MDG Update:
Accelerate Progress for Children Towards a Post-2015 development agenda for all children
The MDGs are the most successful global anti-poverty initiative in history. They stand for a world of prosperity, equity, freedom, dignity and peace – as embodied in the Millennium Declaration. This publication presents an assessment of progress towards the MDG targets using a selection of child and maternal related MDG indicators. It highlights remaining challenges and lists key interventions that are indispensable to contribute to a post-2015 world fit for all children. The insert to this publication contains UNICEF’s guiding principles to contribute to the new development agenda and a list of key issues relevant to children for consideration by the international development community for inclusion under the post-2015 development agenda.
MDG
1
Eradicate Extreme Poverty and Hunger Target 1C Indicator Progress
Halve, between 1990 and 2015, the proportion of people who suffer from hunger Prevalence of underweight children under-five years of age
Underweight prevalence has declined from 25% in 1990 to 15% in 2012 99 million children under-five years of age remain underweight, 162 million are stunted Stunting is associated with a weakened immune response and impaired cognitive development among young children - the effects of the latter are irreversible
Chronic undernutrition is highest in sub-Saharan Africa and South Asia Percentage of children under age five who are moderately or severely stunted. 2008-20121
Sustainable development starts with safe, healthy and well-nourished children
Less than 10% 10 – 19% 20 – 29% 30 – 39% 40% or more Data not available
Chronic undernutrition is declining but still one in four children were stunted
The continuing agenda for children
Stunting prevalence, by MDG region, 1990 & 2012
2
60 Southern Asia Southern Asia 35
South-Eastern Asia South-Eastern Asia
47 28 41% decline
Caucasus && Central CentralAsia Asia Caucasus 17
Eastern Asia Eastern Asia
Improve women’s nutrition
39
Practice early and exclusive breastfeeding
57% decline
37 8 79% decline
37 Oceania Oceania
38
Northern Africa Northern Africa
29 19 37% decline
Western Asia Western Asia
29 18 38% decline
Latin Latin America America & & Caribbean Caribbean
Key interventions to prevent child under nutrition include:
41% decline
Provide timely, safe, appropriate and highquality complementary food 4% increase
23 50% decline 11
Appropriate micronutrient interventions Reduce the incidence of infectious diseases, such as diarrhoea, pneumonia, and malaria
1990 2012
1990
Global Global
40 38% decline 25
Source: UNICEF global databases 2013, based on DHS, MICS, and other national surveys. Source for stunting trend: UNICEF-WHO-WB Joint Child Malnutrition Estimates, 2012.
1 2
Improve access to safe drinking water and sanitation, stop open defecation and improve overall household hygiene
Million
MDG
2
Achieve Universal Primary Education Target 2A
Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling
Indicator
Net enrolment ratio in primary education Survival rate to the last grade of primary education
Progress
Primary net enrolment ratio (adjusted) increased from 85% in 2000 to 91% in 2011 Only three out of four children who start primary school actually finish it
Progress has slowed since 2004, making the goal of universal primary education difficult to achieve Number of primary school age children out-of-school,by region,2000-20113 South and West Asia
120
Sub-Saharan Africa
Total 102 million 100
Rest of world
80
37.8 million Total 57 million South & West Asia
60
12.4 million 40.6 million
40
Sub-Saharan Africa
29.8 million
Rest of the world
14.9 million
Education is the single most powerful investment for development. Educate a girl, you educate a nation.
20 23.5 million 0 2000
2011
Four out of ten children fail to reach minimum learning levels Estimates of minimum learning levels among primary school age children4
130 million
400 million
attend school and achieve minimum level of learning
attend school but fail to achieve a minimum level of learning
120 million will not reach grade 4
The continuing agenda for children How to ensure that all boys and girls go to school and receive a quality education? `` Expand early learning opportunities to increase children’s school readiness `` Address specific needs of the most disadvantaged children (e.g. poor, rural, and children with disabilities), especially girls `` Promote child-friendly education for quality enhancement and improved learning outcomes `` Provide alternative delivery mechanisms for those who dropped out or have never been to school `` Ensure safe and protective access to quality education in humanitarian emergencies
Source: UNESCO Institute for Statistics Fact Sheet, June 2013, No.25. Source: UNESCO EFA-GMR, 2012
3 4
MDG
3
Promote Gender Equality Target 3A
Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015
Indicator Progress
Ratios of girls to boys in primary, secondary and tertiary education
The MDG target for primary education has been achieved In most regions fewer girls 13 are enrolled in secondary school than boys Urban 12 13 Urban 12
24
Rural 23 24
Rural 23 Gender parity in primary education has been achieved Primary, secondary and tertiary school gross enrolment rates by sex and region, 2011 (%)5 32
East Asia & the Pacific East Asia & the Pacific
Poorest
Latin America & Caribbean Latin America & Caribbean
Poorest
South & West Asia South & West Asia North America & Western North America & Western Europe Europe Central & Eastern Europe Central & Eastern Europe
Second
Central Asia Central Asia
Fourth
Sub-Saharan Africa Sub-Saharan Africa
Fourth
Arab States Arab States
Richest
30 32 25
30
23 25 Second 20 23 Middle 19 20 Middle 16 19 14 16 10
Female
14
8 10
Female Male
8
Male
Richest
Investing in children, especially girls, yields high and long-lasting returns for families, societies and future generations
World World
0 0
25 25
50 75 50 75 Primary
100 100
0 0
25 50 75 100 25 50 75 100 Secondary
More primary school age girls are out-of-school than boys
32 Poorest 30 32 Poorest 25 23 25
16 19 20 14 16 19
Fourth Middle Fourth 10 Richest Fourth Richest
30 32
14 16
8 10 14 8 10
Female Female Male Female Male
Richest 8
Male
Note: Original source for wealth quintile and urban/rural data: DHS and MICS Surveys from 57 countries
Source: UNESCO Institute for Statistics (UIS), 2011 Source: UNESCO Institute for Statistics Fact Sheet, June 2013, No.25.
5 6
Key interventions to reduce gender disparities in education include: `` Increase demand for education through community-based interventions `` Create inclusive gender-responsive learning environment through child-friendly education `` Tackle multiple drivers of out-of-school children (e.g. gender, poverty and geography) through innovative approaches
30
20 23 25 19 20 23
Middle Second Middle
25 50 75 100 25 50 75 100 Tertiary
The continuing agenda for children
Average rate of male and 13 female out-of-school children of primary Urban school age, by area of residence and wealth quintiles, 57 countries.6 12 13 Urban 12 24 13 Rural Urban 23 24 12 Rural 23 24 Rural 23
Second Poorest Second
0 0
`` Address gender disparity in access, progression and learning outcomes
MDG
4
Reduce Child Mortality Target 4A Indicator
Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate Under-five mortality rate and infant mortality rate Proportion of 1-year old children immunized against measles
Progress
Under-five deaths have declined from 12.6 million in 1990 to 6.6 million in 2012 About 44 percent of the under-five deaths occur within the first 28 days of life Global under-five mortality dropped from 90 deaths per 1,000 live births to 48 in 2012
Under-five mortality declined but falls short of the two-thirds reduction required to achieve the MDG target Under-five mortality rate (per 1,000 live births), by region, 1990 and 20127
Deaths per 1,000 live births Deaths Deaths per per 1,000 1,000 live live births births
200 200 200
1990 1990 1990 2012 2012 2012 MDG4 MDG4 MDG4 target target target for for for 2015 2015 2015
177 177 177
1990
160 160 160
2012
MDG4 target for 2015
126 126 126
120 120 120
99 99 99
98 98 98 74 74 74
80 80 80
58 58 58
73 73 73
71 71 71
55 55 55 36 36 36
40 40 40
30 30 30
90 90 90
73 73 73
65 65 65
54 54 54
25 25 25
22 22 22
19 19 19
53 53 53
53 53 53
48 48 48
15 15 15 6 6 6
14 14 14
The rate of decline in under-five mortality has accelerated significantly in the last decade
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Diseases of poverty like pneumonia, diarrhoea and malaria accounted for a third of under-five deaths in 20128 Pneumonia (neonatal) (5%) Pneumonia (neonatal) (5%)
Pneumonia (13%) Pneumonia (13%)
PretermPreterm birth birth complications (15%) complications (15%)
Pneumonia (17%)
The continuing agenda for children Key interventions to reduce child mortality include: `` Focus on the poorest, most marginalized and most-vulnerable `` Ensure clean and safe delivery practices `` Improve ante-natal care
Other (19%)
Other (19%)
All Other (24%)
Neonatal (44%)
Intrapartum-related Intrapartum-related complications (10%) complications (10%)
`` Reduce deaths from preventable diseases of poverty: pneumonia, diarrhoea, and malaria `` Encourage exclusive breastfeeding
Measles Measles (1%) (1%)
Sepsis/meningitis (5%)
Sepsis/meningitis (5%)
AIDS (2%) AIDS (2%)
Tetanus (1%)
Meningitis (3%)
Diarrhoea (9%)
Meningitis (3%)
Injury (5%) Injury (5%) Malaria (7%) Malaria (7%)
Diarrhoea (8%) Diarrhoea (8%)
Tetanus (1%) Other neonatal (3%) Other neonatal (3%) Congenital abnormalities
Congenital abnormalities (4%) (4%) Diarrhoea (neonatal) (1%) Diarrhoea (neonatal) (1%)
Globally, almost half of the under-five deaths are attributable to malnutrition
`` Immunize children against measles and other diseases `` Eliminate open defecation `` Promote washing hands with water and soap `` Let children sleep under insecticide treated bednets
Source: The UN Interagency Expert Group for Mortality Estimation, Levels and Trends in Child Mortality Report 2013, UNICEF 2013 Source: UNICEF, Committing to Child Survival: A Promise Renewed Progress Report 2013
7 8
MDG
5
Improve Maternal Health Target 5A Indicator
Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Maternal mortality ratio Proportion of births attended by skilled health personnel
Progress
Since 1990, the maternal mortality ratio has declined by 47% from 400 to 210 per 100,000 live births in 2010 About two thirds of women delivered with the assistance of a skilled birth attendant
Regions with the largest number of maternal deaths have highest levels of births NOT attended by skilled health personnel9 % of births NOT attended by skilled health personnel, 2011
Maternal deaths, 2010 (in 1,000s) 162 83
17
8.8
Sub-Saharan Africa
52
Southern Asia
50
South-Eastern Asia Latin America and the Caribbean
25 10
6.4
Eastern Asia
1
3.5
Western Asia
26
2.8
Northern Africa
0.8
Caucasus and Central Asia
Target 5B Indicator Progress
Making pregnancies wanted and childbirths safe prevents maternal deaths and saves children’s lives
18 3
Achieve, by 2015, universal access to reproductive health Contraceptive prevalence rate
Adolescent birth rate
Antenatal care coverage
In 2011, approximately half of all pregnant women in developing regions did not have the recommended minimum number of 4 antenatal care visits
One in five women gave birth before age 18* Proportion of women age 20-24 who have given birth before age 18, 2000-20109
The continuing agenda for children Key maternal and reproductive health interventions include: `` Increase assistance from skilled health personnel at delivery with proper supplies and equipment `` Improve access to emergency obstetric care
Less than 10% 10 – 19% 20 – 29% 30 – 39% Greater than or equal to 40%
`` Ensure a minimum of four visits with quality antenatal care `` Expand access to information, counseling an supplies for a wide range of contraceptive methods
Data not available
`` Lower birth rates among adolescents
* Excluding China
Source for both graphs: UNICEF Global databases, 2013 Based on MICS and DHS household surveys and other national sources
9
MDG
6
Combat HIV/AIDS, Malaria and Other Diseases Target 6A Indicator Progress
Have halted by 2015 and begun to reverse the spread of HIV/AIDS HIV prevalence among population aged 15-24 years
Globally, new HIV infections dropped by 21% to 2.5 million between 2001 and 2011 Access to antiretrovirals for adults has increased to 59%, but only to 28% for children in 2011 Since 2005, AIDS-related mortality declined from 2.3 million to 1.7 million, but adolescent AIDS deaths increased
In 2011, an estimated 4.6 million young people 15-24 were living with HIV; 64% were girls and 78% were in sub-Saharan Africa HIV prevalence among young people aged 15-24, 2011 (%)10
We now have the knowledge and the means to make an AIDS-free generation a reality
Less than 0.2% 0.2 – 0.9% 1.0 – 2.9% 3.0 – 4.9% 5.0 – 7.9% 8.0% or more Data not available
Target 6C Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases Indicator Incidence and death rates associated with malaria Proportion of children under-five sleeping under insecticide-treated bednets (ITN)
Progress
In 2012, more than a third of children sleep under an ITN, up from less than 5% in 2000
Over half of the households in sub-Saharan Africa own an ITN but only 37% of children under-five sleep under one Children under-five sleeping under insecticide treated nets (ITNs), Africa, 2012 (%)11
2012 2000
The continuing agenda for children Key interventions to reduce HIV/AIDS and malaria include: `` Increase antiretroviral coverage for treatment and the prevention of mother-to-child transmission of HIV `` Scale up high impact HIV prevention, treatment and care in adolescents including key populations `` Provide protection, care and support for children and families affected by HIV and AIDS
0 – 9% 10 – 25% 26 – 50% 51 – 75% Not malaria endemic Data not available
10 11
Source: UNAIDS unpublished estimates, 2012 Source: UNICEF global databases 2013, based on MICS, DHS and MIS
`` Ensure that children and pregnant women sleep under a ITN `` Expand the use of artemisinin-based combination therapy `` Expand rapid diagnostic testing before commencing malaria treatment
MDG
7
Ensure Environmental Sustainability Target 7C
Halve by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation
Indicator
Proportion of the population using an improved drinking water source Proportion of the population using an improved sanitation facility
Progress
The proportion of population without drinking water declined from 24% in 1990 to 11% in 2011 The proportion of population without sanitation declined from 51% in 1990 to 36% in 2011
The drinking water target will be surpassed by >150 million people; the sanitation target will likely be missed by more than 600 million Population without an improved drinking water source and improved sanitation facility, current and MDG trends, 1990-201512 3,000
Population (x 1,000)
Sanitation
May be m Current trend issed by >600 mill ion May be m issed
Sanitatio
n
2,500 2,000
by >600
2.5 billion million
MDG target 1.8 billion
1,500 Drinking water
Drinking w
Cur Mrent trend
ater
1,000
MDG target
et by >15
0 million 871 million Met by >150 million 692 million
Children are at the heart of sustainable development
MDG target 871 million 692 million
500 0
2015
1990
Open defecation rates declined in all regions, but still over 1 billion people continue the practice
The continuing agenda for children
Open defecation rates, 1990 and 201112 Southern Asia
39 39% decline
64
A post-2015 vision for water and sanitation:
Sub-Saharan Africa
36 26 28% decline
`` No one practices open defecation
South-Eastern Asia
31 31 14 55% decline
`` Everyone has water, sanitation and hygiene at home
Latin America & Caribbean
17 4 76% decline
Northern Africa
16 4 75% decline
Oceania
13 10 23% decline
Western Asia
8 63% decline 3
Eastern Asia
7 4 43% decline
Caucasus & Central Asia
World
1990 2011
`` All schools and health centres have water, sanitation and hygiene `` Water, sanitation and hygiene are sustainable and inequalities in access have been progressively eliminated
1 0 24 24 15 36% decline
`` Water supply, sanitation and hygiene services are resilient to disasters
Source: WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), 2013
12
UNICEF is a global leader on statistics for children UNICEF as a global leader in statistics for children is proud to continue to provide the global development community with the latest statistics on children and women, many of which appear every year in the United National Secretary General’s Report on the MDGs. We reaffirm our commitment to work with governments in strengthening the collection and analysis of the evidence that allows for the monitoring of progress towards global development goals which has made such a measurable difference in children’s lives across the world. Prepared by: UNICEF Data & Analytics Division of Policy & Strategy, September 2013
Find the latest statistics on children at the UNICEF-Statistics website: www.childfinfo.org
Front cover photo credit: © UNICEF/NYHQ2010-1548/Asselin
Towards a Post-2015 agenda for all children
Key Issues for Children in the Post-2015 Development Agenda Further reduction of under-five mortality Elimination of all preventable maternal and child deaths Reduction of child malnutrition Achievement of universal coverage of: basic health services safe drinking water and sanitation Completion by all children of quality basic education Protection of all children from all forms of violence, abuse and exploitation Protection and support of children and their families affected by conflict and humanitarian disasters Prioritize the worst-off and most deprived children, families and their communities Monitoring of progress and investment in supporting national statistics systems to collect disaggregated data to ensure that no child is left behind
Guiding Principles to ensure a Post-2015 World Fit for All Children The Millennium Development Goals have been a success and achieved a lot for children and young people. However they have not fully been met. The unfinished and continuing business of investing in the rights and well-being of children – as well as emerging and neglected issues - must be boldly addressed in a vision of a world fit for children and future generations, with achievable goals for the post-2015 development agenda. Governments should reaffirm their existing commitments – specifically to the Millennium Declaration and to the Convention on the Rights of the Child – to underpin future efforts for inclusive and equitable human progress. Sustainable Development starts with safe, healthy and well-educated children. And safe and sustainable societies are, in turn, essential for children. The post-2015 development agenda must provide comprehensive solutions to advance peace, prosperity and a sustainable world – for both the present and future generations. The new development agenda needs to be universal – relevant for all societies and about all people regardless of where they live. Countries cannot achieve sustained growth and shared prosperity without investing effectively in their people, and above all, in their children. Photo credit: © UNICEF/NYHQ2006-1914/Pietrasik
Different Faces of Disparities The poorest children are those more often stunted
More than one third of women in the world marry during childhood, with one in nine of them being married before their 15th birthday
Percentage of children under age 5 who are moderately or severely stunted by selected regions, LDCs and the world1 Poorest 20%
Poorer 20%
Middle 20%
Richer 20%
Percentage of women aged 20-24 years old who were first married or in union before age 18 and before age 15, in the 15 countries with the highest prevalence of child marriage among women and the world2
Richest 20% (%)
(%) 70
100 100 100
59
80 80 80
53
50
48 46 42
40
43 40
36
51
49 46 42
47
36
25
50 50 50
35
27
25
30 30 30
20
45 45
10 10 10 South Asia
East Asia and the Pacific*
Least developed countries
0 0 0
World*
* Excluding China Note: Analysis is based on a subset of countries with available data by subnational groupings and regional estimates are presented only where adequate coverage is met. Data from 2007 to 2011, except for Brazil and India
3rd
52 52
52 52
4th
26
29
20 20
18 18
8 8
39
38 34 43
34 34
41 34
38
37
18 18
39
56 56
43
41
32 32 21 21
14 14
12 12
9 9
10 10
36 36 29 29
29 29
23
20 20
15 15
11 11
Percentage of girls and women aged 15 to 49 years who have undergone FGM/C in the ethnic groups with the highest and lowest FGM/C prevalence4
Richest 6 1
55 55
Levels of female genital mutilation/cutting (FGM/C) prevalence vary dramatically among ethnic groups
Southern Asia: Sanitation coverage trends by wealth quintiles, based on population-weighted averages from three countries, 1995 and 20083 2nd
50 50
* Excludes China
The poorest 40 percent of the population in Southern Asia have barely benefited from improvements in sanitation
Poorest
48 48
66 66
68 68
Si Si er er ra ra LeLe onon SoSo e e mm ali al a ia Er Er itr itr eaea M M IndInd adad ia ia agag asas caca r r MM SoSo al al ut ut awaw h h i i BuB SuSdud rkurk anan in in aa Ethnic group with the highest FaFa soso prevalence MM MM Ethnic group with the lowest ozoz a a prevalence amam li li bi bi ququ ee CeC GG e ui ui nt nt B B ra ra a a nene l Al A ngng a a fri fri la la caca dede n n shsh ReR peupu bl bl ic ic ChC ahdad Ni N geige r r
Sub-Saharan Africa
47 47
35 27
20 20 20
10
(%) 100 100
44 44
47 47
40 40 40
26 23
20
63 63
60 60 60
41
32
30
70 70 70
46
38
75 75 68 68
WW or or ld ld * *
60
0
Married or in union at age 15 or after but before age 18 #REF! #REF! #REF! Married #REF! or in union before age 15
90 90 90
Eritrea 2 4
18
Ethiopia Guinea Mali Gambia
80 80 51
6
Kenya
56 74
60 60
86
Guinea-Bissau Chad
77
Sierra Leone
87
94
Burkina Faso
4 93
40 40
94
Senegal C么te d'Ivoire
76
8
Benin Niger 8
20 20
00
4
45
Nigeria
36
4 2 1995
7
5
7
8
Central African Republic 18
2008 1995
19
Ghana Togo
2008 1995
2008 1995
2008 1995
2008
Ethnic group with the higest prevalence Ethnic group with the lowest prevalence
Cameroon Uganda
Improved + shared
Unimproved
Open defecation
0 0
10 10
20 20
30 30
40 40
50 50
Source: Adapted from Improving Child Malnutrition: The achievable imperative for global progress, based on UNICEF Global Databases, 2012. Sources: UNICEF global databases, 2012. Based on AIDS Indicator Surveys (AIS), DHS, MICS and other national surveys, 2002-2011. Sources: India: NFHS 1993, 1999, 2006; Bangladesh: DHS 1993, 1997, 2000, 2004, 2007; Nepal: DHS 1996, 2001, 2006 4 Sources: MICS and DHS 2002-1011 as presented in Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change, UNICEF, 2013. 1 2 3
60 60
70 70
80 80
90 90
100 (%) 100