An Exploration of Childhood and Childcare for 0-3 year olds in Coastal Kenya

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya An ethnographic deep-dive and quantitative study

Funded by The Kays Foundation / Research by The Good Side

Foreword Decades of research have brought us to the undeniable truth that the early years of human life are inextricably and measurably linked to almost every outcome in adulthood. Researchers from fields within medicine, psychology, sociology, physiology, neurobiology and economics (to name but a few) all broadly agree that investment in the earliest years of an individual’s life is critical to ensuring success in later life.

In carrying out this research we wanted to unearth unbiased insights into childhood and parenthood in coastal Kenya.

We believe that the voices and experiences of parents and children should be at the heart of any work around early childhood.

We hope this research is valuable to those making decisions on policy, practice and funding, and that it sparks new thinking and debate.

And yet we have permitted a global, societal norm of underinvestment in the early years. High quality early childhood experiences are reserved for those with the resources to seek them out rather than being available for everyone. This inequality in early childhood experiences has a catastrophic compounding effect on inequality later in life.

We would like to extend sincere thanks to the members of the steering committee whose wisdom, reflections and challenges helped shape and guide this project. We would also like to thank the researchers who worked tirelessly on collecting, analysing and presenting the data that forms the substance of this work.

Most of all we would like to extend our deepest gratitude to the communities who welcomed us, shared their experiences with us, and trusted us to represent them faithfully within this research.

The Kays Foundation exists to create momentum around early childhood to make it a priority for everyone. We believe that this is central to making meaningful progress in the fight against systemic and entrenched inequality. Ultimately, we want to see the prioritisation of early childhood and the investment of the resources required to create an environment where all children can reach their potential.

Khilen Nathwani Founder & CEO, The Kays Foundation (TKF) 2

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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Contents

Contents Introduction How to use this report Top 10 Insights & Implications Executive Summary Research journey Participant engagement Steering Committee Research principles Setting the scene: geographical & socio-cultural context

Early childhood insights & implications

CAREGIVERS

The central role of mothers in ECD Addressing the teen mother phenomenon Engaging fathers in early childhood Learning to parent and opportunities for innovation How parents understand and behave during the first 1,000 days Building on the foundations of responsive care Embedding play-led learning in culture Childcare options and choices Understanding state support for parents

CAREGIVING

STATE SUPPORT Writers Saul Parker & Sophie Dollar

26 37 44 55 69 79 86 92 101

Appendix Stakeholder feedback that informed research design Research approach & methodology Participant archetypes Quantitative research

Designer Guillem Matallanas Quantitative Survey George Owino (Kenyatta University) & Michael Mikkelsen CONTENT_ANCHOR

05 06 07 14 15 16 17 18

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111 113 119 121

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Introduction INTRO_ANCHOR

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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How to use this report

Introduction How to use this report

This document works best when viewed using Adobe Acrobat.

If you use Apple Preview the file will not be interactive.

You can download a copy of Acrobat free here.

HOWTO_ANCHOR

This study has been carried out with the sole purpose of bringing new insights on early childhood and childcare to the EC community, to help improve support for and services to 0–3 year olds.

3 minutes?

The report groups insights and key implications thematically, covering a range of associated topics, as you will see from the contents page. How you use these insights is entirely up to you: our aim is simply to present our findings and proposed implications as a way to provoke new thinking and reflections from anybody working in Early Childhood Development (ECD).

Glance at page 6 for Top 10 Insights and Implications.

20 minutes?

Feel free to dive in and out, choose the sections that are of most interest to you and extract what you need to support and develop your Early Childhood investments, programmes or studies.

We have designed the report for screens, and it should work well on either a computer or phone screen, as well as being easy to use for presenting and discussing with others.

Dive into the research themes that are most relevant to you in the main body of the report.

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Introduction Top 10 Insights and Implications

Top 10 Insights and Implications

top10insights_ ANCHOR

INSIGHTS

ECD and Nurturing Care practice tends to focus exclusively on children, and doesn’t accommodate primary caregivers’ needs and challenges.

Postnatal depression is recognised by neither state nor society.

Click on the number to jump to that section

Teen mothers are vulnerable and stigmatised, and often fall through the net of existing support structures.

Social norms around what it means to be a man are shifting, but are hard to document because stereotypes make it hard for men to open up.

Innovation in parenting is slow: children learn to parent at an early age, and the previous generation sets the agenda.

Survivalist mentalities lead to short-termism, where immediate needs must take priority over future planning.

A ‘Vulnerability Gap’ exists from days 600-1000, where children receive less attention, and may suffer as a result.

The culture of play is widespread and celebrated, but it’s not a mother’s role to actively play with her toddler when there are siblings around.

A lack of daycare facilities means many parents are forced to rely on untrained and overstretched informal providers.

Community Health Volunteers are a variable resource and are probably over-relied upon by donors and governments.

IMPLICATIONS 1

Mothers must be at the heart of user-centred design for Early Childhood initiatives and frameworks.

2

Greater awareness and support for postnatal depression is critical given its prevalence and potential impact on the first 1,000 days of a child’s development.

3

Teen mothers should be specifically accommodated in programme design, instead of punished and ostracised.

4

Find ways to design for fathers, celebrating their unique role and fitting into their lifestyle.

5

A two-generational approach to ECD programming is required, targeting parents and grandparents specifically.

6

First 1,000 day communications should lead with immediate-term health and strength benefits, rather than narratives around long-term brain development.

7

Children aged 1.5 to 3 years are uniquely vulnerable, and communications and programming should recognise their needs.

8

Build on cultural opportunities for play, involving siblings and other children, rather than focusing solely on parents.

9

Urgently consider ways to provide better daycare for 0–3 year olds, and make their developmental needs a priority within existing formal and informal setups.

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Carefully recruit Community Health Volunteers, to ensure they’re respected by their community, trained, paid and have capacity before investing in them.

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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Introduction Executive summary

Executive summary EXSUM_ANCHOR

Introduction: Surfacing fresh insight on early childhood in coastal Kenya While theories and frameworks have been created and shared to help guide the design of Early Child Development initiatives, relatively little research exists that dives into the realities facing families and children to help guide this design work, and help shape better ECD programming. Coastal Kenya in particular has not benefitted from a great deal of ECD research in comparison to Nairobi and other parts of Kenya, particularly the western counties.

In undertaking this work, we were struck by how many community-level issues we heard about were not reflected in the initial conversations we had with experts from across ECD field.

Issues such as postnatal depression, the needs of teen mothers, the realities of informal daycare and the lack of consistency in Community Health Volunteer provision are just some of the insights gleaned from spending time with families and immersing ourselves in communities. While these issues may not be surprising to many of those working in ECD, we believe that the reason they are not often reflected in ECD programming strategy is indicative of a lack of focus on, and insight into, the real needs, aspirations and challenges of caregivers and families.

This project set out to address this omission. It aims to provide those working in the ECD space – both in Coastal Kenya and beyond – with actionable insights told from the perspective of Kenyan parents and caregivers. We hope that as a result of these insights, future policy decisions, programme design and investment strategies can start from a truly user-centred perspective, and that great ECD initiative design aims to meet the needs of families first and foremost.

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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Introduction Executive summary

Executive summary Our approach: Place-based ethnography and a comprehensive household survey The core of our research was a month of ethnographic fieldwork in coastal Kenya, split evenly between Kibarani (an informal settlement in Mombasa) and Ganze (a rural district in Kilifi County).

Prior to fieldwork we consulted with a range of ECD experts, immersed ourselves in the literature and assembled a Steering Committee to guide our work.

Our film focuses on the particular challenges faced by mothers in managing a household, looking for work and supporting young children. We wanted to show in a respectful and supportive way just how hard so many mothers are working to do the best for their families, and how circumstances conspire to make things difficult for them.

While this was primarily an ethnographic study, we knew that quantitative data could offer value in supporting the insights, particularly for those working in policy and programme design.

As a result we complemented a month of ethnographic fieldwork with a 1,000 household survey in Mombasa and Kilifi to validate and stretch our insights.

Our overarching aim in producing this research is to shed new light on the realities facing parents and communities, to support the work of ECD practitioners, policy makers, donors and academics to better design around their needs. Please feel free to share this work, discuss it, draw what is of relevance to you and your work.

We have included implications based on our thinking and conversations so far, and we very much encourage you to build on those ideas and generate your own conclusions. This work is designed to provoke conversation, encourage new thinking and help us all to better build solutions for the communities we support.

From the outset we knew we wanted to create a documentary film.

We know the most powerful way to communicate audience-led insights is in the words of that audience, and we wanted to use film to bring the environments, people and atmosphere of Ganze and Kibarani to ECD practitioners worldwide.

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Executive summary CORE INSIGHT

Introduction Executive summary

CAREGIVERS

DESCRIPTION

IMPLICATION

1) ECD and Nurturing Care tends to focus exclusively on children, and doesn’t accommodate primary caregivers’ needs and challenges.

Through our conversations with ECD experts and practitioners we heard a great deal about outcomes for children, and what they need. We heard far less about what mothers and caregivers need in order to thrive and provide for their children. During our ethnographic work we learned that mothering/caregiving in Coastal Kenya is fraught with challenges that significantly impact the ability of parents to deliver quality caregiving for 0–3 year olds.

In order to improve outcomes for young children it will be important to improve parenting practices, and to improve parenting practices we must first understand what it’s like to be a mother or primary caregiver in coastal Kenya, and design around their needs, aspirations and challenges.

Mothers must be at the heart of user-centred design for Early Childhood initiatives and frameworks, for these interventions to achieve the greatest success.

2) Postnatal depression is recognised by neither state nor society.

Over the course of our fieldwork we saw little if any recognition or awareness of postnatal depression in the communities we spent time in, from the perspective of both health professionals and members of the public. We tentatively explored this sensitive topic with all of our research participants, and found that mental health is viewed in stark binary terms, where people are either sane or insane, and supernatural causes are often considered to blame for mental health problems. Owing to stigma and confusion around psychological wellbeing, it’s also very hard for anybody to discuss mental health in public.

Greater awareness and support for postnatal depression is critical and urgent, given its prevalence and potential impact on the first 1,000 days of a child’s development.

Postnatal depression is currently not a consideration in Kenya, and is undoubtedly going undetected on a significant level. The impact of postnatal depression on mothers’ ability to provide nurturing care is significant, which makes this a fundamental issue for ECD strategies moving forward.

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Executive summary CORE INSIGHT

Introduction Executive summary

CAREGIVERS

DESCRIPTION

IMPLICATION

3) Teen mothers are vulnerable and stigmatised, and often fall through the net of existing support structures.

Teen mothers are a substantial constituency in coastal Kenya, and have been problematised by the state and society to the extent that a significant level of stigma surrounds them.

Moral outrage around the epidemic of teen mothers has led to many young mothers being ostracised by their families and communities, and left them vulnerable and isolated. Teen mothers are still children, and many of them mourn the loss of their independence and personal identity that comes with being a ‘mama’. They are ill-equipped to take on this new role, and both mother and baby can suffer as a result. Government policies have focused on restricting the movement of young women and naming and shaming those who impregnate them, as opposed to working on ways to support these vulnerable mothers and their babies.

Teen mothers should be specifically accommodated in programme design.

All too often they fall through the gaps.

4) Social norms around what it means to be a man are shifting, but these are hard to document because dominant masculine stereotypes make it hard for men to open up.

Talking to fathers across urban and rural coastal locations, we detected a sense that new ways of being a man are emerging, particularly when it comes to being a husband and father.

Many men are conscious that they could play a more active and supportive role in the lives of their wives and young children, even though a great many choose not to do so – particularly in rural areas, where traditional gender norms are more entrenched.

It is important that ECD practitioners find ways to design for fathers, celebrating their unique role and fitting interventions around their lifestyle.

There are signs that educated fathers play a more active role in their children’s lives, particularly in urban areas, but restrictive norms make it very hard to have an honest conversation about this. Traditional gender norms and domestic roles are highly embedded and reinforced in local idioms, and deviance from those norms is still considered emasculating and shameful by many.

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Executive summary

Introduction Executive summary

CAREGIVING

CORE INSIGHT

DESCRIPTION

5) Innovation in parenting is slow: children learn to parent at an early age, and the previous generation set the agenda.

In extended families, children take on parenting duties from an early age, and most mothers will have done their share of ‘parenting’ well before having children of their own. Children learn to parent from their parents, and young mothers learn almost all of their parenting skills from their own mother. As a result, the previous generation are the most significant influencers setting the agenda for how parenting is learned. When grandmothers are the gatekeepers of parenting knowledge, it is very hard for new ideas to cut through. At the same time, grandmothers represent an untapped resource when it comes to engagement around new parenting programmes and practices.

A two-generational approach to ECD programming is required, targeting parents and grandparents specifically, to ensure new practices and ideas take root.

6) Survivalist mentalities lead to short-termism, where immediate needs take priority over forward planning.

For lower income families, a subsistence lifestyle is commonplace, often characterised by informal work patterns, instability and ongoing struggles to make ends meet. This impacts on parenting decisions, in that all expenses are a challenge, and children greatly add to the pressure on parents. Because subsistence is a challenge and environments are precarious, people frequently adopt a survivalist mindset, prioritising short-term progress and physical needs over future plans and emotional needs.

First 1,000 day communications should lead with immediate-term health and strength benefits, rather than narratives around long-term brain development.

The ECD community should consider moving away from narratives around long-term cognitive development, and think about ways to motivate parents and caregivers around more immediate changes in the lives of their children. It is possible to celebrate short-term development markers as a way to safeguard longer term progress.

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IMPLICATION

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Executive summary CORE INSIGHT

Introduction Executive summary

CAREGIVING

DESCRIPTION

IMPLICATION

7) A ‘vulnerability gap’ exists from 600–1000 days, where children receive less attention, and often suffer as a result.

Owing to a range of factors, once young children are physically independent from their mother or primary caregiver and are able to feed and walk without her, their care is shared by a wider group of carers, and their mothers become more relaxed about their care. Often siblings or neighbours play a strong role in caring for young children aged 600-1000 days, and their level of care and attention is perhaps less focused than that of the child’s mother.

There is an opportunity to help mothers and communities more broadly to understand just how important 600-1000 days are in their child’s life, and how much value they can bring to their child’s development at this time.

Children aged 1.5 to 3 years are uniquely vulnerable, and communications and programming should recognise their needs.

8) The culture of play is widespread and celebrated, but it’s not a mother’s role to actively play with her toddler when there are siblings around.

Children play as much and as often as possible in Kenya, as they do everywhere. Parents understand the role of play in practical and physical terms: to help children grow strong, teach them how to bond with others, make them happy and occupy time. Siblings are often on hand to play with the youngest children, and this is regarded as very much their role in the household. By contrast, it is not expected that an adult, particularly a mother, would actively play with their children; parents’ role is to direct, to adjudicate, and maintain the peace.

ECD communications and programming should build on natural opportunities for play, involving siblings and other children, rather than focusing solely on parents.

If siblings are primarily responsible for playing with young children, should we be thinking differently about how we teach about play-led learning? It would be more constructive to work with culture, and make play-led learning part of natural moments of play.

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Executive summary CORE INSIGHT

9) A lack of daycare facilities means many parents are forced to rely on untrained and overstretched informal providers.

STATE SUPPORT

DESCRIPTION

IMPLICATION

In the communities we visited there were no public daycare facilities, and rural Ganze had very little private provision run by trained ECD professionals in dedicated environments.

Overwhelmingly, parents rely on family members or neighbours to look after their 0–3 year olds when they have to work or move away from the household. In urban Kibarani, neighbours were very frequently paid to mind their neighbours’ children, in a form of informal daycare that has no particular structure or focus beyond keeping the child clean, fed and safe.

Kenyan ECD policy makers, donors and practitioners must provide better daycare for 0–3 year olds as a matter of urgency, and make their developmental needs a priority within existing formal and informal setups.

Providing more structured daycare to the multitude of young children who are left with others every day would be a great way to embed ECD frameworks and Nurturing Care into the lives of 0–3 year olds.

10) Community Health Volunteers are a very variable resource, and are probably over-relied upon by donors and governments.

Introduction Executive summary

The presence, commitment, knowledge and quality of Community Health Volunteers varies enormously, even on a very local level. We met some mothers who had powerful bonds with their CHV, and others who had never even heard that CHVs existed. We also met CHVs who were passionately committed to doing great work, and others who had attended zero training sessions during their tenure.

While some great initiatives have sought to capitalise on the Community Health Volunteer network, in reality this resource is probably over-prioritised as an effective solution to reaching parents, and there is a growing sense that CHVs are over-burdened with initiatives and schemes

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Any ECD initiatives aiming to work with CHVs must carefully recruit these volunteers, to ensure they’re respected by their community, trained, paid and have capacity before investing in them for ECD programming.

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Introduction Executive summary

A collaborative journey JOURNEY_ANCHOR

PHASE 1 Consultation + Research Design

PHASE 2 Fieldwork + Synthesis

PHASE 3 Research Validation + Communication

1

4

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35 x interviews with local and global policy makers, practitioners, donors and academics.

In-depth place-based ethnographic fieldwork with families and communities.

Steering committee workshop and film screenings in Mombasa and Kilifi for local communities.

Consultations with ECD experts

2

Consolidation of research questions

Research questions constructed, clustered and prioritised in consultation with ECD experts.

3

Formation of steering committee

Project steering committee assembled from ECD community, signing-off on all research design elements.

One month ethnographic fieldwork and filming in Mombasa and Kilifi

5

Synthesis of ethnographic insights and quantitative survey design

6

Quantitative research with 1,000 households in Mombasa and Kilifi

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Return to steering committee and local communities in Kenya

8

Communication and dissemination strategy

Development of dissemination strategy in consultation with steering committee and ECD experts.

9

Publication of final report and film

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Introduction Executive summary

Overview of participant engagement PART-ENG_ANCHOR

c. 1,170 35

Local Stakeholders + Experts

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Parent / Caregiver Interviews

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Different Family Ethnographies

participants in the process

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Parents/ Stakeholders Mapping Workshops

Local Stakeholders

15

10

Steering Committee Workshop Attendees

4

ECCE Provider Visits

1000

Households in Quant Survey

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Introduction Executive summary

The Steering Committee COMMITTEE_ ANCHOR

Teresa Mwoma Kenyatta University, Chair for ECD Network for Kenya

Rupert Corbishley Aga Khan Foundation, Regional Education & ECD Advisor

Dr Kofi Marfo Aga Khan University, Professor & Foundation Director (Retired)

Najma Rashid Ex-Madrasa Early Childhood Programme, Regional Director

We formed this committee of influential ECD academics, donors and practitioners at the beginning of the project, to ensure that our research design, implementation and analysis were both culturally appropriate and would ultimately be of most use to the Early Childhood community. All members of the committee are either based in Coastal Kenya or Mombasa, or have significant experience working in the region.

Amina Mwitu Aga Khan Foundation Madrasa Programme Director

They supported the project on a voluntary basis and were consulted with throughout the process, from surfacing research questions, to feeding back on research design; from consulting on initial analysis to reviewing final outputs.

Janet Mwitiki Senior ECD Advisor, Kidogo Early Years

Their involvement culminated in a one day workshop in Kenya, during which we viewed the documentary film, discussed the full research findings and built on implications – all of which has been reflected in this final report.

We would like to take this opportunity to thank our steering committee again for their invaluable input and support at all times.

Arif Neky UN Strategic Partnership Platform, Senior Advisor

Rob Hughes CIFF, Senior Fellow, ECD

Atrash Ali Aga Khan Foundation, Coast Area Manager 16

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Introduction Principles

Principles behind our approach PRINCIPLES_ANCHOR

Rich insights through relationship-building.

Extended engagement with the community through multiple family visits.

Place-based immersion.

360 degree deep-dive into the landscape, researching parents + caregivers, practitioners, experts, stakeholders + policy-makers.

Test and refine.

Allow space for iteration as new insights develop and include decision gates after each phase.

Bring stakeholders on the journey.

To create maximum impact, stakeholder trust and engagement from the off-set is crucial.

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Emphasis on actionable outputs.

Developing tools and thinking that are accessible and useful to the ECD community, creating stimulus for change.

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GEOSOCIO_ANCHOR

Setting the scene: geographical & socio-cultural context

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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Kibarani, Mombasa An informal urban settlement clustered between a goods railway line, a highway and a rubbish dump.

Residents are predominantly Mijikenda tribespeople who have migrated to Mombasa from rural areas in search of employment and opportunity.

Many Kibarani settlers came to the area to help build the Makupa causeway that connects Mombasa Island to the mainland and the Nairobi highway.

As an informal settlement, there are no formal government services in Kibarani, but a private economy exists for healthcare and education.

Kibarani suffers from high crime rates and has serious social challenges with substance abuse, domestic and sexual violence, sanitation and unemployment.

Despite its hyper-urban location, Kibarani sits partly on the coastal floodplain, and its rich soils support some farming.

It is a place of high contrast: banana plantations surrounding open sewers, devout Muslims living beside pig sties, churches next door to drinking dens.

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Introduction Setting the scene: geographical & socio-cultural context

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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Introduction Setting the scene: geographical & socio-cultural context

Ganze District, Kilifi A rural district in south Kilifi County.

Residents are predominantly Giriama tribespeople, one of the largest groups of the Mijikenda, although intermarriage with people from elsewhere in Kenya is common.

Employment opportunities in Ganze are sparse, beyond small businesses, country government and public sector jobs (teaching, healthcare).

Many Ganze residents are subsistence farmers who supplement their farming with informal employment.

The infrastructure in Ganze is poor, with pothole-strewn dust roads and the majority of households exist without improved sanitation.

Ganze is a widely distributed area, with many of our research participants living a long way from the country centre, and many being far from convenient transport.

Social norms in Ganze are highly conservative, with heavy gender inequality and strong moral codes.

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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Subsistence lifestyles and survivalist mentalities • For lower income families a subsistence lifestyle is commonplace,

often characterised by informal work patterns, instability and ongoing struggles to make ends meet.

• This impacts on parenting decisions, in that all expenses are

a challenge, and children greatly add to the pressure on parents.

• Because subsistence is a challenge and environments are precarious,

people frequently adopt a survivalist mindset, prioritising short-term progress and physical needs over future plans and emotional needs.

• Getting through the everyday, and keeping the family alive,

takes priority over all else.

• This survivalist mindset and corresponding behaviour can be

explained by the developmental niche theoretical framework, developed by Charles Super and Sara Harkness. When death is a high likelihood then survivalism becomes the number one priority and an individual’s brain is wired from the bottom up, impacting the way they make decisions and forward-plan.

The developmental niche: A theoretical framework for analyzing the household production of health, SaraHarkness and Charles M.Super, Social Science & Medicine, Volume 38, Issue 2, January 1994, Pages 217-226 21

Introduction Setting the scene: geographical & socio-cultural context

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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Introduction Setting the scene: geographical & socio-cultural context

Precarious and dangerous environments • Lower income families are frequently operating in precarious

environments.

• In urban informal settlements, safety and sanitation are major

challenges.

– Kibarani is full of safety issues, from live railway lines to open drains, and threatening individuals, from drug addicts to thieves.

– Housing security is also a challenge in Kibarani, as an informal settlement at permanent risk of demolition.

• In many rural communities, land productivity and paid work are

always in question.

• These challenges make forward planning difficult, and embed

a short-termist mindset into parenting.

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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Diverse family structures • Households are constituted in a myriad of ways, with the extended

family structure more fragmented but still present in both urban and rural settings.

• Many families are female-dominant, being extended but suffering

from absent fathers. Absent fathers sometimes felt like the norm rather than an exception.

• A preference for large families, with minimal gap between babies

(particularly in rural settings).

• Raises clear challenges for support and caregiving.

• Diverse family structures mean that a range of people are responsible

for caregiving at any one time.

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Introduction Setting the scene: geographical & socio-cultural context

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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Introduction Setting the scene: geographical & socio-cultural context

Moral tensions and risky practices • Strong moral codes make it difficult to talk about sex and sexual health.

• At the same time, contraception is often stigmatised and rejected,

notably by men.

• Traditional practises such as wedding dances have become sexualised

and substance-fuelled, becoming a strong driver of underage pregnancy.

• For young women with little income, the allure of sugar daddies

(often assumed to be boda boda – motorbike taxi drivers) can become too great, and this again is a strong contributor to the teen mother phenomenon.

• Because sexual health is near-taboo, and contraception is stigmatised,

it can be very hard for young women to take the precautions that could protect them from becoming mothers too soon.

“The men refuse to wear a condom.

They tell you ‘meat should be on meat’” Eunice, 21, Ganze 24

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Early childhood insights & implications CH_I+I_ANCHOR

CAREGIVERS

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CH 1_ANCHOR

The central role of mothers in early childhood development

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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The central role of mothers: introduction

Early childhood insights & implications CAREGIVERS | The central role of mothers in early childhood development

TOPINSIGHT_01_ANCHOR

When we began exploring parenting and ECD in coastal Kenya, we started with from an assumption that our focal lens ought to remain from the child’s perspective – given the focus of the sector and the direction of literature and programming in the space.

We developed some focal research questions in order to understand this further: • What

support networks currently exist to help parents, and particularly mothers and female caregivers?

However as we explored the subject further, we became increasingly aware of an omission in the discourse of ECD, around the support that mothers need in order to be able to provide the best for children in the first 1,000 days.

• To

what extent do existing gender norms support women in their role as primary caregivers?

• What

are the cultural meanings and associations with motherhood?

From that insight, we became very interested in understanding more about the material, physical and emotional support that mothers need in order to be their best. We also wanted to better understand the challenges that mothers face every day in caring for their 0–3 year olds, both from a practical and emotional perspective.

• How

do women feel about becoming mothers, and the role that they play?

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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To understand early childhood development we must start with mothers and caregivers Through our conversations with ECD experts and practitioners we heard a great deal about outcomes from children, and what they need. We heard far less about what mothers and caregivers need in order to thrive and provide for their children.

Through our fieldwork we learned that mothering/caregiving in Coastal Kenya is fraught with challenges that significantly impact the ability of parents to deliver quality caregiving for 0–3 year olds.

In order to improve outcomes for young children it will be important to improve parenting practices. To improve parenting practices we must first try to understand what it’s like to be a mother or primary caregiver in coastal Kenya.

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Early childhood insights & implications CAREGIVERS | The central role of mothers in early childhood development

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Mercy and Rosie 25 years / 9 months old Ganze Mercy is a working mother, living in Ganze with her husband. She relies heavily on the support of her mother and mother-in-law for childcare, however she is also able to take her daughter to work with her when this isn’t possible.

She runs her own Safaricom kiosk, and leaves Rosie with her mother during the early hours while she opens up the shop. Her daughter is then brought to her for breastfeeding, and will stay in the kiosk, playing with her mother and napping while Mercy works.

Rosie’s father is very engaged in her upbringing, and will play with and bathe her most mornings. His brother (Rosie’s uncle) takes great pride in his niece and will regularly take her for afternoon strolls round the town, while Mercy works.

Mercy’s family support system is crucial in helping her to maintain a strong bond with her daughter and good personal, mental health as she juggles full-time work and full-time motherhood.

Supported Mother/Caregiver Raising child in an emotionally and practically supportive environment. This may or may not include the child’s father.

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Early childhood insights & implications CAREGIVERS | The central role of mothers in early childhood development

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Early childhood insights & implications CAREGIVERS | The central role of mothers in early childhood development

Being a mother has clear social value, and brings a lot of joy to women • Many mothers told us about the social privileges they enjoyed

as a ‘mama’ rather than just a girl:

–­­ Getting a seat on the matatu (minibus).

– Being seen quickly by doctors.

– Being treated with respect by the community.

– Children are considered a blessing in the communities we worked in.

• For many poor girls, becoming a mother represents a social

graduation into a new social role, and takes them out of childhood towards a position of greater respect and social currency.

• Despite these social privileges, many young mothers face

extraordinary struggles and experience deep regret about motherhood, as we discuss in more detail in ‘Addressing the teen mother phenomenon’ from page 37 onwards.

“I’m so happy because I feel like I have grown as a person.”

Rehema, 17, Ganze

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Because ‘children are a blessing’ it is hard for mothers to talk about their own challenges • The overarching belief that ‘children are a blessing’ makes

it very hard for mothers to feel they have the space to talk about their problems.

• The ‘blessing’ of children makes their problems fade into

insignificance.

• In some respects an ECD narrative centred on outcomes

for children perpetuates this lack of focus on the mother and her personal journey.

“There is no one I talk to about being a mother apart from my mother or grandmother.

There is no one else I confide in about my child or about hardships we face” Mariam, 25, Kibarani

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Early childhood insights & implications CAREGIVERS | The central role of mothers in early childhood development

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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Early childhood insights & implications CAREGIVERS | The central role of mothers in early childhood development

No awareness of, or emotional support for postnatal depression • Coastal Kenya has an emotionally conservative, stoical culture.

• Social norms dictate that emotional problems are dealt with in private,

and mental health is a binary topic – people are sane or insane, and nothing exists in-between.

• Postnatal depression was challenging to explore through fieldwork,

as it is not a medical condition that is recognised and was seen through this binary lens: A. Either a new mother is ‘sad’ for logical reasons, such as lack of food, lack of a present father, loss of her figure B. Or a new mother is ‘possessed’ and ‘crazy’ due to evil spirits – superstitious and religious beliefs were prevalent

• In the former case, mothers are simply told to “…focus on the child and

move on, as babies are a blessing.”

• Consequently, there is no upside to mothers in discussing their mental

state; she is either trivialised and not supported, or stigmatised.

* It is important to caveat that we did not assess the existence or awareness of PND as clinical professionals. Rather, we discussed the topics of emotional stress, anxiety and depression with the mothers, health care visitors and clinicians that we interviewed.

• Mothers therefore tend to internalise any psychological issues, potentially

impacting their capacity to bond with and support young children and in severe cases, resulting in abandonment.

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Anzazi and Rai 28 years / 18 months old Kibarani Anzazi is a single mother living in Kibarani, mother to Amina, aged 11, Fatuma age 9 and baby Rai. Although Anzazi is in contact with her children’s father, he is not present, and has never met his youngest son.

Anzazi relies on her daughters to help with housework and look after Rai when she tries to find casual work. She does not trust her neighbours or others in Kibarani to look after her baby, so she avoids the informal daycares that are so common in the neighbourhood.

She struggles daily to provide for her family, and often has to leave the children for long periods to seek work around Mombasa. The father of her children provides almost nothing, and Anzazi doesn’t feel able to put pressure on him.

Anzazi has no close friends or family to turn to for emotional or practical support. She is worryingly isolated.

She is representative of a great many mothers we met, who felt alone and unsupported.

Isolated Mother/Caregiver Raising child without emotional or practical support.

Family members may be present, but not providing the support she needs to be a fully engaged and present parent.

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Early childhood insights & implications CAREGIVERS | The central role of mothers in early childhood development

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A clear lack of supportive and sharing behaviours between mothers and caregivers

Early childhood insights & implications CAREGIVERS | The central role of mothers in early childhood development 30% of Ganze mothers said

they had no one to turn to for advice. This was less significant in Kibarani: 16%.

Doctors and nurses were the most popular source of advice for mothers: 42% Ganze / 50% Kibarani.

• We did not uncover a culture of sharing and support between

Followed by caregivers’ own mothers: 41% Ganze / 29% Kibarani.

mothers, beyond immediate practical help between close friends and neighbours: – ­Informal childcare, occasional domestic help and ‘soft loans’.

• None of our research participants talked about sharing advice

with their neighbours and friends, and many claimed to have nobody to talk to about their role as mothers.

• The stoical culture of endurance and silence drives friends

to counsel one another to persevere and work hard despite any challenges.

“When you give birth here, there’s no one to give you advice.

You just depend on yourself.”

Eunice, 21, Ganze 34

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Early childhood insights & implications CAREGIVERS | The central role of mothers in early childhood development

Considerations when designing for mothers of 0–3yr olds

Give mothers the space and permission to discuss their challenges

Encourage a peer network for mothers to share & innovate, together

Encourage an open and honest dialogue amongst mothers of 0–3yr olds, acknowledging socially their practical and emotional difficulties against the stifling narrative that ‘all babies are a blessing’.

For example:

Create opportunities for mothers of 0–3yr olds to come together to discuss challenges, share advice and discover new information and approaches to parenting.

For example:

– Edutainment or radio call-ins featuring mothers with personal challenges and suggested support.

– Antenatal groups for expectant mothers, to learn about labour and parenting and share experiences of pregnancy.

– Group peer sessions for mothers of 0–3yr olds, at places they already congregate – e.g. at churches, mosques, markets, clinics.

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Early childhood insights & implications CAREGIVERS | The central role of mothers in early childhood development

Considerations when designing for mothers of 0–3yr olds

Raise awareness of postnatal depression and equip people to support mothers

Build on the existing social currency around being a ‘mama’, to encourage greater support for mothers

Educating society (particularly health workers and community For example: health volunteers) on the seriousness of PND, the symptoms – Educate Health Workers and Community Health Volunteers, and support a mother needs to best support herself and to see this as a serious medical condition – knowing what her baby. to look out for and how to support mothers.

– Start a public conversation around postnatal depression through media – popular radio characters experiencing the condition, famous women coming out and sharing their experiences etc.

There is an interesting tension between the respect that a mother receives from society and the lack of support she receives in caring for her child. Is there an opportunity to build on this respect and open society’s/fathers’ eyes to the support they should be offering her, beyond the small gestures such as a seat on the bus?

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Addressing the teen mother phenomenon

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The teen mum phenomenon: introduction

Early childhood insights & implications CAREGIVERS | Addressing the teen mother phenomenon

TOPINSIGHT_03_ANCHOR

Prior to our fieldwork, none of our conversations with experts and stakeholders highlighted the young average age of mothers in coastal Kenya, nor the presence and associated challenges of large numbers of teen mothers in the region. As a result, they were not initially prioritised as a unique group to focus on.

We considered a number of research questions in order to explore this phenomenon further: • What

does parenting look like amongst young mothers?

• How

do families and communities respond to and incorporate teen mothers?

During our ethnographic work however, we quickly began to understand the prevalence of teen mothers in coastal Kenya, and to hear a little of the cultural narrative around this phenomenon.

As a result we adapted our fieldwork to examine this issue in more depth and altered our fieldwork sample to specifically incorporate this specific group of mothers.

• What

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support exists for this particular group of women?

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Lucy and Joanne 16 years / 18 months old Kibarani Lucy was 15 years old when she fell pregnant with Joanne.

She lives with her husband and his mother, and feels well supported by them both despite having a child at a relatively young age.

Lucy felt that when she became pregnant she was not equipped or ready for the child, although she was excited to be known as ‘Mama’. She receives a great deal of emotional and practical support from her husband, who really cares for his daughter. Whilst juggling work and motherhood is often challenging, it is the support of her family that enables her to maintain a close and nurturing relationship with Joanne while earning money and looking after the home.

She wishes there was more daycare available for lower income mothers in Kibarani, but to Lucy it feels more like a daydream than a reality.

Supported Teen Mum Raising child in an emotionally and practically supportive environment. This may or may not include the child’s father.

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Early childhood insights & implications CAREGIVERS | Addressing the teen mother phenomenon

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Early childhood insights & implications CAREGIVERS | Addressing the teen mother phenomenon

Many teen mums feel lost, without a sense of identity or role models • For many teen mothers, there’s a tension between the positive

ideal and aspiration of becoming a ‘mama’ (gaining respect in the community, having something of your own) and the harsh reality.

“We don’t have the right mind yet to be a mum. I see what other children are doing and I want to join in.”

• For many teen mums who became pregnant unintentionally,

motherhood represents a loss:

Lucy, 17, Kibarani

– Of independence – Of youthful bodies – Of the potential for education – Of a potential future career • Often, teen mums feel unready and ill-equipped for the task ahead

of them.

• Once their child is born, the social identity of being a ‘mama’ feels

far from their current identity as a ‘teenager’ and one that they often do not want to accept / actively reject.

• This combination of unpreparedness, unhappiness and lack of

personal identity makes these reluctant teen mums a particularly vulnerable group.

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Evelyn and Samuel 16 years / 1 year Ganze Evelyn lives in Ganze with her one year old baby, her parents and seven siblings. Her mother gave birth one week after her, so they are raising their young children together.

Evelyn used to have a close relationship with both her mother and grandmother, but once she fell pregnant these relationships suffered. Influenced by the social stigma around underage pregnancy, her parents and teacher tried to force the father of her baby to stay with her (against both his and Evelyn’s wishes) and although she still lives in the family home, she feels rejected by those closest to her, and a stranger in her own home.

She no longer attends school, with no obvious path back into eduction and does not currently have any employment.

From observation, Evelyn was suffering from low moods and was struggling on an emotional level. For the numerous girls in this position, this is likely to have an impact on both their mental state and ability to connect with their child.

Isolated Teen Mum Raising child without emotional or practical support.

Family members or father may be present, but not offering the support she needs as a stigmatised young mother.

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Early childhood insights & implications CAREGIVERS | Addressing the teen mother phenomenon

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Early childhood insights & implications CAREGIVERS | Addressing the teen mother phenomenon

Growing social concern around the phenomenon of teen mothers • There is a strong cultural narrative around the prevalence of teen

mothers that paints them as a social problem.

• Kilifi County Govt statistics from 2017 state that 22% of 15–19 year

old women are pregnant or mothers – the third highest rate in Kenya.

• Boda boda (motorbike taxi) drivers are frequently blamed as a cause

of underage pregnancies.

• Disco Matangas – funeral celebrations that often involve heavy

drinking, substance abuse and sexualised atmospheres – are also seen as a strong contributing factor.

• Kilifi County Govt has taken steps to ban disco matangas

and discourage young people from attending late night parties, impregnating under 18 year old girls has been criminalised, and local chiefs force girls to name the fathers of their babies.

• Increasingly seen as a problem, teen mothers can be ostracised

by their families (although remaining within it) and the community.

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Early childhood insights & implications CAREGIVERS | Addressing the teen mother phenomenon

Ideas to consider when targeting teen mothers of 0–3yr olds Consider teen mothers as a unique and vulnerable group when designing programmes for 0–3yr olds

Create attainable role models for teen mothers

Focus on solutions for teen mothers rather than treating them as a scourge

Many have been thrown into motherhood without any desire to become a parent. As a result they sometimes resent the baby and are unable to connect with them on an emotional level, which is crucial for responsive care. In addition, some girls are so young that they have no idea how to care for a

baby and lack the support from parents, given their disappointment in their daughter becoming pregnant.

It is therefore crucial that teen mothers are considered as a specific audience, separate to mothers in general, given the additional emotional and practical support they often require.

Teen mothers often lack a sense of identity, feeling stigmatised by the community and unwilling to take on the identity of a ‘mama’. There is an opportunity to create attainable, inspiring role models for these young women – teenagers who have had children early, but managed to succeed both as mothers and in other areas of life. Kanze Dena was the only role model mentioned by teens and given she is now c.40years, there is definitely room for younger options.

For example:

While the Kenyan government and communities are doing much to try to prevent young girls from becoming pregnant, there appears to be very little being done to formally support teens who have already become pregnant or had their babies. Given that at least 22% of mothers in Kilifi are teenagers, this is too large a proportion of vulnerable mothers and children to ignore. Programmes need to be designed to connect with and support teen mothers on their level, empowering them with the information and confidence

to successfully raise their 0–3yr olds, and integrating them into society.

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– Celebrate local teen mother ‘heroes’ in the District who have, for example, made it through school, are successfully working and parenting, achieved in areas of life.

– Create fictional teen mother role models to be communicated through media, edutainment programmes etc.

For example: – Create teen mother support groups that are designed on their level – that are fun and playful, whilst imparting important information and emotional support

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Engaging fathers in early childhood

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Engaging fathers: introduction

Early childhood insights & implications CAREGIVERS | Engaging fathers in early childhood

TOPINSIGHT_04_ANCHOR

A set of research questions emerged around gender roles:

Our stakeholder interviews revealed a strong appetite to understand the varied roles that fathers play in early childhood.

We knew that gender norms would restrict fathers’ involvement to some extent, but we were unclear how these norms would play out in the field.

• To

what extent do fathers and men support mothers?

• To

what extent are fathers involved in responsive care for 0–3 year olds?

We heard from stakeholders that rural areas would be very traditional and maintain quite regressive gender norms. We also heard that there were bright spots of change, particularly with more educated fathers.

• What

different types of fathering would we see in the field?

• To

what extent is the role of fathers changing, and where is this occurring?

We heard that progressive shifts were occurring, but more in terms of material provision and less from the perspective of nurturing care.

Little was commonly known about changing gender norms and fatherhood, and there was a lot of appetite to find out more.

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• What

signs of change did we witness in the field?

• What

does modern fatherhood look like in coastal Kenya?

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Ishmael and Sophie 28 years / 11 months old Kibarani Ishamael is a car mechanic who works hard to support his young family, with two young girls: Sophie and Mariam who is 7yrs old. His wife is a full-time mother and they enjoy a close supportive relationship.

Mariam is at school in Nairobi and living with her grandmother. Ishmael speaks to her every other day on the phone, and sends money for her school fees and living expenses.

Every evening after work, Ishmael spends a good hour with Sophie, walking around the neighbourhood, doing chores and fetching groceries.

He is unhappy with the living conditions, safety and school provisions in Kibarani, which is why he works and saves to afford Mariam’s schooling in Nairobi. Ishmael thinks that young fathers today have forgotten their responsibilities to their families, and he is determined to provide a different model for his wife and children.

Modern Father Engaged and progressive father who is involved in all elements of childrearing and is happy to share this responsibility with his wife.

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Early childhood insights & implications CAREGIVERS | Engaging fathers in early childhood

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Early childhood insights & implications CAREGIVERS | Engaging fathers in early childhood

Joseph and Isaac 47 years / 18 months old Ganze Joseph is the father of nine children (five boys and six girls) and is very much the head of his household. Joseph formerly worked in the tourist industry in Malindi, but is now based in Ganze and has no formal employment.

He is a fairly traditional father for the area, in that he maintains his role as head of the house and central to decision-making, but does not think any other tasks at home are his responsibility.

Owing to a lack of funds, Joseph’s younger children are unable to attend school, and it is unlikely that any will graduate to secondary school without external support.

Joseph relies on his older, working children to send money to support the family, and expects his wife to seek casual work alongside raising the six children who remain at home.

Joseph does not interact much with his children. He doesn’t consider playing with them or teaching them.

Traditional Father Believes childrearing is entirely the responsibility of mother. As head of the household he is the key decision-maker, but rarely the financial provider.

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Early childhood insights & implications CAREGIVERS | Engaging fathers in early childhood

Traditional gender norms are firmly entrenched, especially in rural areas • Rural communities conform to traditional gender norms, where

men are not expected to contribute to domestic tasks, or raising young children.

• Many of the mothers and primary caregivers we met in rural

communities were responsible for housework, farming, income generation and child rearing - supported by their children and sometimes siblings.

• Accompanying these norms are some pernicious negative idioms

that in themselves restrict men’s freedom and willingness to help at home.

‘Around here, they say if a man does housework that the women has taken a husband .’

57% of caregivers in Ganze (rural) said their absent

Rehema, 17, Ganze

husband didn’t believe that caring for 0–3 year olds was his role.

This is compared to 31% in Kibarani (urban).

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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Early childhood insights & implications CAREGIVERS | Engaging fathers in early childhood

Urban fathers are beginning to demonstrate more progressive attitudes at home • Some fathers recognise the role they ought to play in supporting

their wives, particularly around the late stages of pregnancy and early months as a new mother, but this does not necessarily translate into action.

• Urban fathers are more likely to demonstrate awareness of their

responsibilities to their wife and children:

– Providing finance, food and medicine – Encouraging their children at school – Playing an active role in their young children’s lives • Strong social norms around domestic work still inhibit even the

more progressive fathers from practically supporting their wives in the house, and the burdens of women in these households still remain substantial.

80% of Kibarani fathers living

at home take part in childcare (playing games, soothing, talking to the child) a few times a week or more often.

51% of Ganze fathers do this regularly.

38% of Ganze fathers rarely or never take part in these childcare activities.

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Intimate, nurturing care is evident amongst some fathers, though seen through a masculine lens • Those fathers who were interested in the care and development

of their young children saw their role as distinct and ‘manly’:

– Playing with babies in the morning – Making them laugh – Providing treats – Walking with child around the neighbourhood – Skin-to-skin contact and soothing — “so it knows I’m the father” • The domestic sphere remained firmly women’s domain for these

fathers, and their role was characterised as one of protector and leader.

‘I am the head of the house and my wife is my assistant. Every day I spend time with my daughter, forging a relationship and making sure she’s happy.’

Ishmael, 37, Kibarani 50

Early childhood insights & implications CAREGIVERS | Engaging fathers in early childhood

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Early childhood insights & implications CAREGIVERS | Engaging fathers in early childhood

Absent fathers are more common in rural areas, but ‘more absent’ in urban locations • 39% of households in Ganze and 24% of households in Kibarani had

absent fathers.

• In Ganze, absent fathers often continue to play a significant role in

their children’s lives;

– 59 % of them continue to play a role in their 0–3 year olds’ lives.

– 54% pay half or more of the costs associated with their 0–3 year old.

• By contrast, in Kibarani, absent fathers tend to remain absent from

the family.

– Only 17% play a role in their 0–3 year olds’ lives.

– 80% pay nothing towards the costs of their 0–3 year old.

• Single mothers in urban areas have far less material and practical

support from fathers, and as a result have a greater need to seek support elsewhere – or to fend for themselves.

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Teen fathers do not attract the social attention of teen mothers • The archetypal story of a teen pregnancy involves a young boda

boda (motorbike taxi) driver as the father.

• We heard more stories of young fathers than we did about sugar

daddies impregnating younger women, but the sense of taboo rests firmly at the woman’s behaviour and not the young man’s.

• The perceived social problem of teen mothers doesn’t extend

to a perceived problem with teen fathers.

• That said, recently the taboo around teen pregnancies has led

to forced marriages, where young men and women are married by their villages due to pregnancy, and not owing to a love match.

• We did not hear about any programmes or provision made for teen

fathers, and it is important that any parenting or family initiatives work to accommodate the specific needs and challenges that this group faces.

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Early childhood insights & implications CAREGIVERS | Engaging fathers in early childhood

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Early childhood insights & implications CAREGIVERS | Engaging fathers in early childhood

Initiatives to encourage greater paternal engagement are proving successful, but lack funding • Local health services have started to experiment with initiatives

to bring fathers into the process of maternity and baby care.

• These programmes have seen promising results (on an anecdotal

level) but they lack funding and more central support, and so perish.

• Grassroots innovation at community hospital level could hold

the key to cost-effective and culturally relevant ways to engage fathers further.

• Programmes like SMS Father are trying to connect fathers who work

away with their children through the sound of their voices and mobile technology.

‘We try to encourage husbands to come to antenatal appointments with the mother by prioritising their appointments in the queue, and we have male champions who tell other men about the benefits of going to such appointments with their wife.’

Chief Nursing Officer, Ganze

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Early childhood insights & implications CAREGIVERS | Engaging fathers in early childhood

Ideas to consider when engaging fathers in parenting For example:

Create attainable role models for fathers

Identify and celebrate ‘modern’ fathers in the community who – Create Father Volunteers who speak to other fathers in the provide financially, practically and emotionally for their young community about their role and the support they give to their children – demonstrating that ‘provision’ goes beyond the young children. material.

– Celebrate ‘modern fathers’ in community meetings and the role they play in the family For example:

Challenge deeply engrained norms of masculinity by working with them

Redefine aspects of positive masculinity by drawing on elements of traditional masculinity to amplify a sense of care and responsibility, playing with different notions of strength.

– Tap into men’s sense of pride and ‘ownership’ to encourage father-baby interaction: explain the importance of carrying a baby from the early days and skin-to-skin interaction, to ensure the baby knows who its father is.

– Build on the protective role of fathers as a way to help protect a child’s emotional wellbeing.

– Emphasise fathers’ sense of paternal care to encourage soothing and close contact.

Find ways to connect to long distance fathers

Identify and design ways to connect absent fathers with their children using mobile technology, like SMS Father tries to.

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– Find physical and virtual ways to bring families together more frequently.

– Investigate remittance technology other mobile services as ways to bridge geographical divides.

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Learning to parent and opportunities for innovation

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Early childhood insights & implications CAREGIVING | Learning to parent and opportunities for innovation

Learning to parent: introduction Our research questions included:

As a team from the global north working with Kenyan partners, we came to this project being highly aware of the social pressures around being a parent, and the extent to which social norms in industrialised countries can reify motherhood, and elevate it from the everyday. Associated with this special focus in the global north comes an entire body of popular literature, social organisation and material culture that further highlights early parenthood as something notable and different to the norm.

• What

information are parents being given, by whom, and at what stages?

• What

interest is there from parents in learning and changing their parenting practices?

• Where

The ECD community is also understandably focused on the act of parenting, and isolating it as a specific practice and life-stage, with associated bodies of knowledge and practice.

and how are mothers learning how to parent?

• To

what extent does the state provide new information to mothers, and how much do parents absorb this information?

As a consequence of our cultural background and the focus of the ECD community, we were keen to understand whether parenting and motherhood in coastal Kenya is as distinguished as it is in the global north, and we were interested to explore more about how parenting was culturally constructed and understood.

• What

does it mean to be a good mother?

What are women aspiring towards?

• What

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role models exist for motherhood in culture?

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Lois and George 42 years / 2,5 years Ganze Lois raises her four children and grandson. Her daughter, George’s mother, has learning difficulties and fell pregnant when she was 15 years old whilst attending a special school in the area. She is now a house-help in Mombasa and visits her son when she has the funds.

Lois has a traditional family set-up. She was taught how to care for her children and husband by her own grandmother and her husband does very little, beyond occasionally providing for them financially. Lois is responsible for all the house work, raising the children and for finding the money for their clothes and school fees.

Her children and grandson do not have a close relationship with her husband. He will check their report cards and tell them to study harder, but beyond this, he is not engaged in them or their upbringing. Lois would love more emotional and practical support, but knows that this will never come from her husband.

George has been attending a local ECD Centre for children aged 3yrs plus for the past year. Lois knows he is too young and does not enjoy it, but she has no alternative. She wishes there were more options available for her grandson.

Relative as primary caregiver Many young children are raised by grandparents or close relatives, due to economic migration and parental mortality.

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Early childhood insights & implications CAREGIVING | Learning to parent and opportunities for innovation

Apart from breastfeeding, parenting responsibilities are shared in the homestead

mother / caregiver – Breastfeeding / feeding – Bathing – Changing diapers / when clothes are soiled – Washing clothes – Providing money for food + childcare – Discipline

Ganze mums enjoy more support than Kibarani mums.

92% 95% grandparents

father

– Daytime childcare – Feeding porridge / ugali – Storytelling – Discipline – Storytelling

– Providing money for food + school fees – Discipline

28% 9%

12% 3%

A4b. Thinking about the people in your household, who helps you look after your 0–3-year-old?

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0–3 year old

46% 50%

40% 21%

key:

% Ganze % Kibarani

mother’s siblings

other children

– Anything and everything (surrogate mum role)

– Daytime childcare – Walking child around – Feeding porridge / ugali – Changing diapers / soiled clothes – Washing clothes – Collecting water – Playing – Teaching basic literacy + numeracy

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Early childhood insights & implications CAREGIVING | Learning to parent and opportunities for innovation

Women and girls play the majority role in parenting • A great many households had absent fathers.

• Those fathers that were present showed variable levels

of interest in their children, and performed no household duties.

• Fathers’ interest in their children was particularly absent

in the earliest years.

• The presence of men within the household was far less significant

to its harmony and success than a supportive environment.

“Fathers aren’t really involved at 3years and below… when they’re 4years and older they’re more interesting.”

Eunice, 21, Ganze

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TOPINSIGHT_05_ANCHOR

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Parenting “starts at 7 and ends at 70” • Parenting is very much a shared practice, with children playing

an important role in looking after siblings from an early age.

• As a result, people learn how to parent very young – way before

they reach puberty.

• In this context, the transmission of parenting practices from mother

to daughter is an established norm from the outset.

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Mothers are the greatest influence on daughters in learning to parent

49% of Ganze caregivers and 37%.of Kibarani caregivers would turn to their mother for advice on their 0–3 year old.

Only doctors are considered more important for advice: 55% Ganze / 56% Kibarani.

• The majority of parenting knowledge and practice is learned

from the family, primarily from mother to daughter.

• This process starts at a very early age, with daughters learning

‘wifely duties’ through domestic chores and parenting practices.

• Often mothers will attend as their daughters give birth, and heavily

support the new mothers, particularly in the early weeks and months.

– This connection is stronger in rural areas than in urban migrant families, where families are often more fragmented.

• In the past, grandmothers and elders played a key role in teaching

young women about impending motherhood, but those traditions and connections have been eroded over time.

“I didn’t have any questions because my mother was there to take care of everything.”

Eunice, 21, Ganze 61

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‘Inherited’ childrearing practices are proven but static • Older mothers are both a positive and negative influence

on new mothers.

• Learning about child rearing from older mothers preserves

social norms, and as a result can contribute towards practices remaining static.

• Older mothers are far more likely to reject innovation owing

to conservative mindsets and a lack of education, and this can make their influence a double-edged sword.

• We heard from health professionals that often their biggest barrier

to changing behaviour of new mothers is their own mother.

“They tell them ‘Your baby doesn’t need those expensive vaccinations. We didn’t have them, and we survived just fine.’”

Private clinic nurse, Ganze 62

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Being a good parent is partly judged in material terms • Providing for your child and satisfying their needs is considered

a vital benchmark for being a good parent.

• In the context of subsistence farming and extreme poverty,

everyday material needs are a priority, and more luxurious material items are aspirational.

• Many mothers talked about feeling happiest when their children

were well fed.

• Parents would often love to spend more time playing with their

children, but the more pressing demands of subsistence and shelter must take priority.

“It makes me happy when I can buy him things.

I was happiest when I had just two children and I could buy them what they wanted.”

Lois, 43, Ganze

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Clinics and CHVs provide parenting advice, but this is contingent • Mothers who give birth in clinic receive advice around breastfeeding,

cleanliness, vaccinations and holding new babies.

• CHVs provide similar knowledge, and can act as a continued channel

for support.

• However many poorer mothers give birth at home, with or without

a midwife present, and many new mothers do not have an ongoing relationship with a CHV.

• Further, those who give birth in clinic do not always stick to an

appointment schedule, and it’s easy for non-attendee mums to slip through the net.

• Village chiefs try to manage these relationships and encourage

new mums to interact with health services.

NB. Services and support outside the family are discussed in detail in the section ‘Understanding state support for parents’ (page 102).

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Dying tradition of didactic story telling and cultural transmission from grandparents • Many people described the key role that grandparents played

in teaching children about family life, traditions and morals through story telling.

• In rural areas, where extended families are more common,

this tradition continues to an extent, but it has become more closely tied to particular occasions such as religious holidays and celebrations.

• In Kibarani, where families are smaller and grandparents

are less likely to be present, we heard less about this practice.

• We also heard that many grandparents are too busy these days

to dedicate a lot of their time to this way of teaching.

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Very few role models for mothers from challenging backgrounds • Kanze Dena was the only named role model we heard about

during fieldwork.

• She is the Government Spokeswoman and came from a tough

background in Kwale County.

– A Mijikenda woman from poverty who had a child at a very early age, and persevered despite all odds.

• Other role models tended to be family members who had achieved

a high level of wealth and material success in life.

• There is a huge absence of inspiring, relatable young female

role models to demonstrate that motherhood (particularly early motherhood) need not represent the end of a woman’s individual journey in life.

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Ideas to consider when sharing new information with parents of 0–3yr olds For example:

Consider broad, social-norm shifting programmes to change attitudes around parenting

Given the many people involved in parenting a 0–3yr old, it’s important to involve everyone in the conversation – particularly the baby’s grandmother. Solely targeting the mother or father may be a short-term solution, but is unlikely to drive sustained change at scale.

– Opportunities to target other family members re. parenting (grandmother with mother at clinic, church/mosque or via the Chief, older siblings/aunties at school).

– Community-level conversations around parenting 0–3yr olds for whole families to hear and discuss together.

For example:

Highlight what’s new and what’s changed in parenting practices to challenge engrained norms

Parenting practices are learnt from an extremely early age, given large families and siblings’ role to care for youngsters. It’s therefore important to highlight with mothers and grandmothers, what has changed over the years and why.

– Interacting with and talking to your baby as much as possible, as we now know that this helps them to grow physically and mentally strong (rather than only talking with them once they can talk).

– Learning through play, in the home and out, as we now know this to be the most effective method (rather than rote learning).

For example:

Create inspiring and attainable role models for mothers

Celebrate inspiring, relatable, young mother role models for those in low-income communities, to encourage the take-up of new parenting attitudes and behaviours.

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– Edutainment shows with modern mothers with progressive attitudes towards pregnancy and early childhood.

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Early childhood insights & implications CAREGIVING | Learning to parent and opportunities for innovation

Ideas to consider when sharing new information with parents of 0–3yr olds

Explore ways to maintain Community Health Volunteers’ engagement with mothers

Community Health Volunteers are of variable quality and commitment, with some mothers reporting that they had never been visited by one. What might be done to track their engagement with mothers and encourage them to maintain the relationship?

For example: – Consider ways to integrate CHVs activity more closely with hospitals and clinics, to provide a more joined up service and to keep a track on expecting and new mothers.

– Find ways to use mobile technology for local authorities and NGOs to stay in touch with CHVs and build reporting and tracking tools.

Revive and modernise the tradition of didactic story-telling

Many spoke fondly of the crucial role grandparents used to play in cultural, moral and practical teaching of children.

There is perhaps an opportunity to revive the tradition of didactic storytelling through new media, rather than grandparents.

For example: – Imagine ways to create ‘virtual’ grandparents, uncles and aunt who can provide advice and guidance to children, through edutainment channels.

– Create printed storytelling materials that can act as educational tools for small children and resources for caregivers.

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How parents understand and behave during the first 1,000 days

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Early childhood insights & implications CAREGIVING | How parents understand and behave during the first 1,000 days

Parents understanding of the first 1,000 days: introduction When we began to understand theories and practices within ECD it quickly became clear that the notion of the ‘First 1,000 Days’ has emerged as the topical mode of thinking and analytical lens within the ECD community. At the same time it was clear that this is a fairly new concept, and that organisations and actors are in the early stages of designing and thinking from this viewpoint.

We explored a number of key research questions around this topic: • Where

are children during the First 1,000 Days?

• To

what extent do parents understand child development during the First 1,000 Days, and recognise stages of change within it?

It was clear to us that there was a real need to think about the First 1,000 Days from a qualitative research perspective, to understand how this period in children’s lives is socially and culturally constructed, and to see it from the perspective of families and parenting practices.

• What

are the current parenting practices during this period?

• To

what extent are children learning in the home before pre-primary education, and what do those learning practices look like?

Within the ECD community and literature, the First 1,000 Days is constructed as a coherent period of time in a baby’s development, and we were keen to understand whether this framework made sense with parents’ sense of their child’s growth and needs.

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Early childhood insights & implications CAREGIVING | How parents understand and behave during the first 1,000 days

Most babies stay with mothers or caregivers for the first 12 months – remaining with them at home or at work • On-demand breastfeeding is widespread and the majority of babies

stay with their mothers throughout the day, until they are walking or too heavy to carry continuously.

• For those returning to work within 12 months, many will take

their babies with them, strapped to their backs.

• Those working in more formal roles will not be able to take their child

to the workplace, and rely instead on a relative or neighbour to care for the child in their absence. In this case the baby may be brought to the mother when feeding is needed, or left with cows milk.

62% of Kibarani mums + 42%. of Ganze mums say they will never return to work.

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Urban mothers are far more likely to leave their baby before three months • Of the 45% of mothers who need to return to work, 67% do

so within the first 6 months..

– 52% take their babies with them – 19% leave them with the baby’s grandmother – 14% leave them with siblings or another relative – 8% leave them with a house help – 7% leave them with a neighbour • 11% of mothers in Kibarani will leave their 0–3 month babies

for +5hrs.

• This is compared with only 3% of mothers in Ganze.

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Early childhood insights & implications CAREGIVING | How parents understand and behave during the first 1,000 days

From 12–18 months onwards, mothers and caregivers have a more relaxed approach

14 months is the average age at which parents will leave their child for longer than 5 hours.

18 months is the average age at which

a child will be left with their 8-16yr old sibling.

• Once children are able to walk, they are often left with older siblings,

grandparents or neighbours in the daytime.

• Mothers and primary caregivers’ knowledge of what their toddler

is doing at this time (9am-6pm) was far less detailed in comparison to those under 12 months, with most mentioning solely the basics of ‘playing’, ‘eating’ or ‘sleeping’.

• This is by no means a reflection of them caring less about their

children, but rather an indication that parents feel comfortable taking a step-back once their children are physically independent.

• As we cover later, this is problematic as informal childcare provision

is ad-hoc and of bare minimum standards, meaning many toddlers aged 12/18 months – 3 years are often left in extremely basic, un-stimulating and poorly supervised environments.

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Parents prioritise physical development over cerebral for the first 12 months • The survivalist mindset drives parents to prioritise their baby’s

physical health and strength.

• Development milestones and parenting practices therefore centre

on physical development: encouraging babies to crawl, sit, walk.

• These physical development achievements are not only easy to

recognise, but crucially they indicate to parents that their baby is strong and healthy.

• These milestones also signal that mothers will soon regain the

physical independence necessary for other activities: domestic work, subsistence and income-generation.

• For less physical milestones, eg. talking, sorting and categorising,

parents seem to be far less involved.

“I felt happy and relieved when I saw my baby starting to walk – it showed me that he was developing well.

That he was strong and healthy.”

Mums group, 40years, Ganze 74

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Early childhood insights & implications CAREGIVING | How parents understand and behave during the first 1,000 days

They’re also stimulating babies’ brain development – although unintentionally and speech is not prioritised • We witnessed and heard from parents about many examples

of early child stimulation that trigger cognitive development: – Tickling – Encouraging children to point – Responding to eye contact

• However talking was notably absent in the earliest months, and

only really a feature for children aged 2 years and older, in learning basic words.

• We witnessed many opportunities for parents to talk to young babies

that were not taken, and there seems to be no culture of actively talking to babies before they are actively vocalising themselves.

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Parents are teaching their babies intuitively – they just don’t see it as ‘learning’ • Parents found it easy to talk about physical development milestones

and the help they provide their children to reach them, but did not consider these changes part of ‘learning’.

• Many parents also described the way their children mimic

their behaviour from an early age, as a way to become involved in domestic work.

• In parents’ eyes, early learning starts with the basic language,

literacy and numeracy that is taught at home, then continues in earnest at ECD centres and primary schools.

• Teachers are regarded as highly skilled and specialised, and this

context means that parents don’t see their role as being one of ‘teaching’ – although many skills are transmitted through daily interactions and domestic activities.

• There is an important contrast between the structured teaching

of school and the informal learning that happens as home with many family members.

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Early childhood insights & implications CAREGIVING | How parents understand and behave during the first 1,000 days

Siblings and young mothers are teaching basic literacy and numeracy, but it’s ad-hoc, without clear milestones • All of the parents we met described how basic literacy and numeracy

are taught at home, often by older siblings and young mothers who have themselves been educated at primary level.

• This teaching takes the form of drawing in the sand, counting pebbles

(perhaps when playing Bao) and naming things around the homestead.

• This practice appears to be a constructive social norm,

and helps provide a grounding in key concepts before school.

• The challenge is that this teaching is ad-hoc, and lacks clear

milestones and structure.

• It is also limited by context and circumstance: naming things in the

immediate vicinity, rather than focusing on growing a broad and expansive vocabulary, for example.

• In addition, it is limited by the capacity and appetite of the teacher:

an 8 year old sibling might not particularly appreciate or enjoy this responsibility.

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Early childhood insights & implications CAREGIVING | How parents understand and behave during the first 1,000 days

Ideas to consider when engaging parents in the first 1,000 days For example:

Consider the vulnerability gap children face: from days 600–1,000

It is easy to focus primarily on the newborn/infancy period as the stage when children are most vulnerable during the First 1,000 days. However, we identified a clear vulnerability gap for children aged between 12/18 months and 3 years.

This is the time when they are at once most curious and adventurous, without any concept of danger, and often have the least adult supervision. There is an opportunity to help parents understand just how important days 600–1,000 are in a child’s life and how much value they can bring to their child’s development during this time.

For example:

Make the connection between early brain stimulation and its short-term benefits

Given the prevailing survivalist mindset, parents’ focus tends to be on the short-term basic needs; feeding their children, keeping them safe, healthy etc. Encouraging parents to act now for the long-term benefit of their child’s cerebral development may not register as a priority, or lead to sustained behaviour change. Instead, perhaps engage with parents’ short-term mindset and talk about the immediate, health/strength-related benefits of brain stimulation.

With so many parenting duties shared, and mothers learning predominantly from their own mothers or mothers in law, it is important that we help all of the family understand the significance of the first 1,000 days.

Grandmothers are not specifically targeted by ECD activity at present, and are less likely than younger generations to interact with health and education services – particularly in rural areas.

Create inspiring and attainable role models for mothers

– Raise awareness of key development milestones that exist, from 18 months – 3years, and instruct parents on what support children need to reach these.

– Open parents’ eyes to this exciting period of curiosity and exploration, demonstrating the need for even greater parental guidance and support than in earlier months.

– “Tickle and play with your baby – the more they are happy and laugh, the stronger their immune system will become”.

– “Massage your baby – this improves weight gain and eases teething pain”.

Two-generational approaches to ECD interventions are critical in order to shift norms at scale, and embed new attitudes towards the first 1,000 days.

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Building on the foundations of responsive care

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Early childhood insights & implications CAREGIVING | Building on the foundations of responsive care

The foundations of responsive care: introduction We examined responsive caregiving through a number of Responsive Care is a pivotal element of the Nurturing Care core questions: Framework, encompassing a number of parenting behaviours and meeting a range of an infant’s needs. In one sense, Responsive Care is the way that the Nurturing Care Framework is ideally delivered: by taking a responsive and adaptive approach to parenting that • What does ‘natural’ Responsive Caregiving look like, reflects the immediate and changing needs of the child. and how can it be built on?

A core question for us in exploring the notion of Responsive Care was the extent to which parents are being responsive to all of their child’s needs during the First 1,000 Days, because this would be an indication of how well the Nurturing Care Framework was being delivered on the ground.

• Is

Responsive Caregiving consistently delivered during the First 1,000 Days, or does it change over this time period?

• Who

We went into the field with an assumption, built on stakeholder interviews, that Responsive Care would not be the norm for parents, and that there was a need for much more of it. Contingent with this assumption was a sense that better connections needed to be forged between mothers / primary caregivers and their children.

is delivering Responsive Care to 0–3 year olds?

• Are

there instances when Responsive Care is better or worse, and why might that be?

• Where

Responsive Caregiving is lacking, why is that the case and what can be done about it?

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Early childhood insights & implications CAREGIVING | Building on the foundations of responsive care

Responsive caregiving of 0–12 month babies is common and instinctive • We witnessed many examples of responsive caregiving with the

majority of the mothers and caregivers we met, with young babies: – Breastfeeding on demand – Tickling and playing with babies to encourage laughter – Comforting when distressed – Close, skin-to-skin physical contact

• These behaviours felt instinctive rather than instructive – driven by

maternal and familial instinct more than received wisdom from experts.

“The more you stay with a child the more you understand what they want. You know what they need better than anyone” Eunice, 21, Ganze 81

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Once babies are able to walk, responsiveness of primary caregiver often declines • As soon as babies are walking, or too heavy to be carried continuously

(at 12-18 months), they are left with siblings or neighbours for greater periods of time so their mother or caregiver can work.

• As a result, they receive far less responsive attention from this

time onwards.

• We observed that toddlers were left to cry for longer periods of

time and often had to find their own games and ways of stimulating themselves, despite being surrounded by siblings or relatives.

“When a child is very young they care very much, but once it reaches two years they tend to leave it and go to look for money.”

Community Health Worker, Ganze

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Early childhood insights & implications CAREGIVING | Building on the foundations of responsive care

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Early childhood insights & implications CAREGIVING | Building on the foundations of responsive care

Beyond the primary caregiver, caregiving is more ad hoc • Many older children play a role in caregiving, but here responsiveness

is less of a given.

• Where other carers outside the family are involved (house helps

and informal daycare providers), responsiveness is even less common.

Reflecting how responsive caregiving is driven more by maternal instinct than received wisdom or best practice.

• In precarious environments such as Kibarani informal settlement,

a lack of responsive caregiving can be hugely risky.

• With substantial gaps in responsive caregiving, early child

development inevitably suffers.

“You know what your child needs better than anyone else. It’s hard for others to know what they need, and when.”

Lucy, 16, Kibarani 83

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A supportive household is what really makes responsive caregiving thrive • When mothers and caregivers lack the practical and social support

of a family unit or close friends and neighbours, the challenges of child rearing increase exponentially.

• The mothers and caregivers we met who suffered additional hardships

were notably less engaged and responsive with their young children.

• Absent fathers, fragmented families, familial rejection and a lack

of emotional support all contributed towards some mothers seeming more unhappy and disconnected from their babies.

• With this in mind, it is crucial to consider those mothers who may

be suffering from post-natal depression and teen mothers feeling stigmatised by society, as primary support with responsive care.

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Early childhood insights & implications CAREGIVING | Building on the foundations of responsive care

Ideas to consider when designing for responsive care For example:

Build on the solid foundations of responsive care that already exist

Many mothers are already doing great things when it comes to responsive caregiving and not being commended for it.

There’s an opportunity to celebrate their actions, explain the implications and encourage them to do more.

– Talk about the longer-term benefits of soothing a child quickly (particularly for those over 12 months)

Raise public awareness of the need for greater responsive care from 12/18 months – 3years

As noted in the previous section, children face a vulnerability gap from 12/18 months, once they’re walking and no longer spending as much time with their primary caregiver, who would instinctively respond to their needs. There’s an

opportunity to raise awareness of the responsive needs of children during this crucial period – not just amongst parents, but to the broader community involved childcare; from neighbours and daycare centres, to siblings and relatives.

Identify mothers struggling to connect with their babies, by assessing how supportive their household is

There is an opportunity to re-consider the notion of a ‘supportive’ household for 0–3yr olds. Rather than this being defined by the presence of both parents, we discovered it to be more about whether the mother had an emotionally supportive adult present. In most instances, this would be

another female household member e.g. her sister or mother, giving her the practical and psychological support she needed to adequately connect with and respond to her children.

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– Talk about the longer-term benefits of talking back to a child and encouraging conversation (particularly for those who can’t yet talk with words)

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Embedding play-led learning in culture

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Early childhood insights & implications CAREGIVING | Embedding play-led learning in culture

Play: introduction Having heard this, we wanted to better understand the existing culture of play within Kenyan families:

Play is a key part of the Nurturing Care Framework, and central to Kenya’s new competency-based curriculum.

From our pre-fieldwork interviews with practitioners and academics, it was suggested that Kenyan parents don’t understand the value of play, and consequently 0–3yr olds aren’t experiencing the full benefits that play can bring to their growth and development.

• Who • To

(if anyone) is playing with young children?

what extent are parents involved in play?

• Is

the notion that ‘parents don’t understand the value of play’ evident in coastal Kenya?

There was the sense from the stakeholders that parents needed to be educated about the relationship between play and cerebral development, and encouraged to invest more time playing with their young children, particularly during the First 1,000 Days.

• Are

there existing norms to build on, to encourage play-led learning play during the First 1,000 Days?

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Early childhood insights & implications CAREGIVING | Embedding play-led learning in culture

The social practice of play is widespread among siblings • We saw countless examples of play in the households and

neighbourhoods we visited.

• It is welcomed and encouraged by parents, who want to see

their children happy and active.

• Common forms of play we observed were:

– Ball games (football and bao) – Improvised toys (cars and sledges) – Mimicking domestic work (cooking and washing) – Dancing and making music (songs on mobile phones and using jerry cans as drums) • We noticed that younger siblings (6-9 years) found real joy in playing

with babies and toddlers. Older siblings (13+) seemed to find this more of a chore.

“I’m happy when I see them playing.

Every parent wants their child to be happy.”

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An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Domestic chores provide opportunities for playful interactions • Whilst parents are not always initiating play pro-actively with

children who are 12/18 month and older, there are instances throughout the day where children instigate play themselves.

• This tends to be during domestic tasks, when they mimic their

mother’s or caregiver’s behaviours:

– ‘Washing’ clothes – ‘Cooking’ using sand and plastic containers – ‘Collecting water’ using small bottles – ‘Cutting maize’ in the farm • This is what play-led learning looks like in coastal Kenyan households.

• Mimicry was described as something instinctive by parents,

rather than something they actively encouraged.

“He likes to cut maize when we’re on the farm… and to wash his clothes while I’m doing the washing – but I always have to re-wash them!”

Lois, 42, caregiver to 2.5yr old grandson, Ganze 89

Early childhood insights & implications CAREGIVING | Embedding play-led learning in culture

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Early childhood insights & implications CAREGIVING | Embedding play-led learning in culture

Play is valued in practical terms by parents • The role of play in child development is viewed in physical and

practical terms:

– Gaining physical strength through activity – Learning how to socialise by playing with other children – Gaining domestic and life skills – Occupying time and keeping them busy • There is also a recognition that playing children are happy children,

and all parents wish for their children to be happy.

• Within this appreciation of play there are the building blocks of

a narrative around play-based cognitive development (through notions of emotional happiness, social development and life skills).

“When a child is very young they care very much, but once it reaches two years they tend to leave it and go to look for money.”

Community Health Worker, Ganze

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Early childhood insights & implications CAREGIVING | Embedding play-led learning in culture

Ideas to consider when designing for play-led learning Build on the existing culture of play amongst siblings and young relatives

Harness the practice of play that’s already prevalent amongst siblings/cousins/neighbours and direct them towards games with 0–3yr olds that are both fun and educative / constructive.

For example: – Teach children (6-10years) as part of the school curriculum how to play fun and constructive games with their 0–3yr old siblings/cousins.

– Teach parents constructive games that their children can play together – and encourage them to play a guiding role.

Acknowledge the ways in which parents currently value play

Harness the organic, playful moments between mother/ caregiver and child

Help parents to understand the link between play and learning, by starting a conversation that builds their existing appreciation of its physical and social values.

For example: – “Play helps your child to become strong in more ways that you might think… it exercises both the body and the brain…”

– “When your child is playing and learning to socialise with others, this is also having a positive effect on their brain development…”

Remind parents of the playful moments that already exist with their 0–3yr olds, and encourage them to use these as fun opportunities for learning and development. .

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For example: – Counting and sorting the clothes together before washing.

– Encouraging children to pour water into different sized containers whilst cooking / singing songs whilst cutting maize etc.

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Childcare options and choices

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Early childhood insights & implications STATE SUPPORT | Childcare options and choices

Understanding childcare options: introduction Through our conversations with stakeholders we heard a great deal of questions about the prevalence of various childcare options within communities, from formal to highly informal provision.

In attempting to explore the landscape and decision-making around childhood we explored the following questions: • What’s

It was clear that parents had a number of options available to them, but what was less clear was how they made choices about childcare for their children.

• What

the landscape for early childcare?

choices are mothers making?

• What

do formal and informal childcare options actually look like?

We heard an assumption from stakeholders that not only were there a wide range of options, but that parents had the time and money to make informed choices about the childcare their child received. There was the suggestion that parents would shop around and adopt a consumer mentality in the childcare choices they made.

• How

do people shop for childcare? What drives their decision-making?

• What

costs are associated with different childcare options?

• What

happens when there are no state services available to parents?

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Sharon Informal daycare provider Kibarani Sharon is an informal daycare provider in Kibarani. She fell into this work by accident, offering to help out a friend who was forced to return to work as soon as possible after childbirth owing to financial difficulties. Once Sharon was looking after one baby, word spread that she was a kind and responsible caregiver, and her workload grew.

Sharon sees her role very clearly: to ensure the children after are kept fed, clean and safe. She has no toys or learning aids, and does not assume the role of teacher. She is a child minder in the literal sense of the term.

None of this is to suggest that Sharon does not care deeply about the children she cares for; she has been neither trained or expected to focus on their further development.

Sharon’s work is hard. Often parents slip behind with their payments (50-100 shillings per day), and others are consistently late to collect their children. Sharon never complains, as she puts the children’s needs first.

Informal Daycare Local woman who takes on the role of informal daycare provider, in the absence of alternative options. Untrained and poorly paid, she works hard to help her neighbours out.

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Early childhood insights & implications STATE SUPPORT | Childcare options and choices

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Early childhood insights & implications STATE SUPPORT | Childcare options and choices

Rural parents prefer to leave their 1-3yr olds with family or neighbours • Formal childcare options for 2-3 year olds in Ganze are limited

• Families in rural villages remain close-knit and nuclear, with

to a few private schools and one private nursery – all out of reach financially for most people – with a tiny number of children accepted at state-run ECD Centres before 3 years.

either grandparents, older siblings or aunties available for childcare.

• For teen mothers, their mothers and sisters play a key role in childcare.

• We saw no state provision for children at this age in Ganze.

• When family help is not available, neighbours are a close second

choice. Payment in the rural area we visited was not necessary; parents simply provided porridge.

GRANDMOTHER / SIBLING / AUNTIE

• More affluent mothers in Ganze do use home helps, but they were

skeptical about their abilities to teach children well, and didn’t value their contribution.

NEIGHBOURS

family

formal HOUSE HELP

ECD CENTRE

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Early childhood insights & implications STATE SUPPORT | Childcare options and choices

Urban parents prefer to leave their 1-3yr olds with older siblings or neighbours • Given the fragmented nature of urban families, there are less relatives

• With the lack of affordable, formal childcare options and family

• As a result, older siblings and neighbours are the most frequent choice

• There were no house helps amongst those families we interviewed,

support, mothers are sometimes left with no choice but to leave their under 3s with paid neighbours for 12-15 hour days, 6-7 days per week.

available to carry out childcare. Those grandmothers who are present tend to be working, rather than available to look after grandchildren, due to the greater cost of living.

as they tend to be employed by those in a higher income bracket.

However we heard that the standard of childcare they deliver is often poor and not overseen.

for childcare. Unlike in rural areas, some neighbours expect to be paid 50 to 100 KSH per day, as well as being provided with food and clothing for the child.

GRANDMOTHER / SIBLING / AUNTIE

FREE/VOLUNTARY ECD

family

formal NURSERY IN PRIVATE SCHOOL

NEIGHBOURS

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Early childhood insights & implications STATE SUPPORT | Childcare options and choices

Informal childcare is primarily about survival and attending basic needs • For those 1–3yr olds left with older siblings, days are structured

around mealtimes, with no specified activities.

• In rural areas toddlers roam around the homestead, whilst in Kibarani

they were wandering more freely throughout the settlement, in highly dangerous environments.

• Informal childcare is seen as a way to provide for children’s basic

needs and keep them safe, with no structure beyond meal times.

• When neighbours care for children, it is unclear how much structure

and attention they provide - and probably varies a great deal.

• Informal childcare is defined by its basic nature, variability and lack

of structure.

“I worry about her playing far away in case she’s kidnapped.

If I leave her with a neighbour, at least I know she will be kept safe.”

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Formal daycare comes in a variety of forms • We visited a variety of formal daycare options:

– Free daycare in Kibarani based in a local church – Nursery class in a Kibarani private primary school – Montessori-led private nursery in Ganze – ECD centre in state primary in Ganze • While these centres varied greatly in their resources and facilities,

what united them was:

– Presence of materials and stimulus for children – Focus on building social relationships – Prioritising the building blocks of reading, writing and counting – A struggle for sufficient materials and up to date resources • In Kibarani, daycares made a point of teaching life skills to children,

to counter the precarious environment they were situated in.

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Early childhood insights & implications STATE SUPPORT | Childcare options and choices

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Early childhood insights & implications STATE SUPPORT | Childcare options and choices

Indicative costs of paid childcare options

ECD Class (state primary school)

Nursery Class (Kibarani private primary)

Paid neighbour

Private nursery (Ganze)

Informal daycare

from 3yrs

from 2yrs

from 2 months

from 2yrs

from 3 months

400ksh/term (1 term=3 months)

1500ksh/term (1 term=3 months)

50ksh/day

3500ksh/term (1 term=3 months)

50–100ksh/day 1000ksh/month

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Early childhood insights & implications STATE SUPPORT | Childcare options and choices

Ideas to consider when designing childcare options for 0–3yr olds Equip informal daycare centres to improve and formalise their practice

Opportunity for the State to support existing private daycare practices

Create demand amongst parents for more and better quality daycare

There is a clear opportunity to work with those running informal practices, through up-skilling and coaching, to help them both deliver an improved standard of care for children, and to help them make more money out of their business.

This would be both beneficial to the children attending and would work to economically empower the women running the practices.

For example:

Given both the extremely varied quality of private formal daycare centres, and the lack of State support for children under 3years (soon to be 4years), there is a need for the State to work more closely with those private operations, to ensure best-practice standards and to offer them the support they require to attain these.

For example:

There is a significant lack of good quality and affordable childcare options for children aged 1–3 or 4years. Most parents consider childcare during this period to be primarily about safety and don’t understand the need for structure and stimulation. There is therefore an opportunity to educate parents on the value of quality care during these early years, encouraging them to make the case for better, more playful and engaging daycare options for their children.

For example:

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– Kidogo is a great example of this model – empowering and equipping women to run quality daycare centres.

– Develop a specialist out-reach team of ‘best-practice’ daycare trainers who visit private daycares and train/guide those working within them.

– Work with community influencers to kick-start an awareness campaign on the benefits of quality childcare.

STATE SUPPORT

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CH 9_ANCHOR

Understanding state support for parents

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Early childhood insights & implications STATE SUPPORT | Understanding state support

Understanding state support: introduction Both our team and our stakeholders were highly interested in understanding the extent to which the state supported new parents, through pregnancy and First 1,000 Days.

Key research questions that informed this element of our research included:

We knew that through formal healthcare and community health volunteers, there was some support network in most locations, and we knew that this provision would understandably vary in presence and quality from place to place.

• Where

do parents most need external support?

• Where

are the gaps in current state provision?

• What

We approached this topic through a series of journey mapping workshops, where mothers and fathers talked us through the development of their child from conception to 3 years, and described the child’ developmental journey and their needs and associated support along that journey.

happens when there’s no existing state support?

• How

do parents perceive different state supported and professional actors?

• To

what extent are existing funded programmes supporting parents in our field sites?

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Support needed by mothers & services available to them -9m

AGE

These are the key moments, identified by mothers, fathers and experts, at which mothers require the greatest support in caring for their 0–3yr olds.

0

PREGNANCY

Early childhood insights & implications STATE SUPPORT | Understanding state support

6m

NEWBORN / INFANT

1y

TODDLER

3y

SUPPORT NEEDED

BY MOTHERS Attending regular check-ups

AVAILABLE SUPPORT: RURAL & URBAN

Access to balanced diet

Physical support in 3rd trimester

HOSPITAL/CLINIC 75% visited months 4-6.

76% visited months 7-9. in Ganze, but only 36% in Kibarani.

HOME WITH TRADITIONAL MIDWIFE 15% for first child in Ganze 8% for first child in Kibarani

INFORMAL

FORMAL

CLINIC CARD & BOOK Rarely read – used for vaccination reminders

HOSPITAL 78% for first child

COMMUNITY HEALTH VOLUNTEER Often unreliable & corrupt, particularly in urban areas.

82% households never been visited by a CHV. MOTHER’S MOTHER OR GRANDMOTHER Guides pregnancy behaviours

Giving birth

FAMILY If in supportive environment with income

HUSBAND/CHILDREN /NEIGHBOURS Often little support for single mothers

FEMALE RELATIVE (GRANDMOTHER OR MOTHER) Often little support for single mothers

Postnatal care & instruction HOSPITAL Doctor advises once on breastfeeding, umbilical care and cleaning baby.

Teething & sickness

Introducing a balanced diet of solids

Starts walking

CLINIC Last resort

Starting preschool: stress of debt CHIEFS & ELDERS Give advice on how to obtain money/save for schooling

Difficult to get second appointment if issues with breastfeeding or similar.

SAMARITANS Sponsor school fees

Ave. of 3 post-natal visits in Ganze (most pop. is 4 weeks – 50% of mothers).

Ave. of 2 post-natal visits in Kibarani (most pop. is 4 weeks – 30% of mothers).

MOTHER’S GRANDMOTHER Often looks after mother and baby for 1-2 months post-natal.

MOTHER’S MOTHER OR MOTHER-IN-LAW Also play a key role in advising new mother 103

TRADITIONAL DOCTOR

BABY’S GRANDMOTHER Helps to provide food if not enough

NEIGHBOUR Leave baby with neighbour, with food LEAVE WITH BABY’S GRANDMOTHER OR SIBLINGS

GRANDFATHER Supports school fees if possible NEIGHBOURS Provide a soft loan

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Early childhood insights & implications STATE SUPPORT | Understanding state support

Prenatal support and accessible information are limited -9m

AGE

0

PREGNANCY

SUPPORT NEEDED

BY MOTHERS

• Mothers visit the clinics infrequently for pre-natal check-ups,

with 75% starting at 6 months and following up with one further visit.

Attending regular check-ups

AVAILABLE SUPPORT: RURAL & URBAN

Access to balanced diet

Physical support in 3rd trimester

• Each expectant mother receives a book with pre and post-natal

advice and information, however this is inaccessible to the illiterate.

HOSPITAL/CLINIC 75% visited months 4-6.

76% visited months 7-9. in Ganze, but only 36% in Kibarani.

• Community Health Volunteers (CHVs) may visit expectant mothers,

however this cannot be relied upon and is covered on page 108 in this document.

INFORMAL

FORMAL

CLINIC CARD & BOOK Rarely read – used for vaccination reminders

• For those in rural areas, many live in inaccessible areas that are

COMMUNITY HEALTH VOLUNTEER Often unreliable & corrupt, particularly in urban areas.

82% households never been visited by a CHV. MOTHER’S MOTHER OR GRANDMOTHER Guides pregnancy behaviours

rarely (if ever) visited by CHVs.

FAMILY If in supportive environment with income

HUSBAND/CHILDREN /NEIGHBOURS Often little support for single mothers

“Women come late in their pregnancy because they cant afford the transport and so skip the frequent visits” Birth Dispensary, Ganze

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Early childhood insights & implications STATE SUPPORT | Understanding state support

Postnatal advice and ongoing support is sparse 0

AGE

6m

NEWBORN / INFANT

SUPPORT NEEDED

BY MOTHERS

• Those giving birth in hospital or clinic (78% for first child) receive

brief advice from a doctor on the basics of caring for the baby.

Giving birth

AVAILABLE SUPPORT: RURAL & URBAN

HOME WITH TRADITIONAL MIDWIFE 15% for first in Ganze 8% for first in Kibarani HOSPITAL 78% for first child

HOSPITAL Doctor advises once on breastfeeding, umbilical care and cleaning baby.

Teething & sickness

• Once they have left the hospital (24hrs later), they are largely

reliant on the support of mothers, mothers-in-law and grandmothers, as returning to the hospital can be difficult. (On average, Ganze mothers make 3 post-natal visits, whilst Kibarani mothers make 2 visits. The most popular time for both is at week 4).

CLINIC Last resort

Difficult to get second appointment if issues with breastfeeding or similar.

• Any issues with breast-feeding or minor ailments are dealt with

at home.

Ave. of 3 post-natal visits in Ganze (most pop. is 4 weeks – 50% of mothers).

Ave. of 2 post-natal visits in Kibarani (most pop. is 4 weeks – 30% of mothers).

FORMAL INFORMAL

Postnatal care & instruction

FEMALE RELATIVE (GRANDMOTHER OR MOTHER) Often little support for single mothers

MOTHER’S GRANDMOTHER Often looks after mother and baby for 1-2 months post-natal.

• Those giving birth at home can go 1-2 weeks without receiving

vaccinations, support and advice from a medical professional.

• When it comes to weaning and nutrition, there’s varied understanding

TRADITIONAL DOCTOR

of what to feed a child and at what age. For some, tea and porridge, for others it’s ugali…

• Some mothers (particularly teenagers) lack the nutrition to breastfeed

MOTHER’S MOTHER OR MOTHER-IN-LAW Also play a key role in advising new mother

successfully, or need to return to work immediately and are forced to wean babies onto cows milk or porridge, often pre-4 months.

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There are bright spots of innovation from state-run clinics, however these suffer due to lack of funding • We heard of a number of innovative programmes that had been

devised by health experts to drive improved pre and post-natal care: – New mothers were offered gift packs with soap, sanitary products and clothes, to encourage them to give birth in hospital.

Mothers were also offered a hot meal after each delivery.

– Women are encouraged to bring their husbands to the Birth Dispensary by getting priority and being seen first.

– Clinics created ‘Male Champions’ who’ve joined their wives to appointments and are encouraged to tell other men of the importance of these sessions for pre and post-natal support of mothers.

– Clinics were also keen to develop outreach programmes to visit mothers who aren’t able to attend the hospital.

• Whilst often successful, these can be hard to sustain with limited

funding and resources.

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Early childhood insights & implications STATE SUPPORT | Understanding state support

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TOPINSIGHT_10_ANCHOR

63% of households in Ganze

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Community health volunteer support for parents is hugely varied

Of those visited:

have never seen a CHV.

64% discussed pregnancy in Ganze vs. 25% in Kibarani.

20% discussed child’s learning in Ganze vs. 8% in Kibarani.

14% have seen one only once.

Early childhood insights & implications STATE SUPPORT | Understanding state support

• CHVs are volunteers, recruited and trained by local authorities.

The training they receive varies according to location, opportunities offered to them and their personal availability.

• Many mothers in Ganze had never heard of CHVs. • Young teens were aware of them, but most did not see them regularly.

• Many urban parents claimed CHVs were corrupt and biased in their

choice of client, motivated by drug sales.

• We did meet highly dedicated CHVs who went above and beyond

in their support of mothers.

• CHVs are not a consistently reliable resource for ECD and parenting

advice. They are busy, over-stretched and not consistently committed to their role.

“I have least respect for the community health worker. They have to be given information to give to us, so they do not really understand it and can’t answer my questions.”

77% of households in Kibarani have never seen a CHV.

12% have seen one only once.

Eunice, 21, Ganze 107

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Early childhood insights & implications STATE SUPPORT | Understanding state support

Ideas to consider when designing childcare options for 0–3yr olds For example:

Tackle the practical barriers preventing mothers from attending antenatal and post-natal care

Many mothers are failing to attend antenatal and postnatal appointments due to practical issues such as transport costs, lack of time due to work commitments and the need to care for other children. As a result, resources are wasted and 0–3yr olds aren’t receiving the vaccinations and support they need. There’s an opportunity tackle these barriers head-on and to better communicate existing initiatives.

Create opportunities for mothers to come together for regular pre and postnatal support

Given the lack of peer mothering support and the practical challenges for mothers to regularly visit the clinic, there may be an opportunity for local, group meet-ups, run by trained Health Workers.

This would minimise the time required by Health Workers to go door-to-door and make regular attendance more of a reality for mothers, if the meetings were both local and had a social element to them.

Consider the consistency of quality care and information offered by Community Health Volunteers

Whilst many of the Community Health Volunteers we met were committed to their role, it was also clear that this was not consistent through the counties. Many had not attended the necessary training and were offering advice based on personal experience and others were not regularly visiting families. In addition, mothers did not view them as a credible

source of information.It is therefore important to thoroughly assess your network of Community Health Volunteers before working with them - not solely in terms of their claimed work, but from the perspective of parents and the extent to which they are respected.

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– Develop outreach programmes for Health Workers (not community health volunteers) to visit expectant and new mothers in the home.

– Communicate the Linda Mama programme, which many were not aware of.

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Appendix APPENDIX_ANCHOR

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

The Good Side

The Good Side is an insight and ideas company, based in London and working worldwide. We create ways for people to understand and change systems, society and culture. We work with organisations from global tech giants to one-woman NGOs, from international brands to social enterprises.

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Appendix The Good Side

We believe that change isn’t black and white; it’s complex, nuanced and full of colour. And, to thrive, knowledge needs action.

We are The Good Side because we’re focused on positive change and bright ideas; identifying opportunity, and working with our clients to be on the right side of history.

Saul Parker,

James Lewis,

Saul has worked in insight, brand and communications strategy for 20 years. He specialises in social and behavioural change, working with Girl Effect, Unilever, Google, USAID, the AIDS Alliance and Facebook. He is passionate about research innovation and the transformative potential of media technology.

James is head of production for us, masterminding our video output. James has more than a decade of experience organising fieldwork and production all over the world. For The Good Side he has produced films for Save The Children, Kays Foundation, Human Dignity Trust and PepsiCo.

Sophie Dollar,

Jen Fearnley,

Sophie has 15 years’ experience in research and strategy for clients including Nike Foundation, DFID, Coca-Cola and Nike Inc. At Girl Effect she helped launch Ni Nyampinga in Rwanda and the award-winning Girl Research Unit.

She is now an independent consultant, working on purpose-led strategies.

Jen Fearnley is an award-winning filmmaker who brings her honed storytelling skills to a wide spectrum of productions.

With an MA from Goldsmiths and a background in community organising, she has made documentaries around the world.

Founder

Producer

Strategy Director

Documentary Director

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FEEDBACK_ANCHOR

Stakeholder queries that informed research design These questions were consolidated from 35+ interviews with local and global Early Childhood policy makers, practitioners, donors and academics to inform our study

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Appendix Stakeholder feedback that informed research design

Questions from stakeholders Understanding the first 1000 days

How to connect and communicate with families

Who else is operating in this space?

“A baseline for childhood: what are the environments that children grow up in, what does it look like and what are the realities on the ground?"

Policy Maker

How to better connect with parents and bring them on board?”

Local practitioner

“Who are the key implementors in this space and who are the key influencers?”

Academic

“How do we deepen awareness of the first 1,000 days and create messages that build on existing norms?”

Donor

“Map who’s doing what, it’s a very fragmented sector.”

Local Practitioner

“The involvement of families and parents in the first 1,000 days of their children’s life - particularly fathers.”

Local Practitioner “What’s currently happening for the first 1000 days in Kilifi?”

Policy Maker “Highlight the problems facing families and all the factors that influence child development, to give us a starting point for design.”

Academic “What are the practices of people with no access to state services?”

Donor

“Systems mapping of families to ensure ECD innovation is designed with users front and centre” Global practitioner “Who in the community has the greatest influence on families?”

Policy Maker “How to work with varying cultures and traditions?”

Global practitioner

"How are mothers currently stimulating their babies to enhance development? What’s their knowledge?”

Academic “What’s the role of every actor involved in childcare – from family, to government level?”

Local Practitioner 112

“What’s the policy environment to facilitate childcare?”

Local Practitioner “What do families think about the current providers and services?”

Donor “How do we bring together the various ministries and get them to work seamlessly together?”

Local Practitioner “How can we produce work that can engage different sectors – health, education, children?”

Donor

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RESEARCHAPPROACH_ANCHOR

Using ethnography and human-centred design

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Appendix Research approach & methodology

Research methodology Ethnographic, immersive and documentary • The core of our research was in-depth ethnographic fieldwork

with families in Ganze district, Kilifi County, and Kibarani informal settlement, Mombasa city.

• We recruited 40 caregivers for initial interviews and chose

20 to work with further, based on demographics and family composition, to give us a spread of different family types and circumstances.

• We spent more time with these caregivers over two half-day

sessions, to build rapport, observe family dynamics and understand caregiving more deeply.

• All interviews were audio recorded, and documented through

photographic records.

• Key participants were also interviewed and shadowed

by our documentary team to form part of our video output.

• We also interviewed a range of community stakeholders,

from chiefs to CHVs to maternity ward staff.

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Why ethnography and HCD? We designed our approach around the principles of place-based ethnography and human centred design, as a way to yield rich insight into the realities of child-rearing and childhood in coastal Kenya.

We wanted to explore the topic from the perspective of people and communities - rather than with an organisational agenda in mind. • Place-based ethnography involves spending extended periods

of time getting to know a specific area and community: meeting a variety of community members, visiting research participants multiple times to build trust and rapport, being present in shared spaces, seeing and being seen by the community.

• Human centred design is a process of problem-solving from

a human perspective: understanding how people perceive of, behave around and respond to potential design solutions, working with communities to understand their needs and then to design to fit them.

We believe that this approach is the best way to truly understand a community and respond to their needs, rather than force fit a solution that suits an external agenda.

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Appendix Research approach & methodology

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Appendix Research approach & methodology

Key principles

Visit key research participants multiple times to build rapport and trust (primary caregivers for this study).

Meet a wide range of community figures and stakeholders (from chiefs to nurses to restaurant owners) to understand a range of perspectives.

Remain flexible, keep an open mind and schedule, to allow for new experiences and conversations.

Plan to ‘snowball’ recruitment, to make the most of local introductions and the potential to discover new participants along the way.

Use creative exercises to make the research more interactive for participants, and avoid extended interviews becoming tiring and repetitive.

Spend time in places that matter to your study (in this case maternity wards, clinics, informal day cares, ECD centres) to observe interactions, appreciate the physical environment and speak to people you find there.

Make yourself visible around the community, so everybody knows you’re there and grows used to your presence. Soon your study will seem more ‘everyday’ and unthreatening, and your interactions will improve as a result.

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Appendix Research approach & methodology

Methods spotlight: Journey Mapping We used Journey Mapping to explore caregivers’ experiences and perceptions of early child development.

We worked with groups of 8–10 mothers, fathers and health workers (in separate sessions) to gain a range of points of view.

With each group we: • Plotted the major development milestones from conception

to 3 years - led by the knowledge of the participants, recording the emotions associated at each stage.

• Captured the critical needs for both mother and baby at each

of these development milestones.

• Recorded what services and provisions were available for families

at each stage.

Journey Mapping allowed us to better understand perceptions and priorities around child development, what support existed for parents from public and private sectors, and where the real unmet needs lay.

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Appendix Research approach & methodology

Returning to the communities On completion of the film and study, we returned to visit our research participants in Ganze and Kibarani, to gain their thoughts and feedback.

Both communities received the film positively and the following areas were discussed: Kibarani, Mombasa The majority of the conversation centred on gender and the role of men within society. The mothers and informal caregivers were extremely vocal about the neglectful and negative behaviours of fathers, and talked about their selfishness and lack of generosity when it came to money for their families, plus the risks of diseases brought upon by their promiscuity. There was also much conversation about economic empowerment, and the need for more funding and programmes to support female entrepreneurs.

Ganze, Kilifi The parents in Ganze were incredibly positive about the film and messages communicated. When asked ‘what would you add to this film to make it better?’ and Eunice replied ‘Why would you add anything and spoil something that is perfect?’ The conversation was less focused on exploring challenges further (as it was in Kibarani), and more on understanding the role of the film and how it might support mothers. They were proud to be able to tell their story and to be of use in igniting conversations that could help mothers across Kenya.

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ARCHET_ANCHOR

Participant archetypes

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Supported Mother/Caregiver Raising child in a emotionally and practically supportive environment. This may or may not include the child’s father.

Isolated Mother/Caregiver Raising child without emotional or practical support.

Family members may be present, but not providing the support she needs to be a fully engaged and present parent.

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Supported Teen Mum Raising child in an emotionally and practically supportive environment. This may or may not include the child’s father.

Isolated Teen Mum Raising child without emotional or practical support. Family members or father may be present, but not offering the support she needs as a stigmatised young mother.

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Appendix Participant archetypes

Modern Father Engaged and progressive father who is involved in all elements of childrearing and is happy to share this responsibility with his wife.

Traditional Father Believes childrearing is entirely the responsibility of mother. As head of the household he is the key decision-maker and (occasional) financial provider.

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QUANT_ANCHOR

Quantitative research Methodology + findings

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Appendix Quantitative Research

Quantitative approach Focused survey to support and deepen insights Introduction

Limitations

This quantitative survey was commissioned to provide statistical data to sense-check, validate and strengthen our qualitative insights. As such, it was designed after the ethnography fieldwork, to deepen our understanding of specific areas, as well as to help answer a few questions that remained in our minds following the qualitative work.

Some clear limitations emerged from the formal and structured survey approach, most notably that teen mothers were underrepresented in the sample. This was due to the fact that many parents forbid them from taking part in the survey, most likely related to the social stigma surrounding teen pregnancy in the region and the delicate nature of the issue.

Through the qualitative work we had learned that women played by far the largest role in childcare, so we focused our study sample on female primary caregivers of 0–3 year old children. A random walk methodology was employed in Ganze District, and Kibarani and Bangladesh informal settlements in Mombasa, covering 500 households in each area, with a total of 1,000 households.

The role of informal daycare is also under-represented in the quantitative data. Despite meeting numerous informal daycare owners and seeing these throughout Kibarani, the data suggests that they are less prevalent in the area. Having investigated this inconsistency further with local experts, we have since learned that parents are reluctant to admit to strangers that they use these services, given their unregulated status.

These shortcomings in the quantitative results only work to reinforce the value of conducting proper ethnographic fieldwork, where relationships are established, and a truer picture of the realities of life emerge.

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Appendix Quantitative Research

Random walk design: methodology Ganze, Kilifi The random walk procedure is a non-probability sampling technique (Bauer, 2016; Hoffmeyer-Zlotnik, 2003) that has many variations of which each invokes choosing a starting point within the selected area and then proceeding along a path, selecting every kth household (Himelein, Eckman, Murray, & Bauer, 2016). For each randomly-chosen sampling points (e.g., urban units, small cities, or voting districts), interviewers are assigned with a starting location and provided with instructions on the random walking rules – e.g., which direction to start, on which side of the streets to walk and which crossroads to take.(Bauer, 2016). The route ends when the predefined number of respondents (or households) is achieved (Bauer, 2016).

Given Ganze is a sparsely populated region (Momanyi & Benards, 2016), random points (e.g. Mosques and water points) were selected to be able to interview a mix of both Christians and Muslims. Starting as near as possible to the Sampling Start Point, the Field Supervisor chose any random point (e.g. Mosque or

a water source). Field workers were working in groups of four and thus a walk pattern was developed Fieldworker A walked towards the sun, Fieldworker B walked away from the sun, Fieldworker C at right angles to Fieldworker A, Fieldworker D in the opposite direction from Fieldworker C. Walking in their designated direction away from the sampling starting point (Whether a mosque or a water source), the field workers were supposed to select the sixth household for their first interview which they did. Once finished with the first household, they continued in the same direction but would pick the next household available which met the study criteria due to the nature of the population distribution in the region. There were two instances where two research assistants had to collect their data from a Huduma Number registration centre since people had left their homesteads and that was the only place where data collection could take place.

Bauer, J. J. (2016). Biases in random route surveys. Journal of survey statistics and methodology, 4(2), 263-287.

Himelein, K., Eckman, S., Murray, S., & Bauer, J. (2016). Second-stage sampling for conflict areas: methods and implications: The World Bank.

Hoffmeyer-Zlotnik, J. H. (2003). New sampling designs and the quality of data. Developments in applied statistics, 19, 205-217.

Momanyi, R. K., & Benards, A. H. O. a. O. (2016). Social-Economic Factors Influencing Biogas Technology Adoption among Households in Kilifi County-Kenya. environments, 6(6).

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Random walk design: methodology Kibarani, Mombasa The Mombasa group constituted 11 enumerators and a supervisor.

To help with mapping and other logistical issues especially since the study site was an urban slum with security challenges especially for non-locals, a community mobilizer assisted the team. The study site was at Kibarani and Bangladesh area within Jomvu sub-county in Mombasa County, Kenya. Being urban slums with densely populated households, the study site was divided into smaller units to enable implementation of the random walk methodology.

Mapping undertaken previously enabled equitable division of the study site into subsections, each section being taken as a study site for each of seven days of the study.

sections, each section consisting of at least one administrative village. In each of the study sites, there were slightly more than 300 households and therefore K was taken to be 3. Each of the sections was further divided into subsections for data collection by the enumerators. Boundaries were demarcated using landmarks such roads or walkways among others that divides villages into different sections. In each case, enumerators working within the same locations started at a central location and moved in opposite directions but staying within their designated locations and keeping K constant. Each of the enumerator returned an approximately 7 fully filled questionnaire.

Specifically, Kibarani area having slightly more than 600 households was divided into two sections/administrative villages. Bangladesh area with more than 3000 households was divided into five

Bauer, J. J. (2016). Biases in random route surveys. Journal of survey statistics and methodology, 4(2), 263-287.

Himelein, K., Eckman, S., Murray, S., & Bauer, J. (2016). Second-stage sampling for conflict areas: methods and implications: The World Bank.

Hoffmeyer-Zlotnik, J. H. (2003). New sampling designs and the quality of data. Developments in applied statistics, 19, 205-217.

Momanyi, R. K., & Benards, A. H. O. a. O. (2016). Social-Economic Factors Influencing Biogas Technology Adoption among Households in Kilifi County-Kenya. environments, 6(6).

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Age of respondent Although we heard a great deal qualitatively about teen mothers, they were not strongly represented in the quant sample.

48% 45%

Ganze 28.5 Mean

36% 34%

Kibarani 28.3 Mean

14%

13%

3%

3%

1%

16–18

18–24

SC3: We would like to start by asking your age on your last birthday? Base: all respondents in Ganze (n=496) and Kibarani (n=503) 125

25–34

35–44

2%

45 +

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Survey team feedback on the challenges in interviewing teen mothers From discussions with research assistants, there were instances, both in Ganze and Kibarani where some teenage mothers were not allowed to talk to the researchers.

Our project leader went to a home in Ganze where the mother and father of the home stopped the teenager from talking to us after initially appearing to grant her permission.

In some cases, they were restrained by either their husbands or by their fathers/mothers/mothers-in-law/fathers-in-law.

SC3: We would like to start by asking your age on your last birthday?

Base: all respondents in Ganze (n=496) and Kibarani (n=503) 126

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Time lived in the area

90%

80%

Ganze 12.3 months Mean Kibarani 11.8 months Mean

3%

5%

0–3 months

8% 3%

4%

4–6 months

SC4: How long have you lived in this area for?Base: all respondents in Kilifi (n=496) and Kibarani (n=503) 127

2%

4%

7–9 months

3%

10–12 months

Over a year

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Highest level of education achieved Majority of parents in both Ganze and Kibarani received primary education-only.

Secondary education was more prevalent in Kibarani.

56% 52%

Ganze 34%

Kibarani 24%

14%

7%

6%

None

Primary Education

SC6. What is the highest level of education you have attained? Base: all respondents in Kilifi (n=496) and Kibarani (n=503) 128

Secondary Education

6%

College +

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Working status Over half of mothers in Kibarani stay at home.

60% of mothers in Ganze are working in some capacity.

51%

Ganze 52% NET working

41%

Kibarani 40% NET working

12%

11% 11% 5%

6% 4%

11%

11% 11%

9% 6%

5%

4%

3%

5% 1%

0%

Full-time job

Part-time job

A few part-time jobs

Irregular part-time jobs

Mainly farming on own land

Own business PT

Own business FT

SC7. Which of the following best describes you in relation to your work? Base: all respondents in Kilifi (n=496) and Kibarani (n=503) 129

Stay at home mother

3%

Actively seeking a job

5% 2%

1%

Full-time student

1%

0%

Part-time student

2%

Other

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Age of returning to work Mothers in Kibarani are more likely to be housewives than in Ganze For mothers who work, the majority (60%+) return within the first 6 months.

16% 19% 9% 4%

Didn’t work before and won’t be returning 15%

Worked before but won’t be returning

7% 4%

Older than 12 months old

5% 4%

38%

5%

42%

5% 8%

10–12 months old

24% 30%

7–9 months old

11%

4–6 months old

14%

0–3 months old

13%

8% 41%

10% Returning to work

All

Ganze

B7a. After your baby was born, how soon did you return to work – how old was your baby? Base: all respondents in Ganze (496) and Kibarani (503) 130

57% All

Kibarani

11% Returning to work

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Weekly income (personal)

Appendix Quantitative Research

0%

1%

Mothers in Kibarani are more likely to be housewives than in Ganze.

1%

For mothers who work, the majority (60%+) return within the first 6 months.

4%

13%

over 30,000 ksh

4%

15,001 – 30,000 ksh

7%

10,001 – 15,000 ksh

9%

5,001 – 10,000 ksh

16%

Ganze 3,064ksh Mean

12% 3,001 – 5,000 ksh

17%

Kibarani 3.401ksh Mean

14% 1,001 – 3,000 ksh

6%

9% 501 – 1,000 ksh

4%

39%

SC8a. Which of the following bands best describes your weekly income? Base: all respondents answering in Kilifi (n=438) and Kibarani (n=371) 131

201 – 500 ksh

0 – 100 ksh

9%

36%

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Weekly income (household) 5%

Households in Kibarani are somewhat higher earners than Ganze, and there is a greater proportion of very low incomes in Kibarani.

8%

11%

27%

Ganze 8,551ksh Mean

22%

Kibarani 9,030ksh Mean

12%

2%

8%

SC8b. And which of the following bands best describes your household income? Base: all respondents answering in Kilifi (n=393) and Kibarani (n=367) 132

15,001 – 30,000 ksh

10,001 – 15,000 ksh

5,001 – 10,000 ksh

3,001 – 5,000 ksh

1,001 – 3,000 ksh

501 – 1,000 ksh

5%

2%

over 30,000 ksh

201 – 500 ksh

0 – 100 ksh

11%

22%

26%

17%

13%

6%

2%

1%

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Husband in the household?

40% of households in Ganze have no father present.

This is only 25% in Kibarani.

31% YES

45+ years

NO 69%

low base

66% YES 24% NO

NO

NO 34%

35–44 years 72% YES NO 18%

39% NO

25–34 years

YES

70% YES

19–24 years

61% YES

76% YES

Ganze

Kibarani

32% YES NO 68%

16–18 years

A3a. Does your husband stay in this household? Base: all respondents in Ganze (496), Kibarani (503), 16-18 (n=25), 19-24 (n=350), 25-34 (n=464), 35-44 (n=134), 45+ (n=26) 133

low base

NO 30%

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Number of children parent of / cared for Family size in urban areas is notably smaller than in rural – one less child on average per family.

35%

3.1 Mean 1

2–3

12%

45+ years

2.3 Mean 4%

4%

23%

12%

31%

low base

37%

34%

24%

19%

22%

52%

25–34 years 47%

Ganze

42%

1.7 Mean

19–24 years

6+ 35%

4%

67%

16–18 years

Kibarani

29%

low base

A1. Number of children parent of / directly responsible for Base: all respondents in Ganze (496), Kibarani (503), 16-18 (n=25), 19-24 (n=350), 25-34 (n=464), 35-44 (n=134), 45+ (n=26) 134

2.9 Mean 5% / 1%

52%

42%

25%

4.5 Mean

35–44 years

14%

21%

4–5

3.5 Mean

1.5 Mean

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Household size Family size in urban areas is notably smaller than in rural – one less child on average per family.

9.2 8.4

Own children in household Other people in household

9.4

45+ years

1 7.6

1

1

2.7

11.7

35–44 years

3.1 2.3

8.8

25–34 years

Respondent 6.6

19–24 years

4.7

TOTAL

5.1

4.2

Ganze

Kibarani

6.2

16–18 years

A1. Number of children parent of / directly responsible for. A3. Household composition Base: all respondents in Ganze (496), Kibarani (503), 16-18 (n=25), 19-24 (n=350), 25-34 (n=464), 35-44 (n=134), 45+ (n=26) 135

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Household size age of caregiver

9.5

Own children in household Other people in household

13.2

4.9

1

1

3.5

7

9.5

1

5.2

5.3

3.3

Respondent 7.2

6.5

1

4.2

1

3.9

2.0

1.7

Ganze

A1. Number of children parent of / directly responsible for. A3. Household composition Base: all respondents in Ganze (496), Kibarani (503) 136

45+ years

35–44 years

25–34 years

19–24 years

16–18 years

3.6

4.7

3.6

5.4

2.6

1

1

4.5

1.5

1

3.5

3

Kibarani

1

1

9.3

1

5

6

8

10.1

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Household composition: Ganze

A3. Other than yourself and the child or children you already mentioned, who lives in this household? Base: all respondents in Ganze (496), Kibarani (503) 137

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Household composition: Kibarani

A3. Other than yourself and the child or children you already mentioned, who lives in this household? Base: all respondents in Ganze (496), Kibarani (503) 138

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Financially supporting & looking after 0–3 year olds Kibarani mothers have far less childcare support (non-financial) than those in Ganze – from GANZE their own children, siblings and parents.

Ganze

93% 95%

Support financially

61% 62%

KIBARANI

Kibarani

You

92%

86%

60%

96% 95% 96% 96%

93% 77%

77%

Your husband

48% 46% 43% 40%

Cares for

2% 3%

30% 40% 35% 40%

Does most caring for

3% 5% 8% 12%

Driven by larger household size, e.g. greater number of households with parents, siblings and own children

70% 76%

18% 28% 17% 26%

Net: Children

Net: Siblings

45%50% 41% 47% 3% 1%

21%

3% 1%

8% 11%

3% 10% 4% 10%

9% 11%

7% 7%

Net: Parents

9% 9%

1% 1% 2% 3% 1% 2%

Net: Grandparents

18% 16%

1% 0% 2% 1% 1% 1%

A4a/b/c. Thinking about the people in your household, who contributes money to your child’s upbringing / helps you look after / does most when it comes to looking after your 0–3-year-old?

Base: all respondents in Ganze (496), Kibarani (503) 139

35%

30%38%

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Working, supporting & looking after 0–3 year olds All

All mothers who work

61%

86%

You

93%

96%

95%

Support financially

96% 77%

70%

Your husband

48%

45%

43%

41%

Cares for

2%

3%

Net: Children

30%

35%

35%

Does most caring for

38% 3%

3%

Net: Siblings

8%

10%

8%

10%

9%

7%

18%

18%

Net: Parents

17%

16% 1% 2% 1%

1%

Net: Grandparents

2% 1%

A4a/b/c. Thinking about the people in your household, who contributes money to your child’s upbringing / helps you look after / does most when it comes to looking after your 0–3-year-old?

Base: all respondents (999) & all who work (459) 140

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Playing with 0–3 year old Interesting to note such a high % of husbands (46 & 55%) play with 0–3yr olds.

After mothers, children are next most likely to play most frequently with 0–3yr olds.

Ganze You

87%

Ganze

Kibarani

Kibarani

46% husband in HH 60% 2+ children in HH

Your husband

34%

41% parents in HH

11%

21%

2%

7%

4%

40%

55% husband in HH 61% 2+ children in HH

Net: Siblings

7%

51% siblings in HH

Net: Parents

8%

65% parents in HH

Net: Grandparents Other family members Someone else

A5. Still thinking about your 0–3-year-old child, which three members of your household plays with him/her the most? Base: all respondents in Ganze (496), Kibarani (503).

141

42%

Net: Your children

46%

45% siblings in HH

93%

1%

3%

5%

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Others looking after 0–3 year old Unpaid neighbours are most frequently used for childcare. How can we support them to better support children?

Ganze

Kibarani Your neighbours (not paid by you)

46%

Ganze

Siblings aged below 16

13%

Kibarani

9%

Siblings aged 16 or above

9%

4%

Your neighbours (paid by you) House help

6%

1%

A6. How often, if at all, are any of the following involved in looking after your 0–3-year-old? Base: all respondents in Ganze (496), Kibarani (503) 142

48%

A daycare / babycare centre

5%

4%

2%

1%

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Monthly spend on childcare for 0–3 year old children Ganze

Kibarani over 5,000 ksh

Ganze 1,768ksh Mean amounting to 5% of monthly household income (crude calculation)

3,000 – 5,000 ksh

2,000 – 3,000 ksh

1,500 – 2,000 ksh

Kibarani 2,168ksh Mean amounting to 6% of monthly household income (crude calculation)

1,000 – 1,500 ksh

750 – 1,000 ksh

500 –750 ksh

250 – 500 ksh

100 –150 ksh

0–100 ksh

A7. Approximately how much do you spend every month on childcare for your 0–3-year-old children, for example in payments to neighbours, daycares, ECD centres or primary schools?

Base: all respondents in Ganze (496), Kibarani (503) 143

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Role played by father in upbringing of 0–3 year old Interesting that 45% Ganze fathers outside the household still play a major role, compared to 7% of those out of the household in Kibarani.

Possibly due to polygamy in Ganze and Kibarani fathers moving away/age of father.

Ganze

Kibarani

9% 15%

Support financially 15%

Plays major role

10% 83%

44%

Husband lives in household

Husband doesn’t live in household

A8. Thinking about the father of your child / children, what sort of role does he play in their upbringing? Base: all respondents in Ganze (496), Kibarani (503) 144

88%

Husband lives in household

7%

Husband doesn’t live in household

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Why is husband not involved?

Kibarani fathers appear more progressive – only 31% of those not involved don’t see it as their role, compared to 57% in Ganze.

Traditional gender norms have a greater impact in rural areas, where in the city fathers are more ready to play an active role in the lives of their young children.

59%

Ganze 9% of households Husband doesn’t live in the household AND doesn’t play a role in the upbringing of 0–3 year old

57%

45% 39%

31%

31% 28% 24%

Kibarani 6% of households

17%

Husband doesn’t live in the household AND doesn’t play a role in the upbringing of 0–3 year old

13%

11%

0%

Left the family

Doesn’t think it’s his role

With another wife

A9. Which, if any, of the following are reasons why the father of your child aged 0–3 plays a minor or no role in their upbringing?

Base: all respondents answering respondent not living in HH and not playing any role in upbringing of 0–3 year old in Ganze (46), Kibarani (29) 145

Refused

Working away from home

Other

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Father’s contribution to lives of 0–3 year old For Kibarani mothers without husbands in the household, 80% receive no financial support from, compared to 38% in Ganze.

Ganze 100% of costs

75%

Husband in household

Husband not in household

2 3 % % 10%

34%

38%

51%

8%

10%

16%

28%

50%

25%

Kibarani Husband in household

2 2 % % 10%

21%

65%

None Husband not in household

80%

7%

A10. How much does the father of your child / children aged 0–3 contribute financially to their lives? Base: all respondents in Ganze (496), Kibarani (503) 146

4 %

3 %

6%

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Profiling Kibarani households with / without husband

Profiling Kibarani HHs with / without husband

(i) NB: proxy for profiling of no husband HHs with (i) contribution no financial husband.

NB: proxyby for profiling of no husband HHs with no financial contribution by husband

Demographics

Age (mean) More than a year in area

HH composition

Other children in HH (net) Siblings

Working and income

Managing return to work

Parental / caregiving status

Parents Working (net) Own income Household Share of HH income Took / take baby with me to work Left / leave baby with siblings (under 16 years) Left / leave baby with other relative (under 16with years) Left / leave baby mother / mother in law / grandmother Parent only Caregiver only Both # children cared for

147

Husband in household 27.89 78%

Husband not in household 29.65 84%

30% 5%

3% 35% Ksh 3214 Ksh 9324 34%

40% 25%

32% 53% Ksh 3929 Ksh 8122 48%

57% 3% 14%

45% 8% 16% 19%

94% 3% 3% 2.34

86% 8% 6% 2.23

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Profiling Kibarani households with / without husband

Profiling Kibarani HHs with / without husband

(ii) NB: proxy for profiling of no husband HHs with (ii) contribution NB: proxy for profiling of no husband HHs with no financial contribution by husband no financial by husband.

Support 0-3 year old upbringing financially

You Your parents Number of contributors (mean)

Husband in household 52%

Husband not in household 83%

1% 1.53

28% 1.35

Do most to look after 0-3 year old

You Your children Your siblings Your parents Number of contributors (mean)

97% 32% 2% 3% 2.22

95% 24% 11% 26% 1.90

Play with 0-3 year old

You Net: Children Net: Siblings (your siblings) Net: Parents

94% 43% 3% 4%

90% 32% 18% 23%

Advice seeking

A doctor / nurse Your mother A close friend or neighbor Â

47% 26% 15%

36% 36% 12%

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Father spending time with 0–3 year old(s), i.e. playing games with, soothing, talking to Kibarani dads are significantly more engaged than Ganze fathers (80% are playing games/soothing/ talking a few days/week or more, compared to 51% in Ganze). However, for 25% of households with no husband, 83% of these never see their children – significantly more than Ganze (38%).

Every day Most days

NB: asked of those who said husband plays a role in 0–3 upbringing

Total Ganze

17%

21%

Husband in household

4% 14%

Husband not in household

38%

8%

10%

18%

15%

15%

23%

21%

34%

32%

15%

10%

4% 1

Ganze Kibarani

1

A few days a week

Husband not in household

83%

Once a week or less

Husband in household

2 6%

Total Kibarani

21%

9%

12%

17%

16%

47%

Rarely Never

6%

10%

13%

13%

37%

A11. How often does the father of your child / children aged 0–3 years spend time with, e.g. playing games, soothing, talking to the child / children aged 0–3years?

Base: all respondents answering husband plays a role in upbringing of 0–3 year old in Ganze (433), husband in HH (268), not in HH (165), Kibarani (467), husband in HH (359), not in HH (108) 149

3

2 2

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Looking after baby when returning to work Many mothers take their babies with them to work, and their mothers/mothers in law play a prominent role in babysitting.

Ganze

Kibarani Take to work

51%

Ganze 51% returned to work

Leave with siblings <16

9%

Kibarani 38% returned to work

Leave with siblings >16

5%

2%

3%

Leave with father

5%

15%

3%

Leave with neighbour

leave at daycare

2%

6%

7%

Leave with older relative

0%

Leave with househelp

B7b. When you returned to work, what did you do with your baby? Base: all respondents who returned to work in Ganze (253) and Kibarani (191) 150

47%

9%

3%

7%

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Looking after baby when returning work – by when age returning to work – by Looking to after baby

age

Total

19-24

25-34

35-44

Took / take baby with me to work

50%

54%

51%

44%

Left / leave baby with mother / mother in law / grandmother

18%

24%

16%

9%

Left / leave baby with siblings (under 16 years)

8%

3%

8%

16%

Left / leave baby with house help

7%

6%

8%

7%

Left / leave baby with other relative (under 16 years)

5%

2%

5%

7%

Left / leave baby with neighbour

5%

4%

7%

4%

Left / leave baby at day-care centre

2%

3%

3%

-

Left / leave baby with father

1%

-

0%

5%

Other

4%

5%

2%

8%

B7b. When you returned to work, what did you do with your baby?

Base: all respondents who returned to work (444), 19-24s (127), 25-34s (223) and 35-44s (75) B7b. When you returned to work, what did you do with your baby? Base: all respondents who returned to work (444), 19-24s (127), 25-34s (223) and 35-44s (75) 151

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O

Appendix Quantitative Research

Leaving children with others for 5+ hours It is more acceptable in Ganze for 0–3yr olds to be left with others for 5+hrs than in Kibarani.

17%

23%

20%

19%

11% 20%

14% 15%

21%

21%

27%

26%

25%

32%

56%

53%

55%

55%

57%

71%

<1s only

<2s only

<3s only

<4s only

<4s to 4–6s

<4s to 4–6s and older

58%

60%

58%

58%

55%

52%

Have done this

62%

Haven’t done this but would

Ganze Kibarani 57%

Haven’t done this and wouldn’t

18%

18%

16%

17%

16%

25%

24%

24%

25%

26%

A12a. At what age did you start or would you start leaving your child / children with others for long periods of time (5 hours or more)? Base: all respondents in Ganze (496), Kibarani (503) 152

25%

12% 36%

20%

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Appendix Quantitative Research

Leaving children with others for 5+ hours – at what age?

11% Kibarani mums are leaving 0–3 month babies for 5+hrs (compared with 3% Ganze).

12-18 months shows a sharp increase in mothers leaving their children (reflective of the Vulnerability Gap).

Average age of child:

Ganze 15.4 months

22% 19% 15%

Kibarani 13.3 months 11%

20% 16%

15%

13% 11% 9%

12%

8% 0%

9% 9% 7%

3% Less than 3 months

3-5 months

6-8 months

9-11 months

12-17 months

18-23 months

24-35 months

3 years or older

A12b. At what age did you start or would you start leaving your child / children with others for long periods of time (5 hours or more)? Base: all respondents who would or have left their child / children in Ganze (496), Kibarani (503) 153

O

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Appendix Quantitative Research

Age baby can be left with 8–16 year old sibling/relative Again, vulnerability gap is suggested from 12 –18 months, when children are left with siblings.

Average age of child:

Ganze 18.5 months Kibarani 19.0 months

0% Less than 3 months

3-5 months

6-8 months

9-11 months

12-17 months

18-23 months

A13. From what age can a baby be left with its older sibling or relative (aged 8-16 years)? Base: all respondents who would or have left their child / children in Ganze (471) and Kibarani (432) 154

24-35 months

3 years or older

O

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Appendix Quantitative Research

Required age of sibling/relative looking after 0–3 year old 12-13 years is the acceptable age to start looking after a 0–3yr old.

Average age of sibling/relative:

62%

Ganze 12.1 years

46%

Kibarani 13.0 years 19% 10%

7% 0%

2% 1% 4–5 years old

16%

16% 13%

2%

6%

6–7 years old

8–9 years old

10–11 years old

12–13 years old

A14. And how old does a sibling or relative need to be to look after their 0–3-year-old relative? Base: all respondents who would or have left their child / children in Ganze (452) and Kibarani (437) 155

14+ years old

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

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Turned to for advice on care for 0–3 year old

Appendix Quantitative Research Ganze

18%

30% of Ganze mothers have no one to turn to for advice.

This is less in Kibarani (16%). Mothers are a key source of advice, but less so in Kibarani where they’re not present. CHVs are generally less popular than docs, family members and friends – clearly not trusted in Kibarani (4%).

4%

42%

Ganze

Kibarani A community health volunteer

A teacher

A doctor / nurse

4%

2%

50%

28%

A close friend or neighbour

25%

1%

Someone at the nursery

0%

41%

Your mother

29%

Kibarani 6%

15%

4%

A15. Who have you ever turned to for advice? Base: all respondents who would or have left their child / children in Ganze (452) and Kibarani (437) 156

Your grandmother

Other member of your family

Someone else

NB

NB

5%

6%

NB

3%

1%

Website

1%

28%

Haven’t / wouldn’t turn to anyone

16%

NB

O

An Exploration of Childhood and Childcare for 0–3 year olds in Coastal Kenya

Would turn to/first for advice on 0–3-year-old care Doctors and mothers remain the most trusted sources of advice in both locations. Friends and neighbours more trusted in rural – perhaps reflecting weaker sense of community in urban areas.

Appendix Quantitative Research Ganze

55%

Kibarani 56%

A doctor / nurse

39% 49%

44% 37%

Your mother

34% 30%

18%

10% 2% 6% 2% 5% 0% 4% 2% 1% 0% 1% 0% 10% 8%

14% 7%

Other member of your family

6%

Turn to first

24%

A close friend or neighbour

7%

Turn to

28%

A community health volunteer

Your grandmother

A teacher

Someone else

Someone at the nursery

Website

Haven’t / wouldn’t turn to anyone

4% 6% 2% 6% 2% 1% 0% 2% 1% 1% 0% 1% 0% 6% 3%

A15. Who would you turn to / turn to first for advice about your 0-3 year old? Base: all respondents in Ganze (496), Kibarani (503). NB: mother in HH based on households with mother or partners mother 157

O

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Appendix Quantitative Research

Local facilities available for pregnant women State services far less prevalent in informal settlements, where private clinics dominate. Heightened awareness of Lindamama insurance in urban centre.

57%

53%

Ganze / Pregnant

51% 43%

26%

28% 19%

15% 4%

Private clinic 81%

Clinic open to the public

Health centres

Sub-district / district hospital

3%

Lindamama / Lindamama

5%

3%

Community health volunteers

78%

Kibarani / Pregnant 17%

15%

22% 7%

0%

Private clinic

Clinic open to the public

Health centres

4%

Sub-district / district hospital

B1. What facilities are available for pregnant women in this local area? Base: all respondents in Ganze (496) all pregnant in Ganze (40), Kibarani (503), all pregnant in Kibarani (23) 158

4%

9%

Lindamama / Lindamama

3%

0%

Community health volunteers

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Appendix Quantitative Research

Where gave birth to 0â&#x20AC;&#x201C;3 year old child/ren Kibarani

Majority having hospital births, although midwives become more common with subsequent births in urban area.

Ganze 4%

4%

At home, no midwife present

5%

3% 5%

6%

Child 1 15%

8%

Child 2

At home, midwife present

12%

Child 3

16%

19%

18%

73%

83%

At a hospital

77%

75% 70%

71%

7%

4%

At a clinic

5%

7% 8%

2%

0%

1% 1% 2%

Somewhere else

0% 0%

B2. Where were you when you gave birth to your 0-3-year-old child / children? Base: all respondents in Ganze (496) and Kibarani (503), all with 2 0-3 year olds, all with 3 0-3 year olds 159

O

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Appendix Quantitative Research

Visits to the clinic/hospital during pregnancy â&#x20AC;&#x201C; by age 78%

Prenatal visits are being postponed til later stages, perhaps owing to cost of appointments.

73% 73%

Ganze

Kibarani 36%

36%

32%

13% 9% 4% 0%

in the first month

in the 1st to 3rd month

in the 4th to 6th month

in the 7th to 9th month

B3. Thinking back to when you were pregnant with your (youngest) 0-3-year-old, when did you visit the clinic or the hospital? Base: all respondents in Ganze (496) and Kibarani (503) 160

didnâ&#x20AC;&#x2122;t visit clinic or hospital

O

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Appendix Quantitative Research

Visits to the clinic/hospital during pregnancy – by age

81% 76%

Every day

77% 71%

68% 64%

Most days

62%

55% 55%

Once a week or less

50%

Rarely

40% 34% 35%

37%

Never 50% 10% 10% 13%

10%

8%

8%

8% 4% 1%

in the first month

in the 1st to 3rd month

in the 4th to 6th month

in the 7th to 9th month

1%

didn’t visit clinic or hospital

B3. Thinking back to when you were pregnant with your (youngest) 0-3-year-old, when did you visit the clinic or the hospital? Base: all respondents aged 16-18 (25), 19-24 (350), 25-34 (464), 35-44 (134), 45+ (26) 161

O

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Appendix Quantitative Research

Postnatal visits to the clinic/hospital

50%

Ganze Average visits: 3.1

36%

34%

Kibarani Average visits: 1.9

24%

23% 15%

15%

14% 8%

Ganze

27%

26%

8%

5%

4% 1–2 days

3–5 days

6–7 days

week 2

week 3

30%

18%

week 4

week 5

week 6

17% 7%

5%

6–7 days

week 2

week 9

week 10

week 11

week 3

week 4

week 5

16%

4%

Kibarani 3–5 days

week 8

4%

3% week 12

week 13

week 14

later

30%

15% 6%

1–2 days

week 7

13%

week 6

week 7

3% week 8

B4. And after you gave birth to your (youngest) 0-3-year-old, when did you visit the clinic or the hospital? Base: all respondents in Ganze (496) and Kibarani (503) 162

14%

week 9

13%

6% 2% week 10

week 11

2% week 12

week 13

week 14

27% later

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O

Number of visits by community health volunteer(s) The majority of households have never had a CHV visit.

Appendix Quantitative Research

Ganze

38% ever

10% of households

90% of households

19% ever

39% ever

1% 6%

5%

Every week Every month

10%

8%

1%

5%

5% 5%

20% of households

80% of households

17% ever

25% ever

1% 1%

3% 1%

1% / 6%

5%

8%

11% 8%

14%

23% ever

1% 4%

10%

Kibarani

12%

5%

12%

14%

Every few months Twice Once Never

62% TOTAL

81% A year or less

B5. In the past year, how often has the community health volunteer been to see you? Base: all respondents in Ganze (496) and Kibarani (503) 163

61% More than a year

77% TOTAL

83% A year or less

75% More than a year

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Appendix Quantitative Research

Topics talked about with CHV(s) 64%

60%

64%

Ganze Visited by CHVs 37% topics discussed: 4

54%

Kibarani Visited by CHVs 23% topics discussed: 2.6

37%

35%

32%

20%

20%

7%

Sanitation

Child’s nutrition

Pregnancy

Your nutrition

Cleanliness

Child’s health

HIV Being a good mother

40%

41%

25%

28%

29%

29%

16%

17%

Child’s learning

Exercise

8%

4%

B5b. Which if any of the following topics did the community health volunteer talk to you about when you last saw him / her? Base: all respondents in Ganze (496) and Kibarani (503) 164

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Appendix Quantitative Research

Awareness of LINDAMAMA and other schemes Despite its early days, awareness of Lindamama is strong.

23%

Unaware 12%

Aware but unable to name specific schemes Mentioned Lindamama

49%

43%

47%

40%

48%

52%

42%

49% 16%

15%

16%

67%

15%

22%

24%

15%

36%

35%

36%

37%

33%

42%

16–18

19–24

25–34

35–44

15%

5%

36%

37% general

TOTAL

28% pregnant

general

Ganze

B6a. Are you aware of any free health insurance schemes to do with pregnancy? Base: all respondents in Ganze (496) and Kibarani (503) 165

pregnant

Kibarani

by age group

65% 45+

O

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Appendix Quantitative Research

Ownership of media devices High radio and basic mobile penetration.

TV far more prevalent in urban areas.

Ganze Ganze 89% own at least one Kibarani 94% own at least one

Kibarani

Radio

57%

62%

TV

54%

51%

Mobile phone with internet

18%

54%

Mobile phone

26%

2%

11%

Desktop / laptop computer

None of these

C1. Which of the following do you own or have access to in your home? Base: all respondents who returned to work in Ganze (253) and Kibarani (191) 166

33%

1%

6%

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Appendix Quantitative Research

Usage of media devices / favourites Ganze

Kibarani

Radio

30% 36%

TV

41%

42%

12%

11%

Mobile phone with internet Mobile phone 14%

16%

Desktop / laptop computer

34% 36%

None of these 1%

21% 9%

Used in past week

1%

18%

18% 1% 9%

15%

7% 1% 9%

Favourite

4% 9%

Favourite

Used in past week

C2. Which of the following have you used or accessed in the past week? C3. Which of the following is your favourite media, i.e. the media that you use or access most often? Base: all respondents in Ganze (496) and Kibarani (503) 167

O

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Appendix Quantitative Research

Ownership of media devices by age

52%

46%

Radio

56%

55%

56%

61%

Relatively uniform across age ranges.

23% 15%

35–44

0%

0%

0%

25–34

12%

19% 10%

1%

19–24

34%

24% 19% 12%

16–18

1%

0%

0%

TOTAL

21%

19%

20%

16%

14% 1%

12%

None of these

18%

Desktop / laptop computer

20%

22%

Mobile phone

10%

Mobile phone with internet

35%

34%

36%

TV

45+

C2. Which of the following have you used or accessed in the past week? C3. Which of the following is your favourite media, i.e. the media that you use or access most often? Base: all respondents across Ganze and Kibarani (999) 168

O

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Appendix Quantitative Research

Media sources â&#x20AC;&#x201C; usage and trust

Ganze

Radio

Kibarani

33%

TV

59%

30%

42%

53% 52%

49%

Mobile phone with internet

11%

Mobile phone

15% 29%

Desktop / laptop computer

14% 11%

22%

None of these

16% 12%

1%

Used past week

34%

43%

22% 18%

18%

1% 14%

10% 5%

7%

11%

9%

10%

Favourite

Trust most

Trust most

Favourite

169

12% 6%

14%

C2. Which of the following have you used or accessed in the past week? C3. Which of the following is your favourite media, i.e. the media that you use or access most often?

Base: all respondents in Ganze (496) and Kibarani (503). NB: data for favourite and trust most manipulated (rebased) to ensure total sum of 100%

1%

1%

Used past week

Acknowledgements This research was made possible by the participation of many people.

We are hugely grateful to the contributions made by our research participants in Ganze and Kibarani, as well as to our Steering Committee members for their ongoing contributions and support.

We would also like to thank the individuals who participated in our initial interviews: – Atrash Ali, Aga Khan Foundation – Nuala Alibhai, Education Consultant – Kathy Bartlett, ECD Consultant – Lisa Bohmer, Hilton Foundation – Rupert Corbishley, Aga Khan Foundation – Amanda Devercelli, World Bank – Esther Goh, Bernard Van Leer Foundation – Rob Hughes, Children’s Investment Fund Foundation – Penny Holding, GCC Saving Brains – David Jeffery, Mikhulu Trust – Dr Alison Joyner, Plan International – Alice Kabwe, Africa Early Childhood Network – Oscar Kadenge, PATH – Professor Katana Gona, Kilifi County Education Board – Ciara Laverty, Lego Foundation – Eric Lindland, Frameworks Institute – Dr Joan Lombardi, Early Opportunities LLC – Rachel Machefsky, Bernard Van Leer Foundation – Dr Kofi Marfo, Aga Khan University – Stella Ndugire-Mbugua – Daphne Metland, Baby Center – Janet Mwitiki, Kidogo – Amina Mwitu, Aga Khan Foundation – Dr Teresa Mwoma, ECD Network for Kenya – Najma Rashid, Ind. ECD Consultant – Arif Neky, UN Strategic Partnership Platform – Agnes Ngonyo, UNICEF – Beatrice Ogutu, ICS Africa – Elvira Thissen, Bernard Van Leer Foundation – Ben Piper, RTI – Tarun Varma, Lego Foundation – Erika Wiese, Innovation Edge

We couldn’t have completed the project without contributions from our local research team, film team, translators, researchers and designers:

– James Lewis – Jen Fearnley – Emily Kay – Anton Yavorsky – Fred Pearson – Mike Keelin – Guillem Matallanas – Havi Murungi – Caroline Wachira – Henry Mwadime – Ruman Idris – David Musasia – Cyrus Uyayi – Josephine Mwangemi

170

Funded by The Kays Foundation / Research by The Good Side