PortraitChild survival, development and protection – August 2009

Accelerated survival, development and protection of children at risk

Trahantsoa: a story that

could have been different
Madagascar is a country facing political uncertainty, with images of violence and
protests having been visible since the beginning of 2009. However, behind this
unappeasing political reality, many families, communities and children
throughout Madagascar continue to suffer challenges to their wellbeing and are
on the brink of survival. Political realities have overshadowed the continued
focus on accelerated child survival, development and protection „

© Rajaonisaona/UNICEF Madagascar/2009

Trahantsoa, a 15 year old girl, faces many adversities which are obstacles to the fulfillment of
her fundamental rights

The story of Trahantsoa, a 15 year old girl who illustrates the reality of what some communities
lives in a village 25 kilometres from the city of have to endure on a daily basis.
Ampanihy in the South of Madagascar,
Trahantsoa recently lost her first child through
a combination of harmful traditional practices
combined with difficulties in accessing basic
social services and problems related to climate
risks and malnutrition. “I think I lost my baby
because I had to work a lot,
such as fetching water, doing
housework and farming” she
says. Her baby’s life was one
that could have been saved. they turn 12. We push them However,
Within the framework of
cultural practices ingrained in
the village for decades, Trahantsoa was forced
by her family and the local villagers to get
married at the age of 14, without concern on the
impact this marriage would have on her
survival, development and protection.
Trahantsoa’s mother explains the situation:
“Here we marry our children off when they
turn 12. We push them into marriage because
we do not have schools. Our girls do not have
any skills; they cannot provide for their needs.
When our girls get married, their husbands
offer them zebus and give them money. We no
longer feed them and this becomes the
responsibility of the husband.”
Deprived of her Childhood
and Adolescence
Trahantsoa had never had the opportunity to go
to school. The nearest school is a three-hour
walk from her village. Deprived of her right to
education, deprived of the right to enjoy her
childhood and adolescence, Trahantsoa - today
© Rajaonisaona/UNICEF Madagascar/2009
Trahantsoa’s village is located 25 kilometres from the
nearest health centre
married to a man twice her age, has to play the
role of an adult at only 15 years old.
In fact, the law in Madagascar offers protection
to children regarding early marriage. In 2007, a
new law was adopted
“ Here we marry our setting the minimum
age for marriage at 18
children off when for both boys and girls.
despite
communication and
into marriage.” awareness raising
campaigns throughout
the country, the execution of this law remains a
challenge. Traditional rather than official
‘marriages’ remain common, making the law
difficult to enforce, and economic and social
pressures on households to marry their
daughters off at an early age compound the
challenge further.
Climate Risks, Malnutrition and
Difficulty in Accessing Basic Services
After being married at 14, Trahantsoa fell
pregnant at 15 when her adolescent body did
not yet allow her a safe pregnancy. Trahantsoa
was also suffering from stunting due to chronic
malnutrition. In the months she was pregnant,
her family ate only once a day [noting that when
women are pregnant, it once again becomes the
parents’ responsibility to feed them].
“We only eat cassava. We only eat once a day.
We no longer eat at midday but only in the
evening” says Trahantsoa’s mother.
The southern part of Madagascar is
systematically subject to climate risks. Rainfall
has become increasingly scarce and sporadic,
which has hugely affected agricultural activities
which constitute the livelihood of many
households. At the end of 2008, 31 communes
of three southern regions were in a state of food
insecurity. During the first half of 2009, more
than 5,400 children under the age of five were
admitted to health services for formal diagnosis
of severe malnutrition in the southern regions
of Androy and Anosy.
Despite the difficult circumstances, Trahantsoa, means of communication were considered
supported by her mother and family, attended beforehand, her baby might have lived. Was
all prenatal consultations during her pregnancy, there a means of reducing the disparity between
regardless of the 25 kilometres between her basic social service delivery and community
house and the nearest health centre. They needs? Could health workers have anticipated
covered the 25 kilometres distance by zebu- such an incident, since they were aware of the
drawn cart in about five hours. family’s situation? Were health workers
qualified enough and sufficiently equipped to
The day before she gave birth, once contractions follow up and handle this case? The answer is
had started, Trahantsoa was rushed to the often a combination of causes.
health centre where she had regularly been
consulted. Unfortunately, after the five hour Tragic incidents like this one are the joint
journey, Trahantsoa arrived at the health centre responsibility of all actors: the community,
too late to save her baby, who died due to youth, community health workers, health
Trahantsoa’s fatigue, malnutrition, difficulties workers in basic health centres, civil society and
in accessing basic services, the authorities at all
and above all due to the “Places where we are going to levels. This situation
combined factors of an calls upon
environment unable to intervene are remote areas humanitarian
provide protection for this where access to healthcare is partners, the
15 year old girl. international
almost impossible” community and
“Trahantsoa regularly donors to further
came to her consultations at the health centre,” strengthen humanitarian assistance in the
confirms Baofeno, the health worker who had country.
followed up on Trahantsoa’s progress, “but
unfortunately, when she arrived here, she was “Almost 1.2 million people living in the South of
too weak to have a baby. This may be due to Madagascar are suffering from food and
her young age and the tiring cart journey.” nutrition insecurity” says Bruno Maes,
UNICEF Representative in Madagascar. “The
Joint Responsibility of All Actors most vulnerable among them are children
under five years old and thousands of young
Had the family decided to go to the health adolescents - with Trahantsoa forming part of
centre before the first signs of contractions, her the latter group. Despite the fact that the
baby’s life might have been saved. If problems Malagasy government signed and ratified the
related to access to basic health services and Convention on the Rights of the Child in March
1991, the realisation of child rights in
Madagascar faces numerous challenges.
Trahantsoa’s rights to quality healthcare,
nutrition, education, safe drinking water and
adequate sanitation have not been respected,
and this urgently needs to be addressed.”

Today, Trahantsoa is slowly recovering from her

ordeal. Having found her smile again, her
health is being closely followed. Trahantsoa,
alongside her entire family, receives food
rations provided by the World Food Programme
© Rajaonisaona/UNICEF Madagascar/2009
and distributed by UNICEF.
Young paramedics working in remote areas in
Toliara II district
 Reducing the Distance Between Services
and Communities
With the aim of reducing the distance between
communities and health services, close to fifty
young paramedics were deployed in the field to
cover the most vulnerable areas of this part of
the island, including the district where
Trahantsoa lives.
Their primary mission is to save lives. The
objective is to support health centres to
implement the accelerated child and mother
survival and development strategy and to
reinforce high impact interventions in order to
reduce maternal and infant mortality.
© Rajaonisaona/UNICEF Madagascar/2009
Many villagers live in difficult conditions in the
South of Madagascar
“Places where we are going to intervene are
remote rural areas where access to care is
almost impossible,” reveals Andriatiana, one of
the newly selected paramedics. “My mission
will consist of bringing the local population
closer to healthcare services. This mission is
only possible if we physically reach out to
communities and villages.”
Besides their functions as mobile health
workers, the paramedics will be used to breach
the gap between communities and basic social
services and to act as communication agents
between the different actors.
“I think that apart from providing healthcare,
the rural population needs communication to
be strengthened,” says Noëline, another
paramedic. “I am ready to reinforce this aspect
of the programme, with the aim of reducing
child deaths in the areas where I will be
deployed.”
These young paramedics are equipped with
logistical and financial means required to
ensure curative, preventive and promotional
activities. They will cover the seven most
vulnerable districts in three regions in the
South of Madagascar: Androy, Anosy and
Atsimo Andrefana, representing an estimated
population of 1,275,000 inhabitants, including
more than 230,000 children under the age of
five and an estimated 294,000 women of child-
bearing age. The health indicators of these
districts are among the weakest in Madagascar.
The different strategies – fixed, advanced and
mobile – will be further developed to ensure an
optimal coverage of all the population,
particularly those living more than 5 kilometres
from basic health services.
Appeal for
International Solidarity
“UNICEF appeals to the international
community to show their support of and
solidarity with children in the South of
Madagascar, within the framework of a
national plan of accelerated child survival and
development”, continues Bruno Maes. “The
national plan’s objective is to ensure children’s
protection, increased health service delivery,
access to safe drinking water and malnutrition
prevention and treatment. Mobilising dozens
© UNICEF Madagascar/2009
Immunisation activities have also been supported by
the young paramedics in this part of the island
 unrest and the socio-economic crisis, the
impacts of emergencies related to a climate
change, problems of nutrition insecurity and
lack of access to safe drinking water, have
exacerbated the already challenging daily lives
of so many families „

Facts and Figures in Madagascar

An estimated 81,000 children under five years
of age die each year (SOWC 2009)*

An estimated 4,500 women die each year from

© UNICEF Madagascar/2009
Noeline, one of the paramedics, supporting the
Mahatsinjo II Basic Health Centre in Toliara II
district
of young Malagasy paramedics in the South of
Madagascar will certainly contribute to
reducing infant and maternal mortality.”
© UNICEF Madagascar/2009
causes related to childbirth or pregnancy
(SOWC 2009)
Only one childbirth out of two (51%) is
attended by a skilled health personnel (SOWC
2009)
Almost half of children under five years of age
(48%) suffer from chronic malnutrition
(SOWC 2009)

Far from the eyes of society, in many villages in
several regions of Madagascar, communities,
families and children face hardships which are
obstacles to the realisation of their fundamental
rights: rights to protection, education, health,
nutrition and access to drinking water and
sanitation. In fact, the infrastructural
difficulties these communities face,
compounded by the effects of political
The number of married women between the
ages of 20 and 24 or in a union before the age
of 18 amounts to 39% (EDS 2003/2004)**
More than 452,000 children between the ages
of 6 and 10 do not go to school (Ministry of
Education, EPT Plan 2007)***
* State of the World’s Children 2009
**Demographic and Health Survey 2003-2004
***Education for All Plan 2007

“UNICEF appeals to the international

© UNICEF Madagascar/2009
Trahantsoa received protection food rations,
provided by WFP and distributed by UNICEF
community to show their support of
and solidarity with children in the
South of Madagascar, within the
framework of a national plan of
accelerated child survival and
development, which aims to ensure
children’s protection, increased
health service delivery and access to
safe drinking water and malnutrition
prevention and treatment.”
Bruno Maes
UNICEF Representative
Madagascar
Traditional practices and customs can, in some
circumstances, present a challenge in fulfilling child rights
in some regions of Madagascar

© Rajaonisaona/UNICEF Madagascar/2009