Wednesday, February 25, 2009

Threats to Child Development in Developing Countries

In 2007, The Lancet published a significant and influential series, Child Development in Developing Countries, which reviews research demonstrating (a) the failure in developing countries of over 200 million children under 5 years of age to achieve their developmental prospects, (b) the biological and psychosocial risks faced by these children living in extreme poverty, and (c) effective interventions which are as yet underutilized in countries where they are needed most.

The failures of children to reach their developmental potential in developing countries can be attributed to poverty and its correlates—poor health and nutrition and inadequate care results in “poor levels of cognition and education, both of which are linked to later earnings” (Grantham-McGregor, et al., 2007, p. 60). Grantham-McGregor, et al (2007) estimate that the percentage of children who are living in poverty and physically stunted in Sub-Saharan Africa, South Asia, and developing countries are 61%, 52% and 39%, respectively. These children will achieve fewer years of schooling and learn less per year than children in wealthy parts of the world, resulting in an estimated 19.8% deficit in adult yearly income. Poverty begets poverty, and this intergenerational transmission of poverty results growing numbers of citizens unable to become active contributors to improving their nation’s fragile development goals in the face of globalization. Most nations who are members of the United Nations have ratified the articles in the 1998 Convention on the Rights of the Child (Article 6: Survival and development) and their development goals are reflected in the 2000 UN Millennium Declaration; six of the latter’s eight goals are relevant to child development and meeting the articles of the UN’s Rights of the Child.

1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases

Both the World Health Organization (WHO) and UNICEF have since the UN Millennium Declaration made substantial financial contributions to support child development programs in developing countries, and progress has been made in the Education for All (EFA) Millennium Goal (EFA Global Monitoring Report, 2007). Yet the focus on young children’s early development has only recently come to the attention of global service organizations, to some degree incited by the 2007 Lancet series, and further verified by the 5th edition of the EFA Global Monitoring Report (2007).

“Poverty is not a distinct episode or state; rather, it is a conglomerate of conditions and events that create pervasive hardship and stress” and affects children through multiple mechanisms (Richter, 2003, p. 244). Poverty increases risk factors in children and their parents and support systems; protective factors for all three are less present than in the more affluent. According to South African research, Linda Richter, “risk factors accumulate and concentrate over time, and few opportunities are available for children in poverty to escape from these cumulative effects or to benefit from interventions that might ameliorate their impact” (Richter, 2003, p. 224).
Risk factors for poor child development under conditions of poverty identified in the few existing research publications can be distributed into two categories: biological and psychosocial risks (Walker, Wachs, Lozoff, Wasserman, et al., 2007). Excluding genetic factors, the biological risks are poor nutrition (low birth weight and stunting), iodine and iron deficiencies, vulnerabilities to infectious diseases, and environmental exposures (lead, arsenic, and pesticides in-utero) (Walker, et al., 2007). Psychosocial risks can be clustered into inadequate parenting factors and exposure to violence; studies have found the former to be consistently related to children’s cognitive and social-emotional competencies (Walker, 2007). The most reliable parenting characteristics associated with positive early developmental outcomes are cognitive stimulation and child learning opportunities, caregivers’ sensitivity and responsivity to the child, and maternal mood (depression) (Walker, 2007).

Tragically, many children growing up in developing countries are exposed to considerable levels of violence, whether in their homes or in their communities, and the likelihood of being exposed to violence is increased when there are disruptions in family cohesion or the mental health of primary caregivers (Walker, 2007). Most of the poorest nations are undergoing violent political unrest, civil wars, and violently oppressive governments, so the odds of children feeling unsafe in their communities or becoming victims of traumatic events are high. Further, the HIV/AIDS pandemic (more later) is decimating the working age adults in sub-Saharan Africa and south Asia, resulting in child-headed households that expose children to greater risk of becoming objects of violence or exploitation in order to survive. Another common outcome for children orphaned by AIDS is to live in grandmother-headed households; their grannies are typically beyond their wage-earning capabilities, which magnifies the degree of poverty experienced by family, leading to the inability to pay school fees, school drop-outs, delinquency, unemployment, etc.

The conditions of impoverished communities foment violence among members, whether due to the effects of drug and alcohol abuse on parents’ self-regulation skills and poor judgment in the care of their children, or due to the violence caused by delinquent youth, civil wars, and systematic government oppression. It is no stretch of the mind to come up with a list of international communities where violence has been the norm for long periods of time: Los Angeles, El Salvador, Guatemala, Columbia, Haiti, Afghanistan, Iraq, Palestine, Lebanon, Israel, Northern Ireland, Somalia, Rwanda, the Democratic Republic of Congo, Zimbabwe, Black South African townships, to name a few. Research on the effects of exposure to violence on children asks us to make a distinction between acute danger and chronic danger (Garbarino, 1993). Children’s recovery from acute danger requires a change in their conditions of life and new ways of understanding of life events; chronic danger, on the other hand, requires developmental adjustments that are likely to include “developmental impairment, physical damage, and emotional trauma, and will be socialized into a model of fear, violence, and hatred…” (Garbarino, 1993, p. 107). While the psychological availability and reassurance of parents and caregivers can improve children’s long-term prognosis after events of acute violnece, chronic violence in the community negatively impacts parents, whose own psychological resources are destabilized or destroyed (Garabino, 1993). For example, in Rwanda where there is a very high number of adolescent-headed households due to both AIDS and the genocide of 1994, the high levels of emotional suffering in young children are related to “high levels of depressive symptoms and social isolation” experienced by their heads of household (Boris, Thurman, Snider, Spencer, & Brown, 2006).

While there are yet few quality studies on the effectiveness of ECD interventions in the developing world, there are promising results in existing international examples. The most common interventions originate from health care and educational programs that monitor the growth and improve hygiene and health services, or offer child care in centers outside the home (Engle, et al., 2007). ECD programs are center-based, home-base, including parent training and parent-child support, and comprehensive (center & home-based care). According to Engle, et al. in the 3rd Lancet article (2007),

The most effective interventions are comprehensive programmes for younger and disadvantaged children and families that are of adequate duration, intensity, quality, and are integrated with health and nutrition services. Providing services directly to the children and including an active parenting and skill-building component is a more effective strategy than providing information alone. p. 239

The 2007 Lancet series on early child development in developing countries is a call to governments, NGOs and civil society is to step up the proliferation of effective and efficient early child development programs, bringing them to up to match the enormous scale of the problem (Engle, Black, Behrman, Cabral de Mello, Gertler, Kapiriri, Young, & the International Child Development Steering Group, 2007).

There is something a little too reassuring about the Lancet’s reports on research on early childhood development risks and interventions, with its emphasis on bringing specific, empirically researchable programs to scale in developing (aka, impoverished) countries. This illusion of confidence is based on the absence of any critique of the economic and political systems that create and perpetuate poverty and oppression. Omitted is any reference to the role of globalization, as global capitalism, in creating and maintaining economic hardship in some parts of the world. I will not tackle that here, except to say that the policies of the International Monetary Fund (IMF) and World Bank (WB) have led to the eroded the health care systems and increases in poverty in Africa (Hunter, 2003); the resulting lack of basic resources (food, clothing, water, sanitation, shelter, employment, access to health care, and lack of education) was fodder to the mushrooming AIDS pandemic.

The Lancet’s other omission is having given bare attention to the complex, gnarly and devastating repercussions from the mushrooming HIV/AIDS pandemic on the poorest regions of the globe. With the spread of the virus, most pre-existing family and community systems of the poor in developing countries have fallen apart, not only further diminishing the capabilities of parents to care for their young children, but removing parents from the equation altogether. AIDS is overwhelming children’s already overburdened communities as well as decimating the rolls of current and potential service providers, both professional and non-professional. For example, when Botswana finally was able to distribute antiretroviral treatments to its devastated citizens, there were no longer enough living adults in health care to administer the treatments.

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