sowm_2015__int__africa_full_report_low_res

High Risk of Death for the Poorest Urban Children
Under-5 mortality in developing regions, by place of residence and urban wealth quintile
UNDER-5 MORTALITY RATE (DEATHS PER 1,000 LIVE BIRTHS)
140
120
100
80
60
40
20
0
Child death rates are higher
among the urban poorest
AFRICA ASIA AMERICAS
■ Rural average ■ Urban average ■ Urban poorest 20% ■ Urban richest 20%
Urban averages mask huge
inequities. The poorest urban
children are twice as likely
to die as the richest urban
children in Africa, Asia and
the Americas. In all three
regions, poor urban children
are also more likely than
rural children to die before
reaching age 5.
Note: These results represent the average
across countries for which urban DHS data
were available for under-5 mortality, from
surveys 2000-2011 (Africa=31 countries,
Americas=8 countries, Asia=14 countries).
As such, they may not be representative of
these regions as a whole.
Adapted from: www.who.int/gho/urban_health/
outcomes/under_five_mortality/en/. Rural
averages were calculated by Save the Children
from the same WHO dataset. Data available at
who.int/gho/data under “Urban health.”
Urban vs. Rural Health and Survival
In general, the risk of death before reaching
age 5 is higher in rural areas than in urban
areas of developing countries. 27 But beneath
these averages, the urban poor are often as bad
as, or worse off than, rural populations. In 35
of 56 countries with available data, the poorest
urban children face a higher risk of death than
rural children.
Despite the comparative advantage of cities,
urban areas are more unequal than rural areas. 28
In low-income countries, these disparities are
likely to increase as the combination of natural
and migration growth – much of which is among
the poor – and scarcity of resources results in cities
being even less capable of providing services to
those who come to live there. 29
There are a few countries where even the
average city dweller does not benefit from an
urban advantage. Published Demographic and
Health Surveys (DHS) data show urban mortality
rates are as high or higher than rural ones in:
Guyana, Haiti, Jordan, Paraguay, São Tomé and
Príncipe, Swaziland and Tanzania. 30 A WHO
analysis of household survey data suggests urban
children in Malawi and Zambia may also face a
higher risk of death than their rural peers. 31
In some cities, the poorest urban children
also do worse on health indicators than rural
populations in the same country. For example,
in 40 percent of the cities studied (9 of 22),
measles immunization rates among poor urban
children are lower than rates among rural
children. Coverage gaps between the city’s
urban poor and the national rural average are
especially large in Delhi, India (for skilled birth
attendance), Kigali, Rwanda (for prenatal care),
Port au Prince, Haiti (for prenatal care) and
Santa Cruz, Bolivia (for measles immunization).
These countries may be doing a better
job of reaching rural populations with these
essential services than they are of reaching the
urban poorest in their largest city. Stunting
rates are similarly high – or higher – among the
urban poor compared to rural populations in
Antananarivo (Madagascar), Bogotá (Colombia),
Dhaka (Bangladesh) and Delhi (India). 32
STATE OF THE WORLD’S MOTHERS 2015 15