Esta nota foi elaborada para informar o dialogo sobre politicas para a eliminacao do casamento na infância e adolescencia no Brasil e aumentar a conscientizacao sobre o assunto no pais. A analise faz parte de um programa de trabalho do Banco Mundial para catalisar a atencao e os investimentos visando a aumentar a escolaridade das meninas, acabar com o casamento na infância e adolescencia e prevenir a gravidez precoce ao redor do mundo. No caso do Brasil, mais do que investimentos, e preciso iniciativas e acoes especificas visando esses objetivos. A nota se baseia em dados dos censos de 2000 e 2010 e da PNAD de 2015 para documentar as tendencias dessas questoes no Brasil. Embasada por dados do programa Mulheres, Empresas e o Direito do Banco Mundial, esta nota tambem examina a legislacao vigente relativa ao casamento infantil. Com base em evidencias internacionais, a nota discute ainda politicas e programas para melhorar os resultados para meninas adolescentes.
Quentin T. Wodon, Paula Magarinos Torres Tavares, Chata Malé et al.
The first 1000 days of life represent a sensitive period for socio-cognitive development, during which culturally embedded caregiving plays a foundational role. However, evidence from Afrodescendant rural populations remains scarce. This exploratory cross-sectional descriptive-correlational study examined associations between caregiver-reported caregiving practices and early socio-cognitive indicators in 26 children (9-36 months; M = 19.27, SD = 7.63) and their caregivers in San Basilio de Palenque, a culturally distinctive Afro-Colombian community. Caregiving practices were assessed using the Care Practices Scale, which captures the reported frequency and consistency of everyday routines and was interpreted within a nurturing care framework rather than as a direct measure of caregiving quality. Children's early socio-cognitive indicators were assessed with the Early Socio-Cognitive Development Checklist. Associations were examined using age- and sex-adjusted partial Pearson correlations, with Benjamini-Hochberg false discovery rate control applied to a pre-specified family of primary indicators. Caregivers reported high emotional warmth and frequent engagement in structured routines despite socioeconomic adversity. Several age- and sex-adjusted associations reached conventional significance (two-tailed p < 0.05), but none remained statistically significant after false discovery rate control (q = 0.05). Nominal patterns (prior to correction) clustered around joint-attention-related behaviors and receptive language and tended to co-occur with routine-based practices (e.g., hygiene) and relational guidance, suggesting culturally plausible hypotheses about how nurturing care may be scaffolded through everyday, interactionally dense routines. Findings are exploratory and should be interpreted cautiously. Overall, this study underscores the need for larger, multimethod, longitudinal research to test culturally grounded pathways of nurturing care in underrepresented Afrodescendant rural caregiving ecologies.
Objectives: Nurturing Care (NC) and growth during early childhood are critical for human capital formation, but less is known about the patterns and role of NC. We used data from a Vietnamese birth cohort to identify trajectories of NC and growth in early childhood and evaluate their associations with cognitive development and academic achievement in early adolescence.
Lan Mai Tran, Phuong Hong Nguyen, Usha Ramakrishnan et al.
Selecting indicators to monitor nurturing care (NC) environments that support decision-making and guide the implementation of integrated early childhood development (ECD) programmes has become a priority globally. Several population-based approaches have been attempted to create a set of indicators or a composite index methodology to measure the NC environment using existing secondary data. However, they have not been systematized. Our scoping review aimed to analyse the population-based approaches for monitoring the domains of the NC (e.g. good health, adequate nutrition, responsive caregiving, security and safety, and opportunities for early learning). ECD experts, peer-reviewed, and grey literature were systematically searched with no year or language restrictions. Data extraction used a standard predefined protocol. Thirty-two population-based approaches were identified. Most approaches were composed of a set of indicators (53.1%, n = 17) versus composite indexes (46.9%, n = 15) and had the country as their unit of analysis (68.8%, n = 22). Twenty-seven approaches were applied in middle-income countries (84.4%) and thirteen in low-income countries (40.6%). Four approaches were guided by the NC framework (12.5%), and 56.3% (n = 18) did not include any indicator representing responsive caregiving. NC indicators (n = 867) were sorted into 100 groups of indicators. Twenty of the 32 approaches had some kind of methodological validation (62.5%). We identified six methodological challenges to build a population-based approach. Standardized methods for selecting and validating indicators, and coordinated efforts to share findings/data with stakeholders should be prioritized. Given the great variability in methods and indicators used to measure NC environments, valid approaches should be flexible to work well across different contexts.
Jéssica Pedroso, Stefanie Eugênia dos Anjos Coelho Kubo, Priscila Olin Silva et al.
PURPOSE: Child marriages and unions can infringe upon adolescent and youth sexual and reproductive health (AYSRH). Interventions increasingly promote strategies to transform social norms or foster the agency of adolescent girls. Recent empirical studies call for further understanding of how social norms and agency interact in ways that influence these practices, especially in contexts where girls' agency is central. METHODS: A secondary cross-case analysis of three qualitative studies (in Brazil, Guatemala, Honduras) was conducted to inform the investigation of how norms and agency may relate in sustaining or mitigating child marriage. RESULTS: Social norms dictating how girls/young women and how men should act indirectly led to child marriages and unions. The data showed that (1) social norms regulated girls' acceptable actions and contributed to their exercise of "oppositional" agency; (2) social norms promoted girls' "accommodating" agency; and (3) girls exercised "transformative" agency to resist harmful social norms. CONCLUSIONS: Research should advance frameworks to conceptualize how social norms interact with agency in nuanced and context-specific ways. Practitioners should encourage equitable decision-making; offer confidential, adolescent-friendly AYSRH services; and address the social norms of parents, men and boys, and community members.
Alice Y. Taylor, Erin E. Murphy-Graham, Julia Van Horn et al.
Background During the COVID-19 pandemic, children faced a disproportionate burden of malnutrition and poor health outcomes. Nurturing care interventions (NCIs) including actions toward good health, adequate nutrition, responsive care, opportunities for early learning, and security and safety are critical for promoting equity. Due to the need for evidence-based responses and preparedness, we analyzed adaptations in NCIs’ implementation strategies during COVID-19 according to the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). Method We conducted a global scoping review including peer-reviewed and non-peer-reviewed literature. The databases searched were PubMed, Embase, Scopus, BVS, Scielo, and Web of Science. This search was complemented by an extensive examination of relevant websites and an additional internet search via Google Scholar. We extracted and analyzed the data following the seven modules of the FRAME-IS. Results Out of 20 records, 27 NCI were identified across Africa (n = 3), Asia (n = 7), Europe (n = 3), North America (n = 11), Oceania (n = 1), and South America (n = 2). NCIs adapted their content (e.g., adding elements), evaluation (e.g., conducting needs assessment), training (e.g., using experts), and context (e.g., setting—shifting from in-person to remote, and population—expanding interventions’ reach). Adaptation goals were to increase acceptability (n = 9, 32.1%), adoption (n = 5, 17.8%), appropriateness (n = 10, 35.7%), feasibility (n = 25, 89.3%), penetration (n = 15, 53.6%), sustainability (n = 23, 82.1%), and fidelity (n = 1, 3.7%). The rationale to adapt varied from sociopolitical (n = 6, 21.4%), organizational (n = 13, 46.4%), implementer (n = 11, 39.3%), practitioner (n = 15, 53.6%), and recipient (n = 11, 39.3%). A quarter were reactive planned adaptations and 75.0% were unplanned modifications. Decisions were led by program leaders (n = 21, 75.0%), funders (n = 9, 32.1%), partners (n = 3, 10.7%), researchers (n = 1, 3.6%), and practitioners (n = 3, 10.7%). Adaptations were widespread from unit (e.g., hospital) (n = 1, 3.6%), organization (n = 4, 14.3%), and community system (e.g., countrywide) (n = 14, 50.0%). Conclusion The results from our global scoping review show that it is possible for NCIs to continue and even improve their delivery despite the global crisis, suggesting that remote delivery is feasible and can work as an alternative when in lockdown. Strategic planning taking advantage of existing structures and partnerships may have allowed NCI adaptations to be sustainable as well as facilitated replication within the organization network system.
Lídia Pereira da Silva Godoi, Simone Schenkman, Ana A. Baumann et al.
PURPOSE: This study explores links among marianismo, girls' mobility and sexuality, and child marriage among adolescent girls in rural areas of Honduras. METHODS: We analyze quantitative and qualitative data collected in 2008-2016 for a longitudinal cohort study of rural Honduran adolescent girls. These data include interviews (n = 10 married before age 18) and surveys (n = 563; 155 married early). We also use qualitative data from focus groups in 2016 that included students, parents, teachers, and community members (n = 120). RESULTS: We find that girls who scored higher on a scale of traditional gender norms were more likely to marry early. Furthermore, our qualitative findings indicate that girls experienced control over their mobility and their sexuality because of rigid gender norms prevalent in their communities. The control girls experience clashes with undergoing psychosocial changes that are associated with increased desire for autonomy and intimacy as well as increased awareness of their sexuality. In some cases, girls believed that marriage was better than staying in their restrictive households, and/or they viewed marriage as the only way to have a romantic relationship. DISCUSSION: Rigid gender norms that promote excessive regulation of girls' behavior and sexuality influence girls' decision-making processes to enter child marriage. Educational initiatives that challenge sexist gender norms and explain and normalize attraction and intimacy during adolescence should be a central component of child marriage prevention programming for adolescents, parents, and community members.
Diana Pacheco-Montoya, Erin E. Murphy-Graham, Enrique Valencia Lopez et al.
An estimated 650 million girls and women alive today married before their 18th birthday. Referred to as girl child marriage, the formal or informal union of the girl-child before age 18, the practice is increasingly recognized as a key roadblock to global health, development, and gender equality. Although more research than ever has focused on girl child marriage, an important gap remains in deconstructing the construct. Through an extensive review of primary and secondary sources, including legal documents, peer-reviewed articles, books, and grey literature across disciplines, we explore what the term "girl child marriage" means and why it more accurately captures current global efforts than other terms like early, teenage, or adolescent marriage. To do this, we dive into different framings on marriage, children, and gender. We find that there has been historical change in the understanding of girl child marriage in published literature since the late 1800s, and that it is a political, sociocultural, and value-laden term that serves a purpose in different contexts at different moments in time. The lack of harmonized terminology, particularly in the global public health, prevents alignment amongst different stakeholders in understanding what the problem is in order to determine how to measure it and create solutions on how to address it. Our intent is to encourage more intentional use of language in global public health research.
Background: This study aims to identify the contexts, environments, and nurturing care predictors that determine whether a child is developmentally on track in Ceará, Brazil. Methods: We analysed data from a cross-sectional study conducted with caregivers of 6,447 children aged 0-59 months during a vaccination campaign in Ceará in October 2019. The validated Child Development Assessment Questionnaire was used to assess early childhood development (ECD) and children with a z-score ≥ -1 SD were considered developmentally on track. We conducted logistic regression models to understand the effects of contexts, environments, and nurturing care domains on ECD. Findings: Children in the early years (< 36 months) were more likely to meet the ECD milestones if they were not born with low birth weight (AOR: 0·64; 95% CI: 0·42-0·97), were exposed to manufactured toys in their house (2·68; 1·97-3·66), their heads of household were employed (1·61; 1·16-2·23), and their caregivers had read the Child Health Handbook (1·42; 1·13-1·77) and engaged them in stimulating activities (1·71; 1·26-2·32). Children aged 36-59 months were more likely to meet the ECD milestones if they were breastfed (never: ref. / < 3 months: 3·72; 1·91-7·26 / 3-5 months: 3·21; 1·74-5·93 / 6-11 months: 3·73; 1·95-7·16 / ≥ 12 months: 3·89; 2·25-6·72), had books at home (0: ref / 1-3: 1·71; 1·22-2·40 / 4-6: 2·24; 1·27-3·94 / 7+: 2·71; 1·05-7·00), and their caregivers received information about ECD (1·49; 1·11-2·01) and engaged them in stimulating activities (1·80; 1·27-2·56). Children aged 36-59 months were less likely to meet developmental milestones if they watched TV or used tablets/smartphones for more than two hours per day (0·61; 0·44-0·84), played with household objects (0·62; 0·41-0·92), participated in governmental early childhood programmes aimed at vulnerable families (0·62; 0·45-0·86), had families that participated in income transfer programmes (0·68; 0·47-0·99) (families living in poverty or extreme poverty), and their caregivers considered slapping (0·67; 0·48-0·94) a necessary disciplinary method. Interpretation: Having favourable socioeconomic conditions, breastfeeding, the absence of harsh discipline, caregivers who provide responsive care, and the provision of opportunities for early learning are the key factors that increase the likelihood of a child achieving their full developmental potential in Ceará, Brazil. Funding: This study was supported by the Maria Cecília Souto Vidigal Foundation (F0245), Brazil. The funder had no role in the design, analysis, or writing of this article.
Sônia Isoyama Venâncio, Juliana Araújo Teixeira, Maritsa Carla de Bortoli et al.
BACKGROUND: In the Dominican Republic about 14.5% of children do not reach their full potential by age five, with children of low socioeconomic position most affected. The Nurturing Care Framework is an evidence-informed actionable framework to help children thrive, but we must first understand cultural contexts and childrearing practices that contribute to delay. This study applies the Nurturing Care Framework to explore the context of home-based care among young children in the Dominican Republic. METHODS: We conducted a sociodemographic survey and semi-structured qualitative interview with 25 mothers ages 19-42 (7 under the age of 18 at first birth) with low socioeconomic position and children under five that live in the capital city Santo Domingo. We asked in-depth questions about the Nurturing Care Framework's domains of responsive caregiving and opportunities for early learning. We used consensual coding and deductive thematic analysis to analyze transcriptions, examined convergence and divergence in themes between adolescent and adult mothers, and organized themes using concept mapping. RESULTS: A few mothers provide responsive caregiving to their child, but they are unaware of its benefit to their child's development. Adolescent mothers expressed lower confidence in their mothering skills. Across age groups, mothers did not see themselves as agents of change in their child's early learning process and allow several hours of videos each day. Mothers provide children opportunities for learning through social interaction, a possible strength among this population. With regards to security and safety, about half of mothers use corporal punishment, all but one of these is an adolescent mother. CONCLUSION: Findings highlight the need for parenting programs that build on strengths such as child-to-child social interaction and provide parents with opportunities to develop knowledge and skills to provide early learning opportunities. Interventions should target families with low socioeconomic position and adolescent mothers.
Adrianne Katrina Nelson, Laura Virginia Sánchez-Vincitore, Melanie Patricia Frias et al.
