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Advancing Early Childhood Development: From Science to Scale


Location: Global

What we know already: There have been major improvements in child survival over the last 30 years. A major focus of the 2030 Sustainable Development Goals (SDGs) is now on early childhood development (ECD) to ensure that every child can achieve their full human potential.

What this article adds: The 2016 Lancet Series Advancing Early Childhood Development: From Science to Scale, has just been released. It estimates that 250 million (43%) of children under five years of age in low- and middle-income countries (LMICs) are at risk of poor development outcomes. Risks to health and wellbeing go beyond stunting and extreme poverty to include factors such as low maternal education and physical maltreatment. This Series highlights emerging scientific evidence and proposes pathways for implementation of ECD programmes at scale. ‘Nurturing care’ is emphasised, especially of children below three years of age, and multi-sector interventions starting with health.


The 2016 Lancet Series Advancing Early Childhood Development: From Science to Scale has just been released, comprised of six comments and five papers. Building on the findings and recommendations of the previous Lancet Series, this highlights new scientific evidence for interventions and recommends pathways for scaling up ECD programmes.

Focus of the 2030 Sustainable Development Goals (SDGs) is on early childhood development (ECD) to ensure that every child can achieve their full human potential. The first three years of life offer a window to amplify ECD interventions if stimulation through parenting, educational support and adequate health and nutrition are provided. Despite the decrease in child mortality over the past 30 years, the extremely high burden of risk for poor developmental outcomes remains, affecting an estimated 250 million (43%) of children under five years of age in low- and middle-income countries (LMICs). Sub-Saharan Africa’s burden is even greater, with two thirds of children affected. The burden of poor child development has been underestimated because risks to health and wellbeing go beyond stunting and extreme poverty to include factors such as low maternal education and physical maltreatment. Multi-sector policies and funding for ECD have increased, but few countries have institutionalised the implementation of these policies. Services for ECD remain fragmented and programmes at scale are rare and poorly evaluated.

This Series provides compelling new evidence in two areas. First, new research on early human development shows that adaptations (e.g. epigenetic and psychological) to the environment begin at conception and affect development throughout life, with implications for targeted interventions. Second, evidence is presented on long-term outcomes in LMICs. For example, a programme to increase cognitive development in stunted children in Jamaica 25 years ago resulted in a 25% increase in average adult earnings.

Key messages from the Series

The burden and cost of inaction is high

A poor start in life limits children’s abilities to benefit from education, resulting in lower productivity and social tensions. Consequences are inter-generational: poor ECD leads to a cycle of lost human capital and perpetuation of poverty for both the individual and future generations.

Predicted losses are 25% average adult income per year; nationally, this could mount to twice current GDP spend on health.

Early means early

Child development starts at conception and depends on good nutrition and certain types of experience. A young child’s developing brain is patterned by the ‘nurturing care’ of adults, including age-appropriate learning experiences. Many families cannot provide these due to stresses and conditions that affect their ability to parent, including extreme poverty and family and societal conflict. Families need support to provide nurturing care; e.g. material and financial resources, knowledge, time and skilled assistance. Support should be provided through policies such as paid parental leave, time at work for breastfeeding and the provision of free pre-primary education.

A start can be made through health

The health sector has unique advantages, since it has existing maternal and child health services that can be expanded to feasibly and affordably include evidence-based nurturing care interventions; most important are those strengthening the growth and health of mothers and young children. Other essential services are child protection for violence prevention, social protection for financial stability, and education for quality early-learning opportunities.

Scale up what we know works

Small-scale civil society initiatives can be scaled up to effective and sustainable national programmes. Government leadership and political prioritisation are prerequisites, but different pathways may be followed to achieve ECD targets, from staged enhancement of existing strategies to transformative, whole-government initiatives.

Overview of papers

Objectives of the first paper (Black et al, 2016) are to update the estimates of children at risk of not attaining their developmental potential and to present a life-course, conceptual ECD framework. The paper also examines current access to, and describes opportunities to implement,  centre-based and home-based cross-sector ECD programmes.

The second paper (Britto et al, 2016) provides a comprehensive, updated analysis of ECD interventions across the five sectors of health, nutrition, education, child protection and social protection.

The third paper (Richter et al, 2016) presents new analyses showing that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed with greater political prioritisation key to scale-up of available effective programmes to support ECD. All sectors, particularly health, education and social and child protection, must play a role to meet the holistic needs of young children.

The fourth paper (Shawar & Shiffman, 2016) describes multiple opportunities to advance political priority for ECD, including an increasingly favourable political environment, advances in ECD metrics, and the existence of compelling arguments for investment in ECD. However, proponents will need to overcome the framing and governance challenges to leverage these opportunities.

The fifth and final paper (Chunling et al, 2016) updates the 2004 estimates (published in 2007) of children exposed to stunting or extreme poverty with the use of improved data and methods and generated estimates for 2010. The 2007 study underestimated the number of children at risk of poor development. Progress has been made in reducing the number of children exposed to stunting or poverty, but it has been insufficient: targeted interventions are urgently needed.


Black MM, Walker SP, Fernald LCH, Andersen CT, DiGirolamo AM, Lu C, … Grantham-McGregor S (2016). Early childhood development coming of age: science through the life course. The Lancet. doi:10.1016/S0140-6736(16)31389-7

Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T … Bhutta ZA (2016). Nurturing care: promoting early childhood development. The Lancet. doi:10.1016/S0140-6736(16)31390-3

Chunling L, Black MM, Richter LM (2016). Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level. The Lancet. Doi:10.1016/S2214-109X(16)30266-2

Richter LM, Daelmans B, Lombardi J, Heymann J, Boo FL, Behrman JR, … Darmstadt GL (2016). Investing in the foundation of sustainable development: pathways to scale up for early childhood development. The Lancet. doi:10.1016/S0140-6736(16)31698-1

Shawar YR & Shiffman J (2016). Generation of global political priority for early childhood development: the challenges of framing and governance. The Lancet. doi:10.1016/S0140-6736(16)31574-4

The full Series (open access) is available online at




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Reference this page

Marie McGrath (2016). Advancing Early Childhood Development: From Science to Scale. Field Exchange 53, November 2016. p41.