United Nations Children’s Fund Background Guide In the dawn of the post-World War II era, the United Nations recognized how a vast majority of the European and Chinese youth faced famine and diseases. The UN addressed the issue in December 1946 by establishing the United Nations International Children’s Emergency Fund (UNICEF) in order to provide these children with food, clothing, and health care. The UN General Assembly officiated UNICEF in 1953, and then from there, the organization extended its reach to the rest of the world whenever new issues would arise. The UNICEF executive board is composed of appointees from each UN Member State region. Active in more than 190 countries and territories through programs and National Committees, UNICEF ultimately serves as the United Nations funding body for children in need. I. Preventing Child Mortality through Immunization Fully aware of the distinct circumstances and vulnerabilities of the children of the world, the international community established the Convention on the Rights of the Child in 1989 as a way to codify the rights of children to life, education, safety, and health into international law.1 Outlined specifically in Article 24, all children have the right “to the enjoyment of the highest attainable standard of health.”2 Furthermore, this Article mandates that all member states pursue the complete implementation of this right and make a priority of reducing infant and child mortality. Defined as the death of children before the age of five, child mortality is a leading issue for much of the world’s population. According to a recent report by the World Health Organization (WHO), approximately 6.3 million children under the age of five died in 2013 alone.3 Furthermore, nearly half of these deaths were due to conditions that could have been prevented or treated with access to simple and affordable vaccinations or medications. The leading causes of death in children under the age of five are preterm birth complications, pneumonia, birth asphyxia, diarrhea, and malaria. With nearly 45% of all child deaths around the globe linked to malnutrition, this creates a dire situation for fighting disease as immune systems and general health are weakened. Additionally, children in sub-Saharan Africa in particular are more than 15 times more likely to die before the age of five than children in developed regions,4 making vaccinations a key component to greatly reducing the burden of 1

WHO, The Right to Health, Fact Sheet N°323, 2012. UN General Assembly, Convention on the Rights of the Child, A/RES/44/25, 1989, p. 11. 3 WHO, Children: reducing mortality, Fact Sheet N°178, 2014. 4 WHO, Children: Reducing Mortality, Fact Sheet N°178, 2014. 2

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these infectious diseases. While many people have expressed skepticism or anxiety about the potential effects of vaccines, modern science and medicine have proven vaccines to be effective and safe methods of disease prevention with most “vaccine scares” having been shown to be false.5 According to the WHO, improving healthcare for newborns is particularly important as babies tend to be the most prone to disease, malnutrition, and medical issues resulting in death. With nearly 3 million babies dying every year in their first month of life, approximately half of these deaths occur within the first 24 hours of life and 75% within the first week.6 The advancement and availability of vaccinations is vitally important in the reduction of child mortality. Through the use of vaccines and immunization techniques, deadly childhood diseases such as measles, polio, diphtheria, tetanus, pertussis, pneumonia, influenza, and streptococcus are significantly lessened and prevented.7 While vaccination campaigns have advanced considerably in the last forty years, increasing from 5% to 83% in total vaccination rates for children, nearly one fifth or 22.4 million children of the world remain unvaccinated.8 This was an important factor in developing the Fourth Millennium Development Goal (MDG). Aiming to lessen child deaths by two-thirds by 2015,9 since the establishment of the goal, a decrease in mortality has been recorded to directly correlate with the spread of immunization practices.10 Additionally, immunization is a very cost-effective tool and readily available for public health providers.11 While there are many challenges in the fight against child mortality, the challenges to immunization operations stem from a number of factors. Weak oversight and accountability by local governments can make it considerably difficult to maintain an immunization campaign. Additionally, poor security and physical barriers may also make certain regions inaccessible to healthcare workers.12 Despite these challenges, the success of immunization often depends more on factors such as political will, hygienic practices, and health infrastructure.13 To ensure better coordination against many of these challenges, the WHO and UNICEF joined forces in 2005 to develop the Global Immunization Vision and Strategy (GIVS) 2006-2015. As a way to enhance national immunization programs and decrease mortality associated with vaccine

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MacIntyre CR, Leask J. Immunisation myths and realities: responding to arguments against immunisation. J Paediatr Child Health 2003; 39: 487-91. 6 WHO, The Right to Health, Fact Sheet N°323, 2012 7 WHO, Children: reducing mortality, WHO response, Fact Sheet N°323, 2012 8 UNICEF, Expanding immunization coverage, 2011 9 United Nations, The Millennium Development Goals Report, 2013, p. 25. 10 Ibid. 11 United Nations, The Millennium Development Goals Report, 2013, p. 25; UN News Centre, UN steps up vaccination campaigns amid measles outbreaks among uprooted Syrians, 2013. 12 UNICEF, Expanding immunization coverage, 2011 13 Chang, Chavez, Hameed, Lamb, Mixon, Eradicating Polio in Afghanistan and Pakistan, 2012, p. 5.

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preventable diseases,14 this program sought to bring together all of the relevant actors as a way to share resources, knowledge, and work in the quest of their collective goal. As a result of GIVS, the Global Vaccine Draft Action Plan was developed for stakeholders, actors, healthcare professional providers, civil society, governments, and development partners involved in immunization. The plan promotes access to vaccines through several guiding principles including national ownership and responsibility in ensuring quality healthcare, integration of immunization systems, sustainable investment, and increased research and development to improve vaccine effectiveness and availability.15 In addition to the GIVS, plans like A Promise Renewed and the Global Alliance for Vaccines and Immunization (GAVI) have also been developed in correlation with the Global Vaccine Action Plan 2011-2020. Launched in June 2012 as joint project of UNICEF and the United States Agency for International Development (USAID), A Promise Renewed is a global call to action to end preventable child deaths by 2035 and has been endorsed by 179 countries.16 Symbolizing strong cooperation between governments, civil society, and the private sector towards the common goal of providing proper health conditions around the world, GAVI is a public-private partnership devoted to boost children’s access to vaccines worldwide. In doing so, GAVI raises awareness through meetings such as the Global Vaccine Summit of April 2013 in Abu Dhabi; providing strong support for deadlines and motivation for global leaders.17 That challenges to reducing child mortality though effective immunization practices are complex and multifaceted. Incorporating elements of religious and cultural beliefs and traditions, government oversight, innovation, and supply-chain logistics, strategies to strengthen community engagement and investment in health systems must be established at the global, national, and local levels. While the world has seen significant success toward the goal of eliminating child deaths by preventable disease, we are far from achieving that goal and any plan to achieve it must address the multitudes of factors that contribute to greater issue. Questions to consider: How do cultural and religious norms and beliefs influence the acceptance and prevalence of immunization campaigns? What logistical challenges affect the availability of vaccines in remote locations? What strategies can be developed to ensure that follow up care and additional doses of vaccines are administered? How can the United Nations, governments, NGOs and pharmaceutical corporations work to ensure increased vaccinations in poor populations and developing countries?

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WHO, Global routine vaccination coverage 2011, 2 November 2012. WHO, Global Vaccine Action Plan 2011-2020, 2013, p. 23. 16 Ibid. 17 Global Polio Eradication Initiative, Polio Eradication and Endgame Strategic Plan 2013-2018, 2013, p. 3. 15

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II. Child Marriage and its Effects on Girls While common throughout history and in many societies across the globe, the practice of child marriage is associated with significant harmful consequences and constitutes a gross violation of the rights of children.18 These consequences often manifest in poor access to education, socioeconomic status, health, poverty, and physical and sexual assault.19 While this practice affects boys and girls, the effects that child marriage has on girls is often exacerbated due to institutionalized genderbased discrimination and patriarchal social structures in many parts of the world. This has led the international community to focus more prominently on girls and their families.20 The practice of child marriage is a truly global issue, occurring in developed and developing countries in every region of the world. Creating a cycle through which poverty, poor education, and violence are sustained, this practice creates many difficulties to global sustainable development; trapping young women and girls into situations from which there are few options for escape.21 Often becoming pregnant shortly after marriage, child marriage prevents young girls from receiving the benefits of education, health, and self-development, trapping entire families in a cycle of poverty for generations.22 To put the issue into scope, there are currently over 700 million women alive today who were married as children with 14 million adolescent and teenage girls married every year; a figure that is expected to grow by 14% to 15.1 million by 2030.23 Understanding the enormous effects that child marriage can have on a country’s social and economic development, the United Nations and the international community have worked strongly to end this practice that denies millions their basic rights as human beings. As outlined in Article 16 of the Universal Declaration of Human Rights (1948), marriage requires the “free and full consent of the intending spouses.”24 As with other issues, while the Universal Declaration of Human Rights does not possess the legal authority to compel state action, it serves as a persuasive moral framework around which the international community can shape discussion and coordinate action.25 In addition to the Universal Declaration of Human Rights, further documents such as the Convention on the Rights of the Child (1989), the International Covenant on Civil and Political Rights (1966), and the International Covenant on Economic, Social, and Cultural Rights (1966) have expanded upon these rights and have outlined clear standards to which signatory states can be held accountable.26 Members of the international community play an important role in ending the practice of child marriage through the establishment of frameworks, goals, and practices designed to address the practice itself as well as the underlying issues that contribute to its proliferation. In 2014, the General Assembly passed the groundbreaking Resolution 69/156 as one of its first substantive actions on the 18

AU, Campaign to End Child Marriage in Africa: Call to Action, 2014, p. 1. Ibid., p. 5; Girls Not Brides, About Child Marriage 20 Equality Now, Protecting The Girl Child, 2014, p. 7. 21 Girls Not Brides, What is the impact? 22 AU, Campaign to End Child Marriage in Africa: Call to Action, 2014, p. 2. 23 UNICEF, Committing to Child Survival: A Promise Renewed, 2013, p. 29. 24 UN General Assembly, Universal Declaration of Human Rights (A/RES/217 A (III)), 1948. 25 De Silva-de-Alwis, Child Marriage and the Law, 2008, p. 24. 26 Center for Reproductive Rights, Child Marriage in South Asia, 2013, p. 24. 19

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subject, addressing the importance to international law enforcement and education as primary methods in ending child marriage.27 Additionally, in 2015 the Human Rights Council strengthened the United Nations’ position on the topic in Resolution 29/8 entitled “Strengthening efforts to prevent and eliminate child, early and forced marriage”; officially recognizing child marriage as a violation of human rights and a barrier to development and calling for states “to improve gender disaggregated data collection” and conduct research on the prevention of child marriage.28 Furthermore, in 2013, the Commission on the Status of Women issued a report that called upon governments to “review, enact, and strictly enforce laws and regulations concerning the minimum legal age of consent and the minimum age for marriage, raising the minimum age for marriage where necessary.”29 As a body of the United Nations, UNICEF has been a leading voice in the elimination of child marriage. By focusing on the economic and social causes of child marriage and advocating for reforms and actions on the local, national, and international levels, UNICEF has become a legitimizing force and forum through which other actors can share information and coordinate action.30 Establishing more than 40 country-specific programs focusing on child marriage in 2014 alone, 18 have developed into national strategies.31 The National Strategy on Ending Child Marriage and Teenage Pregnancy in Uganda is a prime example.32 In addition to knowledge sharing and advocacy, UNICEF also provides financial and technical support to these programs and leads a number of initiatives like the United Nations Girls’ Education Initiative to improve girls’ access to education and health.33 While there has been considerable progress at the international level to end child marriage and protect the rights of children to a healthy, safe, and fulfilling life, there are still many issues that need to be resolved before the practice can be fully eradicated. Many of the underlying factors that contribute to the prevalence of child marriage are truly global in scope and difficult to solve through national and regional level governance. Progress, in many cases, is only possible through the cooperation and collaboration between UN agencies, governments and civil society organizations to change social norms and attitudes towards child marriage.34 This is primarily important in states where cultural norms, traditions and religious practices surrounding the marriage of children are ignored or tolerated by local and national governments. This is particularly true in Thailand and Cambodia, child marriage is not criminalized, and in many African nations which have significantly low conviction rates for the practice as well.35 Through a combination of international advocacy, strengthening legal frameworks, and persistent monitoring, however, there is considerable hope for improvement.36 There is little doubt that the practice of child marriage is a gross violation of human rights; however, this practice remains very common throughout many parts of the world and has significant 27

UN General Assembly, Child, early and forced marriage (A/RES/69/156), 2014. UN HRC, Strengthening efforts to prevent and eliminate child, early and forced marriage (A/HRC/RES/29/8), 2015. 29 UN CSW, Report on the fifty-seventh session (4-15 March 2013) (E/2013/27), 2013, p. 12. 30 UNFPA, Marrying Too Young – End Child Marriage, 2012, p. 50. 31 UN ECOSOC, Annual report on the implementation of the UNICEF Gender Action Plan (E/ICEF/2015/8), 2015. 32 UNICEF, The National Strategy to End Child Marriage and Teenage Pregnancy 2014/2015–2019/2020, 2015, p. 5. 33 UNGEI, Vision & Mission. 34 Equality Now, Protecting The Girl Child, 2014, p. 16. 35 Equality Now, Protecting The Girl Child, 2014, p. 15. 36 UNFPA, Marrying Too Young-End Child Marriage, 2012, p. 49. 28

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detrimental effects on girls in particular. When forced to marry at a young age, girls are put a significant disadvantage; unable to seek educational opportunities to improve their lives, the lives of their family, and contribute to the economic and social development of their community. Additionally, many girls are subjected to violent and abusive situations. To overcome this serious and harmful practice, significant work needs to be done to address the cultural values and traditions that lead to its endurance. Questions to consider: In what ways can advocacy campaigns raise awareness and pressure governments to act in accordance to existing international law? What strategies can be implemented to address the cultural norms that lead to child marriage? How can these strategies influence the culture without condemning the cultures? In what ways can the international community improve the lives of women who are already in forced marriages? How can UNICEF, NGOs and national governments work together to address the complex factors leading to child marriage?

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