sowm_2015__int__africa_full_report_low_res

Blantyre, Malawi
Progress, But Not Equity
Many countries have made important progress
in reducing child death rates overall, including
among the poorest urban children. But progress
often does not eliminate disparities, and
sometimes it exacerbates them. In almost half
of all countries with available trend data (19 of
40 countries), urban survival gaps between the
richest and poorest children have grown. 57
In Kenya, for example, child death rates for
the poorest urban children have declined 31 percent
since the 1993 DHS, but they fell twice as
far for the richest urban children (64 percent),
so the survival gap has doubled. The poorest
are now 4 times as likely to die as the richest,
whereas they had been twice as likely to die.
Rwanda is well known for the spectacular
progress of its health system in recent years.
Nationwide, the child mortality rate has been
reduced 66 percent since 1990. 58 Progress among
the urban richest has been similarly impressive
(65 percent decline in the child death rate since
urban health data were first reported in 1992),
but the poorest only experienced a 41 percent
decline. This leaves the richest urban children
with 5 times the survival advantage of the
poorest urban children (compared with 3 times
the advantage in 1992).
The data suggest inequality has also noticeably
worsened (while overall survival rates
improved) in urban areas of Armenia, Lesotho,
Namibia, Nigeria, Vietnam and Zimbabwe.
Survival gaps (in relative terms) between the
urban rich and the urban poor in these countries
have grown by at least 50 percent over the
period of available data. 59
And even where equity gains are made, they
are not guaranteed to last. In Malawi, important
progress for the poorest in the 1990s enabled
that country to reach near parity in survival
rates between rich and poor urban children, as
reported in 2000. That was a rare achievement.
But in recent years, the gap between rich and
poor urban children appears to have widened to
the point that the poorest children may be twice
as likely to die as the richest urban children.This
suggests equity gains need to be monitored and
safeguarded, lest they be lost.
STATE OF THE WORLD’S MOTHERS 2015 27