Recent research from Nigeria suggests that living in a socio-economically disadvantaged urban area increases the rate of under-five mortality even after the data have been adjusted for factors such as mother's care;family planning;and education on child health,nutrition, education or income.s In Bangladesh,2009 household hygiene,environmental sanitation,accident prevention and the advantages of breastfeeding.In addition to ensuring provi- survey data indicate that the under-five mortality rate sion of primary health care,States parties undertake to combat in slums is 79 per cent higher than the overall urban disease and malnutrition "through the provision of adequate rate and 44 per cent higher than the rural rate.$Around nutritious foods and clean drinking water,taking into consid- two thirds of the population of Nairobi,Kenya,lives eration the dangers and risks of environmental pollution." in crowded informal settlements,with an alarming under-five mortality rate of 151 per thousand live Education,play and leisure births.Pneumonia and diarrhoeal disease are among The Convention establishes the right to education on the basis the leading causes of death.?Poor water supply and of equal opportunity.It binds States parties to make "available sanitation,the use of hazardous cooking fuels in badly and accessible to every child"compulsory and free primary education and options for secondary schooling,including ventilated spaces,overcrowding and the need to pay vocational education(Article 28).It also obliges States parties for health services-which effectively puts them out of to "encourage the provision of appropriate and equal oppor- reach for the poor-are among the major underlying tunities for cultural,artistic,recreational and leisure activity" causes of these under-five deaths.s Disparities in child (Article 31). survival are also found in high-income countries.In large cities of the United States,income and ethnicity Protection have been found to significantly affect infant survival. States parties recognize their obligation to provide for multiple aspects of child protection.They resolve to take all appro- priate legislative,administrative,social and educational Immunization measures to protect children from all forms of physical or mental violence,injury or abuse,neglect or negligent treat- Around 2.5 million under-five deaths are averted ment,maltreatment or exploitation,even while the children annually by immunization against diphtheria,pertus- are under the care of parents,legal guardians or others sis and tetanus(DPT)and measles.Global vaccination (Article 19).This protection,along with humanitarian assis- coverage is improving:130 countries have been able to tance,extends to children who are refugees or seeking administer all three primary doses of the DPT vaccine refugee status(Article 22) to 90 per cent of children younger than 1.More needs to be done however.In 2010,over 19 million Under the Convention,States are obliged to protect children from economic exploitation and any work that may interfere children did not get all three primary doses of with their education or be harmful to their health or physical, DPT vaccination.10 mental,spiritual,moral or social development.Such protec- tions include the establishment and enforcement of minimum Lower levels of immunization contribute to more age regulations and rules governing the hours and condi- frequent outbreaks of vaccine-preventable diseases in tions of employment(Article 32).National authorities should communities that are already vulnerable owing to high also take measures to protect children from the illicit use of population density and a continuous influx of new narcotic drugs and psychotropic substances(Article 33)and from all forms of exploitation that are harmful to any aspect of infectious agents. their welfare (Article 36),such as abduction,sale of or traffic in children(Article 35)and all forms of sexual exploitation and Poor service delivery,parents who have low levels abuse (Article 34). of education,and lack of information about immu- nization are major reasons for low coverage among The Convention's four core principles-non-discrimination;the children in slums as diverse as those of western Uttar best interests of the child;the right to life,survival and devel- Pradesh,India,and Nairobi,Kenya. opment;and respect for the views of the child-apply to all actions concerning children.Every decision affecting children in the urban sphere should take into account the obligation to promote the harmonious development of every child. Children's rights in urban settings 17
Children’s rights in urban settings 17 care; family planning; and education on child health, nutrition, hygiene, environmental sanitation, accident prevention and the advantages of breastfeeding. In addition to ensuring provision of primary health care, States parties undertake to combat disease and malnutrition “through the provision of adequate nutritious foods and clean drinking water, taking into consideration the dangers and risks of environmental pollution.” Education, play and leisure The Convention establishes the right to education on the basis of equal opportunity. It binds States parties to make “available and accessible to every child” compulsory and free primary education and options for secondary schooling, including vocational education (Article 28). It also obliges States parties to “encourage the provision of appropriate and equal opportunities for cultural, artistic, recreational and leisure activity” (Article 31). Protection States parties recognize their obligation to provide for multiple aspects of child protection. They resolve to take all appropriate legislative, administrative, social and educational measures to protect children from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, even while the children are under the care of parents, legal guardians or others (Article 19). This protection, along with humanitarian assistance, extends to children who are refugees or seeking refugee status (Article 22). Under the Convention, States are obliged to protect children from economic exploitation and any work that may interfere with their education or be harmful to their health or physical, mental, spiritual, moral or social development. Such protections include the establishment and enforcement of minimum age regulations and rules governing the hours and conditions of employment (Article 32). National authorities should also take measures to protect children from the illicit use of narcotic drugs and psychotropic substances (Article 33) and from all forms of exploitation that are harmful to any aspect of their welfare (Article 36), such as abduction, sale of or traffic in children (Article 35) and all forms of sexual exploitation and abuse (Article 34). The Convention’s four core principles – non-discrimination; the best interests of the child; the right to life, survival and development; and respect for the views of the child – apply to all actions concerning children. Every decision affecting children in the urban sphere should take into account the obligation to promote the harmonious development of every child. Recent research from Nigeria suggests that living in a socio-economically disadvantaged urban area increases the rate of under-five mortality even after the data have been adjusted for factors such as mother’s education or income.5 In Bangladesh, 2009 household survey data indicate that the under-five mortality rate in slums is 79 per cent higher than the overall urban rate and 44 per cent higher than the rural rate.6 Around two thirds of the population of Nairobi, Kenya, lives in crowded informal settlements, with an alarming under-five mortality rate of 151 per thousand live births. Pneumonia and diarrhoeal disease are among the leading causes of death.7 Poor water supply and sanitation, the use of hazardous cooking fuels in badly ventilated spaces, overcrowding and the need to pay for health services – which effectively puts them out of reach for the poor – are among the major underlying causes of these under-five deaths.8 Disparities in child survival are also found in high-income countries. In large cities of the United States, income and ethnicity have been found to significantly affect infant survival.9 Immunization Around 2.5 million under-five deaths are averted annually by immunization against diphtheria, pertussis and tetanus (DPT) and measles. Global vaccination coverage is improving: 130 countries have been able to administer all three primary doses of the DPT vaccine to 90 per cent of children younger than 1. More needs to be done however. In 2010, over 19 million children did not get all three primary doses of DPT vaccination.10 Lower levels of immunization contribute to more frequent outbreaks of vaccine-preventable diseases in communities that are already vulnerable owing to high population density and a continuous influx of new infectious agents. Poor service delivery, parents who have low levels of education, and lack of information about immunization are major reasons for low coverage among children in slums as diverse as those of western Uttar Pradesh, India, and Nairobi, Kenya
Breastfeeding Z /99Z0-600ZOHAN/3OINn Breastfeeding is recommended during the first six months of life as a way to meet infants'nutritional requirements and reduce neonatal mortality by perhaps 20 per cent.There is some evidence that urban mothers are less likely than rural ones to breastfeed and more likely to wean their children early if they do begin.An analysis of Demographic and Health Survey (DHS)data from 35 countries found that the percent- age of children who were breastfed was lower in urban areas.5 Low rates of breastfeeding may be attributed in part to a lack of knowledge about the importance of the practice and to the reality that poor women in urban settings who work outside the home are often unable to breastfeed. Figure 2.1.Wealth increases the odds of survival for children under the age of 5 in urban areas Under-five mortality rate (per 1,000 live births)in urban areas in selected countries(right end of bar indicates average under- five mortality for the poorest quintile of the population;left end indicates that for the wealthiest quintile) A health worker examines an infant in an incubator at Qingchuan County Richest 20% Poorest20% Materity and Child Care Centre,Sichuan Province,China. Maternal and newborn health More than 350,000 women died in pregnancy or childbirth in 2008,11 and every year many more sustain injuries,such as obstetric fistulae,that can turn into lifelong,ostracizing disabilities.Most of the women who die or are severely injured in pregnancy or child- birth reside in sub-Saharan Africa and Asia,and most of the deaths are caused by haemorrhage,high blood pressure,unsafe abortion or sepsis.Many of these inju- ries and deaths can be averted if expectant mothers receive care from skilled professionals with adequate equipment and supplies,and if they have access to Rwanda emergency obstetric care.12 Urban settings provide proximity to maternity and Uganda obstetric emergency services but,yet again,access and Niger use are lower in poorer quarters-not least because health facilities and skilled birth attendants are in Benin shorter supply.13 Health services for the urban poor tend to be of much lower quality,often forcing people 40 6080100120140160180200 to resort to unqualified health practitioners or pay a Under-five mortality rate premium for health care,as confirmed by studies in Source:WHO estimates and DHS,2005-2007 Countries were selected based Bangladesh,India,Kenya and elsewhere.14 on avadability of data. 18 THE STATE OF THE WORLD'S CHILDREN 2012
18 THE STATE OF THE WORLD’S CHILDREN 2012 Maternal and newborn health More than 350,000 women died in pregnancy or childbirth in 2008,11 and every year many more sustain injuries, such as obstetric fistulae, that can turn into lifelong, ostracizing disabilities. Most of the women who die or are severely injured in pregnancy or childbirth reside in sub-Saharan Africa and Asia, and most of the deaths are caused by haemorrhage, high blood pressure, unsafe abortion or sepsis. Many of these injuries and deaths can be averted if expectant mothers receive care from skilled professionals with adequate equipment and supplies, and if they have access to emergency obstetric care.12 Urban settings provide proximity to maternity and obstetric emergency services but, yet again, access and use are lower in poorer quarters – not least because health facilities and skilled birth attendants are in shorter supply.13 Health services for the urban poor tend to be of much lower quality, often forcing people to resort to unqualified health practitioners or pay a premium for health care, as confirmed by studies in Bangladesh, India, Kenya and elsewhere.14 Breastfeeding Breastfeeding is recommended during the first six months of life as a way to meet infants’ nutritional requirements and reduce neonatal mortality by perhaps 20 per cent. There is some evidence that urban mothers are less likely than rural ones to breastfeed – and more likely to wean their children early if they do begin. An analysis of Demographic and Health Survey (DHS) data from 35 countries found that the percentage of children who were breastfed was lower in urban areas.15 Low rates of breastfeeding may be attributed in part to a lack of knowledge about the importance of the practice and to the reality that poor women in urban settings who work outside the home are often unable to breastfeed. © UNICEF/NYHQ2009-0266/Jia Zhao Figure 2.1. Wealth increases the odds of survival for children under the age of 5 in urban areas Under-five mortality rate (per 1,000 live births) in urban areas in selected countries (right end of bar indicates average underfive mortality for the poorest quintile of the population; left end indicates that for the wealthiest quintile) Cambodia Nepal Honduras Egypt Senegal Rwanda Guinea Uganda Niger Benin India Dominican Republic Indonesia Bangladesh Pakistan Haiti Richest 20% Poorest 20% Source: WHO estimates and DHS, 2005–2007. Countries were selected based on availability of data. Under-five mortality rate 0 20 40 60 80 100 120 140 160 180 200 A health worker examines an infant in an incubator at Qingchuan County Maternity and Child Care Centre, Sichuan Province, China
Nutrition A 2006 study of disparities in childhood nutritional The locus of poverty and undernutrition among chil- status in Angola,the Central African Republic and dren appears to be gradually shifting from rural to urban Senegal found that when using a simple urban-rural areas,as the number of the poor and undernourished comparison,the prevalence of stunting was signifi- increases more quickly in urban than in rural areas.16 cantly higher in rural areas.But when urban and rural Hunger is a clear manifestation of failure in social protec- populations were stratified using a measure of wealth, tion.It is difficult to behold,especially when it afflicts the differences in prevalence of stunting and under- children.However,even the apparently well fed-those weight between urban and rural areas disappeared.24 who receive sufficient calories to fuel their daily activities A 2004 study of 10 sub-Saharan African countries can suffer the'hidden hunger'of micronutrient malnu- showed that the energy-deficient proportion of the trition:deficiencies of such essentials as vitamin A,iron urban population was above 40 per cent in almost or zinc from fruits,vegetables,fish or meat.Without all countries and above 70 per cent in three:Ethiopia, these micronutrients,children are in increased danger Malawi and Zambia.25 of death,blindness,stunting and lower IQ.7 At the opposite end of the nutrition spectrum,obesity The rural-urban gap in nutrition has narrowed in afflicts children in urban parts of high-income coun- recent decades-essentially because the situation has tries and a growing number of low-and middle-income worsened in urban areas.1s In sub-Saharan Africa, countries.26 A diet of saturated fats,refined sugars and a 2006 study showed that disparities in child nutri- salt combined with a sedentary lifestyle puts children tion between rich and poor urban communities were at increased risk of obesity and chronic ailments such greater than those between urban and rural areas.19 as heart disease,diabetes and cancer.27 Undernutrition contributes to more than a third of under-five deaths globally.It has many short-and Figure 2.2.Children of the urban poor are more long-term consequences,including delayed mental likely to be undernourished development,heightened risk of infectious diseases The proportion of children under 5 who are stunted(right end of bar indicates prevalence of stunting for the poorest quintile of the and susceptibility to chronic disease in adult life.20 In urban population;left end indicates that for the wealthiest quintile) low-income countries,child undernutrition is likely to Richest 20% Poorest 20% be a consequence of poverty,characterized as it is by low family status and income,poor environment and housing,and inadequate access to food,safe water, guidance and health care.In a number of countries, Cambodia stunting is equally prevalent,or more so,among the Bolivia (Plurinational State of) poorest children in urban areas as among comparably disadvantaged children in the countryside.21 Banglades A study of the National Family Health Survey(NFHS-3) in eight cities in India from 2005 to 2006 found that erra Le levels of undernutrition in urban areas continue to be India very high.At least a quarter of urban children under Nigeria 5 were stunted,indicating that they had been under- nourished for some time.Income was a significant Madagascar factor.Among the poorest fourth of urban residents, 54 per cent of children were stunted and 47 per cent 109% 20% 30%40% 50% 60% were underweight,compared with 33 per cent and Prevalence of stunting 26 per cent,respectively,among the rest of the urban Note:Estimates are calculated according to WHO Child Growth Standards. population.22 The largest differences were observed in Countries were selected based on availability of data. the proportion of underweight children in slum and Source:DHS,2006-2010. non-slum areas of Indore and Nagpur.25 Children's rights in urban settings 19
Children’s rights in urban settings 19 Nutrition The locus of poverty and undernutrition among children appears to be gradually shifting from rural to urban areas, as the number of the poor and undernourished increases more quickly in urban than in rural areas.16 Hunger is a clear manifestation of failure in social protection. It is difficult to behold, especially when it afflicts children. However, even the apparently well fed – those who receive sufficient calories to fuel their daily activities – can suffer the ‘hidden hunger’ of micronutrient malnutrition: deficiencies of such essentials as vitamin A, iron or zinc from fruits, vegetables, fish or meat. Without these micronutrients, children are in increased danger of death, blindness, stunting and lower IQ.17 The rural-urban gap in nutrition has narrowed in recent decades – essentially because the situation has worsened in urban areas.18 In sub-Saharan Africa, a 2006 study showed that disparities in child nutrition between rich and poor urban communities were greater than those between urban and rural areas.19 Undernutrition contributes to more than a third of under-five deaths globally. It has many short- and long-term consequences, including delayed mental development, heightened risk of infectious diseases and susceptibility to chronic disease in adult life.20 In low-income countries, child undernutrition is likely to be a consequence of poverty, characterized as it is by low family status and income, poor environment and housing, and inadequate access to food, safe water, guidance and health care. In a number of countries, stunting is equally prevalent, or more so, among the poorest children in urban areas as among comparably disadvantaged children in the countryside.21 A study of the National Family Health Survey (NFHS-3) in eight cities in India from 2005 to 2006 found that levels of undernutrition in urban areas continue to be very high. At least a quarter of urban children under 5 were stunted, indicating that they had been undernourished for some time. Income was a significant factor. Among the poorest fourth of urban residents, 54 per cent of children were stunted and 47 per cent were underweight, compared with 33 per cent and 26 per cent, respectively, among the rest of the urban population.22 The largest differences were observed in the proportion of underweight children in slum and non-slum areas of Indore and Nagpur.23 A 2006 study of disparities in childhood nutritional status in Angola, the Central African Republic and Senegal found that when using a simple urban-rural comparison, the prevalence of stunting was significantly higher in rural areas. But when urban and rural populations were stratified using a measure of wealth, the differences in prevalence of stunting and underweight between urban and rural areas disappeared.24 A 2004 study of 10 sub-Saharan African countries showed that the energy-deficient proportion of the urban population was above 40 per cent in almost all countries and above 70 per cent in three: Ethiopia, Malawi and Zambia.25 At the opposite end of the nutrition spectrum, obesity afflicts children in urban parts of high-income countries and a growing number of low- and middle-income countries.26 A diet of saturated fats, refined sugars and salt combined with a sedentary lifestyle puts children at increased risk of obesity and chronic ailments such as heart disease, diabetes and cancer.27 Note: Estimates are calculated according to WHO Child Growth Standards. Countries were selected based on availability of data. Source: DHS, 2006–2010. Figure 2.2. Children of the urban poor are more likely to be undernourished The proportion of children under 5 who are stunted (right end of bar indicates prevalence of stunting for the poorest quintile of the urban population; left end indicates that for the wealthiest quintile) Richest 20% Poorest 20% 0% 10% 20% 30% 40% 50% 60% Cambodia Bolivia (Plurinational State of) Ghana Bangladesh Kenya Sierra Leone India Nigeria Madagascar Peru Prevalence of stunting
MATERNAL AND CHILD HEALTH SERVICES FORTHE URBAN POOR A case study from Nairobi,Kenya Rapid urbanization has been taking are exactly where most local women their height-for-age index falls more place in Kenya-as in much of sub- go for maternal and child health care- than two standard deviations below the Saharan Africa-largely in a context seeking better-quality options only once median of the reference population;they of weak economic development and complications occur.In contrast to public are severely stunted if the index is more poor governance.As a result,local and services,which seldom extend to infor- than three standard deviations below the national authorities have not been able mal settlements,these private facilities median.Stunting prevalence is a useful to provide decent living conditions and are perceived as friendly,accessible and tool for comparisons within and between basic social services sufficient to meet trustworthy,perhaps because they invest countries and socio-economic groups. the needs of a growing urban popula- more time in building relationships with tion.Between 1980 and 2009,the number patients.Only a small proportion of the Figure 2.3 portrays the magnitude of of people living in Nairobi,the capital, urban poor has access to more reliable inequities in child undernutrition by increased from 862,000 to about 3.4 million. maternal health care services,including comparing average stunting levels for Estimates(2007)indicate that around those offered at clinics and hospitals run urban Kenya against data collected 60 per cent live in slums covering only by missionaries and non-governmental between 2006 and 2010 in the Korogocho 5 per cent of the city's residential land. organizations. and Viwandani slum settlements.The Moreover,emerging evidence reveals study covers all women who gave birth in that the urban population explosion in Urban child undernutrition the area.The children's measurements the region has been accompanied by In developing countries,child under- were taken periodically up to 35 months increasing rates of poverty and poor nutrition remains a major public health of age health outcomes.The incidence of child concern.Both a manifestation and a undernutrition,morbidity and mortal- cause of poverty,it is thought to contribute As the graph demonstrates,the preva- ity has been shown to be higher in slums to over a third of under-five deaths glob- lence of stunting among children living and peri-urban areas than in more privi- ally.Insufficient nutrition is one of a wide in slum areas increases sharply from leged urban settings or,sometimes,even range of interlinked factors forming the less than 10 per cent during the first few rural areas. so-called poverty syndrome-low income, months of life to nearly 60 per cent in large family size,poor education and the group aged 15-17 months,and then Access to health services limited access to food,water,sanitation remains at that level.In urban Kenya In Nairobi slums,public provision of and maternal and child health services. overall,the prevalence of undernutri- health services is limited.A study tion reaches a maximum of 35 per cent conducted in 2009 shows that out of Stunting,underweight and wast- among children aged 15-17 months, a total of 503 health facilities used by ing-measured by height-for-age, then declines to around 25 per cent.The residents of three slum communities weight-for-age and weight-for-height gap between the poor(here,slum resi- (Korogocho,Viwandani and Kibera),only respectively-are the three most dents)and the non-poor in Kenya widens 6(1 per cent)were public,79(16 per frequently used anthropometric indi- from this point.For example,among chil- cent)were private not-for-profit,and 418 cators of nutritional status.Stunting is dren above 15 months,the prevalence of (83 per cent)were private for-profit.The considered the most reliable measure stunting stands at around 57 per cent in last category largely consists of unli- of undernutrition,as it indicates recur- the slums and nearly 28 per cent in urban censed and often ramshackle clinics rent episodes or prolonged periods of Kenya as a whole.Separate analysis(not and maternity homes,with no work- inadequate food intake,calorie and/or illustrated in Figure 2.3)reveals that the ing guidelines or standard protocols for protein deficiency or persistent or recur- prevalence of stunting among the urban services.Yet these substandard facilities rent ill health.Children are stunted if rich is close to 21 per cent,suggesting THE STATE OF THE WORLD'S CHILDREN 2012
Rapid urbanization has been taking place in Kenya – as in much of subSaharan Africa – largely in a context of weak economic development and poor governance. As a result, local and national authorities have not been able to provide decent living conditions and basic social services sufficient to meet the needs of a growing urban population. Between 1980 and 2009, the number of people living in Nairobi, the capital, increased from 862,000 to about 3.4 million. Estimates (2007) indicate that around 60 per cent live in slums covering only 5 per cent of the city’s residential land. Moreover, emerging evidence reveals that the urban population explosion in the region has been accompanied by increasing rates of poverty and poor health outcomes. The incidence of child undernutrition, morbidity and mortality has been shown to be higher in slums and peri-urban areas than in more privileged urban settings or, sometimes, even rural areas. Access to health services In Nairobi slums, public provision of health services is limited. A study conducted in 2009 shows that out of a total of 503 health facilities used by residents of three slum communities (Korogocho, Viwandani and Kibera), only 6 (1 per cent) were public, 79 (16 per cent) were private not-for-profit, and 418 (83 per cent) were private for-profit. The last category largely consists of unlicensed and often ramshackle clinics and maternity homes, with no working guidelines or standard protocols for services. Yet these substandard facilities are exactly where most local women go for maternal and child health care – seeking better-quality options only once complications occur. In contrast to public services, which seldom extend to informal settlements, these private facilities are perceived as friendly, accessible and trustworthy, perhaps because they invest more time in building relationships with patients. Only a small proportion of the urban poor has access to more reliable maternal health care services, including those offered at clinics and hospitals run by missionaries and non-governmental organizations. Urban child undernutrition In developing countries, child undernutrition remains a major public health concern. Both a manifestation and a cause of poverty, it is thought to contribute to over a third of under-five deaths globally. Insufficient nutrition is one of a wide range of interlinked factors forming the so-called poverty syndrome – low income, large family size, poor education and limited access to food, water, sanitation and maternal and child health services. Stunting, underweight and wasting – measured by height-for-age, weight-for-age and weight-for-height, respectively – are the three most frequently used anthropometric indicators of nutritional status. Stunting is considered the most reliable measure of undernutrition, as it indicates recurrent episodes or prolonged periods of inadequate food intake, calorie and/or protein deficiency or persistent or recurrent ill health. Children are stunted if their height-for-age index falls more than two standard deviations below the median of the reference population; they are severely stunted if the index is more than three standard deviations below the median. Stunting prevalence is a useful tool for comparisons within and between countries and socio-economic groups. Figure 2.3 portrays the magnitude of inequities in child undernutrition by comparing average stunting levels for urban Kenya against data collected between 2006 and 2010 in the Korogocho and Viwandani slum settlements. The study covers all women who gave birth in the area. The children’s measurements were taken periodically up to 35 months of age. As the graph demonstrates, the prevalence of stunting among children living in slum areas increases sharply from less than 10 per cent during the first few months of life to nearly 60 per cent in the group aged 15–17 months, and then remains at that level. In urban Kenya overall, the prevalence of undernutrition reaches a maximum of 35 per cent among children aged 15–17 months, then declines to around 25 per cent. The gap between the poor (here, slum residents) and the non-poor in Kenya widens from this point. For example, among children above 15 months, the prevalence of stunting stands at around 57 per cent in the slums and nearly 28 per cent in urban Kenya as a whole. Separate analysis (not illustrated in Figure 2.3) reveals that the prevalence of stunting among the urban rich is close to 21 per cent, suggesting FOCUS ON Maternal and child health services forthe urban poor A case study from Nairobi, Kenya 20 THE STATE OF THE WORLD’S CHILDREN 2012
Goals 1(eradicating extreme poverty and Figure 2.3.Stunting prevalence among children under 3 years old: Comparing the Nairobi slums with overall urban Kenya hunger),4(reducing child mortality)and 5(improving maternal health).In addition 的 to a strong focus on health and nutritional ◆-Nairobi slums interventions (e.g.,antenatal,maternal ◆-Urban Kenya and neonatal care,immunization, 60% appropriate feeding practices),the importance of reproductive health is being recognized in this context,as family planning can be a cost-effective 50% and high-yield approach to improving the health of mothers and children.The Urban Reproductive Health Initiative, 40% sponsored by the Bill Melinda Gates Foundation and currently implemented in selected urban areas of India,Kenya, Nigeria and Senegal,is an example. The programme seeks to significantly increase modern contraceptive preva- lence rates-especially among the urban and peri-urban poor-through integrating and improving the quality of family plan- ning services,particularly in high-volume settings;increasing provision,includ- ing through public-private partnerships; and dismantling demand-side barriers 0% to access. 1-33-56-8 9-1112-1415-1718-2021-2324-2930-35 Child age(months) by Jean Christophe Fotso Source:Urbanization,Poverty and Health Dynamics-Maternal and Child Health data (2006-2009): Head,Population Dynamics and Reproductive Health, African Population and Health Research Center;and Kenya DHS (2008-2009). African Population and Health Research Center, Nairobi,Kenya. The African Population and Health Research Center that children in urban poverty are nearly promotion;education about infant (APHRC)is an international non-profit organization whose mission is to promote the well-being of Africans 2.7 times as likely to be stunted. feeding practices(breastfeeding and through policy-relevant research on key population and complementary feeding);and school health issues.Originally established as a programme of the Population Council in 1995,APHRC has been Effective interventions to reduce child feeding programmes. autonomous since 2001 and now has offices in Kenya, undernutrition may include micronutrient Nigeria and Senegal.The Center focuses on research, strengthening research capacity and policy engagement supplementation (iodine,iron and vitamin If the needs of the urban poor are not in sub-Saharan Africa. A);food supplementation(for micronu- addressed,progress towards achiev- trient deficiencies);infection prevention ing the Millennium Development Goals and treatment growth monitoring and (MDGs)may be at stake,especially Children's rights in urban settings 立
that children in urban poverty are nearly 2.7 times as likely to be stunted. Effective interventions to reduce child undernutrition may include micronutrient supplementation (iodine, iron and vitamin A); food supplementation (for micronutrient deficiencies); infection prevention and treatment; growth monitoring and promotion; education about infant feeding practices (breastfeeding and complementary feeding); and school feeding programmes. If the needs of the urban poor are not addressed, progress towards achieving the Millennium Development Goals (MDGs) may be at stake, especially Goals 1 (eradicating extreme poverty and hunger), 4 (reducing child mortality) and 5 (improving maternal health). In addition to a strong focus on health and nutritional interventions (e.g., antenatal, maternal and neonatal care, immunization, appropriate feeding practices), the importance of reproductive health is being recognized in this context, as family planning can be a cost-effective and high-yield approach to improving the health of mothers and children. The Urban Reproductive Health Initiative, sponsored by the Bill & Melinda Gates Foundation and currently implemented in selected urban areas of India, Kenya, Nigeria and Senegal, is an example. The programme seeks to significantly increase modern contraceptive prevalence rates – especially among the urban and peri-urban poor – through integrating and improving the quality of family planning services, particularly in high-volume settings; increasing provision, including through public-private partnerships; and dismantling demand-side barriers to access. by Jean Christophe Fotso Head, Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya. The African Population and Health Research Center (APHRC) is an international non-profit organization whose mission is to promote the well-being of Africans through policy-relevant research on key population and health issues. Originally established as a programme of the Population Council in 1995, APHRC has been autonomous since 2001 and now has offices in Kenya, Nigeria and Senegal. The Center focuses on research, strengthening research capacity and policy engagement in sub-Saharan Africa. Children’s rights in urban settings 21 Figure 2.3. Stunting prevalence among children under 3 years old: Comparing the Nairobi slums with overall urban Kenya Source: Urbanization, Poverty and Health Dynamics – Maternal and Child Health data (2006–2009); African Population and Health Research Center; and Kenya DHS (2008–2009). Child age (months) 1–3 3–5 6–8 9–11 12–14 15–17 18–20 21–23 24–29 30–35 70% 60% 50% 40% 30% 20% 0% 10% Nairobi slums Urban Kenya