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Adversity as a dimension of equity: Pitfalls and practice

Mon, March 26, 11:30am to 1:00pm, Hilton Reforma, Floor: 2nd Floor, Don Diego 1 Section C


The effects of cumulative adversity have been studied in the United States and other developed countries through retrospective reporting such as the famous ACE Study (Felitti et al 1998). However, the literature surrounding the impact of adverse experiences in early childhood and in developing countries is sparse (Dong et al, 2004; Evans et al, 2013).

This presentation reviews Save the Children's work studying adversity in post-earthquake Nepal with a focus on the relationship adversity has with early childhood development, the challenges of measuring inherently abstract concepts, and the value an adversity index could have to ensuring programming is reaching the most deprived children. The following research questions are addressed:
1. How well did measures of adversity from developed contexts perform in the Nepali context in terms of their internal consistency and other psychometric properties?
2. What are the relationships between adversity and developmental outcomes over time in this context?
3. Are children of different gender, ethnic, and socio-economic statuses equally likely to experience childhood adversity?
4. How can data on adversity help organizations ensure that their programming is reaching the most deprived children?
The presentation features panel data from the previous two years from two programs being implemented in rural earthquake-effected districts of Nepal funded by UBS Optimus. One program is implementing and improving ECCD centers for children 4-6 and another program is delivering parental education sessions for parents of children 0-3 years old through village health workers. Data about children's developmental status was collected using Save the Children’s International Development and Early Learning Assessment (IDELA) tool for 4-6 year-old children and Harvard's Caregiver Reported Early Development Index (CREDI) for children aged 0-3 years old. Caregivers of both children were also asked about demographic information and given questions about the types of adverse events their children had experienced.

Dong M, Anda RF, Felitti, VJ, Dube SR, Williamson DF, Thompson TJ, Loo CM. Giles WH. The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse Negl. 2004;28(7):771–784.
Evans, Gary W.; Li, Dongping; Whipple, Sara Sepanski. Cumulative risk and child development. Psychological Bulletin, Vol 139(6), Nov 2013, 1342-1396
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. American Journal of Preventive Medicine 1998;14:245–258.


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