Regardless of education, income or other assets, all parents need support to manage distress and mental health concerns, which have spiked during this COVID-19 period of isolation, service deprivation, and scarcity. Parental mental health is equally as important as physical health and nutrition status in terms of impacts on child development and school readiness. Investments in the holistic wellbeing of mothers and all household caregivers are investments in young children and human capital formation for Pakistan.

Our findings indicate a strong association between parental distress and child development; that is, children of non-distressed parents show higher ECD scores than children of distressed parents, and in more than half (57 percent) of households with children under age 3, parents were distressed. High rates of distress were similarly found across male and female caregivers, indicating that this is a universal issue in Pakistan. Caregivers of young children with pre-existing mental health conditions are at especially high risk for distress because of the social isolation, employment instability and school and childcare center closures imposed by the pandemic (UNICEF, 2021). Stress-related risks can be mitigated through effective interventions that promote parental wellbeing, such as those found in Turkey (Aksoy Derya et al., 2021) and China (Liu et al., 2021). In Pakistan, there are opportunities to meet parents’ mental health needs at least partially through home visits, counseling, and dissemination of health and wellbeing messages.

# Very low rates of psychosocial stimulation, especially for children under 3 years

Our study also found overall low rates of psychosocial stimulation in households, which was especially pertinent for children under 3 years of age, many of whom experience insufficient engaging interactions. This finding indicates a need to teach caregivers in Pakistan why and how to provide engaging and responsive interactions with children from birth onward. We also found that higher levels of psychosocial stimulation at home is strongly and positively associated with both ECD and school readiness levels. However, approximately 1 in every 9 children (12 percent) under age 3 in our study had experienced no psychosocial stimulation in the prior 24 hours. Bonding, hearing words, songs and rhymes, developing trust through responsive caregiving, experiencing playful interactions, and going on outings during the first 1,000 days of life have enormous bearing on brain development and cognitive and social-emotional trajectories. This is true in the next 1,000 days as well. It has been noted that caregivers in Pakistan—including not only mothers, but also fathers, older siblings, and other caregiving adults in the household—need to understand not only how but also why their interactions with infants and young children are pivotal to learning and development for sustained behavioral change (UNICEF, 2017). The ITA (2021) study highlights that children with disabilities are especially disadvantaged in terms of psychosocial stimulation, receiving less playtime, reading time or story telling than children without a disability.

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