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Though the number of children who die before age 5 has declined significantly in the last two decades, the path to ending child mortality is long and hard to navigate. Nearly 7 million young children still die yearly, largely from preventable causes. What works and what doesn’t in the fight against child mortality? What will it take to go the last mile, and end preventable child deaths?
After decades of government neglect, the country's health care system has a chance to serve its people as outside help rushes in.
YANGON, Myanmar — In a tiny wooden home in an impoverished corner of Yangon, a gauzy white hammock swung from the rafters.
Inside that hammock lay baby Khin Phyu Zin, who grew longer and heavier, while her grandmother, Daw Aung Kyi, 54, pushed the swing and dreamt about the baby’s future.
Daw Aung Kyi was the child’s primary caretaker, watching the toddler grow while her mother sold snacks from a mobile food cart. She wanted Khin Phyu Zin to be a doctor. It was an ambitious but not impossible goal for a young girl born into a poor family in a deeply traditional society emerging from five decades of military dictatorship and heading into the hope and uncertainty of a new democracy.
But in early June 2013, when she was 2, Khin Phyu Zin developed diarrhea. The fluid pouring out of her was milky white, a symptom of cholera. Earnings from the food cart barely allowed the family to eat, so Daw Aung Kyi borrowed money for a taxi ride to a hospital 10 minutes away. She later sold the family’s most valuable assets — two gold rings — to pay for expenses related to care.
When Khin Phyu Zin started getting better, her family brought her home. But the diarrhea returned, and in late June 2013, several hours before daybreak, the toddler died in her mother’s arms, one hand splayed across the chest of her sleeping older sister.
“Nothing is more precious than a human life.”~Daw Aung Kyi
“We tried as much as we could to save that baby,” said Daw Aung Kyi, her long, round cheeks and plum-colored lips covered in tears. “Nothing is more precious than a human life.”
After the child died, a neighbor called the Free Funeral Service Society, a nonprofit group that arranges cremations for grieving families. One of the organization’s two baby hearses — white cars specially fitted with diminutive glass coffins — came to collect the child’s body, and the car’s red-and-blue police-style lights flashed as the vehicle trailed away.
The high rate of child death in Myanmar is among the most painful legacies left by the military dictatorship that ran the country from 1962 to 2011. During that time a corrupt and brutal junta shifted the country’s abundant resources to military spending and military industry rather than investing in a progressive health care system. In the years following World War II, Myanmar had the best health care system in Southeast Asia. Today, one in 15 children in Myanmar will not live to see his or her fifth birthday, according to UN data — the highest under-5 death rate the region. Between 56,000 and 70,000 children die here every year, largely of preventable causes.
Save the Children, which ranks the world’s countries in terms of best and worst places to be a mother, puts Myanmar at 152 of 176 countries, worse than Afghanistan, Sudan and India.
Representatives from international health organizations here use phrases like “total neglect” and “complete absence” to describe the military government’s role in promoting the well-being of the country’s citizens. As late as 2005, annual government spending on health care was just 376 kyat per person, about 38 cents in US dollars. Total health care spending — including government assistance, foreign aid, and individual payments — is still just $8 per person.
Many wealthy countries stopped donating to Myanmar during the five decades of military rule, saying that their efforts were being strangled by government restrictions on aid work, and that they were unwilling to funnel money to a government they believed would use it to repress its own people.
On a micro level, the deaths have had devastating effects on families. Days after the loss of baby Khin Phyu Zin, her mother moved to another town, leaving Daw Aung Kyi, already a widow, feeling abandoned by both her granddaughter and her daughter-in-law.
On a macro level, the devastating loss of young lives could cripple Myanmar’s economy just as it is emerging.
“All countries that suffer a high rate of child mortality have underdeveloped economies because of it,” explained Christopher Duggan, a professor at the Harvard School of Public Health who studies nutrition in resource-poor settings.
The government seems to realize this. In fiscal year 2012-2013, Myanmar dedicated about three percent of total expenditures to health care, up from one percent the year before. Large aid groups that were driven away by the previous government are returning.
And new ones are coming in.
Managed well, this injection of aid and turn in policy could dramatically reduce the number of child deaths in Myanmar. But the country’s dark and unique history means that many challenges lie ahead.