CHILDREN'S HUMAN RIGHTS PROGRAM
Global Child Survival: A Human Rights Priority
V. Case Study: Mexico

Executive Summary

Despite the exceptional progress since the 1960s, Mexico still faces major challenges in improving the survival and health of its children. Each year an estimated 158,000 Mexican children die from avoidable childhood diseases before reaching age five. Today, glaring disparities in child health persist among different population groups. Modernization and economic prosperity in Mexico has not been accompanied by equitable social development. Instead, the extended period of economic growth has led to widening levels of regional, class, and ethnic differentials in health and socioeconomic well-being. Improvements in national levels of income, social well-being, and child survival tend to mask underlying inequities that persist between those who bear the disproportionate burdens of illness and mortality and the population at large. Rural, poor, and indigenous children often lack access to basic infrastructure and to health and social services; they have lower literacy levels, higher incidence of poverty, and higher mortality rates than do their wealthier urban counterparts.

Mexicos child mortality rate has shown a steady downward trend since the 1960s. According Mexican government statistics, the mortality rate of children under five years of age declined to 27 deaths per 1,000 live births by 1995, as compared to 148 deaths per 1,000 births of thirty-five years prior. During this period of decline in child mortality, the national economy experienced dramatic growth and survived major disruptions. Economic growth has been accompanied by general improvements in social conditions associated with child survival. UNICEF has noted that, "[o]ver the past 50 years children in Latin America have benefited from two major advantages compared to those in other regions: better educated parents, especially mothers, and a high degree of urbanization." Mexico is no exception.

During the 1940 to 1970 period, rapid growth of the Mexican economy led to the transformation of an essentially rural, agrarian society to an industrial nation, leading to growing urbanization and the emergence of a middle-class. Social conditions within the modernizing Mexican State improved generally as greater resources were allocated to health, education and other basic services. Today, three quarters of all Mexicans are urbanized. The Mexican government reports that immunization coverage now exceeds UNICEFs year 2000 goal of 90 percent overall; the adult literacy rate is close to 90 percent, and 98 percent of primary school age girls are in school. Total fertility has dropped steeply from a high rate of 6.8 in 1960 to 3.0 today. All of these factors are important antecedents for improving child survival.

Yet, the overarching challenge to child survival in Mexico today is to extend the remarkable gains of the last several decades to all segments of society in all regions, especially to the rural, poor, and indigenous populations. The continuing cycle of poverty, hunger and childhood diseases remains an imposing barrier to further reducing mortality among disadvantaged children. However, progress can be made in ameliorating current disparities if equitable social development accompanies economic growth. A national effort to abate the levels of poverty, especially in rural areas and among peasant and indigenous populations, would help to create conditions in which Mexican children can survive and experience a healthy childhood. The Government of Mexico must recognize the crucial interconnection between social development and the health and welfare of its children, and make poverty reduction a national development priority. These goals must be effectively transformed into constructive actions addressing the marginalized populations. A genuine political commitment to comprehensively addressing the biological, behavioral, and socioeconomic factors affecting child survival would bring about positive change in the survival and welfare of all Mexican children.

Findings of this case study

• Mexico has made significant progress in reducing overall child mortality, but disparities in child survival are increasing between urban and predominantly rural areas. Socio-economic inequities make children who are in Mexicos poor and rural areas, and those who are indigenous, more vulnerable to preventable deaths before reaching age five than children in urban centers:

·         Mexican children in the poorest states (rural with large indigenous populations) die at twice the rate of children in the wealthiest states.

·         Sixty percent of reported maternal deaths occurred in rural areas, contributing to higher numbers of prenatal deaths in these regions.

·         Preventable childhood diseases still cause the majority of under-five child deaths, especially for children from impoverished rural states.

·         Malnutrition levels in the southern poverty belt are four times greater than those in the wealthier urbanized states. Infant and child death rates due to nutritional deficiencies have increased by 23 percent since 1980.

·         Close to 14 million Mexicans live in conditions of extreme poverty, unable to meet their daily nutritional needs; two-thirds of these people reside outside the urban areas.

·         The incidence of poverty among indigenous people is 81 percent, compared with 18 percent among non-indigenous people.

• Persistent socioeconomic inequities are exacerbated by economic and structural adjustment policies. Government economic policies have been biased toward urban centers at the expense of marginalized areas. In the past decade, the Mexican government has systematically pursued austerity and structural adjustment programs in accordance with World Bank and IMF specifications. The process has aggravated inequities in socioeconomic development between urban and rural areas. Under the structural adjustment programs, the Mexican government has considered poverty and disparity as by-products of the countrys economic development, rather than as violations of economic, social, and cultural rights. As a result, issues such as child mortality are treated as inevitable rather than preventable.

• The Mexican governments response to preventable child mortality in marginalized areas remains inadequate, in law and practice. Mexicos domestic laws, institutions, and administrative programs embrace the discourse of the Alma-Ata primary health care approach, but in practice they create social dependency rather than social empowerment. Government programs to address child mortality are framed in terms of short-term poverty alleviation or social assistance rather than long-term investments, solutions and priorities. Health and social programs are often politicized and do not adequately address the disparity in child survival nor the underlying socioeconomic conditions which threaten the health and survival of children.

• Although the Mexican government has ratified or adopted international instruments relevant to child health and survival, Mexico has not effectively complied with its international obligations for right to life, health, and non-discrimination. The continued and increasing socioeconomic and child survival disparities constitute a discriminatory impact in marginalized communities in violation of international law.

Recommendations

• Comply with all human rights obligations under treaties and instruments to which Mexico is a party.

• Promote and protect childrens rights, in particular rights related to child health and survival, through adequate programs and funding.

• Combat preventable childhood deaths and diseases among all segments of the population as a national health priority to which the maximum available resources must be allocated.

• Adopt a cohesive strategy for child health and survival which promotes long-term investments and solutions to alleviate underlying socioeconomic disparities in marginalized areas, including:

·         poverty: reorient socioeconomic development policies to redress the devastating impacts in rural and poor communities resulting from World Bank/IMF austerity programs, and government biases and "reforms";

·         malnutrition: establish equitable food policies which promote self-sufficiency through food production and livable wages rather than dependency on micronutrient/food supplementation subsidies;

·         lack of clean water, basic sanitation, and safe housing: improve environmental conditions to prevent childhood diseases resulting from unsafe housing and water, and lack of basic sanitation systems; and

·         lack of health and social services: ensure affordable, accessible, and quality health and social services, especially for women and children, which take into account the socioeconomic and cultural concerns of marginalized, particularly indigenous, populations.

• Observe the Alma-Ata principles of primary health care by ensuring equity, universality, community participation, and intersectoral collaboration in health policies and programs. All segments of the population must be enabled to define and guide their own well-being.

• Improve the productive life and health of women, particularly rural women, as well as the welfare of their children and families.

• Target resources to poor and rural communities, and implement urgent measures to ensure balanced and equitable economic growth in both urban and rural areas.

• Correct inconsistencies in child health data, with particular attention to issues of validity and reliability, and utilize disaggregated indicators for vulnerable populations.

• Consult nongovernmental organizations and consider their information and recommendations in health policies and programs.