INFANT MORTALITY DURING ECONOMIC DOWNTURNS AND .INFANT MORTALITY DURING ECONOMIC DOWNTURNS ... Infant

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WORKING PAPER

INFANT MORTALITY DURINGECONOMIC DOWNTURNS

AND RECOVERY

Ronald Mendoza Nicholas Rees

UNICEF POLICY AND PRACTICE

SOCIAL AND ECONOMIC POLICY

OCTOBER 2009

INFANT MORTALITY DURING ECONOMIC DOWNTURNS AND

RECOVERY

Ronald U. Mendoza Economist

Division of Policy and Practice Social and Economic Analysis Unit

UNICEF

Nicholas Rees Consultant

Division of Policy and Practice Policy Advocacy Unit

UNICEF

OCTOBER 2009 UNICEF POLICY AND PRACTICE

SOCIAL AND ECONOMIC POLICY WORKING PAPER

Infant Mortality during Economic Downturns and Recovery United Nations Children's Fund (UNICEF), Policy, Advocacy and Knowledge Management, Division of Policy and Practice, New York, 2009 Policy, Advocacy and Knowledge Management, Division of Policy and Practice UNICEF 3 UN Plaza, NY, NY 10017 October 2009 This is a working document. It has been prepared to facilitate the exchange of knowledge and to stimulate discussion. The findings, interpretations and conclusions expressed in this paper are those of the author(s) and do not necessarily reflect the policies or views of UNICEF. This paper has been prepared as part of the FACIT Project which undertakes policy research on the impact of economic crises and aggregate shocks on children as well as the policy responses to help protect them. The text has not been edited to official publication standards and UNICEF accepts no responsibility for errors. The designations in this publication do not imply an opinion on legal status of any country or territory, or of its authorities, or the delimitation of frontiers.

ACKNOWLEDGEMENTS The authors are grateful to Sarah Baird, Jingqing Chai, Gaspar Fajth, Bingjie Hu, Leonardo Menchini, Richard Morgan, Holly Newby, Isabel Ortiz, David Parker, David Stewart, Ian Thorpe and Danzhen You for helpful comments on earlier drafts. However, they are not to be implicated in any remaining errors in this paper. Comments would be appreciated and could be addressed to the authors at rmendoza@unicef.org and nrees@unicef.org.

Table of Contents

Page

Executive Summary ......................................................................................................................... i Resumen Ejecutivo ......................................................................................................................... ii Rsum Analytique ........................................................................................................................ iii Introduction ..................................................................................................................................... 1 1. A Brief Review of the Empirical Literature on Economic Downturns and Infant Mortality . 4 2. Impact of the Current Global Economic Slowdown on Infant Mortality ............................. 11 3. Policy Responses to the Global Economic Slowdown ......................................................... 14

3.1. Health and nutrition interventions ................................................................................ 14 3.2. Social protection ........................................................................................................... 15 3.3. Pro-poor countercyclical policy .................................................................................... 18

Conclusion .................................................................................................................................... 25 References ..................................................................................................................................... 26

i

Executive Summary This paper reviews the empirical literature on the impact of economic downturns on infant mortality. Drawing on this, it examines the possible impact of the presently unfolding global economic slowdown. While there is scope for further improving our understanding of the links between economic trends and infant mortality, the available empirical evidence does suggest that children face grave risks if the social impact of the global slowdown is unmitigated. There is also a risk that the global slowdown could undermine recent progress in reducing infant mortality. The analysis and evidence underscore several key areas for policy responses: a) providing humanitarian relief, including health and nutrition interventions to the most hard-hit and vulnerable groups; b) expanding social protection to the poorest and most vulnerable; and c) resuscitating growth in a way that is pro-poor and ensures that the recovery of household incomesnotably among the poor and low income householdsis robust and sustained. The main message of this paper for policymakers is that, based on empirical evidence on past crises, the possible impact of the present crisis on infant mortality is nothing that cannot be mitigated by policies that protect children and women and ensure sufficient social investments in the first place.

ii

Resumen Ejecutivo Este artculo examina la literatura emprica sobre las repercusiones del descenso de la actividad econmica en la mortalidad infantil. Sobre esta base, se examina las posibles consecuencias de la desaceleracin econmica mundial que se est produciendo en la actualidad. Aunque hay margen para seguir ampliando nuestra comprensin con respecto a los vnculos entre las tendencias econmicas y la mortalidad infantil, las pruebas empricas disponibles sugieren que los nios enfrentan graves riesgos si no se mitiga la repercusin social de la desaceleracin mundial. Existe tambin el riesgo de que la desaceleracin mundial socave los recientes progresos en la reduccin de la mortalidad infantil. El anlisis y las pruebas destacan varios aspectos clave para generar respuestas en materia de polticas: a) proporcionar ayuda humanitaria a los grupos ms afectados y vulnerables, incluidas intervenciones de salud y nutricin, b) ampliar la proteccin social a los ms pobres y vulnerables, y c) reactivar el crecimiento de una manera que sea favorable a los pobres y asegure que la recuperacin de los ingresos de los hogares sobre todo de los hogares pobres y de ingresos bajos sea robusta y sostenida. El mensaje principal de este documento para las autoridades encargadas de elaborar polticas es que, sobre la base de las pruebas empricas de las crisis anteriores, el posible impacto de la crisis actual sobre la mortalidad infantil se puede mitigar mediante polticas que protejan a los nios y las mujeres, y que garanticen ante todo suficientes inversiones sociales.

iii

Rsum Analytique Cette communication passe en revue les ouvrages qui analysent dans une perspective empirique les consquences des crises conomiques sur la mortalit des enfants. partir de cet examen, elle considre les effets que pourrait avoir la rcession qui frappe actuellement lensemble de la plante. Bien quil reste beaucoup faire pour amliorer notre comprhension des liens entre les tendances conomiques et la mortalit infantile, les donnes empiriques dont nous disposons laissent penser que les enfants courent des risques graves si lon nattnue pas les consquences sociales du ralentissement conomique mondial. Cette rcession risque galement de saper les progrs rcemment accomplis pour faire baisser la mortalit infantile. Lanalyse et les donnes factuelles mettent en lumire plusieurs domaines cls o des interventions seraient ncessaires : a) secours humanitaires comprenant des actions sur la sant et la nutrition au bnfice des groupes les plus touchs et les plus vulnrables, b) largissement de la protection sociale aux plus pauvres et aux plus vulnrables, c) relance de la croissance dans une perspective favorable aux pauvres et pour assurer quelle se traduise par un rtablissement vigoureux et durable du revenu des mnages notamment pour les mnages pauvres et bas revenus. Pour les dcideurs, le principal message de cet article est que lanalyse empirique des crises prcdentes montre que lon peut attnuer les consquences ventuelles de la prsente crise sur les taux de mortalit infantile en prenant des dcisions politiques qui protgent les enfants et les femmes et assurent en premier lieu un niveau dinvestissement social suffisant.

1

Introduction Despite important gains in recent years, the challenge of saving the lives and improving the wellbeing of newborns and mothers is still quite considerable. Drawing on various sources, its scale could be illustrated by the following facts and figures:

Almost 8.8 million children die in 2008 before they reach the age of 51; and an estimated 6.1 million children die before the age of 1.2

Globally, approximately 45 children per 1000 live births die before the age of one in 2008. This number is considerably higher in poorer countries. In least developed countries, 82 children per 1000 live births die before the age of 1, compared to industrialized countries, where 5 children per 1000 live births die before the age of 1. 3

Every year, nearly 4 million newborns die within 28 days of birth, during the neonatal period.4

An estimated 25 to 45 per cent of neonatal deaths occur during the first day after birth; and around 75% of these deaths occur during the first week after birth.5

Globally, there are approximately 4 million stillbirths each year. 6, 7 Almost all neonatal deaths (approximately 98 percent) and maternal deaths (over 99

percent) occur in low and middle income countries. The lifetime risk of maternal death for a woman in a least developed country is more than 300 times greater than for a woman living in an industrialized country. 8

For every woman who dies from causes related to pregnancy or childbirth,