The Growing Demand
As emphasized throughout this supplement, programs that support parents’ use of nurturing care practices (eg, Reach Up) have improved the well-being of children, families, and societies around the world. However, recent global trends toward urbanization, changing family structures, and rising rates of maternal employment have meant that parents are no longer the sole providers of children’s care.1 A 2020 World Bank report found that 72% of children below primary-school entry age (593 million in total) needed childcare, the majority of whom (59%, or 349 million) did not currently have access.2 Availability of childcare has been particularly limited in low- and middle-income countries, where just over 1 in 5 children under age 5 lacked adult supervision for at least an hour per week3 and an estimated 70% of 3- and 4-year-olds (244 million) lacked access to early childhood education.4 These access gaps widened during the coronavirus disease 2019 (COVID-19) crisis, when an estimated 167 million preschool-age children globally lost access to critical education and care services, with projected implications both for their families’ immediate workforce engagement and for their own developmental and economic futures.5
Together, parents and childcare providers join forces to support children in and out of the home using the same principles of nurturing, responsive, and stimulating care. Indeed, the services provided by the childcare workforce – including both direct care for children and parent education – are increasingly an essential ingredient both for parents’ financial security and for their provision of positive caregiving practices at home. Nevertheless, the conceptualization of childcare as a private and personal responsibility, rather than an essential public good, has limited public investments in its provision and study. Absence of appropriate protections for the childcare workforce amid the pandemic has also resulted in record-high program closures and educator burnout, compromising the long-term viability of childcare systems. This “crisis of care” has led numerous groups to place affordable quality childcare as a “key pillar of economic recovery” post-COVID.6
The Emerging Evidence
Childcare exists in a range of settings and its definition varies. Although most definitions of childcare focus on young children outside of formal schooling (eg, those too young to attend publicly-funded preprimary or primary school), the stated goals of childcare (eg, educational, work support), where it is delivered (eg, centers, home-based providers, informal group settings), who provides it (eg, formal providers, family members), how it is funded (eg, public dollars, parent fees), and social norms surrounding its provision (eg, based on family structure, expectations regarding childrearing) all vary tremendously across countries and contexts. Childcare needs also differ substantially based on children’s age, with distinct demand for and forms of care for infants, toddlers, and preschool-age children. This variation makes it difficult to draw overarching conclusions about childcare’s effectiveness. Furthermore, empirical studies of childcare are rare, especially in lower-income countries and in the informal economy, and often suggest variability in programs’ impacts.7
Nevertheless, there is consensus that, when implemented with high levels of quality, childcare can have meaningful positive impacts for children, their parents, and society. Childcare can provide children with safety and protection, especially among fragile, displaced, and migrant communities. Childcare programs can also provide essential nutritional and health supports in the form of warm meals, immunizations, and screenings. Additionally, several studies have shown that high-quality, affordable, formal childcare implemented at scale can improve children’s cognitive, physical, and social-emotional outcomes, especially for marginalized and/or disadvantaged populations.8,9 Key to these developmental benefits are the quality and frequency of culturally appropriate, responsive, warm, and stimulating interactions between providers and children. Such quality interactions cannot take place without broader structural investments, including adequate training (eg, pre and in-service coursework, mentoring, coaching) and workforce supports (eg, competitive and timely compensation, job security, benefits) for childcare staff. Unfortunately, these training and workforce supports are currently lacking in many formal childcare settings around the world, undermining quality and benefits for children.10
Children may also benefit indirectly from high-quality childcare via its positive impacts on parental (namely, maternal) well-being. Research has shown that, like other interventions for parents (eg, home visiting), increased access to high-quality, affordable childcare can improve a range of maternal outcomes that support positive parenting at home, including employment, financial security and stability, and mental health.9,11 When coupled with the benefits of the direct parental engagement services provided by many childcare programs, these improvements in maternal well-being can have positive implications for individual children and broader economic systems. Indeed, it is clear that increasing both women’s labor force participation and children’s early educational enrollment can raise gross domestic profit and productivity.2
The Action Needed
As the demand for childcare continues to grow and its potential to promote nurturing care both inside and outside of the home becomes evident, we provide 5 recommendations for expanding access to childcare services and improving quality.
Increase Public Investment
Public financing of childcare should be a priority in multilateral, bilateral, and national budgets to assure both affordability for families and quality, particularly in low- and middle-income countries.
Expand the Infrastructure of Support for the Childcare Workforce
Systemic, sustainable supports for the childcare workforce are needed, including program and curricular guidelines, standards and monitoring, professional development opportunities (eg, coaching), extra training and support for home-based care providers, technical assistance, higher and more predictable compensation and benefits, and linkages across sectors from education to health and nutrition to social protection. Where possible, these supports should build upon existing community strengths and infrastructures to improve integration, take-up, and sustainability.
Enhance Alignment Between Ecosystems of Care
Efforts are needed to more intentionally link parenting and childcare programs at local, national, and global levels. These efforts should explicitly recognize the complementarity of parenting and childcare programming, as well as their mutual reliance on principles of nurturing care.
Community-based solutions that are emerging in low- and middle-income countries should be given public support to innovate and scale. These include creating networks and training of home-based providers, developing employer-supported options, and establishing childcare for women who work in the informal economy.
Step Up Data Collection and Research
Data systems (including national and global data on childcare demand, supply, and quality) and new research to build the evidence of what works, for whom, and under what conditions are needed to guide informed decision-making.
In sum, childcare systems provide critical yet largely untapped opportunities to promote the nurturing care of children and the economic well-being of families and societies. The above recommendations highlight 5 complementary opportunities for expanding access to and quality of childcare programming that, when implemented together, can help to create virtuous cycles of support. As the global community begins to envision a postpandemic world that prioritizes equity, inclusion, and opportunity, the provision of high-quality childcare needs to be front and center in policy, practice, and research.
Drs Lombardi and McCoy conceptualized and drafted the initial manuscript; Drs Boo, Wadende, and Yoskiawa, Mr Huang, Ms Matlhape, Ms Mishra, and Ms Moussié provided additional conceptual input and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FUNDING: No external funding.
CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no conflicts of interest relevant to this article to disclose.