Mortality
According to the U.S. Census Bureau report World Population Profile: 2002 (2004), the global under-age-five mortality rate in 2002 was seventy-seven per one thousand live births. In more developed countries the mortality rate was ten per one thousand live births for children under five; in less developed countries the under-five rate was eighty-five per one thousand live births. The global AIDS epidemic is responsible for a rise in child mortality rates in many less-developed countries. In some sub-Saharan African countries, the infant mortality rates have doubled due to AIDS. Countries torn by war, disease, or famine also have high child mortality rates. (See Figure 10.1.)
Political upheaval around the world in the late twentieth century (including in Bosnia, Somalia, Rwanda, Kosovo, Eastern Europe, and the former Soviet Union) subjected untold numbers of children to war, hunger, injury, and death. UNICEF estimated that in the late 1990s alone, 1.5 million children were killed in armed conflicts and four million more were disabled, maimed, blinded, or braindamaged. At least five million became refugees and twelve million more were uprooted from their communities. Many other children suffered harm to their health, nutrition, and education as conflicts destroyed their countries' crops, schools, clinics, and infrastructure.
In the early twenty-first century UNICEF made the humanitarian situation of the children of Iraq a priority. In 2003 Iraq was at war for the third time in twenty years—this time with the United States—making conditions for Iraqi children even worse than they had been under the previous twelve years of United Nations sanctions. Even before the war, one in eight Iraqi children died before his or her fifth birthday. After the initial wave of combat ended, UNICEF determined that 8% of children in Iraq suffered from acute malnutrition, double the percentage from just one year before. Children in Iraq were injured or killed daily from playing with live ammunition that littered the cities and countryside. And no immunizations had been available since before the start of the war.
THE UNICEF GOALS. The UNICEF goal was to reduce the child mortality rate to seventy deaths per one thousand live births, or to two-thirds of the 1990 level—whichever was less—by 2000. The objective for 2015 was for fewer than forty-five deaths per one thousand births—a goal that most experts consider ambitious.
PROGRESS TOWARD GOALS AND THE FUTURE. In 1999 the United Nations invited countries around the world to review the progress they had made since the 1990 World Summit for Children and to submit a report. The results were summarized in two 2001 UN reports, Progress since the World Summit for Children: A Statistical
FIGURE 10.1
Report and We the Children: Meeting the Promises of the World Summit for Children.
The UN reported that the average global under-five mortality rate declined by 11%, from ninety-three deaths per one thousand live births in the early 1990s to eighty-three deaths per one thousand births in 2000, and sixty-three countries achieved the targeted one-third reduction. Looking ahead to 2010, the UN predicted that more than half of all under-five deaths will occur in sub-Saharan Africa, where the child mortality rate in 2002 was 153 per one thousand live births. High rates of HIV/AIDS and low immunization coverage due to weak health care systems contributed to the high child mortality rate there.
Disease
Estimates of the proportion of deaths of children under age five caused by various factors are uncertain, because often vital registration systems that provide cause of death are nonexistent in developing countries, and often there are multiple conditions leading to death. It is estimated that more than half of childhood deaths globally are due to disease and other preventable conditions: diarrhea, respiratory infections and pneumonia, measles, and newborn tetanus. Malnutrition is a factor in half of all of these deaths.
UNICEF hoped to eradicate polio by 2000; eliminate tetanus in newborns; eliminate guinea worm disease; reduce deaths due to acute respiratory infection by one-third among children under five; reduce measles cases by 90% and measles deaths by 95%; cut deaths from diarrhea among children under five in half; and make safe water and sanitation available to every family. Also, immunization rates were to be maintained at "a high level."
PROGRESS REPORT. The UN reported in Progress since the World Summit for Children that the results of efforts to reduce childhood disease worldwide were mixed. Polio was nearing eradication, tetanus deaths of newborns had decreased by more than half from 470,000 to 215,000, guinea worm infection—a parasite—had dropped by 88% worldwide and had been eradicated in India, and deaths from diarrhea had been cut in half. Although reported annual cases of measles had declined by 40%, measles continued to be a major killer of children in sub-Saharan Africa and South Asia because many children in those regions were not immunized. Over a billion people still lacked access to safe drinking water, and 2.4 billion people lacked access to sanitation facilities (although that coverage had increased, from 51% to 61%). In more than forty countries, fewer than half the children with acute respiratory infection were taken to the doctor to be treated with antibiotics. Immunization levels globally remained above 70% through the 1990s (72% in 1999), but in sub-Saharan Africa less than half of the children received routine immunizations in 2000.
SEXUALLY TRANSMITTED DISEASES AND HIV/AIDS. According to the World Health Organization (WHO) fact sheet "Young People and Sexually Transmitted Diseases" (December 1997), 333 million new cases of sexually transmitted diseases (STDs) occur worldwide each year, and at least one-third of them (111 million) are contracted by young people under twenty-five years old. Adolescents are at high risk for STDs because they tend to engage in short-term relationships and do not use condoms consistently. In some countries cultural expectations encourage young men to express their sexual masculinity at a young age, have multiple partners, or visit prostitutes, increasing the risk of STDs and AIDS.
In countries like Thailand, Guatemala, and Ecuador, young men are as likely to experience their first inter-course with a prostitute as with a girlfriend or wife. In some countries girls are sold into prostitution. Throughout Latin America, sexual activity begins earlier for males than for females, and first partners are frequently older women. These factors potentially jeopardize the reproductive health of young men by increasing the number and type of their sexual contacts.
Cultural factors can also make young women vulnerable to STDs. When young women are paired with older men with more experience and more prior sexual contacts, they are more likely to become infected. They are also less likely to be able to demand condom use. Furthermore, STDs are often asymptomatic in women, and young women often lack the information to identify STD symptoms when they do encounter them.
Sexually transmitted diseases increase the risk of HIV transmission as much as fivefold. The WHO, in The World Health Report 2004—Changing History (2004), reported that by 2004 thirty-four to forty-six million people were living with HIV/AIDS, and more than twenty million people had already died of the disease. Of the five million people who became infected in 2003 alone, seven hundred thousand were children, infected by transmission from HIV-infected mothers during pregnancy, birth, or breastfeeding. Because of lack of treatment of HIV-positive pregnant women, almost one-third of babies born to HIV-infected mothers in sub-Saharan Africa contract HIV.
One impact of AIDS and HIV on children is the loss of one or both parents to the disease. A joint U.S. Agency for International Development (USAID), UNICEF, and UNAIDS report, Children on the Brink 2004 (July 2004), noted that at the end of 2003, fifteen million children had lost one or both parents to AIDS, up from 11.5 million just two years previously.
Other consequences of the epidemic are also dire. In The World Health Report 2004—Changing History, WHO emphasized that people in poverty are the most likely to become infected and are also the hardest hit by the suffering caused by HIV/AIDS. The financial burden of the disease forces poor families even deeper into poverty, causing them to turn in desperation to child labor, sale of assets, and migration. Decreasing numbers of working adults in the African countries with the most AIDS cases increases the numbers of children and elderly people who depend on each wage earner. And, WHO argued, as children and adolescents watch their parents and other adults die, the psychological impact is immeasurable; in addition, the high rate of premature deaths of young adults "weakens the process through which human capital—people's experience, skill and knowledge—is accumulated and transmitted across generations." It would be difficult to overestimate the impact the epidemic is having on the countries most affected.
Hunger and Malnutrition
According to 2001 UNICEF data, an estimated 150 million children under age five in developing countries were malnourished. Malnutrition contributes to about half of child deaths globally, because malnourished children have low resistance to common infections. In 1990 UNICEF set as one of its goals the reduction of malnutrition among children under five by 50% by the year 2000. Although this goal was not achieved, prevalence of low weight in developing countries dropped from 32% to 28% between 1990 and 2000. However, South Asia and sub-Saharan Africa still suffer high malnutrition levels. In South Asia nearly half of all children under age five were underweight in 2000. Half of all malnourished children lived in South Asia, and another one-fifth in sub-Saharan Africa.
Other UNICEF goals related to nutrition were the elimination of vitamin A deficiency, which can cause blindness, and the elimination of iodine deficiency, which can cause mental retardation. According to UNICEF data, one million child deaths were prevented between 1998 and 2000 simply by providing vitamin A supplements. In addition, the goal of elimination of iodine deficiency disorders encouraged programs that increased the use of iodized salt from 20% of households in the developing world to 70% in 2000.
Education and Illiteracy
According to UNICEF's report The State of the World's Children 2004, 121 million primary-school-age children worldwide were not in school. The children most likely not to attend school were children who were working; those who had been affected by HIV/AIDS, conflict, or disability; those who were poor or minorities; and those who lived in rural areas. Worldwide, girls were less likely to receive education than boys. UNICEF argues that the negative effects of not attending school are greater for girls than for boys—mothers' lack of education puts the next generation in danger of repeating the cycle, and uneducated girls are at a greater risk for sexual exploitation and exposure to sexually transmitted diseases and HIV/AIDS.
Education of girls has a big impact on the next generation. According to the UN, fertility rates decline as education rises. Children of mothers with no education are more than twice as likely to die or to be malnourished than are children of mothers with a secondary or higher-level education. Education for girls also leads to reduced infant and mother mortality, as well as better nourished and healthier children and families.
The 2000 World Education Forum in Dakar, Senegal, underscored the importance of ensuring education for girls and women. Following that conference, initiatives were formed with the goal of accelerating progress in girls' education and achieving the Millennium Development Goal of gender parity in primary and secondary education by 2005: thirteen agencies formed the United Nations Girls' Education Initiative; and UNICEF launched the "25 by 2005 Girls Education Campaign," which focuses on getting girls into schools in twenty-five specified countries.
In spite of formal commitments by governments, funding for elementary education generally receives low priority, and, according to The State of the World's Children 2004, when money gets tight, girls' education is sacrificed first. We the Children reported that only a small percent of government budgets in the developing world and less than 2% of all international aid for development are directed toward elementary education. Many countries are unable to meet their educational goals because war or political conflicts and the high cost of HIV/AIDS are decimating their budgets.
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