In many developing countries, young children suffer from profound delays in early cognitive development. Worldwide, at least 200 million children fail to achieve their cognitive potential.
This can seriously impair their success as adults, in part because investments in schooling will have low returns if children do not have adequate levels of cognitive and social skills before they enter school. Understanding the causes for these delays and identifying interventions that address these deficits are hence important priorities. Reasons for delayed cognitive development might be children’s inadequate access to nutritious foods, early stimulation, health care or a nurturing and safe home environment. These risk factors can in turn result from the many challenges poor households face to provide a nurturing environment for their young children, including lack of information or financial or human resources.
Conditional cash transfer (CCT) programmes, which have become the prime social safety net in many developing countries, are specifically designed to address many of these constraints simultaneously. They typically provide additional resources to mothers, impose specific conditions relating to attendance to preventive health-care visits and come with information and social marketing regarding investment in the nutrition and education of young children. While such programmes are now widespread in many low- and middle-income countries, they constituted an important innovation in social policy when they were first introduced. In 1997, the Governments of Mexico and Brazil more or less simultaneously decided to try a new approach to address faltering outcomes in education, health and nutrition. The innovation consisted of providing cash transfers directly to poor families to allow them to make the necessary investments, and to coax them into doing so through social marketing and by imposing conditionality. This contrasted with earlier approaches that often were more focused on service delivery and supply side constraints. To test the effectiveness of this new approach, the programme in Mexico incorporated a rigorous impact evaluation design, which made it possible to establish that it was indeed successful in improving educational, health and nutrition outcomes.
Evidence from poor rural Nicaragua further confirms that such programmes can also lead to sustainable gains in early childhood cognitive development. Atención a Crisis was a one-year cash transfer programme that provided poor households in 56 randomly selected communities with regular cash transfers. The beneficiaries were told that transfers were intended to improve the diversity and nutrient content of children’s diets and to buy school material. The impact of the programme was evaluated by comparing the children in those villages with 50 randomly selected control communities. The programme had positive effects on children’s language, short-term memory and social-personal skills – not only when measured during the programme, but also two years after households had stopped receiving benefits.
There was also a substantial effect on the use of various inputs into child development. Households randomly assigned to the programme changed the composition of food expenditures—spending a lower fraction on staples, and higher fractions on animal proteins, fruits and vegetables. Treated households had substantial increases in various measures of child stimulation—they were more likely to tell stories, sing to their children or read to them, and to have pen, paper and toys for children in the house. Their children were also more likely to have been weighed and to have received iron, vitamins or deworming medicine, and they spent fewer days in bed. Furthermore, two years after the programme ended, these households continued to show significant differences in these early childhood investments.
Hence temporary participation in the social safety net programme had an effect on behaviour even two years after the programme was discontinued. This in turn can help explain why programme impacts on cognitive development were also sustained. The lack of fade-out stands in contrast with evaluations of many other interventions, such as nutrition supplements or centre-based interventions that target the child directly. The evidence from Atención a Crisis suggests that parental behavioural changes might be important for obtaining lasting gains in childhood development, and that such behavioural change can be obtained through conditional cash transfer programmes.
“The programmes can benefit children very early in life.”
A second programme in a different part of rural Nicaragua provides further evidence on the potential of such interventions to have long-lasting effects, and also indicates the importance of assuring early coverage of vulnerable children and their parents by such safety nets. The Red de Protecciόn Social, was a conditional cash transfer programme that was randomly offered to 21 localities for three years, and then to another 21 random localities for the next three years. Children of the households living in those localities were tracked back 10 years after the start of the programme, and four years after it ended. This allows studying the long-term consequences of being protected by a social safety net very early in the young child’s life. The results show that improved nutrition and health care due to the programme during a boy’s first 1,000 days of life (from the beginning of pregnancy to the age of 2) had a lasting positive impact on cognitive development, measured by tests for memory, executive functioning and receptive vocabulary. And cognitive development of children who received the programme at later ages did not catch up entirely. Hence the results confirm the critical importance of reducing risk factors during the first 1,000-day window.
By directly targeting parental investment in their young children, conditional cash transfer programmes hold promise to sustainably improve early childhood cognition in vulnerable and poor populations. The benefits of such programmes can be particularly effective very early in a child’s life, indicating that it is important for social protection policies to target the 1,000-day window.