Why are girls still dying unnecessarily? The need to address gender inequity in child health in the post-2015 development agenda.

Abstract

The 40–year anniversary of the United Nations ‘International Women’s Day,’ was celebrated on 8 March 2015. As we approach the end of the Millennium Development Goals (MDGs), we reflect on the gender debate that has arose amidst tackling MDG4 and highlight the need for greater gender equality in measuring child health outcomes in the post–MDG era in line with MDG 3 (see Box 1). Box 1 Summary of Millennium Development Goals 3 and 4 Goal 3: Promote gender equality and empower women Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015 3.1 Ratios of girls to boys in primary, secondary and tertiary education 3.2 Share of women in wage employment in the non–agricultural sector 3.3 Proportion of seats held by women in national parliament Goal 4: Reduce child mortality rates Reduce by two–thirds, between 1990 and 2015, the under–five mortality rate 4.1 Under–five mortality rate 4.2 Infant mortality rate 4.3 Proportion of 1 year–old children immunised against measles NEED TO PROFILE GENDER AS A DETERMINANT OF CHILD HEALTH INEQUITY In recent years, several key UN reports and articles have begun to articulate the gender gap that exists in child health outcomes [1–3]. Indeed, it has been the UN which has taken a lead in promoting gender equality internationally by requiring all UN entities to mainstream gender and promote gender equality as mandated by the Beijing Platform for Action (1995) and ECOSOC resolutions 1996, 1997, 2006 and consolidated by the quadrennial comprehensive policy review 2012 (General Assembly Resolution 67/226). According to the 2012 World Development Report, gender equality is at the heart of development and “…too many girls and women are still dying in childhood and in the reproductive ages” [4]. Perhaps it is a reflection on the relative success of MDG 3 and 4 (despite it not being likely that the numerical targets will be achieved in time) that it has helped to raise the issue of gender in child health and the need for more equitable goals in the future. Leading international organisations have developed organisation specific gender action plans, policies or guidelines in the past two decades in order to tackle gender imbalance issues in its organisational activities (see Box 2). Box 2 Organisations identified through a Google Scholar search of ‘gender’ or ‘sex’ and ‘policy’ or ‘guideline’ or ‘framework’ African Development Bank Asian Development Bank Bill and Melinda Gates Foundation Council of Europe Department for International Development (DFID) European Union Global Alliance for Vaccines and Immunisation (GAVI) Global Fund The International Federation of Red Cross and Red Crescent Societies (IFRC) Organisation for Economic Co–operation and Development (OECD) Save the Children The United Nations Children's Fund (UNICEF) World Bank World Health Organisation (WHO) The authors congratulate recent efforts to collect gender disaggregated child health outcomes data by Inter-Agency Group for Child Mortality Estimation (IGME) and Countdown 2015 as the first step to enable the profiling of gender as a determinant of child health inequity. Nevertheless, if gender is to be mainstreamed as a determinant of child health, future country achievement profiles should require nations to highlight sex disparities in coverage of life saving interventions, especially in countries where girls are known to be subject to discrimination in health care access and outcomes. In other words, it should become the norm, rather than the exception, to report sex–differentiated data for child health indicators. In addition, reporting health interventions which have been proven to reduce maternal, newborn and child mortality rates by gender would prove valuable to better realign services and make targeted policy steps. In response to the challenge of collecting better gender data and developing an effective response, we discuss some of the challenges reported in the literature of researching gender and child health and their potential solutions. We also look briefly at the example of India; one country in which there is evidence of severe discrimination against girls in child health care outcomes, to provide a perspective of the challenge that remains ahead.