Caixin Column 9: China's Most Vulnerable Children

At every conference we attend, we hear statements from our colleagues like: “I study Left Behind Children, the most vulnerable children in China.”

Each year in the media, journalists write literally thousands of investigative reports about Left Behind Children. In nearly all of these articles, the reporter interviews young children that live with their grandparents because their parents are working far away in the city. The conclusion of these reports is almost always the same: Left Behind Children are one of China’s largest social problems. Society and the government need to pay special attention to them.

When you look at the websites of China’s ministries and their provincial/sub-provincial counterparts, one can find that more than 10 ministerial systems – among them the Ministry of Education; Ministry of Health; Center for Disease Control; Ministry of Civil Affairs; All China Women’s Federation and more – have special programs to meet the needs of China’s Left Behind Children: China’s so-called “most vulnerable children”.

With this background, let us be clear about the three main messages of this month’s column:

  1. Left Behind Children are NOT the most vulnerable children in China.
  2. Left Behind Children do NOT need any special treatment.
  3. Policies that target Left Behind Children are misguided.


(Is that what you are thinking?)

We actually have made these same statements at seminars in front of fellow academics, at meetings with NGOs, and in conversations with policy makers and government officials. Their responses are almost always the same: “Wow!”

Do we really believe these statements?

The answer is a “qualified yes.”

Yes: Because these are absolutely true statements. In almost every dimension that we can think of, Left Behind Children are not the most vulnerable children in China. Other children in poor rural areas (such as those who live with their parents) are in even greater need of more education; of better nutrition; of higher quality health care,

But, qualified: Because, while all of this is true, Left Behind Children are still vulnerable and in need of the nation’s support.

In other words, Left Behind Children are NOT the most vulnerable children in China. All children in poor rural areas are in need of more education, better nutrition, and higher quality health care. Left Behind Children certainly have tremendous needs. However, other children in poor rural areas—including children living with their parents—have either equal or even greater needs. And with all of the attention lavished on Left Behind Children, these other vulnerable children are being systematically overlooked.

We hope that the media, government policy makers, academics who work on under-resourced areas, and all concerned readers of CaiXin Magazine will take the time to read about the facts.

The facts will tell our story.

But, before we get into the facts, let’s take a minute to describe where the facts came from.

If you have been following our column since last fall, you know that our organization, the Rural Education Action Project (REAP), has been working in poor rural areas across Western China for the past ten years. Our mission is to help narrow the gap in education, nutrition and health between children in poor rural areas and children in the rest of China. To do so, we conduct “action research.” In carrying out action research, we not only identify the problems facing rural children and their families, we also experiment with solutions. Partnering with foundations, NGOs and government agencies (as well as implementing our own action research projects), we seek to find out what types of programs, projects and investments lead to improvements in rural education, nutrition and health … and which ones do not. We then work with government agencies to upscale the successful ones.

In the past we have worked on many issues: school nutrition, life counseling; computer assisted learning; infant nutrition; intestinal worms; poverty; school drop outs; and more. In total, over the past 10 years, we have conducted more than 20 action research projects in poor rural schools and villages. In conducting these in-the-field experiments and partnering with many creative and influential groups, we have discovered many new ways to help increase human capital in poor areas and have been associated with several successful efforts to upscale our small projects across whole counties, prefectures, provinces and indeed the whole country.

In the course of doing our work, we always evaluate our projects and seek to identify impact. And in carrying out these evaluations, we conduct a detailed baseline survey before each and every project. Not only were all of the samples randomly selected, we also know for each child what type of family he was living with: (1) Both mother and father live at home; (2) Mother living at home, father not living at home; (3) Father living at home, mother not living at home; (4) Left Behind Children (mother and father both live away from home). We have objective measures of 14 different outcomes, including health, nutrition, mental health, and many others. In total, our surveys include data from more than 130,000 children and their families

Armed with this data, our approach is simple: We will compare the nutrition, health and educational outcomes of children from Type 1 families (children living with both parents) to the outcomes of Type 4 families (where both parents live away from home and children are cared for by their grandparents or other relative—Left Behind Children).

As empirical economists, we like to let the data speak. What do the numbers say?


Both Left Behind Children and children living with both parents have the same incidence of anemia. A full 27 percent of both types of children are malnourished. Their levels of hemoglobin, a measure of iron deficiency, are also identical.


The rates of stunting and wasting among Left Behind Children is not low. However, the weight for age indices (WAZ) and height for age indices (HAZ) are more favorable than those of Children Living with their Parents. The body mass indices of Left Behind Children also are more favorable than the body mass indices of Children Living with Their Parents.

In the case of intestinal worm infections there is even a larger gap. The prevalence of intestinal worm infections is high among Left Behind Children, at 25 percent. To be clear, this means that more than one out of four school-aged children live and go to school with worms in their intestines. However, the prevalence is even higher among children living with both parents: fully 39 percent are infected with worms.


To compare the educational performance of Left Behind Children and children living with both parents, we gave standardized exams in math, Chinese language and English. These are the three main academic subjects that students must learn in the Chinese school system. In other work, REAP researchers have shown the huge gap between children from poor rural areas and children from China’s cities. We showed that, on average, children in poor rural areas perform much, much worse than children in urban areas. Poor rural children are nearly two years behind by the time they reach fourth grade.

So while all of the different subgroups of poor children perform poorly, on average, Left Behind Children actually outperform children living with both parents in all subjects. To be clear, the children who score the lowest on their math tests, their Chinese language tests, and their English tests are not Left Behind Children; they are children living with both parents.

These trends continue even as children get older. The drop out rate from junior high school (which is technically supposed to be zero) is equally high for children living with both parents as it is for Left Behind Children.

Mental Health

There is one set of outcomes for which Left Behind Children do show the most vulnerability: mental health. Around 37 percent of Left Behind Children had high levels of anxiety, and 33 percent were “lonely.” These levels were, indeed, higher (although only slightly higher) than those of children living with both parents.

The numbers have spoken, and they have spoken clearly. Left Behind Children are NOT the most vulnerable children in China. All children in poor rural areas are in need of more education, better nutrition, and higher quality health care. Left Behind Children have tremendous needs, no question. However, other children in poor rural areas—including children living with both parents—have equal or even greater needs.

What can we say about this message except: “Wow!”

A postscript: Resources versus Care

We really do not know why it is that, with the exception of mental health outcomes, Left Behind Children perform either equally as well or even better than children living with both parents in terms of nutrition, health and education. Our guess is that it is almost certainly because there is some sort of “care versus resources” tradeoff at play. Without question, children living with both parents receive more care than Left Behind Children. However, with the high and rising wage rates in China, if both parents of a Left Behind Child are working full time, they will have access to more resources than the families of children living with both parents. If both parents are working in the city, their monthly income will be much higher than a family in which both parents are working on the farm. Hence, it appears as if access to more resources helps, at least in part, to offset the negative effects of the absence of care.

And perhaps the care of Left Behind Children is not as bad as everyone thinks. In interview after interview with parents of Left Behind Children, parents told us that they would never leave their child at home if Grandma and/or Grandpa were not capable of giving quality care. So, it may be that the additional resources that are brought in by migrant parents coupled with care from capable grandparents are jointly enough to allow Left Behind Children to outperform (or match) children living with both parents in most measures of nutrition, health and education.

No matter the reason, it is clear that children living with both parents are being overlooked by the popular media, by policymakers, and by academics. While it is premature to suggest that Left Behind Children are no longer in need of help, it is equally unconscionable to imagine that rural children living with their parents are not in need of the same social assistance that is granted to Left Behind Children. We need to come up with a policy solution that will allow all poor children better access to the resources they need to thrive.


About this series:

REAP co-directors Scott Rozelle and Linxiu Zhang wrote a ten-part series for Caixin Magazine titled, "Inequality 2030: Glimmering Hope in China in a Future Facing Extreme Despair." See below for more columns in this series:

> Column 1: Why We Need to Worry About Inequality

> Column 2: China's Inequality Starts During the First 1,000 Days

> Column 3: Behind Before They Start - The Preschool Years (Part 1)

> Column 4: Behind Before They Start - The Preschool Years (Part 2) 

> Column 5: How to Cure China's Largest Epidemic

Column 6: A Tale of Two Travesties

>Columns 7 & 8: China's Widest Divide

> Column 9: China's Most Vulnerable Children

> Column 10: Why Drop Out?

> Column 11: The Problem with Vocational Education

> Column 12: Reforming China's Vocational Schools (in Chinese)