Its hard not to have a mental perception of the 1980s, even if your weren’t born then! Stranger Things? Debatable music? Ludicrous haircuts? The fading of Soviet communism or apartheid fascism? Yet few remember that the decade delivered one of history’s most far-reaching and transformative milestones. It came in the shape of a quantum leap of progress for the world’s children.
As with some of the debatable music, it all started in the UK’s second city Birmingham. A 1982 conference lecture synthesized all of the available data on childhood disease, with razor sharp precision. Globally, 14 million children were lost each year to a handful of preventable disease. Wealthy industrial countries had disrupted and reversed these diseases through universal public health interventions, including vaccines. Advances in science meant low-cost delivery systems could replicate these interventions in poorer countries that lacked robust health systems. They could in fact reach every child every where. If the political will could be mustered of course.
Precisely 3,371 miles away in the slightly more glamorous setting of midtown Manhattan, this paper caused a stir. The relatively new Executive Director of UNICEF Jim Grant proposed to senior internal colleagues and external partners including the World Health Organisation and the World Bank that together they could launch a Child Survival Revolution. The purpose would be to halve child deaths within a decade, by making vaccines and other preventative solutions available everywhere. Most thought Jim Grant taken leave of his senses. The graph below shows what happened next.
Against all odds and an ocean of skeptical resistance, a UN coalition plougfed ahead with the Child survival revolution. Between 1982 and 1990 global vaccine coverage soared from 20% to 80% overall, as the coverage rates for the global diptheria, pertussis and tetanus vaccine above illustrate . Another life saver, oral rehydration salts (ORS) became available to about two thirds of children in the developing world. The goal of halving under five mortality was met. Just as already had happened in high income countries, global child health shifted from fragmented and reactive services here and there to universal prevention everywhere. Vaccines and ORS were galvanizing ‘accelerators’ delivering multiple gains for child survival and public health in general. Progress has stalled in recent years and is in danger of regressing through the multiple impacts of Covid19. Despite this, this year and every year, millions of children are alive because of the shift that the child survival revolution brought.
Almost 40 years later, we now have enough science and evidence to make a similar shift in child protection. When we talk about child protection we talk about those services that protect children from harm. Not harm from disease or hunger, but harm from other human beings. Child protection is transforming because the way we understand harm has evolved in three crucial ways.
We used to think that safety for children was just the absence of violence, abuse and exploitation. The evolving science of child development has shown that the absence of love and nurturing care is also very harmful for children. Emotional and physical neglect dramatically increases the risk for many of the other forms of violence against children. Were have also become aware of the way harm creates toxic stress and poor attachment models which dramatically amplifies risk being a of becoming a perpetrator or victim of harm. The science affirms what to many is common sense. Harm is inter-generationally transmitted.
Secondly we know harm of children is significantly more widespread than we previously thought. Data is showing us how the prevalence of serious neglect, abuse or dysfunctional parenting is perhaps ten times higher than the caseload of the best resourced child protection systems in the world. The limited data we currently have suggests that rates of child maltreatment are similar across continents. Adverse Childhood Experiences and Violence Against Children surveys consistently show at least half of children are affected by one form of harm or violence in the home and to a third are affected by multiple forms. We now know that the overwhelming majority of child maltreatment is unreported, unaddressed and unknown.
Thirdly the science is suggesting we may have a vaccine against harm. Just as the DPT vaccine is a protective factor against disease, quite simply improved human relationships are a resilience-building protective factor against neglect, abuse and exploitation and the deadly toxic stress unleashed. The prescription would include two types of relationships. The first is the deep, affectionate connection with a primary caregiver, usually a parent. This relationship teaches them to navigate the world, protects from harm and soothes with play and love. The second is a dense network of relationships in community and school. This network will watch over them, make them feel like they matter as an individual and prevent the harm of loneliness. If this sounds a bit bonkers, try to imagine our biological imperative as a species. We are designed to attach to a parent and belong to a clan. Both relationships reinforce each other. The school or community soothes the child when love at home is not what it should be. The caregiver buffers and comforts the child in response to shocks at school or in the community.
These three factors give us reason and method to unleash a global child protection revolution. We now have the means to expand global child protection from fragmented and targeted response to population-wide prevention. Adequately funded, low cost and evidence-based parenting programmes may be the single most impactful intervention we can do for child wellbeing. These programmes impart skills and an understanding of child development. They also about help parents to build self-awareness and to self-regulate what can be an automatic replication of their own neglectful or abusive childhood experiences. Parenting support should be available at different times during the life course, but the intervention in the first year of childhood is especially critical as it helps shape the attachment relationship.
We also know that we can strengthen the capability of schools and teaching to protect children from trauma and violence . Many countries are now rolling out trauma-informed or trauma-aware schools, police forces and other key services that actively seek to soothe and support children, help them build resilience and navigate away from child protection risks such as violence or crime. Attuned teachers know that when children are fearful and anxious they cannot learn. Police officers know that the best way of cutting off the recruitment supply for organized crime, political violence or grooming is to intervene early and ensure children at risk are plugged into good support networks. Research could help us adapt this approach to cultural and tradition protection mechanisms in low-resource settings. Sometimes those mechanisms have been unraveled through badly managed transition or colonially designed education systems
Population level prevention through parenting and community support is at the heart of the child protection revolution. But it cannot address all aspects of global child protection. We need to support and expand the intricate and brave work currently being done on harmful practices such as female genital mutilation and early marriage and recruitment of child soldiers, grave violations of children’s rights in humanitarian settings and the often dire situation of refugee or migrant children. A child protection revolution needs to accompany efforts to address structural challenges such as child poverty, discrimination and social exclusion.
In most contexts population-level prevention against harm is a resilience-building protective factors for multiple risks including trafficking , grooming, criminal exploitation and abuse and violence in general. It is arguably the single best preventative factor for the related social problems of addiction, obesity and poor health.
Like the early proponents of the child survival revolution, advocates of population-level child protection systems are told to ‘get real’. Just like them we should politely acknowledge the feedback while working with all of our passion to truly Reimagine Child Protection.