Young child survival and development

Child Survival


Targeting the worst off in South Asia will pay off quicker and save millions of lives, UNICEF study shows.

New, more cost effective ways of narrowing widening gaps between the richest and poorest in South Asia -- where bulk of the world's poor live – will help the region reach its Millennium Development Goals by 2015, according to UNICEF studies.

Better, richer data, broken down beyond national averages demonstrate that current ways of doing business will mean millions of South Asia’s poorest children risk being left behind in the drive to fulfill development commitments simply by being born poor or female, in the wrong caste, religion, ethnic group or in the wrong place.

Two new UNICEF reports that have undergone rigorous review among global development experts - Narrowing the Gaps to Meet the Goals and Progress for Children: Achieving the MDGs with Equity show the scale and depth of the problems South Asia faces. The reports also offer strong evidence that every new dollar invested in the most marginalized communities will produce 60 percent better results than the current path.

Progress for Children, UNICEF’s flagship data-based report assesses poverty, gender and geographic location of residence – all which profoundly affect a child’s chances of growing up healthy, protected and educated. While good progress has been made over the last decade, South Asia, like sub-Saharan Africa, is lagging behind on most MDGs. It makes clear that falling national averages mask widening inequities. The true picture of deepening divides and disparities emerges by drilling down below the surface of national statistical progress.
 In South Asia, as children from the poorest households moves through the life cycle they are:
• 5 times less likely to receive skilled assistance at birth
• 3 times less likely to have his/her birth registered
• 3 times as likely to be underweight
• 2 times less likely to receive basic immunizations
• 3 times less likely to receive a secondary education
     …..than a child from the richest household

The region has more malnourished children than anywhere else in the world with 42 per cent of children under 5 years of age underweight and the highest number of out-of-school children (33 million). South Asia accounted for one third of the world’s child deaths in 2008 and half of nearly 615 million children in the region are living in poverty.

There is a unique South Asian paradox -– dynamic economic growth yet rising disparities. If South Asia fails to meet its MDG commitments, so will the rest of the world. If India, the most populous country in the region fails, so too will the rest of South Asia.

A New Focus on Equity

Inequity means differences that are unnecessary, unfair and unjust. An equity-focused approach to development aims to narrow gaps between the most and least deprived groups by taking free health and education services out to the poorest, upgrading health facilities, providing cash transfers and boosting community involvement.

Barriers to Equity in South Asia

South Asia faces unique challenges around social exclusion with poverty, caste, ethnicity, gender and geographic location unfairly skewing a child’s chances of growing up strong and exposing them to multiple deprivations.

New and emerging forces also threaten to hold the poorest children back - the impact of the global economic crisis which means fewer development dollars, harsh labor market conditions, and the stresses of migration, rapid urbanization, and increasingly catastrophic humanitarian crises - such as the recent massive floods that have struck Pakistan.

GAPS - Poverty

• Throughout South Asia, a child from a poor household is three times more likely to die than a child from a rich household.
• Across the region, 56 percent of children under the age of 5 in the poorest households are underweight. In India, Nepal and Sri Lanka, children from the poorest households are nearly three times more likely to be underweight than children from the richest households.
• In India, there was no meaningful improvement among children in the poorest households while underweight prevalence in the richest 20 percent of households decreased by a third between 1990 and 2008.
• There is no more inequitable place in the world to give birth than South Asia, where only 17 per cent of the poorest women are assisted at birth by a skilled attendant compared to 83 per cent of women from the richest households.
• In Pakistan, a girl from the richest household is 6 times as likely as a girl from the poorest household to go on to secondary education.
• Across the region, girls from poor households are more than three times likely to be married     before 18 years of age than their richer compatriots.

GAPS - Gender

Despite major advances towards gender parity in primary education over the past decade, girls and young women in South Asia are at greater disadvantage in access to education, particularly at secondary level, for reasons of poverty, gender discrimination, exclusion and/or neglect and these differences are also slightly larger in rural than in urban areas and among poorer households.
• While Bhutan, Maldives and Sri Lanka, have achieved gender parity in primary school enrolment, Afghanistan, Nepal, India and Pakistan have far fewer girls than boys in school; in Afghanistan for example, only 46 per cent of primary-school-age girls are enrolled in primary school and in Pakistan only 57 per cent.
• In South Asia, only 45 per cent of girls are enrolled in secondary school compared to 53 per cent of boys. The widest difference is in Afghanistan, where only 6 per cent of girls are enrolled compared in secondary school compared to 18 per cent of boys.
• In South Asia, gender inequality and lack of education amongst women are factors that have a profound influence on the ability for a mother to properly care and provide for her children and ensure their survival. In Nepal, a child whose mother has had no education is 7.2 times more likely to die than a child whose mother has received secondary or higher education - followed by India (3.2), Bangladesh (2.9) and Pakistan (1.7).

GAPS - Geographical Location

Geographic location of residence is a major determinant in accessing essential healthcare services, safe drinking water and sanitation, and primary and secondary education.
• In South Asia, a child from a rural area is one and a half times more likely to die from preventable diseases than a child from an urban area before his/her 5th birthday.
• Within countries too there are striking differences -- a child from Uttar Pradesh in India is six times as likely to die before his/her birthday as a child from Kerala.
• In Pakistan rural children are still 1.4 times more likely than urban children to be missed out on vaccines. 
• Across the region, girls from poor households are more than three times likely to be married before 18 years of age than their richer compatriots.

GAPS – Ethnicity and Caste

•In Nepal Dalits are worst off on every development indicator as are those from scheduled castes and scheduled tribes in India and Hindu families in Bhutan
•In Bangladesh, more Buddhists and Christians live below the poverty line than their Muslim counterparts (UNICEF ROSA Social Policy data).
•In Pakistan, children from ethnic minorities such as Barahui or Marvari-speaking children are far more likely to suffer from absolute poverty than Urdu-speaking children

Keeping the promise, making sense

All national constitutions in South Asia are based on principles of equality and human rights. which also inform the charter of regional body, SAARC. Most countries have outlawed discrimination and have now put in place instruments for affirmative action and social protection, new laws like the right to education and the right to information (India) as well as guaranteed employment for the rural poor (India, Bangladesh). 

Examples of what is working from the region:

• Sri Lanka’s extensive social security coverage and schemes, providing income support and health care with a wide reach in rural and urban areas, have contributed to the lowest maternal mortality rates and best nutritional outcomes in the region.
• Bangladesh, in particular, has focused on addressing the structural issues of inequality in access to income through a combination of cash and in-kind programmes.
• Incentive schemes such as scholarships and school meals exist throughout the region to improve access to education for vulnerable groups such as the Female Secondary Stipend project in Bangladesh, which provides cash to rural girls who stay in school and do not marry.
• Emerging evidence from Nepal and Bangladesh underline the importance of Early Childhood Development in narrowing the gap between the richest and poorest children - by targeting the most marginalized children for pre-school as early as possible, children begin school on the same starting block.

Equity means a stronger focus on leveling the playing field between rich and poor is not only right morally but it is right logically, practically and also cost-effective.
• Compelling governments and development partners to invest more in the most disadvantaged and marginalized communities - it is right in principle
• Promoting simple, inexpensive measures such as hand washing with soap, breastfeeding, and providing water and sanitation in schools, which boost school attendance, especially among girls, cash transfers and incentive schemes. It works.
• Promoting community-based approaches such as lady health workers in Pakistan and barefoot gynaecologists in Nepal who act as agents promoting basic health practices; advocating for communities to demand services and to use them. It is logical.
• Harnessing the power of technology and creative innovations in financing, both public and private resources, such as sending text messages to mothers about immunization. It is practical and cost effective.
• Investing in these children today will provide them with the tools to contribute to the development of their nations tomorrow. It makes sense – and it’s the right thing to do.



For every child
Health, Education, Equality, Protection