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Every Life Counts

Nazme Sabina
IN 2000, governments around the world committed themselves to the Millennium Development Goals (MDGs), eight targets revolving around international development
including education, health and gender equality. MDG 4 is specifically focused on child survival, calling for a reduction by two-thirds in the number of deaths of children under five.
To achieve MDG 4, Bangladesh must reduce under-five mortality, from 151 deaths per 1000 in 1990 to 50 by 2015, and infant mortality rate, the number of children dying at or under the age of one, from 94 deaths per 1000 live births in 1990 to 31 by 2015. The third target is to enhance the proportion of immunised one-year-olds for measles from 53 percentin 1992 to 100percentby2015.
According to the latest MDG progress report, the more pronounced causes of infant and child mortality are diarrhea, pneumonia, infection etc. However, there are other intermediate causes like poor nutrition, maternal literacy, lack of access to water and sanitation, etc. and structural issues such as poverty, inequality and exclusion, climate change and natural disasters, and global political economy. All these factors globally contribute to the deaths of over 9 million children, under-five every year.
It appears from the Bangladesh Demographic Health Surveys (BDHS) that the achievements of Bangladesh in reducing child mortality are very encouraging: under-five mortality decline by almost half, i.e. at an average rate of 5.3% per year which exceeds the required annual decline of 4.3% needed to achieve the Goal. The levels of coverage for BCG and the first two doses of DPT and polio are close to 90 percent or above. Measles vaccine rates at 76 precent are much lower though.
The trends noted above may look promising. The caveat, however, is that the improvements are based on overall trends at the national level. However, things would look quite different if we
put on our "equity" lenses and looked at the socio-economic and geographical disaggregation of this data.
Poverty, though, indirectly remains an underlying cause of child deaths in Bangladesh. Consistently, we see that it is the children in the poorest households and in the poorest communities who are dying.
The BDHS data also suggests that the children of poorest households are more likely than their better off peers to die within the first five years of their i birth. In the richest group, the child mortality rate is 72 per 1000, and in the poorest group, the rate is a staggering 121 per 1000. Although the poorest-richest ratio has been improving, the poorest are not getting benefits for reduction in mortality.
Children in the richest fifth households are more gainful than their poorest peers in measles vaccination— 90 percent children from the highest wealth group and 60 percent from the lowest wealth group are vaccinated for this disease.
Interestingly enough, mortality among rural children is much lower than that of their urban peers over the years. This difference is explained by the thrust or focus put in rural areas by health programs. The urban rates may reflect the lowest levels achievable with existing programs at current coverage levels. This may mean that the recent decline in overall under-five mortality may not be easy to sustain. The measles vaccination coverage is nearly 10 percentage points higher compared to rural areas.
For the full version of this article please read this month's
Forum, available free with The Daily Star on October 5
Nazme Sabina is a development economist