Early Childhood Years
There are well over 800,000 children in Tajikistan who are 0 to 5 years of age. This means that more than one in ten people in the population is in this age group.
Despite economic progress and gains in stability, the life of the typical child of this age remains uncertain. Poverty is still a constant and is having a particularly large impact on young children and on women because of the special vulnerability of these segments of the population.
Due to the fees involved and their lack of awareness of legal requirements, many parents cannot or will not register the births of their children until circumstances oblige them to do so, entry into school or migration, for example. Between 1999 and 2004, only an estimated 75 per cent of all births of children under 5 had been registered. This makes providing adequate health care and education more problematic and also makes data analysis and accurate policy-making more difficult.
Significant unemployment has led to large-scale migration for work, especially among men. Women have been left behind to head households, and they have thus become responsible for supporting their families, as well as carrying out their other domestic duties.
Institutionalization was common in the Soviet era and is still considered an acceptable way of dealing with children. The number of institutionalized children has risen by a third over the last five years. More than 80 per cent of the 11,000 children who are living in institutions are not orphans. The reasons for institutionalization vary, but many of the children have been placed in residential care because their parents cannot afford to keep them at home.
The number of pre-schools has decreased significantly since the early 1990s, as has the enrolment rate in these facilities. In 2002, the enrolment rate was 16 per cent in urban areas, but only 1 per cent in rural areas.
The significant poverty in the country is reflected in the high mortality rates among infants (91 per 1,000 live births) and children under 5 (118 per 1,000 live births). These rates, comparable to those in sub-Saharan Africa, are also disturbing because they have not been declining much despite the best efforts of many partners over the last 10 years, including international non-governmental organizations.
The reasons for this situation are related to inadequate early recognition of the danger signs of childhood illnesses by parents, the lack of access to proper antenatal and postnatal care, and the high level of chronic malnutrition. Early childhood development is not well established and not considered a priority. There is thus much room for advocacy for infants and children.
About half of the mortality is due to preventable diseases. Vaccine-preventable diseases, such as typhoid, still pose a large threat to children. Since the Soviet era, routine immunization programmes have been cut back. As of 2004, the Government was financing only 2 per cent of routine vaccines in the expanded programme on immunization.
Complications in pregnancy resulting from poor health related to insufficiencies in nutrition are frequent. The practice of exclusive breastfeeding is not widespread, and this is a factor in inadequate childhood health and development. Micronutrient deficiency contributes substantially to the occurrence of malnutrition, disease and morbidity. Iodine deficiency, iron deficiency anaemia and vitamin-A deficiency are the most common types of micronutrient deficiency. Iodine deficiency appears to be a serious problem among people living in the mountains. Anaemia rates among children under 5 and women are high. Goitre afflicts more than one in ten people, and the rates are as high as 40 per cent among children and 65 per cent among pregnant and lactating women in some regions. Vitamin-A deficiency affects around a quarter of children. Diarrhoea and acute respiratory infections are the major causes of infant deaths.
The high rate of home births assisted by untrained birth attendants, especially in rural areas, represents one of the many elements affecting child survival.
Another piece in the puzzle of the poor health conditions is the shortage of resources and infrastructure. The Government contributes only 2 per cent of its annual budget to health care, which leaves the financial burden mostly on the shoulders of individuals, with some contributions coming from international organizations.