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Resource centre on India's rural distress
 
 

Ensuring a healthy start to life -Zakiya Kurrien
-The Hindu


The first 1,000 days of life, between a woman's pregnancy and her child's second birthday, are critical for influencing lifelong health and intellectual development of the child

The Human Development Report (HDR) released in July 2014 made an important revelation: that India continues to be positioned at 135 in the ranking of 187 countries based on the Human Development Index, and has not moved from where it was positioned the previous year. This raises urgent questions regarding the efficacy of our development policies and programmes.

In a departure from previous HDRs, this year's document introduces an important concept, vulnerability, and considers it through a human development lens. In the case of life cycle vulnerabilities which are defined as threats that individuals face at different stages of their lives, the HDR lays great emphasis on early childhood as the most sensitive phase in the formation of life capabilities.

The first 1,000 days of life, between a woman's pregnancy and her child's second birthday, are recognised by child development professionals as the critical window of time for influencing lifelong health and intellectual development. India now has a National Early Childhood Care and Education (ECCE) Policy 2013 that lays down government's commitment to providing the comprehensive inputs necessary for the holistic development of all children below six years of age. But there is no holistic direction at the ground level in addressing developmental vulnerabilities, particularly at the critical sub-stage of age 0-3 years.

Our programmes related to this age group focus mainly on the stemming of malnutrition and under-nutrition. Almost half the children below five years of age are stunted in India - a staggering 60 million. They represent about one third of stunted children worldwide. Consequently, ensuring a healthy start to life has naturally meant prioritising adequate and appropriate nutrition - the critical building block for physical growth, brain development and a healthy immune system.

However, even in the case of nutrition, comprehensive inputs are still lacking. We know for instance that there are six low-cost nutrition interventions that are critical during the first 1,000 days: iron and folate, breastfeeding, appropriate complementary feeding, vitamin A, zinc and hygienic practices. It is estimated that these can be delivered at an extremely nominal cost per child. There is also evidence that concerted State-wide delivery can have significant impact, as in Maharashtra, where stunting in infants declined dramatically from 39 per cent in 2006 to 23 per cent in 2012. But political will and necessary budget allocations are sorely lacking. We target only "high burden" districts and have not come anywhere close to universal coverage.

Nurture over nature

In relation to the significance of the first 1,000 days in the formation of life capabilities, it is important to recognise that children will not reach their full potential through nutrition alone. There is ample evidence from research in the neurosciences that the development of the brain is dependent upon the stimulation he/she receives in early childhood. The argument between nature and nurture is over. Genetics and early experience play an equal part in shaping our cognitive abilities; though brain development continues through life, its pace is most rapid in the first few years.

The capacity to learn throughout life, and to have sufficient resilience, is an outcome of early synaptic connections in the brain. In fact, scientists point out that half of all potential for mental development is reached before the age of three. Psychosocial stimulation is hence the key to optimal brain development in early childhood. It consists of providing continuous opportunities to babies and toddlers, from birth onwards, to interact with caring adults who convey affection through warm, physical contact, and who spend time talking and playing with them.

Another relevant research finding is that interventions in early childhood which combine nutritional supplementation with psychosocial stimulation have a greater impact on both physical growth and cognitive development, compared to only nutritional inputs. Longitudinal studies have further established that stunted infants who received both nutrition and stimulation had significant benefits to cognition at the age of 11 and again at 17 years, while for those who received nutrition inputs alone, the cognitive benefits extended only to age seven.

It is not that Indians are oblivious to these findings. There have been seminars, conferences, policy briefs and committed advocacy on this issue. More significantly, as most children in the 0-3 age group are cared for within their families, there have been successful non-governmental organisation efforts from the 1990s onwards to design and deliver home-based caregiver education to disadvantaged families, integrating care messages on prenatal and child health, nutrition, and psychosocial stimulation.

International agencies like UNICEF continue to support certain NGO-government partnerships in this endeavour. However, all such interventions tend to remain discrete. Further what is lacking is clear conviction on the part of the government to implement at scale, and in a sustained way, programmes for holistic, home-based child care. This is in spite of pre-primary education for 3-6 years old children beginning to gain momentum.

A government committed to "Sab Ka Saath, Sab Ka Vikas" needs to have a deep appreciation of the fact that without adequate investment in the development of life capabilities during the first 1,000 days of millions of disadvantaged children, the development of our future human capital will be grossly compromised. This in turn will result in a continuation of the poverty cycle.

With the right commitment, however, there is hope. As Nobel Laureate James Heckman says: "Quality early childhood development can be an important contributor to a successful national economic development strategy."

(Zakiya Kurrien is former co-director of Centre for Learning Resources, Pune, and member, Alliance for the Right to Early Childhood Development.)