Feb 2013. Lancet article.
Last week, the World Policy Analysis Centre released a new report, which for the first time systematically presented comparative data on laws and public policies in 191 countries covering areas essential to children’s healthy development. Changing Children’s Chances examines policy data and their impact in the areas of poverty, discrimination, education, health, child labour, child marriage, and parental care. The report provides a global picture of the policy tools governments can use to make a difference to children’s opportunities in life.
Overall, the report shows that governments have largely failed to keep their commitments to international agreements, and are not providing enabling environments for children to fulfil their potential. Whether it is poverty reduction, provision of child-friendly working policies, or freedom from discrimination, it is evident that the bar has not been set high enough for what is necessary, either for children to thrive or for them to achieve adequate health. However, across regions there are variations in the areas examined, and a few countries, unexpectedly, are ahead of the curve. For example, good progress has been made on universal primary education. 166 countries have free primary schools. But progress in secondary education has lagged behind. Whereas Latin America and large parts of Asia and the Pacific provide free secondary education, opportunities in sub-Saharan Africa without tuition fees are limited, and as a result exclude the poor. Given the transformative role that secondary education plays in health and development—as shown, for example, by the positive correlation between maternal education and reduced child mortality—more needs to be done to remove this financial barrier.
Similarly, for health, the report notes that poor availability and delivery of health care characterise countries where government investment in health is low. These countries could be doing much more to make services available to their populations. The report also reveals which policies can make a difference. For example, the impact of maternity leave on breastfeeding. The best available data show that an extra 10 weeks of paid maternity leave is associated with 10% lower infant mortality and 9% lower mortality in children younger than 5 years. Furthermore, 136 countries guarantee supportive labour policies that allow breastfeeding breaks at work.
According to the report, many governments fail girls, notably in protecting them from child marriage, a practice that is inextricably linked to gender inequity. As well as dropping out of school, early marriage results in early childbirth, which can have serious effects on mothers and children. Additionally, girls in these marriages are at increased risk of gender-based violence. Early marriage is sometimes thought to be a purely cultural or family decision, but the report shows that governments are also culpable. In several countries there is no minimum legal age of marriage, and in 54 countries girls are legally permitted to marry between 1 year and 3 years younger than boys. Similarly, the report shows that many countries do not have national laws and policies that comply with international agreements to protect children from labour. These children are more likely to be injured, tend to have poorer health outcomes, and are not in education. Yet, in several countries children may work full-time as young as 12—13 years of age.
The report represents an impressive body of work that has taken a decade to complete and begins to quantify what countries are actually doing to make a difference to children’s lives. It suggests that many inadequacies in national policies and laws are due to lack of political will, even though several policies are readily affordable, such as breastfeeding breaks in the workplace, making it illegal for children to do hazardous work, and enacting non-discrimination laws. Given that these data will be made publicly available, they should allow civil society to put pressure on countries and hold national policy makers to account, especially those governments lagging behind.
As discussions on the post-2015 development goals continue, the global community should use these findings to address gaps not only within the health sector, but also between sectors that crucially influence health and conditions for health. Commenting on the report, Michael Marmot, Director of University College London’s Institute of Health Equity, says: “What happens in a child’s early life—regardless of where they are in the world—very much determines their chances to lead healthy and productive lives in their adulthood.” Governments owe it to children—and to the sustainability of their national interests—to provide their youngest citizens with the best possible opportunity to ensure these chances are not missed.