URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

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The STaTe of The World'S Children 2016

A fair chance for every child

aCKnoWledGeMenTS

This report is the result of collaboration among many individuals and institutions. The

editorial and research team thank all who gave so willingly of their time, expertise and

energy, in particular:

Advisory Board:

Yoka Brandt,

Deputy Executive Director;

Geeta rao Gupta,

Deputy

Executive Director;

Gerard Bocquenet, Ted Chaiban, Sarah Cook, Paloma escudero,

andres franco, Claudia Gonzalez romo, Goran holmqvist, Karin hulshof, afshan Khan,

olav Kjørven, Jeffrey o’Malley.

Programme and Policy Guidance:

abdul alim, david anthony, ivelina Borisova,

Josephine Bourne, nicola Brandt, Jingqing Chai, Kim dickson, Martin evans, antonio

franco Garcia, Vidhya Ganesh, Katherine holland, Tamara Kummer, George

laryea-adjei, dheepa Pandian, david Stewart, Morgan Strecker, Guy Taylor, Justin Van

fleet, rudina Vojvoda, frank Borge Wietzke, alexandra Yuster, Maniza Zaman.

Thank you to rachel Sabates-Wheeler and Jennifer Yablonski for the background paper,

‘Social protection and child poverty: evidence, practice, and gaps’, and to Gonzalo

fanjul for the background paper ‘Child poverty and inequality in rich countries’.

Thank you to ravneet ahluwalia and Vivek Kumar for their help with the Perspective

essays.

Communication team:

Justin forsyth,

Deputy Executive Director;

Paloma escudero,

Director, Division of Communication;

edward Carwardine,

Deputy Director, Division

of Communication;

Maurico aguayo, nigina Baykabulova, Gerrit Beger, Penni Berns,

Marissa Buckanoff, Patricia Codyre, eliana drakopoulos, Jedd flanscha, Claudia

Gonzalez romo, Bayann hamid, Chulho hyun, angus ingham, Malene Jensen, Ueli

Johner, ariel Kastner, nicholas ledner, Marixie Mercado, najwa Mekki, Christine

nesbitt, david ohana, rebecca obstler, laetitia Pactat, Katarzyna Pawelczyk, hugh

reilly, abhijit Shanker, Melanie Sharpe, arissa Sidoti, Tanya Turkovich, Sonia Yeo.

UniCef country and regional offices and headquarters divisions contributed to this

report by taking part in formal reviews or commenting on drafts. Many field offices and

UniCef national committees arranged to translate or adapt the report for local use.

rePorT TeaM

EDITORIAL AND RESEARCH

Kevin Watkins,

principal author;

Maria Quattri,

research and technical advice on data;

Tara dooley, hirut Gebre-egziabher, anna Grojec, Yasmine hage, Catherine

langevin-falcon, Timothy ledwith, Céline little, Baishalee nayak, Carlos Perellon,

ami Pradhan, Charlotte rutsch, Zahra Sethna, Jordan Tamagni.

DATA AND ANALYTICS

agbessi amouzou, robert Bain, nassim Benali, david Brown, Claudia Cappa, liliana

Carvajal, Karoline hassfurter, hiroyuki hattori, lucia hug, Priscilla idele, Claes

Johansson, Julia Krasevec, Vrinda Mehra, Padraic Murphy, Colleen Murray, Khin

Wityee oo, nicole Petrowski, Tyler Porth, Shahrouh Sharif, Tom Slaymaker, Chiho

Suzuki, haogen Yao, danzhen You.

PRODUCTION AND DISSEMINATION

Samantha Wauchope,

Production Specialist;

Germain ake, ernest Califra.

DESIGN

Publication and graphic design

Soapbox, www.soapbox.co.uk infographics on pages 3, 11, 42, 70 and 90.

June 2016

Permission is required to reproduce any part of

this publication. Permissions will be freely granted

to educational or non-profit organizations. others

will be requested to pay a small fee. Please

contact:

division of Communication, UniCef

attn: Permissions

3 United nations Plaza, new York, nY 10017 USa

Tel: +1 (212) 326-7434

email: [email protected]

for the latest data, please visit <data.unicef.org>.

iSBn: 978-92-806-4838-6

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

The STaTe of The World'S Children 2016

A fair chance for every child

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

Contents

foreword

The state of the world's children

by Anthony Lake , Executive Director, UNICEF

Introduction

reaching every

child: The promise

of equity

pages viii–7

Why focus on equity now?

Meeting the equity imperative

Child health:

a fair start in life

pages 8–39

Patterns and risks of child mortality

Prospects for child survival

inequities in child survival

disparities in access and quality of care

low-cost interventions can make a difference

reaching the most vulnerable

What if the gaps are not closed?

equity objectives

high return on health investments

Benefits of universal health coverage

adequate and equitable financing

Power in partnerships

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Contents, continued

education:

levelling the

playing field

pages 40–67

access to education – from the start

equity and learning outcomes

education in emergencies and protracted crises

Benefits of quality education

reaching children throughout the learning process

equity targets

Teaching matters

education financing

The role of aid

equitable progress is possible

Children and

poverty: Breaking

the vicious cycle

pages 68–87

The effects of poverty in childhood

Measuring how many children live in poverty

Children living in extreme poverty

Children living in ‘moderate’ poverty

Poor children living in rich countries

Child poverty in all its dimensions

disadvantages overlap and reinforce one another

Universal measurement of child poverty

The role of cash transfers in reducing poverty and

inequality

Cash transfers and access to essential services

expanding social protection – and looking ahead

Pathways

to equity

pages 88–101

information

integration

innovation

investment

involvement

The STaTe of The World’S Children 2016

iii

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Contents, continued

Perspectives

a fair chance for girls – end child marriage

by Angélique Kidjo

Give children a chance

by Gordon Brown

What are we waiting for?

Sustainable societies begin with children

by Kailash Satyarthi

endnotes

102

list of Boxes

BoX 1. equity defined

BoX 1.1. female volunteers help health workers reach the marginalized in nepal

BoX 1.2. every child counts: The importance of quality data on child survival

BoX 1.3. Bangladesh shows the challenge of sustained progress in child survival

BoX 1.4. health equity funds provide free health care to the poor

BoX 1.5. eliminating malnutrition can help break the cycle of unequal opportunity

BoX 2.1. The developing brain: an early window of opportunity for learning

BoX 2.2. The destructive impact of armed conflict on education

BoX 2.3. Brazil and Viet nam: Making the grade

BoX 3.1: Monetary child poverty measures

BoX 3.2. Measuring multidimensional child poverty

list of figures

figure 1.1. Countries with limited economic growth can still reduce child mortality

figure 1.2. Progress in under-five mortality does not necessarily come with greater equity

figure 1.3. The poor will need to make faster progress to reach the 2030 goal

figure 1.4. Progress must accelerate for the least advantaged children

figure 1.5. accelerated progress in neonatal mortality is key to meeting the SdG target

figure 1.6. Many countries will miss the under-five mortality target, some by a wide margin

figure 1.7 antenatal care and skilled birth attendance save newborn lives

figure 1.8. in 63 countries, equity in intervention coverage could reduce under-five mortality rates

by almost 30 per cent

figure 1.9. Many countries do not have enough health providers

figure 2.1. More than half of the 59 million out-of-school children live in sub-Saharan africa

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Contents, continued

figure 2.2. if current trends persist, the world is off-track to reach primary and secondary

education for all by 2030

figure 2.3. Many girls and boys drop out as they transition through education levels

figure 2.4. in Pakistan, the level of education achieved depends on gender, residence and wealth

figure 2.5. Wealth, gender and residence affect education in nigeria

figure 2.6. Wealth-based gaps in basic math skills start early and persist over time

figure 2.7 early childhood education gaps vary by wealth and residence

figure 2.8. Progress must accelerate for the least advantaged children

figure 3.1. a disproportionate share of children live in extreme poverty

figure 3.2. in 2030, 9 out of 10 children in extreme poverty will live in sub-Saharan africa

figure 3.3. More than half of the population in low- and middle-income countries live on

less than US$5 a day

figure 3.4. in most european Union countries, children are at higher risk

of monetary poverty than adults

Statistical Tables

pages 107–172

overview

General note on the data

Child mortality estimates

Under-five mortality rankings

regional classification

notes on specific tables

Table 1. Basic indicators

Table 2. nutrition

Table 3. health

Table 4. hiV/aidS

Table 5. education

Table 6. demographic indicators

Table 7 economic indicators

Table 8. Women

Table 9. Child protection

Table 10. The rate of progress

Table 11. adolescents

Table 12. disparities by residence

Table 13. disparities by household wealth

Table 14. early childhood development

108

109

110

112

113

118

122

126

130

134

138

142

146

150

154

158

162

166

170

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foreWord

The state of the

world's children

inequity imperils millions

of children and threatens

the future of the world

as we look around the world today, we’re confronted with an uncomfortable but

undeniable truth: Millions of children’s lives are blighted, for no other reason than

the country, the community, the gender or the circumstances into which they

are born.

and, as the data in this report show, unless we accelerate the pace of our

progress in reaching them, the futures of millions of disadvantaged and vulnerable

children – and therefore the future of their societies – will be imperilled.

Before they draw their first breath, the life chances of poor and excluded children

are often being shaped by inequities. disadvantage and discrimination against

their communities and families will help determine whether they live or die,

whether they have a chance to learn and later earn a decent living. Conflicts,

crises and climate-related disasters deepen their deprivation and diminish their

potential.

But it need not be so. as this report also illustrates, the world has made

tremendous progress in reducing child deaths, getting children into school and

lifting millions out of poverty. Many of the interventions behind this progress –

such as vaccines, oral rehydration salts and better nutrition – have been practical

and cost-effective. The rise of digital and mobile technology, and other innovations

have made it easier and more cost-effective to deliver critical services in hard-to-

reach communities and to expand opportunities for the children and families at

greatest risk.

for the most part, the constraints on reaching these children are not technical.

They are a matter of political commitment. They are a matter of resources. and

they are a matter of collective will – joining forces to tackle inequity and inequality

head-on by focusing greater investment and effort on reaching the children who

are being left behind.

The time to act is now. for unless we accelerate our progress, by 2030:

•

almost 70 million children may die before reaching their fifth birthdays – 3.6

million in 2030 alone, the deadline year for the Sustainable development Goals.

Children in sub-Saharan africa will be 10 times more likely to die before their

fifth birthdays than children in high-income countries.

Pupils play at an early childhood

development (ECD) centre

in Gulu District, Uganda.

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•

nine out of 10 children living in extreme poverty will live in sub-Saharan

africa.

More than 60 million primary school-aged children will be out of school –

roughly the same number as are out of school today. More than half will be

from sub-Saharan africa.

Some 750 million women will have been married as children – three quarters

of a billion child brides.

•

These vast inequities and dangers do more than violate the rights and imperil

the futures of individual children. They perpetuate intergenerational cycles of

disadvantage and inequality that undermine the stability of societies and even the

security of nations everywhere.

More than ever, we should recognize that development is sustainable only if it

can be carried on – sustained – by future generations. We have an opportunity

to replace vicious cycles with virtuous cycles in which today’s poor children – if

given a fair chance at health, education and protection from harm – can, as adults,

compete on a more level playing field with children from wealthier backgrounds.

Thus making not only their own lives better, but their societies richer in every

sense of the word.

for when we help a boy access the medicine and nutrition he needs to grow up

healthy and strong, we not only increase his chances in life, we also decrease the

economic and social costs associated with poor health and low productivity.

When we educate a girl, we not only give her the tools and knowledge to make

her own decisions and shape her own future, we also help raise the standard of

living of her family and her community.

When we provide education, shelter and protection for children caught in

conflicts, we help mend their hearts and their minds – so that someday, they will

have the ability and the desire to help rebuild their countries.

This report concludes with five ways to strengthen our work, building on what

we have learned over the last 25 years – and what we are still learning: increasing

information about those being left behind. integrating our efforts across sectors

to tackle the multiple deprivations that hold so many children back. innovating to

accelerate progress and drive change for the most excluded children and families.

investing in equity and finding new ways of financing efforts to reach the most

disadvantaged children. and involving everyone, beginning with communities

themselves, and with businesses, organizations and citizens around the world

who believe we can change the outcome for millions of children.

We can. inequity is not inevitable. inequality is a choice. Promoting equity – a fair

chance for every child, for all children – is also a choice. a choice we can make,

and must make. for their future, and the future of our world.

Anthony Lake

executive director, UniCef

The STaTe of The World’S Children 2016

vii

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REACHING

EvERY CHILD

THE PROMISE

OF EqUITY

viii

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inTrodUCTion

Reaching every

child

The promise of equity

If the soul of a society can be judged by the way it

treats its most vulnerable members, then by a similar

measure, a society’s future – its long-term prospects

for sustainable growth, stability and shared prosperity

– can be predicted by the degree to which it provides

every child with a fair chance in life. Providing every

child with that fair chance is the essence of equitable

development. And as this edition of

The State of the

World’s Children

argues, promoting equity is more than

a moral obligation. It is both a practical and a strategic

imperative, helping to break intergenerational cycles

of disadvantage and thus reducing the inequalities that

undermine all societies.

Musamat (sitting and facing

camera), 6, plays a game at the

Bakchora pre-primary school

in Satkhira Sadar, Bangladesh.

Photo

every child is born with the same inalienable right to a healthy start in life, an

education and a safe, secure childhood – all the basic opportunities that translate

into a productive and prosperous adulthood. But around the world, millions of

children are denied their rights and deprived of everything they need to grow up

healthy and strong – because of their place of birth or their family of origin; because

of their race, ethnicity or gender; or because they live in poverty or with a disability.

how do these deprivations manifest themselves in the life of a child, on the

journey to adulthood?

an infant deprived of post-natal care may not survive her first days. a child

deprived of immunization or safe water may not live to see his fifth birthday, or

may live a life of diminished health. a child deprived of adequate nutrition may

never reach his full physical or cognitive potential, limiting his ability to learn and

earn. a child deprived of quality education may never gain the skills she needs

to succeed someday in the workplace or send her own children to school. and a

child deprived of protection – from conflict, violence or abuse, from exploitation

and discrimination, from child labour, or early marriage and motherhood – may be

physically and emotionally scarred for life, with profound consequences.

The STaTe of The World’S Children 2016

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Reaching every child: The promise of equity

how do such inequities manifest themselves in the countries and communities

where these children grow up?

The evidence is all around us, in the form of cycles of deprivation that are

transmitted from one generation to the next, deepening inequality that threatens

societies everywhere. Children who do not have the opportunity to develop the

skills they will need to compete as adults can neither break these vicious cycles in

their own lives nor give their children a chance to fulfil their potential. Their societies,

too, are deprived of the full contribution they might have made. left unaddressed,

gaps will grow wider and cycles more vicious, affecting more children. This is

especially true in a world increasingly beset by violent conflict, chronic crises and

other humanitarian emergencies caused by natural disasters and the growing

effects of climate change – all of which affect children disproportionately, and the

most disadvantaged and vulnerable children most of all.

This report’s call to action is, therefore, motivated by a sense of urgency and the

conviction that a different outcome, and a better world, are possible. Children

born into poverty and deprivation are not doomed to live lives of despair. inequity

is not inevitable, if governments invest in expanding opportunity for every child

– shifting policies, programming and public spending priorities so the most

disadvantaged have a chance to catch up with the most advantaged.

as the report shows, the good news is that there are more effective – and cost-

effective – ways to reach the hardest-to-reach children, families and communities.

new technology, the digital revolution, innovative ways to finance critical

interventions and citizen-led movements are all helping to drive change for the

most disadvantaged. investing in these interventions and initiatives, and fuelling

these emergent movements, will yield both short- and long-term benefits for

millions of children and their societies.

The arithmetic of equity is relatively simple, and it is not a zero-sum game.

everyone should move forward, in rich and poor countries alike. But with greater

investment and effort focused on reaching the children and families who have

made the least progress, advances in child survival, health and education can be

more equally shared to the benefit of all. To realize our global development goals,

we must invest first in the children who are furthest behind.

investing in the most disadvantaged is not only right in principle. evidence shows

that it is also right in practice. in a 2010 study,

UniCef demonstrated that an

equity-focused approach would accelerate progress towards global health goals

faster than could be achieved by the current path and would be especially cost-

effective in low-income, high-mortality countries.

The study was based on a simulation that tested two scenarios for achieving

maternal and child health goals. one approach emphasized a greater effort to

reach children who were worse off. The other was a stay-the-course method that

did not place special emphasis on the disadvantaged.

Two key findings emerged: first, by addressing the concentration of various forms

of inequity in the most disadvantaged populations, an equity approach accelerated

progress towards realizing the health goals faster than the stay-the-course path.

Second, by averting more deaths with the same financial investments, the equity

approach was considerably more cost-effective and sustainable than the alternative.

So investing in equity is not only a moral necessity. it is a practical and strategic

imperative as well.

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Unless the world tackles inequity today, in 2030:

167

million children will live

extreme poverty

million children under age 5

will die

between 2016 and 2030

million children of primary

school age will be

out of school

Why focus on equity now?

as governments around the world consider how best to meet their

commitment to achieve the Sustainable development Goals (SdGs) by 2030,

the lessons of global efforts over the past 15 years are instructive.

Progress achieved towards the Millennium development Goals (MdGs) between

2000 and 2015 demonstrated the power of national action, backed by international

partnerships, to deliver transformative results. Children born today are

significantly less likely to live in poverty than those born at the start of the new

millennium. They are over 40 per cent more likely to survive to their fifth birthday

and more likely to be in school.

Governments and communities around the world have rightly celebrated these

advances. Yet in the midst of progress, millions of children continue to live – and

die – in unconscionable conditions. in 2015, an estimated 5.9 million children

died before reaching age 5, mostly as a result of diseases that can be readily and

affordably prevented and treated.

Millions more children are still denied access

to education simply because their parents are poor or from a stigmatized group,

because they were born female, or because they are growing up in countries

affected by conflict or chronic crises. and even though poverty is falling globally,

nearly half of the world’s extreme poor are children, and many more experience

multiple dimensions of poverty in their lives.

in many cases, equity gaps have narrowed over the past 25 years. for example, in

all regions, the poorest households experienced greater absolute declines in child

mortality than the richest. four regions achieved gender parity in primary education.

But in far too many other cases, overall progress did little to narrow deep and

persistent disparities. Governments failed to track the equity gaps separating the

most disadvantaged children from the rest of society. national averages marking

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Reaching every child: The promise of equity

>> Why focus on equity now?

overall progress masked glaring – and sometimes growing – gaps between children

from the poorest households and those from the richest households.

We cannot afford to let that history repeat itself.

To meet the 2030 goals, the pace of progress in the next 15 years will have to

outpace that of the MdG period. The consequences and costs of failure are

enormous. in fact, if the trends of the past 15 years continue for the next

15 years, by 2030, an estimated 167 million children, the great majority in

sub-Saharan africa, will still be living in extreme poverty. approximately

3.6 million children under age 5 will die that year, still from mostly preventable

causes. and there could still be more than 60 million primary-school-aged

children out of school.

far more than the MdGs that preceded them, the 2030 goals recognize the

critical importance of promoting equity. The 17 goals and 169 associated targets

that the world’s governments have committed to achieving are universal, linked

by a pledge “that no one will be left behind … and we will endeavour to reach the

furthest behind first.

”

redeeming that pledge must begin with delivering progress for the

children

who have been left behind. and the need to do so is urgent.

The United nations has projected increasing humanitarian needs and a grim

outlook for children in 2016.

The United nations high Commissioner for

refugees estimated that by 2015, at least 60 million people had fled their

homes because of conflict and violence.

half of them are children.

The

number of children experiencing prolonged and complex disasters, such as the

conflict in the Syrian arab republic, is growing.

The intensifying effects of climate change are also exacerbating the risks to

the most disadvantaged children. Globally, more than half a billion children live

A group of young girls eat

lunch at Salam #9 Primary

School for Girls in the Abu

Shouk camp for internally

displaced people, Sudan.

Chinmaya Shrestha warms

her three-day-old grandson

at the primary health centre

in Gorkha District, Nepal.

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oUr neW TarGeTS for

Children CannoT Be aChieVed

UnleSS We MaKe The MoST

diSadVanTaGed Children a

PrioriTY.

in zones where the occurrence of flooding is extremely high, and nearly

160 million live in zones where the severity of drought is high or extremely

high.

The World health organization has projected that approximately

250,000 additional deaths will occur annually through 2030 from malnutrition,

malaria, diarrhoea and heat stress attributable to climate change.

The challenges of reaching these children with essential services and protection

are considerable, but so are the benefits to be gained. and we must reach

them. for if we do not, we are likely to see hard-won development gains slip

away and watch the consequences of this failure play out across the world.

There is no question that progress for the most disadvantaged children and

families is the defining condition for delivering on the 2030 goals and determining

the future opportunities of generations to come. The time to act is now.

Meeting the equity imperative

Thirty-five years ago, the first

State of the World’s Children

report commented

on an earlier set of development goals. The question arises, the authors wrote,

“as to whether these goals are ... launched with no more than a wing and a

prayer or are they validated by hard evidence that they can be achieved?”

This

report contends that our new targets for children cannot be achieved unless we

make the most disadvantaged children a priority, shifting policies, programmes

and public spending to promote greater equity.

The areas in which children experience inequity are many, but in this report we

focus specifically on three areas that exemplify both the magnitude of the challenge

and the immensity of the opportunity to improve the lives of millions of children.

The report begins with the most glaring inequity of all – disparities in child

survival – and goes on to explore the underlying determinants of preventable

Aida, 16, and her baby, born

prematurely in Bwaila Hospital in

Lilongwe, Malawi.

The STaTe of The World’S Children 2016

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Reaching every child: The promise of equity

>> Meeting the equity imperative

child mortality. it argues that to meet the 2030 child survival target, we must

urgently address persistent disparities in maternal health, the availability of

skilled birth attendants, adequate nutrition and access to basic services, as well

as other factors such as discrimination, exclusion and a lack of knowledge about

child feeding and the role of safe water, adequate sanitation and hygiene in

preventing childhood disease.

The discussion continues with a look at one of the most effective drivers of

development and the greatest equalizer of opportunity: education. Without

quality education, disadvantaged children are far more likely to be trapped as

adults in low-skilled, poorly paid and insecure employment, preventing them

from breaking intergenerational cycles of disadvantage. But a greater focus on

early childhood development, on increasing education access and quality, and

on providing education in emergencies will yield cascading benefits for both this

generation and the next.

having discussed two of the most glaring deprivations children face, this report

then examines child poverty in all its dimensions – and the role social protection

programmes play in reducing it. arguing that child poverty is about more than

income, it presents a case for combining measures to reduce income poverty

with integrated solutions to the many deprivations experienced by children living

in poverty.

finally, as a call to action, the report concludes with a set of principles to

guide more equity-focused policy, planning and public spending. These broad

principles include expanding

information

about who is being left behind and

why; improving

integration

to tackle the multiple dimensions of deprivation;

fostering and fuelling

innovation

to reach the hardest-to-reach children;

increasing

investment

in equity-focused programmes; and driving

involvement

by communities and citizens around the world.

Lunchtime at Kotingli Basic

School, Northern Region,

Ghana.

Child PoVerTY iS aBoUT More

Than inCoMe.

These principles are a guide more than a blueprint, but they can help shape

policy, frame priorities and inform the debate about the best way to deliver on

the promise of the 2030 goals and secure a better future not only for the most

disadvantaged children, but for us all.

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BOx 1. EqUITY DEFINED

The term ‘equity’ may mean different things in different

contexts, but when UNICEF uses it, in this report and

elsewhere, it refers to all children having the same

opportunities to survive, develop and attain their

full potential. Fundamentally, it is about fairness and

opportunity – a fair chance for every child.

The conviction that all children possess the same right

to grow up healthy, strong, well-educated and capable

of contributing to their societies is a cornerstone

of every international agreement to recognize and

protect children’s rights. It culminated, in 1989, with the

adoption of the Convention on the Rights of the Child,

the most rapidly and widely ratified human rights

treaty in history.

Inequity occurs when certain children are unfairly

deprived of the basic rights and opportunities available

to others. It is frequently rooted in complex cultural,

political and systemic factors that shape societies and

the socio-economic status of individuals. Ultimately,

these factors determine a range of outcomes, including

children’s well-being.

Society’s institutions play a critical role in determining

these outcomes for children, most notably in health

and education. Where policies, programmes and

public spending priorities are equitable, targeting

those in greatest need, they can lead to good results

for the most disadvantaged children. Where they

are inequitable, they effectively preselect children

for heightened risks of disease, hunger, illiteracy

and poverty based on their country, community or

family of origin, their gender, race or ethnicity and

other factors. This can perpetuate intergenerational

cycles of disadvantage, harming individual children

and undermining the strength of their societies as

inequality deepens.

An ‘equity approach’ to development begins with

learning more about who is being left behind and why,

identifying the children at greatest risk and analysing

the structural determinants of inequity – poverty,

geography and discrimination, for example – and the

complex interplay among them. It requires asking

hard questions about how deficient public policies,

discriminatory practices, inefficient delivery systems

and other obstacles that prevent children from

realizing their rights, and finding innovative solutions

to these problems. It requires an integrated approach

to closing the gaps, working across development and

humanitarian sectors, at national, local and community

levels, to reach every child.

And, as much as anything else, it demands that the

global community recognize the critical connection

between the well-being of the most disadvantaged

children and the future of our shared world.

Children attend a remedial class, held inside a building

sheltering displaced families in Homs, in the Syrian

Arab Republic.

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CHILD HEALTH:

A FAIR START

IN LIFE

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ChaPTer 1

Child health:

a fair start in life

When it comes to children realizing their right to survive

and develop, the odds are stacked against those from

the poorest and most disadvantaged households. That

any child should face diminished prospects of survival

or decent health because of the circumstances of his or

her birth is grossly unfair and a violation of that child’s

rights. It is also costly in human, economic, social

and political terms. Sustainable progress for today’s

children and future generations requires a focus on

equity – giving every child a fair chance. Reaching the

most marginalized children is more than an ethical

imperative; it is a precondition for meeting the 2030

goals on child health and well-being.

Prisca, 18, and her baby, in

Bwaila Hospital in Lilongwe,

Malawi.

disparities in the survival and health prospects of children from different

backgrounds are not random. They systematically follow the contours of social

disadvantage linked not only to wealth but also to ethnicity, education and

rural-urban divides, among other factors.

one of the most important lessons learned from efforts to improve child – and

maternal – health in the past 15 years is that approaches focusing on overall

progress will not eliminate the disparities that leave the poorest women and

children at the highest risk. While even the poorest countries have achieved

considerable progress, inequities persist.

in terms of child survival, while the absolute gap has substantially narrowed

since 1990, great inequities remain between rich and poor countries. The

relative child mortality gap between sub-Saharan africa and South asia on one

side and high-income countries on the other has barely changed in a quarter

of a century. Children born in sub-Saharan africa are 12 times more likely than

their counterparts in high-income countries to die before their fifth birthday, just

as they were in 1990.

a child born in Sierra leone today is about 30 times more likely to die before

age 5 than a child born in the United Kingdom. Women in sub-Saharan africa

face a 1-in-36 lifetime risk of maternal mortality, compared to 1 in 3,300 in

high-income countries. The lifetime risk in Chad is 1 in 18.

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Child Health: A fair start in life

>> Patterns and risks of child mortality

narrowing the gaps between rich and poor countries is one of the defining

challenges of our time. The starting point for achieving that outcome in child

survival is to work towards bringing mortality rates among the poorest to the

levels of the wealthiest

within

countries.

Prospects for the survival and good health of all children in every society, rich

and poor, should advance as quickly as possible. But the prospects of the

children left furthest behind need the most rapid improvement. in other words,

accelerated gains must be achieved among those facing the highest risks of

death and disease. an effective approach to this challenge will have to address

the wider social determinants of inequity, including poverty, discrimination and

unequal access to basic services.

Patterns and risks of

child mortality

for approximately 1 million children in 2015, their first day of life was also their

last. Globally, the neonatal mortality rate (probability of dying during the first 28 days

of life) is declining less rapidly than the mortality rate for children between 1 month

and 5 years of age. This means that the share of under-five deaths occurring during

the neonatal period is increasing. in 2015, neonatal deaths accounted for 45 per

cent of total deaths, 5 per cent more than in 2000.

The rising share of deaths in the neonatal period reflects the faster decline in

mortality of children aged 1 to 59 months than of newborns. Still, of the 5.9

million under-five deaths in 2015, almost half were caused by infectious diseases

and conditions such as pneumonia, diarrhoea, malaria, meningitis, tetanus,

measles, sepsis and aidS. Pneumonia and diarrhoea remain leading causes of

death in the three regions with the highest under-five mortality: eastern and

Southern africa, South asia and West and Central africa. The burdens of both

disease and mortality are often highest among the most disadvantaged.

There are marked regional variations around the broad neonatal trend. in

sub-Saharan africa, newborn deaths account for about one third of the deaths

of children under age 5. in regions with lower levels of child mortality, neonatal

deaths comprise approximately half of the total. South asia, on the other hand,

has both high overall child mortality and a high share of neonatal deaths.

The geographical distribution of the burden of child mortality is also changing.

Globally, child deaths are highly concentrated. in 2015, about 80 per cent of these

deaths occurred in South asia and sub-Saharan africa, and almost half occurred in

just five countries: the democratic republic of the Congo, ethiopia, india, nigeria

and Pakistan.

Children living in fragile states and conflict-affected countries face

elevated risks. according to the World development report 2011, they are more

than twice as likely to be undernourished as children in low- and middle-income

countries, and twice as likely to die before age 5.

among the 20 countries

with the highest child mortality rates, 10 fall into the World Bank’s list of fragile

contexts.

in countries affected by conflict, damage to health systems threatens children’s

lives. The Syrian arab republic, for instance, had made impressive progress in

reducing under-five mortality prior to the current conflict there. Since 1990, the rate

fell from 37 to 13 deaths per 1,000 live births. Since 2012, however, the country’s

excess crisis mortality

– that is, the under-five mortality attributable to crisis

conditions – has been an estimated one to two deaths per 1,000 live births.

The Share of Under-fiVe

deaThS oCCUrrinG dUrinG

The neonaTal Period iS

inCreaSinG.

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Compared to the richest children,

the

poorest children

are:

1.9

times

as likely to

die before age 5

destruction of infrastructure and lack of personnel, equipment and medicines

have hindered access to maternal and newborn health services, leading to a large

increase in unassisted births in a country where 96 per cent of deliveries in 2009

were attended by skilled personnel.

Crisis conditions have also sparked a rise in

vaccine-preventable and infectious diseases, including diarrhoea and pneumonia,

among children under age 5.

Globally, access to land, credit and property rights has a further impact on child

survival prospects. Marginalized groups living in informal settlements, illegal

dwellings or urban slums are vulnerable to health threats because of overcrowding,

unsanitary conditions, high transportation costs, discriminatory practices and

lack of access to basic services. These factors also create barriers to demand,

impeding the initial and continued use of services by the most disadvantaged.

When combined with low rates of immunization, this situation exacerbates the

transmission of diseases such as pneumonia, diarrhoea, measles and tuberculosis.

Climate change brings added risks. When water becomes scarce because of

drought, the poorest children and families are most likely to resort to unsafe water

sources, making them more vulnerable to diseases such as cholera and diarrhoea.

Climate change is also associated with an increased incidence of vector-borne

infectious diseases such as malaria, as well as with food insecurity, rising air

pollution, diarrhoeal disease and malnutrition.

failure to mitigate these and other background risks associated with ill health

in childhood will dampen the benefits of any progress countries make towards

universal health coverage. Sanitation provides a case in point, illustrating how

the 2030 goals are interconnected.

in low- and middle-income countries in 2012, inadequate drinking water, sanitation

and hygiene accounted for around 1,000 under-five deaths per day.

research in

nigeria suggests that lack of access to improved water and sanitation facilities

may elevate the risk of mortality among children aged 1 to 11 months by as

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Child Health: A fair start in life

>> Prospects for child survival

much as 38 per cent.

Use of unimproved sanitation facilities and, specifically,

the prevalence of open defecation are also implicated in stunting because they

expose children to health problems that can interfere with normal growth.

While progress on sanitation has been slow in many countries, there are encouraging

indications that more rapid progress is possible. in nepal, a Social Movement for

Sanitation has mobilized local communities and civic authorities in some of the poorest

parts of the country, creating 27 open defecation-free districts.

Such initiatives have

the potential to generate large returns for child survival. one evaluation in Mali found a

57 per cent reduction in diarrhoea-related deaths of children under age 5, and a 13 per

cent reduction in child stunting, in open defecation-free communities.

Prospects for child survival

The 2030 goals have set a high bar for progress on maternal, newborn and child survival

and health. among the targets for Goal 3 is the aim to reduce neonatal mortality to at

least as low as 12 deaths per 1,000 live births and under-five mortality to at least as low

as 25 deaths per 1,000 live births in every country. Universal health coverage, another

2030 target, is one of the conditions for reaching the above outcomes.

These targets are achievable, but only if governments keep a relentless focus

on the most disadvantaged children. The deepest and earliest cuts in child and

maternal mortality must benefit those facing the highest risks.

Since 1990, the global under-five mortality rate has been cut by 53 per cent.

The global annual rate of reduction in under-five mortality from 2000 to 2015

was more than double the rate achieved in the 1990s. Between 2000 and 2015,

every region registered major progress in child survival. Sub-Saharan africa has

increased the average annual rate of decline in under-five mortality from 1.6 per

cent during the 1990s to 4.1 per cent since 2000.

Maternal mortality rates are also falling. Since 1990, the annual number of

maternal deaths has decreased by 43 per cent. Between 2005 and 2015, the

global annual rate of reduction was more than twice the 1990–2000 rate.

of the

75 countries accounting for more than 95 per cent of maternal, newborn and child

deaths, about three quarters made accelerated gains.

Some of the world’s poorest countries have made extraordinary progress. While

the world missed the MdG target of a two-thirds reduction in under-five mortality

between 1990 and 2015, 24 low-income and lower-middle-income countries

achieved it.

Some of these countries – such as ethiopia, liberia, Malawi,

Mozambique and niger – started out with very high mortality rates,

in excess of

200 deaths per 1,000 live births. egypt and Yemen achieved respective declines

of 72 per cent and 67 per cent in under-five mortality despite chronic conflict and

economic hardships.

Meanwhile, China has experienced a rapid and considerable

decline in under-five mortality – 80 per cent since 1990.

The diversity of national experiences demonstrates that dramatic reductions in

child mortality are possible in countries whose social, political and economic

contexts vary widely. The same is true for maternal health, given that a range of

countries with different contexts and starting points achieved the MdG target of a

75 per cent reduction in maternal mortality.

While child mortality generally declines as average income increases, many poorer

countries are outpacing richer neighbours in reducing their under-five mortality rates

(see Figure 1.1).

Yet some countries in the fast lane for global economic growth

TheSe TarGeTS are aChieVaBle,

BUT onlY if GoVernMenTS

KeeP a relenTleSS foCUS on

The MoST diSadVanTaGed

Children.

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– including india and nigeria – have been in the slower lane for child mortality

reduction. The policy lesson: economic growth can help but does not guarantee

improved child survival, and a country’s income need not hinder progress.

Inequities in child survival

disparities in maternal, newborn and child health in high-mortality countries represent

a major barrier to sustained progress towards every child’s right to survive and thrive.

on average, children born into the poorest 20 per cent of households are almost twice

as likely to die before age 5 as those born into the richest 20 per cent.

Behind this global average is an array of diverse national patterns. for example,

children born into the poorest 20 per cent are almost twice as likely to die

during their first five years as those from the richest 20 per cent in Bangladesh

and three times as likely in india, indonesia and the Philippines.

Some countries have registered rapid progress since 2000 while also enhancing

equity

(see Figure 1.2, blue dots).

other countries have achieved dramatic progress

without improvements in equity

(see Figure 1.2, yellow dots).

in the latter countries,

the survival gap between rich and poor children has slightly widened.

These disparities have serious consequences. The combination of demography

(poorer households having more children) and inequality in survival prospects

(children in poor households facing higher mortality rates) means that the poorest

children account for a greater share of child deaths than the wealthiest.

FIGURE 1.1

Countries with limited economic growth can still reduce child mortality

annual rate of reduction in under-five mortality, 2000–2015, and annual rate of change in GdP 2000–2014, by country

Annual reduction

in under-five

mortality rate

10%

rwanda

democratic republic of the Congo

Bubble size indicates the

estimated number of

under-five deaths in 2015

ethiopia

india

nigeria

1,000,000

Pakistan

-2%

10%

100,000

10,000

Annual rate of change in GDP

Note:

Countries selected had an under-five mortality rate above 40 deaths per 1,000 live births in 2015, 10,000 or more live births in 2015, and available GdP data,

for 2000–2014 or most recent available year. each bubble represents a country.

Source:

World Bank, World development indicators (update of 22 december 2015), and United nations inter-agency Group for Child Mortality estimation,

Levels

& Trends in Child Mortality: Report 2015.

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Child Health: A fair start in life

>> Inequities in child survival

But it also means that equivalent percentage reductions in child mortality

rates save more lives among the poor. an analysis of survey data covering

51 high-mortality countries found that reducing the neonatal mortality rate of

the poorest 20 per cent to the rate of the richest 20 per cent would have averted

some 600,000 deaths in 2012.

Under-five mortality should continue to decline for all children. But in order to

reach the child survival targets, mortality rates for children from the poorest

households will have to fall much more rapidly than the rates for those from

the wealthiest households

(see Figure 1.3).

To make that happen, governments

will have to address a range of critical factors affecting the poorest and most

disadvantaged children.

FIGURE 1.2

Progress in under-five mortality does not necessarily come

with greater equity

Change in ratio of under-five mortality rate by household wealth and change in overall under-five mortality rate

INCREASING INEqUITy IN

MoRTALITy

Percentage change

in ratio of under-five

mortality rate among

children in poorest

versus richest

households

Countries with decreasing

under-five mortality rate

and increasing inequity

Countries with increasing

under-five mortality rate and

increasing inequity

DECREASING INEqUITy IN

MoRTALITy

-80

-60

-40

-20

-40

-60

Countries with decreasing

under-five mortality rate

and decreasing inequity

Countries with increasing

under-five mortality rate and

decreasing inequity

-80

DECREASING MoRTALITy

INCREASING MoRTALITy

Percentage change in under-five mortality

Note:

Using surveys conducted in the years 2005–2009 and 2010–2014 with respective midpoints of the reference years in 2000–2004 and 2005–2012.

Source:

UniCef analysis based on demographic and health Surveys (dhS), Multiple indicator Cluster Surveys (MiCS) and other nationally representative sources

of data for 37 countries.

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FIGURE 1.3

The poor will need to make faster progress to reach the 2030 goal

required annual rate of reduction in under-five mortality to achieve the SdG target by 2030, by poorest and

richest wealth quintiles, 2015–2030

Sierra leone

nigeria

Guinea

Cameroon

Central african republic

Burkina faso

Mali

niger

Swaziland

liberia

equatorial Guinea

Togo

Burundi

ethiopia

Pakistan

democratic republic of the Congo

Mozambique

Malawi

Uganda

Côte d’ivoire

Guinea-Bissau

Zimbabwe

afghanistan

Zambia

Senegal

rwanda

Mauritania

Gambia

Benin

haiti

Yemen

lesotho

United republic of Tanzania

Madagascar

Congo

Sudan

india

Ghana

Kenya

Timor-leste

Gabon

namibia

Tajikistan

Myanmar

10%

Wealth quintiles

richest

Poorest

Required annual rate of reduction to reach an under-five mortality rate

of 25 deaths per 1,000 live births by 2030

Note:

Most recent available survey data in countries with an under-five mortality rate above 40 deaths per 1,000 live births in 2015 using United nations

inter-agency Group for Child Mortality estimation (Un iGMe) 2015 estimates.

Source:

UniCef analysis based on dhS, MiCS and other nationally representative sources from the most recent survey conducted since 2006.

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>> Inequities in child survival

achieving substantial improvements in nutrition – a target within Goal 2 – will be

key to boosting child survival rates. half of all deaths of children under age 5 are

attributable to undernutrition, and large disparities exist in related indicators such

as stunting. an analysis of 87 countries with recent available data shows that

stunting rates among the poorest children are more than double those among the

richest.

in West and Central africa, progress on stunting has been slow, with

less than a 25 per cent reduction between 1990 and 2014. and in over one third

of low-income countries with available trend data, the gap between the richest

and poorest households in stunting reduction has been widening.

household wealth is one determinant of a child’s chance to survive, but maternal

education is also a strong predictor. across much of South asia and sub-Saharan

africa, children with mothers who received no education are almost three times

as likely to die before age 5 as children of mothers with secondary education.

education enables women to delay and space births, secure access to maternal

and child health care and seek treatment for children when they fall ill.

if all mothers achieved secondary education, there would be 1.5 million fewer

annual deaths of children under age 5 in sub-Saharan africa and 1.3 million fewer

in South asia.

Child marriage and women’s reproductive health management also influence child

mortality patterns. While child marriage rates are decreasing, each year about

15 million girls are married before the age of 18.

These girls represent a highly

vulnerable group: They are denied their childhood, face limited opportunities for

education and often begin childbearing too early. Girls in the poorest 20 per cent of

the population, as well as those living in rural areas, face the greatest risks.

in africa,

the level of child marriage among the poorest has remained unchanged since 1990.

A smiling boy with his

mother, in Bangladesh.

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Rita Iriati and Novia, her

three-year-old daughter, near

the entrance to their home

in the village of Kemalang in

Klaten District, Central Java

Province, Indonesia.

around the world, child brides are less likely than adult women to receive

adequate medical care while pregnant. The lack of care, and the fact that girls are

not physically mature enough to give birth, put both mothers and their babies at

risk. Complications during pregnancy and childbirth are the second leading cause

of death for girls between ages 15 and 19.

and babies born to mothers under

age 20 are 1.5 times more likely to die during the first 28 days than babies born to

mothers in their twenties or thirties.

When a woman is denied opportunities to manage her reproductive health,

she and her children suffer. Short birth spacing, for example, is a risk factor for

preterm birth,

and limited access to contraception is one barrier to safe spacing.

Globally, an estimated 216 million married women need, but lack, access to

modern contraceptive methods.

if women who want to avoid pregnancy had

access to these methods, unintended pregnancies would drop by 70 per cent.

reducing the number of unintended pregnancies, in turn, could avert 60 per cent

of maternal deaths and 57 per cent of under-five child deaths.

The rural-urban divide also contributes to unequal chances in child survival.

Children born in rural areas are 1.7 times more likely to die before age 5 than

children in urban areas.

looking specifically at disparities linked to wealth and residence, a new

comparison

(see Figure 1.4)

uses household survey data to chart child survival

trajectories between 2015 and 2030 in a group of eight countries starting out from

different positions. These projections illustrate the need for the fastest progress

among the worst-off groups. reaching the most marginalized households is more

than an ethical imperative; it is a precondition for ending the preventable deaths

of newborns, children under age 5 and their mothers.

Zara, a mother of two,

attends her first-ever

antenatal consultation at

an extended health centre

recently established by

UNICEF and Save the

Children, in NGuagam, Niger.

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>> Inequities in child survival

FIGURE 1.4

Progress must accelerate for the least advantaged children

required reduction in under-five mortality rate (deaths per 1,000 live births) from 2015–2030 to achieve the SdG

target, by subgroups in selected countries

Population segment

U5Mr = Under-five mortality rate (deaths per 1,000 live births)

richest

Urban

rural

Poorest

Nigeria and Pakistan.

in both

countries, the under-five mortality

rate (U5Mr) in the wealthiest

and the poorest households is

above the SdG target, and marked

disparities persist between regions.

in the north-West region of nigeria,

for example, U5Mr was double

that of the South-West. and while

the richest 20 per cent will have

to cut mortality by more than half

to achieve the target by 2030, the

poorest 20 per cent must achieve a

reduction of three quarters.

NIGERIA

U5MR

100

2015

2020

2025

2030

SdG target

north-West

South-West

100

2015

PAKISTAN

U5MR

islamabad Capital

Territory (iCT)

Balochistan

SdG target

2020

2025

2030

Ethiopia and Mozambique.

Both countries achieved MdG 4

(reducing U5Mr by two thirds

between 1990 and 2015). for

ethiopia to achieve the SdG target

by 2030, U5Mr in addis ababa

– the country’s best performer –

will have to fall by more than one

third. The worst performing region,

Benishangul-Gumuz, will have to

cut mortality by more than two

thirds from 2015 to 2030.

ETHIoPIA

U5MR

100

2015

2020

2025

2030

SdG target

addis ababa

Benishangul

Gumuz

MoZAMBIqUE

U5MR

100

2015

2020

2025

2030

SdG target

inhambane

Zambezia

Note:

required annual rate of reduction to achieve the SdG target of 25 deaths per 1,000 live births by 2030 calculated from reference year (mid-year of reference period of

10 years preceding the survey) of the under-five mortality rate in the survey data. Subgroups that have already achieved the target are kept constant. Selected subgroups are

by best and worst performing region, richest and poorest wealth quintiles and urban and rural residence. Groups may overlap.

Source:

UniCef analysis based on dhS, MiCS and other nationally representative sources.

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Population segment

U5Mr = Under-five mortality rate (deaths per 1,000 live births)

richest

Urban

rural

Poorest

Indonesia and the Philippines.

in both countries, the wealthiest

20 per cent and the most

advantaged regions have

already met the 2030 target. in

the Philippines, while both the

richest quintile and urban areas

have reached the 2030 target,

the poorest 20 per cent and the

autonomous region in Muslim

Mindanao will have to reduce

mortality rates by about two fifths

to do so.

INDoNESIA

U5MR

2015

2020

2025

2030

SdG target

riau

Papua

PHILIPPINES

U5MR

SdG target

2015

2020

2025

2030

Cagayan Valley

autonomous region

in Muslim Mindanao

Bangladesh and Cambodia.

Cambodia is one of the world’s

most striking post-2000 child

survival success stories: in 2015,

U5Mr was close to the SdG

target. however, two provinces

inhabited mainly by ethnic

minorities reported rates of 79 or

80 deaths per 1,000 live births.

Compared to the level in Phnom

Penh, children born in these two

provinces faced about 3.5 times

the risk of dying before their fifth

birthday. Bangladesh will have

to reduce disparities linked to

household wealth and high levels of

mortality in regions such as Sylhet

in order to maintain progress.

BANGLADESH

U5MR

Barisal

Sylhet

CAMBoDIA

U5MR

Phnom Penh

Mondol Kiri/

rattanak Kiri

SdG target

2015

2020

2025

2030

2015

2020

2025

2030

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>> Disparities in access and quality of care

Disparities in access and

quality of care

Providing all women with antenatal care, skilled care at birth and essential newborn

care can dramatically improve prospects for safe pregnancy and child survival.

Unfortunately, these areas are marked by extreme disparity – not just in access

to care but also in the quality of care. evidence shows that unequal access starts

before birth and continues into the critical early years.

disparities in utilization of antenatal care and skilled birth attendance mirror social

disparities in child survival. Globally, women from the richest 20 per cent of households

are still more than twice as likely as those from the poorest 20 per cent to have a

skilled attendant at birth.

and a modest increase in antenatal care coverage since

2000 has done little to narrow disparities in the antenatal period.

rural-urban divides

have also remained intact. in 2015, just over half of pregnant women benefited from

the recommended minimum of four antenatal care visits; the vast majority of those

who do not receive the minimum are poor and live in rural areas.

at the regional level, glaring disparities in antenatal care and skilled birth attendance

exist in South asia and sub-Saharan africa. in both Bangladesh and Pakistan, women

from the richest households are respectively four and six times more likely to receive

antenatal care (at least four visits) than those from the poorest. on the other hand,

some of the largest gaps in skilled birth attendance are in eastern and Southern africa.

in eritrea, women from the richest households are 10 times more likely to benefit from

skilled birth attendance than those from the poorest households.

Mothers and newborns in the poorest households are also less likely to receive a

post-natal check-up. as a result, they are exposed to elevated risks associated with

undetected hypothermia, infection and post-birth complications.

Such large and avoidable inequities cost children’s lives and cause immense suffering.

The lack of adequate health facilities in poor communities plays a role in these

outcomes, and so do the social attitudes of some health providers. Women from

socially excluded groups often experience hostile treatment or a lack of responsiveness

from the health system and health providers. even when health facilities serving the

poor are accessible and affordable, discriminatory practices can be an obstacle to equal

treatment.

in the case of pneumonia, early diagnosis and effective case management by trained

health providers can save lives. Yet children from the poorest households who

develop symptoms of pneumonia, and face the greatest risks, are the least likely to

be taken to a health facility. Children from the wealthiest households are 1.5 times as

likely as those from the poorest to be taken to a health facility in Madagascar,

and

approximately four times as likely in ethiopia.

Similar patterns apply to the treatment

of diarrhoea, another major killer.

Marginalized communities such as the roma population in Central and eastern europe,

for example, face inequities in access to and utilization of health services at every turn.

in both Serbia and Bosnia and herzegovina, one in five roma children are moderately

or severely stunted. as of 2012, only 4 per cent of roma children 18 to 29 months old

in Bosnia and herzegovina had all the recommended vaccinations, compared to 68 per

cent of non-roma children.

achieving equity is not only relevant in the poorest countries. in some rich countries,

children from different backgrounds face starkly unequal prospects. The United States,

SUCh larGe and aVoidaBle

ineQUiTieS CoST Children'S

liVeS and CaUSe iMMenSe

SUfferinG.

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for instance, has a higher reported infant mortality rate than most high-income

countries in the oeCd. for babies born here, the odds of survival are closely linked to

ethnicity: in 2013, infants born to african american parents were more than twice as

likely to die as those born to white americans.

as in other countries, factors such as income, mother’s education and birthplace

also continue to determine a child’s chances of surviving to age 5 in the United

States. These disparities are reflected dramatically at the state level. The infant

mortality rate of the state of Mississippi in 2013, for example, was double that

of the state of Massachusetts.

Combining home visits by health workers with

wider measures aimed at narrowing inequalities in education and income could

play a vital role in addressing the situation.

Low-cost interventions

can make a difference

The overwhelming majority of child deaths could be prevented through well

known, low-cost and easily deliverable interventions. This is true for deaths that

occur both in the neonatal period and after the first month. Quality care during

pregnancy, labour and birth, and in the immediate post-natal period, not only

prevents the onset of complications but expedites their early detection and

prompt management. early post-natal care is particularly important in reducing

mortality in the first few days day of life.

The rising proportion of neonatal deaths points to the more difficult challenges

ahead in sustaining and accelerating progress on child survival. The interventions

needed to address the major causes of neonatal mortality are closely linked to

those that protect maternal health

(see Figure 1.5),

so it is vitally important to

increase coverage of interventions before, during and after pregnancy.

research published in

The Lancet

estimates that 40 per cent of neonatal deaths

could be averted with key interventions around the time of birth. These include

care by a skilled birth attendant, emergency obstetric care, immediate newborn

care (including breastfeeding support and clean birth practices, such as cord and

thermal care) and newborn resuscitation. another 30 per cent could be saved

through ‘kangaroo mother’ care with skin-to-skin contact starting from birth,

prevention or management of neonatal sepsis, treatment of neonatal jaundice and

prevention of brain damage caused by birth-related oxygen deprivation.

The benefits of breastfeeding are still under-recognized in many countries. Starting

within the first hour of birth, longer-duration breastfeeding is associated with

protection against childhood infections, increases in intelligence and reductions in

the prevalence of overweight and diabetes. research found that if breastfeeding

were scaled up to near universal levels, the lives of 823,000 children under age

5 would be saved annually in 75 low- and middle-income countries. for nursing

women, breastfeeding protects against breast cancer and improves birth spacing.

40 Per CenT of neonaTal

deaThS CoUld Be aVerTed WiTh

KeY inTerVenTionS aroUnd The

TiMe of BirTh.

Reaching the most vulnerable

national leadership, backed by international cooperation, has played a critical role in

driving global achievements in child survival over the past 15 years. economic growth,

rising incomes and poverty reduction have certainly contributed, by both improving

living standards and generating resources for investment in health. But in many

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Child Health: A fair start in life

>> Reaching the most vulnerable

low- and middle-income countries, much of the impetus for progress has come from

strengthened health systems and community-based health interventions. Community

health workers have expanded the reach of care, linking vulnerable people to high

impact, low-cost interventions for maternal, newborn and child health.

one striking example comes from ethiopia. Between 2004 and 2010, the

Government of ethiopia trained and deployed 38,000 health extension workers to

local posts across the country, where they delivered basic antenatal and post-natal

care, reaching populations previously not covered by the health system.

Similarly,

health Surveillance assistants in Malawi have provided an essential link between

the formal health system and the community, contributing to one of the world’s

most accelerated national declines in child mortality.

FIGURE 1.5

Accelerated progress in neonatal mortality is key to meeting the SDG target

required annual rate of reduction 2015–2030 versus the observed annual rate of reduction in neonatal mortality

Annual rate of reduction

required from 2015

to reach a neonatal

mortality rate of

12 deaths per 1,000 live

births by 2030 (%)

Pakistan

nigeria

india

-T

Neonatal deaths

1.000.000

100.000

10.000

democratic

republic

of the Congo

-2

observed annual rate of reduction in neonatal mortality

during 2000–2015 (%)

low-income countries

lower-middle-income countries

Upper-middle-income countries

high-income countries

Bubble size indicates estimated number

of neonatal deaths in 2015

1,000,000

100,000

10,000

Note:

Countries above the diagonal line need faster rates of reduction (i.e., accelerated progress) to achieve the target. Countries below the diagonal line will be able to achieve

the target at their current rates of reduction. Those on the horizontal axis had already reached the target in 2015.

Source:

UniCef analysis based on Un iGMe, 2015.

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BOx 1.1 FEMALE vOLUNTEERS HELP HEALTH WORkERS REACH

THE MARGINALIzED IN NEPAL

Nepal, one of the world’s poorest countries, has

registered one of the most rapid reductions in maternal

mortality since 1990. This progress is the result of

sustained policy reform stretching over two decades,

including a period marked by conflict.

Health system development played a critical role in

Nepal’s success. Safe motherhood policies, introduced

in the 1990s and strengthened since then, have greatly

increased the number of community-level health

workers and skilled birth attendants. In addition, the

government made maternal health and family planning

priorities within an expanding health budget, and health

spending per capita doubled between 1995 and 2011.

During roughly the same period, antenatal care coverage

increased five-fold. The number of births assisted by

skilled attendants doubled between 2006 and 2011,

to 36 per cent of the total.

Alongside the formal health system, Nepal developed a

network of female community health volunteers. After

receiving 18 days of basic training and being provided

with medical equipment, the volunteers liaise closely

with health workers, a model that has extended the reach

of the health system into some of the country’s most

marginalized areas.

Health sector plans have aimed to build the

professionalism of health staff, improve training and

expand delivery of basic services across political cycles.

The current National Safe Motherhood and Newborn

Health Long Term Plan (2010–2017) emphasizes the

development of obstetric care and referral systems.

Reframing maternal and child care as health rights or

entitlements, meanwhile, has empowered women, who

can now hold providers to greater account for delivering

interventions related to safe motherhood, neonatal

health, nutrition and reproductive health.

Developments outside the health system have also

fostered equitable progress in Nepal. Behaviour change,

access to reproductive health care and increased access

to education have contributed to a steep decline in fertility

rates. In addition, the proportion of the population living

in poverty has dropped sharply, from 68 per cent in the

mid-1990s to 25 per cent in 2011.

Source:

engel, Jakob, et al., 'nepal’s Story: Understanding improvements in maternal health', Case Study, overseas development institute, July 2013.

around 70 per cent of the global decline in under-five deaths since 2000 can be

traced to the prevention and treatment of infectious diseases. The annual number

of under-five deaths from pneumonia, diarrhoea, malaria, sepsis, pertussis,

tetanus, meningitis, measles and aidS declined from 5.4 million to 2.5 million

from 2000 to 2015.

Malaria deaths among children under age 5 have fallen by

58 per cent globally since 2000,

largely through the use of insecticide-treated

mosquito nets and the antimalarial drug artemisinin. and vaccination programmes

resulted in a 79 per cent drop in measles deaths between 2000 and 2014,

preventing the deaths of an estimated 17 million children.

innovation is also accelerating progress for the hardest-to-reach children.

in Malawi – where 130,000 children under 14 were living with hiV in 2014 –

the government, together with partners, is testing the use of drones as a

cost-effective way of reducing waiting times for hiV-testing of infants, for whom

early diagnosis is critical to quality care.

Currently, dried blood samples are transported by road from local health centres

to the central laboratory for testing, taking an average of 16 days to reach the lab,

and another eight weeks to deliver the results. Challenges such as the cost of

fuel and poor state of roads result in delays, which present a significant problem

for effective treatment. if successful, the innovation using drones could cut both

costs and the time families wait to receive results from months to weeks.

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>> What if the gaps are not closed?

What if the gaps are

not closed?

The pace of progress on child and maternal health and survival can increase

or decrease as a result of policy choices made by governments and the

international community in the coming years. however, if current trends

continue, in 2030:

•

There will be 3.6 million deaths of children under age 5 in that year alone. a

total of 69 million such deaths will have occurred between 2016 and 2030,

with sub-Saharan africa accounting for around half of these and South asia

for another third.

five countries will account for more than half of the global burden of

under-five deaths: india (17 per cent), nigeria (15 per cent), Pakistan (8 per

cent), the democratic republic of the Congo (7 per cent) and angola (5 per

cent).

all but five of the 30 countries with the highest under-five mortality rates

will be in sub-Saharan africa.

Some 620 million children will have been

born in that region between 2016 and 2030

– about 30 per cent of the

world total.

it is the only region expected to see growth in its under-five

population, which is likely to expand by over 40 million.

nigeria alone will

account for around 6 per cent of all births globally.

The global maternal mortality rate will be around 161 deaths per 100,000

live births – still five times the level for high-income countries in 1990.

Pneumonia will remain the second biggest killer of children under age 5,

and preterm birth complications will remain the first.

•

aChieVinG The SdG Child

SUrViVal TarGeT WoUld

SaVe The liVeS of 38 Million

Children.

Based on current trends, then, prospects for universal achievement of the 2030

targets for neonatal and under-five survival are bleak. Unless the trends change,

dozens of countries will miss the mark by a wide margin

(see Figures 1.5 and

1.6).

South asia will not achieve the neonatal target until 2049 and sub-Saharan

africa will reach it after mid-century.

The average annual rate of reduction in

neonatal mortality required for india to reach the target is almost double the

current level.

Compared to staying at the 2015 survival rate for children under age 5, achieving

the SdG child survival target would save the lives of 38 million children

worldwide in the next 15 years. if each country matched its top regional

performer’s trend, an additional 7 million lives could be saved. if each country

matched or fell below the current average rate of under-five mortality in

high-income countries, an additional 21 million lives could be saved.

The latter

scenario – again, compared to staying at the 2015 rate – would save 59 million

children’s lives between now and 2030.

in an analysis of 75 high-burden countries, only eight are expected to reach the

SdG target. if each country scaled up intervention coverage as fast as the best

performer in each area of intervention (e.g., skilled birth attendance, exclusive

breastfeeding for the first six months, etc.), 33 countries could reach the target

by 2030. The annual number of children dying before age 5 in those countries

would drop by almost two thirds — from 5.5 million in 2015 to 2 million in

2030.

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These and other scenarios for 2030 point to the urgent need to scale up proven

interventions. Closing the gap between the current trajectory and the rate of

progress needed to achieve the 2030 child survival goal would save the lives of

13 million children under age 5, almost half of them newborn. around four in

every five lives saved would be in sub-Saharan africa.

FIGURE 1.6

Many countries will miss the under-five mortality target, some by a wide margin

Projected under-five mortality rate, at current trends, in countries that are expected to miss the SdG target by 2030

SdG target under-five mortality rate of 25 deaths

or fewer per 1,000 live births by 2030

angola

Somalia

Chad

Central african republic

lesotho

Benin

nigeria

Mauritania

Sierra leone

afghanistan

democratic republic of the Congo

Mali

Côte d’ivoire

Pakistan

equatorial Guinea

Comoros

Guinea

Cameroon

Togo

Guinea-Bissau

Zimbabwe

South Sudan

Sudan

haiti

Burundi

Burkina faso

djibouti

Papua new Guinea

niger

Gambia

lao People’s democratic republic

Ghana

Mozambique

100

125

Acceleration needed

to meet SDG target

More than 5x

3–5x

2–3x

less than 2x

Excess mortality

Deaths per 1,000 live births

Note:

The countries shown had 10,000 or more live births in 2015 and are expected to miss the SdG target by more than 10 deaths per 1,000 live births, if current

trends continue.

Source:

UniCef analysis based on Un iGMe, 2015.

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>> Equity objectives

Equity objectives

interim equity objectives – or ‘stepping stone’ targets – linked to achievement of

the 2030 goals could play a valuable role in guiding policy on child and maternal

well-being. national strategies aimed at halving disparities in child survival in

five to seven years, for example, would help put the most vulnerable women

and children at the centre of policy. The strategies could focus on inequities

associated with household wealth, education levels, rural-urban divides and

differences between regions or ethnic groups.

Translating these interim targets into outcomes would require fundamental

changes in how child and maternal health services are financed and delivered,

and in policies aimed at lowering background risks. But interim equity objectives

could act as a powerful catalyst towards meeting the 2030 commitments.

The objectives would also provide a reference point for monitoring and reporting.

in effect, they would serve as milestones on the road to 2030. This is a key

link in the chain of accountability. objectives become meaningful only when

they provide a benchmark, backed by data, against which performance can be

measured. Currently, there are large gaps in both coverage and quality of the data

available. Civil registration systems cover only a small fraction of global births, and

coverage is mostly limited in countries with the highest child and maternal death

rates. Coverage of deaths is even sparser.

Globally, the births of nearly one in four children under age 5 have not been

recorded.

of the 74 countries reviewed by the Commission on information

and accountability for Women’s and Children’s health, only two registered more

than half of all deaths.

in low- and middle-income countries, up to

80 per cent of deaths occur outside of health facilities, and many are not

reported accurately.

This means that critical information on the deaths of

newborns, children and mothers is incomplete.

Because of deficits in these areas, data on child and maternal deaths have to be

extrapolated and interpolated through modelling. as child and maternal deaths

decline and become more statistically rare, the importance of observational data

increases – especially for the most marginalized and hard-to-reach populations.

High return on

health investments

The investments needed to end preventable child and maternal deaths offer

high returns. The scale of the returns reflects the hidden costs of health risks.

Childhood illness not only claims lives and causes suffering, but also undermines

the potential of children, their communities and countries. Malnutrition

and childhood illness compromise cognitive development and reduce adult

productivity. When health systems fail to prevent illness, society pays a price in

the form of treatment costs and lost productivity. Conversely, improved maternal

and child health and nutritional status can create a positive cycle, enabling children

to realize their potential and helping their communities and countries to prosper.

What would it cost to effectively end preventable deaths among children and

mothers? detailed financial costings developed under the Global investment

framework for Women’s and Children’s health provide valuable insights.

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Six core investment packages for 74 high-mortality countries would cost about

US$30 billion in additional annual spending, an increase of 2 per cent above current

levels. The spending packages would cover maternal and newborn health, child

health, immunization, family planning, hiV/aidS and malaria, with nutrition as a cross-

cutting theme. Between 2013 and 2035, this investment would avert an estimated

147 million child deaths, 32 million stillborn deaths and 5 million maternal deaths.

in effect, such an approach would bring the level of essential maternal and

child health coverage available to the poorest 20 per cent of the population

in the 74 countries towards the coverage available to the richest 20 per cent.

BOx 1.2 EvERY CHILD COUNTS: THE IMPORTANCE OF qUALITY

DATA ON CHILD SURvIvAL

Accurately counting births and deaths is the first step

towards making sure that every child’s rights are

recognized and respected. yet more than 100 developing

countries lack the civil registration and vital statistics

(CRVS) systems needed to generate accurate birth and

death data.

Around the world, 230 million children currently under

age 5 were not registered at birth. That figure includes

39 per cent of children in sub-Saharan Africa and

44 per cent of children in South Asia. In the absence of

reliable data, estimates for child mortality in countries

lacking CRVS systems are based on a sophisticated

statistical model using survey responses, census

information and other sources. But no model can

compensate for high-quality input data based on birth

and death registration.

Household surveys provide valuable information

on differences in child mortality by socio-economic

characteristics – including parental wealth, location,

education and others. But greater disaggregation of

data on various population groups is required to provide

a detailed picture of localities marked by high levels

of childhood disadvantage. That means collecting,

synthesizing and speeding up data reporting on these

social groups and localities.

The situation is further complicated by large information

gaps on cause-specific mortality. For example, estimates

of the global burden of acute lower respiratory infection

(ALRI) among young children have to rely on hospital-

based data, but those numbers underestimate influenza-

associated ALRI incidence in low-income communities

because of poor families’ limited access to specialized

care. And the best global estimates for severe bacterial

infection among neonatal children range from 5.5 million

to 8.3 million – a large margin reflecting uncertainties in

the underlying data.

Despite considerable progress resulting from increased

surveys, there are still major gaps in data tracking the

coverage of health interventions as well. Such data are

central to accountability, providing information on reach

and disparities. While not every country has the capacity

to report on all indicators, existing survey tools could be

modified to focus more sharply on quality of care.

In the end, however, there is no substitute for CRVS

systems. The cost of achieving universal CRVS coverage

by 2024 has been put at US$3.8 billion for 73 countries

(excluding China and India). In the interim, expanding

health system coverage and applying new information

and communication technologies can generate critical

birth and death registration information, along with vital

information on specific diseases.

Source:

World Bank/World health organization,

Global Civil Registration and Vital Statistics: Scaling up investment Plan 2015–2024,

World Bank, Washington, d.C., 28 May

2014, p. 2. United nations Children’s fund,

Every Child’s Birth Right: Inequities and trends in birth registration,

UniCef new York, 2013. pp. 6, 36. nair, harish, et al., ‘Global

burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis’,

The Lancet,

vol. 378, no. 9807 3 december 2011, p.

1925. Seale, anna, et al., ‘estimates of possible severe bacterial infection in neonates in sub-Saharan africa, South asia, and latin america for 2012: a systematic review

and meta-analysis’,

The Lancet,

vol. 14, no. 8, pp. 731–741, august 2014.

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>> Benefits of universal health coverage

The projected social and economic returns on this investment – in terms of

productivity, increased output and wider benefits associated with improved

health – are also impressive, totalling nine times the cost.

other projected returns on investments in ending child and maternal mortality

include:

•

at least a 10-fold return on health and nutrition spending through better

educational attainment, workforce participation and social contributions.

returns of US$16 for every US$1 invested in immunization. even with the

introduction of new, more costly vaccines, immunization remains one of the

most cost-effective buys in health planning.

returns of US$16 for every US$1 invested in nutrition interventions.

Child

undernutrition can cost between 1.9 per cent (egypt) and 16.5 (ethiopia) per

cent of a country’s GdP

Savings totalling US$302 billion annually through protection, promotion and

support for breastfeeding.

•

Nang Doy and her

four-month-old child, Thao

Nga, sit for growth monitoring

vaccinations administered by

the District Mother and Child

outreach team, in Lao People's

Democratic Republic.

•

The spending identified by the Global investment framework would address the

problem of insufficiently resourced health systems that provide low coverage

of cost-effective interventions. More than US$10 billion of the additional annual

cost would support enhanced delivery of reproductive, maternal, newborn

and child health care – including provision of an additional 544,000 community

health workers and 675,000 nurses, doctors and midwives.

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Benefits of universal

health coverage

Sustained progress will also require health systems that are equipped both to

deliver quality care across a continuum of services and to reach all women and

children, beginning with the most disadvantaged.

The combination of high quality antenatal care, care during labour and around birth

and the first week of life, and care for the small and sick newborn are essential to

improve child and maternal health outcomes. effective antenatal care, for example,

provides early identification of complications in pregnancy and offers women

the micronutrient supplements they need for their own health and normal foetal

development. educated and equipped health workers can deliver obstetric care

and essential newborn care, in addition to promoting and supporting breastfeeding,

identifying and treating infections, and providing potentially life-saving immunization.

The association between antenatal care, skilled birth attendance and child survival is

not automatic

(see Figure 1.7),

in part because the quality of care provided is highly

variable within and among countries. nevertheless, expanded provision in both of

the former has been central to progress in child survival. as the share of neonatal

mortality rises as a proportion of total child deaths, the urgency of achieving

universal coverage of quality antenatal care and skilled birth attendance increases.

FIGURE 1.7

Antenatal care and skilled attendance at birth save newborn lives

association between antenatal care (four or more visits), skilled attendance at birth and the neonatal mortality rate

Neonatal

deaths per

1,000 live

births

20%

40%

60%

80%

100%

20%

40%

60%

80%

100%

neonatal

mortality

rate target

by 2030

12 or fewer

neonatal

deaths per

1,000 live

births

Women attended 4+ times during last pregnancy

Births attended by skilled personnel

Neonatal mortality rate

low ≤12

Medium (13–20)

high ≥20

Source:

for neonatal mortality rate, Un iGMe 2015 estimates. for antenatal care and skilled attendance at birth, UniCef global databases, 2015, based on MiCS,

dhS and other national sources.

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>> Benefits of universal health coverage

FIGURE 1.8

In 63 countries, equity in intervention coverage could reduce under-five

mortality rates by almost 30 per cent

impact on the under-five mortality rate of increasing national coverage to the level of the top wealth quintile

Under-five mortality rate

with scaled-up interventions

(deaths per 1,000 live births)

140

120

100

120

140

No change

20%

reduction

40%

reduction

Baseline in under-five mortality rate

(deaths per 1,000 live births)

Note:

health services in the scaled-up model included interventions such as skilled birth attendance, vitamin a supplementation and vaccinations. The 63 countries

represent 88 per cent of global under-five deaths. The liST analyses were carried out by adrienne Clermont, Yvonne Tam and neff Walker at the institute for

international Programs, Johns hopkins Bloomberg School of Public health.

Source:

lives Saved Tool (liST) analysis by Johns hopkins University, 2015.

Strategies to deliver universal, quality health care by 2030 have to embrace two

closely-related goals: expanding coverage

while

narrowing equity gaps. here

again, coverage rates for the poorest 20 per cent of the population must increase

much faster than rates for the wealthiest 20 per cent in order to reach universal

coverage. in 63 high-mortality countries, scaling up national coverage of health

interventions to the level of the wealthiest 20 per cent could prevent one in four

under-five deaths and decrease average under-five mortality rates in countries by

almost 30 per cent

(see Figure 1.8).

another strategy – set out by the World health organization (Who) and UniCef

in the integrated Global action Plan for Pneumonia and diarrhoea – identifies the

measures needed to eliminate avoidable deaths from pneumonia and diarrhoea

by 2025. Simply scaling up existing interventions would cut deaths by two thirds

at a cost of US$6.7 billion under the plan.

100

in child nutrition, a study of 34 high-burden countries, where 90 per cent of the

world’s children who suffer stunting live, identified 10 proven interventions with

the potential to avert 900,000 under-five deaths. They range from treatment of

acute malnutrition to complementary feeding, breastfeeding, and vitamin a and

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zinc supplementation. The additional annual cost of scaling up present nutrition

coverage to meet 90 per cent of the need in the 34 countries would be about

US$9.6 billion, according to the study.

101

as compelling as such estimates are, they sometimes divert attention from the

critical importance of strengthening health systems’ capacity to deliver services.

Properly trained and motivated health workers are the lifeblood of efficient,

equitable and resilient health systems. The interventions needed to diagnose,

prevent and treat the causes of child and maternal deaths are not stand-alone

technologies. They have to be delivered by skilled community-level health

workers, midwives, nurses and doctors.

Chronic shortages of health workers represent major obstacles to accelerated

progress. in many countries, health workers are concentrated in urban areas or

facilities serving more advantaged populations. They may be reluctant to work

in remote areas because of low remuneration, lack of continuing educational

opportunities, difficult working conditions, shortages of supplies and equipment,

or a lack of social services for their own families.

Who has estimated that a minimum of 23 health workers for every 10,000

people is required in countries seeking relatively high levels of health system

coverage for the basic needs of their populations.

102

Countries falling below this

A health worker administers a

dose of oral polio vaccine to a

child at the entrance to his home

in Baghdad's Sadr City, Iraq.

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Child Health: A fair start in life

>> Benefits of universal health coverage

FIGURE 1.9

Many countries do not have enough health providers

number of physicians, nurses and midwives per 10,000 population and Who minimum threshold

Who minimum threshold =

23 doctors, nurses and midwives

per 10,000 population

Solomon islands

nigeria

Myanmar

Zimbabwe

Pakistan

lao People’s democratic republic

Kenya

Ghana

Gambia

Cambodia

Zambia

Yemen

Benin

Mauritania

afghanistan

rwanda

Guinea-Bissau

Papua new Guinea

Burkina faso

Côte d’ivoire

Bangladesh

Mali

Senegal

United republic of Tanzania

Mozambique

Malawi

Togo

Central african republic

liberia

ethiopia

Sierra leone

niger

Number of physicians, nurses and midwives

Source:

World health organization, Global health Workforce Statistics, 2014.

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threshold struggle to provide skilled care at birth, as well as emergency and

specialized services for newborn and young children. Most countries in

sub-Saharan africa and many high-mortality countries in South asia fall well below

the threshold

(see Figure 1.9).

By 2035, the world will need an additional 12.9 million health workers. already

today, sub-Saharan africa has a health worker deficit of 1.8 million, and unless

there is concerted action, that figure will rise to 4.3 million over the next 20 years

as population rises.

103

The additional cost of providing sub-Saharan africa with just

another 1 million community health workers would be US$3.1 billion per year,

according to an estimate by the earth institute at Columbia University. The return

on that investment, in addition to the lives saved and suffering reduced, would be

an estimated US$19.4 billion per year from enhanced productivity.

104

The ebola crisis in West africa graphically illustrated the fragility of under-

resourced and under-staffed health systems. on the eve of the outbreak, Sierra

leone and liberia had fewer than three health workers for every 10,000 people.

105

liberia had approximately 50 doctors for a country of 4.3 million.

106

deaths among

health workers during the crisis depleted the affected countries’ already limited

number of skilled providers. one of the lessons from the ebola crisis is that

strong health systems are needed not only to contain epidemics and deliver vital

interventions, but to help countries and communities become more resilient.

for its part, indonesia has an overall health worker-to-population ratio close

to Who’s recommended level, but health workers are unequally distributed

throughout the country. facilities serving the poor often lack basic amenities and

trained staff. Thus, approximately half the women in Maluku and Papua provinces

deliver their babies without skilled attendance – more than double the level in

Sumatera – and urban women are more than three times more likely than their

rural counterparts to have skilled attendance at birth.

107

Countries with some of the world’s lowest health worker-to-population ratios

also face equity issues. in liberia, the ratio of skilled birth attendants to

population in the best-covered county is over three times higher than in the

county with the least coverage.

108

An attendant wipes the face

of a preterm baby in the

Special Care Newborn Unit

at Tangail Medical College

Hospital, Bangladesh.

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Child Health: A fair start in life

>> Adequate and equitable financing

Adequate and

equitable financing

By one estimate from 2012, financing a health system equipped to provide a

minimal level of essential services on a universal basis would cost about US$86

per capita annually. This is more than double the average level of health system

spending in low-income countries.

109

even when services are available, formal and informal charges for maternal and

child health care create affordability barriers for the poor. like other obstacles –

including distance, time and costs associated with using services, poor awareness,

quality concerns, and social and cultural impediments – these charges reduce

demand for vital services, often with fatal consequences in the case of maternal,

newborn and child health. They deplete assets and trap poor households in cycles

of ill health and poverty.

When public health spending does not cover the costs of provision, inadequate

service coverage and imposition of user fees invariably hit the poorest households

hardest. according to the World health report of 2010,

Health Systems Financing:

The path to universal coverage,

each year, about 150 million people suffer financial

catastrophe while 100 million are forced into poverty as a result of health-related

expenses.

110

The risk of impoverishment rises sharply once out-of-pocket payments

exceed 15 to 20 per cent of health expenses.

111

increased public spending on health is a feature of many of the countries with the

best performance in child survival. While there are no hard-and-fast rules, evidence

suggests that governments should aim at allocating around 5 per cent of GdP

for health spending.

112

Yet many countries with high mortality rates in South asia

spend less than 3 per cent of GdP on health, and in many cases, that spending is

skewed towards services that do not reach the poor.

113

even with concerted efforts to allocate funding towards health, many of the

world’s poorest countries would fall short of the US$86 per capita spending

target. one exercise estimated a financing gap of about US$74 billion under a

A health worker marks a boy’s

finger to indicate that he

has been vaccinated during

a measles immunization

campaign, at a health outreach

post in Lishiko Village, Lusaka,

Zambia.

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scenario in which all low-income countries meet more stringent standards for

revenue allocation and health sector financing. While only indicative in nature,

this estimate provides a valuable ballpark figure for the additional international

public financing that would be needed to bring the 2030 child and maternal

health targets within reach.

114

Targeted schemes to finance services for the poor, exempt them from user

fees and provide them with insurance have a mixed record of success.

experience shows that targeted financing often has a negligible impact

on service utilization. financing the entry of poor households into existing

national health insurance programmes, which pool risk across populations, has

produced more positive results.

115

Brazil’s family health Programme, for example, expanded coverage from

10.6 million to 100 million people between 1998 and 2010, with an initial focus

on disadvantaged areas. The programme provides access to health care – free at

the point of use – to more than 90 per cent of the country’s municipalities.

116

Thailand’s Universal Coverage Scheme (UCS) enhanced equity by bringing

a large uninsured population under the umbrella of a national programme,

greatly reducing ’catastrophic‘ health payments among the poor and improving

BOx 1.3 BANGLADESH SHOWS THE CHALLENGE OF SUSTAINED

PROGRESS IN CHILD SURvIvAL

In recent years, Bangladesh has made solid progress

in reducing mortality rates among children under age

5. Part of its success can be traced to the expansion

of community-level health interventions. Accelerated

progress will depend on expanded and more equitable

provision of antenatal care and skilled birth attendance.

Starting from a low base, the country has already

achieved a rapid expansion of coverage in both areas.

The proportion of babies delivered in health facilities

increased from 8 per cent to 37 per cent between 2000

and 2014. Antenatal coverage by skilled providers also

rose, from 33 per cent to 64 per cent.

Nevertheless, large disparities remain. The wealth gap

in access to skilled antenatal care has declined only

marginally. Coverage is 36 per cent for the poorest

women and 90 per cent for the wealthiest. The ratio

of poor-to-rich women benefitting from skilled birth

attendance in 2014 was about one to four, with two of

the country’s divisions – Sylhet and Barisal – lagging far

behind the rest of the country. And fewer than one third

of women received the recommended minimum of four

antenatal care visits in 2014.

on a more positive note, Bangladesh has been making

progress towards equity in terms of deliveries that take

place in health facilities. In 2004, the ratio of poorest-to-

richest women delivering in a health facility was 1 to 12.

By 2014, the ratio had improved to one to four.

Recognizing that sustained improvements in maternal

and child health will require a greater reduction in

disparities between different social and economic groups,

the government has introduced a range of equity targets

for key interventions. The targets form the basis for

monitoring coverage in low-income communities, urban

slum areas, poor-performing districts and areas with

ethnic minorities, such as the Chittagong Hill Tracts in

south-eastern Bangladesh. Taken together, they represent

a potential pathway to equity for the country’s most

disadvantaged mothers and children.

Source:

national institute of Population research and Training (niPorT), Mitra and associates, and iCf international, Bangladesh demographic and health Survey 2014:

Key indicators, dhaka, Bangladesh, and rockville, Maryland, USa, 2015.

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Child Health: A fair start in life

>> Adequate and equitable financing

BOx 1.4 HEALTH EqUITY FUNDS PROvIDE

FREE HEALTH CARE TO THE POOR

Cambodia has witnessed extraordinary advances in child

survival and other health indicators. Between 2000 and

2015, under-five mortality fell from 108 to 29 deaths per

1,000 live births, one of the most rapid rates of decline

in the world. The same period saw a dramatic increase

in utilization of child and maternal health facilities. Social

insurance provided through the country’s Health Equity

Funds (HEFs) has played an important role in this success.

HEFs are multi-stakeholder initiatives in which non-

governmental organizations reimburse public health

facilities for treating poor patients, using a combination

of government and donor financing. The mechanism has

largely eliminated the practice of charging under-the-

counter fees. It has also contributed to improving quality of

care by providing cash incentives for staff and facilities to

serve patients.

In essence, HEFs are a purchasing mechanism that provides

free health care to the poor. As of 2013, they covered more

than 2.5 million people in 51 of Cambodia’s 81 districts,

supporting more than a million health centre consultations.

Studies show that where HEFs operate they are a

significant force for inclusion, improving access for the

poor and reducing out-of-pocket payments. However, there

are limits to what has been achieved. An estimated 40 to

50 per cent of the poor do not use HEFs, perhaps as a result

of distance or the quality of care, and those just above the

poverty line are excluded.

Source:

Kelsall, Tim, and Seiha heng, ‘The Political economy of inclusive healthcare in Cambodia’, eSid Working Paper no. 43, 16 december 2014.

BOx 1.5 ELIMINATING MALNUTRITION CAN HELP BREAk

THE CYCLE OF UNEqUAL OPPORTUNITY

In 2014, 159 million children under age 5 were stunted.

Another 41 million children under age 5 were overweight

– and their number is rising. Stunting and other forms

of undernutrition reflect societal inequities; stunting can

serve as a marker for poverty.

In Africa and Asia, 11 per cent of GNP is lost due to poor

nutrition. Eliminating malnutrition in young children has

several benefits. It could improve school attainment by at

least one year, reduce poverty, empower women and, in

turn, break the intergenerational cycle of poverty.

Everyone has a right to food and good nutrition. Realizing

that right is critical to fulfilling children’s rights, including

the right to good health that is a prerequisite to expanded

opportunities in life.

That is the principle behind the Scaling Up Nutrition

(SUN) movement, which brings together governments,

civil society, the United Nations, donors, businesses and

scientists to eliminate all forms of malnutrition through

nationally-driven processes. SUN countries are working

to increase access to affordable and nutritious food, as

well as demand for it.

As of March 2016, 56 countries had joined SUN, including

the Democratic Republic of the Congo, Ethiopia, Haiti,

Kyrgyzstan, Peru and Sri Lanka. This means that SUN has

the potential to reach 82.8 million children.

In Peru, the national programme Incluir para Crecer

(Inclusion for Growth) focuses on children and

pregnant women in the poorest areas with the aim

of reducing social inequities and poverty in order to

reduce malnutrition and promote growth. Since 2006,

stunting has fallen by half – from about 30 per cent in

2004–2006 to 15 per cent in 2014. Stunting prevalence

among children from the poorest households declined

from 54 per cent to 34 per cent over the same time

period.

Source:

United nations Children’s fund,

Improving Child Nutrition: The achievable imperative for global progress,

UniCef new York, 2013, and UniCef global

nutrition database, 2016.

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access to essential health services.

117

Within a year of its launch, UCS covered

75 per cent of the Thai population, including 18 million previously uninsured

people.

118

in rwanda, the national health insurance programme, Mutuelle de Santé,

covers about 90 per cent of the population and provides free coverage for the

very poor. out-of-pocket spending fell from 28 per cent to 12 per cent of total

health expenditures in the programme’s first decade.

119

and Cambodia’s health

equity funds have played a critical role in strengthening both the reach and the

equity of the health system in that country

(see Box 1.4).

Power in partnerships

Many of the interventions needed for more children to enjoy good health are well

known. The challenge is to implement them at scale so that there are enough

community health workers, nurses and doctors to link the most disadvantaged

people to high-quality services. failure to mobilize the necessary resources will

act as a brake on progress in child survival and health.

The challenge is great, but concrete and practical strategies such as the every

newborn action plan offer a road map for equitable policy and financing.

Movements such as every Woman every Child and a Promise renewed (aPr)

provide a platform for action, bringing together governments, the private

sector, international agencies and campaigners.

The aPr movement was launched in June 2012, when the Governments of

ethiopia, india and the United States, in collaboration with UniCef, convened

the Child Survival Call to action in Washington, d.C. answering the call,

178 governments – as well as hundreds of civil society, private sector and

faith-based organizations – signed a pledge under the aPr banner vowing to

do everything possible to stop women and children from dying of causes that

are easily preventable.

Since then, more than 30 countries have deepened their commitments by

launching sharpened national strategies for maternal, newborn and child

survival based on aPr’s core principles: building political commitment,

strengthening accountability and mobilizing societies and communities.

Current multilateral partnerships also provide a strong foundation for broadening

and deepening cooperation to support national strategies on child and maternal

health. one example comes from the GaVi alliance. in collaboration with

global companies involved in pharmaceutical development and supply-chain

management, and represented in the international federation of Pharmaceutical

Wholesalers, the alliance has developed a three-year partnership to immunize

hard-to-reach children in 73 countries. Pharmaceutical companies themselves

have an important role in developing affordable products to prevent and treat

killer diseases, including rotavirus, pneumonia and sepsis.

120

effective implementation of the strategies outlined in this chapter will

require stepped-up coordination and more robust leadership, both nationally

and globally. national strategies to achieve universal health coverage and

equitable, quality care for children and their mothers should set clear

priorities, specifically, to reach the most disadvantaged groups with life-saving

interventions. These strategies will have to include providing trained staff with

incentives to work in hard-to-reach areas.

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PERSPECTIVE:

a fair chance for girls – end child marriage

By angélique Kidjo, award-winning artist and UniCef Goodwill ambassador

Child marriage exemplifies how the world’s poorest

girls bear the heaviest burden of disadvantage,

especially those living in marginalized communities

in rural areas of sub-Saharan africa and South asia,

where the practice is most common.

Girls who are married have their childhoods stolen

from them. i’ve seen this, and how it hurts them.

When i was growing up in Cotonou, Benin, several of

my girlfriends from primary school were married at a

very young age. Some i never even saw again – their

married lives took them far away. others i met up

with later on, but they weren’t the same. Their joy and

enthusiasm were gone. They were no longer free to

act like children, but instead were forced to be grown-

ups. i noticed they carried a sense of shame, a sharp

awareness that they were different from the rest of us.

While there has been progress in reducing child

marriage, it is uneven. Girls from the poorest

households – and those living in rural areas – face

twice the risk of being married before turning 18 as

girls from the richest households or those living in

urban areas.

With no progress, almost 950 million women will have

been married as children by 2030, up from more than

700 million today. and by 2050, almost half of the

world’s child brides will be african.

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a fair chance for girls – end child marriage

The costs are too high – for the girls whose rights are

violated when they are married, and for the societies

that need those girls to grow up into productive,

empowered adults.

Married girls are among the world’s most vulnerable

people. When their education is cut short, girls lose

the chance to gain the skills and knowledge to secure

a good job and provide for themselves and their

families. They are socially isolated. as i observed

among my former schoolmates who were forced to

get married, the consciousness of their isolation is in

itself painful.

Subordinate to their husbands and families, married

girls are more vulnerable to domestic violence, and

not in a position to make decisions about safe sex

and family planning – which puts them at high risk of

sexually transmitted infections, including hiV, and of

pregnancy and childbearing before their bodies are

fully mature. already risky pregnancies become even

riskier, as married girls are less likely to get adequate

medical care. during delivery, mothers who are still

children are at higher risk of potentially disabling

complications, like obstetric fistula, and both they and

their babies are more likely to die.

By robbing girls of their potential, child marriage

robs families, communities and nations of the

contributions these girls might have made as

women. Child marriage hampers countries’ efforts

to improve the health of mothers and children, fight

malnutrition and keep children in school. When girls

are married as children, they cannot help but pass on

poverty, low education and poor health – into which

they themselves have been trapped – to the next

generation.

Child marriage may seem like an intractable problem.

it happens because societies often place a lesser

value on girls – so they don’t get the same chances as

their brothers – and because poverty and other forms

of disadvantage, like low levels of education, further

constrain their opportunities, making marriage seem

like the best option to secure a girl’s future.

But there are proven strategies that can change girls’

lives, preserve their childhoods and empower them to

make better futures for themselves and their societies.

These involve increasing girls’ access to education,

empowering girls with knowledge and skills, educating

parents and communities, increasing economic

incentives and supporting families, and strengthening

and enforcing laws and policies that set the minimum

age of marriage at 18 for both girls and boys.

education is a critical part of the solution. Girls who

have little or no education are up to six times more

likely to be married as children than girls who have

secondary schooling. When a girl is in school, those

around her are more likely to see her as a child, rather

than as a woman ready to be a wife and mother. and

the experience of going to school is empowering for

girls, enabling them to develop skills and knowledge,

and to forge social networks that equip them to

communicate and stand up for their interests.

educated girls are better able to contribute to their

countries’ growth and development, and also to the

prosperity and well-being of their future families.

fifteen million girls are married as children every year,

and the sheer numbers underline the importance

of investing in solutions that can have an impact at

scale, to speed up progress in ending the practice.

focused investments to reach and empower poor and

marginalized girls through health, education, social

protection and other systems can create alternative

pathways for girls and their families.

no less critical is the slow, patient work of changing

social norms. These kinds of long-lasting, fundamental

changes come from within communities, and they

depend on engaging both mothers and fathers in

finding solutions that make a difference in their

daughters’ lives.

When child marriage is a thing of the past, we will

have put an end to an inequity that takes away girls’

fundamental rights and steals their childhoods. More

girls and women will be able to make the most of their

lives and give their best to their families, communities

and societies – which will go a long way towards

breaking intergenerational cycles of poverty and

strengthening communities and nations. ending child

marriage unlocks possibilities that can transform life

for girls and yield benefits for us all.

Florence, 14, at the Hope Secondary School, in

Kinshasa, the Democratic Republic of the Congo.

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EDUCATION:

LEvELLING THE

PLAYING FIELD

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ChaPTer 2

Education:

levelling the playing field

quality education has the power to end intergenerational

cycles of inequity, improving the lives of children and

the societies in which they live. Education can provide

children with the knowledge and skills they need to

succeed in life. It is associated with increased incomes,

reduced poverty and improved health. But for education

to play this role, it must begin with early childhood

development and continue with quality learning

opportunities that provide all children, especially the

most disadvantaged, with a fair chance to thrive.

Jhuma Akhter, 14, does her

homework under the glow

of a lamp post outside her

home in Khulna, Bangladesh.

vII Photo

in rich and poor countries around the globe, education has long served as

a great leveller of opportunity because it helps people realize their potential

and contribute to their communities and the world. Good education increases

knowledge, sparks innovation, builds skills that drive growth and prosperity, and

fosters inclusive societies. for generations, quality and equitable education has

provided children with a pathway out of deprivation. What has been true for the

prospects of individual children has also held true for the future of nations.

and yet, millions of children around the world are still denied their right to

education because of factors they do not control – factors such as poverty,

gender, ethnicity, disability or geographical location. armed conflict, natural

disasters and the impacts of climate change also deprive children of the chance to

go to school and learn. in addition, when public resources are not allocated on the

basis of evidence pointing to the greatest need, education systems can entrench

inequities rather than dismantle them.

This chapter will make the case that two challenges – lack of access to education

and deficits in learning outcomes – must be overcome for education to fulfil

its role as an agent of equity. To overcome these challenges, countries will

be best served if they offer comprehensive early childhood care and learning

opportunities, and if they focus on making the fastest progress for the children left

furthest behind. This approach has the potential to narrow the gaps in educational

outcomes between the richest and poorest children by 2030.

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Education: Levelling the playing field

>> Access to education – from the start

Access to education –

from the start

The Convention on the rights of the Child recognizes that every child has the

right to go to school and learn. That right begins in early childhood, which is one

reason why the Sustainable development Goals (SdGs) call on governments to

“ensure that all girls and boys have access to quality early childhood development,

care and pre-primary education.

”

for education to fulfil its role as a catalyst for equity, it must begin with early

childhood interventions that help mitigate the disadvantages faced by children

born into poor and non-literate environments. investment in quality early

childhood care and education produces a double benefit: it is both fair and

efficient.

one key to success is the provision of comprehensive interventions that cross

development sectors to include nutrition, health, and water, sanitation and

hygiene practices. This kind of holistic approach also takes child protection into

account and focuses on the quality of care provided to infants and young children.

There are indications that a holistic approach can provide success.

Comprehensive interventions that combine nutrition, protection and stimulation

have been shown to produce marked gains in young children’s cognitive

development.

121

improved nutrition and preparedness for learning translate into

improved education outcomes – which, in turn, improve children’s health and

can raise their earning levels as adults. a long-term study in Jamaica found a

42 per cent increase in average adult earnings associated with early childhood

stimulation.

122

research in the United States puts the returns on early childhood

investments at 7 to 10 per cent a year.

123

38%

of children leave primary

school

without learning

how to

read, write

and

simple arithmetic

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Lunchtime at Kotingli Basic

School, Northern Region,

Ghana.

efforts to protect and expand the right to education – starting from early childhood

– have been under way for decades. in many cases, they have led to great

success. But school enrolment figures indicate that the pace of progress is in

jeopardy. Since 2011, the global number of children who do not attend school has

increased.

124

in most countries, less than half of children attend early childhood education

programmes.

125

about 124 million children and adolescents are denied

opportunities to enter and complete school – including around 59 million children

of primary school age

(see Figure 2.1)

and 65 million young adolescents of lower

secondary school age, according to figures from 2013.

126

More than half of the

primary-school-aged children who are not in school live in sub-Saharan africa.

127

addition, gender gaps in enrolment continue to be a problem.

School enrolment trends do not bode well for achieving SdG 4, which, in addition

to an emphasis on early childhood development, calls for primary and secondary

education for all children in the next 15 years. indeed, if current trends persist, by

2030:

•

There could be over 60 million primary-school-aged children still out of school.

128

low-income countries will have primary and lower secondary completion

rates of about 76 per cent and 50 per cent, respectively.

129

lower-middle-income countries will have completion rates of nearly 92 per

cent for primary education and more than 80 per cent for lower secondary

education

(see Figure 2.2).

130

also based on current trends, low-income countries in 2030 will not be on track to

achieve universal primary and lower secondary school completion until around the

turn of the next century.

131

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Education: Levelling the playing field

>> Access to education – from the start

Charting a path towards universal access to primary and secondary schooling,

along with effective learning for all, begins with identifying the children left

behind. Those excluded from learning opportunities often face multiple kinds

of disadvantage. Poor girls living in rural areas usually have the least access

to education.

132

Children also face disadvantages and lack of services due to

discrimination based on ethnic origin or disability.

Some out-of-school children never enter a classroom. Many children – especially

those from the poorest households – arrive on the first day unprepared to succeed

in school.

133

as they progress through the education system, some drop out well

before completing primary school. for many others, the transition from primary

into lower secondary education, or from lower to upper secondary school, remains

an insurmountable hurdle

(see Figure 2.3).

FIGURE 2.1

More than half of the 59 million out-of-school children live in sub-Saharan Africa

number and percentage of primary-school-aged children out of school for UniCef regions for 2000 and 2013

out-of-

school

rate

50%

(22 million)

43%

(43 million)

40%

39%

(19 million)

34%

2000

30%

(33 million)

20%

(18 million)

26%

(8 million)

2013

18%

(99 million)

2000

15%

(33 million)

10%

(12 million)

21%

16%

(2 million)

(5 million)

(10 million)

(3 million)

10%

(11 million)

2013

West

eastern and

and Central Southern

africa

(1 million)

Middle east

and north

africa

Cee/CiS

(4 million)

(7 million)

latin america east asia

and the

Caribbean

Pacific

Sub-Saharan

africa

(59 million)

World

South

asia

Bubble size indicates number of out-of school children

2000

2013

10 million

5 million

1 million

Source:

UniCef analysis based on data from the UneSCo institute for Statistics global database, 2015.

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FIGURE 2.2

If current trends persist, the world is off-track to reach primary and secondary

education for all by 2030

Projected completion rates by country income group and level, 2010–2100

2.2a

Primary

completion

rate

100%

80%

60%

40%

20%

2010

all countries

2030

Upper-middle-income countries

2100

lower-middle-income countries

2.2b

Lower

secondary

completion

rate

100%

80%

60%

40%

20%

2010

2030

low-income countries

2100

Note:

Projections are based on current trends.

Source:

United nations educational, Cultural and Scientific organization,

EFA Global Monitoring Report,

‘how long will it take to achieve universal primary and

secondary education?’, Technical background note for the framework for action on the post-2015 education agenda, UneSCo, Paris, May 2015.

FIGURE 2.3

Many girls and boys drop out as they transition through education levels

Gross enrolment ratio (Ger) in pre-primary, primary and secondary education in five UniCef regions

and sub-Saharan africa, 2013

120%

100%

80%

60%

40%

20%

Sub-Saharan

africa

Pre-primary, boys

Pre-primary, girls

South asia

Primary, boys

Primary, girls

Middle east

and north africa

latin america and

the Caribbean

east asia

and the Pacific

Upper secondary, boys

Upper secondary, girls

Cee/CiS

lower secondary, boys

lower secondary, girls

Source:

UneSCo institute for Statistics global database, 2015.

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Education: Levelling the playing field

>> Equity and learning outcomes

There are multiple reasons for disadvantage in education. in China, for example,

migration from rural districts to urban centres affects whether children have

access to education entitlements.

134

if they are living in cities but remain

registered in rural areas, their entitlements may be severely limited.

Poverty is also an important part of the equation. The impact of poverty on

education begins early, because the poorest children in any country are the least

likely to attend early childhood education programmes.

135

and the disadvantages

continue. in sub-Saharan africa, nearly 60 per cent of 20- to 24-year-olds from

the poorest fifth of the population have been through fewer than four years of

schooling. By contrast, only 15 per cent in the richest quintile have been in school

for less than four years.

136

in egypt and the United republic of Tanzania, being

born poor nearly doubles the risk of missing out on basic education relative to the

national average. for poor women in both countries, the risk is even higher.

137

in recent years, wealth-based disparities in attendance rates have narrowed in

many countries as primary school attendance has increased.

138

however, while

children from the poorest households are now more likely to enter school, they

are also more likely than their more advantaged peers to drop out.

139

Pakistan has more than 5.6 million out-of-school children of primary school age.

140

There are also large wealth-related gaps in school attendance and retention

(see

Figure 2.4).

Children in the richest 20 per cent of the population get nearly nine more

years of schooling, on average, than children in the poorest 20 per cent. This wealth

gap is magnified by gender disadvantages among the poorest girls and by regional

disparities. While Pakistan is making national progress in primary school completion,

some groups – notably poor rural girls – have been left behind.

141

education pathway analysis helps to identify when disparities intensify as

children progress in school. in nigeria, disparities begin early. according to 2013

data, less than a third of poor nigerian children between 15 and 17 years of age

had entered primary school at the correct time, though nearly all of the children

from richer households had

(see Figure 2.5).

The gap continues to widen at the

start of each level of education, as greater proportions of poor children drop

out. By the start of upper secondary education, only 7 per cent of poor children

enter school, compared to 80 per cent of wealthier children.

edUCaTion iS noT JUST aBoUT

GeTTinG ThroUGh SChool;

learninG iS WhaT CoUnTS.

Equity and learning outcomes

education is not just about getting through school;

learning

is what counts. But

assessments of the knowledge and skills that children acquire in school indicate

that education systems have failed millions of children. Worldwide, nearly

250 million children of primary school age – well over one third of the 650 million

children in this age group – do not master basic literacy and numeracy, according

to an estimate from 2013.

142

Some 130 million of them spend at least four years in

school and still lack these skills.

learning deficits begin early, sometimes even before primary school. in

28 countries or areas with available data, less than half of children between the ages

of 3 and nearly 5 were developmentally on track in literacy and numeracy in 2014.

143

The lack of learning in children’s early years raises concerns at many levels.

in early childhood and primary school, children acquire the foundational skills

that allow them to develop problem-solving capabilities, flourish in secondary

education and later succeed in employment markets.

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FIGURE 2.4

In Pakistan, the level of education achieved depends on gender, residence

and wealth

average number of years of schooling of youth aged 20–24, 2013

Boys

11.10

years

Urban

10.51

years

Richest

20%

10.50 years

Boys

10.76

years

Rural

10.46

years

Girls

10.25

years

Girls

9.95

years

National average

6.30 years

Boys

3.69

years

Boys

3.08

years

Urban

2.54

years

Poorest

20%

1.99 years

Rural

1.86

years

Girls

1.27

years

Girls

0.75

years

Note:

Chart is not drawn to scale.

Source:

UneSCo, Global education Monitoring report, World inequality database on education (Wide), 2013 dhS data.

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Education: Levelling the playing field

>> Equity and learning outcomes

FIGURE 2.5

Wealth,

2.5

FIGURE

gender and residence affect education in Nigeria

educational attainment of upper-secondary-school-aged adolescents by sex, residence and wealth quintile, 2013

Wealth, gender and residence affect education in Nigeria

Educational attainment of upper-secondary-school-aged adolescents in Nigeria, 2013

Entered primary school

Completed primary school

Transited to lower secondary school

Completed lower secondary school

Transited to upper secondary school

Still attending primary school

Still attending lower secondary school

Never entered, dropped out or did not transition from previous educational level

17% never

entered school

BOYS

83% entered

primary school

83%

76%

71%

49%

48%

71% entered

primary school

71%

66%

60%

44%

42%

20%

40%

GIRLS

29% never

entered school

100%

80%

60%

40%

20%

60%

80%

100%

48% transited to

upper secondary school

42% transited to

upper secondary school

6% never

entered school

URBAN

94% entered

primary school

94%

90%

86%

65%

63%

64% entered

primary school

64%

57%

51%

33%

31%

20%

40%

RURAL

36% never

entered school

100%

80%

60%

40%

20%

60%

80%

100%

63% transited to

upper secondary school

33% transited to

upper secondary school

1% never

entered school

RICHEST QUINTILE

99% entered

primary school

99%

98%

97%

81%

80%

28% entered

primary school

28%

21%

16%

20%

POOREST QUINTILE

72% never

entered school

100%

80%

60%

40%

20%

40%

60%

80%

100%

80% transited to

upper secondary school

7% transited to

upper secondary school

Note:

Due to rounding, some totals may not correspond with the sum of the separate ﬁgures.

Source:

UNICEF analysis based on Nigeria DHS, 2013.

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experiences at home set the stage for success in learning. While more than

half of children aged 3 to nearly 5 in most countries are engaged by an adult in

learning activities at home, less than half have access to three or more books

at home.

144

learning outcomes are also tied to the multiple kinds of advantages

and disadvantages that children face. evidence shows that poverty often leaves

children with deficits in learning outcomes

(see Figure 2.6).

Starting early in

life, even before reaching age 5, children from poor households are more likely

than their more affluent peers to present developmental delays in literacy and

numeracy.

145

in india, being born into the poorest households carries a learning

‘penalty’ relative to children from the richest households. The penalty widens

between ages 7 and 11, reaching a 19 per cent gap in students’ ability to

subtract.

146

When children face wealth-related disadvantages and have parents who did not

attend school, there are powerful multiplier effects – especially for young girls.

By age 11 in india, girls and boys who come from the richest homes and have

educated parents enjoy a huge academic advantage over other children. The most

advantaged boys and girls are about six times more likely to learn basic reading

and mathematics skills than girls from the poorest households whose parents

were not educated.

147

FIGURE 2.6

Wealth-based gaps in basic math skills start early and persist over time

Percentage of children able to subtract, by age, 2012

90%

80%

70%

60%

50%

40%

30%

20%

Ages 10–11:

10%

india

Pakistan

Kenya

Wealthiest

Poorest

Ages 7–8:

Wealthiest

Poorest

Note:

While indian and Kenyan children should have completed Grade 2 by age 8, Pakistani children should have completed Grade 3 by age 8.

Source:

aSer india, aSer Pakistan and Uwezo Kenya survey data from 2012, in rose, Pauline, and Benjamin alcott,

How can education systems become

equitable by 2030?: DFID think pieces – Learning and equity,

United Kingdom department for international development, london, august 2015.

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Education: Levelling the playing field

>> Equity and learning outcomes

BOx 2.1 THE DEvELOPING BRAIN: AN EARLY WINDOW OF OPPORTUNITY

FOR LEARNING

Long before a child enters the classroom, inequities can

create a lasting imprint on the architecture of the brain.

Recent research on brain development casts new light

on the formative influence of early childhood experience.

In the first few years of life, a child’s brain creates 700

to 1,000 new neural connections every second, a pace

that later diminishes. These early connections set the

foundation on which later connections are built.

The new research shows that nutrition, health care and

interaction between children and their caregivers can help

with brain development in early childhood. Conversation,

repeating and connecting words in meaningful contexts,

and early exposure to literacy through reading and play

are all positively associated with language skills.

Conversely, frequent exposure to chronically stressful

events in infancy, including nutritional deprivation and

violence, can affect children by damaging neurons in

areas involved in learning and emotional development.

In other words, these deprivations affect how the brain

develops. Negative experiences in a child’s life often

manifest themselves later as difficulties with learning,

emotional development and management of anxieties.

Because the first years of a child’s life affect brain

development so significantly, early childhood offers a

critical window of opportunity to break intergenerational

cycles of inequity. Early childhood care, protection and

stimulation can jumpstart brain development, strengthen

children’s ability to learn, help them develop psychological

resilience and allow them to adapt to change.

Early interventions can even affect future earnings.

Research has shown, for example, that preventing

undernutrition in early childhood leads to an increase in

hourly earnings of at least 20 per cent later in a child’s life.

Source:

The World Bank, World development report 2015: Mind, society, and behavior, Washington, d.C., 2015, Chapter 5. Center on the developing Child at harvard Univer-

sity, ‘Brain architecture’, <http://developingchild.harvard.edu/science/key-concepts/brain-architecture>, accessed 15 March 2016. lake, anthony, and Margaret Chan, ‘Putting

science into practice for early child development’, The lancet, vol. 385, no. 9980, 2014, pp. 1816–1817 international food Policy research institute, Global nutrition report 2014:

actions and accountability to accelerate the world’s progress on nutrition, Washington, d.C., 2014.

although evidence is still limited and fragmented, a growing body of research

appears to validate this pattern of substantial differences in key learning

indicators between children from the poorest and richest households. research

from five countries in latin america finds large wealth-related gaps on children’s

standardized test scores for language development. The gaps are evident by

age 3, and there is no evidence of recovery once children enter school.

148

The deficits continue as children progress through school. in latin america,

a region-wide assessment showed that more than one quarter of third-grade

students were unable to recognize basic phrases or locate information in a

simple text.

149

in india’s rural schools, a 2014 study showed that just under

half of children in fifth grade were able to read a basic second-grade text. in

arithmetic, half of fifth graders could not subtract two-digit numbers, and only

about one quarter could do basic division.

150

The same issues arise in other countries. in Uganda, an enrolment success

story, just over half of the children in Grade 5 were able to read a story at Grade

2 level, according to the results of a 2012 assessment.

151

in Kenya, a third of

children in Grade 5 could not perform Grade 2 numeracy tasks. about 10 per

cent of students in Grade 8 were unable to perform these tasks, according to a

2012 assessment.

152

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and at the secondary level, international student achievement tests point to

desperately low levels of learning in many low- and middle-income countries.

in the most recent Programme for international Student assessment

(PiSa), two thirds or more of secondary school students in argentina, Brazil,

Colombia, indonesia, Jordan, Peru, Qatar and Tunisia were performing below

level 2, a marker of baseline proficiency in math. less than 1 per cent were

performing at the top two levels. in comparison, an average of 23 per cent

of students in the high-income organisation for economic Co-operation

and development (oeCd) countries were low-achieving, and 13 per cent

performed at the top level.

153

evidence from latin america underscores the interaction between inequity

and low levels of learning achievement. research on the 2012 PiSa scores by

the inter-american development Bank found that the average gap between

the poorest and richest students of the same age in the region was equivalent

to two years of schooling.

154

Such failures in learning have repercussions for children’s futures and for

national prosperity. Many education systems fail to teach children the skills

they need to become productively employed adults and contribute to national

social development and economic growth. The costs of misalignment between

skills and jobs are visible in many parts of the world.

according to the international labour organization, the share of

undereducated young workers in low-income economies is triple that of the

share in upper-middle-income economies. in sub-Saharan africa, three in five

young workers do not have the level of education needed for their jobs.

155

employer surveys in the Middle east and north africa indicate a pervasive

disconnect between the skills learned in school and those demanded by

modern business.

156

That mismatch is one of the reasons for the persistently

high levels of unemployment among educated youth in the region, and it is an

issue facing young people worldwide.

as the high-level Commission for Quality education for all in latin america

has summarized the problem: “Without significant improvements in learning

levels, the rising levels of schooling will hardly turn into the improvements in

quality of life to which latin american citizens aspire.

157

”

high-income countries also face learning challenges. The growth in the

number of children with access to education in oeCd countries has resulted

in 80 per cent of young people achieving upper secondary qualifications and a

quarter gaining tertiary education.

158

however, around one in five young people

in oeCd countries do not complete secondary education and have to make

the transition to adulthood facing the prospect of lower wages, less secure

employment and marginalization.

159

This education gap is an increasingly

powerful determinant of wider inequalities in wealth and opportunity,

hampering the development of more inclusive societies.

160

for governments, addressing the problems at the source – within education

systems – is the most cost-effective way to make sure that children and young

people develop the skills and competencies they need. efforts to narrow

the learning gaps are under way. in Tunisia, for example, the government

has embarked on a major reform process to improve learning outcomes

for children in school and on a comprehensive programme for out-of-school

children.

161

aroUnd one in fiVe YoUnG

PeoPle in oeCd CoUnTrieS

do noT CoMPleTe SeCondarY

edUCaTion.

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Education: Levelling the playing field

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at the same time, many young people are living with the consequences of the

system’s past failures. in 2012, UneSCo’s

Global Education Monitoring Report

found that 200 million 15- to 24-year-olds had left school without basic skills.

Tackling this backlog will require investment in second-chance education and

skills training for adolescents and young adults through partnerships between

governments and the private sector.

162

Education in emergencies and

protracted crises

increasingly, complex emergencies and protracted crises are impeding the right

to education. These emergencies do not just temporarily interrupt children’s lives

and educations, they close doors on education for the length of a childhood,

or even a lifetime. Though an armed conflict, epidemic or natural disaster can

devastate the life of any child, the poorest and most disadvantaged children are

the most vulnerable.

humanitarian emergencies and protracted crises can disrupt education. an

estimated 75 million children aged 3 to 18 in 35 countries are in desperate need of

education, according to a recent report. of these children, 17 million are refugees,

internally displaced or part of another population of concern

(see Box 2.2).

163

notably, girls in conflict-affected contexts are 2.5 times more likely to be out of

school than girls in more peaceful settings.

164

Two boys carry chopped

firewood in Kafar Batna

village in Damascus, the

Syrian Arab Republic.

in conflict situations, education is often under fire either directly or indirectly, as

conflict damages schools and endangers the lives of teachers and students.

165

a study by the Global Coalition to Protect education from attack documented

thousands of assaults on students, teachers and institutions in 70 countries in a

five-year period ending in 2013. The incidents included bombings, kidnappings,

illegal arrests, torture and killings of students and teachers.

166

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Specific examples are numerous. in nigeria, the armed group Boko haram

abducted hundreds of women and girls in major attacks in 2014. Between

2012 and 2014, the group killed 314 children in schools in north-eastern

nigeria.

167

from the start of the group’s insurgency to the end of 2015, more

than 600 teachers had been killed and more than 1,200 schools damaged or

destroyed.

168

Teachers and children also have been attacked, kidnapped and killed in Yemen,

the Syrian arab republic and many other countries. in 2014 alone, there were

163 attacks on schools in afghanistan; nine schools were attacked in the Central

african republic; and there were 67 reported attacks on schools in iraq.

169

BOx 2.2 THE DESTRUCTIvE IMPACT OF ARMED CONFLICT ON EDUCATION

Conflict has immediate and often life-threatening effects

on children. It also holds back the development of the

education systems that should be functioning to help them

reach their full potential. Recent experience in the Syrian

Arab Republic has shown how conflict can halt and even

reverse progress on education.

In 2010, before the current crisis began, nearly all of the

country’s primary-school-aged children and 90 per cent

of lower-secondary-school-aged children were enrolled

in school. Five years later, some 2.1 million children aged

5 to 17 in the Syrian Arab Republic were not in school. In

addition, about 700,000 school-age Syrian refugee children

– half of the school-age refugee population – were out of

school in neighbouring states.

More than half of the nearly 4.6 million refugees who have

fled the conflict are children, many now facing a future

without the hope that comes with education. Neighbouring

states have struggled to cope with this influx. With support

from donors, the Government of Lebanon has introduced

an innovative system that accommodates large numbers

of out-of-school refugee children by creating a two-shift

system in public schools. About 150,000 refugee children

have entered Lebanon’s public school system in this way.

yet there is still a large gap between the education needs

of Syrian refugee children and the learning opportunities

available to them. The language of instruction is a major

factor hindering their ability to continue their education. In

addition, in most countries where refugees settle, Syrian

teachers are not employed in the public system.

But it is not just the Syrian Arab Republic where education

is interrupted by conflict. In Gaza, nearly 500,000 children

were unable to return to classrooms at the start of

the 2014/15 school year because of damage to school

infrastructure. In yemen, conflict had closed thousands of

schools and pushed 1.8 million children out of education

as of August 2015, adding to the 1.6 million who were

out of school before the violence there escalated. In the

Sudan, war that has lasted decades in some areas has

deprived more than 3 million children of an education.

Armed conflicts in the Central African Republic, the

Democratic Republic of the Congo and South Sudan

have stalled progress in areas already marked by chronic

deficits in education.

In DRC, where conflict has been ongoing since 1993,

more than 3.5 million children of primary school age are

out of school. Even so, recent data show primary school

attendance has been increasing steadily – from 51 per

cent in 2001 to 87 per cent in 2013. Meanwhile, the gaps

in attendance between boys and girls, children living in

urban versus rural areas, and those from the richest and

poorest households have all been narrowing.

170

Source:

UneSCo institute for Statistics and United nations Children’s fund,

Fixing the Broken Promise of Education for All: Findings from the Global Initiative on Out-of-

School Children,

UiS, Montreal, 2015, p. 49. United nations Children’s fund,

Syria Crisis Education Strategic Paper,

london 2016 Conference paper, UniCef new York,

January 2016, p. 1. United nations high Commissioner for refugees, ‘education Sector Situation analysis’ for november and december 2015, found on the Syria regional

refugee response website, <http://data.unhcr.org/syrianrefugees/country.php?id=122>, accessed 12 January 2016. United nations Children’s fund regional office for the

Middle east and north africa,

Education under Fire: How conflict in the Middle East is depriving children of their schooling,

UniCef amman, 3 September 2015, p. 6. Global

Partnership for education, democratic republic of Congo page, <http://www.globalpartnership.org/country/democratic-republic-of-congo>, accessed 8 april 2016;

MICS 2001 and 2010; DHS 2007 and 2013–2014.

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>> Education in emergencies and protracted crises

Conflict that drives children and families from their homes often leads to a

state of persistent displacement. at the end of 2014, half of all refugees had

been in exile for more than 10 years, and at least half of internally displaced

people had a high probability of being uprooted for three years or longer.

171

for

them, displacement has become the new normal.

But conflict is not the only cause of protracted crisis in children’s lives. Climate

change poses another growing danger, intensifying the risks associated with

drought and floods. Climate-related disasters threaten children’s lives and

disrupt their education, creating conditions that leave them at increased risk of

abuse, neglect, trafficking and child labour.

172

These disasters can also inflict extensive damage on school infrastructure.

When Cyclone Pam struck Vanuatu in 2015, for example, it affected about

80 per cent of schools. Some were damaged and others were turned into

evacuation centres.

173

The problem exists throughout the Pacific region, where

many schools in small island states are unavoidably located near coastal areas.

Throughout the region, climate change and weather-related emergencies have

hindered efforts to provide children with good-quality learning opportunities.

174

despite the challenges of conflict and climate change, education accounts

for a small share of requests for humanitarian aid – and only a small fraction

of those requests are funded. less than 2 per cent of the funds raised by

humanitarian appeals went to education.

175

This figure suggests that education

is considered a low priority in humanitarian contexts, a viewpoint that is

curiously out of step with the aspirations of parents and children affected by

crises.

176

for them, a return to school can help restore a sense of security,

normalcy and, above all, hope for a better future.

The deeper problem is that aid mechanisms are poorly aligned with real

needs. it is not possible to finance education for children facing the prospect

of long-term displacement through short-term (and invariably under-funded)

emergency appeals. rapid response has to be coupled with long-term

financing. a holistic approach that bridges the traditional divide between

development expertise and humanitarian response is required. By linking

humanitarian and development efforts, education programmes in emergency

or post-emergency contexts can provide children with the chance to bounce

back and lead productive, peaceful and fulfilling lives.

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Nydeng Khot Gatkwoth, 10,

her brother Chuol, 12, and

a friend attend a UNICEF-

supported temporary

learning space in the Bor

Protection of Civilians Site,

South Sudan.

Benefits of quality education

The inequities that deny children the right to quality education from early childhood

through adolescence can trap young people in low-skilled, poorly paid, insecure

employment, which holds back economic growth and fuels inequality.

Changing demographics underscore the importance of educating all children,

especially those who have been excluded. in the next 15 years, the population of

15- to 24-year-olds worldwide will increase by nearly 100 million. The largest share

of this cohort will be in asia and africa.

177

if current trends continue through 2030, the poor-quality education and high levels

of inequity in access to school compromising young people’s future employment

prospects and their countries’ economic growth can also threaten stability and

social cohesion. indeed, in many low- and middle-income countries, growing

disparities in education among different social groups already have increased the

probability of conflict.

178

Conversely, if this growing population enters adulthood with the skills needed to

build secure livelihoods and make positive choices, the effects could be socially and

economically transformative.

179

Good quality and equitable education serves to unlock opportunity and undo

intergenerational cycles of inequity: on average, each additional year of education a

child receives increases her or his adult earnings by about 10 per cent. and for each

additional year of schooling completed, on average, by young adults in a country,

that country’s poverty rate falls by 9 per cent.

180

The returns on education are

highest in low-income and lower-middle-income countries.

181

Some of the highest returns of all are associated with education for girls. education

empowers girls later in life to seek better health care during pregnancy, in childbirth

and during their children’s early years. The results are reflected in lower levels

of under-five mortality, reduced fertility, improved health-care practices and later

marriage and childbearing.

182

Children – especially girls – born to educated mothers

are more likely to attend school, resulting in a cycle of opportunity that extends

across generations. There is also evidence that education is associated with higher

levels of civic engagement and participation in political processes.

183

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Education: Levelling the playing field

>> Reaching children throughout the learning process

education can also be a tool in the fight against child rights violations such as

child labour, though stopping such violations will demand action on many fronts.

historically, enforcement of compulsory education has provided a powerful

impetus towards ending child labour. in today’s rich countries, that was a critical

part of the largely successful effort to limit the practice in the late nineteenth

and early twentieth centuries.

184

Backed by the right mix of anti-poverty

measures and strategies for improving the quality of learning opportunities,

compulsory education could play a similar role in the struggle to eliminate child

labour in the low- and lower-middle-income countries of the twenty-first century.

The benefits of education are not solely the product of more years of schooling.

learning outcomes also matter and have a powerful effect on earnings, the

distribution of income and long-term economic growth.

185

in lower-middle-

income countries, if all children born today could be educated to a basic level of

literacy and numeracy skills, there would be a 13-fold increase in GdP over their

lifetimes.

186

Universal basic skills can also make economic growth more inclusive. disparities

in access to quality education are among the most powerful determinants of

income disparities because of the effect learning and skills have on productivity,

wages and employment. narrowing the skills gap would create the conditions

for more equitable patterns of growth, while increasing the size of the economy

and reducing poverty.

187

UniVerSal BaSiC SKillS Can

alSo MaKe eConoMiC GroWTh

More inClUSiVe.

Reaching children throughout

the learning process

as suggested previously in this chapter, quality education begins with

interventions in early childhood. There is evidence that early childhood education

can prepare children from the most disadvantaged homes for greater success

when they enter primary school. however, not all children have access

(see

Figure 2.7).

in Cape Verde, an assessment of children entering primary school demonstrated

a 14 percentage point advantage for children who attended pre-primary school

over the children who did not.

188

an evaluation published in 2009 from argentina

found that attending pre-primary school had a significant positive effect on

standardized test scores in third-grade math and Spanish. it also improved

classroom attention, effort, discipline and participation. and the benefits of

preschool for children in neighbourhoods with high poverty levels were greater

than for other argentine children.

189

early childhood interventions for poor children in Bangladesh, indonesia, the

Plurinational State of Bolivia, and other countries have all shown results in

reducing early learning gaps.

190

Unfortunately, attendance rates for pre-primary

education are lowest in the poorest countries with the highest levels of child

poverty.

191

early interventions thus build a foundation for making sure that all children

complete school and learn essential knowledge and skills. But equity in

education requires even more. it calls for a focus on the children who are left

behind

throughout

the learning process. The progress these children make will

have to be accelerated if their rates of school participation and their learning

outcomes are to catch up with those of more advantaged children by 2030.

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This acceleration can take different forms, depending on the national context.

The Philippines, Senegal and Uganda, for instance, all have large out-of-school

populations at different levels of school enrolment and completion. in the case

of Senegal, while there are large disparities in primary school completion rates

among different social groups, all groups are far from universal completion.

The challenge is to accelerate overall progress with rapid advancement for

disadvantaged groups. By contrast, in the Philippines and Uganda, children

from the wealthiest households and the best-performing regions are close to

universal school completion. Therefore, efforts in those countries would best be

concentrated on the poorest and most disadvantaged children

(see Figure 2.8).

disparities in access among different groups of children dictate the rate of

progress needed in each group to achieve universal primary school completion.

The needs of each group, in turn, will have far-reaching implications for how

governments frame policies and allocate resources to specific regions, schools

and children. To succeed, these policies must combine a commitment to equity

in the schools with initiatives that tackle the determinants of inequity operating

outside the classroom.

The reaching out-of-School Children programme in Bangladesh illustrates

how governmental and non-governmental organizations can develop innovative

strategies for reaching the most disadvantaged children. as part of the

programme, ananda (Joy of learning) Schools have offered a second chance at

FIGURE 2.7

Early childhood education gaps vary by wealth and residence

early childhood education attendance by wealth, residence and national average

Early

childhood

education

attendance

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

Ghana

richest

Poorest

Urban

rural

Jamaica

lao People's

democratic republic

national average

nigeria

Tunisia

Viet nam

Note:

data are for 2011, except for the lao People’s democratic republic and Tunisia (2011–2012) and Viet nam (2013–2014).

Source:

UniCef global databases, 2016.

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Education: Levelling the playing field

>> Reaching children throughout the learning process

FIGURE 2.8

Progress must accelerate for the least advantaged children

Speed of acceleration required for universal primary completion for all, by background

richest

Poorest

Urban

rural

SENEGAL

100%

75%

50%

25%

2015

2020

2025

2030

Ziguinchor

louga

UGANDA

100%

75%

50%

25%

2015

2020

2025

2030

Kampala

Karamoja

THE PHILIPPINES

100%

75%

50%

25%

2015

2020

2025

2030

national Capital

region

autonomous

region in Muslim

Mindanao

Note:

Calculations use the survey year and the annual compound rate of change.

Source:

dhS data, overseas development institute calculations.

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education for children in areas of high poverty and low school completion rates.

Blending formal and non-formal methods to prepare students aged 8 to 14 for

Grade 5 exams, the schools enrolled more than 790,000 children in 90 of the

country’s poorest

upazilas

(sub-districts) between 2005 and 2012 and achieved an

83 per cent pass rate.

192

The goal is to reach 148 sub-districts by 2017

initiatives like the one in Bangladesh demonstrate that the goal of reaching the

hardest-to-reach children with quality education is not a matter of simply doing

more of the same. it demands a commitment to trying something new.

from argentina to Zimbabwe, new approaches to education are tested and

scaled to meet local, national and global needs. Some innovations make use of

new technology. eduTrac, for example, is a mobile phone-based data-collection

system using SMS technology to encourage the flow of real-time information

on education indicators in Uganda, among other countries.

193

Through elearning

Sudan, electronic tablets are used to instruct out-of-school children in remote

villages of north Kordofan state, where traditional modes of education are not

available.

194

other innovations tackle the challenge of education in crisis situations

with self-learning curricula that provide access to alternative education with adult

guidance.

attitudes and cultural norms will also have to change. in Montenegro, for

example, national efforts have been under way to change attitudes that block

access to education for children with disabilities. an intensive public awareness

campaign, which started in 2010, is partially credited with generating greater

public interest in the issue.

195

a poll in 2014 showed that 78 per cent of

Montenegrins supported inclusive education.

196

Equity targets

eQUiTY TarGeTS Can ProVide

a Clear SeT of PrioriTieS

ThaT Shine a SPoTliGhT

on a CoUnTrY’S MoST

edUCaTionallY diSadVanTaGed

Children.

To accelerate progress for the hardest-to-reach children, national education

policies may consider setting equity targets – calibrated to national

circumstances – aimed at making sure all children have a fair chance to go

to school and learn. interim or ‘stepping stone’ equity targets on the road to

meeting the 2030 goals for education would also be useful.

for instance, governments could set an interim target of halving disparities

associated with wealth, gender, ethnicity and location in access to early

childhood, primary and lower secondary education by 2022. or they could

decide on an interim target that places special emphasis on the poorest girls.

Similar interim targets could be set to reduce disparities in learning outcomes.

197

equity targets will make a difference only if they are grounded in policy

reform, and closing gaps in school participation will require detailed data

on who is out of school or at risk of dropping out. Some equity targets

can be achieved through the education system – for example, through

learning assessment tools that identify which children are falling behind and

guide resources towards them. other targets can be reached by tackling

disadvantages associated with poverty, gender, ethnicity and disability.

as a guide for policymakers, equity targets can provide a clear set of priorities

that shine a spotlight on a country’s most educationally disadvantaged

children.

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Education: Levelling the playing field

>> Teaching matters

Teaching matters

inextricably linked to issues of effective learning and equity are the women and

men who interact with children in learning environments: teachers. effective

teachers can transform lives. Poorly trained, badly paid, ineffective teachers

working in weakly governed education systems undermine opportunity and often

reinforce inequities.

Problems associated with teachers and the governance systems in which they

operate are evident worldwide. among other issues, teacher absenteeism is

endemic in many countries. for example, a 2013 survey of primary schools in

Kenya reported teacher absenteeism rates of nearly 17 per cent for public primary

schools.

198

other aspects of teaching and class planning have received insufficient attention.

for example, a wave of first-generation learners – children whose parents did

not have access to education – have entered primary school. These students are

considered to be at risk of low learning levels. Yet teacher training systematically

fails to equip educators with the skills needed to teach them.

199

how teachers are distributed within a country can create difficulties with class

size and quality of instruction for disadvantaged children in underserved districts.

in countries with data on student-teacher ratios and qualifications of teachers, it is

the early grades – ironically, the grades with the most students and the greatest

needs – that have the largest classes and the least qualified teachers.

200

Poorly trained and unmotivated teachers are hardly the only governance issue in

underperforming schools. a lack of planning and financing becomes evident in the

form of overcrowded classes, insufficient resources and poor infrastructure. for

example, in sub-Saharan africa, over half of the schools lack access to drinking

water and toilets.

201

not all have separate facilities for boys and girls. few schools

have access to electricity, which they need to take advantage of new learning

technologies. average class sizes in the United republic of Tanzania and Malawi

are 72 and 90 children, respectively.

202

in Uganda, there is one textbook for every

three children.

as countries seek to climb the scale of educational performance, teachers –

by definition – will play a critical role. Societies need to make sure teaching is

considered a high-status profession in keeping with its critical role in shaping the

future. With the future in mind, national equity goals should aim to connect the best

teachers with the most disadvantaged pupils. Too often, career incentives have the

inverse effect, guiding the best teachers towards the most advantaged students.

research provides a number of clues to guide reform in this regard. in india, a

programme run by Pratham, a non-governmental organization, provided remedial

education to the lowest-performing children in public schools.

203

hiring informal

teachers from the local community to provide supplementary education, the

programme achieved marked improvements in test scores. Targeted pedagogical

training for teachers in Kenya, Mali and niger similarly improved early grade

reading among underperforming children.

204

as these examples suggest, preschool and early grade teaching for first-

generation learners and students needing remedial support – scaled up to

a national level – could dramatically improve learning trajectories. The most

effective route to scaling up these efforts is through national teacher training

programmes.

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There will also simply be a need for more teachers, now that the adoption of

the SdGs has committed governments around the world to universal secondary

schooling by 2030. even achieving universal lower secondary education by then

will require an additional 5.1 million teachers, 3.3 million of them for primary

schools. half of the new lower secondary school teachers and 63 per cent of the

primary school teachers will be needed to serve the rapidly growing school-aged

population in sub-Saharan africa.

205

Education financing

one of the lessons of the past decade is that more money, in itself, does

not deliver better learning outcomes. how resources are allocated, however,

does matter.

Many governments around the world have increased education spending.

average spending on education in low-income countries increased from 3.2 per

cent of GdP in 1999 to 4 per cent in 2012.

206

But many governments continue to

systematically underinvest in education, especially in South asia. in 2012, india

invested 3.9 per cent of its GdP in education.

207

The Government of Pakistan

reports spending about 2 per cent of GdP on education.

208

These investment

levels are below the estimated 5.5 per cent of GdP that will be required to

provide education for all by 2030.

209

how resources are allocated within countries has an important bearing on

equity. Providing equal amounts of finance on a per pupil basis is not necessarily

a formula for equitable funding. for a child who enters an education system

carrying disadvantages associated with poverty, gender, disability or ethnicity,

more resources may be needed to achieve opportunities equivalent to those

enjoyed by more privileged children. Unfortunately, spending is often skewed in

favour of the most privileged pupils.

This is partly because poor children are more likely to drop out of school early,

thereby losing the benefits of public spending. UniCef research on low-income

countries overall shows that children from the richest 10 per cent of the

population receive around 46 per cent of the benefits from public spending on

education.

210

A pre-school student, 5,

traces a number on a flip

chart, as part of a numeracy

lesson in Timor-Leste.

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Education: Levelling the playing field

>> The role of aid

Several countries, including Brazil and Viet nam

(see Box 2.3),

have introduced

reforms aimed at achieving more equitable spending patterns. in Chile, a school

subsidy programme, Subvención escolar Preferencial, provides a mechanism

that makes flat-rate payments for each pupil, plus additional payments to

schools that have high concentrations of disadvantaged students and students

with learning difficulties.

211

The global commitment to achieving universal secondary education reflects a

growing awareness of the role of higher-level skills in driving economic growth.

Yet in countries where a large share or even a majority of children fail to

complete primary school, increasing spending on secondary education actually

could have negative consequences for equity. The per-pupil costs of secondary

schooling are far higher than those for primary school, and in many low-income

countries, only a minority of poor children even enter secondary education.

212

in addressing this important equity issue, governments should consider the

sequencing and phasing of any expenditure increases. Broadly speaking,

countries that are still some distance from universal primary completion should

focus public spending at the pre-primary, primary and lower secondary levels.

as progress towards universal access is achieved, spending can gradually shift

to upper secondary education.

The role of aid

The 2030 edUCaTion GoalS

Will reMain oUT of reaCh if

The Children WhoSe liVeS are

diSrUPTed BY ConfliCT are

iGnored.

aid continues to play a critical role in mobilizing the resources needed to

strengthen education systems for the world’s poorest and most disadvantaged

children, including children threatened by conflict and displacement.

When a political crisis led to a potentially shattering shortfall in Madagascar’s

budget for primary schools, for instance, an already fragile education system

faced teacher strikes, a lack of resources and dropping school attendance. in

2013, a UniCef programme provided teacher salaries and supplies that allowed

primary school students to continue their studies.

213

But the question of aid is much bigger than any single emergency. Providing

universal pre-primary, primary and lower secondary education in low-income and

lower-middle-income countries by 2030 will cost an estimated US$340 billion a

year.

214

Much of the cost could be covered through a combination of economic

growth and increased revenue collection. even if governments meet minimum

benchmarks in these areas, though, there will still be an annual education

financing gap of US$39 billion in low-income and lower-middle-income countries.

in the case of low-income countries, the gap is equivalent to 42 per cent of

the financing needed to meet the 2030 education goals.

215

Whichever way the

equation is viewed, without an increase in aid, the gap will leave many countries

far short of the goals, with fragile states experiencing some of the largest

potential shortfalls.

216

recent developments in aid for education are not encouraging. Between

2010 and 2013, development assistance for basic education fell 11 per cent.

217

Several major bilateral donors have cut aid to education, and the international

aid architecture is ill suited to address the plight of children affected by armed

conflict and humanitarian emergencies.

218

But the 2030 education goals will

remain out of reach if the children whose lives are disrupted by conflict are

ignored.

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To address this concern, a group of organizations and leaders – including

UniCef and the United nations Secretary-General’s Special envoy for

Global education, Gordon Brown, launched education Cannot Wait – a fund

for education in emergencies. Geared towards rapid disbursement in the

immediate aftermath of a crisis

and

sustained support over the longer term,

such a fund could help bridge the gap in education financing.

Two factors stand out as critical to its success. first, there is a global shortfall

of around US$8.5 billion a year – an average of US$113 per child – in the funding

needed to educate the estimated 75 million children affected by crises.

219

To make up that deficit, the fund for education in emergencies would need

to involve regional governments in conflict-affected areas, the private sector

and philanthropists. Second, governance arrangements would be needed for

effective coordination across United nations agencies, multilateral partnerships

such as the Global Partnership for education, and aid organizations. Coordination

could give rise to partnerships that successfully bridge the divide between

humanitarian responses and development expertise.

BOx 2.3 BRAzIL AND vIET NAM: MAkING THE GRADE

Brazil and Viet Nam offer valuable lessons on reforming

education systems.

In 2012, students in Viet Nam achieved mathematics and

reading scores in the Programme for International Student

Assessment (PISA) that were far higher than expected given

the country’s income level. Fifteen-year-olds performed

on a par with their peers in Germany and outperformed

students in the United Kingdom and the United States. This

achievement resulted from the country’s commitment to

measuring success and providing resources to achieve its

education goals. By 2012, Viet Nam was allocating

21.4 per cent of its national budget to education. Teachers

were capable and absenteeism was very low.

In Brazil, meanwhile, success was recorded in enrolment,

increased equity and learning outcomes. Between 2003

and 2012, enrolment rates for 15-year-olds increased

from 65 per cent to 78 per cent. Many of the children

entering the school system were from socio-economically

disadvantaged groups. Also between 2003 and 2012,

Brazilian students’ average PISA scores rose by 25 points;

for disadvantaged pupils, the increase was 27 points.

Brazil’s successes were driven by multiple reforms

that began in the mid-1990s and included the

establishment of an independent evaluation body,

which became the Evaluation System for Basic

Education. The system now serves as a transparent

reporting mechanism and a common method for

measuring learning achievements. High-performing

schools are allowed greater autonomy, while

underperforming schools receive support for

improving standards.

Brazil also increased funding for education, which

reached 6.3 per cent of GDP by 2012. The central

government’s financing facility targeted funds to

schools in low-performing municipal education

systems, and it now funds pre-primary education

as well. Teacher training improved and equity was

strengthened with Bolsa Escola, a programme that

provided cash transfers to poor households.

The examples of Viet Nam and Brazil show that

accelerating educational progress for the children left

furthest behind can produce positive results.

Source:

Bodewig, Christian, ‘What explains Vietnam’s stunning performance in PiSa 2012?’, east asia & Pacific on the rise, World Bank blogs, 11 december 2013,

<http://blogs.worldbank.org/eastasiapacific/blogs/christian-bodewig>, accessed 22 January 2015. The World Bank, ‘Government expenditure on education as % of GdP’,

<http://data.worldbank.org/indicator/Se.XPd.ToTl.Gd.ZS>, accessed 12 february 2016. hanushek, eric a., and ludger Woessmann,

Universal Basic Skills: What countries

stand to gain,

oeCd Publishing, 2015, pp. 31–33. Bruns, Barbara, david evans and Javier luque,

Achieving World-Class Education in Brazil: The next agenda,

The World Bank,

Washington, d.C., 2012, pp. 7 40, 11, 8. UneSCo institute for Statistics, database, <http://data.uis.unesco.org/index.aspx?queryid=189>, accessed 10 february 2016.

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>> Equitable progress is possible

five years of conflict in the Syrian arab republic have illustrated the critical need

to make education an integral part of the response to humanitarian crises. in this

case, no lost Generation, an initiative launched by UniCef and partners, offers

protection and learning opportunities for children and adolescents in the Syrian arab

republic and the countries where millions of Syrian refugees have settled, including

egypt, iraq, Jordan, lebanon and Turkey.

Equitable progress is possible

education has the power to end intergenerational cycles of inequity and improve

the lives of children and the societies in which they live. however, achieving

effective learning for all children regardless of their circumstances – from early

childhood education through primary and secondary school – is a daunting

challenge. a drive for greater equity is a condition for meeting the challenge by

2030, but will it run the risk of undermining the overall quality of school systems?

do the demands of equity and quality pull in different directions?

international experience provides an unequivocal answer: The highest-

performing education systems in the world – such as those in finland, the

republic of Korea and Japan – have been successful in combining equity with

quality.

220

These systems strive to deliver quality education for all children,

recognizing that the needs of the most disadvantaged pupils are as important as

the accomplishments of the most advantaged. recent evidence from the PiSa

learning assessments in the oeCd countries is instructive. of the 13 countries

that were able to substantially increase their scores, nine did so from a starting

point of strong equity and the other four increased equity.

221

Fajer, 5, sits in a classroom at

Teabat al Reah School in the

Zumar sub-district of Ninewa,

Iraq.

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Universal primary and secondary schooling and improved learning outcomes

are ambitious but achievable goals. Many countries have developed and

tested innovative approaches to meeting these goals, and there have been

some successes. Chile has been one of the world’s fastest climbers in

international and regional learning assessments, and the gaps in basic

education test scores between the country’s poorest and richest children

have been narrowing.

222

as noted previously, Brazil and Viet nam have

succeeded in expanding access to education, improving learning outcomes

and strengthening equity.

from these examples, some of the ingredients of successful reform emerge.

establishing equity as a central goal for access

and

learning can guide countries

in reforming their education systems to make sure that the most disadvantaged

children are not forgotten. Countries need to identify disadvantaged schools,

pupils and regions, and direct more financial support to them. More spending

on education also will be essential. While much of the impetus for change has

to come from national governments, the international community has a vital role

to play in supporting and financing education.

Success in providing quality education for every child depends on making

learning an explicit objective in education policy and on investing in the

development of strong national learning assessment institutions. it requires a

strong commitment to the professionalization of teaching and improved teacher

training and support systems. To help children from poor and marginalized

groups overcome the disadvantages they start out with, early childhood care

and universal pre-primary education should be priorities.

in addition, providing disadvantaged children with access to quality education

requires integrated strategies to combat poverty and efforts to remove the

financial barriers to education.

The benefits of investing in quality education for the most disadvantaged

children are tremendous – for this generation of children, for the next generation

and for the communities and societies in which they live. education nourishes

young minds, expands horizons and can break the cycle of disadvantage that

traps generations in poverty. By investing in education systems and putting the

needs of the most disadvantaged children first, nations can unlock education’s

potential to transform children’s lives and the world.

Indigenous Awa children stand in

line to enter the El Diviso school in

Colombia.

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PERSPECTIVE:

Give children a chance

By Gordon Brown, United nations Special envoy for Global education

The voices of young people are at fever pitch.

Technologically gifted, hungry for knowledge and with

boundless energy, today’s children and youth adapt

quickly. They are connected. This is the generation that

‘gets it’.

So global leaders should listen. But all too often, they

don’t. Somehow, our planet’s future guardians – millions

of them – continue to be underestimated, ignored and

abused. now, all that children are likely to see is a greedy

world that denies them their right to equal opportunities

and the chance to flourish.

despite international laws designed to protect child

rights, emergencies and protracted crises affected the

education of an estimated 75 million children and young

people 3 to 18 years of age. Many are living without

proper access to food, shelter, health care and education.

Many of them are victims of human trafficking and sexual

exploitation.

around 150 million children under the age of 14 are

engaged in child labour, often in hazardous conditions.

Child trafficking is on the rise and 5.5 million children are

engaged in forced labour, with thousands more subject

to abuse, forced into marriage and coerced into militias

despite the prohibition of such practices under the rome

Statute of the international Criminal Court (iCC).

for decades, civil rights and liberation movements

have fought the worst of oppression – from Western

colonialism to South african apartheid, discrimination

against african americans and centuries-old prejudice

against gay and lesbian adults. By comparison, children’s

rights have been neglected. They continue to be

undermined even as world leaders commit to more

ambitious targets for health, education and security

under the newly adopted Sustainable development

Goals (SdGs).

While the number of out-of-school boys and girls of

primary school age rose from about 56.6 million in 2010

to 59 million in 2013, for example, aid to basic education

has been cut – yet again. it is down nearly 10 per cent

since 2010.

The world’s biggest challenge in the decade to

come is bridging the gap between, on one hand, the

opportunities young people have been promised, see

others enjoying and expect, and on the other, the denial

of those opportunities as doors are closed to them and

the ladders of opportunity are kicked away.

The good news is that children across the world are

participating in rights campaigns. in Bangladesh,

young girls are forming child marriage-free zones. Child

labourers have joined the Global March against Child

labour. and a girls’ rights movement pressing for access

to education has been inspired by Malala Yousafzai, the

more than 200 still-missing Chibok girls of nigeria and

1,000 global youth ambassadors from a World at School,

a campaign working to get all children into school.

it is time for progressive minds everywhere to support

these freedom struggles. here is a set of short-term,

practical proposals that can not only advance the SdGs

but also support a global civil rights movement for

children and young people.

Invest in children

Making sure children have the opportunities they need

to flourish and realize their rights will take resources. We

must focus on getting every child into school and also

ensure that quality of learning is consistently high.

education Cannot Wait – a fund for education in

emergencies can address the needs of the estimated

75 million children affected by crises and protracted

emergencies. The fund, launched in May 2016, would

help offset an annual funding shortfall of US$8.5 billion

needed to maintain access to education for these

children.

in addition to greater international aid, countries

should adopt child-focused budgeting of their available

resources. Under article 4 of the Convention on the

rights of the Child, States parties are obligated to invest

in children to the maximum extent of their available

resources. as a result, increasing numbers of countries

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Give children a chance

are designing budgets with children specifically in

mind. The Committee on the rights of the Child, with

the support of child advocacy organizations, is already

drafting a General Comment on public spending

to realize children’s rights that will clarify the policy

implications of article 4.

an annual meeting of the United nations Security

Council as a Children’s rights Council would have a huge

impact. over the course of the year, a children’s sub-

council of the Security Council could examine the key

issues that need to be raised.

To make this happen, the United nations General

assembly should host a session for children and young

people, preferably before its next session. ideally,

agreement on a United nations Children’s Council that

reports to the Security Council could be reached in time

for the 70th anniversary of the Universal declaration

of human rights in 2018. and by the 30th anniversary

of the Convention on the rights of the Child in 2019,

we could see the establishment of a new international

Children’s Court.

The long-term goal is much simpler: Give children a

chance. Give children a voice. The future is theirs.

Uphold child rights

But more resources, by themselves, will not suffice.

What is to guarantee that children’s rights will be upheld

or even taken seriously?

no United nations convention has been ratified in

as many countries as the Convention on the rights

of the Child. But in too many areas, these rights are

not being implemented. Similarly, the 1998 rome

Statute recognizes the need for special measures

to protect children as victims and witnesses during

judicial proceedings, and requires that judicial staff have

expertise on children’s issues. Yet criminal acts affecting

children and within the province of the iCC – rape, sexual

violence, trafficking and the use of children as soldiers

– are not being properly investigated. impunity remains

widespread.

The Third optional Protocol to the Convention on a

Communications Procedure, which entered into force

in april 2014, allows children to bring complaints about

rights violations directly to the Committee on the rights

of the Child – but only if no solution is found

at the national level. as of february 2016, only

26 countries had ratified the Protocol, and those most

likely to violate it are the least likely to sign on.

an international Children’s Court, along with a Children’s

Commissioner appointed to each country, is therefore

vital to address these outstanding issues.

Listen to young voices

There is at least one other prerequisite for mustering

the necessary resources to secure opportunities for

children and establishing legal mechanisms to protect

their rights. namely, children and young people need

a political mechanism through which they can debate

these important issues. Young people’s parliaments

and other platforms for meaningful participation are a

must.

Education activist Malala yousafzai speaks with

students at a school in the Za’atari camp for Syrian

refugees in Mafraq Governorate, Jordan.

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CHILDREN

AND POvERTY:

BREAkING THE

vICIOUS CYCLE

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ChaPTer 3

Children

and poverty:

Breaking the vicious cycle

No one is more vulnerable to poverty than children.

Poverty perpetuates the cycle of disadvantage and

inequity, which robs millions of children of their potential

and causes irreparable damage that reverberates

throughout a lifetime. Putting children at the heart of

poverty reduction is one of the best ways to break that

cycle and create a level playing field for every child.

Muhammad Modu, 15,

internally displaced from

Malori, digs through a rubbish

dump for saleable items in

Maiduguri, Nigeria.

Photo

The amount of money available in a household plays a crucial role in determining

the opportunities a child may encounter in life. But for children, poverty is about

more than money. it affects very real aspects of their lives – including whether

they can attend school, be well nourished or have access to health care, safe

drinking water and sanitation. Children from the poorest households are the most

likely to die from preventable causes and the least likely to have access to quality

education and health care.

efforts to reduce child poverty must therefore go beyond moving households

above a monetary threshold. a multidimensional approach is critical to respond to

this multifaceted challenge.

This chapter begins by looking at how children experience poverty. it then asks

how many of the world’s children live in poverty, defined in terms of ‘extreme’,

‘moderate’ and ‘relative’ monetary poverty. it also explores the multiple and

overlapping dimensions of poverty that further deprive children of their rights.

The chapter argues that the key to a more equitable world is reducing child

poverty in all its dimensions and narrowing the gaps between those who are

most and least advantaged. it notes that consistent measurement – and knowing

who the most disadvantaged children are, where they live and how they are

deprived – is essential to developing successful policies and programmes to end

child poverty. finally, the chapter examines the role of cash transfer programmes

in reducing poverty and inequality and improving equitable access to nutrition,

health, education and other services.

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Children and poverty: Breaking the vicious cycle

>> The effects of poverty in childhood

The effects of poverty in childhood

There is no universal interpretation of poverty in general, or of child poverty

more specifically. While it may seem like a simple concept, poverty is not always

easy to quantify. Some may understand poverty as the lack of adequate income

to meet basic human needs. Others define it as the inability to keep up with

the average standard of living in a given society. Still others take a wider view,

interpreting poverty as a lack of access to basic services such as education,

primary health care or safe drinking water.

Viewed from the perspective of a child, the exact definition becomes immaterial.

Being deprived, by any measure, is damaging to a child’s development, particularly

when deprivations are experienced in early childhood. A child rarely has a second

chance at a good start in life. Deprivations of health, nutrition or stimulation in the

earliest months and years of life when the brain is developing at a rapid pace, can

lead to damage that is difficult or even impossible to overcome later.

Undernutrition in early childhood, for instance, can result in stunting. Left

unaddressed at that point, it can affect cognitive development, leading to learning

difficulties and poor health in adolescence and adulthood. Poor health, beyond the

physical and emotional consequences, also denies children the chance to play and

learn. Missing out on education in early childhood or living in an environment that

provides little stimulation or emotional support can severely restrict a person’s

productivity as an adult.

In these and many other ways, poverty, in the form of deprivations that begin in

childhood, can be felt throughout a lifetime. Children who grow up deprived not

only have limited opportunities to fulfil their potential; they often have no option

but to raise their own children in poverty. To break this vicious cycle, poverty

reduction must begin with a focus on children.

9 10

out of

of the world’s children living

extreme poverty

will live in

sub-Saharan Africa

in 2030

At current trends

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A woman washes her hands

in dirty water while camping

outside to register for a food

ration card in Thanyang,

South Sudan.

Measuring how many children

live in poverty

The first step in reducing child poverty is measuring it. Methods to calculate

monetary poverty provide a useful yardstick against which to measure social

progress. While limited, these measures are the most widespread indicators

used to capture the extent of poverty at the household level and can gauge the

financial bottlenecks faced by disadvantaged children and their families

(see Box

3.1).

Monetary poverty lines are set at both national and international levels. They

usually work by placing a value on a basket of goods and services considered

the minimum requirement to live a non-impoverished life at current prices.

households lacking sufficient resources to afford that basket are considered

poor.

Monetary poverty measures do not, however, take into account other crucial

dimensions – such as lack of education, health, water or sanitation – that are

extremely important for understanding how children experience poverty.

relying on household-level measures may also mask the fact that individuals

within the household, especially children, may not have adequate resources

allocated to them and may be deprived in other dimensions. for these reasons,

child poverty is best seen as a combination of monetary and non-monetary

factors at both the household and individual levels.

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Children and poverty: Breaking the vicious cycle

>> Children living in extreme poverty

Children living in extreme poverty

The measure most commonly used to calculate monetary poverty is the international

poverty line developed by the World Bank and set at US$1.90 per day since october

2015. By this measure, in 2012, almost 900 million people struggling to survive below

that line, were living in extreme poverty.

223

Because poorer families tend to be larger,

children are disproportionately represented among the extreme poor. While children

aged 17 and under account for about one third (34 per cent) of the total population

in low- and middle-income countries, they make up nearly half (46 per cent) of the

population living on less than US$1.90 per day

(see Figure 3.1).

nevertheless, the last three decades have seen unprecedented progress in

reducing extreme poverty. The overall proportion of people living in extreme poverty

has fallen, and that trend is projected to continue. in 2012, the number of people

living in extreme poverty worldwide was almost half of what it had been at the end

of the 1990s.

224

But particular attention to the pace of progress is warranted in some regions. in

the Middle east and north africa, for example, after years of progress, the rates of

monetary poverty appear to be stagnant or, by some estimates, even on the rise.

225

BOx 3.1 MONETARY CHILD POvERTY MEASURES

The most common indicators to measure monetary child

poverty are:

National poverty lines

Governments use national poverty lines to monitor

monetary poverty within their own countries. According

to these measures, a person is considered poor if he or

she lives in a household with a consumption or income

level below a nationally established threshold. National

poverty lines are estimated in local currencies and reflect

national standards.

While absolute poverty lines reflect the minimum

level of income or consumption needed to fulfil basic

requirements, some governments opt to use ‘relative

poverty’ lines. These thresholds still allow for participation

in the normal consumption and living standards of the

country but measure poverty in relation to the national

average income levels. (The European Union and

organisation of Economic Co-operation and Development

also use relative poverty lines to compare levels of

poverty among their members and with other countries.)

The great advantage of national poverty lines is that

they are specific to the country, reflecting its specific

characteristics and level of development. However, the

methodology used varies greatly across countries and,

therefore, doesn’t allow for comparisons between them.

The international extreme poverty line

The World Bank’s ‘extreme poverty’ line identifies people

living in households that have less than US$1.90 per

person per day. It is calculated by converting the national

poverty lines from a selection of the poorest countries

in the world to a common currency – using purchasing

power parity (PPP) exchange rates to adjust for the

difference in cost of living across countries – and then

taking an average of those lines.

This measure reflects a very low absolute poverty

standard based on basic needs for survival. It was used

to set targets for poverty reduction under the Millennium

Development Goals and is now part of the Sustainable

Development Goals, which aim to eradicate extreme

poverty by 2030.

The World Bank also calculates higher international

poverty thresholds, such as US$3.10 per person per day,

using the same per capita approach. These measures

represent levels of poverty above extreme poverty.

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in the Syrian arab republic, data suggest the conflict that began there in 2011

caused a sharp increase in the rate of extreme poverty, measured by the

proportion of the population living below a national poverty line. The rate increased

from 12.3 per cent in 2007 to an estimated 43 per cent in 2013.

226

Poverty is also

a concern for the millions of refugees who have fled the crisis. in 2014, the United

nations high Commissioner for refugees estimated that 7 out of 10 registered

Syrian refugees in Jordan and lebanon could be considered poor.

227

half of these

refugees are children.

another region of particular concern is sub-Saharan africa, which accounts for a

large and rising share of the world’s extreme poor. Based on current trends, 9 out

of 10 of the world’s children surviving on less than US$1.90 a day will live in

sub-Saharan africa in 2030

(see Figure 3.2).

FIGURE 3.1

A disproportionate share of children live in extreme poverty

Percentage of children under 18 among the total population and the extreme poor, in low- and middle-income

countries, 2012

estimates are presented as the share of

children among the total extreme poor.

The analysis considers how the age profile

of the extreme poor evolves depending

on changes in the age composition of the

population, and fertility rates by wealth

quintile.

The analysis does not include the Middle

east and north africa or europe and Central

asia due to lack of data and low poverty

rates.

Percentages for all low- and middle-income

countries are estimated based on World

Bank data for Sub-Saharan africa, South

asia, and the latin america and Caribbean

regions. data for other regions were not

available at the time of calculation.

66%

54%

34%

Total population

Total extreme poor

(US$1.90 a day)

46%

Children under 18

adults (18 and over)

Note:

Poverty rates are derived from the World Bank’s Povcalnet and

Global Monitoring Report 2015/2016.

age-disaggregated population profiles are from the United

nations department of economic and Social affairs 2012 estimates. fertility rates by wealth quintile are derived from demographic and health Surveys (after 2005).

Child poverty estimates were calculated based on regional poverty aggregates and demographic factors, and not household income or consumption survey analysis.

estimates for children using the updated international poverty line of US$1.90 a day are not yet available. however, the latest profile of the world’s extreme poor (based

on the previous level of US$1.25 a day) revealed that 47 per cent of those living in extreme poverty were 18 years old or younger. Since the data used to calculate the

first estimates relied on ranking profiles based on old surveys, the profile should provide a valid reference.

Source:

overseas development institute calculations for UniCef (2016), based on data from the World Bank (2016), and the United nations department of economic

and Social affairs (2013) and dhS (after 2005).

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Children and poverty: Breaking the vicious cycle

>> Children living in extreme poverty

FIGURE 3.2

In 2030, 9 out of 10 children in extreme poverty will live in sub-Saharan Africa

estimated percentage of children living in extreme poverty (US$1.90 a day), by World Bank region, in 2002, 2012

and projections for 2030

100%

5.1%

3.9%

10.9%

6.5%

4.5%

0.7%

80%

27.3%

32.4%

60%

37.5%

40%

52.9%

30.2%

2002

2012

2030

88.3%

Region:

latin america and the Caribbean

east asia and the Pacific

South asia

Sub-Saharan africa

20%

Note:

Poverty projections are linear interpolations based on projections published in the World Bank’s

Global Monitoring Report 2015/2016

and assume average

growth over the past 10 years. The analysis does not include Middle east and north africa, europe and Central asia due to lack of data and low poverty rates. The

analysis considers how the age profile of the extreme poor evolves depending on changes in the age composition of the population and fertility rates by wealth

quintile.

Source:

overseas development institute calculations for UniCef (2016), based on data from the World Bank (2016) and United nations department of economic

and Social affairs (2013) and dhS (after 2005).

BOx 3.2 MEASURING MULTIDIMENSIONAL CHILD POvERTY

Ideally, all countries should report on the number of

children living in poverty using both monetary and

multidimensional measures.

Monetary measures, such as the national and international

poverty lines mentioned previously, are already widely

used to report progress in reducing poverty. They can form

the basis for estimating the number of children living in

monetary poverty – that is, the child poverty rate – at the

national, regional and global levels.

Multidimensional child poverty measures add depth and

complexity to the data. They can be adapted and applied to

each country’s economic and social context, informing the

development of national approaches to poverty reduction.

The Multidimensional Poverty Index (MPI) is one example

of a tool designed to enhance poverty data. The index

covers three dimensions of disadvantage – health,

education and material deprivation – measured by 10

indicators. MPI data reports, which can be disaggregated

for children, count individuals as poor when they are

disadvantaged in relation to at least one third of the

indicators.

The Multiple overlapping Deprivation Analysis is another

tool, developed by UNICEF to sharpen the equity focus of

child poverty and deprivation analyses around the world.

It selects the child as the unit of analysis, rather than the

household, since children experience poverty differently

than adults.

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This concentration is especially alarming given that sub-Saharan africa is the

world’s youngest region, with children under age 18 accounting for around half the

population.

228

over the next 15 years, the region will account for almost the entire

increase in the world’s population of children. if current trends persist, 156 million

children in sub-Saharan africa will be struggling to survive on less than US$1.90 a day

in 2030; as a group, they will comprise nearly half of the world’s extreme poor.

229

Poverty is not just more pervasive but also more intense in sub-Saharan africa than

in other regions. on average, poor people there are starting the journey towards

the US$1.90 extreme poverty threshold from a lower base than their counterparts

in other parts of the world. Some 89 million people in the region, or around 10 per

cent of the population, lived on less than 80 cents a day in 2012. in sub-Saharan

africa, people who are below the extreme poverty threshold live on an average of

US$1.20 a day, compared to US$1.50 for the extreme poor in South asia.

230

Children living in ‘moderate’ poverty

it is worth noting that the extreme poverty line of US$1.90 a day is not a

hard-and-fast border dividing the poor from the non-poor. Millions of children living

above this line still live in poverty, are vulnerable to it or experience deprivations in

other dimensions of their lives.

data using broader poverty lines give a sense of the global and universal nature

of poverty

(see Figure 3.3).

in 2012, more than 2 billion people in low- and

middle-income countries lived on less than US$3.10 a day, which is considered

‘moderate’ poverty. This total includes almost 900 million people in South asia,

some 500 million in east asia and the Pacific, and about 72 million in latin america

and the Caribbean. about 50 million people in the Middle east and north africa lived

on less than US$3.10 a day in 2008, the latest year for which reliable surveys are

available.

231

Worldwide, more than 3 billion people remained vulnerable to poverty in

2012, subsisting on less than US$5 a day.

232

in many cases, these people – who represent more than half the population in

low- and middle-income countries – are already subject to some dimensions of

deprivation and remain well within the gravitational pull of extreme poverty. a

drought, an illness, the outbreak of conflict or an economic downturn is all it

might take to put them back under the US$1.90 a day level.

The experience of latin america illustrates the need to look beyond poverty

thresholds. Between the mid-1990s and 2011, extreme poverty in the region fell by

half, thanks to rising incomes as well as pensions and other social transfers.

233

2012, there were more people in latin america’s middle class than in the ranks of

the extreme poor. however, 38 per cent of the population lived on a daily income

of between US$4 and US$10 a day in 2013, at risk of slipping back into extreme

poverty.

234

WorldWide, More Than

3 Billion PeoPle reMained

VUlneraBle To PoVerTY

in 2012, SUBSiSTinG on leSS

Than US$5 a daY.

Poor children living

in rich countries

relative poverty, which is of particular relevance in richer countries, can also

affect the lives of children. having fewer opportunities to be educated, healthy or

nourished compared to their peers puts children at a disadvantage and limits their

life chances.

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Children and poverty: Breaking the vicious cycle

>> Poor children living in rich countries

FIGURE 3.3

More than half of the population in low- and middle-income countries live

on less than US$5 a day

Percentage of population living below various international poverty lines, by World Bank region, 2012

100%

84%

82%

80%

67%

60%

44%

55%

43%

35%

25%

19%

13%

12%

15%

40%

22%

20%

east asia and

the Pacific

europe and

Central asia

latin america and

the Caribbean

South asia

Sub-Saharan

africa

Total

People vulnerable to poverty (less than $5.00 a day)

People living in moderate poverty (less than $3.10 a day)

People living in extreme poverty (less than $1.90 a day)

Note:

Total refers to low- and middle-income countries available in Povcalnet. data were not available for the Middle east and north africa at the time of calculation.

all estimates are based on purchasing power parity figures (current international $) extrapolated from the 2011 international Comparison Program (iCP) benchmark

estimates. US$5.00/day is not an official international poverty line used by the World Bank.

Source:

The World Bank (2016).

eight years after the onset of the 2008 financial crisis, the slow pace of economic

recovery, high levels of unemployment, financial pressure and rising inequality

are jeopardizing the hopes of a generation of children in high-income countries

belonging to the organisation for economic Co-operation and development

(oeCd).

235

at the same time, children and poor families are feeling the effects

of deficit reduction programmes initiated by governments in response to the

crisis.

236

in the 41 most affluent countries, nearly 77 million children lived in monetary poverty

in 2014.

237

Taking pre-crisis levels as an anchor point, child poverty rates increased

in 23 oeCd countries after 2008. in five countries, child poverty rates increased by

more than 50 per cent.

238

in most countries in the european Union, the proportion of

children in poverty is higher than the rate for adults

(see Figure 3.4).

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FIGURE 3.4

In most European Union countries, children are at a higher risk

of monetary poverty than adults

Percentage of population at risk of poverty in the european Union, by age group, 2014

average

adult

poverty

rate

16.3%

average

child

poverty

rate

21.1%

Czech republic

netherlands

denmark

Slovakia

finland

france

austria

Cyprus

Slovenia

hungary

Sweden

ireland

Belgium

Malta

luxembourg

Germany

United Kingdom

Poland

lithuania

Croatia

italy

Portugal

latvia

Bulgaria

estonia

Greece

Spain

romania

10%

15%

20%

25%

30%

35%

40%

Population at risk of poverty

Total poverty rate

adult poverty rate

Child poverty rate

Note:

'at risk of poverty' is defined as living below the poverty threshold, which is 60 per cent of median equivalized income after social transfers.

Source:

eurostat (2016) based on european Union Statistics on income and living Conditions.

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Children and poverty: Breaking the vicious cycle

>> Child poverty in all its dimensions

Child poverty in all its dimensions

Simply living in a household that is above the threshold of monetary poverty does

not necessarily mean a child is out of poverty. Consider a family that meets the

threshold defined by the national poverty line but still lacks access to shelter,

food, water, sanitation, education, health care or information. according to a

monetary interpretation of poverty, this family would not be considered poor. a

wider interpretation, however, would consider a child living in that household as

poor because of the deprivations faced by his or her family.

Several measures have been developed to better understand and monitor poverty

in its multiple dimensions

(see Box 3.2).

By looking at the different deprivations

that children experience in crucial aspects of their lives, countries can better

target policies and programmes that benefit the most disadvantaged.

Measures such as the Multidimensional Poverty index aim to accurately estimate

the extent of the problem. its most recent findings indicate that 1.6 billion people

lived in multidimensional poverty in 2015.

239

another study of multidimensional poverty focused on children in sub-Saharan

africa and returned alarming results. in the 30 countries for which comparable

data were available, 247 million out of a total of 368 million children under

age 18 experience two to five deprivations that threaten their survival and

development.

240

a study in 2008–2009 found that 81 million children and

adolescents in countries in latin america and the Caribbean were affected by at

least one moderate or severe deprivation of their rights to education, nutrition,

housing, sanitation, drinking water or access to information.

241

A boy feeds a younger child

in the Nyarugusu refugee camp,

in Kigoma Region, United

Republic of Tanzania.

Disadvantages overlap

and reinforce one another

When children experience poverty, poor health, malnutrition, stress, violence,

abuse, neglect, inadequate care or a lack of learning opportunities, particularly

during the first years of their lives, their ability to fulfil their potential is at risk.

a girl who must walk long distances to fetch water has less time to attend school.

a child who is undernourished is more susceptible to diseases spread through

poor sanitation. a baby who lacks nurturing, stimulation and interaction when the

neural connections in the brain are forming might never have the chance to develop

fully. each deprivation exacerbates the effect of the others, and when two or more

coincide, the effects on children can be catastrophic.

deprivations are particularly magnified for children living in fragile and conflict-

affected states. These children are more than twice as likely to be undernourished

as children in other low- and middle-income countries. They are also more than

three times as likely to be out of school, twice as likely to die before their fifth

birthday and more than twice as likely to lack access to improved sources of

drinking water, according to the

World Development Report 2011.

242

in addition to conflict, the impacts of climate change and environmental degradation

create new risks and reinforce old social and economic vulnerabilities created by

poverty and inequality. Some of the world’s poorest children live in areas that

are especially vulnerable to natural disasters such as flooding, drought or

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Moses, 1, Sarah, 2, and Paul, 7,

stand with their mother Lucy

and cousin Joslyn, 7, outside

their home, destroyed by Super

Cyclone Pam, Tanna Island,

Vanuatu.

severe storms. More than 300 million children live in zones of very high flood

occurrence that are also in countries where over half of the population gets by

on less than US$3.10 a day.

243

Children who are already deprived in many dimensions of their lives are likely to

face some of the most immediate dangers of climate change as their families

are most exposed to the potential harm and find it hardest to bounce back from

climate-related shocks. as noted previously, many families living above the

threshold of extreme poverty may be just one disaster away from falling into

it. as climate hazards arise more frequently, the cumulative effect of repeated

shocks will make it difficult for many of the most disadvantaged households to

survive, recover, cope and adapt.

Urbanization is another force putting pressure on poverty reduction efforts

and highlighting inequities. national poverty lines may not take into account

all of the high costs of urban living – especially housing, transportation, water,

sanitation, education and health services. and children in urban areas may lack

access to essential services even when they live close to them. as a result, the

risks for urban populations can exceed those in rural areas.

for example, a 2006 study in sub-Saharan africa showed greater disparities

in child nutrition between rich and poor urban communities than between

urban and rural areas.

244

a 2012 study in egypt found that rates of poverty and

deprivation among some children in urban slums reached or exceeded those in

the country’s most deprived rural areas.

245

and for the many children in China

who have migrated to cities with their families, holding a

hukou

household

registration from a rural area often means they are not entitled to urban health,

education and other critical services.

246

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>> Universal measurement of child poverty

The challenges facing children in poor urban communities are particularly

relevant in light of the projection that 66 per cent of the world’s population

will be urban in 2050, with the fastest urbanization on the african and asian

continents.

247

excluded from other opportunities, many of the urban poor have

little choice but to take informal jobs that are outside of government regulation,

taxation and observation. The most marginalized people – including women and

people with disabilities – are often trapped in the informal economy because of

discrimination, which limits their opportunities.

248

There is a strong link between informal work and poverty.

249

informal workers

lack basic social protection, face unsafe working conditions and are subject to

layoffs without compensation. They are locked in low-productivity activities with

few opportunities for mobility and no protection in the event of non-payment of

wages.

race, ethnicity and social exclusion also often play a role in determining a child’s

life chances, even in some of the world’s richest countries. in the United States

in 2013, 39 per cent of african american children, 36 per cent of american indian

children and 32 per cent of hispanic children lived in poor families, defined as

having income below the established federal poverty level. That compares to

13 per cent of the country’s white children and 13 per cent of its asian children.

250

in europe, roma people are the largest ethnic minority and are among the most

deprived.

251

a 2011 study in 11 european Union countries found that around 41

per cent of roma children lived in households where someone had to go to bed

hungry at least once in the month prior to the survey because they could not

afford to buy food.

252

Based on national thresholds, families with four or more

children – practically all of the roma households surveyed – were at risk of

poverty.

253

The proportion of roma children living in households that fell below the

national ‘at-risk-of-poverty’ line was twice as high as that of non-roma children

living nearby.

254

Migrant households in europe are also especially vulnerable to poverty. in Spain,

one in two children in migrant households lived in poverty in 2012.

255

in Greece,

child poverty rates for migrant households increased by 35 per cent between

2008 and 2012, compared to 15 per cent for the general population.

256

While the challenges are great, many of the solutions are at hand. an integrated

approach that focuses on interventions in health, nutrition, water and sanitation,

protection, and learning during the first years of children’s lives can set a firm

foundation for their entire lifetime.

The naTionS SiGninG on To

The 2030 GoalS haVe Made a

CoMMiTMenT To addreSS Child

PoVerTY in all iTS diMenSionS.

Universal measurement

of child poverty

The nations signing on to the 2030 goals have made a commitment to

address child poverty in all its dimensions. Given this commitment, they need

consistently updated data on who is poor and how they are poor in order to

monitor progress, identify gaps and guide policies and programmes – all in the

interest of making sure that vulnerable children are not left behind.

efforts to measure child poverty are not new. indeed, many countries have

already taken steps to generate data on how many children are living in poverty,

based on the international extreme-poverty threshold of US$1.90 a day, as well

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Children attending the Traiko

Simeonov primary school, where

90 per cent of students are Roma,

in Shumen, northern Bulgaria.

as on national poverty lines. There are also well-established methodologies,

mentioned previously, to capture the extent of multidimensional child poverty, and

these measurements can complement the monetary measurements.

Still, the number of countries that report child poverty figures is limited. a recent

internal analysis by UniCef found that more than one third of countries are not

measuring child poverty, and around half of those that are measuring it are not

doing so routinely.

257

ideally, all countries should report on the number of children living in poverty using

both monetary and multidimensional measures. Multidimensional child poverty

measures give a fuller picture of how children experience poverty. These data can

be adapted and applied to each country’s economic and social context, informing

the development of national approaches to poverty reduction.

international financial institutions, development agencies, donors and regional

bodies could be cooperating more effectively to raise standards and strengthen

national statistical capacity in these countries. Such a course would bring the

world one step closer to the goal of eradicating extreme poverty in general, and

child poverty in particular.

The role of cash transfers in

reducing poverty and inequality

reducing child poverty in all its dimensions is one of the world’s most important

and urgent tasks, requiring concerted and sustained efforts to put children first

and give them what they need to have a fair chance to survive and thrive.

Because children experience poverty in multifaceted ways, it is critical not

only to provide equitable services – including essential health care and quality

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Children and poverty: Breaking the vicious cycle

>> The role of cash transfers in reducing poverty and inequality

education – but also to make sure the most disadvantaged children have access

to those services. Social protection mechanisms such as pensions, fee waivers,

child support grants and cash transfers are an effective approach that can reduce

vulnerability to poverty and deprivation, strengthen families’ capacity to care for

their children and overcome barriers to accessing essential services.

Cash transfers can work as a ‘safety net’ to keep the poorest, most

vulnerable households out of destitution in all settings, including humanitarian

emergencies. at the same time, they offer families a ladder out of poverty

by boosting incomes, increasing school attendance, improving nutrition,

encouraging the use of health services and providing job opportunities. By

one estimate, social protection initiatives keep some 150 million people out of

poverty,

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and they make a positive impact on children’s lives across a range

of indicators. results from many regions demonstrate direct impacts such as

increased income and consumption, increased access to goods and services,

greater social inclusion and reduced household stress.

Because of their usually modest size, cash transfer programmes alone cannot

directly lift most households above the monetary poverty threshold. But they

can make a real difference in reducing the effects of poverty and bolstering

families and economies. Cash transfers work by putting more money into the

hands of the poor, strengthening local markets and creating a stream of social

benefits that come with poverty reduction. as households spend the transfers

they receive, their impact is multiplied in the local economy and the benefits

transmitted to others in society.

Children in Supaul, a flood-

prone district in the state of

Bihar, India.

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Cash transfer programmes can reduce inequality while contributing to economic

growth, productivity and job creation. in Brazil, for example, Bolsa familia, one

of the largest cash transfer programmes in the world, was paired with Beneficio

de Prestação Continuada – a combination social pension and disability grant.

Together, these programmes contributed to more than one quarter of the

country’s 2.7 per cent fall in inequality as measured by the Gini index between

1995 and 2004.

259

in Ukraine, meanwhile, child allowances contributed to an estimated 1 per cent

decrease in inequality between 2001 and 2007 The allowances were designed

to take into account the specific vulnerabilities affecting households with more

than one child, who faced the greatest risk of poverty.

260

Cash transfer programmes also offer protection against shocks, helping

households to weather downturns without having to sell off productive assets,

take children out of school or cut vital spending on health and nutrition. Some

programmes explicitly target families with children, but cash transfers need not

be child oriented to benefit them.

Some evidence has shown that cash transfers can also increase women’s role in

making household spending decisions, allowing them more financial security and

enabling them to engage in income-generating activities.

261

in conflict-affected countries, fragile states and humanitarian emergencies, cash

grants may be among the most efficient and effective ways of reaching the

poorest households.

262

one recent example is a programme that, each month,

has assisted around 56,000 children from 15,000 vulnerable Syrian refugee

families living in host communities in Jordan. Cash transfers have given the

families the means to cover basic needs and expenses specific to children.

of the 500 families who participated in a survey about the programme, 88 per

cent reported using the cash grant to cover at least one child-specific expense.

The majority said they spent it on fresh foods for children (65 per cent), school-

related expenses (56 per cent) and medicines for children (53 per cent).

263

in Kenya, the hunger Safety net Programme provided cash transfers to poor

households in four arid and semi-arid counties. in spite of a severe drought,

households receiving the grant were 10 per cent less likely than non-recipients to

fall into the poorest tenth of the population.

264

Beyond its effects on poverty, the

transfer programme was found to improve food security and enable households

to spend more on health care. it also had a positive impact on classroom

performance for children already in school.

CaSh TranSferS haVe Been

ShoWn To helP Children

STaY in SChool lonGer and

adVanCe To hiGher leVelS of

edUCaTion.

Cash transfers and access

to essential services

as some of these examples show, cash transfers address multiple deprivations

and help children gain access to services that are critical to their well-being.

for example, cash transfers for the most vulnerable households and children

can be used to trigger eligibility for health coverage – an approach adopted by

Ghana with its livelihood empowerment against Poverty (leaP) programme. a

unique feature of leaP is that, in addition to small, bimonthly cash payments,

it provides beneficiaries with free health care coverage through the national

health insurance Scheme.

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Children and poverty: Breaking the vicious cycle

>> Expanding social protection – and looking ahead

Cash transfers can also address some of the determinants of educational

disadvantage, helping to break the link between poverty and school

drop-out rates.

266

in Morocco, a cash transfer programme led to a significant

improvement in school participation.

267

evidence shows that cash transfers

have increased demand for education

268

and improved school enrolment and

attendance.

269

in addition, cash transfers have been shown to help children stay in school

longer and advance to higher levels of education. in Cambodia, an initiative

providing scholarships to at-risk pupils from low-income households increased

the average time they remained in school by more than half a grade.

270

Colombia, Ghana and Pakistan, cash transfers programmes have helped improve

rates of transition to higher levels of education.

in some cases, cash transfers and other social protection measures have had

an impact on learning as well. for example, cash transfer programmes led to

improved test scores for children in Burkina faso and modest improvements

in Morocco.

271

Meanwhile, school feeding programmes have been linked to

increased learning and cognitive development. in Bangladesh, primary school

students in a school meal programme showed a 15.7 per cent improvement in

learning metrics, mostly in mathematics, compared with children who did not

participate in the programme.

272

Cash transfers have also proven to have some impact on child marriage and

child labour and on the educational disadvantages these practices entail. While

addressing these child rights violations is a complex challenge that demands

action in multiple sectors, cash transfers can play a role in alleviating some

of the financial pressures that force children into work or marriage and out of

school.

273

a cash transfer programme in Panama, for example, led to a nearly 16 per

cent reduction in child labour among indigenous children aged 12 to 15 and

to a nearly 8 per cent increase in elementary school enrolment in indigenous

areas.

274

Pakistan’s female School Stipend Programme reduced girls’ labour-

force participation by as much as 5 per cent.

275

in Bangladesh, a cash transfer

programme was successful in encouraging girls to enrol, particularly in

secondary school, and in delaying marriage.

Expanding social protection –

and looking ahead

every country in the world has at least one social safety net programme in

place, and specific child and family benefit programmes rooted in legislation

exist in 108 countries. Yet these often cover only small groups of the population,

and in 75 countries no such targeted programmes are available at all.

276

expanding social protection is critical to achieving the 2030 goals. in fact, the

goals include a specific target on implementing nationally appropriate social

protection systems and measures to achieve substantial coverage of the poor

and vulnerable by 2030.

a universal approach to expanding social protection would not only increase

coverage but would also reduce the chances of mistakenly excluding eligible

households, create social solidarity and reduce the stigma that is sometimes

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Children stand near their family's

house in the Muhamasheen area

of Mathbah, in Sana'a, yemen.

associated with targeting. however, countries can realize social protection by

taking incremental approaches that work within their resource and capacity

constraints – as well as their social and economic policy frameworks – towards

the ultimate goal of universal coverage.

for rich countries, the immediate challenge is to repair and strengthen the

safety nets and benefits that were eroded in the wake of the global financial

crisis. for many middle-income countries, the architecture of existing cash

transfer programmes provides a basis for further expansion. Governments in

low-income countries face starker choices. With limited budgets and high levels

of child poverty, there are tensions between targeted transfer approaches and

universal approaches. These tensions have to be addressed on a case-by-case

basis.

in the end, however, social protection programmes are just one tool in the

wider effort to address the underlying issue of child poverty. in adopting the

SdGs, world leaders recognized the central importance of that issue. Goal 1

aims to effectively end extreme poverty by 2030 (Target 1.1) and to reduce by

at least half the proportion of men, women and children living in poverty in all

its dimensions under national definitions (Target 1.2). The goals also emphasize

that no country is immune to the impact of poverty, underscoring the fact that

ending child poverty is a universal challenge.

Working towards the 2030 goals, governments will have to recognize and

respond to the distinctive challenges of child poverty in all its dimensions and

make explicit commitments to end it. failing to do so in this generation will

transmit the human, social and economic costs to future generations.

A boy trying to earn money by

weighing people in the street, in

Sana’a, yemen.

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PERSPECTIVE:

What are we waiting for?

Sustainable societies begin with children

By Kailash Satyarthi, nobel Peace Prize laureate and founder, Kailash Satyarthi Children's foundation

in the foothills of the himalayas, many years ago,

i met a small, skinny child labourer. he asked me:

“is the world so poor that it cannot give me a toy

and a book, instead of forcing me to take a gun or a

tool?” another time, a child-mother from the streets

of Colombia who had been trafficked, raped and

enslaved, asked me this: “i have never had a dream.

Can my child have one?” a Sudanese child, kidnapped

by an extremist militia and forced to kill his friends and

family, once asked me: “is this my fault?”

Slavery did not end with abolition in the 19th century.

even in modern times and developed countries, it still

exists in its cruellest forms. Most recent data show

that there are still 150 million child labourers in the

world; that 59 million children of primary school age

are out of school; and that 15 million girls under 18

are forced into marriage each year. Millions of children

live with a disability that makes them more likely to be

marginalized or miss out on education.

Millions of undocumented immigrants and people on

the margins of society are trafficked and forced into

domestic labour or the sex trade. in crisis-affected

areas, slavery is much more rampant, as children are

given guns instead of toys and girls are sometimes

sold for less than a pack of cigarettes. Unfortunately,

37 million children living in crisis-affected countries are

out of primary or lower-secondary school. i have met

children toiling on cocoa farms in Côte d’ivoire, selling

flowers in Colombia, sewing footballs in Pakistan,

working in mica mines and brick kilns in india, and

living unimaginable horrors in nigeria.

all children deserve a fair and equal start in life. They

deserve freedom and a childhood. They deserve

comprehensive, well-rounded, quality education.

These have to be viewed not just as basic rights but

as a means towards a more inclusive and sustainable

society.

in September 2015, more than 200 world leaders

came together to adopt a 15-year plan for sustainable

development. i applaud the United nations for

incorporating the need to eliminate child labour, forced

labour, modern slavery and human trafficking, as well

as a strong emphasis on inclusive and equitable quality

education, into the Sustainable development Goals

(SdGs). for the first time, clear targets have been

set to end these evils, and the relationship between

them and sustainable growth has been recognized. My

fellow activists and i had been calling for this for many

years.

Sustainable societies can only have a prosperous

future when their children are safe, educated and

healthy. Put simply, ending child labour, slavery,

trafficking and violence against children is directly tied

to achieving most of the other development goals.

Together, we have framed a will for a better future.

however, what matters most is the will in the words,

not the words in the will.

addressing the United nations SdG Summit in new

York, i, on behalf of the most marginalized children,

demanded action, not promises. We know progress is

possible: Since the last development agenda, both the

number of people living in extreme poverty and the

number of primary-school-aged children out of school

have been halved successfully.

our generation can be the one that puts a complete

end to the evil of child slavery. We can provide an

education for every last child. We have an opportunity

to embrace peace, equality, inclusivity and sustainable

development by ensuring freedom for all.

But we can only do so when governments,

businesses, civil society and citizens unite, and when

each carries out its role wilfully and effectively. We

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What are we waiting for? Sustainable societies begin with children

need governments to make child-friendly policies and

invest adequately in education and young people.

Governments can no longer ignore the economic

arguments against child labour. increased child labour

leads to higher unemployment. Today, for the 150

million children (5–14 years old) doing jobs meant

for adults, there are 200 million unemployed adults.

Through the right economic measures, governments

should ensure decent living wages for parents so they

can send their children to school.

The benefits of education are known to contribute

to economic growth and poverty alleviation. reports

show that each dollar invested in quality education will

return 15 times the amount in two decades. The rule

of law should extend to every last child. Businesses

must be more responsible and faith leaders must

recognize that compassion for others is a central tenet

for all faiths.

it is the responsibility of each and every one of us: We

must build the world of our dreams with compassion

for our fellow man and woman, regardless of ethnicity,

race, religion, nationality, politics or anything else.

When we as citizens unite in holding governments,

businesses and civil society accountable, anything will

be possible. My colleagues and i have humbly done

our part – drop by drop over the years. The result is

that more than 85,000 children have been rescued

from child labour and servitude and given back their

childhood. it is not enough to extinguish the blaze

represented by the millions of children who remain in

slavery, but to those children and their families it has

meant everything.

We can be and must be the generation that

extinguishes that blaze once and for all.

We need to teach our bright, young, energetic and

idealistic youth the value of compassion, so they don’t

become disillusioned or turn to violence at a time

when both they and the world seem more susceptible

than ever. devli, an eight-year-old bonded labourer

whom my colleagues and i once rescued from a stone

quarry, perfectly captured the urgency upon which

we must act. She asked me, “Why didn’t you come

earlier?”

her question is for all of us. What are we waiting

for? each one of us has the potential to bring about

A girl makes bricks at a factory in the Shahdra

neighbourhood, north of Lahore, Pakistan.

change if we channel our energies and our anger at

injustices in the right way. even a small spark can

dispel darkness in a room. and each of us represents

a small but critical spark if we act on the problems we

see rather than just witness them.

Together we can ensure that the commitments

for a sustainable world are kept and that slavery is

relegated to the history books where it belongs. let

that be the legacy of our lives – our gift to the world.

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PATHWAYS

TO EqUITY

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ChaPTer 4

Pathways

to equity

Every child has the right to a fair chance – and every society

has a stake in expanding opportunity, leaving no one behind.

It’s the right thing to do, and the smart thing to do. And now is

the time to chart our course towards a more equitable world.

Fatuma, 10, lost both of her

parents to Ebola. She attends

primary school in Freetown,

Sierra Leone.

a defining shift in this still-new century is the growing global understanding of the

scope – and the cost – of an increasingly unequal world. This report has argued that,

left unaddressed, inequities in childhood and adolescence will continue to generate

unequal outcomes for families around the world, fuelling intergenerational cycles of

disadvantage that threaten the strength and stability of societies everywhere.

Current rates of progress are insufficient to interrupt those cycles and close gaps in equity

by 2030 – the target year for reaching the Sustainable development Goals, which pledge

to leave no one behind. if current trends continue until then, some regions and countries

with growing populations and high levels of disadvantage, especially africa and asia, will

have the same number of children out of school as there are today. almost 120 million

children will suffer from stunting, undermining their physical and cognitive development,

with potentially irreversible consequences. Conflicts and chronic crises caused by the

effects of climate change will increase risks to children’s lives and futures, displacing more

and more children and families, increasing vulnerability and deepening disadvantage.

But as this report shows, and as growing evidence clearly indicates, inequity is

neither inevitable nor insurmountable. With the right investments, at the right

time, disadvantaged children can realize their rights to a better life. By reducing the

inequities that violate their rights today, such investments can help these children lead

more productive lives as adults and enable them to pass on more opportunities to

their children, thus replacing intergenerational cycles of deprivation with sustainable

cycles of opportunity.

That is the promise – and the imperative – of equity.

every child has the right to a fair chance, and all societies have a stake in expanding

opportunity for their youngest members. drawing from the work of UniCef

and partners, the five key areas that follow – information, integration, innovation,

investment and involvement – represent broad, often overlapping, pathways to equity.

They encompass operating principles and critical shifts that can help governments,

development partners, civil society and communities shape policies and programmes

with the potential to make that fair chance a reality for every child.

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Information

Going beyond national averages to focus

on the most excluded

information – broadly encompassing data about who is being left behind and

how programmes are reaching or failing to reach those in greatest need – is a

first operating principle of equitable development.

one of the most significant drawbacks in the global effort to achieve the

Millennium development Goals (MdGs) was the fact that national averages

showing overall gains towards certain goals sometimes masked persistent

disparities, failing to reveal that the poorest were not always benefiting

proportionately from overall progress. for example, the global target on safe

drinking water was met five years ahead of schedule, even though gaps in access

to safe sources of drinking water actually widened in some low-income countries.

Without solid data on the status of populations at the subnational

level, communities unreached by the advance of progress may remain

unnoticed. improving the availability and quality of data about the

children and families in greatest need is therefore critical, including by

expanding efforts to measure child poverty in all of its dimensions. The

Multiple indicator Cluster Surveys programme, pioneered by UniCef

and conducted with partners, is helping to break down data on children

by household wealth, geography, gender, ethnicity, language, religion,

age and many other key factors. The more governments incorporate such

disaggregated data into policy planning and public spending, the greater

1 4

of the world’s school-aged

children live in countries

affected by crises

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the chances of making a difference in the lives of the most disadvantaged,

vulnerable and marginalized children.

information not only helps shape programmes around community needs, it

also helps governments and their development partners change course when

programmes are not as efficient as they could be in meeting those needs. for

example, M-Trac, an SMS-based disease surveillance and tracking system,

provides real-time data, helping governments and development partners

monitor stocks of essential medicines more efficiently. and in humanitarian

emergencies and other critical situations, information can drive a more timely

and targeted response, directing life-saving aid to where it is most needed.

But in itself, information about disparities and other factors that contribute

to inequity is not sufficient. inequities will persist without equity targets and

tracking mechanisms to monitor the widening or narrowing of gaps. UniCef

and some partners already use a new system called the Monitoring equity for

results System (MoreS) to track the progress of joint efforts to overcome

bottlenecks that stand between children and families and the services they

need. MoreS identifies both barriers to

supply

– for instance, not enough

community health centres or skilled birth attendants to serve the needs of

poor communities – and barriers to

demand

– for instance, the inability of poor

families to pay for medical care, or insufficient understanding of the urgent

importance of post-natal care.

equipped with such data, governments and development partners can target

programmes to expand opportunity – for instance, through cash transfers

to help families pay school fees, or public awareness campaigns about the

importance of birth registration, which provides children with an official

identity that can expand their access to services and shield them from

exploitation throughout their childhoods.

Governments can further accelerate progress towards the 2030 goals by

establishing national equity targets to spotlight disparities, such as those

affecting disadvantaged regions or ethnic groups. Governments can also adopt

interim ‘stepping stone’ markers to measure progress towards achieving the

overall equity targets – and thus towards achieving the SdGs’ mandate to

leave no one behind.

The data revolution can benefit the most disadvantaged and hardest to reach,

but only if it is truly inclusive of those left behind and uncounted. among

the more exciting and promising shifts in recent years is the way in which

communities are collecting and sharing information about local needs and the

degree to which they are unmet. for example, U-report, a real-time social

messaging tool, is enabling young U-reporters to share important information

with their governments about pressing issues in their communities and lives –

from whether girls are able to go to school to where health interventions are

needed to halt the spread of epidemics.

decision makers are listening. in Uganda, Members of Parliament voluntarily

signed up for U-report to find out what their youngest constituents have to

say, and the system has helped strengthen immunization coverage there. in

Zambia, it is raising awareness about hiV testing. With more than 2 million

active users in 22 countries to date, U-report shows that momentum around

citizen-driven data collection and information sharing is a growing trend.

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Integration

Taking a multidimensional approach to tackling multiple

deprivations that deny children a fair chance in life

integration – in how we approach solutions and how we deliver interventions – is a

critical path towards equitable development.

The multiple threats to the survival and well-being of the most disadvantaged and

vulnerable children are not neatly divided by sector. The enormous challenges that

affect them – conflicts, climate change, extreme poverty and more – are all closely

interconnected. The multiple deprivations that children suffer are also overlapping

and all too often mutually reinforcing. So solutions must intersect as well.

Consider the earliest days of a child’s life, a brief window of opportunity when brain

development is at its peak. Whether children’s brains reach the potential that

nature

has given them depends on how they are

nurtured

– whether children receive

proper nourishment and stimulation, whether they are protected from violence and

prolonged adversity. early childhood development programmes must therefore be

integrated, encompassing education, nutrition and protection.

integrating interventions across these separate sectors is more effective than

addressing them individually: Success in one area supports success in another.

for example, the introduction of school feeding programmes to boost nutrition

has been linked to increased learning and cognitive development. as noted

earlier in this report, in Bangladesh, primary school students in a school meal

programme showed a 15.7 per cent improvement in learning achievement, mostly

in mathematics.

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integrated strategies can also be more cost-effective, particularly where service

providers share human resources

278

– for example, using immunization campaigns

in remote areas to deliver critical micronutrients and measure children for stunting.

Most urgently for the hundreds of millions of children affected by conflict and chronic

crises – including those caused by climate change – we need to break down the

artificial barriers between development work and humanitarian action. no such

distinction exists in the lives of the children these interventions are designed to help.

a lack of development can intensify the impact of conflict and worsen or even

help trigger natural disasters, such as flooding and mudslides. disasters and

conflicts can interrupt, and sometimes roll back, years of development progress,

risks that are now playing out in countries like the Central african republic,

the Syrian arab republic and Yemen, with tremendous short- and long-term

consequences. Conversely, strong development reduces the impact and perhaps

even the likelihood of future crises.

immediate humanitarian action can also provide pathways to ‘build back better’

and advance development. for example, following the 2015 earthquake in nepal,

the government’s social assistance programmes provided a platform to disburse

cash transfers to approximately 400,000 of the people most affected. from a

humanitarian standpoint, this assistance supported the immediate needs of

people whose lives had been torn apart. from a development perspective, it

prevented those families from spending their assets to cope with the aftermath of

the disaster and spurred the government to establish a new monitoring system to

strengthen future social assistance efforts.

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Students whose education has

been disrupted by conflict attend

Curriculum B classes at the

Hasan Zaiat school in Aleppo, the

Syrian Arab Republic.

Similarly, during the worst of the ebola crisis in West africa, UniCef and

partners not only built new community care centres to help care for ebola

victims, but also worked to revitalize existing primary-health-care centres to

treat those suffering from other ailments – an important investment in the

future.

The SdGs explicitly recognize – as the MdGs did not – the inherent connections

among economic development, social development, environmental protection

and peacebuilding. We will not meet the global goals without an integrated

approach to development and humanitarian action. not when millions of children

are bearing the brunt of climate-related disasters and chronic crises and nearly

250 million are living in countries and areas affected by armed conflict. not

when 24 million of the children in these places are out of school. not when

these countries account for nearly two thirds of the world’s children who have

not been immunized with basic vaccines.

279

and not when millions of children

are on the move as families desperately flee their homes and embark on

dangerous journeys that leave children more vulnerable and deepen deprivation.

insisting on closer coordination among humanitarian and development

organizations can help break down divisions between sectors. This includes joint

planning, keeping humanitarian needs front and centre as we implement the

SdGs, and integrating appeals for both humanitarian and development funding

during specific crises. and it includes using more social protection tools like

cash transfers in humanitarian emergencies to provide short-term support for

families while strengthening social safety nets for the future.

Taken together, these practical, cost-effective measures, focusing on countries

in crisis, will not only support emergency response in the short term but also

map out a path to expanded opportunity for the most vulnerable and excluded

children throughout their lives.

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Innovation

accelerating change for the most disadvantaged children

by using new and different approaches to development

for UniCef innovation means doing our work in a different way that adds value

to children’s lives. innovation is not a value in itself but, rather, a new approach to

solving difficult problems.

UniCef has a long history of supporting innovation for children. We have

pioneered and collaborated on solutions such as the Mark ii handpump (to

improve access to safe water) and ready-to-use therapeutic food (to treat severe

acute malnutrition). and we found new ways of working with governments and

other partners to increase global immunization rates of children under age 5, from

20 per cent to 76 per cent, in a single decade (1980–1990).

The evolving challenges now facing the world’s children – from disease outbreaks

to the migrant and refugee crisis, to the situation of millions of out-of-school

children – have one thing in common: the great speed at which they are disrupting

young lives. Meeting these challenges means, yet again, reinventing our ways of

working. it means being agile and adaptable in how we build solutions. it means

looking towards new partnerships – including collaborations with companies that

might not be our traditional partners, and with young people themselves.

in an increasingly connected world, more and more people are accessing basic

information services. as a result, the global drive for new solutions is engaging

more and more young people not only as beneficiaries of solutions but also as

problem-solvers in their own right.

A child receives ready-to-use

therapeutic food as part of a

package of services for the

treatment of malnutrition, in

Somalia.

A woman is photographed for

the Rapid Family Tracing and

Reunification mobile phone

application in the Nyarugusu

refugee camp, in Kigoma Region,

Burundi.

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innovation in the development and humanitarian sectors is also about being

open about failures as well as successes. it is about using technology to get

information in new ways, at new speeds.

in an emergency setting, social messaging tools now make it possible to get

information from the affected populations in real time. for example, during

the ebola epidemic in West africa, UniCef was able to talk with young

people directly using the U-report system, our social messaging platform for

communication between young people and decision makers. in liberia, UniCef

and partners involved in the ebola response polled more than 43,000 people

in a single day via text messages to find out about their needs, aggregate that

information and take action accordingly.

U-report is now available in 22 countries and has more than 2.1 million users. it is

one of the many new tools that are dramatically changing the way problems come

to light – and the way solutions are discovered. These tools add urgency to the

work of governments and the rest of the international community. When we get

information in real time, we have an obligation to respond.

Technological innovations not only improve communication and collaboration, but

they also provide new ways of gathering data. for instance, the Ugandan Bureau

of Statistics is using the U-report survey tool to create micro surveys that the

government can distribute via mobile phone. Such digital tools complement paper-

based surveys, which often reflect information obtained several months or even

years in the past. Using real-time data gives governments and their development

partners a quicker sense of critical issues as they arise and enables them to direct

their responses strategically.

But innovative solutions are not only about technology; they also demonstrate

how technology can support human behaviour as a key driver of success in

solving complex, systemic problems in 2016 and beyond.

for UniCef and partners, innovation means working with young people in new

ways. in Blantyre, Malawi, our innovation lab works with the Polytechnic institute

and primary and secondary schoolchildren who are able to design solutions to

their own problems. These young people are using modern design techniques and

concepts to figure out how to best shape their world – including ways to create a

school environment that is more conducive to learning.

in this relationship, UniCef functions as a broker and a convener, not pushing

ideas but working with young people and institutional partners to help them take

good ideas to scale.

This approach points to a new way of doing business, with innovation opening

up opportunities for new types of partnerships in areas such as personal data.

for example, in collaboration with arM, a leading digital technology company,

UniCef recently launched the Wearables for Good Challenge to accelerate the

development of new wearable technologies that can help save and improve

children’s lives. More than 250 teams from around the world applied. Most of

them consisted of young people who believed they could work together on open-

source technologies providing mothers in rural environments with the information

they need to keep themselves and their children safe.

innovating for equity is also about how to fund this work and make it real.

UniCef's innovation fund, launched in 2015, is a novel instrument enabling us to

support local entrepreneurs and designers in a very concrete sense. By creating a

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Pathways to equity

>> Innovation

hybrid with elements from the worlds of both venture finance and development,

we are now in a position to build a network of companies working on open-

source solutions for children who have been left behind.

The innovation fund pushes UniCef to work with partners – including innovation

labs, incubators and accelerators – in new ways. it allows for innovative ideas to

more quickly permeate UniCef’s global system, and for us to test, evaluate and

adapt them to the needs of the world's most vulnerable children.

in the end, our goal is to create real change for children. There is evidence that

adopting new ways of doing business can help us do just that.

in Uganda, for instance, unpublished preliminary data indicate a substantial

increase in national birth registration levels, stemming from policy change,

legislation and community outreach – and the application of mobile technology.

and in liberia, more than 13,000 U-reporters responded almost instantly to

a question about sexual violence in schools, with 86 per cent saying it was a

serious problem. They also provided ideas on how to address the issue. The

government subsequently used their feedback to shape local and national policy

changes and interventions.

U-Reporter Michelle Abika

(centre) helps raise community

awareness about Ebola

prevention, in Monrovia, Liberia.

around the world, innovation is making a difference. Building up real-time, multi-

directional information flows, creating communities of open-source change agents

and funding them to take innovations to scale: These approaches and more have

the potential to reduce inequities by accelerating results for the poorest and most

disadvantaged children.

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Investment

Using equity-focused budgeting and innovative finance

to reach the most excluded children and families

as this report has argued, investing in the most disadvantaged children and

communities is more than a moral imperative. it is a smart, strategic investment

that helps achieve results more effectively and more cost-effectively, in turn

helping to break intergenerational cycles of deprivation and strengthening

societies. The reverse is also true: When we fail to invest in the most marginalized

children and families, we also fail their societies. disparities in access to critical

services and support cost hundreds of billions of dollars globally every year.

280

expanding opportunity for the most disadvantaged children should be a first priority

in budget design and public spending. a country’s budget reflects how well political

commitments are being translated into direct actions to benefit the most excluded

children. Such spending plays a crucial role in funding the systems that connect

disadvantaged children and families with essential services and support, including

social safety nets that protect families during crises and other shocks.

Prioritizing children in national budgets is not enough. all governments – whether

they are in low-, middle- or high-income countries – also need to analyse the impact

of their budget decisions on the most vulnerable children. in some cases, public

spending is skewed in favour of the most, not the least, advantaged children.

Perhaps the most glaring illustration of this injustice is the gap in per capita

spending on education. in some low-income countries, nearly half of all public

spending on education is dedicated to the best-educated students, representing

only 10 per cent of the total student population. Similarly, in many countries,

students growing up in the wealthiest households have access to up to 18 times

more public educational resources, including textbooks and other materials, than

students from the poorest households.

281

But better coordination and planning between ministries of finance and

development can help national budgets better serve the needs of the most

disadvantaged. So can tracking expenditures more closely to understand whether

the programmes they pay for are reaching the hardest to reach.

Better monitoring of the impact of public spending is critical to achieving

virtually all of a government’s priorities, and achieving equity for children is no

exception. Several countries have mechanisms in place to provide a foundation

for monitoring the impact of public spending on child poverty. Bangladesh, for

example, has developed a child-focused budgeting framework that is used by the

Ministry of finance to review potential impacts on children. in South africa, the

Children’s institute is monitoring budgetary allocations aimed at implementing the

provisions of the country’s Children’s act of 2005.

at the same time, governments can increase the return on their investments

by adopting more integrated planning and budget approaches, as well as more

integrated programme delivery across sectors, as this chapter has already discussed.

in the midst of funding shortfalls and increasing competition for official

development assistance and humanitarian aid, low- and middle-income countries

and their development partners are finding new ways of filling gaps in funding

and securing more predictable and diversified funding sources. While targeted,

short-term investments can often break bottlenecks that prevent children and

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Pathways to equity

>> Investment

families from accessing critical services and support, those achievements cannot

be sustained over time without more sustainable financing.

Today, new partnerships are showing how public and private funding can be mobilized

and targeted directly to the most disadvantaged – from cash grants for poor

families so they can afford health care and education for their children, to financing

for programmes that train front-line and community health workers, to support for

expanded education programming in ethnic minority and indigenous communities.

Some of the most promising of these new partnerships are finding new ways

to finance the development and provision of critical supplies such as vaccines,

insecticide-treated mosquito nets and nutritional supplements to the most excluded

children and communities. for instance, the Power of nutrition partnership aims to

raise US$1 billion for nutrition using an innovative matching mechanism that multiplies

every dollar in private funding up to six times with new financing secured from other

investors. Similarly, UniTlife uses micro levies from extractive industries to increase

resources for the fight against malnutrition in sub-Saharan africa; for example, the

republic of the Congo will contribute the equivalent of US$0.10 per barrel of oil sold

by its national oil company. and UniTaid, a global health initiative to combat

hiV/aidS, tuberculosis and malaria, raised more than half its funds over the past five

years through levies on air travel.

among the most successful examples of such an innovative partnership is GaVi,

the Vaccine alliance, which helps shape markets and make vaccines more affordable

for developing countries. GaVi has partnered with the World Bank, the World health

organization, the Bill and Melinda Gates foundation and UniCef to speed up the

development and availability of vaccines to prevent pneumococcal disease, one of the

leading causes of mortality in children under age 5.

The need for more predictable funding and sustained investment is of more urgent

importance when it comes to humanitarian emergencies. humanitarian needs

have grown exponentially as conflicts have become more protracted and crises

both more frequent and more intense. With funding shortfalls growing, donors,

governments and international organizations are exploring new ways to fund

humanitarian action.

investing in emergency-preparedness before emergencies happen improves the

ability of governments and international organizations to respond to them – with

high returns on investment. Prepositioning supplies in regions prone to droughts and

floods and conducting training and simulations in-country can decrease the need to

surge staff in emergencies, reduce procurement and transportation costs, speed

up response time and even cut carbon dioxide emissions. Similarly, investing in

improving local health systems and other critical infrastructure not only strengthens

development, but also reduces the impact and the cost of responding to crises.

a joint research initiative by the World food Programme and UniCef supported

by the United Kingdom department for international development, calculated that

investment for humanitarian preparedness in high-risk contexts yields an average

financial return of 200 per cent – meaning that every US$1 spent on preparing is

worth an average US$2 needed in the event of an emergency.

282

Making resources work best for the most disadvantaged children – by securing

more equitable investment – takes on ever increasing importance in the context of

the Sustainable development Goals. By encouraging governments to leave no one

behind, the new global goals require deliberate shifts in policy, budget design and

public spending to benefit those in greatest need.

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Involvement

achieving equity for children is everybody’s business

By definition, equitable development is inclusive development. Traditional,

top-down ways of promoting development – a vertical system led almost entirely

by governments and international agencies – are beginning to shift. development

is becoming more horizontal, crossing sectors, geographies and age groups, and

transcending traditional barriers to participation. Greater cooperation, coordination

and collaboration among low- and middle-income countries is creating a robust

exchange of resources, technology and knowledge to tackle common challenges.

Social media and digital technology are organizing, increasing and sustaining

public engagement more quickly and effectively, as groups share information,

broaden their memberships and multiply the number of partners dedicated to the

same causes.

These new opportunities and channels are giving citizens a way to raise their

voices about urgent issues affecting their lives. They are providing governments

with valuable insights into the lives and needs of those who have been left behind

and uncounted. and, significantly, they are fuelling a new era of involvement and

public engagement – ranging from local campaigns to broad movements that call

for change and give people a powerful new way to demand accountability for the

promises their leaders have made.

These loosely organized efforts can be local, national, regional or global – or cross

the lines among them. in india, the i Paid a Bribe movement started out as a

website for ordinary citizens to report instances of government corruption in their

own lives, but it rapidly grew into a movement to combat government corruption

in india and beyond.

in nigeria, the #bringbackourgirls campaign – which has achieved global reach

– began with a single tweet by a lawyer in abuja protesting the abduction of

hundreds of schoolgirls by the armed group Boko haram.

As part of the Scaling Up

Nutrition movement, women

attend a nutrition demonstration

in Burkina Faso.

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Pathways to equity

>> Involvement

Mohammad Abdullah-Shariff,

his wife, Shirin Aziz-Amah, and

their five children. After fleeing

Iraq, they received help from

volunteers, near the village of

Skala Eressos, Lesbos, Greece.

At right, the family, at the Moria

reception centre for refugees and

migrants.

Photo

in the United States, the ice Bucket Challenge was started in 2014 by a group of

college students after a friend was diagnosed with amyotrophic lateral sclerosis

(alS), an incurable degenerative disorder. Their online challenge to their friends to

either dump a bucket of ice on their heads within 24 hours and challenge others

to do the same, or make a contribution to the alS association. it raised US$115

million to date and engaged millions of people in finding a cure.

283

Some movements are never meant to ‘go viral’ or to transform a national or local

issue into a global call for action. But they can still have a tremendous impact on

people’s lives. for example, a movement to end open defecation in nepal mobilized

both citizens and civic authorities in some of the poorest parts of the country and,

in a short time, resulted in 27 districts becoming open-defecation–free.

Movements can also be a powerful pillar of support for government efforts to

benefit the most disadvantaged children. for example, the Scaling Up nutrition

(SUn) movement has succeeded in making the prevention of undernutrition

a growing global priority – a success it owes to a powerful combination of

government commitment and resources, supported by networks of activists and

experts around the world using technology to draw attention to the scourge of

stunting and organize for change.

Whatever form they take, movements require a different way of working and a

new kind of leadership. True movements are led from

within,

not solely from the

offices of decision makers in national governments or the United nations. But

governments, international organizations and civil society should see this as an

opportunity to work together with communities to address common challenges,

such as protecting the environment, ending extreme poverty, promoting women’s

rights and, fundamentally, expanding opportunity so that the most disadvantaged

children can realize their right to a fair chance in life.

100

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equity for every child

information and data help us identify the children and communities being left

behind and monitor the effectiveness of our efforts to reach them. integration

across sectors addresses the overlapping deprivations and challenges children

face. innovation spurs new solutions to old problems, helping children and

communities meet the challenges of a changing world. investment, approached

equitably, fuels more sustainable progress for the most disadvantaged.

involvement by communities, including by children and young people, is changing

the way we set priorities and take action. all are pathways to building a more

equitable world where every child has a fair chance for a better future.

fulfilling the promise of equity is possible. inequalities in opportunity for children

can be drastically reduced within a generation.

as the world embarks on an ambitious new course of international development,

the pledge to leave no one behind must become more than a slogan. Providing a

fair chance for every child must be an operating principle for us all.

achieving equity for children is a question of priorities, recognizing both the moral

and strategic importance of investing in those in greatest need.

it is a practical challenge, overcoming barriers and bottlenecks that keep children

from the support they need and block their access to critical opportunities.

it is a matter of political will, translating commitment into action through equity-

focused policies, programmes and public spending to improve the lives of the

most disadvantaged.

it is an investment, shifting how governments and donors finance development to

better serve the most excluded.

it is a broader commitment, putting an end to conflict and violence that target

children and following through on pledges to address the effects of climate

change.

finally, it is a call to action for all people to engage in building a more equitable

world, knowing that a sustainable future – and our shared destiny – depend on it.

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101

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ENDNOTES

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Narrowing

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UNICEF New York,

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Ibid.

United Nations Children’s Fund,

Progress for

Children: Beyond averages – learning from

the MDGs,

No. 11, UNICEF New York,

June 2015, pp. 22, 26.

The projections in this paragraph were

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paragraph 4, United Nations, New York,

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of Humanitarian Affairs,

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United Nations Office for the Coordination

of Humanitarian Affairs,

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Overview 2016,

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New York, December 2015, p. 3.

United Nations Children’s Fund,

Humanitarian

Action for Children 2016 – Overview,

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Unless We

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children,

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Grant, James P

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United Nations Population Division,

WHO,

Geneva, November 2015.

United Nations Children’s Fund,

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UNICEF New York,

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UNICEF

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APR 2015, p. 19.

World Health Organization, United Nations

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102

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p. 64.

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UNICEF projection, based on APR 2015,

p. 63.

Calculation based on APR 2015, p. 63:

Between 2016 and 2030, 2.1 billion children

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127 Ibid., p. 4.

128. A UNICEF projection based on 2013

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130. Ibid.

131. Ibid.

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137 UNESCO World Inequality Database on

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139. United Nations Educational, Scientific and

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Conflict in the Syrian Arab

Republic: Macroeconomic implications

and obstacles to achieving the Millennium

Development Goals,

ESCWA, June 2014,

p. 27

Verme, Paolo, et al.,

The Welfare of Syrian

Refugees: Evidence from Jordan and

Lebanon,

World Bank and United Nations

Refugee Agency, December 2015, p. xvi.

United Nations, Department of Economic

and Social Affairs, Population Division,

World

Population Prospects: The 2015 revision,

UN DESA, New York, 2015.

ODI calculations for UNICEF based on data

from the World Bank and UN DESA.

ODI calculations for UNICEF based on data

from the World Bank.

The World BankPovcalNet.

ODI calculations for UNICEF based on data

from The World Bank.

The World Bank,

Shifting Gears to Accelerate

Shared Prosperity in Latin America and the

Caribbean,

World Bank, Washington, D.C.,

June 2013, p. 9. Note: Extreme poverty is

defined in this case as living on less than

US$2.50 a day. Vulnerability to poverty is

defined as living on US$4.10 a day or less.

Stampini, M., et al., ‘Poverty, Vulnerability

and the Middle Class in Latin America’,

Working Paper Series No. 591, Inter-American

Development Bank, Washington, D.C.,

May 2015.

UNICEF Office of Research, ‘Children of the

Recession: The impact of the economic crisis

on child well-being in rich countries’, Innocenti

THE STATE OF THE WORLD’S CHILDREN 2016

105

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

236.

237

238.

239.

240.

241.

242.

243.

244.

245.

246.

247

248.

249.

250.

251.

252.

253.

254.

255.

Report Card 12, UNICEF Office of Research,

Florence, September 2014.

Ortiz, Isabel, and Matthew Cummins, eds.,

Recovery for All: Rethinking socio-economic

policies for children and poor households,

UNICEF Division of Policy and Practice, New

York, 2012.

UNICEF Office of Research, ‘Children of the

Recession: The impact of the economic crisis

on child well-being in rich countries’, Innocenti

Report Card 12, UNICEF Office of Research,

Florence, September 2014.

Ibid., p. 9.

Alkire, Sabina, et al., Global Multidimensional

Poverty Index 2015 Summary, Oxford Poverty

& Human Development Initiative, Oxford,

June 2015, p. 1.

de Milliano, Marlous, and Ilze Plavgo,

‘Analysing Child Poverty and Deprivation

in sub-Saharan Africa’, Office of Research

Working Paper: WP-2014-19, UNICEF Office

of Research, Florence, November 2014, p. 18.

ECLAC-UNICEF

La pobreza infantil en

América Latina y el Caribe,

CEPAL, Chile,

December 2010.

The World Bank,

World Development Report:

Conflict, security, and development,

World

Bank, Washington, D.C., 2011, p. 62

United Nations Children’s Fund,

Unless We Act

Now: The impact of climate change on children,

UNICEF New York, November 2015, p. 33.

Fotso, Jean-Christophe, ‘Child health

Inequities in Developing Countries:

Differences across urban and rural areas’,

International Journal for Equity in Health,

vol. 5, no. 9, 2006, p. 8.

United Nations Children’s Fund and Informal

Settlements Development Facility, Egypt,

Multidimensional Child Poverty in Slums and

Unplanned Areas in Egypt,

UNICEF Egypt and

ISDF Cairo, 2013, p. 1.

United Nations Children’s Fund China,

What

Matters to UNICEF China,

UNICEF China,

2014, p. 11.

United Nations, Department of Economic

and Social Affairs, Population Division,

World

Urbanization Prospects: The 2014 revision,

UN DESA, New York, 2014, p. 2.

International Labour Organization, ‘Decent

Work and the Informal Economy: A policy

resource guide’, ILO, March 2013, p. 329.

Ibid., p. 30.

Jiang, Yang, Mercedes Ekono and Curtis

Skinner, ‘Basic Facts About Low-Income

Children: Children under 18 years, 2013’, Fact

Sheet, National Center for Children in Poverty,

Mailman School of Public Health, Columbia

University, New York, January 2015, pp. 1−4.

UNICEF Regional Office for Central and

Eastern Europe and the Commonwealth of

Independent States (CEE/CIS), Education

Section,

The Right of Roma Children to

Education: Position paper,

UNICEF Regional

Office for CEE/CIS, Geneva, 2011.

FRA European Union Agency for Fundamental

Rights,

Poverty and Employment: The

situation of Roma in 11 EU Member States,

European Union Agency for Fundamental

Rights, Vienna, 2014, p. 12.

Ibid.

Ibid., p. 37

Fanjul, Gonzalo, ‘Child poverty and inequality

in rich countries’, Background Paper for

The

State of the World’s Children 2016,

UNICEF

2015, p. 4, citing statistics from Eurostat (not

published).

256. Ibid.

257 Internal analysis by UNICEF Social Protection

for

2015 Annual Results Report

(not yet

published).

258. Fiszbein, Ariel, Ravi Kanbur and Ruslan

Yemtsov,

Social Protection, Poverty and the

Post-2015 Agenda,

World Bank, Washington,

D.C., May 2013, p. 12.

259. Soares, Fabio Veras, et al.,

Cash Transfer

Programmes in Brazil: Impacts on inequality

and poverty,

United Nations Development

Programme, June 2006, p. 1.

260. De Neubourg, Chris, Bruno Martarano and

Marco Sanfilippo,

The Impact of Social

Protection on Children: A review of the

literature,

UNICEF Office of Research,

Florence, June 2012, p. 12.

261. Plagerson, Sophie and Marianne S. Ulriksen,

Cash Transfer Programmes, Poverty

Reduction and Empowerment of Women in

South Africa,

Working Paper No. 4 / 2015,

International Labour Organization, Gender,

Equality and Diversity Branch, Conditions

of Work and Equality Department, Geneva,

2015, p. 33.

262. Overseas Development Institute,

Doing Cash

Differently: How cash transfers can transform

humanitarian aid − Report of the high level

panel on humanitarian cash transfers,

ODI,

London, September 2015, p. 18.

263. Barakat, Nesreen, et al.,

A Window of Hope:

UNICEF child cash grant programme in

Jordan − Post-distribution monitoring report

(February−June 2015), UNICEF Jordan

Country Office, August 2015, p. 29.

264. Merttens, Fred, et al.,

Kenya Hunger Safety

Net Programme Monitoring and Evaluation

Component Impact Evaluation: Impact

evaluation final report: 2009 to 2012,

Oxford

Policy Management, Oxford, June 2013,

p. 22.

265. Handa, Sudhanshu, et al.,

Livelihood

Empowerment against Poverty Impact

Evaluation,

Carolina Population Center,

University of North Carolina at Chapel Hill,

North Carolina, October 2013.

266. Fiszbein, Ariel, and Norbert Schady,

‘Conditional Cash Transfers: Reducing

Present and Future Poverty’, A World Bank

Policy Research Report 47603, World Bank,

Washington, D.C., 2009, p. xi.

267 Benhassine, Najy, et al., ‘Turning a Shove

into a Nudge?: A ‘labeled cash transfer’ for

education’,

American Economic Journal:

Economic Policy,

vol. 7 no. 3, August 2015,

pp. 86–125.

268. Guarcello, Lorenzo, Scott Lyon and Furio

Rosati, ‘Child Labour and Out-of-School

Children: Evidence from 25 developing

countries’, Background Paper for

Fixing the

Broken Promise of Education for All,

UNESCO

Institute for Statistics and UNICEF Montreal,

2015, p. 29; International Labour Organization,

World Report on Child Labour 2015: Paving

the way to decent work for young people,

ILO, Geneva, 2015, pp. 66−67

269. UNESCO Institute for Statistics and United

Nations Children’s Fund,

Fixing the Broken

Promise of Education for All: Findings from

the Global Initiative on Out-of-School Children,

UNESCO-UIS, Montreal, 2015, p. 42.

270. Filmer, Deon, and Norbert Schady, ‘The

Medium-term Effects of Scholarships in a

Low-Income Country,’

Journal of Human

Resources,

vol. 49, no. 3, summer 2014,

pp. 663−694.

271. Kazinga, Harounan, et al.,

Seven-Year

Impacts of Burkina Faso’s BRIGHT Program,

Millennium Challenge Corporation,

Washington, D.C., February 2016; and

Benhassine, Najy, et al., ‘Turning a Shove

into a Nudge?: A ‘labeled cash transfer’ for

education’,

American Economic Journal:

Economic Policy,

vol. 7 no. 3, August 2015,

pp. 86–125.

272. Ahmed, Akhter, U., ‘Impact of Feeding

Children in School: Evidence from

Bangladesh’, International Food Policy

Research Institute, Washington, D.C.,

November 2004, p. 41, mentioned in Sabates-

Wheeler, Rachel, and Jennifer Yablonski,

‘Social Protection and Child Poverty:

Evidence, practice, and gaps’, unpublished

UNICEF background paper for this edition of

The State of the World’s Children 2016,

p. 19.

273. UNESCO Institute for Statistics and United

Nations Children’s Fund,

Fixing the Broken

Promise of Education for All: Findings from

the Global Initiative on Out-of-School Children,

UNESCO-UIS, Montreal, 2015, p. 65.

274. Arráiz, Irani, and Sandra Rozo, ‘Same

Bureaucracy, Different Outcomes in Human

Capital?: How indigenous and rural non-

indigenous areas in Panama responded to

the CCT’, Inter-American Development Bank,

Office of Evaluation and Oversight, Working

Paper OVE/WP-0311, May 2011.

275. Alam, Andaleeb, et al., ‘Does Cash for School

Influence Young Women’s Behavior in the

Longer Term? Evidence from Pakistan’, Policy

Research Working Paper Series 5669, World

Bank, Washington, D.C., May 2011.

276. International Labour Organization,

World

Social Protection Report 2014/15: Building

economic recovery, inclusive development

and social justice,

ILO, Geneva, June 2014,

p. 16.

277 Ahmed, Akhter, U.,

Impact of Feeding

Children in School: Evidence from

Bangladesh,

International Food Policy

Research Institute, Washington, D.C.,

November 2004, p. 41, mentioned in

Sabates-Wheeler, Rachel, and Jennifer

Yablonski, ‘Social Protection and Child

Poverty: Evidence, practice, and gaps’,

unpublished UNICEF background paper for

The State of the World’s Children 2016,

p. 19.

278. World Health Organization, ‘Integrated Health

Services – What and why?’ Technical Brief No.

1, 2008, p. 6.

279. Refers to countries and areas that are either

partially or entirely affected by conflict.

UNICEF calculations based on UNICEF global

databases.

280. Hutton, G., ‘Global Costs and Benefits

of Drinking-Water Supply and Sanitation

Interventions to Reach the MDG target

and Universal Coverage’, World Health

Organization, 2012

281. United Nations Children’s Fund,

The

Investment Case for Education and Equity,

UNICEF New York, Jan. 2015.

282. United Nations Children’s Fund and World

Food Programme, ‘Return on Invesmtment

for Emergency Preparedness Study’, Final

Report, Analysis conducted by the Boston

Consulting Group for UNICEF and WFP n.p.,

2015.

283. ALS Association, ‘ALS Ice Bucket Challenge

Commitments’, ALS Association, Washington,

D.C., 2016.

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Statistical

Tables

Economic and social statistics on the countries and areas of

the world, with particular reference to children’s well-being.

Tables

Overview

General note on the data

Child mortality estimates

Under-five mortality rankings

Regional classification

Notes on specific tables

108

109

110

112

113

Basic indicators

Nutrition

Health

HIV/AIDS

Education

Demographic indicators

Economic indicators

Women

Child protection

118

122

126

130

134

138

142

146

150

154

158

162

166

170

10. The rate of progress

11. Adolescents

12. Disparities by residence

13. Disparities by

household wealth

14. Early childhood development

EXPLANATION OF SYMBOLS

The following symbols are common across all tables:

–

Data are not available.

Data refer to years or periods other

than those specified in the column

heading. Such data are not included

in the calculation of regional and

global averages, unless otherwise

noted.

Data differ from the standard

definition or refer to only part of

a country. If they fall within the

noted reference period, such data

are included in the calculation of

regional and global averages.

Data refer to the most recent year

available during the period specified

in the column heading.

** Excludes China.

Sources and years for specific data points are available at <data.unicef.org>. Symbols that appear in specific tables are explained in the footnotes to those tables.

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Overview

This reference guide presents the most recent key statistics on child survival,

development and protection for the world’s countries, areas and regions.

The statistical tables in this volume support UNICEF’s focus on progress and

results towards internationally agreed-upon goals and compacts relating to

children’s rights and development.

Efforts have been made to maximize the comparability of statistics across

countries and time. Nevertheless, data used at the country level may differ in

terms of the methods used to collect data or arrive at estimates, and in terms

of the populations covered. Furthermore, data presented here are subject to

evolving methodologies, revisions of time series data (e.g., immunization,

maternal mortality ratios) and changing regional classifications. Also, data

comparable from one year to the next are unavailable for some indicators. It is

therefore not advisable to compare data from consecutive editions of

The State of

the World’s Children.

The numbers presented in this reference guide are available online at

<ww w.unicef.org/sowc2016> and via the UNICEF global statistical databases at

<data.unicef.org>. Please refer to these websites for the latest tables and for any

updates or corrigenda subsequent to printing.

General note on the data

Data presented in the following statistical tables are derived from the UNICEF

global databases and are accompanied by definitions, sources and, where

necessary, additional footnotes. The tables draw on inter-agency estimates and

nationally representative household surveys such as Multiple Indicator Cluster

Surveys (MICS) and Demographic and Health Surveys (DHS). In addition, data from

administrative sources and other United Nations organizations have been used.

Data presented in this year’s statistical tables generally reflect information

available as of January 2016. More detailed information on methodology and data

sources is available at <data.unicef.org>.

This volume includes the latest population estimates and projections from

World

Population Prospects: The 2015 revision and World Urbanization Prospects:

The 2014 revision

(United Nations Department of Economic and Social

Affairs, Population Division). Data quality is likely to be adversely affected for

countries that have recently suffered disasters, especially where basic country

infrastructure has been fragmented or where major population movements have

occurred.

Multiple Indicator Cluster Surveys (MICS):

UNICEF assists countries in

collecting and analyzing data in order to fill data gaps for monitoring the situation

of children and women through its international household survey initiative, the

Multiple Indicator Cluster Surveys (MICS). Since 1995, over 280 surveys have

been completed in more than 100 countries and areas.

MICS are among the largest sources of data for monitoring progress towards

internationally agreed-upon development goals for children, including the MDGs.

More information is available at <mics.unicef.org>.

108

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Child mortality estimates

Each year, in

The State of the World’s Children,

UNICEF reports a series of

mortality estimates for children – including the annual neonatal mortality rate,

infant mortality rate, the under-five mortality rate (total, male and female) and

the number of under-five deaths. These figures represent the best estimates

available at the time of printing and are based on the work of the United Nations

Inter-agency Group for Child Mortality Estimation (UN IGME), which includes

UNICEF the World Health Organization (WHO), the World Bank and the United

Nations Population Division. UN IGME mortality estimates are updated annually

through a detailed review of all newly available data points, which often results in

adjustments to previously reported estimates. As a result, consecutive editions

The State of the World’s Children

should not be used for analysing mortality

trends over time. Comparable global and regional under-five mortality estimates

for the period 1970–2015 are presented below. Country-specific mortality

indicators for 1970–2015, based on the most recent UN IGME estimates, are

presented in Table 10 (for the years 1970, 1990, 2000 and 2015) and are available

at <data.unicef.org/child-mortality/under-five> and <ww w.childmortality.org>.

Under-five mortality rate (per 1,000 live births)

UNICEF Region

Sub-Saharan Africa

Eastern and Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and the Pacific

Latin America and the Caribbean

CEE/CIS

Least developed countries

World

1970

244

213

276

200

213

116

120

242

145

1975

219

195

246

164

195

103

230

129

1980

201

189

218

127

171

212

116

1985

188

175

206

149

192

101

1990

180

167

198

129

175

1995

172

159

190

111

158

2000

154

140

172

138

2005

127

111

145

111

2010

101

119

2015

Under-five deaths (millions)

UNICEF Region

Sub-Saharan Africa

Eastern and Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and the Pacific

Latin America and the Caribbean

CEE/CIS

Least developed countries

World

1970

3.2

1.3

1.7

1.2

5.8

5.0

1.2

0.6

3.3

17.2

1975

3.2

1.4

1.7

1.1

5.8

3.5

1.1

0.5

3.5

15.6

1980

3.4

1.6

1.8

1.0

5.5

2.4

1.0

0.5

3.6

13.9

1985

3.6

1.6

1.9

0.8

5.3

2.4

0.8

0.4

3.6

13.4

1990

3.9

1.7

2.0

0.7

4.7

2.5

0.6

0.4

3.6

12.7

1995

4.1

1.8

2.2

0.5

4.1

1.6

0.5

0.3

3.6

11.0

2000

4.1

1.8

2.2

0.4

3.5

1.2

0.4

0.2

3.4

9.8

2005

3.7

1.5

2.1

0.4

2.9

0.9

0.3

0.1

3.0

8.3

2010

3.3

1.3

1.9

0.3

2.4

0.7

0.3

0.1

2.5

7.0

2015

2.9

1.1

1.8

0.3

1.9

0.5

0.2

0.1

2.2

5.9

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UNDER-FIVE MORTALITY RANKINGS

The following list ranks countries and areas in descending order of their estimated 2015 under-five mortality rate (U5MR), a

critical indicator of the well-being of children. Countries and areas are listed alphabetically in the tables on the following pages.

HIGHEST UNDER-FIVE MORTALITY RATE

Under-5 mortality

rate (2015)

Under-5 mortality

rate (2015)

Under-5 mortality

rate (2015)

Countries and areas

Angola

Chad

Somalia

Central African Republic

Sierra Leone

Mali

Nigeria

Benin

Democratic Republic

of the Congo

Niger

Equatorial Guinea

Guinea

Côte d'Ivoire

Guinea-Bissau

South Sudan

Afghanistan

Lesotho

Burkina Faso

Cameroon

Mauritania

Burundi

Pakistan

Mozambique

Togo

Comoros

Zimbabwe

Liberia

Sudan

Gambia

Haiti

Lao People's Democratic

Republic

Djibouti

Value Rank

157

139

137

130

120

115

109

100

Countries and areas

Malawi

Zambia

Ghana

Swaziland

Ethiopia

Papua New Guinea

Kiribati

Uganda

Timor-Leste

Gabon

Turkmenistan

Madagascar

Myanmar

Kenya

United Republic

of Tanzania

India

Eritrea

Sao Tome and Principe

Senegal

Congo

Namibia

Tajikistan

Botswana

Rwanda

Yemen

South Africa

Guyana

Uzbekistan

Bangladesh

Bolivia (Plurinational

State of)

Marshall Islands

Nepal

Value Rank

Countries and areas

Micronesia

(Federated States of)

Nauru

Bhutan

Azerbaijan

Iraq

Dominican Republic

Cambodia

Guatemala

Morocco

Philippines

Solomon Islands

Vanuatu

Indonesia

Tuvalu

Algeria

Cabo Verde

Democratic People's

Republic of Korea

Egypt

Niue

Ecuador

Fiji

Mongolia

Nicaragua

Viet Nam

Dominica

Kyrgyzstan

Paraguay

State of Palestine

Suriname

Honduras

Trinidad and Tobago

Jordan

Value Rank

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ABOUT 16,000 CHILDREN UNDER

5 YEARS OLD STILL DIE EVERY DAY.

LOWEST UNDER-5 MORTALITY RATE

Under-5 mortality

rate (2015)

Under-5 mortality

rate (2015)

Under-5 mortality

rate (2015)

Countries and areas

Saint Vincent and

the Grenadines

Samoa

Belize

El Salvador

Panama

Peru

Tonga

Brazil

Colombia

Iran (Islamic Republic of)

Jamaica

Palau

Republic of Moldova

Saudi Arabia

Venezuela

(Bolivarian Republic of)

Albania

Armenia

Kazakhstan

Mauritius

Saint Lucia

Seychelles

Tunisia

Turkey

Argentina

Barbados

Libya

Mexico

Syrian Arab Republic

Bahamas

Georgia

Grenada

Oman

Value Rank

Countries and areas

Thailand

China

Romania

Saint Kitts and Nevis

Brunei Darussalam

Bulgaria

Costa Rica

Russian Federation

Sri Lanka

Uruguay

Kuwait

Maldives

Ukraine

Antigua and Barbuda

Chile

Cook Islands

Latvia

Lebanon

Qatar

Malaysia

Serbia

Slovakia

United Arab Emirates

United States

Bahrain

Cuba

Hungary

Malta

New Zealand

The former Yugoslav

Republic of Macedonia

Belarus

Bosnia and Herzegovina

Canada

Value Rank

Countries and areas

Greece

Lithuania

Montenegro

Poland

Australia

Austria

Belgium

Croatia

Denmark

France

Germany

Ireland

Israel

Italy

Monaco

Netherlands

Portugal

Spain

Switzerland

United Kingdom

Andorra

Cyprus

Czech Republic

Estonia

Japan

Norway

Republic of Korea

San Marino

Singapore

Slovenia

Sweden

Finland

Iceland

Luxembourg

Holy See

Liechtenstein

Value Rank

104

110

112

120

125

130

133

139

142

148

153

159

166

182

193

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Regional classification

Averages presented at the end of each of the 14 statistical tables are calculated

using data from countries and areas as classified below.

Sub-Saharan Africa

Eastern and Southern Africa; West and Central Africa; Djibouti; Sudan

Eastern and Southern Africa

Angola; Botswana; Burundi; Comoros; Eritrea; Ethiopia; Kenya; Lesotho;

Madagascar; Malawi; Mauritius; Mozambique; Namibia; Rwanda; Seychelles;

Somalia; South Africa; South Sudan; Swaziland; Uganda; United Republic of

Tanzania; Zambia; Zimbabwe

West and Central Africa

Benin; Burkina Faso; Cabo Verde; Cameroon; Central African Republic; Chad;

Congo; Côte d’Ivoire; Democratic Republic of the Congo; Equatorial Guinea;

Gabon; Gambia; Ghana; Guinea; Guinea-Bissau; Liberia; Mali; Mauritania; Niger;

Nigeria; Sao Tome and Principe; Senegal; Sierra Leone; Togo

Middle East and North Africa

Algeria; Bahrain; Djibouti; Egypt; Iran (Islamic Republic of); Iraq; Jordan; Kuwait;

Lebanon; Libya; Morocco; Oman; Qatar; Saudi Arabia; State of Palestine; Sudan;

Syrian Arab Republic; Tunisia; United Arab Emirates; Yemen

South Asia

Afghanistan; Bangladesh; Bhutan; India; Maldives; Nepal; Pakistan; Sri Lanka

East Asia and Pacific

Brunei Darussalam; Cambodia; China; Cook Islands; Democratic People’s Republic

of Korea; Fiji; Indonesia; Kiribati; Lao People’s Democratic Republic; Malaysia;

Marshall Islands; Micronesia (Federated States of); Mongolia; Myanmar; Nauru;

Niue; Palau; Papua New Guinea; Philippines; Republic of Korea; Samoa; Singapore;

Solomon Islands; Thailand; Timor-Leste; Tonga; Tuvalu; Vanuatu; Viet Nam

Latin America and Caribbean

Antigua and Barbuda; Argentina; Bahamas; Barbados; Belize; Bolivia (Plurinational

State of); Brazil; Chile; Colombia; Costa Rica; Cuba; Dominica; Dominican

Republic; Ecuador; El Salvador; Grenada; Guatemala; Guyana; Haiti; Honduras;

Jamaica; Mexico; Nicaragua; Panama; Paraguay; Peru; Saint Kitts and Nevis; Saint

Lucia; Saint Vincent and the Grenadines; Suriname; Trinidad and Tobago; Uruguay;

Venezuela (Bolivarian Republic of)

Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS)

Albania; Armenia; Azerbaijan; Belarus; Bosnia and Herzegovina; Bulgaria; Croatia;

Georgia; Kazakhstan; Kyrgyzstan; Montenegro; Republic of Moldova; Romania;

Russian Federation; Serbia; Tajikistan; the former Yugoslav Republic of Macedonia;

Turkey; Turkmenistan; Ukraine; Uzbekistan

Least developed countries/areas

[Classified as such by the United Nations High Representative for the Least

Developed Countries, Landlocked Developing Countries and Small Island

Developing States (UN-OHRLLS)].

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Afghanistan; Angola; Bangladesh; Benin; Bhutan; Burkina Faso; Burundi;

Cambodia; Central African Republic; Chad; Comoros; Democratic Republic

of the Congo; Djibouti; Equatorial Guinea; Eritrea; Ethiopia; Gambia; Guinea;

Guinea-Bissau; Haiti; Kiribati; Lao People’s Democratic Republic; Lesotho;

Liberia; Madagascar; Malawi; Mali; Mauritania; Mozambique; Myanmar; Nepal;

Niger; Rwanda; Sao Tome and Principe; Senegal; Sierra Leone; Solomon Islands;

Somalia; South Sudan; Sudan; Timor-Leste; Togo; Tuvalu; Uganda; United Republic

of Tanzania; Vanuatu; Yemen; Zambia

Notes on specific tables

TABLE 2. NUTRITION

Underweight, stunting, wasting and overweight:

UNICEF WHO and the

World Bank have continued a process to harmonize anthropometric data used for

computation and estimation of regional and global averages and trend analysis.

As part of this process, regional and global averages for underweight, stunting,

wasting and overweight prevalences are derived from a model described in

M. de Onis et al., ‘Methodology for Estimating Regional and Global Trends

of Child Malnutrition’ (International

Journal of Epidemiology,

vol. 33, 2004,

pp. 1260–1270). Owing to differences in data sources (i.e., new empirical data

are incorporated as made available) and estimation methodology, these regional

average prevalence estimates may not be comparable to the averages published

in previous editions of

The State of the World’s Children.

Vitamin A supplementation:

Emphasizing the importance for children of receiving

two annual doses of vitamin A (spaced 4–6 months apart), this report presents only

full coverage of vitamin A supplementation. In the absence of a direct method to

measure this indicator, full coverage is reported as the lower coverage estimate

from semester 1 January–June and semester 2 July–December, in a given year.

The regional and global aggregates only contain the 82 countries indicated as

priority countries for national level programmes. Hence the aggregates are

published where at least 50 per cent of the population coverage for the priority

countries in each region have been met. In other words, East Asia and Pacific

estimates are presented despite there being no data for China, because China is

not a priority country for a national level programme.

Low birthweight:

The data have not been updated since November 2014 due to

ongoing methodological work to revise the analysis method for estimates from

household surveys where a large number of children are not weighed.

Iodized salt:

The data have not been updated since November 2014 due to an

upcoming change in the definition of the of the indicator that will be reported on

in future editions of

The State of the World’s Children.

TABLE 3. HEALTH

Water and sanitation:

The drinking water and sanitation coverage estimates in

this report come from the WHO/UNICEF Joint Monitoring Programme for Water

Supply and Sanitation (JMP). Full details of the JMP methodology can be found

at <data.unicef.org> and <ww w.wssinfo.org>. As the JMP estimates use linear

regression applied to data from household sample surveys and censuses, and

additional data become available between each issue of estimates, subsequent

JMP estimates should not be compared.

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Immunization:

This report presents WHO and UNICEF estimates of national

immunization coverage. Since 2000, the estimates are updated once annually in

July, following a consultation process wherein countries are provided draft reports

for review and comment. As the system incorporates new empirical data, each

annual revision supersedes prior data releases, and coverage levels from earlier

revisions are not comparable. A more detailed explanation of the process can be

found at <data.unicef.org/child-health/immunization>.

Regional averages for the reported antigens are computed as follows:

•

For BCG, regional averages include only those countries where BCG is

included in the national routine immunization schedule.

For DPT, polio, measles, HepB, Hib, PCV and rotavirus vaccines, regional averages

include all countries, as these vaccines are universally recommended by WHO.

For protection at birth (PAB) from tetanus, regional averages include only the

countries where maternal and neonatal tetanus is endemic.

Treatment indicators:

Until recently, ‘Proportion of children under 5 with fever

who are treated with appropriate antimalarial drugs’ was the standard indicator

for monitoring coverage of antimalarial treatment in children under 5. However,

it has become increasingly challenging to track trends in this indicator, following

a 2010 WHO recommendation that advised universal use of diagnostic testing

to confirm malaria infection before applying any treatment. To implement this

recommendation, many countries are scaling up the use of diagnostic testing to

focus treatment on only those diagnosed with malaria. Given that increasingly

higher number of fever cases are not malaria, low levels of antimalarial treatment in

febrile children may indicate that antimalarials are being provided only to confirmed

cases. For more information on this issue, see the 2013 edition of the Household

Survey Indicators for Malaria Control. Given these methodological issues, this

indicator is no longer tracked for coverage monitoring and has now been replaced

with ‘Care seeking for fever’ in this publication.

The indicator ‘Antibiotic treatment for children with symptoms of pneumonia’ has been

dropped from this table as well. This indicator refers to antibiotic treatment among

children whose caretakers report symptoms that are related to acute respiratory

infection. However, these children have not been medically diagnosed with pneumonia,

thus leading to substantial validity issues. Studies have shown that high percentage

of children with symptoms of acute respiratory infection do not have true pneumonia.

Therefore, this indicator is no longer recommended for coverage monitoring.

TABLE 4. HIV/AIDS

In 2015, the Joint United Nations Programme on HIV/AIDS (UNAIDS) released

new global, regional and country-level HIV and AIDS estimates for 2014 that reflect

key changes in WHO HIV treatment guidelines for adults and children and for the

prevention of mother-to-child transmission of HIV, in addition to improvements in

assumptions of the probability of HIV transmission from mother to child and net

survival rates for infected children. Furthermore, there are also more reliable data

available from population-based surveys, expanded national sentinel surveillance

systems and programme service statistics in a number of countries. Based on the

refined methodology, UNAIDS has retrospectively generated new estimates of

HIV prevalence, the number of people living with HIV and those needing treatment,

AIDS-related deaths, new HIV infections and the number of children whose parents

have died due to all causes including AIDS for past years.

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Only new estimates should be used for trend analysis. The new HIV and AIDS

estimates included in this table are also published in the UNAIDS How AIDS

Changed Everything, 2015. Overall, the global and regional figures published in

The

State of the World’s Children

are not comparable to estimates previously published.

More information on HIV and AIDS estimates, methodology and updates can be

found at <www.unaids.org>.

TABLE 7 ECONOMIC INDICATORS

National monetary child poverty

has been added to Table 7 in 2016 to reflect

Sustainable Development Goal 1, Target 1.2 that includes an explicit commitment

to reduce poverty among children. This indicator measures “the percentage

of children aged 0–17 years old living in households that have income or

consumption level below the government defined national poverty threshold”.

Data come from official government sources such as Statistical Office tabulations,

national household survey and poverty reports and from regional databases

such as Eurostat. Note that the methodology used to calculate national poverty

prevalence varies by country. For instance, some countries using income and

others consumption, some applying an absolute poverty line and others a relative

poverty threshold. Therefore, national child poverty rates should be used to monitor

progress, but should not be used to compare or rank countries. This indicator is the

first of three child poverty indicators and will be supplemented with an international

‘extreme child poverty’ measure for Target 1 of SDG Goal 1 and national ‘multi-

dimensional’ child poverty for Target 1.2.

TABLE 8. WOMEN

Maternal mortality ratio (adjusted):

The table presents the ‘adjusted’ maternal

mortality ratios for the year 2015, as published by the Maternal Mortality Estimation

Inter-agency Group (MMEIG), composed of WHO, UNICEF the United Nations

Population Fund (UNFPA), The World Bank, and the United Nations Population

Division, together with independent technical experts. To derive these estimates,

the inter-agency group used a dual approach: making adjustments to correct

misclassification and underreporting in existing estimates of maternal mortality

from civil registration systems, and using a model to generate estimates for

countries without reliable national-level estimates of maternal mortality. These

‘adjusted’ estimates should not be compared with previous inter-agency estimates.

The full report – with complete country and regional estimates for the years 1990,

1995, 2000, 2005, 2010 and 2015, in addition to details on the methodology – can

be found at <data.unicef.org/maternal-health/maternal-mortality>.

Post-natal care indicators:

The period immediately following delivery or post-

natal period is a critical phase in the lives of mothers and newborn babies as most

maternal and infant deaths occur during this time. Given the critical importance of

essential newborn care and postnatal care for the baby and the mother, household

survey programs such as DHS and MICS have recently included indicators to track

their coverage. Thus, two standard indicators related to early post-natal care for

mothers and babies have been added to this table: Post-natal health check for

newborns within 2 days after delivery and post-natal health check for mothers

within 2 days after delivery. These two indicators are now part of the Every

Newborn Action Plan (ENAP) global monitoring indicators.

Even though both DHS and MICS strive at providing comparable results for the

same indicator, data collection and reporting method for these indicators differs

slightly between the two survey programs. Cross-country coverage results and

regional aggregates should be analysed with caution. For the specific source

for each data point please review the post-natal care database published on

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<data.unicef.org> as well as specific country reports available on the respective

website of the survey programs (for MICS: see <http://mics.unicef.org>; for DHS

see <http://dhsprogram.com>).

TABLE 9. CHILD PROTECTION

Birth registration:

Changes in the definition of birth registration were made

from the second and third rounds of MICS (MICS2 and MICS3) to the fourth

round (MICS4). In order to allow for comparability with later rounds, data from

MICS2 and MICS3 on birth registration were recalculated according to the MICS4

indicator definition. Therefore, the recalculated data presented here may differ from

estimates included in MICS2 and MICS3 national reports.

Child labour:

The prevalence rates of child labour presented in the table vary

widely across countries due to significant differences in survey methodology,

questionnaire content, national definitions and thresholds used to establish

child labour prevalence. Only a limited number of countries have produced child

labour prevalence data based on international standards and classifications. Data

from the fourth round of MICS (MICS4, 2009–2012) included in the table have

been recalculated according to the indicator definition used in MICS3 surveys,

to ensure cross-country comparability. In this definition, the activities of fetching

water or collecting firewood are classified as household chores rather than as

an economic activity. Under this approach, a child aged 5–14 would have to be

engaged in fetching water or collecting firewood for at least 28 hours per week to

be considered as a child labourer.

Female genital mutilation/cutting (FGM/C):

Data on the prevalence of FGM/C

among girls aged 0–14 were recalculated for technical reasons and may differ

from that presented in original DHS and MICS country reports. For further details,

refer to

Female Genital Mutilation/Cutting: A statistical overview and exploration

of the dynamics of change,

UNICEF New York, 2013. Regional estimates on the

prevalence of FGM/C and attitudes towards the practice are based on available data

from only practising countries and therefore reflect the situation among those living

in affected countries within the region, and not the region as a whole, as there are

some non-practising countries in the region as well.

Violent discipline:

Estimates used in UNICEF publications and in MICS country

reports prior to 2010 were calculated using household weights that did not take into

account the last-stage selection of children for the administration of the child discipline

module in MICS surveys. (A random selection of one child aged 2–14 is undertaken for

the administration of the child discipline module.) In January 2010, it was decided that

more accurate estimates are produced by using a household weight that takes the

last-stage selection into account. MICS3 data were recalculated using this approach.

TABLE 10. THE RATE OF PROGRESS

Under-five mortality is used as the principal indicator of progress in child well-being.

In 1970, about 17 million children under 5 years old were dying every year. In

2015, by comparison, the estimated number of children who died before their fifth

birthday stood at 5.9 million – highlighting a significant long-term decline in the

global number of under-five deaths.

U5MR has several advantages as a gauge of child well-being:

•

First, U5MR measures an end result of the development process rather than

an ‘input’ such as school enrolment level, per capita calorie availability or

number of doctors per thousand population – all of which are means to an end.

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•

Second, U5MR is known to be the result of a wide variety of inputs: for

example, antibiotics to treat pneumonia; insecticide-treated mosquito nets to

prevent malaria; the nutritional well-being and health knowledge of mothers;

the level of immunization and oral rehydration therapy use; the availability

of maternal and child health services, including antenatal care; income and

food availability in the family; the availability of safe drinking water and basic

sanitation; and the overall safety of the child’s environment.

Third, U5MR is less susceptible to the fallacy of the average than, for

example, per capita gross national income (GNI). This is because the natural

scale does not allow the children of the rich to be one thousand times more

likely to survive, even if the human made scale does permit them to have

one thousand times as much income. In other words, it is much more difficult

for a wealthy minority to affect a nation’s U5MR, and this indicator therefore

presents a more accurate, if far from perfect, picture of the health status of

the majority of children and of society as a whole. The speed of progress

in reducing child mortality can be assessed by calculating its annual rate of

reduction (ARR). Unlike the comparison of absolute changes, ARR measures

relative changes that reflect differences compared with the starting value.

•

As lower levels of child mortality are reached, the same absolute reduction

represents a greater percentage reduction. ARR therefore shows a higher rate of

progress for a 10-point absolute reduction, for example, if that reduction happens

at a lower level of child mortality versus a higher level over the same time period.

A 10-point decrease in U5MR from 100 in 1990 to 90 in 2015 represents a

reduction of 10 per cent, corresponding to an ARR of about 0.4 per cent, whereas

the same 10-point decrease from 20 to 10 over the same period represents a

reduction of 50 per cent, or an ARR of 2.8 per cent. (A negative value for the

percentage reduction indicates an increase in U5MR during the period specified.)

When used in conjunction with gross domestic product (GDP) growth rates, child

mortality indicators and their rates of reduction can therefore give a picture of

the progress being made by any country, area or region, over any period of time,

towards the satisfaction of some of the most essential human needs.

As Table 10 shows, there is no fixed relationship between the ARR of U5MR

and the annual rate of growth in per capita GDP Comparing these two indicators

helps shed light on the relationship between economic advances and human

development.

Finally, the table gives the total fertility rate for each country and area and the

corresponding ARR. It is clear that many of the nations that have achieved

significant reductions in their U5MR have also achieved significant reductions in

fertility.

TABLES 12 AND 13. DISPARITIES BY RESIDENCE AND BY HOUSEHOLD WEALTH

Stunting:

Beginning in 2016,

The State of the World’s Children

no longer includes

the disparities in underweight (weight-for-age) prevalence, and instead provides

the breakdown for stunting (height-for-age). This is because stunting has gained

precedence as a key global marker of child undernutrition and is now a focus of

the SDG agenda, while underweight is no longer among the indicators to be used

to track country, regional or global progress on nutrition. Underweight had been

the indicator used to track MDG target 1.c. on nutrition of children under the age

of 5 years, however, even during the MDG period, UNICEF and other partners had

focused on progress in stunting as the marker of success.

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TABLE 1.

BASIC INDICATORS

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia (Plurinational State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's Republic

of Korea

Democratic Republic

of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

France

Under-5

mortality

rank

Under-5 mortality

rate (U5MR)

1990

2015

U5MR by

sex

2015

male

female

Infant mortality

rate

(under 1)

1990

2015

Annual

number

Annual

of under-5

number

Total

Neonatal

deaths

GNI per

of births

mortality population

(thousands) (thousands) (thousands) capita (US$)

rate

2015

Life

expectancy Total adult

literacy rate

at birth

(%)

(years)

2015

2009−2014*

Primary

school net

enrolment

ratio (%)

2010−2014*

112

182

142

120

112

166

125

153

120

159

166

159

104

133

159

142

130

104

142

133

166

153

182

166

182

193

166

181

226

144

180

134

124

202

172

117

138

177

215

125

153

187

119

190

151

205

157

100

130

139

165

104

137

146

101

105

101

149

123

131

123

134

100

108

103

104

115

116

105

120

128

122

32,527

2,897

39,667

25,022

43,417

3,018

23,969

8,545

9,754

388

1,377

160,996

284

9,496

11,299

359

10,880

775

10,725

3,810

2,262

207,848

423

7,150

18,106

11,179

521

15,578

23,344

35,940

4,900

14,037

17,948

1,376,049

48,229

788

4,620

4,808

22,702

4,240

11,390

1,165

10,543

25,155

77,267

5,669

888

10,528

16,144

91,508

6,127

845

5,228

1,313

99,391

892

5,503

64,395

1,081

936

–

1,128

753

318

193

3,134

112

130

388

253

3,016

717

488

371

847

387

164

630

234

16,601

747

167

–

838

115

107

360

3,217

–

216

331

2,488

105

175

3,176

782

169

119

182

305

184

680

4,450

5,490

43,270 x

13,300

13,480

4,020

64,540

49,670

7,590

20,980

21,060 x

1,080

15,310 x

7,340

47,260

4,350 x

890

2,370

2,870

4,760

7,240

11,530

37,320 x

7,620

700

270

3,450

1,020

1,350

51,630

320

980

14,910

7,400

7,970

790

2,720

–

10,120

1,450

12,980

5,880 x

26,370

18,370

380

61,310

6,930

6,040

6,090

3,050

3,920

10,210

480 x

19,030

550

4,870

48,420

42,960

–

73 x

–

100

–

100

–

100

–

29 x

53 x

29 x

87 x

–

100

–

100 x

–

100

39 x

–

100

–

97 x

–

97 x

–

97 x

100

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TABLE 1.

BASIC INDICATORS

Annual

number

Annual

of under-5

number

Total

Neonatal

deaths

GNI per

of births

mortality population

(thousands) (thousands) (thousands) capita (US$)

rate

2015

Life

expectancy Total adult

literacy rate

at birth

(%)

(years)

2015

2009−2014*

Primary

school net

enrolment

ratio (%)

2010−2014*

Countries

and areas

Gabon

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic

Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia (Federated

States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

New Zealand

Under-5

mortality

rank

Under-5 mortality

rate (U5MR)

1990

2015

U5MR by

sex

2015

male

female

Infant mortality

rate

(under 1)

1990

2015

125

166

159

125

–

153

193

104

166

104

182

112

139

142

120

–

159

193

148

139

153

112

120

166

159

166

153

170

127

238

229

146

–

126

102

162

255

–

161

242

254

118

108

240

110

141

–

115

100

–

120

–

108

141

136

101

–

111

170

–

143

131

160

–

1,725

1,991

4,000

80,689

27,410

10,955

107

16,343

12,609

1,844

767

10,711

8,075

9,855

329

1,311,051

257,564

79,109

36,423

4,688

8,064

59,798

2,793

126,573

7,595

17,625

46,050

112

3,892

5,940

6,802

1,971

5,851

2,135

4,503

6,278

2,878

567

24,235

17,215

30,331

364

17,600

419

4,068

1,273

127,017

104

2,959

626

34,378

27,978

53,897

2,459

28,514

16,925

4,529

685

884

438

460

263

–

169

25,794

5,037

1,350

1,244

167

501

1,033

199

377

1,571

154

179

156

129

–

831

665

509

758

–

134

2,346

–

699

1,087

944

–

577

177

–

1,201

147

–

9,720

500 x

3,720

47,640

1,590

22,680 x

7,910

3,430

470

550

3,940 x

820

–

2,270

13,340

46,350 x

1,570

3,630

7,120 x

6,500

46,550

35,320

34,270

5,150

42,000

5,160

11,850

1,290

2,950

49,300

1,250

1,660

15,280

10,030

1,330

370

7,820

15,430

75,990

440

250

11,120

6,410

650

21,000 x

4,390

1,270

9,630

9,870

3,200

4,280

7,320

3,070

600

1,270

5,630

–

730

51,890

41,070

–

100

–

49 x

–

100

72 x

–

73 x

100

90 x

43 x

–

100

–

98 x

–

46 x

–

76 x

–

100

–

100

–

100

–

98 x

–

97 x

100

–

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TABLE 1.

BASIC INDICATORS

Annual

number

Annual

of under-5

number

Total

Neonatal

deaths

GNI per

of births

mortality population

(thousands) (thousands) (thousands) capita (US$)

rate

2015

Life

expectancy Total adult

literacy rate

at birth

(%)

(years)

2015

2009−2014*

Primary

school net

enrolment

ratio (%)

2010−2014*

Countries

and areas

Nicaragua

Niger

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and the

Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav Republic

of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

Ukraine

Under-5

mortality

rank

Under-5 mortality

rate (U5MR)

1990

2015

U5MR by

sex

2015

male

female

Infant mortality

rate

(under 1)

1990

2015

182

125

104

159

166

142

182

104

130

133

130

112

182

110

148

112

182

148

182

166

133

182

166

120

125

153

112

139

328

213

139

152

111

140

264

180

253

128

108

176

146

187

109

120

137

100

115

127

143

102

113

130

138

126

106

157

108

150

132

111

6,082

19,899

182,202

5,211

4,491

188,925

3,929

7,619

6,639

31,377

100,699

38,612

10,350

2,235

50,293

4,069

19,511

143,457

11,610

185

109

193

190

31,540

15,129

8,851

6,453

5,604

5,426

2,068

584

10,787

54,490

12,340

46,122

20,715

4,668

40,235

543

1,287

9,779

8,299

18,502

8,482

67,959

2,078

1,185

7,305

106

1,360

11,254

78,666

5,374

39,032

44,824

121

983

7,133

–

5,451

–

215

141

615

2,349

387

457

179

1,823

363

–

619

567

229

471

1,111

446

413

323

151

1,319

119

438

256

715

256

202

1,289

112

–

1,665

484

750

432

1,870

410

2,970

–

103,630

16,870 x

1,400

11,110

11,130

2,240

4,400

6,360

3,500

13,690

21,360

92,200

27,090

2,560

9,520

13,220

700

14,920

7,260

6,610

4,060

1,670

25,140 x

1,050

5,820

14,100

700

55,150

17,750

23,580

1,830

6,800

970

29,440

3,460

3,060

1,710

9,950

3,550

61,610

88,120 x

1,080

5,780

5,150

2,680

570

4,260

20,070

4,230

10,830

8,020

5,720

670

3,560

–

78 x

51 x

–

100

95 x

100

–

100

–

70 x

–

100

–

27 x

–

100

–

100

–

100

–

100

96 x

100

–

120

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 1.

BASIC INDICATORS

Annual

number

Annual

of under-5

number

Total

Neonatal

deaths

GNI per

of births

mortality population

(thousands) (thousands) (thousands) capita (US$)

rate

2015

Life

expectancy Total adult

literacy rate

at birth

(%)

(years)

2015

2009−2014*

Primary

school net

enrolment

ratio (%)

2010−2014*

Countries

and areas

United Arab Emirates

United Kingdom

United Republic of Tanzania

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela

(Bolivarian Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Under-5

mortality

rank

Under-5 mortality

rate (U5MR)

1990

2015

U5MR by

sex

2015

male

female

Infant mortality

rate

(under 1)

1990

2015

148

166

148

133

110

165

126

191

100

113

9,157

64,716

53,470

321,774

3,432

29,893

265

31,108

93,448

26,832

16,212

15,603

813

2,064

4,025

667

599

1,582

856

645

539

44,600

43,430

920

55,200

16,350

2,090

3,160

12,500 x

1,890

1,300 x

1,680

840

90 x

–

100

61 x

100

–

Sub-Saharan Africa

Eastern and

Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and Pacific

Latin America and Caribbean

CEE/CIS

Least developed countries

World

180

167

198

129

175

105

108

103

116

109

1,001,417

480,144

480,150

455,880

1,743,865

2,097,940

628,992

413,760

954,158

7,309,846

36,812

16,694

18,778

11,039

36,381

29,541

10,772

6,084

30,969

140,244

2,947

1,068

1,789

324

1,870

538

196

108

2,181

5,945

1,661

1,610

1,703

6,561

1,500

6,845

9,634

9,216

845

10,647

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

MAIN DATA SOURCES

Under-5 mortality rate

– Probability of dying between birth and exactly 5 years of age,

expressed per 1,000 live births.

Infant mortality rate

– Probability of dying between birth and exactly 1 year of age,

expressed per 1,000 live births.

Neonatal mortality rate

– Probability of dying during the first 28 completed days of life,

expressed per 1,000 live births.

GNI per capita

– Gross national income (GNI) is the sum of value added by all resident

producers, plus any product taxes (less subsidies) not included in the valuation of output, plus

net receipts of primary income (compensation of employees and property income) from abroad.

Gross national income per capita is GNI divided by midyear population. GNI per capita in US

dollars is converted using the World Bank Atlas method.

Life expectancy at birth

– Number of years newborn children would live if subject to the

mortality risks prevailing for the cross section of population at the time of their birth.

Total adult literacy rate

– Percentage of population aged 15 years and over who can both

read and write with understanding a short simple statement on his/her everyday life.

Primary school net enrolment ratio

– Number of children enrolled in primary or secondary

school who are of official primary school age, expressed as a percentage of the total number of

children of official primary school age. Because of the inclusion of primary-school-aged

children enrolled in secondary school, this indicator can also be referred to as a primary

adjusted net enrolment ratio.

Under-5, infant and neonatal mortality rates

– United Nations Inter-agency Group for Child

Mortality Estimation (UNICEF, World Health Organization, United Nations Population Division

and the World Bank).

Total population and births

– United Nations Population Division.

Under-five deaths

– United Nations Inter-agency Group for Child Mortality Estimation

(UNICEF, World Health Organization, United Nations Population Division and the World Bank).

GNI per capita

– The World Bank.

Life expectancy at birth

– United Nations Population Division.

Total adult literacy rate and primary school enrolment ratio

– UNESCO Institute for

Statistics (UIS).

NOTES

a low-income country (GNI per capita is $1,045 or less).

b lower-middle-income country (GNI per capita is $1,046 to $4,125).

c upper-middle-income country (GNI per capita is $4,126 to $12,735).

d high-income country (GNI per capita is $12,736 or more).

– Data not available.

x Data refer to years or periods other than those specified in the column heading. Such data

are not included in the calculation of regional and global averages.

* Data refer to the most recent year available during the period specified in the column

heading.

THE STATE OF THE WORLD’S CHILDREN 2016

121

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TABLE 2.

NUTRITION

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia (Plurinational State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's Republic

of Korea

Democratic Republic

of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

France

Low

birthweight

(%)

2009–2013*

Early

initiation

of breast-

feeding

(%)

Minimum

Exclusive Introduction

acceptable

to solid,

breast-

semi-solid or diet 6–23

feeding

months

<6 months soft foods 6–8

(%)

months (%)

(%)

2010–2015*

Breast-

feeding

at age 2

(%)

Underweight

(%)

Stunting

(%)

Wasting

(%)

Overweight

(%)

moderate & severe

2010–2015*

Vitamin A

supplemen-

tation, full

coverage

(%)

2014

Adequately

iodized salt

consumption

(%)

2009–2013*

–

12 x

10 x

22 x

15 x

13 x

11 x

–

25 x

13 x

–

17 x

12 x

10 x

11 x

13 x

14 x

20 x

10 x

43 x

–

55 x

–

40 x

43 x

–

73 x

–

41 x

–

55 x

–

57 x

–

39 x

–

34 x

20 p

–

20 x

39 x

–

60 x

–

28 x

–

23 x

–

40 x

–

40 x

–

78 x

–

83 x

–

94 x

–

60 x

–

35 x

–

40 x

–

54 x

31 x

–

16 x

–

40 x

26 x

–

13 x

–

18 x

–

16 x

–

11 x

10 x

–

23 x

–

29 x

–

31 x

20 x

–

23 x

–

10 x

–

10 x

–

11 x

14 x

–

10 x

–

α,w

–

61 x

–

45 x

–

97 x

–

54 x

–

–f

62 x,y

65 x

96 x

–

34 x,f

–f

75 x

–f

–

97 y

–

77 x,f

73 x,f

–

30 x,f

–

88 x

–

–f

–

78 x

62 x

–f

68 x

–

20 x,f

–

122

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 2.

NUTRITION

Early

initiation

of breast-

feeding

(%)

Minimum

Exclusive Introduction

acceptable

to solid,

breast-

semi-solid or diet 6–23

feeding

months

<6 months soft foods 6–8

(%)

months (%)

(%)

2010–2015*

Breast-

feeding

at age 2

(%)

Underweight

(%)

Stunting

(%)

Wasting

(%)

Overweight

(%)

Vitamin A

supplemen-

tation, full

coverage

(%)

2014

Adequately

iodized salt

consumption

(%)

2009–2013*

Countries

and areas

Gabon

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic

Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia (Federated

States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

New Zealand

Low

birthweight

(%)

2009–2013*

moderate & severe

2010–2015*

14 x

12 x

–

28 x

13 x

14 x

–

18 x

14 x

15 x

16 x

27 x

–

56 x

–

41 x

–

41 x

53 x

–

64 x

46 x

–

73 x

–

76 x

–

55 x

–

39 x

–

46 x

–

69 x

12 x

–

27 x

–

29 x

48 x

38 x

–

31 x

21 x

60 x

–

67 x

–

85 x

–

56 x

–

68 x

–

91 x

27 x

–

86 x

–

17 x

–

77 x,y

–

82 x

–

11 x

–

68 x

56 x

–

53 x

–

15 x

65 x

–

15 x

–

37 x

13 x

18 x

28 x

–

11 x

–

17 x

21 x

–

49 x

17 x

20 x

39 x

–

24 x

–

15 x

–

10 x

15 x

–

20 x

–

17 x

22 x

–

–f

100

–

–f

3 x,f

–

–f

–

–f

–

76 x

–f

–

44 x

74 x

–

91 x

–

71 x

21 x

25 f

57 x

–

THE STATE OF THE WORLD’S CHILDREN 2016

123

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 2.

NUTRITION

Early

initiation

of breast-

feeding

(%)

Minimum

Exclusive Introduction

acceptable

to solid,

breast-

semi-solid or diet 6–23

feeding

months

<6 months soft foods 6–8

(%)

months (%)

(%)

2010–2015*

Breast-

feeding

at age 2

(%)

Underweight

(%)

Stunting

(%)

Wasting

(%)

Overweight

(%)

Vitamin A

supplemen-

tation, full

coverage

(%)

2014

Adequately

iodized salt

consumption

(%)

2009–2013*

Countries

and areas

Nicaragua

Niger

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and

the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav Republic

of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

Ukraine

United Arab Emirates

Low

birthweight

(%)

2009–2013*

moderate & severe

2010–2015*

27 x

–

32 x

11 x

21 x

–

13 x

–

17 x

–

10 x

12 x

–

11 x

–

47 x

–

12 x

–

88 x

–

75 x

23 x

61 x

–

80 x

–

46 x

41 x

60 x

15 x

–

56 x

24 x

34 x

–

16 x

–

51 x

–

74 x

–

76 x

–

43 x

13 x

11 x

35 x

34 x

–

90 x

–

16 x

–

83 x

–

72 x

14 x

55 y

–

74 x

–

30 x

–

67 x

27 x

31 x

–

84 x

–

25 x

22 x

37 x

51 x

29 x

–

12 x

23 x

–

10 x

–

23 x

–

19 x

–

13 x

–

33 x

26 x

24 x

–

28 x

19 x

10 x

–

12 x

–

15 x

–

12 x

–

18 x

–

97 x

–

–f

–

93 y

45 x

–

74 x

–f

87 x,f

–f

–

32 x

–

92 x

–

79 x

94 x,y

60 x

–

28 x

97 x

69 x

75 x,f

–

87 x,f

–

124

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 2.

NUTRITION

Early

initiation

of breast-

feeding

(%)

Minimum

Exclusive Introduction

acceptable

to solid,

breast-

semi-solid or diet 6–23

feeding

months

<6 months soft foods 6–8

(%)

months (%)

(%)

2010–2015*

Breast-

feeding

at age 2

(%)

Underweight

(%)

Stunting

(%)

Wasting

(%)

Overweight

(%)

Vitamin A

supplemen-

tation, full

coverage

(%)

2014

Adequately

iodized salt

consumption

(%)

2009–2013*

Countries

and areas

United Kingdom

United Republic of Tanzania

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela

(Bolivarian Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Sub-Saharan Africa

Eastern and Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and Pacific

Latin America and Caribbean

CEE/CIS (excluding the Russian

Federation)

Least developed countries

World

Low

birthweight

(%)

2009–2013*

moderate & severe

2010–2015*

10 x

11 x

–

67 x

–

26 x

–

47 x

–

38 x

–

20 x

13 x

–

13 x

–

α,w

–

53 x

23 x

–

30 x

64 x

–f

–

16 **

–

41 **

–

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

MAIN DATA SOURCES

Low birthweight

– Percentage of infants weighing less than 2,500 grams at

birth.

Early initiation of breastfeeding

– Percentage of infants who are put to the

breast within one hour of birth.

Exclusive breastfeeding <6 months

– Percentage of children aged 0–5 months

who are fed exclusively with breast milk in the 24 hours prior to the survey.

Introduction of solid, semi-solid or soft foods (6–8 months)

– Percentage of

children aged 6–8 months who received solid, semi-solid or soft foods in the

24 hours prior to the survey.

Minimum acceptable diet (6–23 months)

– Percentage of breastfed children

6–23 months of age who had at least the minimum dietary diversity and the

minimum meal frequency during the previous day AND percentage of

non-breastfed children 6–23 months of age who received at least 2 milk feedings

and had at least the minimum dietary diversity not including milk feeds and the

minimum meal frequency during the previous day.

Breastfeeding at age 2

– Percentage of children aged 20–23 months who

received breast milk in the 24 hours prior to the survey.

Underweight

– Moderate and severe: Percentage of children aged 0–59 months

who are below minus two standard deviations from median weight-for-age of the

World Health Organization (WHO) Child Growth Standards.

Stunting

– Moderate and severe: Percentage of children aged 0–59 months who

are below minus two standard deviations from median height-for-age of the WHO

Child Growth Standards.

Wasting

– Moderate and severe: Percentage of children aged 0–59 months who

are below minus two standard deviations from median weight-for-height of the

WHO Child Growth Standards.

Overweight

– Moderate and severe: Percentage of children aged 0–59 months

who are above two standard deviations from median weight-for-height of the

WHO Child Growth Standards.

Vitamin A supplementation, full coverage

– The estimated percentage of

children aged 6–59 months reached with 2 doses of vitamin A supplements

approximately 4–6 months apart in a given calendar year.

Adequately iodized salt consumption

– Percentage of households consuming

adequately iodized salt (15 parts per million or more based on rapid test kits).

Low birthweight

– Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), other

national household surveys, data from routine reporting systems, UNICEF and WHO.

Infant and young child feeding

– DHS, MICS, other national household surveys and UNICEF.

Underweight, stunting, wasting and overweight

– DHS, MICS, other national household surveys, WHO and

UNICEF.

Vitamin A supplementation

– UNICEF.

Adequately iodized salt consumption

– DHS, MICS, other national household surveys and UNICEF.

NOTES

– Data not available.

x Data refer to years or periods other than those specified in the column heading. Such data are not included in the

calculation of regional and global averages, with the exception of 2005–2006 and 2007–2008 data from India, and

2008 data from China. Estimates from data years prior to 2000 are not displayed.

y Data differ from the standard definition or refer to only part of a country. If they fall within the noted reference

period, such data are included in the calculation of regional and global averages.

p Based on small denominators (typically 25–49 unweighted cases). No data based on fewer than 25 unweighted

cases are displayed.

Regional averages for underweight (moderate and severe), stunting (moderate and severe), wasting (moderate and

severe) and overweight (moderate and severe) are estimated using statistical modeling of data from the UNICEF-

WHO-World Bank Joint Global Nutrition Database, 2015 revision. For more information see <data.unicef.org/

nutrition/malnutrition>.

coverage with vitamin A supplements is reported as the lower percentage of 2 annual coverage points

Full

(i.e., lower point between semester 1 (January–June) and semester 2 (July–December) of 2014). Data are only

presented for VAS priority countries; thus aggregates are only based on and representative of these priority countries.

w Identifies countries with national vitamin A supplementation programmes targeted towards a reduced age range.

Coverage figure is reported as targeted.

Identifies countries that are designated ‘priority’. Priority countries for national vitamin A supplementation

programmes are identified as those having high under-five mortality rates (over 70 per 1,000 live births), and/or

evidence of vitamin A deficiency among this age group, and/or a history of vitamin A supplementation programmes.

The most recent survey for this country uses an indicator definition that is not in line with the international

standard. If available, a previous data point that conforms to the standard definition is presented instead.

* Data refer to the most recent year available during the period specified in the column heading.

** Excludes China.

THE STATE OF THE WORLD’S CHILDREN 2016

125

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TABLE 3.

HEALTH

Immunization coverage (%)

Use of improved

drinking water

sources (%)

Use of improved

sanitation

facilities (%)

2015

Pneumonia

Diarrhoea

Malaria

Care seeking

Newborns for children

with

protected

symptoms of

against

BCG DTP1

DTP3

polio3 MCV1 HepB3 Hib3 rota PCV3 tetanus

pneumonia (%)

2014

2010–2015*

House-

Care

Treatment

holds

with oral seeking for Children

with at

sleeping

rehydration children

salts (ORS) with fever under ITNs least one

ITN (%)

(%)

2010–2015*

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia (Plurinational State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's Republic

of Korea

Democratic Republic

of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

2015

total urban rural total urban rural

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

27 86

90 99

82 99

100 –

22 81

–

98 99

78 99

100 –

87 98

–

99 –

62 99

96 –

95 98

99 –

88 98

7 88

33 99

28 99

92 98

43 98

52 99

– 99

84 97

7 98

49 92

54 99

30 93

27 82

99 –

7 74

6 59

91 98

64 99

68 89

31 76

6 95

98 99

92 80

10 84

96 98

89 99

100 –

99 –

100

–

70 x

–

36 x

–

14 x

50 x

–

80 x

–

54 x

–

49 x

–

74 x

–

58 x

–

71 x

–

75 x

–

20 x

–

71 x

–

100 100

90 97

–

85 85

87 93

99 100

94 97

48 73

58 73

100 100

57 93

96 100

100 100

65 47

–

82 84

76 85

99 95

87 75

31 75

53 16

99 97

49 28

91 91

100 98

126

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 3.

HEALTH

Immunization coverage (%)

Use of improved

drinking water

sources (%)

Use of improved

sanitation

facilities (%)

2015

Pneumonia

Diarrhoea

Malaria

Countries

and areas

France

Gabon

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic

Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia (Federated

States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

2015

Care seeking

Newborns for children

with

protected

symptoms of

against

BCG DTP1

DTP3

polio3 MCV1 HepB3 Hib3 rota PCV3 tetanus

pneumonia (%)

2014

2010–2015*

House-

Care

Treatment

holds

with oral seeking for Children

with at

sleeping

rehydration children

salts (ORS) with fever under ITNs least one

ITN (%)

(%)

2010–2015*

total urban rural total urban rural

100 100

93 97

90 94

100 100

89 93

100 100

–

93 98

77 93

79 99

98 98

58 65

–

91 97

100 100

94 97

87 94

96 98

87 94

98 98

100 100

94 97

100 100

97 98

93 99

63 82

67 87

99 99

90 97

99 100

–

82 95

76 89

–

97 100

100 100

52 82

90 96

98 100

99 100

77 97

100 100

95 94

58 58

100 100

96 97

100

–

100

–

100

–

100

–

100

–

100

–

100

–

74 x

–

81 x

–

74 x

–

22 x

38 x

–

89 x

69 x

–

40 x

–

26 x

–

62 x

–

44 x

–

57 x

14 x

–

38 x

–

16 x

23 x

–

71 x

–

27 x

–

84 x

–

63 x

–

51 x

–

27 x

–

98 88

–

77 30

63 17

–

90 92

100 98

35 12

89 41

93 96

98 98

64 25

100 100

98 77

57 40

100 93

92 85

–

100

THE STATE OF THE WORLD’S CHILDREN 2016

127

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 3.

HEALTH

Immunization coverage (%)

Use of improved

drinking water

sources (%)

Use of improved

sanitation

facilities (%)

2015

Pneumonia

Diarrhoea

Malaria

Countries

and areas

Netherlands

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and

the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav Republic

of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

2015

Care seeking

Newborns for children

with

protected

symptoms of

against

BCG DTP1

DTP3

polio3 MCV1 HepB3 Hib3 rota PCV3 tetanus

pneumonia (%)

2014

2010–2015*

House-

Care

Treatment

holds

with oral seeking for Children

with at

sleeping

rehydration children

salts (ORS) with fever under ITNs least one

ITN (%)

(%)

2010–2015*

total urban rural total urban rural

100 100

87 99

58 100

69 81

–

100 100

93 95

91 94

–

95 98

40 88

98 100

87 91

92 94

98 99

100 100

100 –

– 100

88 97

100 100

97 99

76 87

–

96 100

–

99 97

–

97 99

–

79 93

99 99

–

63 85

100 100

81 93

–

93 100

59 67

100 100

96 99

58 51

–

95 98

74 94

100 100

90 92

74 93

98 98

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100 –

–

56 98

5 76

25 74

100 99

98 –

95 99

51 85

100 –

58 99

13 81

78 95

53 94

71 87

97 93

100 99

98 90

100 99

67 97

63 98

59 96

63 99

– 99

92 89

–

100

–

100

–

100

–

58 x

–

63 x

–

73 x

13 x

65 x

–

58 x

–

77 x

93 x

–

74 x

–

51 x

–

38 x

13 x

40 x

–

50 x

–

50 x

–

40 x

44 x

–

68 x

–

65 x

–

85 x

–

79 x

–

40 x

11 x

–

30 x

–

49 x

12 x

–

128

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 3.

HEALTH

Immunization coverage (%)

Use of improved

drinking water

sources (%)

Use of improved

sanitation

facilities (%)

2015

Pneumonia

Diarrhoea

Malaria

Countries

and areas

Uganda

Ukraine

United Arab Emirates

United Kingdom

United Republic of Tanzania

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela

(Bolivarian Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Sub-Saharan Africa

Eastern and

Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and Pacific

Latin America and Caribbean

CEE/CIS

Least developed countries

World

2015

Care seeking

Newborns for children

with

protected

symptoms of

against

BCG DTP1

DTP3

polio3 MCV1 HepB3 Hib3 rota PCV3 tetanus

pneumonia (%)

2014

2010–2015*

House-

Care

Treatment

holds

with oral seeking for Children

with at

sleeping

rehydration children

salts (ORS) with fever under ITNs least one

ITN (%)

(%)

2010–2015*

total urban rural total urban rural

100

–

100

–

76 19

98 96

100 98

100 99

46 16

98 100

94 96

– 100

93 58

–

100

–

100

–

68 x

72 x

–

28 x

38 x

–

87 **

–

83 **

73 **

–

63 **

52 ‡

46 **

–

41 ‡**

–

50 ‡

66 **

–

54 ‡**

–

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

MAIN DATA SOURCES

Use of improved drinking water sources

– Percentage of the population using any of the following as their main

drinking water source: drinking water supply piped into dwelling, plot, yard or neighbor’s yard; public tap or standpipe;

tube well or borehole; protected dug well; protected spring; rainwater; bottled water plus one of the previous sources as

their secondary source.

Use of improved sanitation facilities

– Percentage of the population using any of the following sanitation facilities,

not shared with other households: flush or pour-flush latrine connected to a piped sewerage system, septic tank or pit

latrine; ventilated improved pit latrine; pit latrine with a slab; composting toilet.

EPI

– Expanded Programme on Immunization: The first diseases targeted by the EPI were diphtheria, pertussis

(whooping cough) and tetanus (DPT); measles; poliomyelitis; and tuberculosis (TB). Additional vaccines have been added

to the original six recommended in 1974 and include vaccines to protect against hepatitis B (HepB), and Haemophilus

influenzae type b (Hib). Pneumococcal conjugate vaccine (PCV) and rotavirus vaccine, also recommended by the WHO,

are increasingly being added to national schedules.

BCG

– Percentage of live births who received bacille Calmette-Guérin (vaccine against tuberculosis).

DTP1

– Percentage of surviving infants who received their first dose of diphtheria, pertussis and tetanus vaccine.

DTP3

– Percentage of surviving infants who received three doses of diphtheria, pertussis and tetanus vaccine.

Polio3

– Percentage of surviving infants who received three doses of the polio vaccine.

MCV1

– Percentage of surviving infants who received the first dose of the measles-containing vaccine.

HepB3

– Percentage of surviving infants who received three doses of hepatitis B vaccine.

Hib3

– Percentage of surviving infants who received three doses of Haemophilus influenzae type b vaccine.

rota

– Percentage of surviving infants who received the last dose of rotavirus vaccine as recommended.

PCV3

– Percentage of surviving infants who received three doses of pneumococcal conjugate vaccine.

Newborns protected against tetanus

– Percentage of newborns protected at birth against tetanus.

Care seeking for children with symptoms of pneumonia

– Percentage of children under age 5 with symptoms of

pneumonia (cough and fast or difficult breathing due to a problem in the chest) in the two weeks preceding the survey

for whom advice or treatment was sought from a health facility or provider.

Diarrhoea treatment with oral rehydration salts (ORS)

– Percentage of children under age 5 who had diarrhoea in

the two weeks preceding the survey and who received oral rehydration salts (ORS packets or pre-packaged ORS fluids).

Care seeking for children with fever

– Percentage of children under age 5 with fever for whom advice or treatment

was sought from a health facility or provider. Excludes drug vendor, stores, shops and traditional healer. In some

countries, particularly non-malaria endemic countries, pharmacies have also been excluded from the calculation.

Children sleeping under ITNs

– Percentage of children under age 5 who slept under an insecticide-treated mosquito

net the night prior to the survey.

Households with at least one ITN

– Percentage of households with at least one insecticide-treated mosquito net.

Use of improved drinking water sources and improved sanitation facilities

– WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP).

Immunization

– UNICEF and WHO.

Care seeking for children with symptoms of pneumonia

– Demographic and

Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS) and other

national household surveys.

Diarrhoea treatment with oral rehydration salts (ORS)

– DHS, MICS and

other national household surveys.

Malaria treatment

– DHS, MICS, Malaria Indicator Surveys (MIS) and other

national household surveys.

NOTES

− Data not available.

x Data refer to years or periods other than those specified in the column

heading. Such data are not included in the calculation of regional and global

averages. Estimates from data years prior to 2000 are not displayed.

Coverage for DPT1 should be at least as high as DPT3. Discrepancies where

DPT1 coverage is less than DPT3 reflect deficiencies in the data collection

and reporting process. UNICEF and WHO are working with national and

territorial systems to eliminate these discrepancies.

WHO and UNICEF have employed a model to calculate the percentage of

births that can be considered as protected against tetanus because pregnant

women were given two doses or more of tetanus toxoid (TT) vaccine. The

model aims to improve the accuracy of this indicator by capturing or includ-

ing other potential scenarios where women might be protected (e.g., women

who receive doses of TT in supplemental immunization activities). A fuller

explanation of the methodology can be found at <data.unicef.org>.

* Data refer to the most recent year available during the period specified in

the column heading.

** Excludes China.

‡ Excludes India.

THE STATE OF THE WORLD’S CHILDREN 2016

129

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 4.

HIV/AIDS

Mother-to-

child

Paediatric

transmission infections

Adult HIV

preva-

lence (%)

2014

People of all ages

living with HIV

(thousands)

2014

high

Children

Women

living

living with

with HIV

HIV

(thousands) (thousands)

2014

estimate

Prevention among young people (aged 15–24)

HIV prevalence

among

young people (%)

2014

Condom use

among

Comprehensive

knowledge of young people with

multiple partners

HIV (%)

(%) 2010–2014*

2010–2014*

male

female

HIV testing

Orphans

Children

Young people who

Children

were tested for HIV orphaned orphaned due Orphan

in the last 12 months by AIDS to all causes school

and received results (thousands) (thousands) attendance

ratio (%)

2014

(%) 2010–2014*

2014

male

female

estimate

2010–2014*

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia

(Plurinational State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's

Republic of Korea

Democratic Republic

of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

France

estimate estimate low

total male female male female

<0.1

–

<0.1

–

2.4

–

0.5

0.2

–

0.1

–

<0.1

–

0.5

–

1.2

1.1

–

0.3

–

25.2

–

0.9

1.1

0.6

4.8

–

4.3

2.5

0.3

–

0.4

–

2.8

–

0.3

3.5

–

0.3

–

1.0

0.2

1.6

–

1.0

0.3

<0.1

0.5

6.2

0.7

–

1.2

0.1

–

300

–

130

–

390

–

110

660

–

140

210

–

120

–

460

–

450

–

730

–

220

–

370

–

610

–

120

170

–

420

–

400

–

600

<0.5

–

430

–

170

–

410

–

130

110

140

790

–

150

270

–

160

–

510

–

490

–

100

–

970

–

160

–

210

–

350

–

110

–

250

–

230

–

390

<0.5

–

<0.5

–

<0.2

–

<0.5

–

<0.2

–

<0.2

–

<0.5

–

110

–

<0.1

–

<0.1

–

0.8

–

0.2

0.1

–

<0.1

–

<0.1

–

0.2

–

0.4

0.3

–

0.2

–

7.2

–

0.5

0.4

0.5

0.2

1.7

–

1.7

0.8

0.1

–

0.2

–

1.2

–

0.1

1.1

–

0.2

–

0.4

<0.1

0.6

–

0.4

0.1

<0.1

0.2

1.9

0.3

–

0.5

<0.1

–

<0.1

–

<0.1

–

0.6

–

0.2

–

0.1

–

<0.1

–

0.1

–

0.3

0.2

–

0.2

–

5.7

–

0.4

0.3

0.8

0.1

1.2

–

1.4

0.6

0.2

–

0.2

–

0.9

–

0.1

0.9

–

0.2

–

0.3

<0.1

0.5

–

0.4

0.2

<0.1

0.2

1.3

0.2

–

0.5

<0.1

–

<0.1

–

<0.1

–

1.1

–

0.1

<0.1

–

<0.1

–

<0.1

–

0.2

–

0.4

–

0.1

–

8.9

–

0.5

0.4

0.3

0.2

2.1

–

2.0

1.0

<0.1

–

0.1

–

1.4

–

<0.1

1.4

–

<0.1

–

0.5

<0.1

0.8

–

0.4

<0.1

0.2

2.5

0.3

–

0.6

<0.1

–

22 x

–

32 x

–

28 x

–

36 x

–

25 x

–

22 x

–

18 x

–

55 x

–

29 x

–

41 x

–

64 p

–

26 x,p

–

57 p

–

120

–

310

–

130

–

230

–

290

–

450

–

1,300

–

440

–

100

–

830

580

–

1,200

–

300

970

–

210

–

1,200

–

4,000

–

140

–

3,500

–

85 x

–

101

–

117

–

108

100

–

130

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 4.

HIV/AIDS

Mother-to-

child

Paediatric

transmission infections

Adult HIV

preva-

lence (%)

2014

People of all ages

living with HIV

(thousands)

2014

high

Children

Women

living

living with

with HIV

HIV

(thousands) (thousands)

2014

estimate

Prevention among young people (aged 15–24)

HIV prevalence

among

young people (%)

2014

Condom use

among

Comprehensive

knowledge of young people with

multiple partners

HIV (%)

(%) 2010–2014*

2010–2014*

male

female

HIV testing

Orphans

Countries

and areas

Gabon

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic

Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia (Federated

States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

New Zealand

Children

Young people who

Children

were tested for HIV orphaned orphaned due Orphan

in the last 12 months by AIDS to all causes school

and received results (thousands) (thousands) attendance

ratio (%)

2014

(%) 2010–2014*

2014

male

female

estimate

2010–2014*

estimate estimate low

total male female male female

3.9

1.8

0.3

–

1.5

–

0.5

1.6

3.7

1.8

1.9

–

0.4

–

0.3

0.5

0.1

–

0.3

–

1.6

–

0.2

5.3

–

0.3

–

<0.1

23.4

1.2

–

0.3

10.0

0.5

–

1.4

–

0.7

0.9

0.2

–

0.1

10.6

0.7

16.0

–

0.2

–

250

–

120

140

–

2,100

660

–

1,400

–

310

–

1,100

100

–

130

–

190

–

1,500

210

260

–

190

–

100

130

–

1,600

600

–

1,200

–

<0.2

290

–

990

–

110

–

140

–

1,300

190

240

–

330

–

140

160

–

2,800

720

110

–

1,600

–

340

–

1,100

110

–

170

–

270

–

2,100

230

280

–

140

–

760

230

–

700

–

<0.2

170

–

560

–

830

130

–

<0.5

–

130

–

160

–

<0.5

–

130

–

160

–

0.9

0.5

0.2

–

0.5

–

0.2

0.6

1.2

0.9

0.7

–

0.2

–

0.4

<0.1

–

0.1

–

0.7

–

<0.1

2.8

–

<0.1

0.1

–

<0.1

8.0

0.3

–

0.1

3.2

<0.1

–

0.6

–

0.3

0.2

<0.1

–

<0.1

4.5

0.3

4.0

–

<0.1

–

0.6

0.4

0.3

–

0.4

–

0.2

0.4

0.8

0.7

0.5

–

0.2

–

0.4

<0.1

–

0.1

–

0.8

–

<0.1

2.2

–

<0.1

0.1

–

<0.1

5.9

0.3

–

0.2

2.4

0.1

–

0.5

–

0.2

0.1

–

<0.1

2.4

0.4

2.9

–

<0.1

–

1.3

0.7

<0.1

–

0.6

–

0.2

0.7

1.5

1.2

0.8

–

0.2

–

0.4

<0.1

–

<0.1

–

0.6

–

<0.1

3.5

–

<0.1

0.2

–

<0.1

10.2

0.4

–

0.1

4.1

<0.1

–

0.7

–

0.4

0.2

<0.1

–

<0.1

6.6

0.3

5.0

–

<0.1

–

24 x

–

47 x

–

36 x

10 y

–

36 y

–

49 x

–

29 x

–

39 x

–

10 x

–

22 x

54 x

–

20 x

11 y

20 y

–

43 y

–

44 x

–

39 x

–

35 x,y

–

27 x

–

13 x

–

27 x,p

–

17 x,p

–

2 x,p

–

45 x

–

8 p

–

9 x,p

–

8 x,p

–

18 x

–

17 x

–

29 x

–

40 x

–

120

–

530

–

650

–

530

–

610

–

950

–

120

–

300

–

29,600

–

2,000

–

120

190

–

990

–

810

–

1,800

–

100

–

101

–

108

–

72 x

–

82 x

–

98 x

–

74 x

–

100 p

–

102

–

102

–

60 x

–

23 x,p

–

17 x,p

–

THE STATE OF THE WORLD’S CHILDREN 2016

131

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 4.

HIV/AIDS

Mother-to-

child

Paediatric

transmission infections

Adult HIV

preva-

lence (%)

2014

People of all ages

living with HIV

(thousands)

2014

high

Children

Women

living

living with

with HIV

HIV

(thousands) (thousands)

2014

estimate

Prevention among young people (aged 15–24)

HIV prevalence

among

young people (%)

2014

Condom use

among

Comprehensive

knowledge of young people with

multiple partners

HIV (%)

(%) 2010–2014*

2010–2014*

male

female

HIV testing

Orphans

Countries

and areas

Nicaragua

Niger

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and

the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav

Republic of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

Ukraine

United Arab Emirates

Children

Young people who

Children

were tested for HIV orphaned orphaned due Orphan

in the last 12 months by AIDS to all causes school

and received results (thousands) (thousands) attendance

ratio (%)

2014

(%) 2010–2014*

2014

male

female

estimate

2010–2014*

estimate estimate low

total male female male female

0.3

0.5

3.2

–

0.2

<0.1

–

0.6

0.7

0.4

<0.1

–

0.6

–

2.8

–

0.8

–

0.5

–

1.4

–

<0.1

–

0.5

18.9

2.7

–

<0.1

–

0.2

1.0

27.7

0.2

–

<0.1

0.4

1.1

–

2.4

–

<0.1

–

7.3

–

3,400

–

210

–

6,800

190

–

210

–

450

–

110

–

1,500

–

3,100

–

190

–

6,500

130

–

210

–

<0.1

400

–

1,400

–

3,700

–

180

–

100

–

230

–

7,500

270

–

220

–

490

–

140

–

1,800

–

1,700

–

120

–

<0.5

–

<0.1

–

3,900

100

–

120

–

<0.2

190

–

770

–

<0.5

–

380

–

<0.5

–

<0.2

–

340

–

<0.1

–

150

–

0.1

1.0

–

<0.1

–

0.2

0.3

0.1

<0.1

–

0.2

–

1.2

–

0.2

–

0.1

–

0.3

–

<0.1

–

0.2

6.1

1.0

–

<0.1

–

0.1

0.4

11.3

<0.1

–

<0.1

0.1

0.3

–

0.7

–

<0.1

–

3.0

–

0.2

<0.1

0.7

–

<0.1

–

0.2

0.3

0.1

<0.1

–

0.1

–

1.0

–

0.2

–

0.1

–

0.2

–

<0.1

–

0.2

4.0

0.7

–

<0.1

–

0.1

0.3

7.2

<0.1

–

<0.1

0.1

0.3

–

0.5

–

<0.1

–

2.3

–

<0.1

0.2

1.3

–

<0.1

–

0.1

0.2

0.1

<0.1

–

0.3

–

1.3

–

0.2

–

<0.1

–

0.4

–

<0.1

–

0.2

8.1

1.3

–

<0.1

–

0.2

0.5

15.5

<0.1

–

<0.1

0.1

0.2

–

0.8

–

<0.1

–

3.7

–

35 x

–

61 x

–

22 x

21 x

–

29 x

–

27 x

54 x

–

39 x

–

42 x,p

–

58 p

–

59 x

–

39 x

–

51 x

–

29 p

–

42 p

–

18 x

–

59 p

–

67 x

–

14 x

–

29 x

–

1,600

–

2,300

–

650

–

9,900

–

300

–

500

–

310

–

630

2,800

570

–

330

–

1,900

–

109

123

–

101

79 p

–

100

–

78 x

98 x

–

100

–

94 p

–

132

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 4.

HIV/AIDS

Mother-to-

child

Paediatric

transmission infections

Adult HIV

preva-

lence (%)

2014

People of all ages

living with HIV

(thousands)

2014

high

Children

Women

living

living with

with HIV

HIV

(thousands) (thousands)

2014

estimate

Prevention among young people (aged 15–24)

HIV prevalence

among

young people (%)

2014

Condom use

among

Comprehensive

knowledge of young people with

multiple partners

HIV (%)

(%) 2010–2014*

2010–2014*

male

female

HIV testing

Orphans

Countries

and areas

United Kingdom

United Republic of

Tanzania

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela

(Bolivarian Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Sub-Saharan Africa

Eastern and

Southern Africa

West and Central Africa

Middle East and

North Africa

South Asia

East Asia and Pacific

Latin America and

Caribbean

CEE/CIS

Least developed

countries

World

Children

Young people who

Children

were tested for HIV orphaned orphaned due Orphan

in the last 12 months by AIDS to all causes school

and received results (thousands) (thousands) attendance

ratio (%)

2014

(%) 2010–2014*

2014

male

female

estimate

2010–2014*

estimate estimate low

total male female male female

–

5.3

–

0.7

0.2

–

0.6

0.5

<0.1

12.4

16.7

–

1,500

–

110

250

1,200

1,600

–

1,300

–

220

1,100

1,500

–

1,900

–

180

280

1,200

1,600

–

800

–

540

830

–

140

–

<0.5

100

150

–

1.8

–

0.3

<0.1

–

0.2

0.3

<0.1

3.7

5.9

–

1.4

–

0.4

<0.1

–

0.2

0.3

<0.1

3.3

4.8

–

2.1

–

0.1

<0.1

–

0.2

<0.1

4.2

7.0

–

31 x

15 x

–

2 x,y

–

810

–

380

570

–

2,600

–

950

810

–

4.7

7.3

2.3

0.1

0.2

0.5

0.6

1.9

0.8

25,800

19,200

6,600

220

2,200

2,700

2,000

1,500

10,900

36,900

24,000 28,700

18,100 21,900

5,900 7,500

130

300

13,800

10,300

3,400

800

900

670

610

5,600

17,400

2,300

1,600

730

140

1,100

2,600

1.6

2.5

0.8

<0.1

0.1

0.2

0.8

0.3

1.2

1.8

0.6

<0.1

0.1

0.2

0.1

0.6

0.3

2.0

3.2

0.9

<0.1

0.1

0.2

1.0

0.4

–

8‡

27 **

–

23 ‡**

–

11,000

7,600

3,400

580

770

550

250

5,200

13,300

46,600

21,700

24,700

6,500

37,800

23,000

10,200

7,700

35,500

140,000

101

–

83 ‡

–

950 3,700

2,400 3,000

1,700 2,300

1,300 1,800

13,100

34,300 41,400

9,900

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

MAIN DATA SOURCES

Adult HIV prevalence

– Estimated percentage of adults (aged 15–49) living

with HIV as of 2014.

People of all ages living with HIV

– Estimated number of people (all ages)

living with HIV as of 2014.

Women living with HIV

– Estimated number of women (aged 15+) living

with HIV as of 2014.

Children living with HIV

– Estimated number of children (aged 0–14) living

with HIV as of 2014.

HIV prevalence among young people

– Estimated percentage of young

men and women (aged 15–24) living with HIV as of 2014.

Comprehensive knowledge of HIV

– Percentage of young men and

women (aged 15–24) with comprehensive, correct knowledge of HIV.

Comprehensive, correct knowledge about HIV and AIDS is defined as correctly

identifying the two major ways of preventing the sexual transmission of HIV

(using condoms and limiting sex to one faithful, uninfected partner), rejecting

the two most common local misconceptions about HIV transmission and

knowing that a healthy-looking person can transmit HIV.

Condom use among young people with multiple partners–

Among

young men and women (aged 15–24) who reported having had more than one

sexual partner in the last 12 months, the percentage who reported the use of

a condom the last time they had sex with any partner.

Tested for HIV in the last 12 months and received results

– Percentage

of young men and women (aged 15–24) who were tested for HIV in the last

12 months and received the result of the most recent test.

Children orphaned by AIDS

– Estimated number of children (aged 0–17)

who have lost one or both parents to AIDS as of 2014.

Children orphaned due to all causes

– Estimated number of children

(aged 0–17) who have lost one or both parents due to any cause as of 2014.

Orphan school attendance ratio

– Percentage of children (aged 10–14)

who have lost both biological parents and who are currently attending school

as a percentage of the non-orphaned children of the same age who live with

at least one parent who are attending school.

Estimated adult HIV prevalence

– UNAIDS 2014 HIV and AIDS estimates, based on 2015 Spectrum modelling,

July 2015.

Estimated number of people living with HIV

– UNAIDS 2014 HIV and AIDS estimates, based on 2015 Spectrum modelling, July 2015.

Estimated number of women living with HIV

– UNAIDS 2014 HIV and AIDS estimates, based on 2015 Spectrum modelling,

July 2015.

Estimated number of children living with HIV

– UNAIDS 2014 HIV and AIDS estimates, based on 2015 Spectrum modelling,

July 2015.

HIV prevalence among young people

– UNAIDS 2014 HIV and AIDS estimates, based on 2015 Spectrum modelling, July 2015.

Comprehensive knowledge of HIV

– AIDS Indicator Surveys (AIS), Demographic and Health Surveys (DHS), Multiple Indicator Cluster

Surveys (MICS) and other national household surveys; DHS STATcompiler, <www.statcompiler.com>.

Condom use among young people with multiple partners

– AIS, DHS, MICS and other national household surveys; DHS

STATcompiler, <www.statcompiler.com>.

Tested for HIV in the last 12 months and received results

– AIS, DHS, MICS and other national household surveys; DHS

STATcompiler, <www.statcompiler.com>.

Children orphaned by AIDS

– UNAIDS 2014 HIV and AIDS estimates, based on 2015 Spectrum modelling, July 2015.

Children orphaned by all causes

– UNAIDS 2014 HIV and AIDS estimates, based on 2015 Spectrum modelling,

July 2015.

Orphan school attendance ratio

– AIS, DHS, MICS and other national household surveys; DHS STATcompiler,

www.statcompiler.com.

NOTES

−

Data not available.

x Data refer to years or periods other than those specified in the column heading. Such data are not included in the calculation of

regional and global averages. Estimates from years prior to 2006 are not displayed.

y Data differ from the standard definition or refer to only part of a country. If they fall within the noted reference period, such data

are included in the calculation of regional and global averages.

p Based on small denominators (typically 25–49 unweighted cases). No data based on fewer than 25 unweighted cases are

displayed.

* Data refer to the most recent year available during the period specified in the column heading.

** Excludes China.

‡ Excludes India.

THE STATE OF THE WORLD’S CHILDREN 2016

133

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 5.

EDUCATION

Pre-primary

school

participation

Youth (15–24

years) literacy

rate (%)

Mobile phones /

Internet users per Gross enrolment

ratio (%)

100 population

2014

internet

users

2010–2014*

male

Gross

enrolment

ratio (%)

2010–2014*

Primary school participation

Secondary school participation

Out-of-school Survival rate to

last primary

Net enrolment Net attendance

Net enrolment Net attendance children of pri-

grade (%)

ratio (%)

mary school age

ratio (%)

2010–2014*

2009–2014*

male

female

2010–2014*

rate

(%)

2010–

2014*

2009–

2014*

2010–2014*

male

2009–2014*

female

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia (Plurinational State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's Republic

of Korea

Democratic Republic

of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

2009–2014*

male

mobile

female phones

female male female male female

number admin. survey

(000)

data

female male

94 x

–

100

–

100

–

100

–

55 x

80 x

100

47 x

90 x

–

100

–

100

–

100 x

–

100

63 x

–

89 x

–

100

–

100

–

100

–

31 x

68 x

100

33 x

88 x

–

100

–

100

–

100 x

–

100

47 x

–

105

132

159

116

131

152

111

173

129

123

114

100

167

139

110

138

122

133

113

108

–

144

106

104

130

126

127

104

114

144

161

–

110

102

–

107

119

–

125

117

106

84 x

185

17 x

–

108

101

–

103

118

–

121

118

103

85 x

189

19 x

131

114

122

–

157

101

111

96 x

107

103

107

–

109

105

114

131

101

–

110

–

107

127

116

120

107

115

102

109

130 x

108

107

108

111

100

100 x

112

102

118

105

113

106

118

101

104

105

–

111

–

115

–

100

110

–

111 x

–

106

102

–

105

109

–

115

105

109

120

–

103

–

107

–

108

–

128

110

113

107 100

100

–

109

–

129 x 97 x

102

115

104

–

110

100

–

100 x

102

101

118

113

105

112

100

106

97 x

–

96 x

–

100

–

97 x

–

100

–

97 x

–

99 x

–

62 y

–

100

–

69 y

–

86 x

100

–

97 x

86 x,y

–

84 y

–

90 y

97 y

–

71 y

–

97 y

91 y

61 x

57 y

–

64 y

–

46 y

–

67 y

–

87 x

–

97 x

88 x,y

–

86 y

–

92 y

97 y

–

68 y

–

97 y

91 y

60 x

56 y

–

67 y

–

624

–

907

169

–

957

193

207

357

110

–

129 x

0.03

879

–

47 x

–

32 x

–

89 x

66 x

–

96 x

100

98 x

–

83 x

–

100 x

–

100 x

–

99 x

96 x

–

100

–

88 x

96 x

100

–

88 x

–

89 x

82 x

–

92 x

–

19 x

–

90 x

–

100

–

92 x

–

99 x

–

84 x

–

82 x

–

40 x

–

74 x

–

98 x

–

29 x

–

97 x

–

100

–

37 x

–

80 x

–

99 x

–

21 x

–

47 y

–

87 y

–

77 x

–

78 x

36 x

–

80 y

87 y

–

45 x

–

81 y

–

23 x

–

13 y

–

27 y

–

85 y

–

85 x

–

75 x

44 x

–

84 y

88 y

–

37 x

–

83 y

–

22 x

21 x

–

18 y

–

0.2 x

179

405

0.3

2,124

134

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 5.

EDUCATION

Pre-primary

school

participation

Youth (15–24

years) literacy

rate (%)

Mobile phones /

Internet users per Gross enrolment

ratio (%)

100 population

2014

internet

users

2010–2014*

male

Gross

enrolment

ratio (%)

2010–2014*

Primary school participation

Secondary school participation

Out-of-school Survival rate to

last primary

Net enrolment Net attendance

Net enrolment Net attendance children of pri-

grade (%)

ratio (%)

mary school age

ratio (%)

2010–2014*

2009–2014*

male

female

2010–2014*

rate

(%)

2010–

2014*

2009–

2014*

2010–2014*

male

2009–2014*

female

Countries

and areas

Finland

France

Gabon

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic

Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia

(Federated States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

2009–2014*

male

mobile

female phones

female male female male female

number admin. survey

(000)

data

female male

–

100

–

74 x

–

100

–

100

83 x

–

100

89 x

100

98 x

63 x

100

–

100

–

99 x

–

66 x

–

83 x

–

100

–

70 x

–

100

–

100

82 x

–

100

79 x

100

99 x

37 x

100

–

100

–

99 x

–

48 x

–

91 x

140

101

171

120

125

120

115

110

107

–

118

111

129

105

121

154

107

120

148

172

218

134

117

161

109

147

149

189

149

127

132

–

105

163

132

114

–

108

–

110

114

–

107

113

101

102

–

102

–

112

101

–

108

–

109

117

–

110

112

108

–

119

104

–

101

106

144

116

103

107

105

106

118

176

–

110

101

105

106

107

–

103

104

102

–

102

111

103

108

119

103

102

108

100

–

103

101

147

145

–

104 x

100

106

102

105

–

103

119

109

101

113

101

105

140

118

103

106

101

102

110

175

–

108

117

106

112

–

103

105

101

–

101

111

112

115

105

107

113

–

100

–

100

–

100

–

100

–

100

–

100

–

96 x

–

91 y

–

85 x

–

68 y

–

97 x

–

91 x

–

92 y

–

82 x

–

71 y

–

97 x

–

88 x

–

413

0.2

258

449

–

0.4

6,402

1,900

–

119

956

0.3

442

–

0.03

0.3

–

48 x

–

1,030

0.02

151

357

–

678

284

–

100

–

68 x

–

79 x

–

83 x

–

75 x

–

98 x

–

100

–

96 x

–

95 x

–

100

–

100

–

93 x

84 x

76 x

–

100 x

–

60 x

89 x

–

100

–

100

–

59 x

–

39 x

–

49 x

–

36 x

102

106

–

105

–

101 100

147

–

148

–

101 x 97 x

105

–

101

104

–

101

113

100

110

–

THE STATE OF THE WORLD’S CHILDREN 2016

135

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 5.

EDUCATION

Pre-primary

school

participation

Youth (15–24

years) literacy

rate (%)

Mobile phones /

Internet users per Gross enrolment

ratio (%)

100 population

2014

internet

users

2010–2014*

male

Gross

enrolment

ratio (%)

2010–2014*

Primary school participation

Secondary school participation

Out-of-school Survival rate to

last primary

Net enrolment Net attendance

Net enrolment Net attendance children of pri-

grade (%)

ratio (%)

mary school age

ratio (%)

2010–2014*

2009–2014*

male

female

2010–2014*

rate

(%)

2010–

2014*

2009–

2014*

2010–2014*

male

2009–2014*

female

Countries

and areas

Nauru

Nepal

Netherlands

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and the

Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav Republic

of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

2009–2014*

male

mobile

female phones

female male female male female

number admin. survey

(000)

data

female male

–

85 x

76 x

–

100

97 x

100

–

100

–

83 x

100

–

100

–

44 x

100

–

100

–

89 x

58 x

–

100

98 x

100

–

100

–

77 x

100

–

100

–

30 x

100

–

100

–

116

112

115

–

116

158

106

104

111

149

112

146

116

108

106

155

119

103

105

119

180

122

162

147

117

112

149

108

103

171

128

137

144

106

119

147

–

113

102 x

53 x

106

–

117

–

125

99 x

56 x

108

–

116

–

110

130

107

124

127

100

106

101

116

107

120

108

101

117

101

112

104

100

136

–

106

114

109

101

104

130

–

103

116

–

102

101

105

102

122

118

117

103

138

129

110

108

100

141

106

123

125

100

115

112

104

109

104

101

117

101

108

101

139

–

103

106

109

108

101

105

130

–

101

112

–

106

100

118

108

124

103

136

121

110

104

–

100

–

100

–

100

97 x

100

–

100

–

100

96 x

97 y

–

71 y

100

–

87 x

92 y

88 x

–

87 y

–

100

–

88 y

–

63 x,y

24 x

–

97 x

93 y

98 x

98 y

–

70 y

100

–

89 x

93 y

89 x

–

89 y

–

89 y

–

69 x,y

19 x

–

96 x

93 y

98 x

–

0.2

174

1,233

8,735

–

5,612

0.01

160

162

402

101

141

–

79 x

–

76 x

–

100

–

99 x

100

–

100

–

89 x

–

56 x

–

90 x

–

100

–

100 x

–

76 x

–

100

–

100

–

88 x

–

100 x

100

–

100 x

100

–

98 x

–

100

–

65 y

–

38 x

–

81 x

80 y

55 x

–

21 y

–

51 y

–

29 x,y

–

64 x

82 y

84 x

72 y

–

48 x

–

80 x

82 y

70 x

–

25 y

–

70 y

–

30 x,y

–

65 x

84 y

90 x

0.1

121

634

0.5

–

1,022

2,713

563

202 x

136

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 5.

EDUCATION

Pre-primary

school

participation

Youth (15–24

years) literacy

rate (%)

Mobile phones /

Internet users per Gross enrolment

ratio (%)

100 population

2014

internet

users

2010–2014*

male

Gross

enrolment

ratio (%)

2010–2014*

Primary school participation

Secondary school participation

Out-of-school Survival rate to

last primary

Net enrolment Net attendance

Net enrolment Net attendance children of pri-

grade (%)

ratio (%)

mary school age

ratio (%)

2010–2014*

2009–2014*

male

female

2010–2014*

rate

(%)

2010–

2014*

2009–

2014*

2010–2014*

male

2009–2014*

female

Countries

and areas

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

Ukraine

United Arab Emirates

United Kingdom

United Republic of Tanzania

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela

(Bolivarian Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Sub-Saharan Africa

Eastern and Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and Pacific

Latin America and Caribbean

CEE/CIS

Least developed countries

World

2009–2014*

male

mobile

female phones

female male female male female

number admin. survey

(000)

data

female male

100

–

100

94 x

–

100

70 x

100

–

100

97 x

–

100

58 x

128

136

144

178

124

110

161

147

–

105

–

103

–

113

107

101

109

103

106

109

100

114

125

102

110

106

103

109

107

102

111

105

107

109

110

122

100

109

104

102

–

94 x,y 92 x,y

99 x

97 x,y 99 x,y

100

–

75 y

78 y

–

95 x

76 y

78 y

91 x

93 x

–

357

–

0.1

477

1,715

1,774

0.5

101

–

243

127

583

325

283

–

95 x

71 x

–

95 x

–

72 x

100

–

91 x

–

100 x

88 x

82 x

73 x

87 x

–

75 x

95 x

35 x

–

91 x

22 y

–

64 x

95 x

47 x

–

90 x

26 y

–

100

107

101

115

128

103

108

100

108

111

118

106

101

109

102

112

117

103

101

107

–

32,960

11,826

18,403

4,852

10,259

6,500

4,020

954

24,360

59,204

–

93 **

–

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

MAIN DATA SOURCES

Youth literacy rate

– Number of literate persons aged 15–24 years, expressed as a percentage of the total population in that group.

Mobile phones

– The number of active subscriptions to a public mobile telephone service, including the number of prepaid SIM

cards active during the past three months.

Internet users

– The estimated number of Internet users out of the total population. This includes those using the Internet from any

device (including mobile phones) in the last 12 months.

Pre-primary school gross enrolment ratio

– Number of children enrolled in pre-primary school, regardless of age, expressed as a

percentage of the total number of children of official pre-primary school age.

Primary school gross enrolment ratio

– Number of children enrolled in primary school, regardless of age, expressed as a

percentage of the total number of children of official primary school age.

Primary school net enrolment ratio

– Number of children enrolled in primary or secondary school who are of official primary

school age, expressed as a percentage of the total number of children of official primary school age. Because of the inclusion of

primary-school-aged children enrolled in secondary school, this indicator can also be referred to as a primary adjusted net enrolment

ratio.

Primary school net attendance ratio

– Number of children attending primary or secondary school who are of official primary

school age, expressed as a percentage of the total number of children of official primary school age. Because of the inclusion of

primary-school-aged children attending secondary school, this indicator can also be referred to as a primary adjusted net attendance

ratio.

Rate of out-of-school children of primary school age

– Number of children of official primary school age who are not enrolled in

primary or secondary school, expressed as a percentage of the population of official primary school age.

Out-of-school children of primary school age

– Children in the official primary school age range who are not enrolled in either

primary or secondary schools. Children enrolled in pre-primary education are excluded and considered out of school.

Survival rate to last primary grade

– Percentage of children entering the first grade of primary school who eventually reach the

last grade of primary school.

Secondary school net enrolment ratio

– Number of children enrolled in secondary school who are of official secondary school age,

expressed as a percentage of the total number of children of official secondary school age. Secondary net enrolment ratio does not

include secondary-school-aged children enrolled in tertiary education owing to challenges in age reporting and recording at that level.

Secondary school net attendance ratio

– Number of children attending secondary or tertiary school who are of official secondary

school age, expressed as a percentage of the total number of children of official secondary school age. Because of the inclusion of

secondary-school-aged children attending tertiary school, this indicator can also be referred to as a secondary adjusted net

attendance ratio.

All data refer to official International Standard Classifications of Education (ISCED) for the primary and secondary

education levels and thus may not directly correspond to a country-specific school system.

Youth literacy

– UNESCO Institute for Statistics (UIS).

Mobile phone and Internet use

– International Telecommunications Union,

Geneva.

Pre-primary, primary and secondary enrolment and rate and number of

out-of-school children

– UIS. Estimates based on administrative data from

national Education Management Information Systems (EMIS) with UN population

estimates.

Primary and secondary school attendance

– Demographic and Health Surveys

(DHS), Multiple Indicator Cluster Surveys (MICS) and other national household

surveys.

Survival rate to last primary grade

– Administrative data: UIS; survey data: DHS,

MICS and other national household surveys.

NOTES

– Data not available.

x Data refer to years or periods other than those specified in the column heading.

Such data are not included in the calculation of regional and global averages,

with the exception of 2005–2006 data from India and 2006 survival rate data from

Brazil. Estimates from data years prior to 2000 are not displayed.

y Data differ from the standard definition or refer to only part of a country. If they

fall within the noted reference period, such data are included in the calculation of

regional and global averages.

* Data refer to the most recent year available during the period specified in the

column heading.

** Excludes China.

THE STATE OF THE WORLD’S CHILDREN 2016

137

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 6.

DEMOGRAPHIC INDICATORS

Population (thousands)

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia (Plurinational State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's Republic

of Korea

Democratic Republic

of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

France

Gabon

2015

total

under 18

under 5

Population

annual growth rate (%)

1990–2015

2015–2030

Crude death rate

Crude birth rate

Life expectancy

Total Urbanized

fertility population

(%)

rate

2015

Average annual

growth rate of urban

population (%)

1990–2015 2015–2030

1970 1990 2015 1970 1990 2015 1970 1990 2015

32,527

2,897

39,667

25,022

43,417

3,018

23,969

8,545

9,754

388

1,377

160,996

284

9,496

11,299

359

10,880

775

10,725

3,810

2,262

207,848

423

7,150

18,106

11,179

521

15,578

23,344

35,940

4,900

14,037

17,948

1,376,049

48,229

788

4,620

4,808

22,702

4,240

11,390

1,165

10,543

25,155

77,267

5,669

888

10,528

16,144

91,508

6,127

845

5,228

1,313

99,391

892

5,503

64,395

1,725

16,716

687

13,067

13,598

13,006

654

5,354

1,481

2,538

347

57,168

1,774

2,280

140

5,312

252

4,138

643

856

58,433

119

1,199

9,475

5,685

186

5,850

11,472

6,961

2,242

7,671

4,398

282,260

14,144

368

2,259

1,308

11,193

775

2,269

236

1,846

6,486

40,639

1,167

344

3,744

5,588

35,095

2,039

383

2,562

243

48,448

302

1,077

14,211

748

4,950

185

4,590

4,718

3,718

207

1,546

404

930

109

15,331

586

653

1,708

1,186

172

266

15,032

337

3,144

2,062

1,772

3,738

1,942

708

2,632

1,170

83,186

3,738

119

759

350

3,667

207

588

538

1,747

13,876

295

102

1,062

1,610

12,116

520

128

815

14,602

304

3,927

239

4.0

-0.5

1.7

1.0

3.2

1.6

1.1

-0.6

1.4

0.4

1.2

1.7

4.1

1.7

0.4

-0.3

0.5

2.6

3.1

1.5

1.8

-0.7

2.0

1.3

2.0

-0.8

2.9

2.8

1.7

2.2

2.6

1.0

2.0

3.4

1.2

0.7

1.4

2.6

0.7

1.8

2.5

-0.5

0.3

1.7

0.1

0.9

3.2

0.4

1.6

0.1

1.5

1.8

1.9

0.6

3.2

2.0

-0.7

2.9

0.8

0.4

0.5

2.4

2.0

0.1

1.3

0.1

3.0

0.9

-0.1

1.1

0.2

0.6

0.9

1.2

1.0

0.1

-0.4

0.4

1.8

2.4

0.9

1.4

-0.4

1.5

0.6

1.1

-0.8

2.7

2.9

1.1

1.3

2.3

0.8

1.9

3.0

0.8

0.2

0.7

2.1

2.6

0.5

0.8

2.3

-0.4

-0.1

0.7

-0.1

0.4

3.0

0.4

1.1

0.3

0.9

1.3

1.6

0.3

2.5

2.2

-0.4

2.2

0.3

0.2

0.4

2.0

–

4.7

1.8

2.8

–

6.0

2.1

2.3

1.5

1.9

1.5

2.3

1.9

2.0

2.1

1.8

1.6

1.8

2.5

4.7

2.0

2.9

1.3

2.8

1.8

1.9

1.6

5.4

5.9

2.3

2.6

4.6

1.6

4.2

6.1

1.7

1.6

1.9

4.4

4.8

–

1.8

4.9

1.5

1.6

1.4

1.5

2.0

5.9

1.7

3.1

–

2.5

3.3

1.9

4.7

4.2

1.6

4.3

2.5

1.8

2.0

3.8

5.5

1.5

3.0

1.2

5.3

0.0

1.2

-1.0

1.5

0.5

1.2

1.8

4.1

3.8

0.3

0.2

0.5

2.2

4.1

4.9

2.8

-0.6

2.8

1.8

2.7

-0.4

5.9

5.2

3.1

3.3

3.9

1.3

2.3

3.6

1.5

3.7

2.0

2.6

3.4

1.7

3.7

3.5

-0.1

0.4

1.7

0.1

1.0

4.2

0.5

1.8

0.5

3.0

2.5

1.6

2.0

3.6

4.3

-1.0

4.6

1.8

0.6

0.8

3.4

3.7

1.4

1.8

0.2

4.2

0.2

0.8

0.0

1.3

0.6

1.2

1.1

1.4

2.8

0.6

-0.2

0.3

2.0

3.4

2.4

1.9

0.6

1.4

0.8

1.3

-0.5

4.7

5.2

1.6

2.7

3.2

1.0

2.8

4.0

0.8

1.7

1.3

2.8

3.0

0.7

1.6

3.1

0.2

-0.1

0.8

0.3

0.8

3.6

0.6

1.3

0.7

1.6

1.7

1.8

1.0

3.0

4.4

-0.3

4.3

1.0

0.4

0.7

2.2

138

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 6.

DEMOGRAPHIC INDICATORS

Population (thousands)

Population

annual growth rate (%)

1990–2015

2015–2030

Countries

and areas

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic

Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia (Federated States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

New Zealand

Nicaragua

Niger

2015

total

under 18

under 5

Crude death rate

Crude birth rate

Life expectancy

Total Urbanized

fertility population

(%)

rate

2015

Average annual

growth rate of urban

population (%)

1990–2015 2015–2030

1970 1990 2015 1970 1990 2015 1970 1990 2015

1,991

4,000

80,689

27,410

10,955

107

16,343

12,609

1,844

767

10,711

8,075

9,855

329

1,311,051

257,564

79,109

36,423

4,688

8,064

59,798

2,793

126,573

7,595

17,625

46,050

112

3,892

5,940

6,802

1,971

5,851

2,135

4,503

6,278

2,878

567

24,235

17,215

30,331

364

17,600

419

4,068

1,273

127,017

104

2,959

626

34,378

27,978

53,897

2,459

28,514

16,925

4,529

6,082

19,899

1,051

832

12,769

12,330

1,899

7,085

6,196

871

279

4,294

3,109

1,724

451,990

85,276

21,847

17,270

1,187

2,626

9,870

821

19,827

3,160

5,356

22,234

997

2,170

2,813

339

1,733

921

2,203

2,187

508

113

11,776

8,949

9,080

119

9,526

1,890

304

42,245

968

142

11,121

14,589

17,885

1,063

11,316

3,390

1,097

2,189

11,332

366

275

3,384

4,056

533

2,089

2,046

289

1,238

816

463

123,711

24,864

6,855

5,727

353

832

2,570

204

5,269

980

1,948

7,166

348

780

839

461

278

701

649

152

3,770

2,954

2,477

3,271

601

11,617

338

3,421

4,816

4,565

338

2,807

885

309

606

4,145

3.1

-1.2

0.1

2.5

0.3

0.4

2.3

2.9

2.2

0.3

1.6

0.2

2.0

-0.2

1.0

1.6

1.4

2.9

1.1

2.3

0.2

0.6

0.1

3.3

0.3

2.7

1.8

2.5

1.2

1.9

-1.2

3.1

1.2

3.0

1.4

1.1

-1.0

1.6

3.0

2.4

2.0

2.9

0.7

0.5

2.8

0.7

1.6

0.3

1.0

1.2

0.1

1.3

3.0

1.0

2.2

0.4

1.7

0.5

1.1

1.5

3.7

3.0

-0.2

-0.1

2.0

-0.3

0.3

1.8

2.5

2.1

0.5

1.1

0.0

1.2

-0.4

0.7

1.0

0.9

0.7

2.6

0.7

1.4

-0.1

0.2

-0.3

1.2

0.9

2.3

1.5

1.7

1.2

1.5

-0.6

-0.7

1.0

2.4

1.1

0.6

-0.5

1.2

2.6

2.9

1.2

2.9

0.1

0.3

2.2

0.2

1.0

0.8

0.4

1.2

-0.1

1.0

2.6

0.7

1.9

0.3

1.0

0.3

0.8

1.0

3.9

–

5.7

1.8

1.4

4.1

1.3

2.1

3.2

4.9

4.8

2.5

3.0

–

2.3

1.4

1.9

2.4

1.7

4.5

2.0

3.0

1.5

2.0

1.4

3.4

2.6

4.3

3.7

2.1

3.1

2.9

1.5

1.7

3.1

4.6

2.4

–

1.6

4.4

5.0

1.9

2.1

6.1

1.5

–

4.5

1.5

2.2

3.2

–

2.6

1.7

2.5

5.3

2.2

3.5

–

2.2

1.8

2.0

2.2

7.6

100

4.8

-1.1

0.2

4.0

0.7

3.3

4.0

4.5

0.3

4.5

0.2

3.4

0.1

1.3

2.6

3.7

2.4

2.8

1.6

2.3

0.4

1.1

0.9

3.8

-0.1

4.5

2.5

2.2

0.8

5.7

-1.2

2.7

3.8

2.6

1.7

0.4

-0.9

1.8

4.6

3.8

3.7

4.3

5.0

0.8

0.9

4.3

0.3

1.9

-0.2

1.1

2.1

1.2

2.2

3.8

2.3

4.2

0.4

4.8

1.6

1.3

2.1

4.4

3.6

-0.1

0.0

2.8

0.3

0.4

3.0

3.6

3.3

1.1

2.3

0.0

2.6

0.2

0.9

2.2

2.0

1.5

2.6

1.3

1.4

0.3

0.9

-0.1

1.5

1.0

4.0

1.9

2.0

3.3

-0.5

0.3

2.6

3.2

1.4

1.1

-0.2

1.3

4.2

1.8

2.7

4.7

0.2

0.9

2.9

0.2

1.2

1.5

0.9

1.7

0.2

1.7

3.5

2.0

3.1

0.5

2.9

0.5

0.9

1.7

5.7

THE STATE OF THE WORLD’S CHILDREN 2016

139

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TABLE 6.

DEMOGRAPHIC INDICATORS

Population (thousands)

Population

annual growth rate (%)

1990–2015

Total Urbanized

fertility population

(%)

rate

2015

Average annual

growth rate of urban

population (%)

1990–2015 2015–2030

Countries

and areas

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav Republic

of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

Ukraine

United Arab Emirates

United Kingdom

United Republic of Tanzania

2015

total

under 18

under 5

Crude death rate

Crude birth rate

Life expectancy

2015–2030

1970 1990 2015 1970 1990 2015 1970 1990 2015

182,202

5,211

4,491

188,925

3,929

7,619

6,639

31,377

100,699

38,612

10,350

2,235

50,293

4,069

19,511

143,457

11,610

185

109

193

190

31,540

15,129

8,851

6,453

5,604

5,426

2,068

584

10,787

54,490

12,340

46,122

20,715

4,668

40,235

543

1,287

9,779

8,299

18,502

8,482

67,959

2,078

1,185

7,305

106

1,360

11,254

78,666

5,374

39,032

44,824

9,157

64,716

53,470

91,855

1,129

1,051

77,779

1,275

3,330

2,412

10,417

38,277

6,911

1,782

406

8,925

777

3,670

27,684

5,532

10,560

7,596

1,774

3,166

1,081

984

361

269

5,787

19,084

6,028

8,119

6,051

2,200

18,954

175

569

1,977

1,479

8,206

3,475

14,656

433

581

3,553

334

3,115

24,240

1,791

21,473

7,897

1,510

13,715

27,611

31,109

315

385

24,664

368

996

674

3,020

11,255

1,994

439

132

2,287

223

924

9,166

1,695

3,161

2,601

451

1,004

269

283

111

1,971

5,370

1,956

2,144

1,643

703

5,952

173

590

423

2,192

1,176

3,799

115

204

1,160

982

6,821

528

7,278

2,461

491

4,058

9,398

2.6

-1.5

0.8

3.6

2.3

1.4

1.9

2.4

1.8

1.5

1.9

0.0

0.2

6.2

0.6

-0.3

-0.7

-0.1

1.9

1.2

0.1

0.7

1.1

2.1

2.6

2.8

-0.3

1.2

2.0

2.5

0.1

2.5

2.1

1.6

3.0

0.7

3.2

2.8

1.1

1.6

0.5

0.9

1.6

1.9

0.7

0.2

1.9

2.6

0.4

1.3

1.5

0.4

3.2

-0.5

6.5

0.5

3.0

2.4

0.2

0.9

1.0

1.7

1.0

1.3

1.9

1.1

1.4

-0.2

-0.3

1.5

0.3

-0.4

-0.7

-0.2

2.0

0.8

0.6

0.2

0.6

0.3

2.0

1.4

2.7

-0.4

0.3

1.9

0.9

-0.1

0.0

1.7

2.8

0.6

2.4

0.0

0.3

2.5

2.3

0.7

1.1

0.6

0.7

2.9

1.8

0.0

1.9

2.4

0.9

0.1

0.8

0.7

0.9

0.5

3.1

-0.6

1.2

0.5

2.9

–

5.6

–

1.8

2.7

3.6

–

2.4

3.7

2.5

2.4

2.9

1.3

2.0

1.3

1.2

1.5

1.7

3.8

–

1.9

2.0

4.0

–

4.5

2.7

5.0

1.6

2.3

4.5

1.2

1.4

1.6

3.9

6.4

2.3

4.9

1.3

2.1

4.1

4.3

2.3

3.2

1.9

1.5

2.9

3.5

1.5

5.6

4.5

3.7

1.8

2.1

2.3

–

5.7

1.5

1.8

1.9

5.1

100

4.5

-1.1

1.2

4.0

3.1

2.3

2.7

1.9

2.8

2.0

1.6

0.0

1.4

6.7

1.0

-1.1

-0.2

-0.1

8.9

0.9

-0.7

0.9

0.3

1.3

3.8

2.8

3.2

0.3

1.6

2.5

-0.1

0.1

4.5

3.4

2.4

4.4

1.0

0.8

3.5

3.4

1.2

1.3

0.6

0.9

3.0

1.3

2.9

0.1

3.6

3.9

0.6

0.3

1.9

2.3

1.9

4.8

-0.4

7.0

0.7

4.9

4.0

0.2

1.1

1.6

2.6

1.4

1.8

2.8

1.9

1.4

1.8

0.1

0.6

1.1

0.5

-0.2

0.1

-0.2

4.8

1.5

1.1

0.7

0.5

0.3

2.7

1.4

3.5

-0.2

0.9

2.7

1.1

0.1

0.3

3.4

4.0

1.2

3.9

0.4

1.4

2.6

3.1

0.7

1.6

0.8

1.1

2.7

1.6

0.3

3.4

1.5

-0.4

1.1

1.3

1.7

1.6

5.1

-0.4

1.9

0.7

4.7

140

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TABLE 6.

DEMOGRAPHIC INDICATORS

Population (thousands)

Population

annual growth rate (%)

1990–2015

Total Urbanized

fertility population

(%)

rate

2015

Average annual

growth rate of urban

population (%)

1990–2015 2015–2030

Countries

and areas

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela

(Bolivarian Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Sub-Saharan Africa

Eastern and Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and Pacific

Latin America and Caribbean

CEE/CIS

Least developed countries

World

2015

total

under 18

under 5

Crude death rate

Crude birth rate

Life expectancy

2015–2030

1970 1990 2015 1970 1990 2015 1970 1990 2015

321,774

3,432

29,893

265

31,108

93,448

26,832

16,212

15,603

73,169

889

10,081

113

10,418

25,578

12,629

8,535

7,504

19,701

241

3,195

2,960

7,741

3,925

2,851

2,505

1.0

0.4

1.5

2.4

1.8

1.3

3.2

2.8

1.6

0.7

0.3

0.9

1.9

1.1

0.8

2.0

3.0

2.1

1.9

2.0

2.4

3.3

2.3

2.0

4.0

5.3

3.9

1.3

0.7

1.1

3.7

2.1

3.2

5.1

2.9

1.9

0.9

0.4

1.7

3.0

1.2

2.2

3.4

4.3

2.3

1,001,417

480,144

480,150

455,880

1,743,865

2,097,940

628,992

413,760

954,158

7,309,846

496,043

233,503

243,243

165,800

621,390

504,114

195,496

98,592

444,297

2,262,157

163,267

75,181

82,032

53,283

173,210

146,650

53,155

30,726

139,575

668,970

2.7

2.6

2.8

2.1

1.7

0.9

1.4

0.2

2.5

1.3

2.5

2.4

2.6

1.6

1.1

0.4

0.9

0.1

2.2

1.0

4.9

4.5

5.4

2.9

2.5

1.8

2.1

1.9

4.1

2.5

4.0

3.7

4.2

2.7

2.8

3.3

1.9

0.3

4.0

2.2

3.6

3.7

1.9

2.3

1.7

1.1

0.4

3.6

1.6

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

MAIN DATA SOURCES

Crude death rate

– Annual number of deaths per 1,000 population.

Crude birth rate

– Annual number of births per 1,000 population.

Life expectancy–

Number of years newborn children would live if subject to the mortality

risks prevailing for the cross section of population at the time of their birth.

Total fertility rate

– Number of children who would be born per woman if she lived to the

end of her childbearing years and bore children at each age in accordance with prevailing

age-specific fertility rates.

Urbanized population

– Percentage of population living in urban areas as defined

according to the national definition used in the most recent population census.

Population

– United Nations Population Division. Growth rates calculated by UNICEF

based on data from United Nations Population Division.

Crude death and birth rates

– United Nations Population Division.

Life expectancy

– United Nations Population Division.

Total fertility rate

– United Nations Population Division.

NOTES

− Data not available.

Based on medium-fertility variant projections.

THE STATE OF THE WORLD’S CHILDREN 2016

141

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TABLE 7.

ECONOMIC INDICATORS

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia (Plurinational State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's Republic

of Korea

Democratic Republic of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

France

GNI per capita (US$)

US$

2014

PPP US$

2014

Average

annual

rate of

GDP per capita

inflation

average annual

(%)

growth rate (%)

1970–1990 1990–2014 1990–2014

Debt

Population

service

ODA

National

below

inflow as a % of

ODA

international monetary

Share of

inflow in as a % of exports of

Public spending as a

child

poverty line

household income

% of GDP (2009–2013*) millions recipient goods and

poverty

of US$1.90

(%, 2009–2013*)

services

GNI

US$

allocated to:

(%)

per day (%)

2009–2013* 2010–2014* health education military 2014

2014

2013

poorest 40% richest 20%

680

4,450

5,490

43,270 x

13,300

13,480

4,020

64,540

49,670

7,590

20,980

21,060 x

1,080

15,310 x

7,340

47,260

4,350 x

890

2,370

2,870

4,760

7,240

11,530

37,320 x

7,620

700

270

3,450

1,020

1,350

51,630

320

980

14,910

7,400

7,970

790

2,720

–

10,120

1,450

12,980

5,880 x

26,370

18,370

380

61,310

6,930

6,040

6,090

3,050

3,920

10,210

480 x

19,030

550

4,870

48,420

42,960

2,000 e

10,180

13,880

–

6,340 x

21,370

–

8,450

42,760

45,930

16,910

22,290

37,680 x

3,330

15,190 x

17,610

43,220

7,590 x

2,020

7,280

6,290

10,010

16,030

15,590

72,190 x

16,260

1,600

770

6,200

3,080

2,950

43,360

600

2,070

21,580

13,170

12,910

1,430

5,200

–

14,420

3,130

20,500

18,630 x

29,800

28,020

–

650

46,210

–

10,480

12,600

11,190

10,260

8,000

17,660

1,400 x,e

26,330

1,500

8,410

39,940

39,610

–

-0.6 x

1.8

-1.3

–

7.9 x

-0.8

–

1.6

2.5

–

1.9

-1.0 x

0.7

1.4 x

–

2.2

3.1

0.4

7.0 x

-1.0

–

8.1

2.2

-2.2 x

3.4 x

1.4

1.2

3.5 x

–

3.4

2.0

-1.3

-0.9

1.5

6.6

1.9

-0.2 x

3.3

–

0.8

-1.7

–

3.9

5.9 x

–

-2.1

2.0

–

5.2 x

2.1

1.7

4.1

-1.9

-2.4 x

–

0.6

2.9

2.2

5.6 x

5.7

1.7

1.2 x

-0.4 x

1.2

2.3

6.2

2.0

1.6

6.4

0.1

3.6

1.2

5.0

1.4

1.7

1.1

5.3

2.0

7.4 x

2.7

1.8

-0.4

3.5

2.9

-1.5

6.3

5.9 x

0.6

1.6

-0.6

3.3

9.2

2.1

-0.2

0.6

–

2.9

-0.5

2.6 x

3.3 x

1.5

2.5

–

-1.9

1.2

0.4

2.0

3.7

1.5

2.6

2.2

19.0

-0.2 x

4.7 x

3.8

1.1

2.1

1.2

–

165

13 x

–

30 x

–

78 x

18 x

29 x

–

66 x

14 x

–

29 x

–

26 y

–

55 y

–

54 x

–

4,823

280

158

–

231

265

–

215

–

2,418

–

120

–

600

130

672

632

100

912

–

1,120

502

230

799

852

–

610

388

241

-960

1,221

106

–

922

–

262

–

153

2,398

–

163

167

160

3,532

–

3,585

–

15 x

–

30 x

–

20 x

–

21 x

14 x

15 x

10 x

11 x

–

15 x

–

22 x

–

16 x

–

49 x

–

30 x

–

41 x

–

43 x

53 x

49 x

61 x

–

49 x

–

40 x

–

50 x

142

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 7.

ECONOMIC INDICATORS

Average

annual

rate of

GDP per capita

inflation

average annual

(%)

growth rate (%)

1970–1990 1990–2014 1990–2014

Debt

Population

service

ODA

National

below

inflow as a % of

ODA

international monetary

Share of

inflow in as a % of exports of

Public spending as a

child

poverty line

household income

% of GDP (2009–2013*) millions recipient goods and

poverty

of US$1.90

(%, 2009–2013*)

services

GNI

US$

allocated to:

(%)

per day (%)

2009–2013* 2010–2014* health education military 2014

2014

2013

poorest 40% richest 20%

Countries

and areas

Gabon

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia (Federated States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

New Zealand

GNI per capita (US$)

US$

2014

PPP US$

2014

9,720

500 x

3,720

47,640

1,590

22,680 x

7,910

3,430

470

550

3,940 x

820

–

2,270

13,340

46,350 x

1,570

3,630

7,120 x

6,500

46,550

35,320

34,270

5,150

42,000

5,160

11,850

1,290

2,950

49,300

1,250

1,660

15,280

10,030

1,330

370

7,820

15,430

75,990

440

250

11,120

6,410

650

21,000 x

4,390

1,270

9,630

9,870

3,200

4,280

7,320

3,070

600

1,270

5,630

–

730

51,890

41,070

17,200

1,600 x

7,510

46,850

3,900

25,660 x

11,720

7,250

1,130

1,380

6,940 x,e

1,730

–

4,570

23,630

41,090 x

5,630

10,190

16,590 x

15,030

42,270

32,830

34,700

8,640

37,920

11,910

21,710

2,940

3,340 e

79,850

3,220

5,060

22,690

17,590 e

3,150

700

16,000 e

–

25,490

65,040

1,400

790

24,770

10,920

1,510

27,020 x

4,700 e

3,710

18,150

16,640

3,590 e

–

11,120

14,530

7,290

1,120

–

9,810

–

2,410

48,260

34,970

0.6

0.7

3.1

2.3

-2.0

1.3

4.2 x

0.1

–

0.8

-1.5

–

0.8

–

3.2

2.0

4.5

-4.3

4.2

2.8

1.9

2.8

-1.3

3.4

2.5 x

–

1.2

-5.0

-6.7 x

–

3.0

-4.1

–

2.2

–

2.6

-2.4

0.0

4.0

–

1.4

6.0

–

-1.1

3.1 x

1.7

–

1.5

–

2.6

-1.1 x

1.4

-2.1 x

–

1.2

1.5

1.5 x

-0.7

0.3 x

3.3

1.3

2.9

1.4

2.4

1.3

0.6

-0.9

2.9 x

-0.6 x

–

1.7

2.5 x

2.1

5.0

2.9

2.4

3.7

3.8

2.4

0.6

0.4

0.7

2.6

4.3

0.8

1.0

0.0 x

1.1

4.9

5.7 x

2.1

2.7

2.4

-1.4 x

2.9 x

5.8 x

2.2

-0.3

1.4

3.2

4.1 x

1.5

2.2 x

0.7

1.2

3.6

1.1

0.6

1.7 x

4.1

2.8 x

2.8

5.1

11.8 x

2.2

–

2.6

1.7

10 x

12 x

–

-1

11 x

15 x

–

45 x

–

25 x

–

34 x

14 x

–

69 x

–

11 x

50 x

–

69 x

–

27 y

–

17 x

–

46 y

–

13 y

11 x

–

34 y

–

111

100

563

–

1,126

–

277

561

109

159

1,084

–

604

–

2,984

-388

1,370

–

2,699

2,665

–

624

472

–

820

104

744

210

–

583

930

1,234

–

257

807

116

–

315

102

2,247

2,103

1,380

227

–

880

–

16 x

14 x

15 x

–

15 x

20 x

13 x

18 x

–

18 x

–

17 x

–

17 x

15 x

–

49 x

53 x

49 x

–

52 x

40 x

54 x

44 x

–

44 x

–

44 x

64 x

–

48 x

51 x

–

THE STATE OF THE WORLD’S CHILDREN 2016

143

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 7.

ECONOMIC INDICATORS

Average

annual

rate of

GDP per capita

inflation

average annual

(%)

growth rate (%)

1970–1990 1990–2014 1990–2014

Debt

Population

service

ODA

National

below

inflow as a % of

ODA

international monetary

Share of

inflow in as a % of exports of

Public spending as a

child

poverty line

household income

% of GDP (2009–2013*) millions recipient goods and

poverty

of US$1.90

(%, 2009–2013*)

services

GNI

US$

allocated to:

(%)

per day (%)

2009–2013* 2010–2014* health education military 2014

2014

2013

poorest 40% richest 20%

Countries

and areas

Nicaragua

Niger

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav Republic

of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

Ukraine

United Arab Emirates

GNI per capita (US$)

US$

2014

PPP US$

2014

1,870

410

2,970

–

103,630

16,870 x

1,400

11,110

11,130

2,240

4,400

6,360

3,500

13,690

21,360

92,200

27,090

2,560

9,520

13,220

700

14,920

7,260

6,610

4,060

1,670

25,140 x

1,050

5,820

14,100

700

55,150

17,750

23,580

1,830

6,800

970

29,440

3,460

3,060

1,710

9,950

3,550

61,610

88,120 x

1,080

5,780

5,150

2,680

570

4,260

20,070

4,230

10,830

8,020

5,720

670

3,560

44,600

4,790

910

5,710

–

66,330

33,690 x

5,090

14,280 e

19,930

2,790 e

8,470

11,440

8,450

23,930

28,010

134,420

34,620

5,500

19,020

24,710

1,630

22,600

10,540

10,730

5,610 e

–

3,140

51,320 x

2,300

12,150

24,780

1,770

80,270

26,820

29,920

2,020 e

–

12,700

1,800 e

33,080

10,370

5,000

3,920

17,040

7,880

46,750

57,960 x

–

2,660

14,870

12,800

5,080 e

1,290

5,270 e

31,970

11,020

18,980

14,520 e

5,410 e

1,720

8,560

67,720

-3.7

-1.9

-2.3

–

3.3

3.2

2.7

–

0.2

-1.0

3.8

-0.5

0.6

–

2.5

–

7.5

1.8 x

–

1.1

6.5 x

5.1 x

3.3

–

1.8

–

-2.1

-0.6

–

2.9

-0.6

5.9

–

-0.8

0.1

–

1.9

3.0

–

-0.1

-2.3 x

3.1

1.8

1.7 x

2.1

–

4.8

–

-0.5

–

-0.5

2.5

1.9

–

-4.3 x

2.1

0.0

3.4

–

1.6

0.6

1.7

-0.4 x

3.8

0.9

3.4

2.3

4.2

1.2

1.5 x

4.3

0.8

3.4

2.5

3.3

1.8

1.2

2.9

2.5

3.4 x

3.0 x

1.4

1.1

3.7 x

2.1

1.4

3.5

4.2 x

2.5 x

-0.4

–

1.2

–

1.5

4.4

1.8 x

3.5

2.2

1.0

2.0

1.0

1.8 x

0.9

3.1

1.8

3.4 x

0.1

1.3

5.1

3.0

2.5

3.5

1.6

3.6

1.0

-2.9

–

14 x

20 x

–

46 x

–

47 x

–

63 x

–

13 y

–

47 y

–

430

918

2,476

–

3,612

-196

577

325

676

–

517

–

1,034

–

1,107

371

911

–

199

1,109

1,070

1,964

–

488

2,487

872

–

4,198

356

351

211

247

208

–

921

3,442

1,633

1,404

–

16 x

–

16 x

–

14 x

–

19 x

15 x

22 x

–

50 x

–

49 x

–

52 x

–

44 x

50 x

41 x

–

144

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 7.

ECONOMIC INDICATORS

Average

annual

rate of

GDP per capita

inflation

average annual

(%)

growth rate (%)

1970–1990 1990–2014 1990–2014

Debt

Population

service

ODA

National

below

inflow as a % of

ODA

international monetary

Share of

inflow in as a % of exports of

Public spending as a

child

poverty line

household income

% of GDP (2009–2013*) millions recipient goods and

poverty

of US$1.90

(%, 2009–2013*)

services

GNI

US$

allocated to:

(%)

per day (%)

2009–2013* 2010–2014* health education military 2014

2014

2013

poorest 40% richest 20%

Countries

and areas

United Kingdom

United Republic of Tanzania

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela (Bolivarian Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Sub-Saharan Africa

Eastern and Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and Pacific

Latin America and Caribbean

CEE/CIS

Least developed countries

World

GNI per capita (US$)

US$

2014

PPP US$

2014

43,430

920

55,200

16,350

2,090

3,160

12,500 x

1,890

1,300 x

1,680

840

39,040

2,510

55,860

20,220

5,830 e

3,030 e

17,700 x

5,350

3,650 x

3,690

1,650

2.2

–

2.2

0.9

–

1.1 x

-1.2

–

-2.4

-0.4

1.8

2.5

1.6

2.5

3.2

0.6

5.5

0.7 x

2.4

-2.8

31 x

15 x

–

67 x

–

65 y

–

2,648

–

324

4,218

1,164

995

758

–

19 x

12 x

20 x

–

43 x

51 x

44 x

–

1,661

1,610

1,703

6,561

1,500

6,845

9,634

9,216

845

10,647

3,416

3,383

3,405

14,047

5,297

12,983

14,247

17,627

2,133

14,633

-0.1

0.3

-0.7

0.8

2.0

6.0

1.4

–

0.0

2.5

2.4

1.7

2.8

1.4

4.6

7.7

1.8

2.8

3.1

2.9

–

3 **

–

7 **

–

4 **

–

5 **

–

2 **

–

2 **

40,706

22,543

17,129

20,921

15,360

8,723

7,739

9,549

43,726

101,963

–

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

MAIN DATA SOURCES

GNI per capita

– Gross national income (GNI) is the sum of value added by all

resident producers plus any product taxes (less subsidies) not included in the

valuation of output plus net receipts of primary income (compensation of employees

and property income) from abroad. Gross national income per capita is GNI divided

by midyear population. GNI per capita in US dollars is converted using the World

Bank Atlas method.

GNI per capita (PPP US$)

– GNI per capita converted to international dollars

taking into account differences in price levels (purchasing power) between

countries. Based on data from the International Comparison Programme.

GDP per capita

– Gross domestic product (GDP) is the sum of value added by all

resident producers plus any product taxes (less subsidies) not included in the

valuation of output. Gross domestic product per capita is GDP divided by midyear

population. Growth is calculated from constant price GDP data in local currency.

Population below international poverty line of US$1.90 per day

– Poverty

headcount ratio at $1.90 a day is the percentage of the population living on less

than $1.90 a day at 2011 international prices. As a result of revisions in PPP

exchange rates, poverty rates for individual countries cannot be compared with

poverty rates reported in earlier editions.

National monetary child poverty

– Percentage of children aged 0–17 years old

living in households with income or consumption below the government defined

national monetary poverty threshold.

ODA

– Net official development assistance.

Debt service

– Sum of interest payments and repayments of principal on external

public and publicly guaranteed long-term debts.

Share of household income

– Percentage of income received by the 20 per cent

of households with the highest income and by the 40 per cent of households with

the lowest income.

GNI per capita

– The World Bank.

GDP per capita

– The World Bank.

Rate of inflation

– The World Bank.

Population below international poverty line of US$1.90 per day –

The World Bank.

National monetary child poverty

– Data are compiled from official national government sources

such as Statistical Office tabulations and national household survey and poverty reports, and from

official regional databases such as those compiled by Eurostat. National estimates are based on

representative household income or expenditure surveys.

Spending on health, education and military

– The World Bank.

ODA

– Organisation for Economic Co-operation and Development.

Debt service

– The World Bank.

Share of household income

– The World Bank.

NOTES

a low-income country (GNI per capita is $1,045 or less).

b lower-middle-income country (GNI per capita is $1,046 to $4,125).

c upper-middle-income country (GNI per capita is $4,126 to $12,735).

d high-income country (GNI per capita is $12,736 or more).

– Data not available.

x Data refer to years or periods other than those specified in the column heading. Such data are not

included in the calculation of regional and global averages.

y Data differ from the standard definition or refer to only part of a country. If they fall within the

reference period, such data are included in the calculation of regional and global averages.

e Estimate is based on regression; other PPP figures are extrapolated from the 2011 International

Comparison Programme benchmark estimates.

* Data refer to the most recent year available during the period specified in the column heading.

** Excludes China.

THE STATE OF THE WORLD’S CHILDREN 2016

145

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 8.

WOMEN

Enrolment ratios:

females as a

Adult

Life

% of males

expec- literacy

rate:

tancy:

females females

as a % as a % of Primary Second-

of males males

GER ary GER

2009–

2015

2014*

2010–2014*

Survival

rate to the

last grade Contra-

of primary: ceptive

females as preva-

lence

a % of

(%)

males

2010–

2010–2014* 2015*

Antenatal care (%)

At least

one visit

Delivery care (%)

Post-natal health

check (%)

For

new-

borns

For

mothers

Maternal mortality ratio

†

Lifetime risk of

maternal death

(1 in:)

Adjusted

2015

At least Skilled Institu-

C-

attendant tional

four

at birth delivery section

visits

2010–2015*

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia (Plurinational

State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's

Republic of Korea

Democratic Republic

of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

Reported

2010–2015*

104

107

106

–

106

107

110

111

105

106

109

108

102

104

107

118

106

108

105

101

107

111

105

110

105

107

105

106

104

105

108

104

107

104

110

105

–

106

103

109

105

106

108

110

105

–

109

107

106

113

105

107

113

106

109

107

79 x

–

101

100

–

100

–

100

–

45 x

59 x

101

59 x

95 x

–

100

–

100

–

100 x

–

100

59 x

–

116 x

102

–

106

101

100

101

–

100

101

100

100 x

107

100

101

100

100 x

100

101

100

104

–

101

108

117 x

105

–

108

103

114

104

107

–

106

–

100

114

85 x

100

102

110 x

104

110

105

104

103

100

101

100 x

102

107

111

104

–

111

109

–

101

102

73 x

–

102

100

–

101

105

96 x

114 x

–

100

103

101

100

103

–

101

115

127

104

134

102

–

101

–

106

–

102

101

102

100

–

101

–

105

101 x

106

100

116

100

69 x

–

72 x

70 x

45 x

–

61 x

53 x

81 x

–

69 x

61 x

74 x

58 x

85 x

–

86 x

–

63 x

–

97 x

–

80 x

100 x

98 x

–

98 x

100 x

100

–

94 x

98 x

99 x

–

98 x

100 x

–

100 x

–

99 x

–

100 x

–

100 x

84 x

–

100 x

67 x

–

100

92 x

–

100

–

73 x

–

72 x

99 x

–

94 x

–

58 x

–

99 x

–

47 x

100

–

100

–

100

95 x

100

100 x

100

–

100

100 x

–

100

100 x

100

–

97 x

–

46 x

–

100

–

100

100 x

76 x

100

100 x

–

100

95 x

–

100

19 x

–

28 x

31 x

24 x

–

18 x

–

11 x

26 x

–

20 x

13 x

21 x

–

16 x

–

100

–

100

–

330

–

17 x

190

–

350

310 x

160

–

340

500

170

780

540 x

860

170

440

610

–

77 x

850

–

380

110

310

490

680

–

396

140

–

477

–

176

405

148

206

129

371

712

161

596

882

856

335

442

–

645

693

229

–

342

501

353

1,900

240

–

790

2,300

8,700

18,200

1,600

660

3,000

240

2,100

13,800

8,000

1,300

310

160

6,800

270

1,200

2,300

6,200

900

210

8,800

2,600

2,400

800

–

2,100

7,900

1,800

9,400

14,800

660

9,500

140

–

400

580

810

890

6,300

1,200

21,700

146

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 8.

WOMEN

Enrolment ratios:

females as a

Adult

Life

% of males

expec- literacy

rate:

tancy:

females females

as a % as a % of Primary Second-

of males males

GER ary GER

2009–

2015

2014*

2010–2014*

Survival

rate to the

last grade Contra-

of primary: ceptive

females as preva-

lence

a % of

(%)

males

2010–

2010–2014* 2015*

Post-natal health

check (%)

For

new-

borns

For

mothers

Antenatal care (%)

At least

one visit

Delivery care (%)

Maternal mortality ratio

†

Lifetime risk of

maternal death

(1 in:)

Adjusted

2015

Countries

and areas

France

Gabon

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic

Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia (Federated

States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

At least Skilled Institu-

C-

attendant tional

four

at birth delivery section

visits

2010–2015*

Reported

2010–2015*

107

102

105

110

106

103

107

110

102

107

–

107

110

104

106

103

107

105

104

106

107

108

105

115

106

110

103

112

104

114

105

100

103

108

–

116

106

105

103

106

103

104

–

105

110

106

103

–

113

106

103

105

106

108

–

104

–

100

–

106

84 x

–

100

–

100

111

–

100

86 x

–

77 x

100

92 x

130

44 x

–

100

–

100 x

103

–

62 x

–

100

105 x

–

105

101

100

–

100

112

100

104

–

101

100

–

100

104

102

–

102

100

101

100

102

–

97 x

106

102

–

108

101

–

100

–

117

100

101

–

102

108

100

105

103

110 x

108

101

137

–

103

–

103 x

102

107

–

103

100

103

–

102

106

–

107

100

101

–

152

–

105

–

103

100

102

–

101

103

100

102

100

–

101

102

104

100

106

134

85 x

–

96 x

100

105

106

–

106

102

91 x

101

102

–

102

107 x

104

–

105

76 x

66 x

76 x

54 x

–

55 x

65 x

–

72 x

54 x

22 x

–

54 x

42 x

–

63 x

–

49 x

35 x

–

45 x

76 x

55 x

–

36 x

100 x

–

100 x

–

74 x

100 x

–

99 x

–

88 x

100 x

92 x

96 x

93 x

–

100 x

–

99 x

70 x

100 x

81 x

–

80 x

–

95 x

–

94 x

–

68 x

–

71 x

–

85 x

35 x

–

77 x

–

73 x

40 x

–

100

–

52 x

100 x

–

100

80 x

100 x

98 x

100 x

–

100 x

49 x

–

100

100 x

–

97 x

100

–

100

–

100

66 x

100

–

100

–

100 x

95 x

45 x

100

85 x

98 x

87 x

–

99 x

21 x

29 x

–

31 x

17 x

25 x

–

40 x

–

10 x

–

29 x

–

32 x

–

11 x

–

320

430

–

450 x

–

140

720

900

86 x

380

–

170

360

25 x

–

19 x

360

–

1,200 x

1,100

–

480

570

140 x

460 x

–

110

630

22 x

160

–

110

410

280

390

280 x

291

706

319

679

549

229

359

–

129

174

126

510

197

487

725

–

353

634

587

–

602

100

–

121

489

178

265

–

258

6,100

1,500

11,700

23,700

1,500

330

170

–

300

4,400

14,600

220

320

2,000

420

6,100

6,200

19,700

520

13,400

490

3,000

300

10,300

390

150

3,500

3,700

4,200

–

6,300

6,500

1,200

600

8,300

–

1,300

1,100

310

–

800

8,300

320

260

100

–

150

THE STATE OF THE WORLD’S CHILDREN 2016

147

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 8.

WOMEN

Enrolment ratios:

females as a

Adult

Life

% of males

expec- literacy

rate:

tancy:

females females

as a % as a % of Primary Second-

of males males

GER ary GER

2009–

2015

2014*

2010–2014*

Survival

rate to the

last grade Contra-

of primary: ceptive

females as preva-

lence

a % of

(%)

males

2010–

2010–2014* 2015*

Post-natal health

check (%)

For

new-

borns

For

mothers

Antenatal care (%)

At least

one visit

Delivery care (%)

Maternal mortality ratio

†

Lifetime risk of

maternal death

(1 in:)

Adjusted

2015

Countries

and areas

Netherlands

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and the

Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav

Republic of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

At least Skilled Institu-

C-

attendant tional

four

at birth delivery section

visits

2010–2015*

Reported

2010–2015*

105

104

108

103

101

–

105

103

–

108

107

106

107

111

107

103

108

112

110

117

109

–

107

106

109

–

106

104

106

108

113

102

108

110

108

104

106

107

104

107

109

106

105

109

104

105

120

111

109

106

105

103

108

110

106

109

114

–

100 x

68 x

–

100

101 x

100

–

100

–

100

–

75 x

101

–

100

–

55 x

–

100

–

100

109

100

101

102

–

100

109

100

101

100

–

100

–

101

106

100

101

106

113

–

101

106

107

100

110

101

107

103

112

103

–

102

–

102

100

–

126

–

100

105

110

131

113

100

107

108

–

103

–

125

–

104

107 x

–

104

103

111 x

101

–

100

–

125

–

100

127

103

–

108

101

–

101

100 x

100

–

100

–

122

107

100

–

101

–

109

–

106 x

–

69 x

–

23 x

88 x

32 x

79 x

–

67 x

80 x

70 x

54 x

48 x

–

24 x

–

35 x

15 x

60 x

66 x

68 x

–

54 x

43 x

48 x

31 x

–

100 x

–

79 x

96 x

–

100 x

–

94 x

–

100 x

–

97 x

–

97 x

100 x

74 x

26 x

97 x

–

99 x

100 x

–

88 x

96 x

99 x

97 x

–

55 x

91 x

–

76 x

–

100 x

–

65 x

87 x

–

93 x

–

64 x

100

83 x

67 x

–

100

–

100

53 x

100 x

100

–

100

–

100

86 x

33 x

94 x

–

99 x

100

–

96 x

100

100 x

98 x

100 x

–

100

98 x

–

100

–

100

–

100

85 x

95 x

–

98 x

–

78 x

100

97 x

98 x

93 x

14 x

23 x

–

16 x

–

33 x

21 x

31 x

32 x

19 x

–

24 x

–

21 x

26 x

24 x

–

30 x

26 x

–

100

–

520

550

–

280 x

730 x

220

–

210

310

29 x

–

430

57 x

1,200

–

150 x

1,000 x

580

2,100 x

–

220

130

590 x

–

65 x

12 x

570

400

–

29 x

150

553

814

–

178

–

215

132

114

290

–

156

315

–

1,360

114

732

138

789

311

155

389

215

368

124

–

8,700

4,500

270

–

11,500

1,900

140

–

420

120

270

570

280

22,100

8,200

3,500

7,200

3,200

2,300

–

1,100

500

–

140

3,100

3,900

–

8,200

12,100

7,000

220

300

14,700

1,600

490

270

12,900

12,400

440

790

3,600

8,500

230

860

710

3,000

940

–

148

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 8.

WOMEN

Enrolment ratios:

females as a

Adult

Life

% of males

expec- literacy

rate:

tancy:

females females

as a % as a % of Primary Second-

of males males

GER ary GER

2009–

2015

2014*

2010–2014*

Survival

rate to the

last grade Contra-

of primary: ceptive

females as preva-

lence

a % of

(%)

males

2010–

2010–2014* 2015*

Post-natal health

check (%)

For

new-

borns

For

mothers

Antenatal care (%)

At least

one visit

Delivery care (%)

Maternal mortality ratio

†

Lifetime risk of

maternal death

(1 in:)

Adjusted

2015

Countries

and areas

Uganda

Ukraine

United Arab Emirates

United Kingdom

United Republic of

Tanzania

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela (Bolivarian

Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Sub-Saharan Africa

Eastern and

Southern Africa

West and Central Africa

Middle East and

North Africa

South Asia

East Asia and Pacific

Latin America and

Caribbean

CEE/CIS

Least developed countries

World

At least Skilled Institu-

C-

attendant tional

four

at birth delivery section

visits

2010–2015*

Reported

2010–2015*

107

115

103

105

104

106

110

106

112

113

104

107

105

100

102 x

–

101

100

101

72 x

102

101

100

101

–

104

101

114

100

108

–

101

103

–

115

–

103 x

101

94 x

115

–

84 x

78 x

65 x

–

100 x

–

99 x

94 x

–

100

–

100 x

100

–

100

97 x

–

26 x

31 x

–

440

–

430

86 x

150

400

–

343

398

385

224

443

2,600

7,900

5,800

3,800

3,300

1,000

360

420

870

105

106

103

105

104

105

109

113

105

106

100

101

106

102

105

100

101

106

102

104

101

103

47 ‡

63 **

53 ‡**

69 ‡

85 ‡

82 **

58 **

49 ‡

75 ‡

15 ‡

20 ‡

–

40 ‡

57 **

–

34 ‡**

–

48 ‡

80 **

–

54 ‡**

–

546

417

679

110

182

436

216

280

200

880

670

2,000

180

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

Life expectancy

– Number of years newborn children

would live if subject to the mortality risks prevailing for

the cross section of population at the time of their birth.

Adult literacy rate

– Percentage of the population

aged 15 years and over who can both read and write

with understanding a short, simple statement on his/her

everyday life.

Primary gross enrolment ratio (GER)

– Total

enrolment in primary school, regardless of age,

expressed as a percentage of the official primary-school-

aged population.

Secondary gross enrolment ratio (GER)

– Total

enrolment in secondary school, regardless of age,

expressed as a percentage of the official

secondary-school-aged population.

Survival rate to last grade of primary

– Percentage

of children entering the first grade of primary school

who eventually reach the last grade (administrative

data).

Contraceptive prevalence

– Percentage of women

(aged 15–49) in union currently using any contraceptive

method.

Antenatal care

– Percentage of women (aged 15–49)

attended at least once during pregnancy by skilled

health personnel (doctor, nurse or midwife) and the

percentage attended by any provider at least four times.

Skilled attendant at birth

– Percentage of births

attended by skilled heath personnel (doctor, nurse or

midwife).

Institutional delivery

– Percentage of women (aged

15–49) who gave birth in a health facility.

C-section

– Percentage of births delivered by

Caesarean section. NB: C-section rates between 5 per

cent and 15 per cent expected with adequate levels of

emergency obstetric care.

Post-natal health check for newborns

– Percentage

of last live births in the last 2 years who received a

health check within 2 days after delivery. NB: For MICS,

health check refers to a health check while in facility or

at home following delivery or a post-natal visit.

Post-natal health check for mothers

– Percentage

of women aged 15–49 years who received a health

check within 2 days after delivery of their most recent

live birth in the last 2 years. NB: For MICS, health check

refers to a health check while in facility or at home

following delivery or a post-natal visit.

Maternal mortality ratio

– Number of deaths of

women from pregnancy-related causes per 100,000 live

births during the same time period. The ‘reported’

column shows country-reported figures that are not

adjusted for under-reporting and misclassification. For

the ‘adjusted’ column, see note below (†). Maternal

mortality ratio values have been rounded according to

the following scheme: Reported: <100, no rounding;

100–999, rounded to nearest 10; and >1,000, rounded to

nearest 100. Adjusted: <1,000, rounded to nearest 1;

and ≥1,000, rounded to nearest 10.

Lifetime risk of maternal death

– Lifetime risk of

maternal death takes into account both the probability

of becoming pregnant and the probability of dying as

a result of that pregnancy, accumulated across a

woman’s reproductive years. Lifetime risk values have

been rounded according to the following scheme:

<1,000, rounded to nearest 1; and ≥1,000, rounded to

nearest 10.

MAIN DATA SOURCES

Life expectancy

– United Nations Population

Division.

Adult literacy

– UNESCO Institute for Statistics (UIS).

Primary and secondary school enrolment

– UIS.

Survival rate to last grade of primary

– UIS.

Contraceptive prevalence

– DHS, MICS and other

nationally representative sources; United Nations

Population Division.

Antenatal care, skilled attendant at birth,

institutional delivery and C-section:

– DHS, MICS

and other nationally representative sources.

Post-natal health check for newborns and

mothers

– DHS and MICS.

Maternal mortality ratio (reported)

– Nationally

representative sources, including household surveys

and vital registration.

Maternal mortality ratio (adjusted)

– United

Nations Maternal Mortality Estimation Inter-agency

Group (WHO, UNICEF, UNFPA, The World Bank and the

United Nations Population Division).

Lifetime risk of maternal death

– United Nations

Maternal Mortality Estimation Inter-agency Group

(WHO, UNICEF, UNFPA, The World Bank and the

United Nations Population Division).

NOTES

− Data not available.

x Data refer to years or periods other than those

specified in the column heading. Such data are not

included in the calculation of regional and global

averages. Estimates from data years prior to 2000

are not displayed.

* Data refer to the most recent year available during

the period specified in the column heading.

** Excludes China.

† The maternal mortality data in the column headed

‘reported’ refer to data reported by national au-

thorities. The data in the column headed ‘adjusted’

refer to the 2015 United Nations inter-agency

maternal mortality estimates. Periodically, the

United Nations Maternal Mortality Estimation

Inter-agency Group (WHO, UNICEF, UNFPA The

World Bank and the United Nations Population

Division) produces internationally comparable sets

of maternal mortality data that account for the

well-documented problems of under-reporting and

misclassification of maternal deaths, including

also estimates for countries with no data. Please

note that owing to an evolving methodology,

these values are not comparable with previously

reported maternal mortality ratio ‘adjusted’ values.

Comparable time series on maternal mortality

ratios for the years 1990, 1995, 2000, 2005 and

2015 are available at <http://data.unicef.org/

maternal-health/maternal-mortality.html>.

+ Data collection method for this indicator varies

across surveys and may affect comparability of the

coverage estimates. For detailed explanation see

General Note on the Data, page 108.

THE STATE OF THE WORLD’S CHILDREN 2016

149

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TABLE 9.

CHILD PROTECTION

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia (Plurinational State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's Republic

of Korea

Democratic Republic

of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

France

Gabon

Child labour (%)

2009–2015*

total

male

female

Child marriage (%)

2008–2014*

married by married by

Birth

registration

(%)

2010–2015*

total

Female genital mutilation/cutting

(%)

2004–2015*

prevalence

women

girls

attitudes

support for

the practice

Justification of

wife-beating (%)

2010–2015*

male

female

Violent discipline (%)

2010–2015*

total

male

female

29 y

–

24 x

–

7 x,y

–

26 x,y

9 x,y

–

19 y

47 y

–

10 y

23 y

–

38 y

–

13 y

19 y

28 x

–

34 y

–

22 x

–

8 x,y

–

28 x,y

11 x,y

10 y

–

20 y

–

13 y

–

36 y

–

28 x

–

24 y

–

25 x

–

5 x,y

–

24 x,y

7 x,y

–

19 y

–

41 y

–

28 x

–

11 x

–

36 x

–

18 x

–

22 x

–

99 x

100

100 v

36 x

–

100 y

100

100 v

94 x

–

100 y

100 v

100

76 x,y

100 x

72 x

–

100 v

99 y

–

100 y

–

100

100 v

100 x

100 v

92 x

–

100 v

–

100 v

–

18 y

–

49 y

–

14 y

–

36 x

–

16 x,y

27 y

–

30 x

59 y

–

33 y

–

16 x

–

17 x,y

50 y

–

36 y

–

77 x

–

77 x

–

82 y

65 y

–

91 y

–

83 x

–

85 y

–

83 y

–

91 x

–

36 y

–

82 y

–

72 x

–

63 y

–

93 y

52 y

–

72 x,y

–

81 x

–

80 x

–

83 y

67 y

–

84 x

–

91 x

–

37 y

–

82 y

–

73 x

–

93 y

–

73 x

–

74 x

–

82 y

62 y

–

82 x

–

91 x

–

35 y

–

81 y

–

71 x

–

93 y

–

150

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 9.

CHILD PROTECTION

Birth

registration

(%)

2010–2015*

total

Female genital mutilation/cutting

(%)

2004–2015*

prevalence

women

girls

attitudes

support for

the practice

Justification of

wife-beating (%)

2010–2015*

male

female

Countries

and areas

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia (Federated States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

New Zealand

Nicaragua

Niger

Nigeria

Child labour (%)

2009–2015*

total

male

female

Child marriage (%)

2008–2014*

married by married by

Violent discipline (%)

2010–2015*

total

male

female

18 x

–

22 y

–

26 y

18 y

–

15 y

–

12 x

11 y

–

2 x,y

26 x

–

26 y

10 y

–

23 x

21 x

–

23 y

39 y

–

15 y

13 y

22 x

–

37 y

–

15 x

20 x

–

23 y

–

35 y

–

22 y

–

12 x

13 y

–

3 x,y

27 x

–

30 y

–

25 x

21 x

–

23 y

42 y

–

15 y

21 x

–

37 y

–

18 x

17 x

–

21 y

–

16 y

–

12 x

10 y

–

0 x,y

25 x

–

22 y

11 y

–

21 x

–

23 y

37 y

–

10 y

24 x

–

38 y

–

11 x

–

18 x

–

10 x

–

47 x

–

26 x

–

16 x

–

27 x

–

41 x

100

100 v

–

97 x

–

100 v

69 y

99 y

100 v

100

100 v

100

94 x

–

100 v

100 x

45 x

25 y

–

100 v

–

93 x

100 v

96 x

–

100 v

94 y

87 y

83 x

100 v

30 y

–

49 y

–

74 y

–

42 x

18 y

–

60 x

–

48 x

–

46 y

–

14 x,y

–

58 x

–

47 x

–

70 y

76 x

–

10 x,y

37 x

–

31 x,y

–

56 x

–

64 x

–

14 x,y

67 x

–

82 y

70 y

–

81 x,y

–

57 y

–

82 x

–

90 x

–

72 y

–

47 y

69 y

91 x

–

82 y

–

70 x

–

60 y

–

82 x

–

90 x

–

73 y

–

73 y

92 x

–

83 y

–

63 x

–

54 y

–

82 x

–

90 x

–

72 y

–

66 y

90 x

–

81 y

–

THE STATE OF THE WORLD’S CHILDREN 2016

151

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TABLE 9.

CHILD PROTECTION

Birth

registration

(%)

2010–2015*

total

Female genital mutilation/cutting

(%)

2004–2015*

prevalence

women

girls

attitudes

support for

the practice

Justification of

wife-beating (%)

2010–2015*

male

female

Countries

and areas

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav Republic

of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

Ukraine

United Arab Emirates

United Kingdom

United Republic of Tanzania

United States

Child labour (%)

2009–2015*

total

male

female

Child marriage (%)

2008–2014*

married by married by

Violent discipline (%)

2010–2015*

total

male

female

–

28 y

34 x,y

11 y

–

3 x,y

–

26 y

–

10 y

–

49 x

–

25 y

–

10 x

28 y

–

16 y

–

29 y

–

32 y

31 x,y

14 y

–

4 x,y

–

12 y

–

45 x

–

29 y

–

17 y

–

29 y

–

24 y

36 x,y

–

3 x,y

–

54 x

–

11 x

27 y

–

16 y

–

28 y

–

21 x

18 x

–

22 x

45 x

–

12 x

–

13 x

10 x

–

100 v

–

85 y

97 y

100 v

–

100

–

100 v

–

100 v

–

100 v

–

85 y

100 v

97 x

100 v

96 x

99 y

100

97 x

99 y

96 x

50 x

100

100 y

100 v

15 y

100 v

–

31 y

–

46 y

–

32 y

–

65 x

–

73 x

–

42 y

–

69 x

76 x,y

–

53 x,y

–

38 x,y

70 x

–

45 y

–

50 y

–

80 y

–

43 y

–

72 x,y

–

92 y

64 y

88 y

–

89 x

78 x

–

81 y

–

77 x

–

47 y

–

53 y

–

44 y

–

93 y

–

90 x

80 x

–

81 y

–

78 x

–

43 y

–

46 y

–

42 y

–

92 y

–

88 x

75 x

–

80 y

–

77 x

–

152

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 9.

CHILD PROTECTION

Birth

registration

(%)

2010–2015*

total

Female genital mutilation/cutting

(%)

2004–2015*

prevalence

women

girls

attitudes

support for

the practice

Justification of

wife-beating (%)

2010–2015*

male

female

Countries

and areas

Uruguay

Uzbekistan

Vanuatu

Venezuela

(Bolivarian Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Sub-Saharan Africa

Eastern and Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and Pacific

Latin America and Caribbean

CEE/CIS

Least developed countries

World

Child labour (%)

2009–2015*

total

male

female

Child marriage (%)

2008–2014*

married by married by

Violent discipline (%)

2010–2015*

total

male

female

8 x,y

–

15 y

16 y

23 x

41 x,y

–

8 x,y

–

15 y

17 y

21 x

42 x,y

–

8 x,y

–

16 y

24 x

40 x,y

–

100

100 x

43 y

81 y

–

16 y

–

61 x

–

70 x

–

68 y

79 y

–

63 y

–

72 y

81 y

–

63 y

–

65 y

77 y

–

62 y

–

10 **

–

11 **

–

9 **

–

15 **

–

80 **

71 **

–

28 **

–

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

MAIN DATA SOURCES

Child labour

– Percentage of children 5–14 years old involved in child labour at the

moment of the survey. A child is considered to be involved in child labour under the

following conditions: (a) children 5–11 years old who, during the reference week, did at

least 1 hour of economic activity or at least 28 hours of household chores, or (b)

children 12–14 years old who, during the reference week, did at least 14 hours of

economic activity or at least 28 hours of household chores.

Child marriage

– Percentage of women 20–24 years old who were first married or in

union before they were 15 years old and percentage of women 20–24 years old who

were first married or in union before they were 18 years old.

Birth registration

– Percentage of children less than 5 years old who were registered

at the moment of the survey. The numerator of this indicator includes children reported

to have a birth certificate, regardless of whether or not it was seen by the interviewer,

and those without a birth certificate whose mother or caregiver says the birth has been

registered.

Female genital mutilation/cutting (FGM/C)

–

(a) Women:

percentage of women

15–49 years old who have undergone FGM/C;

(b) girls:

percentage of girls 0–14 years

old who have undergone FGM/C (as reported by their mothers);

practice:

percentage of women 15–49 years old who have heard about FGM/C and

think the practice should continue.

Justification of wife-beating

– Percentage of women and men 15–49 years old who

consider a husband to be justified in hitting or beating his wife for at least one of the

specified reasons, i.e., if his wife burns the food, argues with him, goes out without

telling him, neglects the children or refuses sexual relations.

Violent discipline

– Percentage of children 2–14 years old who experience any

violent discipline (psychological aggression and/or physical punishment).

Child labour

– Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS)

and other national surveys.

Child marriage

– DHS, MICS and other national surveys.

Birth registration

– DHS, MICS, other national surveys, censuses and vital registration systems.

Female genital mutilation/cutting

– DHS, MICS and other national surveys.

Justification of wife-beating

– DHS, MICS and other national surveys.

Violent discipline

– DHS, MICS and other national surveys.

Italicized data

are from older sources than the data presented for a country for other indicators on

the same topic.

NOTES

− Data not available.

v Estimates of 100% were assumed given that civil registration systems in these countries are

complete and all vital events (including births) are registered. Source: United Nations, Department

of Economic and Social Affairs, Statistics Division,

Population and Vital Statistics Report,

Series A

Vol. LXV, New York, 2013.

x Data refer to years or periods other than those specified in the column heading. Such data are not

included in the calculation of regional and global averages.

y Data differ from the standard definition or refer to only part of a country. If they fall within the

noted reference period, such data are included in the calculation of regional and global averages.

+ A more detailed explanation of the methodology and the changes in calculating these estimates

can be found in the General Note on the Data, page 108.

++ Changes in the definition of birth registration were made from the second and third rounds of

MICS (MICS2 and MICS3) to the fourth round (MICS4). In order to allow for comparability with

later rounds, data from MICS2 and MICS3 on birth registration were recalculated according to

the MICS4 indicator definition. Therefore, the recalculated data presented here may differ from

estimates included in MICS2 and MICS3 national reports.

* Data refer to the most recent year available during the period specified in the column heading.

** Excludes China.

THE STATE OF THE WORLD’S CHILDREN 2016

153

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TABLE 10.

THE RATE OF PROGRESS

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia (Plurinational State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's Republic

of Korea

Democratic Republic

of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

France

Gabon

Under-5

mortality

rank 1970

Under-5 mortality rate

1990

2000

2015

Annual rate of reduction (%)

Under-5 mortality rate

1970–

1990–

2000–

1990–

1990

2000

2015

Re-

duction

Reduction since

since 1990 2000

(%)

GDP per capita average

annual growth rate (%)

1970–1990

Total fertility rate

Average annual

rate of reduction

(%)

Total fertility rate

1970–

1990–

1990

2015

1990–2014 1970 1990 2015

112

182

142

120

112

166

125

153

120

159

166

159

104

133

159

142

130

104

142

133

166

153

182

166

182

193

166

308

–

242

–

224

–

266

272

231

–

121

134

–

319

248

165

–

213

223

–

113

227

143

241

–

248

–

122

138

243

155

–

241

–

181

226

144

180

134

124

202

172

117

138

177

215

125

153

187

119

190

151

205

137

217

145

186

152

108

150

175

190

101

122

146

161

101

152

145

157

100

130

139

2.7

–

8.2

–

4.8

–

4.2

5.6

–

1.3

6.0

2.2

4.9

–

4.4

4.5

2.0

3.5

3.1

–

4.0

3.9

–

2.8

2.3

1.8

4.8

–

2.2

4.9

1.2

–

7.1

3.7

5.1

3.0

2.1

3.8

7.5

2.3

–

5.9

–

1.4

3.1

–

6.6

3.5

4.4

5.2

4.8

–

0.8

3.1

4.4

3.5

–

2.8

4.4

1.6

6.1

0.4

5.0

3.1

5.0

3.9

5.5

2.5

4.0

6.0

4.9

0.9

1.5

5.4

4.6

2.2

5.2

4.4

6.9

-4.2

6.4

2.6

0.5

0.9

1.2

5.7

0.8

-0.9

2.9

0.1

1.2

5.6

3.8

3.4

2.1

-2.6

3.7

2.6

0.5

4.4

4.6

5.2

7.9

-3.2

1.5

4.6

1.7

1.1

3.8

5.0

6.1

2.2

5.3

6.1

3.4

2.0

4.4

5.1

0.9

2.7

4.2

3.0

3.3

2.2

4.3

3.2

5.1

3.3

3.0

5.7

1.7

4.7

5.7

1.5

7.6

2.3

2.8

2.5

5.9

4.9

3.6

4.3

4.5

-0.5

4.7

4.9

4.1

2.5

8.9

3.6

1.6

2.0

2.1

2.0

8.3

3.0

2.1

6.6

4.9

2.0

3.0

4.4

2.8

6.0

4.4

5.9

3.3

3.1

2.9

-2.2

1.9

3.1

4.4

3.2

4.3

8.9

6.0

0.6

4.2

1.5

3.5

2.7

4.3

2.4

4.4

1.5

4.6

3.2

5.0

3.5

4.0

4.4

2.7

5.2

5.4

1.3

5.1

3.6

3.5

2.4

5.6

4.7

4.9

0.9

5.2

0.7

3.0

3.3

3.0

3.8

5.6

1.8

2.1

1.2

1.7

3.4

6.5

3.2

2.1

2.9

4.4

2.2

2.0

4.4

3.5

5.7

5.8

2.2

2.6

3.7

2.4

-0.9

2.7

3.9

5.1

2.8

4.7

7.8

5.0

1.1

4.3

3.0

2.4

-24

-9

-39

–

-0.6 x

1.8

-1.3

–

7.9 x

-0.8

–

1.6

2.5

–

1.9

-1.0 x

0.7

1.4 x

–

2.2

3.1

0.4

7.0 x

-1.0

–

8.1

2.2

-2.2 x

3.4 x

1.4

1.2

3.5 x

–

3.4

2.0

-1.3

-0.9

1.5

6.6

1.9

-0.2 x

3.3

–

0.8

-1.7

–

3.9

5.9 x

–

-2.1

2.0

–

5.2 x

2.1

1.7

4.1

-1.9

-2.4 x

–

0.6

2.9

2.2

0.6

5.6 x

5.7

1.7

1.2 x

-0.4 x

1.2

2.3

6.2

2.0

1.6

6.4

0.1

3.6

1.2

5.0

1.4

1.7

1.1

5.3

2.0

7.4 x

2.7

1.8

-0.4

3.5

2.9

-1.5

6.3

5.9 x

0.6

1.6

-0.6

3.3

9.2

2.1

-0.2

0.6

–

2.9

-0.5

2.6 x

3.3 x

1.5

2.5

–

-1.9

1.2

0.4

2.0

3.7

1.5

2.6

2.2

19.0

-0.2 x

4.7 x

3.8

1.1

2.1

1.2

-0.7

7.5

4.9

7.6

–

7.4

3.7

3.1

3.2

2.7

2.3

4.6

3.5

6.5

6.9

3.1

2.3

2.2

6.3

6.7

6.3

2.9

6.6

5.0

5.8

2.1

6.6

7.3

6.9

6.5

6.2

2.2

6.0

6.5

4.0

5.7

5.5

7.1

6.3

–

4.6

7.9

2.0

4.0

2.6

2.1

4.3

6.2

2.1

6.8

–

6.2

6.1

5.9

6.2

5.7

6.7

2.1

7.0

4.5

1.9

2.5

5.1

7.5

3.0

4.7

–

7.2

2.1

3.0

2.5

1.9

1.5

3.0

2.6

3.7

4.5

1.7

1.9

1.6

4.5

6.7

5.6

4.9

1.8

4.7

2.8

3.5

1.8

7.0

7.5

5.3

5.6

6.4

1.7

5.8

7.3

2.5

2.4

3.0

6.4

5.3

–

3.2

6.6

1.6

1.8

2.4

1.8

2.3

7.1

1.7

6.1

–

3.5

3.8

4.7

3.9

5.9

6.4

1.9

7.2

3.4

1.7

1.8

5.4

4.7

1.8

2.8

–

6.0

2.1

2.3

1.5

1.9

1.5

2.3

1.9

2.0

2.1

1.8

1.6

1.8

2.5

4.7

2.0

2.9

1.3

2.8

1.8

1.9

1.6

5.4

5.9

2.3

2.6

4.6

1.6

4.2

6.1

1.7

1.6

1.9

4.4

4.8

–

1.8

4.9

1.5

1.6

1.4

1.5

2.0

5.9

1.7

3.1

–

2.5

3.3

1.9

4.7

4.2

1.6

4.3

2.5

1.8

2.0

3.8

0.0

2.5

2.4

–

0.1

2.9

0.1

1.2

1.9

2.3

2.2

1.5

2.8

2.2

2.9

1.1

1.7

0.0

0.8

1.2

2.5

1.7

2.9

2.4

0.9

-0.3

-0.2

1.3

0.7

-0.2

1.5

0.1

-0.6

2.4

4.3

3.1

0.5

0.8

–

1.9

0.9

1.1

4.2

0.4

0.7

3.2

-0.6

1.2

0.6

–

2.9

2.4

1.2

2.3

-0.2

0.2

0.4

-0.2

1.5

0.3

1.8

-0.3

1.9

2.0

2.1

–

0.7

0.0

1.0

2.1

-0.1

1.1

1.4

2.4

3.0

-0.1

0.5

-0.6

2.3

1.5

4.2

2.1

1.4

2.1

1.8

2.6

0.5

1.0

3.4

3.1

1.3

0.2

1.3

0.8

1.4

1.7

1.9

1.5

0.4

–

2.3

1.2

0.3

2.1

0.8

0.6

0.7

-0.2

2.7

–

1.4

1.6

1.4

2.9

0.9

1.7

0.7

2.1

1.2

0.0

-0.5

1.4

154

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 10.

THE RATE OF PROGRESS

Re-

duction

Reduction since

since 1990 2000

(%)

Average annual

rate of reduction

(%)

Total fertility rate

1970–

1990–

1990

2015

Countries

and areas

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic

Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia (Federated States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

New Zealand

Nicaragua

Niger

Under-5

mortality

rank 1970

Under-5 mortality rate

1990

2000

2015

Annual rate of reduction (%)

Under-5 mortality rate

1970–

1990–

2000–

1990–

1990

2000

2015

GDP per capita average

annual growth rate (%)

1970–1990

Total fertility rate

1990–2014 1970 1990 2015

125

166

159

125

–

153

193

104

166

104

182

112

139

142

120

–

159

193

148

139

153

112

120

166

159

166

153

303

–

202

–

174

327

–

245

–

148

213

166

–

115

–

148

140

–

175

286

138

–

152

347

261

400

194

109

–

189

273

179

–

268

171

327

170

127

238

229

146

–

126

102

162

255

–

161

242

254

118

108

240

110

141

328

119

101

170

178

105

–

108

118

117

182

–

109

174

220

114

171

227

–

115

2.9

–

5.5

2.3

5.5

–

3.8

1.6

–

1.0

2.6

–

4.7

4.0

4.5

2.6

3.4

–

3.8

4.4

–

6.2

3.2

5.1

4.5

–

1.9

6.9

–

3.3

3.4

0.6

6.0

–

2.1

4.7

-0.3

1.8

6.1

5.1

2.3

4.5

2.8

2.5

6.4

4.2

–

4.3

0.6

2.4

1.4

–

3.2

3.1

4.7

0.0

3.6

2.9

4.5

2.4

4.8

3.8

4.7

3.4

2.6

3.3

–

4.4

5.3

4.7

3.2

4.8

5.1

1.9

2.6

5.2

5.7

3.3

3.4

2.8

1.9

-0.5

3.1

3.4

2.9

3.2

1.7

4.9

-2.8

3.4

3.9

–

3.4

6.1

3.9

3.3

4.9

7.5

1.5

3.7

1.9

0.4

2.2

6.0

0.3

4.1

5.4

1.8

4.7

3.4

2.9

-0.3

3.2

5.6

2.9

4.1

5.1

3.7

3.6

7.3

2.5

3.3

3.5

2.0

3.7

4.0

4.3

1.1

2.8

–

4.0

4.3

4.6

4.3

4.4

5.4

2.2

4.5

3.6

3.0

2.2

3.4

2.9

7.5

5.2

1.6

2.6

5.5

3.8

5.2

5.9

1.7

6.4

4.9

–

5.5

6.2

5.3

6.7

2.5

10.9

4.3

1.3

0.9

2.0

2.1

4.4

2.9

2.6

6.9

7.2

4.0

5.2

3.3

3.4

1.0

5.4

3.3

1.7

4.0

5.8

3.6

5.6

3.3

2.9

4.0

2.7

4.1

3.7

3.6

1.7

3.0

–

4.2

4.7

3.9

4.5

5.2

2.1

3.8

4.3

4.1

2.7

3.4

2.9

5.3

2.9

2.2

2.9

4.5

3.6

3.8

5.5

-0.1

5.2

4.5

–

4.6

6.1

4.7

5.3

3.5

9.6

3.2

2.3

1.3

2.1

5.0

1.9

3.2

6.3

5.0

4.3

4.5

3.2

1.9

5.5

3.1

2.7

4.4

4.9

–

-2

–

0.7

3.1

2.3

-2.0

1.3

4.2 x

0.1

–

0.8

-1.5

–

0.8

–

3.2

2.0

4.5

-4.3

4.2

2.8

1.9

2.8

-1.3

3.4

2.5 x

–

1.2

-5.0

-6.7 x

–

3.0

-4.1

–

2.2

–

2.6

-2.4

0.0

4.0

–

1.4

6.0

–

-1.1

3.1 x

1.7

–

1.5

–

2.6

-1.1 x

1.4

-2.1 x

–

1.2

1.5

1.5 x

-3.7

-1.9

0.3 x

3.3

1.3

2.9

1.4

2.4

1.3

0.6

-0.9

2.9 x

-0.6 x

–

1.7

2.5 x

2.1

5.0

2.9

2.4

3.7

3.8

2.4

0.6

0.4

0.7

2.6

4.3

0.8

1.0

0.0 x

1.1

4.9

5.7 x

2.1

2.7

2.4

-1.4 x

2.9 x

5.8 x

2.2

-0.3

1.4

3.2

4.1 x

1.5

2.2 x

0.7

1.2

3.6

1.1

0.6

1.7 x

4.1

2.8 x

2.8

5.1

11.8 x

2.2

–

2.6

1.7

2.1

0.0

6.1

2.6

2.0

7.0

2.4

4.6

6.2

6.0

5.2

5.8

–

7.3

2.0

3.0

5.6

5.5

6.4

7.4

3.8

2.4

5.5

2.1

7.9

3.5

8.1

5.5

7.3

4.9

6.0

1.9

4.9

5.8

6.7

8.1

–

2.3

2.0

7.3

4.9

7.2

7.1

2.0

–

6.8

4.0

6.8

6.9

–

7.6

2.7

6.7

6.6

6.0

6.5

–

5.9

2.4

3.1

6.9

7.4

6.1

2.2

1.4

5.6

1.4

3.8

5.3

6.6

3.6

5.4

–

5.1

1.8

2.2

4.0

3.1

4.8

5.9

2.0

3.0

1.3

2.9

1.6

5.5

2.8

6.0

4.7

2.6

3.9

6.2

1.9

3.0

4.9

6.5

5.0

–

2.0

1.6

6.3

7.0

3.5

6.0

7.2

2.0

–

6.0

2.3

3.5

5.0

–

4.1

2.1

4.1

6.2

3.5

5.2

–

5.2

1.6

2.1

4.6

7.7

5.7

1.8

1.4

4.1

1.3

2.1

3.2

4.9

4.8

2.5

3.0

–

2.3

1.4

1.9

2.4

1.7

4.5

2.0

3.0

1.5

2.0

1.4

3.4

2.6

4.3

3.7

2.1

3.1

2.9

1.5

1.7

3.1

4.6

2.4

–

1.6

4.4

5.0

1.9

2.1

6.1

1.5

–

4.5

1.5

2.2

3.2

–

2.6

1.7

2.5

5.3

2.2

3.5

–

2.2

1.8

2.0

2.2

7.6

0.0

0.9

2.0

1.1

2.5

0.9

0.8

-0.3

-0.5

1.8

0.3

–

1.7

0.5

1.7

1.6

2.8

1.5

1.1

3.2

1.2

3.2

3.1

1.5

1.8

1.1

1.5

0.8

5.1

1.2

-0.1

0.0

2.5

0.8

0.1

2.5

–

0.8

1.1

0.8

0.2

1.6

0.9

0.0

-0.1

–

0.6

2.7

3.4

1.7

–

3.1

1.4

2.5

0.3

2.7

1.1

–

0.7

2.2

2.0

-0.2

0.3

0.7

-0.2

1.2

0.3

2.4

2.1

1.2

1.3

1.4

2.4

–

3.2

1.2

0.5

2.1

1.0

4.2

1.1

0.0

-0.5

1.5

0.4

2.0

0.3

1.4

1.0

0.9

3.0

1.0

2.2

1.8

1.3

2.9

–

0.8

-0.1

1.5

1.3

2.4

4.2

0.6

1.3

–

1.1

1.8

–

1.7

0.9

2.0

0.7

1.8

1.6

–

3.5

-0.5

0.1

2.9

0.1

THE STATE OF THE WORLD’S CHILDREN 2016

155

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 10.

THE RATE OF PROGRESS

Re-

duction

Reduction since

since 1990 2000

(%)

Average annual

rate of reduction

(%)

Total fertility rate

1970–

1990–

1990

2015

Countries

and areas

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and

the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav

Republic of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

Ukraine

United Arab Emirates

United Kingdom

United Republic of Tanzania

Under-5

mortality

rank 1970

Under-5 mortality rate

1990

2000

2015

Annual rate of reduction (%)

Under-5 mortality rate

1970–

1990–

2000–

1990–

1990

2000

2015

GDP per capita average

annual growth rate (%)

1970–1990

Total fertility rate

1990–2014 1970 1990 2015

182

125

104

159

166

142

182

104

130

133

130

112

182

110

148

112

182

148

182

166

133

182

166

120

125

153

112

139

148

166

285

–

228

189

–

144

164

–

219

–

291

–

335

–

107

–

155

–

176

105

–

100

–

225

181

187

–

190

–

216

213

139

152

111

140

264

180

253

128

108

176

146

187

165

187

112

184

135

236

174

182

106

128

110

121

148

131

109

120

137

1.5

–

3.1

8.8

1.5

–

3.9

2.4

2.6

3.6

1.8

3.7

7.7

5.8

10.0

–

2.8

2.7

1.8

4.5

6.0

5.9

–

-1.2

–

3.6

–

7.4

1.2

6.3

–

5.0

–

4.9

6.1

–

1.0

–

4.3

3.3

4.0

5.2

–

5.0

–

2.1

4.1

2.6

5.8

4.6

–

0.1

–

8.9

4.1

1.3

-5.2

5.7

8.6

2.1

3.0

1.7

1.3

3.3

7.3

3.8

6.2

7.1

5.2

1.5

0.6

3.4

1.1

-1.9

4.2

2.4

1.0

3.6

6.8

2.1

6.6

0.4

8.1

1.4

1.1

6.5

4.1

6.4

1.8

0.3

-2.3

3.3

5.3

2.6

4.0

1.9

3.2

-5.4

5.2

3.8

4.6

1.5

5.0

8.3

4.7

1.9

2.2

0.6

5.9

6.3

1.0

2.9

2.3

0.5

4.0

3.4

2.4

3.6

0.1

4.2

2.4

2.2

3.3

2.8

2.1

3.3

5.5

2.3

3.9

4.6

2.9

3.9

4.6

5.9

9.9

3.8

1.5

1.3

1.4

4.3

4.2

3.0

7.0

4.2

0.3

4.5

2.6

3.1

5.0

1.1

1.6

4.1

4.5

3.1

3.4

2.3

2.8

3.2

5.0

2.1

2.4

4.0

4.9

4.0

7.1

4.9

2.9

0.3

2.3

5.4

7.2

3.1

3.0

6.7

4.8

3.3

3.0

6.6

2.7

-2.0

4.8

4.9

2.1

3.2

2.4

1.8

3.3

6.2

2.9

4.8

5.6

3.8

2.9

3.0

4.9

4.0

5.2

4.0

1.8

1.2

2.3

5.3

3.4

4.5

4.4

5.8

0.8

3.1

4.2

3.5

5.5

1.4

1.1

1.6

4.0

3.9

3.1

3.0

2.4

3.2

0.8

3.3

3.0

4.2

3.5

4.4

7.6

4.8

2.5

1.1

1.6

5.6

6.8

2.3

3.0

4.9

3.1

3.5

3.2

4.9

-67

-2.3

–

3.3

3.2

2.7

–

0.2

-1.0

3.8

-0.5

0.6

–

2.5

–

7.5

1.8 x

–

1.1

6.5 x

5.1 x

3.3

–

1.8

–

-2.1

-0.6

–

2.9

-0.6

5.9

–

-0.8

0.1

–

1.9

3.0

–

-0.1

-2.3 x

3.1

1.8

1.7 x

2.1

–

4.8

–

-0.5

–

-0.5

2.5

1.9

–

-4.3 x

2.2

–

3.4

–

1.6

0.6

1.7

-0.4 x

3.8

0.9

3.4

2.3

4.2

1.2

1.5 x

4.3

0.8

3.4

2.5

3.3

1.8

1.2

2.9

2.5

3.4 x

3.0 x

1.4

1.1

3.7 x

2.1

1.4

3.5

4.2 x

2.5 x

-0.4

–

1.2

–

1.5

4.4

1.8 x

3.5

2.2

1.0

2.0

1.0

1.8 x

0.9

3.1

1.8

3.4 x

0.1

1.3

5.1

3.0

2.5

3.5

1.6

3.6

1.0

-2.9

1.8

2.5

6.5

–

2.5

7.3

6.6

–

5.2

6.2

5.7

6.4

6.3

2.3

3.0

6.9

4.5

2.6

2.8

2.0

8.2

–

6.1

6.0

7.2

–

6.5

7.3

2.4

5.8

6.0

3.2

2.5

2.2

6.9

7.2

5.6

6.9

2.9

4.3

7.9

6.9

5.7

6.9

2.0

2.1

7.6

6.9

5.6

3.2

5.9

7.1

5.9

3.6

6.7

5.6

6.3

–

7.1

2.0

6.6

2.3

6.8

6.5

–

1.9

7.2

6.0

–

3.1

4.8

4.5

3.8

4.3

2.1

1.5

4.0

1.6

2.4

1.9

7.3

–

3.4

3.0

5.1

–

5.8

5.9

6.6

2.1

2.7

6.7

1.7

2.0

1.5

5.9

7.4

3.7

6.8

1.3

2.5

6.7

6.2

3.3

5.7

2.0

1.5

5.3

5.2

2.1

2.2

5.3

6.3

4.6

2.5

3.5

3.1

4.3

–

7.1

1.8

4.4

1.8

6.2

5.6

–

1.8

2.7

3.6

–

2.4

3.7

2.5

2.4

2.9

1.3

2.0

1.3

1.2

1.5

1.7

3.8

–

1.9

2.0

4.0

–

4.5

2.7

5.0

1.6

2.3

4.5

1.2

1.4

1.6

3.9

6.4

2.3

4.9

1.3

2.1

4.1

4.3

2.3

3.2

1.9

1.5

2.9

3.5

1.5

5.6

4.5

3.7

1.8

2.1

2.3

–

5.7

1.5

1.8

1.9

5.1

0.0

–

1.5

0.1

0.5

–

2.6

1.2

2.6

1.9

0.4

3.4

2.7

5.2

0.3

2.1

0.3

0.6

–

2.9

3.6

1.7

–

0.5

1.0

0.5

0.7

3.7

-0.5

3.1

1.0

2.1

0.8

-0.1

2.1

0.1

3.8

2.8

0.8

0.6

2.7

0.9

0.1

1.6

1.8

1.4

4.9

1.8

0.5

0.6

1.2

1.9

3.3

3.0

1.9

–

0.0

0.7

2.0

1.2

0.4

0.6

–

0.1

3.9

2.1

–

0.9

1.0

2.4

1.8

1.5

1.7

0.8

2.8

0.9

2.6

0.9

0.4

2.6

–

2.4

1.7

1.0

–

1.0

3.1

1.1

0.7

1.6

1.3

1.5

-0.4

1.6

0.6

1.8

1.3

0.0

0.7

2.0

1.4

2.3

0.2

0.0

2.4

1.6

1.4

1.5

-0.2

1.3

0.9

1.3

2.0

1.6

2.6

–

0.9

0.6

3.6

-0.2

0.8

156

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 10.

THE RATE OF PROGRESS

Re-

duction

Reduction since

since 1990 2000

(%)

Average annual

rate of reduction

(%)

Total fertility rate

1970–

1990–

1990

2015

Countries

and areas

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela (Bolivarian

Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Sub-Saharan Africa

Eastern and Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and Pacific

Latin America and Caribbean

CEE/CIS

Least developed countries

World

Under-5

mortality

rank 1970

Under-5 mortality rate

1990

2000

2015

Annual rate of reduction (%)

Under-5 mortality rate

1970–

1990–

2000–

1990–

1990

2000

2015

GDP per capita average

annual growth rate (%)

1970–1990

Total fertility rate

1990–2014 1970 1990 2015

148

133

110

–

109

329

182

114

126

191

163

106

3.7

4.3

–

5.6

3.7

2.6

4.8

-0.2

2.0

2.9

3.2

1.2

2.2

3.1

4.1

2.8

1.6

-3.3

1.7

3.4

3.2

0.2

2.5

3.0

5.5

6.2

2.7

2.2

3.3

2.4

1.0

2.7

3.4

4.4

0.3

2.2

0.9

–

1.1 x

-1.2

–

-2.4

-0.4

1.6

2.5

3.2

0.6

5.5

0.7 x

2.4

-2.8

2.3

2.9

5.7

6.3

5.4

6.5

7.8

7.4

2.0

2.5

4.1

4.9

3.4

3.6

8.6

6.5

5.2

1.9

2.0

2.4

3.3

2.3

2.0

4.0

5.3

3.9

0.6

0.7

1.6

1.2

2.2

3.0

-0.5

0.7

1.8

0.2

0.9

2.1

1.6

2.4

3.0

0.8

1.2

244

213

276

200

213

116

120

242

145

180

167

198

129

175

154

140

172

138

1.5

1.2

1.6

5.2

2.5

3.5

4.0

3.5

1.6

2.3

1.6

1.8

1.4

3.4

3.2

3.4

5.2

2.5

2.4

1.8

4.1

4.9

3.7

3.9

5.6

3.9

5.1

4.2

3.9

3.1

3.7

2.8

3.6

4.7

4.4

4.1

3.5

3.0

-0.1

0.3

-0.7

0.8

2.0

6.0

1.4

–

0.0

2.5

2.4

1.7

2.8

1.4

4.6

7.7

1.8

2.8

3.1

2.9

6.7

6.9

6.6

6.7

5.8

5.7

5.3

2.8

6.8

4.8

6.4

6.1

6.6

5.1

4.3

2.6

3.2

2.3

6.0

3.3

4.9

4.5

5.4

2.9

2.5

1.8

2.1

1.9

4.1

2.5

0.3

0.6

0.0

1.4

1.5

3.8

2.5

0.9

0.6

1.9

1.0

1.3

0.8

2.2

2.1

1.5

1.7

0.8

1.5

1.1

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

MAIN DATA SOURCES

Under-5 mortality rate

– Probability of dying between birth and exactly 5 years of age,

expressed per 1,000 live births.

GDP per capita

– Gross domestic product (GDP) is the sum of value added by all resident

producers plus any product taxes (less subsidies) not included in the valuation of output. GDP

per capita is gross domestic product divided by midyear population. Growth is calculated from

constant price GDP data in local currency.

Total fertility rate

– Number of children who would be born per woman if she lived to the end

of her childbearing years and bore children at each age in accordance with prevailing

age-specific fertility rates.

Under-5 mortality rate

– United Nations Inter-agency Group for Child Mortality Estimation

(UNICEF, World Health Organization, United Nations Population Division and the World Bank).

GDP per capita

– The World Bank.

Total fertility rate

– United Nations Population Division.

NOTES

– Data not available.

A negative value indicates an increase in the under-five mortality rate.

x Data refer to years or periods other than those specified in the column heading. Such data

are not included in the calculation of regional and global averages.

THE STATE OF THE WORLD’S CHILDREN 2016

157

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TABLE 11.

ADOLESCENTS

Adolescent population

Proportion

of total

population

(%)

2015

Aged 10–19

(thousands)

2015

Adolescents

currently

married/ in union

(%)

2010–2015*

male

female

Comprehensive

Justification of

knowledge of HIV

Upper

Lower

wife-beating among Use of mass media

among adolescents

secondary

among adolescents

adolescents

Births by Adoles-

(%)

school gross

(%)

cent

age 18

2010–2014*

enrolment ratio enrolment ratio

2010–2014*

birth rate

(%)

2010–

2009–

2015*

2014*

male

female

male

female

2010–2014*

male

female

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia (Plurinational State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's Republic

of Korea

Democratic Republic of the

Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

8,305

454

5,924

–

5,954

7,020

338

2,900

874

1,295

177

32,530

879

1,231

2,528

144

2,216

386

441

34,887

635

4,319

2,403

104

3,064

5,405

3,966

1,120

3,428

2,568

154,222

8,139

175

1,020

–

759

5,329

448

1,348

139

932

3,820

18,121

688

181

–

2,007

3,005

16,511

1,230

178

1,178

118

24,725

157

592

–

1 x

–

4 x

–

2 x

–

13 x

–

16 x

–

20 x

–

22 x

–

90 x

191

67 x

40 x

49 x

89 x

17 x

136 x

65 x

92 x

128 x

229

203

85 x

147

125

135

47 x

100 x

177 x

–

28 x

–

37 x

–

24 x

26 y

–

76 y

–

24 x

55 y

–

33 y

–

17 x

–

23 x

46 y

–

73 y

–

46 y

–

97 x

–

100 x

100

–

88 x

–

55 x

–

100

–

99 x

–

97 x

100

–

88 x

–

24 x

–

100

–

132

–

116

128

97 x

115

–

107

104

181

100

–

108

114

100

103

107

110 x

133

102

101

104

102 x

117

106

116

100

101

–

110

105

101

–

181

135

113

155

–

108

29 x

119

102

105

102 x

142

–

107

182

–

21 x

–

26 x

–

24 x

–

36 x

–

24 x

–

20 x

–

16 x

–

158

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 11.

ADOLESCENTS

Adolescent population

Proportion

of total

population

(%)

2015

Adolescents

currently

married/ in union

(%)

2010–2015*

male

female

Comprehensive

Justification of

knowledge of HIV

Upper

Lower

wife-beating among Use of mass media

among adolescents

secondary

among adolescents

adolescents

Births by Adoles-

(%)

school gross

(%)

cent

age 18

2010–2014*

enrolment ratio enrolment ratio

2010–2014*

birth rate

(%)

2010–

2009–

2015*

2014*

male

female

male

female

2010–2014*

male

female

Countries

and areas

Aged 10–19

(thousands)

2015

France

7,792

Gabon

366

Gambia

464

Georgia

434

Germany

7,644

Ghana

5,860

Greece

1,040

Grenada

Guatemala

3,721

Guinea

2,899

Guinea-Bissau

410

Guyana

185

Haiti

2,285

Holy See

–

Honduras

1,793

Hungary

979

Iceland

India

250,098

Indonesia

46,476

Iran (Islamic Republic of)

10,905

Iraq

8,040

Ireland

582

Israel

1,296

Italy

5,611

Jamaica

510

Japan

11,564

Jordan

1,577

Kazakhstan

2,274

Kenya

10,392

Kiribati

Kuwait

445

Kyrgyzstan

1,003

Lao People's Democratic

1,484

Republic

Latvia

172

Lebanon

1,061

Lesotho

493

Liberia

1,044

Libya

1,089

Liechtenstein

–

Lithuania

292

Luxembourg

Madagascar

5,714

Malawi

4,111

Malaysia

5,400

Maldives

Mali

4,151

Malta

Marshall Islands

–

Mauritania

909

Mauritius

193

Mexico

23,754

Micronesia (Federated States of)

Monaco

–

Mongolia

448

Montenegro

Morocco

5,827

Mozambique

6,731

Myanmar

10,278

Namibia

538

Nauru

–

Nepal

6,623

Netherlands

1,985

–

5 x

–

5 x

–

1 x

–

5 x

–

9 x

–

20 x

–

30 x

16 x

–

16 x

–

16 x

–

21 x

–

18 x

–

22 x

–

22 x

–

13 x

–

46 x

–

21 x

–

13 x

22 x

–

115

53 x

154

137

97 x

–

68 x

72 x

31 x

101

18 x

147

147 x

143

178

–

32 x

166

17 x

106

87 x

–

25 x

–

47 x

48 y

–

65 x

–

54 x

–

71 x

–

39 y

18 x

–

45 x

–

84 y

77 x

–

22 x,y

48 x

–

41 x,y

–

47 x

–

64 x

–

94 x

–

88 x

88 y

–

58 x

–

64 x

–

81 x

–

86 x

55 x

–

65 y

89 x

–

94 x

–

72 x

–

100 y

57 x

–

100

–

69 x

–

100 x

79 x

–

85 x

44 x

–

90 x

–

86 x

–

108

–

109

102

104

–

101

100

–

115

103

109

101

109

103

111

–

104

114

101

125

112

111

–

135

115

–

104

113

–

114

121

–

145

100

102

74 x

110

–

118

110

–

97 x

–

126

–

24 x

–

45 x

–

35 x

4 y,p

–

34 y

–

46 x

–

28 x

–

35 x

–

20 x

53 x

–

19 x

–

39 y

–

41 x

–

35 x

–

22 x,y

–

27 x

–

THE STATE OF THE WORLD’S CHILDREN 2016

159

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TABLE 11.

ADOLESCENTS

Adolescent population

Proportion

of total

population

(%)

2015

Adolescents

currently

married/ in union

(%)

2010–2015*

male

female

Comprehensive

Justification of

knowledge of HIV

Upper

Lower

wife-beating among Use of mass media

among adolescents

secondary

among adolescents

adolescents

Births by Adoles-

(%)

school gross

(%)

cent

age 18

2010–2014*

enrolment ratio enrolment ratio

2010–2014*

birth rate

(%)

2010–

2009–

2015*

2014*

male

female

male

female

2010–2014*

male

female

Countries

and areas

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and

the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav Republic

of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

Aged 10–19

(thousands)

2015

604

1,207

4,654

41,386

–

632

476

38,797

–

686

1,698

1,342

5,606

20,389

3,751

1,072

213

5,740

444

2,108

13,252

2,654

–

5,285

3,430

1,078

1,507

674

543

185

133

2,599

10,328

2,874

4,373

3,284

1,086

9,240

295

1,025

833

4,469

1,707

8,604

261

277

1,650

177

1,618

13,397

959

–

9,603

–

24 x

–

15 x

11 x

–

13 x

25 x

–

10 x

–

28 x

–

14 x

–

15 x

–

15 x

–

210

123

65 x

63 x

41 x

75 x

50 x

110 x

131

62 x

123 x

54 x

158 x

24 x

102

66 x

75 x

54 x

36 x

21 x

42 x

140

–

33 y

–

25 x

–

73 x

–

83 x

–

19 x,y

–

53 y

–

23 x

–

72 x

75 x,y

–

54 x,y

–

10 x

37 x,y

69 x

–

59 y

–

96 x

–

71 x

–

94 x

–

89 x

–

95 x

–

49 y

–

95 x

–

100

–

54 x

–

88 x,y

–

89 x

–

96 x

95 x

103

108

104

100

120

102

118

102

105

108

39 x

110

–

132

100

112

110

–

98 x

107

140

31 x

135

–

126

119

116

119

101

102

108

16 x

–

120

–

130

142

–

14 x

–

5 y,p

–

39 x

–

26 x

–

57 x

–

21 x

19 x

–

39 x

–

29 x

–

23 x

49 x

–

31 x

160

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 11.

ADOLESCENTS

Adolescent population

Proportion

of total

population

(%)

2015

Adolescents

currently

married/ in union

(%)

2010–2015*

male

female

Comprehensive

Justification of

knowledge of HIV

Upper

Lower

wife-beating among Use of mass media

among adolescents

secondary

among adolescents

adolescents

Births by Adoles-

(%)

school gross

(%)

cent

age 18

2010–2014*

enrolment ratio enrolment ratio

2010–2014*

birth rate

(%)

2010–

2009–

2015*

2014*

male

female

male

female

2010–2014*

male

female

Countries

and areas

Ukraine

United Arab Emirates

United Kingdom

United Republic of Tanzania

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela (Bolivarian

Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Sub-Saharan Africa

Eastern and Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and Pacific

Latin America and Caribbean

CEE/CIS

Least developed countries

World

Aged 10–19

(thousands)

2015

3,954

781

7,252

12,291

41,364

508

5,148

5,640

13,588

6,283

3,863

3,504

–

128 x

26 x

101

145

120

–

63 x

–

63 x

–

102

–

111

101

110

–

133

136

–

27 x

14 x

–

2 x,y

230,815

111,070

110,324

81,187

339,843

276,692

110,944

50,538

217,127

1,192,785

–

16 ‡

7 **

18‡**

122

114

130

112

–

33 **

–

91 **

–

104

7‡

25 **

21 ‡**

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

MAIN DATA SOURCES

Adolescents currently married/ in union

– Percentage of boys and girls aged 15–19 who

are currently married or in union. This indicator is meant to provide a snapshot of the current

marital status of boys and girls in this age group. However, it is worth noting that those not

married at the time of the survey are still exposed to the risk of marrying before they exit

adolescence.

Births by age 18

– Percentage of women aged 20–24 who gave birth before age 18. This

standardized indicator from population-based surveys captures levels of fertility among

adolescents up to the age of 18. Note that the data are based on the answers of women aged

20–24, whose risk of giving birth before the age of 18 is behind them.

Adolescent birth rate

– Number of births per 1,000 adolescent girls aged 15–19.

Justification of wife-beating among adolescents

– The percentage of boys and girls aged

15–19 who consider a husband to be justified in hitting or beating his wife for at least one of

the specified reasons: if his wife burns the food, argues with him, goes out without telling him,

neglects the children or refuses sexual relations.

Use of mass media among adolescents

– The percentage of boys and girls aged 15–19

who make use of at least one of the following types of information media at least once a

week: newspaper, magazine, television or radio.

Lower secondary school gross enrolment ratio

– Number of children enrolled in lower

secondary school, regardless of age, expressed as a percentage of the total number of children

of official lower secondary school age.

Upper secondary school gross enrolment ratio

– Number of children enrolled in upper

secondary school, regardless of age, expressed as a percentage of the total number of children

of official upper secondary school age.

Comprehensive knowledge of HIV among adolescents

– Percentage of young men and

women aged 15–19 who correctly identify the two major ways of preventing the sexual

transmission of HIV (using condoms and limiting sex to one faithful, uninfected partner), who

reject the two most common local misconceptions about HIV transmission and who know that

a healthy-looking person can be HIV-positive.

Adolescent population

– United Nations Population Division.

Adolescents currently married/ in union

– Demographic and Health Surveys (DHS),

Multiple Indicator Cluster Surveys (MICS), other national surveys and censuses.

Births by age 18

– DHS, MICS and other national surveys.

Adolescent birth rate

– United Nations Population Division.

Justification of wife-beating among adolescents

– DHS, MICS and other national

surveys.

Use of mass media among adolescents

–DHS, MICS and other national surveys

Gross enrolment ratio

– UNESCO Institute for Statistics (UIS).

Comprehensive knowledge of HIV among adolescents

– AIS, DHS, MICS and other

national household surveys; DHS STATcompiler, <ww w.statcompiler.com>.

Italicized data

are from different sources than the data presented for the same indicators in

other tables of the report.

NOTES

– Data not available.

x Data refer to years or periods other than those specified in the column heading. Such data

are not included in the calculation of regional and global averages. Estimates from data years

prior to 2000 are not displayed.

y Data differ from the standard definition or refer to only part of a country. If they fall within

the noted reference period, such data are included in the calculation of regional and global

averages.

p Based on small denominators (typically 25–49 unweighted cases). No data based on fewer

than 25 unweighted cases are displayed.

* Data refer to the most recent year available during the period specified in the column heading.

** Excludes China.

‡ Excludes India.

THE STATE OF THE WORLD’S CHILDREN 2016

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TABLE 12.

DISPARITIES BY RESIDENCE

Use of improved

Comprehensive

Oral rehydration

sanitation

knowledge of HIV/AIDS

Stunting prevalence salts (ORS) treatment for Primary school net

Skilled attendant

facilities (%)

(%) Females 15–24

attendance ratio

in children under 5 (%) children with diarrhoea

at birth (%)

Birth registration (%)

2015

2010–2014*

2009–2014*

(%) 2010–2015*

2009–2015*

2010–2015*

ratio of

urban to

rural to

urban to

rural

rural urban rural

rural urban rural rural urban rural

rural urban rural rural urban rural urban urban rural

urban rural

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia (Plurinational

State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's

Republic of Korea

Democratic Republic

of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

99 x

100

–

40 x

–

96 x

–

100

98 x

100

–

26 x

–

100

–

92 x

–

100

–

100

1.8

1.0 x

1.0

–

1.5 x

–

1.0

–

1.0 x

–

1.2

1.0

–

1.0

1.1

1.0

1.0 x

1.2 x

–

1.3

1.2

–

1.2

1.7

–

1.5

5.6

–

1.0

1.1

–

1.0

1.6

–

1.0

–

1.0 x

1.3

–

1.1 x

–

1.1

1.0

1.0 x

1.3

–

5.9 x

–

100 x 99 x

–

71 x 26 x

–

100

–

100

–

100

99 x 90 x

–

100

–

100

–

100 x 100 x

–

2.2

1.0 x

1.0

–

2.8 x

–

1.0

–

1.0

–

1.7

1.0

–

1.0

1.2

1.4

1.0

1.1 x

–

1.5

–

1.1

1.9

–

2.2

5.1

–

1.0

1.1

1.2

–

1.0

1.9

–

1.0

–

1.0 x

1.3

–

1.8

–

1.0

1.2

1.1

–

1.6

4.4

–

6.4

–

30 x

–

36 x

30 x

–

14 x

–

33 x

–

47 x

29 x

–

15 x

–

24 x

–

1.0

1.1

–

1.1 x

–

1.3

–

1.4

–

1.2

0.9

2.6 x

–

1.4

1.3 x

1.3

1.8

0.7

1.0 x

1.1 x

–

2.5 x

1.8

1.6

–

1.4

1.8

–

1.1

1.3

–

3.6

1.5

1.3

1.5

–

1.7

–

1.9

1.4

–

1.4

–

0.9

1.5

0.9

1.8 x

1.6

1.4

–

1.6

1.7 x

–

47 x

–

75 x

–

60 x

–

51 x

–

73 x

–

56 x

–

0.9

–

1.0

–

1.0

–

1.1

–

1.1

1.2

–

0.9 x

–

1.6

0.9

–

1.0

2.2

–

2.0

1.5

–

1.2

1.1

1.4

–

1.2

1.5

–

1.0

–

1.0 x

1.2

–

1.0

1.5

0.9

1.1 x

2.0

1.2

–

1.9

–

77 y

–

100

–

68 y

–

98 x

–

91 y

97 y

–

100

–

97 y

92 y

–

79 y

–

80 y

–

51 y

–

67 y

–

96 x

–

92 y

96 y

–

97 y

90 y

–

47 y

–

63 y

–

1.5 y

1.0

–

1.3

–

1.0

–

1.0 y

–

1.1

1.0

–

1.1

1.2

1.0

1.0 x

1.0

–

1.8

1.1

–

1.0

1.2

–

1.3

1.5

1.0 y

1.0

1.1

1.0

–

1.0

1.2

–

1.0

1.1

–

1.0

1.0 y

1.0

1.0 y

–

1.7 y

–

1.3 y

–

51 x

–

32 x

–

11 x

–

18 x

–

26 x

–

4.9

2.0 x

1.7

–

1.0

–

3.3 x

–

1.8

1.0

–

1.7

1.5

2.1

3.5 x

1.1

–

1.9

1.4

–

1.7

2.1

–

1.2

2.6

–

1.5

1.4

1.5

–

1.4

2.7

–

1.0

–

2.8 x

1.6

–

2.0 x

–

1.0

–

2.3 x

–

2.9

1.7

–

2.0

–

100

–

100

–

100

–

100

–

100

–

100

–

1.7

1.1

1.0

3.9

–

1.0

1.2

1.0

1.1

–

1.0

0.9

1.0

1.1

4.9

2.4

2.2

1.1

1.8

1.7

–

1.0

7.5

0.9

1.5

2.9

2.3

1.0

6.0

4.9

1.1

1.4

1.3

1.6

3.6

1.0

3.2

1.0

1.1

1.0

1.2

1.0

11.7

–

1.1

1.0

1.4

1.1

6.1

1.0

1.1

79 x,y 72 x,y

99 x 100 x

78 x 67 x

–

100

–

100

–

100 x 100 x

–

92 x

–

100

99 x

–

29 x

–

84 x

–

99 x

–

1.1 x,y 94

162

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 12.

DISPARITIES BY RESIDENCE

Use of improved

Comprehensive

Oral rehydration

sanitation

knowledge of HIV/AIDS

Stunting prevalence salts (ORS) treatment for Primary school net

Skilled attendant

facilities (%)

(%) Females 15–24

attendance ratio

in children under 5 (%) children with diarrhoea

at birth (%)

Birth registration (%)

2015

2010–2014*

2009–2014*

(%) 2010–2015*

2009–2015*

2010–2015*

ratio of

urban to

rural to

urban to

rural

rural urban rural

rural urban rural rural urban rural

rural urban rural rural urban rural urban urban rural

urban rural

Countries

and areas

France

Gabon

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic

Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia (Federated

States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

–

100

–

96 x 97 x

91 x 87 x

–

78 y 60 y

99 y 98 y

–

100

–

100

95 x 93 x

–

43 x

29 y

–

11 y

–

93 x

–

96 x

–

98 x,y

–

46 x

20 y

–

92 x

–

96 x

–

82 x,y

–

1.0

–

1.3

–

1.0 x

1.7

1.4

1.0 x

1.1

–

1.0

–

1.2

1.3 y

1.0 y

1.0

–

1.0

–

1.0

1.3

1.0 x

–

1.0

1.2

–

1.0 x

1.5 y

–

1.2

2.4 y

–

1.0 x

1.2

–

1.0 x

1.5

–

1.2 x,y

–

1.0

1.1 y

1.1

1.5

1.0 y

–

1.0

–

76 x 43 x

–

100

–

100

–

80 x

–

38 x

–

100

–

1.3

1.9

–

1.5

–

1.5

2.7

2.4

–

2.4

–

1.3

–

1.7 x

1.2

1.1

–

1.0

–

1.0

1.6

–

1.0

2.6

–

1.2

1.5

–

2.0

1.1

–

2.1 x

–

1.8

–

1.0

1.7

1.8

1.4

1.2

–

1.8

–

26 x

–

42 x

–

2.0

1.5

1.2

–

1.5

–

1.5

2.1

1.6

1.8

1.6

–

2.0

–

1.3

1.7

1.1

–

1.2

1.0

1.5

–

1.1

1.8

–

1.3

1.1

–

1.2

–

1.3

1.6 x

–

1.3

–

1.9

–

1.7

1.0

2.4

1.3

1.4

1.7

–

1.7

–

44 x

–

33 x

–

26 x

–

39 x

–

36 x

–

24 x

–

11 x

–

37 x

–

1.3

1.1

1.2 x

–

1.0

–

1.1

1.5

2.1

–

1.1

–

1.0

–

1.4 x

1.1

1.3

–

0.9

–

1.1

–

1.0

1.6

–

1.0

0.9

–

1.1

1.0

–

2.3 x

–

1.1 x

2.0

–

1.1

–

1.4

–

1.1

1.3

1.1

–

1.1

–

92 y 92 y

–

88 x 82 x

–

100

–

86 y

–

96 x

–

66 y

–

83 x

–

1.0

1.4

1.0

–

1.1

–

1.8

1.4

1.0

1.1

–

1.0 y

–

1.1 x

1.0

1.1

–

1.0

–

1.0

1.1

–

1.0

1.1

–

1.0

1.7

–

1.3 y

1.1

–

1.0

1.6

–

1.3

–

1.0

1.2 x

1.2

1.0

–

1.1

–

32 x

72 x

–

33 x

14 y

–

45 x

–

44 x

–

43 x,y

–

33 x

–

14 x

47 x

–

14 x

–

43 x

–

36 x

–

32 x,y

–

12 x

–

2.2

1.8

–

1.4

–

2.2 x

2.0

2.8

1.5 x

1.4

–

1.9

–

2.4 x

1.6 y

–

3.7

–

0.7

1.3

1.2

1.1 x

–

1.7

2.2

–

1.2 x

1.5

–

2.5

1.2

–

1.4 x,y

1.9

–

2.7 x

2.7

–

1.7

1.0

–

1.6

–

1.2

–

1.7

–

100

–

100

–

100

–

100

–

100

1.0

1.4

1.1

1.3

1.0

2.3

1.0

1.6

2.9

3.9

1.1

1.8

–

1.1

1.0

2.2

1.5

1.1

1.0

1.1

1.7

1.0

0.9

1.7

1.1

1.0

1.4

4.7

1.0

–

1.2

1.0

2.1

1.2

1.0

2.3

1.0

1.5

4.2

1.0

1.2

1.7

–

1.6

1.1

1.3

4.2

1.1

3.2

–

1.3

1.0

–

100

97 y 91 y

89 y 86 y

–

THE STATE OF THE WORLD’S CHILDREN 2016

163

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 12.

DISPARITIES BY RESIDENCE

Use of improved

Comprehensive

Oral rehydration

sanitation

knowledge of HIV/AIDS

Stunting prevalence salts (ORS) treatment for Primary school net

Skilled attendant

facilities (%)

(%) Females 15–24

attendance ratio

in children under 5 (%) children with diarrhoea

at birth (%)

Birth registration (%)

2015

2010–2014*

2009–2014*

(%) 2010–2015*

2009–2015*

2010–2015*

ratio of

urban to

rural to

urban to

rural

rural urban rural

rural urban rural rural urban rural

rural urban rural rural urban rural urban urban rural

urban rural

Countries

and areas

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and the

Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav

Republic of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

Ukraine

–

50 y 19 y

–

87 y 80 y

97 y 95 y

–

100

–

76 x 74 x

–

100

–

97 x 98 x

100

–

97 x 95 x

99 y 100 y

100

–

100

99 y 98 y

96 x 95 x

60 x 38 x

100

–

1.5

2.7 y

–

2.6

–

1.1

–

1.1 y

1.0 y

–

1.0

–

0.9

–

1.0

–

1.2

–

1.0 x

–

1.4

1.0

–

1.1

–

3.7 x

–

1.4

–

1.0 x

1.0

1.7

1.0

1.3

–

1.0 x

1.0

1.0 y

1.0

0.9

1.4

1.0

–

1.0

1.0 y

1.0 x

1.6 x

1.3

1.0

–

100

88 x

–

100

–

48 x

–

1.2

2.6

3.0

–

1.6

–

1.3

1.9 x

–

1.3

–

1.0

–

1.1

–

1.2

–

1.8

1.0

–

1.5

–

1.1 x

–

2.0

–

1.0 x

1.0

2.5

1.1

–

1.1 x

1.1

1.0

2.9

2.2

1.0

–

1.0

1.1

1.0 x

–

1.7

1.0

–

14 x

–

23 x

32 x

–

17 x

10 x

20 x

–

15 x

–

34 x

48 x

34 x

–

19 x

11 x

29 x

–

1.6

1.7

–

1.3

–

1.4

0.8

3.5

1.4

–

2.2

1.1 x

–

1.7

–

0.6

–

1.0

–

1.9

0.8

–

1.4

–

1.5 x

1.1 x

1.1

–

1.5

1.0

1.6

1.8

1.4

–

1.0

1.3

1.4

2.1

0.9

–

1.7

1.8

1.1 x

1.9

1.4 x

–

40 x

25 x

41 x

–

57 x

–

56 x

–

37 x

32 x

–

50 x

–

44 x

–

1.3

1.1

1.6

–

1.1

–

1.4

–

1.5

1.2

–

1.3

–

76 y 64 y

100

–

89 x 87 x

92 y 93 y

90 x 87 x

–

91 y 87 y

–

100

–

1.2 y

1.9

1.5

1.0

–

1.3

–

1.0

–

1.0 x

1.0 y

1.0 x

–

1.0

–

1.0 y

–

1.0

–

1.0 y

–

1.0

–

1.5

1.0

–

1.2

–

1.1 x,y

3.4 x

–

2.1

–

1.0

1.4

1.0

–

1.0 x

1.0

1.1

1.0 y

–

1.0

1.0 x,y

1.0 x

1.0 x,y

1.1

1.0

–

27 x

23 x

–

47 x

–

34 x

–

33 x

–

38 x

–

17 x

–

38 x

–

28 x

–

18 x

–

41 x

–

3.3

1.4

–

3.3 x

1.4 x

–

1.3

–

1.3

–

0.9

–

2.4 x

–

1.3 x

–

1.5

–

1.7

–

1.2 x

4.1 x

–

2.3

–

1.3

3.4

1.4

1.3

–

1.0 x

1.4

1.0

1.8 x

1.2

1.5

0.8

–

1.7

–

0.9 x

1.4

1.1

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

100

–

1.4

8.2

1.3

1.0

1.6

1.0

1.4

4.2

1.2

1.6

1.1

1.0

1.3

1.5

1.3

0.9

–

0.9

–

1.0

–

1.8

1.0

1.9

1.0

3.3

–

1.0

5.4

–

1.1

3.7

1.0

0.9

1.0

–

1.4

1.1

1.0

0.9

1.2

2.6

8.4

1.1

1.0

1.2

1.1

–

1.7

1.1

–

100

–

95 x 84 x

–

99 x 99 x

100

–

99 x 93 x

100

–

100

100 x

–

99 x

–

89 y 88 y

–

0.8

2.3

100

–

1.0

–

1.1 x 72 x,y 65 x,y

2.9 x 39 x 11 x

1.3 x

–

1.2

–

1.1 x

–

0.9

1.1

0.6

1.2

–

1.3 x 98 x 96 x

0.9

1.0

–

0.9

–

1.2

–

1.1

–

92 y 93 y

–

94 x,y 91 x,y

99 x 99 x

98 x,y 99 x,y

100

164

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 12.

DISPARITIES BY RESIDENCE

Use of improved

Comprehensive

Oral rehydration

sanitation

knowledge of HIV/AIDS

Stunting prevalence salts (ORS) treatment for Primary school net

Skilled attendant

facilities (%)

(%) Females 15–24

attendance ratio

in children under 5 (%) children with diarrhoea

at birth (%)

Birth registration (%)

2015

2010–2014*

2009–2014*

(%) 2010–2015*

2009–2015*

2010–2015*

ratio of

urban to

rural to

urban to

rural

rural urban rural

rural urban rural rural urban rural

rural urban rural rural urban rural urban urban rural

urban rural

Countries

and areas

United Arab Emirates

United Kingdom

United Republic of Tanzania

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela (Bolivarian

Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Sub-Saharan Africa

Eastern and Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and Pacific

Latin America and Caribbean

CEE/CIS

Least developed countries

World

–

36 y

–

100

100 x 100 x

51 y 37 y

–

4.4 y

–

1.0

1.0 x

1.4 y

–

1.0

2.0

3.0

2.4

–

100 x 100 x

–

2.0

–

1.0

1.0 x

1.1

–

1.1

2.1

1.7

1.2

–

18 x

–

19 x

–

1.3

–

1.1 x

1.6

–

2.3

1.5

1.2

1.5

–

1.0

–

0.7

–

1.2

0.9

1.1

–

91 y

–

96 x

77 y

–

72 y

–

94 x

77 y

–

1.3 y

–

1.0

1.0 x

1.0 y

–

1.0

1.2

1.1

1.0

–

33 x

23 x

–

30 x

13 x

–

1.5

–

1.0

1.1 x

1.8 x

–

1.1

6.7 x

1.5

1.3

100

–

100

–

1.0

3.8

1.0

1.2

1.4

–

1.6

84 **

–

83 **

72 **

–

60 **

1.6

1.4

1.6

1.2

1.3

1.2 **

–

1.4

1.4 **

69 ‡

–

88 ‡

41 ‡

–

59 ‡

1.9

1.4

1.7 ‡

1.1

–

1.0

1.8

1.5 ‡

10 r

16 r

1.5

1.4

1.6

1.3

2.0

1.6 r

1.4

1.7

55 ‡

49 **

–

45 ‡**

52 ‡

44 **

–

39 ‡**

1.2

1.3

1.2

1.1 ‡

1.1 **

1.1

–

1.2

1.1 ‡**

–

1.3

1.2

1.4

1.1

1.0

–

1.2

1.1

–

9‡

26 ** 26 **

–

22 ‡**

1.4

1.6

1.7

–

1.0 **

–

1.6

–

1.7

1.8

1.1

1.8

1.3

1.4

1.1

1.4

1.6

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

MAIN DATA SOURCES

Birth registration

– Percentage of children under age 5 who were registered at

the moment of the survey. The numerator of this indicator includes children

reported to have a birth certificate, regardless of whether or not it was seen by

the interviewer, and those without a birth certificate whose mother or caregiver

says the birth has been registered.

Skilled attendant at birth

– Percentage of births attended by skilled health

personnel (doctor, nurse or midwife).

Stunting prevalence in children under 5

– Percentage of children aged

0–59 months who are below minus two standard deviations from median

height-for-age of the WHO Child Growth Standards.

Oral rehydration salts (ORS) treatment for children with diarrhoea

–

Percentage of children under age 5 who had diarrhoea in the two weeks

preceding the survey and who received oral rehydration salts (ORS packets or

pre-packaged ORS fluids).

Primary school net attendance ratio

– Number of children attending primary

or secondary school who are of official primary school age, expressed as a

percentage of the total number of children of official primary school age.

Because of the inclusion of primary-school-aged children attending secondary

school, this indicator can also be referred to as a primary adjusted net

attendance ratio.

Comprehensive knowledge of HIV

– Percentage of young women (aged

15–24) who correctly identify the two major ways of preventing the sexual

transmission of HIV (using condoms and limiting sex to one faithful, uninfected

partner), who reject the two most common local misconceptions about HIV

transmission and who know that a healthy-looking person can be HIV-positive.

Use of improved sanitation facilities

– Percentage of the population using

any of the following sanitation facilities, not shared with other households: flush

or pour-flush latrine connected to a piped sewerage system, septic tank or pit

latrine; ventilated improved pit latrine; pit latrine with a slab; composting toilet.

Birth registration

– Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys

(MICS), other national surveys, censuses and vital registration systems.

Skilled attendant at birth

– DHS, MICS and other nationally representative sources.

Stunting prevalence in children under 5

– DHS, MICS, other national household surveys, WHO and

UNICEF.

Oral rehydration salts (ORS) treatment for children with diarrhoea

– DHS, MICS and other

national household surveys.

Primary school net attendance ratio

– DHS, MICS and other national household surveys.

Comprehensive knowledge of HIV

– AIDS Indicator Surveys (AIS), DHS, MICS, and other national

household surveys; DHS STATcompiler, www.statcompiler.com.

Use of improved sanitation facilities

– WHO/UNICEF Joint Monitoring Programme for Water Supply

and Sanitation (JMP).

Italicized data

are from different sources than the data presented for the same indicators in other tables

of the report: Table 2 (Nutrition – Stunting prevalence), Table 3 (Health – Diarrhoea treatment), Table 4

(HIV/AIDS – Comprehensive knowledge of HIV), Table 5 (Education – Primary school participation),

Table 8 (Women – Skilled attendant at birth) and Table 9 (Child protection – Birth registration).

NOTES

- Data not available.

x Data refer to years or periods other than those specified in the column heading. Such data are not

included in the calculation of regional and global averages, with the exception of 2005–2006 data on

primary attendance from India. Estimates from data years prior to 2000 are not displayed.

y Data differ from the standard definition or refer to only part of a country. If they fall within the noted

reference period, such data are included in the calculation of regional and global averages.

++ Changes in the definition of birth registration were made from the second and third rounds of MICS

(MICS2 and MICS3) to the fourth round (MICS4). In order to allow for comparability with later rounds,

data from MICS2 and MICS3 on birth registration were recalculated according to the MICS4 indicator

definition. Therefore, the recalculated data presented here may differ from estimates included in MICS2

and MICS3 national reports.

* Data refer to the most recent year available during the period specified in the column heading.

** Excludes China.

‡ Excludes India.

r Excludes the Russian Federation.

THE STATE OF THE WORLD’S CHILDREN 2016

165

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 13.

DISPARITIES BY HOUSEHOLD WEALTH

Birth registration (%)

2010–2015*

Skilled attendant at

birth (%)

2010–2015*

Oral rehydration salts

(ORS) treatment for

Stunting prevalence in

children under 5 (%) children with diarrhoea

(%) 2010–2015*

2009–2015*

Primary school net

attendance ratio

2009–2014*

Comprehensive

knowledge of HIV/AIDS knowledge of HIV/AIDS

(%) Males 15–24

(%) Females 15–24

2010–2014*

Countries

and areas

Afghanistan

Albania

Algeria

Andorra

Angola

Antigua and Barbuda

Argentina

Armenia

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bhutan

Bolivia (Plurinational

State of)

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Côte d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic People's

Republic of Korea

Democratic Republic

of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

ratio of

poorest richest richest to poorest richest richest to poorest richest poorest to poorest richest richest to poorest richest richest to poorest richest richest to poorest richest richest to

poorest

20%

poorest

20%

poorest

20%

richest

20%

poorest

20%

poorest

20%

98 x

–

24 x

–

99 y

100

–

92 x

–

100

99 x

100

–

53 x

–

100 y

100

–

97 x

–

100

1.9

1.0 x

1.0

–

2.2 x

–

1.0 y

1.0

–

1.1 x

–

1.5

1.0

–

1.0

1.6

1.0

1.0 x

–

1.5

1.4

–

1.5

3.2

–

1.8

6.5

–

1.1

1.2

–

1.0

2.0

–

2.4

–

1.5

1.1

1.0

1.0 x

1.0

–

7.0 x

–

98 x

–

100

–

100

–

100 x

–

100

–

100

–

100

–

100

–

100

–

4.9

1.0 x

1.0

–

1.0

–

1.1

–

4.1

–

1.0

–

1.1

1.6

2.8

1.7

1.0

–

2.0

1.6

–

1.3

5.1

–

2.6

7.6

–

1.2

1.4

1.3

–

1.0

2.6

–

1.5

–

1.0

1.2

–

1.8

10.5

–

12.4

–

11 x

–

50 x

38 x

–

31 x

–

29 x

20 x

–

1.6

2.1

1.2

–

1.4

–

1.8

–

2.4

5.3 x

–

3.7

1.7 x

1.9

3.5

1.0

1.9 x

2.1

–

2.3

1.7

–

2.3

4.0

–

1.5

1.3

–

2.9

1.7

3.7

–

2.5

–

2.2

–

2.9

2.6

1.0

6.8 x

1.5

2.1

–

1.7

–

0.9

–

1.5

–

0.2

–

1.2

–

1.3

0.9

1.5

–

2.5

1.2

–

1.1

4.7

–

2.5

2.2

–

1.3

0.9

1.7

–

3.7

–

1.4

–

1.2

1.6

0.9

–

1.2

–

2.5

–

67 y

–

95 x

–

97 y

90 y

–

31 y

–

49 y

–

100

–

70 y

–

99 x

–

97 y

92 y

–

84 y

–

82 y

–

2.0

1.0

–

1.4

–

1.0

–

1.0 y

–

1.3

1.0

–

1.1

1.6

1.1

1.0 x

1.0

–

2.8

1.2

–

1.1

1.6

–

1.6

1.8

–

1.0

1.3

1.1

–

1.0

1.5

–

1.2

–

1.1

1.0 y

1.0

1.0 y

–

2.7 y

–

1.7 y

–

20 x

–

12 x

–

31 x

–

60 x

–

12 x

–

26 x

40 x

–

37 x

–

50 x

–

12 x

–

46 x

–

23.0

3.0 x

3.8

–

1.8

–

10.3 x

–

8.9

1.2

1.0

–

2.7

3.1 x

4.4

8.4 x

1.2

–

4.4 x

–

2.1

4.0 x

–

1.7

2.9

–

2.2

–

2.4 x

–

2.7

–

2.8

–

1.5 x

–

4.9 x

–

4.3

–

10 x 38 x

–

2 x 14 x

–

17 x 52 x

–

11 x 45 x

–

12 x

–

27 x

–

3.8 x

–

6.3 x

–

1.0

–

3.0 x

–

4.3 x

1.2

–

2.2

–

1.5

–

2.3 x

–

2.0 x

–

3.1 x

–

2.0

–

68x,y 90 x,y

100 x 99 x

–

99 100

–

1.3 x,y 57

–

99 100

98 x 99 x

–

3 x 18 x

–

21 x 41 x

–

9 x 28 x

–

166

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 13.

DISPARITIES BY HOUSEHOLD WEALTH

Skilled attendant at

birth (%)

2010–2015*

Oral rehydration salts

(ORS) treatment for

Stunting prevalence in

children under 5 (%) children with diarrhoea

(%) 2010–2015*

2009–2015*

Primary school net

attendance ratio

2009–2014*

Comprehensive

knowledge of HIV/AIDS knowledge of HIV/AIDS

(%) Males 15–24

(%) Females 15–24

2010–2014*

Birth registration (%)

2010–2015*

Countries

and areas

France

Gabon

Gambia

Georgia

Germany

Ghana

Greece

Grenada

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Holy See

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

Kuwait

Kyrgyzstan

Lao People's Democratic

Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia (Federated

States of)

Monaco

Mongolia

Montenegro

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

ratio of

poorest richest richest to poorest richest richest to poorest richest poorest to poorest richest richest to poorest richest richest to poorest richest richest to poorest richest richest to

poorest

20%

poorest

20%

poorest

20%

richest

20%

poorest

20%

poorest

20%

–

84 x

–

100

93 x

–

42 x

16 y

–

92 x

–

92 x

–

83 y

71 x

–

100

–

92 x

–

100

–

100

–

100

94 x

–

49 x

31 y

–

10 y

–

94 x

–

98 x

–

93 y

88 x

–

0.9

1.1

1.0

–

1.5

–

2.4

2.0

1.1 x

1.3

–

1.0

–

1.5

2.2

–

1.0

–

1.0

–

1.0

1.7

1.0 x

–

1.0

1.4

–

1.2 x

1.9 y

–

1.3

2.4 y

–

1.0 x

1.5

–

1.1 x

2.6

–

1.0

–

1.4

1.9

1.1 y

1.2 x

1.1

–

24 x 85 x

–

100

–

100

–

35 x

–

86 x

–

1.3

1.8

–

2.2

–

2.6

4.9

3.6

–

8.1

–

1.7

–

3.6 x

1.6

–

1.2

–

1.0

–

1.0

3.0

–

1.0

8.4

–

1.6

2.1

–

2.7

1.1

–

2.5 x

–

3.6

–

1.0

2.5

2.8

1.9

1.4

1.0 x

3.7

–

44 x

–

52 x

–

22 x

–

18 x

–

5.2

1.9

–

2.9

–

3.8

2.2

2.3

3.0

4.7

–

5.3

–

1.9

1.7

17.3

1.1

–

7.7

1.2

2.6

–

1.7

3.1

–

3.4

1.8

–

1.1

1.4

–

1.4

2.0 x

–

2.2

–

3.2

–

3.9

0.5

4.2

2.1

2.3

3.6

2.9 x

2.2

–

19 x

–

43 x

–

29 x

–

0.8

1.0

–

1.1

–

1.1

1.9

2.3

–

1.2

–

0.8

–

2.3 x

0.9

–

1.1

–

1.0

–

1.0

–

2.0

–

0.8

–

1.6

1.1

–

3.5 x

–

3.8

–

2.1

–

1.7

1.4

1.1

–

1.0

–

70 x

–

54 y

–

77 x

–

96 x

–

100

–

100

–

82 y

–

100

97 x

–

1.1

1.7

1.0

–

1.3

–

2.8

1.4

1.0

1.3

–

1.1

–

1.4 x

1.1

–

1.2

–

1.0

–

1.0

1.4

–

1.0

1.4

–

1.1

2.6

–

1.5 y

1.1

–

1.0

2.4

–

1.9

–

1.1

1.0

1.3 x

1.5

1.2

1.1

–

1.0

–

37 x

18 x

–

13 x

–

29 x

42 x

–

17 x

–

26 x

14 x

–

23 x

–

12 x

–

41 x

–

61 x

13 x

12 x

–

41 x

–

72 x

41 x

–

44 x

–

45 x

–

61 x

49 x

–

29 x

–

48 x

29 x

–

48 x

–

39 x

–

43 x

–

69 x

10 x

49 x

–

2.4

–

2.9

–

7.8 x

–

4.3

2.0 x

2.2 x

–

3.4 x

–

11.7 x

–

7.2

–

1.8

2.1 x

1.2 x

–

1.7 x

6.5

–

1.8 x

2.1 x

–

4.1

1.3

–

2.0 x

2.0

–

3.3 x

7.9

–

2.5

1.3

–

1.1 x

–

1.1 x

0.8 x

4.3 x

–

65 x

52 x

–

55 x

–

68 x

51 x

–

2.6

–

2.6 x

1.9 x

–

3.8 x

–

3.8

1.6 x

1.3 x

–

3.6

–

3.3 x

2.2 x

–

3.2

1.1

–

1.6 x

–

4.1

1.4

–

2.7 x

–

1.2 x

–

2.0 x

–

14 x 45 x

17 x 37 x

–

37 x 58 x

–

16 x 45 x

–

55 x 67 x

–

25 x

30 x 59 x

–

100

97 x 98 x

–

THE STATE OF THE WORLD’S CHILDREN 2016

167

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 13.

DISPARITIES BY HOUSEHOLD WEALTH

Skilled attendant at

birth (%)

2010–2015*

Oral rehydration salts

(ORS) treatment for

Stunting prevalence in

children under 5 (%) children with diarrhoea

(%) 2010–2015*

2009–2015*

Primary school net

attendance ratio

2009–2014*

Comprehensive

knowledge of HIV/AIDS knowledge of HIV/AIDS

(%) Males 15–24

(%) Females 15–24

2010–2014*

Birth registration (%)

2010–2015*

Countries

and areas

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norway

Oman

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and the

Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Sudan

Spain

Sri Lanka

State of Palestine

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syrian Arab Republic

Tajikistan

Thailand

The former Yugoslav

Republic of Macedonia

Timor-Leste

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

ratio of

poorest richest richest to poorest richest richest to poorest richest poorest to poorest richest richest to poorest richest richest to poorest richest richest to poorest richest richest to

poorest

20%

poorest

20%

poorest

20%

richest

20%

poorest

20%

poorest

20%

–

7 y 65 y

–

67 y 89 y

94 y 98 y

–

99 100

–

74 x 86 x

–

97 100

–

97 x 98 x

100

98 100

–

93 x 99 x

99 y 100 y

100

96 x 99 x

98 100

98 y 99 y

94 x 97 x

39 x 71 x

–

1.8

9.7 y

–

14.3

–

1.1

–

1.3 y

1.0 y

–

1.0

–

1.1

–

1.6

–

1.1 x

–

1.8

1.0

–

1.0

–

6.6 x

–

2.7

–

1.0 x

1.0

3.8

1.0

1.9

–

1.1 x

1.0

1.0 y

1.0

1.1

1.5

1.1

1.0 x

1.0

1.0 y

1.0 x

1.8 x

1.6

–

100

–

6.0

15.0

–

2.9

–

1.4

–

1.5

2.3

–

1.0

–

1.2

–

1.3

–

2.8

1.0

–

1.6

–

1.3 x

–

5.1

–

1.0 x

1.0

10.5

1.1

1.4

–

1.3

1.0

6.9

3.6

1.0

–

1.1

1.0 x

–

2.0

–

34 x

52 x

–

21 x

–

22 x

25 x

–

13 x

–

1.4

3.0

–

2.7

–

2.2

9.2

3.4

–

4.2

–

2.3

–

2.2

–

3.3

–

1.5

–

1.6 x

2.0 x

–

1.2

–

2.0

1.1

2.8

2.4

3.0

–

1.5

2.2

3.6

1.5

3.2

0.7

–

2.0

4.3

1.7 x

0.6 x

1.8

–

45 x

–

31 x

–

59 x

–

1.4

2.6

–

1.4

–

1.6

–

1.7

–

1.0

–

1.0

–

4.8 x

–

1.9

–

1.3

0.7

–

1.0

–

1.3 x

1.2

0.7

–

1.0

0.9

–

1.1

–

100

–

93 y

79 x

–

82 y

–

85 y

–

58 x,y

–

92 x

94 y

95 x

87 x,y

99 x

99 x,y

–

100

–

96 y

92 x

–

93 y

–

91 y

–

100

–

78 x,y

50 x

–

99 x

94 y

98 x

97 x,y

99 x

100 x,y

–

2.3

3.3

1.0

–

2.2

–

1.0

–

1.0 y

1.2 x

–

1.0

–

1.1 y

–

1.1 y

–

1.1

–

1.8

1.0

–

1.5

–

1.3 x,y

13.2 x

–

5.1

–

1.0

2.0

1.1

1.0

–

1.1 x

1.0

1.4

1.2

1.0 y

1.0 x

1.0

1.1 x,y

1.0 x

1.0 x,y

1.2

–

14 x

–

27 x

–

17 x

–

48 x

–

34 x

20 x

–

26 x

–

56 x

–

37 x

–

10 x

–

45 x

62 x

–

39 x

47 x

–

5.0

2.2

–

1.8 x

–

3.3

–

1.0 x

–

2.0 x

–

2.4

–

2.6

–

2.1 x

13.5 x

–

6.1

–

2.1

13.6

2.0

1.5

–

2.9 x

–

1.2

5.0 x

1.8

2.3

1.4

1.3 x

2.8

–

1.2 x

2.3 x

–

7.2

1.9

–

3.1

–

2.7 x

–

1.4 x

–

2.4

–

1.5 x

–

1.5

–

3.0

2.7

1.1

–

1.6 x

–

74 x 95 x

–

97 x 99 x

100

–

100

–

100

99 x 100 x

–

3 x 9x

–

39 x 55 x

–

35 x 50 x

–

28 x

–

67 x

47 x

168

THE STATE OF THE WORLD’S CHILDREN 2016

URU, Alm.del - 2015-16 - Bilag 300: UNICEFs årlige statusrapport: The State of the World’s Children 2016

TABLE 13.

DISPARITIES BY HOUSEHOLD WEALTH

Skilled attendant at

birth (%)

2010–2015*

Oral rehydration salts

(ORS) treatment for

Stunting prevalence in

children under 5 (%) children with diarrhoea

(%) 2010–2015*

2009–2015*

Primary school net

attendance ratio

2009–2014*

Comprehensive

knowledge of HIV/AIDS knowledge of HIV/AIDS

(%) Males 15–24

(%) Females 15–24

2010–2014*

Birth registration (%)

2010–2015*

Countries

and areas

Ukraine

United Arab Emirates

United Kingdom

United Republic of Tanzania

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela (Bolivarian

Republic of)

Viet Nam

Yemen

Zambia

Zimbabwe

SUMMARY

Sub-Saharan Africa

Eastern and

Southern Africa

West and Central Africa

Middle East and North Africa

South Asia

East Asia and Pacific

Latin America and Caribbean

CEE/CIS

Least developed countries

World

ratio of

poorest richest richest to poorest richest richest to poorest richest poorest to poorest richest richest to poorest richest richest to poorest richest richest to poorest richest richest to

poorest

20%

poorest

20%

poorest

20%

richest

20%

poorest

20%

poorest

20%

100

–

100 x 100 x

33 y 59 y

–

1.0

–

12.7

–

1.0 x

1.8 y

–

1.1

3.3

6.0

3.9

100

–

100 x 100 x

–

100

1.0

–

2.9

–

1.0 x

1.2

–

1.4

4.2

2.1

1.4

–

21 x

–

15 x

–

1.8

–

1.4 x

2.4

–

6.7

1.4

1.7

2.2

–

0.9

–

0.8

1.1

1.2

100

–

93 x

75 y

86 x

100

–

96 x

80 y

99 x

1.0

–

1.4

–

1.0 x

1.1 y

1.2 x

1.0

1.6

1.3

1.1

–

25 x

–

24 x

–

33 x

23 x

–

48 x

1.3

–

1.4

–

1.3 x

2.7 x

–

2.2

–

2.0 x

1.4

–

1.3

–

1.7

–

2.1 x

1.6

–

24 x 51 x

–

2.4

1.9

2.6

1.2

1.7

1.6 **

–

1.9

1.7

24 ‡

–

‡**

81 ‡

–

‡**

2.9

2.5

3.2

1.5

3.3 ‡

1.6

–

1.1

2.6

2.1

‡**

19 r

2.1

1.8

2.5

1.8

2.0

2.2

3.3

2.3 r

1.9

2.1

49 ‡

–

‡**

60 ‡

–

‡**

1.5

1.3

1.8

1.0

1.2 ‡

1.0

–

1.3

‡**

–

1.7

1.4

2.0

1.2

1.4

1.1

–

1.4

–

2.1

–

2.5

–

2.6

–

2.1

–

For a complete list of countries and areas in the regions, subregions and country categories, see page 112 or visit <data.unicef.org/regionalclassifications>.

It is not advisable to compare data from consecutive editions of

The State of the World’s Children.

DEFINITIONS OF THE INDICATORS

MAIN DATA SOURCES

Birth registration

– Percentage of children under age 5 who were registered

at the moment of the survey. The numerator of this indicator includes children

reported to have a birth certificate, regardless of whether or not it was seen by

the interviewer, and those without a birth certificate whose mother or

caregiver says the birth has been registered.

Skilled attendant at birth

– Percentage of births attended by skilled health

personnel (doctor, nurse or midwife).

Stunting prevalence in children under 5

– Percentage of children aged

0–59 months who are below minus two standard deviations from median

height-for-age of the WHO Child Growth Standards.

Diarrhoea treatment with oral rehydration salts (ORS)

– Percentage of

children under age 5 who had diarrhoea in the two weeks preceding the

survey and who received oral rehydration salts (ORS packets or pre-packaged

ORS fluids).

Primary school net attendance ratio

– Number of children attending

primary or secondary school who are of official primary school age, expressed

as a percentage of the total number of children of official primary school age.

Because of the inclusion of primary-school-aged children attending secondary

school, this indicator can also be referred to as a primary adjusted net

attendance ratio.

Comprehensive knowledge of HIV

– Percentage of young men and women

(aged 15–24) who correctly identify the two major ways of preventing the

sexual transmission of HIV (using condoms and limiting sex to one faithful,

uninfected partner), who reject the two most common local misconceptions

about HIV transmission and who know that a healthy-looking person can be

HIV-positive.