Socio-Economic Disparities in Early Childhood Education Enrollment: Japanese Population-Based Study

Background Accumulating evidence has shown that high-quality early childhood education and care may be an effective way of promoting children’s optimal health and development, especially for the most disadvantaged. However, socially disadvantaged families are less likely to enroll children in center-based childcare. In this study, we explored characteristics associated with use of center-based childcare among Japanese families. Methods We used data from two Japanese birth cohorts in 2001 (n = 17,019) and 2010 (n = 24,333). Enrollment in center-based childcare was assessed at the ages of three and four years in the 2001 cohort and at the age of three in the 2010 cohort. Logistic regression analyses were conducted. Results Children in the lowest quintile of household income were 1.54 (95% confidence interval, 1.20–1.98) times more likely to not receive center-based childcare than those in the highest-income quartile at the age of four in the 2001 cohort. Other socio-economic disadvantage (mother’s low education, non-Japanese parent, and higher number of siblings) and child’s health and developmental problems (preterm birth, congenital diseases, and developmental delay) were also associated with the non-use of center-based childcare at the age of three in the 2001 and 2010 cohorts. Conclusions An inverse care law operates in the use of early childhood education (ie, children with the least need enjoy the highest access). Children with socio-economic, health, and developmental disadvantages are at a greater risk of not receiving early childhood education and care. Social policies to promote equal access to early childhood education are needed to reduce future socio-economic inequalities.

1,590 0 a These include factors that was assessed at the first wave except for the mother's education (assessed at Wave 2). b Chi-square test was conducted to compare the participants who were and were not followed by the categories of factors. Data source Details of assessment and categorization

Parental factors
Household income Wave 1 Household income was categorized into quintiles.
Mother's education Wave 2 Educational level was subdivided into graduation from junior high school, high school, junior college, college or greater, and others.
Mother's employment status Wave 2 Mother's employment status was categorized into not employed, self-employed, part-time employed, full-time employed, and others.
Household structure Wave 1 Household structure was categorized into the following four groups, considering the presence of grandparents who might offer childcare support: two parents (two-generation), two parents (three-generation), single parent (two-generation), and single parent (three-generation).

Number of siblings Wave 1
The number of siblings was categorized into 0, 1, 2, and ≥3.
Nationality of parents Birth records Nationality of parents was determined based on how fathers or mothers listed their nationality in the birth record, i.e., Japanese or citizens of countries other than Japan.
Concerns over child rearing Wave 2 Concerns over child rearing were assessed at three levels, i.e., little, some, and much.

Child factors
Sex Birth records Sex was assigned as boy or girl.
Preterm birth Birth records Preterm birth was defined as delivery before 37 gestational weeks and was further categorized into very preterm (i.e., 31 weeks or earlier) and moderately preterm (i.e., 32-36 weeks).

Congenital diseases
Wave 2 Congenital diseases were assessed based on parental report of visiting a physician for congenital diseases during the previous year.
Developmental delay Wave 3 Developmental delay was defined as children whom their parents reported they could not do at least one of the following six activities: 1) walk, 2) run, 3) climb stairs, 4) say meaningful words such as "mama" and "bubu" (meaning a toy car in Japanese), 5) say a two-word sentence, and 6) say one's name.

Environmental factors 4
Size of residential area Wave 3 The size of the residential area was classified into three levels, i.e., counties, small-to-medium cities, and large cities, and an additional category, namely, foreign country. eAppendix 1. Three types of center-based childcare in Japan The Japanese system of early childhood education and care (ECEC) and the cultural context are different from those in the European countries and the United States. In Japan, two types of center-based ECEC programs have been institutionalized by the government and have been the main source of non-parental childcare. These programs receive public funding if facilities fulfill the standards set by the national and local governments. The first type, known as Hoiku-En, is administered under the Ministry of Health, Labour and Welfare, and a full-day program is provided for children between the ages of 0 and 6.
Because this type is considered to be a welfare program for working parents, the fee is on a sliding scale according to their household income, meaning lower fees for families with lower income. Families that receive public assistance can enroll their children in the program for free and are often given a high priority for enrollment. The second type, known as Youchi-En, is administered under the Ministry of Education, Culture, Sports, Science and Technology, and a half-day program is provided for children between the ages of 3 and 6. The third type, known as Kodomo-En, was institutionalized in 2006 and is administered under the Cabinet Office. This type is a hybrid of the first two types and provides a full-day or half-day program for children between the ages of 0 and 6.
Because the programs need to comply with standards set by the government in order to receive public funding, the minimum quality of education and care is likely to be maintained among licensed facilities though great variability in quality is most likely to be present. Although the availability of center-based childcare has been a problem for working mothers in metropolitan areas such as Tokyo, the issue of short supply has been limited to 10 children under the age of 2 because of the teacher-child ratio: 6 or fewer children for one teacher for the child's age of 2 and 20 or more children for one teacher for the child's age of 3 or above. In other words, the availability of center-based childcare for children above the age of 3 years is not likely to be a problem. Other types of ECEC in Japan, such as childcare for a small number of children by a professional childminder/baby-sitter at one's home, have been rare in Japan.