Shaoni Bhattacharya, consultant
A 13-year-old girl, Aissata Konate, a few days after getting married to 32-year-old Ely Barry in Gbon, Ivory Coast (Image: Carol Guzy/The Washington Post/Getty)
If governments could pass a simple law that would save the lives of millions of infants, they’d do it, right? And if a policy or constitution could transform the lives of women by sparing them the poor health or despair that they inevitably pass on to their children through sickness, disability, and even death, surely they would get working?
But no.
A new book, the first of its kind, together with the extensive report underpinning it, shows just how far the world has to go - even (or perhaps, especially) rich countries like the US.
Children’s Chances: How countries can move from surviving to thriving by Jody Heymann with Kristen McNeill was launched (with the accompanying report) in London last week. It aims to provide an armoury of deeply disturbing data with which to hold to account the world’s passive politicians.
It is a culmination of years of work led by Heymann, who is director of the World Policy Analysis Center and dean of the University of California, Los Angeles, Fielding School of Public Health.
She and her colleagues have sifted through (quite literally sometimes) boxes piled with paper and reams of information from organisations like UNESCO to provide the first global comparison of laws and public policies in 191 countries covering poverty, discrimination, education, health, child labour, child marriage and parental care options.
Laws really matter, found Heymann and her colleagues. Laws covering what look to be family or cultural decisions such as early child marriage or education are important because these issues determine whether a child survives or thrives.
When girls marry young, for example, they tend to drop out of school earlier and have poorer health, and, in turn, their children have poorer health.
At the book’s launch at the Royal Society in London Heymann said that sometimes just having a law can help: “What surprised me is that many people had said, 'What if policies are not fully implemented?' In fact many of these policies are so powerful that it is enough [to make a difference].”
The book, report and website aim to make the crucial information Heymann and her colleagues have gathered accessible to ordinary citizens, non-governmental organisations and policy-makers.
It’s readable, and given the Herculean task the authors had bringing it all together, makes clear sense of what they found with online maps providing a wealth of revealing information never before available, at a keystroke.
But I can’t help feeling that they are missing a trick. The tone of the book may be assertive, but it is not as forceful as its material - just too polite.
Why beat about the bush when children’s lives, health and future are at risk? Name and shame, I say. This book has the moral high ground, and scientific rigour, to do so. And it should.
At the launch, the US was rightly described as a “laggard”, but it is only by trawling through the maps that it becomes clear just how far behind it is for a rich nation.
What, for example, does the US have in common with Papua New Guinea, Liberia and Tonga?
These are three of only eight countries in the world with no guaranteed paid maternity leave. As for paternity leave, paid parental leave for sick children - forget it.
And there isn’t even protection against early child marriage. The US is right up there with Sudan and Iran, with no legal minimum age for marriage for girls or boys.
This was shocking, but the authors don’t go into surprises like this. Surely we should be told what the lack of such a law does to a developed nation like the US? Does anyone actually get married very young? If so, how young, and how common is it?
But we do know that lack of maternity leave makes a huge difference. Globally every 10-week increase in paid maternity is associated with a 10 per cent drop of newborn deaths, infant deaths and under-5 mortality rates. Staggering.
The reasons are simple. Off work, mothers are more likely to breastfeed and take their babies to be vaccinated.
Even in the US, infant mortality rates are not good for a developed nation. And recent studies show the country’s health generally is not as robust as it could be.
There are plenty of other surprises.
What does Laos do for its children that the UK doesn’t? Astonishingly, it is one of five countries in the world with father-specific paid paternity leave of over four weeks. The others are Iceland, Norway, Slovenia and Sweden.
Luxury? No. Paternity leave matters and when it's specifically allocated to men, dads are more likely to take it. Studies show that fathers who take paternity leave when it is available are much more involved with care of their children, even after a pre-existing commitment to mother and child is controlled for.
And where fathers are involved, new mothers are less likely to get depressed - and maternal depression has strong knock-on effects on children.
Then again, what makes one of the poorest African nations a better place to be a child than its neighbours? Madagascar has policies for children and families that are more progressive than many western nations, and this has paid off because its infant and child mortality rates are among the lowest in sub-Saharan Africa.
Sadly, the most powerful of the emerging economies - India and China - fare worse than many very poor countries in terms of children’s chances and healthcare.
The authors want this to be a call for action. But they need to shout louder. While they do quote the numbers of countries opting out of child-friendly policies or laws in their report, they should name the countries - and give them a report card. And likewise hail the countries (especially the poor ones) doing right by their kids.
The book does try quite hard in some ways, detailing heart-rending case studies of kids so hungry that they fall asleep at school, 9-year-olds rising at 4 am to help their parents set up street vegetable stalls before going to school, or parents who can’t take seriously ill kids to the doctor because they risk losing their jobs if they take time off…
The good news is that governments can move mountains if they find the will: saving the lives of millions of children worldwide is surely easy compared with finding a cure for AIDS or cancer?
Heymann and colleagues should be commended for their meticulous and arduous work. Let’s hope citizens, NGOs and movers and shakers pick up this report and wield it forcefully in the faces of governments.
Book information:
Children’s Chances: How countries can move from surviving to thriving by Jody Heymann
with Kristen McNeill
Harvard University Press
$45/£33.95
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