U.S.G. Action Plan onChildren in Adversity

Strategic framework for international assistance

White House LaunchDecember 2012

www.childreninadversity.org

Children in Adversity: who are they?

25%live in

extreme poverty

1.9 billion children in LMIC

Adversity: Serious deprivation or danger

Poor healthand nutrition

Lack ofstimulation-attachment(< 5 years)Living outside

of family care

Exposure to violence,exploitation, abuse

United Nations Population Division World Population Prospects 2010UNICEF State of the World’s Children 2012

FIRST YEAR

-8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Birth (Months) (Years)

Sensory Pathways(Vision, Hearing)

LanguageHigher Cognitive Function

Source: C.A. Nelson (2000)

Neural Circuits are Wired in a Bottom-Up Sequence

Early Experiences Leave Lasting Chemical “Signatures” on Genes

External Experience

Gene Regulatory Proteins

Epigenetic “Signature” Turns Gene On or Off

U.S.G. Framework forInternational Assistance

Promote Evidence-

BaseIntegrationStrengthen

Systems

Put Family Care First

Protect Children from Violence, Exploitation, Abuse, and

Neglect

Build Strong BeginningsPRINCIPAL

SUPPORTING

OBJECTIVES

1 3

4 5 6

2

6

“It is easier to build strong children than to repair broken men.”Frederick Douglass

Obj 1 - Build Strong Beginnings

7

The global burden

• 6.9 million children under the age of 5 worldwide die each year.

• More than 25 times that number -- over 200 million children -- survive, but do not reach their developmental potential.

• As a result, their countries have an estimated 20 percent loss in adult productivity.

Grantham McGregor, S. et al., (2007). Developmental potential in the first 5 years for children in developing countries. Lancet, 369:60-70

WHO and UNICEF. Care for Development.Obj 1 - Build Strong Beginnings

8

109

891

Expected to diebefore their5th birthday.

Expected to livepast their

5th birthday.

Approximately 1/3 are notexpected to reach their

developmental potential

Grantham-McGregor et al. Lancet. 2007January 6; 369(9555): 60–70

In Sub-Saharan Africa, for every 1000 children born in 2011…

Obj 1 - Build Strong Beginnings

9

Adversity impairs development

Obj 1 - Build Strong Beginnings

10

Jamaica Study

11

Sustained results

0%

1%

2%

3%

4%

5%

6%

7%

height weight

% i

ncr

ea

se o

f m

ea

nco

mp

are

d t

o c

on

tro

lgro

up

Supplementation

Maternal tutoring

Both

Source: Van der Gaag, J. School Performance and Physical Growth of Underprivileged Children: Results of the Bogotá Project at Seven Years. (1983). World Bank, Washington D.C.

Obj 1 - Build Strong Beginnings

12

“Any proposed programs should respect the primacy of the family.”

James J. Heckman, Nobel Laureate in Economics

Obj 2 - Put Family Care First

13

The global burden

Children outside of family care – have fallen off the statistical map.

Global estimates:• 17.8 million children have lost

both parents• 2-8 million children may be living

in institutional care• 1.1 million children are trafficked

for forced labor• 1.8 million children are victims of

sex trafficking or pornography• 300,000 children are associated

with armed forces or groups

All children count, but not all children are counted.

Obj 2 - Put Family Care First

14

Children are at high risk of growing up without a biological

parent, usually their father

Percentage of children under 5 living with their biological mother but w/o their biological father

Percentage of children under 5 living with their biological father but without their biological mother, and

Percentage of children under 5 living without both biological parents (x-axis)

Source: UNICEF. Inequities in Early Childhood Development: What the data say - Evidence from the Multiple Indicator Cluster Surveys. February 2012. Figure 5, Page 9.

Note: This analysis included 40 countries.

Obj 2 - Put Family Care First

15

The effects of caregiving• Institutionalization can lead to serious developmental, cognitive,

emotional delays and challenges. Children placed in appropriate family care by age 2 recover

normative growth and development by age 8. Children removed from institutions after age 2 do not reach

normative ranges.

EEG level: Institutionalized children EEG level: Never-institutionalized children

• Placing children in protective family care results in better child outcomes and is significantly less expensive than institutional care.

Obj 2 - Put Family Care First

16

“Safety and security don’t just happen; they are the result of collective consensus and public investment. We owe our children, the most

vulnerable citizens in our society, a life free of violence and fear.”

Nelson MandelaObj 3 - Protect Children

17

The global burden• Between 133 million and 275 million children are

estimated to witness domestic violence annually.• 25-30% of children experience severe forms of

punishment.• 150 million girls and 73 million boys under 18 experienced

forced sexual intercourse or other forms of sexual violence in one year.

• 36 percent of girls and 29 percent of boys globally have been sexually abused.

• 115 million children are engaged in hazardous work; 5.5 million are in forced labor.

• 1.8 million children are victims of sex trafficking or pornography.

• An estimated 300,000 children are associated with armed forces or groups. Obj 3 - Protect Children

18

The lasting effects of adversity

CDC. Adverse Childhood Experiences.Obj 3 - Protect Children

APCA Roll OutThree core outcomes

In six priority countries, achieve significant reductions in the number of:

1. Children not meeting age-appropriate growth and developmental milestones

2. Children living outside of family care

3. Children who experience violence and exploitation

Results-based Approach

Public-Private PartnershipGlobal Alliance for Children

Mission: Mobilize public and private knowledge, commitment and resources at the global and country levels to support country-driven strategies and accountability around three core outcomes that will demonstrate significant, measurable and sustainable results for children in adversity, beginning in a select number of countries.

Inaugural meeting (February 2013):• 19 senior leaders and decision makers• 15 organizations• 11 nationalities• 4 regions

ExampleOutcomes for Cambodian Children

40% reduction in the number of children under the age of five with cognitive delays

70% reduction in the number of children living outside of family care

30% reduction in childhood violence and exploitation