Two million African infants die every year and as many again, before they reach the age of five. These deaths are avoidable but this figure has not changed over two decades. In contrast, remarkable success has been achieved in East Asia in reducing the numbers of infant and child deaths. Policymakers debate whether better economic status and nutrition help in bringing about the decline in deaths or providing better public health services is the solution. A balance between both of these approaches and other measures such as promoting female education, breastfeeding, are necessary to achieve the desired outcome.

Research from the Institute of Development Studies analysed recent and historical data on infant and child mortality from around the globe. The research identified where there was considerable success in reducing infant and child deaths and the key factors in each case. From this, the author makes recommendations on how governments and international organisations can ensure that the Millennium Development Goal of a two-thirds reduction in infant and under-five mortality by 2015 can be achieved.

Worldwide there has been a significant decline in the number of children dying since the 1960s. This reduction was a result of both economic growth and initiatives such as growth monitoring, immunisation, promotion of breastfeeding, early child feeding promoted by UNICEF and others.  However there are regional differences in performance. East Asia’s strong economic growth and North Africa and Middle East’s oil wealth were instrumental in lowering child mortality in these countries. On the other hand income declines and the collapse of health services in Eastern Europe and the former Soviet Union have had a negative impact.  There was a steady decline in Africa before the HIV/AIDS pandemic led to a reversal of this trend in many countries.

The analysis points to the following reasons behind the mortality decline:

• A focus on public health delivery in centrally planned economies such as China and the USSR helped in reducing infant mortality: this has slowed since these countries entered the current period of market-led economic growth.
• Whilst better incomes certainly lower the possibility of a child’s death, the impact of immunisation is more significant over and above that of income: higher income alone is of no use in the absence of immunisation and other mediating factors.
• Mortality rates improve when mothers are educated as this ensures that families avail themselves of improved health technologies and are more open to preventive health practices.

As under-five mortality declines the majority of the remaining deaths become more concentrated in infant deaths (i.e. under 12 months old), and these amongst neo-nates (i.e. within the first month). This fact has implications for policies to reduce mortality, since the cause of death varies by age group, with conditions at birth and other medical interventions mattering most for younger children.

Despite the overall positive historical picture, it is unlikely that the target set by the MDG will be met. To achieve this, required policies include:

• A substantial government investment not just in the public health systems, but also in the provision of water and sanitation services and education for women.
• An emphasis on preventative health care generally and on immunisation programmes particularly.
• Preventive services should be provided on a free-of-cost basis (as a public good) as they would help improve the population health.
• Increasing donor aid for basic health and education services which has remained very low and poorly targeted.

A government’s ability to carry out these actions is crucial. Proper resource allocation, availability of resources at the local level, commitment and enthusiasm can all help take the efforts forward and achieve the desired goal.

Source(s):
‘Reducing Infant and Child Death’ by Howard White in Richard Black and Howard White (eds.) Targeting Development: Critical Perspectives on the Millennium Development Goals London: Routledge, 2004

id21 Research Highlight: 13 September 2004

Further Information:
Howard White
Institute of Development Studies
University of Sussex
Brighton BN1 9RE
UK

Tel: +44 (0) 1273 606261
Fax: +44 (0) 1273 621202/691647
Contact the contributor: h.white@ids.ac.uk

Institute of Development Studies (IDS), UK

Other related links:
'Hitting the mark. Can under five mortality be cut by two thirds?'

'Motherhood in the city: poor urban women and maternal health care provision in sub-Saharan Africa'

'Coverage story: how to deliver better child survival'

'Probing the public purse – the role of public funds in reducing child mortality'

UNICEF Health - Child Survival