Socio-political and Economic Context of Child Survival in Rwanda over the 1950–2000 Period

Abstract

Before 1965, under-five mortality was declining in Rwanda, from an estimated value of 346 per 1,000 in 1950 to 229 per 1,000 in 1965. Then it rose for about 12 years to 261 per 1,000 in 1977, to decline again, reaching a level of 132 per 1,000 in 1990. The 1991-2000 period witnessed a major peak of mortality in 1994 and another peak in 1998. This paper explores reasons for these significant changes in mortality. The 1965-77 period was marked by severe difficulties after independence in 1962, due to the sudden departure of expatriates, the relative international isolation, the lack of international aid, the flight of educated persons of Tutsi origin, and possibly the departure of herders and their cattle following ethnic conflicts between Hutu and Tutsi during the 1959-66 period. During the 1977-90 period, social indicators became more favourable, with the increasing benefits from earlier social investments, higher openness to international markets, more international aid and more internal political stability. The peaks in mortality of 1994 and 1998 are due to the genocide and its aftermaths. This study is an illustration of complex relationships between economic, socio-political contexts and their different health outcomes expressed in terms of under-five mortality. Au Rwanda, la mortalit� infanto-juv�nile �tait en baisse avant l'ind�pendance obtenue en 1962. Elle passe de 346 pour 1000 en 1950 � 229 pour 1000 en 1965. Puis, elle augmente pendant environ 12 ans pour atteindre 261 pour 1000 en 1977, puis baisse de nouveau jusqu'� 132 pour 1000 en 1990. La p�riode de 1991 � 2000 est complexe et a connu deux pics de mortalit� en 1994 et en 1998. Cet article explore les raisons de ces changements significatifs de la mortalit�. La p�riode de 1965 � 1977 est marqu�e par de grandes difficult�s apr�s l'ind�pendance, en raison du d�part soudain du personnel m�dical expatri�, de l'isolement international relatif, du manque d'aide internationale, de l'exil des personnes instruites d'ethnie tutsi et, peut-�tre, du d�part de certains �leveurs avec leur b�tail � la suite des conflits interethniques qui se sont succ�d�s de 1959 � 1966. De 1977 � 1990, les indicateurs sociaux deviennent plus favorables, profitant des investissements sociaux de la p�riode pr�c�dente, d'une plus grande ouverture aux march�s internationaux, de plus d'aide internationale et de stabilit� politique. Les sommets de mortalit� de 1994 et 1998 s'expliquent par la guerre civile, le g�nocide de 1994 et leurs cons�quences. Cette �tude est une illustration de rapports complexes entre les contextes �conomiques et sociopolitiques et les indicateurs de sant� publique, exprim�s ici en termes de mortalit� des enfants de moins de cinq ans.

The Difficult Task of Evaluating MDG-4

“…In Rwanda, the civil war period (1991-1999) was associated with major disruption in already erratic trends. 26,27 In Zambia, the copper crisis period (1975)(1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992) and HIV/AIDS induced major changes in trends. 28 In Lesotho and Swaziland, HIV/ AIDS induced drastic increases in mortality.…”

Social and Psychological Aspects of HIV/AIDS and their Ramifications

“…This decline was even somewhat faster than between 1970 and 1990, a period of turmoil for many countries, and of long lasting economic recession. [see Garenne & Gakusi, 2006b, Gakusi & Garenne, 2007 for more details on the impact of political and economic crises] Mortality levels and trends differed quite significantly among the six groups of countries. Firstly, the levels at baseline differed: countries from the Southern and the Islands groups had much lower levels of mortality in 1950 as well as in 1970.…”