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. 2020 Feb 4;5(2):e002314.
doi: 10.1136/bmjgh-2020-002314. eCollection 2020.

Inequalities in early childhood care and development in low/middle-income countries: 2010-2018

Chunling Lu  1 , Jorge Cuartas  2   3 , Günther Fink  4 , Dana McCoy  2 , Kai Liu  5 , Zhihui Li  6 , Bernadette Daelmans  7 , Linda Richter  8
Affiliations

Inequalities in early childhood care and development in low/middle-income countries: 2010-2018

Chunling Lu et al. BMJ Glob Health. .

Abstract

Background: Inequalities in early childhood development (ECD) tend to persist into adulthood and amplify across the life course. To date, little research on inequalities in early childhood care and development in low/middle-income countries has been available to guide governments, donors and civil society in identifying which young children and families should be targeted by policies and programmes to improve nurturing care that could prevent them from being left behind.

Methods: Using data from 135 Demographic and Health Surveys and Multiple Indicator Cluster Surveys between 2010 and 2018, we assessed levels and trends of inequalities in exposure to risks of stunting or extreme poverty (under age 5; levels in 85 and trends in 40 countries), early attendance of early care and education programmes (36-59 months; 65 and 17 countries), home stimulation (36-59 months; 62 and 14 countries) and child development according to the Early Childhood Development Index (36-59 months; 60 and 13 countries). Inequalities within countries were measured as the absolute gap in three domains-child gender, household wealth and residential area-and compared across regions and country income groups.

Results: 63% of children were not exposed to stunting or extreme poverty; 39% of 3-4-year olds attended early care and education; and 69% received a level of reported home stimulation defined as adequate. Sub-Saharan Africa had the lowest proportion of children not exposed to stunting or extreme poverty (45%), attending early care and education (24%) and receiving adequate home stimulation (47%). Substantial gaps in all indicators were found across country income groups, residential areas and household wealth categories. There were no significant reductions in gaps over time for a subset of countries with available data in two survey rounds.

Conclusions: Available data indicate large inequalities in early experiences and outcomes. Efforts of reducing these inequalities must focus on the poorest families and those living in rural areas in the poorest countries. Improving and applying population-level measurements on ECD in more countries over time are important for ensuring equal opportunities for young children globally.

Keywords: Early Childhood Development Index (ECDI); children at risk of poor development; early care and education; early childhood development; early learning; home stimulation; inequality.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Proportion of children not exposed to stunting or extreme poverty.
Figure 2
Figure 2
Proportion of children attending early care and education by wealth quintile.
See this image and copyright information in PMC

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