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AUTHOR Adamson, Peter, Ed. TITLE The Progress of Nations: The Nations of the World Ranked Acording to Their Achievements in Her'.th, Nutrition, Education, Family Planning, and Progress for Women. INSTITUTION United Nations Children's Fund, New York, N.Y. PUB DATE 93 NOTE 58p.; For the 1994 report, see ED 372 854. AVAILABLE FROM UNICEF House, 3 United Nations Plaza, New York, NY 10017. PUB TYPE Statistical Data (110) Reports Descriptive (141)
EDRS PRICE MFO1 /PC03 Plus Postage. DESCRIPTORS *Academic Achievement; Access to Education; *Child Health; *Developed Nations; *Developing Nations; Economic Progress; Elementary Education; *Females; Foreign Countries; Immunization Programs; Mortality Rate; 'Nutrition; Poverty IDENTIFIERS Africa; Asia; Asia (East); Caribbean; Europe; Middle East; North America; Pacific Region; South America; United Nations Convention on Rights of the Child
ABSTRACT This report documents the progress made in developing and developed nations to improve health, nutrition, education,family planning, and the condition of women over the last 40 years. It presents tables that rank the world's nations and regions on: (1)the mortality rate of children under 5 years of age; (2) the percent of children under 5 years of age who are malnourished;(3) the percent of children immunized against measles;(4) the percent of children reaching grade 5 in school;(5) the average number of births per woman; and (6) the mortality rate of women due tochildbirth complications. The report provides statistics on national performance gaps, the difference of the level of progressachieved and the expected level of progress for each country's gross n;Lionalproduct. It also examines the progress made by the world's nations toratify and implement health, nutrition, and education goalscontained in the United Nation's Convention on the Rights of the Child. (MDM)
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TO THE EDUCATIONAL RESOURCES BEST COPY AVAILABLE INFORMATION CENTER (ERIC) THE PROGRESS OF NATIONS
The day will come when the progress of nations will be judged not by their military or economic strength, nor by the splendour of their capital cities and public buildings, but by the well-being of their peoples: by their levels of health, nutrition and education; by their opportunities to earn u fair reward Jr b their labours; by their ability to participate in the decisions that affect their lives; by the respect that is shown fb for their civil and political liberties; by the provision that is made for those who are vulnerable and disadvantaged; and by the protection that is afforded to the growing minds and bodies of their children. The Progress of Nations. to be published annually hr the United Nations Children's Fund. is a contribution towards that day.
1 9 9 3
3 New Iv independent nations Because comparable data are not vet available. newt\ independent countries are not adequately represented in this first issue of The Progre.s. hoped that more data on social indicator, x% ill be available in time for inclusion in the 1994 edition. 111.1111111111.11.1.111114I ONTENTS introduction The Progress of Nations is published by keeping faith with progres., the United Nations Children's Fund cuntrar1 to widespread blie). the act eloping world has made remarkable (UNICEF) as a contribution to monitoring progress in recent decades. II ith a renewed elThrt, the goal of meeting and improving the well-being of children in minimum human needs is within reach. all nations. Each year, it will record national SUB-SAHARAN achievements in child survival, health, nutri- AFRICA tion, education, family planning, and Survival p ogress for women. Summary: Survivalthe meaitre of all things League table of child death, 8 dela In each of these areas, the international sttA' community has set goals which reflect today's National performance gaps 10 new capacity to meet minimum human Achievement and disparit y 12 - needs. The governments of 149 countries MIDDLE EAST and have formally committed themselves to the Nutrition NORTH AFRICA achievement of these goals by the end of the Summary: NIvt Its of malnutrition stand in %%av 15 century. The Progress of Nations will keep League table of malnutrition lfr track of action and achievement in the fulfil- .1chievement and disparity 18 ment of these commitments.
General editor: Peter Adamson ilealth
SOUTH ASIA Assisted b':: Myriam Barthole Summary: Closing the gap bek% cn kium ledge and need 21 Petra Morrison League table of measles immunization Statistics: Gareth Jones .1ellievettient anddisparity Senior Adviser, Statistics, UNICEF New York Assisted by: Tehnaz J. Dastoor Education Nyein Nyein Lwin Sc mmary: Schools weighed and found wanting 27 Tessa Wardlaw League table of primary education 28 EAST ASIA and PACIFIC Production: Lesley Adamson P&LA, Oxfordshire, UK Assisted by: Pamela Knight Family planning Wendy Slack Summary: A suitable case for pre ent ion 31 Many UNICEF experts contributed specialist League table of births 32 advice to the various chapters of The Progress of Achievement and disparity i Nations. Overall advice was given by: Leila
CENTRAL AMERICA Bisharat, Director of Planning; Mehr Khan, and CARIBBEAN Director of the Division of Information; Dr. Jon Progress for women Rohde, Special Adviser to the Executive Director. Summary : The greatest injustice 37 Photographs of children representing the regions: League table of maternal deaths 38 Jorgen Schytte/Still Pictures (page 2) hievement and disparity 10 Lauren Goodsmith/UNICEF (page 6) 4 Jorgen Schytte/Still Pictures (page 14) Peter Williams/WINGS (page 20) The industrialized world SOUTH AMERICA Melanie Friend/FORMAT (page 26) 13 Tony Armin/CARL (page 30) Summary: The pressures that devalue children Mark Edwards/Still Pictures (page 361 I Ionic and tm ay Maggie Murray/FORMAT (page 42)
Design: Threefold Design Design Unlimited Stil)idementary tables Printer: Burgess of Abingdon Child rights: The Convention and the goal- lb Social indicators: Is N., popn!ou BEST COPY AVAILABLE 5 The industrialized world is entering an INTRODUCTION age of doubt about material progress. Ale But for a billion I people in the world. material progress holds out the hope of adequate food. clean water. safe sanitation. decent housing. reliable health care. and at least a basic education. This is a definition of progress which remains entirely 2 valid. And it is one I with which the rest of the world must keep faith. - 5 rThe industrialized w orld is enter- than ever lief ort...Ad \ ances in know l- ing an age of doubt idiom mate- edge and technolog \ inean that mon \ rial progress. Many of its citizens are of the most serious problems could he Keeping faith overcolille at relativel lots cost. And experiencing what the economist Hobert1 leilbroner ha- (.111111 "the i l l recent \ eat -. the de\ eloping world startled realiz.r hat the quality has built up its infrastruettir and of life is worse- ... that people w ho conimunicat ions capacit tot he point are three or five or ten times richer withprogress \vhere it is capable of bringing thew' I ban their grandparents do not seem advance, to virtuall\ all its citizen-. to lathree or five or ten fillies happier As evidence of this. 010' lived look or more content or more richly devel- An introduction to The Progress of _Nations 110 furtlitr than t he rise ill iminu- oped as human beings.- Coinciding Uri-anon le\ el, its er reeen! War. with such doubts is the gradual real- the specific purpose of meeting these ilzat time. then it would by now have A decade ago. fewer than 20n,. of ization that such progress is also no most obvious and basic of human been largeb accomplished: we would infants in the del eloping -world were longer limitless. that what was once needs is less than the amount that today be livin; in a \vorld in which being imintmized against the major the clear and infinitek extending the people ()f tilt. industrialized world mass hunger. malnutrition. and pre- \ accine-pre.entable disease,. lit the horizon of material advance is now spend each year on sports shoes. ventable disease were things of the mid-1980s. many nations is had begun becoming closer and darker as eco- A serious attempt to meet mini- past. and itis fair to assume that it to take Seriotisl \ the WI 1()/1' N logical limits loom. mum human needs has t herefore not would also be It world with less civil target of 80° t, immunization by the But for at least a billion people in vet been made. conflict. slower population growth. end of the decade. In the great major- the world. material progress has very and more manageable environmental ity of developing countries. that goal different connotations. It holds out Forty :wars of progress problems. was reachet I. And the results have file hope of adequate food. Hem been predietabh. -pert:1(111:1r. water. safe sanitation. decent hous- \ et despite this less than all-out The old and the new Approximatel 3 million sung lives ing. reliable health care. and at least effort. the majority of people in the a vear are being saIed: unknown mil- it basic education. This is a definit ton de eloping world ha \ e progressed to There is a clear danger. in the years lions are being potteted from dis of in-ogress which remains entirek the point at which their minimum ahead. that the combination of an easeinduced malnutrition (see page valid. And it is Oile with w Inch the rest needs art being met. unjustifieddisillusionmentwith 151: and approximateb. 3 million chil- of the world must keep faith. This ma come as something of a de \ elopment, and an understandablo dren are grow ing lip wilt: surprise to mam people in the indus- preoccupation with new challenges. Would have been crippled by polio Disillusionment trialized nations. where information may cause the international ommit- were it 11111 for the rise in immuniza- about the (h.\ eloping world comes nit\ to be-tow it en More neglect oil non over the l,t ten Year-. In the 1960sand 1070s. hopes rode alnlosl elu,i \\ from 10%%, report, the ksliefha-1( Material progre,:-.for The under] \ mg signilicance oftlii- high that national and international id its disasters and appeals for 1)101111 it poorest members. achie villein i s Mal 80" t , immuniza- effort- would soon enable all people to Meet its liee(k lint the fact!, are Thi- wnuid he a mistake holhin tion implies a - -tem ofsuppl \ . train- to meet these needs. But over t he last t hat in little more than one gnera- principle and illpractice. For a ing. management. voiniminiatlons. decade. such hopes ha \ tbeen tion. average real incomes have more renewed effort to overcome the age and dtliver. that is capable of getting replaced In a widespread disillusion- than doubled: child death rates ha\ e old problem of absolute 1101 ert \ the right\ actin, at the right time ment. a sense that development has been more than halved: malnutrition essential if the world is to meet the and at die right temperature to mr not worked. a feeling that t he ef fort to rates have helm reduced by about flew challengt that lie ahead. As bet- 100 million infant- aear on four or end the worst evils of absolute .3(r.t.: life expectancy has increased b ter nutritional health would imprm e fiveseparate pea,ion, during their poverty has been tried and failed. about a third: the proportion of chil- lirmiticit` ill -41itwOlild 11110W till' first veal' of lifeI low e \ er imperfect This perception is wrong on both dren enrolled in primary school has poor to make economic progress. As that s stem -tillIliahe. nothing counts: it has not been tried: and it ristn from less than half to more than education would enable people to par- could moor,. coovinringb demon has not tailed. three quarters: and the percentage of ticipate in political and economic life. strati. that the de \ eloping nation- At a very rough estimate. the gm rural I.:undies with acres,: Ito ,..afe water so it would foster the democratic now have t he capaeit It o (nit I he most :runic nts of the developing countries has risen from less than 10% to mort process. As priniaN health care basic and important benefits of have been devoting, on average. otil than Ur I,. In the meantime. the pro- would giN r people more volifitienc in progress at the disposal of almost all about 10% of their annual budgets to portion of couples using modern con- the survival of their children. so it of their people. nutrition. water supply. primar traceptive methods has risen from would lead to smaller families and health care. primary education. an I almost nothing to more than 5011 t.1 slower population grow ill. And as l'olitical commitment family planning. Similarly. 01111 and in :rage family size is now falling material !align.-- would ease da \ o about 10% of all international aid ft tr in almost every countr \ . day pressures and give the poor a Advances in knowledge. let Imo!. development has been specific all\ Such statistics hide great failures stake in the future, se it would help to ogy . cost reduction. and outreach devoted to these purposes. This and great disparities: poverty.oppres- protect the tti \ irmilnent. capacity are not enough:11w political means that many governments of the sion. and exploitation are alive and The case for renewed national and determination to get the job done is poor world have been spending less well. But by any realistic standards. international efforts to meet mini- also essential. and too often this has on meeting human needs than on the progress made in the last 41 years mum human 1101115 is therefore more been the missing link. not sting military bills and debt-ser- has been remarkable. And if the task compelling than ever as the 20th cen- In the ease of the immunization vicing ohligat ions. And it means that of metting minimum human needs tury draws to a close. achit vement. t hat determination was the total amount of aid being given for had been given any real priority over The task is also more achievable forged ill many different ways. But In little more than one generation, INTRODUCTION average real the common elements were a clear specific ad', attics anti low-cost strate- of other nations in a similar geo and measurable goal. a public com- gies. include a one.t bird reduction in graphic region or economic grouping. incomes have more mitment to that goal by political lead- under-five mortality rat's. a halving internally, monitoring informs pol- ers t' irtuallv e ery president and of child malnutrition. 90.1) immu- icy. introduces acconntability.galva- than doubled; child prime minister in the developing nization cover -..re and control of the nizes and rewards effort. and is a world formalk signed a eorninit ment major childhood diseases. the eradi- means by which sustained pressure death rates have to the inninum:ation goal in the cation of polio. a halving of maternal ran be brought to bear for the fulf 1980s). and the mohilization not just mortality rates. 80% primary-school merit of political promises. been more than of health net.% ire.- 11111 Of allnth,t eVel completion. the provision of safe All this was recognized in the Plan halved: other organized resource the eater and sanitation fur all commu- of Action drawn up at the World schools. t lit mass media. the religious nities. and the universal availability of Summit for Children. "Each country malnutrition rates orders. the poly-gmrnmental orga- family planning serviees. should eiablish appropriate mecha- nizations. the business conammit v. In the last !lave ears, 86 go vro. nisms.- states the Plan. "for the reg- have been reduced and the professional organizations. ments have drawn up national pro. ular and timely collection. analysis \\ ithout such a mobilization. goals grammes of at -t ion (see pages to 481 and publication of data required to by about 30%; life and targets hat' often been mere to achieve these goals. and these plans monitor relevant social indicators rhetoric, promises made an public in' now being put into effect. kith relating to the well-being of children expectancy has platforms. echoing ever more faintly \ arving degrees of commitment and such as neonatal. infant and under- increased by about a down the years. But with sustained vigour. limortality rates. maternal nit public -upport. specific social goals What is needed. in all coantie,is talk % and fertility rates. nutritional third: the can help to catal: se progress: t hey more depth and breadth of support levels. immunization (-overage. mor- ran ...en,- as a stimulus to long-tern) from opinion leaders and the media. bidity rates of diseases of public proportion of el rt, a- a local point ha manage- from educators and religious leaders. health important-v.:shool enrolment ment It% object i es. as a common aim from the non-go \ ernmental organi and achievement and lio-rac% rates. children enrolled in leaall %%II« collaborate in an alter- cations and the professional bodies:. prise. and a- a leer for raising pub- front the politic-al parties and coin Statistical weatkness primary school has lie awareness and political pressure. munity organizations. and front the public at large. 'flit' goals and the As is repeatedly pointed out in the risen from less than W'orld Summit means of achieving them must be pages of The Progress of Nations. half to more than articulated and argued for in every the statistics by which social improve- . \s the 1990s began. it became clear country: the proportion of govern- ments are measured are inadequate. three quarters; and to many that a new potential existed ment spending. and of international Inall rases. the data used are the most for meeting minimum human needs. aid, allocated to the meeting of basic recent and reliable estimates avail- the percentage of Decade- of relativelv small-scale human needs must be doubled to at able to the United Nations system. penmen's had shown that child least 20%: theAVMs fO moitor- Rut fur too main countries. the avail- rural families with malnutrition could be at least halved ing progress must be put in plate: and able figures for several key indica- by new and affordable approaches. he United Nations family must play tors .- andparticularlythose access to safe water that '. irtuallv all of the major child- its part in supporting and monitoring concerning t ild survival and nutri- hood diseases could pre% erne(' or progress towards the goals \\ Inch tionare extrapolations derived front has risen from less treated at very Iii cost. that new tech- have been agreed by almost all its mathematical models and regional than 10% to more nologiesandcommunity -based Member States. trends rather than actual figures strategies could make clean water derived from recent and on-the- than 60%. In the affordable and available to all. and Nionitoring progress ground national surveys or emnpre- that pro% iding at least a Itasic eduea. hensi, ital registration s stems. meantime, the tion for even- child was by no means The Progress of ,Nations is a ills lack of data reflects. in part. bevond the hounds of possibility. At UNICEF contributiontothis the lack of development. But with proportion of the saint- time. the immunization renewed effort to meet minimum each year that goes by. this weakness couples using achievement was showing, in dra- human needs. Each year. it will bring reflects less and less a lack of capac- mati fashion. that the outreach loge! her the stati,r ies. on tile progress i \ and more and more a lack of pri- modern capacity n(11\ e isted to make these being made. in each country. towards ority. Most nations can and (I() advances available not just to I he few basic human goals. For it is time that produce quarterly statistics on the contraceptive but to the many. the standing and prestige of nations health and growth of their economies. In an attempt to lOt osaltention on \\ as assessed less It%their tnilititrs but %Cr% few produce c t`T1annual methods has risen this potential. a World Smomit for and economic prowess and more by statistics on the health and growth of Children was convened at the United the protection t hey provide for the their children. The statistics in The from almost nothing Nations in September of 1990. It wars \ es. the health. the gna \ t h. and the Pro, rr of Notions are therefore attended It% a majority oldie world's education of their children. presented. with full acknoledge- to more than 50%. political leaders. arid its principal ou t- The closer monitoring of social ment of their frailties. as an approxi- Yoffie %%as a commitment toil range of indicators allows nations to see their mate guide to national achievement new goals to be achieved by the Year achievmems and rates of progress and as a challenge to the better mea- 2000. These goals. each one reflecting and to compare them with the record surement of human progress. As a minimum. all nations should life and 150 for those born to ethnic Ninety per cent of the growth of the LESSONS IN NUNIBERS produce annual statistics on basic minorities. or to the geographiealb human bod \ and brain occurs in the indicators of social progress- under- isolated, or to the politically disen- first few years of life. The intricate The overall message of the facts five mortality. child malnutrition, franchised. processes of that growth cannot be and statistics assembled in these primar school completion, adult lit- If national under-fi ve 'portant \ l'"`11"1".1.1"li" will ;1'1 Intl to pro- pages is one of significant eracy. and family planning. Statistics rates are very high or school comple- tect the normal health and growth of achievement in the past and on economic growth. co inflation and tion rates very low, then it is obvious children should be at the forefront of realistic hope for the future. interest rates. are now used on a reg- that the problems they reflect are development strategies. And that is As many nations have shown, ular basis by all serious media and ubiquitous and that action is needed why children have a legitimate first have become part of informed polit- on a broad front. But as rates and call on the capacities and concerns of progress tow arils meeting ical and public debate in almost all ac..erages rise. national social indica- the adult world. minimum human needs can he nations. They are one of the principal tors become less sensitive and the made in a much shorter time- means by which politicians are held measurement of disparit y becomes a First call for childeen frame than many would have accountable in democratic systems. If more important guide te, action. believed possible. Even in the progress towards meeting minimum When under-five mortality rates fall Over the last decade. UNICEF has difficult decade of the 1980s. 20 human needs is to he given more pri- to low levels and Mini unizat ion cot - argued that the essence of this prin- ority. then similar use must be made erage rises above 80%, for example. ciple of first call is that the commit- developing nations have halved of annual statistics which show what then it becomes important to focus ment to protect the growth of their under-five death rates, 50 percentages of a nation's children are more and more on the disparities. to children should be a commitment have more than doubled their adequately nourished, or are immu- find out how many fall below the aver- that is maintained in good times and immunization levels, and 10 have nized, or are enrolled in school, or age and by how far, to identify who in bad. The meeting of a child's needs lifted literacy levels to 90% or have access to clean water and basic and where they are, and to know why for adequate nutrition and full immu- health care. \are being marginalized by nization. for education and health more. care. should not depend on whet her It is particularly important that progress. At this stage, the monitor- The statistics also show that many improved systems for collecting data ing of disparities can he a means of a particular political party is in power. poor nations are closer to meeting on human well-being should be put in achieving one of developments most or on whether the economy is grow- place before the World Summit on difficult tasksthe task of reaching ing or in recession. or on whether the basic needs of all their Social Development in 1995. out to the unreached. to the poorest interest rates rise or commodity citizens than others that are \\ omen. to the minorities and the geo- prices fall. or et en on whet her a coun- considerably wealthier. Limits to distortion graphically remote, to the despised try is at war or peace. The child only Nonetheless. it is the combination 1101111MYINIIr and discriminated against, to the illit- has his or her one chance to grow. Of economic growth and effective Despite these problems, available erate and the unconfident. And for the sake of the child of toda social indicators present a more accu- and the world of tomornm. that one social policies that is11110 Iikrhv rate picture of progress for the major - Symptom and cause hanee should. as far as is humanly to succeed. And if minimum ith of a nation's people than per capita possible. Ice protected against the human needs are to be mei in the GN Pthe conventional measure of The social goals that have been fortunes, mistakes, and mismanage- years ahead. then national and progress and development. The nat- adopted by the international com- ments of the adult world. international action will be ural scale does not allow one person to munity amount to a programme to The commitnimt to children must live a thousand times as long as meet minimum human needs and. in therefore he a commitment which is needed to improve the economic another. even if the man-made scale particular, to protect children from not at the mercy of shifting priorities outlook for the developing world. allows one person to have a thousand the worst effects of poverty. and political or economic expedien- and to ensure that the poor share times as much income as another. It The placing of children at the cen- cies. It must be a commitment which more equitably in the benefits of is therefore more difficult for a tre of this process. and of The is maintained in the face of all other growth. wealthy minority to affect the figures Progress of Nations, is neither an act demands and difficulties. There will for average life expectancy, or the of sentimentality nor a narrow inter- always be something more immedi- The facts and figures of social under-five mortality rate, than it is for pretation of UNICEF concerns. ate: there will never be anything more development point to one other important. that minority to affect the figures for Progress of all kinds is undermined lesson that is too obvious to per capita GNP. when millions of children are mal- This is the heart of the commit- mention yet too fundamental to Despite these limits to distortion, nourished and uneducated. Their ment that has been made specific and social indicators can and do mask prospects for future employment and measurable by the goals that have omit: the countries which htg serious disparities. A national immu- self-reliance are set back by polio, been accepted for the year 2000. It is furthest behind are very often the nization level of 75%. for example, blindness. deafness. mental retarda- a commitment to renew progress countries disrupted by civil or can mean that 95% of children are tiondisabilities which affect many towards the meeting of minimum international war. Peace and immunized in the citie.. and 65% in millions of children and which could human needs. And it is a commit- stability are the bedrock for the the rural areas. A primary-school now be prevented at very low cost. ment that The Progress of Nations completion rate of 80% can mean Specific action to protect children will attempt to monitor over the clos- edifice of human progress: war that 100% of boys are being educated against threats to normal health and ing years of the twentieth century . and political turmoil are the and 60% of girls. An under-five mor- development therefore amount to an tremors that invariably bring that tality rate of 50 per 1000 can mean a attack on sonic of poverty's most fun edifice down. rate of 30 per 1000 for children horn damental causes as well as some of its into the mainstream of the nation's most distressing symptoms. Peter Adamson 5 The number of children who die SUMMARY before the age of five is widely accepted as a key indicator of development. But under-five mortality is more than just a measure of survival. It is also the best single guide to the quality of life for the far greater numbers of children who survive. The evidence also suggests that rising confidence in the survival of children -4111u.d1b,_ is essential to the success of family planning programmes. BEST COPYAVAILABLE For more than a decade, lNICEF tiyeiwss to education. and on their ha, used the reduction of undei adult capacities. five mortality rates (1;5 Nil-Islas both anann and a measure of provess for Survival -the Population concern children. Over that time.the''5MB has come to be known and accepted A second concern over the use of as one of the most important non- 1.!5M11 as an indicator of progress for economic indicators of development. measureof all children is thatittempts some Almostallgovernment, hax e observers into the intuit ke but nib- accepted. as a goal for the year 2(X)0, taken conclusion that the saving of a reduction of U5NIII to 70 or less per children's lines will exacerbate the 11K/0 births. problems of population growth. The following pages as sess the things In part. this view is encouraged by progress of nations w hen mea,urd the indicator itself: a halving of the by the U5N1R. Pages 8 and 9 show the child death rate. for example from a absolute level of achievement: page- survix al: the quail )of life for the tunnies for reducing the number of U5MR of 14-0 to one of 70 per 1(X10. 10 and 11 compare actual LI5Mlis much greater numbers of children children who die also offer signifi- can he made to sound like an alarm- with the level that could reasonabh who survive is summed tip ill the fig- cant benefits to the children who sur- ing increase in the number of chil- be expected for each country's GNP: ure for the much smaller numbers of vive. Even vaccination. Minch might dren: but it could equally well he pages 12 and 13 show the best pet - children who die. seem at first glance to have very little expressed aa a change in the child formances over time and give exam- This problem of misinterpretation effect save that of preventing death survival rate from 860 to 930 per 1000 ples of the internal disparities which has been compounded. in recent from particular diseases, can have -an increase of less than 8%. can be hidden bs national aNerag,-. in longan emphaais far-reaching effect- on the quality of Much more fundamentally. all the on the major immediate causes of a child's future life. evidence suggests that improvements The quality of life child death. Three low-cost int erven- in child su r vival will lead to a slowing tionsvaccination. oral rehydration Nutritional impact down of population growth rat her Despite its growing acceptance as a therapy, and antibioticscan pre than an acceleration. key indicator of development, the vent over half of all child deaths. But Vaccination against measles. for Many strands link falling child L'5NI R is still w ideb 'Manuel] wiled. expressing their potential t las Nat example. does much more than pre- deaths to falling birth rates. First. the The technical definition poses no has encouraged the view that such vent 1.6 million deaths a Year: it also death of a young child prompts many probkrns: it is the number of deaths interventions are relevant only to the prevents over 50 million non-fatal parents to a new pregnancy. Second. before the age of five for everythou- pre eni ion oldeath and have nothing eases of the disease'. And it is Mei eas- when child death rates arc high. par- sand live births. and it ranges from to offer for Ifte improvement of life. highrecognizedthatnon-fatal ents often insure against an antici- perMX) in Sweden to over 300 per The More widespread and successful attacks of measles cause subsequent pated loss by having more children. HMO in Niger. But because iti- "itch specific intervention, become. it malnutrition. pneumonia. diarrhoea. Third. empowering parents with the measure of the quantity of death. it might be argued. the less useful the kwashiorkor.vitamin 1 loss. means to protect their children's has failed to fully establish it self as at 125NIR will be as a measure of child eon phalit aonjunct iv it is. otitis health and well-being helps to build indicator of the quulio well-being and the mone it will become media. blindness. and deaneas. the cournkii,hidi is the sin, quo Emphasis on reducing the 1.5\111 (ink a measure of survival. Rather Measles immunization would there- non of successful family planning therefore lends itself to the criticism than emphasizing tilt' 1 '5N1R and the fore be an important contribution to programmes. that there is little virtue in saving interventions that can reduce it. children's well-being even if it saved That is w by rout wept is e use does lives if notlang is done to improve the would it not be bet ter to concentrate no lives. not generally rise above 35% where health, nutrition, and life prospects of on C()1101114' (ivy e!oproent and let Similar!. , diarrhocal disease is a child death rates remain above 1(/0 the survivors. child deaths fall in response to gen- major cause of malnutrition. And oral per 1000 (see page 35). This amounts to a failure in coin- erally rising living standards, as hap- rebvdration therapywith its Ines. in 0 Meation. The 1..15M R was initially timed in the industrialized countries'? sage olextra fluids. continued feeding Less death. less birth adopted as the prime indicator of during illness. and catch-up feeding .1MMEMO progressforchildrenprecisely Protecting survivors after the illness has passed has The league table of child survival because it reflects many of the ele shown that it too can make a contri- on the next page shows that of all the ments that are widely regarded as This argument rests on two mis butionto protecting nutritional countries with very low incomes the contributing to the quality of life. It conceptions. First. the conscious health. lowest U5MR is to be found in Sri is directly affected by. for example. attempt to !nit specific advances in Frequent illness is a major cause. Lanka. A glance at the league table on the income and education of parents. knowledge at the disposal of the probably the major cause. of child pages 32 and 33 will show that one of the prevalence of malnutrition and majority played a very significant role malnutrition. And the attack on spe- the developing world's lowest fertility disease, the availability of clean water in reducing child deaths in the indus- cific diseases or their consequences ia rates is also to be found in Sri Lanka. and safe sanitation. the efficacy of trialized nations. There is always a an important means of breaking into If all developing countries were to health services. and the health and gap between advances in knowledge the self-perpetuating cycle of fre- achieve the same under-five death status of women. and improvements in human well- quent illness and poor growth. a cych rates and the same birth rates as this The U51111 figures given on the being: and efforts to close that gap are which inflicts so much damage on South Asian island, there would be 10 following pages therefore present a mainspring of human progress. the normal mental and physical million fewer child deaths each year much more than just a measure of Second. almost all of today's oppor- growth of children, on their recep- and 37 million fewer births.PA SURVVAL These pages rank -1 the countries of the LEAGUE TABLE 0 world according to one of the most revealing of all 1411110040,, indicators of the a. well-being of children the !- number of children SUB-SAHARAN MEDDLE EAST and SOUTH ASIA who die before the AFRICA Nom AFRICA agz of five (per 1.000 matiriiiits 2.) Kuwait 17 in Sri Lanka 21 live births). Botsw ana 60 Cnited Arab Emirates ei India 126 la South Africa 72 Jordan 32 1110-Regional average 1:31 Kett a Oman 33 El Nepal 132 133 Many aspects of NO11111146 81 Syria 42 Bangladesh 138 national life are 88 Tunisia 42 gi Pakistan HCameroon 121 ga Saudi Arabia 43 Bhutan 203 reflected in this one (.III( WI% oi re 1.)7 la Algeria O1 Afghanistan No mi.% Tar( 140 Iran 62 1 statisticincluding Benin 149 10Min-occo 66 the income and Senegal 150 13I tg 7'2 WORLD AVERAGE Burkina Faso 154 PIP.Regton(ll aueraLre iii) education of Lesotho 157 ER Turkey 91 parents. the 14Ghana 170 Eig Iraq 143 IittlagaSear 173 Via Sudan 169 prevalence of 16Tanzania 178 Ili Lebanon NOI) VI % Burundi 179 a1.i1)1it NO 1111 t malnutrition and Regional arenage 183 Yemen No akr.% disease. 18Uganda 185 E3 zai re 189 Child deaths per IOW births availability of clean 20Nigeria 191 water, the efficacy of En Zambia 200 gaNlattritattia 209 Statistics: weak butthe best available health services, and rig Ethin, . 919 iv Liberia 218 Many of the statistics used for which is nearly ten years old. the health and The statistics are presented, Rwanda 222 under-five deaths are estimates for 1991 based on mathematical with full acknowledgement of NIali 925 status of a nation's models rather than on recent their weaknesses, in order to 228 M7. Malawi measurements at national level. provide the best available guide women. 99-.) 14031 Mozambique They are therefore inadequate; to national achievement, and to Niger 320 but they are the best available. help stimulate improved moni- The wider-five MaAngola NO MT% For about half of the coun- toring. The present statistical C. .Vricatt Rep. I)11 tries of sub-Saharan Africa, on- weakness is in Part a function of death rate is underde%elopinent; but it also 1Chad NO MI the-ground national statistics \oI ) either do not exist at all or date reflects the low priority given to therefore a measure aCongo the promotion and measurement a Gabon N 0 I)l from the 1970s. For nearly half of basic improvements in the not just of the NO Oki \ the countries of Asia, there are aGuinea no statistics on child deaths lives of the .ajority. aGuinea - Bissau NO IMF% more recent than 1986. In the quantity of death but NO Oat Sie;ra Leone Americas, the figures for Brazil of the quality of life. aSomaliaa NO DU.% and Mexico reflect information BEST COPY AVAILABLE 12 :HELD DEATHS EAST ASIA and SOUTH AMERICA INDUSTRIALIZED PACIFIC and (:ARIBI3EAN COUNTRIES el Ilong Kon 1131 cua 1'2 chile 20 1111 .!.4% Men 5 8 Ei Coma H iea 1.) Colomia 90 Ei Japan 0 nsin.pore 92 Ell Korea. Rep. 10 el Jamaica 1.5 l'ruguav Ei Finland 7 NIalassia 90 Panama 90 Argentina 9 Netherlands, 8 Korea. Dem. :14 la Trinidad and Tobago 93 V en eztiela 95 El Switzerland 8 Iltailam 35 Nlexico :30 Paraguay 35 aCanada 8 1China 43 SO'ReLrirm,t/ (11priup. ,Q> ReArronti/ true/7/4w nNorwa 8 13 N le( \Mil 52 1)011111111'illiR(')). 53 Ecuador 01 Cubed Kingdom () 1)1) Franee OOP' krLrr,rxrl(II 1;Ze .3;* Ilonduras Brazil 07 11 9 Philippines Sithil(101i 1)7 Li Peru 09 pAustria 10Papua Nev Guinea 7() cuafrnmia 80 Bolivia 122 I )enmark O INlon go 1 i a 82 naNiearagim 81 Germany O Indonesia 111 Egi Haiti 137 ri Spain NIamnar 117 113 Italy 10 Lao Rep. 148 1113 .kustralia 10 Cambodia NO DV) \ ati Ireland 10 M Belgium 1() ISNew Zealand I(1 L'SA 11 19 Greece 11 ON. f;rnup avowge 11 gj Israel 19 Ea Portugal 12 Child death rates halved since 1960 EmCzechoslovakia (Former) 13 Under-five mortality rates have Two thirds in 10 countries 24 Poland 17 Deaths down been cut by half in the last 30 years. Annual under-five deaths 24 I I u ngan 17 Under - five deaths per 1000 Despite population growth, the 21 India 3.224.000 EEI Bulgaria births in the developing world absolute number of child deaths is Chino 1,071,000* Itomania 34 also declining. There are today an 2501 Nigeria 1,012,000 111 estimated 13 million child deaths a Pakistan 695,000 year or about 35,000 per day Bangladesh 583,000 down from 15 million, or more than Indonesia 572,000 TARGET 40,000 a day, in the early 1980s. Ethiopia 542 000 About two thirds of those deaths Zaire 253,000 occur in just ten countries. Brazil 247,000 :lone- third reduction in 19(X) tauter- Population size is not the only fac- Tanzania 231.000 flt- mortality rates tort() 70 per 10(80 tor. China and India have about the Total 8,530,000 same nutnbe- of birthsbut India %% cc is InNer). has three times as many child nICK-0's u-der4rootroloinv rot ol 43 oeker deaths. Nor is economic level neces- 4 1.,the/7 tyth,uth, est..-and r6.s e.lesrees Ho oe otekkeo 1960 1970 19801991 mac ve ol o,ler 400 OCO chki deaths loke,g the annual eci sarily decisive (see following pages). iochief 1 frillko FOR THE YEAR 2000 The well-being of a nation's children. as NATONA L PERFOR reflected by under- five mortality rates, Is not determined only by economic development. Some countries are SUB-SAHARAN MIDDLE EAST and SOUTH ASIA achieving much AFRICA NORTH AFRICA more than could be 131 Kim!, a +69 la Egypt (721 +31 ii Sri Lanka (21) +97 expected for their Ta fizan ia +5(1 is Jordan (32) +30 Hi Nepal (1321 +56 levels of national ziorthai. (88) +15 Syria (42) +21 Bangladesh (133) +41 CI :Mauritius (25) +11 1Tunisia (42) +7 India (120) +20 income: others are laUganda (185) +11 IIk1Ornee0 (00) +2 113 Pakistan (131)) achieving much Alaulagascar (173) +4 K t1W111( (17) -6 Bhutan (205) -17 gm Ethiopia (212) +3 El Oman (33) - (9 1Afghanistan less. Burundi 0701 %rah Emirates (23)-14 9,1.0g0 (140) Algeria (f) -21 I Burkina 1in..0 (1541 -12 Saudi Arabia (43) -25 These pages Benin (140) -13 Iran (02) 26 N.MONAL PERFOHNIANCE GAP therefore present a gg zaire !(((in -13 gi Sudan (tug) Bil urke (01) - 48 different way of Namibia (8i) (00) 1:2,nolswana 113 Iraq (143) -94 looking at the (In ILebnanon INigeria (10 6 Ulm a progress of nations. Chana l'7(1) -37 Penmen The figure given South Africa (72) -38 III 7.11 maim hicitie (202) -39 opposite each igg camerthat (1211 -47 we also pages 50 and 51 El Lesotho (157) -5(1 country name is that 3Ialawi (228) -57 country's national Senegal (ISO) -58 Social miles per economic gallon Rwanda (222) -60 mortality rate is 120, then that performance gap Mali (225) -67 Using data on GNP and under- country's national performance Zambia (200) -71 five mortality from all nations, the gap between the it is possible to calculate what gap is +20, meaning that its Liberia 1218) -93 level of under-five mortality a underfive mortality rate is 20 Alauritania (200) -93 actual level of country could reasonably be points better than expected for under-five mortality2Niger (3211) -167 expected to have achieved for its GNP per capita. 111 Angola any given level of GNP per capi- The tables on these pages and the level that III Central African Rep. ta. The difference between the show the national performance NgChad actual and expected level is the gap in under-five mortality for could be expected al Congo national performance gap. all countries. The figure in In Gabon An average-performing coun- parentheses is the actual level of for the country's under-five mortality. 1111Guinea try with a per capita GNP of GNP per capita (see Guinea-Ilissa u $100, for example, could he National performance gaps relevant to the indicators of Sierra Leone expected to have an under-five mortality rate of approximately health, nutrition and education box this page). 111 Somalia ll 140; if the actual ur.ler -five are given on pages 50 and 51. ANC, GAPS Oa+ EAST .1SIA and CENTRAL AMERIC SOUTH AMERICA INDUSTRIALIZED p.\ciFic and CARIBI3EAN COU \TRIES UjetNam):12. +11() 11Nicaragua (81: +03 n Colombia (2o gpiPoland (17 +0 NI China (43', +95 ElIlonduras (00) +48 El Paraguay(35) Bulgaria (21) +29 +99 Nlyannutr(117) +57 cuha(12) +47 Chile(2n) ElCzechoslovakia" rut Korea. Dem. (34 +38 U .L11111111(151 +:67 Il:Slily(22, itinatna (34, +19 Ell Philippines (hi'. +.4n El Costa Rica(I:;) +20 el I el:0 la (27) +9 la Ilungary (17 +10 131 Lao Rep. (148) +23 Dominiean Rep. (.1:0+20 .krgentina(25) +8 Greece (11) +9 Ila 711a1nsia(2)) +15 H Panama(20 +18 EcuadorurI +7 Portugal 13 Thailand (35) +1 Trinidadfrobago(23! +5 LPeril (09; -1 Ireland (1))) +4 9Korea. Rep. (in, +9 !laid(137) +1 Boliia (122) -93 Li Spain (0) +4 _.) 10.Ilona Kong(7) +5 tialadlr (07) 1.0Brazil (07) -30 Nee. Zealand (I)) +3 no NIngolia (t ;2) +5 'Mexico (30) -4 SNeden +3 in Papua N. Guinea (7(n +4 la Netherlands (8' +9 EN Singapore (8) [El canada +1 liel Indonesia (Iti Finland (7) +1 1111 Cambodia igg1-)rael (121 +1 E1 Japan (o) +1 sited kinadnin +1 .%,3,11.alia 1uu is (C, It 103 Fran, Nl It Ea lial (I»! 0 18NorwaN (8 Not by GNP alone Belaitum rig Denmark (r) -1 The internationally accepted goal Per capita GNP below $1000, Achievement can also he assessed Eglern] a ;0 -1 is that all countries should be under-five mortality below 70 by looking at the rate of progress 26Seiizerland (11 able to reduce child death rates over time. The tables on page:: 52 @its (1;, to TO per 1000 or less by the year GNP Under-five and 53 show. for all countric, per capita mortolly it mania 2000. The table shows seven poor rote the rate of progress achieved in countries that have already the 1980s and the rate necessary I if achieved that target. VetNor- 2i0 in the 1990s if the year 2000 goal 43 Demographic trends suggest Coma is to be met. 2' that the phase of under-five mor- Countries with 1990 under-five rionoura: 570 60 mortality rates of 200 or more tality decline from about 150 to Philippines 74') 61 about 7(1associated with steep Dcw,,,conPer of -. 5:; will need to make very rapid fall, in birth rates. The majority KoreaDerr 970 progress to reach the target. But of de'. eloping countries are now sonic countries have shown that entering this phase. during which E n.V.01, 0 N.' COL..... 7,1 S:_''2-7.no, 1, reducing child deaths by half. or progre,s in reducing under-five ("yell I wo thirds. over a ten-year mortalit% should pa.- major divi- period is not impossible (see page 12). dends in falling fertility. BEST COPY AVAILABLE t. r Child death rates in C ANTI industrialized HIE V E M E N T nations were as high Rising deaths in in 1900 as they are 7 countries in Africa in 1990. While overall child death rates in the developing world declined by over Even in the 1960s, .4 20% in the 1980s, best available esti- mates suggest that seven countries under-five mortality scent against this trend by recording in Europe was a rise in under-five mortality: Under-five mortality higher than in most 1 1980 1991 rise of South America irce 83 43 72 Some zoo(' news for children al Varth 4 fru-a and the Middle East Zambia 160 200 25 today. Mozomaaue 269 :92 c, Ghana 157 70 20 nations halve child Uganda i81 '85 ... With more Angoto 261 Afghanistan 280 knowledge and death rates in 10 years No 1991 estimates are available for technology, Arab -tate,. dominatet he list of Halving child deaths Angola and Afghanistan but the UNICEF view is that child deaths nations that has e made most progress Under-five mortality rates have risen. as they have in Iraq and developing in reducing child deaths os er the /Kist 1980 199 I `0 fall Mozwnhique, because of war or inter- decade tahl). Fist of the ten countries can now ..._.,:,1T10.0 f c 66 nal conflict. countries \silk the largest percentage 05 33 65 -nan In Zambia. falling copper prices reduce child deaths reduction in under-five mortality are U Arab Ermiates64 23 64 to be found in North \ Inca and the r,a.ca 39 ' c 62 and austerity programmes designed Portugal 31 I 2 61 to cope with the nation's heavy debts far more quickly. Middle East. 180 -2 60 The list is headed by Colombia Egypt have lowered incomes, pushed up 2 1 60 Twenty nations have err Lanka 52 food prices, and cut health and nutri- with a 66% reduction in its under-five '.,`,0 102 .12 59 tion programmes. Per capita income halved their under- death rate between 1980 and 1991. -;Jena 145 ',:. 58 Colombia was one of the first coun- ".',?xico 81 26 56 fell sharply over the decade in Ghana : 3 . . `.1 ganda. and acijrrstment pro. five mortality rates tries to mobilize behind mass Munn- and ,Viorocco : 45 .-.6 54 grammes to cope with debt have often nization in the mid-1980s. and for i 52 Greece 23 meant abolishing food subsidies and in the last ten years. almost a decade. time toms, ledge j -Jan 66 32 52 cutting hack essential services. Other about child care has been promoted '.',40,,/.5,0 -12 20 52 by Colombian schools. the mass '-> .ludi Arabia :n .:3 52 set-hacks have included recurring 126 62 51 d roughts and famine, the resurgence But even rapid media. the Catholic clergy, and non- Kuwait 35 17 51 of malaria, and the growing toll of governmental organizations, as well ,iet Nam 50 rev. can hide 105 52 AIDS. as by the health services. Uruguay 42 22 48 great disparities. T? second and third-ranked coun- tries. Oman and the Unit0 And) Child death rates in Emirates. have the advantage of oil Under- five mortality 1991 wealth and high per capita GNPs: New estimates 1.111,;ania 20 deprived areas are but both have managed to convert for former USSR Beiorus 23 typically two or that advantage into a tsso-thirds Isr'na 25 reduction in child death rates in only Estimates for under-five death rates Ukraine 25 27 three times higher 11 years. in the 15 countries of the former toper Georgia 30 Sri Lanka makes the top ten despite Soviet Union have just become Russian Federation 33 than in capital has ing ;dreads achies eel a loss under- Thes span a broad range from r,'men,o cities. five mortality mie at the beginning of 20 in Lithuania (about the same as .'Aotdova 37 the period. High levels of female ChileorMalaysia)to92 in Kazakhstan 51 55 literacy, low birth rates. and health Turkmenistan (slightly higher than Azerbanan r.yrgyistan 61 ..eryices for the majority. go a long in Zimbabwe and much higher than uzbemstan 70 way tossanl, explaining Sri Lanka's in Egypt 1. Six of the republics have yar 37 success. I-Me birth rat -are part cause child death rates higher than the aver- '%2 and part consequence of loss under- age for Central America and the USSR fforme.rt 43 Its e death rates (see page 7) Caribbean. Disparities hidden. Most of the child surviN al statistic If few countries produce regular presented in thispages annational nationaktati -tie, for under-five tile- averages. But inequalities within talitNeven fewer produce statistics ....*i's, 4 2W' . countries can be as great as inequali- broken down by gender. location. .1 Fr ties between countries: a single figure state. occupation, or caste. Therefore fa 'ar for a whole nation can mask dispari- the following estimates have had to ties between male and female. urban be taken from many different years. 'i' '°41k1124..4( 9).erdi4:: and rural. black and white. majoriR Till- explains why the national and minority. or rich and poor. averages gienare different from The following table shows the the 1991 estimates given in the league under-five mortality rates of seven tables and elsew here inThe Progress The big leap forward -but not so ;. .1' ago countries. followed by examples of of Nations.The year indicated is the widely differing mortality rates usually the mid-point of a multi-year Spain and Italy did not that lie behind this national average. survey period. Under-five mortality reach target until 1960s Nigeria (1985) 191 Egypt(1983) 132. South-east 144 Cities 89 Seventy years ago, child death rates in ways to promote the growth and North-west 244 Rural areas 164 the cities of the industrialized world health of children. were higher than the average for In 1990. the World Summit for India (1988)* 94 Mexico (1982) 71 Africa today. Respiratory infections Children set the target of reducing UttarPradesh 123 Cities 32 and diarrhoea! disease were leading child death rates to 70 per 1000 or less Kerala 28 Rural areas 104 killers. From the 1920s progress was in all countries by the rear 2000. The rapidthanks not only to rising liv- following chart shows when today's Kenya (1984) 91 Indonesia (1982) 111 ing standards but also to conscious industrialized countries-and the first Central region 47 Yogyakarta Province 56 efforts to reach all parents with new dt eloping countriesreached that Coast region 156 West Java 141 knowledge about hygiene and better target. Sri Lanka (1982) 42 1930 Tec estates 73 Iceland New Zealand Norway 1935 Australia Netherlands Sweden And in the Switzerland United States... 1940 United Kingdom United States Similar disparities are to be found 1945 in industrialized countries. In the United States, for example. Sari Denmark Finland Francisco has an infant mortality 1950 rate of 7 the same as Norway or Canada Ireland Israel Switzerland. Detroit. on the other 1955 hand,ranks belowCuba. and Austria Belgium Cyprus Washington DC finds itself at the Czechoslovakia France Japan same level as krnaica or Kuwait. West Germany Luxembourg If infant mortality in the United 1960 States is broken down by race. then Bulgaria East Germany Hong Kong white infant mortality is seen to be 8 L SA - bleu k infant mortality is double Italy Malta Singapore per 1000- putting it among the best Spain in the world alongside Norway. born to black American mothers also 1965 Switzerland, Canada and Japan. nm double the risk of low birth weight. Barbados Greece I Iungary Black infant mortality, by contrast. %The infant mortality rate is the num- Jamaica Poland Trinidad and Tobago higher than in ber of deathsby age oneper 1000 live Uruguay is 18 per 1000 Bulgaria. Poland. or Cuba. Babies births. 1970 Cuba Fiji Kuwait u:Aoco Ncht.s: , Malaysia Panama Romania ,,tyre WW1 rn 4, if. .we .c Cr00450 flWP 13 I The starving child has become the most IA SUMMARY common symbol of malnutrition. Yet it misrepresents the problem. Most malnutrition is invisible. most malnourished children are not hungry. and the most common cause of malnutrition is not lack of food in the home. The problem of micronutrient malnutrition is even less widely appreciated. Yet the lack of vitamin A is blinding 250.000 children every year, and an estimated 120.000 children are being born brain-damaged every 'ear because their mothers lack iodine in their diet. L14 Mlle league table of malnutrition given iodine capsules twice aear at on the following pages is based a cost of about 15 cents per person. on the best available estimates of the A list of countries with ID!) prOb numbers of children under five who Myths of lems. including an indication of are more than No standard tlt. Lt. w het het the. are being acted on or lions below the median weight for ignored. is published on page 19. age. The goal for the year 2(XX) is a halving of 1990 malnutrition rates it i malnutrition bargescale.low eo.,1 every country. This goal is well within reach over All of these manifestations of mal- the remaining years of the 1990s. The nutrition undermine the develop- main barrier to its achievement is not ment of children and reduce their the absolute lack of food or resources stand inway eventual capacity to contribute to and but the misunderstanding of the benefit from the progress of their problem and the lark of sustained families and their nations. political commitment to its solution. Bolt In pair communi- a third of the world's children live in Yet it has been demonstrated in The starving child has become the ties. babies who are bottle-fed are areas where the intake of vitamin A is the 1980s that both protein-energy most common symbol of malnutri- many times more likely to he mai- inadequate. Recent studies have malnutrition and micronutrient defi- tion. Yet it misrepresents the prob- nourished. Breast milk meets all the shown that a child's chances of ciencies can be overcome on a large lem. Visible malnutrition. usually the nutritional needs of the very voting from common infections rise by 20% scale and at low cost if the right strate- result of exceptional circumstances. child: it also 'immunizes' infants if he or she has even a mild level of vit- gies are adopted and if communities affects only about 1"/0 or 2% of the against common diseases. Infant for- amin A deficiency. The solution is are involved in making low cost solu- world's children. The deeper prob- mulas. on the other hand. ma be either the addition of small amount, tions work. In the words of the World lem is the ordinary. unexceptional overdiluted with unsafe water and of fruit or green vegetables to the Bank, "a direct attack on malnutri- malnutrition which cannot usual'. fed to the child from unsterile bottles child's daily diet. or supplementa- tion is needed ... and governments he- detected without knowing the age and teats. tion with vitamin A capsules costing willing to make that effort now have and exact wei,ht or height of the child 5 cents each and given three times a effective and affordable measures to but which c onetheless stunts the Faltering growth year. make it happen." mental and physical growth of one third of the developing world's chil- Lou. birthweight Low birth Cretinism Year 2000 goals dren. weight. caused by the poor nutritional health of the mother (inluding Similarly, it is possible to bring au Drawirni, on advances in under- Frequent illness anaemia) and by too frequent child- end to the iodine deficiency disor- standing of the nutritional problem birth. predisposes children to mal- ders (11)1)) in those areas of the world and its potential solutions. the 199(1 Some families are unable1: to feed nutrition throughout the early year,. w here soils and diets lack iodine. 0. r World Summit for Children adopted their children adequately because of Weaning practicesif weaning 2(X) million are affected by the most the following specific goals for the drought. famine. war, or poverty. begins too earl'. then the risk of dis- visible symptom of ID the year 2000: swelling of the thy raid gland which Onl political and economic action. ease and malnutrition increases. If D A halving of severe and moderate often involving land reform and it begins too late, growth begins to produces goitres in the neck. But the protein-energy malnutrition in severest symptom the overt cre- investment in food production by falter. children under fi.e and for the poor. can solve this prob- Infrequent feedingYoung chil- tinism of approximately 6 million lem. But the great majority of mal- dren have smaller stomachs and pro profile. The unborn child is particu- OA reduction in the rate of low birth nourished children live in homes port ionat el y higher energy needs lar!.susceptible;anestimated weight to less than 10% in all coun- where older children and adults have than adults. The, therefore need 120.000 children are being horn tries enough to eat and where it is clearly smaller meals but more frequent brain-damaged every Year because Ti) A reduction of at least one third in possible to provide enough food to feeding five or sixtMiesaday with their mothers lack iodine. Millions 1990 levels of iron-deficiency meet the relatively small require- small amounts of energy-rich oil or more are growing up stunted, list- anaemia in women fats added to the family's normal less. mentally retarded. and incapable ments of a young child. 0 The virtual elimination of iodine In such circumstances. the most food. of normal speech or hearing. An esti- and vitamin A deficiencies. important causes of malnutrition mated 50 million children are not include: Vitamin A able to take foil advantage of primary An essential early step towa'... Frequent illnessAll illnesses. and education because of MD. these goals must he the closer moni- especially diarrhoea and measles. Less publicized still is the problem The problem can be inexpensively toring of nutritional problems. At the hare a nutritional impact. They of micronntrient malnutrition. solved. as it has been in most indus- moment. few nations have regular reduce appetite. They inhibit the The lack of vitamin A. in particu- trialized countries. by adding iodine statistics on what percentages of chil- absorption of food. They burn awa. lar. permanently blinds 250.000 chil- to a universal!. consumed product dren are below acceptable levels of calories in fryer. Thev drain awn dren every year in the developing Common salt. Iodization of salt costs weight for age or are suffering from nutrients in vomiting and diarrhoea. world. and leaves tens of million, about 5 cents per person per rear. micronutrient disorders. There could Frequent illness is therefore the most more susceptible to the three leading While the legislation. technologies, be no more important guide to polic. common cause of malnutrition and causes of child deathdiarrhoea' dis- and control procedures are being put or more important measure of poor growth. ease. measles, and pneumonia. About in place. populations at risk can be progress. PA 19 These pages rank all countries of the LEAGUE TABLE OF developing world according to the talerots. percentage of their children estimated to be malnourished in the latest year for I which information SI:13-SA1-IARAN MIDDLE EAST zuld SOCTII ASIA Is available. AFRICA NORTH AFRICA 99 12 111 Jordan 11 Sri Lanka 38 Malnutrition, 1111 cote (oil., 12 la ktmitit caused as much by ketr.a 14 El Algeria 10 1,akistan 40 Relrional eit.,ruzzp aft Bois \\ a na 1.) 1111 l'..g. Pi 10 frequency of illness 1.esotho la Tunisia 10 4India (13 12 El Bangladesh 0 and lack of Cameroon 17 Irttli El I. i ri a 20 1Morocco 1111 Afghanistan \,0 5 \1) 11\1\ information as by Senegal '11`Sudan 20 is Nepal rt Guinea-Bissati 23 Ow Reg/or/W(11(7(1LT a the absolute lack of Sierra 1.ete 23 Ir1111 43 food, stunts the uganda 23 Venters 53 IM W(M-{1,1) A \ ERAGE pel com....0 94 Lebanon \ o1151 mental and physical fig miliatsi 94 II Libya MIA growth of children inMauritius 94 a 0111811 VI 1)515 ItH 1.,a 94 Saudi Arabia MI MI and saps the al Zambia 15 Syria \on\i .)7 economic and social I(:haul Turkey \.1) Int \ Nit mibia 2) 1.....1ral) Emirates\01)5115 development of 19Mali 31 a 11100' RCZI(M(// (irer(Er 31 0 of onfltr-livf-. nations. En Nladagasear 33 [a Rwanda 33 Yet few countries isNigeria 3() The decline of malnutrition El Ethiopia 38 monitor 38 Malnutrition rates have declined dren is twice as high. But sub- El Brruntli Saharan Africa is the only Mauritania 48 in most regions but one child in malnutrition in region where malnutrition has Tanzania 48 three is not growing properly. The biggest nutrition problem not declined over the last 15 45) children on any Efil N iger is to be found not in Africa but years. \O II t MI Angola in South Asiawhere the pro- ,,,aMory,c1frornlInoedNonc-ts.0.911100100y0C001,ra, regular basis (see \Oat!) 0,Cor ¬., Subcomeruk.eNom', Socoodrcoason NI !knit) portion of malnourished chil- qur 3,11.0,471 '001 box facing page). 111 Burkina Filt.1) N1) MI % UC. .1friettit Rep. \u Iii % of under-f yes malnourished aChad \o a \ I\ 70 mi calm!) NoDm 60 1975 ill 50 t BE Guinea .., ovi , 1990.1991E:3 40 MI 011% IIM Alozambique 30 1111Somalia Noa\r 20 1 111 South t flirt' vt ok It 10 III Zaire \omit 0' II South As., EoV Aso & Poc.;tc SubSoKoton Arco N Eosl d N Moto C &IMMO & (orb Sc.. ' 509000 20 AL NUI RITION . ..t.:1*.544.1.47:11114..n.LULL EAST ASIA and CENTRAL AMERICA SOUTH AMERICA INDUSTRIALIZED PACIFIC and CARIBBEAN COUNTRIES JSingapore 14 coma Inca chili. 3 \ lost industrialized nations do not MChina 21 Trinidad and Tobago Paragua 4 publish statistics showing the per- Thailand 26 Jamaica Venezuela 6 centage of their children whose weight for age is below two standard 111100- Regional arera.ge 26 Nicaragua 11 Brazil deviations from the median. This Mlvanmar 32 Domini ea n Rep. 13 Uruguay does not mean that malnutrition does NIexico 14 OP* Regnat/ a rerage 8 Philippines nut exist in the richer oat ions. hithe 10 Papua New Guinea 35 El Sal% ador 15 Colombia nited States. for example. it is est i- ULao Rep. 37 Panama 16 Ea Balkh, mated t hat one child in eight goes Indonesia 40 ipO' Regional aiserage I7 112 peril 13 Ibingry. Viet \UM 42 I londuras 21 Ecuador 17 In the former Soviet republics. Cambodia No ur 4.0(;uatentitlit 34 Argentina No uvrk malnutrition threatens on a signifi- !long Kong* l)VI MI Haiti 37 111 cant scale as %ages fall behind rising Korea. Dem. NO MT.% Cuba No nvt.% food prices. In Albania. a third of all children are reported malnourished. 111 Korea. Rep. NO DATA In most industrialized countries. INIlaysia MIMI% undernutrition persists among the Mongolia DVIA poorest groups. But the commonest 11 form of child malnutrition is obesit North American children obtain as much as 5O% of their energy intake from fats. double the recommended proportion. According to the World Health Organization, 40"/0 of older Europeans are obese. Half have no data since 1984 Similar pat terns are now emerging in .tome developing countries. 1980s. In a few cases, information These tables are largely based on latest year when malnutrition out-of-date information about from more local surveys has been was measured (survey of malnutrition. The pie chart used if it was judged to he data from 99 developing shows just how bad the statistical approximately representative of countries) the national situation. situation is. For almost half of 1975.79 5% 1980.84 15% the developing countries, there is The definition used in these either no information at all or no tables includes both moderate and information from the last decade. severe malnutrition (% of TARGET Yet this is the best information children below the level of two the world has on child standard deviations from the malnutritiona key indicator of median weight for age). A 50% reduction in the 1990 level of children's mental and physical More detrIKI Aonnnvcn m M,-nil n. ,evere and moderate malnutrition development. nuiretcn can be aboard horn (had noweoon power. award WokiSunum k Oacirrn ono, tUN/CEF 10031 The estimates on these pages Regtorci and gioboi kenos ,n rroinuehon ore cIntcnted m the among the world's under-fives. &cold rer7e on 'he ecdcl rarton soocna...inned Nahces are taken from the latest national Ackronevonve Comm** rn CoonicorKe/ SubccennIThe on surveyswhich in many cases Nutdon IAC.C;;C I V?21 Furthel .n nonanm rno rnel, women' 01 mcAnteeon con be lound m AooroOnne No doto 28% 1985.91 52% means surveys from the mid- on6coornonc Pnchersclaim LACC /SCN 190[8 FOR THE YEAR 2081 BEST COPY AVAILABLE Malnutrition takes many forms and has many causes. Developing countries end Lack of food may or free infant may not be a factor. formula Of more than 70 developing coun- Progress depends tries where free or subsidized infant on reducing the t. fOrmulas %%ere commonly distributed in maternity %%anis. nearly all liaxe frequency and nos% banned the practice. \VII() and UNICEF have long nutritional impact argued that %%hat happens ill hospital- and maternity units is one of the of common biggest influences on 1% lictlier moth- illnesses, on neptte the Image -sot,: , Omni ',mines hare ma Inutntion nite.s1...Ime 13% ers decide to breast feed or bon 11.- feed. Banning the free or low-cost reversing the trend distribution of commercial infant tor- Some poor countries do /nu/as is a kv element in the 'ten towards bottle- steps to successi breastfccdind that feeding. on better in nutrition inanv !limo-ands of hospital,- hart' adopted at the request of 11.110 and improving the way About one child in three in the de el- children in good nutritional health N10EF in the last two years. oping %%odd is malnourished and rill grow to the same patterns whether The countries that hone taken in which children not grow to the potential mithbleb they lire in apartments on Fifth action are: he or she was horn. Avenue or slums in Bombay. are weaned, on 11though poor gronIit is closely Similarly. the widespread idea that era tied to poverts. many poor countries malnutrition is morcommon among fic'ea.n informing parents have succeeded in reducing malnu- girls does not seem to be borne out by Benaiodesn about the special trition to limier levels than in coun- Ow facts. .1 1993 rei ivi%* of the e tries with higher le els of average d enc. concludes that "male arid Baize tv'tozomtyci,e feeding needs of the income r see chart 1. fnnde rates ofinalnut zit ion are 11'1'N Such height - for -age comparisons similar for most countries and %,,hen Be', 0 Nger young child, on between countries are often chal- differences are sizable it is not con- N'qerro lenged on the basis that 'some races sistently females %Ilio are is( m..e or. preventing low birth Beoz., Dn-an are smaller than others.. But young -. Pok.stor, weight, and on ch,,e ?Ono MO For richer, for poorer 01.110 Poouo New Ckw ea national action to GNP per capita below $1000, malnutrition below 15% Poeagua, GNP per capita 1991 $ Congo Pew control the 'hidden °,.,; under-fives underweight Egypt 10 AM 620 Cgie c I.eee 'otor 620 C,La Saud, Arch c hunger' of Zimbalo e . 12 11141104Air& Crsite oire 1.2 690 11111 Ecuagoe micronutrient Dominican Rep. 13 ledIvAT 950 [air. ':ewazdanc Bolivia 650 I. deficiencies. 13Eill= a 3.5.0 KIMI 11 Tonzamc GNP per capita more than $1000, malnutrition 15% or more le Tkaland eabon Ts ee.,eiad ono Teeeeaq,..) 29imptmcwrwmtm 1120 Namibia .73nona 1580 Thailand 26MI KW 11111 t I Jeveence Mauritius 24 2120 Congo 21E.=111111 1120 ,d.a Jengua,e Ecuador 17 1020 donoy, 0 ,'enezueln Iron e;e.! Nom 16 1030 1 Morocco Yrrnnn 1070 iena e El Sal\ ador 15 Botswana 2590 15 ,r1 Y" 22 D 1 SPARITY 50 countries not yet 'I actingoniodine problem More than 50 developing countries person tierear. A are still not protecting their popula- The goal ofeliminating IDI) in this 11 . ; . 44 tions againstt he iodine deficienx decade Is accepted hi a majoritof disorders that are the world's biggest the world's political leaders at the cause of mental retardation. 1990 World Summit for Children. In total. about 1 billion people are .A number of countries are now China and India hay of all the malnourished Marken in the world at risk. About 6 million suffer from moving to bring the problem strider cretinism and many millions more control. Ecuador and Tanzania have 80% in 10 countries are living below their physical and made good progress and Bhutan and mental potential. Most vulnerable are Bolivia are on the verge of preventing pregnant women. The children of any new cases of IDD. By 1995. both Eighty per cent of the world's mal- Two other nutritional pniblems iodine-deficient mothers can he born China and India could he producing nourished children are to be found in anaemia and low birth weightsare as cretinsstunted, listless. mentally enough iodized salt for their entire just ten countries. also much more common in South retarded. or incapable of normal populations. Of the estimated total of 190 mil- Asia t han am is here else in I lie world. speech. rum ement. and hearing. Au The tables below tell the story of lion underweight children. 120 mil- The ten nations with 80% of the estimated 50 million children in the where IDD is still a major problem lion or about 60% live in four of the ssorld's malnourished children are: developing world are unable to take and what is being done about it. Bold most populous Asian countries Number of malnourished full advantage of education because of type indicates those countries where China. India. Pakistan. and under-fives (millions) iodine deficienc.. national surveys show that the prob- Bangladesh. India alone has more ir,d 7'2 The solutioni-inexpensisc. lem is se errwith 01 least 30% of than 70 million malnourished chil- Chino 24 Iodine deficiency disorders (IDI)) school-aged children having goitre dren two and a half time,F, as mans. Bcnaiodesh 13 can he eliminated by iodizing all salt. (enlargement of the thyroid gland. as the whole of sub-Saharan Africa. The cost is approximately 5 cents per caused lis iodine deficiency). The conoentratitm of malnutrition in Asia is not just a question of popu- lation size. The proportion of chil- No recent IDD assessment or notional control programme dren who are malnourished is also Afghanistan ino, Swaziland Etniopio 4 much higher. store than 60",of all Angola Eauarciiici Guine;:i Mongolia Tunisia P' -V once the swung children in India and Comoros Gobon Morocco Uganda Cote d Ivo* Lebanon Somalia Yemen Bangladesh are underweighttwice 150 as high as the average for sub-Saharan Assessment and plans exist: control programme not fully operational Africa. E./.. r Ghana Maaaaasc-:. Sierra Leone B-itswar.:-: Guatemoio Mali Sudan B.irk ma Fa. Guinea Mozambique Togo Breastfeeding- top 10 countries Cambodia Guinea. Bissau Mvanno C African Rep i-o. Niger Zambia Nigeria Zimbabwe The deaths of more than 1million Brazil. Ghana and Nigeria. the per- Chad Iraq E Solvaa: Lao Pep Paraguay infants a year could be prevented if all centage falls to below 5%. Etniooia Lesotho Rwanda babies were exclusively breast fed for % infants exclusively breostfed (0-3 months) Gambia Liber:a Senego the first few months of life. according 80 to estimates by the World Health Butuna. National control programme fully operational Organization. Uaondo I-, Bolivia 50 Algeria Chino Ph hap,nes Figures on exclusive breast feeding Morocco 48 baisaiaciesi Congo Namibia Sri Lanka are only available for 32 des eloping Botswana Bhutan Ecuador Nevi' Syria countries. Because so few countries Indonesia 30 Bolivia India Pakistan Tanzania keep statistics. the range shown is Mexico 38 Burundi Indonesia Fooun Ne.. Gui^e..; Thailand wide -enabling Peru to make the top Egypt 38 ameron, Peru Viet Nam ten with orals about one third of its infants being exclusively breast fed. Per 32 sr., , o.A.1 ,I. For countries such as Thailand. , 23 For the first time, the benefits of a major A SUMMARY medical advance have been brought not just to the few but to the great majority of the vorld's families. Fol ing success in 6 reaching 80% immunization by 1990. new goals have now been set for the fear 2000. If reached. they will bring affordable solutions to bear on the three or four most important child health problems in the developing world. Taken together. they 41' could halve child deaths and child malnutrition by the end of this century. BEST COM' AVAILABLE 90 21 I '.It (.It I I \ AI I 0 \ S The following pages record the Almost unknown outside the scien- progress of nations in one very tific community a decade ago. 0 RT is specific area of health (ireMunn- now being used hr one family in three Closing the in the developing world, and is tsti. nization against measles. Measles Naccine is one of the most muted to lie saving over a million lives vital of medical interventions in its a year. But there is still a long is ai to own right: but it is also a barometer of go. both in promoting ORT and in a nation's coninntment to the task of informing all parents about ways to gapbetween prevent diarrhoeal disease and reduce bringing the must obvious and basic medical advances to t he majority of its impact on the nutritional health of its population. children. The year 2000 goals call for The importance of immunization a halving of child deaths caused by against measles is widely underesti- knowledge diarrhoea. and a 25% reduction in the mated. It saves an estimated 1.6 mil- incidence of diarrhoea! disease. lion children's lie es a voar. But it also prevents an est itnated 5t) million non- Water zuld sanitation fatal cases of a disease is hich is now known to be a cause of subsequent and need Clean water supply and safe sani- pneumonia. diarrhoeal disease. vita- tation for all families is the most dif- min A loss. deafness, blindness. and Summit for Children accepted a elimination of neonatal tetanus: a ficult of the goals adopted for the year malnutrition. range of new health goals for the year 90% reduction in measles cases: and 2000. But its achievement would 2000 (sec page .1). Almost all the a 95% reduction in measles deaths. advance virtually even other effort to Outreach orld's go \ eminent:. ha% e now madt. improve human health.Recent MINIINN a !Mnal commitment to these goals Pneumonia advances in technology and strategy The battle against nu.asles in the and many have drawn up specific have brought this goal nearer: the last decade has been part of a wider plans for achieving them b. the end Probably the largest of nick) 's gaps costof sinking a borehole and war on vaccine - preventable disease. of this decade. between what science knows and what installing a handpump, for example, And the achievement of the 80% The new health goals are more than people need is the gap between the has fallen by up to 75% in recent immunization goal has demonstrated a list of desirables. The represent a .Mailability of low -cost antibiotics and cars. and community-based strate- two propositions which hold out the comprehensive programme for nar- the deaths of the 3.6 million children gics have brought the recurring costs hope of further significant advances rowing the gaps between the avail - who arc killed each year by respira- of water supply as low as S200 per in child health. ability of low -cost technologies and tory infections, mainly pneumonia. person per year. In water and sanita- First, it has demonstrated that the their widespread application. The majority of those lives could be tion too. the task is therefore one of outreach capaciti now exists. in The most obvious of those gaps is saved if parents were informed about closing the gap between what can be almost all countries. to bridge the gap the fact that tun thirds of the esti- the danger signs. and ifconununiti don, and is hat is being done. between large-scale problems and mated 13 million child deaths in the health workers were trained to diag- low-cost solutions. For the first time. world each vear are caused by five nose pneumonia. prescribe antibi- Synerg,isms the benefits of a major medical common diseases which medical sci- otics.and recognizethesmall advance have been made available ence has long known how to prevent minority of emergency cases that The two common factors uniting not to the few but to theast major - or treat. need to be urgently transferred to the year 2000 health goals arc that ity of families inall countries. hospital. they are based on solutions which are Advances in vaccine technology have Ending polio Over 60 developing countries now available and affordable. and that helped to make this possible. But the have national programmes to put they have the potential to make a deliver-vol. those aren't., to 100 mil- Three o f t hose diseases can be pre- these strategies into effect. The goal major impact on one of the main lion infants, on four or five separate vented by vaccines. as can the polio for the year 2000 is to reduce deaths causes of illness and death in young occasions each vear. is essentially a which still strikes 100.000 children from pneumonia by at least one t bird. children. Taken together. they could breakthrough in outreach on an each year. The factt hat measles. prevent well over half of all child unprecedented scale. whooping cough. andneonatal One in three deaths and child malnutrition. But Second. the immunization achieve- tetanus are still killing almo:-.t 2 mil- the combined effect would be ex 'n ment has demonstrated the useful- lion children a rear show s that. Close behind pneumonia as the greater than the sum of their parts. ness of quantifiable. well-publicized despite recent successes. the immu- leading cause of child death in the The enemies of child health act syn- targets. A clear and widely accepted nization gap remains to he closed. developing world are the diarrhoeal ergistically, pulling millions of chil- goal has proved inlaluable iii 1110111- The new goals therefore call for an diseases which claim an estimated 3 dren into the downward spiral a lizing the public and political sup- increase in Minion ization coverage to million children's lives each Year. infection and malnutrition. And the po. t that is necessary if available 90% or more in all developing coun- And here too there is a gap to be greatest reward of advancing towards solutions are to be put into action on tries. Twelve developing countries closed between the problem and an a range of basic health goals lies in t he the same scale as the problems. have already reached that year 2000 available low-cost solution. More than breaking of this synergism. Targets provide a focus for national targetfor immunization against half of all deaths from diarrhoeal dis- Future editions of The Progress of efforts and for international -.Import. measles (see page 25). Targets have ease are caused hr dehydration which nfiorr5willmonitorprogre.,s Largely as a result of the Munn- also been announced for individual can in almost all cases he prevented towards all of the major health pais nization success. the 1990 World diseases: the eradivation of polio: the by oral rehvdration therapy (ORT). for t he year 2000. -PA 21 These pages rank E T 13 1, F the nations of the G U F world In the pereentage of their JIM ft..... children 1 iteelluated against measles. !n the mid-1980s. the goal 01.10%, Sl 11-S kli.kli \\ \ I II)I)I.I.: \ST and SOt '1'11 \ itmmtnization \I:lil(: \ \ ORTI I\ \ accepted Im tin 411/ ( in,. political leaders liga bilIM :13 Bhutan worlds\ ide. 'Nandi) 81 94) 101.- 1?,..24,11;,11 I'll!'"' 0 ilig pakintali 511 Lanka 'today. most (;111t0I1 7o 84 gi Nepal deNeloping I .C.41110 7O Banglade,11 ,,ii Ea vuhaiii,,w," countries haN e U reached that goal 10 gatitlii 10 nitdrah l'Imirates 81 1111 71 Ilroo sztving the lives of rfg tit) 01' I1,.:.:10/10/,111rflz_ro Congo O4 mig Iraq h8 approximatel. 3 in Smolt fria 1)3 lag ItIrke () million children Benin 14N emelt (1- 16 55 1,i1)N a 54) each Vear. Es! tilers I (.(,. 54 Goi,.-Bi,111 WALebanon 14)91 Measles ui Touo 31 20 all 11111111111l/cd,waiihi immunization helps ('1.t)' (1.110111. 47 protect children C1'1111%11 11.11allRep. 41) Nigeria 40 Measuring, immunization against other Senegal 40 1100.- H,'L.'1,+1:111 I',71.',' if) Statistic, for immunization are this natural protection fades. 194)1 est tinate,k \\ IR) and leaving the unimmunized child diseases. EgiNlIgolii 40 El Nladligawar IA ICE': and are more at risk. disabilities. and 4 comprlicn,ie awl up to date Inindu,trializd countri -. 39 I gfa Chaim than for ant oilier social \t here Measles is les, pre\ akin 39 malnutrition (see Eli Ilan indicator. Thi, i, because the and usuall les, disastrous. box hieing page). 29hen\ a 38 effort to reach the 80",, goal led \ archly is given at 12 to 15 30.Burkina Fits. 36 clo,i.r monitoring of 'intl.:re-- month, to 811(m natural 141 Cameroon 35 0\111(11 in turn helped fuel the protection to disappear. This It is also a measure Kg (itin, 33 itimittniiation ',urge). increases the surer, rate of the gg Zaire 31 The figure, gi en here. based accine. If measured at age two. of the effectiveness on as is the ease for example in the BESomalia 30 accirte and household )() -or% eragc at Mit' 'SA. lhe immunization of a nation's health EgiNianitaiii (inv. Before tittln Month", 0111(1 signiticantlr. higher in gri Ni2-,.,. :1 de eloping countries such as services. EH ('had 91 MC:Ade.; Cali he nullified Hie Nigeria. El Ililtipia 17 Child ht the mother. Thereafter. 1111 V1EASLES IMMUNIZATION EAST Atii A and \ SOUTII ANIEHICA INDUSTRIALIZE!) and C.11iIIIIIEAN COUNTRIES 11 11 DKorea. Dem. cow .1rgeniina lunga 100 91 Korea. Rep. (..0,(a itien 911 chill Ireland China 95 86 El Brazil 83 (:zetitoslevak la former) (+8 11/ Singapore Trinidad and nhalm81 el Co low is I. Ruh:aria ReLfit,l)(1 I laPanama 80 rugua riniand 00 El Philippines 011 11 ex ieo Re!..,7()Irf t I (ircrri ;1) NJPortugal 91) 03 ® 0 it Nam 88 Pt.RC:21(111ra parzurna, 74 WISweden 8t, Dont ikit n lien. itoii,i Netherland' 94 U 7, (l) Nlalasia .1 a ma ira hll hl poiand 94 Thailand 9Ni('aragnit Peru gm Romania 9 ,11 hidoilp,ia .11 Salado:- 3 10 Ecuador 34 mg rwrnian, go mmanmar (;uatetnalit -19 I mg Nevl Zealand 90 BE4Paw"' Nr" 3') I laid :11 EI Nrwa, (H) mg I long home 4 Eel Switzerland 9t) 14 ni hod ia 34 5 I Uited him:dont 89 0.4. IEI .an Rep. 21) al Mania 1). EllDelimit 11, 81I lag 8() (;iii,,(1;, 85 gi Spain 84 11110. Group a; eru,r .7) S The rise in measles immunization Egl(;re ere 7 Belgium Deaths from measles have been GLOBAL COVERAGE WITH MEASLES VACCINE, 1983-1990 24Japan 73 redured from approximatel EgjFrautee 2.5 million a Year in 1980 to % one -year -old children immunized 26kutralia 68 tinder 900.000 in 1990. just as 80 611 important is the massiN e reduc- 70 30 tion in mm-fatal episodes of the 60 disea.efrom about 75 million a Year to ahout 25 million. Non- 50 .1-11;[1 fatal attack-. of meales are 410 associated With subsequent mal- 30 911" n11'1,11011111 nutrition. pneumonia. diarrhoea. vitamin .\ loss. blindness. and 20 .ind .1 (.)" le 104 dealne,s. Measles iIr11111111IZatioll titi..1-1s deaths. romp.111.11In IS therefore probably the most 0 important -.nighe medical inti 1983 1984 1985 1986 1987 1988 19891990 io.-Itilinuni/..thun vention for protecting children agam-a malnutrition and disea,. 1 i )11 1111:11. \It 200 The league tables on the previous pages ACHEVEMENT AND show each nation's Coverage absolute level of sustained achievement in 11(110) tog the extraordinar idefOri III reach the target of 13(1° protecting children immunization by the end of 1990. it I)as v,idely feared that vaccination against measles. But le els would fall back again in 11)91. achievement can Tin' latest figures shiny that in general this has not happened. also be measured by \leash's immunization is perhaps I he most difficult to sustain. but out the rate of progress of 12; countries for which 1991 fig- IL.,,ittIst w111110lead, Ithenrah' oirmar, Ietwiq measles ures are as ailable. 15 inerea-d the over time, or by the percentage of infants immunized level reached in against the disease. 49 hold coSt.ragt. Fighting measles: best at 01 close to 1490 levels. and 33 saw relation to a their rates drop hy more than 5 per- performances centage points. country's wealth, or In Asia's five most populous coun- The proporti..a of the (lot eloping sith per eilpitil ofle,S 011111 tries. 111th over half the developing by the size of the v,,,,I.1(1" infants living. immunized S300 per Var. wrlifschildren. 1991) immunizatinn task and the against measles has risen 1 1 ) 1 1 1 3 1°4 Kuwait and India head the list. le els ha,. t' been largeb maintained: though both started 11'0111 1e1-1 lo1s io Tlir7rr in the last sip !wars. This Measles coverage 0. 0 difficulties to be achie% ',went. (meld the biggest iue- 11.1.1S ill the mid-1180s. t ganda, 1990 1991 cess stories of the last decade. is moving from I 7r7 coverage to oker 05 overcome. now sal ing the Ides of more than TOrl, in years despite ere cm- one and a half million children each noinir and logistiral problems. is 90 8 ear and helping to protect the the one country from sub-tia ba rat) '14 ;IU11 75 ,1 Two nations which nutritional health of millions more. 1friett to make the list. Nl) amour 17(1190.75h 53 The chart show: the 21) countries and Bangladesh. two oldie world's stand out by any with the best perftirmances since poorest countries. both rnoseil from the 111111-19:10s: half are countries almost zero co1lbrii!ri. 111 11% er 511( r. Falling coverure and all of these The c011111rieS 1%11101 saw a fall of It) measures are India percentage points or more in measles Fastest progress 1 immunization levels between l990 and China. Fifty of children immunized against measles (age 1 year) and 1991 lr.re: Top 20 countries MIMI 1985 I 1 1991 %pt. rise % % pt. million babies are 990 1991 fail RI= 1 93 Rdp .16 born into these two U 186 82 11111E1111---- 786 Yet; countries every year; Nazi 19 188 e:Q 75 16 178 So %floor 53 163 40 million of them 3 11111111111.1111.11111F3 187 envc !? 28 are immunized 111111111111 22 ___J 2.) :;. 71 against measles 111121111 2^ 1 '6 _= '12 ama 80 before their first ME_ 17; birthdays. 51111111111111126 1 .6 52 64 Sc, i3 13 si I'3 7,-1 ..71 ,9 ;.; 11111111110111111132 I" J65 11111.111111111U1__ 66 14 BEST COPY AVAILABLE DISPARITY Somepoorercountries have better record Ten of the world's poorest countries By contrast there are 13 countries have reached the 80% target for where per capita income are more measles immunization. They include than twice as high but where protec- the two largest nations in the world, tion of children against measles falls India and China. which are home to short of the 80% mark. 141'of the developingodd's chil- Inthe industrialized %%odd. \ heir ry dren. Every year. approximately 50 later vaccination schedules make million babies are horn into the,:e tN%o higher coverage less difficult. the countries: 40 million of them are now average level of measles immuniza- .4 rnarnenes pain.° lifetime's protection - China reaches 95% heir ig protected measles vaccine. tion is lower than in East Asia. Two other countries that have Italyand Hong Kong have Twelve countries reach reached the 80% target. Bhutan and vaccination levels as low as 50% - Viet Nam. are among the least devel- approximately the same as in sub. year2000 goal oped nations of the world. Saharan Africa. Poorer countries on target... Richer falling short... Tx%che developing countries health. and normal grin% t Per capita GNP iess than $1000, measles Per capita GNP more than $2000. already reached the year 2000 goal of Thecountries that have met the coverage more than 80% measles coverage less than 80% immunizing 90% of their children 90% measles immunization goal are: Per copito % immunized Per capita immunized GNP ($) 1991 GNP ($) 1991 against measles. They include China. % immunized 1991 which has almost 20% of the world's Korea. Dem 970 99 Mexico 2870 78 children. Argentina 99 Chinn 370 0 c USA 22560 77 Thenewtarget of 90% is more 99 Egypt 620 90 Greece 6230 76 than just a marginal improvement on Korea. Dem 99 Philippines 740 88 Belgium 19300 75 the earlier 80% goal. Because measies Krv, -a Rep 96 Viet Nom 89 Japan 2602:, is particularly virulent, vaccination Oman 90 Honauro:. 570 8o France 20601. 69 lrels must reach well over 90% to 113r:-. India 32: Austrcx) 1659' eb ha e a major impact on reducingdi-- Monoot.o b" South Aiwa 233: 6 easetransmission. It is also important KuvveY Zimbabwe 62C Venezuela 2610. 6' to push coverage to the highest pos- Costa Rico 90 Bnutor 1 8: Q Austr.c 2038. sible lei el in onler to protect the poor- lebono,, est 20% of children who are most Soudi Arab.° PC (rely 18582 51 vulnerable to the disease and among Sinoapere 90 Hong Kam, 1320: whom it takes its heaviest toll on life. Bucking the trend The immunization achievement Ten countries with a six-year Fall in measles coverage Progress against measles is part of a tant as ensuring supply. and man' % pt wider effort to vaccinate infants thousands of individuals and organi- 19851991fall against major childhood diseases. zations have been involved in one of Hong Kong 4'2-38 The chart shows the overall impact in the largest peacetime operations in Mouritani° (1484-1 9911 lives saved and disabilities prevented. history. Ken jo The scale of achievement cannot Few countries have gone against Cholla ( 1980- 1991' 6:: -2z be overestimated. In countries where the worldwide trend towards rising Ei Soivado transport, power supplies. and health vaccine coverage. Since the mid- Belgium 90 75 services are often inadequate. vac- 1980s. only ten nations have regis- Lao Rep 33 - cines are being delivered at the right tered a fall of 5 percentage points or Zaire 40 31 - time and the right temperature to more in measles immunization. Albania 8' over 10(1 million children on four or In some, but not all. the cause has Samara 32 five separate occasions in their first been military, economic or political Year. Creating demand is as impor- upheaval. 29 After decades of rapid progress. SUMMARY primary education is in crisis. Spending has been A A cut back. Policy and ANr `S strategy are in the f 4 ta doldrums. Progress -10 towards universal primary education is faltering. .40 Enrolment remains high almost everywhere. The problem is not getting children into schools. it is keeping them there. Almost half leave before 14, te; completing four ,. Ao. years. 401411Krak Brave new approaches are being tried out. But whatever solutions are found. they must ',7- .4 -.pity 1 eventually become ; V. the responsibility of governments if they are to be put into action on the same scale as the problems. 9 ( 11i he tables on the following pages dren of the poor and the landless. I show the progress of nations Most of its pupils either never started towards the goal of primary education formal schooling or dropped out at an for all. The criterion used is the per- Schools early stage. The BRAG schools pro- centage of children reaching grade 5. vide three years of basic education, Four years of school may not be including literacy, numeracy, and enough to establish literacy, nor does social studies, for an approximate cost it signify the completion of primary weighed and of $15 per pupil per year. Classes are education, but given the available sta- small, and the timetable and school tistics this is the one common stan- year fit in with the demands of the dard by which national achievements agricultural calendar. So far, over can be compared. 90% of BRAC's pupils have gradu- Overall, the proportion of the found wantin ated back into the national pnmary developing world's children enrolled education system. in primary school has risen by two But the total number of pupils in thirds in 30 years. from 48% .n 1960 benefits from. the education being size, and improvements in the health, BRAC's 10,000 schools amounts to to 78% in 1990. Given that the actual offered. nutrition. and survival of children. under 2% of the primary-school-age number of children has almost dou- A poor family may be hard pressed But for all the agreement about the population of Bangladesh. In the bled over that same period, this is an to meet the incidental costs of school importance of primary education, in developing world as a whole, almost enormous achievement. I3ut that is clothes. books. equipment, meals. many regions the progress of the 100 million children a year start pri- where the good news ends. For after bus fares, and donations to school 1960s and 1970s s2ems to have mary school. The task is to keep them decades of rapid progress. primary funds. Perhaps the family needs the stalled. Resources have dried up. and there. And such is the scale of this education is in crisis. child's help in the fields or the home: [Julieand strategy are in the dol- challenge that there is no realistic perhaps there are no employment drums. substitute for a system of universal Spending cuts opportunities for the educated: per. Resources are only part of the primary education provided primar- haps the last school report was poor answer. But primary schools in most ily by governments. The relevance of The crisis has been brought about and the child seems uninterested: per- countries clearly need more invest- the BRAC venture is therefore not as primarily by cut-backs in educational haps the prevailing view is that a girl ment. There are two main ways in an alternative system, but as a guide expenditures during the1980s. does not really need to go to school in which extra resources might be to making national primary educa- Under pressure of debt and falling order to become a wife and mother. found. The first involves a degree of tion systems work better. raw material prices, many govern- Whatever the circumstances, the ben- restructuring in government expen- ments have been forced to make efits of education most be perceived ditures. allocating a higher propor- Para-teachers spending cuts. Military expenditures as real if they are to outweigh such tion to education and tipping the have suffered a little. Health and edu- costs and considerations. But as balance towards the primary schools. Central to BRAC's success are the cation expenditures hate suffered a intesttmertt in education declines. as ln Pakistan. as in many other nations. t win ideas of para-teachers and com- lot. "In nearly half the developing teachers' salaries go unpaid, as books two thirds of the education budget is munity involvement.In BRAC countries." said the Director-General and equipment are worn out arid not spent on seconda7 and higher edu- schools, parents are involved in of UNESCO at the end of the decade. replaced. and as jobs in the modern cation while only one third of children putting up classrooms, selecting edu- "the goal of universal primary edu- sector become harder to find. the per- complete primary school. cated members of the community to cation is receding rather than drawing ceived benefits grow less substantial. A second potential source is over- he teachers, discussing matters of syl- nearer." Every day, thousands weigh educa- seas aid. But to help primary educa- labus and timetable, and achieving a The chart on page 28 shows at a tion in the scale and find it wanting. tion. aid too would have to he better fit between school and the real- glance where the heart of the problem reshaped. At the moment less than ities of children's lives and expecta- lies: enrolment in grade 1 of primary The best investment 1% of total aid goes into primary edu- t ions. Para-teachers, recruited locally education remains high in every cat ion. from among the educated and the region. but up to half of those who No one disagr that education is `good-with-young-children'. can be start school drop out before complet- fundamental to de% elopment. Japan. Lessons for schools quickly trained in today's methods of ing four years. If educational progress Singapore. and the Republic of Korea stimulating eagerness to learn in the is to be reaccelerated. then the clear are sufficient evidence. "It is no exag- Asprogresshasstagnated. very young. More qualified teachers priority is to ensure that children geration to say,- Japan's Prime attempts have been made to find the can then be freed for more advanced remain in school long enough to Minister told the 1990 World Summit educational equivalents of the strate- work in literacy and numeracy. acquire literacy. TIllmeracy, and basic for Children. "that the policy of pro- gies which have begun to make break- A ferment of similar experiments attitude- and skills which trill help moting education constituted the throughs towards universal primary will be needed to find the paths to them to impros e their own and their ery foundation of Japan's deyeloi health care (see page 21). In that education down which a new genera- families' circumstances. ment." Studies have shown that edu- search, much attention has been tion of children might march. But There are many reo,ons for drop- cation helps to replace resignation focused on the achievements of one iiitimatel. new approaches and ideas ping mit of school. But the underlying with a degree of confidence, accep- particular non-governmental organi- must become the responsibility of reason is usually that parents or chil- tance with an awareness of choice. in zation the Bangladesh Rural governments, as well as communi- dren. or both. decide that the effort re'cnt %ears, a strong correlation has cis ancement Committee (BRAG). ties. if Ow problems of primary edu- and cost of staying at school are not been established heti% evil education In eight years. BR AC has opened cation are to he addressed on the matched ht the quality of. or lik* and later marriage. smaller family otcr Row .chools. mainly for Old- necessary scaleP.1 7 31 These pages rank all countries by the LEAGUE TABLE OF percentage of their children reaching grade 5 of primary 011116,os education. Over 90% of the dr , developing world's I SUB-SAHARAN MIDDLE EAST and 501 TII ASIA children start :W RICA NORTH AFRICA school. But in many no Zimbabwe 04 ElTorke II Sri Lanka 1 countries. half drop Nlatirititis 81) 1111 1. likedrah Emirates El India 53 3 -;() out in the first few ® Ghana 74 .Igeriat No- Cameroon 73 Svria 4 Banoad,.41 47 years. conga ")El Jordan 0.) vakis(an 37 9- Ken a 71 Iran 1 Al.gbanismo As a result. there are Namibia 70 Oman 01 Bhutan 19 Toro 70 Tunisia 117 IN Nepal N. I I < I now an estimated ana tit) Kuwait 83 a 100 million children 10Zambia ReLrumfd arcraL!e' %;l Nigeria SO 1:0Egypt ..) aged 6 to 11 not in kla!Wanda fa Iraq 7') mZaire SO DM Saudi Arabia 1)8 school. Two thirds of (R) 14 d'ivoire --iliglioroceo them are girls. Fa; Burundi elSudan 44 Lesotho .)- . aLebanon Senegal 59 a Libya Grade 5 enrolment 18Gabon 50 Yelllell indicates the Re 1101101Nl gr lrri a (;had 43 rdr llilylrr'n reaching grade 3 percentage of 2,0Central .rietiliRep. 44 children who are Pa Benin 41 ggMaul ninia 39 Enrolment and retention completing at least C )1ozambi(iite 33 .1ngola 34 The chart shows that the proportion reaching grade 5 as four years of littlagasea 34 percentage of children reaching South America. but achieves this grade 5 is determined by both by retaining a higher proportion 26 31 primary schoolthe enrolment and retention. Sub- of a smaller intake. Burkina Faso Saharan Africa has the same ,,4'U, IC`.C.45 ,n1:,,,,WO S.A.C.A.13 Us ,..!.F.S....; minimum required Guinea ,,,,, ::.a".., 7 'X Guinea-Bissau 93 if a child is to %ente.ng gode I reachingqode 5 30Tanzania 24 F-71 gm% 100 t receive even a basic gg Niger 23 96 9 89 mg \IaIi 18 Br, e 83 education. H1'101)111 19 71 ao ! Somalia 111 Liberia 4U, 48 aSierra Leone 70f Smith krrieii 1..immia) 1 O ,, ts$01,cron Alrfta M East&N Africa 3,,, Ano i33, AS.0 6fac-1,c So,6Arr4t,C0C Armor.,6 Ca c a RIMARY EDUCATION EAST ASIA and CENTRAL AMERICA SOUTH AMERICA INDUSTRIALIZED PACIFIC and CARIBBEAN COUNTRIES U Singapore 100 Jamair 9 (16 Australia 101) a Ho" Kona. 99 in calm 91) El Chile in Finland 100 aKorea. Rep. 90 Costa Ilica 84 flEcuador 67 a Japan 100 Malaysia 86 Panama 89 in Paraguay 67 s wpd en 100 a China Nlexico 76 in Bolivia 60 ® Denmark 98 Indonesia 83 n Trinidad and Tobago Colombia flCerm.any 98 IIIP Regional urcralze trio- Reiztoma nrermze hh NO- Resriona I a rerG ize 18 la Norway 98 a Philippines 75 48 El Brazil 41 France 97 aI londuras (17 Thailand 63 Dominican Rep. 46 lit !yr:gentia' '.0 ntik Spain IIPapuaNOW Guinea 3 El Sakador 45 aPeru NO 1)VI 10Canada 96 10-Lao Rep. 99 10 Nicaragua 44 El Venezuela NO Iltk in Ireland 96 NI011)1110d it) NO 1)1T \ Cuatemala 41 1-0Poland 96 Korea. Dem. NO MT% llaiti 19 1113 USA 96 96 Mongolia NO D111 Po-Group average II :Myanmar NA) DV! OaCzechoslovakia (former) 94 11 Viet N1111 NO n vrk Greece 94 II Hungary. 94 jIsrael 94 14Netherlands 94 f9Italy 89 gal Bulgaria 88 1111- New Zealand 82 Belgium 81 Schooling target metby some poor nations Romania 79 Four very poor countries (GNP Six more countries with per Eleven countries with per capita Albania No DAT% per capita below $1000) have capita incomes of less than $1000 GNPs of more than $1000 have Austria No DM already achieved the target of are providing primary education not vet achieved 80% primary Portugal NO 1) yr% providing 80% of their children for more than 70% of all their education. Switzerland No nyl % GNP % children with at least four years of school- children and have an excellent per capita reaching United Kingdom NO Dyr% ing. Zimbabwe has achieved chance of reaching the 80% goal 1991($) grade 5 before the end of the century. N remarkably rapid progress: at the Brazil 2920 41 time of independence in 1980, El Salvador 1070 45 TARGET only about one third of its chil- Gabon 3780 50 rolornhin 1280 55 dren Were completing primary GNP `. children Morocco 1030 60 per capita reaching A basiceducation for all childrenand school. Thailand 1580 63 1991($) grade 5 GNP % children Botswana 2590 66 per capita reaching completion of primaryschool by at Egypt 620 75 Pnragua, 1210 1991(5) grade 5 Philippines 740 75 Ecuador 1020 67 least 80%. Zimbabwe 620 94 Ghana 400 74 Saudi Arab:a 7050 68 79 Sri lank() 500 91 Cameroon 940 73 Romania 1340 -1 PC Kenya 370 +.1 ,1,13 iqq? rrooc 5 indonesia 510 83 Togo 410 70 *Oa FOR THEYEAR 2(XX) 99 k.' Approximately one pregnancy in five in the developing world is unwanted and unplanned. Meeting this demand for family planning could reduce maternal mortality and abortion rates. prevent far more than 20% of all child deaths. and improve the health and nutrition of many' millions of women and children. It could also ease the pressure on one of the worlds most over-exploited resources - the time and energy of women. In addition. making family planning available to all couples could bring about a further significant slowing down of population growth. 30 The71 he league tables on the following I attention if he or she is to be safe, list all nations according to I healthy, and well-nourished, and to their average number of births per 1 develop into an intelligent. self-con- woman. They are therefore a guide to suitable fident, and happy child. Family plan- the progress that each country is mak- ning enables mothers to give that ing in the transition towards smaller time and attention. Another preg- families and the eventual stabilize- case or nancy and another birth. on the other lion of populations. Broadly speak- hand, deprives the very young child ing, the tables show that family size of all the detailed attention he or she tends to fall as income rises. But this still needs. Family planning can also pattern is far from consistent. and it bring benefits to older girls and boys. is clear that other forces also have a revell ion All other things being equal, the qual- powerfuleffecnt:1 fertility levels. The ity of child care tends to rise as par- most important of these forces are ents invest their time, energy, and rising female literacy, falling child money in bringing up a smaller num- death rates, and the availability of ing too many children and too feeding and weaning. A major reason ber of children. More than any other family planning services. The first recovery time in between. It can for malnutrition and illness in the single factor, family planning can two of these are discussed elsewhere reduce the anaemia that afflicts half yillIng child is the ending of breast- therefore advance the progress of in The Progress of Nations. This of the developing world's women. feeding: and a major reason for the nations towards the goals that have introduction concentrates on the fam- It can allow ,girls to mature physi- ending of breast feeding is the onset of been internationally accepted for the ily planning factor. call and emotionally before they another pregnancy. year 2000. It is a strategy not just for become mothers. It can allow girls to 3 Nutritional health (nay also be population control but for better stan- Benefits fore omen complete their education or training. affected in other ways. In almost all dards of health, nutrition. education. I t can allow women more time for developing countries uontell grow. housing and material improvement. The 1990 World Summit for enjoying their children. for earning store and prepare most of the family's Children called for family planning incomes. for community activities. food. Too frequent ehild-bearing One billion less education and services to be made and for the rest and recreation that is means that women have less of the 11111. available to all couples by the end of today almost entirely denied to mil- time and energy that such work In addition to all of these argu- this decade. As more is learned about lions of women in the developing demandsand the attempt to cope ments, making family planning avail- the benefits of planning and spacing world. with so much work leaves women per- able to all is essential if population births, the case for an all-out effort to manently exhausted. growth is to be slowed further, if the reach this goal grows stronger. And it Benefits for children Family planning is therefore a pressure on the earth's resources and is a case that can be made without ref- many- faceted means of improving ecosystems is to stay within manau- erence to the problems of population O Family planning could save the the nutritional health of the mother, able limits, and if sustainable devel- growth or environmental degrada- iik es of -e% I.ral million children each her y ming children. and the family as npmcnt is to he achieved in the 21st tion. year. A large share of the births pre- a whole. century. Finally, it has become clear D Family planning could save the vented by family planning would be .) Family planning can also help to in recent years that significant lives of hundreds of thousands of high-risk births- babies born within reduce illness. Overcrowding in the demand for family planning already women each y..ar. At present. an esti- two years of a previous birth. or born home. especially in the context of exists. Approximately one out of five mated 500.000 women die annually to women who already have four or poverty. helps to spread measles, pregnancies in the developing world from the complications of pregnancy more children, or to women who are diarrhoea' disease and pneumonia - is unwanted. If the existing demand and giving birth. About 20% of those Younger than 18 or older than 35. the three most common causes of ill- could he met, if women could choose pregnancies and births are unplanned Reducing the number of these high- ness and death among the world's how many children to have and when, and unwanted. And as most un- risk births. estimated at between children. then in addition to all the advantages wanted births fall into the high-risk quarter and :a third of all births, would ) The means of preventing or treat- for women and children there would category. family planning could pre- prevent a disproportionate number of ing the most conmion illnesses of be a reduction of one third in popu- y ent a disproportionately large num- child deaths. childhoodincluding breastfeeding. lation growth. In only 35 years from ber of maternal deaths. 0 Family planning could improve the oral rehydrat ion therapy. better now, this would mean about one bil- *) Family planning could also drasti- nutritional health of many millions of weaning. hawk. &Ailing. and the safe lion fewer people. cally reduce the toll of unsafe abor- children. preparation and storage of foodall The extra resources needed to tion. Approximately 50.000 illegal Too frequent child-bearing is one require time. Family planning can reach the goal of making family plan- abortions are performed every day of the most important causes of mal- enable the mother to give that time. ning available to all couples by the in the developing world and about nutrition in almost n's cry country. end of this century would amount to I00.000 women die every Year as a The average interval between births Quality" of care approximately $2.5 billion a year. result. is strongly correlated with theinci- When so much could he achieved for ) Family planning can improve the dence of low birth weight. which in In all of these specific ways, family somany and at so little cost - and at overall quality of life for women in the turn is strongly associated with poor planning can improve the quality of such benefit to the planet as a whole developing world. just as it has done nutritional health not only in infancy life for children. But it also offers failure to make family planning for women in the industrialized but throughout the early years of mat.- ! quantifiable benefits. Nlost as ailable to all couples may well come world. It can help to prevent the childhood. St (acing births means that mothers know that a %ming child to be regarded as the 20th century's 'maternal depletion' caused by hay- mothers have more time for breast- requires a great deal of work and most costly mistake.PA 31 These pages rank all countries by their EAGUE TABLE OF average number of births per woman (total fertility rate or ifornamiN TFR). The TFR has a profound influence SUB-SAHARAN MIDDLE EAST and SOUTH ASIA on the well-being of AFRICA NORTH AFRICA mothers and Niamithis 9.0 IILebanon 3.2 Sri Lanka children. Too many Nsotto.. fiea 4.2 Tunisia 3.6 India 4.0 births too close Lesotho 4.8 fill Turkey. 3.6 PP- Regional average 4.4 3.9 Kuwait 3.8 Bangladesh 4.8 together, or at too Hzim,il, e 3.3 Egy pt 4.2 Nepal 3.6 5.9 young or too old an Cameroon 3.8 Morocco 4.3 ® Bhutan NGhana 6.1 INUnited Arab Emirates 4.6 Pakistan 6.3 age. is a major cause -8Central kfriezin Bey.6.9 .klgeria 3.0 N Afghanistan DVIA 6.2 aitRegional average .3.0 of illness, disability, Senegal N ICo 11 ao 6.3 fl Iraq 3.8 poor nutrition, and Kenya 6.4 Jordan 5.8 INMauritania 6.3 NI Iran 6.1 premature death MI Mozambique 6.5 Sudan 6.9 among both women OP- Regional average Syria 6.3 14Nladagasear 6.6 14Libya 6.3 and children. el Togo 6.6 14Saudi Arabia 6.5 16Zaire 6.7 16Oman 6.8 Fewer births can DiBurundi 6.8 GI Vernet! 7.3 NLiberia 6.8 N bring drastic 'Tanzania 6.8 Births per woman 20Ethiopia 7.0 improvements to the Somalia 7.0 lives of women. It 1Benin 7.1 Total fertility rates ag Mali 7.1 births per woman has fallen by can also improve 24%Imola The total fertility rate (TFR) is 50% in 30 years, but the actual Uganda 7.3 the average number of births child survival. number of births each year has E Cote divoire 7.4 per woman. Assuming no child deaths. a TFR of 2.0 means that increased by 50%. i 7.6 nutrition, health. Efi each couple is reproducing Statistics on TFR come main- 8.3 and education and Ea Rwanda itself. Once this replacement ly from censuses and household N Burkina Faso \mum level has been reached, the pop- surveys and have much in com- allow parents to N Chad lit IA ulation will eventually stabilize. mon with the data on child N Cation "II put But rapid population growth deaths. But because birth is invest their energy. Ncuinea N,0 has left developing nations w ith much more common than child Mrt disproportionate numbers in death, a smaller sample size can time, and money in a be used and the quality of TFR Namibia NO their child-bearing years; this means that populations will data is therefore generally bet- smaller number of NI Niger NO 11 continue to grow for some time ter. Nigeria NO DM even after replacement level is For further information see children. Sierra Leone NO DM reached. In Mexio, for exam- United Nations, World popula- zambia \01)1.1 ple. the average number of tion prospects, 1992 revision. P 11.:14 I ti .S (I I \ 1 I I \ S IIRTHS 4141110 EAST ASIA and CENTRAL AMERICA SOUTH AMERICA INDUSTRIALIZED PACIFIC and CARIBBEAN COUNTRIES ® Ilona Kong* 1.4 oda, 1.9 urtig, 2.4 n Italy 1.3 W1Korea. Rep. 1.7 Jamaira 2.5 chile in Slain 1.4 Singapore 1.7 in Trinidad and Tobago 2.8 Colombia 2.7 in Austria 1.5 ( :It na 9.3 Panama 3.1) Argentina 2.8 163 Cermanv 1.5 Thailand 2.3 itia El Brazil 9.9 ris Greece 1.5 113 Korea. Dem. 2.4 Mexico 3.3 Relfiona 1 a rem Lre El Portugal 1.5 1111111P- elv (Ma 2.() 1)ominiean Rep. 3.5 enezuela 3.2 A mount IA) 1111 Imitmer.ia 3.9 Po- arnaal ,11,7(12.., Pera 3.7 gli Switzerland I A) NlalaN sin 3.7 F.I Sa mho- 4.2 Ecuador Denmark 1.7 Philiinos ! laid 4.9 Paragua 4.4 Japan 1.7 Viet Nam 4.0 II londuras 5.1 10Bolivia 4.7 Netherlands 1.7 Nhanmar 4.3 Nicaragua 3.2 a InCanada 1.8 Cambodia 4.5 lagGuatemala 5.5 gm Finland 1.8 lion:roll)) 4.7 gg France 1.8 Papua New Guinea 3.0 a El Hungary 1.8 I .ao Rep. n.7 OW-Group average 1.8 16Australia 1.9 Bulgaria 1.9 Norway 1.9 16United kingdom 1.9 20Czechoslovakia (former) 2.0 Sweden 2.0 Declining birth rates USA 2.0 New Zealand 2.1 The average number of births per FALLING FERTILITY Poland 2.1 woman in the developing world Regional total fertility rates,1980 and 1991 Ireland 2.2 has fallen steeply in the last ElRomania 2.2 decade. In South America the gg Albania 2.8 average number of children has 28Israel 2.9 fallen from 4. to 3 in ten years. In South Asia. fertility has fallen 111 from just over 5 births per woman TARGET in 1980 to just over 4 in 1991. East Asia. dominated in popula- tion size by China, is nearing the Family planning education and replacement level of just over 2 family planning ,ervices to he made births per Woman. Sub-Saharan Africa has seen little change in available to all couples. fertility over the last ten Years but the most recent surveys sug- gest a definite downturn. FOR THE YEAR 2.000 33 37 BEST COPY AVAILABLE Fertility rates are now declining in all ACHIEVEMENT AND regions of the developing world. But rapid population growth in the past has left most countries with disproportionate numbers of people _AL in their repro- Teo/WOW, .`;, !tailia."tie chIld less ductive years. So the absolute number of Steep fall in family size erase family size is falling steeply achieved by today's industrialized Sixteenof the20countries with births is still rising, in almost all regions (tthe de% elop- countries.Seventeennations. the highest fertility rates in the even though average ing world. including the1110:4 [MI/111011SLatin world are in sub-Saharan Aftica. Previously. sub-Saharan Africa AMeriCan countries. Brazil and %% here the a% erage woman gives family size is falling. has stood out against the trend. But Mexico. have reduced the average birth to over six children. Ern in evidence from recent surveys. not number of births per woman by kfrica a turning -point may now yet incorporated into official UN half or more in one generation (see have been reached. By about the year estimates. suggests that in Africa. table). In the last decade alone. None of the 20 nations %, ith the too. fertility may now be making a births per woman have fallen by world's highest fertility rates, with 2000, the annual downward turn. one child or more in 21 nations. the exception of Saudi Arabia. has number of births in Throughout most of 1sia and Thesteepness of these falls in fer- seen any significant change in aver- Latin America, family size is falling tility is unprecedented in demo- age family size over the last ten the developing at a far faster rate than was gtaphic history. years oSee table). world will have Family size halved One child less Fertility still high Where births per woman have been Where births per woman have fallen by Where fertility rates are the highest in the reached its peak. halved in one generation one child or more in the last decode world Average no. of births Average no. of births Average no. of births If women could 1960 1991 % fall 1980 1991 Diff. 1980 1991 Diff. _8 5 05 rr. choose how many 55 1 7 09 IL,50 53 6 _17 76 76 0C. children to have and 7nalana 4 54 :.tondo 70 7 3 +)J rr s4 '7 7 3 -0 4 when, population 7 2 3 7 1 1 Cuba 42 to 7 3.3 4 growth would rl 71 1 3 stabilize at a lower 34 TiOnl; - 5' -1-,raU(OS 4 7 onci, 8 Biozd 62 'Q 'coda' 68 level. 58 ". 8 08 68 Rea !') 7 00 1 5 f 5 .1 67 4 _ 66 65 Bfaz., .1 .) ..:;:i071(1SCO, 66 5 1111MINII1111111INIIIIIMMEN. 38 DISPARITY - Populations 100 Family planning and child deaths 1 billion less if to double in The dots represent 108 countries - placed according to their under-five women could 80 35 years mortality rates and the % of women using contraceptives. The pattern shows choose On current trends. a total 01 that countries do not achieve high rates of contraceptiveuse while child deaths The rate of population growth in the nations an set to double their popu- U remain high. One reason is that parents developing world would fall by lations in one generation between who ore more confident that their chil- approximately :30% if women could 104-X1 and 2025. Tht ve quarters of dren will survive are more likely to adopt a family planning. choose how many children to have. them are in Afriva or the Middle East. Total developing-world population Fastest growth in the year 2025 would be about 1 bil- 0 The 20 fastest-growing nations in the lion people fewer than currently pro- 20 111 world (populations over 1 million) DI jected (see chart). i Ilki Total populationMultiplic. The unmet need for family plan- r Ni.Mr ii (millions) ation mu _m_ohr lc ning has been revealed by surveys in 1990 2025 factor 0 a I. IIPMMN IN ITI., NI 0 50 100 150 200 250 300 350 all parts of the developing world over _ea . -2 r 32 Under-five mortality rate (per 1000 births) recent Years. in some cases. the i desired family size is only about half .9 of the actual family size. The average woman in Peru. for example. wants Contraceptiveuse at50 % two children but has four. Its one generation. the proportion The percentage of married women using In total. an estimated 120 million of married women in the devel- contraception (1987.1991) women in the developing world do 2.d oping world who are using con- 72 not want an more children but are cooco :27 28 traceptionhasrisentoan Indio 43 not using any effective means of .1.0!e 5 78 estimated 50%. But one preg- 48 avoiding another pregnancy. Pact 66 Family planning can drastically IL- '+8 2_ 7 nancy in every five in the devel- Pakistan 12 8 oping world is unplanned and reduce illness. disability, and mater- Somcro 9 7 234 27 unwanted. Bangiaaesh 31 nal and child deaths. It could also 1-;19ro The table gi% es the current level reduce the toll of unsafe abortion Benin 2 4 27 of contraceptive use in the ten Mexico .53 which kills an estimated 100,000 ) 'r net Nam 53 most populous countries w ith two young women every year 26 thirds of the developing world's It is now almost 20 years since the .1:?anaa 6 45 0 IOU No1,5 anrS people.. - first World Population Conference agreed that "all couples and individ- uals have the basic right to decide freely and responsibly the number Some poor countries do better in reducing family size and spacing of their children and to have the information. education and Sons,' %ITV poor countries have achieved lower fertility other fa:-tors influence fertilityincluding the. education means to do so-. rates Iliii some countries with twice the level of -(1)- of women. the availability of family planning services. and If women could choose 11(tlie wealth. The keN to their achievement is that many child survival rates. 8t 0 6 countries with GNP per capita below $1000, 6 countries with GNP per capita above $2000, 71 bn average no. of births below 4 average no. of births above 4 2 GNP Average Under- Female GNP Average Under- Female per no.of five literacy per no.of five literacy 6 lbn capita births mortality rate copita births mortally rate v6 rate $ rate -16 a. 5 5 2320 6I 62 43 .1 2 Qo9 4 5.550 1990 2000 2010 2020 .1P BEST COPY AVAILABLE Despite the lack of statistics. it is clear A SUMMA.RY that the contri- bution of women to both domestic and economic life is consistently undervalued. One of the consequences A is that both the needs and the potential of women are usually neglected in the allocation of resources, investments, credit, training, and technology: , The evidence of recent years shows that this imbalance between the many kinds of contribution women make. and the many kinds of discrimination they suffer, represents ,t not only one of the world's greatest injustices but also one of its greatest inefficiencies. 1141tiiVI.'1981s.i'VVEMG!7.-:-Stiln17121J1INCJIMWEINSIZEWNEMWRe...:WV4;`,...ifffe..LadtrOFAM.12711EVIOCNICMMIlltellNO12,4,-, ,TSC, wr.oaTnitat It is now almost twenty years since and community, and more opportu- the World Conference of the nity to develop their own potential. International Women's Year called Water and sanitation is another on the Lowed Nations to begin col- The greatest obvious example. In many regions. lecting and analysing the stag -ties women and girls spend several hours that would help to monitor progress a day collecting water. They also lose for the world's women. In particular, days and weeks to coping with the ill- the Conference asked for closer mon- injustice nesses which are the result of that itoring of women's health and educa- water not being safe. The cost of tion- of changes in child-bearing bringing clean. piped water to a com- patterns and family life of progress looking after its old and its ill, and security rights. legal rights. property munity can be as little as $2.00 per for women in politics and derision bearing and caring for its children. rights, and even civil and political person per year. The benefits include making. and of women's contribu- Only more recently has it become liberties are all likely to depend upon very significant savings in the time. tion to economic life both inside and widely known that women are also being born male or female. energy, and productivity of women outside the home. responsible for growing the great Over the last decade, in particular. and in the health and well-being of the Some of :he results of the closer majorit y of the poor world's food and closer attention to the many kinds of community in general. attention being paid to these issues for storing and marketing most of its contribution women make, and the are set out in the follow ing pages but crops. On top of all such responsibil- many kinds of discrimination they The right to choose see also the chapters on health. edu- ities. there has also been a steep rise offer, has shown that this imbalance ilarem cation. and Tamil. planning). In par- in the number of w omen who con- represents not only one of the w orid's Finally. lack of investment in fam- ticular. the tables on the following tribute to. or are resporiible for, cash greatest injustices but also one of its ily planning services. combined with pages rank the, naL ;ons of the world income through employment outside greatest inefficiencies. malt- dominance of decision making according to one of the S cry few indi- the home. Discrimination against women in about family size. means t hat an cators of thewell -being of women There is st ill a long way to go before technology. training and credit. for traordinary opportunity is being that is available for all nationsthe the contribution of women irfully example. withholds the keys of lost to improve the lives of millions of maternal mortalit rate. recognized in the statistics t hat play increased productivity from that half women and at the same time to The statisticalmonitoring of such an important part in the making of the population. er often it denies improve the prospects for sustain- progress for women is critical to the of policy and the allocation of invest- the opportunity for increased pro- able economic development. cause of equality for women and to ments and resources. Much of the ductivity to those who need it most It is now clear that hundreds of the cause of development. Without work done by women in both indus- and can use it best. millions of women in the developing statistics. one of the greatest injus- trialized and developing countries is world want the right to determine tices and greatest inefficiencies oft he still not considered economically pro- Lost opportunities how mare hildren they will have modern world runs the risk of being ductive and still not taken into and when. Y ages 31 to 35 summarize minimized by dependence on anec- account in the compilation of national Similarly. the neglect of women in the multiple benefits of meeting that dotal and partial evidence. economic statistics. the provision of social services is one demand. It would save lives and But it is abundantly clear that the of the main causes of poverty's per- improve the health of millions of The contribution multiple burdens of womanhood are petuation. women: it would improve the health. too much and that they are increas- Discrimination against girls in edu- nutrition. and education of millions First of all, closer study and better ing- in most countries. as economic cation. for example. leads to an array of children: and it would give the statistics have more fully revealed the obligationis added to domestic of lost opportunities for human and women of the developing world more disproportionate contribution of responsibility. economic progress. Over many years control over their own lives. women to both fami Is and economic and in many countries. the education Finally, the closer statistical mon- life. Many studies, for example. have The rewards of women has been shown to be asso- itoring of those aspects of poverty shown that women work longer hours ciated with the confidence to adopt and development that are of most than men in almost all societies. In Closer monitoring has also shown new ways, the propensity to make concern to women has begun to frira and Asia. studies suggest t hat that in return for this disproportion- greater use asocial services, the abil- reveal the true extent oft he t raged s women work ace average of 1:3 hours ate contribution women generally itsto earn higher incomes. the of illegal abortion and maternal mor- a week more than men. In Latin receive much less than men in the improvement of child care and nutri- talitythe subie,t of the league table America. the difference is almost six way of incomes, services. credit. tion. the reduction of child deaths, on the folInsri ages. hours. in Japan about two hours. in investments. protection, and human the accepta me of family planning. -stimated 1.500 women are Western Europe about Its e to six rights. the reduction of average family size, dying every day of the year from the hours. In Eastern Europe and the Where women do paid work out- and the literacy of the succeeding complications of pregnancy and countries of the former Soviet Union side the home. their wages are on generation. Empowering women childbirth. Perhaps 300 women a day the difference creeps up to about average between 30% and 40% less with at least basic doration and lit- are dying as a result of illegal abor- seven hours. than those of men, and there is no eracy is therefore one of the most tions. Millions more sustain injuries It was alread% widely known that sign of t his gal' narrowing. In niam important single elements in the and disabilities is hick are often secret. women writ responsible for fetching countries. I w ice as many boys as girls development process. But itis also embarrassing. painful. and lifelong. most of the poor world's water. col- heroine. literate.. In some countries. one of the most important steps Even though t he facts are becoming lecting most of its fuel. cooking its twice as mans hors as girls are towards women gaining more con- known.thesuffering andfear meals. cleaning it- compounds, wash- brought to health centres for treat- trol over their own lives. inore equal- remains unimaginable. And its con- ing its clothes. shopping for its needs. ment. Employment rights. social it in decision taking in the family tinuance is unconscionable. P These pages list all countries according to their maternal mortality rates - the number of women -who die from causes related to pregnancy or giving birth (for every 100.000 SUB-SAHARAN MIDDLE EAST and SOUTH ASIA births). AFRICA NORTH AFRICA South 1frica 83 gi Kuwait 1) Sri Lanka 80 In total, maternal Mauritius oo mi Saudi Arabia 41 India 400 mortality claims the Zambia 150 EN Jordan 48 111120 Regional arerage 490 Benin 100 Tunisia 50 In Pakistan 50(1 lives of an estimated Kenya 170 Li bya 80 Bangladesh 000 le Afghanistan 040 half a million 121Nlitlay% i 170 Iran 120 Cation 100 Iraq 120 la Nepal 830 women every year Rwanda 210 Algeria 14(1 Ei Bhutan, 1310 Botswatill 250 Syria 14(1 99 % of them in the Mozambique 300 Turkey. 150 developing world. Uganda 300 010. Regional average :210 WORLD AVERAGE Tanzania 340 kri 14y1)0 270 Nattrbizt 370 ligSudan 550 The maternal 14Togo 420 NI Lebanon NO MT% mortality rates Cameroon 430 RIMorocco NO 1)101 B3Sierra Leone 450 IN °Mall NO D VIA shown here reflect ESMadagascar 570 1.. Arab hilirill NO Dt1 k the strength of Regional arera,cp .590 go Yemen No mi.% Central .tlileanRep.000 IN health services 18Senegal 000 Deaths per 100.000 births 20.Guinea - Bissau 70(1 generally. But 20Niger 700 progress in reducing Guinea 800 Maternal mortality iggNigeria 800 maternal deaths Eli Zaire 800 Few developing countries main- piecing together evidence from Burkina Faso 810 tain up-to-date statistics of community studies and hospital also reflects the 000 maternal mortality rates (deaths records. Congo Surveys require a large sam- 000 of women related to pregnancy priority given to a rffl Chad and childbirth per 100,(x0 ple size (as maternal mortality is 1000 problem that is of El3 Ghana births). The figures presented a less common occurrence than MI Somalia 1100 here are derived from Maternal child death) and must also crucial concern to 30'Mali 2000 mortality: a global factbook attempt to discover the cause of 11 Angola No mt.% (World Health Organization, death. This process may be most women. gi Burundi No 1991). The are the latest as ail- made more difficult by social, ICote (Moire No mry able estimates, but are drawn religious, emotional, or practical Ethiopia NO Dvrk mostly from the 1980s. considerations, especially if the woman concerned was unmar- gmLesotho NO DM Unlike statistics for under- tied or if death was the result of Liberia \o1)515 five deaths or total fertility, esti- mates of maternal mortality are illegal abortion. Maternal mor- :Mauritania \01)\1.1, 11 not usually based on national tality is therefore generally Zi m balmy e NO DIT1 surveys. They are drawn up by underestimated. 38 42 4ATERNAL DEATHS sow EAST ASIA and CENTRAL. AMERICA SOUTH AMERICA INDUSTRIALIZED PACIFIC and CARIBBEAN COUNTRIES 11 I Iona Lunar` costaBleat 36 in Uruguay 36 11 Ireland 2 in Sin -spore 10 FA(:tibit 30 ig Chile 67 112 Australia 3 leKorea. Rep. ')6 Panama 60 fil Argentina 140 El Belgium 3 Korea. Dem. 41 110 Ecuador 17)) Fi Denmark 3 U Thailand 13 Trinidad and Tobago i 10 Brazil 200 11§ I I1 s r a e I 3 Malaysia 50 Jamaica 120 Colombia 200 11 Norwav 3 1111 China Regional rii crage /00 m 111 Ital 4 Philippines 100 1151Cualvaiala 201) FA Paragua 3(10 Di Canada Viet Nall' 120 aliloadaras 220 Peru 3(H) Cermany 10Alongolia 140 Haiti 340 El Bolivia 600 Elcreeee b. Regional average 160 111Dominican Rep. \()IMIA Venezuela Dti EN,Spain MI LaoRep. 300 El Salvador \()011 1 N n Sweden 5 \01)11.% Ell Switzerland 5 alIndonesia 50 BO INiearagua Lig NIatiiiiar 60 I I I El Austria 8 MCambodia 300 rfj USA 8 Papua New Cuinea 900 Mil United Kingdom 8 Eli Bulgaria o N gi France o 19Czechoslov akia (former) I() 19 Netheriands 10 Portugal 10 El Finland 11 Emergency care needed Egi Japan 11 Es Poland 11 A woman born in Africa today effect. In the United Kingdom El New Zealand 13 has a I in 20 chance of dying in and the United States, maternal The birth gamble 013 Group average mortality remained at very high Risks of maternal death (over a life- childbirth. The risk for a woman time) by region EM Hungary born in Europe or North levels even after rising living rie Romania 130 Lifetime risk America is about I in 3600 (see standards had helped reduce MI Albania \Oottt chart). infant mortality to yen loss lev- Su:- ':, on At' :a The main opportunity for els. Only in the 1930s, ss hen reducing maternal deaths is the emergency obstetric care became M East onoNAtricn TARGET prevention of unwanted pregnan- widely available, did maternal cies and unsafe abortions. Once mortality begin its steep fall. In 1. halving of the 1090 maternal childbirth has begun, reducing certain communities in the C Ame, Ca -;no U a ; mortality rates. the risks depends heayil:, tile United States, where modern F Asia aril 200 availability of emergency obstet- medical services are refused on 3W0 All w, onwn to have prenatal rare. ric care. Even improvements in religious grounds, maternal mor- trained birth attendants. inn I referral the general health and nutrition tality rates are still 100 times facilities for obstetric emerizencie., of soinen has e relatisely little higher than the US average. F011 THE YEAH 2ntx) BEST COPY AVAILABLE te _ . a1.15:L7,7197:at,rta, In most nations, women are ACHIEVEMENT ANL beginning to make Secondary consideration Maternal deaths %girls and boys in secondary school, progress towards developing world, 1960-1990 not just a greater equality in 50 boys question of %.0 education, in legal 40/ 301 national -Areal th status, in the right to ti 201 The league tableson the pre%imp,. page show that in no other area of life 10f choose when to have is the gap between countries as wide L. children, and in 960 19651970 1975 1980;985 1990 as it is in the frequency of maternal death. The tuitttherofMallet! whit die tinLanbut ,LarlNprior but literate opportunities per100.000 births ranges f rom 2 or 3 in Australia. Israel. and Northern outside the home. 12 of poorest reach 60% Europe to het wren 1000 and 20(X) in -uniteparts of the developing world. But it is still But the gap is not only a gap between literacyy forwomen. rich and poor. The overall status of common for women Some nil the poorest countries in the 8 t%stands more than tw as high omen.and especialk their abilit to world ha r outstanding records in as t he average for South Asia. control how many children to have and w hen. can be even more impor- to work twice as promoting litera leer cltO Ten countries atsignificant l' eountries «lilt per capita higher levels of economic de ((lop- tant than a country's econonue stand- many hours a day as ( ;\ I's of than S1000 hac e female mem still fall short of the 60"n mark ing. No country has succeeded in men. literac \ rates of 6(1", or [toter. Four for female literacy. reducing maternal mortality to low cal themSri Lanka. Viet Nam. the 111 literacy statistics should be levels without providing emrgene 1)orninicanliepuhlic.andthe regarded as approximate. as there is obstetric care to cope with complica- tions in childbirth. In developing Philippines ha\ e surpassed the 110hard .111(1 fast definition of r \actly 811 mark. what is Ineant by being able to read Listed below arc seven very poor countries, women Sri Lanka's female literac \ rate of and w rite. countries with low maternal death rates and seven richer countries grow most of the Poor but literate Lagging with significantly higher maternal GNP per capitabelow $1000, female GNP percapita above $1000, female mortality. food and contribute 1,teracy60',plus literacy below60% 7 poor doing well % women GNP %women GNP GNP per capita $500 or less, maternal increasingly to cash literate per capita literate percapita 1990 1991($) 1990 1991($) mortality below 200 incomes. 'Per capita Maternal .38 D:30 GNP($l mortality 43 2320 But they are still 44 '20 Sri Lanka 500 80 ier.0 46 ..020 Zamba 420 lc° expected to fetch 48 7350 Benin 380 160 ill 739 cc ..a 370 Q5 wood and water, Kenya 340 170 . Nam 240 120 clean and cook,. 2.30 wash and shop, look 7 richer not doing so well GNP per capita above $1000, maternal after the old and the mortality 200 or more 0/ Per capita Maternal ill, and bear and 10 reach 90/0 GNP($) mortality care for children. Ten de ((loping countries ha\ e achie 1.(I literacy rates for women of 0(1'', 920 Botswana 2590 women literate %women literate C.cor,b.a 1280 on% 210 Con) 1120 400 20 40 4.4 DISPARITY Where homes Where women arefewer than men Girl children have a better survival Disappearing women are headed by rate than boys and women normally Women per 100 men (1990) live longer than men. Even with the women Av Pakistan 92 natural compensation of more male Papua New Guinea 93 A quarter or more of households are than female births, this still means !nal° 94 headed by women in 21 out of 78 that most nations have more women HongKong 94 countries fur which figures are avail- than men. In the industrialized world. Bangladesh 94 able. In the great majority of cases, for example. the ratio is 106 women Albania 94 this means that the household is made China 94 4.1t. for every 100 men. Afghanistan up of a woman and childrenand no But in some developing countries. 95 Nepol 95 man. In some cases. men are absent there are many fewer women than because they have migrated in search .^kga Un,ed Noocrts Samort aka and PopuionbcDN10 men. The reason may be a lower sur- tee dmo eckat,CLUNK, orge. of work.The proportion of house- vival rate for girlseither because holds headed by women has risen in they receive less health care or all regions in recent years. because of the female infanticide Botswana nearly half of all households headel! IA women which, whether by neglect or inten- Heading home tion. still occurs in some countries. %of households headed by women (1980s) High maternal mortality rates may Saint Kitts a,-6 ties s 46 Ciao 28 also he a cause. as an estimated half a jAr..?naca million women the each Year from the 8 315 wro 45 complications of pregnancy and giv- Barbcaos 44 Ghana ing birth. Unsafe abortion also takes Saint Vincent .Ind Gq?n01,1,PS 42 war= 25 its toll, killing approximately 100.000. Saint Lucia 39 Australia 25 Other possible causes include widow Dominica 38 Canada 25 burning and dowry deaths. Norway 38 2.erto 2c The table shows the nine develop- Jamaica 34 Switzerland 25 ing countries which have 95 or fewer Austria 31 Trinidaci and Tobago 25 USA 31 United Kingdom 25 women for every 100 men; this means Malawi 29 that there are 10% fewer women than , No, .I....n- Zambia 28 I could be expected. Soath Asia -10% of women missing Where parliament is still 95% male Where women are going %women MPs (1991) Women in politics backwards Although women have the vote in all democracies. no country in the world has There are 15 countries in which the Pakistan 1 proportion of women elected to national Kenya 1 as many women members of parliament as men. In only four countries does office has fallen since the mid--1970s: Turkey 1 the proportion of women MPs rise above one third of the totalFinland, Korea Rep 2 Norway and Sweden. plus Guyana which leads the developing world in the pro- % of women MPs Mongolia 2 portion of politicians who are female. % pt. Egypt 2 Regionally. Asia and Europe lead the way with about 13% female partici- 1975 1991 fall Japan 2 pation in national parliaments fall figures are for 1991. the latest available year). AlbanI0 33 4 -20 2 . 29 Malta In the world as a whole. only about one parliamentary seat in nine is occu- -22 Mang-A° 2 Afghanistan 3 pied by a woman. This represents a slight fall from the level of 13% recorded 23 -21 19 Yemen in 1989. Bulgaria -10 11 5 -6 iepol 3 In democrat ic systems. the proportion of nationally elected officials who are Zare Barbados 8 A -4 Albania 4 women is a good barometer of progress towards realizing the principle of equal- Romania 4 Cote d'Iyoire 9 5 -4 ity. Bortod(,, Argentina 5 4 rho,tarla 4 Where there are most women MPs Where there are no women MPs Kuiea rep 4 Central Afoccr, 4 % of women MPs (1991) Pakistan 4 1 -3 Togo 4 Kenya 4 -3 Asia Belize Morocco Bahamrr: :3 Poland 16 -2 Eflooe Bhutan Papua New Guinea Tunisia 4 China 23 21 -2 Ainencos Comoros Saint Luca Malcliyes 4 Korea Dam 21 20 -1 Argentin.) A; 5.) OrrOr l'ar:d Malta 4 3 Tonna Cote 5 Juadan db Sto.es F I bj11 ij Arab Emirates Sr. I.anl,n rc, efrAAS OM 1, 0 ...0C-0 World overage !.0,-;0101, 41 Recent decades have brought rapid A SUMMARY improvements for the children of the industrialized nations. But progress has now slowed and, in some countries, been thrown into reverse. Poverty still afflicts between 5% and 20% of children even as new 1problems emerge. In most countries. there has been a steep rise in divorce, single-parent families. and the numbers of women who work outside 1-5,_''''C 1:A41 the home. There has been no compensating increase in the time fathers spend with children. Millions of the industrialized world's children are now facing a famine of parental time. Matr....t6A.C.1171e.TailerNZT,C__ r-9r, - The 1990 World Summit for HOME ANDAWAY Children called on Nordic countries the industrialized head aid leagues nations to look The industrialized world gives about again at the progress one third of l ", of its GNP in over- seas aidabout $75 a year from each being made by their citizen. n aid target of 0.7% of donor country GN p ssasagreed on in own children. In the 1960s. wealthy countries, Noma.. Denmark and Sweden occupy the first three places in the aid the problems of leagues%%het her measured by per- centage of t;NP or aid given per head. poverty linger on lid to meet the needs of the poorest Aid as % of GNP (19911 and the problems of Less than 10% of aid is affluence are on the increase. .22 spent on basics Less than 10% of aid is allocated Many countries devote t he bolk The Summit also direct. to meeting the most obs loos of educational aid to1111iNersitie or Be.a, urn needs Of the poorest people pri- advanced studies for relative'. fe%% asked all individualsratherthantothe 04 mary health care. primary education. clean water. safe sanitation. and fam- improvement of primary education irzerla111 04 industrialized ily planning. for the majority of children. Similarly. aid for health is often nations to Un red K.naoor,, 03 The funding of such programmes ;apan 2: 3 is not the only way to meet basic directed towards hospitals and high - re-examine aid Pc,coal 03 needs. Aid that creates jobs and cost medical equipment serving the 0 3 incomes allows people to meet their needs of an urban minority rather budgets to see if they 03 ONVIl and their families' needs by their than primary health care fort he poor could better serve o.sn efforts. majorit A 'D 2 Nonetheless. there is a dear case Ireland 32 the year 2000 goals for restructuring aid programmes so Aid to family planning that at least 20% of the total goes % ofaid given to population programmes Aid given per head ($1 (19901* for improving the directly to basics. Low-cost solutions Nowdy 282 are available for many of the major Norway 42 health, nutrition, Sweden 234 problems facing the children of the r,nlond 25 Denmark 231 developing world: aid could help LISA 25 and education of Finland 180 Sweden 2 ensure that the resources are available !68 1 9 to put those ,olutions into effect On children in the France 30 Canada i S...v.tzeddrd :18 the required scale. United Kingdom 1 4 developing world. Je-.2iionas (1,:ernar, :es2. Swtzertend 0 9 ,-.3naaa 02 8 Aid to basic education Germany The aid-ranking 6.!;(1 ,open !) Aid to basic education as % of all direct Jocon aid to education (19901 New Zealand 5 tables on this page ta 50 Austraita 0 4 show how small a A,strO110 58 S &den Beia.urn part of aid is us,a as Ao5tr,o 0 1 Ireland 37 !coon 22 F!ance 0 1 Leda^d '9 currently devoted to Average 1.2 ,...[K3 11 this cause. 0 ,)rO aaa er,k,,, 44 US child poverty twice -410.4c1,-1/4.1,4:Pc)11.1.neitt. Lam- 2.5 $ 4,9I itiliet A.10:410/1411' European level 20 e.1.1.,YA;10gt:, av ,'`1/4: Se : Asks; With 20% of its children living below same degree as in other industrialized 10 the national poverty line, the United countries (see chart). States has more than double the child The United States also leads the poverty rate of any other industrial- rankings for murders of young peo- 1.141141 ple. Nine out of ten killings of young incixinpahnomip dnoJiwd esped+eitiOakban-; lows ized country. oits. b:ci anaars: iculalonatiy M iivAlitAr-otet?' Canada. Australia, and the United people in the industrialized ; world Noah* cab oi hp US INP011ie I* heirpaot imogy to MARA Wary .to Wood ffecice4occd4 vat 40,* 0'49%.05*#00km. Kingdom form a second group with happen in the US. about 10% of children below national Australia. Norwa . Canada and Murder Suicide poverty lines (family income below Switzerland head the league for the Annual deaths by homk:ide per 100,000 Annual deaths by suicide per 100,000 10% of median disposable income). suicide of young people. Among aged 15.24 aged 15.24 Sweden. France. the Netherlands, those aged 15 to 24. suicide has risen Rate per Rate per 100,000 1987-1990 and former West Germany have all in 11 out of 14 industrialized coun- Number 100,000 1970 succeeded in reducing child poverty tries over the last 20 years more OSA 5718 153 Australia 86 164 levels to less than 5%. than doubling in Spain and Norway. Canada 121 3 1 Norway 62 163 1 102 158 The poor performance- of the Only Sweden. Japan. and former 17'9 Canado Nor way tzer'ara 1 3 7 ; 5 7 United States, the United Kingdom. \Vest Germany have brought about a 17:Pain 03 .1 tiSA 80 132 Canada and Australia reflect set- fall in teen suicide. Switzerlona 12 1 3 Sweden 13.3 12.2 backs for the poor during the 1980s. Canada and the United States lead Jaen 13 1 I France 70 103 The proportion of families living the world in the proportion of young Denmark 8 I 0 \A'Germany 13.4 96 21 0 9 Denmark 9.0 92 below the poverty line doubled in adults enrolled in higher education. Netherlands IJK 80 0 9 UK 43 7.2 the UK and rose 0".',, in the US Two thirds of Canadians aged 20 to 2 I rarce 59 0 7 japan 130 70 between 1979 and 1986. are still studying, just ahead of the Japan 73 0 4 Netherlands 49 6.7 The fact that child poverty rates are 63% scored by the USA. Only Italy, Spain 1.7 4.3 Italy 32 twice as high in the US is caused Ireland. Switzerland and the United 2.9 Oia,tot Co s largely by the failure of tax and trans- Kingdom have less than 30% of their ..skeo Nickl No.dheor, ocosncs 0 , wsveon 'WesdsocOe motreItt,to*eneco,,,g a) fer policies to mitigate poverty to the young adults still in education. dab ccnv.e, k new report on children in ten indus- one year is then recorded as a per- trialized countries shows that steady Progress of 70s stalled in 80s centage of this maximum score. The progress has been made over the last indicator scores are then averaged. 20 years except in the United State:; in most of the countries studied was meant that only four measures could The charts show the results. They and the United Kingdom. where chil- rapid in the 1970s but stalled in the 1w used infant mortality. govern- cannot be used for inter-country com- dren are judged worse off today than 1980s. The hest performing coun- ment spending on education. teenage parisons as they are based not on a they were in 1970. tries were Italy and West Germany, suicide, and income distribution. fixed standard but each country's '['he report. prepared by Fordham with Norway and Spain also showing For each indicator, a nation's own own best performance in the past. University 's Institute for limo% anon -t rung progress. best performance -ince 1970 is gi%rn l jr0rVntet n; in Social Policy, shows that progress Lack of standardized statistics a value of 100. Performance in any . unC.NOY. 50,7 The social health of children 100.Combinotion of the highest level reached for each indicator for any year in the period 1970-89 United Kingdom USA 100 Italy W Germany , Spain Australia Japan France Norway Switzerland 80 60 40 20 70 8089 70 80 89 70 80 89 70 80 89 70 80 89 45 i. dn The Convention on the Rights of the THE CONVENTION Child seeks to protect children everywhere against exploitation, neglect and abuse. Many of its provisions are SUB-SAHARA N MIDDLE EAST and SOUTH ASIA AYR ICA NORTH AFRICA reflected in the year 2000 goals for two la N A Igeria A kfghanistan Be 11 a A Lgypt Bangladesh improving health. swanit Iran Bhutan A nutrition and Burkina Faso A 0 Iraq India a Burundi A Jordan A Nepal II A education. Cameroon a Kuwait A Pakistan a A Central 1fricati lien. A Lebanon A Sri Lanka A Monitoring progress Chad Libya Congo a A towards those goals Cote dhoire II A. Oman Country has signed the is therefore one way Ethiopia a A Saudi Arabia Gabon Sudan Convention on the Rights of of monitoring the Charm A Syria the Child. Country has ratified thy progress of the (;ttineit a A Tunisia Guinea -Bissau a A Ttike. Convention on the Rights of Convention. Kenya al Crab Lmirates the Child. Lesinho a A 1 eaten A 41 Country ha,, finalized Liberia National Programme of The tables on these Madagascar 11 A Action for reaching year 2(X-10 pages show, for each Malawi coals. Mali El country. whether the Mauritania A Convention on the Mauritius A promise to keep Mozambique ill Rights of the Child Namibia The Convention on the Rights undertake to submit a report, has been signed and Niger of the Child was adopted by the within two years, of action Nigeria Il A General Assembly of the United taken towards compliance. To (late, (July 1993), 57 reports ratified. and Rwanda a Nations on 20 November 1989. Human rights conventions usu- have been submitted to the ten- Senegal 0 whether a National alltake several decades to member international Sierra Leone achieve widespread internation- Committee on the Rights of the Programme of Somalia al acceptance. In only four Child. Action (NPA) for South Aorica years, the Convention on the In many nations, the process Tanzania E Rights of the Child Ira, been of translating the Cons (-tido!' reaching the year I pg.() A signed or ratified by the great into national law has now l'gainda 111 majority of the world's nations. begun. In all nations, ratifica- 2000 goals has been Zaire A Signing the Convention indi- tion gives the public, the media, drawn up. Zambia cates a governments intention and the non-governmental orga- Zimbabwe to ratify. Ratification means nizations an agreed platform that its provisions become bind- from which to remind political ing and that governments leaders of their commitments. ND- - THES.r..1414011111110811111501AINVEZEMArOMIZMINORWIT~tWtA--- GOALS -,.:-.,tv2wmpalocomicsommangoapo..."- --x...moossxmoriorrtmuisovoindiencacamosimem ? wow EAST ASIA and CENTRAL AMERICA SOUTH AMERICA INDUSTRIALIZED PACIFIC and CARIBBEAN COUNTRIES Cambodia MA Costa Rica I A Argentina 11 A klbania M A China A Cuba 111 Bolivia A 4D kustralia ® A Indonesia A Dominican Rep. fti A Brazil 11 Al Austria M Korea. I) em. M El Salvador ig A Chile 11 A 0 Belgium IS A Korea. Rep. II A Cuatemaia A Colombia 11 A 4D Bulgaria N A I.ao Rep. El I laid Ecuador 11 AL 41 Canada ® A Malaysia I londuras A Paraguay 11 A 0 1)enmark W Mongolia MA Jamaica A Peru 11A Finland NI A NIyanmar M Mexico A Uruguay 11 AL 0 France A Papua Ne'a ( ;Uinta II A Nicaragua RI A Venezuela II AL 0 Certnany W Philippines A Panama M A Greece M Singapore Trinidad and Tobago Ilungary A Thailand NI A Ireland M Viet Nam A Israel Italy M Japan : Netherlands 111 New Zealand M Norway Poland I Portugal A Romania M Spain MA Sweden NEWLY INDEPENDENT COUNTRIES Switzerland 111 United Kingdom M A US% .krtnenia II A Lithuania M Azerbaijan Macedonia Belarus Moldova VI Bosnia and I lerzegovina Russian Federation A Croatia Slovakia MIA Czech Republic Slovenia A Estonia Tajikistan Ceorgia Turkmenistan Ukraine A NOTE Additional signatories to the Kazakhstan ( :on vent ion include the Holy See. kyrg-yzstan Uzbekistan Liechtenstein. Monaco and Sari Latvia Yugoslavia M Marino. San Marino and the Holy Five . . have both ratified the I .onvention and the Holy See has drawn up an action Ilan for children. LESSPOPULOUSCOUNTRIES The main indicators used to construct the league tables in The Progressof than 1 million people). The relative standing of less populous countries can be Nations are the under-five mortality rate. thepercentage of children by comparing the figure:, gin en here with the relevant league tables. malnourished, the percentage of children reaching grade 5 of primary school.The last columns indicate whether the Convention on the Rights of the Child the percentage of children immunized against measles, the maternal mortal- has been signed and ratified, and whether a National Programme of Action ity rate. and the total fertility rate. L sing thew same indicators, the ((Alms ing \ PAI has been drays n up fur the achien ement oft he y ear 2000 goals (see pages table shows the record of the world's less populous countries (population less 46 and 47). 1-year-old GNP % under-5 children % of Year per Under-5 children immunized children Maternal Total Convention on the 2000 capita mortality under- against reaching mortality fertility rate weight measles grade 5 rote rote Rights of the Child goals SignedRatified NPA 1991 1991 197&1990 1991 1980-1990 1980-1990 1991 1 C c Art ;361 -177", 21 Bahamas 11720 30 87 92 69 cc 34 Bahrom 691:' 95 27 17 Barbados 6630 12 5 92 47 19 46 Belize 2050 29 74 BritishVrgn is:araf: 85G 32 Brunei Doiussa 20760 1C, 107 44 Cape Verde 750 61 19 76 68 `/Y7 1'3'3 87 5`.)0 Cook Isianas 155.3 11 74 82 23 CvDruS 8640 740 60 D1ibouti 1210 161 23 79 39 4 91 58 27 Dominica 2440 20 98 430 59 EquatorialGurrea 330 202 79 90 3C Fill 1830 30 84 47 1500 6 2 Gambia 360 234 87 -, C. Grenoaa 2180 37 Qt_ 1r3(', 103 91 207 2: J Guyana 290. 69 Iceland 2258C Oltpc. 96 0' luxerribourc; 31080 9 Moloives 40; 100. Motto 6850 14 80. Marshall Islands 28 25 45 Micronesia Fed States 8Q 5 Montser 10' 333(:` 00 Palau 79C 28 98 0 45 Qatar 15660 35 70 59 2 6 Saint Kitts and Neis 3960 43 31 Saint Lucia 2500 22 14 26 13 Saint Vincent and toe Grenadines 1730 26 9C 25 400 46 Samoa 930 59 1 88 79 Sao Tome and Principe 350 89 66 50 100 Seychelles 5110 21 80 60 28 10 Solomon Islanas 560 34 74 69 55 94 89 28 Suriname 3610 3;" 84 79 110 Swaziland 1060 113 10 50 37 Tonga 1100 26 86 93 39 Turks c"dCocos Islands 780 31 99 460 Tuvalu 650 43 79 107 56 Vanuatu 112( 89 66 Range $1500 $3499 5 BEST COPY AVAILABLE '-- I\ATIOI\AL PERFORMANCE GAPS The following tables provide additional informa- tion on the progress of nations. Pages 50 and 51 show the national performance gaps.fin- all countries, in the fields of child survival. nutrition, and primary education. The national performance gap is the difference between the actual level of progress achieved and the expected level of progress for each country's per capita GNP ( see pages 10 and 11). Using the key indicator of the under-five mortality rate, pages 52 and 53 show the average annual rate of reduction achieved in the 1980s and compare this with the rate required in the 1990s if the inter- nationally agreed goal for the year 2000 is to be met. Countries ctrlisted, by region. in order of their likelihood of reaching the goal. 53 The tables on these pages show each NATIONA PERFOR GNP Under-five % of children % of under-five country's national per mortality rate 1991 reaching grade 5 children underweight Difference performance gap in capita Actual ExpectedDifference Actual ExpectedDifference ActualExpected sUBSAHARAN AFRICA the areas of child An-16i0 -26 -13 -9 0 rival. nutrition, A 0 - 26 -15 4 - 12 -20 -2 +20 -7 and education. -47 +6 24 +7 -7 +7 +2 -7 The national -32 -4 +8 +3 -7 +1 performance gap is 60 ^3 -35 -37 +23 -1 the difference -29 -10 +15 between a countq's +69 +23 +14 -50 -2 +8 -93 +5 actual level of +4 -3 -5 -57 -9 +11 progress and the -67 -26 +2 -93 -17 - 25 expected level for its +11 +9 -9 -39 +15 per capita GNP: -19 0 -13 -167 -22 -17 -36 +14 -7 -60 .12 +17 13 -3 For each indicator, Sf) -58 -11 22 25 +3 23 +9 the expected level of .T.; -22 -38 +50 +4 48 - 13 achievement has :40 -9 +18 +3 +11 +10 been calculated Zo.re - 15 +21 2CO -71 +9 2t +1 from the per capita +15 +34 +9 GNPs and the MIDDLE EAST and NORTH AFRICA -21 +17 -1 relevant social +31 +15 +12 - 26 +11 -33 -94 -2 2 0 indicators of all +7 J -oar, 32 +30 +22 6 -6 -11 6 5 countries (see +2 -9 +5 -12 +2 opposite). The 2.. -25 -23 -40 -8 +6 expected level +21 +24 +7 +13 +4 - 48 +20 therefore represents -14 ; +2 the level that the 3 -30 SOUTH ASIA average-performing ;Pr -19 +41 +9 -33 country could be -17 -22 -4 +20 +6 67: 28 -36 expected to have +56 -5 -14 -14 reached for its level +97 +35 -4 of GNP per capita. EAST ASIA and PACIFIC +95 +35 +8 +5 +5 -7 +23 -16 p 4.1 ANCE GAPS ,=a1/10,Vrafac-:3-=.199111=4110.Jr.-- GNP Under-five % of children % of under-five NATIoNALpERFoRmANcE per mortality rate 1991 reaching grade 5 children underweight GAPS-DERIVING THE capita Actual ExpectedDifference Actual ExpectedDifference ActualExpectedDifference EXPECTED Korea. Dem 970 34 72 +38 , k -_ e r... P e r 6344' r +9 or' 0" 0 For each of the three indicator- -15 Lao Rep 23C 146 +23 -18 used in these tables. deriving an Malaysia 2490 20 3' +15 86 81 +5 Mongolia 780 82 67 +5 expected level of performance Mvanmai 220 t1 7' 17.: +57 32 0 requires the fitting of a line to kropLia N Guinea 824 7 :,, +4 53 -12 = -16 Philippines 740 61 +29 75 63 +12 34 2C' -14 country data represented by Si nqopore 12890 8 12 +4 100 94 +6 8 -6 ,. points on a graph of which one .rioiiand I 48'72 _ +12 -12 -8 Viet Nam 240 52 168 +116 42 , -11 axis is always C7s, per capita. CENTRAL AMERICA and CARIBBEAN When all countries IA ith data are 15 41 +26 84 78 +6 6 15 +9 Costc Rica 1930 -- plotted. the pattern that emerges Cuba 1170 12 c= +47 90 +19 shows that under-live mortalit Dominican Rep 950 .'3 +20 46 67 -21 12 20 +7 El Salvador 1070 67 65 -2 45 69 -24 15 18 +3 rates and malnutrition rates 17 -17 Guatemala 930 80 74 -6 41 67 -26 34 generally decrease with Horn 370 13" 132 +1 12 54' -38 37 33 -4 Honduras 570 60 1OS +48 48 59 -11 21 18 -3 increasing GNP. whereas the Jamaica 1380 15 52 +37 96 73 +23 7 13 +6 percentage of children reaching Mexico 2870 36 32 -4 76 82 -6 14 10 -4 Nicaragua 340 81 144 +63 44 48 -4 1 1 15 +7 grade 5 generally increases with Porta-- 2I3C +18 32 -,-,-, +3 -5 GNP. For each aria ble. a line 1 rimacidi Toaago 3620 23 26 +5 72 85 -13 7 8 +1 : was fitted to match the overall .- .;., :-..-r.k7,10,!-:",--"-5---:'1 -- 47 . --VI SOUTFfAMERK shape of the data points. using a Argentina 2780 25 33 +8 least-squares regression method. Bolivia 650 122 99 -23 60 61 -1 13 21 +8 Brazil 2920 67 3 ! -36 41 63 -42 7 +2 GNP data for 1991 were used in Chile 2160 2r3. +18 -4 14 +11 plotting the graphs except in the Colombia 1280 20 55 +35 55 72 -17 10 14 +4 Ecuador 1020 61 68 +7 67 69 17 16 -1 ease of underweight children, Paraguay 1210 35 +22 67 71 -4 4 +12 where the data were matched Peru 1020 69 68 -1 13 1( +3 Uruguay 2860 22 32 +10 9t 8: +14 7 10 +3 with GNP data for the same enezuela 2610 25 3-1 +9 +2 reference year. INDUSTRIAUZED COkff\ff RIES The adjusted li-squared for the Australia 16590 10 10 0 100 94 +6 lines thus drawn varied from a Austria 20380 9 9 0 Belgium 19300 i0 9 -1 81 95 -14 little less than 0.4 in the case of Bulgaria 1840 21 43 +22 88 77 +11 the percentage of children Canada 21260 8 9 + I (..?t +1 Czechoslovak.° 2450 13 3.:- +22 94 8 +13 underweight to a little ,ner 0.7 for Denmark 23660 9 5 -1 98 95 +3 the under-five mortality rate. F inland 24400 7 : +1 100 +5 France 20600 9 9 0 97 95 +2 Such values show that while Germany 23650 9 8 -1 98 95 +3 there is a general trend linking Greece 6230 1 r 24 +9 94 94. +4 Hungary 2690 1' 33 +16 94 82 +12 each variable with GNP. many Ireland 10780 10 14 +4 96 92 +.1 individual countries diverge Israel 11330 12 13 +1 94 93 +1 Italy 18580 10 IC 0 89 95 -6 considerably from this trend. Japan 26920 6 7 +1 100 96 +5 Netherlands 18560 8 14 +2 94 95 -1 It is this lack of conformity with New Zealand 12140 1C 13 +3 82 93 -11 the trend line the expected level Norway 24160 8 8 0 9c:s o. +3 Poland 1830 17 4'; +26 96 7- +19 of performance which yields the Pc'tuga 5620 12 2' +9 national performance gaps for Romania 1340 34 .ry. +19 +6 Spain 12460 C +4 97 94 +3 each country. l'he tables on these Sweden 25490 5 c +3 100 95 +5 pages show national Switzerland 33510 8 5 -2 United Kingdom 16750 0 +1 performance gaps in bold type. USA 22560 11 0 -3 96 9f +1 ,ncr Awn rev , t i utg c' CS, ,r7g,07 51 Almost all countries have accepted the RATES OF PROGRE Under-five mortality rate Average annual rots of reduction % goal of reducing (per 1000 live births) Difference 1980 1990 2000 1980.1990 1990.2000 between actual under-five mortality actual actual goal actual required and required to 70 per 1000 or less SUB-SAHARAN AFRICA 42 9 4 I )n target 4 1 targ.-4 by the year 2000. ; 02 12 "8 3 3, 4 1 -0 5 Where under-five SC i -0 8 ! 4 5.1 56 4 1 -10 1 -1 8 mortality was less '3 414 4 23 5 8 -2 0 80 2 ,) than 105 per 1000 in 55 8 0 -4 5 r 218 59 %0 82 -51 1990, the goal is a 43 -SI one-third reduction. z1"-, 173 2 '58 8 2 _7 3 202 180 180 70 75 -88 Using average 193 .9 annual rates of 210 reduction. these . . the 0 8 is compare 96 I : C 7 -10 0 rate of progress ! 4 222 222 '0 0n 5 --II -12 achieved in the I t ; -2 1 10 3 32,) 2 1980s with the rate 269 297 70 -1 0 14 5 -15 4 of progress needed MIDDLE EAST and NORTH AFPICA in the 1990s if the 95 35 23 10 1) 4 I on larger 24 O 8 4 1 or targ:.t year 2000 goal is to _ . 02 46 7 0 J I on larger 145 O7 45 5 1 i n target be met. 35 5 4 1 -:r: '01010 -,,,r ;45 72 48, ..: 1 ..: 0 4 I rn larger .1 1 `On target' denotes 12O O% .15 O 3 ,..r: target 66 35 23 O 4 4 1 rot target those countries 44 3n 0 4 I ,1-. ,a,aet A 1 83 48 32 . : 5 41 -0 1 where the required 1-11 9s 29 210 !;: ,,' 0 rate of progress in the 1990s is lower SOUTH ASIA 52 23 15 52 cn large! 2)1 9 2 8 than the rate 3! -3 135 -T! 6 0 -3 0 achieved in the 5 O 9 ! 0 0 11 0 9 1980s. For other , '0 countries, the closer EAST ASIA and PACIFIC 42 21 14 1 4 I en target to zero. the more I 4 I foraet likely the target is to 4 1 n (.1 be reached. -13 4 1 BEST COPY AVAILABLE 56 ..1111".te.:-.115111AIISOL-4.1111.0,41f,'"X114'2,W.i_. 47.".:Aoritltr,C, Under-five mortality rate Average annual rate of reduction % ONTARGET (per 1000 live births) Difference 1980 1990 2000 1980-1990 1990-2000 between actual actual actual goal actual required and required In total. 52 out of the 112 nations listed here are on target to meet ,, , , 1 2 , .,, f.6- 2,.. - ,V,crigoi,o af the year 2000 goal provided they Korea, Dem. 43 35 23 2 2 4 I -1 9 Papua New Guinea 95 80 54 1.7 4 1 -2.3 maintain the rate of progress they Philippines 70 62 41 1 2 4 1 -2 9 achieved in the 1980s. Indonesia 128 111 70 1 4 4 6 -3 2 Myanmar 146 120 70 2 0 5.4 -3 4 In some countries the gap is very 190 152 70 2 2 7 8 -5 5 Lao Rep. wide between the rate of progress achieved in the 1980s and the rate iiCtO 1 required in the 1990s. In the Jamaica 39 16 11 8 8 4 on larger Mexico 81 39 26 7.3 4 1 on target main, these are countries where Cuba 26 13 9 6.8 4. 1 on target under-five mortality is so high Costa Rica 29 16 11 58 4i on target El Salvador 120 70 47 54 4 1 on target that reaching the target of 70 per Dominican Rep. 94 56 37 51 4 1 on target 10(H) implies a much bigger 51 4 1 on target Nicaragua 143 86 58 reduction than one third. The Trinidad and Tobago 40 24 16 51 4 1 on target Guatemala 136 85 56 47 4 1 on forget eight African countries with Honduras 100 62 42 4.7 4 1 on target under-five mortality rates of Panama 31 21 14 39 41 -01 -3 more than 200 in 1990. for Ho 1 0, 142 3 example. would all require a C, "i reduction of two thirds to reach 4 1 Colombia 59 21 21 14 10 2 on target the goal of 70 per 1000. Uruguay 42 23 16 5.7 4 1 on target Peru 130 74 49 5 6 4 1 on target The figures for under-five Chile 35 20 14 5 4 4' :in large' mortality given in the league table Paraguay 61 37 25 5.0 4 1 on target Ecuador 101 63 42 4.7 4 1 on target on pages 8 and 9 are estimates for Venezuela 42 26 17 4 7 .1 1 on target 1991 and may suggest different 4.6 4 1 on target Argentina 41 26 17 rates of progress from the Brazil 93 69 45 2 9 4 1 -1 1 Bolivia 170 125 70 3.0 5 13 -2 8 estimates given here. which represent trendsCaIrukted . v -4NDU across a ten-year span. single- Greece 23 11 7 7 2 4 1 on target year rates are likely to fluctuate. 1 1- 6.6 4 1 on target Portugal 31 16 especially in less populous Austria 17 0 6 6 0 4 1 on target Germany 16 9 6 5 7 4 1 on target countries where a small change Italy 1 7 10 7 5 6 4 ; on target in the number of child deaths Spain 16 10 6 5 3 4 1 on target 4 1 on target may have a disproportionate Japan 1 i 6 4 5 3 Israel 19 12 8 5 0 4 1 on target impact on the under-five Hungary 26 16 11 4 7 4 1 on target mortality rate for that year. Ireland 14 9 6 4 6 4 1 on target Belgium 15 9 6 4 5 4 1 on target All numbers have been rounded Czechoslovakia (former} 20 13 9 4.5 4.1 on target United Kingdom 14 9 6 4 3 4 1 on target for erase of reading. The numbers Canada 13 9 6 4 0 4.1 -0 1 in the last column reflect 3 4 4 1 -0 6 Australia 13 10 6 calculations made before the USA 15 11 7 33 41 -0.7 Bulgaria 25 18 12 3.2 4 I -0 8 rounding. France 13 9 6 3 3 4 1 -0 8 Poland 24 18 12 2 9 4t -1 1 The 'no data' countries (see pages Sweden 9 7 5 2 7 4 1 -1.3 8 and 9) are excluded from these 9 2 6 4 1 -1 4 Finland 7 5 tables. Netherlands 11 9 6 2 4 4 i -1 7 New Zealand 16 12 8 2 3 4 1 -1 8 Switzerland 11 9 6 1 8 4I -2 2 Lt 1 Denmark 10 9 3, 1 3 -2 Norway 11 10 6 1 0 4 1 -3 I Romania 36 34 22 0 7 4 1 -3 4 1990 estimateprecedingthe war in the Persian Gulf. 57 Iluntan development focuses on human health and introduces new methods for In recent years. increasing measuring and comparing the attention has been given impact of various health inter- human development and to ventions. In 1995 the United the evolution of new and bet- Nations will hold the World ter ways of measuring effort, Summit for Social to meet human needs. The Development to focus atten- United Nations Development tion on all of the, i,sues and Programme publishes the particularly on questions of annual Human development poverty. unemployment. and report. incorporating a human social cohesion in different development index: the Wodd parts of the world. UNICEF Bank publishes the annual hopes that The Progress of World development report. Nations will contribute to all which regularly provides esti- of these efforts to put human mates of the proportion of the de\ elopment issues at the cen- world's people living in pover- tre of development thinking h. In its 1993 edition. the and policy making. World development report 4 note on per capita GNP broad range of data on the local pricing of goods and ser- The estimates of per capita vices. So far. this work has GNP given in this publication been completed in fever than are those calculated by the 70 nations. Estimates for all World Bank using the conven- other countries are. at the tional World Bank Atlas moment. based nu mathemati- method which converts local cal models. A further difficul- currencies to US dollars by ty is that different methods of means of averaged exchange calculation can yield different rates, figures from the same data. Alternative estimates based Economists at the University on purchasing-power parity of Pennsylvania. for example. (PPP) are now becoming have used the PPP approach available. The advantage of and estimated China's 1990 the new method of calculation per capita income at approxi- is that it attempts to measure mately 52600. considerably each nation's per capita. more than the World Bank income in terms of its local estimate of 51950 which purchasing power rather than itself significantly larger than its value on international the International Monetary financial exchanges. This Fund estimate of 51300. For means that estimates of per 20 countries. there is a differ. capita income reflect the fact ence of more than 20% that more can be bought with between the 1990 PPP income one dollar in the developing estimates of the World Bank world than in Europe or and those of the United North America. PPP esti- Nations Development mates are also less vulnerable Programme. to exchange-rate fluctuations. For the time being. there- But PPP assessment is a fore. The Progress of Nations major undertaking. especialk employs per capita GNP fig- for poor countries. as it entail, ures based on the exchange- collecting and correlating a rate method of conversion. 58