Asia-Pacific Journal of Public Health 1990-Vol 4
No
4
Child Survival and Development with Special Reference to the Girl Child
Prof Mathura P Shrestha Minister of Health, Nepal
Recently, a Nepali daily newspaper carried a headline which could be translated as "Child Development: A Theme, Neither of Joy nor of Regret, for a Child"'. Many international and national agencies are active in the child survival movement. Many conferences and seminars are organized for it. Days, years and decades are dedicated to children. We must now ask ourselves what do all these activities mean to those children who are neglected, segregated, deprived and exploited and whose survival, development, protection and participation - the four major areas highlighted in the United Nations Convention on the Rights of the Child2 - are grossly undermined in developing countries, like Nepal, where most of such children live? Since the same time yesterday, 40,000 children under five years of age are dead today. One child dies every two seconds. Another child becomes severely disabled with more or less permanent mental or physical handicap every other second. Most of these dead and handicapped children bclong to developing countries. More female than male children die in these countries even though the biological survival rates of female children should be higher. Most of the 14 million children who die each year and a similar number of severely disabled children
could be saved or their disabilities prevented by simple and effective measures such as safe drinking water, appropriate sanitation, immunization, basic nutritional measures and the guarantee of basic human rights including the right to health, information and a clean environment 3. To add to this grim picture, almost a billion adults, mostly women and those living in rural areas of developing countries, cannot read and write. Approximately 102 million of today's six to eleven year olds are not attending school '. Federico Mayor, UNESCO Director General, stated that "The past few years have witnessed an unprecedented halt in the growth of basic educational services and a stagnation and deterioration of educational quality ... In nearly half the developing countries the goal of universal primary education is now receding rather than drawing nearer". Five hundred million children ir. the developing world are struggling to survive with insufficient food and clothing. Nearly one and a half billion people do not have access to Plenary address of any health care. On top of all this, the heavy burden of extreme debt in developing countries results in the diversion of funds meant for social and child development. All this is occurring today not because of lack of resources
Plenary address delivered at the International Symposium on the Girl Child in Asia: A Neglected Majority, Kathmandu, Nepal, December 13, 1990. 219
Downloaded from aph.sagepub.com at FLORIDA INTERNATIONAL UNIV on July 11, 2015
Asia-Pacific Journal of Public Health 1990-Vol 4 No 4
or technology but because of wasteful investments and perversion in the general priorities among the governments of the world. If just part of the trillion dollars spent every year on the arms race is diverted5, it could be used to solve most of the world's problems. If part of the nionies used to produce the present stock of more than four billion tons of TNT had been diverted to human survival, dignity, civilization and world peace, one can imagine how much in human terms we could have done to solve our problems. Former U.S. President Dwight D. Eisenhower wrote in 1953, "Every gun that is made, every warship launched, every rocket fired signifies in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed"6. Dr. Ma Hai De remarked in 1985, "Today, when the whole world has become just one village where we are all neighbors, joined to each other by not only communication but by vital economic links, there is no place left for various neolithic notions to justify war making. This is total regression, an assualt upon all civilizations, all mankind" '. The status of the girl child in developing countries stabs at our collective conscience. The acuteness of this situation becomes clear when we speak of Nepali; children. According to the 1981 census, 14.6% (249,257) of 1.7 million children aged 10-14 years, predominantly girls, were either married, widowed or divorced 8 . The ovenvhelming majority of teenage girls in Nepal today are already married, thus exposing themselves to too many and too frequent pregnancies, too high rates of maternal deaths and diseases, and too many social and personal disadvantages. Fifty-seven percent of Nepali children, 10-14 years of age, are economically active9, mostly working in the primary sector and in makeshift factories without basic sanitation, safety merisures and any health insurance or social security. Illiteracy, especinlly female illiteracy, is unacceptably high. In rural areas of Nepal, girls are rarely enrolled in school, and they generally do not continue in school beyond the primary level. The rights of children begin from the time they become Viable in their mother's womb'". A child begins to develop physically, mentally and intellectually before he/she is born. One can imagine the effects on the development of a child born of a mother "who cats last and least in the family - often the leftovers and spoiled food"", if she lives in poverty, is malnourished and in ill health, is powerless economically, socially and politically, and if her potentiality as a human being is frustrated due to
her gender or caste or any other accidents of birth or development. The situation for females has been succinctly described: A women is forced to be submissive, inferior and self-sacrificing ... to keep up the inale ego in the family. In some cases the sacrifice is so severe that a woman becomes n nonperson ... She is expected to fulfill the wishes of male niembers of the family without even being told ... In some male dominated countries, improved techniques in determining the sex of the fetus enables some to have the excuse or reason to terminate the pregnancy carrying the female fetus I*. The world becomes the womb of a child after he/she is born. The world we have contributed to in our lifetime has little relevance even to our generation. The world is like it is because of our ignorance, greed, and incompetence to manage human behavior, resources and intelligence. It is thus arrogant and irresponsible of us to be presumptive of the future. We have to liberate ourselves from being prophetic, dictatorial and manipulating. If we are to behave properly as parents, citizens and human beings. we must take up our responsibilities seriously to solve the problems of the world of today and tomorrow. When as adults we speak of the rights of the child, we must understand that we are speaking about a portion of humanity that belongs to the future but does not have a say over it. They cannot vote. Their complaints, especially those of girls, are frequently misunderstood, misinterpreted or even ignored. Therefore, it is our first duty to implement the Rights of the Child. Simple ratification of the UN Convention on the Rights of tlie Child is not enough. We have to ensure the survival, development, protection and participation of the children of all countries including Nepal. Rights to education and information, to health and health care, to safe drinking water and sanitation, to a clean environment and to a just and peaceful life are fundnmental ingredients for the survival of the child. Special priority for the girl child needs to be stressed so that equal status with male children can be achieved for her as fast as possible. When we speak of development and education of the child, we must understand that intelligence is not related to sex, race or socioeconomic status. It is the product of environment, love and intellectual stimulus. Several studies in Malaysia, Britain, New York and elsewhere have shown this. However, intellectual stimuli should be
220
Downloaded from aph.sagepub.com at FLORIDA INTERNATIONAL UNIV on July 11, 2015
Asia-Pacific Journal of Public Health 1990-Vol 4 No relevant to the sociocultural context of the children and their country. The present system of evaluating intelligence including the examination system needs critical review. A study in England by Bemstein showed that it was difficult for working class children, especially females, to enter college, not because they lack knowledge but because the examinations assumed the social experiences of elites. Similarly in New York City, when IQ examinations were changed to reflect the experiences of the poor in slums and tenements, the poor child passed the examination brilliantly while the middle and upper class child failed miserably. Therefore arbitrary adoption of technoloqy and education systems is to be discouraged, while appropriate and progressive systems and technology are to be adapted or developed to suit the historical, physical, sociocultural and demographic conditions of the country or community. In terms of protection and survival of the child, we have to challenge our own hypocrisy. What are we to do in the face of problems - when millions of children are abused or battered every day; when 150 million street children are begging, picking rags or plastic or engaged in underpaid, unhealthy and unsafe labor; when 400 million, most of them children, g o to sleep hungry every night; and when millions of children pass their lives as bonded laborers or de facto slaves? The fate of girl children is more depressing. In addition to social inequality, they are not well protected legally, and every day hundreds of girls are subjected to bonded labor, to marriages without their consent, to sexual abuses and to prostitution. It is estimated that more than 130,000 Nepalese girls and women have been forced into serving as prostitutes in Bombay and other metropolises of the world. The prevalence of HIV positive cases are very high in the premises where these women work. Out of twelve HIV positive cases reported in Nepal, six were foreign nationals, and five of the remaining six Nepali HIV positive cases were women rescued and returned from the brothels of Bombay. Mere advocacy for participation is not enough. "A good leader does not speak for the people but rather empowers them and enables them to speak for themselves'' 13. Participation is not a commodity to be given or bestowed but has to be developed through practice. It is well understood that whenever there is a greater degree of people's participation, especially women's participation, in the social and political processes of a country there is n visibly higher level of literacy, including that of women, better health and nutritional status, and greater provision of other
4
services compared to other countries of similar sociocultural and geographic status. The concept of participation should include the elements of conscioi/izirtio/t and empowerment of the people as a whole. It should be enlightened and responsible participation of the people including children, both boys and girls, without discrimination. Health professionals, administrators and leaders all over the world are being challenged by these seemingly insurmountable problems related to the child, especially the girl child. However, we are here determined to d o something. Together we can solve these problems. I hope that the syniposium will come up with concrete solutions to at least some of these problems. With your leadership, I hope that the age of reason will dawn upon this world, and all children including the girl child will grow up as healthy, informed and responsible citizens of the world with the means to struggle and to create placed in their hands for the better and healthier world of tomorrow. References 1. Gorkhapatra (Nepali), 5 October 1990. 2. United Nations Convention on the Rights of the Child. Adopted by UN General Assembly on 2 0 November 1989. 3. Bulletin of Health Professionals for Social Responsibility (Nepal), 1987. 4. UNICEF. The World Summit for Children. New York, 1990. 5. Sivard RL: World military and social expenditure. World Priority, Inc., 1989. (See also 1985, 1986 and 1987 editions). 6. lnfact brings GE to light. Infact, Boston, 1988. 7. Ma HD: A farewell to arms. IPPNW Report, 1985, vol. 3, no. 2. 8. Population Census (Nepal), 1981. Vol. I , Part IV, Table 162. (Cited from seminar paper by Harkha
Gurung). 9. 10.
11. 12.
13.
Population Census (Nepal), 1981. Vol. I, Part IV, Table 162. Shrestha MP: Delivering children from the fate of the condemned. Souvenir program. 5th NEPAS Congress, Kathmandu, 13-15 September, 1990. Shrestha I: MCH Services in Nepal. Thesis for DTCH Course, Liverpool School of Tropical Medicine, 1979. Shrestha I: Demographic catastrophe? Upcoming imbalance in sex ratio. family Health (Nepal) 1989, no. 32. Miksell SL: The interim constitution and transition to democracy in Nepal. Paper presented at the 18th Annual Conference on South Asia, Madison, Wisconsin, 3 November 1990. 22 1
Downloaded from aph.sagepub.com at FLORIDA INTERNATIONAL UNIV on July 11, 2015
No
4
Child Survival and Development with Special Reference to the Girl Child
Prof Mathura P Shrestha Minister of Health, Nepal
Recently, a Nepali daily newspaper carried a headline which could be translated as "Child Development: A Theme, Neither of Joy nor of Regret, for a Child"'. Many international and national agencies are active in the child survival movement. Many conferences and seminars are organized for it. Days, years and decades are dedicated to children. We must now ask ourselves what do all these activities mean to those children who are neglected, segregated, deprived and exploited and whose survival, development, protection and participation - the four major areas highlighted in the United Nations Convention on the Rights of the Child2 - are grossly undermined in developing countries, like Nepal, where most of such children live? Since the same time yesterday, 40,000 children under five years of age are dead today. One child dies every two seconds. Another child becomes severely disabled with more or less permanent mental or physical handicap every other second. Most of these dead and handicapped children bclong to developing countries. More female than male children die in these countries even though the biological survival rates of female children should be higher. Most of the 14 million children who die each year and a similar number of severely disabled children
could be saved or their disabilities prevented by simple and effective measures such as safe drinking water, appropriate sanitation, immunization, basic nutritional measures and the guarantee of basic human rights including the right to health, information and a clean environment 3. To add to this grim picture, almost a billion adults, mostly women and those living in rural areas of developing countries, cannot read and write. Approximately 102 million of today's six to eleven year olds are not attending school '. Federico Mayor, UNESCO Director General, stated that "The past few years have witnessed an unprecedented halt in the growth of basic educational services and a stagnation and deterioration of educational quality ... In nearly half the developing countries the goal of universal primary education is now receding rather than drawing nearer". Five hundred million children ir. the developing world are struggling to survive with insufficient food and clothing. Nearly one and a half billion people do not have access to Plenary address of any health care. On top of all this, the heavy burden of extreme debt in developing countries results in the diversion of funds meant for social and child development. All this is occurring today not because of lack of resources
Plenary address delivered at the International Symposium on the Girl Child in Asia: A Neglected Majority, Kathmandu, Nepal, December 13, 1990. 219
Downloaded from aph.sagepub.com at FLORIDA INTERNATIONAL UNIV on July 11, 2015
Asia-Pacific Journal of Public Health 1990-Vol 4 No 4
or technology but because of wasteful investments and perversion in the general priorities among the governments of the world. If just part of the trillion dollars spent every year on the arms race is diverted5, it could be used to solve most of the world's problems. If part of the nionies used to produce the present stock of more than four billion tons of TNT had been diverted to human survival, dignity, civilization and world peace, one can imagine how much in human terms we could have done to solve our problems. Former U.S. President Dwight D. Eisenhower wrote in 1953, "Every gun that is made, every warship launched, every rocket fired signifies in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed"6. Dr. Ma Hai De remarked in 1985, "Today, when the whole world has become just one village where we are all neighbors, joined to each other by not only communication but by vital economic links, there is no place left for various neolithic notions to justify war making. This is total regression, an assualt upon all civilizations, all mankind" '. The status of the girl child in developing countries stabs at our collective conscience. The acuteness of this situation becomes clear when we speak of Nepali; children. According to the 1981 census, 14.6% (249,257) of 1.7 million children aged 10-14 years, predominantly girls, were either married, widowed or divorced 8 . The ovenvhelming majority of teenage girls in Nepal today are already married, thus exposing themselves to too many and too frequent pregnancies, too high rates of maternal deaths and diseases, and too many social and personal disadvantages. Fifty-seven percent of Nepali children, 10-14 years of age, are economically active9, mostly working in the primary sector and in makeshift factories without basic sanitation, safety merisures and any health insurance or social security. Illiteracy, especinlly female illiteracy, is unacceptably high. In rural areas of Nepal, girls are rarely enrolled in school, and they generally do not continue in school beyond the primary level. The rights of children begin from the time they become Viable in their mother's womb'". A child begins to develop physically, mentally and intellectually before he/she is born. One can imagine the effects on the development of a child born of a mother "who cats last and least in the family - often the leftovers and spoiled food"", if she lives in poverty, is malnourished and in ill health, is powerless economically, socially and politically, and if her potentiality as a human being is frustrated due to
her gender or caste or any other accidents of birth or development. The situation for females has been succinctly described: A women is forced to be submissive, inferior and self-sacrificing ... to keep up the inale ego in the family. In some cases the sacrifice is so severe that a woman becomes n nonperson ... She is expected to fulfill the wishes of male niembers of the family without even being told ... In some male dominated countries, improved techniques in determining the sex of the fetus enables some to have the excuse or reason to terminate the pregnancy carrying the female fetus I*. The world becomes the womb of a child after he/she is born. The world we have contributed to in our lifetime has little relevance even to our generation. The world is like it is because of our ignorance, greed, and incompetence to manage human behavior, resources and intelligence. It is thus arrogant and irresponsible of us to be presumptive of the future. We have to liberate ourselves from being prophetic, dictatorial and manipulating. If we are to behave properly as parents, citizens and human beings. we must take up our responsibilities seriously to solve the problems of the world of today and tomorrow. When as adults we speak of the rights of the child, we must understand that we are speaking about a portion of humanity that belongs to the future but does not have a say over it. They cannot vote. Their complaints, especially those of girls, are frequently misunderstood, misinterpreted or even ignored. Therefore, it is our first duty to implement the Rights of the Child. Simple ratification of the UN Convention on the Rights of tlie Child is not enough. We have to ensure the survival, development, protection and participation of the children of all countries including Nepal. Rights to education and information, to health and health care, to safe drinking water and sanitation, to a clean environment and to a just and peaceful life are fundnmental ingredients for the survival of the child. Special priority for the girl child needs to be stressed so that equal status with male children can be achieved for her as fast as possible. When we speak of development and education of the child, we must understand that intelligence is not related to sex, race or socioeconomic status. It is the product of environment, love and intellectual stimulus. Several studies in Malaysia, Britain, New York and elsewhere have shown this. However, intellectual stimuli should be
220
Downloaded from aph.sagepub.com at FLORIDA INTERNATIONAL UNIV on July 11, 2015
Asia-Pacific Journal of Public Health 1990-Vol 4 No relevant to the sociocultural context of the children and their country. The present system of evaluating intelligence including the examination system needs critical review. A study in England by Bemstein showed that it was difficult for working class children, especially females, to enter college, not because they lack knowledge but because the examinations assumed the social experiences of elites. Similarly in New York City, when IQ examinations were changed to reflect the experiences of the poor in slums and tenements, the poor child passed the examination brilliantly while the middle and upper class child failed miserably. Therefore arbitrary adoption of technoloqy and education systems is to be discouraged, while appropriate and progressive systems and technology are to be adapted or developed to suit the historical, physical, sociocultural and demographic conditions of the country or community. In terms of protection and survival of the child, we have to challenge our own hypocrisy. What are we to do in the face of problems - when millions of children are abused or battered every day; when 150 million street children are begging, picking rags or plastic or engaged in underpaid, unhealthy and unsafe labor; when 400 million, most of them children, g o to sleep hungry every night; and when millions of children pass their lives as bonded laborers or de facto slaves? The fate of girl children is more depressing. In addition to social inequality, they are not well protected legally, and every day hundreds of girls are subjected to bonded labor, to marriages without their consent, to sexual abuses and to prostitution. It is estimated that more than 130,000 Nepalese girls and women have been forced into serving as prostitutes in Bombay and other metropolises of the world. The prevalence of HIV positive cases are very high in the premises where these women work. Out of twelve HIV positive cases reported in Nepal, six were foreign nationals, and five of the remaining six Nepali HIV positive cases were women rescued and returned from the brothels of Bombay. Mere advocacy for participation is not enough. "A good leader does not speak for the people but rather empowers them and enables them to speak for themselves'' 13. Participation is not a commodity to be given or bestowed but has to be developed through practice. It is well understood that whenever there is a greater degree of people's participation, especially women's participation, in the social and political processes of a country there is n visibly higher level of literacy, including that of women, better health and nutritional status, and greater provision of other
4
services compared to other countries of similar sociocultural and geographic status. The concept of participation should include the elements of conscioi/izirtio/t and empowerment of the people as a whole. It should be enlightened and responsible participation of the people including children, both boys and girls, without discrimination. Health professionals, administrators and leaders all over the world are being challenged by these seemingly insurmountable problems related to the child, especially the girl child. However, we are here determined to d o something. Together we can solve these problems. I hope that the syniposium will come up with concrete solutions to at least some of these problems. With your leadership, I hope that the age of reason will dawn upon this world, and all children including the girl child will grow up as healthy, informed and responsible citizens of the world with the means to struggle and to create placed in their hands for the better and healthier world of tomorrow. References 1. Gorkhapatra (Nepali), 5 October 1990. 2. United Nations Convention on the Rights of the Child. Adopted by UN General Assembly on 2 0 November 1989. 3. Bulletin of Health Professionals for Social Responsibility (Nepal), 1987. 4. UNICEF. The World Summit for Children. New York, 1990. 5. Sivard RL: World military and social expenditure. World Priority, Inc., 1989. (See also 1985, 1986 and 1987 editions). 6. lnfact brings GE to light. Infact, Boston, 1988. 7. Ma HD: A farewell to arms. IPPNW Report, 1985, vol. 3, no. 2. 8. Population Census (Nepal), 1981. Vol. I , Part IV, Table 162. (Cited from seminar paper by Harkha
Gurung). 9. 10.
11. 12.
13.
Population Census (Nepal), 1981. Vol. I, Part IV, Table 162. Shrestha MP: Delivering children from the fate of the condemned. Souvenir program. 5th NEPAS Congress, Kathmandu, 13-15 September, 1990. Shrestha I: MCH Services in Nepal. Thesis for DTCH Course, Liverpool School of Tropical Medicine, 1979. Shrestha I: Demographic catastrophe? Upcoming imbalance in sex ratio. family Health (Nepal) 1989, no. 32. Miksell SL: The interim constitution and transition to democracy in Nepal. Paper presented at the 18th Annual Conference on South Asia, Madison, Wisconsin, 3 November 1990. 22 1
Downloaded from aph.sagepub.com at FLORIDA INTERNATIONAL UNIV on July 11, 2015
