Studies have shown that nearly half of rural toddlers in China have cognitive delays due to an absence of stimulating parenting practices, such as early childhood reading, during the critical first three years of life. However, few studies have examined the reasons behind these low levels of stimulating parenting, and no studies have sought to identify the factors that limit caregivers from providing effective early childhood reading practices (EECRP). This mixed-methods study investigates the perceptions, prevalence, and correlates of EECRP in rural China, as well as associations with child cognitive development. We use quantitative survey results from 1748 caregiver–child dyads across 100 rural villages/townships in northwestern China and field observation and interview data with 60 caregivers from these same sites. The quantitative results show significantly low rates of EECRP despite positive perceptions of early reading and positive associations between EECRP and cognitive development. The qualitative results suggest that low rates of EECRP in rural China are not due to the inability to access books, financial or time constraints, or the absence of aspirations. Rather, the low rate of book ownership and absence of reading to young children is driven by the insufficient and inaccurate knowledge of EECRP among caregivers, which leads to their delayed, misinformed reading decisions with their young children, ultimately contributing to developmental delays.

Background: 
The Baby-Friendly Hospital Initiative is generally considered an effective way to promote breastfeeding. Although China has the largest number of baby-friendly hospitals in the world, research on baby-friendly practices in China is limited, and the rate of exclusive breastfeeding (EBF) at 6 months, 20.7%, compared to the 2025 global goal of 50% is low. It is, therefore, important to determine the factors that remain significant barriers to EBF in China. To explore how the key baby-friendly practices affect EBF duration in China, we used a case-control study to compare the effects of baby-friendly-related practices on both EBF and non-breastfeeding (NBF) mothers at 3 months and to investigate the effects of both single and comprehensive baby-friendly practices in promoting EBF duration at 3 months, which is one step toward EBF at 6 months.

Methods: 
Participants were recruited from four maternal and child health hospitals in western (Chongqing), eastern (Qingdao), southern (Liuzhou), and central China (Maanshan). A total of 421 mothers (245 in the EBF group, 176 in the NBF group) of infants aged 3 months were surveyed through a self-reported questionnaire from April 2018 to March 2019. The experience of baby-friendly practices and breastfeeding during hospitalization were assessed with yes/no questions. Socio-demographic factors that influenced breastfeeding at 3 months were analyzed using bivariate and multivariate logistic regression analyses.

Results: 
Of mothers in the EBF group, 65.57% reported engaging in at least seven baby-friendly practices compared to 47.72% of mothers in the NBF group. Significantly more mothers in the EBF group engaged in baby-friendly practices than in the NBF group. These practices included “breastfeeding within one hour after birth” (74.29% vs. 59.09%), “breastfeeding on demand” (86.48% vs. 75.00%), and “never use a pacifier” (46.53% vs. 31.25%). After adjusting for confounding variables, we found that the mothers who engaged in fewer than seven baby-friendly practices were about 1.7 times less likely to breastfeed than were those who engaged in seven or more baby-friendly practices (odds ratio [OR] 1.720, 95% confidence interval [CI] 1.106, 2.667). Further, the mothers who did not breastfeed on demand were as likely to not breastfeed up to 3 months (OR 2.263, 95% CI 1.265, 4.049), as were mothers who did not breastfeed during hospitalization (OR 4.379, 95% CI 1.815, 10.563).

Conclusions: 
These data from hospitals in China suggest that higher compliance with baby-friendly practices may have a positive impact on EBF at 3 months, particularly in terms of promoting the implementation of breastfeeding on demand and breastfeeding during hospitalization in China.

A growing body of literature has documented that community-based early childhood development (ECD) interventions can improve child developmental outcomes in vulnerable communities. One critical element of effective community-based programs is consistent program participation. However, little is known about participation in community-based ECD interventions or factors that may affect participation. This paper examines factors linked to program participation within a community-based ECD program serving 819 infants and their caregivers in 50 rural villages in northwestern China. The results find that more than half of families did not regularly attend the ECD program. Both village-level social ties within the program and proximity to the program significantly predict program participation. Increased distance from the program site is linked with decreased individual program participation, while the number of social ties is positively correlated with participation. The average program participation rates among a family’s social ties is also positively correlated with individual participation, indicating strong peer effects. Taken together, our findings suggest that attention should be given to promoting social interactions and reducing geographic barriers among households in order to raise participation in community-based ECD programs.

Nearly 120 million children in 37 countries are at risk of missing their measlescontaining vaccine (MCV) shots this year, as preventive and public health campaigns take a back seat to policies put in place to contain coronavirus disease 2019 (COVID-19). In March, the World Health Organization (WHO) issued guidelines indicating that mass vaccination campaigns should be put on hold to maintain physical distancing and minimize COVID-19 transmission. The disruption of immunization services, even for short periods, will lead to more susceptible individuals, more communities with less than the 95% MCV coverage needed for herd immunity, and therefore more measles outbreaks globally. A mere 15% decrease in routine measles vaccinations—a plausible result of lockdowns and disruption of health services—could raise the burden of childhood deaths by nearly a quarter of a million in poorer countries. Solutions for COVID-19, especially among the global poor, cannot include forgoing vaccinations.

There is general consensus among experts that K-12 schools should aim to reopen for in-person classes during the 2020-2021 school year. Globally, children constitute a low proportion of coronavirus disease 2019 (COVID-19) cases and are far less likely than adults to experience serious illness. Yet, prolonged school closure can exacerbate socioeconomic disparities, amplify existing educational inequalities, and aggravate food insecurity, domestic violence, and mental health disorders. The American Academy of Pediatrics (AAP) recently published its guidance on K-12 school reentry. However, as many school districts face budgetary constraints, schools must evaluate their options and identify measures that are particularly important and feasible for their communities.

BACKGROUND: Although the Chinese education system has seen massive improvements over the past few decades, there are still large academic achievement gaps between rural and urban areas that threaten China’s long-term development. In addition, recent literature underscores the importance of early childhood development (ECD) in later-life human capital development.

OBJECTIVES: We analyze the life cycle of cognitive development and learning outcomes in rural Chinese children by first exploring whether ECD outcomes affect cognition levels, then determining whether cognitive delays persist as children grow, and finally examining connections between cognition and education outcomes.

METHODS: We combine data from four recent studies that examine different age groups (0–3, 4–5, 10–11, 13–14) to track cognitive outcomes.

RESULTS: First, we find that ECD outcomes for children in rural China are poor, with almost one in two children who are cognitively delayed. Second, we find that these cognitive delays seem to persist into middle school, with almost 37% of rural junior high school students who are cognitively delayed. Finally, we show that cognition has a close relationship to academic achievement.

CONCLUSION: Our results suggest that urban–rural gaps in academic achievement originate at least in part from differences in ECD outcomes.

CONTRIBUTIONS: Although many papers have analyzed ECD, human capital, and inequality separately, this is the first paper to explicitly connect and combine these topics to analyze the life cycle of cognitive development in the context of rural China.

We present the results of a cluster-randomized controlled trial that evaluates the effects of a free, center-based parenting intervention on early cognitive development and parenting practices in 100 rural villages in China. We then compare these effects to a home-based intervention conducted in the same region, using the same parenting curriculum and public service system. We find that the center-based intervention significantly improved children’s cognitive skills by 0.11 standard deviations, accompanied by increases in the material investments, time investments, and parenting skills of caregivers. The average impact of the center-based intervention, however, was approximately half that of the home-visiting intervention. Analysis of the possible mechanisms suggests that the difference in effects was driven primarily by different patterns of compliance. Although children with lower levels of initial skills at baseline benefited the most from the center-based intervention, they were less likely to participate in the program.

Keywords: Center-based parenting intervention; home-based parenting intervention; early cognitive development; randomized controlled trial; program participation

Nearly one-quarter of all children under age 2 in China are left behind in the countryside as parents migrate to urban areas for work.We use a four-wave longitudinal survey following young children from 6 to 30 months of age to provide first evidence on the effects of parental migration on development, health, and nutritional outcomes in the critical first stages of life. We find that maternal migration has a negative effect on cognitive development: migration before children reach 12 months of age reduces cognitive development by 0.3 standard deviations at age 2. Possible mechanisms include reduced dietary diversity and engagement in stimulating activities, both known to be causally associated with skill development in early life. We find no effects on other dimensions of physical and social-emotional health.