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It's 'survival of the richest' in urban areas as U.S. loses ground in mom, kid well-being
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When it comes to child mortality rates in urban areas, it's often a "tale of two cities," with massive differences in survival for the rich and for the poor.

That's according to Save the Children's 16th annual report on the "State of the World's Mothers: The Urban Disadvantage." The annual reckoning considered data on health, education, economics and female political participation in 179 countries. This year, the report paid particular attention to infant and maternal death rates through the lens of whether children were rich or poor in the various cities studied. It also tracked which countries gained or lost ground.

The United States slipped two spots to No. 33. America has a 1 in 1,800 risk of maternal death, which is the worst of any developed country. The report said an American woman is more than 10 times as likely to die in pregnancy or giving birth than a woman in Poland is. And an American child to age 5 faces a death risk similar to that of children in Bosnia and Herzegovina or Serbia.

"We see ourselves as a shining light in the world," Justin Mortensen, urbanization adviser for Save the Children, said. "When we see that statistic, we have to take a step back and say we have got to do better here. We can do better here."

America's drop in the rankings largely reflects that it is not making improvements, while other countries have made progress, he said.

Those who have, live

Of the 25 wealthiest capitals worldwide, Washington, D.C., has the poorest infant mortality rate overall, and the gap between the haves and have-nots in terms of survival is large. In fact, children in the poorest section of D.C. had mortality rates 10 times higher than in the district's wealthiest community: 14.9 deaths compared to 1.2 deaths per 1,000 kids. But even that marks an improvement; the district has halved infant mortality over the past 15 years.

Mortensen said access to the right health care at the right time is key to improving mortality rates. So is the "ability to space your children out on your terms," he added.

The report found that in most developing countries, the poorest urban children faced at least two times the risk of dying before age 5, compared to the richest children in the same city. In some countries, rich city children had three to five times the likelihood of survival as the poorest kids.

Save the Children CEO and President Carolyn Miles called it "survival of the richest" in background material on the report.

Differences in what happens to children in cities has taken on a great deal of importance because, for the first time ever, more than half of the world's population lives in cities and a third of them live in slums, often without amenities like clean water, basic sanitation or health services. World Health Organization estimates close to 1 billion people live in urban slums or under bridges and along railroad tracks, the report said.

The report was released Monday in D.C'.s poorest area, Ward 8, where Dr. Djinge Lindsay, deputy director of programs for the D.C. Department of Health, told journalists that "local government recognizes the importance of giving all babies a healthy start in life by ensuring that women of reproductive age achieve optimal health, before and during pregnancy." She also announced a partnership between education, housing and employment programs to provide "equitable access to preventive care and community resources that support improved health status and healthy behaviors and ultimately prevent infant deaths."

"High child death rates in slums are rooted in disadvantage, deprivation and discrimination," the report said.

Ups and downs

The report said the biggest divide in terms of survival based on economic status was found for children living in Bangladesh, Cambodia, Ghana, Kenya, India, Madagascar, Nigeria, Peru, Rwanda, Vietnam and Zimbabwe. Kids in those countries who live in poor families are between three and five times more likely to die than are kids in wealthy families there. The smallest gaps and relatively low child mortality rates are found in cities in Egypt and the Philippines.

The report highlights six cities that have improved, even against some population growth odds: Addis Ababa, Ethiopia; Cairo, Egypt; Manilla, Philippines; Kampala, Uganda; and Phnom Penh, Cambodia. They've succeeded in increasing access to needed services and health care while keeping costs down.

Besides Washington, D.C., the capitals of the wealthier nations where kids are less apt to survive are Vienna, Austria; Bern, Switzerland; Warsaw, Poland; and Athens, Greece. Those with the best survival odds are Prague, Czech Republic; Stockholm, Sweden; Oslo, Norway; Tokyo, Japan; and Lisbon, Portugal.

Nearly all of the countries at the bottom of the list are from West and Central Africa, where experts cite political and economic instability, armed conflict and lousy governance as causes. In those countries, one in 30 women die because of a pregnancy-related complication and as many one-eighth of children succumb before turning 5.