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	Indigenous children - their Human Rights, mortality and The Millennium Development Goals

By Jane Freemantle, (UN Chronicle)

The first effective attempt to promote children’s rights was the Declaration of the Rights of the Child, drafted by Eglantyne Jebb in 1923 and adopted by the League of Nations in 1924.¹ On 20 November 1959, the United Nations General Assembly adopted a much expanded version as its own Declaration of the Rights of the Child, with ten principles in place of the original five.² The United Nations Convention on the Rights of the Child (UNCRC) was the first legally binding international instrument to incorporate the full range of human rights, describing child-specific needs and rights.³ These human rights included civil, cultural, economic, political, and social rights, as well as aspects of humanitarian law.³ The UNCRC was signed in 1989, and entered into force in 1990. As of May 2010, it had 193 parties which had ratified, accepted, or acceded with stated reservations or interpretations, including every member of the United Nations except Somalia and the United States, which have only signed. 

Nations that ratify this international convention are bound to it by international law. While all the rights contained in the Convention apply to all children, whether indigenous or not, the Convention on the Rights of the Child was the first core human rights treaty to include specific references to indigenous children in a number of provisions (namely, articles 17, 29, and 30). Despite an increased awareness of the rights of indigenous people within the international forum, indigenous children remain amongst the most marginalized groups within our society.⁴ Further, in Australia, Canada, New Zealand, and the United States, the indigenous to non-indigenous infant mortality ratios range from 1.6 to 4.0. 

In 2000, the United Nations Millennium Declaration was adopted by the General Assembly.⁶ Eight Millennium Development Goals (MDGs) were developed with each of the Goals having specific measurable indicators. Four of the MDGs concern reducing extreme poverty, reducing child mortality rates, fighting disease epidemics such as HIV/AIDS, and developing a global partnership for development. All 192 members of the United Nations and at least 23 international organizations have agreed to achieve these goals by 2015. MDG 4 aims to reduce child mortality, and the specific target is to reduce by two-thirds, between 1990 and 2015, the under-five mortality rate. The indicators for MDG 4 are under-five and infant mortality rates, and the proportion of one-year-old children immunized against measles.

In this article I will consider the role (and limitations) of health statistics in monitoring the progress towards achieving the targets in reducing mortality rates in children under five and in infants (MDGs 4.1 and 4.2)among indigenous populations, and I will argue that in order to monitor and measure the impact of initiatives, strategies, policies, or practices aimed at achieving the targets, the human right to be counted must be universally exercised. The barriers to obtaining accurate and complete identification of indigenous persons in vital statistics and administrative data will be considered.

Human rights have been described by the United Nations Children’s Fund (UNICEF) as “those rights which are essential to live as human beings—basic standards without which people cannot survive and develop dignity: everyone, everywhere has the same rights as a result of our common humanity.”8 Human rights discourse argues that “governments have an international obligation to take proactive steps to improve the health and wellbeing of minority, disadvantaged and marginalized population groups”.9 These principles are expressed as a universal right to the opportunity to lead a healthy life, including equal access to quality care and the underlying social determinants of health. ^{9, 10, 11, 12} This “right” should not to be interpreted as an explicit right to good health, but rather as a right to the highest attainable standard of health.

If we are to have an accurate understanding as to whether these principles have been upheld for indigenous infants and children worldwide, then we must be able to acknowledge the existence of indigenous people in population statistics and measure changing health status over time. We must not deny people the right to define themselves.¹⁴ It is indeed a human right to be counted in population statistics in an accurate and timely manner and indigenous children should not be “invisible” in national and international statistics.

Further, as infant and early childhood mortality statistics are important indicators of a population’s health, an accurate picture of mortality informs a moral society of its social progress on a national and/or community level. This is particularly valid given that causes of infant and childhood mortality, such as infections, are potentially preventable. Others, such as low birth weight or preterm birth can be partially prevented with good health care and antenatal interventions.¹⁶ Studies of the trends in mortality and related statistics demonstrate the changing health status of the population.

Measuring and monitoring indigenous rates and causes of morbidity and mortality as well as access to care is made possible through the identification of indigenous status (or ethnicity) in datasets, such as birth, hospital and death collections and registries, health surveys, and population censuces. These data are disaggregated by indigenous status to enable reporting on indigenous and non-indigenous populations and comparisons between the two. Health data disaggregated by indigenous status also provide an evidence base for the development of health policy and programmes, evaluating services and interventions, and monitoring public expenditure.^{17, 18, 19} At a local level, these data enable assessment of the cultural appropriateness and responsiveness of health services to the needs of their clients. These data can be a valuable tool for communities in advocating for policy change and monitoring political accountability.19 Internationally, these data are used to monitor and report on indigenous health in an international context, applying an additional degree of political accountability.

Analysis of expenditure per capita, disaggregated by indigenous status also provides a baseline on which to assess the human right to an equal opportunity to good health.

However, a statistical approach to measuring a population-level enjoyment of the right to health has its limitations due to issues of accuracy and completeness of identification of indigenous status.^14,17,19 Issues are generally due to a combination of differential classification of indigenous persons, the changing propensity to identify one’s indigenous status, and/or inconsistencies in the routine asking of the question by census staff.

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