Building a strong foundation Nurturing children in the first 1000 days

Zakiya Kurrien co-founded Centre for Learning Resources (CLR), Pune, in 1984, and is presently its Director Emerita. She has an M.A. in Education, USA. She has designed curricula, training programs, and varied materials in the ECCE and Primary Education domains. She is co-author of the ‘CLR Parent/Caregiver Education Package’ and has recently served on the National Task Force on ECCE.

Vikramshila: The first 1,000 days of a child’s life, which include pregnancy and the first two years after birth, are considered a critical window for ensuring optimal growth and development. Despite the importance of both the first 1,000 days and the pre-school years, there are often gaps in policies and programs designed to support children during these critical periods, especially 0-3 years.

How are families with young children currently being supported in terms of healthcare, nutrition and early development? Is the provision adequate? Are there any challenges or barriers that families face in accessing these services?

Zakiya Kurrien: That’s a very good place to begin, because one has to get a feel for the existing landscape first. In terms of catering to children in the first 1,000 days of their lives, there are various programs and schemes. The principal one amongst them being the Integrated Child Development Services (ICDS), offering six services.

There are also other schemes that directly or indirectly cater to children in this age group. In the health sector, we have the Reproductive and Child Health, the National Rural Health Mission, now Poshan Abhiyan, PM Surakshit Matritva Abhiyan, Bal Swasthya Karyakram, etc., which focus on providing healthcare and nutrition.

However, the coverage of these services falls short of the actual requirement. Another scheme is the Rajiv Gandhi National Creche Scheme. However, it needs further augmentation to effectively serve working mothers in vulnerable communities.

It is commonly understood that ICDS covers all children. However, in reality, it covers less than 50% of the children in this age group. The coverage is even lower in states like Bihar and Rajasthan. There are several barriers to overcome in accessing these services. Families in remote regions face difficulties due to factors such as long distances and inadequate presence of workers like ASHA workers.

One of the major barriers is that mothers carry multiple responsibilities, including household chores and childcare. They often also engage in daily wage labour in the unorganized sector. The gendered nature of caregiving places a significant burden on mothers, with minimal support from male family members.

Consequently, mothers bear the primary responsibility for accessing healthcare centres, taking their children for growth monitoring, and so on. These challenges and barriers highlight the existing gaps in services. There is a need for better accessibility and support for disadvantaged families with young children.

Vikramshila: Children from low-income families and marginalized groups are often at greater risk for poor outcomes during the first 1,000 days. How should programs aim to address these inequalities?

Zakiya Kurrien: I feel that for anyone concerned with children’s rights, it’s crucial to understand the extent of inequality and the level of developmental risks. You are certainly right that the disadvantaged need urgent and extra attention to bridge inequality.

The statistics are alarming. Around 25% of under-five years children belong to the poorest quintile of households in our country. Nearly 20% of the under-fives are undernourished. What I found staggering was that 90% of children aged 6 months to 2 years do not have an adequate diet. Obesity seems to be an epidemic among the wellto-do urban population. However, children in marginalized communities go hungry and suffer from stunting and wasting.

Furthermore, the first 1,000 days are extremely significant for human brain development and the capacity to learn. Needless to say good nutrition and healthcare impact cognitive outcomes. There’s also the importance of early mental and psychosocial stimulation. Global research has established that infant stimulation has a positive impact even on physical growth outcomes.

A survey conducted by our organization, Centre for Learning Resources (CLR), revealed that there was a total lack of understanding of this aspect in our rural and urban slum communities. There was no awareness that playing and talking to babies and toddlers was crucial to the development of their intelligence and ability to learn throughout life.

To bridge these inequalities, it is the government that has to play the major role. Universalizing ICDS is a must. Restructuring the scheme to provide direct services to children from birth to 3 years through creche facilities is overdue. This would enable mothers to have unfettered access to wage employment. It will also ensure that their children receive comprehensive care, including health, nutrition and stimulation. Mobile Creches and other successful models can provide technical support and guidance in this area. There is no dearth of knowledge and experience. However, it will require a much greater financial outlay on the government’s part.

Two parallel strategies are essential. One is the centre-based approach, where quality creche services can be provided. The other is as important and less expensive. It involves large-scale intensive family education programs, which focus on holistic childcare beyond health and nutrition. These programs should be specially designed and implemented to penetrate the most vulnerable communities.

Parents need to understand their role in holistic childcare and receive practical information on how to provide a nurturing environment in the home, including cognitive stimulation. Both centre-based services and home-based family education programs have the potential to bridge inequalities. However, we have a long way to go.

Vikramshila: Could you please share your experience in designing interventions that support the needs of children aged 0-3 years by giving parents and other caregivers in low-income family’s opportunities to learn about early child development and parenting skills?

Zakiya Kurrien: Up to the early 1990s, CLR’s focus was primarily on providing technical support, training and materials for ECE and primary education. However, as we became more aware of the growing global research in the neurosciences and its implications for education, we realized the importance of early brain development. We also learnt about the negative effects of undernutrition, iron deficiency, and lack of stimulation and social interaction on young children’s brain function.

I have already touched upon the survey we conducted to understand existing childcare practices. A very significant finding was that most parents believed that learning only begins when children go to school. We wanted to change this perception. So we used the slogan, “Learning Begins at Birth,” and designed a comprehensive Parent/Caregiver Education Package.

The CLR Package aimed to provide a holistic understanding of childcare. It integrates messages related to health, nutrition, social and emotional development, and stimulation for children aged from birth to 3 years. We developed modules that focused on creating a nurturing and stimulating home environment, while also providing basic knowledge about early child development.

Vikramshila: What strategies or approaches have been successful in the delivery of the CLR Program?

Zakiya Kurrien: When it came to delivering the program in villages and urban slums, a key aspect of our model was a locally recruited woman in each community who was trained to use the resources of the CLR Education Package. This helped her to engage with mothers, grandmothers and other caregivers through a conversational and interactive communication method. This fostered participation and addressed their concerns.

To validate the effectiveness of our approach and materials, to establish proof of concept, we undertook a 2-year action research. The results were very encouraging. These showed a significant increase in knowledge and positive attitudes among mothers and grandmothers, related to holistic childcare. However, engaging fathers was a challenging task. Although measuring behaviour change was more difficult, we gathered anecdotal evidence and observed several positive outcomes during surprise home-visits.

Since then, the program has been implemented by various NGOs and some government departments. It has undergone revisions to incorporate new insights and improve communication methods. Scaling it up remains a challenge, especially considering the need to address deep-rooted social norms and beliefs.

Digital devices and technology do offer potential for capacity building and training. However, I believe that there is no substitute for face-to-face interactions of caregivers with well-trained communicators. This is especially so, when the goal is to influence actual behaviour change towards responsive parenting.

Culture and context play a significant role in shaping the program’s effectiveness. It is essential to consider these factors. A onesize-fits-all approach may not be suitable. But we believe that a generic set of important messages, together with a tried-and-tested delivery model, needs to be made available which can then be contextualized.

Vikramshila: Very recently, MWCD has launched the Poshan Bhi Padhai Bhi Campaign. It has a considerable financial outlay. Can you elaborate on the challenges and limitations in the current governmental programs for holistic early childcare, specifically for children aged 0 to 3 years? What steps should the government prioritize to address these gaps?

Zakiya Kurrien: When I talked about programs for children aged 0 to 3, I mentioned two major types: centre-based creche services and intensive parent/ caregiver education covering all aspects of holistic childcare. If we look at Poshan Bhi Padhai Bhi, government is definitely allocating resources for nutrition, which does address the needs of children from birth to 3 years old.

The government’s commitment to meeting SDG goals related to physical growth of infants within the given timelines is commendable. However, there is a missing piece when it comes to government programs for holistic, nurturing childcare. While centre-based services do exist, they are not widely available. Home-based childcare interventions are sorely lacking.

Interestingly, just a few weeks ago, the Poshan Bhi Padhai Bhi Campaign was launched. It aims to transform Anganwadis into learning centres based on the recommendations of National Education Policy (NEP) 2020. The Ministry of Women and Child Development (MWCD) had convened a special Early Childhood Care and Education Task Force last year, of which I had the privilege of being a member.

The Task Force placed significant emphasis on the birth to 3 years age group. It also highlighted the need for creches and parent/ caregiver education through communication at the grassroots level.

The Padhai Bhi component focusing on preschool education for 3–5-year-olds is undoubtedly also a need of the hour. So I’m not belittling state efforts to provide quality preschool education. If Anganwadis can truly become vibrant learning environments, poor parents would be less likely to opt for lowquality, fee-charging schools. These don’t provide appropriate pre-school education.

But for the government, it can no longer be an either-or situation. Holistic early childcare has lifelong implications for individual development and the development of our nation’s human capital. Therefore, government needs to prioritize this aspect as well.

Vikramshila: How can partnerships be developed between different sectors (e.g., health, social services) to ensure that children aged 0-3 years and their families receive comprehensive and coordinated support?

Zakiya Kurrien: As I mentioned earlier, convergence needs to happen at the community level. However, it’s essential for the ministries and administrative leadership in different departments to come together, collaborate and ensure that convergence happens. Over the years, we have talked about it a lot. There have been pockets of success, particularly in the Health Department and the Ministry of Family and Child Welfare. There has been some progress in that the recent MWCD Task Force involved participation from the Education Ministry as well.

However, when it comes to the 0 to 3 years age group, there is still a lack of working together for the well-being of the child, not only within the system, but also among NGOs, panchayats and community members. It would be beneficial to establish an entity that focuses on reaching the child as a whole, bringing together different stakeholders. Community-based events that address the child’s health, nutrition, stimulation, and protection can serve as platforms for such convergence.

Vikramshila: What are the funding and resource needs for supporting children aged 0-3 years? How can resources be mobilized and allocated to ensure that young children receive the support they need to thrive?

Zakiya Kurrien: This is a difficult question to answer. In a nutshell, the funding needs are enormous. The allocations are grossly inadequate. Although, there have been sizeable outlays for nutrition in efforts to stem physical growth faltering. One thing to remember regarding financial provision is that you need data as to what is actually the position of young children in different parts of the country, in order to allocate even available funds appropriately.

We are severely constrained by the paucity of reliable data on the child. The data in the public domain on child development outcomes, impact of schemes, particularly at the state level, is sporadic. Without accurate data, it becomes difficult to inform policy decisions and allocate resources effectively. There is a certain invisibility of how bad the problem is for certain disadvantaged groups.

Another aspect to consider is the capacity of states to utilize the allocated resources. There is a lack of capacity in terms of human resources and other constraints, leading to under-utilization of budgets. Currently, the per child cost norm is insufficient, estimated at rupees 8 to 9 per day, under the ICDS alone.

To achieve the desired child development outcomes, the allocation of resources needs to be quadrupled, according to the report on the ‘State of the Young Child in India.’ Mobilizing resources requires political will and increased awareness at the highest levels of leadership, both political and administrative. Unfortunately, children often receive low priority in political considerations. It is crucial to raise awareness and build perspective among political and administrative leaders. I think that every Election Manifesto must include a greater focus on the social sector as a whole. Within it, care of our children during the first 1,000 days of their lives has to be prioritized.

Public-private partnerships can play a significant role in resource mobilization. Global funders, foundations, and corporate social responsibility (CSR) initiatives can contribute.

However, there is often a lack of awareness among corporates about the significance of the first 1,000 days, and the long term benefits of early child development. Engaging with child-focussed civil society organizations and creating platforms to interact with corporates on this issue, can help increase their allocations towards early childcare.

Lastly, the issue of measuring impact poses a challenge. Immediate and measurable outcomes are often favoured by funders. However, the well-researched, long-term impact of early child development, such as improved learning outcomes in school, success in high school due to responsive parenting during the first 1,000 days, the economic returns to the nation, etc., cannot be easily proven within a short project duration. It is necessary for funders to have a more nuanced understanding of impact. They have to also consider the long-term benefits that may not be immediately visible.

I would like to end with a quote relevant to our topic today. I think it was Nelson Mandela who said, “There can be no keener revelation of a society’s soul than the way in which it treats its children.”

Another writer, unfortunately I don’t have a name at this moment, has poetically expressed a thought that also resonates deeply with our discussions. Emphasizing the urgency of investing in our youngest children, she has written, “Many of the things we need can wait. The child cannot. Right now is the time his bones are being formed, his blood is being made, his mind is being developed. To him, we cannot answer ‘Tomorrow.’ His name is ‘Today.’”