Child Mortality and Burma

T.R. wrote a moving entry about the situation in Burma - Putting a Human Face on the Politics of Poverty which included a reference to an entry I wrote about the high child mortality rate in the country. Unicef, in its annual report State of the World's Children, estimated that the under five mortality rate is 104/ 1,000 live births. In the post written on the Tricycle blog, there was a link to another article. The original article was taken off the site so I did a little more digging.

I did find the International Herald Tribune Article - As many as 400 children die daily in Myanmar, the second worst record in Asia.

According to an article in the The Irrawaddy, 7 Feb 2008 ( Unicef chief says International Newspapers misstated Facts ), Dr Osamu Kunii had sent a letter to the Minister of Health apologizing for his comment, where the AP article had quoted him as saying that between 100,000 to 150,000 children under five die every year (that would mean 270 to 400 children per day). According to the state run newspaper, The New Light of Myanmar, WHO statistics indicate that the under five mortality rate is 66/ 1,000.

I then look at the article at the Mizzima News website - Junta Combats Unicef data with dated government statistics The mortality rate cited by the Junta comes from WHO data published in 2004 and collected in 2003, using information from government sources. The new UNICEF data was collected by a "the Inter-agency Group for Child Mortality Estimation, which includes UNICEF, the World Health Organization (WHO), the World Bank and the United Nations Population Divison." This data was collected in 2006.

There is also a difference in the procedure in collecting and analyzing the data. "the UNICEF figure is a projection as opposed to a historical statistic. The under-five child mortality rate, as calculated by UNICEF, estimates the number of fatalities to occur if the current situation and factors inside the country remain static over the ensuing five years." However, more recent WHO - SEARO data (on its web site ) also confirms the UNICEF data. They give the under five mortality rate as 105/ 1,000 (boys: 116, girls: 93 and average 105).

When I looked at the Burma /Myanmar section of the SoWC report, I spotted discrepancies with the news articles above. Instead of having the 4th worst under-five mortality rate (as stated in the Irrawaddy article) , Myanmar ranks 40. That looks like a misprint - and it does look like it ranks #2 in Asia, though quite a bit behind the number one contender, Afghanistan.

There are plenty of other countries that compete for worse child mortality rates: 1. Sierra Leone (with a child mortality rate of 270/1,000 - more than one quarter of their chilren!), 2. Angola, 3. Afghanistan 4. Nigeria 5. Liberia, 6. Mali 7. Chad, 8. Equitorial Guinea, 9. DR Congo, 10. Burkino Faso.

Interesting enough, the web page of the report does not point out how bad the health system is. It says, despite a long period of relative isolation and other political constraints, Myanmar possesses good technical capacity and can successfully undertake major initiatives when there are clear objectives and high-level commitment and support, combined with national mobilization and adequate resources. Examples of these are the National Sanitation Weeks, National Immunization Days (NIDs) and efforts to achieve Universal Salt Iodization and vitamin A supplementation, which have significantly advanced the achievement of the World Summit and National Plans of Action goals. And while the under five mortality rate is high at 104, the rate in 1990 was 130.

So there are a couple of points that can be gleaned from the above information:

Another point about data. Collecting public health data is a challenge in developing countries. Telecommunications is rough - in remote areas, telephones are rare and service erratic. Internet is not available in rural areas and often reports and health statistics have to be sent by letter, or by bus. I imagine that the methodology used by UNICEF (which I can't find in the SoWC report) includes sampling urban and rural areas and then doing statistics on the data.

Both the UNICEF report and the WHO website in Myanmar indicate the need to stay cool, and work on public health issues. In one article above, a government official said that they are happy to continue to work with UNICEF. Hopefully, this kind of engagement until some kind of solution can be found, will help to lower these awful public health figures.

The news articles, even coming from a great source such as the Irrawaddy, may present the facts but may also neglect to fill in the whole picture and may turn up the volume on emotional impact. People can poke holes in the story and end of discrediting all the valuable information. Because - ultimately - what does the figures mean? 104 child deaths out of 1,000 births. It means that 10% of the children born will not reach their fifth birthday, one of of ten. Even the figures cited by the Junta, 66/1,000, means 1 out 17 are horrendous.

Some links:

The Irrawaddy is a print and online news daily founded by Burmese activists who fled the country after the 1988 crackdown. Based in Chaing Mai, Thailand, it has been covering the situation in Burma consistently since 1992. While it is promotes the pro-democracy movement, it is not associated with any of the political groups opposing the junta, making it one of the most credible sources for news about Burma.

Aung Zaw is the editor and founder of the paper. He was a student at Rangoon University at the time that the pro-democracy movement started. He fled his home country in 1988 and found refuge in Bangkok, where he started to write articles for the English language papers. His web site has his biographer and links to articles he has written for The Irrawaddy, The Nation (Bangkok English language newspaper), The Bangkok Post and the Asian Wall Street Journal.

Burmanet News collects news feeds on Burma from around the world.

WHO's web site in Myanmar. While the web site may not seem exciting - in fact, strangely calm given the turmoil in the country, they show that there are steps being made, even if it's coming from an international organization.