Sociodemographic inequities in nurturing care for early childhood development across Brazilian municipalities

Abstract

Providing an enabling nurturing care environment for early childhood development (ECD) that cuts across the five domains of the Nurturing Care Framework (i.e., good health, adequate nutrition, opportunities for early learning, security and safety and responsive caregiving) has become a global priority. Brazil is home to approximately 18.5 million children under 5 years of age, of which 13% are at risk of poor development due to socio‐economic inequalities. We explored whether the Early Childhood Friendly Municipal Index (IMAPI) can detect inequities in nurturing care ECD environments across the 5570 Brazilian municipalities. We examined the validity of the IMAPI scores and conducted descriptive analyses for assessing sociodemographic inequities by nurturing care domains and between and within regions. The strong correlations between school achievement (positive) and socially vulnerable children (negative) confirmed the IMAPI as a multidimensional nurturing care indicator. Low IMAPI scores were more frequent in the North (72.7%) and Northeast (63.3%) regions and in small (47.7%) and medium (43.3%) size municipalities. Conversely, high IMAPI scores were more frequent in the more prosperous South (52.9%) and Southeast (41.2%) regions and in metropolitan areas (41.2%). The security and safety domain had the lowest mean differences (MDs) among Brazilian regions (MD = 5) and population size (MD = 3). Between‐region analyses confirmed inequities between the North/Northeast and South/Southeast. The biggest within‐region inequity gaps were found in the Northeast (from −22 to 15) and the North (−21 to 19). The IMAPI distinguished the nurturing care ECD environments across Brazilian municipalities and can inform equitable and intersectoral multilevel decision making.

Monitoring nurturing care environments for early childhood from the national to the municipal level

“…Third, national and international ECD experts participated in two surveys to score the expected performance of each nurturing care indicator, following the SMART indicator principles. Fourth, the IMAPI team (Buccini et al, 2021b). As expected, there was a strong positive correlation between IMAPI scores and school achievement and a negative one between IMAPI and social vulnerability in children.…”

“…Although this is encouraging, moving forward further validation analysis is needed to confirm that IMAPI correlates well with aggregated ECD outcomes at the municipal level. Furthermore, in the second article (Buccini et al, 2021b), IMAPI was able to identify sociodemographic inequities by nurturing care domains. While low subscores in Good health, Adequate nutrition, and Opportunities for early learning were more frequent in municipalities in the North and Northeast, low subscores in Security and safety were more frequent in the Central-West, closely followed by the South.…”

Population‐based approaches for monitoring the nurturing care environment for early childhood development: A scoping review

“…The creation of approaches to monitor the NC environment can be a powerful instrument for decision‐making (World Health Organization, 2019 ); however, the creation of several approaches with the same goal can make it difficult for stakeholders to prioritize approaches for decision‐making. In Brazil, for example, four approaches were launched with similar aims all in 2020 (Buccini, Coelho, et al, 2021 ; Buccini, Pedroso, et al, 2021 ; Maria Cecília Souto Vidigal Foundation, 2020 ; National Early Childhood Network & Andi Communication and Rights, 2020 ; Nossa São Paulo Network & Bernard van Leer Foundation, 2020 ), and only one has been fully validated (Buccini, Coelho, et al, 2021 ; Buccini, Pedroso, et al, 2021 ). Therefore, due the amount of time and resources required to develop approaches for monitoring NC environments, we recommend that countries prioritize the development of valid monitoring approaches or invest in validating existing approaches.…”

“…It is well‐known that children can experience different social inequalities within a region of a country, a state, or a municipality (Buccini, Coelho, et al, 2021 ; Buccini, Pedroso, et al, 2021 ; Clark et al, 2020 ; Keating, Murphey, et al, 2020 ; São Paulo for Early Childhood et al, 2015 ). For that reason, approaches that measure the NC at the local levels and take an equity approach are necessary to guide the development of equitable programmes and systems for the most vulnerable populations (Clark et al, 2020 ; World Health Organization et al, 2018 ).…”

“…Several studies have attempted to develop population‐based approaches for monitoring NC over the past few years. In this manuscript, NC population‐based approaches are defined as a set of existing indicators or a composite index methodology that uses secondary data to measure, characterize, classify, and evaluate NC environment(s) for ECD (Buccini, Coelho, et al, 2021 ; Köhler, 2016 ; UNICEF & Countdown to 2030, 2020 ). The Countdown to 2030 early childhood country profile, the State of Babies in the United States, and the Early Childhood Friendly Municipal Index (IMAPI) in Brazil are examples of initiatives that measure NC at the countries, state, and municipal level, respectively (Buccini, Coelho, et al, 2021 ; Buccini, Pedroso, et al, 2021 ; Keating, Cole, & Schaffner, 2020 ; UNICEF & Countdown to 2030, 2020 ).…”