Editorials

State of the world’s children

With the media paying so much attention to the casualties of the economic slowdown, it would be easy to overlook a vital report on the grave situation faced by the world’s two most vulnerable classes of citizens — women and children in impoverished countries.

The “State of the World’s Children 2009,” released by the United Nations’ Children’s Fund (UNICEF) last month, focuses on maternal and newborn health, emphasizing the link between the health of mothers and their newborns, and offering solutions to close the gap in childbirth-related deaths between rich and poor countries. Pregnancy and childbirth are all too often marred by tragedy in the developing world.

The report’s statistics on maternal mortality are sobering: UNICEF estimates that since 1990, 500,000 maternal deaths have occurred annually — nearly 10 million deaths in the past 19 years — with the vast majority of these fatalities taking place in developing regions. Based on 2005 data, the latest available, the average lifetime risk of a woman in a least developed country dying of complications from pregnancy or childbirth is more than 300 times that of her counterpart in an industrialized country. Millions more suffer from pregnancy-related injuries, infections, diseases and disabilities.

Babies in least developed countries also face daunting odds of survival, being nearly 14 times more likely to die in their first 28 days of life — the neonatal period — than those born in industrialized countries. Three-quarters of these deaths take place during the first seven days, and between 25 to 45 percent take place on the first day.

Of the 3.7 million under-5 deaths that took place in 2004, the latest year for which firm data are available, 40 percent occurred in the neonatal period, underlining the vulnerability of babies in their first four weeks.

The causes of maternal and newborn deaths are no mystery. Obstetric complications — including postpartum hemorrhaging and infections and prolonged or obstructed labor — and abortion-related problems account for most maternal deaths. The greatest health risks faced by newborns include severe infections, asphyxia and premature births, which together account for 86 percent of newborn deaths.

There is, however, reason for hope: According to UNICEF, most of the conditions responsible for maternal and newborn deaths are “preventable and treatable.” UNICEF states that research has shown that 80 percent of maternal deaths could be averted if women had access to essential maternity and basic health care services. And infections, responsible for 36 percent of neonatal deaths, could be reduced with better maternal health screening and immunization and hygienic deliveries.

UNICEF emphasizes that “Healthy women who receive adequate nutrition, quality reproductive health and maternity services and basic health care before, during and after their pregnancies are more likely to give birth to strong babies who survive.” Creating such an environment, however, is complicated, and requires more than adequate funding.

UNICEF blames gender inequality and discrimination for fostering the environment that claims the lives of so many women and children, and says that the social, economic and cultural barriers that perpetuate these problems must be challenged. To this end, UNICEF advocates educating women and girls and reducing poverty, protecting them from abuse, exploitation and discrimination, fostering their involvement in household decision-making and economic and political life, and empowering them to demand their rights and providing essential services for them and their children.

To establish a more supportive environment, men also must become more involved in maternal and newborn health care, as well as in efforts to address gender discrimination. The U.N. goal is to reduce the mortality rate for pregnant and perinatal women by 75 percent by 2015, and enable all mothers to receive essential health care services.

There is much Japan can do to help improve the situation faced by perinatal women and newborns in the developing world. Japan’s donations to the U.N. Population Fund, which provides services and supplies to protect reproductive health, has been decreasing in recent years. The government must strive to reverse this trend.

In addition to financial-based aid, Japan should expand its contributions in vital areas such as education and health care training, drawing upon its own experience in lowering the nation’s maternal mortality rate from a high of about 440 deaths per 100,000 births in 1900 to the present rate of about 6.1, and reducing its infant mortality rate (in the first year) from more than 150 per 1,000 births in 1900 to the present figure of 2.8.