Nations Make Progress In Helping Children

Two years after World Summit for Children, countries pursue goals that include reducing malnutrition and child mortality rates

TWO years ago, 71 world leaders gathered in New York at the World Summit for Children to discuss the crucial problems facing children everywhere. One of the most horrifying statistics of our time came out of that meeting: A quarter of a million young children die every week from malnutrition, disease, and poverty, according to a report by the United Nations Children's Fund (UNICEF).

Staggering as that figure continues to be, those who have watched the progress of nations since the summit in trying to solve the problems that destroy children insist that the goals were positive, measurable, and continue to offer hope.

The leaders at the summit agreed on a list of 27 goals to be attained by the year 2000. Since then, more than 50 nations have each established a detailed "national program of action" to achieve the goals, with some countries shifting resources to do it. The summit also called for a "first call for children" principle, which means children's needs should be met with sufficient resources even when a country has hard times.

For example, Mexico, under President Carlos Salinas de Gortari, has increased by 40 percent the budget of the government agency that provides services to the poorest fifth of the country.

Basic health care has been extended to the poorest villages. Immunization is close to being nationwide. Several million more people now have safe drinking water, which means that more than 70 percent of the nation has been reached. The goal is 100 percent safe water by 2000. Almost 40 hospitals in the country have been designated as "baby friendly" hospitals and serve as maternity models.

"It's the political will that makes the difference," said John Usher, a UNICEF official in New York. "The summit was vital because it committed the leaders to do things, and now they are following up with national programs of action. And at the Rio conference [on the environment last June], the [children's] summit goals were specifically mentioned in the final agenda." Africa takes action

Despite droughts and wars, more than 20 African nations have agreed to national programs of action that include efforts to control AIDS and malaria, and increased efforts to provide access to safe drinking water and sanitation facilities.

To reduce gender disparities, the countries are committed to improving educational opportunities for women. Another 27 African nations are formulating plans of action.

In addition, Angola, Ethiopia, Somalia, and Sudan have agreed to "corridors of peace" in war zones, where temporary cease-fires allow food and medicine to be distributed to children, including immunization.

John Grant, executive director of UNICEF, stated in a "State of the World's Children Report" that when the summit met two years ago, 80 percent of the world's children had been immunized after nearly a decade of effort. "This accomplishment demonstrated [to the summit] that the world now has the outreach capacity to bridge the gap between mass-scale problems and inexpensive solutions," Mr. Grant said. UNICEF estimates that because of the immunization plan and the other summit efforts, as many as 3 millio n children are saved every year.

"The joint effort by the World Health Organization, UNICEF, and various governments including Sweden, Canada, Italy, and others along with Rotary International helped achieve the goal," says Mehr Khan, a spokeswoman for UNICEF.

Goals of the summit nations include reducing child-mortality rates by one-third; reducing child malnutrition by half; reducing deaths of women related to childbirth and pregnancy by half; making family planning universally available; and providing safe water, sanitation, and basic education for all children.

What is most promising, according to UNICEF studies, is the relationship between falling birth rates and falling death rates of children.

In developing countries, as mortality rates for children under age 5 fall below 150 per thousand live births, confidence in family planning increases. Traditional cultural attitudes often lead to large families as a way to compensate for the children who die.

According to UNICEF, India has reached this point where birth and death rates are declining, but many African nations have death rates as high as 250 per thousand.

Despite the grim conditions these figures indicate, the fact is that in 1960 most sub-Saharan African nations and South Central Asian countries had child mortality rates that averaged in the 300 per thousand range. In 1990, Mozambique, Afghanistan, and Angola were the only countries in the world with mortality rates greater than 290 deaths per thousand.

Among the industrialized nations, Japan's child-mortality rate of six per thousand was the world's lowest in 1990. The country may well be one of the models for a nation that lives by the "first call for children" principle. At the summit, Japan representatives stressed the importance of education in national plans of action and called on other countries "to raise the literacy rate among children" as a first priority. Japanese mothers revered

"In psychological terms, in Japan and some European countries, as contrasted to third-world countries, women who have babies have a lot of respect," says Martha Ozawa, a professor of social work at Washington University in St. Louis. "In those societies, the mothers come close to being revered, and they are thanked for raising children."

While developing nations grapple with maternity and child-care issues at the most basic level - safe water in the village or enough food for a newborn - Mexico may be the interim model. But Japan's social commitment to children and mothers may be the most comprehensive of any industrial nation.

Before children are born in Japan, the mothers (married or unmarried) are required by law to report to a health center. They receive a health handbook, "like a passport," says Ms. Ozawa. Free of charge, the mothers attend workshops on mothering and receive regular prenatal care. When the child is born, medical care is provided along with maternity leave, and if the baby is born prematurely, additional care is available. Depending on the mother's situation, day care is provided, including housing in a res idential facility if she needs it.

If the mother is unemployed or single, or both, she and her children receive ample allowances. If the child is disabled, additional care and allowances are provided. Later, the mother has options for educational loans for herself and her children. She will be given preferential treatment if she wants to start certain small businesses.

"In the US," says Ozawa, "the value attached to people often depends on how much they get in the labor market, while in other cultures, there are multiple ways to respect people. In Japan only 1.2 percent of the population is on public assistance. In the US it is around 8 percent or so."

Most developing nations are far removed from this kind of support for mothers, babies, and children. But as UNICEF officials note, the World Summit for Children indicated that the desperate needs of children are beginning to "feature on the political agenda in a way that is unprecedented in UNICEF's 40-year history."