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UNICEF Social Monitor 2003 Reveals Real Mortality Trends in the Caucasus and Central Asia According to the Social Monitor 2003, a publication of the United Nations Children’s Fund (UNICEF), infant mortality rates in eight countries of the Caucasus and Central Asia are much higher than official figures have long claimed. The real infant death rate in these countries is 5 times greater than in the rest of Central and Eastern Europe and the CIS and 12 times greater than in Western industrial countries. Most of the infant deaths are preventable. Many are caused by combinations of poverty, poor maternal health and nutrition, infection, and poor medical care. UNICEF’s new survey results show high infant mortality rates by global standards in the Caucasus and Central Asia, ranging from 36 per 1,000 live births in Armenia to 89 per 1,000 in Tajikistan. Large portions of the populations in the Caucasus and Central Asia are experiencing persistent poverty, which most directly manifests itself through inadequate nutrition among mothers and infants. The proportion of mothers with anemia, resulting from inadequate iron intake, rose during the 90s, resulting in complications during pregnancy and childbirth. Poor medical care is also an issue, especially given the low and declining levels of health expenditures in many countries in the region. Problems cited in the report include a lack of preventive health care and failure to carry out basic, nontechnological tests at birth, such as weighing in babies or assessing their activity, pulse, grimace, appearance, and respiration (the APGAR test). Additional factors become important among infants who survive the neonatal stage, including infants’ nutrition and hygiene and parents’ knowledge about these issues. The report calls for countries to undertake three measures: adopt and implement the World Health Organization (WHO) definition of live birth, improve the training of medical staff and the management of health care, and provide incentives for parents to promptly register the births of their children. Infant Deaths: The Official Version The report focuses on 10 countries: the 8 countries of the Caucasus and Central Asia, plus Romania and Ukraine. It compares the relatively rosy official infant mortality rate in these countries with household survey data where women were asked about their reproductive histories. In all eight countries of the Caucasus and Central Asia, the estimated infant mortality rate from the surveys is far higher than the official rate. In Azerbaijan, for example, the survey estimate is four times greater: 74 infant deaths for every 1,000 live births, compared with an official rate of 17 per 1,000. In most cases, the official estimates fall well below even the lower bound of the confidence interval of the survey estimates. In Romania and Ukraine, however, the difference between official rates and survey-based estimates is not significant. The table puts the survey-based infant mortality rates from the Caucasus and Central Asia in a global context. They are lower than in Sub-Saharan Africa and South Asia, but much higher than in countries of the Middle East and North Africa and Latin America. There have long been doubts about the veracity of the infant mortality rates and the completeness of vital statistics registration in the former Soviet Union and, to a lesser extent, in some of the countries of Eastern and Central Europe. The communist systems in the former Soviet Union and Eastern and Central European countries did a remarkable job of greatly reducing infant mortality. However, when the rates began to inch upward in the early 1970s, in many of these countries the official response was simply to cease publishing infant mortality rates and other critical demographic indicators. The publication of infant mortality rates resumed during the glasnost period of the late 1980s. More recently, the goals of reducing infant and child mortality embedded in the Millennium Development Goals have made proper measurement of levels and trends a critical issue. Explaining the Gap Examining the reasons for the gap between official rates and survey-based estimates, the Social Monitor 2003 highlights the following three problems: • Failing to use the WHO definition of live birth. A baby’s death may go unrecorded because the baby was never officially alive. The WHO definition says an infant is alive if it exhibits any signs of life. The Soviet era-definition—still dominant in several CIS countries-uses breathing as the sole indicator of life. Under the Soviet definition, moreover, infants who are born before 28 weeks of gestation, who weigh less than 1,000 grams, or who are less than 35 centimeters long are not considered live births unless they survive for seven days. • Under-reporting of infant deaths. Misreporting pushes the official figures down further. This is a legacy of the communist era, when hospitals and medical staff could be penalized for failures to reach infant mortality reduction targets. Because hospitals and medical staff faced penalties if they reported increases in infant deaths, they sometimes reported the deaths of babies in their care as miscarriages or stillbirths and thus many CIS countries have a much higher than expected ratio of stillborns to early neonatal deaths (those in the first week). With deteriorating conditions in health services and little focus on health care reform, this has proved a hard legacy to overcome and misreporting continues in some countries. • Barriers to birth registration. A recent UNICEF study estimated that the births of around 10 percent of babies born in the region each year are unregistered, most of them in the Caucasus and Central Asia. Likely causes are difficulty of travel to registration centers, bureaucratic red tape, and lack of incentives. If an infant’s birth is not registered, it is unlikely that its death will be registered either. Other Disheartening Trends The Social Monitor 2003 also examines other trends affecting children in the region. It finds economic growth alongside continuing poverty, with almost 11 million children in poverty in Russia alone. It highlights the high level of external debt in some CIS countries, with Georgia, the Kyrgyz Republic, Moldova, and Tajikistan devoting at least one-third of government expenditures to debt servicing. At the end of 2001, the region had 3 million refugees, asylum seekers, and displaced people, with the numbers falling in the countries of the former Yugoslavia, but rising in Russia and Uzbekistan. The report finds that at least 100,000 intercountry adoptions from the region have taken place since 1989, which accounts for one-third of the world total and for most of the increase in intercountry adoption in recent years. An examination of the latest HIV/AIDS trends reveals that only 1 in every 25 people registered as being HIV-positive in the region receives antiretroviral therapy. The report and other publications and the TransMONEE database can be ordered or downloaded from the Innocenti Research Center web site: http://www.unicef-icdc.org/. A more detailed Innocenti Working Paper on the issue of infant mortality in the region is forthcoming. For further information contact Tim Heleniak at theleniak@unicef.org or Gerry Redmond at gredmond@unicef.org Official and Survey-Based Estimates of Infant Mortality, Selected Countries and Regions
Source: Monitoring Social Conditions and Public Policy in Central and Eastern EuropeMONEE project database.
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