© UNICEF/Manuel Moreno/2013
A child has a right
to life, survival and development. He or she has a right to health and health
services, as well as a right to an adequate standard of living. He or she has a
right to an identity.
Namibian infants and young children are
likely to find these rights fulfilled, though there are areas where society
fails to provide these basics to all children. Progress in the support and care
of babies and infants is mixed. Successes include the high numbers of mothers
who receive antenatal care, who give birth in health facilities, and who receive Prevention of Mother-to-Child Transmission (PMTCT) services where needed. Concerns arise in the following areas: rising rates of
maternal mortality, little or no improvement in infant mortality, high rates of
waste, and low levels of immunisation and birth registrations.
Most mothers today attend antenatal clinics
and many give birth with a medical professional present. Yet the number of
children and mothers dying at childbirth, or in the year after, is rising again
after falling in the 1990’s. Despite the fact that over 90% of mothers are
receiving antenatal care and over 80% are attended at birth by a trained birth
attendant, it is unlikely that the MDGs will be reached. The rising death rates
are partly explained by the indirect effects of AIDS, although the effect is
hard to quantify.
The costs of access to the health system,
particularly when treatment - such as antenatal care and vaccinations -
requires several visits to a clinic, have an effect on the overall
effectiveness of a programme. Quality of health care support will also vary
according to location, with pockets of lower standard care. Northern rural
areas suffer in particular from staff and resource shortages.
Other factors relate to the social,
economic and educational status of the mother. Children of mothers over 40
years are particularly at risk, as are, to a lesser degree, children of teenage
mothers. Children who are born within two years of a previous child are also at
greater risk. The way in which mothers handle diseases like diarrhoea also has
an effect; many mothers know about oral rehydration therapy but the children of
less educated mothers are more likely to die from diarrhoea than other
Poverty levels amongst mothers have defined
impacts as well. Poorer mothers live further from health facilities, report
difficulty in transportation because of cost and thus attend less frequently
for post natal care. Many are also unable to afford formula milk if they are
HIV positive and have to use wood for cooking (a factor in acute respiratory
infection). Low birth weight and high numbers of children (29%) who are found
to be either moderately or severely stunted are also likely linked to poverty
and lower levels of education of parents and care givers.
Progress towards vaccination targets for
children is not as strong as was hoped when policies were written and resources
allocated. Only 70% of births are currently being registered. These are
important foundations for a child’s future. Efforts have been made to work
across ministries and departments to remedy these challenges and this analysis
highlights how it appears that children and mothers at risk can be identified
according to their background. More work targeting at-risk infants and children
would be valuable.
Finally, the importance of early childhood
education is slowly being recognised through programmes of the Ministry of Gender Equality and Child Welfare (MGECW) and the Ministry of Education (MoE). The City of Windhoek is also being active in this field. Around 50,000
children benefit from Early Childhood Development (ECD) programmes (about half the number of children who
should benefit) but further efforts will be needed to ensure that all provision
meets basic standards.