Worthman Carol M, Tomlinson Mark, Rotheram-Borus Mary Jane
Department of Anthropology, Emory University, Atlanta, GA 30322, USA.
Department of Psychology, Stellenbosch University, Private Bag X1 Matieland, 7602, South Africa.
Soc Sci Med. 2016 Apr;154:62-9. doi: 10.1016/j.socscimed.2016.02.040. Epub 2016 Feb 26.
Compelling evidence for the long-term impact of conditions in gestation and early childhood on both physical and psychosocial functioning and productivity has stimulated a focus in global health policy and social services on the "first 1000 days". Consequently, related initiatives may assume that rationale for this orientation and the agency of parents during this period is self-evident and widely shared among parents and communities. In 2012, we tested this assumption among a sample of 38 township-dwelling caregivers in Cape Town, by asking a question identified during a study of cultural models of parenting, namely: At what age or stage can a parent or caregiver have the most influence on a child's development? Formal cultural consensus analysis of responses met criteria for strong agreement that the period for greatest impact of parenting on a child's development occurs at adolescence, at a median age of 12 years. In follow-up focus groups and structured interviews, caregivers articulated clear ecological and developmental reasons for this view, related to protection both of developmental potential and against powerful, context-specific ecological risks (early pregnancy, substance ab/use, violence and gangs) that emerge during adolescence. Such risks threaten educational attainment, reproductive health, and social derailment with enduring consequences for lifetime well-being that caregivers are highly motivated to prevent. Developmental needs in pregnancy and early childhood, by contrast, were considered more manageable. These findings resonate with emerging evidence for multiple sensitive periods with corresponding developmental needs, and urge the value of complementing efforts to optimize early development with those to sustain and enhance it during later windows of developmental opportunity such as adolescence. Our results also indicate the need to consult local views of developmental risk and parenting practice in communicating with caregivers and planning interventions, and the value of using available methodological tools to do so.
孕期和幼儿期状况对身体及心理社会功能与生产力产生长期影响的有力证据，促使全球卫生政策和社会服务将重点放在“最初1000天”。因此，相关倡议可能认为这一导向的基本原理以及父母在此期间的作用是不言而喻的，并且在父母和社区中得到广泛认同。2012年，我们在开普敦的38名乡镇居民照料者样本中对这一假设进行了测试，方法是提出一个在一项关于育儿文化模式的研究中确定的问题，即：父母或照料者在什么年龄或阶段对孩子的发展影响最大？对回答进行的正式文化共识分析符合强烈共识的标准，即育儿对孩子发展影响最大的时期是在青春期，中位年龄为12岁。在后续的焦点小组和结构化访谈中，照料者阐明了这一观点的明确生态和发展原因，这些原因与保护发展潜力以及防范青春期出现的强大的、特定背景的生态风险（早孕、药物滥用、暴力和帮派）有关。这些风险威胁到教育成就、生殖健康和社会脱轨，对一生的幸福产生持久影响，照料者有强烈的动机去预防。相比之下，孕期和幼儿期的发展需求被认为更易于管理。这些发现与关于多个敏感期及相应发展需求的新证据相呼应，并敦促在优化早期发展的努力之外，还要重视在诸如青春期等后期发展机会窗口维持和加强发展的努力。我们的结果还表明，在与照料者沟通和规划干预措施时，有必要参考当地对发展风险和育儿实践的看法，以及使用现有方法工具这样做的价值。
