My PhD research explored linkages between the poor developmental outcomes associated with stunting and classroom learning among early primary students in Ghana. My work was supervised by Dr. Ricardo Sabates and advised by Dr. Nidhi Singal, members of the REAL (Research for Equitable Access and Learning) Centre at the University of Cambridge Faculty of Education. Research was generously supported by the Royal Geographical Society’s Slawson Award, the University of Cambridge Faculty of Education Fieldwork Fund, and the Mary Euphrasia Mosley Travel Fund, the Hughes Hall Edwin Leong Travel Grant, and the UAC of Nigeria Travel Fund.
Research Summary
To address the global learning crisis and fulfil the promise of education for all, we need to understand how early childhood adversity and malnutrition shape the unmet learning needs of students in low- and middle-income countries (LMICs). Exposure to undernutrition, poor health, and extreme poverty in their first months and years of life negatively affects child development and cognition for hundreds of millions of children around the world.
1 in 4 children under 5 in LMICs are affected by stunting, a measure of chronic undernutrition windows which negatively affects height, cognitive development, and metabolic health for the rest of their lives. Young people affected by stunting enrol in school later, drop out earlier, and earn less than their peers in adulthood, translating to $176.8 billion* of lost productivity per year.
Targeted child development interventions can mitigate early adversity before a child turns five, yet there is little research into what works among older children. The implication of this is that nutrition and child development researchers effectively give up on children affected by stunting once they turn five.
Across the global South, children who were considered most difficult to reach are now more likely to attend school than ever before in history. Educational systems in LMICs have developed to meet the needs of students which were until recently fairly homogenous and elite. As diversity increases, this manifests in the global learning crisis which saw 600 million children and adolescents unable to reach minimum proficiency levels in reading and mathematics in 2016 (UNESCO).
Acknowledging that not all struggling students are affected by stunting, I chose to look closer at how early adversity shapes the way students learn and what they need to thrive. As we re-imagine educational provision to better meet the needs of all learners, a substantial portion of students are likely to have experienced environmental or health inequities affecting their subsequent development.
My research examined learning among early primary students in rural and peri-urban government schools in the Northern region of Ghana. By comparing learners affected by stunting to classmates with otherwise similar backgrounds, I examined whether stunting predicted performance on tasks assessing memory, learning, and attention, and teacher’s assessment on a series of school readiness measures. Countering much of the stunting literature, I found no statistically significant differences between children whose height was categorised as stunted and their otherwise similarly marginalised classmates.
This study’s purposive pro-poor sampling strategy resulted in a study sample that collectively faced many disadvantages when compared to regional and national averages: underinvestment from colonial and postcolonial governments, centuries of out-migration, episodic conflict, increased climatic variability, and food insecurity among others. These factors increased the likelihood of exposure to early adversity for most if not all study participants, not just those whose height fell below the technical threshold for stunting. Thus, while many students in the study sample were categorised as stunted, a much larger portion of the sample were likely to have been affected by stunting.
In conclusion, this thesis finds that in rural and peri-urban government schools at the outskirts of the Tamale Metropolitan District, some students categorised as stunted struggled with learning, but so did many of their classmates. In a population where few students are likely to meet their physical growth potential, differences in patterns of individual student performance could not be predicted by whether that student’s growth was categorised as stunted. Rather than risk stigmatising this particular set of learners, findings indicate improved provision of academic support to all struggling students – at least in the research context – regardless of height-for-age z-score.
When it comes to early adversity, prevention is always better than treatment. But by treating early adversity deterministically, we ignore brain plasticity and the learning potential of hundreds of millions of children. There is more to understand, but we do know that meeting these needs requires systemic support for flexible, responsive learning environments. It also requires curiosity about what is working in challenging contexts, rather than blaming students, their families, or teachers for low levels of learning. It is possible for education systems to meet the needs of all learners, and this research hopes to contribute to that possibility.
*Fink et al., 2016
Deborah Spindelman 