalabash or a cradle, the baby is con-stantly close to the mother’s body. Inthe mother’s arms or on her back asshe goes about her busy life, the babytakes part in a variety of activities andexperiences constant tactile and visualstimulation.

Bobbed up and down as their mothersrun along a path, bent to the earth astheir fathers sharpen a knife or jouncedat a dance party, babies are constantlyexercising their muscles as they adapt tothe movements of the adults carryingthem. Yequana Indians in Venezuelacarry their babies from the moment ofbirth until they are able to crawl. Java-nese babies spend most of their timeclose to their mother’s chest in a shawl,able to nurse on demand. To protectbabies from bodily harm, mothers willnot let them set foot on the ground untilthey are seven months old.

Popular wisdom now contends thatthe early bonding with the mother during

PANEL 5 Paternity leave, baths and evil spirits


Taking paternity leave to care forand bond with his newborn baby,British Prime Minister Tony Blair

joined his Finnish counterpart as a pio-neer among Western world leaders who,in the past, have left these early weeksof childcare to their wives. By settingsome time each day for ‘high office’paperwork, the Prime Minister managedto satisfy all media watchers by balanc-ing old cultural habits with new beliefs.

In some other parts of the world, prac-tices that surround the birth of a baby are,at first glance, less pragmatic. A Wayapifather in Guyana rests still in his hammockfor three days after the birth of his child inthe belief that he is diverting the attentionof evil spirits away from the infant andonto himself. A parent in some parts ofIndia smudges her newborn’s foreheadwith charcoal or smoke, holding that blackaverts the evil eye and frightens off harm-ful spirits. In many cultures, babies wear

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for the next generation of children. Investingin children from their very earliest momentsdisplaces negative patterns in a society andallows cycles of hope and change to havetheir turn.

If a country hopes to loosen the strangle-holds to development that are currentlywrapped tightly around the lives of families,then it must do four, equally essential things,at the same time.

1. It must continue to make childsurvival a priority.

2. It must assure that surviving childrenare healthy and possess the skills tothrive and to live full and productivelives.

3. It must prepare parents for theirpivotal role in childcare and buildthe capacities of communities tosupport them.

4. It must create a society that is freefrom violence and discrimination atall levels and that values the lives andcontributions of children and women.

Special Session on Children

When the United Nations General Assembly’sSpecial Session on Children takes place inSeptember 2001, leaders of governments andNGOs will face the continuing challenge ofapplying the principles of the Convention onthe Rights of the Child and meeting the goalsset forth at the 1990 World Summit forChildren. They will also have the opportunityto be architects of a new agenda for children.They must not fail to recognize that what isbest for the youngest citizens is ultimatelybest for countries.


a confinement period or the constantcarrying of the baby and breastfeedingon demand further the development ofthe baby’s feelings of security, trust inother people, and sense of self-worth.And indeed, increasing numbers of par-ents in the Western world are takingtheir babies out of strollers and carryingthem in slings. Those customs that stim-ulate a baby’s senses and enhance his orher development and even the mysticalrituals that have traditionally been usedfor child protection – different frommodern practices as they might seem –merit closer scrutiny as to how well theymeet a young child’s needs.

Sources:

Evans, Judith L. and Robert G. Myers, ‘ChildrearingPractices: Creating programs where traditions andmodern practices meet’ [http://www.ecdgroup.com/cn/cn15lead.html].

Fontanel, Béatrice and Claire d’Harcourt, BabiesCelebrated, Harry N. Abrams, Inc., New York, 1998.

Liedloff, Jean, The Continuum Concept, PerseusBooks, 1975.

Timyan, Judith, ‘Cultural aspects of psycho-socialdevelopment: An examination of West African child-rearing practices’, Regional UNICEF WorkshopReport, Abidjan, 18-22 January 1988.

Zeitlin, Marian F., et al., Strengthening the Family –Implications for International Development, UnitedNations University Press, New York, 1995.

THE STATE OF THE WORLD’S CHILDREN 2001

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Transcript of THE STATE OF THE WORLD’S CHILDREN 2001