At a glance: United States of America

Equity in child survival: An opportunity to do things better

'Progress for Children' interview series

© UNICEF/2009/Markisz
UNICEF Director of Policy and Practice Richard Morgan.

By Eileen Wu

The 2010 edition of UNICEF’s 'Progress for Children' shows that despite advancement towards the Millennium Development Goals (MDGs), many of the poorest and most disadvantaged children are still missing out. UNICEF invited several experts to offer their insights on what can be done to realize the MDGs for all.

NEW YORK, USA, 9 September 2010 - The theme of this year’s flagship ‘Progress for Children’ report, ‘Achieving the MDGs with Equity,’ makes reference to the gap in opportunity between the haves and the have-nots around the world. It is a gap that, in some cases, has widened over the past two decades.

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As analysis in the report shows, proportionally, more and more of the children who are dying in their first five years of life are in sub-Saharan Africa and South Asia. And across all regions of the developing world, the poorest children – those living in the poorest 20 per cent of households – are more than twice as likely to die before age five than their richest peers.

Narrowing the gap

In order to make further progress toward United Nations Millennium Development Goal 4, which aims to reduce child mortality by two-thirds, these gaps between and within regions must be minimized. During a recent interview, UNICEF Director of Policy and Planning Richard Morgan helped to explain.

“Those children who are not vaccinated, those mothers who don’t have access to antenatal care, are the very ones that we should be focusing on if we want to make the most rapid progress,” he said.

Millions of children continue to die before age five from preventable causes, including pneumonia and diarrhoea, often exacerbated by undernutrition. Mr. Morgan said that nutritional supplementation, immunizations and medicine, along with practical advice to mothers and fathers, are essential to a young child’s survival.

Again, it is children from the poorest families, and those living in rural areas, who seem to be missing out on these critical interventions. In countries that have reduced the overall number of underweight children, for example, the poorest households often see the smallest share of that reduction.

Reaching the unreached

“Every leader should know who are the poorest families, where they are and how to reach them,” said Mr. Morgan.

Reaching the unreached, then, begins with one step: knowing who is missing out and why.

“Many families face barriers,” explained Mr. Morgan. “Maybe the distances are great that they have to travel, maybe they’re short on time and maybe they’re short on cash that they need to pay for local fees. We have to understand those barriers that families face.”

One widespread solution that has proven successful, says Mr. Morgan, brings bundles of basic services from clinics and health posts to families who might otherwise not have access to either.

One such example are ‘Child Health Days’ where multiple services, such as measles immunization and deworming, are offered at the same time and on a specific day in villages and in urban areas.

Community empowerment

Diarrhoeal disease, a leading killer of children, is linked to poor sanitation. In the late 1990s, Bangladesh pioneered an approach called ‘Community-Led Total Sanitation’, which brought communities together to seek alternatives to open defecation. The approach worked to change a community’s norms, and appealed to the sense of pride felt when all members of the community were using latrines.

Similar initiatives have since been introduced to more than 40 countries spanning four continents in both rural and urban areas.

And perhaps most importantly, demand for change often arises within the community itself.

Since the introduction of the sanitation programme, Bangladesh has recorded a dramatic decrease in open defecation. Improvements in the use of sanitation facilities have reached even the poorest segments of the population. These lessons, accumulated over the years, illustrate the opportunity ahead – to make sure that the most disadvantaged children are not left out of global advancement toward the MDGs.

“There are many countries that have achieved much greater equity in terms of children surviving,” said Mr. Morgan. “We should be inspired by those successes, we should learn from them.”




17 August 2010: UNICEF Direct of Policy and Practice Richard Morgan helps to explain some of Progress for Children's major findings.
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Here's a transcript of the interview. [PDF]

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