PHA-Exchange> PHC Survival Crisis!

[Dhruv Mankad]

Press release

UNICEF report finds ‘Child Survival Crisis’ in Caucasus and Central Asia

EMBARGOED UNTIL TUESDAY, 22 JULY 2003 until 05:00 GMT

ROME, 22 July 2003 – Infant mortality rates in nine countries of Eastern
Europe and the Commonwealth of Independent States are much higher than
official figures have long claimed, according to a new report by UNICEF
released today. UNICEF found that in some countries deaths among
children less than one year old were four times higher than the official
counts.

According to UNICEF’s Social Monitor 2003, the infant death rate in the
Caucasus and Central Asia  is five times greater than in the rest of
Central and Eastern Europe and the Commonwealth of Independent States,
and 12 times greater than in western industrialised countries.

“Our research shows that infant mortality is a far greater problem in
these countries than suggested in the official data,” said UNICEF
Executive Director Carol Bellamy. “We have looked beyond the official
statistics and talked to mothers in their own homes. And their stories
reveal a child survival crisis.”

Most of the infant deaths are preventable, according to the report,
which was produced by UNICEF’s Innocenti Research Centre in Florence.
UNICEF said a mix of factors such as poverty, poor maternal health and
nutrition; infection and poor medical care were to blame for most of the
deaths.

“What we have is two distinct problems,” Bellamy said.  “We have tens of
thousands of infant deaths that should be prevented.  And we have a
systemic failure to properly count the lives being lost.
Misunderstanding the scope of what’s happening prevents effective action
to fix it, so getting the numbers right is a major issue. It’s a crucial
first step to saving young lives.”

The report focuses on infant mortality trends in the eight countries of
the Caucasus and Central Asia, plus Romania and Ukraine. It compares the
official infant mortality rate in these countries against data gathered
in face-to-face interviews with women. In all eight countries of the
Caucasus and Central Asia, the estimated infant mortality rate from the
surveys is far higher than the official rate. In Azerbaijan, for
example, the survey estimate is four times greater – 74 infant deaths
for every 1,000 live births, compared to an official rate of 17 per
1,000. Romania also appears to be affected by under-reporting, although
on a smaller scale.

“These kinds of inaccurate and misleading statistics can breed
complacency,” Bellamy said. “They keep governments and health workers
unaware of the risks of child death and the need for action, and they
keep parents and community leaders in the dark.”

What’s Going Wrong

Examining the reasons for the gap, the Social Monitor highlights three
problems: failure to define ‘live birth’ according to accepted
international standards, misreporting of infant deaths at the local
level, and barriers to birth registration.

The report finds that the death of a baby may go unrecorded because,
officially, the baby was never ‘alive’. According to the definition
established by the World Health Organization, an infant is alive at
birth if breathing or showing any other signs of life, such as muscle
movement or heartbeat. Under the Soviet era definition, however,
breathing is the only criterion for life. In addition, infants who are
born at less than 28 weeks, weighing less than 1,000 grams, or less than
35 centimetres in length are not counted as live births if they die
within seven days. This Soviet definition still predominates in many
countries of the Commonwealth of Independent States.

Misreporting pushes the official figures down further. The communist
system stressed the need to keep infant mortality low, and hospitals and
medical staff faced penalties if they reported increases in infant
deaths.  As a result, they sometimes reported the deaths of babies in
their care as miscarriages or stillbirths. With deteriorating conditions
in health services and little focus on health care reform, this has
proved a hard legacy to overcome and misreporting continues in some
countries.

Difficulties in measuring infant mortality are exacerbated by barriers
to birth registration. A recent study estimated that about 10 per cent
of births in poorer parts of the region each year go unregistered – most
of them in the Caucasus and Central Asia. Parents face obstacles to
registration such as the costs or difficulty of travel to the nearest
civil registration centre, heavy bureaucracy, and the lack of incentives
to register births promptly. If a birth is not registered, it is
unlikely that a death will be registered.

Why So Many Lives Lost?

By global standards, new surveys show high infant mortality rates in the
Caucasus and Central Asia, ranging from 36 per 1,000 live births in
Armenia to 89 per 1,000 in Tajikistan.

Many of these deaths are rooted in poverty, linked to malnutrition and
health problems among women and resulting complications in pregnancy and
childbirth. Poverty restricts access to health care and drug treatment,
as one mother in Tajikistan told researchers, when describing the death
of her son: “I went to a paediatrician who prescribed drugs, but I did
not have any money to purchase drugs. I went to a healer. But the
child’s condition became worse. On the seventh day he died.”

Poor medical care is also an issue. Problems cited in the report include
a lack of preventive health care, and failure to carry out basic,
non-technological tests at birth, such as weighing the baby or assessing
his or her activity, pulse, grimace, appearance and respiration (the
APGAR test).

The Report Calls For:

• Adoption and implementation of the WHO definition of live birth in
every country
• Improved training of medical staff and better management of health
care
• Incentives for parents to promptly register the births of their
children

Resumed economic growth in the region presents an opportunity to reduce
poverty, improve the well-being of mothers and children, increase
investment in basic and preventive health care, and, with international
help, upgrade the skills of medical staff and administrators in order to
provide effective health care services. Good statistics have a crucial
role to play in alerting governments and the public to the magnitude of
the problem, in supporting reform and in mobilizing resources and
action.

“States have an obligation to give every child the best possible start
in life,” said Bellamy. “States in this region have all ratified the
Convention on the Rights of the Child. They have all signed up to the
Millennium Development Goals and to the goals of a World Fit for
Children – goals that can only be reached by tackling the issue of
preventable infant death and its causes. It is time to give infant
mortality the attention it deserves as a sign of national well-being – a
sign that is every bit as important as economic growth and poverty
reduction.”

The Social Monitor Covers 27 Countries

The Social Monitor is an annual regional report examining the well-being
of children in the transition countries of Central and Eastern Europe
and the Commonwealth of Independent States.

And while it finds the risk of infant death is low in some of the 27
countries in the region, such as the Czech Republic, official figures
suggest that in the region as a whole, at least 60,000 babies died
before their first birthday in 2001.  This is three times greater than
the number of infant deaths in the European Union, which has only
slightly fewer births each year.

In addition, Social Monitor 2003 looks at other trends affecting
children in the region.

• It finds economic growth but continuing poverty, with almost 11
million children in poverty in Russia alone.
• It highlights the debt crisis, with Georgia, Kyrgyzstan, Moldova and
Tajikistan spending at least one-third of government expenditure on debt
servicing.
• It reports three million refugees, asylum seekers, and displaced
people in the region at the end of 2001, with numbers falling in the
countries of the former Yugoslavia but rising in Russia and Uzbekistan.
• It finds that there have been at least 100,000 adoptions since 1989
from the region, which now accounts for one-third of the world total and
for most of the increase in intercountry adoption to industrialized
countries in recent years.
• And an examination of latest trends in HIV/AIDS reveals that only 1 in
every 25 people registered with HIV in the region receives
antiretroviral therapy.

The report includes a statistical annex covering a broad range of
indicators for the years 1989 to 2002, and statistical profiles on each
country in the region.
________________________________

[1]Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyz Republic,
Tajikistan, Turkmenistan, Uzbekistan

[1]The 27 countries of Central and Eastern Europe, the Commonwealth of
Independent States and the Baltics are: Albania, Armenia, Azerbaijan,
Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic,
Estonia, Georgia, Hungary, Kazakhstan, Kyrgyz Republic, Latvia,
Lithuania, former Yugoslav Republic of Macedonia, Moldova, Poland,
Romania, Russian Federation, Serbia and Montenegro, Slovakia, Slovenia,
Tajikistan, Turkmenistan, Ukraine, Uzbekistan.



*   *   *

Note to Editors

The Social Monitor is produced by the UNICEF Innocenti Research Centre
in Florence. Embargoed media materials, including information on UNICEF
activities on infant mortality and downloadable copies of the report in
English and Russian, are available from the IRC Newsroom:
http://www.unicef-icdc.org/presscentre/indexNewsroom.html

Early childhood care – to give every child the best start in life – is a
major UNICEF priority, along with immunization, education for all boys
and girls, preventing the spread of HIV/AIDS among young people, and
protection of children from violence, abuse, and exploitation.

For further information, please contact:

Angela Hawke, UNICEF Regional Office for CEE/CIS and Baltics, Geneva
(+41 22) 909-5607
Patrizia Faustini, UNICEF Innocenti Research Centre, Florence (+39 055)
203-3253
Donata Lodi, Italian National Committee for UNICEF, Rome (+3906) 478
09287
Kate Donovan, UNICEF New York, Media Section, (212) 326 7456




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Dhruv Mankad
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