Scaling Early Childhood Development – what to read this month | May 2025

Scaling Early Childhood Development – what to read this month is curated by Bet Caeyers (Lead Editor, Chr. Michelsen Institute), Meghan Taylor (Editor, Oxford Policy Management) and Daniel Munday (Editor, Oxford Policy Management) .

First up, The 2025 Report of the Lancet Countdown to 2030 for Women’s, Children’s, and Adolescents’ Health highlights progress in 2016–2022, despite global challenges like economic slowdown, conflicts and climate change. However, the pace of improvement is slower than previous decades and insufficient to meet 2030 SDG targets, especially in sub-Saharan Africa (see Figure 1, which shows that child, adolescent and maternal deaths are disproportionately concentrated in this region). Obesity rates have surged, and while some intervention coverage has improved (e.g. birth attendance), progress remains uneven. Routine data and rapid assessments have advanced, but donor-funded household surveys remain the primary source of nutrition and reproductive, maternal, newborn, child and adolescent health data due to weak civil registration systems. Slow progress continues in policy, health system strengthening (e.g. workforce) and financing. So, what now? The report lists five priority areas (see box on p. 1,507): targeting sub-Saharan Africa, strengthening health systems, safeguarding progress against crises, country-level investments in health information systems and creating a global narrative to uplift reproductive, maternal, newborn, child and adolescent health services.  

Figure 1: Distribution of global population, births, child and adolescent deaths, and maternal deaths, by region, 2020–22 Source: Amouzou, Barros, Requejo et al. (2025)

A newpaper by Siboyintore et al. investigates whether home-visiting parenting programmes aimed at reducing harsh discipline and improving family dynamics influence the temperament of younger siblings (aged under 3). The study, involving 247 siblings of children in Rwanda’s Sugira Muryango programme – which successfully decreased harsh discipline and family violence and improved the nurturing care environment and child development – found no significant impact on key child temperament traits like surgency, feelings of anger and distress, or ability to focus and regulate emotions. These negligible effects on child temperament are similar to other parenting studies that target caregivers rather than children directly  (e.g. Ward et al.2019 and Olds et al. 2010). The authors suggest that, to achieve greater impact, interventions should probably include more child-centred activities, booster sessions, and use objective temperament assessments. Whether this would make a difference would need to be tested.

Antonaccio et al. demonstrate how user-centred design can improve the usability and acceptability of an mHealth supervision tool for community health workers in rural Sierra Leone. By involving community health workers and supervisors as experts through focus groups, user testing sessions and exit interviews, the team aimed to create a mobile app that considers local challenges and boosts supervision quality and programme delivery. While the resulting tool was well received and easy to use, feedback also revealed issues with connectivity and phone charging as well as a need for better training. The study serves as a model for designing and implementing user-friendly mHealth solutions that address local challenges in resource-limited settings, to enhance engagement and scalability.

How do parents perceive a chatbot-based parenting intervention aimed at preventing intimate partner violence and promoting gender equity at scale? Schafer et al. explore parent experiences with ParentText,a digital tool based on the in-person Parenting for Lifelong Health programme in Jamaica and South Africa. Using automated messaging via WhatsApp, Telegram, Facebook messenger and SMS, ParentText offers a scalable solution. A previous formative quantitative pilot showed tentative but significant reductions in women´s experiences of intimate partner violence and men´s harmful attitudes towards it. This new qualitative study found the chatbox convenient and easy to use. It was especially valued by men for its anonymity, which encouraged open dialogue. Benefits cited include better communication, less conflict and shifts in workload division – though the authors suggest that changes in deeper gender beliefs may require combining one-way digital content with interactive in-person or virtual group sessions.

With limited evidence from LMICs on healthcare access for people with disabilities, Scherer et al.’s new qualitative paper from Zambia is a welcome contribution. Covering Lusaka, Chongwe and Kafue, they identified multiple barriers to equitable care: lack of understanding from healthcare workers, stigma, negative attitudes (‘They don’t see [people with disability] to be human beings’), inaccessible environments like rocky roads, communication issues for the deaf or hard of hearing, and the affordability or suitability of available services. So, what is the path forward? The team recommends a toolkit for change — better training for health professionals, accessible infrastructure, funding for support services like interpreters, and smarter health financing. They emphasise a participatory, multisectoral approach that actively involves people with disabilities, their families and caregivers, with particular attention to the intersecting challenges faced by female caregivers due to their child´s disability and gender-based health inequalities.

Editors Gaidhane et al. reflect on two recent article series that explore innovations in how we use information and embed it in sustainable systems to create large-scale impact for early childhood development (ECD). These series were inspired by the Measurement for Change (M4C) framework (here and here). The editors note that there is often too much emphasis on results – simply measuring change – rather than on the processes involved. When scaling up interventions, the focus tends to be on numbers and size, rather than on how well interventions are integrated into local systems and how to engage local actors. The authors suggest a shift in how we think about scaling ECD. Instead of primarily looking at quantitative results and effect sizes, they recommend considering local needs, collective decision making, and understanding how change actually happens. By exploring what factors support or hinder progress at the local level, we can gain a deeper understanding of how to achieve long-term, sustainable scaling of ECD programmes. This approach complements traditional measurements of effectiveness, offering a fuller picture of both process and outcome.

Zhang and Xue advocate for governments to fund large-scale longitudinal cohort studies from diverse populations, to accelerate developmental brain research. Big data are essential to answer complex questions about brain development, which involves genetic, social and environmental factors. Such research needs large samples, advanced analysis, and computing power to ensure reliable, reproducible results. Including diverse populations and tracking development over time improves validity and generalisability. While several large longitudinal cohort studies exist, most focus on European ancestry, limiting diversity. Projects such as China Child Brain Development, which follows 10,000 children under 12, aim to fill this gap. The authors emphasise that despite high costs, several challenges related to ECD could be tackled through an increased investment in big data and large-scale studies. These include identifying universal and culturally specific factors that impact cognitive development and educational outcomes, arising from urbanisation, lifestyle changes and culture, whereas smaller-scale studies may struggle to produce generalisable findings across large populations.  

On financing, Choudhary et al. conducted a cost-benefit analysis of a combined nutrition and parenting programme in India, targeting preconception, pregnancy and early childhood. Their goal was to help policymakers understand which programmes are worth expanding. The programme has already shown big health benefits, like a 24% drop in low birthweight babies and reductions in stunting and wasting by 49% and 32%. In this new study, the team looked at programme costs and calculated the returns on investment (see p. 4 for details on how they monetised the benefits). They found that for every dollar invested, the programme returned US$6.1 purchasing power parity (PPP) for preconception, US$9.9 PPP for pregnancy and early childhood, and US$3.7 PPP for the full package, compared to routine care. These positive results suggest that investing in an integrated maternal and child health programme is a good idea and worth considering for larger-scale implementation.

Many studies have looked at the positive impacts of ECD investments in sub-Saharan Africa, but Behrman and Vazquezare the first to study what happens if we do not invest in ECD in sub-Saharan Africa. They model the costs of inaction in three areas — early stimulation, nutrition and pre-primary programmes — by estimating the loss in adult earnings later in life. To do this, they discount and add up the potential future benefits of ECD programmes for a group of children, then subtract the total costs of the interventions. The results? Not implementing stunting programmes in Niger and Rwanda (which have high stunting rates) costs 2.8% and 2.7% of GDP, respectively. Not supporting universal pre-primary education across sub-Saharan Africa costs around 1.6% of GDP on average. And skipping home visits for children aged 3–5, who are not developmentally on track, costs about 2.6% of GDP. These numbers once again highlight how important it is to invest in ECD now.

Aivalli et al. undertook a systematic review to explore bottlenecks in intersectoral collaboration in the design and implementation of health policies in LMICs. They find that power struggles, especially between donors and recipients, often slow things down. Roles are unclear between donors and local groups working on multiple fronts, which creates power vacuums and makes it harder for everyone to participate equally. However, interventions with novel approaches to addressing power imbalances were identified and highlighted by the team as promising approaches to improve the use of intersectoral collaboration and the development of collaborative health policy interventions in LMICs. These include the use of pooled, multisectoral financing to reduce power asymmetries and foster local sustainable collaboration, and the development of informal interpersonal networks to support trust-building across local collaborative groups, to reduce power hierarchies and the marginalisation of some sectors.

And finally, a round-up of recent systematic reviews. Firstly on health and nutrition, Indravudh et al. examine studies looking at the impact of community-led strategies in disease prevention and management; Khan et al. review evidence on integrated nutrition interventions in conflict-afflicted areas; Bird et al. explore the impact of integrated interventions with child health and social support programmes. On parenting, Engelbrecht reviews integrated nutrition and stimulation interventions – focusing on nutrition education and behaviour change techniques. Finally, Moyo et al. produce a call to action to address violence against children early, highlighting its impacts on childhood and health.