Many children in Pakistan do not survive infancy, while more than 30 per cent become physically stunted before their second birthday, and 40 per cent under the age of five are malnourished. Biomedical research has demonstrated the direct impact of prenatal and early childhood experiences on brain development, and the influence of the early years on physical and mental development later on in life. Understanding the dynamics of Early Childhood Development (ECD) is therefore crucial when designing enrichment programmes for children. In the Pakistani context, not only is there a need for this, but the insights gained through ECD research will also establish the foundation for educating caregivers in the community on child nurturing and rearing practices.

A two-phase action research initiative is presently being undertaken by AKU’s Human Development Programme (AKU-HDP). The study will form baseline research for AKU-HDP, which is intended to be a precursor to the Institute of Human Development, highlighted in the 1994 Chancellor’s Commission Report as a future programme of the University. The first phase was conducted in 2002 under the auspices of the Department of Community Health Sciences and School of Nursing, and investigated factors in different social environments that affect the learning abilities of children. More than 1,200 children aged 0 to 3 years in an urban and rural population of 35,000 in Sindh, provided valuable baseline data for AKU-HDP's community-based ECD component.

In collaboration with Aga Khan Health Service, Pakistan,  and the Health and Nutrition Development Society, an all-female field team of 14, including clinical psychologists, physicians, sociologists and community health nurses, collected information over a five-month period, relating to environments, learning abilities and psycho-social development status of the children. Children were assessed through observation of physical growth, social behaviour and language, as well as by a parent questionnaire on health, nutrition, economic conditions, social interaction, stimulation and play. A mixed methodology was used, comprising both qualitative and quantitative components.

Some of the information on child rearing practices was collected in focus groups conducted with mothers, fathers, older siblings and grandmothers. In both rural and urban areas, fathers perceived themselves as providers rather than caregivers, being more attached to their sons than their  daughters. The son was seen as eventually taking his father's place, whereas the daughter was expected to leave the family unit after marriage. Adolescent girls caring for younger siblings were also found to be frustrated with this added burden, which often resulted in very poor care of infants and young children. As an adolescent girl said, "Girls are born to toil." However, it was found that such differentials in the upbringing of children were not significant enough to create a gender bias in terms of developmental delays. The investigation report documented delayed psychomotor development in 27 per cent of children aged 0-2, with the proportion increasing with age, reaching 40 per cent at age 3. This trend was more pronounced among rural children.

Phase Two of the ECD study is focusing on evolving effective community-based parenting and ECD models, and useful monitoring tools, to address children's physical, intellectual, emotional, social, language and psychomotor development in a holistic manner.

AKU-HDP aims to enhance survival, growth and development prospects of infants and young children, through culturally appropriate, community-based support that benefits from associated training, education, advocacy and multidisciplinary research activities. While funding for the  programme is currently being met by AKU and Aga Khan Foundation, Pakistan (AKF,P), for longer term development, proposals are under discussion with the Canadian International Development Agency, under their Pakistan  Social Institutions Development Project,  managed by AKF, P.

AKU-HDP will work with communities, partners, and national and international ECD specialists in Pakistan and the wider region, to evolve a longer-term programme in human development throughout the life cycle, initially through a focus on the unborn child and the early years.