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What We Know About How to Save Kids’ Lives

MOGADISHU, Somalia — Hunger and loss make up a kaleidoscope in Somalia, but one scene stands out in my visit: A mom, Fardosa Ahmed, confides shyly that she had eight children but lost four of them, and now she fears she may lose a fifth, her daughter Catiko, who is sick, weak and motionless.

The tremble in Fardosa’s voice offers a reminder of the prospective human cost of the famine that, as I wrote in my last column, is looming this spring. United Nations officials are warning as loudly as they can about this impending catastrophe, which reflects the conjunction of two global forces driven by the West — and it’ll be up to us to choose which prevails.

The first is climate change, which is widely believed to be a factor in the drought here that is withering crops and killing livestock. Climate change is complicated, but my guess is that Fardosa would not be on the verge of losing a fifth child if we had not secured our standard of living by pumping carbon into the atmosphere for more than a century.

Credit…Giles Clarke for The New York Times

The second global force is a more promising one: the revolution in child mortality that has already saved tens of millions of lives and that enables us to help Somali children this year if that’s a priority.

One gauge of our progress in saving children’s lives:

According to one analysis of data, as recently as the 1920s, the child mortality rate in the United States was higher than it is in Somalia today — and since then it has plunged in America by more than 95 percent. In 1960, child mortality was higher in Mexico, Brazil, China and Turkey than it is in Somalia today.

We know how to save kids’ lives. At UNICEF in the 1980s and 1990s, an American executive director named James Grant — for my money, the most important U.N. official in history — oversaw an effort that slashed death rates in the developing world and saved perhaps 25 million lives. If we built statues of heroes based on their impact on the world, busts of Grant would adorn every town square.

All this underscores that we live in an age of miracles, when it is possible to multiply loaves and fishes, feed the hungry and overcome death itself. And we can do this remarkably cheaply.

Take Ubax Muhamad, a 5-year-old girl I met who weighs just 20 pounds. Preventing this kind of severe acute malnutrition in Somalia can cost as little as 15 cents a day, UNICEF says. The modern version of manna from heaven is a high-energy variant of peanut butter called Plumpy’Nut, costing $57 for a carton and lasting a severely malnourished child about two months.

Another effective way of fighting malnutrition is lower tech — promotion of exclusive breastfeeding. Only about one-third of Somali moms breastfeed exclusively for six months, and one highly regarded nonprofit that focuses on breastfeeding, Alive & Thrive, estimates that the lives of almost 10,000 Somali children a year could be saved with optimal breastfeeding.

Credit…Giles Clarke for The New York Times

One factor is suspicion of colostrum, the highly nutritious first milk that can be yellow and thick.

“The first milk is very bad — never give it to a baby,” one grandma, Hawa Ibrahim, who has lost seven grandchildren, told me. “Give honey instead, and then after two days you can give mother’s milk.” That’s terrible advice.

Other moms repeated the mistaken advice that on hot days, a baby needs to drink water as well as breast milk, or that other foods should be given to the baby beginning at three or four months.

Breastfeeding promotion has been underway in Somalia and is having an impact, for exclusive breastfeeding rates have risen sixfold since 2009 when they were only about 5 percent.

I know I’ll hear from some well-meaning readers who will say something like: What you describe is heartbreaking, but if we help Somalis won’t they just keep having kids who will then starve?

The answer is no.

It’s true that Somalia has one of the highest fertility rates in the world: 6.3 births per woman. But the number is already dropping, and there are three approaches that have worked globally to lower fertility: educate girls, improve contraceptive access and lower child mortality so families can be confident that their children will survive.

One of the dads I met, Saalax Abdiqadir, 22, has a 2-year-old girl who is severely malnourished and near death. When times are difficult, I asked him, does he think he and his wife should have fewer children, because they can’t afford to feed them, or have more children, in case some die?

“I want to have more babies, in case I lose one,” he replied.

So let’s have some empathy. For those asking how to help, check out the Dr. Hawa Abdi Foundation or the International Rescue Committee. And for government officials, a message: One lesson of history is that we can overcome famines — but it’s crucial to act early.

The next few months will be critical. I fear we’re going to miss that window.

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Huge thanks to readers for donating more than $5.5 million so far to the three outstanding nonprofits in my annual holiday giving guide, including one that works in drought-affected areas of Africa. You can donate until Jan. 31. For more information, visit KristofImpact.org.

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