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Child Survival and Development Goals for the 1990s

by Cote P. Dodge
The year 1990 has been a significant year for the world's children. Sev-enty one Heads of State came together for the first World Summit for Children in United Nations Headquarters in New York on 30 September 1990. It was the largest gathering of heads of state and government in history. The outcome was an extraordinary new commitment : to reduce child deaths and child malnutrition by the year ,2000; to provide basic protection for the normal physical and mental development of all the world’s children; to dramatically reduce maternal mortality; a one-third reduction in child deaths; halving of child malnutrition; primary schooling for at least 80% of the poor world's children; and several detailed aims such as ending night blindness caused by the lack of vitamin-A. In all. it adopted more than 20 specific new goals for the year 2000.
The year 1990 saw the ratification of the Convention on the Rights of the Child. The Convention was adopted by the General Assembly of the United Nations orf November 20. 1989. Since then, the Convention has been signed by 150 nations and ratified by 70 — by far the most rapid ratification of any international Convention in history. Bangladesh was one of the first signatories of the Convention in January 1990. The Government ratified the Convention on 3 August 1990 and on 2 September it became international law for ratifying countries. As well as setting standards for the health and education of children, the Convention also addresses the estimated 80 million children who are exploited in the workplace. the 30 million who are left to fend for themselves on city streets, the uncounted millions whose development is disrupted by war. and the rising numbers of children in the industrialized world who are living^in poverty and abuse.
What do these political commitments mean to the world's children? How can these ambitious goals for the year 2000 become a reality? The last few years' experiences indicate that it is indeed possible. Despite all the difficulties of the last decade, the goal of immunizing 80% of the children in the developing world seems to have been achieved. The extraordinary effort of immunization has saved over 12 million young lives and prevented, over one and a half million children from being crippled by polio. It has also given the world new hope by showing what can be achieved when the international community commits Itself to a great endeavor
Today. 40.000 children die each day around the world from ordtnaiy malnutrition and common diseases. One hundred fifty million children live on. but with ill health and poor growth. The means of ending these child deaths are now available and affordable. The question, therefore, is whether or not morality would keep step with capacity, whether or not what can be done will now be done.
Let us look at Bangladesh. More than one third of the 4 million children born each year weigh below 2.5 kgs (which Is considered low birth weight) putting these babies at risk from their first breath of life. Most are born at home delivered by untrained birth attendants or family members or by mothers themselves About 500.000 of newborns do not survive their first year and another 300,000 die before the age of five. The Infant mortality rate has been declining but at a very slow rate for the past 75 years. The large majority of those who survive face recurrent bouts of diarrhoea. Infections and malnutrition, with 20% or fewer of the original group reaching their true growth potential.
The levels of maternal morbidity and mortality in Bangladesh are also extremely high. The number of mothers w!m> die in child birth are 6 per 1000 live births as compared to less than one per 1000 live births in Sri Lanka. This represents approximately 23.000 maternal deaths per year.
Despite this unfavorable picture. Bangladesh has made outstanding achievements in some important programme areas. One good example is Immunization. In Bangladesh about 20% or one out of every five child deaths are due to vaccine-preventable disease tetanus, polio, diphtheria, whooping cough, measles and tuberculosis. Starting from 2% coverage in 1985. Bangladesh reached close to the level of UC1 (Universal Child Immunisation) by the end of 1990 This remarkable achievement was possible because not only the health pr ofcssionals and political leaders but also all sectors of society were mobilized. Politicians, teachers, students, religious leaders, mass media, folk media. professional organizations. voluntary groups. the business community, and many ordinary people Joined together to inform the public about the Importance of Immunizing all children. The network of journalists established through CFSD's (Center (or Sustainable Development) activities is another excellent example of this partnership.
A number of positive commitments have been undertaken by Bangladesh. In many ways they reflect a growing and genuine desire to give importance to child sur vlval and development. The Impact of these decisions will be significant
— Bangladesh ratified the Con
vention on the Rights of the Child on 3 August. 1990
— Parliament approved leglsla bon aimed at banning, by 1993. Importation and sale of non-lodtzed salt as a measure to control Iodine deficiency disorders.
— Similarly, legislation has been enacted to ban the advertisement of breast milk substitutes on TV and radio and to require companies who import and market milk. products to register and follow an international code
— The 1990s were declared the SAARC Decade of the Olrl Child" during the SAARC Summit held In the Maldives tn November 1990 During the 1990s various advocacy promotional and devel opmental activities on the Ctrl Child will be undertaken
Now it is up to us to advocate for the Implement atlon of all of these initiatives with whoever comes into power.
However, if Bangladesh is to achieve the goals for the year 2000. more has to be done — First, the level of immuntza tion coverage needs to be expanded and sustained. Our attempt to reduce any disparities tn coverage within the country as well as to eradicate polio by 2000 and eliminate measles and tetanus by 1995. has to be accelerated.
— Despite the success and popularity of tubewells for drinking water, only 12% of the rural population use tubewell water for all domestic purposes. This must change-.
— Only an estimated 6% of the 15 million rural household have a sanitary latrine Over one half of the household have no latrine at all and people defecate wherever tradition dictates. Lack of sanitation and poor pe rsonal hygiene In an environment where the population density Is the highest tn the world puts every one at risk from Infection from fecal overload in the environment.
— The high proportion of mal nourished children and the perpetual cycle of Infection and further nutritional wasting finally leading to far too many child deaths. The Bangladesh sh^uM^W ^a tubewell in every pera and Uu*“
r’—Mil whig
2000 **Li^o2btZdfy the diffkmftica IT?-^ important Io have tsnlkknt• that these goal* are achtevabfe After all. the knowledge and technology already '<>•! and
financial cost and maximum political benefit
tn fact. the global cost of achieving all the goal* for children by the year 2000 is estimated at around *20 billion a year - about aa much a* the world now spend* on the military every 10 days In practice the »20 billion a year might be found through - a small reduction tn military spending
— by debt relief linked Io in vestments in children
— or. by redirecting existing budgets from high cost services for the few to low cost services for the many However political still and the availability of the tow cost technologies and strategies —
Incl udlng vaecines. oral rehydratlon salt*. antfotoUcs. growth charts, iron tablets, vitamin A supp lement*, and family planning services — are not enough Equally Important is a country's capacity to put new knowledge at people * disposal. In the drive towards Universal Child Immunization ft was the partnership srith media such as newspapers, radio, television, cinema and traditional folk media and with communities such as religious leaders, artists, entertainers sports organizations, non governmental and voluntary bodies, professional societies, service clubs. youth organizations, which transformed the capacity of Bangladesh to communicate with the majority of it* people. The question of whether or not the agenda for the 1990s can be achieved, whether or not the World Summit for Children commitments can be kept. Is a question not just for whoever comes to power on February 27th. it's a question for society as a whole, including you and me. It Is the task of all of us. and particularly of media to ensure that our children are the first to benefit from human advances and the last ter suffer from our
We author Is the Representative of UNICEF in Bangladesh.