Child survival revolution gains speed. Better health care, changed attitudes save over 1 million children a year

The dominant image of third world children this year has been the face of a hungry African child. But now comes word of a different image: one of hope. Three years ago, the United Nations Children's Fund (UNICEF) began predicting that a ``child survival revolution'' was possible in the third world within 12 years if political leaders galvanized available resources and technologies.

Last year, UNICEF reported the first glimmerings that the revolution had begun.

Now, in its annual ``State of the World's Children 1986'' report for 1986, UNICEF asserts that the revolution is well under way -- and accelerating -- in more than 40 nations including the world's two most populous, China and India.

Officials see it as a third world safety net being spread under society's most vulnerable members: children under the age of five.

Economic recession, unemployment, drought, exploitation, neglect, and other obstacles still keep the safety net away from countless millions of children. Faster economic development is also needed to let children make the most of the lives the ``revolution'' is said to be saving.

But UNICEF Deputy Executive Director Richard Jolly, during an interview in London, insisted that he saw ``hard evidence'' of a ``near miracle'' in health care and in changing parental attitudes.

For years now, about 45,000 children under five -- 15 million a year -- have died daily from malnutrition and other ``easily preventable diseases,'' UN officials say.

Today, Dr. Jolly says, child mortality rates are beginning to fall -- dramatically -- in China, India, Pakistan, Bangladesh, Brazil, Nigeria, Indonesia, Colombia, El Salvador, Ecuador, Bolivia, and elsewhere.

The lives of ``well over 1 million children a year'' are being saved by two cheap, simple techniques alone, says UNICEF Executive Director James P. Grant -- immunization and tiny salt-and-sugar packets to fight the dehydration that afflicts millions of poor children. Despite the continuing African famine, he says, it is now conceivable that 7 million lives a year can be saved by 1990.

Among parents, Jolly believes, apathy is slowly retreating before greater awareness. Old ways are yielding to new.

The salt-and-sugar packets are so simple and cheap that parents can adminster them without professional help. Release of the latest UNICEF report coincided with a global conference on the salt-sugar packets (technically referred to as ``oral rehydration'') organized by the US Agency for International Development in Washington Dec. 10-13.

Attended by about 1,000 delegates, the conference was opened by AID administrator M. Peter McPherson, who described his agency's own ``Child Survival Action Program'' now operating in 50 countries.

The program is partly financed by a special Congressional allocation of $50 million for the year ending Sept. 30, 1986. Last year Congress allocated $85 million. AID also provides some funds for UNICEF programs.

Two other methods included in UNICEF's ``revolution'' are also straightforward -- breast-feeding of infants and regular weighing to check growth.

The fourth -- widespread immunization -- means parents must know when to bring children in. So a self-help, self-health revolution is emerging, officials say.

``The attitude that health care is someone else's responsibility is linked to the fact that, in the past, health professionals have taken away from the people their [health] decisionmaking power,'' according to a recent UN World Health Organization committee cited by UNICEF. ``Therefore an effort must now be made to give them back their confidence and to help them develop their skills in making the right choices.''

One question raised by the report: Won't sharply lower infant mortality rates push up already high rates of population growth in poorer countries?

No, Mr. Grant replies. Parents who are confident that their children will survive into adulthood tend to have fewer, not more, children.

UN population experts agree that this has been the pattern in China, Sri Lanka, South Korea, Costa Rica, Singapore, and the state of Kerala in India.

These experts also point out that more is needed than lower infant mortality. The status and literacy of women, for instance, must increase, along with their ability to find work outside the home.

UNICEF offers another argument: that the ``child survival revolution'' increases ``parents' sense of control over their lives.''

Anything that helps increase the ``confidence of parents that they can improve their lives by their own informed decisions and actions . . . [is] also likely to lower birthrates.''

The UNICEF report spotlights the importance of top political leaders supporting all aspects of the ``revolution.'' It cites:

Prime Minister Rajiv Gandhi of India this year launching an immunization plan to save the lives of more than 1 million children a year by 1990 as a ``living memorial'' to his assassinated mother, Indira Gandhi.

Chinese leaders adopting this year the World Health Organization goal of halving infant mortality rates by 1990.

Turkish Prime Minister Turgut Ozal launching an immunization campaign in all 67 of Turkey's provinces in September.

Leaders in Colombia, the Dominican Republic, Ecuador, Bolivia, Pakistan, El Salvador, and Brazil pushing their own health programs hard this year, partly in response to the World Health Organization goal of major progress by 1990.

The number of salt-and-sugar packets distributed rising from 100 million in 1984 to 200 million in 1985.

Jolly cites several reasons for the ``revolution'' apparently taking off this year.

Political leaders from left to right -- Prime Minister Gandhi, President Belisario Betancur of Colombia, Prime Minister Ozal in Turkey, President Thomas Sankara in Burkina Faso -- see political as well as humanitarian appeal in reaching out to more people.

Private organizations such as Oxfam, Save the Children, and Rotary International have pitched in. The news media have helped make people aware. The Band Aid/Live Aid organization started by singer Bob Geldof has contributed $3 million for immunizations in Ethiopia, Sudan, and the Sahel.

Western governments have given money and know-how: Italy, $100 million in 26 African countries; Canada, $25 million; plus US support for the salt-and-sugar packets.

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