UN Special Session on Children Ends In Acrimony

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Goals Set to Save the Lives of Youth, Mothers

May 14, 2002 - The UN Special Session on Children closed Friday amidst acrimonious debate and adoption of a far-reaching action plan to help improve the lives of children and save the lives of their mothers.

At the Special Session, nations from around the world gathered to chart a course for global efforts on behalf of children. Recognizing the inextricable links between the maternal and child health, the action plan calls for concerted efforts to improve women’s health, and lays out steps to reduce infant and child mortality, improve nutrition, ensure universal basic education and protect the rights of children.

Key debates at the Special Session centered on whether to reference the Convention on the Rights of the Child – ratified by all nations except the United States and Somalia – as the international standard for child rights; how to address the needs and rights of adolescents for sexuality and reproductive health information, education and services; and the definition of reproductive health services.

The United States, standing virtually alone, blocked consensus on including in the document language that reaffirmed the near-universal recognition of the Convention on the Rights of the Child as the standard reference for children’s rights – including those to health and education. Despite numerous references in the agreement establishing the rights, roles and responsibilities of parents, some American conservatives have chosen to interpret the treaty as an infringement on the rights of parents, and have balked at the idea of enshrining children’s rights. The US has signed the agreement, but due to conservative opposition, the Senate has not ratified it. Non-American participants at the Special Session were outraged at the exclusion of language underscoring an agreement ratified by 190 nations, and not ratified by only two nations.

Similarly, many delegates were displeased by US efforts to block consensus on text aimed at ensuring that adolescents – of which there are 2 billion in the world – have access to sexuality and reproductive health information, education and services. The US delegation argued for an “abstinence only” approach, aligned with the Holy See and a handful of Muslim countries including Syria and Iran. Most other delegations, including the European Union, Latin American, African and other nations argued for an “abstinence and” approach that recognizes the importance of encouraging abstinence, but also the reality that many adolescents are married, HIV/AIDS is particularly threatening to young people and that hundreds of millions of adolescents are sexually active and therefore should be educated about reproductive health and have access to services need for protection and care. In this instance, the United States did not prevail.

Finally, the delegates debated how to define reproductive health services. Again, the United States resisted, along with a handful of nations, against previously agreed language that stipulates that wherever abortion is legal, it should be safe, and that treatment for the consequences of unsafe abortion should be provided everywhere. The United States repeatedly stated that in no cases should reproductive health services refer to abortion-related activities – even though abortion is legal in certain circumstances in more than 100 countries. The final language referenced the need for reproductive health as well as the prior agreements on what constitutes reproductive health care.

Beyond the debates, the final agreement, titled “A World Fit for Children,” set far-reaching goals, including:

·Reduction in infant and under-five mortality by 2/3s by 2015;

·Reduction in maternal mortality by 3/4s by 2015;

·Improvement in child nutrition and rate of low birth weight babies by 1/3;

·Universal access to reproductive health for all individuals by 2015;

·Eradication of polio by 2005;

·Major reductions in the incidence of measles, tetanus, tuberulosis, malaria and other child killers;

·Universal primary education by 2015 and elimination of the gender gap in primary education by 2005;

·Reduction in proportion of HIV infected infants by 50% by 2010.

Progress Made Toward Meeting Summit Goals

Progress in achieving specific objectives has been mixed – with some remarkable achievements related to children’s health and nutrition, as well as in water/sanitation and school enrolment; less promising has been progress in addressing women/maternal health, human rights and certain other objectives.

Children’s Health

Children’s health efforts have received high-priority in the development strategies used by recipient and donor nations alike. On the most far-reaching Summit goal – reduction of under-5 mortality by one-third – there has been important but insufficient progress. Globally, infant and child mortality has been reduced by 11 percent (impressive given population growth) and more than 60 countries have met the Summit goal of a one-third reduction. However, 14 countries have seen increases in under-5 mortality (most in sub-Saharan Africa), and 11 countries have had no change.

On key priorities set at the 1990 Summit, polio has been virtually eliminated and is now endemic in less than a dozen countries; routine immunization is being achieved for 75 percent of the world’s children; the incidence of measles has declined by 40 percent; 104 countries have achieved the goal of eliminating neonatal tetanus, resulting in a 50 percent drop in the incidence of deaths associated with the illness; and deaths due to diarrhea have been reduced by 50 percent.

Still, approximately 11 million children die each year before their 5th birthday. About 600 million children, or 40 percent of all children in developing countries, are living in abject poverty (less than $1 per day). Although higher, immunization coverage has not reached the goal of 90 percent. 30 million children are not routinely vaccinated, resulting in millions of deaths from preventable killers like diphtheria, TB, measles and tetanus.

Key challenges in the future include expanding immunization coverage, developing effective public health systems capable of delivering immunization and other basic health needs; families and communities need to be better educated about basic health.

Nutrition

Reinforcing children’s health is the need for good nutrition. Consequently, the Summit set as a goal a 50% reduction in child malnutrition by 2000. Initiatives to achieve these goals have included encouraging breastfeeding and promoting supplements of key micronutrients – specifically vitamin A, iodine and iron.

During the past decade, under-five malnourishment was reduced from 177 million kids to about 150 million (again, impressive given population growth). Overall, malnutrition was reduced to 28 percent of all kids in developing countries, from 32 percent. One hundred developing countries are meeting the Summit goal of less than 10% low-birth weight levels. Almost 75% of LDC households are using iodized salt and gains have been achieved in breastfeeding.

Still, malnutrition has not been reduced by the 50% goal set at the Summit. Two-thirds of all malnourished children are in Asia, while in sub-Saharan Africa the number of malnourished children increased during the decade.

Women’s Health

The Children’s Summit recognized the close relationship between the health of mothers and the health of children and set an ambitious agenda for maternal health, calling for a 50% reduction over the decade.

Unfortunately, women’s health has not improved significantly since the 1990 Summit. There has not been measurable progress in reducing maternal mortality (more than 500,000 women die each year as a result of pregnancy and childbirth).

Globally, 4 women in 1000 will die from pregnancy related causes and only 50 percent of all births in developing countries are attended by a midwife, doctor or trained assistant. There has been little progress in reducing anemia among pregnant women (which contributes to low-birth weight babies).

Given the paltry gains of the past decade, the unfinished agenda for women’s health is quite large, and includes: expanding access to skilled birth attendants, expanding reproductive health care and contraceptive prevalence; addressing the needs of adolescents; giving pregnant women iron supplements during pregnancy.

In addition, important new challenges have emerged, including growing recognition of the need to address obstetric fistulas – a complication associated with childbirth that leaves women with physical and emotional scars.

The UN Population Fund and a coalition of organizations have recently formed the Working Group on Fistulas to begin an international campaign to help prevent obstetric fistulas and encourage treatment for mothers suffering from the condition.

Water and Sanitation

Much of the children’s health and nutrition challenge can be traced to inadequate sanitation and unsafe drinking water.

During the 1990s, access to improved water supplies increased from 77% to 82% of the global population. Access to sanitation increased by 10 % from 51% in 1990 to 61% in 2000. Led by President Carter, significant progress was made toward elimination of guinea worm.

Despite progress, the absolute numbers of people without improved water and sanitation is staggering – more than 1 billion without safe water and twice as many without sanitation.

Basic Education

The Children’s Summit also wisely recognized the relationship between education and health and called for universal access to basic education. During the past decade, net primary school enrolment has reached 82 percent and the international community reaffirmed at the World Education Forum the global strategy known as “Education For All”. Increased emphasis has been placed on early childhood development, which is increasingly recognized as important for future success. Globally, adult illiteracy has been reduced to 20% from 25% a decade ago. Still, global education efforts do not warrant a passing grade. More than 120 million children are not in school, with up to 60 percent of them girls. The gender gap in education has not been reduced significantly. Almost 1 billion of the world’s people are illiterate. Even though enrolment is up, the quality of education for many of the world’s children remains poor. The World Bank estimates that global expenditures on education are about $82 billion, and that universal education could be achieved with a 10% ($7-8 billion) increase. Less than 2% of international aid goes to basic education and most educational assistance goes to university-level programs.

Children’s Rights

The Summit recognized some of the key social and situational challenges facing children – from those in refugee camps to those that are exploited in the workplace, in trafficking and in prostitution.

During the 1990s, a number of so-called “optional protocols” to the Convention on the Rights of the Child were adopted to address key challenges facing children. These include the protocols on children in conflict situations; and one to help reduce child trafficking.

Much remains to be done. 40 million children under 15 are subjected to abuse or serious neglect each year. 50 million births each year are unreported/unregistered, making it difficult to protect children’s rights in the future. Female Genital Mutilation puts 2 million girls at risk each year. 190 million children are working each year, most without access to educational opportunities. 300,000 children are actively involved in conflict, according to estimates. And there are 7 million refugee children around the world.

Lessons Learned and Key Special Session Issues

To fulfill the promise of the original 990 Children’s Summit, the international community must heed some of the key lessons learned in the last decade:

1.Recognizing children’s rights in the overall context of human rights -- Establishing internationally recognized agreements that define basic rights for children – related to service in conflict, trafficking, labor, etc. – can play an important role in ensuring that children’s needs are met.

2.Adolescents – Much of the focus of the 1990 Summit was on infants and children under 5; it is now recognized how important a focus on adolescents is. There are more than one billion children between the ages of 10-18. The Children’s Summit defined children as anyone under 18. Adolescence is increasingly seen as a critical period in shaping a child’s future, with important implications not only for their own health and development, but also for the children they will have later in life.

3.Resources – Successful development efforts on behalf of children depend on resources, which have not changed appreciably in the past decade and in some cases have declined. Host countries are investing about 12-14 percent of national budgets, and donors are allocating about 11 percent for basic social services. During the decade, the UN attempted to mobilize support for the 20-20 Initiative, through which recipient and donor nations would agree to invest 20 percent of resources in basic social services.

4.Continue with specific goals – the clear, measurable goals established at the 1990 Summit have proven valuable, if not altogether successful. Success can best be seen in imitation, as other global conferences in the 1990s adopted the practice of setting clear goals.

5.Vertical approaches to health challenges have been successful – targeted, single-focused campaigns (polio, guinea worm, etc.) have been successful in achieving gains on key challenges. However, in the 1990s, the international health community urged attention to broader-based strategies aimed at strengthening the public health infrastructure more broadly.

6.The HIV/AIDS crisis has emerged as an important new challenge on the international children’s agenda – including such issues as children getting infected, children being orphaned and children being affected by the broad social consequences of the pandemic. Adolescents are among the most vulnerable to the growing pandemic.

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