6 Reduce child mortality
Where we are?
OVERALL PROGRESS TO DATE
Viet Nam has already achieved the targets for both under-five mortality and infant mortality, with both these rates being halved between 1990 and 2006. The infant mortality rate was reduced from 44.4 per 1,000 live births in 1990 to 14 in 2011 (MICS 2011). The under-five mortality rate has also been reduced considerably, from 58 per 1,000 live births in 1990 to 16 in 2011 (MICS 2011). The ratio of children under five who are underweight fell from 25.2 percent in 2005 to 18.9 percent in 2009.
Despite the achievements made, disparities are beginning to widen, mainly related to ethnicity, place of residence, household income and maternal education. For example, child mortality rates for ethnic minorities have increased between 2006 and 2011 and they remain 3.5 times higher than for the Kinh majority. Full immunization rates are 22 percent lower for children in the poorest quintile, than for children in the richest quintile, and this gap has increased.
The Government has identified several priorities within the overall health plan as well as the national target programmes on nutrition, immunization and population and reproductive health. These all identify inequity as an issue, with interventions targeted towards hard to reach populations, areas of high neonatal deaths and high rates of stunting.
Despite the remarkable progress achieved to date, the largest proportion of under-one mortality is neonatal mortality, which accounts for close to 70 percent of all deaths in children under one and 52 percent of all deaths in children under five (JAHR 2010). Studies reveal that disparities in neonatal mortality exist across regions and amongst different groups in the country. The death rate in mountainous rural areas is 2 to 2.5 times higher than in urban and plain rural ones.
Newborn survival is closely linked to maternal health and making motherhood safer is also critical to saving newborns. Given the widening disparity in neonatal mortality, it is important to strengthen the healthcare system, especially at community level and ensure sufficient investment for scaling up essential newborn interventions for ethnic minority mothers and children in hard-to-reach areas. Many women in rural mountainous areas do not have access to basic health services, including pregnancy checkups, delivery support, post-natal care, vaccinations and access to routine care and treatment.
The increasing role of the private sector in health service provision, and its possible impact on inequity in health access and outcomes, also requires attention. In addition, the fact that not all newborns are registered immediately after their birth contributes to the lack of accurate data. More than half of those infants who die before one month of age are unregistered.
There has been a substantial decline in underweight children and a notable reduction in stunting (low height for age) at the national level over the last ten years. However, the stunting prevalence of nearly 30 percent (affecting about 2.1 million children under five) is still very high for a middle-income country1. Stunting is caused by long-term insufficient nutrient intake and frequent infections. The effects of stunting include delayed motor development, impaired cognitive function and poor school performance.
The latest National Nutrition Survey has revealed emerging disparities in relation to socio-economic status and among provinces and ethnic groups. The level of stunting was approximately three times higher amongst children from the poorest households, compared to children from the wealthiest households. The stunting prevalence is above 40 percent in Lao Cai and Kon Tum provinces, compared to less than eight percent in Ho Chi Minh, and over 50 percent in H’Mong, Ba Na and Gia Rai ethnic minority groups, compared to 23 percent in Kinh children.
The new National Nutrition Strategy for 2011-2020 recognises the need to focus on reducing stunting and intensifying interventions which address stunting before birth and during the first two years of a child’s life.
Improved coordination among sectors and ministries in their response to stunting is also needed, as well as greater budget allocations to preventive health care and for better routine data collection. Finally, the coverage, quality and relevance of other basic social and health services throughout the country, especially in remote mountainous areas, are also crucial to address.
The 8 Millennium Development Goals
- 1 Eradicate extreme hunger and poverty
- 2 Achieve universal primary education
- 3 Promote gender equality and empower women
- 4 Reduce child mortality
- 5 Improve maternal health
- 6 Combat HIV/AIDS, malaria and other diseases
- 7 Ensure environmental sustainability
- 8 Develop a global partnership for development
Targets for MDG4
- Reduce by two thirds the mortality rate among children under five
- Under-five mortality rate
- Infant mortality rate
- Proportion of 1 year-old children immunised against measles