Early Childhood Development for the Poor: Evaluating the Impacts in India

The first three years of life are critical for the healthy development of the brain. Unfortunately, during these early years, children are especially vulnerable to the harm caused by malnutrition, illnesses and other problems, most of which are linked directly to poverty. This evaluation seeks to assess cost-effective means for addressing these problems through stimulation and nutrition, building on what has been learned in the long-term follow-up of the Jamaica child stimulation evaluation and through a similarly structured SIEF-supported evaluation in Colombia. Together, the evidence from these evaluations are providing policymakers with evidence of how to design programs that can improve child development during the critical early years.

Context

Poverty rates in Odisha, a state on the Bay of Bengal in eastern India, are among the highest in the country. About two thirds of people there live in poverty and half of young children are stunted by age two. This evaluation will provide the government with evidence on the impact of different approaches for improving child development by encouraging mothers to play and talk to their young children and through better nutrition. Pratham, the country’s largest non-governmental organization focusing on early education programs, will implement the program. The program has been designed in such a way that it could be brought to scale through India’s existing Integrated Child Development Service, which currently provides nutritional assistance to children through age six and part time children’s centers for those aged three to six. 

Intervention and Evaluation Details

Intervention

Specially trained local women will provide child stimulation and nutrition education to poor, rural families who have children aged 9 to 15 months old at the start of the intervention. Similar to the program in Jamaica – where children showed big cognitive gains years after their mothers were taught how to stimulate them through play and talk – mothers will be encouraged to praise and play with their children, and they will be given home-made toys and puzzles to promote interaction. In addition, families will be counseled on good nutrition, and this will be evaluated on its own and in conjunction with the stimulation program. All families, whether in the treatment or control groups, will also be included in a program to strengthen links between families and existing social services offered by the national existing Integrated Child Development Service. This will create a baseline where the current policy framework is well understood and taken up.

Evaluation

There are three treatment arms and one control group. The treatment arms are:

1. Nutrition education
   Local women hired and trained will visit homes every other month to deliver the nutritional education curriculum, which will be designed to produce positive changes in food choice, preparation and storage.
2. Nutrition education combined with stimulation via home visiting
   In addition to the nutrition visits, local women who are hired and trained in child stimulation will make weekly visits to deliver the stimulation curriculum and involve mother and child in play and learning activities.
3. Nutrition education combined with stimulation via group intervention
   Instead of home visits to encourage stimulation, a trained local woman will hold a weekly group meeting for a maximum of seven mothers and their children. This is likely a cheaper way to deliver the stimulation program, but it may also pose problems because mothers won’t be getting one-on-one attention and children and their mothers may get distracted by being in a group.

Each treatment arm will be implemented in 45 villages in Odisha. There will also be 90 villages that will serve as controls and where none of the programs will be implemented. All families with a child in the age range 9-15 months will be recruited for the study, for an estimated total of 1,688 families, of which about 675 will be in the control group. In each village, four families with children just outside the 9-15 month window will be randomly chosen to measure possible spillover effects. These will add another 900 families to the evaluation.

A baseline survey will be conducted at the beginning of the program, with follow-up surveys after one year and two years. The effort will collect a range of data on the children’s health and developmental progress, as well as household behavior and practices.

Policy Impact

The analysis of this evaluation will help identify program components that are most effective in producing meaningful impact. In addition, the evaluation will highlight whether any changes in household behavior and practices are spread evenly throughout the program or clustered in either the first or second year. The result will help India and other countries facing similar situations to draft developmental policies that are cost-effective and deliver the greatest results.