The Lottery of Birth report: All children must have equal chance to survive

Thursday 5 February 2015
A child’s chances of survival should not depend on where they are born, how wealthy their parents are, or their ethnic identity. Yet across the world, these factors continue to determine whether a child lives to celebrate his or her fifth birthday – factors which, for the child, are purely a matter of chance. 
This unfair lottery of birth violates every child’s right to an equal start in life.

In the last 25 years the world has made great strides in reducing infant mortality with the numbers dying before their fifth birthday dropping from 12 million in 1990 to 6.3 million today. However, progress is uneven. Save the Children's new report, The Lottery of Birth, finds that in too many countries many children are being left behind on the basis of where they are born and who they are born to. In many places this inequality is getting worse.

For example in 2012, a child born in one region of Niger was nearly five times more likely to die before their fifth birthday than a child in the region with the best survival rates. This inequality has doubled since 1998.

In Indonesia, a child born in the poorest 40% of households in 2012 was nearly 2.5 times more likely to die than a child in the richest 10%.

Thankfully, this inequality isn't rising in all countries. Some have managed not only to reduce child mortality but have done so for all parts of society. And when policies to help disadvantaged groups are followed, such as health systems that put the needs of the poorest first, the rate of progress is accelerated for everyone.

In September, world leaders are meeting at a crucial UN Summit which will set the development goals for the next 15 years. It's critical that they set targets and help fund programmes that address the inequality gap between region and rich and poor in developing countries. The prize if they do is great. We could be the generation that sees no child die from hunger or illnesses we know how to cure. And this could happen by 2030.

Watch this film that explains the current scenario around the world.


An example of positive change in Rwanda

Life can be tough for Modeste and her husband, who live in Burera district, Rwanda. They are farmers, with a small plot of land and eight children to bring up, and money is tight. But ill health is one thing that they don’t have to worry about as much anymore.

Despite being one of the world’s poorest countries, Rwanda’s child mortality rates have actually reduced and it is one of the few sub-Saharan African countries on track to achieve MDGs 4 and 5. (Rwanda reduced child mortality by a factor of 4 - from 230 per 1000 live births in 1998 to 52 in 2013) Maternal mortality also fell from 1000 to 320/100,000.

The introduction of a new national health insurance system - Mutuelles de Santé - is a key factor in this change for the better. In the past, Modeste often couldn’t afford to seek medical help when she or her children were ill. But when her youngest child, six-week-old Eliabu, was sick with whooping cough, Modeste took him straight to the health centre. She says, “I was very worried. I thought I could even lose my baby. But when I came here they gave me the drugs and I followed the instructions. Previously a child could fall sick because there was no insurance system. I kept my child at home sometimes because I didn’t have money to pay. Now, when you get a problem you can immediately come to the clinic."

Talking about access to the health centre and trained health workers, Modeste says, “People are now enlightened, when you get a problem you can immediately come to the clinic. We can access the health facility easily because of the roads. And for little children who get pneumonia or diarrhoea, we have community health workers who live in the village who can attend to that."
Save the Children in Rwanda
Save the Children in Rwanda started working in Burera district in 2007 with the development and implementation of a health programme. This programme has focused on neonatal health, mothers’ nutrition, antenatal care and infant feeding practices such as exclusive breastfeeding for the first 6 months of life. Since 2007, Save the Children has rehabilitated and equipped 4 facilities in the district (1 health centre and 3 health posts - Gahunga Health Centre, Nyanamo health post, Mariba health post, Kiribata health post). We have also provided training and resources to support district health teams to deliver healthcare and treatment to children through trainings provided by Ministry of Health. Save the Children in Burera has also established and supported 9 Early Childhood Care and Development Centres in Burera, which provide referrals to the health posts if children are sick.

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