The 16th annual State of the World’s Mothers report published by Save the Children places Sierra Leone at 169 out of 179 countries ranked on five key factors: risk of maternal death, under-five mortality rate, educational status, economic achievement and political status.
The report presents the first-ever global assessment of health disparities between rich and poor in cities, highlighting that poor mothers and children in urban settings have much worse health outcomes than their wealthier counterparts in the same city or country; thus the urban disadvantage.
“The report includes findings from low, middle, and high income countries. It examines where survival gaps are smallest and largest and looks at whether gaps have widened or narrowed over time. As noted, over half of the world’s population now lives in cities and a growing proportion of child deaths occur in these areas,” the report states.
The report however indicated that great progress has been made in reducing deaths in children under the age of five around the world, but that inequality is worsening in many cities.
“The poorest urban children are at least twice as likely to die as the richest urban children before they reach their fifth birthday. In Malawi, these gaps have doubled in the past decade. Ghana and Nigeria have some of the highest urban child survival gaps in the world. In these countries, children are 3 to 5 times more likely to die as their richer peers”.
According to the report, there are huge disparities in access to prenatal care and skilled birth attendance in urban areas worldwide and that public sector health systems often fail to reach those most in need with basic health services.
“In low-income countries, over one third of urban residents live in slums. This is equivalent to over 860 million people. Social and economic discrimination contribute to high child death rates in slums. Overcrowding, poor sanitation and food insecurity make poor mothers and children even more vulnerable to disease and ill health in slums”.
179 countries are ranked on five key factors: risk of maternal death, under-five mortality rate, educational status, economic achievement and political status.
Substantial progress has been made in reducing child deaths since 1990. The global under-5 mortality rate has been cut by 49 percent – from 90 deaths per 1,000 live births in 1990 to 46 in 2013.11 Global child mortality rates are falling faster now than at any time in history, made possible in part by action on immunization, family planning, nutrition and treatment of common childhood illnesses, as well as improvements in the wider social determinants of health.12
Save the Children also reported that the bold child survival target set out in the fourth Millennium Development Goal – to reduce global under-5 mortality by two thirds between 1990 and 2015 – has already been met by eight developing countries with high child death rates.
Inspiring progress has been made in Malawi (72 percent reduction in child mortality), Bangladesh (71 percent), Liberia (71 percent), Tanzania (69 percent), Ethiopia (69 percent), Timor-Leste (68 percent), Niger (68 percent) and Eritrea (67 percent).
The dramatic progress made by some of the world’s poorest countries has led many to speculate that an end to preventable child mortality is within our reach. Within a generation, we could live in a world where no child dies from preventable causes – conditions such as diarrhea and pneumonia for which vaccines and cost-effective treatment are available, or complications at birth that could be resolved through the presence of a skilled birth attendant.
However, there is still a long way to go. More than 6 million children died in 2013 and progress for most countries has been too slow. Only 12 of the 60 countries with the highest child deaths rates are on track to achieve MDG 4. Greater attention is urgently needed in sub-Saharan Africa and South Asia, the regions where under-5 deaths are increasingly concentrated.
Increased attention to newborn babies is also critically important. While newborn death rates have been falling, the proportion of under-5 deaths that occur in the first month of life has increased from 37 percent in 1990 to 44 percent in 2013. The share of under-5 deaths that occur during the newborn period is rising in every region and in almost all countries.
Historically, the highest child mortality rates have been found in rural areas and in the most remote regions of developing countries.
Many governments have rightly made important efforts to improve health infrastructure in those geographic areas. Decades of investments in rural areas are paying off, as death rates in small villages in most countries are declining.
But much work remains to be done to ensure the most vulnerable children everywhere have an equal chance to survive and thrive. Unmet needs in rural areas cannot be neglected, but the urgent task of completing the MDG agenda is increasingly concentrated in urban contexts.
Country Ranking out of 179*
Sierra Leone 169th