Setting the scene:Links between poverty and maternal, newborn and

child survival

Hilary Homans17th January 2011

www.abdn.ac.uk/sustainable-international-development

Key messages MDG ReportLinkages – progress in one MDG goal affects othersNeed 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 1,400• Chad 1,200• Somalia 1,200• Guinea Bissau 1,000• Liberia 990• Burundi 970• Sierra Leone 970

Not only poor nations, but also conflict-affectedand malaria endemic

Note Rwanda MMR 1100 in 1995 to 540 in 2008

Countries where MMR has increased since 1990

1990 1995 2000 2005 20080

100

200

300

400

500

600

700

800

900

Botswana Congo Lesotho South Africa Swaziland Zambia Zimbabwe

Source: UN Inter-agency Estimates, 2010

Inequalities within countriesMaternal 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)

Bangla

desh

Bolivia

Cambodia

Camero

onNepal

Nigeria

Pakist

an

Senega

l

Somali

aSu

dan0

20

40

60

80

100

120

Poorest 20% Richest 20%

Antenatal care coverage (at least once) by richest & poorest %

(all countries where the difference was more than double)

Bangla

desh

Central A

frica

n RepublicChad

Moro

ccoNepal

Niger

Nigeria

Pakist

an

Somali

aSu

dan0

20

40

60

80

100

Poorest 20% Richest 20%

Child mortality

• Since 2000 the number of children dying before age 5 has from > 10 million a year to 8.8 million.

– 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)

Chad Niger Nigeria Pakistan0

10

20

30

40

50

60

70

80

Poorest 20% Richest 20%

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 well-

being• 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 reductionSource: 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

levelSource: 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

www.abdn.ac.uk/sustainable-international-development

Thank you for your attention

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