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W O R K I N G P A P E R N O . 3 3

Childhood poverty, basic services and cumulative disadvantage:

An international comparative analysis

Minna LyytikäinenNicola JonesSharon HuttlyTanya Abramsky

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Young Lives Save the Children UK 1 St John's Lane London EC1M 4AR

Tel: 44 (0) 20 7012 6796 Fax: 44 (0) 20 7012 6963 Web: www.younglives.org.uk

ISBN 1-904427-34-0 First Published: 2006

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Young Lives is an international longitudinal study of childhood poverty, taking place in Ethiopia, India, Peru and Vietnam, and funded by DFID. The project aims to improve our understanding of the causes and consequences of childhood poverty in the developing world by following the lives of a group of 8,000 children and their families over a 15-year period. Through the involvement of academic, government and NGO partners in the aforementioned countries, South Africa and the UK, the Young Lives project will highlight ways in which policy can be improved to more effectively tackle child poverty.

The Young Lives Partners Centre for Analysis and Forecast, Vietnamese Academy of Social Sciences

Centre for Economic and Social Studies (CESS), India

Department of Economics, University of Addis Ababa, Ethiopia

Ethiopian Development Research Institute, Addis Ababa, Ethiopia

General Statistical Office, Government of Vietnam

Grupo de Análisis Para El Desarrollo (GRADE), Peru

Institute of Development Studies, University of Sussex, UK

Instituto de Investigación Nutricional (IIN), Peru

London School of Hygiene and Tropical Medicine, UK

Medical Research Council of South Africa

Queen Elizabeth House, University of Oxford

RAU University, Johannesburg, South Africa

Save the Children UK

South Bank University, UK

Statistical Services Centre, University of Reading, UK

Childhood poverty, basiC serviCes and Cumulative disadvantage: an international Comparative analysis


an international comparative analysis

minna lyytikäinennicola Jonessharon huttlytanya abramsky

WorKing paper no.33


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prefaceThispaperisoneofaseriesofworkingpaperspublishedbytheYoungLivesProject,aninnovativelongitudinalstudyofchildhoodpovertyinEthiopia,India(AndhraPradeshState),PeruandVietnam.Between2002and2015,some2000childrenineachcountryarebeingtrackedandsurveyedat3-4yearintervalsfromwhentheyare1until14yearsofage.Also,1000olderchildrenineachcountryarebeingfollowedfromwhentheyareaged8years.

YoungLivesisajointresearchandpolicyinitiativeco-ordinatedbyanacademicconsortium(composedoftheUniversityofOxford,theUniversityofReading,theLondonSchoolofHygieneandTropicalMedicine,LondonSouthBankUniversityandtheSouthAfricanMedicalResearchCouncil)andSavetheChildrenUK,incorporatingbothinter-disciplinaryandNorth-Southcollaboration.

YoungLivesseeksto:

Producelong-termdataonchildrenandpovertyinthefourresearchcountries

Drawonthisdatatodevelopanuancedandcomparativeunderstandingofchildhoodpovertydynamicstoinformnationalpolicyagendas

Traceassociationsbetweenkeymacropolicytrendsandchildoutcomesandusethesefindingsasabasistoadvocateforpolicychoicesatmacroandmesolevelsthatfacilitatethereductionofchildhoodpoverty

Activelyengagewithongoingworkonpovertyalleviationandreduction,involvingstakeholderswhomayuseorbeimpactedbytheresearchthroughouttheresearchdesign,datacollectionandanalyses,anddisseminationstages

Fosterpublicconcernabout,andencouragepoliticalmotivationtoacton,childhoodpovertyissuesthroughitsadvocacyandmediaworkatbothnationalandinternationallevels

Initsfirstphase,YoungLiveshasinvestigatedthreekeystorylines-theeffectsonchildwellbeingofi)accesstoanduseofservices,ii)socialcapital,andiii)householdlivelihoods.Thisworkingpaperisoneofaserieswhichconsideranaspectofeachofthesestorylinesineachcountry.Asaworkingpaper,itrepresentsworkinprogressandtheauthorswelcomecommentsfromreaderstocontributetofurtherdevelopmentoftheseideas.

TheprojectreceivesfinancialsupportfromtheUKDepartmentforInternationalDevelopmentandthisisgratefullyacknowledged.

Forfurtherinformationandtodownloadallourpublications,visitwww.younglives.org.uk

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Contents

�. Introduction 4

2. Literature review: Multi-dimensionality of poverty and implications for service delivery 5

2.1 the human development approach to poverty 5

2.2 Chronic poverty and multiple disadvantage 6

2.3 linkages between caregiver education and child wellbeing 8

2.4 lessons from cross-cutting themes 9

3. Methods and results �2

3.1 methods 12

3.2 results 13

4. Discussion 2�

4.1 Childhood poverty as a cross-cutting policy theme 21

4.2 policy approaches to overcome disparities in children’s access to social services 22

4.3 Conclusions and directions for future research 28

References 29


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the authorsMinnaLyytikäinenandNicolaJonesarepartoftheYoungLivesteambasedatSavetheChildrenUK’sheadquartersinLondon,whileSharonHuttlyandTanyaAbramskyarebasedattheLondonSchoolofHygieneandTropicalMedicineintheUK.


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acknowledgementsTheauthorswishtoacknowledgetheveryhelpfulcommentsofCarolineHarperandJoyMoncrieffe,andtothankColetteSolomonforeditingthispaper.


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i. introduction

Althoughthereisaconsiderablebodyofresearchonsector-specificevaluationsofbasicservicedelivery(education,healthandnutrition,sanitationandwaterservices,etc.)andchildoutcomesindevelopingcountries(egLavyet al., 1996;Gwatkinet al.,2004;Mehrotra,2004;Harper,2004),therehavebeenfarfeweranalysesofinter-sectorallinkagesandchildhoodpoverty.However,understandingthecumulativenatureofdisadvantageandthebenefitsofinter-sectoralsynergiesiscrucialforanystrategyaimingtocombatpoverty.

“A symptom of poor strategy is failure to recognise the inter-relationships between sectors and interventions. For example, health services cannot be effective… where they cannot be used by women because of gender related restrictions. […] Thus, policy design and programming needs to take account of a range of key sectors and recognise the way in which they build upon each other. This should result in integrated service delivery and simultaneous improvements in core sectors” (Harper, 2004: 5).

Theaimofthispaperistoexplorepatternsinaccesstomultiplebasicservicesamongchildrenlivinginpovertybydrawingonasampleofover8,000childreninfourdevelopingcountries-Ethiopia,India,PeruandVietnam-participatinginthelongitudinalYoung Lives(YL)projectonchildhoodpoverty.Ouroverarchinghypothesisisthatchildrendeniedaccesstoeducationorhealthservicesaremorelikelytoresideinhouseholdsdeprivedofotherbasicinfrastructureandthereforelikelytosufferfromcumulativedisadvantages.Byexaminingthisquestioninfourcountrieswithdistincthistorical,social,politicalandeconomicdevelopmenttrajectories,wearewell-positionedtocontributetodebatesontherelationshipbetweenaccesstoservicesandbreakingpovertycycles.AstheWorldBank,forexample,emphasises:

“any children and youth strategy – be it national, regional, or global – needs to be multi-sectoral and multidimensional. […] Interventions should […] address children and youth well-being simultaneously in several sectors, as well as through integrated packages of services and activities specifically tailored to their needs” (World Bank, 2005b).

Disaggregationofouranalysisbysub-nationalregions,gender,urban-rurallocationandpovertystatusallowsustocapturesomeofthecomplexitythatistoooftenoverlookedindiscussionsaboutpublicpolicyinterventionstotacklechildhoodpoverty(egHarper,2004).

Thepaperisdividedintofivemainsections.Section2reviewscross-disciplinaryliteratureonthemulti-dimensionalityofpovertyandimplicationsforservicedelivery.Section3outlinesthemethodsusedtoanalyseYoung LivesdatafromEthiopia,India(AndhraPradeshstate),PeruandVietnam,whileSection4discussesthemultivariateresults.TheconclusionsandrelatedpolicyimplicationsarepresentedinSection5.


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2. literature review: multi-dimensionality of poverty and implications for service delivery

2.1 The human development approach to povertyTheconventionalincome/consumption-centredconceptionofpovertyhasbeencriticised,amongotherissues,foritsneglectofthemulti-dimensionalnatureofpovertyandtheimportanceofpublicservicesforwellbeing(KanburandSquire,1999;HulmeandMcKay,2005).AnalternativetonarrowmonetarydefinitionsofpovertyisthehumandevelopmentapproachwhichhasitstheoreticalunderpinningsintheworkofSen(1999)andNussbaum(2000);itsbest-knownpracticalapplicationistheUNDP’sHumanDevelopmentIndex.AccordingtoSen’sformulation,povertycanbeseenascapabilitydeprivationorthelackof“substantivefreedomspeopleenjoytoleadthekindoflifetheyhavereasontovalue,suchassocialfunctioning,betterbasiceducationandhealthcare,andlongevity”(KanburandSquire,1999:10).

Althoughnotwithoutitscritics—particularlyregardingthedifficultiesentailedinmeasuringmulti-dimensionalpoverty(HulmeandMcKay,2005)—thehumandevelopmentapproach’stheoreticalandconceptualcontributionisimportantbecause“broadeningthedefinitionofpovertychangessignificantlyourthinkingaboutstrategiestoreducepoverty”(KanburandSquire,1999:2).Abroaderdefinitionintuitivelybroadenstherangeofpoliciesrelevanttopovertyreductionand,equallyimportantly,allowsustotakeintoaccounttheinteractionbetweenvariousaspectsofpoverty(KanburandSquire,1999;Mehrotra,2004).

Mehrotra(2004)hasarguedthatmaximisingsynergiesamongdifferentaspectsofwellbeinganddifferentservicesectorshasbeenanimportantfactorinthedevelopmentofcountriesthathavebeenabletoachievehighlevelsofsocialdevelopmentrelativetotheirnationalincome.HighachieversincludeKorea,Cuba,SriLankaandthestateofKeralainIndia.Suchsynergiesareimportantandcaninduceavirtuouscircleofdevelopmentbecause(1)interventionsinonesectorimpactonmorethanoneareaofwellbeing;andbecause(2)people’slevelofwellbeinginoneareapositivelyinfluencesefficiencyofservicesacrosssectors(Mehrotra,2004).Forexample,theimpactofeducationalinterventionsisgreaterwhenchildrenarewell-nourishedandhealthy.Historically,investmentinbasiceducationinhighachievercountriestendedtoprecedesuccessesininfantmortalityreduction.Inotherwords,“[t]hesynergiesbetweeninterventionsinhealthandeducationarecriticaltothesuccessofeach,andincreasethereturntoinvestment–andthesequenceisimportant”(ibid:23).

Althoughevidenceofinter-sectoralsynergiesisnotnew,differentsectorsareoftentreatedseparately“probablyinpartduetoover-specialisation”(Mehrotra,2004:7).Opinionsarealsomixedregardinghowatheoreticalunderstandingofthemulti-dimensionalityofpovertyshouldbetranslatedintopolicyrecommendations.TheWorld Development Report 1980,forexample,acknowledgesa“seamless


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web”ofinterrelationsamongsocialinterventionsandemphasisesthat“differentelementsofhumandevelopmentarekeydeterminantsofeachother”(quotedinKanburandSquire,1999:12).However,althoughacknowledgingtheimportanceofhumandevelopmentandthemulti-dimensionalnatureofpovertyonaconceptuallevel,themorerecent World Development Report 2004 Making Services Work for Poor People(WorldBank,2003)failstoaddresstheissueofsynergiesamongservices.Instead,itsapproachismorefocusedonagency:theroleofthegovernment,privatesectorandclientsthemselvesinimprovingaccesstoservices.

Socialpoliciesmayalsobenefitfromintergenerationalsynergies.Mehrotra’s(2004)illustrationofthelife-cycleofaneducatedgirlshowsthateducatedwomenaremorelikelytohavefewerchildrenandbehealthier,betterfedandhavethebenefitsofeconomicactivityoutsidethehome,aswellasbeingabletogivetheirchildrenbettercareandnutrition,seekhealthcareforthemandsendthemtoschool.

Bothinter-sectoralandintergenerationalsynergiesaremostoftenrecognisedwhendesigningservicesfor(young)children.Thisisduetoholisticunderstandingsofchildren’sneedsorinthewordsofAlva(1986)“…achildisbornfreewithoutbarriers.Itsneedsareintegratedanditiswewhochoosetocompartmentalizethemintohealth,nutritionoreducation”(quotedinMyers,1992a).However,regardlessofthewidespreadconsensusofthemulti-dimensionalandintegratedneedsofchildrenandyouth,inpractice,itisoftendifficulttodefineanintegratedapproachandthekindoforganisationalstrategiesrequiredattheimplementationlevel(Myers,1992a).Furthermore,governmentagenciesresponsibleforco-ordinatingchildren’sstrategiestendtobemarginalisedandunder-resourced(Harper,2004).

2.2 Chronic poverty and multiple disadvantageMulti-dimensionalpoverty,including“deprivationsrelatedtohealth,education,isolation,‘voice’andsecurity”(Birdet al.,2002:4),maybe(come)chronic:

“when individuals or households are trapped in severe and multidimensional poverty for an extended period of time. This may be five years or may be linked with the inter-generational transmission of poverty, where people who are born in poverty, live in poverty and pass that poverty onto their children.” (Bird and Shinyekwa, 2003: 8)

Theinterlockingproblemsofthechronicallypoorrangefromdomesticviolenceandhouseholdbreak-uptotheftanddistrustinthepoliceandjusticesystem.Remotenessandisolationofthepoorleadtolowlevelsofaccesstohealthcareservices,healthinformationandeducation,whichinturnleadtohigherlevelsofmortality,morbidityanddisabilityamongthepoor.Morevulnerablegroupsamongthepoor,suchaswidowsortheelderly,areparticularlyseverelyaffectedbypooraccesstoservices(BirdandShinyekwa,2003).Furthermore,poornutritionandlackofaccesstopreventativeandcurativehealthcare,cleanwaterandsanitationmayimpactonchildrenandyoungpeopleinwaysthatresultinirreversibledamage,makingtransientpovertyachroniccharacteristic(Birdet al.,2002;Harper,2004).Forexample,malnutritioninadolescentgirlsmayaffecttheirreproductivecapacitiesandfoetaldevelopment.


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Multi-dimensionaldeprivationandlackofaccesstoservicesmaybeparticularlysevereinruralareas.Inthemajorityofdevelopingandtransitioncountries,ruralratesofpovertyarehigherthanurbandeprivation,whenmeasuredwithbothincomeandotherindicators.

“The picture that emerges from surveys of social indicators and access to basic services confirms that rural populations experience higher levels deprivation despite general improvements in such indicators over the last 30 years.” (Bird et al., 2002: 6).

Thismaybeduetolesspoliticalwillorurgencytoprovideservicestotheruralpoorthantourbanareas,andthefactthatthe“constructionofphysicalinfrastructureinmanyremoteareas[…]canalsobetechnicallyverydifficult”(Birdet al.,2002:22).Consequently,

“[h]uman capital in [remote rural areas] may be lower than elsewhere. […] food security may be erratic, leading to under-nutrition, damaging children’s mental and physical development. Government provision of education and health services […] is likely to be poorer that in non-remote areas. Low population densities may make it difficult to supply good quality provision” (ibid: 27).

Theyfurtherarguethatdemographicfactorsmayexplainsomeofthepersistenceofchronicpovertyinremoteruralareas.Fertilityishighinruralareas,duetointer alia lowaccesstofamilyplanningservicesandlowlevelsofeducation;disabilityratiosarealsohighintheabsenceofadequatehealthservices.Incombinationwiththeout-migrationofworkingageadults,thesefactorscontributetohighdependencyratiosinruralareas.

Furthermore,disadvantagesinmanyareasofwellbeingtendtoaccumulateinruralareasduringtherainyseasonbeforetheharvestwhenworkloadsaregreat,lackoffoodandcashrenderspeopleincreasinglyvulnerabletoshocks,andmanycommunitiesfindthemselvesisolatedduetopoorroadconditions.AccordingtoaDFIDparticipatorypovertyassessment,financialandgeographicbarrierstoserviceaccess(eglackofcashandtime,poorruralroadconditions)areexacerbatedduringtherainyseasonwhendiseaseisalsomoreendemic(Brocklesby,1998).Tropicalseasonality,afactoroftenignoredbyurban-basedgovernmentanddonorofficials,causes

“many adverse factors for the poor [too] often coincide during the rains – hard agricultural work, shortage of food, scarcity of money, indebtedness, sickness, the late stages of pregnancy and diminished access to services” (Chambers, 1995: 190).

Similarly,intheirstudyofchronicpovertyinruralUganda,BirdandShinyekwa(2003)notethatinvestmentsinruralroadshavereducedthedistancefrommarketsconsiderably,andtheyconcludethatcomplementarypoliciesarenowneededto“createanenablingenvironmentforruralenterprise,employmentandeconomicgrowth”(ibid: 32).Thisis,however,onlypossibleifimprovementsaremadeatthehouseholdlevel,suchasimprovementsinthehumancapitalofhouseholdmembers,“whichwillprovidethechronicallypoorwiththetoolstobenefitfromopportunitiesintheirimprovedenvironment”(ibid: 32).


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2.3 Linkages between caregiver education and child wellbeingThepositiveimpactofmaternaleducationallevelsonchildwellbeingiswell-documentedinempiricalhealthandmicroeconomicliterature(CaldwellandMcDonald,1982;ClelandandVanGinneken,1988;Barrera,1990;Thomaset al.,1991;Sastry,1996;Glewwe,1999;ChristiansenandAlderman,2001;Escobalet al.,2005).

Maternaleducationmayalsoincreasethepositiveimpactofavailablepublicservicesonchildwelfare,althoughtheresultsofempiricalstudiesexaminingthisrelationshiparemixed.Forexample,Thomaset al. (1991)andBarrera(1990),whostudymaternaleducationandchildhealthinBrazilandthePhilippinesrespectively,findthatmaternaleducationandsewerageinruralareasarecomplementary,iehouseholdswithbetter-educatedmothersderivegreaterbenefitsfromtoiletconnections.Intheirresearch,thepositiveimpactofmaternaleducationwasdueprimarilytomothers’increasedaccesstoinformation,which“suggests that part of the interaction between mother’s education and community infrastructure is coming through better information, processed more efficiently by better educated mothers” (Thomaset al.,1991:208).IntheirstudyofPeru,Escobalet al.(2005),incontrast,findthatpublicinfrastructurehasgreaterimpactsinhouseholdswithlesseducatedmothers,whichleadstheauthorstoconcludethattheprovisionofpublicservicesinareaswithlowlevelsofmaternaleducationisofcrucialimportance.

Withregardtoaccesstohealthservices,Thomaset al.(1991)findthatavailabilityofhealthservicesseemstobeasubstituteformaternaleducation,thatis,lesseducatedmothersandtheirchildrenmayderivemorebenefitsfromaccesstoclinicsorhospitalsthanmotherswhoaremoreeducated.Barrera(1990),ontheotherhand,findsthataccesstohealthcareismostbeneficialtoachild’swellbeingiftheirmotherisbettereducated.

Equallyimportantly,positiveexternalitiesfrommother’seducationandaccesstoservicesarenotlimitedtotheindividualhousehold.TwostudiesontheeffectsofaccesstoservicesinPeruvianneighbourhoods(Aldermanet al.,2003;Escobalet al.,2005)andonestudyinEthiopia(ChristiansenandAlderman,2001)allfindthattheoverallleveloffemaleeducation/levelofhealthknowledgeintheneighbourhoodhasapositiveimpactonthenutritionalstatusofchildren,regardlessoftheircaregiver’seducationalstatus.However,asincomelevelsincrease,theimportanceofcommunityknowledgebecomeslesssubstantial(ChristiansenandAlderman,2001).Similarly,accesstocleanwaterandsanitationfacilitiesatthecommunitylevelappeartohaveapositiveimpactonchildren’shealth,particularlyincommunitieswithlowlevelsofaccesstosanitation(Aldermanet al.,2003).

Nevertheless,someanalystssuggestthatweshouldbecautiousaboutoverstatingthepositivelinkagesbetweencaregivereducationandchildoutcomes.Acceptingthestrongcorrelationbetweenlevelsofmaternaleducationandindicatorsofchildhealth,DesaiandAlva(1998)arguethatthereisnotnecessarilyastrongcausalrelationship,andthatmaternaleducationismerelyaproxyforboththesocio-economicstatusofthefamilyandgeographiclocation.Whenhusband’seducation,waterandsanitationinfrastructureandlocationarecontrolledfor,theimpactofmaternaleducationdeclinesconsiderably.


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Moreover, regardlessofextensiveempiricalfindingsonsynergiesbetweenmaternaleducation,children’shumancapitalandwellbeing,andcommunitycharacteristicsandinfrastructure,thereisadearthofliteratureonhowtheselinkagescouldbebuiltoninpolicydesignandimplementation.Infact,arecentWorldBankprogrammeevaluationarguesthat,whileinterventionsinothersectors(egwomen’seducationandruralelectrification)clearlyhavepositiveimpactsonmaternalandchildhealthandnutrition,“thepresenceofintersectoralimpacts[is]not[to]beconfusedwiththeneedformultisectoralinterventionsorovercentralizationofsectoralactivities”(WorldBank,2005a:41).Thereportsuggeststhatthisisbecausethesynergisticeffectsobservedhadoccurredintheabsenceofco-ordinatedinter-sectoralinterventions.Wewillreturntothispointagainintheconclusion.

2.4 Lessons from cross‑cutting themesIncontrasttothedearthofempiricalliteratureontheinter-sectoralimpactsofpublicpolicyinterventionsonchildwellbeing,thereisagrowingbodyofanalysisoninter-sectoralapproachestopovertyreduction,HIV/AIDSpreventionandthepromotionofgenderequality,whichpotentiallyoffersomeimportantinsights.

Poverty Reduction Strategy PapersTherationalebehindthePovertyReductionStrategyPaper(PRSP)“isbasedontheprincipleandmeritsoftheintegrationofdifferentsectors”(CaillodsandHallik,2004:78)andthataninter-sectoralstrategicapproachisneededforsuccessfulreductionofpovertyinitsmultipledimensions.AsO’Malley(2004:1)argues:

“Inthefiveyearssinceitsinception,thePRSPhasbecomeadefiningdocumentforeconomicandsocialpolicy….Theprocessofproducingastrategycanprovidesignificantnewopportunitiesforinfluencingpolicytoimprovethelivesofpoorchildrenandtheirfamilies.Forthefirsttime,governmentsarerequiredtoundertakeapubliclyaccessibleanalysisofpovertyintheircountry–acknowledgingtheextentofpoverty,whoisaffectedandthereasonsbehindpoverty.Theymustoutlinewayspovertywillbetackled.Thisrequiresgovernmentstoformulateacoherentplan,linkingeconomicpolicyandgovernancemeasureswithneworexistingsectoralplans,forexample,ineducationandhealth,toreducepoverty”.

DriscollandEvans(2005)assessthatoneofthegreatestachievementsofthefirstfewyearsofthePRSPprocesshasbeenthestrongerfocusthatpovertyhasreceivedinsidegovernments.Whereasbeforepovertyreductionwasconsideredtobefarfrom“themainstreamofgovernmentbusiness,itnowappearstobemoreofapriorityconcernandonewithpotentialtoshapethewholeofgovernmentactivity”(ibid: 7).Accordingtotheauthors,thePRSapproachhasledtotheadoptionofplanstoreducepovertythataremoreoverarchingandmulti-sectoralthanbefore,andmore‘pro-poor’spendinghasbeensecuredinnationalbudgets(ibid.).Furthermore,inAfricanPRSPs,“aclearlinkbetweencoreunitschargedwithpovertyplanningandMinistriesofFinancechargedwithresourceallocation”hassecuredastrongercorrelationbetweenPRSprioritiesandbudgetallocationsinEthiopiaandTanzania(ibid.).


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Thecross-cuttingrationaleofthePRSdoesnot,however,necessarilytranslateeasilyintomulti-sectoralplansinpractice.IntheirstudyoftheeducationagendainPRSPs,CaillodsandHallik(2004:150)concludethatPRSPsshouldtakeamoreintegratedapproachtoservicedelivery,aspresentlytherearefewattemptstosynchroniseeffortsineducationwithothersectorsand“theeducationchapterisdevelopedverymuchindependentlyfromtheotherchaptersandfromwhatisproposedinothersectors.”Thedifficultiesincreatingacomprehensiveandinter-sectoralpovertyreductionstrategyarepartlydueafearwithinsectoralministriesoflosing“controloversectorpriorities,targetsandindicators,aswellasreducedshareofdonorfundingiftheymoveprojectsandprogrammesontothenationalbudget”(DriscollandEvans,2005:10).Suchincentiveproblemsinsectoralministriesisoneofthechallengesthatthesecond-generationPRSPsfaceintheireffortstodevelopthestrongerfocusonpovertythathasemergedinsidegovernments“intoadeeperandmoreinstitutionalisedformofstatecommitmenttopovertyreduction”(ibid: 10.)

HIV/AIDSInter-linkagesbetweenHIV/AIDSandpovertyarenotonedimensionalas“HIV/AIDSleadstopovertyandvulnerability,bothnationallyandindividually,butpovertyalsoincreasesthechancesofbeinginfected”(CaillodsandHallik,2004:90).TheHIV/AIDSepidemicandpolicyresponsestoitcanbeconceptualisedinaninter-sectoralframework,anditis,indeed,oneofthecross-cuttingthemesthatisdominantinAfricanPRSPs(Thin,UnderwoodandGilling,2001).Interventionsintheeducationsector–referredtoasthe‘educationvaccine’byVandemoortele(2001)–forexample,arecrucialinfightingtheepidemicintheabsenceofamedicalvaccine.1Educationincreasesaperson’sabilitytoprocessrelevantinformationwhichcanresultinbehaviouralchange.“Thespreadofeducationalsochangesthefamilyandcommunityenvironmentinwhichsuchbehaviouralchangesbecomesociallyacceptable–primarilythroughgreatergenderequity”(Vandemoortele,2001:48).AlthoughCaillodsandHallik’sreviewofAfricanPRSPsfoundthatHIV/AIDSwasmainlydealtwithinthehealthsection“anditisrarelymentionedin[chapters]oneducation,employment,ruraldevelopment,andgenderissues”(2004:92),theUgandancaseoffersamodelofbestpractice.UgandahasanAIDSstrategicplan,monitoredbytheUgandanAIDScommissionthat“involvesthehealth,socialdevelopmentandeducationsectors”(ibid:92).

Gender mainstreamingThankstorecognitionoftheinter-connectednessofthedeterminantsofgenderinequalityatthe1995UNFourthWorldConferenceonWomeninBeijing,“gendermainstreaming”isnowawell-acceptedgoalinnationalandinternationaldevelopmentstrategies.Mainstreaminginvolvesensuringthatgenderperspectivesandattentiontothegoalofgenderequalityarecentraltoallpolicy-relatedactivities–egpolicydevelopment,research,advocacy/dialogue,legislation,resourceallocation,planning,implementationandmonitoringofprogrammesandprojects.Illustrativebest-practiceexamplesofintegratinggenderintovarioussectorsareattemptsmadeinNorthernandSoutherncountriestoanalysetheirbudgetarycommitmentsfromagenderequalityperspective.Gender-sensitivebudgets“areamechanismforestablishingwhetheragovernment’sgenderequalitycommitmentstranslateintobudgetarycommitments”(SharpandBroomhill,2002:26).ThepioneeringprojectwastheAustralianWomen’sBudgetStatement,initiatedinthemid-1980s,duringwhich“federal,stateandterritorial

1 ItispromisingthatinmanyAfricancountries,HIVinfectionratesaredecreasingamongpeoplewhohavecompletedprimaryeducation(Thin,UnderwoodandGilling,2001).


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governmentsinthecountryassessedtheimpactoftheirbudgetsonwomenandgirlsovertwelveyearsoldbetween1984and1996”(BudlenderandHewitt,2003:8).Mostimportantly,thisinitiativecoveredallgovernmentexpenditure,notjustthose‘obviously’relatedtowomenandgirls’welfare.ExamplesofgenderbudgetanalysisprogrammesindevelopingcountriesthatwereinspiredbytheAustralianexperiencearetheSouthAfricanWomen’sBudgetInitiative(WBI),anNGO-parliamentinitiative,andtheCommonwealthSecretariatInitiativewhichpromotesgenderbudgetanalysisinresponsetoeconomicrestructuringinCommonwealthcountries2,andisco-ordinatedbytheministriesoffinanceineachcountry(SharpandBroomhill,2002;BudlenderandHewitt,2003).

Insum,althoughfrequentlyflawedinpractice—oftenduetobureaucraticcomplexitiesandinter-agencypolitics—analysesofpolicyareaswhereacross-cuttingmodelhasbeenadoptedsuggestthattheapproachcanbefruitfulwhenbackedbysufficientpoliticalwill.WenextanalyseYoungLives’empiricaldataonchildrenandtheircarers’access(orlackthereof )tovariousbasicservices,afterwhichweturntoadiscussionofinternationalbestpracticesinserviceprovisionthatcouldprovideinsightsregardinghowtoaddressthemulti-dimensionalnatureofpovertyandcumulativedisadvantage.

2 ItspilotincludedSriLanka,St.KittsandNevis,FijiIslands,BarbadosandSouthAfrica(SharpandBroomhill,2002).


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3. methods and results

Thedatapresentedinthispaperaredrawnfromthehouseholdquestionnairesadministeredduringthe2002baselinesurveyofYoungLives(YL).Ineachcountry,thecaregiversofapproximately2,000one-year-oldswereinterviewed.DetailsofthemethodologyareavailableinAttawell(2004).Preliminaryresultsfromeachcountryandthecorequestionnairesusedareavailableatwww.younglives.org.uk.

3.1 MethodsEligiblehouseholdswereselectedfrom20sitesineachcountrybyastrategywhichover-representsthepoor-furtherdetailsofthesamplingmethodsareoutlinedinWilsonandHuttly(2004).Ininterpretingthefollowingresults,itisimportanttonotethattheYoungLivessamplesarenotnationallyrepresentativeandoverallfiguresforaparticularcountryshouldthereforenotbeinterpretedasnationallevelfigures.Foreaseofpresentation,however,theYLsamplesfromeachcountrywillbereferredtosimplybythecountry’sname,forexample“inEthiopia….”.Lackofnationalrepresentativeness,however,doesnotprecludeintra-countrycomparisonsofserviceusebetweensub-groupssuchaswealthquartiles.Thus,moreweightshouldbegiventotheresultswhichdescribethedistributionsofdisadvantagewithin,ratherthanbetween,eachcountrysample.

Indicators of service disadvantageWefirstinvestigatedexperiencesof‘disadvantage’withinspecificsectors.Inthehealthsector,weexaminedlackofanyantenatalcareforthemotherduringherpregnancywiththeindexchildandthefailureofthatchildtoreceivetheBCGvaccine.Forinfrastructure,welookedathouseholds’lackofelectricity,pipeddrinkingwater/privatetubewell,andflushtoilet/privatepitlatrine.Foreducation,theindicatorusedwaswhetherchildrenofprimaryschoolageinthehouseholdwereenrolledinschool.Forthisindicator,thenumberofhouseholdsavailableforanalysiswasnecessarilyrestrictedtothosewhohadchildrenofprimaryschoolage(between630and1,250percountrycomparedtoapproximately2,000percountryforhealthandinfrastructureanalyses).Further,thiseducationindicatorwasbasedondataaboutotherchildreninthehousehold,nottheindexchild(whowasbelowprimaryschoolage).Informationoneducationaccesswasavailableforthesechildrenbutnot,forexample,indicatorsofachievementorservicequality.3

Inadditiontolookingatdisadvantagewithinsinglesectors,wealsoexploreddisadvantageacrosssectors.Wecreatedbinaryindicatorsofdisadvantageforthehealth,infrastructureandeducationsectors–thisenabledustoexamineco-occurrenceofdisadvantageinmorethanonesector.4Ahouseholdwasclassifiedasdisadvantagedinthehealthsectorifthemotherand/orindexchildhadnothadaccesstooneormoreofthehealthserviceslistedabove(antenatalcareandBCGvaccine).Disadvantageintheinfrastructuresectorwasdefinedbyalackofatleasttwoofthethreeservices

3 Indicatorswerechosenonthebasisofavailabledata.Itshouldbenotedthattheydonottapmeasuresofqualityofservices,whichshouldbethefocusforfuturein-depthqualitativeanalysis.

4 Itshouldbenoted,however,thatbecauseofthebinarynatureoftheindicatorsemployedwewerenotabletodistinguishbetweendifferentlevelsofdisadvantageandthusresultshavetobeinterpretedsomewhatcautiously.Forexample,apersonwhodidnothaveaccesstoprivatewaterfacilitiesbuthadgoodaccesstosafecommunalwatermightnotconsiderherself‘disadvantaged’andcertainlynotasdisadvantagedasapersonwholackedanyaccesstoasafewatersource.


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citedabove(electricity,privatewatersupplyandprivatesanitationfacility).Adisadvantagedstatusintheeducationsectorwasassignedtothosewholivedinahouseholdwherenotallchildrenofprimaryschoolagewerecurrentlyenrolledinschool.

LevelsofuseofservicesarepresentedforeachofthefourYoungLivescountrysamples,disaggregatedby:

regionofresidence(urban/ruralasdefinedbycountry-specificcriteria);

relativewealthgrouping(seeBox1);

levelofcaregiver’seducation(none,incompleteprimary,completeprimary);

regionofthecountry(regionalstateinEthiopia,sub-stateregioninIndia,coastal/mountain/jungleinPeru,andprovinceinVietnam).

Box 1: Relative wealth groupingsThewealthindexusedheredrawsonworkundertakenbytheWorldBankandMacroInternational.Itisasimpleaverageofthefollowingthreecomponents:housingquality(thesimpleaverageofscaledroomsperpersonanddummyindicatorvariablesforeachofgoodquality:floor,roofandwall);consumerdurables(thescaledsumofconsumerdurabledummyvariableswhichincludeitemssuchasradio,fridge,etc.);services(thesimpleaverageofdrinkingwater,electricity,toiletandfuel–allofwhichare0-1variables).

Whenexaminingthedistributionofinfrastructureservices(water,sanitationandelectricity)betweenwealthgroups,thehousingqualityindex,anindividualcomponentofthewealthindex,isusedinsteadoftheoverallwealthindex.Thisisdoneinordertoavoidtheinherentcorrelationsthatwouldbepresentduetotheinclusionofthesamevariablesinthe“serviceindicator”andthe“wealthindicator”ifthecompositewealthindexwereused.

3.2 ResultsThefollowingthreefiguresshowpatternsofservicedisadvantageaccordingtorural/urbanlocation(Figure1),wealthgroup(Figure2)andcaregiver’seducation(Figure3)ineachcountrysample.

Figure 1. Service disadvantage by rural/urban

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Figure 2. Service disadvantage by wealth group


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Figure 3. Service disadvantage by caregiver’s education

Notethatthenumberofsubjectsinthe“belowprimary”groupinIndiawastoosmalltobeincluded(n=6).


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Ruralhouseholds,thepooresthouseholdsandthosehouseholdswherethecaregiverhadlowerlevelsofeducation,experiencedmoredisadvantageforhealth,infrastructureandeducationinallcasesexceptwithrespecttohealthservicesinAndhraPradeshandinPeru.LevelsofdisadvantagewereconsistentlyhigherintheEthiopiansamplewiththegreatestdisparitiesbetweenruralandurbangroups.Location-relateddifferencesarealsopresentedinFigure4.Regionaltrendswerenotidenticalacrossallindicators,althoughineachcountry,certainregionshadmarkedandconsistentlylowerlevelsofdisadvantagethanothers.InEthiopia,thelowestlevelsofdisadvantagewereinAddisAbaba;inAndhraPradeshandPeru,thecoastalregionshadthehighestcoverageofservices,andinVietnam,DaNang,themosturbanoftheprovinces,hadthelowestlevelsofdisadvantage.

Figure 4. Service disadvantage by region

Region coding:Ethiopia1=AddisAbaba India1=CoastalAP Peru1=Coast Vietnam1=PhuYenEthiopia2=Amhara India2=Rayalseema Peru2=Mountain Vietnam2=BenTreEthiopia3=Oromia India3=Telangana Peru3=Jungle Vietnam3=LaoCaiEthiopía4=SNNP Vietnam4=HungYenEthiopia5=Tigray Vietnam5=DaNang


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Figures5-8showthedistributionofdisadvantageacrosssectorsamonghouseholdsintermsofhealth,infrastructureandeducationdisadvantage.Thesamplesizeissmallerbecauseoftheinclusionofthelatterindicator.Forexample,Figure5illustratesthatmultipledisadvantageismorecommoninruralthaninurbanareasineachcountrysample.Theresultssuggestthatinmanysituations,thosegroupswithoutaccesstoanysingleservicearealsolikelytolackaccesstootherservicesandthattheycopewithmultipledisadvantagessimultaneously.FurtheranalysisshowedthatineachoftheYLcountrysamples,correlationsbetweenalmostallpairsofindicatorsofdisadvantagewerestatisticallysignificantatthe0.001level.Thisfurthersupportsthefindingsthatmultipledisadvantagesareconcentratedinparticularsectionsofthepopulation.

Figure 5. Number of sector disadvantages by rural/urban location

Region coding:Ethiopia1=AddisAbaba India1=CoastalAP Peru1=Coast Vietnam1=PhuYenEthiopia2=Amhara India2=Rayalseema Peru2=Mountain Vietnam2=BenTreEthiopia3=Oromia India3=Telangana Peru3=Jungle Vietnam3=LaoCaiEthiopía4=SNNP Vietnam4=HungYenEthiopia5=Tigray Vietnam5=DaNang


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Figure 6. Number of sector disadvantages by wealth group

Figure 7. Number of sector disadvantages by caregiver’s education

Note:thenumberofsubjectsinthe“belowprimary”groupinIndiawastoosmalltobeincluded(n=6)


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Figure 8. Number of sector disadvantages by region

Sincelocation(urban/rural)issostronglyassociatedwithmultipledisadvantageandwithwealthindex/caregivereducation,weexaminedthesefactorsconjointlyinalogisticregressionmodel(Table1).Sincethelevelsofmultipledisadvantageareverylowinsomesub-groups,confidenceintervalsforsomeestimatesareverywide.However,theresultsemphasisethestronginfluenceoflocationonthelikelihoodofdisadvantageinatleasttwosectors.Theydemonstratethatthedataarealsoconsistentwiththeindependenteffectsofwealthandcaregivereducation.

Table 1. Adjusted Odds Ratios* for association between caregiver education, household quality quartile and urban/rural location, and experience of disadvantage in 2 or more sectors

Ethiopia(n=1221) India(n=632) Peru(n=1048) Vietnam(n=616)

OR 95%CI OR 95%CI OR 95%CI OR 95%CI

Caregiver education:

None 1 - 1 - 1 - 1 -

Belowprimary 0.57 0.40–0.83

- - 1.22 0.68–2.19 0.35 0.17–0.68

Primaryorabove 0.35 0.23–0.53

0.28 0.15–0.51

0.48 0.25–0.94 0.11 0.06–0.21

Wealth (Housing quality):

Lowestquartile 1 - 1 - 1 - 1 -

Secondquartile 0.51 0.32–0.81

1.07 0.68–1.69

0.47 0.28–0.78 0.51 0.29–0.91

Thirdquartile 0.39 0.24–0.63

0.86 0.51–1.44

0.40 0.20–0.80 0.45 0.23–0.88

Highestquartile 0.24 0.15–0.39

0.47 0.23–0.97

0.056 0.01–0.42 0.22 0.09–0.54

Urban/rural location:

Urban 1 - 1 - 1 - 1 -

Rural 7.52 5.37–10.52

4.69 1.94–11.33

2.18 1.29–3.68 24.26 3.25–181.14

*Logisticregressionmodelincludesalloftheseexposurevariables.


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4. discussion

UsingthefirstroundofYLdata,wehavebeenabletolookatintra-countrydistributionsofdisadvantageandidentifygroupswhosufferfrommultipledisadvantage.Regionalandurban/ruraldisparitiesemergedasparticularlysalient,althoughimportantlythesedifferenceswerenotalwaysconsistentacrossallservicesectors.FutureroundsofYLdatawillallowustoexaminelongitudinaltrendsinthesedistributions,explorechangesintheconcentrationofdisadvantageovertime,andlookforevidenceofentrenchmentamongthosealreadydisadvantagedinthefirstround.

Theinclusionofadditionalvariables(forexample,indicatorsofservicequality,accesstosocialprotectionmeasures)infutureroundswillalsoallowustocreateindicatorsofdisadvantageacrossawiderrangeofsectors,andthusprovideamorecomprehensivepictureofmultipledisadvantageforaparticularpointintime.

Whatpreliminarypolicylessonscanwedrawfromthesefindings?First,ourresultsillustratethatdisadvantagesinserviceaccess,especiallyamongruralandpoorhouseholds,arelikelytobeoverlappingandreinforcedbyintergenerationaltransmissionsofpoverty.Thiswouldseemtolendcross-countryweighttotheimportanceofconceptualisingchildhoodpovertyasacross-cuttingpolicythemeandinvestigatingmulti-dimensionalinterventionstotacklechildhoodpoverty.Internationalbestpracticesofmulti-sectoralinterventionstodateincludecarefullytargetedchild-focusedcashtransferprogrammes,EarlyChildhoodDevelopment(ECD)initiativesandfamilyliteracyprojects.

Section4.1examinesthefeasibilityofconsideringchildhoodpovertyasacross-cuttingpolicytheme.Section4.2presentssomeexamplesofinternationalbestpracticesthathavebenefitedfromacross-sectoraloranintergenerationalapproach,butalsosomecautionaryevaluations.Finally,Section4.3concludesandidentifiesfutureresearchdirectionsforYoungLivesregardingcumulativedisadvantageinaccesstobasicsocialservices.IthighlightswaysinwhichYoungLivescouldfurtherexploreintergenerationalsynergiesandtensionsassociatedwithpublicpolicyinterventionstoimprovechildrenandwomen’swellbeing.

4.1 Childhood poverty as a cross‑cutting policy theme

Presently,governmentanddonoragencies’approachtothemultipledisadvantagesofchildrenlivinginpovertyisproblematic,asthey

“either consider children a ‘special interest group’ or confine attention to the core sectors of health and education. The former results in special ‘one off ’ projects for perceived vulnerable groups such as ‘street children’ and orphans, while the latter encourages a piecemeal approach to issues of childhood by, for example, aspects of health but not necessarily addressing critical factors such as children’s food security or supply of clean water” (Harper, 2004: 3-4).

Acentralco-ordinatingagency,suchasaministryinchargeofchildren’sissues,couldenforceanintegratedstrategytoaddresschildhoodpovertybecause:


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centralco-ordinationcouldeaseproblemsatthelevelofprogrammeimplementationwhenagenciesatthelocallevelhaveweaklinkswitheachotherandaregeographicallydisperse(Myers,1992a).Indeed,centralisedco-ordinationandbudgetinghasbeenidentifiedasoneofthesuccessfulelementsofthecashtransferprogrammesdiscussedbelow;

acentralagencycoulddemandanalysesofallpolicycommitmentsandbudgetsfromachild-sensitiveperspective.AdoptingasimilarapproachtothegendermainstreamingandgenderbudgetinitiativesdiscussedinSection2,anagencyresponsibleforensuringthefulfilmentofchildren’srightscouldplayausefulwatch-dogandliaisingrole.

Achievingsuchgoalswould,however,bedependentonthegovernmentagency’scommitmenttoabroadunderstandingofchildren’sneedsandrights,aswellasontheagency’spowertoworkwithotheractors.Unfortunately,todate,children’sissuestendtoberelegatedtomarginalisedministriesthatareresponsiblefor:

“a range of perceived ‘needy’ groups, such as war widows and veterans, orphaned children and the disabled […] These ministries are often marginalised in decision making and resource allocation processes, under-resourced and not engaged with the wider issues which force people into poverty” (Harper, 2004: 4).

Suchdisadvantagemakesitdifficulttotakeastrategicpositiononchildren’spoliciesandbudgetsandtoinfluencethestrategiesofothersectors.Infact,thesuccessfulgenderbudgetinitiativesreviewedabovewereoftenco-ordinatedbytherelativelystrongministriesoffinancewhich,however,lackedcommitment.Nevertheless,learningfromtheseexperienceswouldallowagenciesandtheircivilsocietysupporters(especiallyadvocatesofchildren’srights)tolobbyformoreeffectiveinstitutionaldesignsandmonitoringmechanismstosafeguardagainstpotentialweaknesses.

Whereassuchsystematicattemptstoestablishagovernmentagencywithadequatepoliticalwill,resourcesandaholisticapproachtochildren’swellbeinghavebeenlimited,wecanidentifyinternationalbestpracticesofpolicyinterventionstargetedataddressingchildhoodpovertywithamulti-sectoraloranintergenerationalapproach.Wewillnowturntoadiscussionofthreeofthem,namelyconditionalcashtransfers,earlychildhoodeducationandfamilyliteracyprogrammes,andhighlightpotentialareasforfutureYoungLivesresearch.

4.2 Policy approaches to overcome disparities in children’s access to social services

Conditional cash transfers (CCTs)Conditionalcashtransferprogrammesareconsistentwiththemulti-dimensionalconceptionofpovertyastheyaiminthelong-termto“eradicatethestructuralcausesofpovertybyfosteringinvestmentinthenextgeneration’shumancapital…[and]toalleviateincomepovertyintheshorttermthroughmonetarytransfers”(Pereznieto,2004:20).Rawlingssumsuptherationalebehindinter-sectoralCCTs:

“By focusing on health, nutrition and education, most CCT programs recognize and foster the complementary relationships between these elements of human capital development that are crucial to breaking the inter-generational transmission of poverty. This direct fostering of the synergies between these areas is also a recognition of the evidence concerning the ineffectiveness of certain human capital investments, such as education, without the provision of other basic inputs, such as adequate nutrition” (Rawlings, 2004: 7-8).

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Thefirstlarge-scaleconditionalcashtransferprogrammewasMexico’sProgresa(nowcalledOportunidades),launchedin1997,thesuccessofwhichhasinspiredsimilarprogrammesthroughoutLatinAmerica.5AsillustratedinmoredetailinBox2,Progresa,whichfromthestarthadarobustmonitoringmechanismbuiltintotheprogrammedesign,hasincreasedchildren’sschoolenrolment,improvedinfantnutritionandtheoverallhealthofhouseholdmembers,andgivenwomenmorebargainingpowerwithinthehousehold.

ThesuccessofProgresaandothersimilarprogrammesinLatinAmericanotwithstanding,someunresolvedconcernspersistwithcashtransfers.AlthoughMorleyandCoady(2003:42)concludethat“inlow-incomecountriessuchasNicaraguawithtighterbudgetconstraintsandgreaterneedforeducationalresourcestoaddressinferioreducationaloutcomes,lowertransferscanachievelargeimpactsonhumancapitalaccumulation,especiallyamongthepoor.”NigendaandGozalez-Robledo(2005),incontrast,arguethatitisunlikelythatCCTprogrammeswillbesuccessfuloutsideLatinAmerica,especiallyinpoorercountriesofsub-SaharanAfrica.

Forexample,inAfricancountriessuchasMalawi,targetingwouldbemoreproblematicasthemostvulnerablegroupsinsocietyaregenerallyunregisteredandhavelittlecapacitytotraveltoabankorpostofficetoreceivepayments.Therearealsoconcernsaboutensuringasmoothtransferofcashbecauseofsecurityproblemsandtheabsenceofcomputerisation(NigendaandGozalez-Robledo,

5 Similarcashtransferprogrammeshavebeenimplemented(theReddeProteccionSocialimplementedinNicaragua2001andChileSolidarioinChilein2002).Whilepreviousprogrammeswere“basedontheviewthateducationdeficits,togetherwithdeficitsinparenting,primaryhealthcare,andnutritioninearlychildhood,arethemainfactorsexplainingpersistentpoverty[,]ChileSolidariomaintainsthatpovertyisintrinsicallymulti-dimensional,andregardsthehouseholdasawhole,andnotonlythechildren,asthemainagentofchange”(BarrientosandDeJong,2004:24;PalmaandUrzua,2005).

Box 2: ProgresaMexico’sProgresa(nowOportunidades)providescashtransferstopoorfamiliesconditionalontheirinvestmentintheirchildren’shumancapital.Sinceitsinceptionin1997,theprogrammehasbecomeanimportantpartofMexico’spovertyreductionagenda,andin2002,coveragereached20percentofthecountry’spopulation.

Theprogrammeinvolvesamonthlycashtransfertobeneficiaryhouseholdsconditionalontheirchildrenattendingschool(grades3-9)andgirls’enrolmentinsecondaryschool.Inadditiontocoveringschoolcosts,thereisalsoaconsumptionsubsidyforhouseholdsparticipatingintheschemeandanutritionsubsidyforpregnantandlactatingmothersandsmallchildren,conditionalonregularvisitstothehealthcentrebyallfamilymembers.Thebenefitsaredirectedtothemotherwiththemaximumamountperhouseholdbeingcappedinordertodiscouragehigherfertilityandreducedependence.

EvaluationsfoundthatProgresaresultedinhigherenrolmentrates,especiallyforgirlsinsecondaryschool.“Improvedschoolattendanceisassociatedwithanextra0.66yearsofschoolingbythefinalgrade,andanextra0.72forgirls”(BarrientosandDeJong,2004:27).Stuntingofchildrenaged12-36monthswasreduced,althoughsupplementsweresharedwithinhouseholds.Evidencealsoshowsadecreaseinillnessamongadultsandchildren,especiallyamongbabies(a25percentreduction)andchildrenbetween3and5years(areductionof22percent).Finally,womenreportedhavinggreatercontroloverhouseholdresources(MorleyandCoady,2003;BarrientosandDeJong,2004).


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2005).Althoughexistingcashtransferschemesinsub-SaharanAfricatendtobeunconditional(SavetheChildrenUK,HelpAgeInternationalandInstituteofDevelopmentStudies,2005),thereisalsoadebateaboutwhetherconditionalityiskeytopovertyreductionandhumancapitalaccumulation.However,detractorscounterthatitispaternalistictobelievethatwithoutconditionalitythepoorwouldnotrespondtoservices(NigendaandGozalez-Robledo,2005),andthatstrictconditionstendtopenalisehouseholdswhicharemostinneedofsupporttoovercomepoverty(BarrientosandDeJong,2004).

Afurtherconcernregardingthefeasibilityofimplementingcashtransferprogrammesrelatestothefactthattodatetheyhaveonlydealtwiththedemandsideofservicedelivery;thus,itisoftenonlyfamiliesinareaswithadequateserviceswhichcanparticipate(BarrientosandDeJong,2004;Rawlings,2004;Britto,2005;PalmaandUrzua,2005).Furthermore,forcashtransferschemestohaveintendedeffects,existingschoolswillhavetobeabletodealwithincreasedenrolmentandclasssizes,aswellaswiththeneedsofchildrenwhocomefromfamilieswithlesseducatedparents(MorleyandCoady,2003).Inotherwords,improvementsinwelfareareunlikelyifcashtransfersareconditionalontheuseofpoorqualityhealthservicesandschools(Rawlings,2004).MorleyandCoady(2003:36)have,nevertheless,suggestedthatalthoughexistingprogrammeshavenotincludedacomponenttodealwiththequalityofeducation,initiativessuchasaschoolvouchercomponentortheroleofcommunitiesinmonitoringprogrammeperformance,couldaddressthesupplysidedimensionofCCTprogrammes.

Inthelongerterm,theimpactofgreaterhumancapitalinpovertyreductioncannotbetakenforgrantedas,inadditiontothequalityofeducation,itisinfluencedby“ratesofemployment,absorptionofskilledlaborintheeconomicstructureandgeneralratesofreturntoeducation”(Britto,2005:13;NigendaandGonzález-Robledo,2005).Infact,Oportunidadeshasstartedmovingtowardstheprovisionofyoungpeoplewithbetteropportunitiesoffindingemployment,whileChile Solidariohasincorporatedpensionsandjobopportunitiesinthecoreoftheprogramme(NigendaandGonzález-Robledo,2005).

OurYoungLivesfindingsshowedthatinhouseholdswherechildrenwereenrolledinschool,membersalsohadbetteraccesstohealthandcommunityinfrastructureservices.Thissuggeststhatconcernsaboutthedemandsidebiasofcashtransferprogrammesneedtobeaddressedinordertoeffectivelytacklechildpoverty,especiallyinEthiopiawhereaccesstoservicesisparticularlylow.ItwillalsobeimportantforYoungLivestoevaluaterecentlyintroducedcashtransferprogrammesinPeruandpartsofEthiopia—providedthatthereisoverlapwithYLsentinelsites—andtheirimpactsonchildpovertyoutcomesovertime.

Early Childhood Development (ECD)EarlyChildhoodDevelopment(ECD)isanumbrelladefinitionofcareandservicesaimedatpreschool-agedchildren(0-6years)and,dependingonthedefinition,canincludeschool-,community-,centre-,orhome-basedchildcare;preschooleducation;supplementaryfeedingprogrammes;healthprogrammesandparentsupport/education(Penn,2004).ECDisnowpromotedbythemajormultilaterals,suchastheWorldBank,whichacknowledgethatECDisimportantinpromotingthephysical,cognitiveandpsycho-socialwellbeinganddevelopmentofvulnerablechildrenandasameanstoreducingpovertyandinequalityandachievinglong-termeconomicprosperity


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(Penn,2004;WorldBank,2005c).AnexampleofanintergenerationalECDprogrammeistheTurkishMother-ChildEducationprogramme,whichispresentedinBox3.

AlthoughmanyECDprogrammesareprimarilymeanttoimprovechildren’sreadinesstostartprimaryschool,theycanhaveseveralotherexpectedoutcomes.ItisgenerallyhopedthatECDswillalsoimprovechildren’sphysicalhealth,providesupportfortime-poormothers,rehabilitatedisabledchildrenandgenerallyimprovechildren’squalityoflife(Myers,1992b).Furthermore,whenservicesinacommunityarestrengthenedasaresultofanECDintervention,thecommunityasawholeislikelytobenefit.“Thispoint[…]isoftenoverlooked,inpartbecauseearlychildhooddevelopmentprogramsaredefinednarrowlyaseducationprogramsforyoungchildrenratherthaninthebroaderintegratedperspective”(Myers,1992b:24).

EvaluationsofexistingECDprogrammes,however,pointtoimportantshortcomings.ManyECDprogrammesintheSouthrelyoneducatingparentsasacost-effectivemeansofimprovingchildren’swellbeing.“Thereisanimplicationthatparentsmaybeignorantofessentialtenetsofchilddevelopment,[…]andthatdonorsshouldattempttoprovidesuchknowledgeandeducation.[…]Whatisrarelyconsidered[…]istheextenttowhichpovertydistortsparent’sabilitytosupporttheirchildreninallbutthemostbasicways,orleadstoparentsbeingabsent,eitherbecauseofmigrationordeath”(Penn,2004:20).

Furthermore,asmanyECDprogrammes,particularlyintheSouth,dependonhome-basedcareandparentaleducationascost-effectiveoptions,therearepossibletensionsbetweenmothers’andchildren’swellbeing.Home-basedprogrammesinBrazil,forexample,“areexploitativeofpoorwomenwhoactascaregivers,andservetoreinforcegenderstereotypes,whilethecostingmodelsthatareusedassumeacheapservicewhosemaineffectistolowertheexpectationsofthepoor”(Penn,2004:16).

Box 3: The Turkish Mother‑Child Education ProgrammeThisprogrammeaddressestheneedforinterventionprogrammesthattakeaccountoftheintersectingneedsofwomenandchildren.Itisbasedonexperiencesthatsuggestthatsuchanapproachmotivatesparticipationandismoreeffectivethansingle-purposeprogrammes(Kagitcibasietal.,1995).IthasitsrootsintheEarlyEnrichmentProject,whichcomprised:1)cognitivetrainingformothersand2)mother“enrichment”,withbi-weeklygroupdiscussionsessionsfortwoyearswhenchildrenwereofpreschoolage.

Theimpactsoftheprojectwereevaluatedinalongitudinalstudy,theresultsofwhich,inthefourthyear,showedsignificantpositiveeffectsonchildren’sdevelopmentandschoolachievementcomparedtothoseinthecontrolgroup.“Itthusappearsthat,workingonlywiththemothers,andthemothersworkingwiththeirchildrengoesalongwaytowardcontributingtochildren’sdevelopment”(Kagitcibasi,1992).Thestudyalsofoundthattheprogrammehadempoweringeffectsonthemothers.Notonlyweretheyabletoimprovetheirinteractionwiththeirchildren,theprojectimprovedtheirintra-familystatusvis-à-vistheirhusbands(ibid).Inthefollow-upstudytenyearslater,theauthorsfoundthat86percentofthe13-15-year-oldadolescentswerestillinschool,comparedtoonly67percentinthecontrolgroup(ibid).


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ThepotentialtensionsbetweenECDprogrammesandrelianceonwomen’sunpaidorunder-paidlabourandtimeisanimportantissuethatshouldbeexploredinfutureYLsurveysandanalyses.ThiswillbeparticularlypertinentinthecasesofAndhraPradeshwhichhasalong-standingprogramme(IntegratedChildDevelopmentService(ICDS))andPeru,withitswell-knownwawa-wasi(earlychildcare)programme.

Intergenerational programmesWidelyrecognisedempiricalevidenceandconceptualunderstandingofinter-sectoralandintergenerationallinkages(egMehrotra,2004)haveencouragedsocialservicesplannerstointroduceparentaleducationprogrammesthattapintothesesynergies.Intergenerationalprogrammesmayinvolveparenting supportwhereparentsandcaregiversareprovidedwithinformationabouthowtocarefortheirchildreninordertomaximisetheirdevelopmentandpotential,suchastheTurkishMother-ChildEducationProgrammediscussedabove.Alternatively,parent educationprogrammesincludeanytrainingactivityprovidedtoparents,notnecessarilyaboutparenting,thatmayindirectlyenhancethewellbeingoftheirchildren(EvansandStansbery,1998).Box4reviewstwoexamplesofparenteducationprogrammesinMalaysiaandMali,whichhighlightthestrengthsandpotentialweaknessesoftheapproach.Keyingredientsofsuccessincludedgreatermotivationforwomentobecomeinvolvedintheirchildren’seducation,fosteringofmoreegalitarianintra-householddynamics,participatoryapproachestoprogrammingtoensurerelevantcontentandparticipants’senseofownershipoftheprogrammes.


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GiventhatYLanalysishasfoundapositiveassociationbetweencaregivereducationlevelsandchildoutcomes(especiallyeducation,health,nutrition,involvementinworkactivities)(Escobalet al.,2005;Woldehanna,JonesandTefera,2005;Woldehanna,Tefera,JonesandBayrau,2005;Mekonnen,Jones,Tefera,2005),butempiricalevaluationspointtomixedefficacyofthespill-overeffectsofadultliteracyprogrammes,itcouldbeinterestingforYLtocarryoutmorein-depthqualitativeresearchonintra-householddynamics,socialsectorprogrammesandpovertyreductionstrategies.

Box 4: Adult literacy programmes: strengths and weaknesses

Adult literacy programme in MalaysiaCarriedoutinasquattercommunity,thisprogrammewaspremisedontheideaofintergenerationallearningandhadtwocomponents:1)adulteducationand2)parent-childtime.Usingparticipatoryqualitativemethods,Sivasubramaniam’s(2005)assessmentoftheimpactsoftheprogrammefoundthatwomenwhoparticipatedinthecoursefunctionedasteachersfortheirchildren,andthecoursehelpedthemtounderstandtheirroleinhelpingtheirchildrentolearn.Theinterviewedwomenexpressednewconfidenceintheirabilitytoteachtheirownchildren.Thewomenalsoreportedmoreinstancesofusingliteracyexerciseswiththeirchildren,andanabilitytosee“instancesofemergingliteracy”intheirchildren(ibid:11).

Bothwomenandchildrenenjoyedparticipatingintheprogramme,andthiswasidentifiedasakeyfactorinthesuccessoftheprogramme.Previously,theparticipantswouldhavelinkedlearningtofearanddiscipline(Sivasubramaniam,2005).Theintergenerationalcomponentalsomotivatedwomentoattendtheprogrammeandovercomeobstacles(egworkload,intra-householdpowerimbalances).Theprogrammewasdesignedinparticipationwiththewomen,whichguaranteedthatitwasmorerelevanttotheirlives,“andcreatedasenseofownership”(ibid:13).Thefindingsalsosupportthebeliefthatintergenerationalprogrammeshavebetterretentionandattendanceratesthansinglefocusprogrammes.

Family literacy in MaliHowever,thesimpleintroductionofadultliteracyprogrammesdoesnotautomaticallytranslateintointra-householdgains.AcasestudyofalargelyunsuccessfulliteracyprogrammeinMalihighlightstheimportanceofconcernforthecontentandmechanismsthroughwhichpositivebenefitswillaccruetothefamily.

AccordingtoPuchner’s(1997)evaluationofanadultliteracycourseinruralMali,runbySavetheChildrenUS,developmentworkersandvillagersgenerallybelievedthatwomen’sliteracywouldbebeneficialfortheirfamilythroughanimprovedabilitytotakecareoftheirchildrenandhusbands,stemminglargelyfromanincreaseinincome-generatingopportunities.However,Puchnerfoundalmostnoevidenceofanintra-familytransferofliteracy.Thefewexceptionswerewomenwhotoldherthattheyhadgottheirchildrentoteachthemreadingskills,egduringthemonthofRamadan,whentheadultliteracyclassesweresuspended.Puchnernotesthatthepoorqualityofadultliteracyclasses,theirirrelevancetowomen’slivesandfewopportunitiestoutilisetheskillsoutsidetheclassroom,resultedinmanywomennotacquiringevensimpleskills,regardlessoflongperiodsofattendance.This,inturn,mayhavecontributedtolowerself-esteemamongsomewomenaswellasnegativeperceptionsofwomen’sorgirls’educationingeneral.


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4.3 Conclusions and directions for future researchGiventheemergenceofcumulativedisadvantageasanoverarchingcharacteristicintheanalysisofthepreliminaryYLdata,thelongitudinalnatureofourresearchwillallowfurtherstudyofthesetrendsovertime.Itwillbeinteresting,forexample,toseewhetherlackofaccesstobasicservicesearlyinlifeleadstocumulativedisadvantageovertime.Longitudinalanalysiscouldincludeanexaminationofwhethermeasuresofdisadvantageacrosssectorsbecomemoreorlesscorrelatedovertime.Ifdisadvantageinonedomainweretobecomemorestronglyassociatedwithdisadvantageinotherdomains,itwouldindicatenotonlyaneedforpolicyinterventionstotaketheselinkagesintoaccountbutalsothedevelopmentofmoretailoredcontext-appropriateapproachesinordertoimprovechildwellbeing.

Wewillalsobeabletolookatchangesinthenumberofdisadvantagesexperiencedovertime.Itwillbeinterestingtodistinguishbetweenchangesinthenumberofpeopleexperiencingnodisadvantage,andchangesintheaveragenumberofdisadvantagesexperienced.Theformerwouldallowustoseeifthenumberofpeopleexperiencinganydisadvantagewasgrowingordecreasing.Thelatterwouldgiveusthecapacitytolookforevidenceof‘entrenchment’,somethingwhichwouldbedemonstratedifthesame/fewerindividualsbecamedisadvantagedinatleastoneindicator,butthosedisadvantagedinatleastoneindicator,experienceddisadvantageacrossagreaternumberofindicators.

Tobebetterabletoassessthefeasibilityoftheinter-sectoralandintergenerationalinterventionsdiscussedabove,furtherresearchisneeded.InadditiontoanalysingdataabouttheYLindexchildrenandtheirfamilies,itwillbeimportanttoevaluatetheefficacyofrecentlyintroducedcashtransferprogrammesinPeruandEthiopia–providedthatthereisoverlapwithYLsentinelsites-particularlyinordertoaddresstheconcernsaboutademandsidebiasincashtransferprogrammes.Similarly,intermsofEarlyChildhoodDevelopmentprogrammes,thereisscopeforevaluationofinterventionsinAndhraPradeshandPeru,especiallyinthecontextofgreaterdecentralisationandthedevelopmentofcommunitypolicyandbudgetmonitoringmechanisms.

Finally,analysisofintergenerationalsynergiesinwelfareanddisadvantageinthispaperhasbeenaccompaniedbyattentiontothemixedrelationshipbetweenthewelfareofchildrenandtheircaregivers.Forexample,potentialtensionsstemmingfromrelianceonwomen’sunpaidorunder-paidlabourinECDprogrammesshouldbeexploredinfutureYLsurveysandanalysesofsuchinterventions.Equallyimportantly,though,synergiesbetweencaregivereducationandchildoutcomesmeritfurtherstudy,asdoesmorein-depthqualitativeresearchonintra-householddynamics,socialsectorprogrammesandpovertyreductionstrategies


29

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W O R K I N G P A P E R N O . 3 3


An international comparative analysis

Minna LyytikäinenNicola JonesSharon HuttlyTanya Abramsky

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Young Lives is an international longitudinal study of childhood poverty, taking place in Ethiopia, India, Peru and Vietnam, and funded by DFID. The project aims to improve our understanding of the causes and consequences of childhood poverty in the developing world by following the lives of a group of 8,000 children and their families over a 15-year period. Through the involvement of academic, government and NGO partners in the aforementioned countries, South Africa and the UK, the Young Lives project will highlight ways in which policy can be improved to more effectively tackle child poverty.

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