united nations development goals regarding child mortality

8/8/2019 United Nations Development Goals regarding Child Mortality

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2010

DI Conference 2010

DNYS Sjlland

GOAL 4: REDUCE CHILD MORTALITY

TARGET

Reduce by two thirds, between 1990 and 2015, the under-five mortality rate


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Goal 4: Reduce Child Mortality

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The Millennium Development Goal 4 (MDG 4) is to reduce child mortality. Its target is to reduce by two

thirds, between years 1990 and 2015, children under-five mortality rate. Under-five Mortality Rate is a

probability of a child born in a specific year or period dying before reaching the age of five, if subject to age-

specific mortality rates of that period. The world has been witnessing a remarkable improvement in decreasingthe total number of under-five child deaths throughout these years.

This paper will consist of and focus on three main parts: where the world is standing in reducing the

child mortality rate today, what strategies and efforts have worked in specific countries to improve the

situation, as well as what we as Development Instructors can do to make it even better. The analysis will be

based on statistical data provided by the World Bank, United Nations, World Health Organization, UNICEF, and

other international organizations working in the field of development. Using statistical data as a tool, the paper

will analyze the global, regional and local under-five child mortality trends, as well as conclude the possibility of

achieving the Goal 4.

Since 1990 the global under-five mortality rate has fallen by a third -from 89 deaths

per 1,000 live births in 1990 to 60 in 2009. All regions except Sub-Saharan Africa, Southern Asia and Oceania

have seen reductions of at least 50 percent. Northern Africa and Eastern Asia have made the most progress in

reducing under-five mortality. The rate of decline in under-five mortality has accelerated over 20002009

compared with the 1990s.1 But are we fast enough to reach the MDG 4 by the year 2015 globally?

The trend of decreasing under-five mortality rate has been happening throughout a long period of

time. Due to the lack of statistical data of child mortality rates earlier than 1960s, it is not possible to argue

when exactly the situation started to improve. However, based on the statistical data provided by the World

Bank starting around 1960,it can be clearly seen, that number of child deaths had already been going down at

that time already until now. That means that under-five mortality rates had already been decreasing before

the Millennium Development Goals were set. The trend is continuing due to development of the countries and

the efforts that each country has implemented to encourage development. This is going to be illustrated later

on in this paper. The strategies and results vary on country bases. That is why it is important to evaluate the

situation in each country rather than grouping them into regions and providing the trends in regions.

We, as Development Instructors, are a great part of and effort to improve the child mortality reductionin the countries we are going to work in. Contributing to the good quality of education, health and environment

while working with the communities we can achieve a lot: improve these fields as well as contribute to the

result of their development - reduction of child mortality.

1 http://www.unicef.gr/pdfs/UNICEF_Levels_and_Trends_in_Child_mortality.pdf

ntroduction
http://www.unicef.gr/pdfs/UNICEF_Levels_and_Trends_in_Child_mortality.pdfhttp://www.unicef.gr/pdfs/UNICEF_Levels_and_Trends_in_Child_mortality.pdfhttp://www.unicef.gr/pdfs/UNICEF_Levels_and_Trends_in_Child_mortality.pdfhttp://www.unicef.gr/pdfs/UNICEF_Levels_and_Trends_in_Child_mortality.pdf


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Good news - child mortality in a global level has been substantially decreasing since 1990. The total number of

under-five deaths declined from 12.5 million in 1990 to 8.8 million in 2008. Under-five mortality is increasingly

concentrated in a few countries. Please refer to Chart #1 for a visual illustration of the total change from the

year 1990 to 2008.

Chart #1About half of global under-five deaths in 2009 occurred in

only five countries: India, Nigeria, Democratic Republic of

the Congo, Pakistan and China. India, with 21 percent, and

Nigeria, with 10 percent, together account for nearly a

third of under-five deaths worldwide.

Some 40 percent of under-five deaths occur within the first

month of life, and some 70 percent occur within the first

year of life. The two biggest killers of children under age

five are pneumonia (18 percent of deaths) and diarrhea

diseases (15 percent). Most child deaths are preventable ortreatable. Despite that, the number of child deaths is

extremely high in a number of countries. The summary of

major causes of child deaths are presented in Chart #2.

Major Causes of Child Deaths Number of under-five Deaths by Region

Chart#2 Chart #3Source: http://www.prb.org Source: http://www.childinfo.org

The way the information about the situation in the world is presented today is dividing and grouping

countries into regions and giving us the average of number of deaths in the whole region. Please refer to Chart

#3 to see the achievements in each region. The biggest progress has been made in Northern Africa, Eastern

Asia, Western Asia, Latin America and the Caribbean, and the countries of the CIS (Commonwealth of

Independent States). Even though not all the regions have such impressive improvement in reducing child

mortality, the general trend seems to be going to the right direction.

Current Situation


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It is important to notice that these are the average

numbers in a whole region, so do these groups of countries

are representing the real situation of what is going on in each

of the country in the region? To give a real picture of where

we are standing today in reducing child mortality, let's focus

on Sub-Saharan Africa region. Graph #32

(on the right side)

shows the child mortality rate per 1000 births in year 2008 inthis specific region. The blue bubbles that are representing

different countries are spread around the graph, which shows

that the child mortality rate is very different in all the

countries. Let's take a look at separate countries in Table #1:

Table#1

Graph #3

Based on the figures seen in each different

country of Sub- Saharan Africa region, we want to

emphasize that neither Africa, nor Sub-SaharanAfrica region are a country. The interval of highest

and lowest child mortality rates is too big to make

averages that could tell us the truth of what is

happening in the countries in this region. That is

why they cannot be presented as one unit to

reflect the current situation of child mortality. Due to this reason, while presenting the information about child

mortality rates we will focus on separate countries in Sub-Saharan Africa region, specifically on Angola, Ghana,

Gabon, Malawi and Congo Republic.

Graph #4

The final numbers of 2008 that are given do

not say much what exactly is happening and what the

trends are in the countries today. That is why it is

good to take a look at the progress or even regress

that each country has made so far since the year 2000.

Graph #4 illustrates the trend.

Even though Malawi, Ghana, Angola, and

Gabon are witnessing improvement (which is a

decrease in child mortality rate), Congo Republic faces

an opposite trend. The number of children deaths has

a trend to be increasing until now.In order to evaluate the success of Millennium

Development goals, it is important to identify the

starting point of the improvement. Was there really a

big change and improvement starting in the year 1990

2 How to read and interpret the following graphs: x-axis represents the income per person, while y-axis - Infant mortality rate per 1,000 births. Eachbubble represents a different Sub-Saharan Africa country. The number in the background of the Graph is the year of statistical data presented. It

applies for all the remaining graphs.

Country Deaths per 1,000 Births

Seychelles 13

Botswana 59

Ghana 72

Congo Republic 127

Congo Democratic Republic 199

Angola 166

Progress Made


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or 2000 when the Millennium Development Goals were set? Let's take a look at the Graph #5 to see what the

trend in different Sub-Saharan Africa countries were before the goals were set.

Graph #5Due to the availability of the data starting

approximately around 60s, the starting point (year)

of the line representing each country is1958-60and it continues throughout the years until now.

The x-axis of the Graph represents the Income per

Person in the specific year. This axis is representing

the development of the country. As the Graph

shows, there is a relationship between the

development of the country and child mortality

rate. The more developed country is, the lower

child mortality rate it is witnessing. The last five

decades have witnessed an impressive decline in

child mortality in the world as a whole, as well as in

these specific countries. What was the reason? Theanswer is development of the countries. As the

Graph# 5 illustrates, the child mortality rate is

decreasing when the country is developing. The

trend that is shown starting from 1960s proves that

the trend of decreasing number of child deaths had been already happening before the Millennium

Development Goals were set because of the trend of development in the country.

The target of the Millennium Development Goal 4 is to reduce by two thirds, between 1990 and 2015,the under-five mortality rate. That means, that starting from the year 1990, the child mortality rate should be

decreasing by approximately 4.3% annually. The average annual rate of decline increased to 2.3 per cent for

the period 2000 to 2008, compared to 1.4 per cent in the 1990s. The improvement is big but the rate is too

slow to achieve the goal. However, some of the countries can reach the goal if they continue improving at the

rate that they have been doing until now. Table #2 illustrates the change in child mortality rate in a number of

countries throughout the years 2000-2008.

Country

Deaths per 1,000

births in the year

2000

Deaths per 1,000

births in the year

2008

Mortality rate per

year

Malawi 164 110 -4.1 %

Ghana 106 72 -4 %

Gabon 83 71 -1.8 %

Angola 212 166 -2.7 %

Congo Republic 116 127 1.1 %

Table #2

Will the Goal be Reached?


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Taking into consideration the global trend as well as separate countries, it is clear that with the path and speed

that some of the countries are decreasing child mortality, the MDG 4 will not be reached until 2015.

AngolaIf we look specifically at sub-Saharan Africa, we can see very different situations between different countries.

The thing that is common to most successful countries is relatively stable political situations. Countries like

Ghana and Malawi hasnt had big military conflicts since the gain of independence and that has given these

countries possibility to develop in peace and has lead to constant decrease of child mortality for the 50 years.

During wars are more problems with accessing basic thing like medicine and food, which is extremely

dangerous for the less protected groups like children, it also usually stops any possible economical development

in the area. If we look at Angola, then during the Civil war the child mortality stayed in the same level (270

deaths per 1000 births) however when the peace negotiations started between the sides, even though the war

didnt end until 2002 the child mortality rate started falling and now the approximate number is 160, so it is

more than ne third of reduction in 15 years (since 1994). The main reasons for high child mortality have been

measles and malaria. To fight child mortality Angolan government started an action called Viva a Vida comSade (Enjoy a Healthy Life) involving thousands of health workers and vo lunteers. It was a major campaign

with a goal to reach 3,6 million children under 5 and provide them with vaccines and interventions. The

provision included measles vaccine, oral polio vaccine, de-worming medicine and vitamin A supplements to

boost their immune systems. Their mothers were given long-lasting, insecticide-treated bed nets to protect

their families from malaria. This huge action wouldnt have been possible if the country would still be divided

by a civil war.

GhanaIn 1987 in Ghana started education reforms and in 1992 the constitution stated that everyone has right to free,

compulsory, universal, basic education. Ghana had a success in fighting child mortality during the 1990s, when

it was reduced from 122 deaths on 1000 live births in 1990 to 98 in 1998. However after the situation got worse

an during 2004 2006 period the under-five mortality level had stuck on 111 on 1000 live births. To improvethe child survival Ghana launched a new Child Health Policy and strategy. It focuses on improving access to,

quality of, and demand for essential services. The strategy also includes new technologies and introduces new

vaccines. These improvements help fighting diseases like measles, rotavirus and diarrhoeal diseases. This has

lead to 28 % decline from 111 deaths per 1000 live births in 2004 Ghana Demographic Health Survey to 80 in

2008.

MalawiOne of the most efficient countries to fight child mortality in sub-Saharan Africa has been Malawi so far. It has a

stable political situation (multi party democracy) in the country which allows step by step development to take

place. The most common reasons for under 5 mortality has been pneumonia, malaria, diarrhoea, AIDS and

malnutrition. The cases of malnutrition include lack of knowledge about child-care practices, inadequate

diet, frequent incidences of disease among young children, and the low socio-economic status and poor

nutritional condition of most mothers. Up to 50 per cent of identified acute malnutrition is associated with HIV.

The Expanded Programme on Immunization (EPI) was officially launched in Malawi in 1979. The Malawi policy

regarding EPI is to immunise all children under 12 months old with a goal of reducing morbidity and mortality

due to six preventable diseases namely measles, tuberculosis, whooping cough,

diphtheria, poliomyelitis and tetanus.

In 2006 Malawi adopted a policy for Acceleration of Child Survival and Development (ACSD). It is planned to

work particular in community level using dialogue as the preferred way of communication. Malawi has

managed to achieve routine immunisation coverage of over 86 percent, which has reduced the vaccine

Success Stories. What has worked?


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preventable diseases. Polio, measles and neonatal tetanus have been virtually eliminated. More than 5,5 million

insecticide-treated nets (ITN) have been distributed, as a result more than a half of households now owns at

least one net.

Nutrition: Malawi has maintained over 90 percent of vitamin A supplementation in children under the age of

one, still the coverage for older children is still low. The mortality rate between children with severe

malnutrition was reduced from 30 40 percent to 16-17 percent between 2002 and 2003. A new approach

Community Therapeutic Care is implemented. It uses a therapeutic food called plump nut for the treatment ofsevere malnutrition.

The national policy on newborn care has been revised. Health workers were trained in newborn care. The

emergency obstetric care increased from 2 sites in 2006 to 22 in 2007.

The coverage of prevention of mother-to-child transmission services have increased from 7 in 2002 to 454 in

2008. Number of pregnant women testing for HIV increased from 320 in 2001 to over 280 000 in 2008.

As we can see the fight against child mortality depends on nutrition, health system and education. All these

things are hard to develop without having stable political situation the country. Nutrition is essential for the

children and their mothers to build up their immune system. Many deadly diseases have been eradicated by

vaccination; therefore it has reduced the child mortality a lot. However not every disease has a vaccine. Raising

awareness and educating about diseases like malaria and Aids have reduced the threats for children to be

infected.

As DIs our role in development is of extreme relevance. We are not only simple workers or helpers in the

projects, but also we act as role-models to set examples and standards. We can contribute in many fields and

be part of the work with the communities. Some of us will be in city areas, others will be in more remote rural

areas. Nonetheless, no matter what project we might be on it could be TTC, Child Aid, Malaria Project,

Farmers Club, etc a huge part of the job will consist in teaching the communities how to help themselves in

the process of development.

Concretely, in the case of Child Mortality, our contribution comes mostly in the form of teaching, but also

the footprint can be left in more material forms. The focus should be on 3 main points: Education, Health and

Communities. Specific efforts in each area will help out generally in the 3 areas and all together contribute for

more than just one issue. Remember that the problems of Child Mortality are not the same for every country in

Africa. Each country has its own individual issues and depending on their own reality, your actions should come

accordingly.

In terms of Education, the essential would be spreading the know-how. Primary and Secondary education

available for all is essential to promote a safe environment for the children and knowledge to the parents to

take care of their families. Knowing how to proceed in different situations (health issues, economic/financial

adversities, labour opportunities, etc) will give the tools necessary for the parents to provide their children with

better conditions throughout life. Family planning, family care, gender equality, community-wise occupations

are all part of educating the families into building a better social and sustainable background for future

generations.

Health is a big issue, mainly concerning basic conditions that are needed for the healthy development ofthe children (especially for under-five infants). Easy and safe access to clean and drinkable water as well as

basic medical care like vaccinations and medical attention will represent a big step in improving the infants

health. Promoting diverse kinds of prevention of diseases (like Matacanha, HIV/AIDS, Diarrheal Infections and

Parasitic Worms) through the simple mean of filtering water and cleaning food is a great example of something

that you can achieve. Building water pumps (rope pumps), improving sanitation (tippy-tap) and improving

nutrition are other examples of steps towards better health conditions for both children and parents.

When concerning the communities you can promote gender equality and childrens rights just by

advertising it and showing the example yourself. Also, by teaching the families how to practice different

What Can We Do?


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income-generating activities, how to improve their own labour techniques (farming, handcrafting, etc) or even

how to budget their economies will make the difference in providing financial stability for the families and

consequently better conditions for the children.

All kinds of actions can be taken to make a better environment for the children to grow in! Whether in the

fields of Education, Health, Communities or even the Environment itself, you can take part in bringing

development and giving your own input to decreasing Child Mortality in the country of your project. You can

follow these steps for more adequate actions: Analyse the country youre in, as well as the region youre working on. What kind of environmental factors are you facing? (If, for example, youre in watery areas or

jungle areas the risk of parasitic diseases are higher).

What cultural factors can contribute to a better integration of your actions? Focus oncooperation and not replacement of traditions!

What is the reality of your area labour wise? Adjust your actions (such as improving incomegenerating activities or specialisation) to the needs of the community.

Find out how to focus on the form the base of children welfare. Focus your actions on forming asolid ground for sustaining the development of childrens life.

Make sure youre actions are long living and that they leave more than an immediate mark inthe place of your project. Short-term solutions must have long-term effects to have real impact

on the lives of the people in the community.

united nations development goals regarding child mortality

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