Setting the scene: Links between poverty and maternal, newborn and child survival Hilary Homans

1. Setting the scene: Links between poverty and maternal, newborn and child survival Hilary Homans 17th January 2011 www.abdn.ac.uk/sustainable-international-development

2. 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

3. 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

4. Overview • Dimensions of poverty • Poverty & inequality maternal health • Poverty & inequality child health • Lessons learned in poverty alleviation • Future challenges

5. 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

6. Poverty is more than low income • Alsoinability 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

7. 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

8. 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

9. 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

10. www.chronicpoverty.org

11. 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

12. Countries by income level High income Upper-middle income Lower-middle income Low income

13. Maternal mortality 2005 - 2009

14. 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-affected and malaria endemic Note Rwanda MMR 1100 in 1995 to 540 in 2008

15. Countries where MMR has increased since 1990 Source: UN Inter-agency Estimates, 2010

16. Inequalities within countriesMaternal health • Skilled attendant at delivery • Antenatal care coverage

17. Skilled attendant at delivery by richest & poorest % (all countries where the difference was more than four times)

18. Antenatal care coverage (at least once) by richest & poorest % (all countries where the difference was more than double)

19. 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

20. Under 5 mortality 2005 - 2009

21. Inequalities

22. Robin Waugh, Uganda

23. 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

24. Disparities in child immunisations:Measles coverage by richest and poorest % (all countries where the difference was more than double)

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. Available data on HDI vary by regions Child malnutrition Births attended by skilled health staff Source: World Development Indicators data files

33. www.abdn.ac.uk/sustainable-international-development Thank you for your attention Copy of presentation is available