By 2012, child mortality had fallen to almost half its level in 1990. The next major challenge is to improve early-life conditions to harness developmental potential. An estimated 200 million children under age five years in low- and middle-income countries (LMICs) are unlikely to reach their developmental potential because of inadequate health, nutritional, and other investments in early life (Grantham-McGregor and others 2007). This inability to achieve full potential implies substantial losses of welfare and future economic productivity for these children and for their societies (Akresh and others 2012; Behrman, Alderman, and Hoddinott 2004; Bhalotra and Venkataramani 2011; Bhutta and others 2008; Currie and Vogl 2013; Hoddinott and others 2008; Horton, Alderman, and Rivera 2009) and increases the risk of adult morbidities and lower life expectancy (Bhalotra, Karlsson, and Nilsson 2015; Hjort, Solvesten, and Wust 2014). This chapter supplements previous work focusing on estimates of economic benefits from early-life nutritional interventions in LMICs.
Figure 27.1 shows the pathways through which early-life interventions can affect later-life economic outcomes. Prenatal and early childhood interventions affect outcomes at every stage of the lifecycle. These impacts accumulate, making it important to study long-term dynamic effects of interventions. Familial and public investments enter during all lifecycle stages, often induced by the initial intervention. Later investments may in principle complement or substitute for those early in the lifecycle, but some evidence suggests they may be reinforcing (Almond and Mazumder 2013; Bhalotra and Venkataramani 2011, 2013), consistent with recent models that describe human capital production as involving dynamic complementarities across types of investment (for example, health and schooling) and across ages, such that investments early in life increase rates of return to investments later in life (Cunha and Heckman 2007; see also Alderman and others 2017, chapter 7 in this volume).
In the first section, we provide a selected review of evidence of long-term human capital and economic benefits from early-life interventions and then some illustrative calculations of benefit-cost ratios for these interventions. We focus on interventions affecting maternal and early childhood health, including micronutrient supplementation and breastfeeding, and maternal survival. We then present evidence of effects of early interventions on low birth weight (LBW), stunting, and cognitive development in the second section. The third section discusses issues in the estimation of benefit-cost ratios of early-life interventions and presents simulations, illustrating sensitivity of estimates to alternative parameters. The fourth section discusses issues of designing policy based on the growing body of estimates from randomized trials in LMICs. Definitions of age groupings and age-specific terminology used in this volume can be found in chapter 1 (Bundy and others 2017).
© 2017 International Bank for Reconstruction and Development / The World Bank.