15 Exploring Intersections of Culture, Science and Power in Early Childhood Development Programs in India
Vandana Prasada and Shanti Ramanb
aPublic Health Resource Society, New Delhi, India
bSchool of Medicine and Health, University of New South Wales, Australia
Abstract
The science behind the importance of the first few years of a child’s life, the interrelated critical transition periods of pregnancy, childbirth and starting school, is well established. India, with the largest child population in the world, must get the foundations of early childhood care and education right to optimise health, education and employment outcomes of its population. In this chapter, we explore the challenges in delivering responsive early childhood services using two case studies. One is the Integrated Child Development Services (ICDS) system, the largest publicly run early childhood service system in the world; the other is community-based creches run in remote tribal regions of Odisha. We dissect how the intersections of culture, science and power play out in the delivery and acceptance of these two very distinct systems, a top-down versus bottom-up approach. There are key lessons to be learned for both government and community sectors from this analysis.
Keywords
early childhood development, community engagement, integrated service development, infant and young child nutrition, partnership, India
Global attention and acknowledgment of the importance of the early years of life have culminated in the inclusion of early childhood development in the UN Sustainable Development Goals (SDGs) (Britto et al., 2016). There is incontrovertible evidence that the first 1,000 days ‒ that is, from conception to the end of the child’s second year ‒ is the period of maximum developmental plasticity, and therefore the period with the greatest potential to affect health and well-being over the life course (Moore et al., 2017). Many governments, especially in high-income countries, have taken on joined-up initiatives for the first 2,000 days, due to the evidence behind early childhood education and development, and the Lancet update on the "next 2000 days" has clearly articulated why focusing on this period is equally important (Nores et al., 2024; The Lancet, 2024). Collectively, the various Lancet commissioned series on early childhood development (ECD) in 2007, 2011, and 2017, with the additional updates, have provided a solid body of scientific evidence to support the importance of the early years. The evidence is clear – in utero experience of a baby, followed by a child’s early life experience, predicts their chances of succeeding at school, of doing well in life and of having chronic diseases as an adult. However, despite this widespread acknowledgment, ECD programs vary enormously in coordination and quality ‒ especially in low-resource settings, with inadequate and inequitable access, especially for children younger than 3 years.
A decade ago, using proxy measures of stunting and poverty, approximately 250 million children younger than five years in low-income and middle-income countries were deemed at risk of not reaching their developmental potential (Black et al., 2016). This actually represented progress; as the proportion of children at developmental risk had dropped from 51% in 2004 to 43% in 2010 (Lu et al., 2016). Narrowing it down to children aged 3 and years, a staggering 80.8 million in low-and-middle-income countries (LMIC) experienced low cognitive and/or socio-emotional development according to estimates from 2010, with the largest number of affected children in sub-Saharan Africa and South Asia. The Lancet series on ECD (2017) built on earlier work and promoted a life course perspective. Recommendations were that children’s early development required nurturing care – defined as health, nutrition, security and safety, responsive caregiving, and early learning – provided by parent and family interactions, and supported by an enabling environment (Black et al., 2016). A truly comprehensive ECD program needs to provide joined-up integrated child development services for the first 2,000 days of life. Unfortunately, in LMICs, only 62 million children aged three and four years (25%) currently receive adequate nurturing care during the second 1,000 days (between two and five years), leaving 182 million children exposed to risks that jeopardise their healthy development (Draper et al., 2024).
Guidance From the Nurturing Care Framework
Drawing on the quintessential relationship between maternal health, wellbeing and that of the child, especially in the first few years of life and building on state-of-the-art evidence about how early childhood development unfolds, the Nurturing Care Framework provides a welcome blueprint for action (World Health Organization et al., 2018). The Framework describes a whole-of- government and a whole-of-society approach to optimising early childhood outcomes, with guiding principles, strategic actions and ways of monitoring progress. The framework outlines five components of nurturing care, each of which is important to get right. These are: 1) Good health – of infant/child, mother, family and household; 2) Adequate nutrition – again of mother and child, promoting breastfeeding and adequate complementary feeding with dietary diversity; 3) Responsive caregiving; 4) Opportunities for early learning – tailored guidance packages for a range of settings promote caregiving practices that are responsive to young child needs and provide opportunities for early learning; 5) Security and safety – recognising the extreme vulnerability of young children, the serious risks of poverty, environmental threats and that infants and young children are most at risk of maltreatment. There are evidence-based policies and strategies suggested for each of these components ‒ see Table 1 (World Health Organization et al., 2018). Recognising that not all children and families need the same level and intensity of care, the framework identifies three levels of support: universal, targeted and indicated. The guiding principles of the framework are based on children’s rights, equity, family-centred care, and whole-of-government, whole-of-society. Most importantly, the five strategic actions that governments and nation-states need to sign up to include: investment and leadership; focus on families and communities; strengthen services; monitor progress; use data and innovate.
Analysing the available evidence from across the health, education, child and social protection sectors, Britto et al. (2016) suggest that successful, smart and sustainable interventions to improve developmental outcomes need to be implemented as multi-sectoral intervention packages anchored in nurturing care, be applied at developmentally appropriate times during the life course, target multiple risks, be of high quality, and build on existing delivery platforms for feasibility of scale-up. Britto et al. (2016) make the case that early parent–child programs aimed at enhancing responsive parenting can reduce adverse childhood experiences – for example, poor nutrition, neglect, abuse and exposure to violence in the home – and can positively affect children’s cognitive and socio-emotional development and their physical health. Ensuring the Nurturing Care Framework works in majority world settings like South Asia, the existing platforms need to be acutely tuned in to the cultural and community norms of the subcontinent. They need to acknowledge both mother and child celebratory cultural practices as well as the threats and risks that target women and children in the subcontinent.
ECD Status in India
India is home to the largest child population in the world, with 115 million children in 2023 under the age of 5 years, as estimated by UNICEF (2025). Despite being – ostensibly – the fourth largest economy in the world, in certain childhood indices, India’s performance trails behind other comparable countries. Early childhood programs in India, perhaps necessarily, target nutritional and health outcomes rather than developmental outcomes ‒ thus the indices, collected or available, reflect that bias. While India has made gains in child survival, there are substantial variations between the states in the magnitude and rate of decline in mortality, and even higher variations between the districts of India. Overall, the under-five mortality rate per 1,000 births was 42.4 in 2017, with variations of six times between the states and 11 times between the 723 districts of India (Dandona et al., 2020). From the most recent round of the National Family Health Survey data, the highest under-five mortality rate per 1,000 was observed in states such as Uttar Pradesh (60), Chhattisgarh (50) and Odisha (41), whereas the best performing states were in the South – Tamil Nadu (22) and Kerala (five) (C. Kumar et al., 2022). As for nutrition status, there was a prevalence of 36% for stunting, 19% for wasting and 32% for underweight among children under 5 years in India between 2019 and 2021 (IIPS, 2021). While stunting and underweight have declined over the past three decades, wasting has changed negligibly, and as with other indices, there is wide-ranging disparity between regions. Findings from a study from an urban slum in South India found that, worryingly, developmental domains of cognition, language, motor and social skills showed a significant decline in scores between six and 36 months of age. Three domains were associated with developmental scores: nurturing home environment and socio-economic status, maternal education, maternal depression and iron status and linear growth (Koshy et al., 2021). There are a plethora of national programs and policies promoting ECD in India, principally the Integrated Child Development Services (ICDS) scheme, yet experts in the field believe it is unlikely that India will meet the countdown-to-2030 targets for ECD (Chattopadhyay & Aneja, 2021).
In this chapter, we use two case studies to explore how ECD programs are delivered in practice in India in the 21st century: the large State-run Integrated Child Development Scheme and the community-based creches run in remote tribal regions of Odisha. We examine the intersections of culture, science and power in these two very different ECD systems. We posit that much more needs to be done to ensure children’s right to optimum early childhood health and development in the most populous country in the world, possibly starting with social legislation to promote the rights of very young children
Table 15.1
Laws, Policies and Interventions for Creating Enabling Environments
| Component | Laws and policies | Examples of Services and Interventions |
|---|---|---|
| Component 1:
Good health |
Universal health coverage |
|
| Component 2:
Adequate nutrition |
The International Code of Marketing of Breast-milk Substitutes and the accompanying guidance
Baby-friendly Hospital Initiative (BFHI) |
|
| Component 3:
Responsive caregiving |
Paid parental leave
Affordable childcare services Urban design |
|
| Component 4:
Opportunities for early learning |
Universal access to good-quality day care for children, as well as pre-primary and primary education |
|
| Component 5:
Security and safety |
Social protection and social services
Minimum wage |
|
| This is an adaptation of an original work 'Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential. Geneva: World Health Organization (WHO); 2018. Licenced under CC BY-NC-SA 3.0 IGO. This adaptation was not created by WHO. WHO is not responsible for the content or accuracy of this adaptation. The original edition shall be the binding and authentic edition. | ||
The State-Run Integrated Child Development Scheme[1]
The Integrated Child Development Services Scheme in India was launched in 1975 and currently covers about 90 million children, 11 million pregnant and lactating women and 2 million adolescent girls. While this milestone is in itself worth celebrating, and the scheme is considered well-conceived, there remain many challenges and gaps with respect to the quality of services and their outcomes with respect to comprehensive child development (Prasad, 2025).
History and Progress of ICDS in India
Initially, the scheme was limited to a very small number of ICDS centres (popularly known as "Anganwadis" or courtyard centres) covering only 33 (4 rural, 18 urban, 11 tribal) blocks. This progressed to 3,654 blocks in 1995, and currently, there is near "universal coverage" through the existence of nearly 1.4 million Anganwadi Centres (AWCs) run by the Anganwadi Worker (AWW) and helper (AWH) (Kumar et al., 2022; Ministry of Women and Child Development, 2013). Though the ICDS was originally focused on early childhood education, subsequent policy and program shifts have created a stronger focus on nutrition within the various elements of early childhood care and development (ECCD) services. Under the National Food Security Act (NFSA), 2013, the provision of nutritious meals to all children became a universal entitlement, with norms for additional provisions for malnourished children. The ICDS "Mission Mode" was declared in 2012 with the laudable objective of making the Anganwadi a "vibrant ECD centre" at the village level (Ministry of Women and Child Development, 2013). While the policy states that the Anganwadi should move beyond the image of being a "feeding centre" and adopt a comprehensive approach to all elements of child development, in practice, however, four of five indicators of achievement are related to nutritional outcomes. Further integration with other policies has occurred, including the National Nutrition Mission (Poshan Abhiyan) in 2017 and Saksham Anganwadi and Poshan 2.0 in 2022. Parallel and less visible processes have been ongoing to promote early education, with the inclusion of ECCE within the National Education Policy (NEP) 2020 (MHRD, 2020), which identifies standalone Anganwadis as a site for ECCE activities. Where child protection is concerned, a formal integration has barely been attempted, with the bulk of services within the Integrated Child Protection Scheme (Ministry of Women and Child Development) being largely left to civil society groups (Prasad, 2025).
ICDS Service Delivery
The ICDS is a central scheme with norms that are largely fixed and uniform; however, flexibilities have been created to some extent to suit different contexts. Thus, population norms have been created that allow for one Anganwadi centre (AWC) for a population of 400 to 800; two AWCs for 800 to 1,600; three AWCs for 1,600 to 2,400 and thereafter in multiples of 800 ‒ one AWC. These have been reduced to one AWC per 300 to 800 for Tribal/ Riverine/Desert, Hilly and other difficult areas. The rules allow for an Anganwadi on Demand where a settlement has at least 40 children under 6 years with no AWC. However, this rarely translates into practice. The six basic services comprise supplementary nutrition, preschool non-formal education, nutrition & health education, immunisation, health check-up and referral services. The nutrition services further expand into critical activities of growth monitoring and anthropometry, the provision of take-home-rations for children under the age of three and pregnant and lactating women, the provision of hot cooked meals for children from 3 to 6 years who attend the centre for ECCE activities and special rations for children in severely malnourished categories. All 6 services are to be delivered by one AWW and one AWH per AWC. Though the AWC is expected to run for a few hours a day, practically speaking, it is full-time for the AWW and helpers with 21 core responsibilities and 11 registers to fill, with the addition of the online Poshan Tracker. Studies have confirmed that AWWs work about 6 to 9 hours a day, with 52% of their daily time directly serving children and paper register work taking up 14% of daily work time (Jain et al., 2020; Lall et al., 2024). Nonetheless, AWWs are considered honorary workers and paid an honorarium that is currently less than the minimum prescribed wage of an unskilled worker.
How is the ICDS Functioning?
Despite its longevity and reach, few robust evaluations of this scheme have been undertaken. The most comprehensive evaluation thus far, done by the NITI Aayog (2020), the former Planning Commission of the Government of India, highlights that uptake is highest for supplementary nutrition, lower for ECCE and lowest for health and nutrition education. The report documents a significant gap in utilisation between urban and rural areas, with 60% of children from rural areas and only 40% of children from urban areas receiving at least one of the ICDS services. From the point of equity, utilisation is higher among mothers from middle-income groups in rural areas, but this trend is reversed in urban areas, with Anganwadis serving lower-income groups more. The role of the ICDS and indeed the monitoring of its functioning has always been about facilitation of infant/young child feeding, given its supplementary nutrition as well as health and nutrition education agenda. However, the budget for the nutrition program is woefully inadequate to supply dietary diversity ‒ severely malnourished children are allocated 12 rupees per day, for example. There is also no attempt to connect to the community in rural areas for the utilisation of culturally acceptable local produce and the use of community-approved menus. Decisions on food and feeding remain highly centralised and top-down. Younger children are provided take-home rations, sometimes of unacceptable quality or kind (Marathe et al., 2015). The Indian government has chosen to invest in mandatory rice fortification for the containment of anaemia rather than in enhancing dietary diversity of the meals (Prasad, 2024). Most importantly, there are major problems with the data needed to track nutrition outcomes; especially through the Poshan Tracker, to identify, manage and track children with malnutrition, as well as take stock of trends at local levels (Prasad, 2021).
Creches in Remote Tribal/Adivasi Areas of Odisha: A Community-Based Exercise in Early Childhood Care and Development
The program is offered as an example of development-related work negotiating different and often competing cultural paradigms to be able to run a service that fulfils a mutually felt need. Tribal areas of Odisha are typically beset by geographical and social exclusion characterised by persistent poverty, illiteracy, malnutrition and ill health. Women work long hours in subsistence farming and as daily wage labourers, alongside their duties with respect to tending to animals, foraging for forest produce, household work and unpaid care work for the sick and elderly as well as their children. Given the intersection between the need for ECCD services, existing malnutrition and women’s labour, creche services for children under the age of three years have long been envisioned as a good and logical overall developmental intervention, though their existence on the ground leaves much to be desired. This is even more relevant considering that the ICDS program, as mentioned above, typically does not do justice to the critical age group of children under the age of 3 years, with the assumption that they would be well taken care of at home.
History and Development of Creches in Remote Odisha
While urban slum areas have had creches run by a handful of civil society organisations, rural creches had not been attempted, and communities in the Adivasi (First Nations) areas under consideration had never heard of them or seen them function. In this context, Public Health Resource Society (PHRS) ‒ a non-government organisation working in child health and nutrition through participatory approaches ‒ was approached by a donor partner to attempt this experiment and agreed to do so with some degree of trepidation. The state of Odisha has stood out from the rest of India in its commitment to community-based work through its women-led Self Help Group programs. In some sense, that has also influenced the initiation of the experimental program described below. Many other states in India are likely to be less considerate of the community as a key stakeholder in development activities. Thus, the selection of Odisha was a considered one, keeping in mind the eventual goal of enabling the state to run such services at scale as a full-fledged public program.
As part of the participatory process, the first step was to engage the community in a dialogue to see if they were at all open to the idea. Several village meetings were undertaken at each hamlet, often running into late evenings and nights, where villagers could speak of what they might gain or expect. Short films were shown on a laptop to provide a visual experience of what a creche comprised. It was made clear that the creche would be run by a committee of the village and the creche workers would be women from the village, selected by the village community, but with our participation as well, to ensure certain non-negotiable requirements. The creche workers would be paid, the children would receive a combination of services including early stimulation activities, decent quality food, and safety and protection, but the community would also hold some responsibilities, such as providing space and oversight.
We were aware that we too had an agenda and influencing perspectives. We came from a modern, scientific, public health understanding of malnutrition with the primary intention of improving the nutritional status of participating children under the age of 3 years, albeit with a commitment to all the comprehensive elements of ECCD. The community did not understand malnutrition or ECCD in the way we did, but almost invariably, they agreed to and almost demanded that we go ahead with facilitating the opening of creches. Though it was not a problem they identified spontaneously, or a need they felt before a possible intervention was presented to them, they could immediately see the benefit to children as well as the family.
Through the years, this relationship – often fraught with tensions and sometimes disagreements – matured to allow for changes in the culture of all who participated, even though PHRS was far more powerful. This was by no means enforced by the tribal community, which has been largely consigned to an acceptance of their circumstances, resulting in a lack of voice as has been well documented (Prasad, 2022). It arose more from a certain reflexivity and acknowledgment of power differentials as a result of training in social action and a public health approach that at least acknowledged politics.
Demonstrating this negotiated existence within the principles of equity and participation, many flexibilities were set into the program, which, however, was still quite centrally determined and uniform by dint of its funding and implementation by non-community actors. The flexibilities pertained, for instance, to timings and to some extent menus, in distinct difference from the ICDS-run services. On occasion, the PHRS team had to argue against, defy or "disallow" a cultural practice since it was considered harmful. The most common arenas for cultural differences came up in infant and young child feeding, where scientific understanding of colostrum feeding, exclusive breastfeeding and initiation of complementary feeding were not part of the cultural practice of the community but were considered necessary behaviour-change to be discussed with the women from our point of view. Some other practices that are fortunately on their way out, such as branding babies with a hot iron to ward off evil, were actively resisted; they would have been considered illegal from a child protection lens as well. Sometimes, the community exerted a bias against a section of the village that belonged to a different tribe or caste, and that created challenges for the implementation of a program that considered itself secular and non-discriminatory. On occasion, we had to move away from a community that persisted with such discrimination. Thus, the process has been one of negotiation and dialogue and sometimes walking on eggshells. What is undeniable, however, is the mutual benefit and interest in this program and the beauty of participating in such a complex exercise. Much has been questioned and learned along the way, reinforcing our overall sense of the integrity of a process that allows for dialogue, creates safe and open spaces, is respectful and compassionate at its core and takes existing knowledge as a starting point – sometimes to be contested and often to be accepted, but always of significance.
The key substantive differences between the two programs described briefly above are summarised in Table 2. However, what is most important to highlight is that it is the vision and process that creates the difference, not the elements per se. Here, the perspective of the facilitatory institution and the communication during capacity building and supportive supervision are paramount in maintaining respect for community ownership and participation as opposed to merely running a protocolised and mechanical program.
Table 15.2
Negotiating Intersections and Fault Lines: Culture, Science and Power
| Delivery Systems |
ICDS | Adivasi Creche |
|---|---|---|
| Culture | Community considered passive ‘beneficiaries’ rather than rights-holders with power over the service. Poorly adapted ECD practices, especially for children <3 years, though the state of Odisha has made efforts to create culturally adapted play and other early stimulation material in local dialects for children aged three-six years. According to the ICDS Mission, states would be 'provided necessary flexibility to take care of local needs and socio -cultural variations'. No other explicit consideration of culture exists in policy documents. |
Community strongly engaged, and key stakeholders.
ECD practices specific to the community were found to be sparse in the creche villages. Thus effort had to be made to resurrect them. In their stead, an effort was made to co-create action songs and play material with the women’s groups and creche workers from the community. The program started afresh to create material with the help of the community. Organising ECCD resonated with the needs of working tribal women for decent childcare services. Also allows older siblings to be released from childcare duties to attend to their education and recreation. A creche committee was set up around each creche comprising mothers and frontline health and ECCD workers to take decisions regarding the daily functioning of the creche and monitor accounts. This was also used as a vehicle to start Participatory Learning and Action meetings with the village community around the various elements of ECCD. |
| Science | Evidence-based, scientific outlook and program protocols.
Main focus including data collection/ monitoring- on components 1 and 2 of the Nurturing Care Framework. Disproportionate focus on nutrition, to the detriment of developmental promotion. |
Evidence-based scientific protocols with adaptation to local practices and aspirations as far as possible.
Traditional cultural practices that are potentially harmful to children had to be discouraged via dialogue and negotiation. All five components of the Nurturing Care Framework considered in service delivery, some more successful than others. Attempts made to engage the community in understanding the science of ECD. Special focus on children with special needs and disability. Red flagging of children with specific health concerns. |
| Power | Represents the top-down, all-powerful, hierarchical ‘State’ and thus contributes to the power differentials that historically exist, while at the same time delivering a necessary service that the community depends upon, as a welfare exercise.
ICDS Mission states as one of its goals, to promote a rights-based approach with women’s empowerment as the 'mover of social change.' In practice, the ICDS workforce- AWWs and helpers are poorly renumerated and acknowledged. |
Ongoing legacy of historical discrimination, inequity and injustice.
Dominant paradigm of development; neoliberalism and role of the state to facilitate industrial development, such as mining activities that displace and or disrupt natural resources. In this program, Adivasi women hold some degree of power as creche workers and creche committee members. Rights are considered an important framework; in terms of human rights and the right to participate or refuse to participate, but also specifically child rights. |
| Note. Table created by Shanti Raman and Vandana Prasad. Licensed under CC BY 4.0. | ||
Discussion and Conclusions
We have described two distinct ECCD programs run in India. As Table 2 shows, there are strengths and weaknesses in both delivery systems. Comparing the two approaches, one is a top-down, centralised, overly bureaucratised service system that is nevertheless enduring; the other is a precarious, bottom-up community-led service, not state-supported, thus vulnerable. Despite ICDS being the largest universalised state-run ECCD program in the world with an enviable record of sustainability, the fault lines are clear. When reviewed against the components of the Nurturing Care Framework, there are obvious gaps. The key strategic actions needed by nation-states are investment and leadership, focus on families and communities, strengthening services, monitoring progress, using data, and innovating (World Health Organization et al., 2018) – one could argue that all sections need more action. Thus, for the ICDS program to succeed in delivering equitable and accelerated outcomes for all children, it requires significant reinvestment and revisioning. The main structural and systemic issues remain its highly centralised management that fails to allow community participation and ownership, and the failure to institutionalise it as a system as stable as schools and healthcare services. Services related to early stimulation, child development, health and supportive care need to be re-established and strengthened beyond the current narrow focus on nutrition. The Adivasi creches, by virtue of being rooted in community, culture and entirely women-run, are fragile, possibly because of these characteristics themselves. Given the massive challenges facing India’s child population in terms of health, nutrition and optimal development, perhaps the only safeguard would be if all ECCD programs are elevated through a law that upheld ECCD services as a universal right, but with greater attention to decentralised, contextually appropriate governance alongside adequate tax-based funding.
Author Note
Vandana Prasad 
https://orcid.org/0000-0003-0640-4965
Shanti Raman https://orcid.org/0000-0002-4546-3231
Correspondence concerning this article should be addressed to Vandana Prasad. Email: chaukhat@yahoo.com.
Acknowledgments
The authors acknowledge the leadership, participation and contributions of the tribal communities in general and the creche workers specifically involved in the program mentioned above. The program acknowledges the non-financial support of the Government of Odisha and the frontline workers of the ICDS and National Health Mission that collaborate with it to enable the entitlements of children attending the creche from state programs related to ECCD, including the six ICDS services.
SDG Alignment
Goal 1: No poverty
Goal 2: Zero hunger
Goal 3: Good health and well-being
Goal 4: Quality education
Goal 5: Gender equality
Goal 16: Peace, justice and strong institutions
Target 16.2: To end all forms of violence against children
Cite This Chapter
Prasad, V., & Raman, S. (2026). Exploring intersections of culture, science and power in early childhood development programs in India. In L. Naidoo, S. Gannon, C. Woodrow, C. H. Díaz, V. Lopez, & J. F. Salazar (Eds.), Sur-Sur Southern knowledges: Education, sustainability and social transformation. Western Open Books. https://doi.org/10.61588/HGMT4758
Attribution
Except where otherwise noted, this work by Vandana Prasad and Shanti Raman is licensed under CC BY 4.0.
References
Black, M. M., Walker, S. P., Fernald, L. C. H., Andersen, C. T., DiGirolamo, A. M., Lu, C., McCoy, D. C., Fink, G., Shawar, Y. R., Shiffman, J., Devercelli, A. E., Wodon, Q. T., Vargas-Barón, E., & Grantham-McGregor, S. (2016). Early childhood development coming of age: Science through the life course. The Lancet, 389(10064), 77-90. https://doi.org/10.1016/S0140-6736(16)31389-7
Britto, P. R., Lye, S. J., Proulx, K., Yousafzai, A. K., Matthews, S. G., Vaivada, T., Perez-Escamilla, R., Rao, N., Ip, P., Fernald, L. C. H., MacMillan, H., Hanson, M., Wachs, T. D., Yao, H., Yoshikawa, H., Cerezo, A., Leckman, J. F., & Bhutta, Z. A. (2016). Nurturing care: Promoting early childhood development. The Lancet, 389(10064), 91-102. https://doi.org/10.1016/S0140-6736(16)31390-3
Chattopadhyay, N., & Aneja, S. (2021, 2021/10/01). The status of early childhood development in India: Will we reach the countdown to 2030 targets? Indian Pediatrics, 58(1), 4-10. https://doi.org/ 10.1007/s13312-021-2348-6
Dandona, R., Kumar, G. A., Henry, N. J., Joshua, V., Ramji, S., Gupta, S. S., Agrawal, D., Kumar, R., Lodha, R., Mathai, M., Kassebaum, N. J., Pandey, A., Wang, H., Sinha, A., Hemalatha, R., Abdulkader, R. S., Agarwal, V., Albert, S., Biswas, A., Burstein, R., Chakma, J. K., Christopher, D. J., Collison, M., Dash, A. P., Dey, S., Dicker, D., Gardner, W., Glenn, S. D., Golechha, M. J., He, Y., Jerath, S. G., Kant, R., Kar, A., Khera, A. K., Kinra, S., Koul, P. A., Krish, V., Krishnankutty, R. P., Kurpad, A. V., Kyu, H. H., Laxmaiah, A., Mahanta, J., Mahesh, P. A., Malhotra, R., Mamidi, R. S., Manguerra, H., Mathew, J. L., Mathur, M. R., Mehrotra, R., Mukhopadhyay, S., Murthy, G. V. S., Mutreja, P., Nagalla, B., Nguyen, G., Oommen, A. M., Pati, A., Pati, S., Perkins, S., Prakash, S., Purwar, M., Sagar, R., Sankar, M. J., Saraf, D. S., Shukla, D. K., Shukla, S. R., Singh, N. P., Sreenivas, V., Tandale, B., Thankappan, K. R., Tripathi, M., Tripathi, S., Tripathy, S., Troeger, C., Varghese, C. M., Varughese, S., Watson, S., Yadav, G., Zodpey, S., Reddy, K. S., Toteja, G. S., Naghavi, M., Lim, S. S., Vos, T., Bekedam, H. J., Swaminathan, S., Murray, C. J. L., Hay, S. I., Sharma, R. S., & Dandona, L. (2020, 2020/05/23/). Subnational mapping of under-5 and neonatal mortality trends in India: The Global Burden of Disease Study 2000–17. The Lancet, 395(10237), 1640-1658. https://doi.org/https://doi.org/10.1016/S0140-6736(20)30471-2
Draper, C. E., Yousafzai, A. K., McCoy, D. C., Cuartas, J., Obradović, J., Bhopal, S., Fisher, J., Jeong, J., Klingberg, S., Milner, K., Pisani, L., Roy, A., Seiden, J., Sudfeld, C. R., Wrottesley, S. V., Fink, G., Nores, M., Tremblay, M. S., & Okely, A. D. (2024). The next 1000 days: Building on early investments for the health and development of young children. The Lancet, 404(10467), 2094-2116. https://doi.org/10.1016/ S0140-6736(24)01389-8
IIPS. (2021). National Family Health Survey (NFHS-5): 2019-21 India. https://dhsprogram.com/ publications/publication-OF43-Other-Fact-Sheets.cfm
Jain, A., Walker, D. M., Avula, R., Diamond-Smith, N., Gopalakrishnan, L., Menon, P., Nimmagadda, S., Patil, S. R., & Fernald, L. C. H. (2020, 2020/12/07). Anganwadi worker time use in Madhya Pradesh, India: A cross-sectional study. BMC Health Services Research, 20(1), 1130. https://doi.org/10.1186/ s12913-020-05857-4
Koshy, B., Srinivasan, M., Bose, A., John, S., Mohan, V. R., Roshan, R., Ramanujam, K., & Kang, G. (2021, Jun 6). Developmental trends in early childhood and their predictors from an Indian birth cohort. BMC Public Health, 21(1), 1083. https://doi.org/10.1186/s12889-021-11147-3
Kumar, P., Kundu, S., & Bawankule, R. (2022). District level geospatial analysis of utilization of ICDS services among children in India. Frontiers in Public Health, 10, Article 874104. https://doi.org/10.3389/fpubh.2022.874104
Kumar, C., Piyasa, & Saikia, N. (2022). An update on explaining the rural-urban gap in under-five mortality in India. BMC Public Health, 22, Article 2093. https://doi.org/10.1186/s12889-022-14436-7
Lall, G., Roy, R., Chandrika, K. S., & Divan, G. (2024). “The Early Years are Like a Foundation for the Future” Perspectives, facilitators, and challenges of Anganwadi workers in supporting early child development interventions in Hyderabad, India: Qualitative findings from a scalable program incorporating early child development interventions. Indian Journal of Public Health, 68(2), 214-221. https://doi.org/10.4103/ijph.ijph_868_23
Lu, C., Black, M. M., & Richter, L. M. (2016). Risk of poor development in young children in low-income and middle-income countries: An estimation and analysis at the global, regional, and country level. The Lancet Global Health, 4(12), e916-e922. https://doi.org/10.1016/S2214-109X(16)30266-2
Marathe, S., Shukla, A., & Yakkundi, D. (2015). Is “take home ration” really improving the nutritional status of children? A study of supplementary nutrition for under 3 children in four districts of Maharashtra. Journal of Community Nutrition and Health, 4(15).
MHRD. (2020). National Education Policy 2020. https://www.education.gov.in/sites/upload_files/ mhrd/files/NEP_Final_English_0.pdf
Ministry of Women and Child Development. Revised integrated child protection scheme (ICPS). https://cara.wcd.gov.in/pdf/revised%20icps%20scheme.pdf
Ministry of Women and Child Development. (2013). ICDS mission mode: The broad framework for implementation. https://socialwelfare.tripura.gov.in/sites/default/files/ IcdsMission%20-%20Broad%20Framework.pdf
Moore, T. G., Arefadib, N., Deery, A., & West, S. (2017). The first thousand days: An evidence paper. Parkville, Victoria; Centre for Community Child Health, Murdoch Children’s Research Institute.
NITI Aayog. (2020). Evaluation of ICDS Scheme of India. https://www.niti.gov.in/sites/default/files/2023-03/Evaluation%20of%20ICDS%20Scheme%20of%20India.pdf
Nores, M., Vazquez, C., Gustafsson-Wright, E., Osborne, S., Cuartas, J., Lambiris, M. J., McCoy, D. C., Lopez-Boo, F., Behrman, J., Bernal, R., Draper, C. E., Okely, A. D., Tremblay, M. S., Yousafzai, A. K., Lombardi, J., & Fink, G. (2024). The cost of not investing in the next 1000 days: implications for policy and practice. The Lancet, 404(10467), 2117-2130. https://doi.org/10.1016/S0140-6736(24)01390-4
Prasad, V. (2021). Misconceived measures for malnutrition: Poshan Abhiyaan’s new monthly height measurements. Economic & Political Weekly, 56(14).
Prasad, A. (2022). Contested Indigeneities: “Adivasi” politics historically and in contemporary times. Agrarian South: Journal of Political Economy, 11(1),37-61. https://doi.org/10.1177/22779760211068317
Prasad, V. (2024). Messing about with anaemia: Current public health policy conundrums in India. Economic & Political Weekly, 59(40).
Prasad, V. (2025). 50 years of a nation-wide child development programme in India. BMJ Paediatrics Open. 2025;9:e003857. https://doi.org/10.1136/bmjpo-2025-003857
The Lancet. (2024). The next 1000 days: The forgotten ages of child health. The Lancet, 404(10467), 2021. https://doi.org/10.1016/S0140-6736(24)02553-4
UNICEF. (2025). How many children are there in India? https://data.unicef.org/how-many/how-many-children-under-18-are-there-in-india/
World Health Organization, United Nations Children’s Fund, & Group., W. B. (2018). Nurturing care for early childhood development: A framework for helping children survive and thrive to transform health and human potential(CC BY-NC-SA 3.0 IGO).
- An earlier version of this section was published in BMJ Paediatrics Open 2025;9:e003857 (Prasad, 2025) and can be accessed at https://doi.org/10.1136/bmjpo-2025-003857. ↵