It's called the urban survival gap – fueled 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.
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."
Speaking from the launch at U.N. Headquarters, 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.
The document estimates that 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.
The World Health Organisation (WHO) says that nearly a billion people
live in urban slums, shantytowns, on sidewalks, under bridges and along
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.
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
"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," Clay told IPS.
He said lack of data makes it harder for charities like Save the
Children, or national and municipal governments, to access these
The 10 developing countries with the largest child survival divide
are Bangladesh, Cambodia, Ghana, Kenya, India, Madagascar, Nigeria,
Peru, Rwanda and Vietnam.
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
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.
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.
Positively, the report has also uncovered some successful solutions
found by governments to reduce maternal and infant mortality, and close
the inequality gap between rich and poor children in their own
countries. The most successful countries are Ethiopia (Addis Ababa),
Egypt (Cairo), Guatemala (Guatemala City), Uganda (Kampala), Philippines
(Manila) and Cambodia (Phnom Penh).
"Ethiopia, which recently had accelerated economic growth, managed to
develop effective targeting policies, and provided accessible
preventive and curative health care for poor mothers and children," Clay
"[Ethiopia] should be a blueprint for other countries, which should
bring access to communities in slums so that local people are not left
behind," he underlined, adding that hiring urban outreach workers who
can go into the communities, speak the language of the people living
there and understand their conditions and needs is vital.
Save the Children is calling on national governments worldwide to
find new policies and plans to invest in a universal maternal and infant
health care, develop cross-sectoral urban plans, and reduce urban
disadvantages, and to increase the focus on the Sustainable Development
Goals in the post-2015 development agenda, concluded Miles.
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