Stanford Center on China’s Economy and Institutions is a joint effort of the Freeman Spogli Institute for International Studies and Stanford Institute for Economic Policy Research.
Stanford Daily reporter Kayla Chan spotlights Scott Rozelle, REAP Program Director, and the research he has conducted over his 40 years studying agriculture and development in China.
Achieving minimum dietary diversity (MDD), a crucial indicator of infant and young child diet quality, remains a challenge in rural China, especially for infants aged 6–11 months. This study examined the rate of MDD attainment in rural China, identified its determinants using the Capability, Opportunity, Motivation, and Behavior (COM-B) model and Bayesian network analysis, and estimated the potential impact of improving each modifiable determinant. A multi-stage sampling design selected 1328 caregivers of infants aged 6–11 months across 77 rural townships in China. Data were collected through a cross-sectional survey via in-person household interviews. Bayesian network analysis identified key factors influencing MDD attainment and their interrelationships, while Bayesian inference estimated MDD attainment probabilities. Results showed that only 22.2 % of the sample infants attained MDD. Bayesian network analysis revealed that caregiver knowledge (a proxy of capability), self-efficacy and habits (proxies of motivation), and infant age directly influenced MDD attainment. Social support (a proxy of opportunity) indirectly promoted MDD attainment by boosting self-efficacy and habit. Notably, simultaneous improvements in knowledge, self-efficacy, and habit could increase MDD attainment by 17.6 %, underscoring the potential effectiveness of interventions focused on enhancing caregiver capability and motivation. The critically low MDD attainment rate among rural Chinese infants highlights the urgent need for targeted interventions. Strategies should prioritize enhancing caregiver feeding knowledge, self-efficacy, and habit formation to improve infant dietary diversity. Addressing these key factors could substantially boost MDD attainment in rural China.
Background: The content of children’s screen exposure and interactive coviewing with caregivers are important determinants of early childhood development (ECD) that have been overlooked in past research in resource-limited rural regions. Given the prevalence of digital devices and diverse digital content today, determining screen use practices that minimize the negative impacts on children’s development is crucial for promoting healthy screen use among children.
Objective: This study aims to examine screen exposure among children aged <3 years in rural China and investigate its relationship with ECD outcomes, focusing on duration, content, coviewing, and interaction.
Methods: The sample includes all children aged between 6 and 26 months and their primary caregivers residing in the study area. A survey of screen exposure and household characteristics was conducted for 1052 eligible households. Caregivers reported the duration of screen exposure, defined as the average daily screen time over the past month; the content of exposure, defined by the time spent on educational and child-friendly content; and the caregiver’s presence and interaction with the child during exposure. ECD outcomes were evaluated using the third edition of the Bayley Scales of Infant and Toddler Development assessment scale and the Brief Infant Toddler Social Emotional Assessment. Ordinary least squares regression, logistic regression, and chi-square tests were conducted.
Results: In total, 28.23% (297/1052) of the children in our sample were first exposed to screens before the age of 12 months. Children exposed to screens had an average daily screen time of 27.57 (SD 38.90) minutes. Children who were exposed to screens before the age of 12 months and those who had longer screen time between the ages of 12 and 18 months were more likely to be at risk of motor developmental delays. Children exposed to educational content for >15 minutes on a daily basis had fewer social-emotional or behavioral problems than those with no screen exposure and a lower risk of delay in motor skills development than those exposed to educational content for <15 minutes on a daily basis. Caregiver interaction during screen exposure was associated with a lower risk of cognitive and language delays and better socioemotional skills.
Conclusions: The type of content viewed and how caregivers engaged in children’s screen time were strongly associated with ECD outcomes. Guiding parents to select educational content for their children and engaging in interactive coviewing may better protect children from the negative effects of screen exposure. The findings complement conclusions regarding the impact of screen exposure on ECD in resource-limited rural areas.
The 2nd International Symposium on Early Childhood Development, Advancing Development with "Children First" Strategy, was held in Hangzhou, China, March 27-29, 2025. It was hosted by: the National Clinical Research Center for Child Health; the Zhejiang University School of Medicine's Pediatric Hospital; Stanford University's Rural Education Action Program (REAP); and REAP's partner inside China, the 1000-Day Initiative. The symposium gathered over 100 experts from China and abroad to discuss cutting-edge developments, research topics, and practical approaches in early childhood development (ECD).
At a time when China's National Health Commission and its National Development and Reform Commission are considering upscaling a nationwide ECD program in rural China, the ECD symposium featured keynote speakers Professor Scott Rozelle, director of REAP at Stanford University, Ali Shirazi of UNICEF China, Professor Jiang Fan of Shanghai Jiaotong University's School of Medicine, and Professor Shao Jie of Zhejiang University's School of Medicine. The speakers delivered insights on the importance of ECD in rural communities for both the families themselves, as well as for China's overall economic development. Much of the discussion was focused on evaluating current pilot programs, reviewing research efforts, and developing policy recommendations for upscaling ECD across rural China.
Key Takeaways
The conference highlighted the importance of continued research, collaboration, and innovation to advance ECD and achieve high-quality population development. Both REAP and the 1000-Day Initiative was recognized for its contributions to exploring intervention models and fostering ECD in China.
Experience sharing. Many of the presentations and reports showed that investing in ECD projects is effective. One-on-one intervention models tailored to children and caregivers significantly enhance developmental outcomes. Training caregivers in health, nutrition, and mental health amplifies the impact of these initiatives. By focusing on underserved communities and understanding success factors, the lives of young children and their families can be transformed by ensuring ECD projects reach those in need and deliver meaningful benefits.
Researching cost effectiveness - and effectiveness. While it is known that it is possible to intervene and address the basic ECD challenges in rural China, one of the main goals now of academic and policy officials is to identify interventions that are also cost effective. Shen Yun, a postdoctoral scholar at REAP/Stanford University, is running a group-based training project in Zhejiang Province using a one-on-five approach to enhance early learning. In Hubei Province, Xiao Yuyin, also a REAP/Stanford University postdoctoral scholar, and Yiwei Qian, an associate professor at Southwest University of Finance and Economics (and former postdoctoral scholar at REAP/Stanford University) are principal investigators in an innovative "digital plus" intervention that combines digital technology with short-term (8-12 weeks), traditional one-on-one training methods. A cost-benefit analysis shows that if these interventions enhance cognition, language, and social-emotional skills, costs per child could drop to 30-40% of previous one-on-one training models, maximizing reach and impact. Professor Guan Hongyuan, Capital University School of Medicine, introduced a community-based parenting skills model emphasizing parental involvement in child development. These initiatives are vital in transforming education for young rural children.
Long-term impacts. In the presentation by Professor Wang Lei of Shaanxi Normal University (pictured right), the audience was shown the real importance of ECD training for mothers and grandmothers in fostering large, positive, short- and long-term child outcomes. In the longitudinal study with over 600 infants, about 300 received ECD training while the others did not. The results showed that not only did the treatment group children have significant improvements in cognition and language by age 3, even more outstanding is that the benefits of the 0 to 3 training program become even more pronounced by the ages of 5 and 10 and 11. When the treatment children were in the fifth grade, they also scored notably higher in math, indicating long-term academic advantages. This training encourages families to invest in their children's potential, promoting greater educational engagement. The study's title, "Same Village / Different Destinies," underscores the impact of early interventions on life trajectories. Support for ECD programs can help many children experience transformative benefits and create brighter futures.
Grassroots practices. Maternal and child health professionals from three pilot counties in eastern, central, and western China shared experiences from their ECD projects. Professors Shao Jie, Zhejiang University, and Li Guohong, Shanghai Jiaotong University, emphasized the vital need for high-quality nutrition and healthcare for young children. Their discussions highlight that improving these foundational elements is crucial for better health and developmental outcomes. By focusing on grassroots practices, these professionals aim to implement effective strategies to enhance the well-being of children and families in their communities. The study, presented by Dorien Emmers, an assistant professor at Belgium's KU Leuven University, showed that when 1- to 2-year old children have better health and nutrition, their levels of cognition rise faster in a stimulating home environment when they are 2 to 3 years of age.
"Advancing Development with 'Children First' Strategy", the second International Symposium on Early Childhood Development, was held in Hangzhou, China on March 27-29, 2025. The symposium gathered over 100 experts from China and abroad to discuss cutting-edge developments, research topics, and practical approaches in early childhood development.
Background: Micronutrient powder (MNP or Yingyangbao, a dietary supplement that contains multiple vitamins and minerals) programs can reduce the risk of anemia among children. One such program in China distributed free MNP to children aged 6–24 months in poor rural areas. However, there are indications that the generation of primary caregiver (i.e., parent or grandparent) may influence MNP feeding behavior. The purpose of this study was to investigate the prevalence and influencing factors of effective MNP feeding behavior among parents and grandparents in a rural developing setting.
Methods: We conducted a cross-sectional study of 884 caregivers and children in formerly impoverished rural areas of Sichuan Province using multi-stage random sampling. Data were collected on caregivers’ MNP feeding behavior, their core perceptions and health beliefs about MNP, children’s responses to MNP, MNP delivery patterns, and demographic characteristics. Influencing factors of parents’ and grandparents’ MNP feeding behavior were analyzed using two-level logistic regression.
Results: Total effective MNP feeding behavior rate among caregivers was 40.95%. Grandparents demonstrated higher MNP adoption than parents (χ2 = 4.445, P = 0.035). After controlling for sociodemographic characteristics, grandparents were more likely than parents to achieve effective MNP adoption (OR = 1.360, P = 0.035); child’s preference for MNPs (ORparental subgroup = 1.736, ORgrandparental subgroup = 1.496; P < 0.050) and caregiver’s self-efficacy (ORparental subgroup = 1.157, ORgrandparental subgroup = 1.393; P < 0.050) were influencing factors of feeding behavior for caregivers of both generations. Parents were also influenced by perceived barriers to feeding MNPs (OR = 0.904, P = 0.040), while grandparents were more strongly influenced by child’s discomfort to MNPs (OR = 0.240, P = 0.023) and caregiver’s knowledge about MNPs (OR = 1.557, P = 0.014).
Conclusion: Future efforts to improve the feeding behavior of caregivers in MNP programs both in China and abroad should improve children’s preference for MNP by changing its composition and taste, and increase caregivers’ feeding self-efficacy through health education. Moreover, parents should be taught to cope with time and ability barriers that may limit MNP adoption, while grandparents should be emphasized the importance and potential side effects of MNP.
The effects of psychological factors on complementary feeding behavior have been widely described, yet the mechanisms underlying the complex relationships among personality traits, self-efficacy, and complementary feeding behavior remain unclear. This cross-sectional study was conducted using a multi-stage cluster sampling process to select caregiver-child dyads in Western rural China. Personality traits, self-efficacy, and complementary feeding behavior were evaluated respectively. Both multiple logistic regression and Bayesian network structure (BNs) were used to explore these associations. A total of 787 caregiver-child dyads were enrolled. Results from multiple logistic regression indicated that caregivers with medium (OR = 2.05, p < 0.001) or high (OR = 1.58, p = 0.04) levels of extraversion, as well as those with high self-efficacy recording complementary feeding (OR = 2.08, p < 0.001), significantly increased the likelihood of meeting the criteria for the Infant and Child Feeding Index (ICFI) qualification. Further, BNs were employed to elucidate the pathways of influence, revealing a direct association between the caregiver's level of extraversion, level of self-efficacy and the ICFI. Additionally, the analysis indicated that a caregiver's openness indirectly influenced the ICFI through its influence on self-efficacy regarding complementary feeding. This is one of few studies exploring associations between personality traits, self-efficacy, and complementary feeding behavior. The study highlights the importance of understanding individual differences in caregiving and suggests that interventions should focus on enhancing caregivers' self-efficacy, rather than solely targeting personality traits.
Read the article originally published on the Stanford Impact Labs website.
"Early childhood development (ECD) delays affect an estimated 250 million children under the age of five in low- and middle-income countries (LMICs), leading to lower educational attainment, reduced lifetime earnings, and perpetuation of poverty cycles. In rural China, nearly 50% of children aged 0-5 experience developmental delays, underscoring the urgent need for effective, scalable interventions. Over the past decade, the Rural Education Action Program (REAP) has been at the forefront of addressing these challenges through targeted ECD research and intervention programs, successfully raising government awareness and influencing policy in China.
Our project seeks to build upon REAP's achievements by developing a comprehensive, adaptive mobile application that integrates three evidence-based programs: a parenting stimulation program, a maternal and child health curriculum, and a caregiver mental health intervention. Each program has demonstrated significant positive outcomes in rural China, enhancing cognitive, language, motor, social-emotional, and mental health development. Our key partnerships with Sichuan University and Zhongnan University of Economics and Law further strengthen our efforts by providing academic expertise and local insights..." Continue Reading
With support from the Stanford Impact Labs, the Rural Education Action Program is developing an app-based integrated early childhood development program for rural China.
This study aims to compare the ratings of primary caregivers and teachers of any mental health problems of preschool children in rural China. The primary caregivers and teachers provided their ratings of mental health of 1,191 sample rural preschool children (mean age = 56.8 months; 587 girls) using the Strengths and Difficulties Questionnaire (SDQ). According to the findings, primary caregivers consistently gave their children higher SDQ scores and identified more symptoms across the different categories of mental health problems (i.e., normal, borderline, and abnormal) than teachers. The correlations between the ratings of caregivers and the ratings of teachers were low. The study also identifies the characteristics of children, caregivers, and teacher that were correlated with the differences in the ratings. Specifically, boys, children that were identified by scales of cognitively development as being delayed, and those that parented with authoritarian style were more likely to be rated differently by primary caregivers and teachers. In addition, primary caregivers from relatively poor families rated their children differently from teachers, compared with primary caregivers from relatively rich families. Regarding teachers, they tended to rate on child mental health differently from primary caregivers when they were male or at older age. These findings suggest considering multi-informant reports when assessing the mental health problems of preschool children in different settings. In addition, understanding factors linked to informant discrepancies can potentially improve the accuracy of the assessments.
Yun Shen is a postdoctoral scholar at the Stanford Center on China's Economy and Institutions. Her research areas include maternal labor supply, childcare service, and early childhood development. She's currently focusing on research related to group-based interventions in early childhood development and caregivers' mental health in rural China. She received her Ph.D in Agricultural Economics from Zhejiang University. Yun is an expert on Friends and The Office.
Purpose: This mixed-methods study examined how differences in parental time, knowledge, and economic constraints, as well as community socioeconomic contexts, may contribute to differences in home language environment and child language ability outcomes between peri-urban and rural households in China.
Method: We conducted an explanatory sequential mixed-methods analysis using data from 158 children aged 18–24 months among peri-urban and rural households with low socioeconomic status (SES) in southwestern China. Audio recordings were collected from each household and analyzed using the Language ENvironment Analysis system. The Mandarin version of the MacArthur–Bates Communicative Development Inventories was administered to each child's primary caregiver. We also conducted qualitative interviews with primary caregivers in 31 peri-urban and 32 rural households. Interviews were recorded, transcribed, and coded.
Results: The quantitative results reveal that children in peri-urban households heard less adult speech and had lower language ability than children in rural households. Directed content analysis of interviews found that peri-urban caregivers faced more severe time constraints and less favorable community socioeconomic contexts than rural primary caregivers. Taken together, these findings suggest that differences in time constraints and community socioeconomic contexts between the two populations are the most likely factors contributing to the inferior language environment and language ability among children in peri-urban households.
Conclusion: The mixed-methods study indicated that parental time constraints and community socioeconomic contexts should be considered alongside SES for a comprehensive understanding of factors influencing parental investment in the home language environment in China.
