Elsey H, Fieroze F, Shawon R A, Nasreen S, Hicks J P, Das M, Huque R, Hirano I, Wallace H J, Saidur M
Department of Health Sciences, University of York, Seebohm Rowntree Building, York, YO10 5DD, UK.
ARK Foundation, Suite no C3, C4. House no. 6, Road no 109, Gulshan 2, Dhaka, 1212, Bangladesh.
BMC Public Health. 2020 Dec 10;20(1):1899. doi: 10.1186/s12889-020-09891-z.
Centre-based child-care has potential to provide multiple health and development benefits to children, families and societies. With rapid urbanisation, increasing numbers of low-income women work with reduced support from extended family, leaving a child-care vacuum in many low- and middle-income countries. We aimed to understand perceptions of, and demand for, centre-based child-care in Dhaka, Bangladesh among poor, urban households, and test the feasibility of delivering sustainable centre-based child-care.
We used sequential mixed methods including a household survey (n = 222) and qualitative interviews with care-givers (n = 16), community leaders (n = 5) and policy-makers (n = 5). We co-produced and piloted a centre-based child-care model over ten-months, documenting implementation. A co-design focus group with mothers, parents' meetings, and qualitative interviews with child-care centre users (n = 5), non-users (n = 3), ex-users (n = 3) and staff (2) were used to refine the model and identify implementation issues.
We found 24% (95% CI: 16,37%) of care-givers reported turning-down paid work due to lack of child-care and 84% (95% CI:74, 91%) reported wishing to use centre-based child-care and were willing to pay up to 283 Takka (~$3.30) per month. Adjusted odds of reported need for child-care among slum households were 3.8 times those of non-slum households (95% CI: 1.4, 10). Implementation highlighted that poor households needed free child-care with food provided, presenting feasibility challenges. Meta-inference across quantitative and qualitative findings identified the impact of the urban environment on child-care through long working hours, low social capital and fears for child safety. These influences interacted with religious and social norms resulting in caution in using centre-based child-care despite evident need.
Sustainable provision of centre-based care that focuses on early childhood development requires subsidy and careful design sensitive to the working lives of poor families, particularly women and must respond to the dynamics of the urban environment and community values. We recommend increased research and policy focus on the evaluation and scale-up of quality centre-based child-care, emphasising early-childhood development, to support low-income working families in urban areas.
基于中心的儿童保育有潜力为儿童、家庭和社会带来多重健康和发展益处。随着城市化的快速发展，越来越多的低收入女性在大家庭支持减少的情况下工作，这在许多低收入和中等收入国家造成了儿童保育的空白。我们旨在了解孟加拉国达卡贫困城市家庭对基于中心的儿童保育的看法和需求，并测试提供可持续的基于中心的儿童保育的可行性。
我们采用了顺序混合方法，包括一项家庭调查（n = 222）以及对照顾者（n = 16）、社区领袖（n = 5）和政策制定者（n = 5）的定性访谈。我们共同制作并试点了一个为期十个月的基于中心的儿童保育模式，并记录了实施情况。与母亲们进行的共同设计焦点小组、家长会以及对儿童保育中心使用者（n = 5）、非使用者（n = 3）、曾经的使用者（n = 3）和工作人员（2人）的定性访谈被用于完善该模式并确定实施问题。
我们发现24%（95%置信区间：16, 37%）的照顾者表示由于缺乏儿童保育而拒绝了有薪工作，84%（95%置信区间：74, 91%）表示希望使用基于中心的儿童保育并愿意每月支付高达283塔卡（约合3.30美元）。贫民窟家庭报告的儿童保育需求的调整后几率是非贫民窟家庭的3.8倍（95%置信区间：1.4, 10）。实施情况表明贫困家庭需要免费的儿童保育并提供食物，这带来了可行性挑战。对定量和定性研究结果的元推断确定了城市环境通过长时间工作、低社会资本以及对儿童安全的担忧对儿童保育的影响。这些影响与宗教和社会规范相互作用，导致尽管有明显需求，但在使用基于中心的儿童保育时仍持谨慎态度。
可持续提供注重幼儿发展的基于中心的保育需要补贴，并进行精心设计，以适应贫困家庭，特别是女性的工作生活，并且必须应对城市环境和社区价值观的动态变化。我们建议加大研究和政策关注力度，对高质量的基于中心的儿童保育进行评估和推广，强调幼儿发展，以支持城市地区的低收入工作家庭。
