Refugees International: Articles: The Reduction of Child Mortality

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The Reduction of Child Mortality

Ethiopia 2003: Malnourished Children
08/04/2005

UN Millennium Development Goal #4

The suffering and unnecessary death of children every year is perhaps the most tragic consequence of the extreme poverty that characterizes much of the world. Since 1970, the international community has been able to reduce the global child mortality rate by nearly half --- from 147 deaths per 1,000 live births to the current rate of 80 deaths for every 1,000 live births. Due to improvements to nutrition and public health in 112 developing countries, the international community has shown that simple, low-cost interventions can save millions of lives.

Progress, however, has not been consistent throughout the world. Africa, particularly sub-Saharan Africa, continues to lag behind the rest of the world. Sub-Saharan Africa continues to have the highest level of under-five mortality, estimated at 174 under-five deaths per 1,000 live births, nearly twice the rate of the next highest region, Southern Asia, and more than 20 times the rate in developed regions. According to the World Health Organization, a baby born in Sierra Leone, today, is three and a half times more likely to die before its fifth birthday than a child born in India, and more than a hundred times more likely to die than a child born in Singapore or Iceland. Despite gains in global child mortality rates, children’s health continues to suffer. Nearly eleven million children under the age of five still die from preventable diseases, such as diarrheal disease, every year – four million within the first month of life.

Intensive vaccination and public awareness campaigns have reduced measles-related deaths worldwide and the increase in knowledge of how to use Oral Rehydration Therapy has helped reduce the incidence of diarrheal diseases. But the rapid spread of AIDS in Africa and around the world has impacted children’s health greatly. The advances made in lowering children’s mortality rates are slowing as AIDS begins to take its toll. Child mortality is now higher than it was only ten years ago in sixteen countries. Nine countries have been afflicted even worse, facing their highest death rates in twenty years. With 332,000 children dead as a result of AIDS last year alone, nearly 60% of all child deaths in Africa are now associated with the epidemic. For the family, the community and the country, it is more than a loss of life – it is the loss of their future.

The Fourth Goal

The fourth goal of the UN Millennium Challenge is thus to reduce the mortality rate of children under five years of age.

To Reduce Child Mortality

Target: Reduce by Two-Thirds, Between 1990 and 2015, the Mortality Rate Among Children Under Five

A child’s ability to survive the first five years of life is, to a great extent, determined by the family’s level of poverty. Nearly every child death in the world today occurs in a developing country – half of them in Africa, alone. Malnutrition, caused by poverty, contributes to a majority of these deaths. Under-nourished children’s growth is stunted by lack of vital micronutrients and protein. Sapped of energy and weakened by being perpetually sick, millions of children become susceptible to even minor infections. A common childhood ailment can quickly lead to death. Most childhood deaths result from diarrhea, respiratory infections, measles, perinatal conditions or malaria. As a result, unsafe and inadequate drinking water, poor sanitation, air pollution, limited accessibility to healthcare, and poor vaccination coverage unnecessarily threaten the lives of children throughout the developing world.

To achieve the targeted measure of reducing the global child mortality ratio by two-thirds, the UN Taskforce on Child and Maternal Health has made several suggestions. Investments in children’s nutrition and healthcare must be increased alongside extensive improvement of local, regional and national healthcare systems. Most children in the world do not have access to clinics and health facilities, trained healthcare providers, or proper medication. Additionally, non-HIV positive mothers can improve their children’s health by exclusively breastfeeding for the first six months of life and supplementing the infant’s diet with protein-rich foods while continuing to breastfeed for two years after birth. Other protective strategies include: vaccinating all children before their first birthday, proving treated bed-nets to prevent malaria, providing oral rehydration therapy to dehydrated infants and guaranteeing that every pregnant woman has adequate access to full antenatal, birthing, and post-partum healthcare.

The Displaced and Stateless Populations

Inequity is the root cause of suffering in developing countries. The persistence of deeply-rooted social, cultural and economic disadvantages leaves women and children acutely vulnerable. The health and well-being of the child is inextricably linked to the welfare of its mother. Thus, for millions of children throughout the developing world, being born poor is a death sentence. For refugees, internally displaced and stateless populations, however, this vulnerability is particularly dangerous. Women who comprise the majority of refugee and displaced populations struggle to provide for their children in a hostile environment characterized by violence, want and fear. This inevitably leads to additional vulnerability for their children.

With limited access to food, water, sanitation, medication and shelter, displaced populations face some of the highest rates of infant and under-five mortality. Stateless women, stripped of their citizenship and nationality, are unable to access even basic services of the state for their children and themselves and also face blatant discrimination and persecution on a daily basis.

The achievement of the fourth Millennium Development Goal will thus be more likely if the following actions are taken to address the needs of displaced and stateless persons:

Donor governments and the international community increase funding and humanitarian aid in order to increase early-childhood vaccination campaigns, emergency food rationing, malaria prevention, birth assistance and emergency obstetric care and other measures to reduce avoidable childhood deaths. Increased programming should specifically target stateless populations.
There must be a shift in priorities from international financial institutions, donors and national governments to invest in public healthcare facilities, particularly in rural areas in developing countries where displaced populations are often hosted. These priorities should include building more health facilities, training more health workers, and ensuring available and adequate medical supplies.
National government health ministries should promote breastfeeding and incorporate comprehensive health and nutrition education into all national policies and public awareness campaigns.
Donors and international agencies must increase basic healthcare for displaced women and children, including more reproductive health services. Many refugee camps are relatively stable environments where it is possible to achieve full coverage for child vaccinations, as well as being able to reach mothers with public health education and maternal health services.