Child poverty and early death

Every day, 17,000 children die before reaching their fifth birthday.

Save the Children’s annual report on the State of the World’s Mothers 2015 ranks 179 countries and concludes that that “for babies born in the big city, it’s the survival of the richest.” Globally, under-five mortality rates have declined, from 90 to 46 deaths per 1,000 live births. However, these numbers, says the organisation, mask the fact that child survival is strictly linked to family wealth, and miss addressing the conditions of poverty and unhealthy life of slums. The report finds that in most developing countries, the poorest urban children are at least twice as likely to die as the richest urban children. In some countries, they are 3 to 5 – or even more – times as likely to die.

Carolyn Miles, president and CEO of Save the Children, said that for the first time in history, more families are moving into cities to give their children a better life. But this shift from a rural to an urban society has increased disparities within cities. “Our report reveals a devastating child survival divide between the haves and have-nots, telling a tale of two cities among urban communities around the world, including the United States,” Miles added.

It’s called the urban survival gap – fuelled by the growing inequality between rich and poor in both developing and developed countries – and it literally determines whether millions of infants will live or die before their fifth birthday.

54 percent of the world’s population lives in urban areas, and by 2050 the concentration of people in cities will increase to 66 percent, especially in Asia and Africa. While women living in cities may have easier access to primary health care, including hospitals, many governments have been unable to keep up with this rapid urban growth. One-third of all urban residents – over 860 million people – live in slums where they face lack of clean water and sanitation, alongside rampant malnutrition. The World Health Organisation (WHO) says that nearly a billion people live in urban slums, shantytowns, on sidewalks, under bridges and along railroad tracks.

Miles said that despite the progress made on reducing urban under-five mortality around the world, the survival divide between rich and poor children in cities is growing even faster than that of poor children in rural areas. In most of the developing nations surveyed, children living at the bottom 20 percent of the socioeconomic ladder are twice as likely to die as children in the richest 20 percent, and in some cities, the disparity is much higher.

Robert Clay, vice president of the health and nutrition at Save the Children, explained that urban poor are more transient, as they tend to have unsteady jobs and living situations. In rural areas, many people at least have land and food, and a stronger support system within the community “In urban areas this doesn’t exist. Urban cities are overcrowded by many ethnic groups living side by side so it’s a bit harder to bond, communicate and build trust. It’s the hidden population that is more problematic to reach.” He said lack of data makes it harder for charities like Save the Children, or national and municipal governments, to access these marginalized communities.

 Among the 10 worst wealthy capital cities for child survival, out of the 25 studied, Washington D.C. (U.S.) was number one, followed by Vienna (Austria), Bern (Switzerland), Warsaw (Poland), and Athens (Greece). Washington, DC had the highest infant mortality rate at 6.6 deaths per 1,000 live births in 2013. While this rate is an all-time low for the District of Columbia, it is still 3 times the rates found in Tokyo and Stockholm. There are also huge gaps between rich and poor in Washington. Babies in Ward 8, where over half of all children live in poverty, are about 10 times as likely as babies in Ward 3, the richest part of the city, to die before their first birthday. Many major U.S. cities have even higher infant mortality rates than Washington, DC in recent years. In 2011, Cleveland and Detroit reported infant mortality rates of 14.1 and 12.4, respectively. Eight other cities had death rates at or above 8.9 in 2011 (see table on page 42). A Detroit News investigation last year found that a majority of deaths among Detroit children under 5 occurred during the first year of life. Infant deaths accounted for 130 of the 208 Detroit children who died before the age of 5 in 2011. Prematurity was cited as the leading killer of Detroit babies. Other factors contributing to infant deaths included pervasive poverty, young and uninformed mothers and poor prenatal care. Race is also a factor. In many U.S. cities, poor, unmarried and young African-American mothers are losing their babies at much higher rates than the U.S. average of 6.1 deaths per 1,000 live births. In San Francisco, an AfricanAmerican mother is 6 times as likely as a white mother to lose her baby before her child’s first birthday.

By looking at the mother’s index rankings of 2015, based on five criteria – maternal health, children’s well-being, educational status, economic status and women political status, Save the Children says that conditions for mothers and their children in the 10 bottom-ranked countries – all but two of them in West and Central Africa – are dramatic, as nations struggle to provide the basic infrastructure for the health and wellness of their citizens. “On average, in these countries one woman out of 30 dies from pregnancy-related causes, and one child out of eight dies before his or her fifth birthday,” Miles said.

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