There are many elements that affect a child’s start in life. But the preconditions for achieving these elements are likely to go well beyond the immediate circumstances of children themselves, to include the wider social, economic and cultural environment. For instance, nutrition depends heavily on the health of mothers and the knowledge and support they get in feeding infants. These factors in turn depend not only on food availability and prices in the economy as a whole, but also on how resources are distributed within households, gender attitudes and the availability of health services. Good health depends on a hygienic, safe environment including access to clean water and sanitation. But much rural and urban living in India are characterized by crowding, lack of clean water, poor sanitation, high levels of rubbish, exposure to dirt and in some cases environment toxins. The quality of child care depends on how much time parents have for each child, which in turn depends on diverse factors ranging from the structure of the rural and urban economy to birth spacing. There are wide ranges of things that need to happen to improve early childhood development.