The Millennium Development Goals Report 2011 asdf UNITED NATIONS This report is based on a master set of data that has been compiled by an Inter-Agency and Expert Group on MDG Indicators led by the Department of Economic and Social Affairs of the United Nations Secretariat, in response to the wishes of the General Assembly for periodic assessment of progress towards the MDGs. The Group comprises representatives of the international organizations whose activities include the preparation of one or more of the series of statistical indicators that were identified as appropriate for monitoring progress towards the MDGs, as reflected in the list below. A number of national statisticians and outside expert advisers also contributed.

INTERNATIONAL LABOUR ORGANIZATION

FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS

UNITED NATIONS EDUCATIONAL, SCIENTIFIC AND CULTURAL ORGANIZATION

UNITED NATIONS INDUSTRIAL DEVELOPMENTCover Inside ORGANIZATION

WORLD HEALTH ORGANIZATION

THE WORLD BANK

INTERNATIONAL MONETARY FUND

INTERNATIONAL TELECOMMUNICATION UNION

ECONOMIC COMMISSION FOR AFRICA

ECONOMIC COMMISSION FOR EUROPE

ECONOMIC COMMISSION FOR LATIN AMERICA AND THE CARIBBEAN

ECONOMIC AND SOCIAL COMMISSION FOR ASIA AND THE PACIFIC

ECONOMIC AND SOCIAL COMMISSION FOR WESTERN ASIA

JOINT UNITED NATIONS PROGRAMME ON HIV/AIDS

UNITED NATIONS CHILDREN’S FUND

UNITED NATIONS CONFERENCE ON TRADE AND DEVELOPMENT

UNITED NATIONS DEVELOPMENT FUND FOR WOMEN

UNITED NATIONS DEVELOPMENT PROGRAMME

UNITED NATIONS ENVIRONMENT PROGRAMME

UNITED NATIONS FRAMEWORK CONVENTION ON CLIMATE CHANGE

UNITED NATIONS HIGH COMMISSIONER FOR REFUGEES

UNITED NATIONS HUMAN SETTLEMENTS PROGRAMME

UNITED NATIONS POPULATION FUND

INTERNATIONAL TRADE CENTRE

INTER-PARLIAMENTARY UNION

ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT

WORLD TRADE ORGANIZATION The Millennium Development Goals Report 2011

asdf United Nations New York, 2011

Foreword | 3 Foreword

Since they were first adopted, the Millennium Disparities between urban and rural areas are also Development Goals (MDGs) have raised awareness and pronounced and daunting. Achieving the goals will shaped a broad vision that remains the overarching require equitable and inclusive economic growth — framework for the development activities of the United growth that reaches everyone and that will enable all Nations. people, especially the poor and marginalized, to benefit from economic opportunities. At the September 2010 MDG Summit, world leaders put forward an ambitious action plan — a roadmap We must also take more determined steps to protect outlining what is needed to meet the goals by the the ecosystems that support economic growth and agreed deadline of 2015. The information presented sustain life on earth. Next year’s United Nations on the following pages demonstrates that this can be Conference on Sustainable Development — Rio + 20 — done if concrete steps are taken. is an opportunity to generate momentum in this direction, which is vital for achieving the MDGs. Already, the MDGs have helped to lift millions of people out of poverty, save lives and ensure that Between now and 2015, we must make sure that children attend school. They have reduced maternal promises made become promises kept. The people of deaths, expanded opportunities for women, increased the world are watching. Too many of them are anxious, access to clean water and freed many people from angry and hurting. They fear for their jobs, their deadly and debilitating disease. At the same time, families, their futures. World leaders must show not the report shows that we still have a long way to go in only that they care, but that they have the courage and empowering women and girls, promoting sustainable conviction to act. development, and protecting the most vulnerable from the devastating effects of multiple crises, be they conflicts, natural disasters or volatility in prices for food and energy.

Progress tends to bypass those who are lowest on the economic ladder or are otherwise disadvantaged Ban Ki-moon because of their sex, age, disability or ethnicity. Secretary-General, United Nations 4 | The Millennium Development Goals Report 2011 Overview

Lives have been saved or changed from malaria have been reduced by 20 per cent worldwide— for the better from nearly 985,000 in 2000 to 781,000 in 2009. This was accomplished through critical interventions, including the distribution of insecticide-treated mosquito nets, which, More than 10 years have passed since world leaders in sub-Saharan Africa alone, are sufficient to cover 76 per established goals and targets to free humanity from extreme cent of the population at risk. The largest absolute drops poverty, hunger, illiteracy and disease. The Millennium in malaria deaths were in Africa, where 11 countries have Declaration and the MDG framework for accountability reduced malaria cases and deaths by over 50 per cent. derived from it have inspired development efforts and helped set global and national priorities and focus subsequent •• Investments in preventing and treating HIV actions. While more work lies ahead, the world has cause are yielding results to celebrate, in part due to the continued economic growth of some developing countries and targeted interventions in New HIV infections are declining steadily, led by sub-Saharan critical areas. Increased funding from many sources has Africa. In 2009, an estimated 2.6 million people were newly translated into the expansion of programmes to deliver infected with HIV—a drop of 21 per cent since 1997, when services and resources to those most in need. Here are some new infections peaked. Thanks to increased funding and of the highlights: the expansion of major programmes, the number of people receiving antiretroviral therapy for HIV or AIDS increased 13- •• Poverty continues to decline in many countries fold from 2004 to 2009. By end-2009, 5.25 million people and regions were receiving such treatment in low- and middle-income countries—an increase of over 1.2 million people since Despite significant setbacks after the 2008-2009 economic December 2008. As a result, the number of AIDS-related downturn, exacerbated by the food and energy crisis, the deaths declined by 19 per cent over the same period. world is still on track to reach the poverty-reduction target. By 2015, it is now expected that the global poverty rate will •• Effective strategies against tuberculosis are saving fall below 15 per cent, well under the 23 per cent target. This millions of lives global trend, however, mainly reflects rapid growth in Eastern Asia, especially China. Between 1995 and 2009, a total of 41 million tuberculosis patients were successfully treated and up to 6 million lives •• Some of the poorest countries have made the greatest were saved, due to effective international protocols for the strides in education treatment of tuberculosis. Worldwide, deaths attributed to the disease have fallen by more than one third since 1990. Burundi, Madagascar, Rwanda, Samoa, Sao Tome and Principe, Togo and the United Republic of Tanzania have •• Every region has made progress in improving access achieved or are nearing the goal of universal primary to clean drinking water education. Considerable progress has also been made in Benin, Bhutan, Burkina Faso, Ethiopia, Guinea, Mali, An estimated 1.1 billion people in urban areas and 723 Mozambique and Niger, where net enrolment ratios in primary million people in rural areas gained access to an improved school increased by more than 25 percentage points from drinking water source over the period 1990-2008. Eastern 1999 to 2009. With an 18 percentage point gain between Asia registered the largest gains in drinking water coverage— 1999 and 2009, sub-Saharan Africa is the region with the from 69 per cent in 1990 to 86 per cent in 2008. Sub- best record of improvement. Saharan Africa nearly doubled the number of people using an improved drinking water source—from 252 million in 1990 to •• Targeted interventions have succeeded in reducing 492 million in 2008. child mortality Despite real progress, we are failing to reach The number of deaths of children under the age of five declined from 12.4 million in 1990 to 8.1 million in 2009. the most vulnerable This means that nearly 12,000 fewer children are dying each day. Between 2000 and 2008, the combination of improved Alhough many countries have demonstrated that progress immunization coverage and the opportunity for second-dose is possible, efforts need to be intensified. They must also immunizations led to a 78 per cent drop in measles deaths target the hardest to reach: the poorest of the poor and worldwide. These averted deaths represent one quarter of the those disadvantaged because of their sex, age, ethnicity or decline in mortality from all causes among children under disability. Disparities in progress between urban and rural five. areas remain daunting.

•• Increased funding and control efforts have cut deaths •• The poorest children have made the slowest progress from malaria in terms of improved nutrition Through the hard work of governments, international In 2009, nearly a quarter of children in the developing partners, community health workers and civil society, deaths world were underweight, with the poorest children most Overview | 5

affected. In Southern Asia, a shortage of quality food and is 1.8 times more likely to use an improved drinking water poor feeding practices, combined with inadequate sanitation, source than a person living in a rural area. has contributed to making underweight prevalence among children the highest in the world. In that region, between Continued progress requires an active 1995 and 2009, no meaningful improvement was seen commitment to peace, equity, equality and among children in the poorest households, while underweight prevalence among children from the richest 20 per cent of sustainability households decreased by almost one third. Children living in rural areas of developing regions are twice as likely to be At the 2010 High-level Plenary Meeting of the General underweight as are their urban counterparts. Assembly on the Millennium Development Goals, world leaders reaffirmed their commitment to the MDGs and •• Opportunities for full and productive employment remain called for intensified collective action and the expansion of particularly slim for women successful approaches. They acknowledged the challenges posed by multiple crises, increasing inequalities and Wide gaps remain in women’s access to paid work in at persistent violent conflicts. least half of all regions. Following significant job losses in 2008-2009, the growth in employment during the economic They called for action to ensure equal access by women and recovery in 2010, especially in the developing world, girls to education, basic services, health care, economic was lower for women than for men. Women employed in opportunities and decision-making at all levels, recognizing manufacturing industries were especially hard hit. that achievement of the MDGs depends largely on women’s empowerment. World leaders also stressed that accelerated •• Being poor, female or living in a conflict zone increases action on the goals requires economic growth that is the probability that a child will be out of school sustainable, inclusive and equitable—growth that enables The net enrolment ratio of children in primary school has only everyone to benefit from progress and share in economic gone up by 7 percentage points since 1999, reaching 89 per opportunities. cent in 2009. More recently, progress has actually slowed, dimming prospects for reaching the MDG target of universal Finally, further and faster movement towards achievement primary education by 2015. Children from the poorest of the MDGs will require a rejuvenated global partnership, households, those living in rural areas and girls are the most expeditious delivery on commitments already made, and an likely to be out of school. Worldwide, among children of agile transition to a more environmentally sustainable future. primary school age not enrolled in school, 42 per cent— 28 million—live in poor countries affected by conflict.

•• Advances in sanitation often bypass the poor and those living in rural areas

Over 2.6 billion people still lack access to flush toilets or Sha Zukang other forms of improved sanitation. And where progress has occurred, it has largely bypassed the poor. An analysis Under-Secretary-General for Economic of trends over the period 1995-2008 for three countries and Social Affairs in Southern Asia shows that improvements in sanitation disproportionately benefited the better off, while sanitation coverage for the poorest 40 per cent of households hardly increased. Although gaps in sanitation coverage between urban and rural areas are narrowing, rural populations remain at a distinct disadvantage in a number of regions.

•• Improving the lives of a growing number of urban poor remains a monumental challenge Progress in ameliorating slum conditions has not been sufficient to offset the growth of informal settlements throughout the developing world. In developing regions, the number of urban residents living in slum conditions is now estimated at 828 million, compared to 657 million in 1990 and 767 million in 2000. Redoubled efforts will be needed to improve the lives of the urban poor in cities and metropolises across the developing world.

•• Progress has been uneven in improving access to safe drinking water In all regions, coverage in rural areas lags behind that of cities and towns. In sub-Saharan Africa, an urban dweller 6 | The Millennium Development Goals Report 2011

Target Halve, between 1990 and 2015, the proportion of people Goal 1 whose income is less than $1 a day Eradicate extreme Sustained growth in developing countries, poverty and particularly in Asia, is keeping the world on hunger track to meet the poverty-reduction target

Proportion of people living on less than $1.25 a day, 1990 and 2005 (Percentage) Sub-Saharan Africa 58 51 Southern Asia 49 39 Southern Asia (excluding India) 45 31 Caribbean 29 26 Caucasus & Central Asia 6 19 South-Eastern Asia 39 19 Eastern Asia 60 16 Latin America 11 7 Western Asia 2 6 Northern Africa 5 3 Developing regions 45 27

0 20 40 60 80

1990 2005 2015 target

Robust growth in the first half of the decade reduced the number of people in developing countries living on less than $1.25 a day from about 1.8 billion in 1990 to 1.4 billion in 2005. At the same time, the corresponding poverty rate dropped from 46 per cent to 27 per cent. The economic and financial crisis that began in the advanced countries of North America and Europe in 2008 sparked declines in commodity prices, trade and investment, resulting in slower growth globally. Goal 1: Eradicate extreme poverty and hunger | 7

Despite these declines, current trends suggest that the momentum of growth in the developing world remains strong enough to sustain the progress needed to reach the global poverty-reduction target. Based on recently updated projections from the World Bank, the overall poverty rate is still expected to fall below 15 per cent by 2015, indicating that the Millennium Development Goal (MDG) target can be met.

The World Bank’s new poverty projections for 2015 incorporate several changes: additional data from over 60 new household surveys, updates of historical consumption per capita from national accounts, and a new forecast of growth in per capita consumption. The forecast therefore captures changes in income distribution in countries for which new survey data are available, and assumes that inequality remains unchanged in other countries. It also incorporates some of the effects of the global economic crisis, such as food and fuel price shocks. By 2015, the number of people in developing countries living on less than $1.25 a day is projected to fall below 900 million.

The fastest growth and sharpest reductions in poverty continue to be found in Eastern Asia, particularly in China, where the poverty rate is expected to fall to under 5 per cent by 2015. India has also contributed to the large reduction in global poverty. In that country, poverty rates are projected to fall from 51 per cent in 1990 to about 22 per cent in 2015. In China and India combined, the number of people living in extreme poverty between 1990 and 2005 declined by about 455 million, and an additional 320 million people are expected to join their ranks by 2015. Projections for sub-Saharan Africa are slightly more upbeat than previously estimated. Based on recent economic growth performance and forecasted trends, the extreme poverty rate in the region is expected to fall below 36 per cent.

The task of monitoring progress on poverty reduction is beset by a lack of good quality surveys carried out at regular intervals, delays in reporting survey results, and insufficient documentation of country- level analytical methods used. It is also hampered by difficulties in accessing the underlying survey micro- data required to compute the poverty estimates. These gaps remain particularly problematic in sub-Saharan Africa, where the data necessary to make comparisons over the full range of MDGs are available in less than half the countries. For example, between 2007 and 2009, the countries that had collected, analysed and disseminated survey data, represent only 20 per cent of the region’s population. 8 | The Millennium Development Goals Report 2011

Target More than three years have passed since the onset of the fastest and deepest drop in global economic Achieve full and productive employment and activity since the Great Depression. While global decent work for all, including women and young economic growth is rebounding, the global labour people market is, in many respects, behaving as anticipated in the middle of the crisis: stubbornly elevated Economic recovery has failed to translate unemployment and slow employment generation in developed economies, coupled with widespread into employment opportunities deficits in decent work in even the fastest-growing developing countries. Employment-to-population ratio, 2000, 2009 and 2010 preliminary estimates In the developed regions, the employment-to- population ratio dropped from 56.8 per cent in 2007 Eastern Asia 74 to 55.4 per cent in 2009, with a further drop to 54.8 70 per cent in 2010. Clearly, many developed economies 70 are simply not generating sufficient employment opportunities to absorb growth in the working-age Oceania 66 population. Again, this reflects an ongoing lag between 66 economic recovery and a recovery in employment 66 in this region. This contrasts with many developing South-Eastern Asia regions, some of which saw an initial decline in the 67 employment-to-population ratio but where, with the 66 exception of the Caucasus and Central Asia and 66 Eastern Asia, the estimated employment-to-population Sub-Saharan Africa ratio in 2010 has changed little since 2007. 63 64 64 Latin America & the Caribbean 58 61 61 Caucasus & Central Asia 55 59 60 Southern Asia 57 58 58 Northern Africa 43 46 46 Western Asia 45 44 43 Developed regions 55.8 55.4 54.8 Developing regions 63.2 62.7 62.7

0 10 20 30 40 50 60 70 80 2000 2009 2010 Goal 1: Eradicate extreme poverty and hunger | 9

Progress in reducing vulnerable is characterized by informal working arrangements, employment stalled following the lack of adequate social protection, low pay and difficult economic crisis working conditions. On the basis of available data, it is estimated that Proportion of own-account and contributing family workers in the vulnerable employment rate remained roughly the total employment, 1999, 2008 and 2009 (Percentage) same between 2008 and 2009, both in developing Oceania and developed regions. This compares with a steady 77 average decline in the years preceding the economic 78 and financial crisis. Increases in the vulnerable 78 employment rate were found in sub-Saharan Africa Southern Asia and Western Asia. 80 78 77 Sub-Saharan Africa 80 75 76 South-Eastern Asia 66 62 62 Eastern Asia 61 53 51 Caucasus & Central Asia 57 44 44 Northern Africa 33 33 33 Latin America & the Caribbean 36 32 32 Western Asia 37 28 29 Developed regions 11 10 10 Developing regions 65 60 60

0 10 20 30 40 50 60 70 80 90

1999 2008 2009

In developing regions overall, the majority of workers are engaged in “vulnerable employment”, defined as the percentage of own-account and unpaid family workers in total employment. Vulnerable employment 10 | The Millennium Development Goals Report 2011

Worldwide, one in five workers and their families are living in extreme poverty

Proportion of employed people living on less than $1.25 a day (Percentage) and number of working poor (Millions), 1999-2009

Millions Percentage 1000 35.0

Working poor Working poverty rate 800 30.0 Pre-crisis trend (2002-2007)

600 25.0

400 20.0

200 15.0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

A slowdown in progress against poverty is reflected of the working poverty incidence curve beginning in in the number of working poor. According to the 2007. The estimated rate for 2009 is 1.6 percentage International Labour Organization, one in five workers points higher than the rate projected on the basis of and their families worldwide were living in extreme the pre-crisis trend. While this is a crude estimate, it poverty (on less than $1.25 per person per day) in amounts to about 40 million more working poor at the 2009. This represents a sharp decline in poverty from extreme $1.25 level in 2009 than would have been a decade earlier, but also a flattening of the slope expected on the basis of pre-crisis trends. Goal 1: Eradicate extreme poverty and hunger | 11

Target Halve, between 1990 and 2015, the proportion of people who suffer from hunger.

The proportion of people going hungry has plateaued at 16 per cent, despite reductions in poverty

Number and proportion of people in the developing regions who are undernourished, 1990-1992, 1995-1997, 2000-2002 and 2005-2007

Millions Percentage

1,500 25

20 1,200 18 20 16 16

900 15 828 818 837 770 600 10

300 5

0 0 1990- 1995- 2000- 2005- 1992 1997 2002 2007

Number of Percentage of undernourished people undernourished people

The proportion of people in the developing world who went hungry in 2005-2007 remained stable at 16 per cent, despite significant reductions in extreme poverty. Based on this trend, and in light of the economic crisis and rising food prices, it will be difficult to meet the hunger-reduction target in many regions of the developing world.

The disconnect between poverty reduction and the persistence of hunger has brought renewed attention to the mechanisms governing access to food in the developing world. This year, the Food and Agriculture Organization of the United Nations will undertake a comprehensive review of the causes behind this apparent discrepancy to better inform hunger-reduction policies in the future. 12 | The Millennium Development Goals Report 2011

Disparities within and among regions are found in the fight against hunger

Proportion of undernourished population, 2005-2007 (Percentage)

Very high (undernourishment 35% and above) Moderately low (undernourishment 5-14%) High (undernourishment 25-34%) Very low (undernourishment below 5%) Moderately high (undernourishment 15-24%) Missing or insufficient data

Trends observed in South-Eastern Asia, Eastern Asia in Eastern Asia since 1990 are largely due to progress and Latin America and the Caribbean suggest that they in China, while levels in South-Eastern Asia benefit are likely to meet the hunger-reduction target by 2015. from advances made in Indonesia and the Philippines. However, wide disparities are found among countries in Based on current trends, sub-Saharan Africa will be these regions. For example, the strong gains recorded unable to meet the hunger-reduction target by 2015. Goal 1: Eradicate extreme poverty and hunger | 13

Nearly a quarter of children under lack of quality food, suboptimal feeding practices, five in the developing world remain repeated attacks of infectious diseases and pervasive undernutrition. In Southern Asia, for example, one undernourished finds not only a shortage of quality food and poor feeding practices, but a lack of flush toilets and Proportion of children under age five who are underweight, other forms of improved sanitation. Nearly half the 1990 and 2009 (Percentage) population practises open defecation, resulting in Southern Asia repeated bouts of diarrhoeal disease in children, which 52 contribute to the high prevalence of undernutrition. 43 Moreover, more than a quarter of infants in that region Sub-Saharan Africa weigh less than 2,500 grams at birth. Many of these 27 children are never able to catch up in terms of their 22 nutritional status. All these factors conspire to make South-Eastern Asia underweight prevalence in the region the highest in the 30 world. 18 Western Asia* Nutrition must be given higher priority in national 11 development if the MDGs are to be achieved. A 7 number of simple, cost-effective measures delivered Eastern Asia at key stages of the life cycle, particularly from 15 6 conception to two years after birth, could greatly 15 reduce undernutrition. These measures include Northern Africa 10 improved maternal nutrition and care, breastfeeding 6 within one hour of birth, exclusive breastfeeding for the Caucasus & Central Asia first 6 months of life, and timely, adequate, safe, and 7 appropriate complementary feeding and micronutrient 5 intake between 6 and 24 months of age. Urgent, Latin America & the Caribbean accelerated and concerted actions are needed to 10 deliver and scale up such interventions to achieve 4 MDG 1 and other health-related goals. Developing regions 30 23

0 10 20 30 40 50 60

1990 2009 Target

* Regional aggregate only covers 47 per cent of the regional population, due to lack of data from Yemen.

Note: Trend analysis is based on data from 64 countries covering 73 per cent of the under-five population in developing regions. Prevalence of underweight children is estimated according to World Health Organization (WHO) Child Growth Standards. For the Caucasus & Central Asia, the baseline for trend analysis is 1996, since there are not sufficient data for 1990.

In developing regions, the proportion of children under age five who are underweight declined from 30 per cent to 23 per cent between 1990 and 2009. Progress in reducing underweight prevalence was made in all regions where comparable trend data are available. Eastern Asia, Latin America and the Caribbean, and the Caucasus and Central Asia have reached or nearly reached the MDG target, and South-Eastern Asia and Northern Africa are on track.

However, progress in the developing regions overall is insufficient to reach the target by 2015. Children are underweight due to a combination of factors: 14 | The Millennium Development Goals Report 2011

In Southern Asia, progress in combating child undernutrition is bypassing the poorest

Proportion of under-five children who are underweight in Southern Asia, by household wealth, around 1995 and 2009 (Percentage)

80 64 63 60 60 51 60 54 37 40 47 40

20 26

0 -5 -20 -14 -21 -21 -30 -40 Poorest Second Middle Fourth Richest 20% 20% 20% 20% 20%

Prevalence around 1995 Prevalence around 2009 Relative reduction between 1995 and 2009

Children from the poorest households are more likely to be underweight than their richer counterparts. Moreover, the poorest children are making the slowest progress in reducing underweight prevalence. In Southern Asia, for example, there was no meaningful improvement among children in the poorest households in the period between 1995 and 2009, while underweight prevalence among children from the richest 20 per cent of households decreased by almost a third.

Children in developing regions are twice as likely to be underweight if they live in rural rather than urban areas. Little difference was found in underweight prevalence between girls and boys. Goal 1: Eradicate extreme poverty and hunger | 15

Close to 43 million people worldwide are displaced because of conflict or persecution

Number of refugees and internally displaced persons, 2000-2010 (Millions)

40

Refugees 15.2 15.4 30 16.0 16.0 15.2 14.6 13.7 13.8 14.3 Internally displaced persons 15.9 13.0

20

26.0 26.0 27.1 27.5 25.0 25.0 24.6 25.3 23.7 24.4 10 21.2

0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Humanitarian crises and conflicts continue to uproot have been confined to camps and other settlements millions of people across the globe. They also hinder for many years without any solution in sight. Excluding the return of refugees and those internally displaced. refugees under UNRWA’s mandate, UNHCR estimates As of end 2010, close to 43 million people worldwide that 7.2 million refugees spread across 24 countries were displaced due to conflict and persecution, the are currently trapped in a protracted situation of this highest number since the mid-1990s and about half kind. This is the highest number since 2001 and a million more than the previous year. Of these, 15.4 clearly demonstrates the lack of permanent solutions million are refugees, including 10.5 million who fall for many of the world’s refugees. The number of under the responsibility of the United Nations High refugees who have returned to their homes has Commissioner for Refugees (UNHCR) and 4.8 million continuously decreased since 2004, with the 2010 Palestinian refugees who are the responsibility of the figures (197,600 returns) being the lowest since 1990. United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). In addition, 27.5 On average, four out of five refugees are hosted by million people have been uprooted by violence and developing countries. Afghans and Iraqis continue to persecution but remain within the borders of their own be the largest refugee populations under the UNHCR countries. While often not displaced per se, UNHCR mandate with 3 million and 1.7 million refugees, estimated that some 12 million people were stateless. respectively, at the end of 2010. Together they account for nearly half of all refugees under UNHCR’s mandate. While millions of refugees have found a durable solution to their situation over the decades, others 16 | The Millennium Development Goals Report 2011

Target Ensure that, by 2015, children everywhere, boys and girls Goal 2 alike, will be able to complete a full course of primary schooling Achieve universal primary education Sub-Saharan Africa has the best record for improvement in primary school enrolment

Adjusted net enrolment ratio in primary education,* 1998/1999 and 2008/2009 (Percentage) Sub-Saharan Africa 58 76 Western Asia 83 88 Southern Asia 79 91 Caucasus & Central Asia 94 93 Northern Africa 86 94 South-Eastern Asia 93 94 Latin America & the Caribbean 93 95 Eastern Asia 95 96 Developed regions 97 96 Developing regions 82 89

0 25 50 75 100

1999 2009

* Defined as the number of pupils of the theoretical school age for primary education enrolled either in primary or secondary school, expressed as a percentage of the total population in that age group. Note: Data for Oceania are not available.

In the developing world as a whole, enrolment in primary education has increased slowly. The net enrolment ratio has gone up by just 7 percentage points since 1999, reaching 89 per cent in 2009. In more recent years, progress has actually slowed, with an increase of just 2 percentage points between 2004 and 2009, dimming prospects for reaching the MDG target of universal primary education by 2015. Goal 2: Achieve universal primary education | 17

Most regions have advanced somewhat, though Being poor, female or living in a progress varies considerably among geographical conflict zone increases the probability groupings. With an 18-percentage-point gain between that a child will be out of school 1999 and 2009, sub-Saharan Africa has the best record for improvement, followed by Southern Asia and Northern Africa, which had a 12-percentage- Distribution of out-of-school children by region, 1999 and 2009 (Percentage) point and an 8-percentage-point increase, respectively. By contrast, the net enrolment ratio fell 100 from 94 per cent to 93 per cent in the Caucasus and Central Asia.

80 To achieve universal primary education, children 44 everywhere must complete a full cycle of primary 48 schooling. Current statistics show that the world is far from meeting that goal. Only 87 out of 100 children in the developing regions complete primary 60 education.1 In half of the least developed countries, at least two out of five children in primary school drop out before reaching the last grade. 40 34 24 In 2009, more than 20 per cent of primary-age children in least developed countries were excluded Sub-Saharan Africa Southern Asia from education. Nevertheless, some of the poorest 6 Eastern Asia countries have made the greatest strides since 1999. 20 6 5 South-Eastern Asia Burundi, Madagascar, Rwanda, Samoa, Sao Tome and 4 4 Latin America & the Caribbean Principe, Togo and the United Republic of Tanzania 4 4 Western Asia have achieved or are nearing the goal of universal 3 2 Northern Africa 3 6 primary education (with an adjusted net enrolment 0 3 Rest of the world ratio above 95 per cent). Considerable progress 1999 2009 was also made in Benin, Bhutan, Burkina Faso, Ethiopia, Guinea, Mali, Mozambique and Niger, where The total number of children out of school fell from net enrolment ratios increased by more than 25 106 million to 67 million between 1999 and 2009. percentage points from 1999 to 2009. The abolition Almost half of these children—32 million—live in of school fees is considered an important driver of sub-Saharan Africa, despite the region’s strong efforts rapid progress in many of these countries. to increase enrolment. A quarter of the children out of school, or 16 million, are in Southern Asia. Being female, poor and living in a country affected 1 Measured by the gross intake rate to the last grade of by conflict are three of the most pervasive factors primary education. keeping children out of school. Of the total number of primary-age children in the world who are not enrolled in school, 42 per cent—28 million—live in poor countries affected by conflict. Over the decade, the share of girls in the total out-of-school population dropped from 58 per cent to 53 per cent. 18 | The Millennium Development Goals Report 2011

Refugee children face steep barriers to getting an education

Children displaced from their homes face a multitude the remaining 62 camps, fewer than 70 per cent were of problems, including getting an education, according enrolled. One reason for poor enrolment may be the to the United Nations High Commissioner for lack of qualified teachers willing to work in refugee Refugees. In 87 urban areas for which the UNHCR has camps. Moreover, classrooms tend to be overcrowded, data, 37 per cent of refugee children had no access textbooks are generally in short supply, and basic to schooling. When they do, it is often an unsettling sanitation is frequently lacking. Among youth in experience, due to stigma and discrimination that refugee camps, 73 per cent of adolescent girls and 66 can result from being an outsider, the fact that they per cent of adolescent boys were out of school. may not understand the language of instruction and difficulties in obtaining certification of classes It is important to note that these data reflect only completed. In addition, governments may not allow registered refugees. Those who are unregistered are refugee children to attend public schools. A strained probably even less likely to attend school, since they economic situation in the family often means that may have entered the country illegally. Access to children are forced to work or care for their siblings, education is particularly difficult for refugees living and obligatory school fees may simply make education without legal status in urban areas. unaffordable. A major obstacle in remedying the situation is the Out of the 132 refugee camps with available data (in lack of funding for education in emergencies. Just 2 both urban and rural areas), only 38 reported that all per cent of humanitarian aid globally is allocated to refugee children were enrolled in school. In 32 camps, education. at least 70 per cent of children were enrolled. And in

The majority of children who are out of school in sub-Saharan Africa will never enter a classroom

Distribution of out-of-school children by school exposure, selected countries, surveys between 2002 and 2010 (Percentage)

100

80

60

40

20

0 Mali India Niger Brazil Nepal Ghana Yemen Bolivia Liberia Guinea Nigeria Zambia Senegal Ethiopia Pakistan Maldives Colombia Tajikistan Cambodia Kyrgyzstan Bangladesh Timor-Leste D. R. Congo

Expected never to enter Expected to enter Dropped out Goal 2: Achieve universal primary education | 19

The majority of out-of-school children in sub-Saharan out-of-school children will eventually enter school, Africa are largely excluded from education, and most revealing the extent to which late entry is a widespread will never enter a classroom. However, household phenomenon. In that country, dropping out of primary survey data from 23 countries show that in several school is uncommon. In Nigeria, about three quarters countries with large out-of-school populations, many of primary-age children who are out of school will likely children do have exposure to education. Countries have no exposure to education at all. This pattern show distinct patterns in the distribution of out-of- indicates that barriers to education in Nigeria are school children. especially difficult to overcome.

In the Democratic Republic of the Congo, for example, In some countries, such as Brazil, Colombia and the about half of all out-of-school children of primary Maldives, a significant proportion of out-of-school age are expected to enter school late. About one children had attended school in the past, but dropped quarter will never enter a classroom, while another out. In other countries, such as Cambodia, Liberia and quarter attended school in the past but dropped out. Zambia, most out-of-school children will be attending In Ethiopia, almost three quarters of primary-age school at some point in the near future.

Southern Asia and Northern Africa lead the way in expanding literacy among youth

Youth literacy rate, 1990 and 2009 (Percentage)

Sub-Saharan Africa 65 72 Oceania 73 75 Southern Asia 60 80 Northern Africa 68 87

World 83 89

Western Asia 87 93

Latin America & the Caribbean 92 97

South-Eastern Asia 94 98

Eastern Asia 95 99 Caucasus & Central Asia 100 Developed regions 100

60 70 80 90 100

Worldwide, the literacy rate of youth (aged 15 to 24) Still, it remains the region with the lowest youth increased from 83 per cent to 89 per cent between literacy rate (72 per cent in 2009). In spite of overall 1990 and 2009. Southern Asia and Northern Africa progress, 127 million young people lacked basic chalked up the most progress, with increases of reading and writing skills in 2009. Nearly 90 per cent 20 percentage points and 19 percentage points, of all illiterate youth live in just two regions: Southern respectively. Sub-Saharan Africa showed significant Asia (65 million) and sub-Saharan Africa (47 million). improvement as well—a rise of 7 percentage points. 20 | The Millennium Development Goals Report 2011

Target Eliminate gender disparity in primary and secondary Goal 3 education, preferably by 2005, and in all levels of education no later than 2015 Promote gender equality and Girls are gaining ground when it comes empower women to education, though unequal access persists in many regions

Gender parity index for gross enrolment ratio in primary, secondary and tertiary education (Girls’ school enrolment ratio in relation to boys’ enrolment ratio), 1998/1999 and 2008/2009 (Girls per 100 boys) Primary education Oceania 90 89 Sub-Saharan Africa 85 92 Western Asia 86 92 Northern Africa 90 95 Southern Asia 83 95 Latin America & the Caribbean 97 97 South-Eastern Asia 96 97 Caucasus & Central Asia 99 98 Eastern Asia 101 104 Developing regions 91 96 Secondary education Sub-Saharan Africa 82 79 Western Asia 74 86 Oceania 89 88 Southern Asia 75 89 Caucasus & Central Asia 98 98 Northern Africa 93 98 South-Eastern Asia 95 103 Eastern Asia 93 106 Latin America & the Caribbean 107 108 Developing regions 88 96 Tertiary education Sub-Saharan Africa 67 63 Southern Asia 65 74 Oceania 81 86 Western Asia 78 87 Northern Africa 74 98 Eastern Asia 67 103 Caucasus & Central Asia 91 107 South-Eastern Asia 96 109 Latin America & the Caribbean 117 126 Developing regions 82 97

0 20 40 60 80 100 120

1999 2009 Target = Gender parity index between 97 and 103

In developing regions, 96 girls were enrolled in primary and in secondary school for every 100 boys in 2009. This is a significant improvement since 1999, when the ratios were 91 and 88, respectively.

However, only three regions—the Caucasus and Central Asia, Latin America and the Caribbean, and South-Eastern Asia— have achieved gender parity in primary education (defined Goal 3: Promote gender equality and empower women | 21

as a gender parity index between 97 and 103). Latin America and the Caribbean when it comes to Exceptionally, in Eastern Asia, girls slightly outnumber participation in secondary school. boys in primary school. Progress for girls has lagged in most other parts of the developing world, and The picture is quite different at the tertiary level of equal access to education in the early years remains education. It is at this level that the gender parity a distant target in Northern Africa, Oceania, Southern index for the whole of the developing world is highest, Asia, sub-Saharan Africa and Western Asia. at 97 girls for every 100 boys. But it is also where the greatest gender disparity is observed. Among the At the level of secondary education, the Caucasus and developing regions, only Eastern Asia and Northern Central Asia, Northern Africa and South-Eastern Asia Africa have achieved gender parity in tertiary have achieved gender parity. However, girls remain education. Participation rates are either skewed heavily at a distinct disadvantage in Oceania, Southern Asia, in favour of boys, as in Oceania, Southern Asia, sub- sub-Saharan Africa and Western Asia. In contrast, Saharan Africa and Western Asia, or in favour of girls, girls have surpassed boys in Eastern Asia and in as in the Caucasus and Central Asia, Latin America and the Caribbean, and South-Eastern Asia.

Wide gaps remain in women’s access to paid work in at least half of all regions

Employees in non-agricultural employment who are women, 1990, 2009 and projections to 2015 (Percentage)

50 48 49 46 45 45 44 43 43 44 40 42 41 38 40 37 38 38 36 36 36 35 35 33 30 33

24 20 22 20 19 19 19 20 19 15 13 10

0 Western Northern Southern Sub-Saharan Oceania South-Eastern Eastern Latin America Caucasus Developed World Asia Africa Asia Africa Asia Asia & the & regions Caribbean Central Asia 1990 2009 2015 projections

Worldwide, the share of women in non-agricultural wage employment represents only a minor share of paid employment increased from 35 per cent in 1990 employment for both women and men, who tend to to almost 40 per cent in 2009. Progress has slowed work in jobs that lack financial security and social in recent years, however, due to the financial and benefits. economic crisis of 2008-2009. The situation in Northern Africa has remained Southern Asia and sub-Saharan Africa saw the greatest practically unchanged since 1990. In that region as improvement, though the proportion of women in paid well as in Western Asia, fewer than one in five paid employment in the former region remains below 20 per jobs outside the agricultural sector are held cent. In sub-Saharan Africa, progress is undermined by women. to some extent by the fact that non-agricultural 22 | The Millennium Development Goals Report 2011

Women have yet to see the fruits of the Representation by women in parliament 2010 economic recovery is at an all-time high, but falls shamefully short of parity The global financial and economic crisis of 2008- 2009 had an adverse impact on labour markets Proportion of seats held by women in single or lower houses worldwide and slowed progress towards many of the of national parliaments, 2000 and 2011 (Percentage) MDGs. Employment declined, unemployment increased Oceania and millions of people dropped out of the labour force 4 because they were too discouraged to continue looking 2 for work. Pay cheques, too, were affected. Western Asia 4 At the onset of the crisis in 2009, unemployment rates 9 for men were increasing faster than those for women. Northern Africa In 2010, the world economy began to recover and 3 unemployment started to decrease among both sexes. 12 However, the unemployment rate for men declined Caucasus & Central Asia faster than that for women. This trend—combined 7 with the fact that women’s unemployment rates 16 already exceeded those of men—suggests that the South-Eastern Asia gap between women and men in many regions will not 12 close any time soon. 18 Southern Asia Similarly, following significant job losses in 2008- 7 2009, the growth in employment that occurred during 18 the recovery in 2010, especially in the developing Eastern Asia regions, was lower for women than for men. Women 19,9 employed in manufacturing industries were especially 19,5 hard hit. Sub-Saharan Africa 13 20 Latin America & the Caribbean 15 23 Developed regions 16 23 Developing regions 12 18 World 14 19

0 5 10 15 20 25 2000 2011

Despite growing numbers of women parliamentarians, the target of equal participation of women and men in politics is still far off. By end-January 2011, women held 19.3 per cent of seats in single or lower houses of parliament worldwide. This is an all-time high. Still, it confirms a pattern of slow progress over the past 15 years from a world average of 11.6 per cent in 1995.

In addition, large disparities are found in women’s representation among countries. In early 2011, women Goal 3: Promote gender equality and empower women | 23

made up 30 per cent or more of the members of parliamentarians, from 19.3 per cent to 17.6 per cent single or lower houses of parliaments in 25 countries, between 2010 and 2011. In the Philippines, women including seven countries where the share was 40 lost ground in the upper house. In Oceania, the per cent or more. Some countries have achieved high percentage of women parliamentarians dropped to only levels of participation by women in either of these 2.3 per cent in 2011. houses of parliament: Rwanda (56.3 per cent), Sweden (45.0 per cent), South Africa (44.5 per cent) and Cuba Quota arrangements and measures taken by political (43.2 per cent). In contrast, 48 countries have less parties continue to be key predictors of success. than 10 per cent women members in their lower or Legislated quotas or voluntary party quotas have been single houses. Nine countries—Belize, the Federated implemented for 67 per cent of the 43 lower houses States of Micronesia, Nauru, Oman, Palau, Qatar, with 30 per cent or more women members. Saudi Arabia, Solomon Islands and Tuvalu—have no women parliamentarians at all. At the leadership level, two parliaments saw women speakers elected for the first time: Mozambique and In 2010, gains for women were registered in just half the United Republic of Tanzania. Worldwide, women of all parliamentary elections or renewals. The most now account for only 13.4 per cent of presiding notable progress was seen in Northern Africa, where officers in parliament. In January 2011, just 10 women’s representation in single or lower houses countries had female heads of state, and 13 countries increased from 9.0 per cent to 11.7 per cent between had female heads of government. 2010 and 2011. Progress was also made in Western Asia, where women’s representation in single or lower Quotas are not the only factors that influence the level houses continued to rise: from 4.2 per cent in 2000 of women’s political participation, however. Electoral to 8.8 per cent in 2010 to 9.4 per cent in 2011. systems are also key, as are gender-sensitive electoral Even so, vast disparities are found among countries arrangements. In 2010, many women contenders for in the region. Moreover, progress for women is often political office suffered from a shortage of both media dependent on special measures. In Bahrain, only one coverage and public appearances. Well trained and woman parliamentarian, who ran unopposed, was financed women candidates and political will at the elected to the lower house. Meanwhile, the women in highest levels of political parties and governments are Bahrain’s upper house, representing 27.5 per cent of paramount for overcoming gender imbalances in the its members, were mostly appointed. Jordan now has world’s parliaments. 13 women in its lower house and nine women in its upper house due to a strengthened quota system.

In the Americas, Costa Rican women continue to wield power, representing 38.6 per cent of the lower house. The mid-term elections in the United States saw a record number of women running for both houses of Congress, but this did not result in major gains.

Sub-Saharan Africa has also seen recent progress, with Ethiopia, Madagascar and the United Republic of Tanzania recording improvements in 2010. Burundi consolidated its representation by women in the lower house of parliament with an increase to 32.1 per cent, from 30.5 per cent in 2005, and saw a significant rise in the upper house (from 34.7 to 46.3 per cent), largely due to a quota system. Women’s representation in Sao Tome and Principe, unaided by quotas, increased from 7.3 per cent in 2006 to 18.2 per cent in 2010.

In a year of high-profile elections, Southern Asia and South-Eastern Asia saw no progress. Women maintained strong representation in Afghanistan in the 2010 polls, but this resulted in only a small gain of one additional woman parliamentarian. South- Eastern Asia saw a small drop in the number of women 24 | The Millennium Development Goals Report 2011

Target Reduce by two thirds, between 1990 and 2015, the under- Goal 4 five mortality rate

Reduce child Achieving the goal for child survival hinges on mortality action to address the leading causes of death

Under-five mortality rate, 1990 and 2009 (Deaths per 1,000 live births)

Sub-Saharan Africa 180 129 Southern Asia 122 69 Oceania 76 59 Caucasus & Central Asia 78 37 South-Eastern Asia 73 36 Western Asia 68 32 Northern Africa 80 26 Latin America & the Caribbean 52 23

Eastern Asia 45 19 Developed regions 15 7 Developing regions 99 66

0 50 100 150 200

1990 2009 2015 target

Steady progress is being made in reducing child deaths. Globally, the mortality rate for children under five has declined by a third, from 89 deaths per 1,000 live births in 1990 to 60 in 2009. All regions, except sub-Saharan Africa, Southern Asia and Oceania, have seen reductions of at least 50 per cent. Despite population growth, the number of deaths in children under five worldwide declined from 12.4 million in 1990 to 8.1 million in 2009, which translates into nearly 12,000 fewer children dying each day.

The greatest success is found in Northern Africa and Eastern Asia, where under-five mortality declined by 68 per cent and Goal 4: Reduce child mortality | 25

58 per cent, respectively. Among countries with high time, major inroads are being made. Four of the ten under-five mortality (above 40 deaths per 1,000 live countries with more than a 50 per cent reduction in births), 10 countries reduced their rates by at least child deaths between 1990 and 2009 are in sub- half. Among them, Bangladesh, Eritrea, Lao People’s Saharan Africa. Furthermore, five of the six countries Democratic Republic, Madagascar, Nepal and Timor- with a reduction of more than 100 deaths per 1,000 Leste recorded a 60 per cent drop or more. live births are in this region.

The highest levels of under-five mortality continue Increasing evidence suggests that the MDG target can to be found in sub-Saharan Africa, where one in be reached, but only with substantial and accelerated eight children die before the age of five (129 deaths action to eliminate the leading killers of children. In per 1,000 live births), nearly twice the average in sub-Saharan Africa, diarrhoea, malaria and pneumonia developing regions overall and around 18 times the are responsible for more than half the deaths of children average in developed regions. With rapid progress in under five. In Southern Asia, over half of all childhood other regions, the disparities between them and sub- deaths occur in the first 28 days after birth, pointing Saharan Africa have widened. Southern Asia has the to the need for better post-natal care. In both regions, second highest rate—69 deaths per 1,000 live births undernutrition is an underlying cause of a third of these or about one child in 14. deaths. Special efforts to fight pneumonia, diarrhoea and malaria, while bolstering nutrition, could save the All of the 31 countries with under-five mortality of lives of millions of children. at least 100 deaths per 1,000 live births, except Afghanistan, are in sub-Saharan Africa. At the same

Children in rural areas are more at risk of dying, even in regions where child mortality is low

Ratio of rural to urban under-five mortality rate, 2000/2008 Despite substantial progress in reducing child Latin America & the Caribbean deaths, children from rural households are still at a 1.7 disadvantage, according to household survey data from Eastern Asia (excluding China) & South-Eastern Asia 80 countries. This holds true for all developing regions. 1.6 Disparities are most pronounced in Latin America and the Caribbean and in Eastern and South-Eastern Asia Southern Asia 1.5 (excluding China), where overall child mortality is low. Northern Africa & Western Asia 1.4 Sub-Saharan Africa 1.4 Caucasus & Central Asia 1.3 Developing regions 1.4

0 1 2 Higher under-five mortality Higher under-five mortality in urban areas in rural areas Equal

Note: Analysis is based on 80 developing countries with data on under-five mortality rate by residence, accounting for 73 per cent of total births in developing regions in 2008. 26 | The Millennium Development Goals Report 2011

Children from the poorest households are two to three times more likely to die before the age of five than children from the richest households

Ratio of under-five mortality rate for children from the poorest According to data from 66 countries, children from households to that of children from the richest households, the poorest households are also at a disadvantage 2000/2008 when it comes to surviving their first five years of life. Latin America & the Caribbean In the developing regions as a whole, children from 2.9 the poorest 20 per cent of households have more Eastern Asia (excluding China) & South-Eastern Asia than twice the risk of dying before their fifth birthday 2.8 as children in the richest 20 per cent of households. Southern Asia Again, the greatest disparities are found in Latin 2.7 America and the Caribbean and in Eastern and South- Northern Africa & Western Asia Eastern Asia (excluding China), where the risk is nearly 2.6 three times as high. Sub-Saharan Africa 1.8 Caucasus & Central Asia 1.7 Developing regions 2.2

0 1 2 3 Higher under-five Higher under-five mortality among mortality among the richest 20% Equal the poorest 20%

Note: Analysis is based on 66 developing countries with data on under-five mortality rate by household’s wealth quintile, accounting for 71 per cent of total births in developing regions in 2008.

A mother’s education is a powerful determinant of child survival

Ratio of under-five mortality rate of children of mothers with no education to that of children of mothers with secondary or higher education; ratio of under-five mortality rate of children of mothers with no education to that of children of mothers with primary education, 2000/2008

Latin America & the Caribbean Children of mothers with no education compared to children 3.1 of mothers with secondary or higher education 1.6 Children of mothers with no education compared to children Eastern Asia (excluding China) & South-Eastern Asia of mothers with primary education 3.0 1.9 Note: Analysis is based on 68 developing countries with data on under-five mortality rate by mother’s education, accounting for 74 per Southern Asia cent of total births in developing regions in 2008. 2.1 1.3 Northern Africa & Western Asia A mother’s education is key in determining whether her 2.0 children will survive their first five years of life. 1.2 In all developing regions, children of mothers with Sub-Saharan Africa some education are at less risk of dying. A child’s 2.0 chances of surviving increase even further if their 1.2 mother has a secondary or higher education. In Developing regions addition to education, child survival rates can also 2.1 be improved by increasing equity in other social 1.3 services. Empowering women, removing financial and 0 1 2 3 social barriers to welfare, encouraging innovations to Higher Higher under-five mortality make critical services more available to the poor, and under-five among children of increasing the accountability of health systems at the mortality among Equal less educated mothers local level are examples of policy interventions that children of more educated mothers could improve equity, with benefits for child survival. Goal 4: Reduce child mortality | 27

Children who are poor and hardest to Child deaths due to measles have reach still lack access to the lifesaving plummeted, but shortfalls in funding put measles vaccine continued success in jeopardy

Proportion of children 12-23 months old who received Estimated child deaths due to measles, 1999-2008 at least one dose of measles vaccine, 2000 and 2009 (Thousands) (Percentage) 900 Oceania 66 58 Sub-Saharan Africa 55 600 68 Southern Asia 56 75 300 Western Asia 84 82 South-Eastern Asia 81 0 88 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Caucasus & Central Asia Middle East & Central Asia Southern Asia 93 Eastern Asia & the Pacific Africa 92 Latin America & the Caribbean 92 Between 2000 and 2008, the combination of 93 improved immunization coverage and the opportunity Eastern Asia for a second dose led to a 78 per cent drop in measles 84 deaths worldwide. These averted deaths represent 94 one quarter of the decline in mortality from all causes Northern Africa among children under five. 93 94 However, this resounding success could be in jeopardy. Developed regions Reduced funding for measles-control activities means 92 94 that a number of priority countries are facing shortfalls in resources for both routine immunizations and Developing regions 69 immunization campaigns. As a result, outbreaks of the 80 disease are on the rise. With adequate funding, strong political commitment and high-quality implementation, 0 25 50 75 100 the exceptional gains made so far can be maintained 2000 2009 and protection extended to all children.

Expanded coverage of immunization against measles is an important indicator for child survival. In 2009, 80 per cent of children in the appropriate age group received at least one dose of the measles vaccine, up from 69 per cent in 2000.

Though important gains have been made, the poorest, most marginalized children, especially in hard-to-reach areas, have been left behind. In countries with lower coverage, immunization campaigns have been effective in vaccinating children who are beyond the reach of existing health services. However, reinvigorated and sustained efforts are needed to consistently improve access to the most vulnerable, through both routine immunization and campaigns. 28 | The Millennium Development Goals Report 2011

Target Reduce by three quarters, between 1990 and 2015, the Goal 5 maternal mortality ratio

Improve maternal Despite progress, pregnancy remains a major health health risk for women in several regions

Maternal deaths per 100,000 live births, 1990, 2000, 2008

Sub-Saharan Africa 870 790 640 Southern Asia 590 420 280 Oceania 290 260 230 Caribbean 320 230 170 South-Eastern Asia 380 230 160 Northern Africa 230 120 92 Latin America 130 99 80 Western Asia 140 98 70 Caucasus & Central Asia 70 69 54 Eastern Asia 110 63 41 Developed regions 26 17 17 Developing regions 440 370 290 0 200 400 600 800 1000 1990 2000 2008 Target

Despite proven interventions that could prevent disability or death during pregnancy and childbirth, maternal mortality remains a major burden in many developing countries. Figures Goal 5: Improve maternal health | 29 on maternal mortality tend to be uncertain. Still, the Major gains have been made in increasing most recent estimates suggest significant progress. skilled attendance at birth, most notably In the developing regions as a whole, the maternal mortality ratio dropped by 34 per cent between 1990 in Northern Africa and Southern Asia and 2008, from 440 maternal deaths per 100,000 live births to 290 maternal deaths. However, the MDG Proportion of deliveries attended by skilled health personnel, target is still far off. around 1990 and around 2009 (Percentage) Sub-Saharan Africa Eastern Asia, Northern Africa, South-Eastern Asia 42 and Southern Asia have made the greatest strides. 46 Between 1990 and 2008, 90 countries showed Southern Asia declines in their maternal mortality ratios of 40 per 32 cent or more, while another 57 countries reported at 50 least some gains. However, more can and must be Oceania done to save women’s lives and prevent disabilities 54 that could irrevocably alter a woman’s and her family’s 56 future. This is especially true given the increasing Caribbean* number of young women entering their prime 67 reproductive years in countries already hard pressed to 69 meet current demands for improved maternal health South-Eastern Asia and reproductive health care. 49 72 Maternal deaths are concentrated in sub-Saharan Western Asia Africa and Southern Asia, which together accounted for 62 87 per cent of such deaths globally in 2008. Southern 78 Asia has made steady progress, with a 53 per cent Northern Africa decline in maternal mortality between 1990 and 45 2008. In contrast, the ratio has fallen by only 26 per 81 cent in sub-Saharan Africa, though evidence suggests Latin America* that progress has picked up speed since 2000. 70 90 The vast majority of maternal deaths are avoidable. Caucasus & Central Asia The largest proportion of such deaths are caused by 93 obstetric haemorrhage, mostly during or just after 97 delivery, followed by eclampsia, sepsis, complications Eastern Asia of unsafe abortion and indirect causes, such as malaria 94 and HIV. Studies have also shown that the likelihood 99 of maternal death increases among women who have Developed regions many children, are poorly educated, are either very 99 young or very old, and who are subjected to gender 99 discrimination. Developing regions 55 65

0 20 40 60 80 100 1990 2009

* Includes only deliveries in health-care institutions.

The presence of a trained health-care worker during delivery is crucial in reducing maternal deaths. A skilled health professional can administer interventions to prevent and manage life-threatening complications, such as heavy bleeding, or refer the patient to a higher level of care when needed.

In developing regions overall, the proportion of deliveries attended by skilled health personnel rose 30 | The Millennium Development Goals Report 2011

from 55 per cent in 1990 to 65 per cent in 2009. Despite dramatic progress in many regions, coverage Target remains low in sub-Saharan Africa and Southern Asia, Achieve, by 2015, universal access to where the majority of maternal deaths occur. That reproductive health said, the proportion of deliveries attended by a skilled health professional in Southern Asia has increased substantially—from 32 per cent in 1990 to 50 per Across all regions, more pregnant women cent in 2009. are offered at least minimal care

Proportion of women (15-49 years old) attended at least once by skilled health personnel during pregnancy, 1990 and 2009 (Percentage) Southern Asia 51 70 Sub-Saharan Africa 68 78 Oceania 77 79 Northern Africa 51 79 Western Asia 62 84 Eastern Asia 70 91 South-Eastern Asia 72 92 Latin America & the Caribbean 77 95 Caucasus & Central Asia 90 96 Developing regions 64 81 0 20 40 60 80 100 1990 2009

Health care during pregnancy is vitally important in detecting and managing conditions that may complicate pregnancy and childbirth. Basic antenatal care provides women with a package of preventive interventions, including nutritional advice. Women are also alerted to danger signs that may threaten their pregnancy and given support in planning a safe delivery. Moreover, in countries where malaria is endemic, they may be provided with intermittent preventive treatment. Women who are HIV-positive receive help in avoiding transmission of the virus to their babies. Goal 5: Improve maternal health | 31

Since 1990, the proportion of women receiving Gains made during the 1990s to reduce antenatal care has increased substantially in all adolescent pregnancies have stalled in regions. Across all developing regions, the share of pregnant women attended at least once during many regions pregnancy increased from 64 per cent in 1990 to 81 per cent in 2009. Number of births per 1,000 women aged 15-19, 1990, 2000 and 2008 Sub-Saharan Africa Not enough women receive the 124 123 recommended frequency of care during 122 pregnancy Latin America 92 88 Proportion of women (15-49 years old) attended four 82 or more times by any provider during pregnancy, Caribbean 1990 and 2009 (Percentage) 81 Southern Asia (excluding India) 77 69 10 26 Oceania 83 Sub-Saharan Africa 63 44 61 43 Southern Asia Southern Asia 89 59 23 59 53 72 44 Western Asia Western Asia 64 32 53 54 52 Northern Africa South-Eastern Asia 20 54 57 40 44 South-Eastern Asia Northern Africa 46 43 69 33 Latin America & the Caribbean 30 69 Caucasus & Central Asia 84 45 28 Developing regions 29 35 Eastern Asia 51 15 0 20 40 60 80 100 6 6 1990 2009 Developed regions Note: Data for Eastern Asia are not available. 34 26 24 A minimum of four antenatal care visits is Developing regions recommended to ensure that pregnant women receive 65 the interventions they need to prevent and manage 56 complications. The proportion of women receiving the 54 recommended number of visits in developing regions 0 20 40 60 80 100 120 140 remains low, though progress is being made, increasing 1990 2000 2008 from 35 per cent in 1990 to 51 per cent in 2009. Very early childbearing brings with it heightened risks of complications or even death. In almost all regions, the adolescent birth rate (the number of births per 1,000 women aged 15 to 19) decreased between 1990 and 2000 and then slowed its decline or even 32 | The Millennium Development Goals Report 2011 increased in the subsequent eight years. Sub-Saharan Contraceptive use rises, but gains Africa has the highest birth rate among adolescents made will be difficult to sustain due (122 births per 1,000 women), which has changed little since 1990. to the growing number of women of reproductive age Across the developing world, women are having fewer children. But even in some of the regions where overall Proportion of women who are using any method of fertility has declined, adolescent fertility remains contraception among women aged 15-49, married or in a union, 1990, 2000 and 2008 (Percentage) relatively high. Sub-Saharan Africa 13 20 22 Oceania 29 32 37 Southern Asia 40 47 54 Western Asia 44 51 55 Caucasus & Central Asia 54 60 56 Northern Africa 44 59 61 Caribbean 54 60 62 South-Eastern Asia 48 57 62 Latin America 63 72 74 Eastern Asia 78 86 84 Developed regions 69 71 72 Developing regions 52 60 61

0 20 40 60 80 100 1990 2000 2008

Throughout the world, increased access to safe, affordable and effective methods of contraception has provided individuals with greater opportunities for choice and responsible decision-making in matters of Goal 5: Improve maternal health | 33

reproduction. Contraceptive use has also contributed in sub-Saharan Africa—where maternal mortality is to improvements in maternal and infant health by high and access to skilled care during pregnancy and preventing unintended or closely spaced pregnancies at childbirth is limited—continue to have the lowest and pregnancy in very young women, which can be level of contraceptive prevalence (22 per cent), with risky. little progress reported since 2000. As the number of women of reproductive age in developing regions By 2008, more than half of all women aged 15 to continues to rise, increasing by nearly 50 per cent 49 who were married or in a union were using some since 1990, family planning programmes and health- form of contraception in all but two regions—sub- care services need to invest more, to simply keep pace Saharan Africa and Oceania. However, progress slowed with the growing number of women wishing to use from 2000 to 2008 in almost all regions. Women contraception.

The unmet need for contraceptives remains high in many regions, with inadequate support for family planning

Proportion of women who have an unmet need for family Worldwide, more than 120 million women aged 15 to planning among women aged 15-49 who are married or 49 who are married or in a union have an unmet need in a union, 1990, 2000 and 2008 (Percentage) for family planning. In other words, these women have Sub-Saharan Africa the desire to delay or avoid pregnancy, but are not 26 using any form of contraception. The unmet need for 24 25 family planning has remained at the same moderate to Caribbean high level in most regions since 2000, but is highest 19.5 in sub-Saharan Africa and the Caribbean. In those 20.4 regions, respectively, at least one in five and one in 20.2 four women of childbearing age who are married or Southern Asia in a union have an unmet need for contraception. 20 The unmet need for family planning is lowest where 17 contraceptive prevalence is already high (above 60 15 per cent). Yet, even in regions such as South-Eastern Caucasus & Central Asia Asia and Northern Africa, where contraceptive use is 14 relatively widespread, the family planning needs of at 12 12 least one in ten women are not being met. Western Asia 16 14 12 South-Eastern Asia 15 11 11 Northern Africa 19 11 10 18 Latin America 16 10 9 Eastern Asia 3 2 2 Developing regions 14 12 11 0 5 10 15 20 25 30 1990 2000 2008 34 | The Millennium Development Goals Report 2011

Reaching adolescents is critical to In sub-Saharan Africa, contraceptive use among improving maternal health and achieving adolescents is substantially lower than that of all women of reproductive age, though they have similar other Millennium Development Goals levels of unmet need (25 per cent). This was the conclusion drawn from data available for 22 countries, Contraceptive prevalence, unmet need for contraception, which looked at contraceptive use among women aged and total demand for contraception that is satisfied among women who are married or in a union, by age group, selected 15 to 19 who were married or in a union. Thus, the countries in sub-Saharan Africa, 1998/2008 (Percentage) percentage of adolescents who have their demand for contraception satisfied is much lower than that 50 of all women aged 15 to 49. This disparity in access has changed little according to data from the same 45 sources for earlier periods, pointing to scant progress 40 in improving access to reproductive health care for adolescents.

Global population estimates suggest that the number 30 of women aged 15 to 19 is approaching 300 million. The fastest growth is expected in sub-Saharan Africa 29 and in the least developed countries overall, where 26 24 the risks associated with pregnancy and childbearing 20 are greatest. Intensified efforts are urgently needed 21 to delay or prevent unintended pregnancies among this vulnerable age group. These efforts will not only result in improved maternal and child health, but will 10 contribute to reduced poverty, greater gender equality 10 and the empowerment of women by improving the chances that these young women will go to school and eventually engage in paid employment. 0 Contraceptive Unmet need Total demand for prevalence for contraception contraception that is satisfied 15-49 years old 15-19 years old Goal 5: Improve maternal health | 35

Official development assistance to health, total (constant 2009 US$ millions) and proportion going to reproductive health care Aidand family for planningfamily ( percentageplanning), 2000-2009 has fallen in all recipient countries

Official development assistance to health, total (Constant 2009 US$ millions) and proportion going to reproductive health care and family planning (Percentage), 2000-2009

Millions Percentage 20,000 19,790 100

18,000 90 17,581 Total aid to health 16,726 (Constant 2009 US$ millions) 16,000 15,442 80 Aid to reproductive health care (Percentage) 14,000 70 12,584 Aid to family planning (Percentage) 12,000 60

10,353 10,000 9,745 50

8,000 7,949 40

6,557 6,402 6,000 30

4,000 20

11.3 9.2 9.8 2,000 8.5 7.2 7.7 10 6.1 6.1 5.1 6.0 8.2 5.9 5.4 1.0 1.7 1.3 3.2 3.3 2.6 0 3.1 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Over the coming decades, demand for family planning in 2009. This means that, on a per capita basis, aid will likely increase, based on substantial unmet need for family planning has fallen in virtually all recipient and the expected rise in the number of women and men countries. Ensuring the funding necessary to meet the of reproductive age. Yet funding for family planning growing demand for contraceptives could ultimately services and supplies has not risen commensurately. Aid reduce the cost of maternal and newborn health care by for family planning as a proportion of total aid for health preventing unintended pregnancies. declined over the past decade and stood at 2.6 per cent 36 | The Millennium Development Goals Report 2011

Target Have halted by 2015 and begun to reverse the spread Goal 6 of HIV/AIDS

Combat HIV/AIDS, New HIV infections are declining, led by sub- malaria and other Saharan Africa, but trends in some other regions diseases are worrisome

HIV incidence rates* (Number of new HIV infections per year per 100 people aged 15-49), 2001 and 2009 Sub-Saharan Africa 0.57 0.40 Caribbean 0.09 0.08 South-Eastern Asia & Oceania 0.04 0.04 Latin America 0.04 0.03 Caucasus & Central Asia 0.01 0.03 Southern Asia 0.04 0.02 Eastern Asia 0.01 0.01 Northern Africa 0.01 0.01 Western Asia <0.01 <0.01 Developed regions 0.05 0.03 Developing regions 0.09 0.08 World 0.08 0.06

0.00 0.10 0.20 0.30 0.40 0.50 0.60

2001 2009

* The incidence rate is the number of new HIV infections in a population over a certain period of time, expressed as a percentage of the adult population aged 15-49. For example, an incidence rate of 0.4 per cent in sub-Saharan Africa in 2009 meant that 4 adults out of 1,000 were newly infected that year (leading to a total of 1.8 million new infections in the region).

Between 2001 and 2009, the HIV incidence rate declined steadily, by nearly 25 per cent worldwide. However, this global progress masks substantial regional differences. While the Goal 6: Combat HIV/AIDS, malaria and other diseases | 37

incidence rate fell significantly in sub-Saharan Africa In 2009, an estimated 2.6 million people were newly and Southern Asia, it remained unchanged in Eastern infected with HIV. This represents a drop of 21 per Asia, Western Europe, Central Europe and North cent since 1997, the year in which new infections America. Worse, it is on the rise in Eastern Europe and peaked. Central Asia after an initial decline during the first half of the decade.

The number of people living with HIV continues to rise, due to life-prolonging treatment

Number of people living with HIV, number of people newly infected with HIV, and number of AIDS deaths worldwide,* 1990-2009 (Millions)

3.5 40.0

35.0 3.0 33 32 33 31 31 32 30.0

30 People living with HIV (Millions) 2.5 30 29 28 26 25.0 25 2.0 23 21 20.0 19 1.5 17 15.0 15 1.0 13 10.0 10 8 0.5 5.0

0.0 0.0 People newly infected with HIV and number of deaths due to AIDS (Millions) 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Number of people living with HIV Number of people newly infected with HIV Number of deaths due to AIDS

* All AIDS-related figures are the midpoint in a range. The estimate of 2.6 million new infections in 2009, for example, is based on a range of 2.3 million-2.8 million. The complete data series of ranges and corresponding midpoints is available at http://mdgs.un.org.

The number of people receiving antiretroviral treatment of AIDS deaths. Yet the epidemic has not spared other for HIV or AIDS increased 13-fold from 2004 to 2009. regions, with more than 10.8 million people outside of As a result, the number of AIDS-related deaths declined sub-Saharan Africa living with the virus. by 19 per cent over the same period. Although new infections are waning, the number of people living with Women and young people are especially vulnerable. HIV has grown. Globally, nearly 23 per cent of all people living with HIV are under the age of 25. And young people (aged In 2009, 33.3 million people were living with the 15 to 24) account for 41 per cent of new infections virus—a 27 per cent increase over 1999. Sub-Saharan among those aged 15 or older. In 2009, women Africa remains the most heavily affected region, represented a slight majority (about 51 per cent) of accounting for 69 per cent of new HIV infections, 68 people living with HIV. per cent of all people living with HIV and 72 per cent 38 | The Millennium Development Goals Report 2011

Most young people lack comprehensive Understanding how HIV spreads is the first step to knowledge of HIV, but now know avoiding infection. On average, only 33 per cent of young men and 20 per cent of young women in specific ways to prevent its spread developing regions have a comprehensive and correct knowledge of HIV.1 Proportion of women and men aged 15-24 who know they can reduce their risk of getting HIV by using a condom every time they have sexual intercourse, selected countries, Though global averages remain low, a number of 2005/2009 (Percentage) countries have made impressive progress in increasing people’s knowledge about HIV, as measured by the five D. R. Congo 54 components that make up the indicator. For instance, 63 knowledge of the methods that can be used to avoid Niger 54 HIV transmission is generally widespread among young 63 people. Sierra Leone 47 64 Liberia 52 Recent data from population-based surveys in selected 66 sub-Saharan African countries show that the proportion Ethiopia 47 of young people who know that using condoms can 66 reduce the chances of getting HIV ranges from about Mali 59 50 per cent to almost 90 per cent in some countries. 68 However, in almost all countries surveyed, young Madagascar 67 women are less likely to have such knowledge. Youth in 70 rural areas are also less likely to know about prevention Nigeria 52 methods than their urban counterparts. 70 Senegal 71 71 United Republic of Tanzania 68 1 China is not included in the calculation. 73 Zambia 71 74 Côte d'Ivoire 63 75 Lesotho 85 79 Zimbabwe 72 79 Kenya 73 79 Sao Tome and Principe 76 80 Guinea 74 82 Uganda 72 82 Ghana 75 83 Congo 66 83 Namibia 83 86 Benin 73 87 Swaziland 89 87 Rwanda 80 88

0 20 40 60 80 100

Women Men Goal 6: Combat HIV/AIDS, malaria and other diseases | 39

Condom use to prevent HIV is still Despite low levels of condom use on average, some dangerously low in many developing countries are doing better than others, with condom- use levels of 60 per cent or more among either young countries, especially among women men or women. However, disparities persist.

Proportion of women and men aged 15-24 reporting Young women in developing countries are less likely use of a condom during higher-risk sex, selected countries than young men to use condoms during sex that poses 2005/2009 (Percentage) special risks. Condom use is also much less common D. R. Congo among young people in poorer households and among 17 27 those living in rural areas. India 22 37 Zambia 33 39 United Republic of Tanzania 46 49 Nigeria 36 49 Ethiopia 28 50 Uganda 38 55 Malawi 40 58 Central African Republic 41 60 Kenya 40 64 Lesotho 66 68 Zimbabwe 42 68 Swaziland 54 70 Ukraine 68 71 Namibia 64 81

0 10 20 30 40 50 60 70 80 90 Women Men

Condom use during higher-risk sex is still low among young people in developing regions. On average, less than half of young men and just over a third of young women used condoms during their last high-risk sexual activity in sub-Saharan African countries. 40 | The Millennium Development Goals Report 2011

More children orphaned by AIDS in The impact of the HIV epidemic has been acutely sub-Saharan Africa are now in school, felt by children in terms of both health and social outcomes. Globally, in 2009, about 16.6 million increasing their chances of receiving vital children were estimated to have lost one or both protection and support parents to AIDS, up from 14.6 million in 2005; 14.8 million of these children live in sub-Saharan Africa.2 Ratio of school attendance of children aged 10-14 who have lost both biological parents to school attendance Education is vital to children’s futures, and school can of non-orphaned children of the same age, selected countries provide them with a safe, structured environment in in sub-Saharan Africa, around 2000 and around 2008 which they can benefit from the emotional support and Rwanda supervision of adults. Disparities in school attendance 0.83 show that children who have lost both parents are less 0.82 likely to be in school than children who have two living Côte d'Ivoire 0.83 parents and who are residing with at least one of them. 0.83 This gap, however, is narrowing rapidly in sub-Saharan Burundi Africa. 0.70 0.85 Recent progress has been remarkable. In some Mozambique countries in which survey-based trend data are 0.80 0.89 available, the level of school attendance among Ethiopia children aged 10 to 14 who have been orphaned has 0.60 increased to near parity with that of other children. 0.90 These improvements suggest that policies such as the Zambia elimination of school fees and targeted educational 0.91 assistance to orphans and other vulnerable children 0.93 are working. Furthermore, recognition is growing that Kenya 0.74 child-sensitive social protection plays an important role 0.95 in scaling up support for children orphaned or made Zimbabwe vulnerable by AIDS and in keeping these children in 0.85 school. 0.95 Lesotho 0.87 0.95 2 The numbers of children orphaned by AIDS are estimates. Uganda Lower and upper bounds of these estimates are available 0.95 at http://mdgs.un.org. 0.96 Central African Republic 0.91 0.96 United Republic of Tanzania 0.74 0.97 Malawi 0.93 0.97 Swaziland 0.91 0.97 Namibia 0.92 1.00 Chad 0.94 1.05

0.00 0.20 0.40 0.60 0.80 1.00 1.20

Around 2000 Around 2008 Parity Goal 6: Combat HIV/AIDS, malaria and other diseases | 41

need) to antiretroviral therapy and/or interventions Target to prevent mother-to-child transmission of HIV. For Achieve, by 2010, universal access to treatment a good number of countries, universal access by the for HIV/AIDS for all those who need it end of 2010 was clearly within reach. Despite these encouraging findings, it is unlikely that the global target for HIV treatment was achieved that year. Treatment for HIV and AIDS has expanded quickly, but not fast enough to In 2009, the World Health Organization (WHO) revised its guidelines for treatment of adults and adolescents meet the 2010 target for universal access with HIV, including pregnant women. As a result, the number of people defined as needing antiretroviral Proportion of population living with HIV who are receiving therapy grew—from 10.1 million to 14.6 million at the antiretroviral treatment*, 2004 and 2009 (Percentage) end of 2009. In the medium term, the higher initial Eastern Asia investments required to conform to these guidelines 6 23 are expected to be fully compensated for by fewer hospitalizations and lower morbidity and mortality Southern Asia rates. 2 24 Based on the new 2009 guidelines, coverage of Northern Africa 10 antiretroviral therapy increased from 28 per cent in 25 December 2008 to 36 per cent at the end of 2009. Caucasus & Central Asia Under the previous 2006 guidelines, global coverage 2 would have reached 52 per cent in 2009. 26 Sub-Saharan Africa Antiretroviral therapy coverage varies by sex and 3 age. In 2009, coverage was higher among women 37 (39 per cent) than among men (31 per cent). Caribbean Also, overall coverage among children in low- and 5 middle-income countries was lower than that among 38 adults. About 356,400 children under age 15 were South-Eastern Asia & Oceania receiving antiretroviral therapy at the end of 2009, 12 up from 275,300 at the end of 2008. These children 46 represented an estimated 28 per cent of all children Latin America under 15 who needed treatment in low- and middle- 39 51 income countries, up from 22 per cent in 2008. Western Asia 44 57 Low- and middle-income countries 6 36

0 10 20 30 40 50 60 70 80 90 100 2004 2009 Range of estimates

* Antiretroviral treatment coverage is measured among people living with HIV with a CD4 cell count at or below 350 cells/mm3.

By the end of 2009, 5.25 million people were receiving antiretroviral therapy for HIV or AIDS in low- and middle-income countries. This represents a jump of over 1.2 million people from December 2008, the largest increase ever in one year.

Some countries, including Botswana, Cambodia, Croatia, Cuba, Guyana, Oman, Romania and Rwanda, have already attained universal access (defined as coverage of at least 80 per cent of the population in 42 | The Millennium Development Goals Report 2011

Steady progress is being made in reducing Target the risk of HIV in newborns Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases Proportion of women receiving antiretroviral drugs to prevent mother-to-child transmission of HIV, 2004 and 2009 (Percentage) Intensive control efforts have cut deaths Northern Africa 0 from malaria by 20 per cent, with major 20 advances in hard-hit African countries Western Asia 0 22 Major advances are being made against malaria. Over Southern Asia the past decade, increases in funding and attention to 7 malaria control have resulted in widespread reductions 24 in the number of malaria cases and deaths. This Eastern Asia was accomplished through critical interventions, 3 particularly in sub-Saharan Africa, involving the 25 development of more effective tools to prevent Sub-Saharan Africa and fight the disease. These include long-lasting 9 53 insecticide-treated mosquito nets and artemisinin- based combination therapies. Bottlenecks have also Latin America 33 been reduced in their production, procurement and 53 distribution. South-Eastern Asia & Oceania 28 Globally, deaths from malaria are down by an 54 estimated 20 per cent—from nearly 985,000 in 2000 Caribbean to 781,000 in 2009. At the same time, the number of 20 malaria cases rose from about 233 million in 2000 to 55 244 million in 2005 but decreased to 225 million in Caucasus & Central Asia 2009. In all countries, the decreases are associated 11 with intensive control efforts. The largest percentage 56 drops in malaria deaths were found in Europe and Low- and middle-income countries the Americas; the largest absolute decreases were 10 observed in Africa. Nevertheless, 90 per cent of all 53 deaths from malaria still occur in sub-Saharan Africa, 0 10 20 30 40 50 60 70 80 90 100 and most of these deaths are among children under 2004 2009 Range of estimates age five.

Without treatment, approximately one third of children Since 2000, 11 countries in Africa showed reductions born to women living with HIV will become infected of more than 50 per cent in the number of confirmed with the virus in the womb, at birth or through malaria cases (and/or reported hospital admissions for breastfeeding. This risk can be greatly reduced by malaria) and deaths. These include Algeria, Botswana, treating an expectant mother with antiretroviral Cape Verde, Eritrea, Madagascar, Namibia, Rwanda, therapy. Sao Tome and Principe, South Africa, Swaziland and Zambia. In other regions, the number of confirmed An estimated 53 per cent of pregnant women living malaria cases declined by more than half between with HIV received antiretroviral medicines in 2009, 2000 and 2009 in 31 of the 56 countries where up from 45 per cent in 2008. Sub-Saharan Africa is malaria is endemic; downward trends of between home to about 91 per cent of the 1.4 million pregnant 25 per cent and 50 per cent were reported in eight women who are in need of treatment. other countries. In 2009, for the first time, Europe reported no cases of Plasmodium falciparum malaria. The following year, WHO certified that Morocco and Turkmenistan had eliminated malaria.

In 2009, evidence pointed to an increase in malaria cases in three countries that had previously reported reductions (Rwanda, Sao Tome and Principe, and Goal 6: Combat HIV/AIDS, malaria and other diseases | 43

Zambia). The reasons behind these resurgences are The use of mosquito nets in Africa is uncertain, but they highlight the fragility of progress rising rapidly, with lifesaving benefits in malaria control and the need to maintain control programmes rigorously, even when cases have been for children reduced substantially. Proportion of children under age five sleeping under an insecticide-treated mosquito net, sub-Saharan African countries with two or more comparable data points, around 2000 and around 2010 (Percentage)

0 Swaziland 1 1 Côte d’Ivoire 3 2000 1 Guinea 2010 5 1 Nigeria 6 2 Burkina Faso 10 1 Chad 10 1 Cameroon 13 2 Central African Republic 15 3 Zimbabwe 17 7 Benin 20 1 Djibouti 20 2 Sierra Leone 26 4 Ghana 28 2 Senegal 29 2 Ethiopia 33 0 Uganda 33 11 Namibia 34 7 Guinea-Bissau 36 1 D. R. Congo 38 2 Togo 38 1 Niger 43 1 Burundi 45 0 Madagascar 46 3 Kenya 47 15 Gambia 49 1 Zambia 50 4 Rwanda 56 23 Sao Tome and Principe 56 3 Malawi 57 2 United Republic of Tanzania 64 27 Mali 70 44 | The Millennium Development Goals Report 2011

One of the most effective ways to prevent malaria More African children are receiving the is to sleep under an insecticide-treated net, since recommended medicines for malaria, but mosquitoes carrying the malaria parasite mostly bite at night. Regular use of mosquito nets can reduce deaths accurate diagnosis remains critical in children under five. Prompt diagnosis and treatment are needed to prevent The past 10 years have seen a remarkable surge in the life-threatening complications from malaria. However, production, purchase and distribution of insecticide- accurate diagnosis is critical. The majority of childhood treated mosquito nets globally, particularly in Africa. fevers, for example, are not due to malaria, and should Data from household surveys indicate a marked not be treated with antimalarial drugs. In 2010, WHO increase in both net ownership and use among declared that everyone with suspected malaria has a children. Between 2008 and 2010, 290 million nets right to a diagnostic test before treatment, rather than were distributed in sub-Saharan Africa, enough to presumptive treatment based on clinical symptoms, cover 76 per cent of the 765 million people at risk in such as fever. 2010. As a consequence, an indicator that tracks the Most African countries with data for 2009-2010 proportion of febrile children receiving antimalarial show increased mosquito net coverage and reduced medicines does not reflect current treatment policy disparities among various population groups—largely guidance and should be interpreted with caution. due to nationwide campaigns for the distribution of Household surveys indicate that, during 2008- free nets that emphasize poor, rural areas. Rural and 2010, 38 per cent of febrile children in sub-Saharan urban children in Africa are now equally likely to sleep Africa received antimalarial drugs, which may be an under an insecticide-treated mosquito net. underestimate of appropriate treatment of malaria if suspected cases were actually confirmed through diagnostic testing. However, it may also reflect patients receiving antimalarial medicines who do not, in fact, have the disease.

The recommended treatment for uncomplicated malaria in nearly all African countries is artemisinin- based combination therapy. In five African countries with trend data on drug types, a greater proportion of feverish children receiving antimalarial drugs are using this first-line treatment. Goal 6: Combat HIV/AIDS, malaria and other diseases | 45

The incidence of tuberculosis is falling, bringing the MDG target within sight

Number of new tuberculosis cases per 100,000 population (incidence) (including people who are HIV-positive), 1990-2009

Sub-Saharan Africa South-Eastern Asia Oceania 400 400 400

300 300 300

200 200 200

100 100 100

0 0 0 1990 1993 1996 1999 2002 2005 2008 1990 1993 1996 1999 2002 2005 2008 1990 1993 1996 1999 2002 2005 2008

Southern Asia Caucasus & Central Asia Eastern Asia 250 250 250

200 200 200

150 150 150

100 100 100

50 50 50

0 0 0 1990 1993 1996 1999 2002 2005 2008 1990 1993 1996 1999 2002 2005 2008 1990 1993 1996 1999 2002 2005 2008

Latin America & Northern Africa Western Asia 250 the Caribbean 250 250

200 200 200

150 150 150

100 100 100

50 50 50

0 0 0 1990 1993 1996 1999 2002 2005 2008 1990 1993 1996 1999 2002 2005 2008 1990 1993 1996 1999 2002 2005 2008

Developing regions World 250 250 Range of estimates

200 200 Incidence trends

150 150 Note: The scale used for the sub-Saharan Africa, South-Eastern Asia 100 100 and Oceania regions is different from the scale used for the rest of the regions due to the higher tuberculosis incidence 50 50 levels in the former three regions.

0 0 1990 1993 1996 1999 2002 2005 2008 1990 1993 1996 1999 2002 2005 2008 46 | The Millennium Development Goals Report 2011

The burden of tuberculosis is gradually easing. Tuberculosis prevalence and mortality Globally, the incidence rate peaked at 142 cases per are also declining 100,000 people in 2004. Since then, it has fallen by about 1 per cent a year, reaching 137 cases per Number of tuberculosis deaths per 100,000 population 100,000 people in 2009. This corresponds to an (excluding people who are HIV-positive), 1990 and 2009 estimated 9.4 million people (range, 8.9 million–9.9 million)3 newly diagnosed with the disease worldwide Sub-Saharan Africa in 2009, the same number as in 2008. If these trends 32 continue, the world is on track to achieve the goal of 53 halting and reversing the incidence of tuberculosis. South-Eastern Asia 52 31 In 2009, most new cases of tuberculosis were reported in Asia (55 per cent) and Africa (30 per cent). The Southern Asia five countries with the largest numbers of cases were 47 26 India, China, South Africa, Nigeria and Indonesia. China and India combined accounted for 35 per cent Oceania of the world’s new tuberculosis cases. An estimated 12 53 20 per cent of people newly diagnosed with the disease in 2009 were HIV-positive, and sub-Saharan Africa Caucasus & Central Asia accounted for approximately 80 per cent of those 23 20 cases. Eastern Asia 37 12 3 All tuberculosis-related figures are the midpoint in Western Asia a range. The complete data series of ranges and 8 corresponding midpoints are available at 5 http://mdgs.un.org. Latin America & the Caribbean 13 3 Northern Africa 7 2 Developed regions 8 4 Developing regions 37 23 0 10 20 30 40 50 60

1990 2009

Mortality rates from tuberculosis are dropping in all regions. Worldwide, deaths attributed to the disease have fallen by more than one third since 1990. In 2009, tuberculosis caused an estimated 1.3 million deaths among those who were not infected with HIV. An additional 0.4 million deaths from tuberculosis were recorded among people who were HIV-positive. The total of 1.7 million deaths is equivalent to 26 deaths per 100,000 people.

Current projections suggest that the Stop TB Partnership target of halving 1990 death rates by 2015 could be achieved at the global level and in a number of regions. Several regions have already halved their 1990 mortality rate from tuberculosis. Goal 6: Combat HIV/AIDS, malaria and other diseases | 47

Tuberculosis prevalence is also falling in most regions. Only Western Asia appears to be on track to achieve An estimated 14 million people were living with the the Stop TB Partnership target of halving 1990 disease in 2009—the equivalent of 200 cases per prevalence rates by 2015. 100,000 people. However, trends remain uncertain.

Up to 6 million lives have been saved since 1995, thanks to an effective international strategy for the diagnosis and treatment of tuberculosis

Progress against tuberculosis today is the result of more remains to be done. In approximately one third intensive efforts over the past 15 years to implement of new cases, the recommended strategy is not the “DOTS” strategy (1995-2005) and its successor, being used. Moreover, about 90 per cent of patients the Stop TB Strategy (launched in 2006). Between with multidrug-resistant tuberculosis are not being 1995 and 2009, a total of 41 million tuberculosis diagnosed and treated according to international patients were successfully treated according to the guidelines. Many people with tuberculosis who are DOTS/Stop TB Strategy and up to 6 million lives were also HIV-positive do not know their HIV status, and are saved as a result. not yet accessing antiretroviral therapy. Funding gaps remain large, despite increased resources over the past In 2009, it was reported that 5.8 million people decade and substantial financing in many countries worldwide had been officially diagnosed with from the Global Fund to Fight AIDS, Tuberculosis and tuberculosis. This represents about 63 per cent of the Malaria. estimated number of all cases. Among patients that were notified of their diagnosis in 2008, 86 per cent In the next five years, intensified efforts are needed to were successfully treated—exceeding the 85 per cent plan, finance and implement the range of interventions target of successful treatment of new positive cases. and approaches included in the Stop TB Strategy, according to the targets established in the Global Plan Despite these positive outcomes, and related to Stop TB, 2011-2015. interventions such as antiretroviral therapy, much 48 | The Millennium Development Goals Report 2011

Target Integrate the principles of sustainable development into Goal 7 country policies and programmes and reverse the loss of environmental resources Ensure environmental Forests are disappearing rapidly in South sustainability America and Africa, while Asia — led by China — registers net gains

Net change in forested area between 1990 and 2000 and between 2000 and 2010 (Million hectares per year)

3.0 Africa Asia Europe North & Oceania South Central America America

2.0 2.2

1.0 0.9 0.7 0.0 0.0 -0.3 -0.04 -0.6 -0.7

-1.0

-2.0

-3.0 -3.4

-4.1 -4.0 -4.0 -4.2

-5.0

Net gain Net loss 1990-2000 2000-2010 1990-2000 2000-2010

Note: The composition of regions is different from the rest of the report. In this chart, Oceania corresponds to what in the MDG regions is Oceania and Australia combined; Europe in the MDG regions is part of the developed regions; and North & Central America are included under developed regions and Latin America, respectively.

Although still alarmingly high, the rate of deforestation and loss of forest from natural causes is slowing down. At the global level, it decreased from an estimated 16 million hectares per year in the 1990s to about 13 million hectares per year in the past decade. At the same time, afforestation and the natural expansion of forests in some countries and regions have reduced the net loss of forest area significantly at the global level. The net change in forest area over the period 2000-2010 is estimated at -5.2 million hectares per year, down from -8.3 million hectares per year in the period 1990-2000. However, most of the forest loss is still occurring in countries in the tropics, while the net gain is mostly found in countries in the temperate and boreal zones. Goal 7: Ensure environmental sustainability | 49

South America and Africa saw the largest net losses Despite the downturn in economic of forest areas between 2000 and 2010. Oceania also activity, global greenhouse gas emissions reported a net loss, largely due to severe drought and forest fires in Australia over the past decade. Asia, continue their ascent on the other hand, registered a net gain of some 2.2 million hectares annually in the past 10 years, mostly Emissions of carbon dioxide (CO²), 1990 and 2008 because of large-scale afforestation programmes (Billions of metric tons) in China, India and Viet Nam. Rapid conversion of Eastern Asia forested lands to other uses continued in many other 3.0 countries in the region. 7.7 Southern Asia 1.0 The rich biodiversity of the world’s forests remains 2.5 imperilled by the still high rate of global deforestation Latin America & the Caribbean and forest degradation as well as a decline in primary 1.0 forests. One positive trend, however, is growth in the 1.7 establishment of protected areas, which increased Western Asia by 94 million hectares since 1990 and now cover an 0.6 estimated 13 per cent of the world’s forests. 1.3 South-Eastern Asia 0.4 Forests play an important role in the global carbon 1.2 cycle. Trees absorb carbon from the atmosphere and Southern Asia (excluding India) store it in their wood, but the carbon is released 0.3 back into the atmosphere when the wood is burned 0.8 or decomposes. It is estimated that the forestry Sub-Saharan Africa sector alone is responsible for one sixth of all human- 0.5 induced greenhouse gas emissions—mainly due 0.7 to deforestation. In late 2010, countries agreed to Eastern Asia (excluding China) establish a mechanism under the United Nations 0.5 Framework Convention on Climate Change to reward 0.6 developing countries that reduce carbon emissions Caucasus & Central Asia 0.5* from deforestation and forest degradation—through 0.5 the so-called REDD+ mechanism. So far, more than Northern Africa $4 billion has been pledged for early action. 0.2 0.5 In addition, the United Nations General Assembly Oceania designated 2011 as the International Year of Forests <0.1 to raise awareness of sustainable management, <0.1 conservation and development of all types of forests. Developing regions 6.8 “Forests for People” is the theme for the Year, 16.0 highlighting the dynamic relationship between forests Developed regions and the people who depend on them. 15.0 13.9 World 21.8 30.1

0 5 10 15 20 25 30 35 1990 2008 * Data for Caucasus & Central Asia refer to 1992.

In 2008, the latest year for which data are available, global carbon dioxide (CO2) emissions continued to rise, reaching 30.1 billion metric tons, an increase of 1.7 per cent from the previous year. This change was smaller than in the period 2006-2007 (2.9 per cent) due to the economic crisis, which resulted in a decrease in emissions in 2008 in several countries, 50 | The Millennium Development Goals Report 2011

in particular in developed regions. Still, emissions The Montreal Protocol is not only overall increased, underscoring the urgent need for helping to restore the ozone layer, strengthened global action against climate change. but to curb climate change According to the World Meteorological Organization, which issues annual updates on the status of climate Consumption of all ozone-depleting substances (ODSs), change and greenhouse gas emissions, the decade 1986-2009 (Thousands of tonnes of ozone depleting 2001-2010 was the warmest on record since 1880 in potential) terms of average global temperatures. It was warmer 1,400 than the previous record decade 1991-2000. Developed regions 1,200 Developing regions The 2008 emissions were 38 per cent above the 1,000 Caucasus, Central Asia, 1990 level. Per capita emissions remain highest in the Eastern & South-Eastern Europe 800 developed regions—11.2 metric tons of CO2 per person per year in 2008, compared to about 2.9 metric tons 600 in the developing regions and 0.8 metric tons in sub- Saharan Africa, the lowest regional value. The gap 400 in CO emissions per capita between developed and 2 200 developing regions has diminished somewhat since 1990: In 1990, 12.3 metric tons of CO2 were emitted 0 per person per year in developed regions, compared 1986 1990 1994 1998 2002 2006 2009 to about 1.7 metric tons in the developing regions and 0.9 metric tons in sub-Saharan Africa. The Montreal Protocol is an undisputed—but still unfinished—success story. Much more work remains Emissions per unit of economic output fell by more to be done to ensure the protection of the ozone layer than 36 per cent in the developed regions and by for this and future generations. Still, what the parties about 9 per cent in the developing regions. The 2008 to the Protocol have managed to accomplish since values for this indicator were significantly higher for 1987 is unprecedented, providing an example of what developing than for developed regions: 0.58 versus international cooperation at its best can achieve. 0.38 kilograms of CO2, respectively, per dollar of As of end-2009, the consumption of 98 per cent of economic output. all ozone-depleting substances controlled under the Montreal Protocol had been phased out. The December 2010 United Nations Climate Change Conference in Cancún, Mexico, was an important Global observations have verified that atmospheric step forward in international negotiations under the concentrations of such substances are declining. With UN Framework Convention on Climate Change. At the full implementation of the Protocol’s provisions, the conference, a set of decisions known as the “Cancun ozone layer is expected to return to its pre-1980 levels Agreements” were adopted by the international around the middle of this century. community to address collectively and comprehensively the long-term challenge of climate change. However, The Protocol has also delivered substantial climate many of these decisions need to be elaborated upon benefits, since ozone-depleting substances are to drive national actions to mitigate greenhouse gas also global-warming gases. The reduction in such emissions. Operationalizing these decisions will be the substances between 1990, when they reached peak subject of further negotiations, which are expected to levels, and 2000 has yielded a net reduction of about take place at the next major climate change conference 25 billion tonnes equivalent of CO2-weighted global- in Durban, South Africa, in December 2011. warming gasses. Goal 7: Ensure environmental sustainability | 51

managed by indigenous and community groups. By Target 2020, under the new targets, at least 17 per cent of Reduce biodiversity loss, achieving, by 2010, a land and inland water areas, and 10 per cent of coastal significant reduction in the rate of loss and marine areas, are to be conserved, including more priority sites for conservation. An expansion of sites will only deliver benefits for biodiversity, however, if Added effort and innovative approaches they are well managed and supported. are needed to meet new targets for the conservation of priority The global tide of extinctions continues ecosystems unabated

Proportion of terrestrial areas protected and proportion IUCN Red List Index of species survival* (showing the of coastal waters (up to 12 nautical miles) protected, proportion of species expected to remain extant in the near 1990-2010 (Percentage) future in the absence of additional conservation action) for mammals (1996-2008), birds (1988-2008), amphibians 14 (1986-2004) and aggregate index (1986-2008) 12 0.95 10 8 0.90 6 0.85 4

2 0.80 0 1990 1994 1998 2002 2006 2010 0.75 Developed regions Developing regions 0.70 Land Land Sea Sea 1986 1990 1994 1998 2002 2008

The extent of ecosystems worldwide designated as Aggregate index Birds protected areas has increased dramatically over the Mammals Amphibians last half century. In 2010, over 150,000 protected * A Red List Index value of 1.0 means that the species in question is sites covered 12.7 per cent of the world’s land area of least concern since it is not expected to go extinct in the near future. A Red List Index value of zero indicates that species has gone extinct. and 7.2 per cent of its coastal waters (extending out to 12 nautical miles). Beyond this, marine protection is still very limited. Only 3.5 per cent of exclusive To measure trends in the percentage of species economic zones (up to 200 nautical miles) and threatened with extinction, the International Union for less than 1.5 per cent of the total ocean area are Conservation of Nature and its partners have compiled designated as marine protected areas. what is known as the Red List Index, now available for all the world’s birds (10,000 species), mammals Despite the overall increase in protected ecosystems, (4,500 species) and amphibians (5,700 species). The biodiversity is still in decline, owing to inadequate latest indices show that, overall, species are declining management of existing sites and gaps in the in population and range and are moving towards protection of areas deemed priorities for conservation. extinction—with consequences for the ecosystem Two global networks have been formed for the services upon which all people depend. An aggregated protection of such sites: Important Bird Areas (11,000 index shows the average trends across these three sites of importance for avian conservation) and Alliance groups. Amphibians are most threatened, and are for Zero Extinction sites (588 areas supporting the only declining most rapidly, but all groups with known remaining populations of one or more highly threatened trends show a deterioration in status. Other classes species). However, only 26 per cent and 22 per cent of of organisms not yet indexed are likely to mirror this these critical sites, respectively, are fully protected. pattern, with some being even more threatened (such as cycads—a palm-like tropical plant) and others New targets adopted in 2010 by the 193 parties disappearing even more quickly (such as corals). to the Convention on Biological Diversity called for the expansion of the global protected area network. Targeted sites include ecological corridors and areas 52 | The Millennium Development Goals Report 2011

Global marine resources continue The global production of marine capture fisheries to decline reached a peak of 86.3 million tonnes in 1996. Since that time, it has declined slightly, to 79.5 million tonnes in 2008, with large fluctuations between years. The Status of the exploited fish stocks, 1974-2008 (Percentage) proportion of fish stocks estimated to be underexploited 100 or moderately exploited declined from 40 per cent in the mid-1970s to 15 per cent in 2008. Over roughly the same period, the proportion of overexploited, 80 depleted or recovering fish stocks increased from 10 per cent to 33 per cent. The proportion of fully 60 exploited stocks has remained relatively stable at about 50 per cent since the 1970s, with some slightly lower levels between 1985 and 1997. 40 In spite of action on the part of coastal States, and 20 good progress in some cases, the overall decline in global fisheries continues. The most serious pressures on fisheries resources remain overfishing, pollution 0 and loss of habitats. Policy and management actions 1974 1979 1984 1989 1994 1999 2004 2008 to safeguard these resources must focus on countering Overexploited + Depleted + Recovering the overcapacity of fishing fleets and the integration of Fully exploited plans to rebuild marine resources with national political Underexploited + Moderately exploited and economic decision-making.

The limits for sustainable water resources have already been exceeded in Western Asia and Northern Africa

Surface water and groundwater withdrawal as a percentage of internal renewable water resources, taking into consideration official treaties between countries, around 2005

Western Asia 166 Northern Africa 92 Southern Asia 58 Caucasus 56 & Central Asia Water resources are still abundant Eastern Asia 20 Water scarcity South-Eastern Asia 8 is approaching Sub-Saharan Africa 3 Sustainable limits Latin America have been exceeded & the Caribbean 2 Oceania <0.1 Developed regions 10

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180

The proportion of water resources used by a country is Most regions withdraw less than 25 per cent of their a complex indicator reflecting development, national renewable water resources. Considering usage trends water policies, and physical and economic water since 1960, they will not approach the range of scarcity. At low levels of development, it is generally physical water scarcity for some time. Two regions, advantageous to increase total water withdrawal. But however, Western Asia and Northern Africa, have far beyond a certain “inflection point”, ecosystems will exceeded the threshold of 75 per cent, meaning that be strained and competing water uses will not allow their water resources are no longer sustainable. Two all users to receive their fair share. Dry years may other regions are approaching the threshold of 60 per exacerbate the problem, which makes identifying the cent. exact inflection point difficult, as do years of above- normal precipitation. Goal 7: Ensure environmental sustainability | 53

Target Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation

The world is likely to surpass the drinking water target, though more than 1 in 10 people may still be without access in 2015

Proportion of population using different sources of water, 1990 and 2008 (Percentage)

100 11 10 8 7 14 13 12 12 14 14 15 16 28 25 8 12 9 28 31 6 8 80 40 13 49 28 50 51 32 35 14 35 60 53 33 64 54 55 80 40 83 82 84 29 44 78 31 34 72 58 56 53 55 49 20 39 33 22 23 19 15 16 17 21 0 1990 2008 1990 2008 1990 2008 1990 2008 1990 2008 1990 2008 1990 2008 1990 2008 1990 2008 1990 2008

Oceania Sub-Saharan South-Eastern Southern Caucasus & Eastern Western Northern Latin America Developing Africa Asia Asia Central Asia Asia Asia Africa & the Caribbean regions

Piped water on premises Other improved sources Unimproved sources 54 | The Millennium Development Goals Report 2011

Progress to improve access to clean drinking water cent in 1990, to 86 per cent in 2008. Sub-Saharan has been strong. Globally, coverage increased from 77 Africa nearly doubled the number of people using an per cent in 1990 to 87 per cent in 2008. If this trend improved drinking water source—from 252 million in continues, the MDG drinking water target of 89 per 1990 to 492 million in 2008. Coverage in that region cent coverage will be met—and likely surpassed—by increased from 49 per cent in 1990 to 60 per cent in 2015. 2008.

In 92 per cent of developing countries (103 out of 112 In all regions, coverage in rural areas lags behind that countries), drinking water coverage increased between of cities and towns. In 2008, an estimated 141 million 1990 and 2008 or stayed the same, at a rate of 98 urbanites and 743 million rural dwellers continued per cent or higher. In only 13 countries did coverage to rely on unimproved sources for their daily drinking decline. water needs. In sub-Saharan Africa, an urban dweller is 1.8 times more likely to use an improved drinking Latin America and the Caribbean, Eastern Asia and water source than a person living in a rural area. South-Eastern Asia have already met the MDG drinking water target. Eastern Asia registered the largest increase in drinking water coverage—from 69 per

Poor, rural populations remain at a disadvantage in accessing clean drinking water

Proportion of population using different sources of water by wealth quintile, rural and urban areas, sub-Saharan Africa, 2004/2009 (Percentage)

Urban areas Rural areas 100 100 8 6 12 20 35 32 80 80 32 46 56 53 53 65 60 60 62

64

40 40 59 60 62 52 46 44 20 39 20 35 26 16 2 9 5 1 0 0 Poorest Second Middle Fourth Richest Poorest Second Middle Fourth Richest 20% 20% 20% 20% 20% 20% 20% 20% 20% 20%

Piped on premises Other improved sources Unimproved sources

An analysis of survey data from sub-Saharan African the poorest households are 12 times less likely than countries shows that the poorest 20 per cent of the richest households to enjoy the convenience and the population in urban areas are almost six times associated health benefits of having a piped drinking more likely to rely on an unimproved drinking water water supply on premises. source than the richest 20 per cent. In urban areas, Goal 7: Ensure environmental sustainability | 55

Over 2.6 billion people still lack flush 17 per cent in 2008. Almost two thirds of the people toilets and other forms of improved who practise open sanitation reside in Southern Asia. sanitation Northern Africa is the only region that has already surpassed the MDG sanitation target, increasing Proportion of population using an improved sanitation facility, coverage from 72 per cent in 1990 to 89 per cent in 1990 and 2008 (Percentage) 2008. Sub-Saharan Africa 28 The International Year of Sanitation in 2008 gave 31 64 much needed impetus to the debate on sanitation. And Southern Asia in various regions, yearly sanitation conferences are 25 held to ensure that sanitation remains on the political 36 63 agenda and receives the attention it deserves. Oceania 55 53 78 Gaps in sanitation coverage between Eastern Asia 43 urban and rural areas are narrowing 56 72 South-Eastern Asia Urban/rural ratio of the proportion of population using 46 an improved sanitation facility, 1990 and 2008 69 73 Southern Asia Latin America & the Caribbean 4.3 69 2.2 80 85 Western Asia Latin America & the Caribbean 79 2.1 85 90 1.6 Northern Africa Sub-Saharan Africa 72 2.0 89 86 1.8 Caucasus & Central Asia South-Eastern Asia 91 1.9 95 96 1.3 Developing regions Oceania 42 1.8 53 71 1.8 World Western Asia 54 1.8 61 77 1.4

0 20 40 60 80 100 Northern Africa 1.7 1990 2008 2015 1.1 Eastern Asia The world is far from meeting the sanitation target. In 1.4 1.2 fact, at the current rate of progress, it will take until Caucasus & Central Asia 2049 to provide 77 per cent of the global population 1.1 with flush toilets and other forms of improved 1.0 sanitation. Almost half the population of developing Developing regions regions and some 2.6 billion people globally were not 2.2 using an improved form of sanitation in 2008. 1.7 Developed regions That year, an estimated 1.1 billion people did not use 1.1 any facility at all and practised open defecation, which 1.1 poses enormous health risks, particularly for poorer 0.0 1.0 2.0 3.0 4.0 5.0 segments of the population who are most exposed Equal to the dangers of inadequate human waste disposal. Rural populations at Globally, open defecation rates have declined by one a disadvantage third, from 25 per cent of the population in 1990 to 1990 2008 56 | The Millennium Development Goals Report 2011

Rural populations everywhere are disadvantaged when Asia, where an urban resident is 2.2 times more likely it comes to improved sanitation, though disparities to use an improved facility than a rural resident. Still, with urban areas are decreasing in all regions. Globally, this represents significant improvement since 1990, an urban resident is 1.7 times more likely to use an when an urban resident was 4.3 times more likely to improved sanitation facility than someone living in use an improved sanitation facility than a person living a rural area. Inequalities are most stark in Southern in a rural area.

Improved sanitation has failed to reach the poorest households in parts of Southern Asia

Proportion of population by sanitation practices and wealth quintile, Southern Asia, 1995 and 2008 (Percentage) 100 6 2 1 4 Open defecation 18 Unimproved

Improved 80 6 51 56

74 77 60 86 87 94 4 93 94

40 8 76

8 4 45 20 36 5 7 18 19 4 8 2 7 0 1995 2008 1995 2008 1995 2008 1995 2008 1995 2008 Poorest 20% Second 20% Middle 20% Fourth 20% Richest 20%

An analysis of trends over the period 1995-2008 increased, and four out of five people in the bottom for three countries in Southern Asia shows that two quintiles continue to practise open defecation. improvements in sanitation have disproportionately The most progress was made by those in the fourth benefited the wealthy. Sanitation coverage for wealthiest quintile, while the richest 20 per cent of the the poorest 40 per cent of households has hardly population has maintained its very high coverage level. Goal 7: Ensure environmental sustainability | 57

39 per cent to 33 per cent. More than 200 million Target of these people gained access to either improved By 2020, to have achieved a significant water, sanitation or durable and less crowded housing. improvement in the lives of at least 100 million However, in absolute terms, the number of slum slum dwellers dwellers continues to grow, due in part to the fast pace of urbanization. The number of urban residents living in slum conditions is now estimated at some 828 Growing urbanization is outpacing million, compared to 657 million in 1990 and 767 slum improvements, calling for new and million in 2000. realistic national and local targets In 2010, the highest prevalence of slum conditions was found in sub-Saharan Africa. There, 62 per cent of Population living in slums and proportion of urban population the urban population were sheltered in slums, followed living in slums, developing regions, 1990-2010 by Southern Asia (35 per cent) and South-Eastern Proportion of urban population Asia (31 per cent). Particularly critical is the situation Population in slums (Millions) in slums (Percentage) in conflict-affected countries, where the proportion of 900 60 urban populations living in slums increased from 64 800 per cent in 1990 to 77 per cent in 2010. 46.1 50 700 42.8 Redoubled efforts will be needed to improve the lives 39.3 600 40 of the urban poor in cities and metropolises across 35.7 34.3 32.7 the developing world. Towards that end, in April 2011, 500 30 the Governing Council of the United Nations Human 400 Settlements Programme encouraged countries to enumerate their slum populations, and to set realistic 300 20 national, regional and local targets for improving the 200 lives of slum dwellers. These could extend beyond 10 100 the current MDG target, which has a deadline of 2020. Priorities include housing and basic services, 0 0 infrastructure such as water and sanitation facilities, 1990 1995 2000 2005 2007 2010 transport, energy, health and education. Countries are Percentage of urban Population in slums also urged to promote access to affordable land with population living in slums secure tenure and to create the conditions in which people are able to carve out and sustain a livelihood. From 2000 to 2010, the share of urban residents in the developing world living in slums declined from 58 | The Millennium Development Goals Report 2011

Aid to developing countries is at a record high, Goal 8 but falls short of promises made in 2005 Official development assistance (ODA) from developed countries, Develop a global 2000-2010 (Billions of constant 2009 US$ and current US$) partnership 140 for development 120

100

80

60

40

20

0 2000 2002 2004 2006 2008 2010 (Preliminary) Net debt forgiveness grants Humanitarian aid Multilateral ODA Bilateral development projects, programmes and technical cooperation Total net ODA in billions of current US$

In 2010, net aid disbursements amounted to $128.7 billion, equivalent to 0.32 per cent of developed countries’ combined national income. This was the highest level of real aid ever recorded and an increase of 6.5 per cent in real terms over 2009.

If debt relief and humanitarian aid are excluded, bilateral aid for development programmes and projects rose by 5.9 per cent in real terms, as donors continued to scale up their core development projects and programmes. Most of the rise was in new lending (which grew by 13.2 per cent), but grants also increased (by 6.8 per cent).

In 2005, at the Gleneagles Group of Eight (G8) Summit and other forums, donors committed to increase their assistance to developing countries. The pledges they made at these meetings, combined with other commitments, implied a lifting of aid from about $80 billion in 2004 to nearly $130 billion in 2010 (at constant 2004 prices). However, when comparing the 2010 outcome with pledges made in 2005, there was a shortfall of $19 billion. A little over $1 billion of this shortfall can be attributed to lower-than-expected levels of gross national income due to the economic crisis. However, the remaining gap—$18 billion—was due to the failure of donors to meet their commitments. Overall, the combined effect of the increases has lifted aid by 37 per cent in real terms since 2004, or about $30 billion (in 2004 dollars). Goal 8: Develop a global partnership for development | 59

At the Gleneagles summit, G8 donors also envisaged that their commitments, combined with those of other Target donors, would raise official development assistance Address the special needs of the least developed (ODA) to Africa by $25 billion in 2010. That year, countries, landlocked countries and small island bilateral aid to the continent as a whole was $29.3 developing states billion, of which $26.5 billion was for sub-Saharan Africa. These amounts represent increases of 3.6 per cent and 6.4 per cent in real terms, respectively, over ODA outlook: Expect leaner years ahead 2009. Preliminary estimates show that Africa will receive only about $11 billion out of the $25 billion Net official development assistance from OECD-DAC countries increase promised at Gleneagles, due mainly to the as a proportion of donors’ gross national income to all underperformance of some European donors that give developing countries and to the least developed countries large shares of their aid to Africa. (LDCs), 1990-2010 (Percentage) 0.40 Total ODA 0.35 ODA to LDCs 0.30

0.25

0.20

0.15

0.10

0.05

0.00 1990 1994 1998 2002 2006 2010 (Preliminary)

In 2010, Denmark, Luxembourg, the Netherlands, Norway and Sweden continued to exceed the United Nations target for ODA of 0.7 per cent of their gross national income (GNI). The largest donors by volume were the United States, followed by the United Kingdom, France, Germany and Japan. The largest increases in ODA in real terms between 2009 and 2010 were made by Australia, Belgium, Canada, Japan, Portugal, the Republic of Korea and the United Kingdom.

In 2005, the 15 European Union countries that are members of the Development Assistance Committee of the Organisation for Economic Co-operation and Development (OECD-DAC) committed to allocate a minimum of 0.51 per cent of their GNI to ODA by 2010. The following countries surpassed that goal: Luxembourg (1.09 per cent), Sweden (0.97 per cent), Denmark (0.90 per cent), the Netherlands (0.81 per cent), Belgium (0.64 per cent), the United Kingdom (0.56 per cent), Finland (0.55 per cent) and Ireland (0.53 per cent). France nearly met the goal with an ODA/GNI ratio of 0.50 per cent, while others fell short by a larger margin: Spain (0.43 per cent), Germany (0.38 per cent), Austria (0.32 per cent), Portugal (0.29 per cent), Greece (0.17 per cent) and Italy (0.15 per cent).

Other DAC member countries, including Australia, Canada, Norway, Switzerland and the United States, 60 | The Millennium Development Goals Report 2011

also made promises for 2010 that they kept. In 2005, Japan committed to providing an additional $10 billion Target in aid over the period 2004 to 2009. It fell short Develop further an open, rule-based, predictable, by $3.6 billion due to severe economic constraints; non-discriminatory trading and financial system however, in 2010 its ODA again rose significantly. New Zealand plans to achieve an ODA level of $NZ 600 Protectionism was averted, despite million ($472 million) by 2012-2013 and appears to be on track. The Republic of Korea was not a DAC troubling economic times, due to strong donor in 2005 and made no promises to increase its international cooperation aid. Still, since 2005, its aid programme has increased in real terms by 56 per cent. Proportion of developed country imports from developing countries and from the LDCs admitted free of duty, Looking ahead, a recent OECD survey shows that all duty-free access and preferential duty-free access,* most donors plan to increase aid over the coming 1996-2009 (Percentage) three years, though at a sharply reduced pace. Aid will 90 grow at 2 per cent a year between 2011 and 2013, 80 compared to an average of 8 per cent a year over the past three years. Aid to Africa is expected to rise by 70 just 1 per cent a year in real terms, compared to the 60 average of 13 per cent over the past three years. In 2008-2009, out of an average total of $82.1 billion 50 in ODA that was allocable by sector, $23.1 billion 40 focused on support for gender equality and women’s 30 empowerment. Aid concentrates increasingly on the poorest countries, with the least developed countries 20 (LDCs) receiving about a third of donors’ total aid 10 flows. 0 1996 1998 2000 2002 2004 2006 2009

Total duty-free access, all developing countries Total duty-free access, LDCs Preferential duty-free access, all developing countries Preferential duty-free access, LDCs

* Preferential duty-free access is calculated by subtracting from the total duty-free access all products receiving duty free treatment under the most-favoured-nation treatment (MFN) regime.

Despite fears of renewed protectionism at the beginning of the economic crisis in 2008, the strong international governance that emerged from the Group of Twenty (G20) Summit and other multilateral initiatives averted a return to restrictive trade practices. The preferential market access granted to the LDCs and developing countries remained relatively unchanged from the levels of the previous five years.

The vast majority of exports from developing countries are now imported free from custom duties in developed country markets. Recent years have seen a slight increase in the proportion of duty-free imports from developing countries other than LDCs, with the proportions for the two groups converging at about 80 per cent of their exports.

The preferential nature of the duty-free access granted by developed countries is very different between LDCs and developing countries more generally. Thanks to Goal 8: Develop a global partnership for development | 61

the general reduction of tariffs in developed markets, On the other hand, true preferential duty-free more and more products are now routinely imported treatment remains the dominant mode through duty free under the World Trade Organization’s most- which LDCs gain access to the markets of developed favoured-nation (MFN) treatment. Products that are countries. The proportion of LDC exports benefiting MFN duty free include not only raw materials but from such preferences has been increasing over the also manufactures, such as electronics equipment years, reaching 53 per cent in 2009. All but one of under the Information Technology Agreement. This the developed countries have granted duty-free market has benefited many of the more advanced developing access to at least 97 per cent of products originating countries. When MFN treatment is excluded, only from LDCs. The exception is the United States, which 19 per cent of exports by developing to developed has tariffs on imports of textile and clothing from Asian countries benefited from “true” preferential treatment. LDCs.

Tariffs on agricultural products from developing countries continue to fall, but remain unchanged for clothing and textiles

Developed countries' average tariffs on imports of key Developed countries' average tariffs on imports of key products from developing countries, 1996-2009 (Percentage) products from LDCs, 1996-2009 (Percentage) 12 Agricultural goods 12 Agricultural goods Clothing Clothing 10 Textiles 10 Textiles

8 8

6 6

4 4

2 2

0 0 1996 1998 2000 2002 2004 2006 2009 1996 1998 2000 2002 2004 2006 2009

In 2009, applied tariffs on agricultural products and the best tariff for all developing countries, have from developing countries and LDCs continued to fall seen only marginal changes in the past five years. slowly, while remaining largely unchanged for textiles However, thanks to the special preference granted and clothing. During a period dominated by the to them, the margin of preference for LDCs is higher global economic crisis, no major tariff initiatives were than that for other developing countries. Nevertheless, undertaken. Rather, specific modifications, such as these preferences are declining as tariffs in developed those by the European Union relating to rice and sugar, economies diminish. As a result, the LDCs have been served to advance progress. turning their attention to large emerging economies, where demand is increasing and MFN tariffs remain Since 2005, the decline in preferential tariffs has high (about 10 per cent for raw materials and 18 tended to follow the trend observed for most-favoured- per cent for processed products). Other developing nation treatment. As a result, preference margins, countries now absorb half the exports of LDCs. measured as the difference between MFN treatment 62 | The Millennium Development Goals Report 2011

A country’s external debt burden affects its Target creditworthiness and vulnerability to economic shocks. Deal comprehensively with developing countries’ debt Better debt management, the expansion of trade and, particularly for the poorest countries, substantial debt relief have reduced the burden of debt service. A sharp drop in exports in 2009 Between 2000 and 2008, the average ratio of public interrupted the downward trend of debt service to exports for developing regions declined from 12.5 per cent to 3.4 per cent. In 2009, due developing countries’ debt service ratios to the global economic crisis, export earnings of developing countries declined by 21 per cent, while External debt service payments as a proportion of export total public debt service remained at about the same revenues, 2000, 2008 and 2009 (Percentage) level as in 2008. As a consequence, the ratio of public Western Asia debt service to exports increased for all developing 16.2 regions except Southern Asia, Western Asia and 9.2 9.0 Oceania, with the overall average rising to 3.6 per cent. The impact was most pronounced for the small island Latin America & the Caribbean 21.8 developing States (SIDS) and the LDCs. 6.8 7.2 Forty countries are eligible for debt relief under the Northern Africa Heavily Indebted Poor Countries (HIPC) initiative. 15.3 Of these, 36 countries have reached the “decision 6.1 6.9 point” stage in the process and have had future debt South-Eastern Asia payments reduced by $59 billion (in end-2009 net 6.5 present value terms); 32 countries that subsequently 3.0 reached their “completion point” have received 4.0 additional assistance of $30 billion (in end-2009 net Southern Asia present value terms). The debt burdens of countries 13.7 included in the HIPC initiative are below the average 5.2 3.5 for all LDCs. Sub-Saharan Africa 9.4 2.0 3.1 Oceania 5.9 2.8 1.9 Caucasus & Central Asia 8.4 0.6 1.0 Eastern Asia 5.1 0.6 0.6 Developing regions 12.5 3.4 3.6 Small island developing States 8.7 7.6 9.5 Least developed countries 11.4 2.9 5.6 0 5 10 15 20 25 2000 2008 2009 Goal 8: Develop a global partnership for development | 63

68 per cent by end-2010. Mobile cellular networks Target are offering alternative communications opportunities In cooperation with the private sector, make to previously unconnected regions. In the LDCs, for available the benefits of new technologies, example, mobile cellular penetration is around 30 per especially information and communications cent, compared to only 1 per cent fixed telephone line penetration.

The world is increasingly interconnected Mobile communications are not only connecting remote through mobile, high-speed and rural populations to basic voice services. They are communications also offering innovative applications in, for example, the areas of business, health and education, which can contribute to the achievement of other MDGs. Number of fixed telephone lines and mobile cellular subscriptions per 100 inhabitants, 1995-2010 Two thirds of the world’s population have 120 yet to gain access to the Internet 100 Number of Internet users per 100 inhabitants, 1995-2010 80 80 Least developed countries 60 70 Developing regions 60 40 Developed regions 50

20 40

30 0 1995 1997 1999 2001 2003 2005 2007 2010* 20

Mobile cellular telephone subscriptions, developed regions 10 Fixed telephone lines, developed regions 0 Mobile cellular telephone subscriptions, developing regions 1995 1999 2003 2007 2010* Fixed telephone lines, developing regions * Data for 2010 are estimates. * Data for 2010 are estimates. The number of Internet users continues to expand. By the end of 2010, 90 per cent of the world’s However, penetration levels in the developing world inhabitants were covered by a mobile cellular signal. remain relatively low, at 21 per cent by end-2010, The number of mobile cellular subscriptions had grown compared to 72 per cent in the developed regions. to an estimated 5.3 billion—including nearly 1 billion Globally, two out of three people are not using the subscriptions to 3G (third generation) services—and Internet. And in LDCs, Internet penetration was as more than 2 billion people worldwide were using the low as 3 per cent by end-2010. In absolute numbers, Internet, increasingly through broadband access. the developed regions have been surpassed by the developing world, which in 2010 accounted for 60 per Growing demand for information and communications cent of Internet users worldwide, up from 40 per cent services, combined with technological advances, in 2005. growing infrastructure and falling prices, are allowing more and more people across the globe to join the information society. By the end of 2010, mobile cellular penetration levels had reached an estimated 76 per cent, and almost one in three people were online.

Many developed countries are reaching saturation levels in mobile cellular subscriptions, with an average penetration level of 116 per cent. Growth in mobile telephony continues to be strong in the developing world, where mobile penetration had reached around 64 | The Millennium Development Goals Report 2011

High-speed Internet connections, now networks. More countries are introducing national more widely available, have promising broadband plans to bring more people online, but applications for development major differences in broadband access persist. By the end of 2010, fixed broadband penetration in the Fixed broadband subscriptions and mobile broadband developed regions averaged 24.6 per cent, compared subscriptions per 100 inhabitants, 2000-2010 to only 4.4 per cent in the developing world. And fixed 60 broadband subscriptions in the developing world are Mobile broadband, developed regions heavily concentrated in a few countries. In the majority 50 Mobile broadband, developing regions of LDCs, the number of fixed broadband subscriptions Fixed broadband, developed regions remains very low and services are prohibitively 40 expensive. Fixed broadband, developing regions 30 Mobile broadband has started to become a true alternative to fixed broadband access. In 2010, 143 20 countries were offering mobile broadband services commercially, compared to less than 50 in 2005. 10 Demand is expected to grow rapidly over the next few years, especially in the developing world and in such 0 regions as Africa, where fixed-line infrastructure to the 2000 2002 2004 2006 2008 2010* end-user is limited. * Data for 2010 are estimates. Two thirds of mobile broadband subscriptions are still Some of the most promising applications and services in the developed regions, where, in 2010, penetration in information and communications for development levels had surpassed the 50 per cent mark. are those that are delivered over high-speed broadband Goal 8: Develop a global partnership for development | 65 66 | The Millennium Development Goals Report 2011 A note to the reader

Measuring progress towards the MDGs are also accompanied by metadata with a detailed description of how the indicators are produced and the methodologies Progress towards the eight Millennium Development Goals is used for regional aggregations. measured through 21 targets and 60 official indicators.1 This report presents an accounting to date of how far the world Reconciling national and international data has come in meeting the goals using data available as of June 2011.2 Reliable, timely and internationally comparable data on the MDG indicators are crucial for holding the international Most of the MDG targets have a deadline of 2015, using community to account. They are also important in 1990 as the baseline against which progress is gauged. encouraging public support and funding for development, Country data are aggregated at the subregional and regional allocating aid effectively, and comparing progress among levels to show overall advances over time. Although the regions and across countries. aggregate figures are a convenient way to track progress, the situation of individual countries within a given region may Discrepancies among sources and gaps in national data have vary significantly from regional averages. Data for individual raised concerns in the statistical community and troubled countries, along with the composition of all regions and country data producers who find themselves dealing with subregions, are available at http://mdgs.un.org. different figures for the same indicator.

The basis for this analysis A number of initiatives have been launched to reconcile national and international monitoring and to resolve Regional and subregional figures presented in this report are differences in methods and definitions used by various compiled by members of the United Nations Inter-Agency agencies within countries and in international agencies. and Expert Group on MDG Indicators (IAEG). In general, The IAEG has promoted a dialogue between national the figures are weighted averages of country data, using and international agencies to improve the coherence of the population of reference as a weight. For each indicator, national and international data and to ensure the quality individual agencies were designated as official providers of and transparency of methodologies and data produced. The data and as leaders in developing methodologies for data IAEG has also provided training to national statistics experts collection and analysis (see inside front cover for a list of in more than 60 countries. As a result, data production contributing organizations). in countries is increasingly aligned with internationally agreed-upon recommendations and standards. Moreover, Data are typically drawn from official statistics provided by international agencies have developed a better understanding governments to the international agencies responsible for the of countries’ data availability and of how to work with national indicator. To fill data gaps, data for many of the indicators are experts to produce and estimate indicators. supplemented by or derived exclusively from data collected through surveys sponsored and carried out by international Improving monitoring systems agencies. These include many of the health indicators, which are compiled, for the most part, from Multiple Indicator Cluster Improved data and monitoring tools are crucial for devising Surveys (MICS) and Demographic and Health Surveys (DHS). appropriate policies and interventions needed to achieve the MDGs. Although some progress is being made, reliable In some cases, countries may have more recent data that statistics for monitoring development remain inadequate have not yet become available to the relevant specialized in many poor countries, and the challenge of building agency. In other cases, countries do not produce the data in-country capacity to produce better policy-relevant data required to compile the indicator, and the responsible is enormous. Building such capacity demands increased international agencies estimate the missing values. Even and well-coordinated financial and technical support from when national data are available, adjustments are often development partners. It also requires country ownership and needed to ensure international comparability. Data from government commitment to spur the institutional changes international sources, therefore, often differ from those needed to ensure the sustainability of capacity-building available within countries. efforts. The United Nations Statistics Division maintains the official As a results of recent efforts, more data are now available website of the IAEG and its database (http://mdgs.un.org). In in the international series for the assessment of trends for an effort to improve transparency, the country data series in all MDGs. In 2010, 119 countries had data for at least two the database are given colour codes to indicate whether the points in time for 16 to 22 indicators; in contrast, only four figures are estimated or provided by national agencies; they countries had this data coverage in 2003. These advances are the result of increased national capacity to venture into new data collection initiatives as well as to increase the 1 The complete list of goals, targets and indicators is available at frequency of data collection. For instance, the number of http://mdgs.un.org. 2 Given the time lag between collecting data and analysing them, countries with two or more data points on contraceptive few indicators can be compiled for the current year. Most of them prevalence increased from 50 in the period 1986-1994 to are based on data from earlier years—generally up to 2009 or 103 in 2010. At the same time, the number of countries with 2010. no data on this indicator decreased from 106 to 34. Regional groupings | 67 Regional groupings

Developed regions This report presents data on progress towards the Millennium Development Goals for the world as a whole and for various country groupings. These Caucasus & Central Asia are classified as “developing” regions and the “developed” regions.* The Northern Africa developing regions are further broken down into the subregions shown on the map above. These regional groupings are based on United Nations geographical Sub-Saharan Africa divisions, with some modifications necessary to create, to the extent possible, South-Eastern Asia groups of countries for which a meaningful analysis can be carried out. A complete list of countries included in each region and subregion is available Oceania at mdgs.un.org. Eastern Asia The designations employed and the presentation of the material in the present Southern Asia publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any Western Asia country, territory, city or area of its authorities, or concerning the delimitation Latin America & the Caribbean of its frontiers or boundaries.

* Since there is no established convention for the designation of “developed” and “developing” countries or areas in the United Nations system, this distinction is made for the purposes of statistical analysis only. For more information visit the UN Statistics Division Millennium Development Goals website at http://mdgs.un.org Visit the UN Millennium Development Goals website at www.un.org/millenniumgoals Visit the UN Millennium Campaign Office website at www.endpoverty2015.org

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Editor: Lois Jensen Copyright © United Nations, 2011 All rights reserved. | 5 2 | The Millennium Development Goals: Report 2010

“Between now and 2015, we must make sure that promises made become promises kept. The consequences of doing otherwise are profound: death, illness and despair, needless suffering, lost opportunities for millions upon millions of people.”

— UN Secretary-General Ban Ki-moon

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