The First Twelve Years: Growing-Up in Low and Middle- Income Countries

November 2014

Paul Dornan

AGES: 1 5 8 12 15

YOU

NG

ER C

OH

ORT

Following 2,000 children

OLD

ER C

OH

ORT

Following 1,000 children

AGES: 8 12 15 19 22

Round 1 Round 2 Round 3 Round 4 Round 5 2002 2006 2009 2013 2016

Study design

2014

Same age children at different time points

Study that aims to:- improve understanding of the determinants and outcomes of childhood poverty - provide evidence to improve policies & practice

AGES: 1 5 8 12 15

YOU

NG

ER C

OH

ORT

Following 2,000 children

OLD

ER C

OH

ORT

Following 1,000 children

AGES: 8 12 15 19 22

Round 1 Round 2 Round 3 Round 4 Round 5 2002 2006 2009 2013 2016

Study design

2014

Same age children at different time points

Study that aims to:- improve understanding of the determinants and outcomes of childhood poverty - provide evidence to improve policies & practice

Two stories

Physical development, recovery and faltering-> Early investment is best, but understanding risks of faltering and potential of recovery

Dominant role of the school-> widening or narrowing learning gaps?-> Potential of school to integrate policy for children?

Underpinning all of this – life course understandings of how inequalities develop -> implications for SDGs and reaching most marginalised.

Physical development

• Child stunting caused by early (chronic) under-nutrition, with long term consequences for health and skill development

• High levels of stunting, concentrated among the poorest households. During infancy, poorest third of households across Young Lives samples typically have twice the risk of being stunted

High rates of stunting. Poorest have much the highest rates

Poorest th

ird

Scheduled Trib

eRural

Backw

ard Clas

ses

Scheduled Cast

e

Least

poor third

Other C

astes

Urban

0

5

10

15

20

25

30

35

40

45

20062013

% o

f 12

year

old

s st

unte

d

Data from Andhra Pradesh, India

Physical development

• Child stunting caused by early (chronic) under-nutrition, with long term consequences for health and skill development

• High levels of stunting, concentrated among the poorest households. During infancy, poorest third of households across Young Lives samples typically have twice the risk of being stunted

• But – height trajectories not totally ‘fixed’ infancy, there is change later on and that change is itself associated with learning gains

Stunting status in infancy

Ethiopia Andhra Pradesh

Peru Vietnam0

102030405060708090

100

Not stuntedStunted

Lundeen et al (2013) ‘Growth faltering and recovery in children aged 1-8 years in four low – and middle income countries: Young Lives’, Public Health Nutrition

Same status by 5 years?

Ethiopia Andhra Pradesh

Peru Vietnam0

102030405060708090

100

Not stuntedStunted

Lundeen et al (2013) ‘Growth faltering and recovery in children aged 1-8 years in four low – and middle income countries: Young Lives’, Public Health Nutrition

But considerable change in development indicators beyond the very earliest period of life

Example: change in height for age status between 1 year and 5 years, Vietnam

Lundeen et al (2013) ‘Growth faltering and recovery in children aged 1-8 years in four low – and middle income countries: Young Lives’, Public Health Nutrition

Early stunting has profound long term consequences, but there is change in height

status post infancy

Stunted at 1 Not stunted at 1 0

10

20

30

40

50

60

70

80

90

100Not stunted at 5Stunted at 5

Recovered

Faltered

Why?

Factors which seem important –• Mothers height• Household socio-

economic status• Policy – school

feeding programmes• Infrastructure

Foundations of later learning

• Key role of schooling as key institution in MDGs/ SDGs. Assumptions of opening up later opportunities

Dominant role of school in children’s lives

Age 5 Age 8 Age 12 Age 15 Age 190

2

4

6

8

10

12

14

16

18

Own time

Study

Education

Paid work

Unpaid work

Hours per day

Girls and young women, Ethiopia

Reported time-use in a typical day

Dominant role of school in children’s lives

Age 5 Age 8 Age 12 Age 15 Age 190

2

4

6

8

10

12

14

16

18

Own time

Study

Education

Paid work

Unpaid work

Hours per day

Girls and young women, Ethiopia

Reported time-use in a typical day

And impact of schooling?• Many of the gaps well in place before children

enter school, but widen after depending on the impact of school system

• Different patterns of overall learning and learning inequities depending on the school system:

->Vietnam, high performer and more equalising-> Andhra Pradesh, low performer and widening gaps

Conclusion (a) Critical foundational role of early childhood(b) Greater focus on school effectiveness for learning(c) Capitalising on school for other policy purposes

Conclusions for SDGs1. Children at particularly high risk of poverty. Childhood

as key opportunity to intervene to reduce transmission of inequalities

-> reach of social protection for households with children-> effectiveness of basic services and schooling

2. Pre-birth and early childhood foundational stage, but not only the very early years – capitalizing on later change also

3. Cohort analysis tends to show accumulating disadvantages over the early life course. ‘Lifecourse’ policy approaches – prevention plus recurrent investment as children grow up.

Thank you