Nurturing Care for Children Living in Humanitarian Settings

THEMATIC BRIEF

Nurturing care for children living in humanitarian settings

What is nurturing care?

What happens during early childhood (pregnancy to age 8) lays the foundation for a lifetime. We have made great strides in improving child survival, but we also need to create the conditions to help children thrive as they grow and develop. This requires providing children with nurturing care, especially in the earliest years (pregnancy to age 3). Nurturing care comprises of five interrelated and indivisible components: good health, adequate nutrition, safety and security, responsive caregiving and opportunities for early learning. Nurturing care protects children from the worst effects of adversity and produces lifelong and intergenerational benefits for health, Why is nurturing of displacement and conflict. productivity and social cohesion. When children are deprived of Nurturing care happens when we care important in opportunities to develop, the maximize every interaction with a ability of families, communities and humanitarian settings? child. Every moment, small or large, economies to flourish is limited. structured or unstructured, is an More than 29 million children were opportunity to ensure children are born into conflict-affected areas healthy, receive nutritious food, are in 2018 (2). Young children in these The early years in a child’s safe and learning about themselves, situations face compounded risks to others and their world. What we life are critical in building their development stemming from do matters, but how we do it a foundation for optimal a continuum of experiences which matters more. development through a stable may include forced displacement, and nurturing environment, migration and resettlement in a new setting, such as a refugee This brief summarizes actions as described in the Nurturing camp, or integration within host that programme planners and Care Framework (1). communities. These experiences implementers should take are likely to result in mothers, to minimize the impact that However, infants and young infants and young children having emergencies have on the lives of children in humanitarian settings limited access to preventive and young children and their families. It face massive challenges to survive curative health services; high risk calls upon all relevant stakeholders and, even more so, to thrive. As the for malnutrition; elevated levels of to invest in evidence-based policies number of crisis-affected people insecurity, violence and stress; and and interventions that have been continues to rise, so does the other potential effects arising from shown to build resilience and proportion of future generations socioeconomic adversity mitigate the harmful effects who experience the severe distress or extreme poverty. of emergencies.

01 Photo credit: © UNICEF/UNI337473 Defining ‘emergencies’ What are the nurturing The needs of women and children affected by emergencies have reached care components? an unprecedented scale. An emergency is defined as a humanitarian crisis in a country, region or society demanding decisions and follow-up in terms of extraordinary measures that exceed the ability of the affected community or society to cope using its own resources, and therefore requiring urgent GOOD HEALTH action to save lives as well as prevent additional morbidity and mortality. An emergency may be caused by conflict; disease outbreaks (such as Refers to health and well-being of COVID-19); or other events, such as massive food contamination, chemical the children and their caregivers. or radionuclear spills, extreme weather and geological events. The Why both? We know that the emergency may be of varying length and severity, and the situation physical and mental health of may change from day to day. It’s therefore that we use the phrase caregivers can affect their ability humanitarian settings to express the variety of circumstances that affect to care for the child. families and young children who are confronted with an emergency.

ADEQUATE Key facts and best To meet these different needs, NUTRITION services should include a mix of practices interventions of different intensity Refers to maternal and child The disruption of essential services (see Table). Attention to children nutrition. Why both? We know that can be severely detrimental to with developmental difficulties and the nutritional status of the mother young children and their families. disabilities is particularly important, during pregnancy affects her Morbidity and mortality rates as they are often the least likely to health and well-being and that for children under 5 years of age receive appropriate care. Provision of her unborn child. After birth, among crisis-affected populations of interventions may also differ at the mother’s nutritional status may be as high as twenty times the onset of a crisis versus during a affects her ability to provide that of children living in less fragile protracted crisis. adequate care to her young child. contexts (3). And when children When attention is paid to meeting do survive, an estimated 43% of the developmental needs of children, under 5s in low- and middle-income populations will build resilience SAFETY AND countries—inclusive of humanitarian against adversity and strengthen SECURITY contexts—are at risk of not reaching their ability to achieve their full Refers to safe and secure their developmental potential (4). human potential. Investing in early environments for children and their For parents and caregivers in conflict childhood development programmes families. Includes physical dangers, settings there is an increased risk of in the uncertainty and instability of emotional stress, environmental mental health challenges, including protracted crises and displacement anxiety and depression, paired risks (e.g., pollution), and access lays a foundation for life-long success to food and water. with a lack of support services and resilience, social cohesion, and (5-8). These effects have been linked sustainable and peaceful societies to a reduced capacity to provide (13-17). Prioritization of responsive consistent, responsive care, a caregiving ensures that parents and OPPORTUNITIES FOR paramount component of any child’s caregivers provide the necessary EARLY LEARNING health and development (9-11). forms of intervention, helping to Refers to any opportunity for the formulate long-term buffers from Reflective of these challenges, an infant or child to interact with a conflict and crisis. On a macro scale, integrated set of crisis-sensitive person, place, or object in their investments in early childhood services across health, nutrition, environment. Recognizes that every development can produce up to education, sanitation and child interaction (positive or negative) 13% return per year by improving protection sectors is needed. These or absence of an interaction is health, growth and development services must be designed, planned contributing to the child’s brain outcomes, and boosting learning and costed to be adaptable when development and laying the and productivity in later life, thereby responding to emergencies, starting foundation for later learning. during pregnancy and continuing improving social cohesion and the throughout a young child’s life. In prosperity of nations (13). order to maximize the well-being To advance well-being and RESPONSIVE of children, humanitarian response reduce inequities around the CAREGIVING must also adopt a multi-generational world, leadership is needed to approach that allows for ‘caring for drive early childhood development Refers to the ability of the caregiver the caregivers’. Some families will in emergencies. Global and to notice, understand, and respond need only limited assistance while national stakeholders should come to their child’s signals in a timely others will require intensive support, together behind a comprehensive and appropriate manner. especially when they are affected by approach for preparedness Considered the foundational significant trauma as well as basic and response, requiring robust component because responsive health and survival issues. investments and continued caregivers are better able to prioritization across development support the other four components. and humanitarian settings. 02 Table. Examples of interventions according to different levels of implementation intensity

SERVICE/ LOW-INTENSITY MEDIUM-INTENSITY HIGH-INTENSITY PROGRAMME (UNIVERSAL SUPPORT) (TARGETED SUPPORT) (INDICATED SUPPORT) TARGET

Interventions Key messages focused on Parenting support groups Intensive home visiting, for caregivers responsive caregiving, early that include a focus on typically conducted weekly and families learning and caregivers’ responsive caregiving, early or bi-weekly for at least mental health. Delivered learning and caregivers’ 6 months to one year. through in-person mental health. Visits include psychosocial interactions, telehealth, support for caregivers, Integration of early digital messages, text guidance on responsive childhood development messages, phone calls, caregiving, and tailored support within existing pamphlets, posters or support for early learning caregiver groups, such as other media. Distributed activities depending on the mother-to-mother feeding at registration points, child’s developmental stage support groups, parent distribution centres, health and abilities. committees and others. clinics, community centres Individual or small group and other safe spaces. support for caregivers Mass media content with disabilities or (television, radio, etc.) substantive health issues designed to promote early such as HIV, and adolescent childhood development caregivers to provide more through culturally-relevant, intensive help. engaging content. Content may include modelling of responsive caregiving behaviours.

Interventions Early learning kits Safe play and learning Individual or small group for children including culturally relevant spaces can be established intensive support for and developmentally within existing community children with disabilities appropriate local toys, buildings, waiting areas, such as occupational books and games that can safe and secure outdoor therapy, psychologists be combined with existing spaces and other safe and social workers where food or non-food item places. These can range available. distributions, and cash from low-intensity self- Individual or small group transfer programmes. guided experiences in support for children and/ which children engage Mass media content or caregivers experiencing (such as in waiting areas) (television, radio, etc.) high levels of stress or to more intensive child designed to engage young recovering from traumatic care settings with trained children in play and early experiences, delivered facilitators. learning activities. by trained mental health Pre-schools/child care professionals or para-

services can be established professionals. in tents, vacant classrooms and other safe community spaces where children engage in developmentally appropriate play and learning activities with trained facilitators/ teachers.

03 of information on how much countries spend on early childhood development. Ultimately, early childhood development falls through the cracks of international and national responses during emergencies.

What can be done? As per the Nurturing Care Framework (1) and the recent World Health Organization Guideline: improving early childhood development (20), the following recommendations apply to all settings, including in emergencies:

1 All infants and children should receive responsive care during the first 3 years of life; parents and other caregivers should be supported to provide responsive care.

2 All infants and children should Sub-optimal standards According to a recent analysis of have early learning activities with the most common humanitarian their parents and other caregivers and insufficient standards, responses do address the during the first 3 years of life; investment for early nutrition, health, safety and learning parents and other caregivers should childhood development needs of young children. However, be supported to engage in early no one set of standards provides learning with their infants and in humanitarian settings comprehensive guidance on all children. of these areas, and there is little attention to responsive caregiving 3 Support for responsive care and and early learning activities for early learning should be included children, especially those under as part of interventions for optimal All too often, the needs the age of 3 (12). An analysis of nutrition of infants and young humanitarian response plans in 2018 of children and their children. caregivers are not prioritized showed that only 58% mentioned nutrition interventions, fewer than or comprehensively included 25% mentioned safety and security 4 Psychosocial interventions to when it comes to directing or health interventions, and even support maternal mental health investments in response to fewer mentioned interventions to should be integrated into early global crises. Humanitarian support responsive caregiving or childhood health and development early learning (13). services. standards (which outline the As relates to financing, less than essential elements and best These recommendations remain the 3% of US$ 75.8 billion, or US$ 2.5 same in humanitarian settings, but practices for high-quality billion, of overseas development implementing them may involve response) vary in their assistance in crisis-affected adaption given specific needs countries is allocated to early attention to young children and challenges. In any setting, childhood (19). Many of the obstacles and their caregivers. opportunities exist through varying to improve early childhood interventions and services, building development outcomes in low- on the strengths of caregivers and middle-income countries and peer support. Actions can be can be traced to domestic public taken at different phases of an financing constraints. Symptoms emergency, with interventions of insufficient and/or inequitable adjusted based on the length and budget allocation may include type of humanitarian, security or low coverage as well as poor displacement factors at play in a developmental and learning given context (see Table). outcomes (18), particularly for displaced and refugee populations that are often neglected in national budgets. There is an overall lack

Photo credit: © UNICEF/UN0348581/Saad 04 Photo credit: © UNICEF/UNI316660/Dejongh Did you know? Refugee settlements The human brain develops faster The Baytna initiative in early childhood development from conception to age three Greece, developed by the approach allows Baytna staff years than at any other time. Refugee Trauma Initiative, uses to work with the whole family group gatherings to deliver and offer resources to support psychosocial support and early children’s needs, as well as More than 80% of a human brain learning opportunities to children give the staff a place to tackle is formed in the first three years. aged 0-6 and their caregivers difficult and painful issues for who have fled to Europe from the sake of the whole family. Afghanistan, the Syrian Arab Baytna provides a nurturing The care and support parents Republic and elsewhere. First- environment for children, and and other caregivers provide year results showed a clear gives families a place to take children in the earliest years correlation between high a breath, regroup and refocus attendance and developmental the energies that helped them is critical for healthy brain progress for children as well as to safety on the development development. empowerment and well-being of their children and rebuilding of primary caregivers. Using an their lives. In the first years of life, parents, close family members, and other caregivers are the closest to the young child and thus the best Conflict-affected areas providers of nurturing care. In order to provide caregivers with In conflict-affected areas of services reflects the Nurturing time and resources to provide eastern Ukraine, COVID-19 Care Framework’s intensity nurturing care, policies, services, has impacted education and of interventions. In addition parenting services in many ways. to adapted health services, and community supports need In order to adapt to the outbreak, a comprehensive, inclusive to be in place. the government, in collaboration early childhood development with UNICEF and other partners, programme was created in has adjusted its programme to targeted communities to ensure Nurturing care improves health, virtual and blended formats. that parents, including those productivity and social cohesion Telemedicine, with direct access with children with developmental throughout a lifetime, and the to experts, has been combined delays or disabilities, continue to benefits continue into the next with targeted visits to vulnerable be supported. Finally, alternative generation. families. Health workers who learning approaches have been carry out these visits have designed to ensure that young personal protective equipment children and preschoolers In low- and middle-income and prepare extensively to continue to have access to countries, 250 million children support families. This model quality and inclusive home- younger than five years – more of universal and targeted based learning. than 40% of children – have greater risk of not reaching their developmental potential because of poverty and neglect.

Every additional US$1 invested in early childhood development can yield a return of between US$6 and $US17 (21).

Nurturing, protecting and supporting caregivers and children is essential to achieve the Sustainable Development Goals.

05 REMEMBER Sustain specific actions that 2. Make or purchase stimulating contribute to nurturing care for and developmentally appropriate children relevant to the setting and toys, pictures and other materials the phase of the emergency to encourage play, talk and other early learning and psychosocial 1. Continue community- and support opportunities. home-based services, including Children’s well-being outreach, throughout an 3. Ensure that vulnerable emergency. The following forms populations, including victims of and future are primary of support should be seen gender-based violence and child concerns expressed by as essential: abuse, are targeted for inclusion in safe and secure spaces through every population, particularly • antenatal and postnatal care the most vulnerable, in community outreach and • baby-friendly maternity care, awareness-raising. crisis settings throughout perinatal maternal mental health the world. care and kangaroo mother care 4. Ensure spaces, structures, materials and communications • early initiation of exclusive are accessible to children and Many existing services already breastfeeding families with disabilities. contribute to improving early • support for responsive childhood development, and caregiving and early learning Build on contextually appropriate at a minimum, these should be activities practices and integrate them into supported and enhanced by • immunization existing service delivery platforms leveraging opportunities to involve and counselling tools everyone who has contact with • infant and young child feeding primary caregivers, infants and counselling and support for 1. Understand the affected young children. Where displaced nutrition populations’ beliefs and cultures and refugee families have been • prevention and integrated as they relate to early childhood integrated into host communities, management of common practices, and work together to services should address the entire childhood illness design inclusive and culturally population. When interventions are • psychosocial and trauma- sensitive approaches to address inclusive and grounded in cultural informed support for young nurturing care in services, health and contextual realities, they can children and their caregivers facilities and the community. be highly valued by families and • developmental monitoring and 2. Provide information, care communities experiencing crisis. counselling to identify children at and support in formats that risk of sub-optimal development are accessible, inclusive and or experiencing delay or consultative, including affected disability. persons with disabilities, adolescent mothers, and families 2. Prevent separations and reduce affected by adverse health child and caregiver stress. conditions such as HIV. 3. Promote hygiene and health 3. Prioritize remote and face-to- training, investing in accessible, face support for caregiver mental adequate and safe water, health and child protection, sanitation and hygiene facilities. help alleviate family conflict 4. Establish child-friendly services and support caregivers to that allow for singing, playing and reduce stress. reading in all intervention and support spaces.

Establish safe play and learning spaces for young children and their caregivers 1. Enable positive and responsive interaction within safe spaces such as community centres, clinics, homes and other designated structures. Children are some of the most vulnerable among the forcibly displaced, representing 50% of the world’s refugees (22).

Photo credit: © UNICEF/UN0316264/ 06 Knowles-Coursin Selected Displaced populations resources

Ahlan Simsim is a programme programmes, playgrounds and The Early Childhood Development in the Middle East to support digital support for caregivers Task Team young children affected by using text messages and social aims to serve as a community of conflict and displacement with media. The digital engagement practice for front-line providers, high-quality early childhood provides parenting tips that field managers, technical staff and development services. Through empower caregivers to take other relevant stakeholders working the collaborative efforts responsibility for nourishing in the field of early childhood of Sesame Workshop, the children’s ability to think, solve development in emergencies International Rescue Committee problems, express themselves, and in humanitarian settings. and New York University’s Global control their emotions, and TIES for Children, Ahlan Simsim develop healthy relationships https://inee.org/task-teams/ear- reaches children ages 0-8 and with others. The culturally ly-childhood-development their caregivers in Iraq, Jordan, appropriate Middle Eastern Lebanon and the Syrian Arab adaptations reach caregivers Inter-Agency Standing Committee Republic. Services for families, through WhatsApp, videos its Reference Group on Mental caregivers and their children and audio messaging, allowing Health and Psychosocial Support are delivered through home low-literacy caregivers to access in Humanitarian Settings has visits, group-based parenting the tips. developed multiple resources including during the COVID-19 pandemic. https://interagencystandingcommit- tee.org/mental-health-and-psychosocial-support-resources-covid-19

Moving Minds Alliance seeks to catalyse a new way of responding to crises that addresses the inter-sectoral needs of the youngest refugees and their families. https://movingmindsalliance.org/

Early Childhood Peace Consortium is a network dedicated to leveraging social services to mitigate conflicts and promote social cohesion. https://ecdpeace.org/about-us/ early-childhood-peace-consortium-ecpc

Emergency Nutrition Network Photo credit: © Ahmad Al-Jarery / International Rescue Committee is working with programmers, policy-makers and researchers to strengthen know-how and evidence to overcome malnutrition in countries affected by conflict or natural disasters. https://www.ennonline.net/ aboutenn/

07 Disease outbreaks

When the Zika virus began to family, and assist families in spread in Latin America and addressing the potential long- the Caribbean in 2016, mother- term health and developmental child health and early childhood issues of congenital Zika development services were syndrome and other disorders. identified as essential entry In El Salvador over 5628 families points to provide child care were supported to engage and support to affected infants in early learning activities and their families. Over three and provide responsive care years, eight countries began to to their children, including use the WHO/UNICEF package 77 children with congenital Care for child development (20) Zika syndrome. The impact as part of their family-centred, of the response was twofold: nurturing care response, and enhancement of child care and thus were able to adapt and family support components strengthen their programmes in mother-child health and to provide more appropriate early childhood development support to parents and other services and mainstreaming of caregivers. Of particular concern support for nurturing care into were families with young childhood disability services. children born with congenital The experience also helped Zika syndrome and/or other stakeholders and implementers congenital disorders. Care for across sectors develop a deeper child development counselling, understanding of the importance as part of early intervention of sustaining ongoing support for actions, helped to strengthen families with young children with responsive caregiving practices, developmental disabilities during promote inclusion within the times of crisis.

08 STRENGTHEN 2. Assess activities across sectors 2. Collect timely information to and services to understand evaluate whether interventions what they already do and how that support nurturing care are they could do better to ensure delivered in an equitable and attention to one or more safe manner and are having a components of nurturing care. positive effect.

Services focused on single 3. Develop contingency options to 3. Capture information across determine how interventions can population groups including interventions are unlikely be maintained or carried out in infants, young children, caregivers to address the underlying the midst of an emergency. and families to reflect not only child development, but conditions and needs of a 4. Disaggregate indicators by age, also caregiver mental health, young child. sex and disabilities. behaviours and interactions with children. Action for early childhood Update existing policies and plans development in humanitarian to ensure continued attention and 4. Disaggregate indicators by age, settings involves raising awareness financing for nurturing care sex, disability and, where relevant and safe, ethnicity or nationality. and strengthening planning by 1. Address all components of governments across the education, nurturing care in national policies Ensure representation of health, sanitation and social affairs and plans as part of preparedness all relevant nurturing care ministries as well as across national efforts before a crisis occurs. and subnational levels among both stakeholders in assessment, development and humanitarian 2. Update global and regional planning and implementation authorities. Progress will require humanitarian response plans to of emergency response include an integrated package the different humanitarian and 1. Work with national disaster of interventions for nurturing child development-related sectors and emergency coordination care across the health, nutrition, (e.g. emergencies, health, nutrition, bodies to position nurturing education, child protection and education, water and sanitation, care into humanitarian response social services sectors, covering all child protection) to work together. implementation frameworks. Strengthened action to prepare and phases of an emergency. 2. Enable participation of the respond with integrated services 3. Clarify responsibility, affected population in all must also occur across these accountability, activities and costs phases of the planning and sectors with international and local for early childhood development- implementation cycle, harnessing nongovernmental stakeholders. related actions in a humanitarian their local capacity as service setting for all international, Even in circumstances where providers, facilitators and mentors. countries and global actors have national and subnational adopted cross-sectoral early responders. 3. Engage with United Nations emergency clusters and childhood development policies 4. Consider designating an coordinators for health, nutrition, and interventions, there is usually early childhood focal point education, water, hygiene and a lack of explicit inclusion of within humanitarian response sanitation, and protection crisis-affected populations. Clear mechanisms to facilitate to promote multisectoral outcomes and standards should accountability of comprehensive actions which address all five be defined for early childhood and costed inclusion of nurturing components of nurturing care in development in emergencies as well care and young children’s needs an integrated manner. as an assessment of how to carry into policy and planning. Make out interventions in a crisis setting. sure this responsibility is taken 4. Collaborate with United Nations This work needs to start with over by national authorities at agencies and engage with a wide strengthening the identification the appropriate time. array of stakeholders, including of early childhood as a necessary faith-based and civil society component of humanitarian Capture data that measure early organizations, who have a national response, in alignment with the childhood development across presence and are involved in Nurturing Care Framework, which different domains in national health, education, food security, may be expressed in various ways. policies and humanitarian labour, housing, migration, response plans and community development, Conduct rapid response amongst other sectors. assessment of the needs of 1. Develop capacity with and for pregnant women, young children national actors to collect, analyse and their caregivers and use data to work cross- sectorally, with the intent of 1. Review humanitarian assessment strengthening planning, policies tools to ensure that they and services. address all five nurturing care components and examine options for how services can be sustained or initiated.

09 07

ADD 2. Adapt job-aids and resources for Protect caregiver mental health all relevant workers including and provide psychosocial support health care professionals, 1. Address caregiver mental health community-based caregivers, in essential services, starting peer counsellors, educators and from pregnancy, using a mix of protection service providers to approaches and services including ensure fit-for-purpose content to community-based support by Once basic services have support age-appropriate services. peer and lay counsellors. been established and 3. Produce and distribute training 2. Provide psychological first aid or are functional, relevant materials in multiple relevant basic emotional or psychological languages, if needed. stakeholders should dedicate support and interventions for resources for preventive 4. Develop a coherent set of caregiver mental health from and promotive care, mental inclusive messages in simple the very beginning of a crisis, health, trauma-informed language for use through especially where there have been multiple channels and coordinate interpersonal violence exposures. psychosocial support, their dissemination in various 3. In delivering mental care and counselling to support accessible formats such as audio, services, pay special attention local sign language or print. parenting practices, and to children and families who care for children with experience bereavement. Identify and test the feasibility of additional needs. existing and innovative delivery While a growing number of channels for outreach to various countries and global actors This requires capacity-building of types of populations have prioritized early childhood front-line workers and coordination development, there is usually a 1. Identify which community health between programmes, sectors and lack of explicit inclusion of crisis- workers, mobile health teams, agencies. affected populations in policy educators and protection service and programming. A deeper Currently there is limited support providers are from the local area commitment to nurturing care for responsive caregiving, early and have ongoing access to family for young children will require the learning activities and caregiver homes, and build their capacity different humanitarian and child mental health in the essential to lead activities. development-related actors to work service packages that are provided 2. Consider which digital (such as together to craft policies, plans, in many settings. Achieving more WhatsApp or messenger texting) services and tools before, during and support will require national and or other outreach channels after a crisis. Progress will require local authorities and the various (such as radio and television) clear outcomes and standards organizations and partners that provide low-cost and low-contact to be defined and reflected in support them to ensure that all five engagement opportunities with assessments as well as rigorous components of nurturing care and a wide variety of caregivers and data collection tools that enable caregiver mental health permeate activate them for wider use. real-time action for interventions across policies, plans, services and that promote nurturing care in tools – before, during and after an 3. Identify which economic support crisis settings. emergency. interventions exist and can increase cash assistance to Bolster staff capacity to support pregnant women and caregivers nurturing care for early childhood of young children. development 4. Design inclusive social 1. Determine capacity-building protection schemes providing Moving forward requirements for staff, considering targeted interventions for scale and delivery platforms. families of children with The actions proposed in this Analyse who already has disabilities, such as top-up brief should be carried out by training on relevant skills, such cash assistance or distribution all relevant global and national as counselling on responsive of assistive devices. stakeholders to help families caregiving and early learning and communities who are activities, mental health and living with adversity to build psychosocial support, and a nurturing environment for disability inclusion, and decide young children. Globally, multiple where additional expertise partnerships exist to support is needed. implementation, facilitate learning, and strengthen the evidence of what works to provide nurturing care for young children in humanitarian settings. By working together, it will be possible to intensify the actions and make a difference towards the goal of leaving no 10 child behind. 11

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Aditi Shrikhande, Elvira Thissen

11 Nurturing care framework for early childhood development

The Nurturing Care Framework the Sustainable Development for early childhood development: Goals and the survive, thrive and A framework for helping transform goals of the Global children SURVIVE and THRIVE to Strategy on Women’s, Children’s TRANSFORM human potential and Adolescents’ Health. Launched builds on state-of-the art evidence alongside the 71st World Health of how child development unfolds Assembly in May 2018, it outlines: and of the effective policies and i) why efforts to improve health interventions that can improve and well-being must begin in the early childhood development. earliest years, from pregnancy to WHO, UNICEF and the World age three years; ii) the major threats Bank Group developed the to early childhood development; iii) Framework in collaboration with how nurturing care protects young the Partnership for Maternal, children from the effects of adversity Newborn & Child Health, the Early and promotes physical, emotional Childhood Development Action and cognitive development; and iv) Network and many other partners what families and caregivers need to provide a roadmap for attaining to provide nurturing care for young children.

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