According to new estimates jointly released by the UNICEF, World Health Organization (WHO), Population Division of the United Nations Department of Economic and Social Affairs and World Bank Group, the number of global under-five deaths dropped to its lowest point on record in 2019 – down to 5.2 million from 12.5 million in 1990. However, since then, the COVID-19 pandemic has caused major disruptions in health services all around the world that could reverse decades of progress in the sector.

In a recent statement Henrietta Fore, UNICEF Executive Director, said: “When children are denied access to health services because the system is overrun, and when women are afraid to give birth at the hospital for fear of infection, they, too, may become casualties of COVID-19. Without urgent investments to re-start disrupted health systems and services, millions of children under five, especially newborns, could die.”

Over the past few decades, steady improvement in health services have gone a long way to prevent child death caused by low birth weight, complications during birth, pneumonia, diarrhea and malaria. However, the progress made so far is under threat from disruptions in the child and maternal healthcare system caused by resource constraints and a general uneasiness with using health services due to the fear of getting COVID-19.

A UNICEF survey conducted in 77 countries found that almost 68 per cent of countries reported at least some disruption in health checks for children and immunization services. In addition, 63 per cent of the countries surveyed reported disruptions in antenatal checkups and 59 per cent in post-natal care. On the other hand, the WHO has found out through a survey of 105 countries that 52 per cent of countries reported disruptions in health services for sick children and 51 per cent in services for the management of malnutrition.

Health interventions are important for stopping preventable newborn and child deaths. For example, women, who receive care by professional midwives trained according to international standards, are 16 per cent less likely to lose their baby and 24 per cent less likely to experience preterm birth, according to the WHO.

Based on the responses from countries that participated in the UNICEF and WHO surveys, the most commonly cited reasons for health service disruptions included parents avoiding health centers for fear of infection; transport restrictions; suspension or closure of services and facilities; fewer healthcare workers due to diversions or fear of infection due to shortages in personal protective equipment, such as masks and gloves; and greater financial difficulties.

According to the survey, Afghanistan, Bolivia, Cameroon, the Central African Republic, Libya, Madagascar, Pakistan, Sudan and Yemen are among the hardest hit countries. Seven of the nine countries had high child mortality rates of more than 50 deaths per 1,000 live births among children under five in 2019. In Afghanistan, where 1 in 17 children died before reaching age 5 in 2019, the Ministry of Health reported a significant reduction in visits to health facilities. Out of fear of contracting the virus, families are avoiding pre- and post-natal care, adding to the risk faced by pregnant women and newborn babies.

Even before COVID-19, newborns were at the highest risk. In 2019, a newborn baby died every 13 seconds. Moreover, 47 per cent of all under-five deaths occurred in the neonatal period, up from 40 per cent in 1990. With severe disruptions in essential health services, newborn babies could be at much higher risk of dying. For example, in Cameroon, where 1 out of every 38 newborns died in 2019, the UNICEF survey reported an estimated 75 per cent disruptions in services for essential newborn care, antenatal checkups, obstetric care and post-natal care.

The findings of various surveys emphasise the need for urgent action to restore and improve childbirth services and antenatal and postnatal care for mothers and babies, including having skilled health workers to care for them at birth. Working with parents to assuage their fears and reassure them is also important.

The infant mortality rate was very high in Pakistan until the early 1990s, at 86 deaths/1,000 live births. It has decreased 24 points and declined to 62 deaths/1,000 in the last three decades, but Pakistan is still in the group of countries with the highest infant mortality rate. The low status of women’s education, poor economic conditions and low level of using public healthcare services are closely tied to higher infant death rates in Pakistan. Experts say that health interventions in Pakistan should be designed to reach the most under-served—women and children—especially in rural areas.

Poverty and inequality in health is pervasive in Pakistan. The provisions and conditions of health are very dismal. Pakistan is in the bottom 5% of countries in the world in terms of spending on health and education. It is ranked the lowest in the world with sub-Saharan Africa in terms of child health equality.

According to the latest studies, children under 5 years of age in Pakistan account for about 16.34% of the total population, 11.76% (2.5 million) of whom suffer from diarrhea frequently. More than one-third of the households have no toilet in the house, and only 29% of the households are connected with pipe-borne drinking water. About 7.73% (1.6 million) children have never been immunized.

Child health issues in Pakistan are related to factors such as poverty, illiteracy, lack of knowledge, and awareness of child healthcare, inadequate provision of health services, and poor infrastructure. The World Health Organization recommends a minimum allocation of 5% GDP on healthcare, but Pakistan spends less than 1% on health, which is the lowest in South Asia. Unless we substantially increase budgetary allocations for health, we cannot save our children from the threats posed by various childhood diseases.