Regulatory Quality, as defined by the World Bank Group, refers to the “perceptions of the government to formulate and implement sound policies and regulations that permit and promote private sector development” (12). This indicator was found to be moderately associated with adolescent pregnancy (r2 = 0.38, p < 0.001) (Fig. 11.21).
Fig. 11.21. Adolescent pregnancy rate (UNFPA, 2006–2015) and its association with the Regulatory Quality Estimate (World Bank Group, 2015)
Findings in perspective
Child mortality remains a top concern, as indicated by its inclusion in the SDGs, specifically target 3.2 (16). Most countries in the European Region exhibit low child mortality rates relative to global comparisons, but in some countries, the rate in 2015 was close to the global average of 43 deaths per 1000 live births (16). As Brownell & Enns (17) state, progress to decrease child mortality “has been uneven and inequalities persist across both developing and high-income countries”.
There is a discrepancy between modelled and self-reported data in several of the higher-mortality countries, which indicates problems with the reliability of data for global monitoring, an issue that Victora & Boerma discussed recently in a commentary (18). This review’s analyses took, as a conservative approach, the self-reported mortality rates provided by countries. They nevertheless indicated a link between child mortality and indicators describing the political and socioeconomic environment of children. The quality of governance in countries is affecting the health of children.
Strong relationships between under-5 mortality and corruption and government effectiveness can also be shown globally (19). A European response to under-5 mortality therefore needs to look into a commitment and action to decrease corruption. Child mortality is also a useful indicator of other government sectors that need to function to ensure its reduction.
Adolescent pregnancy limits access to education for young girls and exposes them to risks for their own physical and mental health (20), as well as that of their infants (21). The number of births to young mothers aged 15–19 years varies across the Region, with a higher rate in the CIS. Young children are not the only ones affected by the political and economic environment: adolescents are too. The findings also showed a strong relationship between adolescent pregnancy, GDP and perceived corruption.
Social determinants of health are well established (22) and have been underpinning the Health 2020 framework (4). It was therefore surprising not to find an association of inequity, as measured with the GINI Index, or the proportion of children living in poverty with the mortality and adolescent pregnancy outcomes. This might indicate that these national indicators are insufficiently sensitive to capture these inequities.
Conclusion
The global commitment to reducing both child mortality and adolescent pregnancy (SDG targets 3.2.1 and 3.7.2) in the coming 12 years calls for renewed action to meet these goals in Europe. The presented findings can help in the development of effective European programmes to achieve progress by 2030.
Table 11.1 includes all indicators used in this chapter, and data from the country profiles and the survey displayed by country with summary statistics.
Table 11.1. Country context of child and adolescent health and well-being: summary table
Country
Country code GDP, US$ per capita Total health expenditure per capita ($PPP) Total mid-year population (million) Child population (0–14 years old) (million) Child population size (0–17 years) (million) (2015 data) Total immigrant population Child immigrant population (0–14 years) Adolescent immigrant population (15–19 years) Live births per 1 000 population Civil registration coverage of births (%) Adolescent birth rate per 1 000 girls aged 15–19 (2006–2015) Early neonatal deaths per 1 000 live births Under-5 mortality (GHO, 2015) Probablility of dying before 5 per 1 000 children Mortality rates all causes 5–9 years per 100 000 Mortality rates all causes 10–14 years per 100 000 % of children at risk of poverty and social exclusion (0–15 years)
Albania ALB 3 965 307 2.9 0.84 – – – – 11 99 20 3 14 8 26 25 –
aMKD: the former Yugoslav Republic of Macedonia (MKD is an abbreviation of the ISO).
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seeks to shed light on areas that influence young people’s transformation not only developmentally, but also in the social and political landscapes they inhabit in their home countries.
The European child and adolescent health strategy provided a regional template for this effort and gives countries a framework from which to build. The survey findings (1) and the child and adolescent health country profiles (2) provide feedback to Member States on areas where improvements can be made, and allows countries to compare themselves to others. Practical tools like AA-HA! (3) and other regional tools (4) contribute to this improvement process.
Indicators included here were mapped against other international initiatives such as the SDGs (5) and the global strategy for women’s, children’s and adolescents’ health (6) (see Annex 2) to show the high degree of reciprocity between them, suggesting that by adopting actions in line with the European strategy, Member States will also be contributing to these wider initiatives. The 2030 Agenda encompassed by them places additional pressure to optimize investment and integration across policy areas to meet the commitments made by Member States.
Overall, the findings demonstrate the need for action in every country to realize the full potential of European children and adolescents. Policies are not enough. What needs to be considered can be taken out of this document, and specific feedback is being provided to countries by WHO. The data have been made available to all stakeholders, which also contributes to an improved accountability process in countries.