Early Childhood Development in India
Meena Cabral de Mello
GFMER Coordinator of Early Childhood Development
The annual cohort of newborns in India is about 27 million. Unfortunately, more than 1 million of these children die every year before their first birthday. Although reductions in infant and under five mortality have been impressive, India is unlikely to reach the MDG 4 unless rapid acceleration in program implementation takes place. Hunger and undernutrition in India is rampant with an estimated 48% stunted children. The situation is especially grim in 10 states which led Sh. ManMohan Singh, Prime Minister of India, to declare in November 2012 that this high rate of undernutrition is a national shame.
Among those who survive, a large proportion of children do not reach their developmental potential because of poverty, poor health, nutrition and lack of early stimulation. Spending one’s early years in an unstimulating, emotionally and physically unsupportive environment will affect brain development in adverse ways, and lead to cognitive, social and behavioural delays with life-long consequences. These disadvantaged children are likely to do poorly in school and subsequently have low incomes, high fertility, and provide poor care for their children, thus contributing to the perpetuation of poverty. As a result, India, stands to suffer an estimated 20% loss in adult productivity.
The science is clear - the first 1000 days after conception are the most important. Intervening within this period will have life long and life changing impacts on educational attainment, labour capacity, reproductive health and adult earnings. If we wait until a child is two years old the effects of undernutrition are already irreversible. (Victora CG et al in Maternal and Child Undernutrition: Consequences for Adult Health and Human Capital, Article 2 Lancet 371, 240-57)
The availability of ECD programmes and services to support children’s development during the early years is a crucial component of an overall strategy for reducing poverty and helping children achieve their full potential in life as well as for reducing risks for morbidity and mortality.
Policy and progam support in India
According to Dr Dinesh Paul, Director National Institute of Public Cooperation and Child Development (NIPCDD), India, over a period of time the Integrated Child Development Services Scheme (ICDS), which came into existence in 1975 in selected 33 community developmental blocks of the country, has expanded to 6506 operational projects in 2009 with more than 700,000 workers. This is a centrally sponsored and state administered nation-wide program and is probably the largest public initiative in the world to offer early childhood education and care services in an integrated way. The basic premise of the program is to meet holistically the early childhood education and care needs on a continuum basis and in an integrated way from the common platform of the Anganwadi Centre (AWC) using the Anganwadi Worker (AWW). However, the major limitation of ICDS has been that it has failed to reach and capitalize on the importance of early years (0-3 years). The programs have not focused on building the capacity of parents for assuring psychosocial stimulation and thus providing a conducive environment for child development at the household level.
The health sector in India has the capacity to play a unique role to promote ECD starting from pregnancy to the first three years of life. The National Rural Health Mission (NRHM) has expanded the opportunities available within the health sector by increasing availability of resources as well as new initiatives in the form of Accredited Social Health Activists (ASHA) and Village Health and Nutrition Days (VHND) in more than 600,000 villages in the country.
Maternal and Child Protection Card
The WHO growth standards for children have been endorsed by India along with a strategic framework for promoting early childhood development. In consultation with WHO and UNICEF, the Ministry of Health and Family Welfare (MOHFW) and Ministry of Women and Child Development (MOWCD) have jointly developed and launched the Mother and Child Protection Card (MCP Card). This new card, which is being used by ASHAs, AWWs and the nurses/midwives in the community, is a comprehensive tool to provide continuous care to the mother-child dyad from pregnancy to first three years. Apart from messages related to maternal and child health, this MCP card also has messages on nutrition and child development for different age bands. Thus, the MCP Card provides a common rallying point for promotion of Early Childhood Development.
Recognizing the huge potential for promoting ECD in India as well as various opportunities available through ICDS scheme and the initiatives under NRHM, the World Health Organization (WHO) has provided technical support to a project aiming to maximize successful implementation of the ECD component of the MCP card by working hand in hand with communities to help families ensure that children are given all chances to grow up healthy and develop to their full potential. The project builds on the integration/strengthening of ECD interventions utilizing opportunities available through the services being delivered through the programs of the Ministry of Health and Family Welfare, and the Ministry of Women and Child Development. Attention is focused on building skills of frontline workers, family caregivers and community groups for providing responsive care to improve the cognitive and psychosocial development of infants and young children. The interventions are delivered to all infants and young children up to 3 years of age but especially to those living in disadvantaged circumstances or suffering from malnutrition. This focus is based on the recent evidence published in the Lancet series which has underscored the value of interventions in this target group.
The pictures provided herein reflect scenes of daily life in the project communities. All images are clickable for larger versions.