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Inequalities in child survival

looking at wealth and other socioeconomic disparities in

Maricar Garde
Nazme Sabina


Understanding child survival in developing countries requires looking at theinequalities in children’s mortality, and analysing the factors that contribute to thesedisparities. Countries with higher rates of under-5 mortality tend to have lessinequality in child mortality between the richest and poorest households. In contrast,in countries with lower levels of under-five mortality, child deaths are moreconcentrated in the bottom wealth group. The share of child deaths accounted for byneonatal mortality also tends to be higher in countries with lower rates of childmortality. The data also shows that progress towards MDG 4 in many on-trackcountries has been accompanied by rising inequality in mortality rates. This suggeststhat progress has often been achieved through interventions that first reached betteroffhouseholds.The analysis in the paper illustrates that the child survival picture—in terms of rateand inequality—varies in the developing world highlighting the importance ofdifferentiated child survival strategies between middle and low income countries. Inmany countries, reductions in child mortality among poorer households have beensmaller than for the higher income groups. Once child mortality is concentratedamong lower income groups – as is the case in many middle-income countries - majorefforts to reduce child mortality should be equalising, but these require a focus onsystematic interventions rather than “quick win” strategies. On the other hand, underfivemortality in low-income countries is usually high not only among the poorestquintile, but in the bottom 40-60 percent of the population, suggesting the need formore comprehensive strategies to reduce under-five mortality across a broaderspectrum of the population.Neonatal mortality tends to fall more slowly than under-five mortality, since reducingit needs longer-term and relatively more expensive interventions associated withfunctioning health systems. This indicates that while there are quick wins that canhelp improve child survival, middle income countries (and low income ones that haverelatively low child mortality rates) need to focus more heavily on reducing neonataldeaths. This strategy is more important in some geographic regions than others. Forexample in South Asia roughly half of child deaths occur in the first 4 weeks, whereasin sub-Saharan Africa neonatal deaths account for about a quarter of the total.The case studies of India and Bangladesh illustrate that economic growth is not asufficient precondition to reduce child mortality. A low income country like Bangladesh, by providing wide coverage of the relevant health interventions,improved child survival significantly. While wealth is an important dimension ofinequalities in under-five deaths, unequal child survival outcomes are present acrossother socioeconomic factors, including gender, caste and religion. Reducing unequalchild survival outcomes requires addressing socioeconomic factors that become asource of inequality and paying special attention to groups that have traditionally beenexcluded. The case of India illustrates how national-averages hardly tell the picture ofchild survival in a big and diverse country, reinforcing the need for differentiatedpolicies across states with a focus on the poorest and disadvantaged groups to reduceunder-five mortality more equitably.While most countries that experienced significant improvements in child survival sawa rise in inequality in mortality, a few have made progress without increasinginequality in child survival. Egypt is an example of a country which is on-track tomeet MDG 4 and has also seen a fall in inequality in child mortality. It is importantto look at the cases of “outliers” and the lessons they can offer to countries makingefforts to improve child survival.

Publication Type(s)

Conference Paper

Ten Years of War Against Poverty Conference Papers

Conference: Ten Years of War Against Poverty


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