Thank you.
Good morning. I am very grateful for the opportunity to appear before your committee. I am sorry that I couldn't be in Ottawa in person.
I'll say a word about our centre as we start. I am the chair of global child health and policy at our Centre for Global Child Health at the Hospital for Sick Children. I am also one of the seven member experts in the independent Expert Review Group of the UN Secretary-General for monitoring the MDGs and chair of the countdown process for monitoring trends.
Let me speak generally in terms of the issues that your committee has set in front of itself and start with the whole discussion on the millennium goals. I'll try very hard not to repeat and underscore some of the important points made by the preceding speakers.
Ladies and gentlemen, the last decade has been a phenomenal decade in human history. When we started the millennium development goals journey in 2000, the world had set itself a huge target of reducing child mortality by two-thirds and maternal mortality by three-quarters from a 1990 base by the year 2015, the year we are in. As we approach September 2015, when many of these targets will be reviewed, I think the last decade has seen tremendous progress. Today, from a base figure of around 12.5 million child deaths in 1990, we have been able to bring those down to around 6 million deaths worldwide, and maternal deaths worldwide from about 580,000 to a figure of around 280,000.
That has been a remarkable success in many geographic areas, including in global awareness of the importance of this issue. But it has also come with the realization that perhaps the focus on survival and on reducing this burden of premature mortality over the last decade has also led to several gaps. Those gaps have been highlighted by several of the presentations you have heard today.
One of those gaps was a lack of focus on equity. We have recognized that the bulk of the global progress and change has been driven by progress in a handful of countries, the Brazils and Chinas of the world. If you look at inequity in maternal and child health and survival today in the world, there are many countries that are still far away from achieving those survival targets. I very strongly underscore the huge role Canada has played, and is playing, in ensuring that we keep our eye on that principal focus of reducing premature mortality in some of the poorest countries of the world.
There has also been the recognition that in our desire and quest to achieve these goals perhaps we have not paid equal attention to several aspects that are important in terms of your committee's task. One of those is not having adequate focus on the determinants, particularly the social determinants, of maternal and child health and survival.
As I speak, I am very cognizant of the fact that over the last decade and a half, because of a lack of targets, the survival of newborns and the reduction of stillbirths have been orphaned as global priorities. As we speak, of the six million children who die prematurely every year before reaching their fifth birthday, around half or 45% die within the newborn period—the first four weeks of life—and the vast majority of them within the first few days of life. As my colleague David Morley pointed out, many of these are a direct consequence of inadequate maternal nutrition and factors that sometimes transcend one pregnancy, and maybe even a generation.
There hasn't been enough focus on morbidity and consequences. As we move toward sustainable development goals and the important issue of trying to address human capital and human development, we haven't paid enough attention in the last several decades to the whole concept of morbidity, mental health, and the important issue of child and family development. These are extremely important when you consider some of the tasks you have set in front of yourselves.
I want to underscore the whole issue of adolescence, particularly adolescent girls but also adolescent boys. This has not been on the radar screen over the last 20 years or so while we have been focused on the development of the MDGs and the post-MDG process.
As we speak, it is a startling statistic that around 60 million births every year, around 11% on average—in some populations, it's close to around 20% of all births—are by adolescent girls. In some parts of the world, these also include a substantial number of pregnancies in girls under 15 years old.
There are not just socio-cultural factors that contribute towards child marriage in many communities. They also reflect the lack of attention towards gender empowerment, the ability of girls to be in schools, and ensuring that state systems provide equal opportunities to boys and girls in those environments.
When, yes, we move towards the whole issue of trafficking and protection, it is important to recognize this is also a very important issue. What do we need to do to address the global tragedy of early child marriage, of children having children, which has consequences across generations?
We now know, colleagues, that close to a fifth of all stunting in children at six months of age is determined by the nutritional status of the baby. The nutritional status of the baby in turn is closely dependent upon the nutritional status of the mother. The nutritional status of the mother in turn depends upon what she was like when she was a girl. If you just do the statistics, it turns out that for around a third of all small-for-gestational-age births worldwide—babies who were born less than five pounds in weight and are therefore exposed to a developmental trajectory that's very different from their normal counterparts—the root cause lies in the way we support young mothers, young girls, in opportunities for development and education.
This is also very closely intertwined with the issue of how societies protect girls and the issue that you're tackling around female genital mutilation. The stunning figure is that of the 125 million individuals who are victims of female genital mutilation in the world today, the vast majority, or close to 80%, are from the 29 African and Middle Eastern countries. In these countries, it is also recognized that close to a fifth, around 18% to 20%, of all these female genital mutilations are at the hands of health care professionals.
I would very strongly underscore what my colleagues have said around the importance of Canada engaging, in our support to these countries around maternal, newborn, and child health, on these important areas of child rights and child protection, and particularly in working with governments to ensure that there are opportunities provided for girls' education and for their fulfilling their complete potential for contributing to society.
I want to say a word or two about boys as well in terms of the important subjects around conflict, child-trafficking, and exposure to violence. Very few people are aware of the global statistic that around a third of all under-five deaths and maternal deaths worldwide are now in geographies that are affected directly or indirectly by conflict. In many of these countries, as you are aware, perhaps better than others, children are not only just being exposed to violence; children are being forced, conscripted, to become part of that violence themselves. You just need to see what is happening at the hands of ISIS in Syria, and in geographic areas like Nigeria and Somalia, to see how important this whole issue of child soldiers is. Most of them are forced to play a part in this.
I wrote a paper, given my work in Afghanistan some 15 years ago, talking about the children of war, talking about the potential consequences of children being exposed to nothing but violence as they were growing up. As David has said, some of the problems we face today are because a generation has grown up facing nothing but violence. I feel very strongly, although I come from a child survival and maternal survival background, that, as we move forward to the sustainable development goals, we keep our eye on the importance of child rights and protection. We need to ensure that these children bearing arms, these children being confronted with violence in many of these geographies, are protected. I feel that whatever mechanism we have at hand, be it through development assistance or be it through working with countries as we implement our Muskoka II initiatives, we can support this through mechanisms that are promotive, protective, and legislative.
Lastly, I want to say a word or two about school-aged children. I say that with the recognition that the global science and public policy community hasn't sufficiently addressed the issue of school-aged children in relation to their morbidity, mortality, exposure, and the importance of this particular group in helping them enter adolescence in optimal shape.
We have focused largely on under-five survival and under-five needs as an agenda. There hasn't been enough focus, in the very countries that have about a 95% burden of maternal and child mortality, on addressing the issue of what happens in schools to health, nutrition, and development of children. They are very closely intertwined.
I would like to thank you, ladies and gentlemen, for your attention and the opportunity to share this testimony with you. I would like to underscore the fact that social determinants of health, which are the living conditions in which many women, children, and families in these developing countries live, are a reality. As we move forward, we need to expand our repertoire of work to include social determinants of health, not just social determinants of survival.
Thank you.