Honourable Prime Minister Imran Khan in his maiden speech mentioned, we are among the top 5 countries in the world where children die due to malnutrition resulting in stunted growth. He also indicates that about 45 percent of Pakistan’s children, that is, almost every other Pakistani child’s brain has not been growing completely.
I agree with the statements of Honourable Prime Minister, but first fight of infant in Pakistan for his/her life is more severe than the later fights against malnutrition, and stunted growth. According to UNICEF report new-borns in Pakistan, with its rapidly growing population of 207 million inhabitants, one in 22 infant’s lost their first fight for life. While new-borns in Pakistan face the worst odds. That makes it worse than neighbouring war-torn Afghanistan, as well as the Central African Republics and eight other sub-Saharan African countries, which are often unstable and struggling with desperate poverty.
The report said, babies born in “Iceland one infant out of 1,000 lost their first fight for life. Whereas, these numbers for Singapore (one in 909), Finland (one in 833) Norway (one in 667)”. My own study by using World Bank data shows that there are only 34 countries whose infant mortality rates lies between range of zero and ten in 1990. While in 2018 this number increased to 80, which is more than double, this shows that there is significant reduction in infant mortality rates.
In our region we need to learn from the Maldives and Sri Lanka in order to reduce infant mortality rates by re-prioritise the government spending. Currently, Pakistan has 50 to 40 Per 1,000Births and ranked as 31. While, these numbers for Sri Lanka and Maldives are 8.21 & 21.26 respectively. We have to learn a lot from these countries of our region to reduce our infant mortality rates. Following are the recommendations to reduce infant mortality rates.
Firstly, we need to spend on the targeted health programs and increase per capita health expenditure as done by our neighbouring countries. The Main reason of the low Infant mortality rate of Sri Lanka was the spending on anti-malaria program started by the government which reduced the infant mortality significantly during 1980’s.
According to Pakistan health demographic survey 2013 (PHDS-2013) Infant Mortality Rates are 30 percent higher in urban areas than rural areas
While in Maldives, their Social sector expenditures are nearly 50 per cent of the budget in recent years. Maldives has also maintained almost universal coverage for all vaccines for preventable childhood diseases for nearly two decades. The per capita expenditure on the health sector in the Maldives is cited amongst the best practices in the South Asia region. In the period 2005-2011, per capita health expenditure increased from US$ 136 to US$ 247.While,in the last decade, Pakistan has spent just 0.5-0.8 percent of its GDP on healthcare. It’s only a tenth of what WHO (the World Health Organisation) requires Pakistan to spend. UNICEF also said as many as three million children could be saved each year with more per capita health expenditures.
Secondly, according to Pakistan health demographic survey 2013 (PHDS-2013) the IMR are 30 percent more in urban areas than rural areas. So, government needs to spend more in the rural and under developed and remote areas. We need to provide healthcare facilities, skilled birth attendants, and health infrastructure.
Thirdly, we need to spend on the education of mothers, which plays significant role in the reduction of infant mortality. According to PHDS-2013, the mothers having no education have high infant mortality rates for their children which are about 85 children per 1000. Whereas, this number for the mothers having secondary education is 42. Female literacy rate is 91.7 percent and 98.8 percent in Sri Lanka and Maldives respectively, and Pakistan’s female literacy rate is 45 percent, which is also encouraging teenage marriages. So, Education to female provides her awareness about the health care, family planning and avoid the incidence of teen age pregnancy which are causes of high infant mortality rates in Pakistan.
Lastly, According to PHDS-2013, infant mortality rates are 43 per 1000 children for the highest income percentile and for the bottom income percentile this number is 90. So, major contributor in the reduction of infant mortality rates for past decade is the highest income percentile. Government needs to spend on the bottom percentiles if country want to reduce its infant mortality rate by providing good public health facilities and targeted health programs. So, Government should launch targeted programs for the bottom income communities, which are more vulnerable to infant mortalities. We need to think very seriously about how to reprioritise the government spending on infants to save their life in first fight, and reduce the pain of their parents.
The writer is a visiting lecturer at Department of Economics, NUML Islamabad, and PhD Fellow & Visiting lecturer at School of Social Sciences and Humanities, NUST
Published in Daily Times, October 12th 2018.