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Special Theme: Develop a Child

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Status of Children in the Region

Health and nutrition

Over the last 40 years, the health of children in Asia and the Pacific has improved. Infant and under-five mortality rates have been more than halved, in line with global trends. East Asia and the Pacific witnessed the most rapid improvement. Throughout the region, access to potable water supplies has improved and the urban-rural gap has narrowed. The health and nutrition of preschoolers has changed for the better as well, although progress has been uneven across the region. For example, in Bangladesh and Central Asia, average child size actually fell in the 1990s. Also, while life expectancy for today's newborn in South Asia is more than 10 years longer than a child born in the 1960s, it is seven years less than for new-borns in East Asia and the Pacific. Infant and under-five mortality rates in South Asia, except for Sri Lanka, are among the highest in the world. Sanitation is also a problem in South Asia, with only one third of the total population—one fifth of the rural population—having access to adequate sanitation facilities.

Micronutrient deficiencies cause death and disability among the region’s children. Vitamin A deficiency is implicated in a substantial proportion of maternal and under-five deaths. Major supplement programs are in place to raise vitamin A status in the region; but in South Asia, only one child in four actually receives them.

Iodine deficiency disorders are the leading cause of mental disability in the world. Iodized salt is the cost-effective solution. The Universal Salt Iodization initiative, led by the United Nations Children’s Fund (UNICEF), increased the percentage of the world’s households using iodized salt from one fourth to over two thirds in the late 1990s; but a billion Asians still do not use iodized salt and lack sufficient iodine in their diets. In Bangladesh and Central Asia, palpable goiter is endemic. This means the average child is deprived of 13–14 intelligence quotient (IQ) points that can never be recovered. The solutions are to improve iodine nutrition for pregnant women so that the embryo’s brain development does not suffer, and ensure adequate iodine in early infant feeding that complements breastfeeding.

Anemia, a form of iron deficiency, is the most prevalent nutritional problem in the world. In Asia, more than a billion people are iron-deficient. In South Asia, 9 out of 10 pregnant women are anemic⁴ and at higher risk of dying during pregnancy. An ADB study showed that at least 65,000 anemic pregnant women die each year in low-income Asia. For about half of Asia’s infants and school-age children, anemia leads to poor motor skills and delayed speech and reading. A regional initiative to reduce anemia is urgently needed (Box 4).

Education

Nearly 90 percent of East and Southeast Asian children and almost 70 percent of South Asia’s children are now enrolled in primary school. Yet, more than 30 million children between the ages of 6 and 11—the majority girls—are not enrolled. Most are from families with uneducated parents, live in remote areas, come from ethnic minority groups, live in urban slums, or are from families that are displaced.

Children—especially poor children in remote areas— often have to walk long distances to school. For the young or undernourished, the effort can become too great. Children who are ill, tired, or hungry have limited attention spans and are unlikely to benefit from school. Those whose mother tongue is a minority language face even more difficulties. These children often drop out of school.

Children also drop out of school because their parents cannot afford to pay for transportation, school supplies, or uniforms, or because their labor may be needed at home or they have to contribute to the family’s income. Most children drop out within the first two grades. Most dropouts are girls, often because of the perception that there is less value in educating daughters. In the Philippines, only 70 of every 100 children who enter Grade 1 finish primary school; in Bangladesh, the number falls to 65 out of 100; and in Cambodia to 45 out of 100. Children from low-income groups in Indonesia are much less likely to attend lower secondary school than other children.

There is sometimes a misconception among the poor that attending school brings little benefit. It is difficult to dispel this notion when the schooling provided is inadequate and fails to meet minimum standards, or the schools are under-resourced and badly managed. And this is often the case. Many children in the region complete their basic education without mastering the skills needed to participate effectively in society. (Few of the region’s schools teach even the rudiments of computer literacy, and still fewer are connected to the Internet.) Poor education usually results from insufficient teacher training, overcrowded and ill-equipped classrooms, badly designed curricula, inadequate instructional materials, and defective facilities.

Early childhood development (ECD) projects focus on mothers and children (normally from birth through eight years) and aim to ensure that children achieve adequate health and nutrition as well as mental stimulation and preparation for learning (Box 5). ECD activities—nutritional supplement and education, essential child health services, and psychosocial and cognitive stimulation—are cost-effective ways of reducing dropout rates and improving learning and achievement. Yet, only a small percentage of young children benefit from ECD, mostly from middle- and upper-income groups. Investing in the needs of very young children, especially children of the poor, is an effective strategy for enhancing their capacity to learn and benefit from schooling. ADB is increasingly supporting ECD.

Environment

In the early stages of Western industrialization, children carried canaries in cages down mine shafts to alert adult workers of odorless gases seeping through rock fissures. When the canary died, the workers ran. In many ways, children are the sacrificial canaries of industrializing Asia, mute victims of an increasingly polluted environment. Respiratory infections and mental impairment are ever more common. With Asia’s urbanization continuing apace, the impact of pollution on the health and cognitive development of children will get worse.

In cities and towns throughout Asia, lead pollutes the air and takes the vibrancy from children’s brains and limbs. Children working in some areas of the People’s Republic of China have been found to have blood lead levels far in excess of levels considered injurious in some countries, with the consequent risk to intelligence and growth. Before an ADB-financed project to improve Metro Manila's air quality led to a ban on leaded gas in the Philippines, the average child in Manila was at risk of developing with nearly five IQ points less than a child raised in a nonlead environment.

In many Asian cities, children are employed as dumpsite scavengers, a job that exposes them to toxic wastes and increases their risk of infection. Other children face the even more widely damaging effects of poor sanitation and unhealthy water. These children are often physically stunted and mentally dulled. They enter school later and retain what they are taught at a lower rate than children who meet their genetic potential.

In rural environments, pesticide runoff into water tables damages immature respiratory and pulmonary functions in children, with disabling effects in later life. And in both rural and urban areas, water is often polluted by untreated sewage, chemical discharges, spilled toxic materials, salt from irrigation schemes, and atmospheric pollutants dissolved in rainwater.⁵

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