Every Last Child 2016

EVERY LAST CHILD

The children the world chooses to forget Save the Children works in more than 120 countries. We save children’s lives. We fight for their rights. We help them fulfil their potential.

Acknowledgements This report was written by Faiza Shaheen, Jonathan Glennie, Amanda North West Balkans, occupied Palestinian territory, Peru, Philippines, Lenhardt, José Manuel Roche and project managed by Lucia Cizmaziova Rwanda, Sierra Leone, Somalia, Syria, Tajikistan, Tanzania, Uganda, from Save the Children. The production of the report would have Vietnam and Zambia. Special thanks to Michel Anglade, Misty Buswell, not been possible without invaluable inputs and feedback from many Jorge Freyre, Eric Hazard, Jasminka Milanovic, Anne Mitaru and colleagues across the global Save the Children movement. Special Caroline Nenguke for their leadership throughout the production of thanks for substantive inputs and support at different stages to: Joana the country spotlights, and to many others across the movement who Alfaiate, Hugh Bagnall-Oakeley, Catharina Bu, Amy Jo Dowd, Helen supported the process. Elliott, George Graham, Dimitri Gugushvili, Luisa Hanna, Roisin Hinds, Thanks to Julianne Weis (primary researcher); Megan Feeney, Katie Sébastien Hine, Alexis Le Nestour, Mihir Mankad, Claire Mason, Moore and Juliet Bedford from Anthrologica; and Jacqui Mattingly from Kirsten Mathieson, Tim Norton, Katherine Richards, Giorgiana Rosa, Education Development Trust for the structured literature reviews Yousra Semmache, Beck Smith, Jesse Sperling, Andrew Wainer and undertaken as background for this report. Rosanne White. We would like to thank external reviewers for comments on earlier We are grateful to colleagues from across Save the Children for report drafts: Homi Kharas (Brookings Institution), Robert Chambers comments and inputs that have helped to improve and enrich the (Institute of Development Studies) and our external advisory group report: Saba Al Mobaslet, Anthony Caswell, Natasha Dos Santos, Kitty who helped to shape the campaign – Owen Barder (Centre for Global Arie, Rob Doble, Lysa John, Michael Klosson, Gunvor Knag Fylkesnes, Development), Romilly Greenhill (Overseas Development Institute), Lena Karlsson, Kirsty McNeill, Richard Morgan, Claire O’Meara, Marie David Hulme (Global Development Institute), Naila Kabeer (London Rumsby, Vishna Shah, David Skinner, Lene Steffen, Monica Sydgard, School of Economics), Keetie Roelen (Institute of Development Studies) Mat Tinkler, Patrick Watt and Simon Wright. and Devi Sridhar (Edinburgh University). We are grateful to colleagues who produced country spotlights that We would like to thank Michelle Dunn, Sue Macpherson and Ravi helped inform this report and who are based in Save the Children Wickremasinghe for support with production, and James Lonergan country offices in Albania, Bolivia, Burkina Faso, China, Egypt, Iraq, Associates, Luke Peraux and Soapbox for support on graphics. Jordan, Kenya, Laos, Lebanon, Malawi, Mali, Mexico, Myanmar, Nigeria,

Some children’s names have been changed to protect identities.

Published by Save the Children 1 St John’s Lane London EC1M 4AR UK +44 (0)20 7012 6400 savethechildren.org.uk

First published 2016

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Typeset by Grasshopper Design Company Printed by Page Bros CONTENTS

Foreword v

The story in numbers vi

Executive summary ix

PART ONE: AN UNCOMFORTABLE TRUTH 1

1 What’s the problem? 3 How many children are excluded? 3

2 Why does exclusion matter? 4 The direct impact of exclusion on children 4 Economic and social costs of children’s exclusion 5 Fuelling conflict 6

3 What are the drivers of exclusion? 7 Where are the barriers that exclude children? 8 New findings on excluded children 10

PART TWO: WHO ARE THE EXCLUDED CHILDREN? 11

4 Excluded by ethnicity, race, religion and caste 13 Differences in the Child Development Index by ethnicity 15

5 Excluded by regional disadvantage 18 The geographical lottery 19

6 Excluded girls 25 What are the main inequalities between girls and boys? 27

7 Excluded refugee and internally displaced children 32 Missing out on essential services 33

8 Uncounted children 36 Children with disabilities 37 Children living in informal urban settlements and street children 38 Lesbian, gay, bisexual, transgender, questioning and intersex children 39 iv EVERY LAST CHILD

Endnotes Development Child the noteon Index 3: Methodological Appendix analysis data noteon Methodological 2: Appendix versions –summary 1:Spotlights Appendix Country Conclusion 10 CHILDREN ALL FOR PART AFAIR CHANCE THREE:

11 9

So C Accountability treatment Equal Fair finance Wo C C So S olutions hallenges hallenges hallenges lutions lutions rking together

48 48 48 68 60 54 45 45 45 75 53 53 57 57 41 71 FOREWORD

In September 2015 the international community At its worst, discrimination is deadly. A disproportionate came together to agree on the most ambitious number of the 16,000 children who die each day, set of global goals the world has ever known. The most from preventable causes, are from these Sustainable Development Goals, which are founded excluded groups. But exclusion exists even in the on the progress achieved in the era of the Millennium wealthiest countries, where children from ethnic Development Goals, set out to build a new world – minorities are more likely to grow up in poverty. a better world for us and our children. A critical Conflicts have also created a specific group of theme of the SDGs is that we ‘leave no one behind’ – excluded children – those who are refugees or everyone must benefit from the progress being made. internally displaced. On average, twice as many If we are to meet these exciting objectives, we need children die before their fifth birthday in conflict all sectors to step up and play their part. That is why zones compared with countries not in conflict. I am delighted to support Save the Children’s new The data in this report makes troubling reading for global campaign, Every Last Child, and to welcome all of us who want not just a better world but a fairer this thorough and hard-hitting report. For almost one too, where the legacy of discrimination and 100 years Save the Children has fought for the rights poverty is finally overcome. of children the world over. Its bold ambition – that all children, whoever they are and wherever they It’s no good going forward as a world if we can’t bring live, should have decent healthcare, education, everyone with us. We cannot be satisfied until every and protection from harm – is worthy of the last child has the opportunity to survive and thrive. organisation’s history and mandate. It’s time to build the fairer world we all want. It’s inspiring that so much progress has been made in Save the Children is taking a bold lead in confronting the last few years in lowering the number of children one of the great moral struggles of our time. For dying and increasing the number of children in school. all those involved in Save the Children, I wish you Yet the numbers of child deaths and of children out strength in the fight to ensure that children are of school are still unacceptably high, inflicting deep not only empowered to escape from poverty, but distress on parents whose children don’t survive liberated from inequality and discrimination. or who miss out on the opportunity to fulfil their potential because of poor nutrition or education. Helen Clark A huge concern here is the disparity between Administrator of the different groups of children. Every Last Child shows United Nations that recent progress in fighting extreme poverty has Development Programme often not reached those children who need it most – and the former because of geography, gender, ethnicity or disability, Prime Minister LEILEI PHYU/UNDP PHOTO: or because they are victims of conflict. of New Zealand

v THE STORY IN NUMBERS

Children from excluded groups are being left behind across the globe.

400 million children from ethnic and religious groups are discriminated against according to our estimations.1

One quarter of all children we have data on – equivalent to 1.2 billion children in developing countries – are living in a region of their country that’s been left behind.2

117 million women were missing from the global population in 2010 largely due to pre-natal sex selection.3

720 million women were married before they were 18 – compared with 156 million men.4

1 in 4 refugee children of secondary age are estimated to be in school5 compared with 3 in 4 children worldwide.6

5% of the global population are from indigenous groups but they make up 15% of those people in poverty.7

There’s a 3–4 times greater likelihood that children with disabilities will experience physical and sexual violence and neglect than their peers.8

vi THE STORY IN NUMBERS vii 9 increase 16 fourfold 14 15 13 10 of Rwanda’s population was covered by the national by population was covered Rwanda’s of of countries for which data is available have seen an which data countries of for have is available of families of health, who lack good nutrition education and are 12

11 people a day fled their homes in 2014, a fled peoplehomes a day their in 2014, reduction inequalities gender in mortality child in has been achieved increase in the number of children immunised in the Ayacucho region region the in increase the in immunised Ayacucho number children of of girls worldwide completed primary school as of 2013, up from up from completed primary girls worldwide of as 2013, school of years: the average length the years: average time from of refugees spend uprooted health insurance system its in first decade. from 2010. in Bangladeshin the in last two decades. from a minorityfrom ethnic group. 91% 50% More than 90% 30% 17 42,500 Two-thirds More thanMore half their homes. increase inequality in chances life between in between and ethnic groups regions within the countries 2000s since research. to new our according 78% in 2000 in 78% completion rate 93%. of nearing and boys’ of Peru after Peru of cash receiving transfers. And it’s gettingAnd worse. it’s But things can better. get THE WORLD HAS MADE PROGRESS IN IMPROVING CHILDREN’S LIVES – BUT MILLIONS HAVE BEEN EXCLUDED BECAUSE OF WHO THEY ARE OR WHERE THEY LIVE.

POVERTY DISCRIMINATION LACK OF VOICE

Save the Children is calling on world leaders to make three guarantees to all children...

ACCOUNTABILITY

EQUAL TREATMENT

FAIR FINANCE

...to ensure basic rights for all children and to reach every last child.

TO SURVIVE AND THRIVE TO LEARN TO BE PROTECTED EXECUTIVE SUMMARY

THE WORLD’S FORGOTTEN CHILDREN THE WORLD MUST RENEW THE BATTLE AGAINST DISCRIMINATION Around 16,000 children under five will die today.1 Around 250 million school-age children – two out of In our lifetimes, the world has made tremendous 2 five children – are missing out on learning. progress in the fight against poverty. Since 1990, the Which children survive or die, learn or don’t, is no number of children dying before their fifth birthday 3 accident. It’s a result of choices that exclude some from preventable causes has halved. There are groups of children by design or neglect. 42% fewer children out of primary school than in 2000.4 And the number of children who are stunted We live in a world where the bodies of child refugees as a result of malnutrition has fallen by more than are washed up on European beaches, and where an a third.5 indigenous child can miss out on life-saving healthcare simply because of their heritage. It’s a world where a These celebrated achievements have saved and girl can have her access to education denied and her changed millions of lives, but we have not had similar whole future blighted simply because she is a daughter successes in the fight against discrimination. That and not a son. It’s a world where millions of children means that this progress has not been spread fairly with disabilities are missing out on the education that among all children. would free them to make the most of their lives. Extreme poverty continues to be a fatal outrage, For nearly a century, Save the Children has been but a disproportionate number of children who fighting to save children from poverty. Now we are die or lose out on education are not ’just’ poor. determined to defeat an enemy every bit as deadly Whether they live in a rich country or in one of the and destructive: the discrimination that means world’s poorest countries, they tend to experience millions of children are dying needlessly, being denied a combination of poverty and discrimination. the chance to learn or being exposed to violence, Together these two injustices add up to exclusion. just because of who they are. This report tells the story of these forgotten children and sets out what is required to reach every last child.

WHAT DO WE MEAN BY ‘EXCLUSION’?

The world’s forgotten children are excluded are and where they live and that prevents them groups of children who are not benefiting from enjoying their rights – plus poverty means a child recent global progress in social well-being – is excluded. That exclusion is stopping millions particularly in health and learning – because of of children getting the food, healthcare and a toxic mix of poverty and discrimination. The education they need. What’s more, these children discrimination they face can be deliberate or and their communities generally have little the result of neglect or oversight. power to change this and little influence over the decisions that shape their lives. Experiencing a combination of discrimination – any distinction or restriction based on who they

ix x EVERY LAST CHILD • • • • ofchildren: millions for and country every in apparent is Exclusion new campaign. new campaign. our of heroes the and focus the are both they and children world’s are the These forgotten behind. left those disproportionately are children Excluded •

that has been behind. left country their of aregion in –are living countries e – on we have children all of data quarter One p 13 under children million live extreme in 400 w living be to 150 are estimated children million discriminated against. are that groups religious and from ethnic 40 1 ch public sources. We used GRID to compute the the compute to We sources. public GRID used aggregated of compilation alarge and surveys household 280 of processing data from direct human development computed outcomes (GRID) Database Inequality Groups-based from our gender and countries within regions ethnicity, on data computed we newly use report, this In Indonesia. and Chad in outcomes average between differences the as large are as disparities Mozambique, In country. apoor Gambia, the in for average children the to equivalent chances have children life Quechua indigenous country, amiddle-income Peru, In Somalia. and Egypt in outcomes average between differences as large are as groups ethnic between disparities Congo, of Republic the In are striking. inequalities Emerging children’s– according to chances. life countries within groups importantly, more and, – countries rank to us allowing life, in start fair a of key indicators measures It are. they who of because simply today experience globe across the children that chances life in inequalities wide the ChildOur Development Index (CDI) CHILDREN EXCLUDED ON FINDINGS NEW quivalent to 1.2 billion children in developing developing in 1.2 to children billion quivalent overty. ith aith disability. 0 million children around the world are around the children 0 million ild in 10 lives in a conflict-affected country. 10 in ild aconflict-affected in lives 9 . This database contains statistics on on statistics contains database . This 8 6

reveals reveals 7 from Save the Children programmes. from Save Children the benefited who parents and children individual of studies case with complemented was analysis fromtheir Evidence children’sin outcomes. inequalities vast the behind drivers the and contexts country specific helps understand to that evidence rich with Spotlights, Country of aseries produced groups, excluded most the with ground the on working experts, Children Save the we work. where countries 28 in undertaken analysis in-depth from benefits also report The secondary data on based estimations with complemented was analysis Our statistics. to invisible remain also they as groups, excluded with challenges of the one remains data of lack Unfortunately, within countries. regions and groups ethnic between chances life in inequality in increase have an seen sample fromour countries of half We evolving overis than more time. that found situation how the including new of analyses, series a undertake to and Index Child Development • • • lives: many too destroying and costing is discrimination because We children these on are focusing community cohesion, economic growth and peace. and growth economic cohesion, community trust, undermines Exclusion are profound. discrimination of forms these of impacts social and economic the children, of millions hurting well as As • • •

72 were 18 – compared with 156were 18 with men. –compared million p global 5% up make the of groups Indigenous group. minority ethnic from an by aperson are headed countries middle-income n health, experience Two-thirds who families of l more times are 3–4 disabilities with Children a secondary of children refugee four in one Only and neglect than their peers. their than neglect and in school than boys in the poorest households. poorest boysthe in than school in be to likely are less households poorest the in Girls ikely to experience physical and sexual violence violence sexual and physical experience to ikely ge is in school. in ge is utrition and education poverty in low- in lower and poverty education and utrition opulation but 15% but poverty. in people opulation those of 0 million women were married before they they before were married women 0 million . 15 16 11 13

14 12

EXECUTIVE SUMMARY xi , with the and voices experiences of – when the decision about whether or a boy d, despite important norms and conventions clusion is reinforced at the local – with level clusion national the at is institutionalised clusion is experienced at the household Ex Ex certain groups penalised, and local schools and health clinics failing to inclusive provide services. Ex level excluded children and their communities ignored, and a lack of resources to ensure every child survives and thrives. An theset by United Nations and agreed most by countries, this injustice is too often under- written at the international a failure by level to developing give countries their fair share of global taxes and aid, and a failure to ensure the rights of all excluded children realised. are level girl goes to school is based on the income, family’s or their disability gender, the child’s status.

It is not enough to blame mismanagement or bad luck. The enduring nature of thesedisparities signal bestat gross neglect and worst at profound and deep-seated discrimination. • • WE ARE ALL RESPONSIBLE Without urgent action to tackle exclusion, progress in tackling poverty will and slow may halt altogether. even leaders world agreed set a new of GlobalIn 2015 Goals Sustainable (the Development Goals or ‘SDGs’), which the give shared world targets to end poverty once and all. for In agreeing the goals they promised share those no-one ambitionsto ‘leave We behind’. and applaud those leaders world who pushed for bold commitments. But know we these goals can’t withoutbe achieved ending discrimination against excluded groups. Focusing on poverty alone won’t enough.be In recent years the has world rightly begun to challenge income and wealth inequalities. But what’s needed is a similar now focus to on how tackle inequalities in life chances between girls and boys, between different ethnic groups and between different regions, and to address all forms of identity- based inequality. The exclusion of children because of who they or where are they is a choice, live with actors responsible every at level. • •

17 , not less, important. And 2014 saw the saw highest number of displaced And 2014 18 people on record – 59.5 million – withpeople a staggering on – 59.5 record 8.3 million more people displaced than in 2013. Over half of those internally displaced children. are It might be tempting to dismiss someof these problems as simply injustices ‘unfinished business’, that will be rectified as poverty is eliminated. In fact, the impact of exclusion on life chances is becoming more IN MANY COUNTRIES COUNTRIES MANY IN IT’S GETTING WORSE At theAt same time, the number of child refugees is on seeingthe the rise, highest with number 2014 of child children made refugees a decade. in over In 2011 that to rose of refugeesup 46% worldwide; in 2014 51%. Our analysis also shows that inequalities in life chances between regions within countries are the for growing majority of cases with available data. Where a child lives in a country can be as important as which country they born are in. For example, our Child Development Index shows that in Burkina Faso children living in the Sahel region life chances lower have than children living in Chad poorer country)(a – whereas children from the capital region of Ouagadougou on are a par with the childrenaverage for in Indonesia. In most countries, these inequalities in life chances increasing. are For example, in Benin children in the most deprived region of Alibori made progress slower and dropped further behind despite important improvements for the country as a whole. Our findings, based on new data analysis, show that inequalities in life chances between excluded ethnic groups and others worsening are in the majority of countries whichfor data isavailable. Our research found that, more than 20 years after the end of apartheid and more than 60 years after the birth of the American civil rights movement, ethnicity is still important in defining life outcomesevery in corner of the globe. For example, Quechua children in Peru times more likely to 1.6 are die before their fifth birthday and more than twice as likely to be stunted as children from a Spanish-speaking background. In Ghana, Gruma children about were twice as likely to be stunted as more advantaged groups in 1998; this gap had to grown nearly 3.5 more likely by In the majority of2014. countries, inequalities are getting worse and excluded ethnic groups being are left behind. xii EVERY LAST CHILD TABLE 1 Guarantees must be delivered to every last child. last every to delivered be must Guarantees won’t steps these exclusion: end Small everywhere. children all of behalf on everywhere decision-makers we of make are demands Guarantees These 3. 2. 1. Children All to Guarantees Three make to world acrossthe we’re leaders inclusion, on calling to barriers accountability and discriminatory To down. them tear financial, overcome the help can choices human and choices, human of result They are the inevitable. are not they high, are bychildren excluded faced barriers the While CHILDREN ALL FOR A FAIR CHANCE

allocation must be ensured. be must allocation budget and policy-making – in children including – groups excluded of participation Greater communities and families their children, Acc marriage). child and schools in violence perpetuate and tolerate that those removed be (for instance, barriers policy and legal and change, must norms Discriminatory behaviours and norms policies, Eq most. the children excluded help will they but children, all help will services essential improved. Universal and increased be must services essential equitable and good-quality in investment Public services essential to access free Fa all children for security financial Minimum to services to barriers Remove cost and internationally supported collected and spent equitably, revenue, public Increased ir finance – sustainable financing of and of financing sustainable – finance ir ual treatment – end discriminatory discriminatory –end treatment ual ountability of decision-makers – to –to decision-makers of ountability

TH 1. finance Fair REE GUARANTEES TO CHILDREN ALL GUARANTEES REE Every birth registeredEvery birth norms and behaviours and norms challenge to campaigns Public services to barriers discriminatory remove to policies and Laws 2. Equal2. treatment :

Together we can reach every last child. last Together every reach we can Together born. exclusion. end we can were they are where or they by who are determined child’s no which in one chances build we can help your With children. for our building be we should world the world we not is live today in exclusionary narrow, The urgent. more be not could task This forgotten children. world’s for the and with we campaign will And persist. to discrimination and allowed poverty have that policies and norms laws, the challenge We approaches. will programmatic and solutions innovative with up coming children, excluded with We thrives. workdirectly and will survives child last every that ensure help to takes it whatever do will Children Save the years three next the Over child. last every reach to takes it whatever doing in us join world to the fromaround leaders urges and – exclusion end Children’sSave the help to ambition out sets report This place. ‘wrong’ the in living or by conflict haveor are or displaced adisability, against, discriminated is that group ethnic froman or are agirl, they because simply behind left gets child no that ensure to done be to We needs what know GLOBAL CAMPAIGN SAVE CHILDREN’S THE monitoring and transparency Budget includes children includes levels atall Governance Better data disaggregation data Better 3. Accountability PART ONE AN UNCOMFORTABLE TRUTH PHOTO: HEDINN HALLDORSSON/SAVE THE CHILDREN

The banks of the Yamuna river, Agra, India, where child workers come to wash clothes PART ONE AN UNCOMFORTABLE TRUTH

In the span of a generation, the world has been transformed for millions of children. Since 1990, the proportion of children dying before their fifth birthday from preventable causes has more than halved.1 The number of children out of primary school has been cut by 42% since 2000.2 And the number of children who are stunted because of malnutrition fell by a third between 1990 and 2010.3

But despite this impressive progress, millions of of… race, colour, sex, language, religion, political children are being left behind. Every day 16,000 or other opinion, national, ethnic or social origin, children under five die, most from preventable property, disability, birth or other status”. causes.4 58 million children of primary-school age In September 2015 world leaders agreed a new are out of school.5 set of Global Goals, which give the world shared In the 21st century it is unacceptable that children’s targets to end poverty and secure the future of our lives and futures are being destroyed when the planet within a generation. The new 2030 Agenda on world has the power to stop this happening. Sustainable Development signals a firm commitment from all countries to ‘leave no-one behind’, and that Global leaders have promised to act. Across the those furthest behind will be prioritised. world governments have committed to ensure children’s basic rights are upheld, and that the most But despite those commitments, and despite higher vulnerable and marginalised children are not left levels of global wealth than ever before, humanity behind. The United Nations Convention on the is still failing to ensure that the basic rights of all its Rights of the Child (see box below) – the most children are realised. widely ratified human rights treaty in history – states Who are the children being left behind? And why that governments must ensure the rights of children are they being excluded? without discrimination of any kind and “irrespective

THE UN CONVENTION ON THE RIGHTS OF THE CHILD

Children are afforded and protected by the and development; and respect for the views of same human rights as adults. However, children the child. are also protected by the UN Convention on Article 4 of the UNCRC mandates states the Rights of the Child (UNCRC). to “undertake all appropriate legislative, The UNCRC, which has been ratified by almost administrative, and other measures for the every country in the world, stipulates the legal implementation of the rights recognized in the obligations of states to realise children’s rights present Convention. With regard to economic, to, inter alia, education, health, and protection. social and cultural rights, States Parties shall The UNCRC contains 54 articles and has three undertake such measures to the maximum optional protocols. It has four core principles: extent of their available resources and, where non-discrimination; ensuring the best interest needed, within the framework of international of the child; ensuring the right to life, survival co-operation”.

2 1 WHAT’S THE PROBLEM?

When we examine in more detail which children are being left behind, an WHAT DO WE MEAN uncomfortable truth emerges. Increasingly, BY EXCLUSION? the children dying needlessly and missing out on basic education are not just poor. In this report excluded groups of children are They also belong to groups whose identities those children who are not benefiting from have been culturally devalued, or who live in recent global progress in social well-being – disadvantaged regions of their countries, or particularly in health and learning – because of who lack political representation. And when a toxic mix of poverty and discrimination. The discrimination they face can be deliberate or these group identities intersect, children the result of neglect or oversight. facing multiple forms of discrimination are often the furthest behind.1 Are you a girl? A refugee? Do you have a disability? Are you a member of a minority ethnic group? If so, you are more likely to see the opportunities now children is 40%, compared with the national average abundant in our world go to other children. of 17%. 8 Indigenous children are also more deprived • In the poorest countries, two-thirds of families in terms of educational attainment, crowding and experiencing health, nutrition and education homelessness, poor water quality, infant mortality, poverty are headed by a person from a minority health and suicide rates. ethnic group.2, 3 • Indigenous groups make up 5% of the global population but 15% of the poorest people HOW MANY CHILDREN globally.4 ARE EXCLUDED? • Children in conflict-affected areas make up 36% of out-of-school primary-age children worldwide.5 No child should face discrimination and poverty. But • Children with disabilities are three to four times right now, in the second decade of the 21st century, more likely to experience physical and sexual the scale of discrimination and exclusion is shocking. violence and neglect than their peers.6 According to our estimates there are: • 400 million children from ethnic, religious and Put plainly, children are missing out on decent indigenous groups that are discriminated against9 healthcare and learning not just because they are • 1 in 10 children living in countries affected poor, but because they face discrimination – based by conflict10 on their ethnic background, their gender, the region • 150 million children estimated to be living of the country they live in, a disability, their migrant with disabilities11 status, or another aspect of their identity. Socially, • 400 million children under 13 in extreme economically, politically, these are ‘excluded children’. poverty,12 with girls in the poorest households And it happens in rich countries as well as poor. less likely to be in school than boys in the In the UK, more than half of Bangladeshi and poorest households.13 Pakistani children are growing up in poverty, compared with one in five children overall.7 And in Canada the poverty rate among indigenous

3 2 WHY DOES EXCLUSION MAT TER?

THE DIRECT IMPACT OF EXCLUSION against are more vulnerable to violence.3 There is ON CHILDREN a growing body of evidence that violence against children increases their risk of being subjected Exclusion is a clear violation of children’s rights. to and perpetrating subsequent violence, and of Mandates to protect the rights of all groups are experiencing a downward spiral of marginalisation, set out in a succession of human rights treaties – isolation, and exploitation.4 Parents often stop their the Universal Declaration of Human Rights; children, especially girls, going to school if they risk the Convention on the Rights of the Child; the sexual harassment, rape or other forms of abuse.5 Convention on the Elimination of all Forms of Discrimination Against Women; the International …are more likely to face stigmatisation and Convention on the Elimination of All Forms of unfair cultural practices. Racial Discrimination; the International Covenant For example, despite extensive legislation prohibiting on Economic, Social and Cultural Rights; the UN child marriage, it continues in many parts of the Declaration on the Rights of Indigenous Peoples; world under customary laws (see page 30). and the Convention on the Rights of Persons with Disabilities. …are more likely to be persecuted because The impact of exclusion on children can be severe, of their beliefs or identity. long-lasting and wide-ranging, particularly so For example, child migrants who are lesbian, gay, because of children’s vulnerability and because bisexual, transgender, intersex or questioning, and childhood is such a critical developmental period. who have obtained refuge or asylum in the USA Children’s individual experience of exclusion is, and Canada, report encountering severe verbal and of course, unique. Nevertheless, there are many physical abuse by parents and family members, from common themes: an early age – some from as young as five.6

EXCLUDED CHILDREN… …are more likely to be administratively …have poorer access to quality health and invisible, ie, unregistered. education services, and to water, sanitation This makes it much harder for children to access and electricity. health and education services (see page 37). • A child in the Afar region of Ethiopia is almost nine times less likely to be vaccinated against killer …are more likely to be adversely affected by diseases than a child in Addis Ababa, the capital.1 disasters related to climate change. • Discrimination in access to water and sanitation According to the Intergovernmental Panel on Climate on the basis of race and ethnicity has been Change, “socially and geographically disadvantaged documented for indigenous people in Costa Rica people exposed to persistent inequalities at the and Rwanda, for Dalits in Bangladesh, Roma in intersection of various dimensions of discrimination Europe, and communities of Korean descent based on gender, age, race, class, caste, and disability in Japan.2 are particularly negatively affected by climate change and climate-related hazards.”7 …are more likely to experience violence. Excluded groups, including children with disabilities, …may face long-term psychological damage. street children and children from ethnic, racial, Research has long established that the early stages caste or indigenous groups that are discriminated of life are of enormous importance in development.8

4 2 WHY DOES EXCLUSION MATTER? 5

22 23 However, it However, 20 The lost potential The 11

19 Economic growth has increased 21 is worth noting that many of the countries with inequalitiesgrowing experienced have impressive rates of economic growth: growth does not necessarily deliver equality of life chances between children. Nigeria, most populous Africa’s nation, is of particular interest in this respect. The economy expanded an average of 8.2% by annually since and has the third-highest1999, number of millionaires on the continent after South Africa and Egypt. of excluded children is associated with significant productivity losses. Exclusion is not only costly to individual children and their families, but to society as a whole. ECONOMIC COSTS Social and economic inequalities already are having negative impacts on supply chains, capital flows, productivity. employee and ECONOMIC AND SOCIAL COSTS OFCHILDREN’S EXCLUSION per-capita income nearly by fivefold $2,970. to ECONOMIC GROWTH AND CHILDREN EXCLUDED Countries where inequalities health in children’s and education getting are worse – including Nigeria, Peru, Uganda – as as well those that seen thehave fastest reduction in inequalities – including Bangladesh, Kenya, Nepal – vary in size, income-level and conflict status. vice versa. But it should not be assumed that a focus on group-based inequality will naturally result in a reduction in economic inequality. For example, in South Africa a reduction in group- based inequalities since the end of apartheid has not been accompanied an overall by reduction in economic inequality. However, growing inequalities growing in children’s However, healthcare and learning, notably between the north and the south of the country, demonstrate that this progress is not being equally shared. Another 9 – also drive 16, 17 18 10 and to deliver equality of At the At same time, strong 14 12 The shift in policy discussions – 15 to have strong to have and stable rates of 13 evidence has emerged that inequality is undermining the ability of countries to reduce poverty, Often policies to address group-based inequalities alsowould help reduce economic inequality and ECONOMIC INEQUALITY AND EXCLUDED GROUPS Income and wealth inequality increased have across the globe. opportunity. Levels of economicLevels inequality huge relevance have thefor situation of excluded groups and, hence, excluded children. As excluded groups more are drivers of economiclikely inequality to be poor, – including globalisation; segmentation of labour markets; regressive tax collection and social spending; political capture and corruption; the increase of and size influence of the financial industry; and skills-biasedgrowth across low-, middle-across low-, and high-income countries – from a primary focus on poverty reduction to means looking also inequality, of consideration whatat is happening the at top-end of the income and wealth spectrum, and the at the way economy and political structures impacting are social hierarchy overall. economic growth differences between excluded groups and others. The combination of economic inequality with discrimination means that policies that address only the latter will not suffice. Countries must adopt policies that deliver inclusive growth – whereby economic growth creates opportunities allfor segments of society and the proceeds of distributed. fairly are prosperity Discrimination and undignified treatmentresult may in children internalising inequality, believing they are inherently ‘worth less’ than others. In a controlled experiment in India, from high boys caste and low displayed the same abilityto mazes solve under monetary incentives, but low-caste performed boys worse if the name and caste of the were boys announced the at beginning of the session. study found that female university students who read scientific essays asserting that there genderno are differences in mathematicalability perform better in mathematical problems. 6 EVERY LAST CHILD • selected Latin American countries. in groups ethnic different among cooperation and trust of alack of aresult as 22% to up of loss welfare and financial accountability. provision service public have to better tend cohesion and trust higher with countries have that found Studies interactions. social in power relations unequal of –aproduct cohesion and trust community of alack include exclusion of costs social The SOCIAL COSTS • • •

additional loss of US$234 million ayear. million US$234 of loss additional add an caregivers adult among losses income year; a million US$891 of loss economic atotal to lead to estimated is Bangladesh in market labour the Th much as 5.4% as GDP, of much over or $2 billion. as be could school to never returning children Th lost productivity.lost m ethnic the of exclusion that found study One reduces agricultural productivity by up to 37%. by to up productivity agricultural reduces St • • is associated with: education Maternal outcomes. improved health acountry’s of predictors robust most four the of one is for girls education Secondary suffer. communities wider and families future their educated, are not girls When EDUCATION: ASMART INVESTMENT GIRLS’

inority Roma cost Romania 887 million euros in in euros million 887 Romania cost Roma inority udies in Bolivia estimate that ethnic exclusion exclusion ethnic that estimate Bolivia in udies e exclusion of people with disabilities from disabilities with people of e exclusion e long-term impact of 2.8 million Syrian Syrian million 2.8 of impact e long-term fe la ter marriage and pregnancy and marriage ter wer women dying in childbirth in dying wer women 24

28 One study calculates a calculates study One 29

26 27

2002. in conflict to led exclusion, political about brought which leadership, in achange until violence without for years persisted inequalities group d’Ivoire Côte In mobilise. to amotivation group excluded an of population general the and leadership the both giving conflict, violent of likelihood the increase can exclusion economic and social exclusion, political with combined When for grievances. ground fertile create groups religious or ethnic between inequalities mirror that people poor and rich between Disparities when mothers have themselves gone to school. school. to gone have themselves mothers when improves also attainment Children’s educational • • based inequalities, based group- with conflicts violent link regularly Studies CONFLICT FUELLING income countries. income low- in education secondary had mothers all if by 26% decreased would be stunting child of Rates groups, religious groups or regions are greater. ethnic between inequalities asset where countries in the 2007 election and the conflict in South Sudan. South in conflict the and election 2007 the Kenya in after violence the Tutsi Burundi, in groups

im in creased use of health services health of use creased proved child health and nutrition. and proved health child 34 The probability of conflict increases threefold threefold increases conflict of probability The 31 32

including between Hutu and and Hutu between including 30 35 33

3 WHAT ARE THE DRIVERS OF EXCLUSION?

Understanding the drivers of exclusion means 2. Discrimination: Discrimination at local and considering a large range of social, economic and national levels may take many forms, ranging from political factors. These vary from country to country. laws and policies that explicitly discriminate against However, whatever the context, there are three particular groups to social and cultural norms that common barriers to progress driving children’s result in discrimination. exclusion across the world: 3. Lack of accountability of those in power: 1. Financial barriers: The cost of paying for basic Without structures and processes that ensure services, such as health and education, push people decision-makers are accountable to excluded groups, into poverty or prevent them escaping poverty. Up to dominant groups are able to keep lower-status 17% of people in low- and middle-income countries – groups at a disadvantage and maintain the status quo. nearly 1 billion people – are pushed into or further into At the international level, the roots of the unfair poverty as a result of paying for health services.1 In distribution of tax funds that could potentially benefit developing countries, low tax ratios (generally 15–20% children living in poverty lie in a decision-making of GDP, compared with 30–40% in rich countries) lead infrastructure that is skewed towards the needs of to limited resources for essential education, health and high-income countries (see page 53). social protection services for children.

FIGURE 1 THE THREE DRIVERS OF EXCLUSION

Poverty

Excluded children

Lack of Discrimination accountability

7 8 EVERY LAST CHILD effect from the international level through to the the to level through international fromthe effect atrickle-down is there that level, such next at the outcomes level atbox one below).affect Drivers (see children voices excluded and of chances life international and national local, at levels four –household, out play themselves barriers of types three These THAT EXCLUDE CHILDREN? BARRIERS THE ARE WHERE poverty as they seek to rebuild their lives far away. far lives their rebuild to seek they as poverty and discrimination face are to and likely homes, (see 32). page are forced fromtheir Children (IDPs) people displaced internally and refugees – children excluded of group aspecific creates conflict hand, one children’s the On exclusion. on two effects key has This crisis. and conflict – exclusion in component afurther is There EXCLUSION AND CONFLICT TOUGH CONTEXTS: in schools. violence and groups; ethnic specific or girls –against discrimination indirect and direct fees; user include healthcare or education good-quality receiving children to Barriers visible. most children’s where – is becomes exclusion local The healthcare. to access and supplies food adequate having of chances improves and their school, of out dropping children of chances the reduces households to available income Increasing resources. financial to access and autonomy education, amother’s is for instance, education, and health children’s on decision-making and dynamics household at the Children’s imposed be can exclusion INTERNATIONAL LEVEL TO THE –FROM HOUSEHOLD THE EXCLUSION CHILDREN’S the youngest, girls, and children with disabilities disabilities with children and girls, youngest, the are poor, who those children, Among situations. crisis and conflict in exacerbated exclusion their find are to likely exclusion of effects the suffering were already who children hand, other the On level – including a child’s neighbourhood achild’s level –including neighbourhood level. A key factor driving power- driving level. Akey factor – and combine to limit the the limit to combine –and and other health problems in times of conflict. of times in problems health other and malnutrition to leading girls, and women to food as such resources scarce of distribution inequitable to lead can discrimination gender Forare example, disproportionately affected. managing the difficult situations that arise. that situations difficult the managing in disadvantaged further be are to likely groups are excluded in who those –ie, ‘de-development’ with associated usually are crisis and conflict poorest children, rather than to enable progress. progress. enable to than rather children, poorest the on spend to countries poorest the to available revenue of amount the limit to serves uphold they finance of system global the and nations The wealthier finance. on obviously most critical, dimension is also Finally, international the children). transgender and children and gay, disabilities, lesbian, with bisexual for (including protection legal of absence an and groups; religious or by ethnic disaggregated is that data collect few countries very that fact the resources; available of allocation inequitable the afactor. includes That often also is problem group excluded the acknowledge to Failure children. poorest for the outcomes learning and health poor in akey factor often is resources, national At the in the midst of an emergency. an of midst the in are fewer available resources as marginalised even more become and action humanitarian in overlooked are often disabilities with Children agents of change themselves. change of agents active potential also but others, of actions by the affected both centre, at the children with levels, four at these exclusion of drivers the of some out sets that framework aconceptual 2provides Figure taking responsibility. levels at all involve thus actors will drivers these to Solutions levels. household and local national, level, an absolute lack of of lack absolute level, an 2 4 In addition, addition, In 3

FIGURE 2 UNDERSTANDING EXCLUSION: A CHILD-CENTRED APPROACH

EXCLUDED NATIONAL CHILDREN ● Growth that is not inclusive ● Unfair ﬁnancing (eg, inequitable regional budgeting, A child’s self-conﬁdence and agency are regressive tax systems) affected by the actions at the household, ● Exclusion from markets local, national and international levels. Empowering children and allowing them to participate meaningfully in society will help ● Lack of (enforced) discrimination laws ensure accountability to excluded children.

● Excluded groups not visible in data or policy ● Lack of accountability to excluded groups ● Land rights absent or not upheld ● Conﬂict ● Elite capture/clientalism

INTERNATIONAL ● Economic ideologies that promote inequalities ● Unfair ﬁnancing (eg, a global tax system that favours high-income countries)

● Absent or insufﬁcient norms and accountability mechanisms established through conventions, charters and declarations

● Lack of awareness about excluded groups ● Unfair trade deals

HOUSEHOLD LOCAL

● Poverty ● Limited access to free, good-quality health, education and protection services ● Remoteness and poor transport infrastructure

● Cultural/gender norms that ● Institutional discrimination within local services affect power dynamics ● Stigmatisation/discriminatory cultural norms ● Mothers’/caregivers’ ● Patriarchal and other discriminatory customary laws lack of education ● Development projects that harm excluded groups’ livelihoods ● Threat/fear of violence/inter-community conﬂict

FINANCIAL DISCRIMINATORY BARRIERS GOVERNANCE AND BARRIERS AND CULTURAL/GENDER NORMS ACCOUNTABILITY BARRIERS 10 EVERY LAST CHILD 2. 1. inputs: seven on draw core research this report in presented findings and evidence The EXCLUDED CHILDREN ON FINDINGS NEW

Inequality Database (GRID), by developed Database Inequality Groups-based fromthe gender and regions ethnicity, on data we available use report this In Grou 3.) Appendix see CDI, the on details more (For groups. for ethnic disaggregation with countries for 22 and country, the within for regions disaggregation with countries 48 girls, boys and between 83 for disaggregation of acoverage with population of by subgroup disaggregated further is index the country, within inequalities analyse to order In children. 1.2 billion than more of population a combined with countries, 94 on level data national includes CDI The disparities. gender and ethnic/racial regional, on provide to new analysis allow us and globally injustice of providethey alandscape broken down, Once progress. development o indicators four these comprehensive, not While CHILD DEVELOPMENT INDEX TA completion. education primary and stunting, child levelsbirthday, of fifth their to surviving of children’s chances at birth, registered being life: in start afair linked to key four indicators computing by Indexes Development Child previous on O Note: For further methodological details see Appendix 3. Appendix see details methodological further For Note: ffer a substantive measure of wider human human wider of measure asubstantive ffer Education Nutrition registered not children %of registration Birth Survival Dimension ur BLE 2 BLE Child Development Index: ps and Inequality Database Inequality ps and

IN DICATORS THE OF completed primary school. completed primary have not who 15–24 years, aged people % young rate stunting Under-five at birth rate mortality Under-five Indicator We built (GRID): 7. 6. 3. 5. 4.

involved in Save the Children programmes. involved Children Save in the are who parents their and children individual of We studies case have parents: included their In page 9). (see exclusion 2on Figure understanding to approach child-centred the develop to movement Children Save the the within actors relevant with workshops and interviews conducted Tes GRID see Appendix 2. Appendix see GRID on details Education).methodological on For Database World the and World Inequality Bank UNICEF, Organization, World Health Estimation, Mortality for Child Group Inter-agency (the UN sources public aggregated various and Surveys, Indicators Cluster Multiple and Surveys Health Demographic of processing data direct on based is GRID Institute. Development Overseas the with collaboration in Save the Children address discrimination. to policies on and children against violence and exclusion health, child and exclusion education, and reviews –exclusion literature org.uk/resources/online-library/every-last-child www.savethechildren. website: Save Children the fromthe downloaded be can Spotlights Country 1; the of versions Appendix full in are given Spotlights Country of Summaries outcomes. children’s in inequalities vast the behind drivers the and contexts country specific understand to which with evidence provided rich Zambia to Albania from offices 28 than more in conducted Research basis. adaily on ground the on groups excluded most the with working experts has Co organisations. credited or agencies UN various from estimates best on are based report this in statistics many Therefore, GRID. or index our surveysin household and hence not in included captured They are not data. official in uncounted –remain children street refugees, disabilities, with –children children excluded Many groups. excluded with challenges the of one remains Se Li terature reviews: terature terviews with excluded children and and children excluded with terviews condary data: untry Spotlights: untry ting our conceptual approach: Unfortunately, lack of data data of lack Unfortunately, We four commissioned Save the Children Children Save the 5

We We PART TWO WHO ARE THE EXCLUDED CHILDREN? PHOTO: HEDINN HALLDORSSON/SAVE THE CHILDREN

Fiker, 12, left his home in rural Ethiopia when his father died and came alone to the capital, Addis Ababa. He lives on the street. PART TWO WHO ARE THE EXCLUDED CHILDREN?

In this section we look at how children are faring in the four groups of excluded children for which data exists: • minority ethnic groups • disadvantaged regions • girls • refugee and internally displaced children. We then look at other groups for which there is very limited data: • children with disabilities • street children and children living in informal urban settlements • lesbian, gay, bisexual, transgender, questioning or intersex (LGBTQI) children.

We use the Child Development Index (CDI), developed group. A score of 100 implies that the minimum by Save the Children, for this report. The CDI requirements of the four dimensions are fully met.1 reflects four key dimensions of a fair start in life. The CDI provides insights on the large global The rationale is simple. Every child, including those disparities in children’s life chances. While Chile has in the excluded groups, should be guaranteed an average CDI score of nearly 100, Somalia and survival, birth registration, nutrition and education Chad score below 30, underlining what we already (see Table 2 on page 10). know well – the country you are born into defines to While not comprehensive, these four indicators a large degree your life chances. offer a substantive measure of wider human But the real surprises appear when we disaggregate development progress. Once broken down, they country averages by social and economic groups. This provide a landscape of injustice globally, allowing us shows that in many supposedly more prosperous to provide new analysis on regional, ethnic/racial countries, excluded groups of children are faring and gender disparities. worse than in other countries that are on average a The higher the index value, the better the children lot poorer – see, for example, page 15 and page 19. are doing in a particular country or excluded

12 4 EXCLUDED BY ETHNICITY, RACE, RELIGION AND CASTE

BORN EQUAL? TRAN THI HOAN’S STORY

Tran Thi Hoan is a tailor. Her husband, Tran Help came too late. Duy Hung, is a farmer. They live in a village in a “Our baby died a few days after being born,” says mountainous region of Vietnam. Thi Hoan. Their son was born at their local district hospital. Dr Du Quang Lieu works at the local hospital But from birth he had difficulty breathing. The where Thi Hoan gave birth. “We want to be able to doctors were unable to treat him. Instead, they treat newborn cases here at the district hospital,” were referred to the provincial hospital. she says. “But to able to do that we need newborn The provincial hospital was 80 km away, along care training. And we need a newborn care unit with mountain roads. machines and equipment that can help save lives. “It took three hours,” says Thi Hoan. “We went “The death rate of children under the age of five by ambulance, but there was no equipment on the here is still high. So we also need help to train ambulance to help my baby breathe. When we got midwives at the commune level on how to teach to the provincial hospital, the doctor said the baby mothers to look after their child once they are was now in a critical condition.” back home.” PHOTO: TUL PINKAEW/SAVE THE CHILDREN THE PINKAEW/SAVE TUL PHOTO:

Tran Thi Hoan lives in a mountain village in Vietnam.

13 14 EVERY LAST CHILD 68% for Lao-speaking children and only 26% only and for children for Lao-speaking 68% was comprehension reading average the that found project Children for aSave survey the a baseline Laos, In design. curriculum and barriers language in are manifested barriers discriminatory education, In groups. ethnic minority some among concentrated is poverty countries, many In marginalisation. and injustice of experience an share all but location, and histories language, appearance, their in diverse may be groups These USA. the in Americans African or Europe Eastern in Roma the Peru, in Quechua the India, of Dalits are the they cumulative discrimination whether and disadvantage, and systematic of centuries havegroups experienced religious and caste racial, indigenous, ethnic, Many have or religious ethnic groups. minority world, world’s and all almost the countries groups ethnic in the There are some 5,000 associated tensions. associated tensions. and groups faceinequalities discrimination, other in many contexts, harmoniously live communities together different While are virtually absent from the richest quintile. richest fromthe absent are virtually they whereas quintiles, poorest in the predominantly feature groups ethnic minority particular example, the UNCRC and the Convention on the the on Convention the and UNCRC the ILO as Convention 169, such peoples, indigenous affecting conventions or agreements rights human (orother of fulfilment) implementation proper for the guide important an also is It peoples. indigenous of rights human the respect should how governments out sets (UNDRIP) Peoples Indigenous of Rights the on Declaration UN The the Convention. under rights their and no. 11Comment children indigenous concerns Child’s the of General Rights the on Committee The rights. enjoy their fully to order in measures special require they that recognition indicate UNCRC the in children indigenous to references specific The provisions. of anumber in children indigenous to references specific include to treaty rights corehuman first the was (UNCRC) Child the of Rights the on Convention UN The GROUPS INDIGENOUS IN CHILDREN OF RIGHTS 2 In Bolivia, for Bolivia, In 3 1

and rights. languages cultures, indigenous respect that ways in and children other as system education the from benefit same the get communities their of, outside or in, –living children – particularly peoples indigenous that ensure must governments that means This are indigenous. they because out left be not must and school go to to else everyone as right have same the children, Indigenous individuals,systems. particularly education and ownschools their manage and up set to have right the peoples indigenous 14), art. (UNDRIP education of case the In rights. these protect to take must governments that and actions rights, specific describe that articles 46 of consists Women. UNDRIP against Discrimination of Forms All of Elimination • where Tranwhere from. is Vietnam, rural in over achildhood itself reinforces 17), 4(page Figure in howout see exclusion we can • countries. poorest the of some children’s in to outcomes are comparable groups disadvantaged in children of health and education the that so vast be can groups ethnic between inequalities countries, prosperous relatively In • 49% of Sino-Tibetan children. Sino-Tibetan of 49% with compared schools primary in are enrolled ofLao-Tai 90% children. children non-Lao-speaking excluded today’s world in being of are and at risk against are discriminated who children million 400 We are there that estimate

higher than the national average. national the than higher 50% to up is rate poverty the Albania, east and north of mountains the in and Serbia south-east Am On national average of 91%. of average national the with compared Montenegro in schooling national average of 92%. of average national the with compared schooling, primary receive B In ly 29% of Roma children receive primary receiveprimary children Roma of 29% ly ong Roma households in north-east Romania, Romania, north-east in households Roma ong osnia and Herzegovina, 40% of Roma children children Roma of 40% Herzegovina, and osnia in ethnic, religious and indigenous groups groups indigenous and religious ethnic, in 5 6 .

8 In the timeline set set timeline the In 4 7

4 EXCLUDED BY ETHNICITY, RACE, RELIGION AND CASTE 15 echua times children more likely to 1.6 are die ildren from those excluded ethnic groups are ey are also are ey three times less likely to finish before theirfifth birthday and more than twice as likely to be stunted as children from a Spanish- speaking background. primary school and 4.5 times less likely to be registered birth. at Qu Ch times2.1 more likely to die and 3.5 times more likely to be stunted. Th

In Cameroon, ethnicity still life shapes children’s chances. Children from more disadvantaged Biu- Mandara an index groups of about score have 44 compared with Bamilekeand Bamoun an who have index of 82. score • Another striking example is Mozambique. While the country as a whole has a CDI of 52, score Portuguese-speaking CDI of 75 score children’s InPeru, another middle-income indigenous country, Quechua life children chances have similar to those of children living in a poor African country such Gambia: as • • Child Development Index score Child Development Child Development Index score Child Development worst-performing ethnic group worst-performing best-performing ethnic group country average 0 10 20 30 40 50 60 70 80 90 100 worst-performing ethnic group worst-performing best-performing ethnic group country average Mali Benin 0 10 20 30 40 50 60 70 80 90 100 Gabon Congo Liberia Guinea Albania Guyana Gambia Pakistan Honduras EQUALITIES IN CHILDREN’S LIFE CHANCES BETWEEN ETHNIC GROUPS Mali Cameroon Benin Mozambique Gabon Congo Liberia Guinea Albania IN Guyana Gambia Pakistan

Honduras Cameroon Mozambique This graph compares the Child Development Index scores for the best and the worst performing ethnic groups ethnic groups performing the best and the worst for Index scores the Child Development compares This graph the between of inequalities in CDI scores to levels according ranked Countries are which data is available. for group. best and the worst-performing INEQUALITIES IN CHILDREN’S LIFE CHANCES IN CHILDREN’S INEQUALITIES BETWEEN ETHNIC GROUPS % of Mbochi children complete primary school, gmy childrengmy four times are more likely to be compared with of Pygmy just 6% children. stunted than Mbochi children. Py 88 FIGURE 3 Democratic Republic of Congo This graph compares the Child Development Index scores for the best and the worst performing ethnic groups ethnic groups performing the best and the worst for Index scores the Child Development compares This graph the between of inequalities in CDI scores to levels according ranked Countries are which data is available. for group. best and the worst-performing INEQUALITIES IN CHILDREN’S LIFE CHANCES IN CHILDREN’S INEQUALITIES BETWEEN ETHNIC GROUPS

• The Republic of Congo, a middle-income country, has an average CDI of 82, score but wide disparities between ethnic groups – from a CDI of 85 score for the more advantaged Mbochi children to of a score 28 Pygmy for children. Thisis equivalent to the gap between children in Egypt and children in Somalia. Inequalities striking: are • Our Child Development Index reveals the wide inequalities in life chances that children of different ethnic origin still experience today in the 21st century. Unfortunately, data on ethnic group is not available most for countries only are we able so to disaggregate the CDI ethnic by groups in a selection of countries. The available comparative data shows significant inequalities 3). (see Figure DIFFERENCES IN THE CHILD DEVELOPMENT INDEX ETHNICITY BY Democratic Republic of Congo 16 EVERY LAST CHILD • data: available with countries those for We increasing. that, found are often chances life in inequalities unfair these that reveals analysis Our INCREASING IS GROUPS ETHNIC BETWEEN CHANCES LIFE IN INEQUALITY • • fragile country. and apoor Chad, of that to 35of equivalent is children’s Elomwe score But CDI Indonesia. as such country amiddle-income of that to equivalent is Refugee children forced to flee unrest and violence in Burundi, now in a camp in camp Tanzania in a now Burundi, in violence and unrest flee to forced children Refugee

countries (67% countries). of countries in are increasing birth of out 11 16 fifth their In Elomwe children. than education primary complete to likely more Po children. Portuguese-speaking of 87% to opposed as at birth are registered M In equalities in the relative chances of surviving surviving of chances relative the in equalities rtuguese-speaking children are four times are times four children rtuguese-speaking ozambique, only 26% only children Elomwe of ozambique, • and 2012. 2000 between same the stayed roughly has figure This groups. advantaged most the to respect with malnourished be to likely as twice is group ethnic worst-off the in achild countries, most In other groups. than stunted be to likely more 3.5 nearly children by 2014 Gruma but groups, with grown, had gap this advantaged more as stunted be to likely as twice were about children 1998, In Gruma malnutrition. tackling in progress recent country’s the amid behind left been have children arguably Gruma Ghana, In •

In In 11 (91% countries countries). of 10 in of out are increasing education primary countries). 11 of 6out in are increasing (55% countries of equalities in the risk of children not completing completing not children of risk the in equalities stunted being of chances the in equalities

PHOTO: TOM PILSTON/SAVE THE CHILDREN THE PILSTON/SAVE TOM PHOTO: FIGURE 4 EXCLUSION TIMELINE OFEXCLUSION ETHNIC MINORITY TIMELINE CHILDREN IN OF VIETNAM ETHNIC MINORITY CHILDREN IN VIETNAM

KINH MAJORITY ETHNIC MINORITY CHILDREN CHILDREN FROM BIRTH 18% 67% of their mothers don’t of their mothers don’t receive antenatal care receive antenatal care (4 or more visits)1 (4 or more visits)1

Infant mortality of Infant mortality of 10 per1000 30 per 1000 live births1 live births1

9% 23% of children don’t of children don’t receive DPT3 vaccine1 receive DPT3 vaccine1

2% 12 % of children don’t complete of children don’t complete primary school1 primary school1

24% 57% of children don’t of children don’t attend secondary school1 attend secondary school1

30 per 1000 115 per1000 adolescent birth rate1 adolescent birth rate1

TO ADOLESCENCE For references see timeline endnotes 5 EXCLUDED BY REGIONAL DISADVANTAGE

MISSING OUT IN TURKANA, KENYA AULE’S STORY

Aule, nine, lives in Turkana County, Kenya with with the animals all day I get hungry because there is his parents and his six brothers and sisters. Aule no food to eat. works herding livestock every day, providing “I went to nursery school when I was younger, but I essential income for his family. He is the only stopped going to school when I was small. My older school-age child in his family who does not attend sister goes to school and my younger siblings do too. I school. Aule says he would like to go to school would like to go to school to get some education and but has never considered it to be a real possibility. have a good life, but I’ve never thought that chance “Every day I take care of the animals. From morning could come. It is not something I even think about.” until night I watch after them, then I take them back Nine out of ten people in the drought-prone safely in the evening. I take them out to places where Turkana region of Kenya live in poverty – there are green plants to eat. Sometimes when I’m compared with two out of ten people in Nairobi.1 taking care of the animals, I go far away from home Only 42% of children in the North East region and there are foxes. Sometimes I get afraid that my have completed primary school – far below the animals will get attacked. Sometimes when I am out rate in Nairobi of 93%.2

Aule, nine, from the remote region of North East Kenya, has to work tending livestock. It means he’s unable to go to school. PHOTO: COLIN CROWLEY/SAVE THE CHILDREN THE CROWLEY/SAVE COLIN PHOTO:

18 5 EXCLUDED BY REGIONAL DISADVANTAGE 19 5 some factors contributing to 4 tosi, the most disadvantaged region of Bolivia, a middle-income than country,scores lower the Zimbabwe,average for a low-income country. In Potosi children 3.6 are times more likely to die before their fifth birthday or to be stunted than in Santa Cruz. Po

Many of the regions being left behind very are large. Our Child Development Index shows that29% of children data whom for have in we a region live where the index is less score than 80% the national average index score. That makes million up about children 242 out of more than 800 million who in countries live data whichfor have we disaggregated the at regional Itlevel. is clear that tackling regional inequalities could substantially the lives improve of huge numbers of children the across world. MORE PROSPEROUSRELATIVELY COUNTRIES WITH WIDE DISPARITIES Excluded groups living in disadvantaged regions middle-income prosperous more in countries experience life chances similar to those of children living in much poorer countries. Figure 6 illustrates this situation India, for Cambodia, Nigeria and Peru. Nigeria is a middle-income country with considerably greater resources than many other African countries. a Nigerian life chances child’s depend However, hugely on where he or she was born. The South East inequalities between health regions in children’s influencedare geographyby for – example, the low population density and difficulties in transport, which make itharder to healthcare provide services to our researchremote shows populations. However, that factors not derived from physical geography also significant a influenceincluding – healthcarehave user fees and an inequitable distribution of resources between regions. People in remote areas face a double burden: they poor to are and pay they have health servicesfor quality. of low The data shows that in regions where children more likely toare die or to be stunted, they alsoare generally less likely to finish primary school had their or to have birth registered. In the majority of cases, regions that the have lowest index lagging are score behind many of the dimensions simultaneously. What some are of the factors contributing to these regional disparities? In Burkina Faso where children in the Sahel region 2.8 are times more likely to die before their fifth birthday than children in the region, Centre-East • 3 onduras, the most disadvantaged region, ooué-Ivindo – the most disadvantaged region of Gabon, a middle-income country – scores on thelower CDI than Comoros, a low-income country. In Ogooué-Ivindo children times 1.5 are more likely to die before their fifth birthday than capitalin Gabon’s city Libreville more and are than three times more likely to be stunted. Og Lempira, has a similar CDI to score the average Haiti,for a low-income country. 48% of children in Lempira stunted, are a rate usually observed in much poorer countries such as Malawi or Nepal. In Gracias a Dios, the second worst performing region in Honduras to according the index, child mortality is on a par with countries such as Senegal or Yemen. In H

• In some countries the regional inequalities are extreme. For example, in BurkinaFaso, Cameroon, India the of children and score Tanzania in the most deprived region of each of those countries is less than half the index of children score living in the most region. favoured In Burkina Faso, children living in the Sahel an index – less region of 35 score have than children living poorer in country) Chad (a – whereas children from the Centre region, where the capital Ouagadougou is situated, an index score have – on a par withof 76 children in Indonesia. • A child’s life chancesA child’s depend not just on which country they born are in, but which part of that country. Figure 5 shows the wide disparities in development outcomes between the best and worst-performing regions ofselection a of regional widely countries, demonstrating how inequalities persist. THEGEOGRAPHICAL LOTTERY Disadvantaged regions within countries often are home to minority ethnic groups. For instance, the northern mountainous the and Central Highlands regions of Vietnam the country’s have highest proportions of ethnic minorities; they also are the poorest regions in the country. Remoteness, difficult terrainconflict or pose challenges services to delivering these – and factorsexplain might variation some from health, in national averages nutrition and there where education outcomes. However, much biggerare gaps between and a region the systematic national average, disadvantage be a factor. may 20 EVERY LAST CHILD Democratic RepublicofCongo FIGURE 5 FIGURE BETWEEN REGIONS INEQUALITIES INCHILDREN’SLIFECHANCES and theworst-performing region. which dataisavailable. Countriesare ranked according tolevels ofinequalitiesinCDIscores between thebest The graph compares theChildDevelopment Indexscores for thebestandworst performing regions for Democratic RepublicofCongo Sao Tome andPrincipe Dominican Republic BETWEEN REGIONS INEQUALITIES INCHILDREN’SLIFECHANCES and theworst-performing region. which dataisavailable. Countriesare ranked according tolevels ofinequalitiesinCDIscores between thebest The graph compares theChildDevelopment Indexscores for thebestandworst performing regions for Kyrgyz Republic Sao Tome andPrincipe Dominican Republic Mozambique Timor-Leste Bangladesh Cameroon Zimbabwe Honduras Kyrgyz Republic Comoros

Tajikistan Armenia Maldives Namibia Lesotho Pakistan Gambia INEQUALITIES IN CHILDREN’S LIFE CHANCES BETWEEN REGIONS BETWEEN CHANCES LIFE CHILDREN’S IN INEQUALITIES Zambia Albania Nigeria Guinea Liberia Congo Gabon Bolivia Jordan Mozambique Kenya Timor-Leste Niger Benin Egypt Haiti Bangladesh Cameroon Mali Zimbabwe Honduras Comoros Tajikistan Armenia Maldives Namibia Lesotho Pakistan Gambia Zambia Albania Nigeria Guinea Liberia Congo Gabon Bolivia Jordan Kenya Niger 02 04 06 08 0100 90 80 70 60 50 40 30 20 10 0 Benin Egypt Haiti Mali country average best-performing region worst-performing region 02 04 06 08 0100 90 80 70 60 50 40 30 20 10 0 country average best-performing region worst-performing region Child Development Indexscore Child Development Indexscore 5 EXCLUDED BY REGIONAL DISADVANTAGE 21 ildren in the most disadvantaged regions, ildren from Mondulkiri and Rattanak Kiri are equalities relative chances in of children’s equalities chances of being in children’s stunted equalities in the risk of children not completing surviving past their fifth birthday increasing are in countries out of countries). of 52 (59% 31 countries out of 33 (52% increasingare in 17 of countries). primary education increasing are out of in 24 countries of 35 countries). (67% In Ch Ch In In Mondulkiri and Rattanak of 54 –Kiri, a score have similar to the Nigeria. for average score more than twice as likely to die before their fifth birthday or be stunted as children from Phnom Penh, and they six are times less likely to finish primary school.

• • • INCREASING ARE INEQUALITIES REGIONAL COUNTRIES… MANY IN Our analysis reveals that disadvantaged regions within countries systematically are making slower relative progress than more prosperous regions. As a result, inequalities in life chances between regions increasing are in most countries: • Dominican Republic. However, not all children inDominican Republic. However, Cambodia benefiting are to the same extent: • ild in the remote North region of West % of children complete primary education in

Nigeria – where stunting rates around 55% are – isnearly four times more likely to experience malnutrition than child a in the South East region. 95 A ch the South East of Nigeria; only50% do in so the West. North PHOTO: HEDINN HALLDORSSON/SAVE THE CHILDREN THE HALLDORSSON/SAVE HEDINN PHOTO:

A primary school in a camp forinternally displaced people in Puntland, Somalia • region – equivalent has a CDI of 74 score to the national average in Ghana. In contrast, the North whichregion has West a CDI of39, score is equivalent to the average index of Chad, score a low-income country Figure 6). (see • As a low-income country, Cambodia illustrates the opposite example. While it is a poor country, Cambodia is doing relatively as well measured against the CDI. It has an average index of 73 – close score to a much more developed country such as the India is another middle-income country with wide geographic inequalities in life chances. Children in its most disadvantaged fare similarly region, Bihar, on the CDI as the children average for in Ethiopia, a low-income country. Children living in Bihar lag behind other children in all dimensions but their of birth level low registration is particularly striking. Only of children 6% in Bihar registered are birth at in contrast with of children nationally. 43%

22 EVERY LAST CHILD Child Development Index score Index Development Child 100 10 20 30 40 50 60 70 80 90 0 FIGURE 6 FIGURE GEOGRAPHICAL LOTTERYGEOGRAPHICAL worst performing regions inIndia, Nigeria, CambodiaandPeru. The graph compares theChildDevelopment Indexscores for selectedcountriesandfor thebestand

country average best-performing region worst-performing region Somalia Chad Ethiopia Dominican Republic Chile Child Development Index score Index Development Child 100

10 20 30 40 50 60 70 80 90 GE 0 GEOGRAPHICAL LOTTERYGEOGRAPHICAL worst performing regions inIndia, Nigeria, CambodiaandPeru. The graph compares theChildDevelopment Indexscores for selectedcountriesandfor thebestand OGRAPHICAL LOTTERY OGRAPHICAL country average best-performing region worst-performing region Somalia Chad Ethiopia Dominican Republic Chile Bihar India Kerala Bihar India Kerala North WestNorth Nigeria South East North WestNorth Nigeria South East Mondulkiri &RattanakKiri Cambodia Phnom Penh Mondulkiri &RattanakKiri Cambodia Phnom Penh Huancavelica Peru Tacna Huancavelica Peru Tacna 5 EXCLUDED BY REGIONAL DISADVANTAGE 23 Zinder Zambia national average Alibori Benin national average

46 76 78 82 2012 2012 (%) (%) 57 85 85 90 2006 2006 Not completing completing Not Not completing completing Not primary education primary education

44 51 53 43 2012 2012 (%) (%) Stunting Stunting 43 62 55 65 erall, the region of Alibori made progress slow 2006 2006 Ov on the CDI to 38 – from 32 – in contrast with the faster improvements the country experienced as a whole, to 63. from 52

• …BUT IN ALL NOT The most successful country in reducing inequalities Regions that lagging were is Niger. behind such as Zinder and Maradi experienced have faster a rate of progress the that capital. Niamey, Niger remains a highly unequal country but the progress of these most deprived regions has benefited children with the lowest life chances in the world. 59 20 36 58

2012 2012 (%) (%) at birthat at birthat 47 58 82 68 2006 2006 Not registered Not registered 119 89 110 137 2012 2012 Under-five Under-five 113 193 128 2006 2006 162 1,000 live births) 1,000 live births) mortality rate (per mortality rate (per 38 63 50 40 2012 2012 ANGE IN CORE CHILD WELFARE IN BENIN INDICATORS AND NIGER Child Child Index Index CH 33 52 32 23

Development Development 2006 2006 0 0 der-five child mortalityactually worsened in ere was no change in birth registration and only

60 60 20 20 40 40 80 80 ogress in primary school completion was slower

120 120 160 160 140 140 180 100 100 200

Indicator score Indicator modest improvement in malnutrition. in modest improvement score Indicator in Alibori than the national average. Th Pr Un Alibori in stark contrast to the significant progress in the country as a whole. FIGURE 7 Niger Benin

• • In Benin inequalities in lifechances systematically are increasing as – represented changes by in the Child Development Index between (see 2006 and 2012 Figure 7). While Benin as a whole importantshowed improvements, children from the most deprived region of Alibori dropped further behind: • 24 EVERY LAST CHILD regions of the world and those already trying to to trying already those world and the of regions poorest the of Some households. poorest the of many of security food and livelihoods the threatens production agricultural on impact The temperatures. high are extreme as areas, vulnerable of number a in are projected droughts prolonged more and severe More change. by climate exacerbated be to are likely areas semi-arid and arid in communities other and by pastoral faced challenges acute The REGIONS POOREST THE ON IMPACT CLIMATETHE OF CHANGE discrimination they face from health workers. fromhealth face they discrimination the of because services health under-use HIV with living people that revealed has research example, For care. health access to abarrier as acts also and exclusion in results HIV with living of people andStigmatisation discrimination against DISEASES INFECTIOUS OTHER OR HIV, WITH TUBERCULOSIS LIVING PEOPLE them. against discrimination in result may and stigmatised –is condition physical or amental –whether status aperson’s health cases, these In exclusion. further and discrimination for grounds as serve may also itself status health outcomes, health poorer to leads exclusion While HEALTH OF GROUNDS DISCRIMINATION THE ON STATUS including mental health conditions. including health mental outcomes, health negative to vulnerable especially are are HIV-positive household the of members more or one where households from children that shown has Africa fromsouthern Evidence 10 9

(from 42% 50%). to (from Tigray of 46%51%) to regions the in Afar and level from51% 2011, in 44% to 2005 in increased it national at the decreased has stunting while Ethiopia, In change. by climate thwarted be are to likely areas these in children of improvewell-being to the Efforts nutritional deficits in those regions. in deficits nutritional exacerbating country, the hit to drought latest by the stunted or wasted. be were to likely more children HIV-positive suffer. already Kenya, In children exclusion the compounds often also status HIV-positive with moderate or severe or disability. moderate with years 0–14 aged 93 children million estimated an are There evidence. scientific on based not is that practices traditional and local through treatment to subject are often they and conditions, health mental with living people of neglect and stigmatisation is world there the Around diseases. infectious with people those to limited not is status health of grounds the on Discrimination CONDITIONS MENTAL WITH HEALTH LIVING PEOPLE positive. HIV- be were to likely more insecurity food those most at risk of future climate extremes. climate future of at risk most those are among change climate of impact the cope with of discrimination because of their HIV status. HIV their of because of discrimination form some face will who of majority world the the around HIV with living children million 2.6 12 There are currently approximately approximately are currently There 11 7 Both regions have been affected affected have regions been Both In Zimbabwe, women with with women Zimbabwe, In 14 8

13 6

6 EXCLUDED GIRLS

BREAKING THE MOULD ANGELINA’S STORY

Angelina is 15. She lives with her parents, five “Sometimes I don’t come to school for a few days sisters and her brother in Pariak, South Sudan. because I have to stay at home to look after the Her father is sick, so her mother looks after younger children when my mother is working, and the family and runs a restaurant in the market. sometimes I have to cook or fetch water for the Angelina is in grade 7 at her local school. family. This work means I have little time to read and to study. “There are 45 students in my class – just two of us are girls. Lots of girls dropped out in the lower classes “My mother never finished school, but she encourages – some got married and some of their parents were all of the girls in my family. She doesn’t want us not able to afford to send them to school any more, so to struggle like she has, having to work hard for they have to stay at home and help with the family. little money in a restaurant. She wants us to have a better life. That’s why she doesn’t want us to get “Coming to this school means a bright future for me. married early, but to finish our education so we can When I’m older I intend to go to university so I can all get good jobs. I’ll support my younger sisters to do become a doctor. But my fear is that my parents won’t the same.” be able to afford the fees. PHOTO: COLIN CROWLEY/SAVE THE CHILDREN

Angelina, 15, from South Sudan, is one of only two girls in her secondary school class of 45 students.

25 FIGURE 8 EXCLUSION TIMELINE OF GIRLSEXCLUSION IN INDIA TIMELINE OF GIRLS IN INDIA

BOYS IN INDIA GIRLS IN INDIA

FROM BIRTH

2– 4% estimated female foeticide1

Child mortality rate of Child mortality rate of 51 per 1000 2 55 per 1000 live births live births2

40% 38% of boys are stunted3 of girls are stunted

96% 97% primary school primary school completion rate4 completion rate4

16% 58 % married married before age 185 before age 185

TO ADOLESCENCE For references see timeline endnotes 6 EXCLUDED GIRLS 27 1 3 4

2 ozambique of only the 5% poorest girls udan, of the 69% poorest complete boys he poorest households in the (those bottom complete primary of school compared with 21% the poorest boys. primary education compared with of the 37% girls.poorest In t only 84quintile), girls complete primary school everyfor 100 boys, on average. In M In S

GENDER DISPARITIES IN EDUCATION IN GENDER DISPARITIES The has world made dramatic progress in reducing disparities between and boys girls, and a lot of this has been driven political by changes that women and This has been pushed particularlygirls have for. true in access to education, as the gender gap in primary school enrolment has reduced significantly. justIn years, the number15 of girls every for has 100 boys risen in from 92 to primary 97 educationand from in to secondary 97 91 education, since 2000. • In Afghanistan, 40 girls complete primary school everyfor 100 boys. In the poorest households that girls every for reduces 100 boys. to Figure 10 16 gendershows how and household asset levels interact that so girls remain a greater at disadvantage than in boys the poorest households. It is clear that gender disparities persist in education all at wealth inlevels Afghanistan. And when poverty and gender inequality combine, chances of completing a girl’s primary school remote are – just 4%. But despite these gains, great disparities persist in some countries in both primary and secondary education, particularly in Africa. And when taking household economic status into account, gender inequalities become much starker. • • A study conducted in Andhra Pradesh, India, found that each additional older brother decreased a likelihood of attendingchild’s a private school by percentage35 points. The study also found that, compared with girls in general, from boys even poorer families in rural areas twice were as likely to attendedhave a private school age eight. by What is the global pattern? In some regions of the world, such as Latin America and the Caribbean, and Eastern and Southern Africa, girls tend to outperform boys.By contrast, girls appear to be systematically African behind in West countries. In Asia, India and Nepal the highest have absolute difference between and boys girls, with scoring boys though the differencehigher, between and boys girls in these two countries is less than four points. These global differences mainly are driven differences by in education. In 31 of the 50 countries recentIn which for 31 have we data, the index of girls score is actually higher than it is boys, for though in most cases the difference is so small that it is not statistically significant. However, in the populous countries of India and Nigeria, girls than lower score – underlining boys through weight of numbers the significance of this issue. And in the countries that perform worst on the CDI, girls are than score a lower more likely to boys. Thus, have of thein seven ten worst performing countries of our dataset, girls lag behind boys, suggesting that in situations of extreme vulnerability, girls often are left behind. The story of gender disparities that emerges from the Child Development Index is different from the patterns described in the previous two chapters for children from ethnic minorities and disadvantaged regions. Most countries or no disparities low have between girls and in boys the development outcomes that the CDI compares. Gender inequalities are generally manifested a later at stage in life (see Figures 8 and 9). WHAT ARE THE MAIN INEQUALITIES WHAT BETWEEN GIRLS AND BOYS? Girls and women face gender inequality gender face women Girls and different violations many in and They ways. with exclusion and discrimination confront marriageregards to child education; and pregnancy; violence, including sexual violence; restricted to nutritious the access food; health and reproductive denial and sexual of therights denial (SRHR); opportunities of and unpaid and political and public life; in domestic work. unrecognised 28 EVERY LAST CHILD Democratic RepublicofCongo Boys Girls Boys advantaged Girls advantaged FIGURE 9 FIGURE Democratic RepublicofCongo available. Countriesare ranked according tolevels ofinequalitiesinCDIscores between boys andgirls. The graph compares theChildDevelopment Indexscores for girlsandboys incountriesfor whichdatais BETWEEN BOYS AND GIRLS INEQUALITIES INCHILDREN’SLIFECHANCES Boys Girls Boys advantaged Girls advantaged Dominican Republic Côte d’lvoire Burkina Faso Mozambique Timor-Leste Sierra Leon Madagascar Bangladesh Cameroon Azerbaijan available. Countriesare ranked according tolevels ofinequalitiesinCDIscores between boys andgirls. The graph compares theChildDevelopment Indexscores for girlsandboys incountriesfor which datais BETWEEN BOYS AND GIRLS INEQUALITIES INCHILDREN’SLIFECHANCES Zimbabwe Cambodia Honduras Dominican Republic Swaziland Tajikistan Tanzania Namibia Lesotho Pakistan Burundi Rwanda Gambia Uganda Zambia Senegal Nigeria Guinea Liberia Congo Gabon Bolivia Ghana Kenya Nepal Niger

Benin Egypt Haiti India Peru Mali INEQUALITIES IN LIFE CHANCES BETWEEN BOYS GIRLS AND BETWEEN CHANCES LIFE IN INEQUALITIES Côte d’lvoire Burkina Faso Mozambique Timor-Leste Sierra Leon Madagascar Bangladesh Cameroon Azerbaijan Zimbabwe Cambodia Honduras Swaziland Tajikistan Tanzania Namibia Lesotho Pakistan Burundi Rwanda Gambia Uganda Zambia Senegal Nigeria Guinea Liberia Congo Gabon Bolivia Ghana Kenya Nepal Niger Benin Egypt 02 04 06 08 0100 90 80 70 60 50 40 30 20 10 0 Haiti India Peru Mali 02 04 06 08 0100 90 80 70 60 50 40 30 20 10 0 Democratic RepublicofCongo Boys Girls Boys advantaged Girls advantaged available. Countriesare ranked according tolevels ofinequalitiesinCDIscores between boys andgirls. The graph compares theChildDevelopment Indexscores for girlsandboys incountriesfor whichdatais BETWEEN BOYS AND GIRLS INEQUALITIES INCHILDREN’S LIFECHANCES Dominican Republic Democratic Republic ofCongo Boys Girls Boys advantaged Girls advantaged Côte d’lvoire Burkina Faso Mozambique Timor-Leste Sierra Leon Madagascar Bangladesh Cameroon Azerbaijan Zimbabwe Cambodia Honduras Swaziland Tajikistan Tanzania Namibia Lesotho Pakistan Burundi Rwanda Gambia Uganda Zambia Senegal Nigeria Guinea Liberia Congo Gabon Bolivia Ghana Kenya Nepal Niger Benin Egypt available. Countriesare ranked according tolevels ofinequalitiesinCDIscores between boys andgirls. The graph compares theChildDevelopment Indexscores for girlsandboys incountriesfor whichdatais BETWEEN BOYS AND GIRLS INEQUALITIES INCHILDREN’S LIFECHANCES Haiti India Dominican Republic Peru Mali Côte d’lvoire Burkina Faso Mozambique Timor-Leste Sierra Leon Madagascar Bangladesh 02 04 06 08 0100 90 80 70 60 50 40 30 20 10 0 Cameroon Azerbaijan Zimbabwe Cambodia Honduras Swaziland Tajikistan Tanzania Namibia Lesotho Pakistan Burundi Rwanda Gambia Uganda Zambia Senegal Nigeria Guinea Liberia Congo Gabon Bolivia Ghana Kenya Nepal Niger Benin Egypt Haiti India Peru Mali 02 04 06 08 0100 90 80 70 60 50 40 30 20 10 0 6 EXCLUDED GIRLS 29 11

13 73% Richest boys 45% Richest girls boys 24% Poorest girls 4% Poorest Inequality by gender andby Inequality status economic While gender differentials in child mortality are generally unapparent, prenatal sex selection is increasing, with the spread of prenatal diagnosis million women were technology. An estimated 117 missing from the global as a result population in 2010 of prenatal sex selection, mostly in China and India. There no major are gender disparities in rates of up to stuntinghalf of below the age of five. However, all adolescent girls stunted are in some countries. Adolescent girls and women particularlyare vulnerable to malnutrition due to their high nutrient requirements during pregnancy and lactation, and because of gender inequalities in poverty. There wider are and related issues of gender discrimination that result in poorer outcomes for girls and women. In many settings, women denied are the right to make decisions about their health and that of their children, need and may to seek approval and be accompanied male by relatives if they need health services. Denial of sexual and reproductive health services significantly rights. limitswomen’s

8 47% Boys 19% Girls

6, 7 Inequality by gender by Inequality boys girls national average 34% National average 34% National average completion primary TERSECTION OF POVERTY AND GENDER IN AFGHANISTAN – PRIMARY IN

10 However, a notable exception to the However, INTERSECTION OF POVERTY AND GENDER IN AFGHANISTAN GENDERAND IN INTERSECTION POVERTY OF COMPLETION EDUCATION – PRIMARY 5 and the investments required in the 9 EDUCATION COMPLETION EDUCATION FIGURE 10 health system to ensure a continuum of care for reproductive, maternal, newborn and child health. Early marriage and lack of investment in family planning is driving early and closely spaced births, and underlies proportion a growing of maternal and child deaths. GENDER DISPARITIES IN HEALTH AND NUTRITION There similar are challenges gender over inequalities in health. Under-five mortality rates tend to be slightly higher boys, for due to innate biological differences. Progress in reducing child deaths is therefore closely connected to the challenge of maternal health and mortality Increasingly, child mortality is concentrated in the newborn period first life). (the 28 of a child’s days general pattern of higher male mortality in the under-five group is in South Asia – indicative of persistent discrimination. gender 30 EVERY LAST CHILD nine is married under 15. under married is nine 18 is she before in one and married is girls three one in countries, developing in that estimated is It EARLY VIOLENCE AND MARRIAGE GIRLS, ADOLESCENT psychologically and emotionally by child marriage. by child emotionally and psychologically both affected, be age 18 also –boys can are girls before married children 82% of about that indicate fromUNICEF –estimates involves girls generally marriage child While future. their securing and marriage) outside sex and violence sexual (eg, from them awayprotecting of as seen is at ayoung age daughters their marrying crises, humanitarian and by conflict affected or poverty in PHOTO: SUZANNE LEE/SAVE THE CHILDREN 14 For many families living living families many For and deprivation. severe even exclusion face greater and home parental their of forced may out be girls Adolescent well. as child for her and for awoman stigma major entails violence sexual of aresult as violence. 12–16 aged girls sexual to due be were to found among pregnancies of 60% Peru, in example, For countries. many in pregnancy adolescent of cause amajor is violence sexual Widespread 15 In many cultures, becoming pregnant pregnant becoming cultures, many In 16 six-months pregnant. six-months is 13 at and married was Nepal, 14, from Sita, continued opposite continued 6 EXCLUDED GIRLS 31 25 Girls in 21 22 continued 24 In Tanzania, the government should 23 particular – especially those from the poorest communities and with the least education are – often unable to make decisions about sex or to protect themselves against unintended pregnancy, with potentially devastating consequences. Many experience higher of gender-based levels violence and coercion, including sexual violence and exploitation, and increased risks of early and unintended and pregnancy, early marriage, putting their survival, health and well-being under threat. vulnerable more girls makes also marriage Early to sexually-transmitted infections – girls aged in sub-Saharan15–19 Africa between are two and six times more likely to contract HIV compared with of the boys same age. Restrictive norms, as as well institutionalised discriminatory practices, pregnant limit also adolescent girls’ access to education in many places. For example, despite continued calls from local civil society organisations, in Sierra Leone pregnant girls not to are allowed attend schools and take exams, and thus are effectively excluded from the mainstream education system. found that attending were of boys 42% school of girls. In conflictcompared situations, with 51% boys alsoare more likely to be targeted recruitment for into armed groups, and often do not back go to school again after even they demobilised. are also put an end to pregnancy testing in schools, bothallow pregnant and married students to remain in school, and take all possible steps to ensure all girls remain in school to complete their education. in Bolivia reported problems with accessing healthcare services a myriad for of reasons, ranging lack from of money to needing family treatment. receive to permission 19

17 In Sierra Leone, teenage girls 18 20 ADOLESCENT GIRLS, MARRIAGE AND VIOLENCE EARLY Pregnant adolescents’ health problems made are specificworse by barriers accessingto sexual and reproductive health information and services. These barriers can be both financial and non- financial. For example,adolescent of 93% girls Even when not resulting in death, early pregnancy increases the risk of diseases that can become a cause of social exclusion. For example, in Nigeria, girls young who develop vesicovaginal or rectovaginal fistula resultas a of childbirth are often from their forced homes their by husbands, leading to their stigmatisation. It is estimated that between 400,000 and 800,000 women in Nigeria withlive this condition, with 20,000 cases new every year. Early pregnancy among adolescent girls also increases risks to the survival and health of of all global births are theirchildren – 11% to adolescent girls, risking both the infant’s and healthmother’s and nutritional status. Compared with older mothers, pregnancy during adolescence is associated with50% a increased risk of stillbirths and neonatal deaths and greater risk of preterm birth, of babies birth- having low weight andbeing small gestational for age. It is estimated that globally there around are 3 million unsafe abortions among girls aged many resulting in deaths every year, of girls 15–19 themselves and causing lasting health problems. Complications during pregnancy and childbirth are thenow second cause of death 15–19-year- for old girls globally. account up for to 40% of all maternal deaths. At timesAt of crisis, where families depend on income their children earn through work, often are boys more likely to take on of a role breadwinner than girls, and as a result risk more at are of being out of school. Among Syrian refugees in Iraq, the Save Children EXCLUDED BOYS 7 EXCLUDED REFUGEE AND INTERNALLY DISPLACED CHILDREN

LOST CHILDHOODS, LOST FUTURES IMAD’S STORY

Fadya and her six children – Ali, Yasmeen, Nassim, His sister, Yasmeen, feels the same. “In Syria, there Imad, Alim and Alima – came to Lebanon in 2011, were schools and doctors – but none are available fleeing fighting in their home town of Homs in Syria. here. I used to go to school every day. My wish was to They fled with nothing. A week later, the home they be a teacher. had left was bombed and completely destroyed. “In Syria, we used to play and go places. Here we The family now lives in a tented settlement. Fadya can’t go anywhere. At night, I don’t walk because it’s is a single parent and has no source of income. dark. In front of our place here, there’s a big ditch. It’s difficult to walk around here.” None of her children are in school. Ali, 15, and Nassim, ten, support the family by working – The family were given registration papers when when work is available – as agricultural labourers. they arrived in Lebanon. But those papers have They earn just $4 a day. since expired; Fadya can’t afford the $600-plus to renew them. Nassim, his sister, Yasmeen, 15, and his brother, Imad, eight, all have a visual impairment. A teacher “Not having up-to-date papers affects everything,” from a local NGO comes once a week to teach says Fadya. “I can’t go anywhere, I can’t leave the disabled children at the camp, though not in winter. camp in case I’m stopped at a roadside barrier. I can’t go to Beirut to look for a school for children Imad longs to learn. “I dream of getting an with a visual impairment.” education. I want to learn. There are lots of students at the school here, but teachers won’t let me join them “All of my children are falling behind; no one cares because of my sight. I stay at home all the time.” about our needs.”

Imad, right, with his brother, Nassim PHOTO: NOUR WAHID/SAVE THE CHILDREN THE WAHID/SAVE NOUR PHOTO:

32 7 EXCLUDED REFUGEE AND INTERNALLY DISPLACED CHILDREN 33

4 8 6 Children in conflict- 5 among displaced children 7 3 rises and in refugee situations, exposed are to double that in non-conflictcontexts. average, On out of 100 die before their12 children fifth birthday conflict-affectedin situations, compared with six out of in 100 non-conflict contexts. Children, especially those living in protracted c a higher number of health risks, infectious and communicable diseases than and lower normal nutritional intakes, putting them greater at risk of the children of malnutrition. 41% In Yemen, under are five stunted because of malnutrition, with the most acute cases among displaced people. The malnutrition rate in the Doro refugee camp in in South Sudan from 12% rose in March to 18% February 2014. 2014

affected areas of out-of-school make up 36% primary agechildren worldwide. within Syria the rate is only 17%. The poorest children less are likely to attend school and complete their education in conflict-affected contexts because they more likely to are be pushed to work to help support their families. Traditional attitudes mean often are boys more likely to be seen as ‘breadwinners’ and more likely to are be forced to work than girls, putting greater at boys risk of being out of school. the At same time, girls be may from schoolremoved to take on the role of caregiver or their families arrange may them for to marry early, either as a means of protection to or a way relieve increasing financial pressures. Research carried the out Save Children by in Iraq found that school attendance of refugee children outside of camps is and boys as 51% for as low 42% girls,for while attendance rates people young for is as as low 10%. Schools in refugee15–17 camps may benot seen even as safe spaces camp – in Za’atari indicatedin Jordan, of families 25% surveyed in 2015 that they thought schools in the camp unsafe were In two Syria, years– up from 10% earlier. the school enrolment rate, which was nearly universal before the war started, had plummeted to less than 50% country-wide by 2013; • EDUCATION million refugeesThere more than are and 14 internally displaced children from crisis-affected countries. Of them, only half of the primary-aged children in school, are and just one in four is in school secondary lower at age. With 1 for many for children around the 2 e average mortality rate children for under five five conflict-affectedin situations is more than Th

HEALTH Refugee children face huge challenges in trying to access the healthcare and nutrition they need. • MISSING OUT ON ESSENTIAL SERVICES troubleChildren have accessing on may the move essential services a range for of reasons. Sometimes host communities cannot cope with the increased demand. In other situations, displaced children and their families be may discriminated against on the basis of their status and not are actively provided with specialist support and access to services. Or they be may living in refugee camps, which are often under-resourced and unable to cope with the scale of demand. Displaced families’ livelihood opportunities also drastically will have reduced either on account of crisis or their need to move around, and they not may be able to afford to access health services to the extent they able were to in the past. Children make up half displaced of the world’s people, including those living as refugees. For those children who already were suffering the effects of exclusion pre-crisis, their situation is particularly dire. These children often see their exclusion further exacerbated in conflict and crisis situations as their families more likely to are be pushed into deeper poverty, placing pressure on children to work or increasing the chances they will be exploited. Conflict,other crisis and of causes excluded of groups displacement create new exclusion face not who did Children children. thein past their options access see and life to essential services, as such health and As child education, dramatically fall away. children, displaced’ ‘internally refugees or barriers new face tothey their survival and learning: the destruction of collapse and health and schools systems; homelessness; the identity of loss papers; the and neglect of settings. refugee in needs basic world itworld is instead a permanent state of childhood. the length of conflict-induced displacement now years,estimated being displaced to average 17 is not a temporary state; FIGURE 11 EXCLUSION OFEXCLUSION CONFLICT-AFFECTED OF CHILDRENCONFLICT-AFFECTED IN SYRIA CHILDREN IN SYRIA

BEFORE THE CONFLICT

96% 95% 80% births attended by a of the population had access of children received skilled birth attendant1 to local health services2 the DPT3 vaccine3

UNIVERSAL 96% primary completion4 youth literacy rate5

AFTER 5 YEARS OF CONFLICT

MORE THAN 306,000 IN 2015 OVER 20% 2 MILLION CHILDREN OF CHILDREN children have left have been born had to cross active Syria and are living in exile since the start lines of conflict to as refugees around of the crisis and take their grade the world.6 are vulnerable to 9 and grade statelessness.7 12 examinations.8

LESS THAN 1 4 of sub-districts surveyed of public of primary health centres estimated have regular reproductive hospitals to be damaged, destroyed or closed services9 64% and 38% due to insecurity9

MORE THAN 2 of Syria’s of schools have doctors 43% 2 MILLION 1 been destroyed, 3 have fled of children received CHILDREN damaged, or the country9 the DPT3 vaccine3 are out of school10 5 occupied.10 For references see timeline endnotes 7 EXCLUDED REFUGEE AND INTERNALLY DISPLACED CHILDREN 35

PHOTO: SOUVID DATTA/SAVE THE CHILDREN 9 While national Currently, the national Currently, protection rengthen national child protection Psychosocial support child for deportees. Deported children often end up back in the dangerousTo communities they fleeing. were interrupt this vicious circle, repatriated children need stronger psychosocial and economic support specifically tailored to their needs. Focus on communities. strategies needed, are violence prevention programmes should be tailored to communities to restore the social fabric home, at in schools, and in the streets. There is no one-size-fits-all solution the at regional or national level. St systems children for in the region, child migrants intransit, and repatriated children are underdeveloped, if they exist all. at Without a place tofeel safe, children will continue to flee. systems.

• • solidarity among elites and citizens and more effective and targeted assistance from multilateral bilateraland agencies, including: • The roots of this violence deep are and there no easyare solutions. Addressing the violence requires improved governance, leadership, and But Central for American children, the crisis continues, though even there reaching fewer are Children continuethe to US flee border. violence and a lack of economic opportunities, but they more often now are detained in Mexico, rather than the at US border. While in 2014 the global media theWhile crisis covered in 2014 almost now absentextensively, it’s from US and international news. In 2014 almost 63,000In 2014 unaccompanied children sought to cross the border from Mexico into the USA. The overwhelming majority of these children came from Guatemala, and El Salvador, Honduras – three countries that experiencing are most intensesome of the violence, world’s against a backdrop of endemic poverty. Reaching the US border was a dangerous 2,000-mile trip. FROM EXCLUSION TO MIGRATION – VIOLENCE MIGRATION EXCLUSIONFROM TO IN CENTRAL AMERICA School students in Guatemala take part in a Day Against Violence workshop. 8 UNCOUNTED CHILDREN

EVERY CHILD’S RIGHT TO LEARN MITU’S STORY

“I didn’t think my daughter would be able to Save the Children opened an early years centre speak, go to school or read,” says Beauty, mother in the village. It’s an inclusive centre, open to all of Mitu. children. A worker from the centre persuaded Mitu’s parents to enrol Mitu at the centre. A Mitu, age eight, lives with her parents in a village trained teacher helped Mitu make friends and take in Rangpur in Bangladesh. She has a speech part in activities. Her parents attended parenting disability, which meant she had difficulties learning sessions, where they were encouraged to treat to talk. As a result, other children avoided her. Mitu as equal with other children. Mitu became very shy and withdrawn. She stayed indoors, on her own. “I feel very proud when I see her playing with friends and people understand her speech”, said More than 2 million children in Bangladesh aged Mitu’s mother. 3–10 have different forms of disabilities. The vast majority don’t attend any form of school. PHOTO: SAVE THE CHILDREN THE SAVE PHOTO:

When she was younger, Mitu, who has a speech disability, was kept at home. Since she started going to school her speech has improved, and she’s made friends with other children and has grown in confidence.

36 8 UNCOUNTED CHILDREN 37

3 When 2 A recent 7

8 Rates of disability tend 1 Among those children with disabilities 5 6 In Tajikistan, where overall school enrolment 4 who do manage to enrol in school, exclusion from learning persists where the curriculum has not been adapted to their needs, where teachers do not have the capacity to adapt to their needs, or where they lack access to assistive devices necessary them for to learn. disability intersects with other forms of exclusion, children often jeopardy’: girls face with a ‘double disabilities, example, for a higher at are risk of violence andneglect than girls who a disability. do not have While most countries ratified have the Convention on the Rights of Persons with Disabilities (CRPD), many states lack the necessary policy and funding Having a child with a disability is often associated with shame, or as a punishment wrong-doing. for Evidence shows that these negative attitudes a barrier are not access to educationonly to children’s but also to their participation and education. in achievement It is estimated million children that with there 150 are disabilities 80% globally, of whom and in low- live middle-income countries. Children with disabilities among are the most disadvantaged; health deprivation in their and nutrition is often In severe. poor households, children with disabilities be may further excluded when limited resources mean that they given are less priority, with a significant impact on nutrition outcomes where food resources scarce. are While official statistics and estimates are poor, children with disabilities disproportionately are represented in the group of out-of-school children. Even in countries with high primary-school enrolment rates, children with disabilities more are likely to drop out of school than other any vulnerable group. CHILDREN WITH DISABILITIES to be higher among minority ethnic groups – for example, Strait Aboriginal Islander and Torres children in Australia aged more than 0–14 are twice as likely a disabilityto have as non-indigenous children. survey conducted the Save Children by in China, in areas where projects helped have support children with disabilities to attend mainstream schools, found that some parents worried were that children with disabilities distract would other children from their studies a negative and have influence through behaviour. inappropriate displaying stands of children 97%, officially at only 12% registered with disabilities enrolled are in mainstream education. Large household surveys Some groups of children are Situational reasons: Financial constraints: Financial Politicalconsiderations: The collection of data on some groups be may highly politicised example,– for on refugees and stateless children, or where there concerns are that the identificationcertain of awareness groups and of disparities between them could lead to unrest. Argentina, France, South Sudan and other countries do not collect information on race or ethnicitypeople’s in official statics; in India the categories that used are vague. are WHY SOME DO CHILDREN GO UNCOUNTED? can Partly be costly. as a result of this, some areas of a country be may underrepresented, leaving certain groups of children – such as those living in informal urban settlements and those living in remote regions – uncounted in the data. difficult to survey simply because are they hard to findfor – example, children with disabilities who hidden are within the household or institutions; children on who the do not move register with authorities; and street children withaddress. no fixed Poor data,Poor data that disaggregated, not is an data outrightor of absence some for the of some biggest are groups challenges to the needs rights and addressing the of most Certain children. excluded children of groups be leftmay out official of statistics due to financialconstraints, or becauseof a political box situationaldecision, for reasons or (see In on this secondary draw section we below). material the to consider health education and who children those of outcomes some for oftenare in underrepresented absent or national statistics: with children disabilities, informalstreet in urban children children, settlements, bisexual, lesbian, and gay, questioning intersex and transgender, children. (LGBTQI) 38 EVERY LAST CHILD non-slum, urban neighbourhoods. Child stunting is is stunting Child neighbourhoods. urban non-slum, 3% in and 5% neighbourhoods be slum in to mortality infant estimates countries 45 of study A recent averages. city with compared children, street and settlements urban informal in living children between inequalities deep shows exist does evidence What surveys. national into feature not do who cities in living worldwide people million 250 (2013) are Carr-Hill there scarce. is areas estimates urban in children vulnerable most the on data urban, majority now being world population the Despite CHILDREN STREET AND SETTLEMENTS URBAN INFORMAL IN LIVING CHILDREN 2015 in from2.7% 2016. in 2.4% to sector the for slipped has allocation spending time, same At the rights. enjoytheir to fail disabilities with children of majority the that meant has infrastructure of a lack and disabilities with children of needs the address to personnel However, qualified of reforms. ashortage of number a introduced has CRPD, the ratified having Zambia, areality. it make to required mechanisms India. Kolkota, in track arailway to next area aslum in live family his and seven, Ahmad, 9

of rural India. rural of areas disadvantaged most the to are similar groups these among rates schooling and children, street among and slums in concentrated are highly school shelters. Only 8% of those living in informal shelters shelters informal in living those of 8% Only shelters. 5% formal only in and 14%shacks; street; the on or settings informal in were living 80% found Africa South in children migrant unaccompanied of A survey national average. the than fromschool excluded be to likely more times are 2.5 slums in living children Bangladesh, In areas. slum in conditions housing poor and services antenatal limited facilities, sanitation and water drinking safe lower to access to attributed be can This status. socioeconomic of independent areas slum in rates mortality infant higher found study same the outcomes, nutrition and health in variation some explain could this and neighbourhoods, slum in higher be to tends poverty participate in social life. social in participate develop, workand learn, to chances the girls these deny also so they by doing but harassment, sexual from them protect to at home daughters their keep 24% in non-slum, urban neighbourhoods. urban 24% non-slum, in and 37% neighbourhoods be slum in to estimated 12 In Egypt, many families living in slums slums in living families many Egypt, In 11 In urban India, children out of of out children India, urban In 13 10

While While PHOTO: CJ CLARKE/SAVE THE CHILDREN THE CLARKE/SAVE CJ PHOTO: 8 UNCOUNTED CHILDREN 39

21 In countries where 22 19 Such also may laws prohibit 23 access tocritical health information or prohibit particular forms of essential health outreach services, such as in to the these case communities. of HIV, consensual same-sex conduct is criminalised, health workers often are legally required to report to the authorities, people young leading to avoid LGBTQI using health services. to discrimination reinforce thatexist may in their households and the widercommunity. UNICEF also points out that “similar patterns of human rights abuses can be found against children whose parents perceivedare to be LGBT.” Within the household, discrimination against and stigmatisation of children and people young with diverse genders and sexualities result may in abuse and neglect family by members. In the USA, 40% of homeless youth identify In as Vietnam, LGBTQI. street work with children LGBTQI Save the Children’s has shown that less than half of these children think their families accept would them who for they are or that they can speak openly about their sexual orientation or gender identity home. at Over a third felt emotionally or physically abused their by families. A lack of availability and awareness of social services, compounded the by inability to afford those which do exist, puts these youth additional at risk. What keeps these people young on the street is a desire to as live they are, to findcommunity a thataccepts them and to escape exclusion experienced at home. A survey of LGBTQI communitiesA survey of LGBTQI in Europe found of respondents had negativethat personal 61% experiences school at related to their perceived status identifiedLGBTQI and 43% prejudice or discriminatory elements inthe school curriculum. The impact of homophobia and transphobia on mental health is evidenced well – as the are increased incidences of suicide and self-harming behaviours people. young amongst LGBTQI A survey conducted in Thailand on harassment in secondary children of LGBTQI school 56% showed reporting being bullied in the previous month. 17

16 A study conducted 15 14 UN Secretary-General Ban-KiMoon Exclusion of those who 18 “Lesbian, bisexual gay, and transgender people are all entitled to the rights same as everyone else. They too are born free and equal and I stand shoulder-to- shoulder with them in their struggle rights.” human for by Save the Save Childrenby in India street found 51,000 children in Delhi alone. Half of these children were illiterate; half of them reported having suffered verbal, physical or sexual abuse. Only 20% of these children had an ID card or birth certificate, one of which is necessary to obtain government benefits. attended school. of 28% boys of girls and 19% reported being physically hurt and many expressed xenophobia. of experiences One form of exclusion receiving increasing recognition is that experienced in all parts of the children by world and people young with diverse genders and sexualities. LESBIAN, GAY, BISEXUAL,LESBIAN, GAY, TRANSGENDER, QUESTIONING AND INTERSEX CHILDREN So little is known about the welfare of street children that do know not certain we even in any terms how many there are. Global estimates vary widely – from tens of millions to 100 million. Criminalisation of consensual same-sex conduct and stigmatising behaviours associated with such conduct – along with the mistaken belief that non- conforming identities can or changed be ‘cured’ – deny these force by people young recognition as full, equal members of society and has the potential identify or as perceived or are to be LGBTQI non-gender conforming stems from deep-rooted beliefs about sexual orientation, sexual behaviour, Stereotypes expression. gender and identity gender girlsfor and restrict boys the opportunities and choices of children and people, young and leave feelingmany excluded. 40 EVERY LAST CHILD children since 2008. children among and Aboriginal Torres Islander Strait numeracy and reading in improvement overall no than non-indigenous children non-indigenous than vulnerable developmentally be to likely as twice are than more children Torres Islander Strait and Aboriginal class. from alow socioeconomic students Torres and Islander Aboriginal Strait among particularly disadvantage, educational and low levels achievement of between link strong However, apersistently displays also it global comparisons of education attainment. of top the near ranked typically is Australia welfare systems. developed highly with even countries in present are often populations host and refugees between and genders, between groups, urban–rural and regional, ethnic, different between Disparities likely to live in an overcrowded live an in to likely home. more times are and five levels, income similar with offamilies children non-indigenous with compared repairs major requires that live ahome in to likely more times are three poverty in living children Nations First Status that found Children Save the by commissioned Astudy homelessness. and crowding suicide, health, mortality, infant quality, water attainment, educational income, family being: well- of measure every practically on children non-indigenous trail children indigenous Canada In behind. left are –being were still –and that groups minority to refer to Western context the in used first exclusion’ ‘social was term The countries. low-to middle-income and confined However, are not discrimination and exclusion we have used. indicators education and health basic the and data the of because part –in countries low- middle-income on and report We this in have analysis our focused EXCLUSION IN HIGH-INCOME COUNTRIES 27

26 and there has been been has there and 28 24 25

than poor White children, White poor than results test school better gain to tend groups majority population. majority White the in children five in one with compared poverty, in are growing up children Pakistani and Bangladeshi of half than more UK, the In children. White than health poor have levelare to likely more fair/ overall of an children Black and mothers, are White than care prenatal receive to likely are less mothers Black families. White than mortality infant and babies low of birth-weight have rates higher families Black are profound. children White and American African between disparities USA, the In non-discriminatory laws and watchdogs. non-discriminatory mature of spite in prevail which attitudes, and practices discriminatory address to need good-quality of importance the underlines It systems. education and health to access increased than more requires exclusion tackling that suggest countries wealthier in exclusion levels social of high The upon graduating from school or university. or fromschool graduating upon employment find to harder it find to continue markers of social class. social of markers for controlling even after remain differences racial colleagues in other schools. in other colleagues their as much as paid are not who experience less with haveto more likely teachers are significantly students Latino and Black and students, White than often more are suspended groups racial and ethnic fromminority students education, rather than Muslim or African. or Muslim than rather British White obviously was name applicant’s the if vitae curriculum to positively respond to likely more were far employers that found study services. And it points up the the up points it And services. 32 While poor minority ethnic ethnic minority poor While 31 33 30 ethnic minorities minorities ethnic These ethnic and and ethnic These 35 29 In terms of of terms In 34 A PART THREE A FAIR CHANCE FOR ALL CHILDREN PHOTO: KAUNG HTET/SAVE THE CHILDREN THE HTET/SAVE KAUNG PHOTO:

Ma Zon Htay Hlaing, nine, waits for emergency supplies after her village in Myanmar was flooded following a cyclone. PART THREE A FAIR CHANCE FOR ALL CHILDREN

“Social inclusion is the process of improving the ability, opportunity, and dignity of people – disadvantaged on the basis of their identity – to take part in society.”1

Achieving inclusion means breaking down three While these guarantees must apply to all children, we barriers that prevent children from realising their will measure their fulfilment in terms of how they are basic rights: financial barriers, discrimination and delivered to excluded children. lack of accountability of those in power. These Each guarantee consists of three strands, shown barriers must be tackled systematically at household, in Table 3. We note that inclusion must not be local, national and international levels. interpreted too narrowly. For some groups, such as To meet this challenge – and to achieve the prize of indigenous peoples, the right to accessing education ensuring no child is left behind – we call on leaders or health services does not necessarily translate in all countries to make Three Guarantees to into a strict definition of “taking part in society” – All Children: eg, through participation in financial or labour markets, or through mainstream education that is 1. Fair finance not adapted to their needs and rights. We ask that 2. Equal treatment each of these strands be adapted to the country and group context. 3. Accountability

TABLE 3 THREE GUARANTEES TO ALL CHILDREN

1. Fair finance 2. Equal treatment 3. Accountability

Increased public revenue, Laws and policies to remove Better data disaggregation collected and spent equitably, discriminatory barriers to and supported internationally services

Remove cost barriers Public campaigns to challenge Governance at all levels to services norms and behaviours includes children

Minimum financial security for Every birth registered Budget transparency and all children monitoring

42 PART THREE: A FAIR CHANCE FOR ALL CHILDREN 43 ADDIS ABABA – ACTION AGENDA DEVELOPMENT SUSTAINABLE FINANCING UN MemberIn July States 2015, met in Addis Ababa, Ethiopia, the for third international Financing Development for Conference (FFD) and reached agreement on its outcome document, the Addis Ababa Action Agenda. FFD outlines the commitments that to are be taken by partnership in and individually governments to secure adequate and fair financing of sustainable development. FFD gives strong attention to and recognition of the importance of investing in children. Countries committed to deliver social protection, including floors, and essentialservices for all. This included focus “a on those furthest below the poverty line and the vulnerable, persons with disabilities, indigenous persons, children, youth and older persons.” And it also included encouragement all for countries to “consider setting nationally appropriate spending targets qualityfor investments in essential public services all,for including health, education, energy, water and sanitation”. The FFD reaffirms existingcommitments to Official Development while Assistance(ODA), calling heightened for focus on national and international tax matters as a crucial driver for sustainable development. For the first time, an FFD outcome document also includes a control national strengthen to “commitment mechanisms, such as supreme audit institutions along with other independent oversight institutions”, and to “increase transparency and equal participation in budgeting processes”. The Sustainable Development Goals 2 Going forward, governments will be required to accessibleprovide and timely data on the extent to which the goals and targets being are met for all relevant social and economic groups, including income,by sex, age, race, ethnicity, migration status, disability and geographic location, to ensure that the 2030 Agenda truly transforms our the for world better. Most the crucially, agreement that all of the targets should be met “for all nations, peoples and all for segments of society” is of paramount importance – it delivering is by on this commitment that the no-one leave behind principle will become a reality the for world’s most excluded children. (SDGs) promise to(SDGs) correct this oversight, placing equality the at heart of this next period of development and promising to “Leave No One central been has commitment This Behind”. to the global discussion and is a significant shift in the the way international community approaches development. Because the MDGs focused on average progress across the world, they stark hid inequalities in outcomes children, for allowing them to persist and sometimes – a country grow that a saw reduction in poverty on actually average may have seen poverty increase some for excluded groups of children. SUSTAINABLE DEVELOPMENT GOALS – NOLEAVE ONE BEHIND UN Member States agreed September 2015, In the 2030 Agenda Sustainable for Development – an ambitious blueprint people for and planet years. the for The next agenda 15 features 17 Sustainable Development Goals an integratedand 169 targets: and indivisible package of measures to advance the job of the Millennium Development Goals (MDGs), end poverty and hunger everywhere, tackle inequalities and build just and inclusive societies. 2030 AGENDA FOR DEVELOPMENT SUSTAINABLE AGENDA 2030 AND FINANCING DEVELOPMENT FOR 44 EVERY LAST CHILD Kikwete. At various events – including a press apress –including events various At Kikwete. Jakaya our TanzanianHon. including President, of Tanzanian stakeholders, numerous to children messages the delivered and Malala with Ceremony Opening Assembly General UN the in participated of Save the Children, representatives child different my New York experiences with I shared “In City, of Tanzanian lives the children. better and Goals Development new Sustainable the implement to leaders our country’s Can’. challenges song This Tunaweza’, ‘Pamoja called asong in or ‘Together We Tanzania in rapping and leaders youth writing 80 and over with by meeting America for myto journey 70 New York in Iprepared Assembly City. General of Tanzania Nations United the at representative child 2015, September “In the be me to elected my peers children’sand rights. education about articles writing enjoy and Network Young for Zanzibar’s Reporter areporter also “I’m mapping. body like activities through struggles and emotions their how and express to ARVs properly how take their to children Iteach health. manage their how play, to to learn and study, for HIV+ children space asafe offers Our club same. the are children abuse– because and all discrimination stigmatisation, of eradication means which of 0–3, goal the reach to the government for fighting Iam activist, children’s and rights chairperson ZAPHA+ “As the theft. and labour child sex, unprotected use, drug like activities dangerous in involved become children many Therefore, by society. isolated and stigmatised HIV/AIDS are with living Children of stigmatisation. obstacle the faced with are that children is Zanzibar of Tanzania challenges main of the “One and Tanzania. in children facing challenges the about events spokeat various she where Assembly, General UN at the representative 2015 In HIV/AIDS. Tanzania’swith was she child Living People of Association Zanzibar – the children’s the of ZAPHA+ club, chairperson 17, age Suhaila, fromZanzibar, is Tanzania, SUHAILA’S STORY FROM EXCLUSION TO INCLUSION the world.” the around all from children with collaborate to and messages these deliver HIV.to Iwasexcited so with living of children stigmatisation and children against violence supplies, education in shortages – including of Tanzanian challenges the I spoke about children Foundation – Gates &Melinda Bill for the conference

Suhaila, age 17 age Suhaila, activist rights Children’s PHOTO: BENJ BINKS/SAVE THE CHILDREN THE BINKS/SAVE BENJ PHOTO: 9 FAIR FINANCE

Financial barriers – at the household, local, for instance, health funds are allocated according national and international levels – are a major to population levels – whereas remote areas, with obstacle to children’s inclusion. high needs, are less populated. Education funding is allocated according to the number of government schools in an area, so less funding goes to districts CHALLENGES with few schools, exacerbating inequities.4 High direct, indirect and opportunity costs Inadequate resources: Insufficient, inefficient mean families in excluded groups are often unable and unequal public investment in essential services to afford the basic services their children need to means that for many excluded children, basic health, survive and learn. In addition, children and their nutrition and education services – essential to families also need a minimum level of financial children’s survival and development, and which all security. There is broad consensus “that even tiny children have a right to – are simply not available. out-of-pocket charges can drastically reduce the use At the national level, there are several reasons of needed services.” 5 why countries fail to raise adequate resources. These include their economy and labour market structures (for example, a large agricultural economy and a SOLUTIONS low level of urbanisation are often associated with low tax-take1); the design of the tax system; and the We are calling for action in three areas in order to capacity of the tax authorities. deliver Fair Finance: • Increased national and international public At the international level, there are further revenues, collected and spent equitably significant barriers to increasing revenues. For • The removal of cost barriers to basic example, according to the United Nations services Conference on Trade and Development (UNCTAD), • Minimum financial security for all children developing countries lose about $100 billion annually in tax revenues due to inward investments being routed through offshore financial centres.2 Inequitable government spending: National Fair Finance draws together numerous budgets are too often inequitably distributed, commitments that have already been made resulting in regional and local governments lacking around investing in children and financing for the financial resources to reach or cater for excluded development. Most recently, the language of a children. For example, in Rwanda, investment in ‘social compact’ has been used in the Financing primary education has been consistently reduced for Development process associated with the over eight years, while spending at secondary level SDG launch. Save the Children is building on has increased, and the share for higher education has this momentum by setting out the following remained high – a regressive shift in spending.3 key actions required if we are to meet The national distribution formula to distribute the guarantees. resources to the local level is crucial. In Uganda,

45 46 EVERY LAST CHILD of all children in the classroom. classroom. the in children all of needs the meet to services additional delivering and diversity embracing in are supported teachers ensure –to conduct of codes and curricula meaningful materials, teaching adequate need, in most children for teachers best the attract to providing incentives and teachers, training includes also It schools. quality for girls and children in rural areas. areas. rural in children and for girls particular in rates, drop-out reduces fees Abolishing Tanzania Uganda, andMalawi, Timor-Leste, Zambia. Kenya, including countries, many in groups excluded of enrolment the increased has and enrolment on impact astrong had fees school of abolition The learn: to chance the child every Giving taxes in GDP of 20% 13% collect only present countries low-income of At compliance. improving and systems tax their by revenues reforming domestic more far mobilise means: progressive through tax-take the Increasing AND SPENT EQUITABLY COLLECTED REVENUES, PUBLIC INCREASED increase insectors. in investment social increase 14.9%to 2013/14 in asignificant to –contributing 2001 in from10.8% increasing ratio tax/GDP the with – decade last the over significantly increased have revenues tax Rwanda, In possible. is Change poor people. VAT,as on burden adisproportionate place which such taxes, regressive and indirect than – rather property and wealth income, on levied –those taxes considerations, by focusing on direct and progressive equity tax on act also must Governments REMOVE COST BARRIERS TO ESSENTIAL SERVICES TO ESSENTIAL BARRIERS COST REMOVE proposed by experts. proposed and 2010. 2003 from12%revenues 25% to between GDP of tax its doubled than more Georgia – for example, intake tax their increasing in successful exceptionally at those most in need, in most at those targeted funding per-pupil includes this education In levels. local and regional to distributed equitably be spending: National Equitable ownefforts. their support to aid development require to continue will countries poorest the And reforms. financial other with along tax avoidance flows and financial illicit stem to action public revenuesinternational increase without to able be not will Poor well. level countries as international at the supported be to needs This At the national At the 9 6 7, 8 7, – a minimum tax intake intake tax –aminimum 11 Some countries have been have been countries Some and providing enough providing enough and level, many countries could could countries level, many budgets need to to need budgets 10

• approached.” is goal that as up catch and wait to having than rather coverage, universal way towards the of step at every off are better who those as much as least as gain are poor who “people that ensure to ‘progressive seeks universalism’; which of notion the embrace to need UHC of Systems steps towards UHC. have taken countries 100 low- middle-income and than More poverty. into people pushing without services health essential to for all access ensuring means (UHC) coverage health universal SDGs, the coverage: health Universal • national countries’ To UHC, towards progress genuine make addressed. be to need also services, of quality as such issues, other many critical, is access to barriers financial of elimination and reduction (86 pupils per teacher). areas rural of expense at the teacher) (46 per pupils areas skewed urban highly toward was teachers 2013, in Malawi, of In deployment areas. the those provided in services of quality the on impact a huge with countries, many in proven challenging has areas remote –in workers health –and teachers Retaining skills. maths and literacy even basic learning without school complete and teachers undertrained with overcrowded classrooms households poorest the in for those particularly diminished, are therefore school attend to for children incentives the and teaching, of quality the of expense at the come often provision have school primary in expansions Wide education. on have effects positive livelihoods family improving policies and Programmes groups. excluded and by poverty affected children on impact costs informal these as needed also is transport of cost and textbooks uniforms, as such inequalities. widen fact in can fee-abolition poorest, very the reach to measures other without out carried if household the workto contributing not of cost opportunity the –and uniforms and – books materials school of costs the to due poorest for the costly too However, be can education even fee-free

use. of point the at free Be conditions that affect particular excluded groups groups excluded particular affect that conditions Health systems. information and technologies health governance, workers, health financing, to –fromdelivery services health of design the Se need to be prioritised to reduce these inequalities. these inequalities. reduce to prioritised be to need through access equitable ensure to ek UHC plans must: plans UHC 12 Lowering indirect costs of education education of costs indirect Lowering 14 13 . Many children sit in in sit children . Many Now a target in in Nowatarget 15 But while the the while But . Indeed, . Indeed, 9 FAIR FINANCE 47

21 This 23 economic and and Bolivia and 20 Suchinterventions also 29 22 Mexico 19 It also means that newly created economic 24 can be an effective tool income for re-distribution to promote inclusive growth – and fair finance. Inclusive growth equitably distributes jobs and wealth. This includes investment in agriculture and labour-intensive sectors, regional economic policies to address spatial inequalities and equitable access to credit. It is critical that humanitarian financing systems mobilise more financialresources response in to early warnings tomeet the full range of needs experienced children by in emergencies. Reforms to the global financing architecture must consciously needs prioritise and children’s their rights, in a transparent, participatory and accountable manner. Child-sensitive social protection takes into account the and views voices of children and their caregivers, including analysing and monitoring children age, by gender and different types of vulnerability. Social protection programmes delivered the have big dividends excluded for groups, with the cash transfers programmes in Brazil, perhaps most widely celebrated.While not always targeted specifically towards excluded groups, they disproportionatelyhave benefited excluded children because of theirfocus on the poorest. Furthermore, where cash transfers given are directly to women, there is evidence to that show social protection can contribute empowerment, to women’s increase their self-esteem and ultimately induce greater gender equality the in household. prosperity is redistributed in ways to increase access services. essential to bring long-term benefits for national benefitsfor long-term bring development.social usually the first ones respondto to crisis, find ‘themselves the at end of a chain of middle-men and consequently face delays in receiving the funding needed to begin operations’ when it comes to multilateral administered pooled funding humanitarianfor response. 17

27 level 16 financial pooling. financial pooling. to ensure services Funds often are not 28 18 26 health insurance system covers – for UN-coordinated – for appeals alone the 25 % increase in girls passing secondary school 6%) in chronic malnutrition6%) among child Also, on average, education receives less than of humanitarian2% aid. In crisis situations, child protection is one of the lowest-funded sectors. In of 2009, only 32% estimated total requirements funded. were FAIR FINANCEFAIR IN CRISIS AND CONFLICT SITUATIONS The humanitarian system aid is under great strain owing to the increasing numbers of people affected crises. by Despite a record US$24.5 billion in international humanitarian the shortfallassistance in 2014, continues to grow flexible enough adaptto to protracted and NGOs, onsetslow who are crises. Moreover, shortfall or 38% of billion was in 2014, US$7.5 total requirements. immunised in Peru after receiving cash transfers 98% of the population and includes subsidies thefor poorest people, while combining local Take targeted measures Take are accessibleare and appropriate excludedfor groups, within a system of UHC. For example, Rwanda’s national with national accountability nine percentage point to decrease 55% (from 4 participants Mchinji of Malawi’s Social Cash scheme pilot.Transfer 24 30% increase in the number of children after receiving a stipend in Bangladesh

• • There is a strong body of evidence that well-designed and well-delivered social protection programmes can lead nutrition, to improvements in children’s health and education – and reduce the risk of abuse, exploitation and neglect. For example: • itself. itself. MINIMUM FINANCIAL SECURITY FOR CHILDREN ALL Much of the most important work to make finance fairer needs to take place the at household • 10 EQUAL TREATMENT

Excluded children are also being left behind embedded phenomena; change requires substantial because of inherently discriminatory social additional efforts. norms, economic policies, and discriminatory Uncounted children: The right of every child to laws, which stop children from surviving exist is both a symbolic and practical starting point by and learning. which to ensure equal treatment. Yet many children are uncounted, and hence excluded from essential services and exposed to danger (see page 37). CHALLENGES Low birth registration can be explained by a number Discriminatory laws and policies: At the local of factors – most notably weak state institutions level discrimination at the point of service delivery and infrastructure and a lack of awareness among – a health facility, for example – is a significant issue the population. Cultural and social norms also seem facing excluded groups. It includes health workers to impact birth registration on an institutional level, sometimes targeting people in specific groups for since in many countries, such as Bhutan, Bangladesh, bribes and informal user fees – as reported in India, Sierra Leone and Sudan, children of unmarried West Africa and Guatemala.1, 2, 3 mothers or of absent fathers cannot register. Excluded children also face huge disadvantages in education – as described in Part Two of this report. SOLUTIONS For example, girls may face the threat of violence at school. In disadvantaged regions of a country, the Recognising that changing social norms and attitudes quality of education may be poor. Children from ethnic requires a longer time frame than a three-year minorities and indigenous groups are often taught and campaign, we are calling for action in three areas in tested in a language they speak poorly and are denied order to deliver Equal Treatment for all children: education in their mother tongue. Indigenous peoples • Laws and policies to remove discriminatory are often sceptical about an education they see as barriers to services irrelevant to their own context and culture. • Public campaigns to challenge norms and Addressing discrimination is complex because there behaviours are so many varieties of discrimination, directed • Every birth registered against so many different groups, and it often involves changing deeply embedded and longstanding social LAWS AND POLICIES TO END DISCRIMINATORY and cultural norms. Specific measures are needed BARRIERS TO SERVICES so that discrimination is tackled through budget Protecting children’s rights through the law: allocations, through service coverage for targeted At the national level, there are different legal groups, through participation of excluded groups in and policy mechanisms governments can use to decision-making, through disaggregating data, and help realise human rights and ensure accountability. through addressing stigma and negative attitudes. An obvious starting place is a constitution or Discriminatory norms and types of behaviour: foundational legal documents recognising and Removing or changing explicitly discriminatory articulating the full breadth and depth of human laws and policies can be done with a stroke of rights. Alongside this, countries should adopt and a pen. But that is just the first step. Social and ratify all of the major international human rights cultural discrimination are persistent and deeply treaties and where necessary incorporate them into national law. Accountability also requires the effective

48 10 EQUAL TREATMENT 49 And coordinated interventions And coordinated 7 6 of excluded groups and – correct issues that may undermine their rights. example, For development projects often have failed to recognise the specific rights of indigenous people concerning their ancestral lands, and their right to free, prior and informed consent concerning projects affecting them or their lands. For children excluded from groups, transforming schools into hubs other for services a can have profound impact. For instance, girls’ enrolment increased in rural India due to a large-scale midday meals programme. Inclusive policies in education: In education, inclusive policies needed are that support teachers to embrace diversity and meet the needs of all children in the classroom. For example, policies to increase the retention of girls in school include creating girl-friendly teacher formal providing and environments school training in subject content, pedagogy, classroom See management, sensitivity. gender and inclusion on supportingalso the on page box 14 children from indigenous minority or ethnic communities. combining nutritional support, responsive feeding support, nutritional feeding combining responsive andstimulation and early learning been have found to counteract the effects of poor diet on learning and development. cognitive discrimination kind, of any irrespective of the or his or her parents’child’s or legal guardian’s sex, language,race, colour, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status. 2. States Parties shall take all appropriate measures to ensure that the child is protected against all forms of discrimination or punishment on the basis of the status, activities, expressed opinions, or beliefs parents, of the child’s legal members.” family or guardians, Other treaties, including the UN Convention on the Rights of Persons with Disabilities, the UN Convention on the Elimination of All Forms of Discrimination against and the Women, UN Declaration on the Rights of Indigenous Peoples theirhave own clauses on discrimination. 5

4 “1. States Parties“1. shall respect and ensure the rights set forth in the present Convention to each child within their jurisdiction without The right not to be discriminated is well established in international human rights law. It forms the basis of the foundation of the UN: The Charter of the United Nations of 1945 established that the UN shall promote “universal and observancerespect human of, for, rights and fundamental freedoms all for without distinctions as to race, sex, Later language and religion”. treaties art. The UNCRC’s further. go 2, which also serves as one of the principles four core implementationfor of the convention, includes discrimination based on parents’ status or convictions, as as well discrimination based on, social others,among disability, opinion, political origin, et al. Article 2 states that: NON-DISCRIMINATION AND INTERNATIONAL HUMAN RIGHTS LAW HUMAN RIGHTS INTERNATIONAL AND NON-DISCRIMINATION Assessments should affected allow communities to participate in decision-making processes that affect their lives, and promote and protect the rights Some countries also opted have oversight for bodies such as national human rights commissions that may serve to catalogue systemic discrimination and human rights violations and as accountability mechanisms – such as the National Human Rights Commission of India. For example, the constitution of South Africa includes an entire section (Section27) articulating and protecting social and economic rights, such as the rights to health, education and housing. This section has been usedhuman by rights advocates andothers to successfully identify and remedy discrimination health,in other housing and areas. rule of law, through therule functional of law, division of powers and an independent and competent judiciary. Policies to protect children’s rights: Some countries begun have to require human rights impact assessments before putting into place policies that significant have may human rights impacts or when certainreviewing policies. For example, the Canada– AgreementColombia Trade Free requires an annual human rights impact assessment. 50 EVERY LAST CHILD Our early childhood development and education education and development childhood early Our Tanzania. and Sudan Nigeria, Ethiopia, in plans education specific nomadic to leading governments, and increased opportunities with recognition from communities have pastoralist in provided children programmes learning Flexible children. street or communities frompastoralist those displaced, or by crises affected those children, poorest the as such activities labour in engaged be to likely more those particular, –in children excluded most the reach to important be can for education timing Flexible development. language community-based and group by language classrooms multi-grade organising include strategies effective low-cost example, for themselves– peoples indigenous from coming local to given be to needs attention More translated. merely not and context, local to relevant are so they developed be to need curricula peoples, indigenous to relevant education make to order In recognise the vocabulary of the lessons and texts. texts. and lessons the of vocabulary the recognise are to likely and more instruction, of language that in letters more – know at home language different a speak who children with –compared at home instruction of language the speak who children those that shows countries four in programmes 12 Figure in data The Children –fromSave the at home. speak they language the than different is school in instruction of language the that is learning to challenge additional an backgrounds, ethnic minority or indigenous of children many For TO TACKLINGSAVE EDUCATION BARRIERS CHILDREN THE LINGUISTIC Percentage of students AT HOME INSTRUCTION OF 12 FIGURE 100 80 40 20 60 0

Indonesia 77% PE (n=672) RCENTAGE OF ALPHABET KNOWN AT BASELINE BY SPEAKING LANGUAGE LANGUAGE BY AT SPEAKING KNOWN RCENTAGE BASELINE ALPHABET OF 69%

Guatemala 75% (n=557) 54% solutions

Pakistan 86% (n=149) and participation. children’s promote to order in understanding at and school, at home used languages two the across children’s understanding support teachers we help for example, Nepal, In context. the on depending strategies of arange using schools, We support change. also systemic creating key is to advocacy This critical. is instruction of language the speak not do who children supporting that understand staff government and trainers teachers, help programmes Our environment outsideclassroom. the learning enriching an create to supported be should communities and Families crucial. is classroom the of outside learn to have opportunity children the Ensuring grade one enrolment. grade a21% in resulted children, in increase non-enrolled with families identify to mapping community and partnerships, of facilitation and planning district national strong included which initiative, Welcome the School to for example, Nepal, In school. in enrol to groups disadvantaged encourage to important be can campaigns school’ education: around attitudes Changing AND BEHAVIOURS NORMS TO CHALLENGE CAMPAIGNS PUBLIC involvement. community through is groups excluded reach way to effective most the that have demonstrated programmes 67%

Philippines 38% (n=739) 27% 8

level advocacy, advocacy, level instruction at home instruction school of language speak not Does at home school instruction of language Speaks 9 ‘Back to to ‘Back 10 EQUAL TREATMENT 51 ildren’s perceptions of genderildren’s roles ys advocated with their parents their for rticipants more optimistic were about rticipants much were more confident their future. Bo Ch Pa theirdiscussing feelings promoting and gender equality in their lives. Pa sisters’ education and delayed marriage. altered,were with more acceptance of non-traditional roles. gender

those addressing the human rights of excluded groups, such as women, children and people living with disabilities served – have to acknowledge the depth and extent of particular challenges and to set global norms with regards to these groups. In turn, communities that discriminated are against are governments. to claims make to empowered An adapted version of the activities is being used in Egypt and there plans are to implement Choices in Ethiopia and Bolivia. Choices is part of a programme partnership between the Save Children and the Georgetown Health. Reproductive Institute for University’s • • • • committed activists and joining updifferent sectors, Girl Generation has helped make FGM a global issue. the GambianIn President 2015, declared FGM illegal; this campaign an played is believed to have important role in that decision.

11 14 , regional on female genital 10 , national level has level the effect levels. Teams are spread are out levels. Teams

12 bout continuing their studies and avoiding early marriage. early Girls felt empowered to talk to their parents a

Over three months, the intervention targeted years old – almost to 14 603 children from 10 equally divided between girls and boys. Eight activities carried were out, designed to stimulate discussion and reflection between girls and boys. In Nepal women and girls face may discrimination castebased or ethnicity, on gender, and they can be exposed to various forms of psychological or physical violence. The evaluation significant showed improvements in attitudes and behaviours towards gender: • CHANGING CHILDREN’S ON GENDER ATTITUDES IN NEPAL The Choices intervention has been developed in the Siraha district region in Nepal of the Terai – where there high are rates of early marriage, early child-bearing and dowry – to challenge restrictive norms and promote gender equity. The Girl Generation project GIRL GENERATION GIRL mutilation (FGM) is a public awareness campaign that aims to change perceptions about FGM and bring about change local at and international across many countries in Africa. Bringing together of highlighting the issue as legitimate and significant. Global norm-setting and associated campaigns – much of which takes place the at UN or through UN-related mechanisms therefore – are essential in combatting exclusion. For example, the major international human rights treaties – particularly Using inclusive global norms: Recognition of a problem the at international 52 EVERY LAST CHILD • in Algeria, Colombia, Namibia and Venezuela. Namibia Colombia, in Algeria, results excellent produce to said been has services have resulted in increased registration in Ukraine in registration increased in have resulted child’s the to family directly paid incentives monetary to registration, barriers remove to financial order In and Bangladesh. to health services. health to improved require access may also facilities health at birth of registration increasing groups, excluded • • • • are similar. example: For are needed that actions the suggest stories success approaches, different require and issues different present countries different While registration. birth have increasing in proven steps successful Several EVERY BIRTH REGISTERED

and national and registration practices. registration pu immunisation centres and wards maternity as such services, health in pr re registration birth to fa cilitating access – whether financial or physical – physical or financial –whether access cilitating tegrating registration units in existing existing in units registration tegrating moving institutional and legal barriers at local barriers legal and institutional moving omoting awareness-raising campaigns awareness-raising omoting tting in place cost-effective and innovative innovative and cost-effective place in tting 17 levels Siting registration centres in health health in centres registration Siting 15

18 For For 16

available to them. to available lessons the with up catch to assistance special need or anew curriculum, are facing instruction, of language the speak not do often children Refugee education. in particularly transition, them help to necessary be also may children for refugee provisions Special article 22. UN education secondary in aliens refugee non- to given that as favourable as at least treatment and education, primary in nationals as treatment” “same the receive must refugees that stipulates Refugees of Status the to Relating Protocol and Convention The social norms. do discriminatory as countries, many in persist children IDP and refugee laws andDiscriminatory policies towards AND CONFLICT SITUATIONS EQUAL TREATMENT CRISIS IN 19 11 ACCOUNTABILITY

Decision-makers’ accountability to excluded that development aid can be misused for political groups under the SDGs must be far more gain rather than investing in the realisation of social comprehensive than that which existed and economic rights. This can come in the form of previously under the MDGs. Children and outright corruption, or in the form of discrimination marginalised groups must have opportunities on the basis of political opinion in the distribution to play a central role in holding decision- of aid, and investing in areas where politicians will most benefit rather than investing in the areas of makers to account – at local, national, greatest need. People have also been excluded regional and international levels. from development programmes, deliberately or Involving children is good for their own development inadvertently, because of their religion, ethnic and for improving their engagement in future background, gender, sexual orientation or disability, political processes. It is also good for development amongst other grounds. Because of the weakness of effectiveness and outcomes. And it is vital to tackling international enforcement mechanisms for human exclusion and to achieving the SDGs. rights violations and considerable legal barriers, such as jurisdictional issues, accountability at this level remains limited. CHALLENGES Lack of data – and understanding – about Disadvantaged children’s exclusion from excluded children: The accountability void that decisions and choices that affect their lives: often exists between governments and excluded The first two Guarantees – Fair Finance and Equal groups can stem from a lack of acknowledgement Treatment – both require greater participation of the challenges faced by excluded groups (see of excluded groups, including children, in policy chapter 8, page 37). For example, very few countries making and budget allocation, as well as greater collect or publish data that are disaggregated accountability towards these groups by policy makers by ethnic or religious groups, or by relevant and budget holders. geographical level. A common feature among excluded groups is their Ignorance of the exclusion of a particular group is lack of voice and political representation in decision- not an excuse for government inaction. Governments making bodies. For excluded children and their have a human rights responsibility to ensure that families, a lack of voice and political representation they collect sufficiently disaggregated information to can in many ways exacerbate exclusion and understand which groups may be excluded and how widen inequality. they may be excluded, in order to design policy and programme solutions that remedy such exclusion. Lack of international accountability to The SDGs and associated ‘Data Revolution’ 1 have excluded groups: At the international level, put disaggregated data at the top of the development donor money is often not allocated to support agenda, but governments must have the political will building universal public services that excluded groups to commit necessary resources. would benefit from. There is also evidence to suggest

53 54 EVERY LAST CHILD • school student councils. According to UNICEF, UNICEF, According to councils. student school strengthen and create to Ecuador in provinces several in adolescents supports Children Save the clubs. and groups and parliaments assemblies, children’s include instruments inclusionary Some exclusion. social reduce to demonstrated benefits. economic long-term in result and citizenry engaged and active an build services, essential to access improve to shown children’s been has Participation villages. these in for teenagers reduced pradhan afemale to exposure of seven years about After for women. (pradhan) councillor chief of position the have reserved villages some India, In norms. cultural exclusionary address and inequalities group-based decrease to help both can structures decision-making Local-level CHILDREN AND GROUPS EXCLUDED GOVERNANCE AT INCLUDES ALL LEVELS radar. the beneath exist to continue can exclusion of challenge the inequalities, these about account to governments hold to Unable problem. the of nature precise and extent the of oblivious are representatives society civil and researchers data, these Without absent. mostly –is children street well as as groups; caste and religious ethnic, persecuted disabilities; particular,in with children – bygroups excluded disaggregation where data, national to further extends often invisibility are reviewed that regularly. Administrative data up-to-date requires turn in which accountability, effective requires protection social child-sensitive inequalities, address to example, For policies. inclusion of impacts and coverage the consider to also but levels inequality, of the understand to help only would not data Disaggregated (see 37). are ‘uncounted’ page who children facing challenges the 8we explored chapter In DATABETTER DISAGGREGATION • • Accountability: improve to areas three in We for action are calling SOLUTIONS

groups and children children and groups Bu Go Be tter data disaggregation disaggregation data tter dget transparency and monitoring and transparency dget vernance at all levels includes excluded excluded levels includes all at vernance , the gender gap in aspirations was sharply sharply was aspirations in gap gender , the 3 In short, meaningful participation has been been has participation meaningful short, In representation of excluded groups in in groups excluded of representation 2 survey survey improving the space for women in political debate. in for women space the improving in critical is concessions make to elite political the of awillingness and activism strong of a combination that suggests analysis economy have Political mixed. is However,world. they impact how on much evidence acrossthe use are now common in governments local At the to education and protection. and education to rights for their advocate involved to able have been adolescents the as building, for capacity aspace as have and served schools the in implemented practices and new policies monitor have councils helped these reinforce inequalities. entrenched not must decision-making in children’s engagement support to Strategies events. or activities public in consultation among a limited number of individuals of instances selective fromin apart successes, these into incorporated have been not disabilities However, Albania. in with children celebrated been has decision-making in role for children astronger and parliaments youth of creation The debt or climate, to name a few. name to climate, or debt (or such) of lack trade, on agreements global in or and Bank, IMF the World as such institutions financial international arewithin found power imbalances Similar are absent. countries voices developing of the where OECD, or areG20 convened byreform the tax on discussions current the of Many children. the world’sto vulnerable most answers and field a level playing creates that system tax aglobal need we short, In systems. tax progressive and robust build to them enable and needs their reflect policies which in asystem how we to create practices tax harmful of effects the mitigate countries developing from how conversation the in a shift we need tax, On annual basis. on an this publish should Donors location). geographic and disability status, migration ethnicity, race, age, sex, (income, Agenda 2030 the in out set as groups, excluded on ODA has impact the of terms in analysis distributional by undertaking aid takes that journey follow and the spend they what publish to We donors excluded. would encourage (ODA)most the on assistance development official of impact the to consider be would step A first mechanisms. reporting human rights international through including excluded to groups, accountable international the which in ways of are anumber There and national and community can be made more more made be can community levels, gender quotas in in quotas gender levels, 4

6 5 11 ACCOUNTABILITY 55

decision- 11 7 In Brazil youth participation in 10 government institutions are explicitly explicitly are institutions government al ildren engaging are more local blic service provision has in a improved rious complaints – including cases of sexual Se harassment, physical punishments, child marriage, and rape been have submitted to the authorities andsuccessfully up. followed Loc Ch making processes through participating in planning and budgeting meetings, and open budget sessions. Pu number of areas – including financial support vulnerablefor children and of provision school uniforms and books. taking account of children who in their live communities, including in budgeting – for example, funding was allocated in 2014–15 the“to well-being improve of poor and disadvantaged children and their families.”

identification of gaps in funding community-ledof initiatives. budgeting has resulted in an additional allocation of $760,000 to children and people young in 2005 in the Ceará region. This entails a comprehensive budget analysis and effective measurement of budget transparency and participation. Budget monitoring tools particularly are useful in identifying specific issuesrelated withgender and children. For example, drawing on the call of the 2006 Paris Declaration Monitoring Survey the for need moreparliamentary for engagement in budget Budget monitoring initiatives civil led by society and others can effectively promote budget transparency identifyingby and detailing ‘the distribution of actual inputs, activities and outputs’ in order to make budgets accessible and comprehensible. • • participation; and mobilise existing localparticipation; mobilise and government resources. A long-term step is to create Index’ a ‘CFLG that can ‘measure and track progress on the child-friendliness of local institutions’. governance The project has had a number of successes: • • -level government and civil civil and government In the specific case 9 Being part of the process gives 8 In the short-to-medium-term, this project aims to institutionalise child participation; include a specific mandate focusto socialon development of children in budget and development plans; increase government funding child for CFLG alsoCFLG raisesrights awareness of children’s and participation with local society organisations.For example, it supports civil society in budget tracking, mass awareness campaigns and equitable safety net targeting. Issues the initiative include covers children’s rights, social safety nets, complaint and response mechanisms, local budgets. and governance. The Child Friendly Local Governance (CFLG) initiative in Bangladesh aims to ensure an improvement of services andof accountability of government the for rights of children through participationfacilitating children’s in local Bangladeshhas around 64 million children, but the country lacksan appropriate formal framework that includes them in decision-making processes, that disempowers demographic divide a creating anddisengages children from a very early age. GIVING CHILDREN IN BANGLADESHVOICE A of youth participation, in Argentina, example, for municipalitya undertook participatory a youth budget that included around 1,000 youths annually from several different districts, which led to the Several experiences of participatory budgeting very proved successful.have first-handaccess to budget information that may otherwise be available. not BUDGET TRANSPARENCY AND MONITORING AND BUDGET TRANSPARENCY One of the most often quoted ways of increasing budget transparency is to guarantee informed or Participatory processes. budgeting participatory budgeting process which is “a by citizens, either may associations, civic through or as individuals voluntarily and regularly contribute to decision- making least at over part of a public budget through an annual seriesof scheduled meetingsof government authorities.” 56 EVERY LAST CHILD to ‘ensure availability and accessibility of essential, essential, of accessibility and ‘ensureto availability commit to able was it And children. and for women provision service specific in gaps identify to able was women’s on resolution children’s and Union health Tanzania and 2012 –the Zambia Inter-Parliamentary in done research on –based review advocacy and planning humanitarian responses andplanning in humanitarian needs –in neglected often –and important particularly is children’s and participation Accountability to internal and external stresses. respond to able least are and the instability, and violence to vulnerable most aregovernance the and legitimacy institutional weakest the with Countries exclusion. their addressing and services essential to access key be their improving will to states fragile in governance effective promote and institutions strong build peace, sustainable foster to efforts targeted crisis, in living children For CONFLICT SITUATIONS AND ACCOUNTABILITY CRISIS IN TO CHILDREN EXCLUDED is chronically underfunded. and response humanitarian in prioritised usually not is education even though education, their prioritise overwhelmingly children that found several assessments, needs child-led undertaken has Children Save the prioritised. being –not education and protection child as –such sectors child-centred to lead can This children’sneeds. specific neglecting needs, overall of for validation approach a household taketypically assessments conflict situations, in and slow and crises rapid In assessments. across the globe. across the children’ and for women services health integrated distribution of future budgetary allocations. budgetary future of distribution the hold and governments influence accountable to stakeholders national the allows which analysis, budget extensive undertaking is Children Save the 13 In collaboration with partners, partners, with collaboration In 15 14 which which CONCLUSION

How can the Three Guarantees to learn in school. Failure to complete school leads be delivered? to fewer economic opportunities in adulthood. If excluded children do not manage to overcome these We have shown that interventions need to be challenges, they are likely to pass on poverty to their made at four levels – household, local, national and own children, and the cycle will continue. international – if progress is to be made, from a range of fully implemented laws, policies and programmes, We hope that this campaign will spur those leaders to a shift in resource allocation, with devotion of on so that across the world the jigsaw pieces begin greater resources to excluded groups. And with to fall into place and we make global strides towards special emphasis on conflict contexts. including all children in progress. Save the Children is committed, through a Save the Children will be working through its combination of programming and campaigning, to programmes at all levels to contribute to this big work to ensure these Three Guarantees are met global push, partnering with local communities and as soon as possible. It won’t be easy, but together we local governments, and implementing comprehensive can make progress in the next three years. responses in over 100 countries. Most of these issues require action nationally and internationally, as well as locally and at the household WORKING TOGETHER level. It is impossible to list all the various ways in which national governments and international bodies One thing is clear – the size of the challenge means can support the Three Guarantees. Across the we cannot do it alone. We need our global partners world, every day, decision makers in many different and supporters to take this journey with us. types of institution need to shift their thinking and Save the Children’s work around the world has the direction of their policies in order to make these brought us up close and personal with children left aspirations a reality. behind and the realities of their struggle. This work The effects of exclusion are a recurring barrier is what has motivated us to fight for equality to be for children to living safe, healthy lives and to at the heart of the new SDG agenda, and to see that accessing quality education and equal life chances. ‘no one is left behind’. From conception to adulthood, excluded children Save the Children is recommitting to do whatever it face more challenges than their peers, and these takes to reach these groups. We call on you to join challenges have a domino effect as a child grows up. us in this new global campaign. Malnutrition in early life may impair a child’s ability

57 FIGURE 14 THE GLOBAL CHALLENGE OF CHILDREN’S EXCLUSION

Countries shaded red are where Save the Children is working to tackle children’s exclusion.

More than half of Bangladeshi and Pakistani children are growing up in poverty in the UK, compared with one in five children overall. 3

Mothers can only temporarily register their children in Nicaragua without the father's signature, preventing them from being fully protected.1 The CDI score for the Sahel

Region of Burkina Faso is

less than half the CDI score for the capital, Ouagadougou. 4 93% of adolescent girls in Bolivia reported problems with accessing healthcare.2

58 1/4 of refugees surveyed in Jordan said they saw going to school as an unsafe activity.5

Around

1/3 of children with disabilities in China do not complete compulsory education8

Ethnic minority children in Vietnam are 3.5 times more likely to die before the age of five compared with their Kinh peers.9

Only 42% of children in the North East region of Kenya have completed primary school compared to 93% in Nairobi.6

80% of unaccompanied migrants surveyed in South Africa were living in informal settings or Aboriginal and Torres Strait shacks; 14% on the street; and Islander children are only 5% in formal shelters. Only

8% of those living in informal more than twice as likely to be developmentally vulnerable shelters attended school.7 than non-indigenous children.10

59 APPENDIX 1: COUNTRY SPOTLIGHTS – SUMMARY VERSIONS

Save the Children has experts working We found that children with disabilities are excluded with the most excluded groups of children from mainstream education services as a result of on the ground on a daily basis. Research stigma and discrimination, environmental barriers, conducted in 28 offices, from Armenia to school curriculums not being adjusted to their Zambia, provided us with rich evidence to specific needs and a lack of effective participation understand specific country contexts and mechanisms. Save the Children has pledged to work with the Albanian government and wider society the drivers behind the vast inequalities in to address the financial, legal, structural, social and children’s outcomes. While the barriers cultural barriers that prevent children with disabilities that excluded groups of children face are from enjoying unrestricted access to education. universal, their relative importance varies across different settings. This report draws on research and learning from BOLIVIA those country case studies. The Country Spotlights Spotlight on teenage pregnancy offer insights into the country context, providing a diagnosis of the causes of exclusion, a brief The number of teenage pregnancies in Bolivia is on assessment of relevant policies, an analysis of the rise. Between 2003 and 2008, the adolescent remaining gaps and policy recommendations as well fertility rate increased from 84 to 88 per 1,000 as national campaign calls. The Country Spotlights teenage girls. Approximately 70% of these pregnancies are based on the most recent and reliable national are not planned and are often the result of violence, quantitative and qualitative sources, as well as the sexual abuse, and other violations of girls’ sexual wealth of insights gained by Save the Children’s and reproductive rights. Our research explores the frontline staff. socioeconomic factors underlying higher teenage pregnancy rates for certain groups – including girls This appendix provides a summary of each Country with lower levels of education and girls living in Spotlight. The full versions can be downloaded in rural areas. And it considers the drivers of high digital format from: www.savethechildren.org.uk/ rates of teenage pregnancy – including barriers to resources/online-library/every-last-child accessing health services, trafficking of adolescent girls for sexual and labour purposes, and low levels of contraceptive use. ALBANIA In Bolivia Save the Children will focus on the Spotlight on education for children implementation of newly enacted child safeguarding with disabilities laws, to ensure that these effectively protect children Although Albanian legislation guarantees the right to and adolescents while guaranteeing their access to education to all residents, over half of children with services. This will require awareness-raising at all disabilities do not receive any form of education. levels, including among judicial bodies, the police and Recent estimates suggest that 60% of children with municipal personnel, to improve the protection of disabilities aged between six and 15 are out of school. adolescents when they are looking for help.

60 APPENDIX 1: COUNTRY SPOTLIGHTS – SUMMARY VERSIONS 61 can lead to depression. As a coping strategy, many families in urban slums try to keep their daughters homeat or only them allow to outside go when accompanied male by family members. While this strategy can reduce the risk of harassment, it also results in effective exclusion of girls living in urban slums from education, as as well from participating in social life, and often irreversibly damages their future prospects. theSave Children will with work relevant government authorities, UN agencies, civil society organisationsand adolescents to tackle the gender-based harassment against girls living in urban slums. IRAQ Spotlight on internally displaced and refugee education children’s The current conflict in Iraq has led to a large-scale crisis of displacement, which is affecting the schooling of more than 3 million children, 2 million of whom out now are of school. Of the 3 million children in need of education assistance, 1 million displaced, are million in host are communities, 136,0001.1 have returned to newly liberated areas, and an estimated in areas897,000 are controlled armed by groups. In addition, there more than are 100,000 refugee children from Syria, mostly concentrated inthe of theseKurdistan refugee Region of Iraq. Only 71% children living in camps enrolled are in school, and more than half of Syrian refugee children living (54%) outside of camps out are of school. Action taken to address the crisis the by Ministry of Education has included establishing a second, and third,even shift in some schools refugees for and displaced children, and the construction of additional schools. Due to the mass displacement and refugee crisis, the education sector in some governorates is under huge strain. Funding is lacking to for provide good-quality education, notably to additional for pay materials. learning provide and salaries teacher theSave Children is focusing care providing on: and development children for aged 3–5; delivering non-formal education, including catch-up classes; building additional learning spaces; and as co-lead of the working Education closely Cluster, with the Kurdistan regional government and the Iraqi government to address the ongoing education crisis. Our research found that sexual harassment is an everyday reality many for girls in Egypt, but especially thoseliving in urban slums. The constant fear of being verbally or physically assaulted erodes confidence and EGYPT Spotlight on protection of urban, adolescent girls Children with disabilities among are the most educationally vulnerable in China. Government data reveals that approximately one third do not complete nine years of compulsory education. identify We some of the barriers children with disabilities face and highlight inclusive how education can help tackle their also detailexclusion. We findings from an opinion poll about inclusive education almost involving 900 families provinces and municipalities. The survey findsin 11 that while support inclusive for education is relatively high across the board, the concept is not well understood. In practice, stigma and misunderstanding remain common. Save the Children will be working to dispel misconceptions and promote inclusive education as a cost-effective solution to help realise the right to learning all. for CHINA Spotlight education on childrenfor with disabilities Since 1990, BurkinaSince 1990, Faso has significant achieved progress in terms of reducing child mortality. our research reveals that these gainsHowever, are not shared equally across all sectors ofsociety. In particular, some regions and socio-economic fargroups higher have under-five mortality rates than others. Our analysis reveals that inadequate health mechanisms, protection unequal distribution of health services across the country and uneven andinadequate all funding contributed have to the marginalisation inclusive achieve of these groups. To development, Burkina Faso must implement universal health insurance, as as well exempt children under five and pregnant and lactatingwomen from user fees. The government must also strengthen the supply of healthcare throughout the country. BURKINA FASO Spotlight on the health of poor children in remote regions 62 EVERY LAST CHILD are working to improve equitable access to these these to access improve to equitable are working teams Our poverty. child and sanitation, and water nutrition, health, education, governance, rights child protection, child on focused Kenyain has 1950s, the Children’s SaveSince the programming implementation. of terms in exist still gaps major but for all, services to access guarantee to provisions legal and policy robust place in put has government and The Mandera Turkana. Kilifi, Kakamega, are Bungoma, in children deprived of numbers largest Turkana, Wajir the West and while Pokot counties, Marsabit, are Mandera, in deprivation levels child of highest the that suggest Estimates 25.3%. low as as is NER the Mandera as such counties in whereas at 88.2%, stands education for primary (NER) Kenya’s rate enrolment net malnourished. national are chronically children slum of half approximately and rate national the twice is slums urban in children among diarrhoea of prevalence the example, For lands. semi-arid and arid and settlements informal urban in marked most is inequality Kenya, In areas in marginalised children poorest the of education and health the on Spotlight KENYA needs. their to are adapted that activities extracurricular and academic of acombination with involve will This providing them system. education local the into integrate to them prepare and children refugee out-of-school reach to us enable will that solutions piloting is initiative Learning Child Every Children’s Save the Jordan, In education. quality with children provide way to vulnerable a cost-effective activity. Informal, community-basededucation offers unsafe an as school saw to going they said surveyed 2015, refugees of In families. aquarter their support workto forced to being children provision and overcrowding, of include lack school in staying to Obstacles out. dropping of arerisk at high education in are enrolled who those of Many 40%. around is figure the communities host in while school, of out are camps the 43% in and children of 30% Between Za’atari as Azraq. and such are camps in rest the while communities, 85% live host in About refugees. child Syrian 200,000 than more hosts Jordan education children’s refugee Syrian on Spotlight JORDAN which reinforces a cycle of poverty and exclusion. exclusion. and poverty of acycle reinforces which pregnancy, early of risk the and education of by alack are diminished girls for these prospects Health roles. gender and dowries marriage, early as such norms cultural and by social back held are also groups these from girls general, in children minority ethnic affect that access and poverty of obstacles the to addition in reveal that, families and children with consultations Our boys. among lower than points 33be percentage can girls among rates literacy groups, minority ethnic within Even affected. heavily most being girls minority ethnic with Laos, in 41 points reach can percentage groups minority and majority ethnic between rates enrolment school primary in gap The parity. of lack this with associated risks and norms gender access, to barriers the identify and girls minority ethnic affecting gap equity the we highlight sources, of anumber on group.Drawing Lao-Tai ethnic majority fromthe children than education and health of areas the in outcomes worse significantly –experience girls –especially communities from these Children Laos. in groups minority 49 ethnic are than more There and health education girls’ minority ethnic on Spotlight LAOS programme by supporting enrolment in public public in enrolment by supporting programme schooling formal the to support providingis direct Lebanon in Children Save the marriage. early and issues psychosocial communities, refugee and host between tensions documentation, of lack school, to distance barriers, language include costs, financial education quality accessing to Obstacles learning. anyof access form to are struggling whom of many child, refugee aSyrian is Lebanon in people ten in one Now, education. of out are still rest the but them, of half almost to places school offer to managed has far, So children. Lebanon are school-aged 400,000 1.1 the Lebanon, in Of refugees Syrian million education children’s refugee Syrian on Spotlight LEBANON marginalised communities. to government of accountability greater and policies, existing of implementation accelerated for children, increased investment in quality essential services We for changes. are calling policy through services APPENDIX 1: COUNTRY SPOTLIGHTS – SUMMARY VERSIONS 63 increasing health Mali’s budget and creating a nutrition-specific budgetaryWe also propose line. sustaining essential community healthcare and strengthening health services implementing by healthuniversal coverage. MYANMAR MYANMAR nutritionSpotlight children’s poor on Chronic malnutrition in children eventually causes stunting, resulting in irreversible physical and cognitive damage. more than In Myanmar, a third of all children under are five stunted. In rural areas, the rate of stunting stands 38%, at while in urban areas it is 27%. children Poor more than are twice as likely to be stunted than those living in the wealthiest households and this represents a major barrier to child survival and learning. Compared to a stunted child, a well-nourished child completes more years of school, learns better and earns higher wages in adulthood, the providing foundation to escape a life of poverty. In our next campaign, the Save Children will work to mitigate the causes of stunting – chronic inadequate intake of food and frequent illness – by addressing underlying food and nutrition insecurity, poor care-givingpractices children young for and access to health services. These factors are, in turn, shaped income by poverty, lack of access to capital and poor economic and social conditions. MEXICO Spotlight on adolescent health Sexual and reproductive health in Mexico is strongly relatedhousehold topoverty. Lower economicstatus is associated with poorer sexual and reproductive health (SRH) indicators. draw on national We statistics to detail the impact of poor SRH services on adolescents. Our findingsreveal that significant numbers of adolescents not are using contraception. Furthermore, adolescent girls twice are as likely to die from complications in pregnancy or childbirth than women between the ages of 20 and 30. theSave Children is working with the government and others to promote coordination between agencies that so people young access to high- have quality sexual and reproductive health services. also identifying the barriersWe’re adolescents face when accessing health services. Between 1990 and 2015, Mali halvedBetween its child and 2015, 1990 mortality analysis of health rate. and However, regional significant reveals nutritional indicators disparities. The conflict that has affected the has contributedcountry to since a worsening 2012 nutritionalof children’s status and their exclusion from access to basic health services. Nutrition and healthcare services and financingwere already limited before the crisis, despite so recent efforts theby government some been regions have left behind. In order to finish workthe governmentthe has started the and achieve SDGs, recommend we MALI Spotlight on health and nutrition for children and remotein regions children poor Save theSave Children will be working with the government and other stakeholders to ensure that policy changes in health, nutrition, education and protection deliver the for most excluded children in remote areas. Poor childrenPoor living in remote areasof Malawi amongare the most excluded in the country, and lack access to basic health, education and social protection. Drawing on national survey evidence, our research finds that of 34% deprived children live in rural areas. Access to basic health services for children in hard-to-reach areas challenge, is a key with only of the 46% population having access to a health facility within a 5 km radius. Health surveillance assistants – a critical access point to healthcare often – are inaccessible to rural people due to poor roads and remoteness. The deployment of teachers is also affected region, by with one teacher to 86 children in rural areas, compared with one to 46 children in urban areas. Spotlight on health, education and protection childrenfor remote in regions MALAWI MALAWI education and building community-based systems community-based building and education to monitor the quality of teaching and learning in public institutions. Further international support is needed to fund education in Lebanon, as as well policy andcommunity work to address violence and bullying in schools, decrease social tensions between communities Syrian and improve families’ livelihoods. 64 EVERY LAST CHILD In the West Bank, children are systematically are systematically children West the In Bank, attacks. and invasions school and Gaza, of blockade the separation, of policy the including occupation, Israeli and conflict ongoing by the hindered be to continue movement and education to right and safety children’s (OPT), territory Palestinian occupied the In children of detained on protection Spotlight OCCUPIED PALESTINIAN TERRITORY education. primary into transition subsequent their support to order in services children’s Roma pre-school by to increasing access these gaps close to partners national workwith will Herzegovina we and Bosnia In education. of stages at all children’s rates other and Roma completion between gaps large in result entitlements and rights children’s Roma of awareness limited and support, community and family of lack discrimination, status, legal unresolved poverty, countries, three the of each in We that, found education. fromreceiving children Roma deter that barriers the explored research Our sanitation. or water clean to access no with accommodation live poor-quality Roma children in of majority The vaccinated. have and been not birth at registered have been not education, any of form in have enrolled children never Roma been Many Serbia. and Montenegro Herzegovina, and Bosnia in group vulnerable most the remain children Roma on Romachildren’sSpotlight education NORTH-WEST BALKANS policy action. and reform, legal norms, cultural and social in change empowerment, girls’ promote to strategies through We marriage chid end to areeducation. working secondary completed who group age same the in 13% with 18, of by compared the age women of were married education no with 20–24 aged women 82% of East. 10% South the in with 18, compared of age the before West are married region North that the in 76% finds girls of Evidence key factors. as identified education and geography poverty, with marriage, child of prevalence the on impact can vulnerabilities 18. of age We intersecting that found the before married girls 39% of with world, the in marriage child of rates highest the of one has Nigeria protection girls’ on Spotlight NIGERIA religious, administrative and budgetary obstacles. In In obstacles. budgetary and administrative religious, political, to due implemented effectively are not these but issue, this address to strategies government laws and are numerous There poverty. of cycle the reinforces and attainment educational affects negatively pregnancy early health, on impact the to addition In • • are two-fold: causes principal The basin. Amazon the in particularly areas, rural in poverty in living groups ethnic minority to belong to tend affected most girls adolescent the we that found interviews, group focus and studies statistics, national on Drawing period. over same the by 2% increased has it whom among adolescents, among case the been not has this years, 25 last the in declined has Peru in rate fertility overall the While pregnancy teenage on Spotlight PERU ex-detainee children aresupported. also children ex-detainee and detainee of families activities. The generating income- start to and society into reintegrate them helps that training vocational receive school to are over go back to 16 refuse who and old years who Additionally, ex-detainees school. to return to order in classes catch-up from They benefit services. legal and care medical counselling, receive children ex-detainee programme, the of OPT. part the As in children ex-detainee and detainee of needs special the address to programme governmental to provideInternational) only the national non- for Children Defense and (YMCA organisations two supported and partnered has Save the Children support, governmental tangible Lacking isolation. to atendency and anxiety insomnia, apathy, thoughts, displaying negative –for example, disorders stress post-traumatic from suffer They also services. education and medical to and counselling, legal good-quality to access lack genders fromboth children Ex-detainee are boys. law. detained 95% children Around the of 12 of Israeli under years penalty amaximum carries that offence an is which settlers, or soldiers Israeli at stones throwing with are charged detainees child year. these of every prisons majority The Israeli in are detained children law. 500–700 average, On international under illegal as considered is which act an courts, military Israeli in prosecuted and detained

se services health sc arce and poor-quality sexual and reproductive reproductive and sexual arce poor-quality and xual violence – especially within the family. the within –especially violence xual APPENDIX 1: COUNTRY SPOTLIGHTS – SUMMARY VERSIONS 65 gent increase in the share of the national mmitment from government that there uity to be placed the at heart of government e provision of fee-free pre-primary services, an ur budget to education and increased spending at pre-primary and primary levels th leastat the for poorest children in Rwanda eq bilateral models financing education and a co will be sustainable action and investment to the qualityimprove and effectiveness of early years education.

• • • children means acquiring basic literacy skills is still a major challenge. Our analysis found that budget disparities affect the delivery ofservices, with the worst-performing districts low more likely to have budgets, and the best-performing districts tending to higher budgets.have ensure that education deliversTo all for children in Rwanda, calling are we for: • Spotlight on teenage pregnancy A survey the by Sierra Leone Ministry of Education Science and the and Technology United Nations Population Fund (UNFPA) reveals least at 14,000 casesnew of teenage pregnancy occurred in the nine months between and July 2015 October2014 districts. of the 14 The high rateacross 12 of teenage pregnancy remains an endemic threat for the country’s pregnancy 3 million children. Teenage is a contributory factor in a high proportion of maternal and infant deaths. A number of studies confirmedhave that there was an increase in teenage pregnancy during the Ebola outbreak. This is understood to be due in part to the closure of schools and an increase in transactional sex. Sierra Leone has enacted the Child Right Act and PregnantSexual girls Offense benefit Act (2012). antenatal,from the government’s delivery and postnatal services as part of the Healthcare Free neither FHIInitiative nor the (FHI). However, Child Rights Act address the special attention and standards required to support pregnant girls and child mothers. A study undertaken Action by Against Concern the and Save Children in 2014 Hunger, thereshowed is a need multi-sector for support for childyoung mothers each at phase of motherhood. Officialgovernment policycontinues to ban pregnant girls from attending mainstream schools and taking exams. Alongside other organisations, are we SIERRA LEONE mprehensive policy regime that is improved xtension of maternity women. for leave ck of human resource capacity clear policy and a lack of accountability riation in health system performance. aining courses health for workers by civilby society and other stakeholders an e a co tr a la va un

With regards to early childhood education, found we that services not are available fee-free and access is largely dependent on parents’ capacity As a to pay. result, the poorest children generally are excluded. In primary education, while infrastructure is in place, the poor-quality of education on offer to some Rwanda has accomplished some significant achievements in education. But the country still has a lot to do in order to a good-quality provide education system that meets the needs of all children, especially the poorest. Drawing on national statistics, carried we out research into children’s access to good-quality education. • RWANDA educationSpotlight children’s poor on • • • theSave Children is calling policy for change both at national and local to levels address malnutrition and stunting, including: • The Philippines has one of the highest burdens of malnutrition in the world, with approximately 3.6 million children stunted. Poverty has a significant impact on rates of malnutrition, with evidence finding that more underweight, stunted and wasted children found are among the poorest households and in the poorest regions. Barriers to addressing malnutrition include: • Our research identifiesevidence on the current state of malnutrition in the Philippines, and it presents policy recommendations to ensure a comprehensive health programme the for 1,000 first of a days child’s development. Spotlight on poor children’s nutritionSpotlight children’s poor on PHILIPPINES PHILIPPINES orderto ensure excluded teenage access girls have to the information and services they need to help early prevent pregnancy and protect them from sexual violence, recommend we the Peruvian government enforce these and laws adequately funds its strategies. 66 EVERY LAST CHILD barriers girls face. discriminatory the address to order in behaviour and attitudes public influence to we seek dignity. will And and rights girls’ protect to provisions legal strengthen to and excludegirls that barriers financial the address to donors and government We the on call will FGM. and marriage fromchild areand protected education, particularly services, public good-quality have young to girls access that ensuring on efforts We our focus people. will for displaced settlements and populations mobile areas, rural in girls among –especially tackled be to exclusion for girls’ campaign will Somalia/Somaliland in Save Children the world. the in FGM of rate highest the has Somaliland Somalia/ and (FGM), mutilation genital female reducing on policies are active no There marriage. age at ascertain to difficult it making marriages, and births of 2015, registration the are laws on no there in Child the of Rights the on Convention UN the ratified Somalia while And reality. into right this enough consistent financial investment to translate not is there Somalia, in citizen every of aright as enshrined is education While practices. harmful and discrimination; active governance; weak education; and healthcare –including services basic poor of because dignity and rights their denied and excluded are Girls girls. especially grow in, to up for children world the in places toughest the of one is Somalia protection and nutrition health, education, girls’ on Spotlight SOMALIA services. basic access to and education their complete to them enable to mothers pregnant young to urgently assistance provideto targeted government the on calling and policy this challenging on schools across the world happened in Syria. Syria. in world happened across the schools on 2011Between 2014 and attacks all of half than more areas. other in as high as are twice camps IDP in for children rates 17%. low as as is Drop-out rate the Syria within children displaced For 50%. under to 100% nearly levels of frompre-conflict plummeted has school primary in children of rate enrolment the Syria In education on Spotlight SYRIA the education system. system. education the in integrated are properly disabilities with children that ensure to counterparts other and government national the workwith will Children Save the needs. special with children supporting in interest of lack providers’ education and programmes; tailored and environment physical enabling an of absence the stigma; and attitudes public negative highlighting from exclusion education, disabilities’ with children of causes root the traces research Our status. their of confirmation have not do official disabilities with children of majority the that given lower, times several perhaps is percentage this reality In education. mainstream in are enrolled disabled as registered 12% are officially who children of Tajikistan in –only disabilities with for children slim are very education formal receiving of chances The disabilities with for children on education Spotlight TAJIKISTAN • areas: rural in living and households poorest from the educated, are least who girls among are highest marriage child of 18.of Rates age the before are world: 37%married girls of the in rates marriage child highest the of one Tanzania has girls adolescent among marriage early on Spotlight TANZANIA NGOs and the international community. international the and NGOs achieved by been already has what scale-up to need a is there country, the of areas many in structures governance of lack the Given classrooms. damaged and rehabilitatingwar-and recreational equipment, materials learning training, teacher incentives, teacher providing 53 we schools, are running partners, with Along children. 1million than more supported 2012Since have programmes Children Save the response. any education into integrated be to for children’s well-being a dire need psychological is There Initiative. Generation Lost No the despite underfunded, chronically is system The towns. neighbouring in exams attend to journeys perilous face and fromschools kidnapped haveChildren been

higher education. education. higher or secondary with 5% girls of with compared 61 % of girls with no education are married by 18, are married education no with girls % of APPENDIX 1: COUNTRY SPOTLIGHTS – SUMMARY VERSIONS 67 ZAMBIA Spotlight on the nutrition and education of children in rural areas and remote regions An estimated of children 65% and adolescents in Zambia in poverty. Our live research looked at malnutrition, between poverty, intersections the surface water use, disability, literacy, and labour underinvestment, participation. weak Chronic force policy implementation, discriminatory and social and cultural drivers norms of children’s key are working with government and otherexclusion. We’re dimensions the multiple stakeholders address to advocating child-sensitive for of poverty, and we’re protectionsocial policies. Spotlight on the nutrition and education of children ethnic from minorities Despite rapid Vietnam’s economic growth and progress in child care and protection, children from ethnic minority groups continue far to have childlower development outcomes than children from the majority Our group. research focused on exclusionary barriers faced minority by ethnic groups in education and nutrition. school, At ethnic minority children often find it difficult tounderstand what is being taught and to participate in class because of the limited number of teachers who can speak their first language and because of an inflexible curriculum. In mountainous regions, insufficient investment in infrastructure means that children spendmay hours walking on mountain trails to get to school. In these areas poor sanitation and lack of knowledge of proper nutrition practice children for and expectant mothers underlie persistently higher rates of diarrhoea, digestive-related diseases and poor nutrition among children. will advocate greater for publicWe investment in improving the lives of children from minority ethnic groups – particularly their nutrition andeducation. And will call we inclusive for economic development and the reduction of economic inequality affecting ethnic minority children. VIETNAM ar of being sick, given their distance from sure thatsure appropriate resources to provided are ncern that they might not complete their rls living in rural areas almost are twice as likely xiety personal over safety, including -formulate the health spending distribution ke stepske to finalise, fund and implement a wice as likely to be married as before they 18 are cohesive child protection strategy. schools in remote areas en ta re formula to take account of local challenges health facilities education due to their parents not letting them attend school an marriage. early a fe co girls from the richest households. Gi to be married as under their the age urban of 18 counterparts. Girls from the poorest households more than are t

• • • • working with children to tackleWe’re these issues. calling the for UgandanAnd we’re government to: • For children in Uganda, the chances of surviving, learning and being protected vary significantly toaccording where they live. In remote areas, the challenges faced children by include poor access toservices – including very weak transport infrastructure in rural areas – and extremely poor- quality services. When asked children we in remote areas what worries them and what needs to happen, their responses included: • UGANDA UGANDA Spotlight on the education, health and protection children of remote regions in • fails law Tanzanian to protect girls from child marriage. While commitments been have made to promote girls’ education, along with legal and policy reforms in the human rights,area of girls’ and women’s these do not address child calling are marriage on explicitly. We the government to undergo a comprehensive reform of its marriage and related laws, including settingthe minimum age marriage for 18. at • APPENDIX 2: METHODOLOGICAL NOTE ON DATA ANALYSIS

There are numerous data challenges in GRID has some advantages over data that can be conducting a global analysis of exclusion obtained from online stat compilers. GRID includes of children across different groups and data on sample sizes and standard errors in order dimensions. Save the Children has made to assess whether comparisons are statistically substantial efforts to compile existing significant and the reliability of estimates. This is statistics and produce additional data, in particularly important for analysis at the group level as the sample size of some groups can be particularly order to provide a global diagnostic of small. Also, GRID is computed systematically for exclusion and to analyse inequalities in all regions and ethnic groups available. It makes it life chances between social and economic possible to have figures for the same ethnicity or groups. This methodological note describes region across all the outcomes. the groups-based inequality database (GRID) and the parameters for analysis undertaken in Part Two of this report, ‘Who are the UNDER-FIVE MORTALITY RATE DATA excluded children?’. National-level under-five child mortality rates in GRID are compiled from UN Inter-agency THE GROUPS-BASED Group estimates, corresponding to the official INEQUALITY DATABASE MDG 4 figures. GRID uses all available nationally representative data that have been judged to be of The background research in this report is based good quality (ie, vital registration data, census data, on either new calculated data or compiled household surveys and sample registration systems). from public sources into the GRID, developed Using these data, the methodology fits a statistical by Save the Children in collaboration with the model (called Bayesian B-spline bias-reduction model) Development Progress project at the Overseas to generate a smooth trend curve that averages Development Institute (ODI).1 It is based on direct over possibly disparate estimates from the different 4 data processing of 280 Demographic and Health sources. These figures are arguably more accurate Surveys (DHS) and Multiple Indicator Cluster than the ones derived through surveys only. Surveys (MICS); on aggregated public sources Disaggregated estimates in GRID are derived 2 (UN IGME, WHO, UNICEF and UNESCO); and through: on official disaggregated figures for a few countries i) processing DHS/MICS data 3 without survey data. It contains data on a total of ii) public sources mentioned above 89 countries, with disaggregated data on disparities iii) national administrative accounts. across social and economic groups, and a total of 62 countries with data over time for up to seven data GRID uses the direct estimation method for points (190 periods). In the current version, GRID under-five child mortality when processing DHS/ 5 contains measures of stunting, wasting, overweight, MICS data. The recall period in the birth history child mortality, primary completion rate and birth corresponds to the five-year period prior to registration. Each of these indicators is disaggregated the survey. by the following groups: boys/girls; urban/rural areas; To make the DHS/MICS disaggregated figures subnational regions; ethnolinguistic groups; and compatible with the UN IGME national estimates, economic groups (either quintiles or bottom 40% we adjusted the figures in order that the national and top 10% according to asset index).

68 APPENDIX 2: METHODOLOGICAL NOTE ON DATA ANALYSIS 69 8 GROUP-BASED INEQUALITY METRICS considered using twoWe main metrics the for analysis: the absolute gap and the relative ratio. The former measures absolute difference in the given indicator between disadvantaged and reference groups, while the latter measures much how more likely the disadvantaged group is to experience the given condition compared to the reference group. Reduction in the gap implies conversion in the total absolute number of children experiencing child mortality. Reduction in the ratio tells more directly about equalisation in life chances, as the measures effectively much how show more likely a child from one group is to die than opted a child from another for group. We the ratio as it is more useful making for comparisons across countries/groups. As reference groups used we the for boys gender analysis, the region with the best outcome regional for inequality and theethnicity with the best outcome regional for ethnicity. One of the advantages of GRID is that it contains sample sizes and confidence intervalsfor each of the disaggregated estimates obtained from direct processing of DHS and MICS data. This is particularly useful, as in some cases DHS/MICS sample sizes tooare small particular for groups (especially in countries that dozens of regions have and/or ethnicities) and confidence intervals comparedof groups be may overlapping. Therefore, reported rates simply may be a data artefact rather than an indicator of genuine difference between the groups. For these reasons, when the sample sizes were below the 100 for nutrition and education analysis the for child mortalityand 150 analysis, groups were not included in the analysis. The standard error of the Child Development Index has been computed using the standard errors of the four sub-indicators and groups not analysed were when the standard error was 0.025. above classification the ethno/regional in Changes also poseadditional challenges. In a significant number of countries, the number of ethnic groups administrativeand/or borders of regions have changed between surveys. For this reason, in the retrospective analysis included we only those countries where the number of regions and ethnic changes. experienced had minimum groups DISAGGREGATION BY SUBNATIONAL SUBNATIONAL BY DISAGGREGATION REGIONS AND ETHNIC GROUPS

6 no significant differenceswere 7 noticed. Groups with a small sample (less size than not included were 100 children) in the analysis. Data on birth registration was computed directly from DHS datasets which for data on birth registration is available (78 in total). The population of reference is children under the age of five who in thelive household. Ethnicity of the mother was used as a proxy the for ethnicity of the child. The figuresbeen compared have with by figuresprovided the DHS stat compiler where possible; no significant differences noticed. were BIRTH REGISTRATIONBIRTH PRIMARY COMPLETION RATE DATA COMPLETION RATE PRIMARY Data on primary school completion rate was computed directly from DHS datasetswhich for data onprimary in total). completion is available (216 The population of reference consists of individuals aged 15–24-years-old in order to focus on the age cohort that is expected completed to have primary school. Estimates been have compared with figures from the WIDE dataset computed the by Global Monitoring report; STUNTINGRATE DATA Stunting is defined as a height-for-agehaving 2 standard deviations below the median height-for- ageof the reference population produced the by HealthWorld Organization. Stunting rates each for social computed group were directly from DHS datasets which for data on child anthropometry is available (208 in total). The standard deviation of height-for-age is computed to according the WHO reference population DHS. and is by provided average in GRID is equal to the nationalaverage from the UN Inter-agency group. Groups with a sample notincluded were in the belowsize analysis. 150 The population of reference corresponds to living children between birthyears and five old. The final estimationsat nationalwere and group levels cross-checked with those the by provided DHS stat compiler when data was available and no significant differences noticed. were Groups with a small sample (lesssize than not included were 100 children) in the analysis. The standard errors computed were allfor groups. 70 EVERY LAST CHILD outcome of interest and level of disaggregation. level and disaggregation. of interest of outcome the on depending varies countries of number the focus, different the of Because countries. from 89 data contains database GRID the above, noted As ANALYSES THE IN COUNTRIES INCLUDED We formula: following the used in the report. report. the in presented those to similar results yielded tests these cases, of majority vast the In inequality. of measure as a gap absolute the using findings our checked also We were compared. groups have disadvantaged most of rates the which to point areference as averages national we used groups, advantaged most the of instead where, tests robustness out have we carried findings our of To validity the test performer. best the with up catching may be groups other all time same at the may increase, groups disadvantaged most/least the between ratio the while example, For distribution. entire the of account provide not afull does We ratio the are aware that context. country agiven within possible is progress level of pace and what shows society in group top-performing of the performance the examining Third, action. motivate therefore should and understand, to citizens and politicians for both easy is groups advantaged least and most the between ratio the Second, chances. life in inequity of extent the of revealing is groups bottom and top the between ratio the that means This unjust. are fundamentally and chances life in differences systematic to ascribed be can groups between –any differences rights human are basic have to and education an nourished properly be to To protected, be to analysis. survive, our in metric main the as ratio use to decision our support that reasons additional are three There O =O Ratio O outcome in =Inequality Ratio Where d a = estimated outcome in advantaged group group advantaged in outcome =estimated = estimated outcome in disadvantaged group group disadvantaged in outcome =estimated d /O a or promotion of its self-defined interests”. self-defined its of promotion or defense in action collective and mobilization political for abasis is group “the whether or treatment” discriminatory systematic from, benefit or from, suffer “actively groups these whether identifying from1945 groups ethnic 2006, to active politically 284 tracked has which Database, (MAR) at Risk Minorities the using calculated been has figure This DISCRIMINATED AGAINST ESTIMATED ARE GROUPS TO BE RELIGIOUS AND FROM ETHNIC CHILDREN MILLION NOTE: 400 Republic, and Maldives, Tomé São and Príncipe. Kyrgyz Guyana, Comoros, 9: fromFigure omitted were countries following the space limited to Due 9 NOTE FIGURE ON against. are discriminated who groups from ethnic children of number total estimated at the arrive to country each in 0–19 aged children of number for the alongside Population UN the Division’s 2015 estimates used have data). These been the in point latest the (as 2006, of country the in up makes group this that population the of proportion the on figures includes also set policy. The exclusion/repressive and data policy; exclusion/neutral social policies; remedial no discrimination policies; are: neglect/ neglect/remedial groups’ these describe to used categories The calculation. this in used have been economically or politically either ‘discriminatedagainst’ as MAR by identified have been that groups All two data points. points. data two with country no but 2008 as recent as registration birth on data with countries are 48 There points. data two at least 49 and with 2008 as recent as data with are 53 there countries education, For 2008. as recent as data with countries 65 and analysis mortality child for the points data two aleast with were 55 There countries points. data two at least 33 and we have for which 2008 as recent as data with nutrition of analysis the in were 52There countries 9 APPENDIX 3: METHODOLOGICAL NOTE ON THE CHILD DEVELOPMENT INDEX

The Child Development Index builds on the WHAT PROPERTIES DOES THE INDEX previous versions published in 2008 and 2012 AIM TO SATISFY? by Save the Children.1 The parameters of the index were substantially refined for this • The index aims to be simple in design, intuitive report. The CDI aggregates four indicators, and easy to communicate. covering four key dimensions of a fair start • It is aligned to the changes Save the Children’s in life. campaign aims to achieve for children. • It has high country coverage to allow comparison The rationale is simple. Every child, including those in and wide use. the excluded groups, should have a global guarantee to: • It provides a basis to assess exclusion, so it is 1. survive disaggregated by as many social and economic 2. avoid hunger groups as possible. 3. be educated and learn • It is based on official and publicly available data. 4. be protected from violence

The index provides a country ranking, giving an WHAT DOES THE INDEX LOOK LIKE? indication of where is the worst country in the world to be a child. Disaggregating the index by sub-group of The index provides a synthesis of four core population allows assessment of the inequalities in life dimensions, which are measured with best proxy chances and the worst circumstances to be born as a indicators and gives a sign of the ultimate results the child within each country. Disaggregation is achieved campaign expects to achieve for children. for as many groups as data is available for in GRID, including boys/girls, subnational regions and ethnolinguistic groups. We have also computed inequalities between economic groups and urban/rural areas.

FIGURE 13 THE STRUCTURE OF THE CHILD DEVELOPMENT INDEX

Child Development Index Index ranges from Every child, including those in the excluded groups, should have a global guarantee to: 0 to 100

Be educated Sub-index for each Survive Be protected Avoid hunger and learn dimension

Under-five Percentage of Percentage of Percentage of mortality rate children under children under five young people aged Measured with best five without birth who are stunted 15–24 years, who indicator available registration have not completed primary school

71 72 EVERY LAST CHILD we expect to see for children in our campaign. in for children see to we expect outputs the and levels, at different calls policy our between links the illustrates below diagram The TO INDEX? CONNECTED THE CALLS HOW POLICY THE ARE Birth life. in stage at later participation wider and services frompublic exclusion with citizenship, and identity to right the of denial fundamental the reflects registration birth child of Lack children. registration Birth PROTECTED BE greater maternal empowerment and education. and sanitation, and improved water of to sources broadaccess well as –as vaccination and attendance birth skilled care, antenatal to access provides that system health astrong including are needed measures comprehensive of arange rates, mortality improve to order child In acountry. in development human overall of indicator synthetic agood is rate mortality child The development. childhood early in improvements of a for series indicator flagship is a It birthday. fifth their survive to right the have should children all that guarantee basic the reflects rate childmortality under-five The SURVIVE public sources. on based be to and manner; aconsistent in groups and countries of number for alarge available be to possible; well as as dimension the measure to order in carefully selected have index been the of dimensions four the measure to used Indicators OFCHOICE INDICATORS 3. Accountability to children to 3. Accountability treatment Equal 2. 1. finance Fair All Children… to Guarantees Three is a fundamental right for right afundamental is …implemented at at …implemented all four levels… four all International National Local Household of countries. countries. of number acrossalarge are comparable that learning for are indicators no there but learn, children that guarantee not does school primary Completing 2.A). (target MDGs the in used was and schooling in achievement measure to indicators available best the of one is school primary complete not do 15 aged 24 who to children of percentage The LEARN EDUCATED AND BE groups. and countries of number for alarge available is It poverty. child of forms various with associated indicator acomprehensive is rate stunting The children. of status nutritional long-term the reflects Stunting AVOID HUNGER AVOID economic groups. and by social many disaggregated be can and countries for many available is registration birth on Data calls. campaign our of one is registration is a top indicator of human development and and development human of indicator atop is 4. Being protected protected Being 4. learning and Education 3. Avoid2. hunger 1. Survive children in all sectors of society of sectors all in children all to rights basic …to ensure APPENDIX 3: METHODOLOGICAL NOTE ON THE CHILD DEVELOPMENT INDEX 73

3 100

* the average U5CM for highincome OECD countries 0% is the desirable minimum 0% is the desirable minimum Desirable minimum 0% is the desirable minimum 4 x 1,000 live birth. Equivalent to 2 8 4

5 ximum – Desirableximum – minimum Ma 76% (Bangladesh76% 1991) 100% is the maximum possible 100% is the maximum possible Maximum Maximum – Actual value of the indicator =

Rescaled indicator 7 PARAMETERS FOR SCALING

Stunting rate % children without birth certificate without children % Indicator Under-five child mortality rate1,000 x 337 live birth1987) (Niger % of children not completing primary school TABLE 4 TABLE We used the desirableWe minimum of 0% birth for registration, stunting and not completing primary school but used we 4 per 1,000 child for mortality, rich since even countries with the best available health technology still experience a child mortality rate of about 4 per 1,000. PARAMETERS FOR SCALING Theparameters defined are by the desirable minimum and either the possible maximum or the observed maximum. For child mortality and stunting, maximums correspond to the worst situation observed Indeed,in the using the between world maximum and 2013. 1980 possible of 1,000 the for under five mortalityrate or 100% the for stunting weight rate givento a lower these have would two components in the index where careful were such we a high to numbers use been a never observed. have However, maximum number child for mortality and stunting that was high enough that so no groups currently are it and thatabove will be we able to track future changes in the index without having the index exceeding 100. For unregistered births andnot completing primary school, the possible maximumof 100% was used as there countries are or groups that close are to this of deprivation. level The Child Development Index combines the four dimensions of child well-being. Each dimension is rescaled that so the maximum equals the for 0 worst possible outcome and the for 100 desirable belowminimum the for parameters (see of rescaling). FORMULA OF THE CHILD DEVELOPMENT INDEX The Child Development Index is computed taking by the average of the four rescaled indicators with each rescaled indicator carrying an equal weight. A value of 0 corresponds to a situation where children experience outcomes the at highest possible of deprivation, level and a value of 100 corresponds to a situation where the four global guarantees are achieved. 74 EVERY LAST CHILD living in developing countries. TABLE 5 children million 1,880 the of 68% about or children million 1,280 level. up They make national at the available data with only. countries are 94 There countries for developing computed been has index The COVERAGE in the table below. table the in living in developing countries population child total of Percentage Number of children Total number of countries Upper-middle income Upper-middle income Lower-middle Low income

COVERAGE FOR OF DIFFERENT DISAGGREGATION LEVELS 10 Details on the coverage for different levels of disaggregation are shown are shown levels disaggregation of for different coverage the on Details 1,270 million 1,110 million 834 million 208 million 208 834 million 1,110 million 68% 1,270 million 27 37 30 94 average National Level of disaggregation 59% 21 33 29 83 boys and Girls 44% 8 17 23 48 Regions 11% 4 7 11 22 Ethnicity 9

ENDNOTES

THE STORY IN NUMBERS EXECUTIVE SUMMARY 1 Calculated using the Minorities at Risk database (http://www.cidcm. 1 UN Inter-Agency Group for Child Mortality Estimation (2015) umd.edu/mar/about.asp) and UN population statistics (see Appendix 2) Estimates for child mortality. http://www.childmortality.org/ 2 This is 1.2 billion out of 2.2 billion children living in developing 2 UNESCO (2014) Around 250 million children of primary school-age are not countries based on population estimates from 2014. Figures correspond reaching a minimum learning standard. Technical note prepared for the to own analysis based on Save the Children Group Based Inequality Education for All Global Monitoring Report 2013/2014. http://unesdoc. Database. unesco.org/images/0022/002287/228723E.pdf 3 UNFPA (2012). Sex Imbalances at Birth: Current trends, consequences 3 UN Inter-Agency Group for Child Mortality Estimation (2015) and policy implications. http://www.unfpa.org/sites/default/files/pub-pdf/ Estimates for child mortality. http://www.childmortality.org/ Sex%20Imbalances%20at%20Birth.%20PDF%20UNFPA%20APRO%20 4 UNESCO (2014) Global progress towards universal primary education publication%202012.pdf has halted. http://www.uis.unesco.org/FactSheets/Documents/fs-28-out- 4 UNICEF (2014). Ending Child Marriage: Progress and prospects. UNICEF, of-school-children-en.pdf New York. http://www.unicef.org/media/files/Child_Marriage_ 5 Only between 1990 and 2010 the global figure reduced to a third, see: Report_7_17_LR..pdf De Onis, M., Blossner, M. and Borghi, E. (2012) Prevalence and trends 5 UNHCR (2016). Education. http://www.unhcr.org/pages/49c3646cda.html of stunting among pre-school children, 1990–2020. http://www.who.int/ nutgrowthdb/publications/stunting1990_2020/en/ 6 The World Bank Group (2016 Gross enrolment ratio, secondary, both sexes (%). http://data.worldbank.org/indicator/SE.SEC.ENRR/ 6 Own estimations based on the Minorities at Risk database countries?display=graph (http://www.cidcm.umd.edu/mar/about.asp) and UN population statistics (see methodological Appendix 2 for further details) 7 IFAD (n.d.). Rural Poverty Portal: Indigenous people and rural poverty. http://www.ruralpovertyportal.org/topic/home/tags/indigenous_peoples 7 UNICEF (2014) More than 1 in 10 Children Living in Countries and Areas Affected by Armed Conflict. https://www.unicefusa.org/press/releases/ 8 Jones, L., Bellis, M.A., Wood, S., Hughes, K., McCoy, E., Eckley, L., unicef-more-1-10-children-living-countries-and-areas-affected-armed- Bates, G., Mikton, C., Shakespeare, T., Officer, A. (2012) ‘Prevalence conflict/21551 and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies’. The Lancet, Vol. 380, 8 UNICEF (2006). The State of the World’s Children. http://www.unicef. No. 9845 org/sowc06/pdfs/sowc06_fullreport.pdf 9 Own calculations based on Save the Children’s Groups-based 9 Olinto, P., Beegle, K. Sobrado, C. & H. Uematsu (2013). The State of the Inequality Database (GRID). See Appendix 2 for methodological details. Poor: Where are the poor, where is extreme poverty harder to end, and what is the current profile of the world’s poor? http://siteresources.worldbank. 10 Sumner, A. (2012). The New Face of Poverty: How has the Composition of org/EXTPREMNET/Resources/EP125.pdf Poverty in Low Income and Lower Middle Income Countries (excluding China) Changed since the 1990s? IDS Working Paper No 408. https://www.ids. 10 This is 1.2 billion out of 2.2 billion children living in developing ac.uk/files/dmfile/Wp408.pdf countries based on population estimates from of 2014. Figures correspond to own analysis based on Save the Children Groups-based 11 UNHCR. (2014). UNHCR Global Trends, Forced Displacement in 2014, Inequality Database. World at War. http://unhcr.org/556725e69.html 11 Sumner, A. (2012). The New Face of Poverty: How has the Composition of 12 Executive Committee of the High Commissioner’s Programme Poverty in Low Income and Lower Middle Income Countries (excluding China) (2004). Protracted Refugee Situations. Standing Committee 30th Meeting. Changed since the 1990s? IDS Working Paper No 408. https://www.ids. http://www.unhcr.org/40ed5b384.html ac.uk/files/dmfile/Wp408.pdf 13 Jones, N., with Vargas, R. and Villar, E. (2008) ‘Cash transfers to 12 IFAD (n.d.). Rural Poverty Portal: Indigenous people and rural poverty. tackle childhood poverty and vulnerability: an analysis of Peru’s Juntos http://www.ruralpovertyportal.org/topic/home/tags/indigenous_peoples programme’, Environment and Urbanization, 20(1), 2008, pp 255–273 p. 264. 13 UNICEF (2014). Ending Child Marriage: Progress and prospects. UNICEF, New York. http://www.unicef.org/media/files/Child_Marriage_ 14 Makaka, A., Breen, S & A. Binagwaho (2012). ‘Universal health Report_7_17_LR..pdf coverage in Rwanda: a report on innovations to increase enrolment in community-based health insurance’. The Lancet. Vol 380, Special Issue, S7. 14 Own calculations. See endnote 9 in The Story in Numbers (p 75). 15 Save the Children (2015). The Lottery of birth: Giving all children an equal 15 The World Bank Group (2016) Gross enrolment ratio, secondary, chance to survive. http://www.savethechildren.org.uk/resources/online- both sexes (%). http://data.worldbank.org/indicator/SE.SEC.ENRR/ library/lottery-birth countries?display=graph 16 The World Bank Group (2016). World Development. http://data. 16 Jones, L., Bellis, M.A., Wood, S., Hughes, K., McCoy, E., Eckley, L., worldbank.org/indicator/SE.PRM.CMPT.FE.ZS Bates, G., Mikton, C., Shakespeare, T., Officer, A. (2012) ‘Prevalence and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies’. The Lancet, Vol. 380, No. 9845

75 76 EVERY LAST CHILD org/sowc06/pdfs/sowc06_fullreport.pdf Pensions Research Report No. 576. No. Report Research Pensions For methodological details see Appendix 2 and 3). 2and Appendix see details methodological For (CDI). Index Development Child the on analysis and (GRID) Databased story.asp?NewsID=50929 - .VrX9XS4nzct crisis in funding school urging says, envoy 11 10 9 8 7 of studies’.meta-analysis observational The Lancet and review asystematic disabilities: with children against violence of risk and (2012)A. ‘Prevalence T., Officer, Shakespeare, C., Mikton, G., Bates, 6 5 http://www.ruralpovertyportal.org/topic/home/tags/indigenous_peoples 4 3 2 1 1 5 4 3 2 1 TO PARTINTRODUCTION ONE PART ONE 19 18 17 2014, World at War.2014, at World http://unhcr.org/556725e69.html Development Institute: London. Overseas response. a strengthened towards crises: protracted and umd.edu/mar/about.asp) and UN population statistics Children.pdf National%20Office/2013/06/Poverty_or_Prosperity_Indigenous_ https://www.policyalternatives.ca/sites/default/files/uploads/publications/ Alternatives. Policy for Centre Canadian Canada. in children unesco.org/images/0023/002325/232565e.pdf 2007. in LMICs and LICs of population total the of 50–55% was data ethnicity of coverage population the coverage: population low to due caution with treated be should results The groups. ethnic other all or groups’ minority ‘ethnic and country each for group’ ethnic ‘largest 408. No Paper Working 1990s? IDS the since Changed China) (excluding Countries Income Middle Lower and Income Low in Poverty assets/publications-opinion-files/9213.pdf intersecting inequalities. http://www.odi.org/sites/odi.org.uk/files/odi- of-school-children-en.pdf has halted. http://www.uis.unesco.org/FactSheets/Documents/fs-28-out- http://www.childmortality.org/ for child mortality. Estimates nutgrowthdb/publications/stunting1990_2020/en/ http://www.who.int/ 1990–2020. children, pre-school among stunting of of-school-children-en.pdf has halted. http://www.uis.unesco.org/FactSheets/Documents/fs-28-out- forEstimates child mortality Calculated using the Minorities at Risk database (http://www.cidcm. database Risk at Minorities the using Calculated Indigenous Prosperity: or (2013). Poverty D. &D. Wilson Macdonald, poverty child and Ethnicity (2009). l. Platt, L., Eckley, E., McCoy, K., Hughes, S., Wood, M.A., Bellis, L., Jones, 2015 Report Monitoring (2015). Global EFA UNESCO poverty rural and people Indigenous Portal: Poverty Rural (n.d.). IFAD categories: two creating by estimated were ethnicity for Data Note: of Composition the has How Poverty: of Face (2012). New The A. Sumner, address to justice social (2014). Strengthening al. et Arauco Paz education primary universal towards progress (2014) Global UNESCO (2015) Estimation Mortality Child for Group Inter-Agency UN trends and (2012) Prevalence E. Borghi, and M. Blossner, M., Onis, De education primary universal towards progress (2014) Global UNESCO (2015) Estimation Mortality Child for Group Inter-Agency UN The State of the World’s Children World’s the of State The (2006). UNICEF Own calculation based on Save the Children Groups-based Inequality Inequality Groups-based Children the Save on based calculation Own 2015 ‘year of fear’ for children, UN education education UN children, for (2015). 2015 fear’ of Centre News ‘year UN UNHCR. (2014). UNHCR Global Trends, Forced Displacement in in Displacement Forced Trends, Global (2014). UNHCR UNHCR. Nicolai, S. Hine, S. & J. Wales (2015). Education in emergencies emergencies in (2015). Education Wales &J. S. Hine, S. Nicolai,

WHAT’S THE PROBLEM? WHAT’S THE

AN U AN . http://www.childmortality.org/ NCOMFORTABLE TRUTH NCOMFORTABLE . http://www.un.org/apps/news/ . Department of Work and and Work of . Department , Vol. 380, No. 9845 No. 380, , Vol. . http://www.unicef. . http://unesdoc. . http://www.unicef.org/violencestudy/reports/SG_violencestudy_en.pdf 2006. August 29 session: Sixty-first Assembly, General UN General, growth the Study of Labor (IZA) Discussion Paper 1993. Paper Discussion (IZA) Labor of Study the Mobility Earnings Generational Of Comparison Country Cross 7 6 5 4 3 2 1 2 13 12 13 12 11 10 9 8 16 15 income-inequality-and-its-impact-on-economic-growth_5jxrjncwxv6j-en http://www.oecd-ilibrary.org/social-issues-migration-health/trends-in- 14 805–829. Economic European Review Reduction’, Poverty in Diversity Regional in Income of Distribution the of Role The Alone: Growth worldbank.org/EXTPREMNET/Resources/EP125.pdf http://siteresources. poor? world’s the of profile current the is what and end, to harder poverty extreme is where poor, the are Where Poor: the of bg_papers/bp_wess2013_svieira1.pdf http://www.un.org/en/development/desa/policy/wess/wess_UNDESA. levels national and international global, at inequality, income on data Private_Sector_Investment_and_Sustainable_Development1.pdf http://www.sustainablefinance.ch/upload/cms/user/2015_01_UNGC_ development sustainable in foundation and banks companies, investors, institutional of role potential and current The Development: Sustainable Affects Women’s Math Performance’. Science Performance’. Women’s Math Affects https://www.imf.org/external/pubs/ft/sdn/2015/sdn1513.pdf Fund. Monetary International Note. Discussion Staff IMF perspective Aglobal inequality: income of consequences and (2015). Causes Neglect & Abuse Child identity.’ gender and orientation sexual their of because persecuted migrants forced among abuse child of Recollections life’: unesco.org/images/0023/002321/232107E.pdf all for education quality of achievement ChildreninDanger_ViolencereportW.pdf children. https://www.unicef.org.uk/Documents/Publications/Unicef_ discrimination-inequality-and-poverty-human-rights-perspective Perspective Rights A Human International. ICF and Agency Statistical Central USA: Maryland, Calverton, and 2011 Survey and Health Demographic Ethiopia Working Paper Series, No. 6223. The World Bank. World The 6223. No. Series, Paper Working society amodernizing in performance and preferences on longitudinal data Climate Change on Panel Intergovernmental the of Report Assessment Fifth the to Group II Working of Contribution Aspects. Sectoral and Global A: Part Alessi, E., Khan, S., & S. Chatterji. (2015). ‘The darkest times of my my of times darkest (2015). ‘The Chatterji. &S. S., Khan, E., Alessi, the preventing is violence gender-based (2015). School-related UNESCO against violence end to Act Danger: in Children (n.d.). UK UNICEF child the of Rights (2006). Nations United Poverty – and Inequality, (2013). Watch Discrimination, Rights Human 2012. International. ICF and [Ethiopia] Agency Statistical Central Making up people – the effect of identity identity of effect –the people up (2012). &P. Making K. Pandey Hoff, from Insights Exclusion: Social of Outcomes and Risks (2003) J. Bynner, Vulnerability and Adaptation, 2014: Change Impacts, (2014) Climate IPCC Private Sector Investment and and Investment Sector (2015). Private Compact Global Nations United Own calculations. See endnote 9 in The Story in Numbers (p 75). (p Numbers in Story The 9in endnote See calculations. Own See, for instance, Kalwij, A. and Verschoor, A. (2007). ‘Not by by ‘Not (2007). A. Verschoor, and A. Kalwij, instance, for See, The State (2013). State The Uematsu &H. C. Sobrado, K. P., Beegle, Olinto, Inequality on the rise? An assessment of current available available current of assessment An rise? the on (2012). Inequality S. Vieira, Trends in income inequality and its impact on economic economic on impact its and inequality F. income in (2014). Trends Cingano, Do Poor Children Become Poor Adults? Lessons From A From Lessons Adults? Poor Become Children Poor Do (2006). M. Corak, Dabla-Norris, E., Kochhar, K., Ricka, F., Suphaphiphat, N., Tsounta, E. Tsounta, E. N., F., Suphaphiphat, Ricka, K., Kochhar, E., Dabla-Norris, Dar-nimrod, I. & S. Heine (2006). ‘Exposure to Scientific Theories Theories Scientific to ‘Exposure (2006). Heine &S. I. Dar-nimrod,

WHY DOES EXCLUSION MATTER? EXCLUSION DOES WHY . OECD Social, Employment and Migration Working Papers. Papers. Working Migration and Employment Social, . OECD , Jan;51:93. , , London: Institute of Education. of Institute , London: . https://www.hrw.org/news/2013/01/11/ . . Policy Paper 17. Paper http://unesdoc. . Policy . Note by the Secretary Secretary the by . Note . Addis Ababa, Ethiopia Ethiopia Ababa, . Addis . 20 Oct 2006: 435. 2006: Oct . 20 . Policy Research Research . Policy , Institute for for , Institute , 51.4: . . . . ENDNOTES 77 . . http://www.unicef. . Research commissioned . Development Progress O ARE THE EXCLUDED , Vol. 60, No. 3, pp 723–754. WH . Overseas Development Institute: London.

. http://www.romadecade.org/cms/upload/file/9810_. EXCLUDED ETHNICITY, BY RACE, RELIGION WHAT ARE THE DRIVERSWHAT OF EXCLUSION? ND CASTE

See Spotlight on Laos (Appendix 1). Decade of Roma Inclusion Secretariat Foundation Roma (2015). ibid UNICEF (2007). Breaking the Cycle of Exclusion: Roma Children in UNICEF (2006). The State of the World’s Children Arauco, et. V. Strengthening al (2014) social justice to address intersecting Lenhardt, A. & E. Samman In (2015). quest of inclusive progress: exploring World Health Organization & World Bank Group Tracking (2015) The concept behind the framework is adapted from the work of & E. Plumper, Neumayer T. (2005). ‘The Unequal Burden of War: UNICEF. Children (2013). and People Young with Disabilities Fact Weis J, Feeney M, Moore K, Bedford Social J (2015) exclusion and its The index is composed of four flagship indicators that are a good Inclusion Index 2015 Index Inclusion file1_roma-inclusion-index-2015-s.pdf South East http://www.unicef.org/ceecis/070305-Subregional_ Europe. Study_Roma_Children.pdf inequalities post-2015 http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion- files/9213.pdf intersecting development inequalities human in Research Report 4. Overseas Development Institute: London. Universal Health Coverage – First Global Monitoring Report Bronfrenbrenner, a child development psychologist. He explained how everything in child’s a environment affects how a child grows and develops and argued that the agency and self-confidence of a child is largely dependent on the behaviour of actors around them. In our adaptation of Bronfrenbrenner’s model, drivers of exclusion orbit around children and combine to limit their life chances and their voice. The effect of armed conflict on the gender gap in life expectancy’, Organization International Sheet. http://www.unicef.org/disabilities/files/Factsheet_A5__Web_ NEW.pdf impact on health and nutrition: a literature review by Save the Children, November 2015. measure of wider human development progress and a fair start in life. For example, the index includes child mortality rate which is a fundamental right, but also a good indicator of wider development. In order to improve child mortality rates a range of comprehensive measures are needed including a strong health system that provides access to antenatal care, skilled birth attendants and vaccination; but also wide access to improved source of water and sanitation; increase mother empowerment and education; among many others. Stunting rate is a comprehensive indicator associated with various forms of child poverty. Birth registration rate is one of the very basic child protection indicators, reflecting the fundamental denial of the right to identity, citizenship, with the equivalent exclusion to participation at later stage in life. Primary completion rate providescomparative a measure of minimum level of access to education. Unfortunately, there is not an equivalent international comparable learning outcomes. measure of Save the Children is calling for the SDGs to include indicators of learning outcomes to be used for monitoring the new sustainable framework. development 4 5 6 7 4 A 1 2 3 1 2 3 4 5 TWO PART CHILDREN? TWO INTRODUCTION PART TO 1 3 org/sowc06/pdfs/sowc06_fullreport.pdf

. . . . London: . Policy . World Bank: . Inter-American Inter-American . . Conditions of Work and . International Centre for Evidence . Centre for Research on Inequality, Human Security . The International Conference for Social Cohesion. . Inter-American Development Bank Working Paper Paper Working Bank Development Inter-American . . US: Washington, D.C. http://siteresources.worldbank.org/ The World Bank Group GNI (2016). per capita, Atlas method UNESCO Education (2013). Transforms Lives. http://unesdoc.unesco. Own calculations. See endnote 5 in The Story in Numbers (p 75). Foa, The Economic R. (2011) Rationale for Social Cohesion – The Cross- Zoninsein, J. (2001). The Economic Case for Combating Racial and Ethnic ibid. Own calculations. See endnote 9 in The Story in Numbers (p 75). World Bank (2008) Project appraisal document on a proposed credit ibid. Chong, A. et al. (2009). Do Welfare Programs Damage Interpersonal Save the Children The (2015) cost of war: calculating the impact Stewart, (Ed.). (2008). F. Horizontal inequalities and conflict Stewart, (2010). Horizontal F. Inequalities as a cause of conflict: A review De Laat, J. (2010). Economic Costs of Roma Exclusion See Cruz, M., Foster, J., Quillin, B., Schellekens, & Ending (2015). P. New World Wealth African Top (2015). cities for millionaires Wittenberg, M. Analysis (2014). of employment, real wage, and ibid Bogliacino, andMaestri, F. ‘Increasing (2014). V. economic (current US$). http://data.worldbank.org/indicator/NY.GNP.PCAP.CD/ (current countries Development Bank Research Report: Combating Social Exclusion in LAC. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.195.8119 &rep=rep1&type=pdf Exclusion in Latin American and Caribbean Countries Research Note October World Bank 2015. 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EXCLUDED GIRLS EXCLUDED DISADVANTAGE BY REGIONAL EXCLUDED . Overseas Development Institute: London. Institute: Development . Overseas ; 5:7. ;

EX CLUSION TIMELINE OF ETHNIC ETHNIC OF TIMELINE CLUSION . http://reliefweb.int/report/ethiopia/ethiopia- , http://apps.who.int/iris/bitstream/10665/ ; 15:420. ; . Ha Noi, Viet Nam. Nam. Viet Noi, . Ha . 19: 383–395. , 21 Suppl 1:28–33. , 21 Suppl

. child-marriage-facts-and-figures Report_7_17_LR..pdf New York. http://www.unicef.org/media/files/Child_Marriage_ adolescent_pregnancy/en/ http://www.who.int/maternal_child_adolescent/topics/maternal/ Fact%20sheet_RSOC%20_02-07-2015.pdf Fact%20sheet_RSOC%20_02-07-2015.pdf (NFHS-3) Survey Health Family National 17 16 15 14 13 and countries’. middle-income The Lancet low-income in overweight and undernutrition child and (2013). ‘Maternal 12 UNFPA%20APRO%20publication%202012.pdf default/files/pub-pdf/Sex%20Imbalances%20at%20Birth.%20PDF%20 http://www.unfpa.org/sites/ Bangkok. Thailand: and implications. policy 11 10 9 8 7 5 4 3 2 1 IN INDIA 8 FIGURE 25 24 23 22 21 20 19 18 Academy of Sciences York New the of impact’. andmothers the intergenerational Annals Ezzati, M., Grantham-McGregor,S., Katz, J., Martorell, R., Uauy, R., R., Uauy, R., Martorell, J., Katz, Grantham-McGregor,S., M., Ezzati, http://www.who.int/mediacentre/factsheets/fs364/en/ familyplanningsaveslives.pdf http://www.prb.org/pdf09/ Bureau. Reference Population DC and_Trends_in_Child_Mortality_2014.pdf Mortality Child in Trends and WorldsWomen2015_chapter2_t.pdf Trends and Statistics LO.FE.ZS (%) female) and (male National_Fact%20sheet_RSOC%20_02-07-2015.pdf (RSOC) Children on Survey ARapid (2013–2014). chapter2.html Trends and Statistics 1991 from data 2011 to census and 2005 1990 from to histories birth representative nationally of analysis India: in girls Ibid (2014). Levels Estimation Mortality Child for Group Agency Inter UN 2015: Women World’s (2015). The Division Statistics Nations United (2016) Lower Completion Secondary Indicators Development World India of Government Development, Child and Women of Ministry 2015: Women World’s (2015). The Division Statistics Nations United of abortions (2011) al. et selective in R, Trends Kumar P, MA, Jha Kesler

WHO (2016). Maternal, newborn, child and adolescent health. health. adolescent and child newborn, (2016). Maternal, WHO Delisle, H. (2008) ‘Poverty: the double burden of malnutrition in in malnutrition of burden double the ‘Poverty: (2008) H. Delisle, Black, R., Victora, C., Walker, S., Bhutta, Z., Christian, P., de Onis, M., P., Onis, M., de Christian, Z., Bhutta, Walker, S., C., Victora, R., Black, Ending Child Marriage: Progress and prospects and Progress Marriage: Child (2014). Ending UNICEF See Spotlight on Sierra Leone (Appendix 1). (Appendix Leone Sierra on Spotlight See See Spotlight on Bolivia (Appendix 1). (Appendix Bolivia on Spotlight See Ministry of Health and Family Welfare, Government of India (2005–06). India of Government Welfare, Family and Health of Ministry See Spotlight on Peru (Appendix 1). (Appendix Peru on Spotlight See See Spotlight on Sierra Leone (Appendix 1). (Appendix Leone Sierra on Spotlight See WHO (2014). Adolescent pregnancy WHO Family Planning Saves Lives Saves Planning Family (2009). al. et R. Smith, See Spotlight on Tanzania (Appendix 1). (Appendix Tanzania on Spotlight See See Spotlight on Sierra Leone (Appendix 1). (Appendix Leone Sierra on Spotlight See See Spotlight on Iraq (Appendix 1). (Appendix Iraq on Spotlight See See Spotlight on Nigeria (Appendix 1). (Appendix Nigeria on Spotlight See Child marriage facts and figures and facts marriage ICRW. (2015). Child UNFPA (2012). Sex Imbalances at Birth: Current trends, consequences consequences trends, Current Birth: at Imbalances (2012). Sex UNFPA

EX CLUSION TIMELINE OF GIRLS GIRLS OF TIMELINE CLUSION . Vol. 1136:172–84.. Vol. . http://unstats.un.org/unsd/gender/downloads/ . http://unstats.un.org/unsd/gender/chapter2/ . http://data.worldbank.org/indicator/SE.SEC.CMPT. . http://www.unicef.org/media/files/Levels_ . Fact sheet N°364. N°364. sheet . Fact . http://wcd.nic.in/issnip/National_ . Lancet, 2011; 377:1921–1928.. Lancet, , Vol 382 August 3, 2013. 3, August , Vol 382 . http://wcd.nic.in/issnip/ . http://www.icrw.org/ . . US: Washington Washington . US: . UNICEF, . UNICEF,

ENDNOTES 79 .

. Vol. 2013. . Vol. 2013. . . New York, United . http://www.unicef. . http://www.unicef. . http://www.unicef. http://unesdoc.unesco.org/ . ILGA-Europe and IGLYO. . Report of the UnitedNational High . http://www.abs.gov.au/ausstats/[email protected]/ . . http://www.unicef.org/publications/files/Under_Siege_ . . http://resourcecentre.savethechildren.se/library/forgotten-. UNCOUNTED CHILDREN UNCOUNTED

Takács, J. (2006). Social Exclusion of young lesbian, gay, bisexual and Kyu, H., Shannon, H., Georgiades, K.,Boyle, ‘Association M. (2013). of UNICEF Under (2014) Siege: The devastating impact of three years of United Nations Discrimination (2015), and Violence Against Individuals Save the Children Forgotten (2015). Voices: The World of Urban Children de Benitez, State of the S. World’s (2011). Street Children: Research Mahidol University, Plan International Thailand, UNESCO Bangkok UNESCO Bangkok Thailand, International Plan University, Mahidol UNICEF Eliminating (2014) discrimination against children and parents Save the Children South Africa In (2015). search of a better future: Ibid. See Spotlight on Egypt (Appendix 1). Secretary-General Ban Ki-moon Secretary-General’s (2012). remarks UNICEF Global (2014). Initiative on Out-of-School Children: South UNICEF (2006). The State of the World’s Children Australian Bureau of Statistics Comparison (2012). of Disability United Nations Thematic (2012). study on the issue of violence against WHO & The World Report World Bank on (2011). Disability. See Spotlight on Tajikistan (Appendix 1). (ibid) UNICEF (2006). The State of the World’s Children See Spotlight on China (Appendix 1). See Spotlight on Zambia (Appendix 1). Consortium Street Children. http://www.streetchildrenresources. for org/resources/state-of-the-worlds-street-children-research/ Prevalence Between Aboriginal and Torres Strait Islander Peoples and non-Indigenous Peoples women and girls and disability Commissioner Human for Rights. http://www2.ohchr.org/english/issues/ women/docs/A.HRC.20.5.pdf http://www.who.int/disabilities/world_report/2011/en/ in India in voices-world-urban-children-india Urban Slum Residency with Infant Mortality and Child Stunting in Low and Middle Income Countries’. BioMed International Research http://www.hindawi.com/journals/bmri/2013/604974/ conflictSyria in March_2014.pdf Asia Regional Study. http://www.unicef.org/education/files/SouthAsia_ OOSCI_Study__Executive_Summary_26Jan_14Final.pdf Based on Their Sexual Orientation and Gender Identity Nations High Commissioner for Human Rights. LGBT-friendly in Thailand? in Office LGBT-friendly (2014). images/0022/002277/227706E.pdf 20 21 11 12 13 14 15 16 17 18 19 8 1 2 3 4 5 6 7 8 9 10 10 based on sexual orientation and/or gender identity gender orientation and/or sexual on based org/videoaudio/PDFs/Current_Issues_Paper-_Sexual_Identification_ Gender_Identity.pdf transgender people Europe in (LGBT) https://www.salto-youth.net/downloads/4-17-948/ReportSocial ExclusionIGLYOilga.pdf? ro special event on “Leadership in Fight against Homophobia” http://www.un.org/sg/statements/index.asp?nid=6504 experiences of unaccompanied migrant children in Limpopo & Mpumalanga in South Africa. https://www.savethechildren.org.za/sites/ Studies.pdf savethechildren.org.za/files/field/file/Case org/sowc06/pdfs/sowc06_fullreport.pdf Lookup/4429.0main+features100292009 org/sowc06/pdfs/sowc06_fullreport.pdf . .

. . . http://unesdoc. . Overseas Development . http://www.savethechildren. . http://www.unicef.org/education/ . Overseas Development . http://childrenofsyria.info/ . . Standing Committee 30th Meeting. . http://data.worldbank.org/indicator/. . South Sudan: UNHCR. http://www.unhcr.org/ CLUSION OF CONFLICT- , December p.36. 2013, http://reliefweb.int/report/ EX

. http://unhcr.org/556725e69.html . . http://data.worldbank.org/indicator/SE.PRM.NENR?page=2. . http://reliefweb.int/sites/reliefweb.int/files/resources/2016_ . . http://data.worldbank.org/indicator/SH.STA.BRTC.ZS?page=1. EXCLUDED REFUGEE AND INTERNALLY REFUGEE INTERNALLY AND EXCLUDED ISPLACED CHILDREN ISPLACED

Save the Children (n.d.) Save the Children Calls for Urgent Action to Assessment Working Group for Syria Syria (2013). Integrated Needs UNESCO EFA Global (2015). Monitoring Report 2015 The World Bank Group Net (2016). enrolment rate, primary, both Nicolai, S., Hine, S. J. & Wales Education (2015). in emergencies and Rulashe, Malnutrition (2014). P. a serious threat as food shortages impact UNESCO World Education Forums Quoted (2015). in Nicolai, S., UNHCR UNHCR (2014). Global Trends, Forced Displacement in 2014: Executive Committee of the High Commissioner’s Programme (2004). Save the Children State (2014). of the World’s Mothers Saving 2014: UNICEF ‘In (2015). Syria taking school exams across conflict lines’, UNICEF No place (2016). for children: the impact of five years of war UNOCHA Humanitarian (2015). Needs Overview Syrian Arab 2016: The World Bank Group Primary (2016). completion rate, both sexes (%) The World Bank Group Youth literacy (2016). rate, population WHO WHO-UNICEF (2015). estimates coverage of DTP3 The World Bank Group Births (2016). attended by skilled health staff (% Syrian Ministry of Health Indicators(2015). of Health Coverage syrian-arab-republic/syria-integrated-needs-assessmentdecember-2013- enartr Protect Children on the Move from Central American to the United States Institute: London. http://www.odi.org/sites/odi.org.uk/files/odi-assets/ London. Institute: publications-opinion-files/9714.pdf (SINA) Assessment https://www.savethechildren.mx/sites/savethechildren.mx/files/ resources/Position%20Paper%20Migrant%20Children%20from%20 Northern%20Triangle%20and%20Mexico-Save%20the%20Children.pdf sexes (%) protracted crises: towards a strengthened response Maban refugee camps refugee Maban 5370cfbb6.html unesco.org/images/0023/002325/232565e.pdf Hine, S. & J. Wales Education (2015). in emergencies and protracted crises: towards a strengthened response World at War Situations Protracted Refugee http://www.odi.org/sites/odi.org.uk/files/odi-assets/ London. 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No. Department Report Research cities British in practice recruitment in discrimination racial for A test Children.pdf National%20Office/2013/06/Poverty_or_Prosperity_Indigenous_ https://www.policyalternatives.ca/sites/default/files/uploads/publications/ Alternatives. Policy for Centre Canadian Canada. in children org/sites/www.ghwatch.org/files/B133-6_LGBT.pdf and transgender persons Pensions Research Report No. 576. No. Report Research Pensions troubling-racial-disparities news/press-releases/expansive-survey-americas-public-schools-reveals- Disparities Racial Troubling Reveals Schools Public Gap_2015_Report.pdf https://www.dpmc.gov.au/sites/default/files/publications/Closing_the_ 702–708. American Journal Health’. ofChildren’s Public Health in Status Socioeconomic and Race of Role The Disparities: Health 35 34 differences.pdf data/file/474273/BIS-15-85-socio-economic-ethnic-and-gender- https://www.gov.uk/government/uploads/system/uploads/attachment_ 186. No. Paper Research . BIS in participation HE gender differences 33 32 31 30 29 28 27 26 25 24 23 22 16–21. Journal Board School gap’. American achievement race the close can’t ashx?id=e6402564-db9a-6d2b-9fad-ff0000a141dd http://www.aedc.gov.au/Websilk/Handlers/ResourceDocument. http://www.aihw.gov.au/publication-detail/?id=60129552789 indicators performance health on report annual second Development: Childhood sekn_meaning_measurement_experience_2008.pdf.pdf University.Lancaster http://www.who.int/social_determinants/media/ literature of Areview inequalities. health to links and experience and measurement Meaning, Exclusion: Social L. &Rispel., H., Johnston, M., Hernandez, iser/2016-02.pdf https://www.iser.essex.ac.uk/research/publications/working-papers/ or neighbourhood? background parental choice, university graduates: British minority ethnic Index.aspx?queryid=242 articles/10.1186/1471-244X-8-70 BMC Psychiatry people’. bisexual and gay lesbian, in harm self deliberate and suicide, Rothstein, R. (2004). ‘Class and the classroom: Even the best schools schools best the Even classroom: the and ‘Class (2004). R. Rothstein, For discussion see Mathieson, J., Popay, J., Enoch, E., Escorel. S., S., Escorel. E., Enoch, J., Popay, J., Mathieson, see discussion For Socio-economic, ethnic and (2015). Socio-economic, Greaves &E. C. Crawford, Ethnicity and child poverty child and Ethnicity (2009). l. Platt, Closing the Gap Report 2015 Report Gap the (2015). Closing Australia of Commonwealth Chen, E., Martin, A. D., Matthews, K. A. (2006). ‘Understanding ‘Understanding (2006). A. K. Matthews, D., A. Martin, E., Chen, Wood, M., Hales, J., Purdon, S., Sejersen, T. & Hayllar, O. (2009). T. O. (2009). &Hayllar, Sejersen, S., Purdon, J., Hales, M., Wood, National Partnership Agreement on Indigenous Early Early Indigenous on Agreement Partnership (2015) National AIHW Improving the health and well-being of lesbian, gay, bisexual bisexual gay, lesbian, of well-being and health the (2013). Improving WHO Labour market disadvantage of of disadvantage market (2016). Labour S. W., Longhi, Zwysen, Mean Years of Schooling of Years (2016). Mean UNESCO Macdonald, D. & D. Wilson (2013). Poverty or Prosperity: Indigenous Indigenous Prosperity: or (2013). Poverty D. &D. Wilson Macdonald, Expansive Survey of America’s America’s of Survey (2014). Expansive Education of Department U.S. King, M. et al. (2008). ‘A systematic review of mental disorder, disorder, mental of review ‘A systematic (2008). al. et M. King, . SEKN, Commission on Social Determinants of Health and and Health of Determinants Social on Commission . SEKN, . Cat. no. IHW 151. Canberra: AIHW. AIHW. 151. IHW no. Canberra: . Cat. 8:70. http://bmcpsychiatry.biomedcentral.com/ Institute for Social & Economic Research. Research. &Economic Social for Institute . Report by the Secretariat. http://www.ghwatch. Secretariat. the by . Report . Department of Work and and Work of . Department . http://data.uis.unesco.org/ . http://www.ed.gov/ . April; 96(4): 96(4): . April; . . , 191, at-world-health-assembly speech/2013/05/21/world-bank-group-president-jim-yong-kim-speech- http://www.worldbank.org/en/news/ Assembly. Health World the at who.int/iris/bitstream/10665/174536/1/9789241564977_eng.pdf?ua=1 Report Monitoring Global First Coverage: coverage-friend-or-foe-of-health-equity http://www.jointlearningnetwork.org/resources/universal-health- The Lancet equity?’ health of foe or friend 6 5 4 3 2 1 9 2 1 TO PARTINTRODUCTION THREE ALL CHILDREN PART THREE 16 15 14 13 12 11 10 9 8 7 Malawi.pdf EDUCATION/Resources/278200-1099079877269/Education_System_ DC: World http://siteresources.worldbank.org/ Washington Bank. Malawi in System Education The uk/files/odi-assets/publications-opinion-files/10101.pdf Kenya in education post-primary domestic education financing.UK _20061222113833/Rendered/PDF/wps4102.pdf external/default/WDSContentServer/WDSP/IB/2006/12/22/000016406 in Punjab enrolments school public on programme stipend school female the of impact ET(2014)433849_EN.pdf europa.eu/RegData/etudes/etudes/join/2014/433849/EXPO-DEVE_ Challenges and Issues Countries: Development. http://unctad.org/en/PublicationsLibrary/wir2015_en.pdf Governance Investment odi-assets/publications-opinion-files/9877.pdf planning odi.org.uk/files/odi-assets/publications-opinion-files/9213.pdf post-2015inequalities pdf?sequence=1&isAllowed=y worldbank.org/bitstream/handle/10986/16195/9781464800108. Prosperity reforms 15647088/fighting-corruption-public-services-chronicling-georgias- Georgia’s reforms Challenges and Issues Countries: Developing in (2014). Mobilisation Tax Revenue issues in countries low-income MacMillan. development for Policy Fiscal editors, T. A., &Roe, Addison, In Tax Revenue Mobilisation in Developing Developing in Mobilisation (2014). Tax Revenue Parliament. European Future Human the and Health Y. J. (2013) 21st. Poverty, May Kim, 1). (Appendix Uganda on Spotlight See 1). (Appendix Rwanda on Spotlight See International 2015, Reforming Report Investment (2015), World UNCTAD and analysis protection social into taxation F. (2015), Bringing Bastagli, intersecting address to justice social (2014). V. Strengthening al. et Arauco, Shared for Foundation The Matters: (2013). Inclusion Bank. World Fighting corruption in public services: chronicling chronicling services: public in corruption (2012) Fighting Bank World design policy fiscal and Monetary (2005). Fund Monetary International design in countries Fiscal policy low-income D. (2004) &Bevan, C. Adam, See Save the Children. (2014). More is not enough: Achieving equity in in equity Achieving enough: not is (2014). More Children. the Save See International Bank for Reconstruction and Development. (2010). (2010). Development. and Reconstruction for Bank International Beyond Basic: The Growth of of Growth The Basic: (2014). Beyond Hine &S. A. Prizzon, S., Nicolai, Tracking Universal Health Health Universal (2015) Tracking Group. Bank World and WHO Gwatkin, D. & A. Ergo (2011). ‘Universal health coverage: coverage: health (2011). Ergo D. &A. ‘Universal Gwatkin, Income transfers and female schooling: the the schooling: female and transfers Income (2008). N. Chaudhury, See Spotlight on Rwanda (Appendix 1). (Appendix Rwanda on Spotlight See

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A FA . Washington D.C. in European Parliament Parliament European in D.C. . Washington . http://www.odi.org/sites/odi.org. ODI, . Brussels. http://www.europarl. . World Bank Working Paper No: 182. 182. No: Paper Working Bank . World IR CHANCE FOR FOR CHANCE IR . Switzerland: Geneva. http://apps. Geneva. . Switzerland: , Vol. 377, June 2011. 377,, Vol. June . Palgrave . Palgrave . Speech . Speech

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. ODI. . 45(2): 285–305. , 20(1), 2008,, 20(1), pp 255–273 104(Suppl1): S17–S24 . Overseas Development Agency. . UNDP. http://carnegieendowment.org/ UNDP. . . Development Initiatives and Global 126(4): 355–363; 126(4): Mumtaz et al. ‘Improving (2014) 11(150); Nayar (2007) 11(150); ‘Social exclusion, caste & health: . Development Initiatives. http://www.globalhumanitarian Initiatives. Development . . ILO. http://www.social-protection.org/gimi/gess/ShowTheme. ILO. . . ESS Working Paper ILO: Geneva. No. 37. http://www.ilo.org/ , and Larkin, M. Davos briefing: (2015). inclusive growth EQUAL TREATMENT . UK: London. . UK: London.

Tessier et Social al. (2013). Protection Floors and gender equality: A brief Honkanen, Social (2015). T. Inclusion and Poverty Reduction (Vivir Mejor Nhan-O’Reilly, J. and Mason, C. More (2015). and Better: Global Action Lattimer, C. World (2015). Humanitarian Summit: Making financing Save the Children International Draft (2015). Child-Sensitive Social Global Humanitarian Assistance Humanitarian Global Humanitarian Global Assistance. (2015). Save the Children. Position (2015). paper: World Humanitarian Summit Save the Children. Position (2015). paper: World HumanitarianSummit See Asian Development Bank Taking the (2013) right road to inclusive Homes, R. Bhuavanendra & D. Social (2013). protection and resilient Moser, C and Antezana, (2001). O. Social protection Practises in Bolivia: Soares et al. (2007). Conditional Cash transfers in Brazil, Chile and Jones, N., with Vargas, R. andVillar, E. (2008) ‘Cash transfers to In Ghana see Ganle et al. ‘Inequities (2014). in accessibility to Poder, T & J. Poder, He ‘The (2015). Role of Ethnic and Rural Discrimination Skordis-Worrall et al. (2011) ‘Maternal and neonatal ‘Maternal health and (2011) al. et Skordis-Worrall 13(89). http://www.equityhealthj.com/content/13/1/89;13(89). In Mali see Ravit et al. ‘The (2015). Hidden Costs of a Free Caesarean Section Policy in West Africa (Kayes Journal Health Region, Child and Maternal Mali)’. and utilisation of maternal health services in Ghana after user-fee exemption: a descriptive study’. International Journal for Equity in Health 19(8): 1734 –1743. in the Relationship Between Income Inequality and Health in Services Health of Journal International Guatemala’. a review based on the social determinants framework’. Journal Indian Research Medical of Maternal Health in Pakistan: a Deeper Toward Understanding of the Social Determinants of Poor Access Women’s to Maternal Health Health Public of Journal American Services’. expenditure in Mumbai slums (India): A cross sectional study’. BMC HealthPublic overview wcmsp5/groups/public/---ed_protect/---soc_sec/documents/publication/ wcms_218850.pdf Humanitarian Assistance, July 2015. http://www.globalhumanitarian Humanitarian Assistance, 2015. July assistance.org/wp-content/uploads/2015/07/The-World-Humanitarian- Summit-making-financing-work-for-crisis-affected-people.pdf work for crisis-affected for work people food systems: The role of cash transfers http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion- files/8601.pdf growth https://agenda.weforum.org/2014/01/davos-briefing-notes-inclusive- growth/ Its Implications for Bolivia’s Poverty Reduction Strategy Paper (PRSP) http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion- files/1788.pdf Report 2015 assistance.org/wp-content/uploads/2015/06/GHA-Report-2015_- Interactive_Online.pdf 2 29 27 28 26 25 24 23 22 21 20 19 18 17 3 1 10 2016 files/conditional_cash_transfers1.pdf Mexico: Impacts Upon Inequality Upon Impacts Mexico: 2016 do?tid=2670 strategy) tackle childhood poverty and vulnerability: an analysis of Peru’s Juntos programme’. Urbanization and Environment p. 264. Protection Position Paper. Protection Position to Improve Funding, Support and Collaboration for Education in Emergencies Save the Children. Available at: https://www.savethechildren.org.uk/ sites/default/files/images/More_and_Better.pdf 7 Based on Fernando, S. (2015). Turning Rights into Realities in Bangladesh: http://countdown2015mnch.org/about-countdown/countdown-data; Child Friendly Local Governance. Save the Children, Bangladesh. World Bank reports, http://documents.worldbank.org/curated/ http://resourcecentre.savethechildren.se/library/turning-rights-realities- en/2012/01/16860295/inequalities-health-outcomes-child-health , bangladesh-child-friendly-local-governance http://documents.worldbank.org/curated/en/2012/01/16860889/ inequalities-health-utilization-maternal-child-health-interventions 8 Goldfrank, B. (2006) Lessons from Latin American Experience in Participatory Budgeting (Presentation at the Latin American Studies 3 The cases of Brazil, China, India and Mexico. Association). San Juan, Puerto Rico as quoted by Carlizt, R. (n.d.) 4 UN IGME (2014). Op. Cit. For detailed discussion of the model please Improving Transparency and Accountability in the Budget Process: An consult http://childmortality.org/files_v17/download/unicef-2013-child- Assessment of Recent Initiatives. Los Angeles, US. EVERY LAST CHILD EVERY mortality-report-LR-10_31_14_195.pdf. For detailed discussion of the 9 Carlizt, R. (n.d.). Op. Cit. model please consult http://arxiv.org/pdf/1309.1602v1.pdf 10 Carter, B. (2015). Op. Cit. 5 Direct estimation method implies using retrospective birth or pregnancy histories to collect the data needed for computing child 11 World Bank. (2013). Inclusion Matters. Washington DC, US as quoted mortality rates. Birth or pregnancy histories include information for by Carter (2015). Op. Cit. each birth or pregnancy that the interviewed woman has ever had. 12 Gore, R and Minujin, A. (2003). Background Note: Budgeting Initiatives Usually as a minimum it includes: month and year of birth of each child; for Children. UNICEF sex of each child; survival status of each child (i.e., alive or dead); age of each surviving child; age at death of each deceased (or date of death). 13 Global Health Visions. (n.d.). Engendering Accountability: Upholding In the case of pregnancy histories, information on the outcome of each Commitments to Maternal and Newborn Health. http://globalhealthvisions. pregnancy (i.e., live birth, still birth, miscarriage, or induced abortion) com/Engendering_Accountability_Full_Report.pdf is collected (http://www.un.org/en/development/desa/population/ 14 See Risso-Gill, I. and Finnegan, L. (2014). Children’s Ebola Recovery publications/pdf/technical/TP2011-2_MortEstMajorSampSurv.pdf). Assessment: Sierra Leone. http://www.savechildren.or.jp/scjcms/dat/img/ 6 Onis, M., 2006. WHO Child Growth Standards based on length/ blog/2011/1435151547697.pdf and Finnegan, L. (2013). After Yolanda: height, weight and age. Acta paediatrica, 95(S450), pp.76–85. What Children Think, Need and Recommend. Philippines: Manila. https://www.savethechildren.net/sites/default/files/After%20Yolanda%20 7 Available at: http://www.education-inequalities.org/ What%20Children%20Think%20Need%20and%20Recommend%20 8 In most cases this implies exactly the same structure, and in some only Joint%20Agency%20Report.pdf one group has changed. 15 Save the Children. (2015). What Do Children Want in Times of 9 Minorities at Risk website: http://www.cidcm.umd.edu/mar/about.asp Emergency and Crisis? They Want an Education. UK: London.

FIGURE 14 THE GLOBAL CHALLENGE OF APPENDIX 3: METHODOLOGICAL NOTE CHILDREN’S EXCLUSION (MAP) ON THE CHILD DEVELOPMENT INDEX 1 Save the Children (2008) The Child Development Index: Holding 1 UNICEF (2013) Every Child’s Birth Right: Inequities and trends in birth governments to account for children’s wellbeing. London: Save The registration, UNICEF, New York. Children. http://www.savethechildren.org.uk/sites/default/files/docs/ 2 See Spotlight on Bolivia (Appendix 1) child-development-index.pdf and Save the Children (2012) The Child Development Index 2012: Progress, challenges and inequality. London: Save 3 Platt, l. (2009). Ethnicity and child poverty. Department of Work and the Children. http://www.savethechildren.org.uk/sites/default/files/ Pensions Research Report No. 576. images/Child_Development_Index_2012_0.pdf 4 Own calculations. See endnote 9 in The Story of Numbers (page 75). 2 The highest group in our sample is 371 x 1,000 for Tuareg Bella ethnic 5 See Spotlight on Jordan (Appendix 1). group from Niger (1992). 6 UNESCO (2016). World Inequality Database on Education. 3 The minimum observed for any country between 1980 – 2013 is http://www.education-inequalities.org/countries/kenya-?dimension=all& Luxemburg 1.9 x 1,000 in 2015. group=all&year=latest 4 Some groups have over 90% children without registration in Chad, 7 Save the Children South Africa (2015). In search of a better future: Ethiopia, Liberia, among others. experiences of unaccompanied migrant children in Limpopo & Mpumalanga 5 The second highest is India (1980) with 72.9%. in South Africa. https://www.savethechildren.org.za/sites/savethechildren. org.za/files/field/file/Case%20Studies.pdf 6 We recognise that statistically it is possible to be under two standard deviations to the mean, which is the threshold to compute stunting rate 8 See Spotlight on China (Appendix 1). based on population of reference. In a normal distribution this would 9 Own calculations. See endnote 9 in The Story of Numbers (page 75). be equivalent to about 2% of children (probability to be under 2 SD = 2.28%). We run robustness analysis with this minimum value also. 10 AIHW (2015) National Partnership Agreement on Indigenous Early Childhood Development: second annual report on health performance 7 The age cohort considered is 15 to 24 years old. indicators. Cat. no. IHW 151. Canberra: AIHW. http://www.aihw.gov.au/ 8 Somalia has 95% of children not completing primary school, and some publication-detail/?id=60129552789 http://www.aedc.gov.au/Websilk/ groups within the country are close to 100%. Handlers/ResourceDocument. ashx?id=e6402564-db9a-6d2b-9fad- ff0000a141dd 9 Population of children include individuals between the age of 0 and 15. From World Bank (2015) World Development Indicators: Population. http://data.worldbank.org/indicator/SP.POP.TOTL APPENDIX 2: METHODOLOGICAL NOTE 10 It corresponds to the country and lending groups classification from ON DATA ANALYSIS the World Bank. http://data.worldbank.org/about/country-and-lending- 1 Colleagues from ODI contributed by computing the estimates from groups MICS, and by compiling disaggregated estimates for India. 2 Including: UN IGME data (www.childmortality.org), WHO stats (http://ow.ly/FMNDu), DHS Stat Compiler (http://www.statcompiler. com/); UNICEF Data (http://ow.ly/FMMrw); WIDE dataset (http://www.education-inequalities.org/), Countdown equity profiles,

82 EVERY LAST CHILD

The children the world chooses to forget

It’s estimated 16,000 children under fi ve will die today – most from causes we know how to treat. Meanwhile, more than 121 million school-age children are missing out on learning.

Which children are being left out and left behind? And why?

Extreme poverty continues to be a fatal injustice. But a disproportionate number of children who die or lose out on education are not ’just’ poor. Discrimination is also an underlying cause of millions of children dying needlessly, being denied the chance to learn or being exposed to violence.

Together these two injustices – poverty and discrimination – add up to exclusion. And it’s apparent in every country and for millions of children.

Every Last Child tells the story of these forgotten children, addressing key questions:

• How many children are excluded? • What’s the impact of exclusion on children? • What are the drivers of exclusion? • Is it getting better or worse? • What can be done to tackle exclusion?

This report presents new quantitative research fi ndings on excluded groups – children from ethnic minorities, those in disadvantaged regions of their country, and excluded girls. We also point to shocking inequalities faced by refugee and internally displaced children, as well as those who often go uncounted – including children with disabilities and street children.

Drawing on these new fi ndings and analysis, this report identifi es a series of measures to ensure no child is left behind. And it urges leaders around the world to meet that challenge by making Three Guarantees to All Children: Fair Finance, Equal Treatment and Accountability. savethechildren.net