With very few exceptions, children living in Barbados and the Eastern Caribbean are born healthy and have access to good health care services. This is evidenced by the high immunization rates, low under-five mortality rate and the fact that few children suffer from diseases such as polio, chronic malnutrition or ‘wasting’ (low weight for height) and stunted growth, which was characteristic among children of previous generations. The main health problems affecting children may come from the occasional outbreaks of rubella, dengue fever and gastroenteritis.
In spite of the remarkable strides made in health, a growing concern is the number of babies being born HIV-positive and the increasing number of young children being orphaned by AIDS. Some of these children may be cared for by the state and others are usually taken care of by the extended family – however, the latter are still subject to discrimination within various social settings, including in the home.
Encouraging mothers to exclusively breastfeed for six or more months, which positively affects the overall health of their children is also a concern. Although because of the baby friendly hospital initiative programme, mothers do initiate breastfeeding, anecdotal evidence indicate that young children are normally breastfed for three months or less. This is primarily because many mothers discontinue breastfeeding upon their return to work as many work environments make it difficult for working mothers to continue breastfeeding.
Universal access to early childhood education and quality early childhood care continue to be challenges
Although in a country, such as Barbados, a large number of children have access to early childhood education, this is not necessarily the case in other countries. In some countries, early childhood centres are heavily concentrated in urban areas, depriving children who live in isolated rural areas from accessing these facilities. Some parents also cannot afford the cost of early childhood centres, which are primarily privately-owned and operated. As might be expected therefore, the enrollment rate at pre-primary level tends to be low. Most governments are taking steps to improve this situation and it is hoped that universal early childhood services will be achieved within the next decade in all countries.
Even when children have access to early childhood education, the quality of care is sometimes questionable. In many early childhood centres, there is not enough emphasis on the early stimulation of children, especially for those under three years of age. In addition, many pre-schoolers sit in overcrowded classrooms with little or no apparatus with which to work. In these situations, instruction is not child-centred but teacher-directed and rote-learning is the main method of teaching. Although countries such as Barbados, St. Kitts and Nevis and Grenada have minimum standards for operation of child care centres, other countries do not and therefore, government monitoring tends to be weak and several centres operate without a licence or any official governmental monitoring. The turn-over rate of caregivers is quite high, mainly due to low wages in the sector, and this makes it difficult to sustain good quality of care of young children.