Air Date: December 17, 1996 Program 9651

UNICEF AT FIFTY

Guests:
Faye Chung, Chief, Education Section, UNICEF
Suomi Sakai, Senior Health Advisor, for Immunizations, UNICEF
Tessa Wardlow, Epidemiologist, UNICEF

(This text has been professionally transcribed. However, for timely
distribution, it has not been edited or proofread against the tape.)

MARY GRAY DAVIDSON, producer: This is Common Ground.

BOUTROS BOUTROS-GHALI, former Secretary-General to the United Nations: The progress achieved so far is a victory for children and all of humanity, because healthy and educated children are the key to future prosperity of all nations.

DAVIDSON: Fifty years ago, in December of 1946, the United Nations created the UN Emergency Children's Fund to rescue the children of war-ravaged Europe. During this next half hour of Common Ground we celebrate some of UNICEF's recent victories without forgetting that war is still a plague and for an unprecedented number of children.

CHILD SOLDIER 1: I'm fighting to save my people and my life and my country, defend my country.

CHILD SOLDIER 2: [They] killed my family. That's why I've joined the soldiers to fight for my people.

DAVIDSON: Common Ground is a program on world affairs and the people who shape events. It's produced by the Stanley Foundation. I'm Mary Gray Davidson.

If you've ever wondered whether that loose change you turn over to trick or treaters at Halloween or those cards you buy at holiday time do any good, consider this: eight cents will buy one packet of oral rehydration salts to protect against diarrheal dehydration, a leading child killer in developing countries. Or think about this one astonishing achievement of UNICEF, in just twenty years the United Nations Children's Fund has managed to vaccinate 80% of the world's children against six of the most common early childhood diseases. Two decades ago, only 5% of the children in the world were immunized against diphtheria, measles, pertussis, polio, tuberculosis and tetanus. Suomi Sakai is Senior Health Advisor for Immunizations at UNICEF. She says initially there was a lot of skeptism about immunizing most of the world's children, but once they convinced the politicians and public health officials it could be done they had to figure out how to actually get the vaccines to the children.

SUOMI SAKAI, Senior Health Advisor for Immunizations, UNICEF: And all of these vaccines we're talking about have to be kept within a certain temperature range and so...

DAVIDSON: Possibly refrigerated or...?

SAKAI: Meaning refrigerated, some of them frozen, but for transport at least refrigerated. And that means you have to set up what we call a cold chain. Cold chain is essentially a chain of cold storage, and it has to be unbroken.

DAVIDSON: You mean from the point of where it's created?

SAKAI: From the point of where it's created to the point of the child. One of the metaphors that we have used is making an ice cream in, say, New York and taking it to the remotest village in very hot places like somewhere in Sahel or in Africa.

DAVIDSON: Where you can't always count on electricity.

SAKAI: Yes, and keep that ice cream not melted and deliver it to the child to eat, not melted. That's the kind of metaphor we're using, and that's not easy. And so to create that infrastructure requires a lot of initial funds which many donor countries have been providing to buy the refrigeration capacity, both electric and kerosene and gas and all sorts, solar nowadays. So that's one part of it. The health workers at different levels in all countries had to be trained. So there's that training cost and the personnel cost, all of the personnel costs is covered by the government of the countries themselves. And then getting a reliable procurement system for vaccine. I think the UNICEF procurement system has developed over years considered for these essentials vaccines to be the best procurement system to deliver the vaccine at a very affordable price.

DAVIDSON: What are some of the other obstacles once you've overcome the cold chain and are able to get the vaccines to where they're needed and you've trained personnel, then do you have difficulties perhaps in convincing people of the necessity of these vaccines?

SAKAI: I think especially initially, it was difficult. But as you can see from the results going above 80%, people must have been convinced, they have been convinced. And that required another aspect of the whole effort which we call social mobilization as well as health education and that has gone on at different levels, at political levels and community leadership level and then family level. So you have to convince everybody. But one of the things going around as I have done in several countries is interview mothers or families. It is amazing how convinced they are and they do believe that it's good for the children.

DAVIDSON: That's an amazing education campaign.

SAKAI: It is and one of the things I think is that these vaccines against childhood diseases that they have seen around them and since these childhood diseases tend to happen during the first several years of life, they do see the immediate effects. They see that the measles is not a big problem anymore, because measles is known to be a big problem in many countries. They know it's a killer disease because once they get it—measles kills immediately but also it kills within a few months' period because after you get measles your immunity goes down for several months and so the children become susceptible to other diseases—diarrhea, pneumonia—and so they die. And I was surprised, and this is aside, but in Japan where I come from, how my mother told that when she was young, she was child, she was young, measles was considered a killer disease in Japan.

DAVIDSON: Has UNICEF been able to quantify how many children have been saved by this effort?

SAKAI: Yes, within two decades through immunizations, the deaths of three million children a year, at least, have been prevented. And they estimate that about 750,000 fewer children were blinded, crippled or mentally retarded because diseases such as polio don't necessarily kill, but they do paralyze. So you have disabilities. Also, measles causes Vitamin A deficiency to set in severe cases, and that could cause blindness. So there are other issues than death also involved that can be prevented not because of that disease particularly, but because of the effects, say, of measles.

DAVIDSON: Is it going to be possible to reach that last 20% of the children who have not yet been reached? Is that going to be the most difficult hurdle even?

SAKAI: I think it is a difficult hurdle and I think that's where a lot of the attention will be moving. There are several areas where new attention is moving but reaching the last 20%, 10%, is going to be a challenge and it requires additional funding, it requires more social mobilization and vigilance.

DAVIDSON: What kind of situations are those children in that so far has prevented you from getting to them? I know sometimes, say when there's a war, it's very difficult to carry out public health programs. Is that one of the situations included in that 20%?

SAKAI: Conflict situations are always difficult, like in Rwanda, when you have a conflict situation, then it actually disrupts and lowers your... even if you had achieved something, it lowers it. So naturally the conflict situations are a part of the 20%. The other part are very, very remote areas where it is very difficult for the health system to reach. I think those two are the main populations.

DAVIDSON: The cry of the healthy baby is what we all anticipate when awaiting the birth of a child and UNICEF has long recognized that healthy, well-nourished women are the key to healthy children. But even a healthy woman may not survive childbirth if she has a last minute emergency. One of UNICEF's newest campaigns is to decrease the maternal mortality rate and make sure that women are around to raise their children. Tessa Wardlow is an epidemiologist for UNICEF who has been working first to assess the scope of maternal deaths in the world.

TESSA WARDLOW, Epidemiologist, UNICEF: We had previously underestimated maternal mortality by about 20%. Previous estimates of the global number of maternal deaths were around 500,000 and the new study puts it closer to 600,000, more precisely 585,000 deaths in the world.

DAVIDSON: When we're talking about maternal mortality, we're talking about women who die in childbirth or during pregnancy?

WARDLOW: During pregnancy or childbirth. Basically within 42 days of the termination of pregnancy.

DAVIDSON: Are these basically healthy young women who at the last minute have an emergency that leads to their death?

WARDLOW: Yes.

DAVIDSON: Were you surprised at this increase?

WARDLOW: I really wasn't. For years we've been publishing figures which we knew were not very good. Maternal mortality is very difficult to measure. It's a very complex thing to measure. Industrialized countries even have problems even though they have complete vital registration systems because a lot of maternal deaths are misclassified. Let's say a woman develops eclampsia, hypertension during childbirth and this results in renal failure, then she's often moved to the medical ward to be treated for that. And then if she dies, her death is classified as renal failure rather than eclampsia which was the precipitating event to her final death which was linked to her childbirth. So a lot of deaths are misclassified. In addition to that, a lot of deaths are underreported, for example abortion related deaths. The family doesn't want it to be known that the woman had an abortion. Or simply didn't know that she was pregnant at the time that she died.

DAVIDSON: Are the deaths of pregnant women confined to specific areas of the world according to your study?

WARDLOW: Maternal mortality rates are found in sub-Saharan and Africa and South Asia. But actually we found that a quarter of all maternal deaths occur in India alone. Fifty percent occur in five countries. Those countries are India, Nigeria, Bangladesh, Ethiopia and Indonesia.

DAVIDSON: Is the problem mostly related to poverty?

WARDLOW: Maternal mortality functions very differently from let's say child mortality, and I think the historical record supports that. For example, if we look at the United States or the United Kingdom or France, economic development took place in the late 19th century, early 20th century and during that period we saw a very dramatic decline in mortality due to many causes, including infant mortality, but maternal mortality stayed the same. And we didn't see a decline in maternal mortality until the 1930s when access to obstetric care became more widely available, particularly the use of antibiotics, safe blood transfusions and the capacity to do C-sections to deal with obstructed labor.

DAVIDSON: It would appear that the main problem then is no access to obstetric care or to a hospital or a clinic where a last minute emergency could be taken care of.

WARDLOW: Exactly, right. And this is particularly the case because most obstetric complications cannot be prevented or predicted in advance.

DAVIDSON: So is obstetric care just too expensive for most countries?

WARDLOW: It doesn't necessarily have to be. I don't think we're starting from scratch. Most countries do have district health hospitals. Many of them need upgrading and this can involve training nurses, midwives and doctors in life saving skills or in repairing equipment or upgrading equipment or purchasing drugs. So, it doesn't necessarily mean that we have to begin by building facilities or large capital intensive infrastructure investments.

DAVIDSON: Are there cultural factors that lead to this kind of emergency situation? You said there are women who don't seek out these centers and the hospitals?

WARDLOW: There can be. I should emphasize that UNICEF is not implying that all births should take place in hospitals. This is not the message. However, we do believe that there should be a backup system available should a woman develop life-threatening obstetric complications. In other words, she may be giving birth with the assistance of a midwife, but should she need a blood transfusion she should be able to have easy access to that. Now this may involve arranging for transportation to that facility in advance. This has been shown to be a big barrier in a lot of places. She may have to cross mountains in order to get to the nearest district hospitals.

DAVIDSON: It's probably obvious to many listeners, but let's talk about why UNICEF, the United Nations Children's Fund, is putting so much emphasis on mothers.

WARDLOW: Well we feel that once a woman becomes pregnant she should have the right to deliver that infant, that child, in a safe way without dying. But secondly, for every woman who dies she leaves children as orphans and this is of very serious concern to UNICEF.

DAVIDSON: UNICEF has long seen education as the key to progress for individuals, communities and countries. More recently UNICEF has been emphasizing education for girls, since nearly two-thirds of the world's 900,000 illiterate adults are women. And educated women are more likely to have the knowledge and wherewithal to raise healthy, educated children. UNICEF has pledged to double funding for basic education and pays special attention to girls' education. Faye Chung is Chief of UNICEF's Education Section.

FAYE CHUNG, Chief, Education Section, UNICEF: As you probably know we have more than 100,000,000 six to eleven year olds worldwide who are not at school. For example in Africa we have 40,000,000 six to eleven year olds not in school. About two-thirds of the children who are not in school are girls, so this is the issue that UNICEF is concerned about. In addition we look at early childhood and the education of women, particularly of the mothers.

DAVIDSON: What is the principal reason that these children aren't in school? Is there a lack of schools or are there other factors?

CHUNG: I think the principal reason is poverty. When you have a family which earns say $100 a year or $200 a year and then they have to pay say $50 a year for the education of a child, they find they can't afford it. So I think the main reason is poverty rather than cultural factors. I think cultural factors are there when the parents are not consulted about the education of their children. I think when you speak to the parents and ask them what kind of education they want, you find that most parents want their children to do better and want some form of education for their children.

DAVIDSON: Why is it that more girls are not in school than boys?

CHUNG: I think what happens is when they have to pay, and in the third world very often they have to pay in some way either in terms of actual school fees or they have to... they're not allowed into school without books so they have to spend, in Guinea for example, you may be spending fifteen or thirty US dollars a year on textbooks when your income is maybe $200 or $300. So it's a lot of money. I think also in opportunity costs because these children are working so parents have to decide well if my child works either in a factory or in the field would I gain more money from the child working or from the child going to school. So I think that problem is very severe, children working.

DAVIDSON: And it's probably very difficult to convince a family in dire economic circumstances that in the long run their child is going to be better off educated than working right now.

CHUNG: Well I think we have to try and make primary education at least free. I think as soon as primary education becomes free you find that a lot of parents will see the sense of sending their kids to school. For example, it just happened in Malawi. With the change of government a year and a half ago, the new government said that education was free and that they didn't have to buy uniforms because uniforms are a very expensive item for many parents. Immediately the number of children who presented themselves in schools doubled. You know, they had a million kids extra in school overnight.

DAVIDSON: So are you focusing a lot of your attention on governments to provide free education?

CHUNG: Well obviously this is what we want, we want free education but some governments are too poor to do this. You take an example, say Mozambique, where teachers are only paid $20 a month. Nevertheless the government cannot afford even that $20 a month to provide education for everybody. But of course governments are partners that we try to work with first because obviously governments have a critical role in insuring that all these young children are in school.

DAVIDSON: I think it's rather obvious, but for the sake of explanation, why is education such a focus of UNICEF? What does that do for child survival and the survival of the country.

CHUNG: I would say education is something which enables other things to happen. You know you cannot talk about democracy, you cannot talk about the empowerment of women, you cannot talk about economic growth, you cannot even talk about achievements in health like nutrition and vaccination without education. Also of course, in terms of development in health, in family planning, the girl is critical and in Africa in the economic field it is the mothers who feed the family so they have a big role in agriculture so improvement of agriculture will depend on the women in Africa. And we know very well that education is absolutely essential before we have all these types of achievement. So we can say it's an enabling right. I mean it's a basic human right. Children and adults, for that matter, have a right to develop their intellectual as well as their values—their intellectual skills and their values—through education.

DAVIDSON: In some ways, UNICEF has come full circle in its mission. Fifty years ago it came into being to help the suffering children at the end of World War II. Unfortunately, today not only are children the so-called collateral damage in war or caught in the crossfire, they are the targets of the war-makers. Two million children were killed in wars this past decade. Even more are maimed, left orphaned or traumatized for life. Children are routinely recruited as soldiers. Sometimes they're kidnapped and forced into armies, sometimes it's their only source of food and shelter. In 1988 alone, 200,000 children were fighting in wars throughout the world. UNICEF interviewed a few of them.

CHILD SOLDIER 1: [They] killed my family. That's why I joined the soldiers, to fight for my people.

INTERVIEWER: Have you had to shoot many people?

CHILD SOLDIER 1: Five people.

INTERVIEWER: You've killed five people? How do you feel about that?

CHILD SOLDIER 1: Feel free.

INTERVIEWER: You think that's okay?

CHILD SOLDIER 1: Yes, sir.

CHILD SOLDIER 2: I have to fight, because there are so few of us compared to them.

CHILD SOLDIER 3: I'm fighting to save my people and my life and my country, defend my country.

DAVIDSON: As part of an anti-war campaign this fall, UNICEF released the results of a major world-wide study detailing the impact of war on children. Graça Machel, the former Minister of Education and First Lady of Mozambique, headed the group of eminent persons who conducted the study for UNICEF.

GRAÇA MACHEL, former Minister of Education and First Lady, Mozambique: It is really a tragic irony that at the time the international community is celebrating 50 years of UNICEF. I would even say more. The United Nations itself, it was created as our common house through which we build peace and we would prevent the horrors of the second World War to happen again. UNICEF was just one instrument to heal the wounds and of course to deal specifically with children. But the whole of UN, that's the major reason of the mission of the UN is peace building and preventing conflict ever happening. And you know here we are 50 years later, and we have much more conflict than at that time. We have even proven unable to embrace, I mean the magnitude and the dimension of the problem we have to deal with. It's just the right time to reflect, what has gone wrong? What's happening here? And maybe more than UNICEF's mission to be readdressed is the whole mission of UN to concentrate on what is the essential way in which really we can readdress the causes of conflict. And to embark in a process of peace building in which children are not going to be victimized as they are.

DAVIDSON: UNICEF has committed itself to exposing and ending the process of making children the targets in war just as it has committed itself to reducing the worse effects of poverty on children. Through its pragmatic cost-effective approach, UNICEF has made great strides in immunizing the world's children, providing safe drinking water, giving oral rehydration therapy to prevent death from diarrhea and iodizing salt to prevent mental retardation to name just a few of UNICEF's programs. Perhaps a key indicator of UNICEF's success is that the deaths of children under age five have been cut in half since 1946. The work isn't finished, however. UNICEF Executive Director Carol Bellamy is developing new goals that will take the United Nations Children's Fund into the next century. These goals are guided by the Convention on the Rights of the Child, which has now been signed by nearly every nation.

CAROL BELLAMY, Executive Director of UNICEF: So UNICEF sees much of the work that it will be involved in as it heads into the 21st century within the framework on the Convention on the Rights of the Child. The issues of children's rights, whether it is avoiding exploitation based on labor or exploitation sexually, protecting children against violence, whether it's violence in the home or armed conflict.

DAVIDSON: Carol Bellamy is Executive Director of the United Nations Children's Fund, celebrating its 50th anniversary this month. For Common Ground I'm Mary Gray Davidson.

Our thanks to UNICEF for audio material from the battleground and from the UN General Assembly. Cassettes and transcripts of this program are available, the transcripts are free and the cassettes cost $5.00. To order a tape or transcript or if you'd like to share your thoughts about the program, write to us at the Stanley Foundation, 216 Sycamore Street, Suite 500, Muscatine, Iowa 52761. Our e-mail address is commonground@stanleyfdn.org. To order by credit card you can call us at 319-264-1500. Be sure to refer to Program No. 9651. And you can hear the entire interview with Graça Machel about UNICEF's war study by ordering Program No. 9647.

Our theme music was created by B.J. Liederman. Common Ground was produced and funded by the Stanley Foundation.


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