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Changing the lives of very young children

Evidence from Rwanda

by Patricia Justino, Marinella Leone, Pierfrancesco Rolla, Monique Abimpaye

Globally, around 250 million children under the age of five do not meet key development milestones, which reduces their ability to reach their full potential. This column explores the evidence on what works to promote positive parenting practices, particularly in low-income contexts. The authors report on the encouraging outcomes of an intervention in Rwanda delivered by group-based village meetings and radio programs.

The first one thousand days of life have shown to be crucial in determining both the physiological development of young children and their future economic success. Promoting early childhood development can therefore improve prospects for the achievement of broader social goals, such as sustainable development.

A large body of scientific evidence confirms that parenting is one of the strongest influences on early childhood development. Up to the age of three, children’s entire world is typically restricted to their homes, where the majority of interactions are with their families. In recognition of this, there has been a recent push in international policy towards the implementation of training programs that focus on parents as key agents of change.

systematic review of research in this area, as well as recent empirical evidence, show that parents’ investments in and interactions with their children are key to better outcomes. At the same time, in a growing body of research on the economics of parenting, analysis has been modified to include parenting inputs as key elements in the production of children’s cognitive and non-cognitive skills.

Much of the existing evidence on early child development programs draws on interventions in advanced economies or middle-income developing countries with well-functioning welfare systems and far-reaching bureaucracies.

Evidence of the effects of early childhood parenting interventions in weaker institutional settings and among more vulnerable communities is limited – and knowledge about what interventions may work and can be scaled up in these challenging contexts is scarce.

This is especially true in sub-Saharan Africa where the same kinds of programs used in high-income countries may be more difficult to implement for a variety of reasons – including budget constraints, lower levels of infrastructure, and less access to technology.

Improving knowledge about parenting

In a recent study, we show that in contexts where literacy levels among parents are very low, improving knowledge about parenting and acting on this knowledge can change parents’ practices and improve child wellbeing.

Early years interventions have focused primarily on supporting pre- and post-natal nutrition and ensuring access to critical maternal healthcare. But there is growing recognition that just providing these basic requirements is not enough.

An emerging body of research on early childhood development programs explores the effects of large cash transfers or nutrition interventions combined with the provision of information to parents. This work highlights the crucial role of the information component of the various interventions.

Our study confirms its importance by varying the combination and intensity of the training and information provided to parents. Importantly, it does so in a poor remote area of sub-Saharan Africa, exploring whether interventions that change parental behavior can be implemented in environments with real constraints on budgets, technology, and social infrastructure.

We evaluate the short- and medium-term impact of a unique early childhood parenting program, which was designed with a combination of novel components, and implemented among some of the poorest communities in the world in Rwanda.

Introducing First Steps

With support from the British Academy, the Institute of Development Studies and Save the Children embarked on a partnership in 2019 to evaluate and scale-up a holistic program called First Steps. The results of the evaluation are here.

The objective of First Steps is to enhance the knowledge, attitudes, and practices of parents to support the cognitive, physical, and socio-emotional development of their children up to the age of three. It is offered in Ngororero, one of Rwanda’s poorest districts, through weekly community meetings guided by local facilitators that support peer learning, aided by a radio program.

Over 17 weeks, the meetings and radio program focused on promoting simple activities, such as playing and talking with children, singing songs or telling stories, providing love and attention, naming objects and counting, matching things, and preparing healthy meals.

To avoid resorting to what might be perceived as patronizing lectures on how to be a good parent, a maximum of 20 parents in each village were organized into discussion groups and listened to a radio program exploring children’s development and parenting practices developed by Save the Children.

Understanding the project’s effect

To analyze the impact of First Steps, the five-month intervention was randomly assigned to three groups, composed of 27 villages each. A ‘light touch’ group listened to a weekly radio session and received support from a trained local facilitator with a basic package of training materials.

In the ‘full intervention’ group, the weekly meetings were paired with a local facilitator with a full package of training materials, a children’s book given to each family, and the support of a salaried facilitator, who conducted home visits. The third group was a control group.

In both intervention groups, the program had a positive impact 12 months later on three outcomes: children’s development, the time that parents spent with their children, and parents’ confidence in supporting their children’s development. Two and a half years later, the effects on the ‘full intervention’ group persisted.

Scaling it up

Is such an intervention scalable nationally, in terms of value-for-money and effect over time?

The cost was modest as the program uses the radio, which is an accessible technology in Ngororero. This is an innovative feature of the program in a context where literacy rates are very low. To our knowledge, First Steps is the first program implemented as a ‘randomized controlled trial’ in which group meetings included a live radio listening component seamlessly woven into the core meeting activities and built around the curriculum.

Although we are unable to isolate the effect of the radio program on its own, the mounting evidence of the effectiveness of radio and other media to promote social change and development suggests that the radio component may have contributed significantly to the large program impact we find.

First Steps also takes advantage of economies of scale by gathering parents in groups with trained facilitators drawn from the local community, rather than relying on individual family visits by trained social workers. Group-based programs are often less expensive than home visits. They encourage peer-to-peer learning and support, and have the potential to modify group norms with respect to child-raising and education. But the evidence is still mixed, and our study suggests that group meetings should possibly be accompanied by some home visits.

In terms of effects over time, changes in parents’ practices persist after almost three years. This is important because evaluations of similar programs have shown that improving parenting practices are key for the success and long-term sustainability of early child development interventions. Moreover, the positive contribution to a child’s development up to the age of five has been well documented to have positive long-term consequences in terms of health, education, and professional career later in life.

While this is no magic cost-effective pill to solve the challenges involved in ensuring that children living in vulnerable contexts achieve their full potential, interventions like First Steps show how simple solutions such as a radio program and group meetings with parents can improve children’s lives for the better, even in the world’s poorest communities.

Based on the First Steps intervention, and consistent with what might be expected from previous research, even low-cost interventions in parents’ interactions with their children can have big effects. In fact, they may be more worthwhile in low-income settings where every dollar spent has to count.

 

The views expressed in this piece are those of the author(s), and do not necessarily reflect the views of the Institute or the United Nations University, nor the programme/project donors.

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