Global achievement of the health related Millenium Development Goals, the MDGs, depends largely on India’s success and on China accelerating progress even further, according to a new UNICEF report which examines the latest trends in child and maternal health.
In this year’s State of Asia-Pacific’s Children 2008, UNICEF says it is a “fundamental truth” that unless India achieves major improvements in health, nutrition, water and sanitation, education, gender equality and child protection, global efforts to reach the MDGs will fail. China too needs to make significant strides to regain early progress it made in child survival. In 2006 2.5 million child deaths occurred in these two countries accounting for nearly a third of all child deaths: India (2.1m) and China (415 000).
However the region’s robust economic growth, the fastest in the world since 1990, has lifted millions out of poverty. Child survival, regarded by UNICEF as a key test of a nation’s progress in human development and child rights, has improved considerably. But gains have been overshadowed by deepening disparities, which means health care often fails to reach the poorest. This is a region with half of the world’s children, spanning 37 countries and two hemispheres.
The report underscores a disturbing trend across the region: public health expenditure remains well below the world average on 5.1 per cent, with South Asia spending only 1.1 per cent of GDP and 1.9 per cent being spent in the rest of Asia-Pacific. In addition, as more services within countries are privatized and the government share of health budgets diminishes, public facilities become more run down and health workers leave for better paid jobs in the private sector or outside the country.
“The divide between rich and poor is rising at a troubling rate within subregions of Asia-Pacific, leaving vast numbers of mothers and children at risk of increasing relative poverty and continued exclusion from quality primary health-care services,” the report says.
Pneumonia, diarrhoea and malnutrition are the major causes of child death in the region. But vast inequities in income, geography, gender and ethnicity are essentially what stand in the way of children surviving and thriving.
The most fragile period for a child in Asia-Pacific is during the very first moments of life – if the baby is born without the help of a skilled birth attendant due to poor access or cultural practices, and if the mother is underweight, the chances of that baby staying alive becomes increasingly slim. In China most under-five child deaths occur within the first week of life, largely due to a lack of obstetric services. In India one out of every three women is underweight putting them at risk of having low birth weight babies and these babies are 20 times more likely to die in infancy than healthy babies.
South Asia is also the only sub-region in the world where female life expectancy is lower than male life expectancy and where girls are more likely to be underweight than boys. Pakistani boys are more likely to be immunized than girls and have better access to health care.
“Unless discrimination against women and girls is addressed as part of overall strategies to improve child and maternal health, high rates of maternal and child mortality will remain stubbornly entrenched,” says the report.
Civil conflict also affects a child’s chance of survival -- the two countries where a child has the hardest struggle to survive and thrive beyond his or her fifth birthday, are countries that experience ongoing conflict – Afghanistan and Pakistan. On the other hand despite the civil strife in Sri Lanka, that country has managed to cut child deaths by half since 1990, and stands out as a country that has budgeted well for children.
As the world has moved past the half way mark and into the final laps towards the Millennium Development Goals’ 2015 target line, what is needed now is political will and sound strategies to dramatically increase investment in public health services that specifically target the poorest and most marginalized.
Without improved health care, 13 of the Asia-Pacific countries will struggle to reduce the child mortality rates by two thirds. The Pacific has only managed to lower its under-five mortality rate by 22 per cent to 64 deaths per 1,000 live births – a far smaller reduction than recorded in other parts of the region. Despite overall strong performance in Southeast Asia, where on average the under-five mortality rate has been halved since 1990, wide variations between countries show that the poorest and least developed are still lagging.
The State of Asia-Pacific’s Children 2008 urges all governments, international agencies, non-government organizations, civil society and the private sector not to take for granted the recent gains but instead “consolidate and deepen” them by extending critical health services.
The report offers the following recommendations targeted to reduce child mortality further:
- to focus health resources on areas where the rates of child mortality are highest;
- to strengthen health systems by involving communities in preventative public health interventions;
- provide ongoing care from the beginning of pregnancy through the birth of a child and into adolescence;
- boost public health care spending by at least 2 percent (based on 2001 levels) to make quality public health care services affordable to the poorest people.
- tackle ongoing gender disparity by educating communities so they are better able to direct household resources towards the welfare of children.
Full report (PDF)
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