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Central Asia/Caucasus: UNICEF Report Notes Child Survival 'Crisis'

UNICEF today issued a report calling attention to the plight of children in Central Asia and the Caucasus. The report says infant mortality rates in the region are far higher than official figures indicate -- and more than five times greater than in the rest of the postcommunist bloc.

Prague, 22 July 2003 (RFE/RL) -- The United Nations Children's Fund (UNICEF) today issued its annual Social Monitor report. This year's report paints a disturbing picture of the plight of children in the transition countries of Central and Eastern Europe and the Commonwealth of Independent States (CIS).

The report is based in part on face-to-face interviews conducted with women in many countries of the region -- including the five Central Asian states and the three Caucasus republics.

Elena Nikleva of RFE/RL's Bulgarian Service spoke to Carol Bellamy, UNICEF's executive director. Bellamy said the 2003 report highlights a growing divide between real-life testimonials and the official statistics on infant mortality and other child-care issues. "The figures indicate that infant mortality rates are much higher than anyone would probably think, and certainly much higher than official figures have long claimed," Bellamy said.

In Azerbaijan, for instance, the survey estimates that out of 1,000 live births, some 74 infants died within their first year. Official data puts that number at just 17.

Gerry Redmond, who worked on the UNICEF report, offers several explanations for the discrepancy. One is the failure to meet international definitions of "live births."

The World Health Organization classifies a birth as "live" if the baby shows any sign of life. But Soviet-era standards -- still in use in Azerbaijan and the five Central Asian republics -- use breathing as the sole criterion. They also preclude the classification of many premature and underweight babies as live births unless they survive seven days.

Redmond said: "This means that some babies' deaths may go officially unrecorded simply because they were never officially alive. And in particular, very premature infants, whether born alive or not, are routinely classified as stillbirths, or dead on arrival, if you like."

Moreover, Redmond added, many doctors and hospital staff prematurely classify infants as stillborn in order to reduce the number of infants who are recorded as dying in their care. This is another legacy of the Soviet era, when hospitals and medical workers could be penalized for failure to reach infant-mortality reduction targets.

Lastly, many births are simply not registered at all. Redmond said the difficulty of travel to registration centers, bureaucratic red tape, and lack of incentive all contribute to this trend. "In the Caucasus and Central Asia, the level of nonregistration of infant birth is quite high. In Tajikistan, a UNICEF survey showed that the birth of 40 percent of infants between the age of six and 11 months was not registered [in the late 1990s]. If such a high percentage of infant births are not registered, there must be a lot of deaths that are also not registered," Redmond said.

The UNICEF report indicates that infant mortality rates in Tajikistan, Kyrgyzstan, Kazakhstan, Turkmenistan, Uzbekistan, Georgia, Armenia, and Azerbaijan are some five times greater than in Central and Eastern Europe and the rest of the CIS. They are up to 12 times higher than in most Western industrialized nations.

The report estimates mortality rates in the eight countries in the 1990s as ranging from 36 per 1,000 live births in Armenia to 89 per 1,000 in Tajikistan.

Redmond said most infant deaths that occur in the first month are due to ill health on the part of the mother before and during pregnancy.

Jumabubu Doskeeva is the head of the pediatric department at Kyrgyzstan's Health Ministry. "The results from the first five months of this year show that the causes of death for children under one year old are firstly perinatal, secondly respiratory illnesses, and thirdly infectious diseases," Doskeeva said.

Kamal Ormantaev, head of the pediatric surgery center in Almaty, Kazakhstan, said that many women of reproductive age are affected by pregnancy-related anemia, an iron deficiency that can have profound effects on the health and development of their children. "Mothers' health [in Kazakhstan] is currently getting worse," Ormantaev said. "The majority of mothers are ill. About 70-80 percent of mothers have anemia. All that causes a decline in children's health as well."

Shamil Tajibaev, vice president of Kazakhstan's State Food Academy, agrees. He said widespread iodine deficiency also has a dramatic impact on the health of infants in the region. "As for iodine deficiency, it depends upon the region where children live. In general, about 40-50 percent of newborn children suffer from a lack of iodine in this country. This and anemia can bring on many other diseases. That is why these two diseases are the major cause of death among children," Tajibaev said.

Radioactive pollution also has dramatic consequences on the health of Kazakh infants. Jemisgul Abdumalik-Qyzy is a member of the Nevada-Semey ecological movement in northern Kazakhstan. "The consequences of the Semey nuclear test field are severe. People in the area have middle and high levels of radiation," he said. "50 percent of the children in this area are ill. The major problem is the birth of children with deformations. Children in many cases are already ill while still in their mothers' wombs."

Despite such challenges, UNICEF Executive Director Carol Bellamy said many infants' deaths can be prevented. She said the important first step for governments in Central Asia and the Caucasus is to publicly acknowledge that infant mortality is high.

"Most infant deaths [worldwide] are caused by poverty, malnutrition, substandard medical care, inadequate health systems," Bellamy said. "Or the parents are just too poor to pay for the care. What we have here [in the Caucasus and Central Asia], though, is a problem that is not being recognized. So if it isn't being recognized in these countries, the kinds of change or systems that need to be in place to avoid this kind of high infant mortality are not in place."

In order to accurately evaluate infant mortality rates, the report calls for the adoption and implementation of the international standards on live births, better training for medical staff, and improved management of health care in order to diminish misreporting. Parents must also receive better incentives to promptly register the births of their children.

More generally, action must be taken to ensure that economic growth benefits all sections of society with greater investment in public services, especially education and health care. In Central Asia and the Caucasus, public spending in 2002 was just half of what it was in 1989. In Kyrgyzstan, public expenditure per capita amounted to just $10 in 2000, lower than in many sub-Saharan countries. In 2001, only two-thirds of all officially registered births in Tajikistan were attended by medical personnel, compared with 94 percent in 1989.

The report also calls for more international assistance to manage the countries' debt burdens, followed by national action to ensure debts are not reflected in further public-spending cuts. In Georgia and Tajikistan, the public expenditure on health care and education combined is less than expenditure on debt service.

(RFE/RL's Kazakh and Kyrgyz services contributed to this report.)