A quarter of a billion children across the globe may not achieve their full potential because of extreme poverty and stunting, says a series of papers published in The Lancet.

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Preschool programs can help children build a better future.

More children are now surviving into adulthood, but around 43 percent of those in low- and middle-income countries risk not fulfilling their potential.

The authors of the research, entitled Series on Early Childhood Development, call for more policies and programs to support early child development, calling this a “wise investment.”

When children do not fulfill their developmental potential, their adult earning capacity can be up to 25 percent lower, and the cost to governments in the long run may be double the amount they normally spend on national healthcare.

Problems faced by children during the all-important 1,000 first days of life, starting from conception, include poor sanitation and infections, and a lack of nurturing care and stimulation.

The study highlights the role played by nurturing care in enabling children to reach their full potential. Nurturing care is the kind of care that promotes nutrition, health, security, safety, and early learning.

Most children receive this care from their family, but poverty, violence, poor working conditions, and a lack of supporting policies can leave caregivers struggling to provide adequate nurturing care.

Policies that can help families to provide this kind of care include free early schooling, paid maternity and paternity leave, breast-feeding facilities, and a minimum wage.

Free early education

Children who attend preschool, especially those that provide both nutrition and education, do better in primary school. The report notes that 2 years of free preschool education is recommended, but only 40 countries provide this. Forty-three percent of countries provide 1 free year or more. Nearly 1 in 3 high-income countries do not provide free preschool education.

Paid leave

Parental leave provides opportunities to bond with and care for young children. Only eight countries do not guarantee paid maternity leave. Most provide at least 12 weeks, with two thirds of wages.

However, those in the informal sector may not enjoy such benefits. Paid paternity leave is offered in only 77 countries.

Breast-feeding facilities

Breast-feeding can protect a child from disease and improve cognitive function. In 139 countries, breast-feeding breaks are guaranteed for 6 months or more. In 43 countries, breaks are paid.

Again, this is not guaranteed in the informal sector, and women in workplaces where there is nowhere to use a breast milk pump and no refrigeration may not be able to benefit.

Minimum wage

When parents earn a basic income, children are more likely to have access to healthcare and education. Eighty-eight percent of countries have minimum wage policies, but they do not necessarily guarantee that this income will be more than $2 a day, considered the poverty level for a parent supporting a child.

Increasing numbers of children are surviving, but begin life at a disadvantage because they do not receive the nurturing care they need. Political prioritization, legislation and financing of early childhood development programs are key to ensuring their success, as is creating a policy environment that supports nurturing care, for instance by providing paid maternal and paternal leave, free preschool education and support for breastfeeding.”

Series author Prof. Linda Richter, University of the Witwatersrand, Johannesburg, South Africa

Programs such as Early Head Start in the United States appear to be effective in supporting children. However, programs in many countries face a lack of resources and uncertain funding.

Series co-author Prof. Gary Darmstadt, of Stanford University School of Medicine in Stanford, CA, calls for nurturing care to be made a priority in countries around the world. “The cost of inaction is huge,” he says.

Exposure to stunting and extreme poverty have been linked with lower cognitive and educational development, and ultimately, poorer health and a lower income in adulthood. Stunting is when a child’s height is below accepted growth standards, normally due to inadequate nutrition.

In 2010, 43 percent of children in low- and middle-income countries were at risk of poor development due to stunting and extreme poverty. In sub-Saharan Africa, the figure was 66 percent, in South Asia, 65 percent, and in the Caribbean and South America, 18 percent.

There is also a need for better nutrition for mothers and young children, mental health care for mothers, and strategies to protect children from violence and maltreatment.

While health services are well placed to reach children in at-risk populations, greater coordination is needed between sectors. Health, education, and social protection agencies should be working more closely together.

In a linked Comment, Dr. Margaret Chan, director general of the World Health Organization (WHO), Anthony Lake, executive director of the United Nations Children’s Fund (UNICEF), and Keith Hansen, vice president for human development at the World Bank note that not only children in low-income countries face these problems. In middle- and high-income countries, those growing up in disadvantaged households are also at risk.

They also call for stronger systems to be set up to help vulnerable communities to cope in the case of natural disasters, conflicts, violence, and fragility.

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