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      Who actually cares for children in slums? Why we need to think, and do, more about paid childcare in urbanizing sub-Saharan Africa

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          Abstract

          The early years are critical and inform the developmental trajectory of children. This is justifiably attracting growing policy attention. Much of this attention is focused on interventions and policies directed at parents, especially mothers. Yet emerging evidence suggests that increasing numbers of children in rapidly urbanizing low- and middle-income countries are now spending much of their day with other formal and informal childcare providers, including largely unregulated paid childcare providers. This paper summarizes the limited literature about the use of such paid childcare in low- and middle-income countries in sub-Saharan Africa, before considering possible reasons behind the lack of research evidence. Finally, key research gaps and their implications for public health practice are explored, with reference to the ongoing British Academy funded Nairobi Early Childcare in Slums research programme in Nairobi, Kenya. We argue that improving childcare may be an under-explored strategy to help some of the world's most disadvantaged children in the most important period of their lives, and that interventions in this largely informal market should be built on a rigorous research base.

          This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’.

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          Most cited references37

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          Early childhood development coming of age: science through the life course

          Early childhood development programmes vary in coordination and quality, with inadequate and inequitable access, especially for children younger than 3 years. New estimates, based on proxy measures of stunting and poverty, indicate that 250 million children (43%) younger than 5 years in low-income and middle-income countries are at risk of not reaching their developmental potential. There is therefore an urgent need to increase multisectoral coverage of quality programming that incorporates health, nutrition, security and safety, responsive caregiving, and early learning. Equitable early childhood policies and programmes are crucial for meeting Sustainable Development Goals, and for children to develop the intellectual skills, creativity, and wellbeing required to become healthy and productive adults. In this paper, the first in a three part Series on early childhood development, we examine recent scientific progress and global commitments to early childhood development. Research, programmes, and policies have advanced substantially since 2000, with new neuroscientific evidence linking early adversity and nurturing care with brain development and function throughout the life course.
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            Nurturing care: promoting early childhood development.

            The UN Sustainable Development Goals provide a historic opportunity to implement interventions, at scale, to promote early childhood development. Although the evidence base for the importance of early childhood development has grown, the research is distributed across sectors, populations, and settings, with diversity noted in both scope and focus. We provide a comprehensive updated analysis of early childhood development interventions across the five sectors of health, nutrition, education, child protection, and social protection. Our review concludes that to make interventions successful, smart, and sustainable, they need to be implemented as multi-sectoral intervention packages anchored in nurturing care. The recommendations emphasise that intervention packages should be applied at developmentally appropriate times during the life course, target multiple risks, and build on existing delivery platforms for feasibility of scale-up. While interventions will continue to improve with the growth of developmental science, the evidence now strongly suggests that parents, caregivers, and families need to be supported in providing nurturing care and protection in order for young children to achieve their developmental potential.
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              Investing in the foundation of sustainable development: pathways to scale up for early childhood development.

              Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.
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                Author and article information

                Contributors
                Journal
                Philos Trans R Soc Lond B Biol Sci
                Philos Trans R Soc Lond B Biol Sci
                RSTB
                royptb
                Philosophical Transactions of the Royal Society B: Biological Sciences
                The Royal Society
                0962-8436
                1471-2970
                June 21, 2021
                May 3, 2021
                May 3, 2021
                : 376
                : 1827 , Theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’ compiled and edited by Abigail E. Page, Emily H. Emmott and Sarah Myers
                : 20200430
                Affiliations
                [ 1 ]Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, , Keppel Street, London WC1E 7HT, UK
                [ 2 ]Maternal and Child Wellbeing Unit, African Population and Health Research Center, , Nairobi, Kenya
                [ 3 ]Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, , Newcastle upon Tyne, Tyne and Wear, UK
                [ 4 ]Epidemiology and Public Health, Institute of Global Health, University College London, , London, UK
                Author notes
                Author information
                http://orcid.org/0000-0002-1345-3063
                http://orcid.org/0000-0003-4206-9746
                http://orcid.org/0000-0003-1229-781X
                Article
                rstb20200430
                10.1098/rstb.2020.0430
                8090813
                33938281
                35796e47-c4e3-4419-b957-154ea0337476
                © 2021 The Authors.

                Published by the Royal Society under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, provided the original author and source are credited.

                History
                : January 28, 2021
                Funding
                Funded by: British Academy, http://dx.doi.org/10.13039/501100000286;
                Award ID: ECE190134
                Funded by: Echidna Giving;
                Award ID: n/a
                Categories
                1001
                87
                Part I: Understanding the Need for Mother-Infant Support
                Opinion Piece
                Custom metadata
                June 21, 2021

                Philosophy of science
                early childhood development,urban health,child health,childcare,nurturing care

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