Child Rights and Child Poverty: Can the International Framework of Children’s Rights Be Used to Improve Child Survival Rates?
The Consequences of Child Poverty
It is estimated that over 10 million children in developing countries die each year, mainly from preventable causes. In approximately half of these deaths, malnutrition is a contributory cause.1, 2 However, the World Health Organization has argued that seven out of ten childhood deaths in such countries can be attributed to just five main causes, or their combination. In addition to malnutrition,3 these causes are pneumonia, diarrhoea, measles, and malaria. Around the world, three of every four children seen by health services are suffering from at least one of these conditions. Many of these deaths could be prevented using readily available medical technologies at comparatively little cost. In 1997, the United Nations Development Programme estimated that the cost of providing basic health and nutrition for every person on the planet was $13 billion per year for ten years.4 To place this sum in perspective, in 2002, the United States population spent $30 billion on pizza and Europeans spent $12 billion on dog and cat food. While medical interventions can, in principle, prevent most young children from dying early, they cannot remove the underlying causes of poor health, which are linked directly to the severely deprived or absolutely poor living conditions suffered by 30% of the world’s children.5, 6 For example, almost a third of the world’s children live in squalid housing conditions, with more than five people per room or with mud flooring. Over half a billion children (27%) have no toilet facilities whatsoever and over 400 million children (19%) are drinking from unsafe open water sources (e.g., rivers, lakes, ponds) or have to walk so far to fetch water that they cannot carry enough to meet minimum health requirements.6 The World Health Organization has argued that: “The world’s biggest killer and the greatest cause of ill health and suffering across the globe is listed almost at the end of the International Classification of Diseases. It is given code Z59.5—extreme poverty.”7 Eliminating extreme poverty is the key to improving global child survival rates, particularly over the long term.
Child Survival and Child Rights
In recent years, the importance of the link between child rights and child survival has been contested. In 2004, an editorial in The Lancet8 argued that UNICEF’s focus on child rights had been detrimental to international campaigns to improve child survival. In particular, the article claimed that the outgoing UNICEF Director (Carol Bellamy) had focused on “girl’s education, early childhood development, immunisation, HIV/AIDS, and protecting children from violence, abuse, exploitation, and discrimination,” and that in doing this she had “failed to address the essential health needs of children.” The current Director of UNICEF (Ann Veneman) has so far given much less prominence to child rights, making “child mortality public enemy number one for the agency.”9
We argue that a rights-based strategy will increase child survival, in part by reducing child poverty, but only if some rights are prioritised over others. UNICEF, under Bellamy, adopted a position in which all the rights in the UN Convention on the Rights of the Child (UNCRC) were regarded as of equal importance, and both developed and developing countries were urged to realise these rights progressively (i.e., one after the other).5, 10 This position has become hard to defend, since some rights are clearly more important than others and/or contingent on others. For example, whilst UNICEF recognises that children living in poverty are more likely to experience non-fulfilment of other rights,5 the right to vote is little use to a child who has died in infancy as a result of a lack of medical care due to poverty.
There is a clear need to prioritise the realisation of rights in policy so that action can be divided into successive stages according to degree of severity of transgression and available resources. Ensuring child survival provides a good basis for this prioritisation, but to be effective, actions need to tackle both the symptoms and the underlying causes. The UNCRC (see Box 12.1) established a strong ideological, moral, and political tool for challenging these structural causes and its utility should not be undervalued.
Article 24 (1) of the UNCRC states that:
States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.
Similarly, Article 24 (2) of the UNCRC continues:
States Parties shall pursue full implementation of this right and, in particular, shall take appropriate measures:
- To diminish infant and child mortality;
- To ensure the provision of necessary medical assistance and health care to all children with emphasis on the development of primary health care;
- To combat disease and malnutrition, including within the framework of primary health care, through, inter alia, the application of readily available technology and through the provision of adequate nutritious foods and clean drinking-water, taking into consideration the dangers and risks of environmental pollution;
- To ensure appropriate pre-natal and post-natal health care for mothers;
- To ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding, hygiene and environmental sanitation and the prevention of accidents;
- To develop preventive health care, guidance for parents and family planning education and services.
If these rights were to be fulfilled, child survival rates would rapidly improve.
Box 12.1 The Five Core Principles of the UN Convention on the Rights of the Child
- The right to life, survival, and development
- Non-discrimination
- Devotion to the best interests of the child
- Respect for the views of the child
- The right to an adequate standard of living and social security.
The Potential of a Human Rights Approach
A human rights approach offers the possibility for progressive interventions into child poverty and child survival in three ways. First, conventions like the UNCRC have been signed by most countries in the world and thus can be considered to embody universal values and aspirations. Second, human rights conventions place a legal obligation upon states, a view endorsed by Mary Robinson (former UN High Commissioner for Human Rights) in her speech to the 2002 World Summit on Sustainable Development in Johannesburg, South Africa: “… a human rights approach adds value because it provides a normative framework of obligations that has the legal power to render governments accountable.”11
Any comprehensive understanding of the root causes of poverty and the 10 million annual premature child deaths cannot ignore the legal and institutional structures that create and perpetuate income and wealth imbalances within society. Thus, human rights provide a challenge to these structures.12