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Summary: Despite the exceptional progress since
the 1960s, Mexico still faces major
challenges in improving the survival
and health of its children. 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 highe
r mortality rates than do their wealthier urban counterparts.
Mexico's 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 UNICEF's 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
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 margi
nalized 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 Mexico's 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
Sixty percent of reported maternal deaths occurred in rural areas,
contributing to higher numbers of perinatal 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
country's 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 government's response to preventable child mortality in
marginalized areas remains inadequate, in law and practice. Mexico's
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
Comply with all human rights obligations under treaties and
instruments to which Mexico is a party.
Promote and protect children's 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
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.