Parental and Medical Negligence

According to the United Nations Children’s Emergency Fund (UNICEF), one in twelve children in the world dies before the age of five. A recently released UNICEF report says that in most countries that have been called upon to reduce child mortality this rate remains unchanged or is rising. African nations account for a large percentage of child mortalities, while a record low rate has been registered in Switzerland, where child mortality is below three children per one thousand newborns. In neighboring Russia this rate is twenty-one per one thousand. What is the situation in Ukraine, and how much truth is there to official statistics?

Experts claim that child mortality is closely monitored in Ukraine. Its dynamics reflect the dynamics of the nation’s socioeconomic development. Overall, a positive trend is discernible in Ukraine, where child mortality is declining. It should be noted, however, that the Ukrainian system of measuring child mortality differs significantly from the international system. Whereas the World Health Organization (WHO) measures child mortality as the number of children who die before the age of five per 1,000 newborns, it is impossible to analyze the death rate among Ukrainian children before age five, as Ukraine began measuring this rate only in 2000. Moreover, our experts register only those first-year infant deaths in which a stillborn or dead child lived no less than twenty-eight weeks in the mother’s womb and weighed over one kilogram. Meanwhile, according to WHO standards, which Ukraine formally accepted a decade ago, infant deaths must be registered if they occurred in the twenty- second week of pregnancy and if the child weighed more than 500 grams. Because of the differing estimation methods Ukraine has a comparatively low infant mortality rate — on a par with Japan and the US. According to Olena Sherstiuk, coordinator of a UNICEF-integrated program for infant development, opinions differ as to the actual child mortality rate in Ukraine by international standards, but overall they are 10% to 30% higher than the figures quoted today. “It is unethical to compare the child mortality rate in Ukraine with mortality rates in other countries, which use completely different estimation criteria,” she said.

Ukraine recorded the highest first-year infant mortality rate of 14.9% in 1993. Ten years later this rate was 9.7%. Ukraine’s mortality rate among children under five is among the lowest in the post-Soviet space (nineteen deaths per one thousand liveborn infants), but significantly exceeds the mortality rates in the developed countries of Europe, in Japan, and the US. As for the death rate among children under fourteen years of age, in the years of Ukraine’s independence it has declined by 33%. Meanwhile, the number of children who died at age fifteen and seventeen declined by 17% and 12%, respectively.

The WHO’s analysis of the first-year infant mortality structure showed that most deaths could be prevented “at the household level.” For example, in 2003 15% of infants died at home, i.e., in those cases when parents did not call emergency services, or did so when it was too late. This is mostly true of rural residents. Statistically, children under fourteen years of age are one and a half times more likely to die in the countryside than their urban peers. According to a survey conducted in four regions by the Family and Youth Institute under the auspices of UNICEF, fewer than 28% of parents understand the importance of regular medical examinations, while only 68% of those polled are familiar with the norms of children’s physical development.

Yet parental negligence is only one of the causes of child mortality. Another cause is doctors’ official attitude toward children’s health. Research suggests that cases of wrong diagnoses and inadequate treatment are widespread. According to Olena Sherstiuk, some medical practices should be abandoned. For example, a decade ago staphylococcus infection was omnipresent in maternity homes, transmitted via feeding bottles. Today, doctors who have refused to use bottles in favor of breastfeeding have eradicated staphylococcus. “Child disease equals child mortality,” she says. Maternity homes have yet to undergo a revolution, primarily in the personnel’s attitude toward mothers and children.

Within the general structure of first-year infant mortality endogenous, or internal causes, which largely depend on the expectant mother’s health, account for two-thirds, or 68%, of all deaths, while 17.4% of deaths are caused by exogenous, or external causes, which can be prevented in most cases. Among the causes of death among children under fourteen years of age, accidents, injuries, and poisonings top the list at 24%, followed by diseases of the nervous system, sensory organs, and malignant tumors. Meanwhile, accidents, injuries, and poisonings account for 66% of teenage deaths.