69992 Labor Markets and Youth Social Protection & Labor Policy Note June 2012 | Number 11 Highlight Early Childhood Economic crises Protecting and Promoting Human during pregnancy and early childhood can Development in Times of Economic Shocks1 have serious long- term consequences. Alice Wuermli, Kevin Hempel, Mattias Lundberg, Nutritional deficiencies Juliana Arbelaez2 and stress and mental D health issues during the evelopment from conception to five years of age can determine later life out- first few years starting comes ranging from educational achievement, labor market success, to risky and delinquent behaviors. Crises can cause nutritional deprivation which can with conception can lead negatively affect physiological and neurological development during gestation and to serious physical and infancy. This can have potentially serious physical and mental consequences. Crises can psychological problems, also cause stress and mental health issues of primary caregivers hampering the process of establishing secure attachment relationships and reducing stimulating interactions. some of which may not These factors are known to be key to the healthy development of socioemotional, behav- be reversible. A better ioral and cognitive competencies. Successful safety net programs will address not only understanding of human the resource constraints at the household level, but find ways to address the psycho- social aspects of economic hardship, strengthen the child-caregiver relationship, and developmental processes make sure that the program reaches the most vulnerable: women of child bearing age, provides useful entry especially pregnant women, and very young children and their caregivers. points for policies and programs. Context Economic crises can have serious implications for human development. Financial crises, at both the global and the national level, are ubiquitous. This raises concern about the human impacts of crises, especially among more vulnerable populations in develop- ing countries. This is particularly true during childhood and youth, when the brain is developing rapidly, and when socioemotional and behavioral development are at their peak. Given the cumulative nature of human development, shortfalls or setbacks at any stage of the life course—from the antenatal environment through adolescence—are often difficult to reverse later in life and may have severe consequences for individual develop- ment as well as for the growth and development of successful communities. Thus, it is essential to protect and promote human development in the face of adversity. 1 This Note is part of a three note series that summarizes findings from Lundberg, M. & Wuermli, A. (eds.) 2012. Children and Youth in Crisis: Protecting and Promoting Young People’s Development in Times of Economic shocks. Washington, DC: World Bank. 2 The authors wish to thank Davíd Robalino and Michael Weber for their invaluable collaboration and comments. 1 Policy Note: Labor Markets and Youth June 2012 | Number 11 Three interrelated concepts provide the foundation for including educational achievement, success in the labor market, understanding the potential impacts of shocks on children and healthy behaviors and choices. In particular, harm to physi- and youth. cal and neurological development and failure to establish secure attachments very early on may be difficult to reverse, and may ■ Timing: Human development is characterized by critical have high personal and social costs in the long run. periods of life during which certain investments must be made to facilitate the achievement of specific milestones Table 1 breaks down early childhood development into four in development, or stage salient developmental tasks. main periods and relates these periods to salient developmen- These age-related expectations for the mastery of particu- tal tasks that the developing child needs to master. During lar tasks provide benchmarks for the abilities that an in- early childhood mastery of developmental tasks tends to fol- dividual should ideally master by different ages, and that low this sequence relatively linearly due to common neurobio- are correlated with successful development and transition logical processes and development. to subsequent stages in life. Economic crises can disrupt a young person’s “normal� development by preventing or ■ From conception to birth, the child is undergoing rapid delaying the mastery of these developmental tasks at spe- physical and neurological development, which requires cific stages, which—if uncorrected—can have potential adequate nutrition and an otherwise healthy intra-uter- long term consequences. ine environment. ■ Context: Development in childhood and youth is in- ■ From birth to one year the infant develops attachment fluenced by diverse contexts or settings (family, peers, relationships to primary caregivers. Developing schools, communities, sociocultural belief systems, policy secure attachments, reliable relationships that provide regimes, and the economy). The relative importance of protection and comfort when in distress, provides a these settings changes during the lifecourse. Interactions secure base from which a child can explore and learn among these settings determine both the transmission about her environment3. of shocks, such as a financial crisis, to the young person’s ■ Feeling confident and secure, children from one to three immediate environment and the impact of the shock on years learn to explore and communicate. Many of the her development. As development is partly a function of a person’s repeated interactions with her immediate environment (the proximal processes of human develop- Table 1: ment), shocks can disrupt the contexts in which these Economic Crisis during Gestation and Early Childhood processes occur, and hinder a young person’s ability to develop successfully. Age Stage-salient De- Transmission (in years) velopmental Task Mechanisms ■ Transmission mechanisms: There are numerous pathways Concep- • Physical and • Malnutrition through which a crisis can affect the well-being and de- tion-birth neurological velopment of a young person. Crises may be experienced • Toxins development directly at the individual level (through e.g. a change in • Maternal stress and aspirations and identity), or indirectly through the family, mental health issues school, or other settings (through e.g. increased parental 0-1 • Physical and • Malnutrition stress, parental job loss, a reduction in publicly-provided neurological services). The developing person will experience crises development through the loss in income, but also through other chan- • Family dynamics and nels, such as psychological distress. The relevance of each • Establishing se- functioning, particular transmission mechanism varies depending cure attachment including parental on the life stage of the person as well as on the context. relationships and maternal time Different settings may provide protective factors that pre- 1-3 • Learning to and mental health vent, mitigate or attenuate negative impacts; these factors explore and can be a source of resilience, facilitating positive adaptive communicate behavior on the part of the developing person. 3-5 • Learning to self-regulate Effects of economic crises on fetal and thoughts, early childhood development behaviors and emotions The first few years of a person’s life, starting at conception, have been found to be of utmost importance for later-life outcomes, 3 Ainsworth, M. D. S. 1967. Infancy in Uganda: Infant Care and the Growth of Love. Baltimore, MD: Johns Hopkins University Press.; Bowlby, J. 1988. A Secure Base. New York, NY: Basic Books. 2 Social Protection & Labor | Human Development Network | The World Bank cognitive processes that enable children to communi- relationships with peers and teachers6. Delays in developing cate through language, to quantify and classify objects these competencies are related to lower academic achieve- in the world around them, to consider other people’s ment and lower socioeconomic outcomes in the long-run perspectives, and to distinguish cause from effect and including lower earnings, higher unemployment, and higher solve problems, all begin to emerge well before the age rates of delinquent behavior7. of three. ■ Between three and five years of age, children develop Policy Implications significant ability to self-regulate thoughts, behaviors, The importance of this stage of development for later life out- and emotions. Whereas during infancy and toddlerhood comes and the vulnerability to insults provides very concrete they seek emotional and behavioral support from their targeting guidelines. The spectrum of possible consequences caregivers, children must develop the ability to modu- arising from food and nutritional shortages during various late and control their thoughts, actions, and feelings by stages of gestation and for very young children indicates the themselves. These self-regulatory processes are inter- need to focus on pregnant women, or more generally women of related and include cognitive (planning, rule following, child-bearing age, and mothers with very young children. Fur- and focusing), behavioral (impulse control and activity thermore, interventions must address stress, mental health, and reduction), and emotional processes (management of family functioning. Given the importance of parenting, mother- excitement and anger). child (or caregiver-child) interactions and the family context for Economic crises can impair healthy fetal and early child- children’s socioemotional and cognitive development, programs hood development. There are two main pathways, or trans- should focus not only on the children themselves but also on the mission mechanisms, through which young children can be healthy functioning of the entire family. affected: (1) nutritional deficiencies and other health insults, During gestation and the early years, the mother and other and (2) family dynamics and functioning, including stress primary caregivers will be the main influences on the child’s de- and mental health (see Table 1). Insults during gestation and velopment. Policy will thus need to address the constraints and early childhood can lead to a range of measurable outcomes stresses produced and experienced in the immediate settings in at different stages of subsequent development4. Nutritional which these primary caregivers interact: The household, health deprivation and other health threats during pregnancy clinics and possibly day care. The transmission mechanisms can be measured in infant mortality, low birthweight, or identified above provide several nested points of entry, including even neurological developmental abnormalities (e.g. spina services provided by health clinics and day care, income sup- bifida, hydrocephalus) at birth, and in serious long-term port, and counseling and other psychosocial support services. consequences ranging from lower educational achievement and worse labor market outcomes, to severe psychological Health Care Services and Infrastructure. Government spend- disorders (e.g. schizophrenia, major affective and antisocial ing in developing countries tends to be procyclical. Poor people personality disorder). usually lack health insurance or access to other social insur- ance, while the need for health care services likely increases Once the child is born, depression or stress of the primary during a crisis period. It is important for countries to sustain or caregiver(s) may lead to emotional unavailability or incon- even scale up public health services, with particular emphasis sistency, hindering the formation of a secure attachment. on services to pregnant women and very young children. Secure attachment has also been related to the development of self-efficacy and competency5. Insecure attachment and Household Support Programs: Income and Counseling reduced intensity and frequency of positive interactions Services. Cash transfer programs can alleviate short-term can slow cognitive, socioemotional, and behavioral devel- resource constraints. Conditional cash transfers, while proven opment, including language and problem solving, and the successful in improving child outcomes, may not always be ability to self-regulate emotions, thoughts, and behaviors. feasible during crisis because of the increased constraints for Children with a strong capacity to self-regulate tend to be targeting and monitoring compliance. Public works, while better at focusing and sustaining their attention, better at a popular crisis response, may not be sufficient to ensure inhibiting emotional and aggressive behaviors, and more healthy child development if resources do not reach the child successful at forming and sustaining positive and supportive or mother. Broadening public works programs to include 4 For a more complete account see Tabel 6.2 in Wuermli, A., Hempel, K., Aber, L. & Lundberg, M. 2012. Policies to Protect and Promote Young People’s Development during Crisis. In Lundberg, M. & A. Wuermli (eds.), Children and Youth in Crisis: Protecting and Promoting Human Development in Times of Economic Shocks (ch. 6). Washington, DC: World Bank. 5 Carson, J., and R. D. Parke. 1996. “Reciprocal Negative Affect in Parent-Child Interactions and Children’s Peer Competency.� Child Development 67 (5): 2217–26. 6 Barkley, R. A. 1997. “Behavioral Inhibition, Sustained Attention, and Executive Functions: Constructing a Unifying Theory of ADHD.� Psychological Bulletin 121 (1): 65–94.; Gross, J. J., and J. P. Oliver. 2003. “Individual Differences in Two Emotion Regulation Processes: Implications for Affect, Relationships, and Well-Being.� Journal of Personality and Social Psychology 85 (2): 348–62. 7 Feinstein, L. 2003. “Inequality in the Early Cognitive Development of Children in the 1970 Cohort.� Economica 70 (277):73–97.; Schweinhart, L. J., H. V. Barnes, and D. P. Weikart. 1993. Significant Benefits: The High/Scope Perry Preschool Study through Age 27. Monographs of the High Scope Educational Research Foundation Series, no. 10. Ypsilanti, MI: High/Scope Press. 3 Policy Note: Labor Markets and Youth June 2012 | Number 11 public service tasks, flexible payment schemes, and provid- ing child care arrangements can make such programs more Case Study: Hardship, Depression, and Improving the appealing for women, as in the case of Argentina’s crisis Quality of Mother-Infant Relationships and Infant response program Jefes y Jefas8. Similarly, in order to comple- Attachment13 ment income support with child-focused elements, the Crisis Response program in Djibouti combined a public service Economic hardship and depression can reduce the intervention with a component addressing child malnutrition capacity of parents to provide sensitive and responsive through behavioral change in breast feeding practices9. parenting. Parenting interventions thus aim to improve parent-child interactions (responsive feeding, secure Alternatively, governments may choose to adopt in-kind or attachment, learning, reading, play, positive discipline other transfers to support nutrition and food consumption, etc.) that enable secure attachments and healthy devel- which have the advantage of focusing directly on nutrition, opment. freeing up income for other uses, and being generally under the control of women in the household10. They also may be An intervention in a peri-urban settlement of Khay- relatively easier to scale up in response to a crisis and to scale elitsha, South Africa randomly assigned 449 pregnant back afterward. However, evidence of their effectiveness in women to a treatment or control group. The treatment, maintaining children’s nutritional outcomes is mixed. Thus, provided by previously untrained community workers, specific micronutrient supplementation, for example during provided support and guidance in parenting, and con- pregnancy, may be particularly effective, as it is less likely to sisted of a total of 16 sessions in their homes starting be consumed by other household members. in late pregnancy and ending 6 months after birth. Provide support and guidance on parenting and care (see At both six and 12 months treatment mothers were case study). Since income is but one of the transmission significantly more sensitive and less intrusive in their mechanisms through which crises can affect fetal and early interactions with their infants. Infants in the treatment childhood development, policy makers may want to consider group had a significantly higher rate of secure attach- providing conflict resolution skills, parenting assistance, and ments at 18 months. Although there was no significant other psychosocial support to (expecting) parents in order change in the prevalence of maternal depressive disorder, to reduce intrahousehold conflict and stress and to maintain the intervention seems to have reduced the severity of positive family dynamics despite the hardship11. It may be maternal depressed mood at six months. most useful to incorporate parent-focused pre- and post- natal interventions into existing programs and services, such as the health care system or community services that engage clients face to face. Parenting interventions may be delivered via home visits, community groups, clinics, or media12, some of which may be much more cost-effective. Community- based programs can also foster a sense of belonging and sup- port, which can reduce perceived stress and improve family dynamics and parent-child interactions. 8 Galasso, E., and M. Ravallion, M. 2004. Social Protection in a Crisis: Argentina’s Plan Jefes y Jefas. World Bank Economic Review 18 (3): 367–99. 9 A rigorous evaluation is underway; Silva, J., Levin, V., Morgandi, M., Castaneda, T. and Cuevas, F. (forthcoming): Enhancing Social Safety Net’s Effectiveness in the MENA region, World Bank: Washington DC. 10 Rogers, B. L., and J. Coates. 2002. “Food-Based Safety Nets and Related Programs.� Social Protection Discussion Paper 0225, World Bank, Washington, DC. 11 See Engle et al. 2011 (Endnote 12) for a review of 15 parenting programs from around the world; also Al-Hassan, S. M., and J. E. Lansford. 2010. “Evaluation of the Better Parenting Programme in Jordan. Early Child Development and Care 181(5): 587–98. 12 Engle, P.L., Alderman, H., Behrman, J., et al. 2011. Strategies for Reducing Inequalities and Improving Developmental Outcomes for Young Children in Low- income and Middle-income Countries. Lancet, 378: 1339-53. 13 Cooper, P. J., Tomlinson, M., Swartz, L. et al. 2009. Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: Randomised Controlled Trial. British Medical Journal, 338:b974. The findings, interpretations, and conclusions expressed herein are those of the author(s), and do not necessarily reflect the views of the International Bank for Reconstruction and Development/The World Bank and its affiliated organizations, or those of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. For more 4 information, please visit www.worldbank.org/sp.