Empowering refugee and migrant children to claim their right to health: Improving health literacy
“I have always had to behave ‘like a girl’ and I am not used to being asked for my opinion, but you ask me to say what I think during these workshops.” A 13-year-old girl from Syria describes the impact of empowerment workshops in Serbia Boy is drawing a picture. UNICEF-supported activities for children on the island of Lesvos, Greece The ‘RM Child-Health’ initiative has supported work across five European countries to improve health literacy among refugee and migrant children over the past year. As a result, they and their families have learned about key health issues, about the health services available to them, and how to demand health services as their right. Through its support for health literacy – the ability to find, understand and use information to take care of your own health – the initiative has helped to dismantle some key barriers to health services for refugee and migrant children and their families in Bosnia and Herzegovina, Bulgaria, Greece, Italy and Serbia. This 27-month, €4.3 million co-funded initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, works alongside young refugees and migrants to ensure that they have accurate health information in their own languages – information that reaches them via the channels they use and the people they trust. Importantly, the initiative makes them more aware of their right to health care in these European countries – welcome news for those who have fled from countries where good quality health care is either unaffordable or unavailable. With support from the initiative, UNICEF and its partners first worked with young refugees and migrants to identify gaps in the information available to them and in their own knowledge. This informed the health literacy packages that have been rolled out in all five countries over the past year, spanning a wide range of topics from immunization and nutrition to sexual and reproductive health (SRH) and gender-based violence (GBV). The packages themselves have been backed by detailed plans to ensure that their messages reach their audiences and gain real traction. Great care has been taken to ensure that information materials are culturally appropriate, gender sensitive and child-friendly, and that they are suitable for the ages and backgrounds of their audiences. Cultural mediators and interpreters have helped to overcome language and cultural barriers, while materials have been made available in, for example, Arabic, Farsi and Pashto. Activities have often been led by trusted professionals, such as nurses, physicians and psychologists who are already familiar with the needs of refugee and migrant children and their families. Materials have been shared through channels and locations that are well-used by refugees and migrants, including asylum offices, temporary reception centres, health centres, Mother and Baby Corners (MBCs), workshops and discussion sessions, during outreach activities and via social media. As a result, health literacy is now embedded into existing activities with refugee and migrant children and parents across all five countries, and is based firmly on their views and needs.
Safeguarding the health of refugee and migrant children during COVID-19
, the initiative has supported UNICEF’s efforts to improve the immunization process for refugee children and migrants by strengthening the assessment and monitoring process. As a result of such efforts, refugees and migrants have been included in the national COVID-19 Immunization Plan.
Breastfeeding: the best gift a mother can give her child
Breastmilk saves lives, protects babies and mothers against deadly diseases, and leads to better IQ and educational outcomes, yet rates of breastfeeding in Europe and Central Asia are low, with only 23 percent of the wealthiest families and 31 percent of the poorest breastfeeding up to the recommended age of two. Empowering and enabling women to breastfeed needs to be at the heart of countries’ efforts to keep every child alive and to build healthy, smart and productive societies. “Breastfeeding is the best gift a mother, rich or poor, can give her child, as well as herself,” said Shahida Azfar, UNICEF’s Deputy Executive Director. “We must give the world’s mothers the support they need to breastfeed.” A mother breasfeeds her baby at a maternity centre in Tashkent region, Uzbekistan. A mother breasfeeds her baby at a maternity centre in Tashkent region, Uzbekistan. The early initiation of breastfeeding – putting newborns to the breast within the first hour of life – safeguards infants from dying during the most vulnerable time in their lives. Immediate skin-to skin contact and starting breastfeeding early keeps a baby warm, builds his or her immune system, promotes bonding, boosts a mother’s milk supply and increases the chances that she will be able to continue exclusive breastfeeding. A mother learns to breastfeed her baby at a maternity hospital in Fergana, Uzbekistan. A mother learns to breastfeed her baby at a maternity hospital in Fergana, Uzbekistan. Breastmilk is safe as it is the right temperature, requires no preparation, and is available even in environments with poor sanitation and unsafe drinking water. It’s also more than just food for babies – breastmilk is a potent medicine for disease prevention that is tailored to the needs of each child. The ‘first milk’ – or colostrum – is rich in antibodies to protect babies from disease and death. A patronage nurse teachers a mother how to breastfeed in Kyzylorda city, Kazakhstan. A patronage nurse teachers a mother how to breastfeed in Kyzylorda city, Kazakhstan. In Kazakhstan, UNICEF has been working with patronage nurses to support mothers to breastfeed their children. The project has been running for several years and includes two visits during pregnancy and nine visits until the child reaches the age of three. As a result, there was a 14 percent increase in the number of children who were exclusively breastfed in the pilot region. A patronage nurse visits a family in Kyzylorda city, Kazakhstan. A patronage nurse visits a family in Kyzylorda city, Kazakhstan. There are several reasons why a mother may not be able to breastfeed, or does not wish to do so. Reasons include low awareness of the importance of breastfeeding and long-term impacts, as well as not knowing how to breastfeed properly which can subsequently cause the mother a lot of pain. Patronage nurses work with mothers to try to overcome these obstacles. A mother breastfeeds her baby, while the father and the older son support them. Mother Jovana breastfeeds her son Aleksa (two-months-old) while older son Ognjen (18-months-old) and husband Nikola support her at a clinic in Serbia. Breastfeeding is not a one-woman job. Women who choose to breastfeed need support from their governments, health systems, workplaces, communities and families to make it work. UNICEF urges governments, the private sector and civil society to create more enabling environments for breastfeeding mothers including arming mothers with the knowledge to make informed decisions, and providing them with the support they need from their families, communities, workplaces and healthcare systems to make exclusive breastfeeding for the first six months happen. Smiling parents watch as their baby breastfeeds at a maternity unit in Armenia. Smiling parents watch as their baby breastfeeds at a maternity unit in Armenia. In Armenia, UNICEF, together with the ministry of health and local health authorities, have created a sustainable parental education system at maternity and primary health-care facilities across the country to encourage breastfeeding and provide support to parents. In a UNICEF-supported space for refugee and migrant families, two mothers breastfeed their babies. In a UNICEF-supported space for refugee and migrant families in Serbia, two mothers breastfeed their babies. During the refugee and migrant crisis in Europe, UNICEF stepped in to provide support for children and mothers. Support included providing private spaces for breastfeeding mothers, nutritional guidance and breastfeeding support. UNICEF supports action to improve infant and young child nutrition across Europe and Central Asia, aiming to ensure that every child has the best possible nutritional start in life. Through its global campaign, Every Child ALIVE , which demands solutions on behalf of the world’s newborns, UNICEF urges governments, the private sector and civil society to: Increase funding and awareness to raise breastfeeding rates from birth through the age of two. Put in place strong legal measures to regulate the marketing of infant formula and other breastmilk substitutes as well as bottles and teats. Enact paid family leave and put in place workplace breastfeeding policies, including paid breastfeeding breaks. Implement the ten steps to successful breastfeeding in maternity facilities, and provide breastmilk for sick newborns. Ensure that mothers receive skilled breastfeeding counselling at health facilities and in the first week after delivery. Strengthen links between health facilities and communities, so that mothers are ensured of continued support for breastfeeding. Improve monitoring systems to track improvements in breastfeeding policies, programmes and practices.
7,000 newborns die every day, despite steady decrease in under-five mortality, new report says
– Every day in 2016, 15,000 children died before their fifth birthday, 46 per cent of them – or 7,000 babies – died in the first 28 days of life, according to a new UN report. Levels and Trends in Child Mortality 2017, reveals that although the number of children dying before the age of five is at a new low– 5.6 million in 2016, compared with nearly 9.9 million in 2000 – the proportion of under-five deaths in the newborn period has increased from 41 per cent to 46 per cent during the same period. “The lives of 50 million children under-five have been saved since 2000, a testament to the serious commitment by governments and development partners to tackle preventable child deaths,” said UNICEF Chief of Health, Stefan Swartling Peterson. “But unless we do more to stop babies from dying the day they are born, or days after their birth, this progress will remain incomplete. We have the knowledge and technologies that are required – we just need to take them where they are most needed.” At current trends, 60 million children will die before their fifth birthday between 2017 and 2030, half of them newborns, according to the report released by UNICEF, the World Health Organization, the World Bank and the Population Division of UNDESA which make up the Inter-agency Group for Child Mortality Estimation (IGME) Most newborn deaths occurred in two regions: Southern Asia (39 per cent) and sub-Saharan Africa (38 per cent). Five countries accounted for half of all new-born deaths: India (24 per cent), Pakistan (10 per cent), Nigeria (9 per cent), the Democratic Republic of the Congo (4 per cent) and Ethiopia (3 per cent). “To achieve universal health coverage and ensure more newborns survive and thrive, we must serve marginalized families," says Dr Flavia Bustreo, Assistant Director-General for Family, Women’s and Children’s Health at WHO. "To prevent illness, families require financial power, their voices to be heard and access to quality care. Improving quality of services and timely care during and after childbirth must be prioritized.” The report notes that many lives can be saved if global inequities are reduced. If all countries achieved the average mortality of high-income countries, 87 per cent of under-five deaths could have been averted and almost 5 million lives could have been saved in 2016. “It is unconscionable that in 2017, pregnancy and child birth are still life-threatening conditions for women, and that 7,000 newborns die daily,” said Tim Evans, Senior Director of Health Nutrition and Population at the World Bank Group. “The best measure of success for Universal Health Coverage is that every mother should not only be able to access health care easily, but that it should be quality, affordable care that will ensure a healthy and productive life for her children and family. We are committed to scaling up our financing to support country demand in this area, including through innovative mechanisms like the Global Financing Facility (GFF). ” Pneumonia and diarrhea top the list of infectious diseases which claim the lives of millions of children under-five globally, accounting for 16 per cent and 8 per cent of deaths, respectively. Preterm birth complications and complications during labour or child birth were the causes of 30 per cent of newborn deaths in 2016. In addition to the 5.6 million under-5 deaths, 2.6 million babies are stillborn each year, the majority of which could be prevented. Ending preventable child deaths can be achieved by improving access to skilled health-professionals during pregnancy and at the time of birth; lifesaving interventions, such as immunization, breastfeeding and inexpensive medicines; and increasing access to water and sanitation, that are currently beyond the reach of the world’s poorest communities. For the first time, mortality data for older children age 5 to 14 was included in the report, capturing other causes of death such as accidents and injuries. Approximately 1 million children aged 5 to 14 died in 2016. “This new report highlights the remarkable progress since 2000 in reducing mortality among children under age 5,” said UN Under-Secretary-General for Economic and Social Affairs Mr. LIU Zhenmin. “Despite this progress, large disparities in child survival still exist across regions and countries, especially in sub-Saharan Africa. Yet many deaths at these ages are easily preventable through simple, cost-effective interventions administered before, during and immediately after birth. Reducing inequities and reaching the most vulnerable newborns, children and mothers are essential for achieving the SDG target on ending preventable childhood deaths and for ensuring that no one will be left behind.” The report also notes that: In sub-Saharan Africa, estimates show that 1 child in 36 dies in the first month, while in the world’s high income countries, the ratio is 1 in 333. Unless the rate of progress improves, more than 60 countries will miss the UN Sustainable Development Goal (SDG) to end preventable deaths of newborns by 2030 and half would not meet the target of 12 neonatal deaths per 1,000 live births by 2050. These countries account for about 80 per cent of neonatal deaths in 2016. Medical staff in Kyrgyzstan check over a newborn baby. UNICEF Kygryzstan/2017
The Roma are one of Europe’s largest and most disadvantaged minority groups. Of the 10 to 12 million Roma people in Europe, around two-thirds live in central and eastern European countries. While some have escaped from poverty, millions live in slums and lack the basic services they need, from healthcare and education to electricity and clean water. Discrimination against Roma communities is commonplace, fuelling their exclusion. Far from spurring support for their social inclusion, their poverty and poor living conditions often reinforce the stereotyped views of policymakers and the public. And far from receiving the support that is their right, Roma children face discrimination that denies them the essentials for a safe, healthy and educated childhood. Discrimination against Roma children can start early, and have a life-long impact. The problems facing Roma children can start early in life. In Bosnia and Herzegovina, for example, Roma infants are four times more likely than others to be born underweight. They are also less likely to be registered at birth, and many lack the birth certificate that signals their right to a whole range of services. As they grow, Roma children are more likely to be underweight than non-Roma children and less likely to be fully immunized. Few participate in early childhood education. They are less likely than non-Roma children to start or complete primary school, and Roma girls, in particular, are far less likely to attend secondary school. Only 19 per cent of Roma children make it this far in Serbia, compared to 89 per cent of non-Roma children. There are also disparities in literacy rates across 10 countries in the region, with rates of 80 per cent for Roma boys and just under 75 per cent for Roma girls, compared to near universal literacy rates at national level. Roma children are too often segregated into ‘remedial’ classes within regular schools, and are more likely to be in ‘special’ schools – a reflection of schools that are failing to meet their needs, rather than any failure on their part. In Roma communities, child marriage may be perceived as a ‘valid’ way to protect young girls, and as a valued tradition. In reality, such marriages deepen the disparities experienced by girls, and narrow their opportunities in life. In many Balkan countries, half of all Roma women aged 20-24 were married before the age of 18, compared to around 10 per cent nationally. Child marriage and school drop-out are closely linked, particularly for girls, and such marriages also expose girls to the dangers of early pregnancy and childbirth, as well as a high risk of domestic violence.
Nearly a quarter of the world’s children live in conflict or disaster-stricken countries
In the 1950s, UNICEF’s first immunization campaigns targeted diseases such as tuberculosis and yaws. In 2015, UNICEF procured 2.8 billion doses of vaccines, helping to protect 45 per cent of the world’s children under age 5 from deadly diseases. In 1998, UNICEF became a founding member of the Roll Back Malaria Partnership to support malaria treatment and research, and expand prevention measures such as long-lasting insecticide-treated bed nets. In 2015, UNICEF procured 22.3 million bed nets to protect children and families in 30 countries.
Refugee and migrant children in Europe
People have always migrated to flee from trouble or to find better opportunities. Today, more people are on the move than ever, trying to escape from climate change, poverty and conflict, and aided as never before by digital technologies. Children make up one-third of the world’s population, but almost half of the world’s refugees: nearly 50 million children have migrated or been displaced across borders. We work to prevent the causes that uproot children from their homes While working to safeguard refugee and migrant children in Europe, UNICEF is also working on the ground in their countries of origin to ease the impact of the poverty, lack of education, conflict and insecurity that fuel global refugee and migrant movements. In every country, from Morocco to Afghanistan, and from Nigeria to Iraq, we strive to ensure all children are safe, healthy, educated and protected. This work accelerates and expands when countries descend into crisis. In Syria, for example, UNICEF has been working to ease the impact of the country’s conflict on children since it began in 2011. We are committed to delivering essential services for Syrian families and to prevent Syria's children from becoming a ‘ lost generation ’. We support life-saving areas of health , nutrition , immunization , water and sanitation, as well as education and child protection . We also work in neighbouring countries to support Syrian refugee families and the host communities in which they have settled.