11 March 2007

Stark disparities revealed by Thailand's largest-ever household survey

Gongsak and his mother being interviewed at home in Baan Tung Faet village in Rachaburi Province. © UNICEF-Thailand/2006/Rob Few
Story by Robert Few

RATCHABURI, Thailand – Three-year-old Gongsak, an ethnic Kalieng boy, lives with his mother in a flimsy wooden shack off a minor road in rural Ratchaburi. Here, some 30 kilometres from the border with Burma, Gongsak and his mother, Noy Meer, subsist in poverty, without access to adequate health care, sanitation or other services many Thai families take for granted.

Gongsak’s household was one of 43,000 covered by a nationwide survey carried out last year by the National Statistics Office (NSO). The survey, officially called the Multiple Indicator Cluster Survey (MICS), was the largest assessment ever of the situation of children and women in Thailand.
The results of the survey, conducted with support from UNICEF, were launched recently in Bangkok by the NSO.

The UNICEF Representative for Thailand, Tomoo Hozumi, said the survey’s results confirm that Thailand’s remarkable economic progress over recent decades has brought many social benefits to a large proportion of the population. Hozumi noted that these include significant improvements in children’s nutritional status, widespread access to safe drinking water and sanitation, and high coverage of essential health services

“But at the same time, the survey has confirmed that there are still challenges to ensuring the well being of all children in Thailand, including exclusive breastfeeding and the low levels of iodized salt consumption,” Hozumi said. “The survey has also underlined the disparities among different geographical areas and social groups that require attention.”

Late last year, three of the nearly 1,000 NSO staff members working on the survey visited Gongsak and Noy Meer to ask questions about their basic situation. The questions covered access to health care and education, nutritional status, levels of exclusive breastfeeding and iodized salt coverage, knowledge of HIV/AIDS and a host of other issues critical to children’s survival and development.

While the questions were asked, little Gongsak, dressed only in a filthy T-shirt, played in the dirt with one of his dogs. Another local boy, Naing, clearly of school age but whose parents have never sent him to school since they migrated here from Burma several years ago, sat on the shack’s rickety wooden steps, idly watching the interview.

The lives of Gongsak and Naing are examples of what some of the survey’s results show: the disparity in the living conditions between a majority of Thai children and children in remote and isolated areas, particularly those of ethnic minorities and migrants.

At the national level, for example, great progress has been made in ensuring universal primary school education. The survey shows that 98 per cent of all children aged 7 to 12 are attending school. But in Ratchaburi, this figure drops to 83 per cent for boys of the poorest households, meaning that nearly one-in-five boys in poor households are not receiving a basic education.

This may be the fate that awaits Gongsak. Although his older brother is currently in the third grade at a primary school, Noy Meer explained that keeping him there is difficult.

“School books cost 200 baht, and then there is the cost of uniforms and travel,” she said. “This is a lot of money for us. The only income we have is from my husband, who earns 100 baht a day cleaning cars. But there isn’t work for him every day, and on the days he doesn’t work, he doesn’t get paid.”

Gongsak should start primary school when he is six, but with their meager income already stretched to the limit, his family will find it difficult to send him to school. Naing, who is old enough to be enrolled in school, is already missing out on an education.

The chances of children like Gongsak and his brother attending secondary school are even slimmer. Although the survey found that 80 per cent of children between 13 and 18 years of age attend secondary school nationwide, only 74 per cent do so in Ratchaburi. For children whose mothers have no education, such as Noy Meer, that figure falls to 54 per cent. 

If Thailand is to achieve its Millennium Development Goals (MDG) Plus target of universal secondary schooling by 2015, progress for children like Gongsak and Naing needs to be much accelerated (The MDG Plus targets are a set of long-term development goals that Thailand committed itself to achieve by 2015, and they are more ambitious than the targets agreed to by other countries).

There is similar disparity in health care coverage. Nationally, 90 per cent of children are immunized against the six major preventable childhood diseases by the age of two. But the rate drops to 81 per cent for children in households where Thai is not the first language. Gongsak’s mother, whose first language is Kalieng, said she forgot to take Gongsak to be vaccinated. Gongsak is one of the roughly 200,000 young children in Thailand at risk of a serious illness or death from easily preventable diseases.

Naing also received no vaccinations.  In his community, few are aware that children could be crippled or killed by illnesses for which immunization is easily available.  For parents who have heard of immunization, a common attitude is that since their parents never had them vaccinated and they are still fine, there is no need to vaccinate their own children.  They do not take into account the children who died from vaccine-preventable illnesses.

Nationally, only 5 per cent of infants are exclusively breastfed for the first six months – the best way to guarantee that infants get all the nutrients they need during this crucial period of early development.  This is the lowest exclusive breastfeeding rate in Asia and among the lowest in the world.

Thailand also lags behind many other countries in Asia in terms of iodized salt consumption – the best and the most economical way to ensure that the population has an adequate amount of this essential nutrient in its daily diet.  Iodine deficiency Disorders are the world’s largest cause of preventable mental retardation, and they can substantially lower children’s mental capacity.  At the national level, only 58 per cent of households consume iodized salt.  In other parts of the country, such at the Northeast, coverage is as low as 35 per cent.

Armed with the survey’s results, the government and its partners will be able to design better policies and programmes to address disparities at the sub-national level and the challenges that remain for the country as a whole.

One clear remaining challenge for Thailand is HIV/AIDS.  The survey showed that less than half of all women aged 15 to 49 had comprehensive knowledge of HIV transmission – measured by knowing a minimum of two ways of preventing HIV transmission and rejecting three common misconceptions. Among women with no education, nearly one-third did not know how to protect themselves, and one-quarter said they have never heard of AIDS.

In addition, negative attitudes towards people living with HIV/AIDS still persist – 29 per cent of the survey’s respondents replied that an HIV-positive teacher should not be allowed to work, and 65 per cent said they would not buy food from a vendor with HIV/AIDS.

Gongsak’s mother says she has never used a condom, although she knows what one looks like.  As for the HIV/AIDS virus, she has no idea how to prevent it, but thinks it can be spread by mosquitoes – a misconception held by nearly a third of all women aged 15 to 49, according to the survey’s results.

This lack of HIV/AIDS awareness was noted by Sumontha Kamkaen, one of the NSO staff who helped to conduct the survey.

 “Most of the ethnic Thais know the basics about HIV/AIDS, although they may not be too sure of things like whether a mother can pass it on to her child,” Sumontha said. “But few of the ethnic minority women even know what HIV/AIDS is.”

Sumontha said carrying out this survey helped government staff better understand local needs and also introduced those interviewed to the importance of some of the issues covered.

During the survey, Sumontha said, interviewers began to realize that malnutrition is a serious problem among the children of ethnic minorities (20 per cent of ethnic minority children are underweight), and that many children cannot afford to go to pre-school (less than half off all children in non-Thai speaking households get a pre-school education).

At the end of the interview with Gongsak’s mother, she was reminded of the importance of taking Gongsak to school and getting him immunized. But the real benefits will come later – when the data generated by the survey lead to policies that will improve the lives not just of Gongsak, but of all children in Thailand.

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