We live in exciting times. I am not talking about the advances of medicine, science and engineering. Nor the growth of the internet, the mobile phone or the fact that Africa is the world’s fastest growing market for the latter… I could go on.
I’m talking about the dramatic drops in child mortality, birth rates and death rates in the poorest countries. It’s a trend that appears to be accelerating, and it is expected that figures to be published in a few years will show an even more dramatic fall. Give thanks for all the energy and sweat that has been poured into the problem by local governments, by the Bush administration’s programme to fight AIDS and malaria, organisations such as the Bill and Melinda Gates foundation, the global fund for AIDS, tuberculosis and malaria, and countless small NGOs.
Today we have a preview of their success. This week the Indian census office published its latest results on these indicators. Based on an India-wide sample of 7 million, there has been a 14 per cent decline in the annual birth rate. In eight major states it was much more. In the breadbasket of Punjab it was almost a quarter. In West Bengal and Kerala, where communist governments have been in office for decades, it was nearly 20 per cent. And the drop in death rates was also astonishing—in the desert state of Rajasthan it was almost a quarter. And Bihar, the poorest of the large states, experienced a drop of 22 per cent.
Contraception is one explanation. So is better sanitation, life-saving drugs and, in West Bengal, an increase in income. There, rural incomes are now high enough to cut down migration into Kolkata. In Kerala high education levels, especially of young girls, are another factor of success—a policy that produces dramatic results wherever it is tried. Kerala now has the best infant mortality rate in India. The southern state of Tamil Nadu has slashed its infant mortality by an incredible 42 per cent; West Bengal by 34 per cent and Maharashtra (in which the city of Mumbai dwarfs everything else in the state) by 33 per cent.
In a recent report Unicef noted that its millennium goals, which most countries have signed up to, commits the UN membership to cut the rate of infant mortality in third world countries by two thirds by 2015. The progress over the last decade suggests this is an achievable target, except in sub-Saharan Africa where progress is slow. Even there, though, it is accelerating, as many economies are achieving GNP growth rates of 7 per cent or more—and would have done even better it hadn’t been for the Great Recession.
Measles infections falling by 60 per cent has been one of the third world’s successes. So has the effort to resist the advertising and clever marketing of companies like Nestlé to get mothers to use “sophisticated” bottle feeding instead of breastfeeding.
The Dominican Republic, Vietnam and Morocco are setting the world pace and have cut infant mortality rates by one third. This beats the Indian average, but is on a par with the leading Indian states. Madagascar shows what can be done with a bit of extra effort—it has cut its rate of infant mortality by 41 per cent. India with much more knowhow and medical infrastructure at hand, should seek to emulate this.
To keep up the pace, all countries need more mosquito nets, more Vitamin A drops, more breastfeeding, more inoculations, more testing for malaria and an increased use of vaccines. When the last citizens of Nigeria were vaccinated against polio two years ago, the World Health Organisation announced that the world was polio-free, just as with an earlier campaign against smallpox.
The recession hasn’t done as much damage to third world countries as had been feared. This is because most of its banks hadn’t overextended themselves as western banks did. So in principle all these countries and regions could do much better if priorities were re-ordered. For example, smaller defence budgets, and more rural and poor urban area health clinics than large city hospitals.
Come to West Bengal, on average the best all-round Indian performer, where I am at the moment. If all the words spouted by politicians in their petty arguments every day were channelled into the energy needed to enhance children’s programmes, the state would soon have the best infant mortality rate in the third world. That would make a truly exciting result.