Madagascar’s children are a source of great pride and pleasure. A common blessing heard at weddings is to wish the couple the joy of seven sons and seven daughters. Such a family is evidence of the prosperity and happiness that a successful life together brings.
Yet the reality for many of Madagascar’s young citizens does not always match these expectations. In Madagascar, poverty brings with it major challenges to early childhood survival and development; and Madagascar ranks 135 out of 169 on the Human Development Index.
Half of Madagascar’s population of 20 million is under 18 years old. Of these young people a third, or three million, are under five. For many of them, basic health interventions are vital to ensure their survival and growth.
Although in recent years, Madagascar has emerged as one of few African countries to show a decrease in the number of children dying before reaching their fifth birthday, it still ranks joint thirtieth among countries with the highest infant mortality rates in the world. In remote rural areas, mothers and their babies are often unable to reach health facilities, leaving newborns especially vulnerable.
Maternal mortality remains high. While 86 percent of expectant mothers between 15 and 49 years receive antenatal care one to three times during pregnancy, the figure masks disparity between pregnant women in cities and those in rural areas. Most women lack access to emergency obstetric care, and nearly half of all births take place without a skilled attendant present. Recent data show that maternal mortality has risen from 470 deaths per 100,000 live births in 2006, to 500 deaths per 100,000 live births in 2009.
Preventable diseases, poor hygiene, a lack of access to safe water and inadequate sanitation still account for the vast majority of childhood deaths. Malnutrition – particularly in southern regions – is a persistent, underlying cause of death and stunted development, weakening children’s immune systems and their ability to fight disease.
Interventions including immunisation, vitamin A supplementation and the use of insecticide-treated mosquito nets to prevent malaria are helping children to survive. These interventions are also giving children a greater chance of reaching their early childhood development potential, laying the foundations not only for successful physical development, but also for mental and emotional development.