Economic disparities widening - UNICEF

The gap between rich and poor is rising against a backdrop of soaring food prices, dwindling health services, deteriorating quality of education and faltering political commitment in many countries, said the UN Children's Fund (UNICEF) at the launch of its State of Asia-Pacific's Children 2008 report, covering 37 countries, on 5 August.

"The divide between rich and poor is rising at a troubling rate within sub-regions of Asia-Pacific, leaving vast numbers of mothers and children at risk of increasing relative poverty and continued exclusion from quality primary health-care services," the report said.

Pakistani boys are more likely to be immunised than girls and have better access to healthcare, while one in every three women in India is underweight, leading to an increasing likelihood of low ­birth-weight babies.

These in turn are 20 times more likely to die in infancy than healthy babies and remain stunted throughout life, the report explained.

The report emphasised the need for addressing discrimination against women and girls as part of overall strategies to improve child and maternal health, without which high rates of maternal and child mortality would remain stubbornly entrenched.
 


Photo: Shamsuddin Ahmed/IRIN
On the streets of Dhaka, this beggar and her child do not have much hope in the future

The case of Bangladesh

"Further acceleration of Millennium Development Goal [MDG] 4 [reduce under-five mortality rates by two-thirds between 1990 and 2015] and MDG 5 [reduce by three-quarters the maternal mortality ratio and achieve, by 2015, universal access to reproductive health] depends particularly on rapid and sustained reduction on neo-natal mortality," Carel de Rooy, UNICEF's country representative in Dhaka, told IRIN, citing issues such as breast-feeding, low birth-weight, anaemic mothers and women suffering from micronutrient deficiency.

"Boosting health expenditure to at least 2 percent of the gross domestic product so that the public sector can play its role and not depend on the private sector to do all - is crucially important," he said.

According to the UNICEF's State of the World's Children Report 2008, the maternal mortality rate (MMR) for Bangladesh was 570 per 100,000 live births.

In comparison, the rates in neighbouring India and Pakistan are 450 and 320 respectively.

According to the Tracking Progress in Maternal, Newborn and Child Survival Report, a collaborative effort between individuals and institutions launched last April, 21,000 mothers die annually of pregnancy and childbirth-related causes, principally because skilled birth attendants account for just 13 percent of all deliveries in Bangladesh.

The problem is particularly pronounced in rural areas, where more than 75 percent of the impoverished nation's 150 million inhabitants live.

"Eighty percent of maternal deaths happen in the countryside," said Sabera Khatun of the department of gynaecology and obstetrics at the Bangabandhu Sheikh Mujib Medical University in Dhaka. "Medical facilities have not reached the rural areas as extensively as they should."

Most women die of haemorrhaging, followed by anaemia, hypertensive disorders, obstructed labour and abortion, explained Ferdousi Begum of the Dhaka Medical College Hospital.


Photo: Shamsuddin Ahmed/IRIN
Girls' education holds the key to creating demand for better health services at the grassroots level

CARE Bangladesh, which has been organising community initiatives to promote maternal and neo-natal health for the past 25 years, cites delays in seeking medical assistance and receiving the appropriate healthcare, as well as transportation problems, as contributing factors.

"Fifty-six percent of women go to hospitals and clinics for ante-natal care, but the rate is only 18 percent for post-natal care," noted Laila Anjumand Banu, health and environment secretary of Bangladesh Mahila Parishad, a women's rights organisation.

Equally important is to increase expenditure on girls' education from the present 2.5 percent to 5 percent of GDP, added UNICEF's De Rooy.

"Spending on education is not expenditure; it is a long-term investment. By increasing expenditure on education of girls the demand for health services increases. Fertility can be reduced through better family planning. If we adopt family planning then fewer but healthier children will be born," he said.

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