Home visitation and group meeting parenting programmes have improved child development in low- and middle-income countries, but are too expensive to be delivered at large scale. Evidence from India shows that a programme using automated phone calls was not effective in improving child-rearing practices, yielding important lessons in the process.
Child-caregiver interactions during the first years of life have lasting effects on children’s life outcomes. Vital development occurs across multiple domains during the early years of a child’s life (Phillips and Shonkoff 2000). Interventions that equip caregivers with skills to effectively stimulate their children have enhanced development, school performance, and labour market outcomes in low- and middle-income countries (LMICs) (Grantham-McGregor et al. 1991). Specifically, home visitation and group meeting parenting programmes have improved child development in LMICs, but are costly to scale due to the high costs associated with training workers (Grantham-McGregor et al. 2020, Trias and Arteaga 2022).
We evaluated an inexpensive, low-tech alternative to train parents on early childhood practices in India: automated phone calls that explain the basic concepts of child rearing, suggest parent-child activities, and offer advice (Arteaga et al. 2025). We contribute to the limited research evaluating programmes on child-rearing practices using live or automated phone calls, either alone or in combination with other supports for caregivers, in LMICs. While Arteaga and Trias (2023) finds positive effects on both caregiver and child outcomes, Smith et al. (2023) only does so for caregiver outcomes. However, Rafla et al. (2024) does not find any impact on caregiver or child outcomes.
Child development services need to focus more on child-rearing practices
Our study takes place in the northern Indian state of Uttarakhand, home to approximately 1.4 million children ages 0-6. Uttarakhand has one of the highest neonatal mortality rates in the country, with one in three children stunted, and one in four underweight (MHFW 2020, NIPCCD 2018). Additionally, only one in two children can describe a picture, and one in four understand a story read to them (ASER 2019).
India is home to the world’s largest public childcare system, the Integrated Child Development Services (ICDS), which serves over 81 million children ages 0-6 through anganwadi centres. These centres provide a range of services, including those related to health, nutrition, and education. They are also expected to conduct home visits to encourage mothers to play an active role in their child’s growth and development. However, given the number of families they serve and the voluntary nature of their work, their focus is on vaccination, feeding practices, and caregivers’ reproductive health (Ministry of Women and Child Development 2022). These visits thus lack a focus on child-rearing practices.
Using automated phone calls to provide child-rearing advice
The non-profit Dost offers an automated phone call programme providing child-rearing advice to caregivers of young children, which has served more than 100,000 caregivers since 2017. Though Dost targets children under age six, our study focuses on children aged 6-30 months at baseline. The phone recordings were around two minutes long and consisted of 18 modules, with the entire programme lasting around six months. These modules included topics such as the importance of early years development; embedding talk, care, and play into everyday life; art as a medium for learning ; child behaviour management; child nutrition; and parental well-being.
Each call followed the following structure: introducing a concept or challenge that caregivers may be facing and empathising with them, suggesting activities to help address the challenge, reviewing common strategies across activities, and, finally, checking caregivers’ understanding by asking them questions. In this way, the calls provided information was easy to follow and culturally appropriate.
Automated phone calls do not improve child-rearing outcomes
We used a randomised control trial to evaluate the effectiveness of this programme. Our sample consisted of 2,433 caregivers with at least one child (aged 6-30 months at baseline) served by 250 anganwadi centres who signed up for the programme. We randomly assigned caregivers within each centre to either receive the programme at that point (treatment group) or after the impact evaluation (control group).
We measured caregiver and child outcomes using standardised measures that have been used in developing countries for this specific age group. Specifically, we measured caregivers’ knowledge of child development using an adapted version of the Knowledge of Infant Development Inventory (MacPhee 1981), caregivers’ interaction with their children using the Family Care Indicator-Play subscale (Hamadani et al. 2010); caregiver’s anxiety using the General Anxiety Disorder-7; and caregiver’s self-efficacy using the Tools for Parents Self-Efficacy (Kendall and Bloomfield 2005). These instruments have previously been used in studies on India and Bangladesh.
To measure overall child development, we used the Caregiver Reported Early Childhood Development (McCoy et al. 2017); to measure children’s language and vocabulary, we used an adapted version of the McArthur-Bates Communicative Development Inventory (Fenson et al. 2000), both of which have been previously used in the Indian context. We do not find any statistical effects at the 5% level. We only find significant effects for two outcomes at the 10% level, which go in the opposite direction as hypothesised: the programme increases caregivers’ anxiety and reduces their self-efficacy.
Following Riis-Vestergaard (2023), we determined that the null effects of this intervention were not due to implementation failure or low take-up rates. We then explored whether the causal chain broke, emphasising the word “explore” as our experiment was not intended to understand why the programme may or may not work, but whether it worked and by how much. Although we believe that there is a need for the programme, our assumptions about how it would affect intermediate outcomes were probably incorrect.
One reason for the null results may be that the programme covered too broad a range of topics and lacked depth. While this may provide caregivers with support across various practices, such breadth may have come at the cost of less coverage on child development. Additionally, unlike similar interventions, the programme materials were not differentiated by age (e.g. 6-8 months, 9-11 months, 12-14 months). As young children complete key developmental milestones at different ages, it is important to suggest activities that continue to challenge and help them grow.
Policy implications for low-cost parenting programmes
While remote child-rearing programmes are convenient, these interventions should be accompanied by in-person interactions, such as group meetings, follow-up phone calls, or video calls to demonstrate activities and answer questions. This is especially relevant for parents who start the programme with less prior knowledge of child-rearing practices.
Research shows that well designed home visits and group meeting parenting programmes have sizeable positive effects, but their costs are high. Further research is thus needed to explore creative ways to scale-up low-cost parenting programmes.
References
Arteaga, I, A de Barros, and A J Ganimian (2025), “The challenges of scaling up effective child-rearing practices using technology in developing settings: Experimental evidence from India,” Journal of Research on Educational Effectiveness.
Arteaga, I, and J Trias (2023), “Can technology narrow the early childhood stimulation gap in rural Guatemala? Results from an experimental approach,” Unpublished manuscript.
ASER (2019), "Annual status of education report (rural) 2018: Early years," ASER Centre.
Fenson, L, S Pethick, C Renda, J L Cox, P S Dale, and J S Reznick (2000), “Short-form versions of the MacArthur communicative development inventories,” Applied Psycholinguistics, 21(1): 95–116.
Grantham-McGregor, S, A Adya, O Attanasio, B Augsburg, J Behrman, B Caeyers, et al. (2020), “Group sessions or home visits for early childhood development in India: A cluster RCT,” Pediatrics, 146(6).
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Kendall, S, and L Bloomfield (2005), “Developing and validating a tool to measure parenting self-efficacy,” Journal of Advanced Nursing, 51(2): 174–181.
MacPhee, D (1981), "Manual: Knowledge of infant development inventory," Unpublished manuscript, University of North Carolina.
McCoy, D C, C R Sudfeld, D C Bellinger, A Muhihi, G Ashery, T E Weary, et al. (2017), “Development and validation of an early childhood development scale for use in low-resourced settings,” Population Health Metrics, 15: 1–18.
MHFW (2020), "National family health survey-5 (2019-20): Key indicators from 22 states/UTs from phase I," Government of India.
Ministry of Women and Child Development (2022), "Home visits planner," Government of India.
NIPCCD (2018), "Handbook 2018: Statistics on children in India," National Institute of Public Cooperation and Child Development, Ministry of Women and Child Development, Government of India.
Phillips, D A, and J P Shonkoff (eds.) (2000), "From neurons to neighborhoods: The science of early childhood development," National Academies Press.
Rafla, J, K Schwartz, H Yoshikawa, D Hilgendorf, A Ramachandran, M Khanji, R A Seriah, M Al Aabed, R Fityan, P Sloane, et al. (2024), “Cluster randomized controlled trial of a phone-based caregiver support and parenting program for Syrian and Jordanian families with young children,” Early Childhood Research Quarterly, 69: 141–153.
Smith, J A, S M Chang, A Brentani, G Fink, F Lopez-Boo, B M Torino, M R Codina, and S P Walker (2023), “A remote parenting program and parent and staff perspectives: A randomized trial,” Pediatrics, 151: e2023060221F.
Trias, J, and I Arteaga (2022), “Home visitation or group meeting? Training parents on early stimulation in rural Guatemala,” Unpublished manuscript.
Riis-Vestergaard, M (2023), “So, you got a null result. Now what?” Poverty Action Lab Blog.