What to do about infant mortality in Africa?

While infant mortality is declining worldwide, progress in this area still lefts much to be desired, and particularly in Africa. According to the latest joint report by UNICEF, the World Health Organization, the United Nations Population Division and the World Bank, another 6.3 million children died worldwide last year, nearly half of them in Sub-Saharan Africa. This figure should be compared with the 14.3 million child deaths recorded worldwide in 1990 but it only highlights the fact that Africa did not progress much. It reflects the shortcomings that still exist in terms of access to emergency care, to difficult maternity units, to basic medicines and also in terms of compliance with basic hygiene rules.

It is worth noting that in the same period, global GDP in purchasing power parity (in constant 2011 dollars) increased from $47.199 billion to $112.261 billion, representing a 2.37-fold increase in global wealth in 28 years. The correlation between rising living standards and falling infant mortality is a two-way street. Lower infant mortality results in a larger working population and increased national production. This good result also reflects a consistent application of measures to improve people’s living comfort, and is explained in particular by a well-managed demographic transition.

Indeed, there is empirically a higher infant mortality rate in societies with more children, because it stretches sparse financial and medical resources, resulting in less resources for each child. For the same income, the concentration of resources on a smaller number of children allows for more effective care and greater chances for each child to reach adulthood in good conditions. But the key factor in the demographic transition has always been an increase in  living standards, not a controlled reduction in the birth rate, even in China.

In Sub-Saharan Africa, where a vast majority of the population remains dependent on non-mechanized field work – up to 70% – the number of children closely matches the productivity of the family unit. This is why the demographic transition and its benefits in terms of child health are still slow to be felt. This explains why sub-Saharan Africa bore a disproportionate burden of children’s deaths worldwide. While global GDP grew, Sub-Saharan Africa’s GDP grew more slowly, from a constant $1.300 billion in purchasing power parity in 1990 to $3.574 billion in 2017. In high-income countries, one in 185 children died before their fifth birthday, compared to one in thirteen in sub-Saharan Africa.This is all the more unacceptable that solutions to this scourge are well known and “easy” to implement. Most of these deaths would be avoidable with better vaccination, sanitation and access to basic medicines. It is therefore necessary to rethink the entire health and hospital system, from hygiene education to the training of competent doctors, specialists and general practitioners. It also necessitates the completion of the health pyramid with a more effective network of territories with health centres, clinics, regional and national hospitals.

The experience of African countries that have successfully tried such or such solution should be copy-pasted. For instance, the spread of antibiotics in Niger has allowed to cut death rates among infants, perhaps by as much as 25 percent. Beyond technical solutions, it is sometimes the mentalities that still need to change, as illustrated by the Ebola crisis in Guinea, Sierra Leone and Liberia in 2015 where simple changes to death rituals were critical to halt the epidemic.