Realising childcare’s full potential in low- and middle-income countries

For decades, childcare - its availability, affordability, and sustainability - has been an issue of concern for communities worldwide. The disruption and challenges brought on by the pandemic have drawn new attention to the issue. Now, efforts to not just recover but improve the childcare sector have generated a unique sense of momentum and opportunity, but to realise the potential impact of childcare, it will be necessary to incorporate additional perspectives and address some of the ways the field is currently divided.  

In recognition of the potential of childcare to improve outcomes for children, their primary caregivers, other caregivers in the family, and the economy more broadly, we reviewed rigorous research and synthesised findings from ten randomised evaluations of childcare interventions in low- and middle-income countries (LMICs) (IPA 2024). We argue that one key concern for the field is that childcare research, policy, and programmes often operate in silos, focused on either early childhood development or women's empowerment. This has limited our ability to assess and understand its full impact.  

The fragmented research agenda on childcare 

The term “childcare” refers to the action or skill of looking after children, particularly as a service while parents are working. This emphasis signals that childcare is defined by this outcome - it enables parents to work. Given that women perform the vast majority of unpaid childcare, the discourse on childcare typically and rightfully focuses on women and mothers. Accordingly, childcare is often framed in relation to women’s economic empowerment, and by labour market outcomes for women.  

But women are not the only caregivers and their work, paid and unpaid, both influences and is influenced by other family members. It is important to consider how childcare affects other caregivers, such as men and fathers, grandparents, and even older siblings, as well as the dynamics between these different family members.  

And what about the children who are placed in care? All ten studies we focus on report the impact of childcare on various measures of women’s economic empowerment, but only six of them reported any outcome for children (IPA 2024). Childcare is typically understood in relation to the service and impact it provides for women, the term does not refer to a specific intervention or experience for children. Instead, when viewed from the child’s perspective, a range of different terms like daycare, creche, preschool, and nursery are used, depending on the context, age of children served, and other factors.  

In our review, we consider the insights from the broader literature on early childhood care and education, but similarly note that many of these interventions do not consider the potential impact they might have on caregivers. A study on early childhood research found that only 22% of studies reported outcomes for mothers, other than their parenting practices, and only 3% report any outcome at all for fathers (Evans et al. 2021).  

Finally, it is important to consider the field from the perspective of the childcare workforce and service providers. This perspective is particularly underexplored in existing literature and was only explored in one study in our review (Ajayi et al. 2022).  

Our review highlights five main insights that help us understand the potential impacts of childcare, and where more work is needed.

The cost of childcare is a barrier for families  

The cost of childcare remains the most significant barrier for families in LMICs. Subsidies or public services that lower these costs usually lead to increased use of childcare. All the existing literature we reviewed focused on free, subsidised, or small-fee provision of childcare. Affordable options are especially limited for low-income families and especially for parents of children aged 0-3 (Devercelli et al. 2020). Despite these constraints, there is still a significant demand for, and take up of, childcare services.  

Results are mixed on whether childcare’s positive effect on caregivers’ income offsets the cost of care. A childcare subsidy in Uganda improved the monthly household income by 19%, but this corresponded to only about 80% of the monthly costs of childcare (Bjorvatn et al. 2022). In Burkina Faso, researchers observed that the operating costs of childcare were similar to the earning increases for caregivers (Ajayi et al. 2022). However, in Nicaragua, a cost-benefit analysis of a childcare programme found that the increases in mothers’ work outside the home and in household income would pay for the programme (Hojman and Boo 2022). Similarly, in the Democratic Republic of Congo (DRC), the community childcare cost per child was around $16 per month, compared to a $38 increase per month in household income (Donald et al. 2023). 

Childcare contributes to positive economic impacts for mothers, but these may be constrained by gender dynamics and market opportunities 

Most research on the impact of childcare focuses on mothers (Chaturvedi 2019). Research shows that childcare positively impacts mothers' participation in the workforce, their productivity, and/or the types of income-generating activities they engage in, as demonstrated by the randomised evaluations we examined in Uganda (Bjorvatn et al. 2022), the Democratic Republic of Congo (Donald et al. 2023) , Burkina Faso (Ajayi et al. 2022)), Nicaragua (Hojman and Boo 2022), Mozambique (Martinez et al. 2017), Kenya (Clark 2019), and Chile (Martinez and Perticará 2017).   

However, gender norms and limited labour market opportunities present significant obstacles that can prevent mothers from experiencing the economic benefits of childcare (J-PAL Policy Insight 2023). Beliefs and practices regarding women's work outside the home and restricted employment opportunities may prevent women from enhancing their earnings, even when affordable childcare is available. 

Household composition, such as whether a household is run by a single (female) parent, or whether there are two-parents in the household (in these studies, a man and a woman), may also play an important role in women’s economic benefits from childcare, though this area is under-researched. In Kenya, vouchers for subsidised care had a strong impact on employment among married mothers (Clark et al. 2019). No significant improvement in employment was found for single mothers, likely because they were already more likely to be employed. However, single mothers were able to reduce the number of hours they worked without reducing earnings by switching to jobs with fixed hours. Research in Uganda found impacts varied significantly between single mothers and households where a father was present (Bjorvatn et al. 2022). In single mother-headed households, mothers used the extra time provided by childcare in their own businesses; in two-parent households, the household freed up time to increase fathers’ wage work. 

Childcare may have positive impacts on other adult family members, but more evidence is needed  

Research on the effects of childcare on adult family members besides mothers is scarce, but this evidence is promising. Among the ten studies we identified in our review, four reported on outcomes for adult family members beyond mothers (Bjorvatn et al. 2022, Donald and Vaillant 2023, Martinez et al. 2012, Attanasio et al. 2022).  

Available evidence suggests that childcare can enable fathers or male partners to increase their labour supply and income and potentially secure more favourable employment. In the DRC, researchers (Donald, Lowes, and Vaillant 2023) found that childcare positively affected husbands’ participation in economic activities and enabled them to spend more time farming crops destined for sale and engage in non-agricultural self-employment. In Mozambique, early findings showed a 10% increase in the likelihood that fathers would report having worked in the previous 30 days in households with children attending preschool (Martinez et al. 2012). 

Childcare may also enable grandparents to increase their income and employment. Research on the impact of childcare in Brazil, for example, found a positive effect on time spent working and income for grandparents and older siblings, but not for parents, most of whom were already working (Attanasio et al. 2022).   

Quality childcare programmes can enhance the target child’s development 

Research on the impact of childcare on children in LMICs is featured in slightly over half of the randomised evaluations studies we reviewed. These studies, as well as the broader early childhood education literature on interventions such as preschool, indicate that high-quality, centre-based childcare significantly enhances early learning and development for children. However, the effectiveness of these programmes largely depends on the quality of care and children’s meaningful participation. Although many programmes improve some early childhood development outcomes, they do not consistently improve all targeted outcomes. 

The provision of childcare may benefit other children in the household  

The availability of childcare may offer educational and employment benefits for older children in the household who are not enrolled in the childcare intervention, but only three studies we found include a focus on this (Attanasio et al. 2022, Bjorvatn et al. 2022, Martinez 2017). Older children, who would otherwise be tasked with caring for younger siblings, can instead pursue their own educational and work opportunities, due to the reduction of time they spend caring for younger children. Studies from Brazil (Attanasio et al. 2022) and Mozambique (Martinez et al. 2017) demonstrate positive effects, while a study from Uganda (Bjorvatn et al. 2022) had no effect for childcare on its own, but a positive effect when a childcare subsidy was coupled with a cash grant to mothers. 

Realising childcare’s potential  

Childcare is highlighted in IPA’s Best Bets Report as an intervention with great promise, but more research is needed, especially in relation to its potential for impact at scale. It is critical that we consider the multi-generational and workforce perspectives. By incorporating these perspectives in research, programme design, and public policy, we can better understand how to design childcare interventions that improve education, development, and livelihood outcomes across generations. These insights can also help coalitions of organisations from diverse fields to advocate for high-quality, affordable, and accessible childcare. 

References

Amadu, S, et al. (2018), "Improving Early Childhood Development in Rural Ghana through Scalable Low-Cost Community-Run Play Schemes: Baseline Report," Econstor, No. R144.

Arbour, M C, H Yoshikawa, J Willett, C Weiland, C Snow, S Mendive, M C Barata, and E Treviño (2016), "Experimental Impacts of a Preschool Intervention in Chile on Children's Language Outcomes: Moderation by Student Absenteeism," Journal of Research on Educational Effectiveness, 9(sup1): 117-149. doi:10.1080/19345747.2015.1109013.

Attanasio, O, R P de Barros, P Carneiro, D K Evans, L Lima, P Olinto, and N Schady (2022), "Public Childcare, Labor Market Outcomes of Caregivers, and Child Development: Experimental Evidence from Brazil," NBER Working Paper No. w30653.

Gulesci, S, K Bjorvatn, D Ferris, A Nasgowitz, and V Somville (2022), "Childcare, Labor Supply, and Business Development: Experimental Evidence from Uganda," CEPR Discussion Paper No. 17243.

Banerjee, A, T Andrab, R Banerji, S Dynarski, R Glennerster, S Grantham-McGregor, K Muralidharan, et al. (2023), "Cost-effective Approaches to Improve Global Learning: What Does Recent Evidence Tell Us Are Smart Buys for Improving Learning in Low- and Middle-income Countries?" GEEAP.

Caria, S, B Crepon, H ElBehairy, N Fadlalmawla, C Krafft, A Nagy, L Mottaghi, N Zeitoun, and S El Assiouty (2023), "Child Care Subsidies, Employment Services and Women’s Labor Market Outcomes in Egypt: First Midline Results," G²LM|LIC Working Paper No. 73.

Chaturvedi, S (2019), "Global Evidence on the Impact of Centre-based Quality Childcare on Maternal Employment and Early Childhood Development Outcomes," Initiative for What Works to Advance Women and Girls in the Economy, New Delhi.

Clark, S, C W Kabiru, S Laszlo, and S Muthuri (2019), "The Impact of Childcare on Poor Urban Women’s Economic Empowerment in Africa," Demography, 56(4): 1247-1272.

Cuartas, J, J Jeong, C Rey-Guerra, D C McCoy, and H Yoshikawa (2020), "Maternal, Paternal, and Other Caregivers’ Stimulation in Low-and-Middle-Income Countries," PLoS One, 15(7): e0236107.

Donald, A, and J Vaillant (2023), "Experimental Evidence on Rural Childcare Provision," Preliminary Draft, World Bank.

Devercelli, A E, and F Beaton-Day (2020), "Better Jobs and Brighter Futures: Investing in Childcare to Build Human Capital," World Bank, Washington, DC.

Du, F, and X Dong (2013), "Women’s Employment and Child Care Choices in Urban China during the Economic Transition," Economic Development and Cultural Change, 62(1): 131-155.

Evans, D K, P Jakiela, and H A Knauer (2021), "The Impact of Early Childhood Interventions on Mothers," Science, 372(6544): 794-796.

Evans, D K, P Jakiela, and A Mendez Acosta (2024), "The Impacts of Childcare Interventions on Children’s Outcomes in Low- and Middle-Income Countries: A Systematic Review," CGD Working Paper 676, Center for Global Development, Washington, DC.

Halim, D Z, H C Johnson, and E Perova (2021), "Preschool Availability and Women’s Employment: Evidence from Indonesia," World Bank Group, Washington, D.C.

Ganimian, A J, K Muralidharan, and C R Walters (2021), "Augmenting State Capacity for Child Development: Experimental Evidence from India," Journal of Political Economy.

Hojman, A, and F Lopez Boo (2022), "Public Childcare Benefits Children and Mothers: Evidence from a Nationwide Experiment in a Developing Country," Journal of Public Economics, 212: 104686.

Holla, A, M Bendini, L Dinarte, and I Trako (2021), "Is Investment in Preprimary Education Too Low?" World Bank Policy Research Working Paper 9723.

J-PAL Policy Insight (2023), "Access to Childcare to Improve Women’s Economic Empowerment," Abdul Latif Jameel Poverty Action Lab, Cambridge, MA.

Ajayi, K F, A Dao, and E Koussoubé (2022), "The Effects of Childcare on Women and Children: Evidence from a Randomized Evaluation in Burkina Faso," CGD Working Paper 628, Center for Global Development, Washington, DC.

Martínez, C, and M Perticará (2017), "Childcare Effects on Maternal Employment: Evidence from Chile," Journal of Development Economics, 126: 127-137.

Martinez, S, S Naudeau, and V A Pereira (2017), "Preschool and Child Development under Extreme Poverty: Evidence from a Randomized Experiment in Rural Mozambique," World Bank Policy Research Working Paper 8290, World Bank.

Nandi, A, P Agarwal, A Chandrashekar, and S Harper (2020), "Access to Affordable Daycare and Women’s Economic Opportunities: Evidence from a Cluster-Randomised Intervention in India," Journal of Development Effectiveness, 12(3): 219-239.

Richardson, R A, S Harper, N Schmitz, and A Nandi (2018), "The Effect of Affordable Daycare on Women's Mental Health: Evidence from a Cluster Randomized Trial in Rural India," Social Science & Medicine, 217: 32-41.

Anukriti, S, L Dinarte-Diaz, M Elefante, M Montoya-Aguirre, and A Sakhonchik (2023), "Filling the Gaps: Childcare Laws for Women's Economic Empowerment," World Bank Policy Research Working Paper No. WPS 10492, Washington, D.C.

Yoshikawa, H, D Leyva, C E Snow, E Treviño, M Barata, C Weiland, C J Gomez, et al. (2015), "Experimental Impacts of a Teacher Professional Development Program in Chile on Preschool Classroom Quality and Child Outcomes," Developmental Psychology, 51(3): 309.