/ 18 December 2007

Not much cheer for children

The United Nations Millennium Development Goals, set at the turn of the century, made up the most aspirational development programme ever devised. But a progress report published recently by Unicef says that even though more babies are surviving, more children are in school and fewer families live in poverty, urgent action is needed if the goals are to be met by the target date of 2015.

Goal 1 To eradicate extreme poverty and hunger

To monitor the fight against hunger, the UN took as its yardstick the proportion of children under five who are underweight. In 1990, 32% of under-fives in the developing world were underweight, undernourished and therefore at high risk of stunted growth, disease and death.

Asia, the second-poorest part of the globe, has seen a drop from 41,1% ­living below the poverty line to 29,5% by 2004. But there have been no such gains in sub-Saharan Africa. If progress continues to be this slow and patchy, the 2015 target will be missed by a margin of 30-million children.

Goal 2 Universal primary education

The two indicators used to monitor progress in meeting this goal are the percentage of children enrolled in primary school and those who complete this stage of education by reaching grade five or “primary completion rate”. Both developed and developing countries have put considerable effort into achieving the education goal and the Unicef report says there has been “substantial progress”. Partly as a result of debt cancellation, countries such as Tanzania are on course to achieve 100% primary participation by 2015, although sub-Saharan Africa as a whole will not meet the target without more rapid progress over the next seven years.

Goal 3 To promote gender equality and empower women

The gap between boys and girls receiving a primary education narrowed between 1990 and 2005 — from 8 percentage points to 3 percentage points — but Unicef says big gender disparities remain. Only two-thirds of countries met the target of gender parity in primary education by 2005, with a third achieving gender parity in secondary education. Gender disparities are greatest in rural areas and among poor households.

Goal 4 To reduce child mortality

Unicef recently celebrated the passing of a milestone in the battle to reduce the death toll among babies in the developing world. In 2006, for the first time since records were kept, the number of children dying before their fifth birthday dropped below 10-million a year, to 9,7-million.

But baby deaths are still distressingly commonplace. The death rate is substantially higher in sub-Saharan Africa than elsewhere. In 1990, 187 babies and children under five died there for every 1 000 births. By last year, that had been reduced, but only to 160 per 1 000 births. Most deaths occur during and shortly after birth (37%), but preventable diseases also take a big toll. Pneumonia kills 19%, diarrhoea 17% and malaria 8%.

One bright spot has been the success of routine measles vaccination, which cut measles deaths by 75% in sub-Saharan Africa between 1999 and 2005.

Goal 5 To improve maternal health

Every year, half a million women die in pregnancy or childbirth, almost all of them in sub-Saharan Africa and Asia. According to Unicef, a woman has a one in 22 lifetime chance of dying in pregnancy or childbirth, compared with one in 8 000 in countries like Britain. Many countries have no system of death registration, and death from diseases such as Aids or malaria will not be added to the maternal mortality count, even though they are made more likely by pregnancy. A report from the World Bank, the World Health Organisation, Unicef and the UN Population Fund, claims that the numbers of maternal deaths actually rose in sub-Saharan Africa from 212 000 a year to 270 000 between 1990 and 2005.

However, antenatal care has improved in all regions. Preventing unplanned pregnancies could cut deaths by a quarter, but only 23% of sub-Saharan African women use any form of contraception.

Goal 6 To combat HIV and Aids, malaria and other diseases

The percentage of people living with HIV/Aids levelled off for the first time this year, UNAids said last month, at 33,2-million. But the total number of people living with HIV continues to rise, as people survive longer thanks to treatment. Only 24% of 15- to 24-year-olds in low and middle income countries have a comprehensive understanding of HIV.

Malaria kills more than a million people a year, 80% of them children under five in sub-Saharan Africa. Africa has widely adopted, in principle, new anti­malarial drugs recommended by the WHO, but they are not always given to the children who need them. While 16 out of 20 countries have tripled their use of bed nets to protect against bites from carrier mosquitoes, only a handful came close to the target of 60% bed net coverage set in 2000, and in sub-Saharan Africa only 5% of small children sleep under them.

Goal 7 To ensure environmental sustainability

Although sanitation coverage increased from 49% in 1990 to 59% in 2004, pro­gress has been far too slow and the Unicef report says that on current trends the target will be missed by more than half a billion people.

Lack of sanitation, poor hygiene and unsafe drinking water cause the deaths of more than 1,5-million children every year from diarrhoeal diseases and lead to millions of children being kept out of school. At least 2,6-billion people — almost half the world’s population — lack access to proper sanitation. — Â