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The 1980s: Campaign for child survival

As the 1980s -- the third Development Decade -- dawned, the countries of the developing world were beginning to feel the chill of global recession. In the industrialized countries, growth had slumped and unemployment had risen to levels higher than at any time since the 1930s. This slow-down was transmitted to the developing countries, and one major consequence was an international debt crisis -- sparked off in 1982 when Mexico suspended interest payments on an accumulating mountain of debt. As a result, many African and Latin American countries were hit by recession and directives that they structurally adjust their economies. The situation had severe implications for the poor, in time prompting a call similar to that of the 'emergency for children' in the 1970s: 'adjustment with a human face'. The concept responded so persuasively to the anxiety about what was happening to vulnerable groups in developing countries that it quickly entered the lexicon of international development. In a very real sense, it served to take UNICEF into the mainstream of economic and social policy-making, giving UNICEF a voice and credibility not experienced before in these circles.

Photo: Global immunization reached an average 80 per cent of children in 1990, achieved through national campaigns, immunization days and other intensive efforts. Children were immunized at school in Thailand. ©

At the same time, there were emerging signs of hope for the children's cause. The evolution of the 'basic services' and PHC approaches had given the practitioners of social and human development a new sense of purpose. And the success of the 1979 International Year of the Child implied that the time was ripe for a new push on behalf of children. UNICEF's new Executive Director, James P. Grant, was determined to capitalize on these opportunities.

In December 1982, in his annual State of the World's Children report, James Grant launched an initiative known as the child survival revolution, later including child development. This campaign reversed conventional wisdom. Rates of infant and young child mortality had previously been seen as measurements of a country's development. Now UNICEF suggested a direct attack on infant and child mortality as an instrument of development.

In a throw-back to the great disease campaigns of the 1950s, UNICEF now proposed to vanquish common infections of early childhood using simple medical technologies. From the primary health care package, it singled out four techniques, which collectively were referred to as 'GOBI': 'G' for growth monitoring to keep a regular check on child well-being; 'O' for oral rehydration therapy to treat bouts of childhood diarrhoea; 'B' for breastfeeding as the perfect nutritional start in life; and 'I' for immunization against the six vaccine-preventable childhood killers: tuberculosis, diphtheria, whooping cough, tetanus, polio and measles. One of the strengths of this prescription was that all the techniques were low cost ( Panel 10).

Initially, some members of the international public health community had reservations about the 'child survival and development revolution'. They were concerned about its narrow emphasis on a few primary health care ingredients. But the cause of child survival found an extraordinary degree of worldwide resonance, gathering a wide range of allies -- national, international, bilateral, non-governmental -- and from all walks of public and professional life.

This accumulation of popular and political support was not accidental. It was the result of a sophisticated use of communications, taking advantage of two fundamental developments over previous decades. First, there had been a dramatic expansion worldwide of basic education. Second, a media revolution had brought millions more people within reach of radio and television. Previous strategies had been hampered by the difficulty of 'imposing' health on unreceptive populations. But at this point, the new communications channels opened up a different option -- persuasion.

During the 1980s, UNICEF developed and fine-tuned a strategy of social mobilization. Not only did it enlist the media and advertising industries, it also invited partners from every nook and cranny of society -- from religious leaders to Goodwill Ambassadors, from Heads of State to municipal mayors, from sports personalities to parliamentarians, from professional associations to trade unions -- to join the child survival and development movement and spread its message (Panel 11). (See also Panel 13, for the role of UNICEF National Committees).

At the international level, a Task Force for Child Survival and Development, including all the big-league players in international health -- the Rockefeller Foundation, UNDP , UNICEF, the World Bank and WHO -- was established to resolve technical issues associated with the campaign and help build its momentum. The campaign thus became far broader than UNICEF itself, which explains the use of the vivid phrase, 'a grand alliance for children'.

But whatever the power of the alliance, much of its success was still due to the extraordinary energy that James Grant injected into it personally and with which he infected others. His visits to scores of presidents and prime ministers did much to raise the visibility of the children's cause, and systematic lobbying within regional bodies such as the Association of South-East Asian Nations (ASEAN), the League of Arab States (LAS), the Organization of American States (OAS), the Organization of African Unity (OAU), the Organization of the Islamic Conference (OIC) and the South Asian Association for Regional Cooperation (SAARC) helped build political will.

In November 1985, at a special ceremony to commemorate the UN's 40th anniversary, nations recommitted themselves to the target originally set in 1977 -- universal child immunization (UCI) by 1990. Of the four GOBI elements, the expanded programme on immunization (EPI) had been taken up with the greatest enthusiasm in the largest number of countries, including the most populous on earth, China and India.

From an average at the beginning of the decade of 15 per cent immunization coverage, some developing countries had already pushed their rates to 60 per cent or more. A goal that a few years before seemed completely unattainable was now within striking distance.

During the rest of the 1980s, scores of developing countries conducted an all-out drive to reach a coverage of 80 per cent child immunization or more (75 per cent in Africa). This international effort, described as perhaps the greatest mobilization in peacetime history, succeeded in spite of the major cut-backs in social services necessitated by the economic recession and adjustment crisis.

Some voices were raised against the disproportionate share of public health resources used for childhood immunization. But the energy behind the campaign was such that in practice it spilled over into almost every area of maternal and child well-being -- carrying in its wake a much wider range of primary health care services.

Towards the end of the decade, optimism was warranted on several fronts. Nutritional progress was encouraging enough to permit the World Summit to establish the goal of halving the 1990 rate of child malnutrition by the year 2000. Many countries in Latin America and the Caribbean and in Asia are improving child nutrition. Indeed, during the 1980s, nutritional status improved in every region of the world (only marginally in sub-Saharan Africa), and in every category of malnutrition except anaemia.

Moreover, extraordinary improvements were made in access to safe drinking water. According to WHO's end-of-decade review, between 1981 and 1990, the proportions of families with access to safe drinking water rose from 38 to 66 per cent in South-East Asia, from 66 to 79 per cent in Latin America, and from 32 to 45 per cent in Africa.

In total, during the International Drinking Water Supply and Sanitation Decade (1981-1990), an additional 1.2 billion people gained access to safe water, and about 770 million to adequate sanitation. This has continued in the 1990s, so that by 1994, a further 780 million gained access to water.

By the end of the decade, the child survival and development revolution was estimated to have saved the lives of 12 million children. However, it was never aimed exclusively at saving children's lives and preventing childhood disease and disability. The wider purpose of the revolution was to revitalize the flagging cause of human-centred development and to place children at the leading edge.

One result was the international conference held in 1990 under the auspices of UNDP, UNESCO, UNICEF and the World Bank in Jomtien (Thailand), which set the target of 'Education for All by the Year 2000'. And in subsequent years, the World Bank tripled its lending for basic education to US$1 billion.

Also in 1990, UNDP brought out its first annual Human Development Report, which declared human beings to be both the means and the ends of development. Human, rather than economic, prospects were once again beginning to take pride of place.

The momentum behind human-centred development was particularly sustained by the activities of women. International organizations such as UNICEF began to recognize that women had an importance that went beyond their biologically or socially determined maternal roles: that women were also economic providers, organizers and leaders. In many parts of the developing world, women made up one third of heads of households.

Thus far, the development process had pushed women to the margins. This not only excluded them from social and economic participation but it also acted as a powerful brake on development in general. Future progress would mean, therefore, that investment would have to be affirmatively structured in favour of women: that development would have to be 'gendered'.

This had major implications for UNICEF. Its child survival and development prescription did have two elements that directly supported the women's agenda -- female education and birth spacing. But for the much more important GOBI ingredients, women were cast in an exclusively maternal role. Throughout the 1980s, UNICEF resisted becoming involved in the mainstream of the women's cause. Towards the end of the decade, however, it re-evaluated its policy on women in development to take on the language and dynamic of women's rights, with a special focus on girls. (See also Panel 14)

The movement in the direction of women's rights also coincided with mounting pressure for the rights of children, which had hung fire somewhat in the years following the 1959 Declaration of the Rights of the Child but had been rekindled by IYC. The NGO community working on behalf of children took advantage of this renewed concern for children to argue that special protection for children should be more than a high-sounding principle; it should also be enshrined in law.

Population growth and rapid rates of industrialization were putting increasing pressures on childhood and family life. (Figure 8: Demographic trends offers a later, more positive analysis.). The most conspicuous symptom of social stress and family breakdown was the increasing number of children working on city streets -- with some also living there. In Latin America, where the phenomenon was at its most acute, there were thought to be several million street children.

Meanwhile, many other children were also being damaged by forces that went beyond the general rubric of poverty and underdevelopment. These included child victims of mass violence and warfare, and children with disabilities. They also included children suffering from exploitation -- as workers and labourers, or as objects of commercial sexual gratification. In the mid-1980s, UNICEF coined a new term to cover all these categories of childhood disadvantage -- children in especially difficult circumstances (CEDC).

At this point, UNICEF began to analyse CEDC situations and evolve policy responses. The international children's NGOs, on the other hand, were more concerned with advocacy and legislation to protect these children and bring their exploiters to book. After IYC, they had helped establish an intergovernmental group under the auspices of the UN Commission on Human Rights, which had begun to draft a convention to replace the 1959 Declaration of the Rights of the Child. The NGOs' input was critical to this process and helped to keep it moving.

In 1987, recognizing the potential convergence of the child survival and development revolution with the thrust for children's rights, UNICEF threw its weight into the child rights ring. Although its support arrived relatively late, UNICEF's capacity for international mobilization was decisive.

In 1989, the UN General Assembly adopted the Convention on the Rights of the Child. On 2 September 1990, the Convention entered into force as international law. Within a year, more than 90 countries had ratified, and by end-September 1995 the total was 179. No human rights convention has ever attained such widespread ratification, nor so quickly.

Almost simultaneously, the campaign for child survival and development reached a peak. On 30 September 1990, 71 Heads of State or Government took their seats at a World Summit for Children. The climax of the occasion, held under the auspices of the UN in New York, was the joint signing of a World Declaration and 10-point Plan of Action comprising a set of child-related human development goals for the year 2000. These included targeted reductions in infant and maternal mortality, child malnutrition and illiteracy, as well as targeted levels of access to basic services for health and family planning, education, water and sanitation.

The Summit was one of the most important events in UNICEF's history: it marked the moment at which children's issues had reached such a high point on the international agenda that there seemed nowhere higher for them to go.

The immediate post-cold war period was a time of great optimism in international affairs. But it was also a time at which the wider development movement had reached a nadir. In the face of debt and structural adjustment, environmental degradation, the deepening crisis in Africa and the onset of AIDS, the 1980s had been labelled development's 'lost decade'. But for children, the 1980s was the decade in which their cause was not lost, but re-found.

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