In 2013, 6.3 million children under the age of 5 died. That’s a tragic statistic — yet it represents a 49 percent drop from 1990, according to data released Tuesday by the United Nations.
Dr. Mickey Chopra, the head of UNICEF’s global health programs, spoke with us about the encouraging trend — and what still needs to be done in parts of the world where children’s lives are threatened by unsanitary water, disease and malnutrition.
What do child mortality numbers tell us?
In many ways, under-5 mortality is a lens of how far we have progressed as a civilization. Newborns, premature babies and children under 5 are the most vulnerable members of our society. They are completely reliant on the values, the care and the love that we as a society are providing to each other.
The reduction in mortality rates is a measure of children’s lives, which are very important. Each life saved is someone else who will contribute to our well-being as a whole. But it’s also a measure of how we are progressing as human beings. If there are still children dying of causes which can be easily prevented, cheaply, and we still aren’t doing that? Then we aren’t really progressing as much as we think we are.
A record number of children under 5 are surviving. What’s made the difference?
We have much more awareness of the problem than we’ve ever had. Government leaders and communities recognize there are things they can do to solve this problem, and they’ve been doing them. We have new technology, specifically vaccines to respond against the biggest causes of death such as diarrhea and pneumonia.
We also have ways of delivering those interventions. Community health workers have been very important in many of the poorest countries where health systems are not yet properly established. They can now reach out, diagnose and treat common illnesses and common causes of death.
Finally, we have been making investments in other areas apart from health which also impact children’s health, most importantly girl’s education. We are seeing a close relationship with girls that are educated and the fact that their children are far less likely to die of diseases and illnesses.
In this report, WHO says, “We know what to do and we know how to do it. The challenge now is to move from plan to action.” What are some of those challenges?
First and foremost, we still need more resources to buy more vaccines, to pay for more health workers, to build more clinics and so forth. [African] governments all committed to putting 15 percent of their budgets aside for health and not many are doing that. And among richer countries, the aid going for children and women’s health is not rising fast enough to be able to accelerate change further.
Even when we have the resources, they don’t go to the right things. In many countries, most of the health budget is taken up by large hospitals and intensive care in the capital city, quite often addressing the needs of the better off, rather than where most of the child deaths are occurring, which is amongst the poor in the rural areas.
What can women do during pregnancy to increase their child’s chance of survival?
As you see in the report, [neonatal care] is the one area where we have not made as much progress as we have done with the child after one month of age. Of these childhood deaths, 44 percent are happening in the first month of life.
We know that delaying your first pregnancy until you’re 17 or 18 increases the chance of your child surviving by almost fivefold. We know that being well-nourished before you become pregnant is also important. During pregnancy, if we can avoid the mother getting malaria, HIV or syphilis, that increases the chance of survival.
One of the interventions highlighted in the report is called “kangaroo mother care,” or skin-to-skin care, which replaces the need for incubators for premature babies. Premature babies have trouble keeping their body temperature up. If you keep the baby right by the skin of the mother and wrap the baby and the mother together, the mother’s body temperature will regulate the baby’s. Just doing that has reduced newborn mortality, where it has been implemented, by 40 percent.
Have you been able to see these effects firsthand?
When I worked in Africa in the 1990s and early 2000s, I would see every year, like clockwork, hundreds of kids coming into the hospitals with measles. And many of them would die. But because of the attention to vaccinating children from measles, we’ve been able to almost eliminate it. There has been more than 70 percent reduction in measles deaths even in the last 10 years or so. You can see across large numbers of children how this has transformed their lives.
This interview has been condensed and edited for clarity.
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