The Asia-Pacific Journal | Japan Focus Volume 17 | Issue 16 | Number 3 | Aug 10, 2019

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The Landscape of Early Childhood Development in RuralChina

Sarah-Eve Dill, Yue Ma, Andrew Sun, Scott Rozelle

Rural Education Action Project, StanfordUniversity, Stanford, CA 94305, USA

Summary

In China, low levels of early childhooddevelopment (ECD) in rural areas may inhibiteconomic development as the nation attemptsto t rans i t ion f rom a midd le - incomemanufacturing-based economy to a high-income innovation economy. This paper surveysthe recent literature on ECD among childrenages 0-3 years in rural China, including rates ofdevelopmental delays, causes of delays, andimplications for the future of China’s economy.Recent studies have found high rates ofdevelopmental delays among young children inrural China and point to poor nutrition andpsychosocial stimulation as the primary causes.This review highlights the need for large-scaleECD interventions in rural China to raisehuman capital and support future economicgrowth.

Key words: early childhood development,cognition, nutrition, parenting, rural China

The Landscape of Early ChildhoodDevelopment in Rural China

Introduction

Early childhood development (ECD) isfundamental to success in later life. Researchhas shown that the majori ty of braindevelopment occurs in the first three years of achild's life, making this a key period for the

development of cognitive and noncognitiveskills (Currie & Almond 2011; Grantham-McGregor, 2007). In turn, the skills developedin the first three years lay the foundation forlater skills development (Cunha et al., 2006).For this reason, healthy ECD has been linked toa variety of positive long-term outcomes inhealth, education, employment, and adultearnings (Attanasio et al. 2015; Heckman et al.2006; Heckman et al. 2010; Currie & Almond2011; Knudsen et al., 2006).

Due to the importance of ECD for lateroutcomes, investments in early childhood alsosupport overall human capital accumulationand economic growth (Cunha et al. 2006;Rolnick & Grunewald, 2003; Wang et al., 2018).Recent research has demonstrated thatinvestments in cognitive and noncognitivedevelopment in early childhood yield thegreatest economic returns compared toinvestments later in childhood or in adulthood(Heckman et al. 2006; Gertler et al., 2014). Lowlevels of investments, however, have beenlinked to persistent poverty and lower levels ofhuman capital that limit a country’s ability totransition to a skills-based economy (Heckman& Masterov, 2007).

Yet despite the well documented economic andsocial benefits of investments in ECD, poorcognitive development remains a significantproblem among young children in developingcountries. Recently, a Lancet review paperestimated that 250 million (43%) childrenunder the age of five in low- to middle-incomecountries are at risk for developmental delaysand reduced cognition (Black et al., 2013). As

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ECD outcomes have been closely linked toeducational and employment outcomes in laterlife, large shares of children at risk fordevelopmental delays may limit a country’sability to raise human capital and grow anddevelop its economy.

As China attempts to transition from a middle-income, manufacturing-based economy to ahigh-income innovation economy, investing inthe human capital of the nation’s future laborforce is critical to its overall goals. Researchhas shown that cont inued economicdevelopment for middle-income countries suchas China hinges on promoting an educatedpopulation (Barro, 2001; Kharas and Kohli,2011). However, China suffers from a widerural-urban gap in educational outcomes (Wanget al., 2018). Low levels of ECD in rural areasmay inhibit economic development if largeshares of the population are unable to achievehigh levels of education due to developmentaldelays in early childhood. Until recently,however, the literature on ECD in China,almost all of which is in Chinese, has focusedmainly on urban areas (e.g., Zhou et al., 2013).There is now a need for better understanding ofthe ECD landscape in rural China, which ishome to nearly three fourths of the nation’schildren and the majority of its industrial laborforce.

This paper provides an overview of the recentliterature on ECD across rural China. To meetthis goal, we have three objectives. First, wedescribe the prevalence of developmentaldelays, including delays in cognitive, language,social-emotional and motor skills, amongchildren ages 0-3 years in rural China. Second,we identify causes of the low levels of ECD andhigh rates of delays among China’s ruralinfants and toddlers. Finally, we discuss thelong-term social and economic implications ofpoor ECD in rural China. Ultimately, we aim toprovide informed policy recommendations forimproving ECD and raising human capitalacross rural China.

In pursuit of these objectives, we draw onlarge-scale studies of ECD among children age0-3 years in rural China. The studies, whichwere conducted by our research teams acrossChina between 2013 and 2018, are the first todocument trends in ECD, as well as causes ofdevelopmental delays, among young children inChina’s rural areas. We also review studies,conducted by both our own survey teams andthose of others, that examine cognition amongschool-age children in rural China and thatevaluate interventions to improve rural ECD.

ECD in Rural China

Recent studies of ECD in rural China,conducted by the coauthors of this paper andtheir colleagues, have revealed a troublingtrend: large shares of rural children ages 0-3years are not achieving their developmentalpotential. The first of these studies, conductedin 2014, assessed the cognitive development of1,442 infants and toddlers aged 18-30 monthsin rural Shaanxi Province, using the FirstEdition of the Bayley Scales of Infant andToddler Development (Bayley-I), a well-recognized tool for measuring the developmentof children ages 0-42 months (Bayley, 1993;2006). The Bayley Scales is considered to bethe “gold standard” for assessing infant andtoddler development internationally (Yue et al.,forthcoming; Rubio-Codina et al., 2016), andthe Bayley-I has been used widely usedthroughout China since it was formally adaptedto the Chinese language and environment in1992 (Yi et al., 1993; Huang, Tao & Zhang,1993).

The results, reported in Yue et al. (2017; 2019),found that 48% of children in the sample hadcognitive scores below 85. This is equivalent toan adult IQ below 90, and at one standarddeviation (SD) below the healthy mean of 100,a s c o r e o f 8 5 m a r k s t h e c u t o f f f o rdevelopmental delays. In other words, nearlyhalf of the children sampled were at risk for

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delayed cognitive development. This is morethan three times the rate of delay that onewould expect to find in a “healthy population”(for example, in London, San Francisco, orShanghai), where only about 15% of individualswould exhibit developmental delays.

A subsequent study, reported in Luo et al.(2017), measured the development of 448infants and toddlers age 6-18 months in ruralHebei and Yunnan provinces. For this study,the research team used the third edition of theBayley Scales (Bayley-III), which measurescognition as well as language, social-emotionaland motor development. The Bayley-III… Thisversion of the test was adapted into Chinesethrough a collaboration between StanfordREAP and Shanghai Jiaotong University in2015.

In this second study, the research team foundthe same results as those reported in Yue et al.(2017; 2019): nearly half (48.7%) of sampleinfants were cognitively delayed. In addition,the study found that 40.6% of infants weredelayed in language development, and 35.0%were delayed in social-emotional development(Luo et al. 2017). Taken together, these twostudies indicate that the rates of developmentaldelays in rural China are much higher than thatof a healthy population, and that delays are notonly in cognition, but also in the developmentof essential noncognitive skills such aslanguage and social-emotion. Notably, nearlyall of the sample individuals in both the Yue etal. and Luo et al. studies were of Han ethnicorigin.

Enumerators administer a Bayley-I test toa toddler in rural China. Recent studieshave found that nearly half of infants andtoddlers in rural China are at risk forcognitive delays. Source: REAP FieldSurvey, 2014.

Although these initial studies revealed highrates of developmental delays, they were notnecessarily representative of all ruralcommunities across China. Both studies wereconducted in narrow geographic ranges withinShaanxi, Hebei, and Yunnan Provinces, as wellas among one specific type of rural population(mountainous communities, which tend to moreremote and less economically developed thanother rural communities). Therefore, tounderstand the overall nature of ECD acrossChina’s diverse rural communities, members ofthe research team used the Bayley-III to assessthe cognitive, language, social-emotional andmotor development of 3,353 infants andtoddlers aged 6-30 months in four major ruralsubpopulations of China, which altogetheraccount for 69% of the nation’s rural infantsand toddlers (Wang et al., 2019). The foursubpopulations include mountainouscommunities in western China, communities inChina’s central plains, rural resettlementcommunities (state-built residential areas toconsolidate scattered populations thatoriginally lived in mountainous villages), and

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rural migrant enclaves in China’s cities. Afterthese new samples were added, the scope ofthe study areas spread across the provinces ofHebei, Henan, Guizhou, Yunnan, and Shaanxiand the cities of Beijing, Xi’an and Zhengzhou.

The results of this most recent study arereported in Wang et al. (2019). Among the fourmajor rural subpopulations, the research teamfound the same rates of delay as were found inour previous studies (Table 1). About half (49%)of the infants and toddlers surveyed exhibitedcognitive delays, while more than half weredelayed in language and social-emotionaldevelopment (52% and 53%, respectively), andnearly one third (30%) were delayed in motordevelopment. Furthermore, 88% of infants(6-18 months) and 79% of toddlers (18-30months) exhibited a delay in at least one of thefour areas measured (Table 2). Compared tothe rates of delay in a healthy population(15%), the rates of delay across rural China areover five times higher, indicating a severeproblem in early childhood development amongChina’s rural communities.

How do the rates of developmental delays inrural China compare to urban areas? In fact,studies in urban China have found rates ofdelay between 5% and 16% (Zhou et al., 2013;Xie et al., 2006; Xu et al., 2009; Shi et al.,2001), which is about what one would find in ahealthy community elsewhere in the world.This means that in China, poor early childhooddevelopment and high rates of delays areprimarily a rural problem. However, the ratesof delay among our sample are similar to ratesof developmental delays found in studies ofother developing settings, such as Colombia,Mexico and South Africa, in which rates ofcognitive delays were found to be 40%, 36%and 39%, respectively (Attanasio et al., 2015;Fernald et al., 2006; Rademeyer and Jacklin,2013; Table 3). Moreover, although per capitaGDP in Colombia, Mexico and South Africa arelower than rura l Ch ina , the ra te o fdevelopmental delays in rural China (49%) ishigher than that in any of the other threecountries. These results suggest that poor earlycognitive development is a common problemamong developing countries, and that amongdeveloping countries, rural China’s ECDproblem is particularly severe.

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Causes of poor ECD

The previous section discussed ECD outcomesin rura l China , not ing h igh rates o fdevelopmental delays among rural infants andtoddlers, comparable to or somewhat higherthan in other developing countries. In thissection, we draw on past studies conducted bythe research team to identify the main causesof poor ECD outcomes in rural China. Ourresearch has identified two main causes of poorECD in rural China: poor nutrition andinsufficient psychosocial stimulation. Thesefactors are also mitigated by the effects ofparental migration.

Poor Nutrition

Research has indicated that poor nutrition maybe one cause for low ECD outcomes in ruralChina. Undernutr i t ion, part icular lymicronutrient deficiencies such as anemia,have been linked to developmental delays incognition, social-emotional skills, and physicalgrowth (Grantham-McGregor and Ani, 2001;Chang et al., 2007). Unfortunately, earlychildhood anemia remains prevalent acrossrural China. Wang et al. (2019)’s study ofdevelopmental outcomes among infants andtoddlers across China’s four major ruralsubpopulations found that 42% of infants andtoddlers were anemic, despite very low rates ofstunting, being underweight, and wasting(Table 4). Another study, reported by Luo et al.(2015), found that 48.8% of rural infants andtoddlers in China were anemic. Both exceed the40% threshold set by the World Health

Organization (WHO) for consideration as a“severe public health problem” (WHO, 2001).The rates of anemia among children in ruralChina are also higher than the rate of 18%found among children under age two in urbanChina (Hu et al., 2014); they are also muchhigher than those in developed countries suchas the United States, where rates amongsimilarly aged children have been found to beas low as 3% (Le, 2016). Hence, the data showthat rural China still lags significantly behinddeveloped countries in terms of nutrition,leading to consequences for ECD.

Insufficient Psychosocial Stimulation

Research has also pointed to insufficientpsychosocial stimulation, caused by a lack ofinteractive parenting, as another major causeof poor ECD outcomes in rural China.International literature has demonstrated thatpsychosocial stimulation in early childhood isfoundational to the development of cognitive,language, social-emotional and motor skills(Britto et al., 2017). Young children typicallyreceive psychosocial stimulation throughinteractive parenting—activities in whichcaregivers and children engage together, suchas reading, signing, telling stories and playing.This means that parenting practices are anessential input in healthy ECD.

Studies conducted by our research team haveshown empirically that interactive parenting bya child’s primary caregiver (typically the child’smother or grandmother) is strongly and

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significantly linked to ECD outcomes, withchildren who receive more interactiveparenting showing better developmentaloutcomes. Yue et al. (2017; 2019)’s study foundthat children whose caregivers read, sang andplayed with them were significantly less likelyto be cognitively delayed. Additionally, in theirs t u d y o f C h i n a ’ s f o u r m a j o r r u r a lsubpopulations, Wang et al. (2019) found thatplaying with children had the largest andbroadest impact on ECD: children whosecaregivers played with them on a daily basiswere significantly less likely to be delayed incognition, language, and social-emotionaldevelopment compared with children whosecaregivers did not play with them. The findingsof both studies point to the importance ofinteractive parenting and early education forhealthy ECD outcomes.

Yet despite the significant and positive impactsof interactive parenting on ECD, the share ofcaregivers (parents and grandparents) in ruralChina who regularly engage in key interactiveparenting practices is small. Yue et al., (2017;2019)’s study found that only 39.2% of ruralcaregivers had played with their child in theprevious day, while 37.5% reported singing andonly 12.6% reported reading with their child.The share of caregivers who engaged in allthree activities was even smaller, at 7.1%.Furthermore, Yue et al. (2019) found that, onaverage, toddlers played alone without parentalsupervision for more than 2.5 hours (155minutes) per day, and toddlers spent more thanan hour each day watching television, meaningthat rural children spend large shares of timeeach day without human interaction. High ratesof television viewing mean that caregiversoften leave their toddlers alone with no form ofhuman interaction.

Other studies conducted by our research teamhave found the same results. Luo et al., (2017)reported that although 59.4% of caregiversplayed with their child, only 36.2% sang totheir child, and only 13.8% told stories to their

child. The research reported in Wang et al.,(2019) similarly found that 59% of caregiversplayed with their child, while only 36% sang,18% told stories, and only 9% read to theirchild (Table 5). These rates stand in starkcontrast with urban areas of China such asSichuan, where nearly two thirds of caregiversread to their child at least every other day(Guo, 2016). They are also much lower than therates of interactive parenting in otherdeveloping countries. A study of poor areas ofColombia found that 67% of caregivers tellstories to their child, and 73% of caregiversread books to their child (Attanasio et al.,2015), compared to 18% and 9%, respectively,among caregivers in rural China. Thus, ruralChina is not only lagging behind developedsettings such as urban China and the UnitedStates, but also behind other developingcountries with similar levels of income,including rural areas.

In addition to low levels of interactiveparenting, our research team also found thatChina’s rural caregivers are not creatingstimulating environments for their children. In2017, two studies conducted by the researchteam examined the family environment in thefour rural subpopulations assessed in Wang etal. (2019)’s study, using the Family CareIndicators (FCI) survey developed by theUnited Nations. The two studies, reported inworking papers by Wang and Zheng (2019) andWang and Yue (2019), found that families inrural China had fewer toys, less variety of toys,and engaged in fewer play activities with

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children than families in developing countrieswith lower income levels, such as Bangladeshand Malawi (Hamadani et al. 2010; Gladstoneet al. 2018). These findings indicate thatcaregivers in rural China are failing tostimulate their children either throughinteractions or through the home environment.

Taken together, the findings of these studiesindicate that poor parenting—in terms of bothnutrition and psychosocial stimulation—arecertainly the root cause of poor ECD outcomesand high rates of delays among infants andtoddlers in rural China. High rates of anemiaare indicative of poor feeding practices in ruralhouseholds, as the chief cause of anemia isdeficiency of iron-rich foods, such as meat andleafy vegetables. Similarly, low levels ofinteractive parenting suggests that the majorityof rural caregivers are not actively practicingparental investment.

Children and their caregivers pose for aphoto. Research indicates that poorparenting is the main cause of low levels ofECD in rural China. Source: REAP FieldSurvey, 2014.

This is not to say that China’s rural caregiversdo not care about their children. In fact,qualitative data collected by our research team

suggests that most families want to invest intheir children (Yue et al., 2017; 2019; Wang &Yue, 2019). However, we believe that manyrural caregivers lack awareness of how tosuccessfully invest in healthy ECD—that is, howto provide micronutrient-rich diets to theirchildren, and how to stimulate their childrenthrough interactive parenting. Throughinterviews, Yue et al. (2017) found that a largeshare of rural parents do not know what goodparenting looks like or how to engage ininteractive parenting practices. Additionally, amixed-methods study of infant feedingpractices in rural China, reported by Yue et al.(2016), found that caregivers do not know thedifferences in nutritional quality of differentfoods, believing that children will be healthy aslong as they are fed and are full. This evidencepoints to a lack of parenting knowledge amongcaregivers in rural China as the main driver ofpoor nutrition and stimulation, and, ultimately,of poor developmental outcomes.

Parental migration

Another aspect of ECD in rural China thatfurther complicates the picture is parentalmigration. In the past four decades, rural-to-urban migration in China has become thelargest movement of people in the modernworld, reaching 288 million in 2018 (Chan,2013; China National Bureau of Statistics,2019). Within this, women make up over a thirdof all working-age rural migrants (ChinaNational Bureau of Statistics, 2019). As aresult, large shares of young children in ruralareas are growing up in the care of surrogatecaregivers, usually grandparents. In paststudies conducted by the research team, abouttwo thirds of young children are in the care oftheir mothers, while the other third are “left-behind children,” usually cared for by paternalor maternal grandmothers as many mothershave migrated to urban areas for work.

How does parental out-migration affect the

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ECD of left-behind children in rural China?International studies have found two competingeffects of migration (Antman, 2013). On the onehand, parental migration may benefit ECD, asincreased income allows families to invest morein the health and development of their children(Macours & Vakis, 2010). On the other hand,migration may also negatively impact ECDoutcomes as a result of decreased parental care(Ngyuen, 2016).

In rural China, a study conducted by ourresearch team found maternal migration inearly childhood to negatively impact thecognitive development of infants and toddlers(Yue et al . , 2016). This may be due todecreased care, as grandmothers tend to beworse caregivers than mothers in terms of bothnutrition and stimulation. Grandmothers inrural China tend to feed infants less diversediets and fewer iron-rich foods than mothers(Yue et al., 2018) and have less knowledgeabout child nutrition than mothers (Yue et al.,2018; Tan et al., 2010). Grandmothers are alsoless likely to engage in interactive parentingthan mothers: Yue et al. (2019) found thatamong grandmothers, 12% told stories tochildren. 32% sang and 32% played withchildren, compared to 14%, 41% and 42%,respectively, among mothers.

However, despite the fact that grandmotherstend to be poorer caregivers than mothers, theissue of poor parenting in rural China is notexclusively one of parental migration andsurrogate caregivers. Although mothers doprovide better nutrition and more diverse dietsto their children compared to grandmothers,Yue et al. (2018) found that only a third ofchildren cared for by mothers met the minimunrequirements for dietarty diversity .Additionally, although mothers are more likelyto engage in interactive parenting thangrandmothers, less than half of mothers engagein each of the three targeted practices assessedin our past studies (Yue et al., 2019). Thesefindings indicate that although surrogate

caregivers do not provide the same quality ofcare as parents, parenting practices among allrural caregivers are in need of improvement.

Implications for China’s future growth

The previous sections of this paper outlined theECD outcomes of infants and toddlers in ruralChina, as well as the causes of high rates ofdevelopmental delays. In this section, wediscuss the long-term implications of poor ECDoutcomes. We first describe the impacts of poorECD outcomes on academic achievement, afterwhich we discuss the potential consequences ofpoor ECD for China’s economic growth anddevelopment.

Poor ECD outcomes among China’s ruralinfants and toddlers, caused by low parentalinvestment in nutrition and psychosocialstimulation, may have significant consequencesin the long-term. Research in psychology andneuroscience suggests that uncorrected delaysoccurring in the first 1,000 days of a child’s lifelargely persist through adulthood (Biesalski,2016), and additional research has shown thatpersistent cognitive delays from earlychildhood are linked to worse educational andemployment outcomes in later life (Heckman etal., 2010; Heckman et al., 2006). This meansthat poor ECD among China’s rural infants andtoddlers can be expected to lead to worseacademic performance, lower educationalattainment, and worse employment outcomesin adulthood. Moreover, if the trend of poorECD has existed for years, rural school-agedchildren may already be suffering theconsequences of delayed development, whichmay lead to lower levels of human capitalaccumulation across rural China.

In fact, our research team has found thatcognitive delays are not only common amongrural infants and toddlers; rural children inprimary and junior high school also exhibit highrates of developmental delays. A recent study

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of primary school students in rural migrantcommunities in Beijing and Suzhou and ruralareas of Henan and Anhui Provinces, reportedin Zhao et al. (2019), found that one third(33%) of children were cognitively delayed (asmeasured by Raven’s Standard ProgressiveMatrices). Another study of junior high schoolstudents in rural northwestern China, reportedin He et al. (2019), found that between 37%and 40% of students were cognitively delayed(using Raven’s Standard Progressive Matricesand the Weschler Intelligence Scale forChildren). This suggests that rural China’s ECDproblem has persisted for some time, and thatwithout intervention, early cognitive delaysamong the current generation of rural infantsand toddlers will likely persist as children growolder.

Furthermore, these two studies found thatlower IQ in children is linked to worseacademic performance. Among primary schoolstudents, Zhao et al., (2019) found thatstudents with an IQ below 85 (the cutoff forcognitive delays) scored 0.5 SD lower onstandardized math tests than students with anIQ of 100 (the healthy mean IQ score). He et al.(2019) found an even greater achievement gapin junior high school: students with cognitivedelays between 0.78 SD (using Raven’s) and0.95 SD (using WISC) below their peers interms of academic performance. To put thisinto perspective, 0.5 SD represents onesemester to one year of learning (Koedel &Betts, 2007; Rivkin, Hanushek, & Kain, 2005;Rockoff, 2004). By conservative estimates, thismeans that cognitively delayed students lagbehind their peers by about one semester inprimary school and by nearly a year by the timethey are in junior high school. As a result,about half of rural primary school students inChina are not prepared for junior high school(Zhao et al, 2019).

High rates of cognitive delays and pooracademic outcomes in rural China present achallenge for the nation’s future economic

growth and development. Currently, manyworkers in China do not need high levels ofeducation, as there are abundant low-skill jobsin manufacturing and construction. However,China is making plans to transition into aneconomy based on higher value-added, high-wage industries. International experience hasshown that in order to be competitive in thesehigher value-added industries, individuals willneed to have acquired skills taught at the levelof high school or above (Bresnahan et al., 2002;Bresnahan, 1999). Yet with only 30% of thecurrent labor force in China holding a highschool education or higher, China is far fromreaching adequate levels of high skilledworkers (Khor et al., 2016). Although highschool education has expanded considerably,rural students are still attending high school atfar lower rates than their urban peers: whereas99% of urban students matriculate intoacademic high school, only 77% of ruralstudents do so (Wang et al., 2018). If cognitivedelays inhibit the academic achievement ofrural students, not only will many individualshave a difficult time finding employment; newlyemerging industries may also falter from ashort supply of skilled labor. This may lead to a“middle-income trap,” an economic theory thatdescribes a decrease in a nation’s growth rateafter reaching middle-income status, whichinhibits further development and growth. Infact, countries with similar levels of ECD torural China, such as Colombia, Mexico, SouthAfrica and others, are already known to havebeen mired in the middle-income trap and havebeen unable to maintain even moderate growthrates (Li et al., 2017). To prevent this fromhappening in China, the nation will need tomake significant investments in raising thehuman capital of its rural population, startingwith ECD.

Conclusion

China has made vast strides in economic and

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social development in the past 40 years.However, there remain significant challenges,particularly for young children growing up inrural communities. In the long run, there isevidence that poor ECD in rural China iscontributing to overall low levels of ruraleducational attainment and human capitalaccumulation, with troubling implications forChina’s future economic growth. Based on thisevidence, there is a clear need for large-scaleECD interventions targeting rural childrenunder three years of age.

International literature has found ECDinterventions in nutrition and psychosocialstimulation to be effective in improving overalldevelopmental outcomes and reducing theprevalence of delays (Aboud & Yousafzai,2015). In particular, curriculum-basedi n t e r v e n t i o n s , i n w h i c h t r a i n e dparaprofessionals teach caregivers how toprovide adequate nutrition and stimulation totheir children, have been shown to havesignificant positive impacts on cognition in theshort-term (Grantham-McGregor & Walker,2015; Walker et al., 2011; Hamadani et al.,2006; Nahar et al., 2012; Attanasio et al.,2014). Follow-up studies of ECD interventionshave also found significant long term benefitsto cognition and education (Grantham-McGregor & Walker, 2015; Walker et al.,2011).

A parenting trainer from the NationalHealth and Family Planning Commissionconducts a home visit to a rural family inNorthwestern China as part of an ECDprogram to improve interactive parenting.A recent evaluation of this interventionfound significant positive impacts on childdevelopment. Source: REAP Field Survey,2014.

Members of our research team have tested theeffects of ECD interventions in the context ofrural China. In a recent study, colleagueswithin our research team examined the effectsof a psychosocial stimulation home-visitingintervention, delivered through the NationalHealth and Family Planning Commission(NHFPC), on the cognitive development oftoddlers age 18-36 months. In association withthe NHFPC and early childhood developmentexperts, the researchers designed a week-by-week curriculum targeting toddlers age 18-36months. In each weekly home visit, cadres fromthe NHFPC delivered age-appropriateinformation on child cognitive, language,socioemotional and motor skills and activitiesfor caregivers to engage and interact with theirchildren. The study, which is reported in Sylviaet al. (2018) found that the interventionsignificantly increased the cognitive abilities ofchildren in the intervention group relative tochildren in the control group (who received noECD intervention). Our research team is also inthe process of evaluating a center-based ECDintervention in rural western China, whichoffers curriculum-based one-on-one parentingtraining and group activities in a centrallocation to which caregivers can bring theirchildren. Preliminary results from this studysimilarly indicate positive impacts on childdevelopment. In other words, our recentstudies find that interventions to increaseinteractive parenting can effectively improveECD outcomes in rural China.

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A caregiver and her child read together ina parenting center in rural northwesternChina. Source: REAP Field Survey, 2017.

Recent government efforts indicate that Chinais also aware of the problem of poor ECD inrural areas. Since 2015, China’s Ministry ofEducation, the NHFPC and other departmentswithin China’s government have called foreffective ECD programs in health, nutrition andsimulation, paying particular attention to poorrural areas (UNICEF, 2017). It is yet to be seenwhether this initiative will effectively raise theECD of China’s rural infants and toddlers;however, it indicates a step in the rightd i rec t ion . Now, there i s a need fo rpolicymakers to work with researchers andchild development experts to scale and deliverevidence-based interventions that will helpChina’s rural children achieve their fulldevelopmental potential.

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Sarah-Eve Dill is a researcher at the Rural Education Action Program at Stanford University.She earned her B.A. in Development Studies and East Asia Studies from Brown University in2017. Her research centers on health and educational issues in rural China, with a focus onearly childhood development.

Yue Ma has been researching the economics of education and human capital in rural Chinafor over eight years. His research has focused on rural education in China and includesprojects on providing subsidized vision care to myopic students, teacher performance pay,and baby nutrition. His current projects include computer-assisted learning, text messaginginterventions in early childhood development, and cheating behavior among primary school

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students.

Andrew Sun is has been an intern with the Rural Education Action Program since 2016. Hehas worked on various projects related to early childhood development in rural China.

Scott Rozelle is the Helen F. Farnsworth Senior Fellow and the co-director of the RuralEducation Action Program in the Freeman Spogli Institute for International Studies atStanford University. He received his BS from the University of California, Berkeley, and hisMS and PhD from Cornell University.