baby is born. Is it wanted? Who is its mother? Is she married? Does she have a partner or family able to provide support to her and her infant? How old is the mother? Is she educated? Literate? Is she prepared emotionally and otherwise mature enough to give the child the care and foundation it needs for a good start in life in an increasingly complex world?

The circumstances into which a child is born determine to a great extent not only whether it survives but the entire course of its life. The reproductive choices of women significantly affect both their life prospects and those of their children. The age of the mother, the spacing of births, and care during pregnancy and delivery are important determinants of infant survival and progress through childhood.

Children born outside a formal union, and those born after their parents already have the number of children they want, are at risk of inadequate attention and support from their parents.

The Burden of Being Born to a Young Mother

The impact of reproductive health on the newborn is immediate and can be dramatic. Children born to adolescent mothers are usually at a disadvantage, given the mother’s physical and emotional immaturity and the fact that having a child usually puts a stop to her schooling. The risks are especially great for the child if its mother is a young teen (12-16), if she is unmarried, if she is poor, or if the child is unwanted. The burden of being born to an adolescent mother is greatest when all of these conditions prevail.

About half of all deaths among children under age five occur in their first month of life. In developing countries, an infant’s risk of death during the first year is 30 per cent greater if born to a young mother than to an adult woman. 6 Even if they survive, infants born to adolescent mothers are more likely to be premature and low birth-weight. Such survival risks are far greater in developing countries, given conditions of poverty, poor nutrition and poor availability of medical care.

Infants born to adolescent mothers are also at risk due to adverse socioeconomic conditions that are typically more severe when the mother is a teen. Adolescent mothers are generally less able to provide the compensatory care for a pre-mature or low birth-weight infant. In poor families, other adults are less likely to be available or able to provide the needed support.

• Data from Nigeria show a striking contrast in infant mortality for adolescent versus slightly older mothers. For mothers under 20, infant mortality was 121 deaths per 1,000 live births, compared to 79 deaths for the mothers aged 20-29.
  
  
• In many African countries, girls who become pregnant are forced to leave school and are also likely to face moral persecution. Data from Rwanda, for example, show about 10 per cent of pregnant schoolgirls being disowned by their families. This, in turn, can result in child abandonment ("baby dumping") and entry of the young mother into prostitution.

Whatever the reason a baby is unwanted, he or she is likely to start life at a disadvantage. Abandonment is common, a reason for the swelling numbers of street children in large cities from Manila to Rio de Janeiro. If the child is kept in the family, the mother still may not be psychologically prepared for the responsibility of child rearing, or family resources may not be adequate to meet the baby’s needs. The child is also more likely to be subjected to abuse.

Short Birth Intervals and Infant Mortality

Spacing births offers important benefits for both infants and mothers. Infants born less than one year after the end of their mothers’ last pregnancy are much more likely to be malnourished and die than infants born after a longer interval. The risk of death posed by short birth intervals continues even after the first year of life.

Furthermore, when two children are born very close together, the health of the older child may also be in jeopardy. The word "kwashiorkor" is used in Ghana to describe the kind of malnutrition often seen when a child is weaned from the breast too early because the mother is pregnant again. Children weaned too early are much more susceptible to malnutrition and infection.

The higher death rates among closely-spaced infants may be due, in part, to the lack of time for the mother’s body to fully recover after the last pregnancy—sometimes called the "maternal depletion syndrome". This may be especially true among women who breastfeed their children for long periods and among women who are mal-nourished and perform heavy physical work.

Son Preference and Sex Selection

In many countries girls suffer from deep-seated cultural preference for sons. In many poor communities, little girls are often neglected and denied education and medical care. Parents on all continents are more likely to send their sons to school and keep them there longer than their daughters.

Strong preference for male children has led in some countries to sex-selective abortion of female foetuses and even female infanticide. Increased availability of reproductive technology such as amniocentesis and ultrasound has made possible this particular form of gender-based discrimination, resulting in higher-than-normal male-to-female sex ratios, as in China, the Republic of Korea and India. Laws in India and China now ban sex-determination testing. Nevertheless, in Asia alone, at least 60 million girls are "missing" due to these phenomena.

The Impact of Maternal Mortality

Unfortunately, maternal mortality remains all too common in developing countries where more than half a million women die each year from pregnancy-related causes, including unsafe abortion. This is equivalent to about 1 in 50 women dying in developing countries from complications of pregnancy and unsafe abortion, about 35 times more than in developed countries.

The death of a mother has extremely serious consequences, especially for an infant or young child. In developing countries, if the mother dies, there is a high risk that her children under age 5 will also die—a probability as high as 50 per cent in some places. Many families are able to provide adequate care for the children whose mother has died, but many cannot.

Mother-to-Child Transmission
of HIV/AIDS and Other STDs

For children whose mothers are infected by HIV, early life chances are even grimmer. Mother-to-child transmission is by far the largest source of HIV infection in children below age 15. In a growing number of countries, AIDS is now the biggest single cause of child death. In urban centres in southern Africa, HIV rates of 20-30 per cent among pregnant women tested at antenatal clinics are common.

In 1998, 10 per cent of all those newly infected were children, the vast majority of whom acquired the virus from their infected mothers. (The virus may be transmitted during pregnancy, childbirth or breastfeeding.) Africa is home to 90 per cent of the world's HIV-infected children, largely due to very high levels of HIV infection among women combined with high fertility rates. However, the number of HIV-infected children in India and South-east Asia appears to be rising rapidly.

• Where no preventive measures are taken, the risk of a baby acquiring the virus from an infected mother ranges from 15 to 25 per cent in industrialized countries and from 25 to 45 per cent in developing countries.
  
  
• Nearly 4.5 million children below age 15 have been infected by HIV and more than 3 million of them have already died of AIDS.
  
  
•  AIDS threatens to reverse years of steady progress in child survival achieved through such measures as the promotion of breast-feeding, immunization and oral rehydration. The Joint United Nations Programme on HIV/AIDS (UNAIDS) projects that by the year 2010, AIDS may have increased mortality of children under 5 years of age by more than 100 per cent in regions most affected by the virus.
  
  
• There are also serious long-term consequences of congenital and perinatal sexually transmitted infections. For example, syphilis contributes to blindness, deafness, paralysis and bone disease, and gonorrhoea to blindness.

A new drug called nevirapine (Viramune) offers hope to resource-poor countries. An anti-retro-viral that slows the reproduction of HIV, nevi-rapine has been reported to cut infection in half—and is far less expensive than other drugs. Used to treat HIV-positive pregnant women in Uganda (now a leader in HIV/AIDS control efforts), nevirapine has also received clearance from the U.S. Food and Drug Administration for treatment of paediatric HIV/AIDS.

Orphans

Wars, civil strife and AIDS are leaving behind huge numbers of orphans, many severely traumatized. The impact has been most extreme in Africa. The 1994 massacres in Rwanda, for example, left an estimated 200,000 children orphaned or separated from their parents.

But nothing compares with the devastation inflicted by AIDS. More than 10 million African children under age 15 have lost a mother or both parents to AIDS. The number of "AIDS orphans".7 in the 23 most afflicted countries is projected to reach 40 million by 2010. Huge anticipated increases in infant and child mortality due to AIDS are projected to reduce life expectancy to 40 years or less in nine countries by 2010.

In countries where AIDS has claimed the lives of many adults, more than 10 per cent of children lose one or both parents during their childhood. Children orphaned by AIDS are more likely to stop going to school than others their age. They are more likely to have to support themselves and to take on adult responsibilities. They are more likely to leave home or lose their homes and join the growing numbers of street children.

Orphaned girls may feel increased pressure to marry, turn to "sugar daddies", or turn to prostitution for survival—which, for many, will be only short-term survival. A large burden of supporting AIDS orphans falls on grandparents and other extended family members. Family systems in high-prevalence countries are undergoing tremendous stress.