Nurturing Care: Strategies to Achieve the Sustainable Development Goals

• In Event: 3-151 - Developmental Science and Pathways to Sustainable Early Childhood Development: Implications for UN Sustainable Development Goals

Integrative Statement

The United Nations is preparing for global equity and prosperity through 2030 with the Sustainable Development Goals (SDGs). At least 7 of the 17 goals are relevant to children, emphasizing the life-course perspective that forms the basis of developmental science. To reach their developmental potential, children require Nurturing Care, based on the bioecological model, which promotes health, nutrition, responsive caregiving, opportunities for learning and exploration, and protection from stress, violence, toxins, and infections.
Methods
In a recent investigation, we tested hypotheses that: 1) chronic undernutrition, marked by stunting, is negatively associated with changes in children’s development and 2) home environments characterized by nurturance and early learning opportunities are positively associated with changes in children’s development and attenuate negative associations with stunting. Data were from a randomized controlled trial of multiple micronutrient powders conducted in rural India among 829 infants and preschoolers that successfully reduced the prevalence of anemia, resulting in improvements to children’s development. Stunting was defined as length/height-for-age <-2 z-scores based on WHO standards, nurturance was assessed using the HOME Inventory, and child development was measured using Mullens Early Learning Scale. Linear mixed effects models accounting for repeated measures, clustering, and confounders were used to assess associations between stunting and changes in child development (infants: enrollment, 6- and 12-months; preschoolers: enrollment and 8-months). Moderating effects of nurturance were tested with interaction terms. Effect sizes were calculated by Cohen’s d.
Results
Stunting was negatively associated with changes in child development (d= -0.17-0.33) and nurturant home environment was positively associated with changes in multiple domains of child development (d=.18-.29), with no moderating effects, illustrating that a nurturant home did not attenuate the effects of stunting.
Implications
By demonstrating that changes in child development are negatively associated with stunting and positively associated with a nurturant home environment, this study supports the bioecological model. The Nurturing Care Framework is well suited as a central strategy for the success of the SDGs because it relies on an enabling environment that supports families; is based on sustainable systems of accountability that include monitoring, evaluation, and continuous quality improvement; and operates through country-specific policies and leadership. Although reaching developmental potential early in life illustrates the successful application of science into practice and increases the odds of success throughout life, early success cannot always protect children from past or subsequent adversities, as illustrated by the inability of the home environment to mitigate the effects of stunting. Children need Nurturing Care throughout early childhood, particularly during the preschool years when there is often a gap in services. Success in achieving the equity and universal prosperity for this generation and the next envisioned by the SDGs will require a citizenry and workforce with the capacity to address both technological and humanitarian issues. With a foundation in developmental science, strong supportive evidence, and necessary advances in a systems perspective, the Nurturing Care Framework is well positioned to increase the number of children reaching their developmental potential and to demonstrate advances of equity and universal prosperity in attainment of SDGs.

Authors

• Maureen M. Black, RTI International & University of Maryland School of Medicine
  Presenting Author

• Katherine A. Merseth, RTI International
  Non-Presenting Author