TAILIEUCHUNG - Applying an equity lens to child health and mortality: more of the same is not enough

In developing countries, a mother’s death in childbirth means that her newborn will almost certainly die and that her older children are more likely to suffer from , when mothers are malnourished, ill, or receive inade- quate care, their newborns face a higher risk of disease and premature death. 9 Almost one-quar- ter of newborns in developing countries are born low birth weight, largely due to their mothers’ poor health and nutritional status, which results in increased vulnerability to infection and a high- er risk of developmental problems. The quality of care that both mother and newborn receive during pregnancy, at delivery, and in the early postnatal period is essential to ensuring women remain healthy and. | CHILD SURVIVAL IV Child survival IV Applying an equity lens to child health and mortality more of the same is not enough Cesar G Victora Adam Wagstaff Joanna Armstrong Schellenberg Davidson Gwatkin Mariam Claeson Jean-Pierre Habicht Gaps in child mortality between rich and poor countries are unacceptably wide and in some areas are becoming wider as are the gaps between wealthy and poor children within most countries. Poor children are more likely than their better-off peers to be exposed to health risks and they have less resistance to disease because of undernutrition and other hazards typical in poor communities. These inequities are compounded by reduced access to preventive and curative interventions. Even public subsidies for health frequently benefit rich people more than poor people. Experience and evidence about how to reach poor populations are growing albeit largely through small-scale case studies. Successful approaches include those that improve geographic access to health interventions in poor communities subsidised health care and health inputs and social marketing. Targeting of health interventions to poor people and ensuring universal coverage are promising approaches for improvement of equity but both have limitations that necessitate planning for child survival and effective delivery at national level and below. Regular monitoring of inequities and use of the resulting information for education advocacy and increased accountability among the general public and decision makers is urgently needed but will not be sufficient. Equity must be a priority in the design of child survival interventions and delivery strategies and mechanisms to ensure accountability at national and international levels must be developed. The survival prospects of poor children are not as good as those of their better-off peers often strikingly so. Worse still these gaps show signs of widening both between and within countries panels 1 and 2 .1-7 They exist despite the .

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