At 200 schools, they checked each child’s
vision and gave them a math test. Then,
in half the schools, the kids who needed
them got free glasses. A year later, the
math scores of the kids with glasses had
improved far more than those of peers in
the other schools. Vitamin supplements and
deworming yielded similar results. Luo says
these and other findings helped convince
the central government in 2011 to estab-
lish a school lunch program now benefiting
20 million rural students daily. “What im-
presses me about Scott,” says Martorell, “is
that his work does not end with just publi-
cations; he is deeply committed to making
sure government officials become aware of
the problems and solutions.”
But Rozelle believed that he might
achieve more by starting with younger chil-
dren, persuaded by the work of economists
showing that investment in the first 1000
days of life yields economic dividends. As
he puts it: “The development economics
field discovered babies in the past five or
so years.” Adversity early on—malnutrition
or neglect of an infant’s physical and emo-
tional needs, for example—can leave cog-
nitive deficits that persist for life. And in
REAP, Rozelle had an organization that
could do rigorous studies of interventions
and their benefits.
In 2013, REAP launched a study enrolling
more than 1800 babies, ages 6 to 12 months,
and their caregivers from 348 villages in impoverished Shaanxi province. A team took
blood samples and measured the height and
weight of each infant. An evaluator gave
each baby a widely used test—the Bayley
Scales of Infant and Toddler Development—
that measures cognitive, language, and
motor skills. Each caregiver answered a
questionnaire used to assess the infant’s
social and emotional status. The tests were
repeated three times at 6-month intervals.
The team also tracked whether and when a
mother had migrated away for work.
On the bright side, Rozelle says, the tests
indicated rural kids “don’t need help with
their motor skills.” But 49% of the babies
were anemic. And 29% scored below normal on the Bayley test: nearly twice the 15%
of babies that naturally fall at the low end of
intelligence tests in any population.
The researchers initially focused on nutrition, providing vitamins in the trial’s intervention arm. But follow-up tests showed that
the supplements had marginal impact and
that mental development scores deteriorated
in both intervention and control groups.
At that point, Rozelle recalls, the team
began to think, “Maybe it’s a parenting
problem.” In spring 2014, REAP started
asking caregivers in their study about par-
enting practices. Only 11% had told a story
to their children the previous day, fewer
than 5% had read to their children, and
only a third reported playing with or sing-
ing to their children.
The situation is particularly fraught for
“left-behind” children. Fully one-quarter of
Chinese children under age 2 are left in the
care of relatives at some point, according
to UNICEF statistics. Grandparents often
end up as the caretakers—and many “are
still in a survival mode of thinking,” without the time, energy, or education to read
to their grandchildren, Young says. The test
scores confirm a devastating impact: After
mothers left home to work in another city,
mental development scores among their
children declined significantly and socio-emotional indices “fell apart,” Rozelle says.
The declines were greatest when a mother
left during the child’s first year.
REAP was already adapting what’s
known as the Jamaican intervention.
Sally Grantham-McGregor, a physician
and child development specialist, devised the strategy to help developmentally stunted children she observed while
at the University of the West Indies in
Kingston in the 1970s and 1980s. The Jamaican intervention relied on home visits to teach mothers, one-on-one, how to
interact with their toddlers using books
and toys designed to raise cognitive, language, and motor skills. The REAP team
enlisted child education specialists and
psychologists at Shaanxi Normal University in Xi’an, the province’s capital, to
translate and adapt the teaching materials. For coaches, REAP turned to China’s
National Health and Family Planning Commission, which was seeking new roles for its
NEWS | FEATURES
22 SEPTEMBER 2017 • VOL 357 ISSUE 6357 1229 SCIENCE sciencemag.org
Childhood in the other China
Compared with peers in the cities, rural kids have higher rates of malnutrition, uncorrected vision problems, and
intestinal parasites. Many rural parents leave kids in the care of grandparents. The result, according to a team of
economists: the intellectual stunting of roughly one-third of China’s population.
are underway here,
in some of China’s
Percentage of HS grads in workforce
In nearly half of families with young children in rural China, one or both parents have
migrated to a city for work. The “left-behind” children often lack intellectual stimulation.
Out of school
About a third of students in poor rural areas drop
out of junior high school.
Among mid-income countries in 2010, China had the
lowest ratio of high school (HS) grads in the workforce.
0 10 20 30 40 50 60 70 80