Afghan Children Pay the Price of Brutal War

This blog by César Chelala highlights the issues that children are facing in Afghanistan, which heavily impact their health, education and overall well-being. The post is a part of Wikichild's series on under-5 mortality rates, along with it's spotlight on the recent Save the Children report "State of the World's Mothers 2013: Surviving the first day".

Decades of insecurity and war in Afghanistan have provoked a heavy toll on children’s lives and well-being. An under-5 mortality rate of 199 per 1,000 live births as reported by UNICEF is among the highest in the world. That means that more than one out of every five children is dead by the time they are five. In addition, health and education systems suffer from lack of funds and qualified professionals, a situation worsened by the security situation.

The statistics are frightening. More than 60% of all child deaths and disabilities are due to respiratory and intestinal infections, and of vaccine-preventable diseases such as measles. Diarrhea kills tens of thousands of children every year. Many also die from severance of breast-feeding before time. An estimated 7.5 million children and adults are at risk from hunger and malnutrition, the latter affecting children's growth in particular.

According to United Nations statistics, malnutrition among children has increased by 50 percent or more countrywide when compared to 2012. This is happening despite billions of dollars in humanitarian aid by Western governments. One of the most affected places is the malnutrition ward at Bost Hospital, in war-torn Helmand Province, but a similar situation can be found even at Indira Gandhi Children’s Hospital in Kabul.

Although it is difficult to pinpoint the causes for the increase in malnutrition levels, experts indicate several factors that contribute to it such as widespread poverty, difficulties in the implementation of feeding and therapeutic programs, and lack of breastfeeding. Despite low incomes, many mothers are lured by the beautiful pictures on milk cartons, and tend to believe that this milk provides better nutrition for their children.

Children in Afghanistan can also be affected by polio, since Afghanistan is one of only four countries in the world where the disease is still endemic. Despite high vaccination rates, however, there were 47 documented cases of polio in the country.

Some cities, such as Jalalabad, the largest city in eastern Afghanistan, located at the junction of the Kabul and Kunar rivers, are high risk areas for polio due in large part to the massive and continuous population movements from and into polio infected areas. In South Asia in 2000, over 40 percent of the confirmed cases of polio occurred in Pakistan and Afghanistan.

To control the spread of disease, UNICEF and the Department of Public Health in Nangarhar, one of Afghanistan’s 34 provinces, have launched the “Women Courtyard” initiative, aimed at providing local women with information about polio and other vaccine-preventable diseases, as well as such related issues as hygiene and waterborne illnesses.

While this is an important initiative, certain popular traditions still constitute a hindrance to its successful implementation. One such tradition is that babies cannot leave their homes before the 40th day after birth, a tradition which prevents many newborns from being vaccinated at the appropriate time.

To make matters worse, deadly attacks have targeted schools and impeded access to critical health care. According to Daniel Toole, UNICEF Regional Director for East Asia and the Pacific, “We have had attacks on villages and on schools by both anti-government elements as well as by coalition forces and international troops that have hit civilians."

Just in the first four months of 2013 over 400 children were killed and maimed as a result of the protracted conflict. Statistics seem to show that 2013 may well have been the second most deadly year since 2001.

The result of this conflict is that not a single child growing up in Afghanistan today has known peace in his/her lifetime. Deteriorated mental health is one of the consequences of a permanent state of war. A UNICEF study has found that the majority of children under 16 years of age in Kabul suffer from psychological trauma resulting in serious mental health problems including psychiatric disorders and post-traumatic stress syndrome.

Children in Afghanistan are exposed not only to violence related to acts of war but also to violence resulting from accidents, beatings by close relatives or neighbors, or seeing close relatives being beaten or executed. A study published in the Lancet has pointed out, “In Afghan children’s lives, everyday violence matters just as much as militarized violence in the recollection of traumatic experiences.”

Daniel Toole remarked at a press briefing in Geneva, “Afghanistan today is without doubt the most dangerous place to be born,” a sad commentary on the beleaguered country.

- César Chelala

César Chelala, MD, PhD, is an international public health consultant and the foreign correspondent for the Middle East Times International (Australia). He also is a co-winner of an Overseas Press Club of America award for an article on human rights.

This blog first appeared 11 January, 2014 on The WIP blog site. 

See related articles:

Levels and Trends in Child Mortality 
Childhood Under Fire: The impact of two years of conflict in Syria

UNICEF Child Well-being measure

UNICEF - Towards a Post-2015 World Fit for Children

UNICEF Report Card 10: Measuring child poverty

Children and Malnutrition

Abstinence doesn’t do the trick

This blog, written by Wikichild co-ordinator Melinda Deleuze, discusses the negative impact that adolescent pregnancies can have on the child, the mother and all of society. It is a contribution to the last day of the Wikiprogress spotlight on the Wikigender Network.

When I was 16 years old, I had one week of sex education required by my American high school. However, my state’s curriculum revolved around abstinence as the preferred means of birth control, along with fear as the method to encourage restraint until marriage. In my class, at least one girl, aged 15, already had an abortion before taking the course, and one boy, also aged 15, was a father. The course provided too little, too late. YES, abstinence has a 100% success rate. YES, it is the best way to avoid catching a sexually transmitted infection. NO, I’m not surprised that the US ranks second to last among the rich countries for number of teen births: 36 per 1,000 births among 15-19 year old girls (read more in this blog). 

Rich countries vs. the US in teen births (per 1,000 15-19 years old)

*Legend: In the lefthand graph, the UNICEF 

colors  represent the first, second and third 

Data from UNICEF's 11th Report Card and KIDS COUNT Data Book. 

tiers of countries' ranking. In the graph on the right, the colors match states with the country tiers. In this case,  the darkest blue indicates the 21 states which have a higher rate of teen births than the lowest ranking country (i.e. Bulgaria).

This year’s UN World Population Day focused on adolescent pregnancies, a persistent occurrence in both developing and developed countries. Around 16 million adolescent girls aged 15 to 19 give birth each year, according to the WHO. While there may be varying opinions on this issue, the fact is that adolescent pregnancies gravely affect the teen mother, the child and the rest of society (i.e. you and me). Despite misleading perceptions, these consequences can occur among married and unmarried adolescents in developed and developing countries for both intended and unintended pregnancies.

 How does it affect the well-being of the child?

The immediate health of children born to adolescent mothers is at risk, and the younger the mother, the higher the risk. This WHO Report states that “in low- and middle-income countries, stillbirths and death in the first week and first month of life are 50% higher among babies born to mothers younger than 20 years than those born to mothers aged 20–29 years.” Also, babies born to adolescent mothers are more likely to be pre-term, have a lower birth weight and have asphyxia, which all increase the baby’s chance of death or future health problems. Substance abuse during pregnancy is higher among adolescent girls, which contributes to a higher percentage of low birth-weight babies and infant mortality, along with other health issues.

How does it affect the well-being of the young mother?

First of all, the health of young mothers is severely compromised, as pregnant teenagers face double the risk of dying from pregnancy-related complications relative to women in their 20s.* This UNFA report summary states that “across developing countries, complications from pregnancy and unsafe abortion are the leading cause of death for girls aged 15-19.” The younger the mother, the more she is at risk of maternal complications, death and disability, including obstetric fistula. Up to 65% of women with obstetric fistula developed this during adolescence, says this WHO Report. Additionally, adolescent pregnancies are at higher risk for sexually transmitted diseases. Younger girls are less likely to practice safe sex and make up 64% of all new infections among young people worldwide, states this UNFPA factsheet.

Additionally, adolescent pregnancy contends with secondary education. In developed countries, motherhood during adolescent years increases girls’ chances of dropping out of school. In the United States, teen mothers are 10% less likely to obtain a high school diploma, as shown in this UNFPA report summary. Whereas in developing countries, the longer girls remain in school, the less likely they are to become pregnant in their teens. In Timor-Leste, for example, total fertility rates vary from 6 to1 ratio births per woman with no education to only 2 to 9 ratio births for women with secondary schooling or above, as indicated in this Women Deliver background paper. Delaying childbearing also increases chances of obtaining a higher income and better careers, among with other aspects of well-being, such as mental and psychological.

How does it affect the overall well-being of society?

Adolescent pregnancies concern us all as they negatively impact the development of a society. This UNFPA report summary states that “investing in family planning helps reduce poverty, improve health, promote gender equality, enable adolescents to finish their schooling and increase labour force participation.” In the UN Secretary-General Ban Ki-moon’s message for this year’s World Population Day, he stated that “when we devote attention and resources to the education, health and well-being of adolescent girls, they will become an even greater force for positive change in society that will have an impact for generations to come.”

I’m grateful that the World Population Day addressed adolescent pregrancy. While we often talk about maternal and infant mortality rates, as well as low birth-weight babies, we overlook at times this major proponent. I hope that there can be more open conversations with teens in order to overcome some of the obstacles to preventing teen pregnancies. And believe me, teaching abstinence just doesn't do the trick.

Melinda Deleuze

* Gennari, Pamela, J. 2013. “Adolescent Pregnancy in Developing Countries.” International Journal of Childbirth Education 28:57

The U.S. versus the rich world in child well-being

This blog, written by Wikichild coordinator Melinda George, is a comparison between the recently published 2013 KIDS COUNT Data Book on America's child well-being with UNICEF's 11th Report card on rich countries' child well-being. This blog is a part of the Wikiprogress Series on its well-being and progress networks.

Since last week’s launch of the Annie E. Casey Foundation’s 2013 KIDS COUNT Data Book, discussions about America’s child well-being, particularly concerning each states’ rankings, have been a hot topic. (For those of you who missed the highlights, read more here.) The Data Book examine trends of 16 indicators pertaining to 4 dimensions (economic well-being; education; health; and family and community). 

In April 2013, the United Nations Children’s Fund (UNICEF) Innocenti office of research launched its 11^th Report Card on child well-being in rich countries. This report ranks the world’s 29 advanced economies in terms of their overall well-being, using 26 internationally comparable indicators separated into 5 dimensions (material; education; health and safety; behaviors and risks; housing and environment).

According to this UNICEF study, the U.S. was ranked 26^th out of 29 in overall child well-being and was on the lower end for most dimensions and indicators. The Data Book recognises that when the data was disaggregated, the results were strikingly different, particularly the education data for the lowest-income students.

So, how do America’s states and races compare to 

the well-being of children in other advanced economies?

Between these two studies, there are 3 shared indicators (low-birthweight babies; child and youth mortality; teen births) and a 4^th indicator where the observed age range differs by one year (teens not in education, employment or training; i.e. NEET rate). 

I've aligned the state and race data* with the rich countries implementing UNICEF's 3 color system**, showing the first, second and third tiers. I also added a 4th color (the darkest) to indicate the states which are off the country charts. 

Low-birthweight babies

(% born below 2.5 kilograms or 5.5 pounds)

Regarding the percentage of babies born below 2.5 kilograms, Alaska is comparable to Norway, Idaho to Belgium, Georgia to Greece, and Mississippi is off the charts. A majority of the states are in the bottom third of the advanced countries. However, Hispanics and non-Hispanic Whites are in the middle, closer to Germany, while African Americans (at 13.2%) have a much higher percentage of babies below 2.5 grams than the average in Greece (around 9.5%). 

Child and youth mortality rate

(deaths per 100,000 among 1-19 year-olds)

We see the same trend in child and youth mortality rates as we did in the low birthweight percentages. The majority of states are in the bottom third of advanced countries' rates, with only 5 states in the top two-thirds. However, the Asian and Pacific Islanders in the U.S. have the same rate as Sweden and the Netherlands.

Teen births

(per 1,000 15-19 year olds) 

Since the United States has the second highest number of teen births next to Bulgaria, it is not surprising that 21 out of 50 states are off the charts. There are no states in the top two-thirds of the rich countries; however, the Asian and Pacific Islanders are in the middle third, with the same number of teen births (11 births per 1,000 15-19 year-olds) as Greece and the Czech Republic.

NEET rate

Percentage of 15-19 or 16-19 year olds not in education, employment or training 

The percentage of teens in the United States neither attending school nor working varies a lot between the states. In comparing with the advanced country rankings, most states were in the bottom third, and 13 states were in the middle third. Also, Vermont and Wyoming have rather low percentages (4%) and are comparable to Germany. When the U.S. data is disaggregated by race, it also is more evenly spread, covering all three tiers of the advanced countries. American Indians have the lowest percentage (15%), only slightly lower than Bulgaria's percentage. I must note that the UNICEF study observed teens 15 to 19 years old, while KIDS COUNT observed only 16 to 19 year olds in its study.

It’s unfortunate that there were not more shared indicators among the two studies and most of the shared indicators were related to children's health. While the KIDS COUNT data is most likely very relevant to local policy-making, it cannot be compared internationally.

The Data Book recognises childhood obesity as a growing problem; however, the KIDS COUNT index regrettably does not include an indicator for childhood obesity as there is no 50-state data source available. In the 11^th Report Card, the U.S. is almost off-the-charts for its childhood obesity rate in comparison with other rich countries. Comparable data is crucial in order to highlight the problem areas, share best practices, and tackle America’s childhood obesity. 

When considering America's improvements and declines in child well-being, we should look across states, across races and across other advanced economies to get a better understanding of what success looks like. I hope that policy-makers will do the same when deciding where efforts should be spent.

*The data concerning the U.S. is available online at www.datacenter.kidscount.org. 

**The countries with grey bars have data for fewer than 75% of the total number of indicators used in the UNICEF study.

Melinda Deleuze