What We Are Doing

Born in the urban shades 12 May 2015

Written by Tove R. Wang, CEO, Redd Barna (Save the Children Norway) and Kirsten Jørgensen, CEO, Norwegian Midwifery Association

Op-ed originally published pn 5 May 2015 in Dagsavisen, a Norwegian daily newspaper.

In a dirty back street a young woman gives birth, on her own. The baby dies in the same minute. Just around the corner there are modern hospitals, medicines, skilled doctors and midwives. How can we accept that basic health care is available only for those who can pay for it?

People all over the world seek the cities, and so does poverty. For the first time in history, more than 50 per cent of us live in cities. The UN estimates that in 2050 66 per cent (2/3) of the world’s population will live in cities.

Today Save the Children launches their annual State of World Mothers report. The report draws a dramatic picture of the inequalities internally in the world’s cities. This is particularly visible in statistics of mother and child health. A city can be a merciless place to be, especially when you can’t afford to pay for basic services. The report gives us several reasons to glance into the cities, and further into the dirty quarters in the shades, to be able to fight child mortality in the future.

Survival of the richest

17000 children under the age of 5 die every day. The poorest city children die from birth complications, suffocation, pneumonia, diarrhea and malaria. The majority of them could have been saved if they had access to skilled health personnel. We know from our work that midwives, who go to see the most vulnerable mothers in the back rooms of the cities, save lives every day. The most important tool, besides skilled hands and knowledge, is the absence of an invoice. If we want to prevent newborns from dying, we need to target the poorest parts of the cities and support them with midwives, medicines and accessible health services.

Urban poverty

There are many reasons for people moving to the cities. Cities are associated with progress, prosperity, health services, education, and employment. This might be true, but inequalities in the cities are enormous. Around 1/3 of the urban population in development countries live in slum areas.

Fewer children die in the cities than in rural areas, but an increasing part of children dying before the age of 5 now live in urban areas. One of the reasons is poor sanitation. Fatal diseases can hide in a glass of water. Diseases contaminate, kill and spread easily and more effectively in urban environments. Other challenges might be lack of formal registration of slum dwellers; hence they do not get the health care they are entitled to have. Immigrants might encounter linguistic and cultural barriers when encountering the health care system.

Not equipped to tackle growth

The world’s cities grow, far faster than we manage to plan for. Consequences are urban blind zones with miserable health conditions for pregnant and newborns. These blind zones are not only to be found in developing countries. Disturbingly many cities, also in OECD countries, lack plans for controlling the growth in inequality.

Washington DC ranks bottom

Out of 25 capital cities in the world, Washington DC ranks bottom on statistics for child mortality under age 1 in OECD countries. The report shows that if you are born in a big city in the US and you give birth in the poorest part of the city, the risk of dying is ten times higher compared to giving birth in an affluent part of the city. An interesting paradox in a country where resistance to a health reform is strong.

The need for more knowledge

The State of World Mothers 2015 shows how life conditions are radically different, depending on whether you are born in the sunny or the shady side of a city. The differences might be difficult to spot when looking at national statistics, as it is based on average figures. These figures can tell us a lot about the poverty situation in a country, but we run the risk of not spotting the extreme life situation of the most vulnerable ones. We have a striking need for nuanced data on how urban inequality develops. Patterns are complex, and they change as cities grow.

Norway on top

In this year’s index, Norway is back on top, followed by the rest of the Nordic countries. This is not by accident. Access to free health care is one of the fundaments in the Nordic welfare system, a system that should be exported to a greater extent than it is today. Higher levels of taxation are needed to finance basic lifesaving health services for the poor.

Global demographic development tells us we need to look to the cities. The urban blind zones must be brought to the light, to be able to give mothers assistance through pregnancy and birth, and for babies to have a fair chance of surviving their first vulnerable weeks. We cannot lean on the success of global reduction of child mortality. We need to reach everyone, including those ones not well off.

Some countries have managed to reduce inequality by strengthening skilled birth attendance, increased use of contraception, and free – or heavily subsidized – health services for the poorest. Being physically close to the services is not enough, real access is key. Free healthcare carried out by skilled midwives is a good starting point.