Why Botswana's children are dying

While Botswana has succeeded in decreasing its poverty rate, it is unlikely that the country will achieve the United Nations’s fourth Millennium Development Goal of decreasing child mortality rates by two-thirds by 2015. Figures have shown an increase in child mortality between the 1990s and the 2000s.

A 2001 report by the government’s Central Statistics Office (CSO) on population and housing indicates that in 1991, infant mortality in Botswana stood at 48 deaths per 1 000 live births. This figure increased to 56 deaths per 1 000 live births by 2001. Over the same period, under-five mortality increased from 63 to 74 deaths per 1 000 live births.

The UN Children’s Fund’s figures for the under-five mortality rate in Botswana are worse than the Botswana government’s official figures, rising from 58 deaths per 1 000 live births in 1990 to 116 in 2004. The high prevalence of HIV/Aids is one of the factors behind this phenomenon.

The link is being made between child mortality and the status of women in society. Women, who still mostly bear the burden of child care, are able to feed their children what they need if they live in households with relatively high and stable incomes.

Malebogo Keataretse, mother of a five-year-old, makes sure that she buys “nutritious food like vegetables, fruits and cereals at the grocery store, which is prepared well before feeding the young one”.

“For breakfast I feed my child oatmeal and fruit with a glass of juice. For lunch and supper he gets what the family is having, which ranges from rice with chicken to maize meal with pounded meat [called seswaa]. He likes all the meals and rarely ignores his plate, unless when he is distressed,” she says.

Oarabile Matongo says that her four-year-old daughter Thato has a penchant for eating snacks. Thato takes snacks to kindergarten. “Now she likes snacks so much she cannot eat anything else. In the evening I cook a meal with vegetables and meat, but she would prefer to eat the meat only.”

Socio-economic status determines the range of choice in children’s diets. Children from low-income households are sometimes forced to skip meals like breakfast just because there is not enough food in the house.

Magdeline Khamandisi says that her four-year-old son Kenneth seems to be content despite there being only soft porridge for him to eat throughout the whole day sometimes. “He eats anything, so I do not need to buy anything fancy for his meals.”

University of Botswana health economist Narain Sinha believes that, at the current pace, it may be possible for Botswana to achieve the goal of reducing the mortality rate of children under five by two-thirds by 2015.

“It has been observed that the infant mortality rate is not only influenced by factors such as government expenditure and the availability of health facilities and health professionals, but also by social-development indicators such as poverty, malnutrition and female literacy,” he says, adding that there is a need to address these issues more stringently.

According to Sinha, women’s lack of access to decision-making, employment, finance and education is at the root of infant mortality. Poor nutrition in girls, early sexual activity and teenage pregnancy all have consequences for these young mothers.

Educated and empowered women are more likely to marry at an older age and to seek neonatal and postnatal care, all of which are crucial in reducing child and maternal mortality.

Many women cannot afford healthcare, says Sinha. Therefore, on a continent where large numbers of women still live in rural areas and have limited access to health clinics or hospitals, community partnerships can be the most immediate means to better health.

For example, the important social status of traditional birthing assistants, or midwives, in the community should be harnessed, according to Sinha. Training of these professionals by the public health authority can provide rural women in Africa with safe pregnancies and deliveries, as well as access to family planning information and services. The government is also focusing its health programmes on child mortality.—IPS



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