In low-income and middle-income countries (LMICs), 181.9 million children – almost three quarters of all children aged three or four years old – currently do not have access to adequate nurturing care*, putting their healthy development at risk, estimates a new two paper Series published in The Lancet. Building on the foundation of the first 1,000 days of life (conception until two years old), the Series highlights how the ‘next 1,000 days’ (from aged two to aged five) is a crucial window of opportunity to provide nurturing care to children.
Currently, during the next 1,000 days, children are often not in direct regular contact with health or education services. Fewer than one in three children aged three or four years old attend early childhood care and education (ECCE) programs in LMICs, despite evidence they improve children’s healthy development. Children not involved in ECCE programs miss crucial nurturing care opportunities as approximately 80% of interventions to promote healthy development are taking place in ECCE settings which offer a platform to integrate annual screenings and growth monitoring, food assistance and nutrition supplements, and caregiver supports.
Authors of the Lancet Series on the next 1,000 days call for policymakers to increase investment in the next 1,000 days period – especially in LMICs – with a particular focus on increasing children’s access to high quality ECCE which should include adequately paid and trained teachers, reasonable teacher-student ratios, child-centered play, evidence-based curricula, and warm, stimulating, and responsive classroom interactions.
A new analysis as part of the Series shows providing one year of ECCE for all children would cost on average less than 0.15% of LMIC countries’ current gross domestic product. The potential benefits of providing these programs are on average 8–19 times larger than the cost of implementing them.
Authors also call for wider investment to ensure children in the next 1,000 days receive:
Co-chair of the Series, Dr Catherine Draper, University of the Witwatersrand, South Africa, said: “This Lancet series has brought together global researchers who share a passion for early childhood development, and were keen to profile the ‘next 1,000 days’ as a crucial stage of development, especially in low- and middle-income countries (LMICs). Children from LMICs not only need to feature more strongly in research on the next 1,000 days, but should also be receiving the care they need to thrive. This includes supporting caregivers of young children, and ensuring that they have access to high quality early care and education programs.”
Co-chair of the Series, Dr. Milagros Nores, Co-Director for Research and Associate Research Professor at the National Institute for Early Education Research (NIEER), said: “While early care and education have expanded globally, significant gaps remain in fully supporting our youngest. This Lancet Series highlights the challenges children face in the next 1,000 days, emphasizing how these shape their development—and how insufficient investments during this period come at a significant cost to societies. The series calls for robust investments in access to high-quality ECE programs, alongside aligned investments in health care, nutrition, and family supports.”
*Nurturing care is defined as the overall health, nutrition, security and safety, responsive care-giving and learning at an early age for every child.
The two Series papers and linked comment are available on the Lancet website (free to access once you make a free account on the lancet website):
Paper 1 – The next 1000 days: building on early investments for the health and development of young children will be available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01389-8/fulltext
Paper 2 – The cost of not investing in the next 1000 days: implications for policy and practice will be available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01390-4/fulltext
Comment – The first and next 1000 days: a continuum for child development in early life will be available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02439-5/fulltext
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