from EVIDENCE to POLICY Learning what works for better programs and policies Updated May, 2014 77086 Jamaica: Can Disadvantaged Kids Ever Catch up with Better-Off Peers? EARLY CHILDHOOD DEVELOPMENT What’s the best way to help disadvantaged children The World Bank is focused on developing and sup- reach their potential? What do they need to succeed in porting programs that help children reach their poten- school, in work and in a family? How can they receive tial and live lives free of poverty. To help build a body the necessary build- of evidence of what works, the World Bank financed ing blocks for a happy an evaluation of a program in Jamaica that targeted and productive life, mothers of babies stunted due to malnutrition. The one free of poverty? mothers received either support and guidance on how For policymakers and to encourage their babies’ development through play development experts, and language, or nutritional supplements, or a com- the answers lie in early bination of the two. Twenty years later, the evaluation childhood develop- found that children that received the extra stimulation, ment, when children’s whether with nutritional supplements or not, were brains and bodies earning more money than similarly stunted babies are still developing. whose mothers received just nutritional supplements Proper healthcare, nu- or no intervention. These children whose mothers had trition, psychosocial received the extra guidance in stimulating their babies stimulation, and emotional support all play a role in giv- also were doing as well financially as the less disad- ing children the foundation they need to do well later on. vantaged (and non-stunted) children. This study, a But what happens after? Do programs designed to bolster rare look at the effects of early childhood intervention disadvantaged children’s cognitive, emotional and physi- over the decades, gives policymakers and development cal development really help over the long term? Or are experts tangible proof of the potential effects of early gains seen in the early years lost by adulthood? childhood development programs. Context The importance of early childhood development is well- less likely to do as well and more likely to drop out be- known. Children who don’t receive the proper nutri- fore graduating, hurting their chances to succeed later tion, stimulation, and emotional support in early years in life. Impact evaluations financed by the World Bank are more likely to lag behind more advantaged peers through the SIEF trust fund are helping build evidence even before they start school. Once in school, they are of what works to give poor children the same advantages as their better-off peers: For example, in Mozambique, Did you know… pre-schools were shown to be effective at boosting chil- 85 percent of the human brain is developed by age 5 dren’s emotional, cognitive, and physical readiness for 50 percent of a child’s cognitive capacity is influenced by environment school and getting them to start school at the right age. Evaluation In 1986-1987, a Jamaican study enrolled 129 children formula. To reduce the chances that the formula would aged 9-24 months who were living in poor neighbor- be shared with other family members, families also were hoods of the capital, Kingston. The children, who were given supplementary milk powder and cornmeal. all stunted based on height-for-age measurements, were Participants were surveyed at baseline, after two stratified by age and sex, and then split into four groups. years, and again at aged 7, 11, and 18. In 2007-2008, EARLY CHILDHOOD DEVELOPMENT One group received psychosocial stimulation, one group when the original participants were around 22 years received nutritional supplements, one received both, old, they were interviewed again. In the last survey, re- and the fourth group, the control group, received noth- searchers were able to find and interview 105 out of the ing. The treatment continued for two years. Children in original 129 stunted children in the program. all groups received access to free health care. During the When the study started, the research team identified two-year program, households in the psychosocial stim- a comparison group of 84 non-stunted children who ulation treatment group received weekly, hour-long vis- were from the same neighborhoods as those in the pro- its from trained community healthworkers, who taught gram. These children were deemed less disadvantaged mothers how to play educational games with their chil- based on a variety of measurements: they had taller dren and encouraged them to converse with their chil- mothers with higher vocabulary scores, higher birth dren. They also were encouraged to praise their children weights, larger head circumferences, and higher devel- and improve the self-esteem of the child. Homemade opmental scores on initial tests. At the 20-year mark, 65 toys were brought to each visit and exchanged the next out of 84 of the original non-stunted children were lo- week for other toys. Families that qualified for the nu- cated and surveyed. For more details on methods used, tritional supplement received one kilogram of fortified please see the full paper.* Findings Nearly 20 years after poor mothers were children whose families received nutritional supplements shown how to play and interact with their alone. In fact, they were doing so well that their earnings had children in ways that promote cognitive, caught up with earnings of their less-disadvantaged peers. physical, and emotional development, the gains were apparent. While giving mothers parenting support to aid early childhood development had a big impact, Children in this treatment group—stimulation or stimula- the nutritional supplements alone didn’t have tion plus nutritional supplements—had significantly higher any long-term effect. earnings as young adults than the control group, regardless of whether they held a part-time, full-time or permanent The supplements were designed to help offset nutritional de- job. They were doing equally better when compared with ficiencies that may have led to the stunting and contained 66 * Science 30 May 2014: 344 (6187), 998-1001. [DOI:10.1126/science.1251178]; and NBER Working Paper No. 19185. “Labor market returns to an early childhood stimulation intervention in Jamaica,” Paul Gertler, James Heckman, Rodrigo Pinto, Arianna Zanolini, Christel Vermeersch, Susan Walker, Susan M. Chang, Sally Grantham-McGregor. Issued in June 2013. percent of daily recommended calories and 100 percent of those taken to attend college. They were three times more daily recommended protein. Although families also received likely to have some college education and, at the time of extra milk powder and cornmeal, in hopes of minimizing the survey, they were twice as likely to still be in school sharing of the formula, the supplements were shared, diffus- and three times more likely to be a full-time student. ing their effect. But the follow-up surveys did not show that As was the case with earnings, the treatment group children in families that received nutritional supplements caught up with their less disadvantaged peers in edu- were doing any better than the control group. cation and socio-emotional skills, even though they didn’t completely catch up in cognitive skills. Children in the stimulation treatment groups earned more money than the control group and the group that received only nutritional supplements, even after the effect of relatively higher wages for those who had migrated was removed. They also managed to catch up to their non-stunted peers on earnings. The differences in earnings of children in the stimula- tion treatment groups compared with the control group were marked (because the nutritional supplement-only group didn’t show any long-term differences with the control group, the authors group both together). Average monthly lifetime earnings for young adults in permanent jobs (as opposed to temporary workers) were 25 percent higher than that of the control group and they had com- Courtesy of Susan Walker pletely caught up with the earnings of the non-stunted comparison group. Children in the study were also more likely to have emigrated to the U.S. or to Britain, which Children in the treatment group also were may have affected earnings (as described earlier). more educated and did better on cognitive tests, two areas that help with earnings. Compared with the control group, children in the treatment group were 10 percentage points more likely Young adults whose mothers received advice on how to have emigrated, according to the baseline sample. to interact with their children did much better based When only the follow-up sample is considered, the on tests of cognitive function than those in the control rate of migration was the same as that for the non- group—in fact, they did as well as children who were stunted children in the comparison group. Migration not stunted as babies. Based on an analysis of earlier clearly is a way to attain better earnings. surveys at age 18, the now-young adults scored higher on tests measuring cognitive abilities, including math, The treatment was designed to improve mother- reading, verbal skills, and socio-emotional skills, giv- child interaction during the critical early years. It ing them the tools needed for doing well in school, succeeded and that early success appears to be jobs, and relationships. the reason behind the gains later in life. These children—now young adults—had more schooling than the control group and did better on the Using the infant toddler HOME measure, which exams that students in Jamaica take in high school and relies on home observation of various activities re- lated to stimulation, including verbal engagement of control group, and had caught up that of the non- caregiver and availability of play materials, the treat- stunted group. ment intervention did raise scores. At baseline, the By ages 7 and 11, there was no difference between HOME score of the treatment and control groups the treatment and control groups in terms of home was the same, while the score of the stunted group environments and mother’s activities. Given the dif- was significantly lower than the non-stunted. At the ferences in earnings and education that appeared later end of the two-year treatment period, the HOME between the two groups, it appears that it’s the early score of the treatment group was higher than the childhood intervention that made an impact. EARLY CHILDHOOD DEVELOPMENT Conclusion A rare long-term study of the effects of an early child- For policymakers and development experts look- hood development program shows that children’s lives ing to improve people’s lives and reduce poverty, the can be improved by ensuring that they have the right message is clear: Parental training groups that engage stimulation and emotional support as babies and tod- mothers in activities to promote development can suc- dler. A simple, two year intervention gave children the ceed. What’s key is setting the framework for children foundation to develop the skills that allowed them to to receive the support and skills they need to succeed earn more later on, catching up even to their less dis- as students and young adults. As the Jamaica study advantaged peers. showed, the pay-off is forever. The Human Development Network, part of the World Bank Group, supports and disseminates research evaluating the impact of development projects to help alleviate poverty. The goal is to collect and build empirical evidence that can help governments and development organizations design and implement the most appropriate and effective policies for better educational, health and job opportunities for people in developing countries. For more information about who we are and what we do, go to: http://www.worldbank.org/sief. The Evidence to Policy note series is produced by SIEF with generous support from the British government’s Department for International Development. THE WORLD BANK, STRATEGIC IMPACT EVALUATION FUND 1818 H STREET, NW WASHINGTON, DC 20433 Produced by the Strategic Impact Evaluation Fund Series Editor: Aliza Marcus; Writer: Daphna Berman