Setting the scene:
Links between poverty and maternal, newborn
and child survival
Hilary Homans
17th January 2011
www.abdn.ac.uk/sustainable-international-development
Key messages MDG Report
Linkages – progress in one MDG goal affects others
Need for local policy commitment & coherent international
enabling environment
in agricultural productivity responsible for a decrease in poverty and hunger
Elimination of user charges has tremendous benefits
Need investments in skilled health workers and birth attendants, water and
sanitation in slums
Importance of girls access to education, health and productive assets
Need for targeted interventions, including social protection & employment
Diversification of livelihoods – clean energy, reduction in indoor air pollution
Changes to domestic resource allocation
Progress towards MDG 4 & 5
• 34% decline in MMR since 1990, less than half
what is needed to meet MDG 5
• A growing proportion of child deaths occur in the
first four weeks of life.
• Sub-Saharan Africa
–
–
–
–
very high child and maternal mortality
high adolescent birth rate
high HIV prevalence
very low access to reproductive health services (22% women
using contraception), clean water, sanitation
• > half women in sub-Saharan Africa & South Asia
attended by a skilled birth attendant
Overview
•
•
•
•
•
Dimensions of poverty
Poverty & inequality maternal health
Poverty & inequality child health
Lessons learned in poverty alleviation
Future challenges
Dimensions of poverty
• Poor nations – least developed countries
– links with MMR & IMR
• Impoverished communities –
geographical residence (urban/rural),
social cohesion and resilience to external
shocks
• Poor people – low income less than US$1
/US$1.25 per day
Poverty is more than low income
• Also inability to acquire the basic goods and
services necessary for survival with dignity.
• Encompasses low levels of health and
education, poor access to clean water and
sanitation, inadequate physical security, lack
of voice, and insufficient capacity and
opportunity to better one’s life.
Source: World Bank, 2010
Inequality
• Broader concept than poverty - defined over
the entire population, not just for the portion
of the population below a certain poverty
threshold.
• Poverty & inequality can change in different
directions
– over the past decade poverty
Brazil & China
– inequality
China &
Brazil
Source: World Bank, 2010
Vulnerability
• The risk of falling into poverty in the future, even if
the person is not necessarily poor now.
• Often associated with the effects of "shocks" e.g.
drought, a drop in farm prices, financial crisis,
humanitarian situations.
• Key dimension of well-being - affects individuals’
behaviour in terms of investment, production, &
coping strategies.
Source: World Bank, 2010
• Women’s lack of representation/political voice,
household bargaining power & accessible asset rights
may increase their vulnerability to chronic poverty.
Espey, J. & Harper. C. ‘The global financial crisis: are women more likely to be pushed into chronic poverty?’, 2009
Progress towards
poverty alleviation
• Despite the global financial crisis, overall
global levels of poverty
• Marked improvements in many continents/
countries BUT large differences between and
within countries.
• Poverty remains very high in
– sub-Saharan Africa (across the board chronically
deprived)
– South Asia (partially chronically deprived)
urban slum dwellers in these regions
www.chronicpoverty.org
Maternal and child
mortality
• Poor nations – least developed
countries – links with MMR &
IMR
• Sub Saharan Africa & South Asia
account for 99% of maternal
deaths & 83% of child deaths
Countries by income level
High income
Upper-middle income
Lower-middle income
Low income
Maternal mortality 2005 - 2009
Highest MMR
•
•
•
•
•
•
•
Afghanistan
Chad
Somalia
Guinea Bissau
Liberia
Burundi
Sierra Leone
1,400
1,200
1,200
1,000
990
970
970
Not only poor nations,
but also conflict-affected
and malaria endemic
Note Rwanda MMR
1100 in 1995 to
540 in 2008
Countries where MMR
has increased since 1990
900
800
700
600
500
400
300
200
100
0
1990
Botswana
1995
Congo
Source: UN Inter-agency Estimates, 2010
2000
Lesotho
South Africa
2005
Swaziland
Zambia
2008
Zimbabwe
Inequalities within countries
Maternal health
• Skilled attendant at delivery
• Antenatal care coverage
Skilled attendant at
delivery by richest & poorest %
(all countries where the difference was more than four times)
120
100
80
60
40
20
0
Poorest 20%
Richest 20%
Antenatal care coverage
(at least once) by richest & poorest %
(all countries where the difference was more than double)
100
90
80
70
60
50
40
30
20
10
0
Poorest 20%
Richest 20%
Child mortality
• Since 2000 the number of children dying before
age 5 has
million.
from > 10 million a year to 8.8
– BUT under 5 mortality highest in poorest
countries.
– AND under 5 mortality for richer children is less
than half that for poorer children.
Shaida Badiee, World Bank, Development Economics Data Group, 2010
Under 5 mortality 2005 - 2009
Inequalities
Robin Waugh, Uganda
Child immunisation
• Measles immunization rates
to 81%, with
similar progress in other vaccination programmes
& health-related services.
• BUT inequalities in measles coverage between
rich and poor.
• AND in access to
child health services.
Shaida Badiee, World Bank, Development Economics Data Group, 2010
Disparities in child immunisations:
Measles coverage by richest and poorest %
(all countries where the difference was more than double)
80
70
60
50
40
30
20
10
0
Chad
Niger
Poorest 20%
Nigeria
Richest 20%
Pakistan
Lessons learned
poverty reduction
• Trickle down theory does not work - Economic
growth is necessary, but not sufficient to
reduce poverty and inequality
• World’s richest 2% hold over 50% of wealth
• Inequalities in access to resources
• Income not the only measure that affects wellbeing
• Importance of social cohesion & social inclusion
Progress in poverty reduction
Mainly through:
• state-directed strategies which combined
economic development objectives with active
social policies that were complementary and
synergistic
Source: Combating Poverty and Inequality, UNRISD Flagship Report 2010
• Countries with stronger social protection &
assistance institutions show lower rates of
poverty & vulnerability, and are more resilient.
Source: Barrientos, A. Social protection and Poverty Reduction, UNRISD, 2008
Key messages:
poverty reduction
• Equality & redistribution matter for poverty
reduction
• Social policy an integral part of the
development strategies of countries that have
transformed their economies and reduced
poverty relatively quickly
• Linkages between policies & institutions in the
social, economic and political spheres must be
recognised
• Politics matter for poverty reduction
Source: Combating Poverty and Inequality, UNRISD Flagship Report 2010
Future
• Need for socially inclusive structural change
linked with inequality reduction
• Social policy must address:
–
–
–
–
Distribution
Protection
Production
Reproduction
Sources: Combating Poverty and Inequality, UNRISD Flagship Report 2010
Future
• Promote an “international
social norm of the moral
unacceptability of extreme
poverty in an affluent world”.
• Focus much more on the
national level
– setting national goals
– raising domestic resources
– debating policies at national
level
Source: David Hulme, Director, Brooks World Poverty Institute, University of Manchester
Future
• Focus on inequities & vulnerability reduction
– Intergenerational poverty
– Ultra poor – lack of social assets/landless
– Women and children in urban slums
– Socially excluded children & youth (72 million out
of school)
– Mobile/displaced populations
– Humanitarian situations
• Importance of governance & accountability
• Need for accurate data for evidence based
programming
Available data on HDI vary by regions
Child malnutrition
Births attended by skilled
health staff
Source: World Development Indicators data files
Thank you for your attention
Copy of presentation is available
www.abdn.ac.uk/sustainable-international-development