© Blog First Steps, IDB’s Social Protection and Health Division
by Filipa de Castro and Betania Allen
A recent report on child development in Mexico (link in Spanish) concluded that although the issue is a current topic of discussion that is being addressed by national programs, there is no general policy or comprehensive vision for child development. Mexico’s best goal is making a commitment to child development, but, how?
Progress, in any area of public health, results from the introduction of evidence-based policies and programs. When there is an adequate scientific basis, public policy makers can more easily turn results into decisions and actions. In this context, and to better understand the basis of the evidence available on the subject of child development in Mexico, we asked ourselves the question, what do we know and what do we need to know about early childhood development in Mexico?
To answer this question, we conducted a systematic review of the literature published in scientific journals over the past 20 years on the development of children under the age of 10 in Mexico.
Almost half a million children have been studied, but exactly which children?
We identified 543 scientific articles that report data on a total of 426,645 Mexican children. Most of these studies (74%) focus on children living in urban and metropolitan areas, with only 12% reporting data on indigenous children. Less than one-fifth looked at children during the first 1,000 days of life, which includes the period from pregnancy to age 2.
Although it is significant that child development issues have been studied in almost half a million children, only 14 studies use representative samples from which conclusions can be drawn about the entire population of Mexican children. It is important to invest in child development studies with representative samples that include very young children, children living in rural areas, indigenous children and other population groups for which we have less evidence.
What is measured? Which topics are studied?
Child development is determined by biological, psychological and social factors, so it is important to have evidence that reflects the richness and complexity of these mechanisms. In this regard, we found that the literature reports a variety of methodologies among which psychometric methods (57%) predominate, including developmental assessments such as the Bayley Scales of Infant Development and language and psychopathology assessments. Of these articles, 17% include measurement of biomarkers such as cortisol, and 14% and 12% include neuropsychological or neurophysiological methods, respectively.
The issue most often addressed is nutrition (24%), especially undernutrition and supplementation. The most frequently examined risk factors are psychosocial risks (15%) and exposure to pollutants (11%), particularly lead. Nine percent of the articles measure the impact of Oportunidades, a poverty reduction program, on various child development outcomes. In terms of outcomes analyzed, most studies investigate neurodevelopment, cognitive skills and psychopathology, with just a few addressing non-cognitive skills and social-emotional development. Also, the limited number of studies that focus on disability have a clinical emphasis, and therefore epidemiological information, including prevalence, prevention, risk factors, utilization of services, and service needs, is virtually absent.
What about moms?
In 1947, the English pediatrician and psychoanalyst Donald W. Winnicott said, “There is no such thing as a baby…if you set out to describe a baby, you will find you are describing a baby and someone,” to call attention to the absurdity of studying a child without including the infant’s caregiver. In this regard, it is important to reflect on the following fact: although 29% of the articles mentioned some parental figure, less than 7% include this person as a primary variable (main effect) and only 2% explicitly and directly explore the early mother-baby relationship.
We suggest promoting research on the mother-baby relationship, emotional attachment, the challenges of parenting in risky contexts, teenage parenthood, postpartum depression, and parenting premature babies, among others.
Is child development analyzed as a dynamic process?
Child development is the result of the constant interaction and synergy between physical aspects and a set of risk and protection factors that exist in the lives of children. In other words, in addition to the child’s genetic makeup, we must consider a number of factors ranging from prenatal care, nutrition, and exposure to environmental hazards to the quality of child care, early stimulation and the emotional environment. Together, these factors can lead to deficiencies and vulnerabilities or contexts that favor full, healthy development.
This approach examines both processes as well as outcomes, and it requires the use of longitudinal data absent in most of the studies we reviewed (75%). We believe that longitudinal studies with methodological designs and analytic strategies are needed to determine the mediators/moderators of specific risk and protection factors through dynamic models such as the “cascade effect,” progressive associations, and the “spillover” effect, which consider both proximal and distal factors, in the short and long term, for the explanation of development trajectories and outcomes.
Are public policies based on scientific evidence?
Despite the considerable number of studies that we identified in this review, it is unclear how the results translate into input for evidence-based public policy. In this regard, it is important to explore in more detail how we can get decision-makers at various levels to use evidence derived from the wide variety of research carried out in Mexico.
It seems essential to include carefully designed modules on child development and disabilities in the population surveys and program evaluations that are conducted regularly in Mexico (national health surveys, evaluations of the Oportunidades program, surveys conducted by the National Institute of Statistics and Geography [INEGI], etc.). These modules should be made available to interested parties free of charge so that their application can be expanded. Lastly, beyond its unquestionable academic significance, it is important to disseminate scientific knowledge about child development that offers solid sources of evidence and, in turn, to promote its relevance to the public sector areas responsible for making important decisions on these issues.
Do you know if scientific evidence on child development has been incorporated into the public policies of your country? Share this article so that others interested in the topic can reflect on this important issue.
Filipa de Castro and Betania Allen work for the Department of Public Health Methods, Directorate of Reproductive Health, Center for Population Health Research, National Institute of Public Health of Mexico.