Reducing fertility rates in developing countries is critical for ending global poverty. Common methods of doing so include education, contraception and women’s empowerment. However, another important factor affecting fertility rates is child survival.
There are many biological and behavioral factors that affect women and families when children die early. Physiologically, the early death of an infant triggers the resumption in ovulation, leaving the mother at early risk of conceiving again. Additionally, parents who lose children early are more likely to attempt to replace lost children or have extra children as insurance or compensation.
To fight high fertility rates in developing countries and around the world, it is important to understand the rates, causes and prevention efforts of stillbirths and under-five mortality.
The World Health Organization (WHO) defines a stillbirth as “a baby born with no signs of life at or after 28 weeks’ gestation.” There are an estimated 2.6 million stillbirths per year across the globe, which equates to more than 7,178 occurring daily.
The majority of stillbirths happen in developing countries with little or no access to skilled health professionals during pregnancy and labor. The WHO estimates that of the 2.6 million yearly stillbirths, 90 percent occur in low and middle-income countries, 75 percent occur in South Asia and sub-Saharan Africa, and 60 percent occur in rural areas of those Asian and African regions.
Stillbirths are caused by child birth complications, post-term pregnancy, maternal infections during pregnancy (such as malaria, syphilis and HIV), maternal disorders (such as hypertension, obesity and diabetes), fetal growth restrictions and congenital abnormalities.
Most stillbirths can be prevented with improved access to maternal healthcare. The Every Newborn Action Plan (ENAP) aims to prevent these avoidable deaths and has a target of 12 stillbirths per 1,000 live births by 2030. To compare, today, the stillbirth rate in sub-Saharan Africa is 29 per 1,000 live births and, in developed countries, is three stillbirths per 1,000 live births on average.
An estimated 5.9 million children under five die every year around the world. However, instances in developing countries are higher. In low-income countries, the under-five mortality rate is about 76 deaths per 1,000 live births. To compare, in high-income countries, the under-five mortality rate is about seven deaths per 1,000 live births. Seventy percent of these deaths in developing countries are preventable and caused by acute lower respiratory infections (such as pneumonia), diarrhea, malaria, measles, HIV/AIDS, malnutrition and neonatal conditions.
About 2.7 million children die annually during the first month of life. Seventy-five percent of these newborn deaths happen during the first week and up to 50 percent during the first 24 hours. Causes of neonatal and infant mortality include prematurity, low birth weight, infections, birth asphyxia, HIV-infected mothers and birth trauma.
The majority of these infant deaths are preventable with health measures and care during and after birth, particularly during the first week of life. Additionally, most deaths under the age of five can be prevented with access to basic goods and services such as nutrition, water, sanitation, shelter, education, healthcare and information. Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) aim to decrease instances of under-five mortality as well as stillbirths. Part of SDG goal three is to end preventable infant and child mortality by 2030.
Improving fertility rates has positive effects on economics, health, environment and education. And, contrary to a popular foreign aid myth, improving child survival rates can actually decrease population growth rates around the world. Ironically, fertility rates in developing countries and around the world can, in turn, affect stillbirth and under-five mortality rates. Addressing this perceivably unending cycle is critical to ending global poverty.
– Francesca Montalto