Ending Preventable Child & Maternal Deaths:
American Bi-partisan Support for Child Survival and Development
by Kul Chandra Gautam
Washington, DC, 21 June 2017
Thank you for the opportunity to share a snapshot of the glorious history of bipartisan leadership that has been exercised in these great halls of the US Congress to save the lives and promote the wellbeing of millions of women and children around the world.
Here in the US Congress historically there has been exceptional, bi-partisan solidarity on many issues of global health. Nowhere has that bi-partisan solidarity been more prominent than in protecting and nurturing the world’s most vulnerable citizens – the children.
Such bi-partisan solidarity does not come easily or naturally. It was cultivated over many years by the good work of organizations like Save the Children, UNICEF and reinforced by groups like RESULTS, whose hundreds of citizen volunteers helped generate grassroots support for child survival in the home constituencies of Congressmen and Senators.
I have many vivid personal memories of how UNICEF, the agency I worked for over three decades, and the US government, and especially its Congressional leadership collaborated closely to design and implement a massive movement that unleashed a virtual child survival revolution – starting in early 1980s.
Jim Grant’s Inspiration
Perhaps the greatest American who led the global child survival movement in the 1980s and 90s was James Grant, the legendary Director of UNICEF.
He was appointed head of UNICEF in 1980 by the United Nations Secretary-General. In a mark of true bi-partisanship, he was first nominated by Republican President Gerald Ford and reconfirmed by Democrat Jimmy Carter.
Grant was a frequent visitor to these great halls of the US Capitol, where he testified why supporting child survival on a massive scale was not only a great moral, ethical and developmental priority, but also in the long-term national interst of America.
Grant articulated a bold vision of a Child Survival Revolution, arguing that it was unconscionable that 40,000 children a day, or 15 million annually, were dying at that time, when there were many low-cost, low-tech, readily available interventions to prevent such deaths.
Simple but proven measures such as growth monitoring and breastfeeding to improve nutrition of young infants, oral rehydration therapy against diarrhea (the world’s biggest killer), and childhood immunization, were proposed as cutting edge interventions that could save millions of lives and improve children’s health.
Empowering women with knowledge, skills and education was the glue that, he argued, linked child survival with human progress, national development and global peace and prosperity.
Grant promoted child survival with an infectious passion. He visited over a hundred countries and met their leaders and persuaded them to invest massively in child survival.
He cajoled world leaders to raise life-saving childhood immunization rates from single digits to 80 percent in less than a decade, by 1990.
To reach children in situations of wars and conflict, UNICEF promoted temporary cease-fires using the concepts of “Days of tranquility”, “corridors of peace” and “bubbles of child protection” in conflict zones ranging from El Salvador to Sudan, Iraq to Sri Lanka, and elsewhere.
Grant’s crowning achievement was the convening of the World Summit for Children in 1990.
It was the first ever World Summit, attended by the largest gathering of world leaders in history until that time, including President George Bush, the father.
I personally had the great privilege to work closely with Jim Grant, serving as his point man to draft the historic Declaration and Plan of Action of the Children’s Summit.
It laid down many bold humanitarian and development goals, which later greatly influenced the UN Millennium Development Goals, the precursors of today’s Sustainable Development Goals.
Early Results of Child Survival Revolution
What was the net result of all this effort?
Compared to early 1980s, some 10,000 fewer children died every day a decade later, thanks to the increase in childhood immunization from less than 20 percent to nearly 80 percent, and similar rise in oral rehydration therapy, and other child survival interventions.
Cumulatively, it was estimated that the lives of some 25 million children were saved during Jim Grant’s tenure as head of UNICEF, leading a prominent columnist Nick Kristof to say that Grant’s efforts probably saved more lives than were destroyed by Hitler, Mao Zedong and Stalin combined.
Building on the bedrock of that foundation, it is estimated that 100 million children have been saved and the quality of their lives greatly enriched in the past quarter of a century.
Impact at country and community levels
Dear friends, I have briefly shared with you the global picture of the great gains in child survival. But how does that really impact at national and local levels.
Later in the program we will have some colleagues sharing the exciting results of work on maternal and child health in Africa. Let me share with you my own brief life story that illustrates the impact of the work of USAID and other donors on child survival and development.
I was born in a small village in the western mountains of Nepal – five days walk from the nearest paved road or bus station. When I grew up, my village had no school, no health post, no electricity, no telephones, no toilets.
One out of four children died before they turned 5 years old. I was one of the lucky survivors. One hundred percent of women, including my mother, were illiterate.
Like winning a rare lottery, through a series of coincidences and accidents, I managed to get out of the village; got some education, and ended up at Dartmouth College and Princeton University and landed a job at UNICEF. The rest, as they say, is history.
As there was no major program of US aid or other donors to promote child survival and development in my childhood seven decades ago, my escape from my poverty-stricken village, truly had an element of winning a lottery.
But for the younger generation of Nepal in the past four decades or so, the positive impact of the US supported child survival and development programs, the work of the American Peace Corps, along with that of other international donors and the United Nations has been life-saving and life-enhancing.
I can vouch for you from personal experience that the child survival and development programs of international cooperation have made a real difference.
Today Nepal is still one of the poorest countries in the world, often ravaged by horrific disasters like the mega-earthquake we had two years ago, and many other man-made political earthquakes, but we have come a long way in the past half century.
Instead of 100,000 children dying every year, we now have only 25,000 child deaths, although many more children are born today than a few decades ago.
But lately, the population growth – the fertility rate – is also going down steeply, as more girls go to school and delay their marriage; health conditions are improving; transport and communications infrastructure is upgraded; women and other vulnerable groups are empowered.
In my own small village, we now have 5 primary schools, one high school, a health post. 95 percent of children, including girls, attend primary school, childhood immunization rates are higher in my village than in Washington, DC, and virtually every family has a toilet and at least one cell phone.
If somebody tells you that all foreign aid is wasted and does not produce any results, they are giving you truly fake news.
Child Survival and broader Human Development
When we speak about child survival and development, we are concerned not only about preventing deaths but also about improving the lives of children who survive. But if you don’t survive nothing else counts.
To parents nothing is more disempowering than to see their children die. Inability to save their children makes parents feel powerless and fatalistic.
On the other hand, when parents feel that they can take action to save their children’s lives, they feel a sense of empowerment rather than helplessness.
When parents know that simple, low-cost actions can save their children, they begin to demand such services. When parents feel confident that their first children will survive, they tend to have fewer children.
When they have fewer children, they care more about giving them the best possible education and upbringing.
That triggers a virtuous cycle of empowerment and upward mobility.
US Congress’s Leading Role in Child Survival
With bipartisan Congressional support USAID too has played a great role in promoting child survival. And that has been of critical importance for global acceptance of child survival as a development priority.
In fact, in the 1980s, UNICEF and USAID worked out a division of labor whereby UNICEF took the lead on immunization, and USAID led a global effort to cut down deaths from diarrheal diseases, the two biggest killers of children in the world at that time.
Today, thanks to USAID’s pioneering leadership and support, more than a billion episodes of childhood diarrhea are treated with ORT saving the lives of over three million children around the world every year.
The early success of US-UNICEF collaboration became the lynchpin for persuading many European donors, the World Health Organization, the World Bank and others to give high priority to child survival and development.
Today we see many new players like the Bill and Malinda Gates Foundation, greatly contributing to child survival through GAVI and other initiatives.
With the persuasive advocacy of Jim Grant and Pete McPherson (and Dr. Bill Foege as well), in 1985 the US Congress established a Child Survival Fund with an initial allocation of $25 million.
Through continuing bipartisan Congressional support, that fund supporting maternal and child health has now grown to over $800 million a year.
We fear big cuts in it in the new administration’s budget proposals for 2018. If that happens our great success so far could be reversed.
Please do not allow that to happen.
Let me conclude with an appeal for continuing bi-partisan Congressional support that has so far been the great hallmark of American leadership in global health.
Historically, US Congressional support for child survival has always been truly bi-partisan.
If we had a great Hall of Fame of Child Survival, etched in it would be many Congressional leaders. Among them Republican leaders like Senators: Richard Lugar (R-IN), Bill Frist (R-TN), Susan Collins (R-Maine), and Lindsey Graham (R-SC); and Representatives: Chris Smith (R-NJ), Sonny Callahan (R-AL), Jim Kolbe (R-AZ), Dave Reichert (R-WA) and Kay Granger (R-TX).
Some of their Democratic counterparts would be, Senators Patrick Leahy (D-VT), Chris Coons (D-Delaware); and Representatives: David Obey (D-WI), Tony Hall (D-OH), Nita Lowey (D-NY), Betty McCollum (D-Minnesota) and Barbara Lee (D-CA), just to name a few.
Millions of children in Asia, Africa and elsewhere are alive and thriving today thanks to the commitment of these and many other Congressional leaders whose names they have never heard, but whose contribution shines in their faces.
As we will hear from my friend Justin Forsyth of UNICEF, and from USAID, Save the Children and others later, the revolution for child survival and development continues to this day and is producing impressive results. Let us ensure those results are sustained and further improved.
Sometimes the executive branch of the government has its own political compulsions in proposing budget cuts. So we look to Congressional leadership to ensure that a noble mission like child survival is protected.
I recall many times in the past when faced with the compulsion of presenting more balanced budgets, the White House Office of Management and Budget prepared budget submissions to the Congress recommending across the board cuts in foreign aid, including US contribution even to UNICEF and child survival.
But UNICEF and child survival commanded such strong public support that the Congress always not only restored the cuts recommended by OMB but consistently increased the allocation from the previous year.
I really hope that the Congress today will honor that historic tradition.
That would be the greatest contribution US Congressional leaders can make to the world’s children; and a great honor to America’s enlightened global leadership.