Children in an urban world

Summary of report¹

The experience of childhood is increasingly urban. Over half the world’s people - including more than a billion children - now live in cities and towns. The UNICEF State of the World’s Children reference guide presents the most recent key statistics on child survival, development and protection for the world’s countries, territories and regions in a single volume on an annual basis. The 2012 edition has sought to shed light on the experience of children and young people in urban areas, especially the poorest and most marginalised. This report focuses mainly on those children in urban settings all over the world who face a particularly complex set of challenges to their development and the fulfilment of their rights.

In 2011, for the first time, The State of the World’s Children 2011 included tables on Adolescents and Equity, the latter focusing on disparities by household wealth. The State of the World’s Children 2012 adds a second table on Equity, focusing on urban-rural disparities. This new table (Table 12 of the report) provides urban, rural and urban:rural ratio data for the following indicators - birth registration, skilled attendant at birth, underweight prevalence in children under 5 years, under-fives with diarrhoea receiving oral rehydration solution (ORS) and continued feeding, primary school net attendance ratio, comprehensive knowledge of HIV (females 15-24y), and % population using improved sanitation facilities. Table 6 of the report includes % population urbanised and average annual growth rate of the urban population.

The report highlights a key challenge to assessing children’s wellbeing in urban settings is the lack of disaggregated data. In rural v urban comparisons, urban results tend to be better, whether in terms of the proportion of children reaching their first or fifth birthday, going to school or gaining access to improved sanitation. But these comparisons rest on aggregate figures in which the hardships endured by poorer urban children are obscured by the wealth of communities elsewhere in the city. Where detailed urban data are available, they reveal wide disparities in children’s rates of survival, nutritional status and education resulting from unequal access to services. Gathering accessible, accurate and disaggregated data is an essential step in the process of recognising and improving the situation of children in urban areas.

The report considers in particular the rights of children to shelter, health, nutrition, water, sanitation and hygiene, education and protection. Issues raised include:

Inadequate living conditions are among the most pervasive violations of children’s rights. The lack of decent and secure housing and such infrastructure as water and sanitation systems makes it so much more difficult for children to survive and thrive. Yet, the attention devoted to improving living conditions has not matched the scope and severity of the problem. Evidence suggests that more children want for shelter and sanitation than are deprived of food, education and health care, and that the poor sanitation, lack of ventilation, overcrowding and inadequate natural light common in the homes of the urban poor are responsible for chronic ailments among their children.

The locus of poverty and undernutrition among children appears to be gradually shifting from rural to urban areas, as the number of the poor and undernourished increases more quickly in urban than in rural areas. However, even the apparently well fed - those who receive sufficient calories to fuel their daily activities - can suffer the ‘hidden hunger’ of micronutrient malnutrition: deficiencies of such essentials as vitamin A, iron or zinc from fruits, vegetables, fish or meat. In a number of countries, stunting is equally prevalent, or more so, among the poorest children in urban areas as among comparably disadvantaged children in the countryside.

Nearly 8 million children died in 2010 before reaching the age of 5, largely due to pneumonia, diarrhoea and birth complications. Some studies show that children living in informal urban settlements are particularly vulnerable. High urban child mortality rates tend to be seen in places where significant concentrations of extreme poverty combine with inadequate services, as in slums. For example, around two thirds of the population of Nairobi, Kenya, lives in crowded informal settlements, with an alarming under-five mortality rate of 151 per thousand live births. Pneumonia and diarrhoeal disease are among the leading causes of death. Poor water supply and sanitation, the use of hazardous cooking fuels in badly ventilated spaces, overcrowding and the need to pay for health services - which effectively puts them out of reach for the poor - are among the major underlying causes of these under-five deaths.

Urban settings provide proximity to maternity and obstetric emergency services but, yet again, access and use are lower in poorer quarters - not least because health facilities and skilled birth attendants are in shorter supply. The report includes a case study of good practice around maternal and child health services for the urban poor from Nairobi, Kenya.

There is some evidence that urban mothers are less likely than rural ones to breastfeed and more likely to wean their children early if they do begin. An analysis of Demographic and Health Survey (DHS) data from 35 countries found that the percentage of children who were breastfed was lower in urban areas. Low rates of breastfeeding may be attributed in part to a lack of knowledge about the importance of the practice and to the reality that poor women in urban settings who work outside the home are often unable to breastfeed.

Around 2.5 million under-five deaths are averted annually by immunisation against diphtheria, pertussis and tetanus (DPT) and measles. Global vaccination coverage is improving but more needs to be done. Lower levels of immunisation contribute to more frequent outbreaks of vaccinepreventable diseases in urban communities that are already vulnerable owing to high population density and a continuous influx of new infectious agents. Poor service delivery, parents who have low levels of education, and lack of information about immunisation are major reasons for low coverage among children in slums as diverse as those of western Uttar Pradesh, India, and Nairobi, Kenya.

Urban life can also have a negative effect on the mental health of children and adolescents, particularly if they live in poor areas and are exposed to the dangers of violence and substance abuse. Disrupted and poor access to education by children, protection issues (risk of trafficking, child labour, and living and working on the streets) add to risks. Migrant children are often on the periphery of service access and 1 in 5 moves to an urban settlement without a parent.

When emergencies occur in marginalised urban areas, children are among the most susceptible to injury and death. Over three quarters of casualties in recent decades have been children in sub-Saharan Africa or South Asia. Droughts, flooding and post-disaster conditions all intensify pre-existing risks. Information on slum communities is often inadequate, outdated or non-existent, making it difficult to locate the most vulnerable and those in greatest need. There are examples of successful practices in community identification from Nairobi and the Philippines.

In poor urban areas, failures in development contribute to disasters, and disasters, in turn, undo or undermine development gains - deepening poverty and further widening the social and health gaps separating poor from rich. Routine, smallscale calamities in many settlements result from poor governance, planning and management, and often indicate vulnerability to much larger disasters. Existing poor health and nutrition can increase disaster risk for children, hamper recovery and, if not addressed in the emergency response, leave children more vulnerable to future shocks. When disaster strikes, supportive environments critical to children’s well-being may break down. Families may remain in emergency camps for extended periods, and these dysfunctional environments can become the only home children know during their formative years.

Access the full report, associated video content and individual statistic tables at: http://www.unicef.org/sowc2012

¹The State of the World’s Children 2012. Children in an Urban World