Leave no child out

Leave no child out Building equity for children across CEECIS

UNICEF works for children in 21 countries and one territory in Central and Eastern Europe and the Commonwealth of Independent States (CEECIS): Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Georgia, Kazakhstan, Kosovo (under UN Security Council Resolution 1244), Kyrgyzstan Moldova, Montenegro, the former Yugoslav Republic of Macedonia, Romania, Russian Federation, Serbia, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan.

Foreword: Building equity for children Child survival and development: the unfinished agenda

The best start in life

Education

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Protecting children from violence 34 and exploitation

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HIV 42 and AIDS

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A voice for children Regional commitments

Contents

Building equity for children

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Equity is about tackling disparities that are unnecessary, avoidable and unfair.

It is about ensuring the most vulnerable children are first in line for the help and support that UNICEF provides. This is a challenge in Central and Eastern Europe and the Commonwealth of Independent States (CEECIS) where the gap between the ‘haves’ and the ‘have nots’ appears to be widening, rather than closing.

Too many children are being excluded from national progress, towards, for example, the Millennium Development Goals (MDGs), because of who they are and where they live.

There has been progress on MDG 2, on universal primary education. But the progress has not fully included children with disabilities or the marginalized and stigmatized. For instance, only 18 per cent of Roma children in South East Europe make it through to secondary school, compared with 75 per cent of the general population. The region has made overall progress on MDG 4 on child survival. But in many countries the infant mortality rate is 50 to 100 per cent higher in the poorest families than in the richest, and countries in Central Asia and the Caucasus have infant mortality rates that are now two to three times higher than the regional average.

Building equity for children Foreword

Inequity has contributed to two particularly alarming statistics. First, CEECIS is the only region in the world where the HIV epidemic is clearly on the rise.

Second, the region has the world’s highest rates of children growing up without parental care.

But this is also a region rich in young people who are dynamic, resourceful, and eager to shake off past legacies and influence global trends. It is home to one of the most literate populations on earth, and it has a growing, increasingly vocal civil society that is gaining strength across the region. It has made remarkable progress on the poverty front during a vibrant period of economic growth between 2000 and 2008 and there are clear signs of a bounce- back from the transition recession and global financial crisis. The region’s dramatic changes of 20 years ago paved the way for nationhood, and once- fragile freedoms are now becoming more entrenched: the right to vote, to express opinions, and to influence those who make the decisions.

The progress made to date on such human development targets as the MDGs is a fragile one. It has been built on weak foundations - the most vulnerable children do not share in the benefits of economic growth and social reforms.

Balancing nationwide progress for all children with the need to prioritize particular groups is right in principle and in practice. By working ‘upstream’ to influence national policies and programmes and public attitudes, and ‘downstream’ with partners on the ground, we can make equitable progress.

We can ensure tangible differences in the lives of all children, from the moment they are born to the end of their adolescence. We work in partnership, with governments and non-governmental organisations, and increasingly with children and young people themselves.

Equity for the most vulnerable people cannot be achieved without protecting girls, boys and women from the impacts of political, security, socio-economic and disaster risks. UNICEF has expanded the scope of its humanitarian work to help build the resilience of families and communities through risk reduction in the region.

The building blocks are in place for a new and equitable approach to child wellbeing. The role of UNICEF CEECIS is to harness the region’s human capital, its economic strength and its growing confidence, to ensure the equitable survival, development and prosperity of its children.

Steven Allen, UNICEF Regional Director

Building equity for children

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Child survival and development: the unfinished agenda

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The story of child survival and development in the CEECIS region is a story of persistent inequity, fragile progress and a failure to adapt to harsh new realities. While many countries have made progress on key child health indicators, including the Millennium Development Goal (MDG) targets, some children - and communities, and even entire countries, are being left behind.

Child survival and development: the unfinished agenda

The ‘cradle -to -grave’ health services that were once the norm are deteriorating - and struggling to cope with new health risks linked to growing social deprivation, including malnutrition and the spread of HIV and AIDS.

Since 2009, the region has been facing the re-emergence of diseases that had long been forgotten. The polio outbreak of 2010 caused disability and death in Central Asia, while measles outbreaks continue to spread. These outbreaks highlight serious weaknesses in routine immunization.

The challenges Many countries in the CEECIS region have implemented health reforms, but these have rarely generated more equitable health care for mothers and children and have left important aspects of service quality lagging behind.

While the region is broadly on track to reach the health-related Millennium Development Goals, or MDGs (MDG 1 on hunger, MDG 4 on child mortality and MDG 5 on maternal mortality), there are alarming health disparities.

Countries in Central Asia and the Caucasus have infant mortality rates that are two to three times higher than the regional average.¹

Across the region, children are dying as a result of inequity. They are dying because of their gender, or because of their mother’s - lack of education, or where they live, or their ethnicity.

In many countries, the infant mortality rate is 50 to 100 per cent higher in the poorest families than in the richest.² In many countries in South Eastern Europe, child mortality rates for Roma children are often two to six times higher than those of the general population. 3 Governments are spending too little on health – less than 4 per cent of Gross Domestic Product in many countries.4 And hard-pressed families often fill the gap, with the cash from their pockets accounting for up to half of total health spending across the region, and up to 70 per cent in some countries in the Caucasus and Central Asia.5 Progress on MDG 6 – combating HIV and AIDS, malaria and other diseases – is simply inadequate.

Child survival and development: the unfinished agenda

11 As the recent polio and measles outbreaks haves shown, the progress that has been made to date is fragile. What is needed is a public health approach based on equity, taking life-saving interventions to communities that have little access to quality health services. This approach needs to be backed by high quality health care that is safe, effective and responsive to the needs of patients.

A continuum of health care is needed for children from conception right through to adolescence, alongside health services that forge strong links not only with families - but also with other basic services, such as education and social welfare.

Nutrition: the first 1,000 days Malnutrition during a child’s first 1,000 days of life can damage their physical and intellectual growth beyond repair.

To prevent this irreversible damage, nutrition interventions must focus on these early days, as stepping in later is less likely to have any impact.

The problems include low rates of exclusive breastfeeding and poor complementary feeding, sometimes exacerbated by infectious diseases and micronutrient deficiencies.

Malnutrition is inequitable. Even in countries where it is not seen as a national public health priority, it may have a devastating impact on specific groups or minorities. The evidence can be seen across the region in chronic malnutrition, exacerbated by poverty, rising food prices and high rates of child stunting – children who are too short for their age.

In Tajikistan, for example, almost 30 per cent of children under five are stunted compared with a regional average of 16 6 per cent.

Millions of children are also at risk of preventable mental retardation as a result of iodine deficiency, with only half of all households consuming salt that has been adequately iodized – the lowest 7 percentage worldwide. The region’s most populous countries, Russia and Ukraine, do not yet have universal salt iodization legislation.

An equity lens is vital when it comes to nutrition. UNICEF is prioritizing the scale-up of proven and equitable nutrition programmes for all children under the age of two, regardless of where or who they are.

Child survival and development: the unfinished agenda

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UNICEF in action Our regional framework for action on health and nutrition aims to tackle inequities in the region’s health systems.

It works ‘upstream’, influencing health policy and resource allocation, and ‘downstream’, to support and scale up examples of best practice.

By taking a cross-sectoral approach, the strategy aims to help strengthen health systems to promote the rights of children and achieve the MDGs. Our priority is to ensure that the most vulnerable women and children have access to a continuum of equitable, high quality health care. We work with governments across the region to build and scale-up health services that support the life-long continuity of health care and that are part of a wider protective environment for children and their families. And we develop the communication skills of national institutions so that they can spread the word on public health priorities, particularly during health crises.

Increasing access to quality maternal and child health services in Uzbekistan.

The Mother and Child Health project in Uzbekistan brings quality health services to families who could not otherwise afford them. Implemented by the Ministry of Health in partnership with UNICEF and the European Union, the project works through 85 hospitals and more than 2,000 primary health care units to reach 14.5 million people – more than half the population of Uzbekistan.

Monitoring shows more than 67 per cent of the trained doctors and other health providers are now practising the skills they have learned to save the lives of sick children and mothers. The registration of newborn babies in line with the International Life Birth Definition criteria has increased by 28 per cent during the last three years.

‘Safe motherhood is high on the list of priorities of the European Union’s development agenda,’ said Alfred Rubiks, Vice Chairman of an European Union delegation visiting Uzbekistan. “Thanks to this partnership, we were able to see the best use of European Union development assistance in this part of the world.”

Response to the Central Asia Polio Outbreak in 2010.

The polio outbreak that erupted in Central Asia in April 2010 was the first since 1998, in a region declared polio free. The outbreak crossed borders but was concentrated in Tajikistan, which accounted for 70 per cent of the world’s polio cases at the peak of the epidemic.

Most of those affected were children.

The UNICEF Regional Office for CEECIS - and the Supply and Programme

Child survival and development: the unfinished agenda

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Divisions responded immediately, in collaboration with WHO and the US Centers for Disease Control and Prevention, supplying vaccines, communication, social mobilization and field monitoring to support 24 mass immunization campaigns in seven countries.

UNICEF delivered more than 50 million doses of oral polio vaccine worth US$8 million, and spent more than US$1 million on communication and social mobilization at community level.

The swift response by the affected countries contained the outbreak and has paved the way for stronger routine immunization.

The last polio case was identified in the region in September 2010, but there is still a risk that the European Region could lose its polio-free status as a result of the 2010 outbreak.

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The best start in life

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The best start in life The period of early childhood – from prenatal development to eight years of age – is a time of great potential and great risk. Everything comes together in this short space of time: emotions are shaped, an understanding of the world is formed, the foundations of language are laid and the most significant proportion of brain development takes place.

There is a wealth of research that has established the links between early experiences and school success, economic participation, and physical and mental health. We know that, given the right opportunities, including a caring, safe and stimulating home environment, access to health and early education services, and protection from violence, abuse and neglect, all children have the possibility to blossom to their fullest potential. Sadly, early deprivation has the opposite effect.

One study has estimated that almost one quarter of young children in the CEECIS region are unlikely to reach 8 their full potential. Young children are especially vulnerable to a variety of risks when they come from families that are disadvantaged and marginalized because of poverty, ethnicity and, or, geographical location.

Their lives are characterized by higher rates of mortality, ill-health, poor nutritional status, low participation and performance in school, disability and, in the worst cases, abandonment during infancy.

Disparities in early childhood development (ECD) and school readiness mean that some children start primary school already lagging behind their peers. These disparities persist and even widen during the school years, resulting in differences in educational achievement, vulnerability to child labour and trafficking, and long-term social and economic exclusion. A comprehensive mix of responsive and high quality health, education and protection services could shield young children and their families from the impact of deprivation.

The challenges The odds are stacked against some young children from the very start, including those from ethnic minorities, such as the Roma, and those who have disabilities or special learning needs.

For many of the most vulnerable children, a life-long pattern of poverty and exclusion is hard-wired into their lives long before they reach school-age.

The best start in life

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Children are now the group most likely to live in poverty- and, among children, it is the youngest who are at greatest risk. Increasing economic and social disparities across the CEECIS region have resulted in ever deeper poverty.

At the same time, social spending has plummeted, reducing drastically the coverage and quality of vital services to support parenting and child development in the early years. Despite efforts in some countries to address this, the most vulnerable children – those who would benefit most from health and education services - have the least access.

UNICEF in action We aim to ensure that every child has the best possible start in life. The current economic climate makes it more important than ever to invest limited resources wisely, in ways that support families.

ECD is a prime example – a unique entry point that can determine the future course of a child’s life. UNICEF supports ECD across the region to help to break the cycle of exclusion and poverty, address human rights, and ensure strong foundations for the development of both individuals and society. Investment in the early years yields high returns, improving school performance and, eventually, productivity and income.

The costs are negligible when compared with the enormous inter-generational benefits.

We work to ensure that the most vulnerable children have access to good quality ECD services, participate in at least two years of early childhood education and make a successful transition to primary education. We aim for the full inclusion of every child, supporting the early identification of any developmental delays, disabilities or special learning needs through the health system. We work with local authorities and civil society to set up early education and good parenting programmes. And we work ‘upstream’, supporting the development and revision of policies and standards for early education as well as the design and scale-up of alternative and costeffective preschool approaches, especially in remote rural areas.

The best start in life

23 Strong policies for young children: Bosnia and Herzegovina.

A joint effort between UNICEF and governments of the various entities in Bosnia and Herzegovina has resulted in comprehensive policies and new approaches to improve developmental opportunities for all of the country’s youngest citizens. Strategies include early childhood training for health workers and teachers, cost-effective models of early education, and stronger parent support programmes. The ECD policy was drafted by representatives from the health, education and protection sectors of the government, local civil society organizations, international organizations and universities.

Leveraging resources for young children: Turkey.

UNICEF has been working closely with the government of Turkey to highlight the special needs and vulnerabilities of young children – especially those from disadvantaged families and communities. Sustained collaboration has resulted in a multi-million- Euro grant from the European Union to expand early childhood education services in a number of districts. At the same time, UNICEF has supported the successful incorporation of ECD in the nationwide retraining of family physicians.

A fair chance for every Roma child: Central and Eastern Europe.

UNICEF is working to prioritize ECD in order to create a level playing field for Roma children who are among the poorest and most marginalized in CEE. Efforts aim to ‘start early’, focusing on quality health care, parenting support, kindergarten and preschool education as well as access to, and completionof quality education. UNICEF is working closely with partner organizations such as the Open Society Foundation, the Roma Education Fund and the European Union to ensure that every Roma child has the opportunity to opt out of a life of disadvantage and discrimination.

The best start in life

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Education

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Education With falling school enrolment rates, deteriorating education quality and school systems struggling to overcome the global financial crisis, education is a top priority for UNICEF across the CEECIS region.

The region was once famous for universal education and high learning achievements. Yet the economic, social and political upheaval of the period of transition placed enormous stress on education systems, and today the region is falling behind.

Education quality in the region has not kept pace with its economic development, and the region now has the second lowest central government expenditure on education worldwide.

Under-resourced education systems struggle with challenges of access, quality and governance. Education is also jeopardized by classrooms that have no heating or textbooks, and by family poverty that keeps children out of school.

UNICEF found that, in 2006, 15-year-old students in the region scored significantly below their peers in Western Europe 9 in reading, mathematics and science.

Many countries are nearing the target for MDG 2 on– universal primary education. But while the number of children in school is important, there are serious concerns that their education is not good enough to keep them in the classroom and prepare them for adult life.

The problems in education affect some children more than others. For example, only 18 per cent of Roma children make it to secondary school, compared with 75 per cent of non-Roma children, and 10 less than 1 per cent go on to university.

Education

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The challenges Families in poverty are struggling to cope with the rising costs of education, and the global financial crisis has only exacerbated the problem.

Enrolment and attendance rates have dropped in many countries, with dropout rates soaring in some. With youth unemployment often double or triple the rate of national unemployment, the demand for post-primary education is falling. Meanwhile, selectivity and competition have increased, excluding marginalized communities still further, and education policies and programmes for minority groups have had little impact.

While overall enrolment rates remain quite high, nearly 1.8 million children of primary school age were estimated 11 to be out of school in 2007.

Disparities in access and completion of basic education vary by country but worrying gaps are found for children affected by conflict, children from disadvantaged families, children of marginalized ethnic groups (especially the Roma), children with special educational needs and, in some cases, girls.

All the evidence shows that education in the region is not meeting the needs of students in terms of the basic skills they need for learning, or the life skills they will need to make a positive contribution in society. The education system can also be tapped to help build resilience in communities from the impacts of political, security, socio-economic and disaster risks.

UNICEF in action

Leaving no child out in Montenegro.

A UNICEF-supported campaign in Montenegro has helped to change mindsets Our vision is of a region in which every about children with disabilities. The child can access and complete basic campaign ‘It’s about ability’ was based education of good quality. We have two on a survey of 1,000 people, which key objectives: increasing the inclusive- revealed their ambivalence towards ness of education and improving its children with disabilities, many believing quality. We advocate for greater invest- that they should be consigned to special ment, urging even the poorest countries schools and institutions. to prioritize education to make economic During the three-month awareness progress. campaign that followed, billboards all over the country showed children with UNICEF has education programmes disabilities as active members of socior projects in 20 countries, working ety. Primary schools across the country with governments and other partners organized school parliaments on incluon systemic reform for long-term im- sion based on UNICEF publications provements in education systems, and for students and teachers. Eight of the we support regional and sub-regional country’s 21 municipal parliaments held education partnerships. special sessions on inclusion alongside representatives of local school parliaOur aim is to ensure that every child ments and parents’ associations, where has the chance of completing one year they watched one-minute videos proof pre-primary education, as well as duced by children with disabilities. primary and lower secondary education – always with a strong focus on equity The public were won over by the camand the inclusion of the most disad- paign’s key messages: where many see vantaged. We link education to other difficulties, we see opportunities; where relevant social issues, such as child many see obstacles, we see friendship; poverty, child labour, child trafficking, where many see weakness, we see violence against children, disability, and courage; and where many see burden, institutionalization, to foster a compre- we see love. hensive approach.

The campaign has notched up significant results. A follow-up survey has found that the percentage of people who believe that children with disabilities should only live in special institutions has almost halved. Parents are more open to inclusive classes than ever before.

In 2010, the campaign won the annual award for ’the best humanitarian action’, organized by one of the country’s leading TV stations and a national daily newspaper, with the public voting for the winners. Receiving the award on behalf of the campaign, Lazar Dragojevic, one of many active child advocates, commented on his experience as a child with disability who goes to a mainstream school, saying simply: “I am part of my school just like any other child.”

The campaign was the result of a broad coalition of more than 100 partners led by the Government of Montenegro and UNICEF.

Education

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Child-Friendly Schools.

UNICEF has used the Child-friendly Schools (CFS) approach to leverage quality reforms in 11 CEECIS countries. A CFS is inclusive of all children, in particular those from disadvantaged backgrounds, and offers good quality teaching that is tailored to individual children. The curriculum and education content are relevant to the needs of the society in which the children live and the school is a safe, healthy and protective environment where children learn such values as respect and tolerance.

Children, families and communities are involved in all aspects of school life, backed by strong parent-teacher associations and local partnerships in education with civil society.

In Uzbekistan, a positive evaluation of the country’s 750 CFS model schools, which reach 600,000 students, led to the national ownership of this approach, with the government committing to integrate CFS concepts in all teacher training institutes, national quality standards and school’s inspection regulations. In the former Yugoslav Republic of Macedonia, CFS principles are being included in education reforms, with life skills-based education being incorporated into the national curriculum, the launch of CFS standards for secondary school and teacher training to promote active learning in mathematics.

Integration with disaster risk reduction education The region is vulnerable to natural and man-made hazards. Mainstreaming Disaster Risk Reduction (DRR) through life skills education ensures that students and teachers have a strong role in building community resilience. Inclusion of disaster risk information, safe behaviour and school safety in the education process not only protects children’s lives but also avoids the disruption of learning activities by disasters. In line with this approach, UNICEF is implementing a regional DRR programme in the South Caucasus and Central Asia, which is supporting specific strategies that enable communities and institutions to better prepare for, mitigate and respond to disasters, and help build a safer and more protective environment for children.

It is supported by the DIPECHO programme under the European Commission, Directorate General for Humanitarian Aid and Civil Protection.

Education

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Protecting children from violence and exploitation

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Many children across the CEECIS region are subjected to violence, abuse and exploitation. It happens at home, at school, in orphanages or detention facilities, within the community, at work and during armed conflict. And millions more – not yet victims – lack adequate protection from such violence. In many parts of the region corporal punishment, for example, is still seen as an acceptable way to discipline a child.

Much of this violence goes on behind closed doors and most cases go unreported. But the latest research suggests many children endure ‘minor to moderate’ physical punishment – being hit, slapped or struck with an implement on any part of the body except the head – as high as 55 per cent in Serbia and 60 per cent in Tajikistan. ‘Severe’ physical punishment is commonplace, with 16 per cent of children facing such violence – which includes blows to the head – in the former Yugoslav Republic 12 of Macedonia.

Protecting children from violence and exploitation There are inequities here, as in so many other areas of child well-being. Certain children are particularly vulnerable, and their rights to protection are more likely to be violated. These include ethnic minorities (such as Roma), children with disabilities, those who live or work on the street, and those in residential care or detention. Children who grow up in violent and abusive homes or without parental care are extremely vulnerable to exploitation and trafficking, and so the cycle of violence and abuse continues.

The challenges The CEECIS region has the world’s highest rates of children growing up without parental care, with around 1.3 million children living in some form of family substitute care, and 600,000 in residential care and over 31,000 children below three years of age placed in 13 infant homes. Despite strenuous efforts over the years to bring these numbers down, institutional care remains the first resort, rather than the last, for many children at risk.

Children often end up in institutions because of family poverty or breakdown, violence in the home or disability and the sheer lack of social support systems. Between 1 and 9 per cent of children live in families officially registered 14 as poor or extremely poor, and those from homes that are violent or dysfunctional as a result of alcohol or substance abuse are at high risk of being placed in formal care.

Only around five per cent of children in residential care institutions are actually true orphans.15 The rest have living parents who, in many cases, might be able to care for them, given the right support.

This tendency to see children as the problem and remove them from society is also apparent in juvenile justice systems across the region. Children are routinely deprived of their liberty and few juvenile justice systems comply with international standards. Most remain punitive, even for children who have not been tried. Children may face long periods of detention for petty offences, sometimes alongside adults. Violence in police and detention facilities is rife and in some countries juveniles can still be held in solitary confinement.

Social services are failing to prevent children coming into conflict with the law or to reintegrate those who do so into their communities. The practice of removing children –into residential care or prison –has a long history in the region and is still sanctioned by society.

Because it is seen as the norm, it remains a serious barrier to the full reintegration of children into their communities.

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Protecting children from violence and exploitation

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UNICEF in action We support programmes to prevent violence and exploitation, and to identify and help the victims. We work on the front line, supporting hotlines for children suffering from violence in Albania, Bulgaria and Croatia, violence-free schools in Bulgaria, Croatia, Romania and Serbia, and the development of effective referral systems and services for victims.

But we go further, working with governments, civil society, individuals and the private sector to build a protective environment around each and every child.

In a protective environment, everyone takes responsibility to protect children from violence, abuse and exploitation from law-makers, the media and social services, to parents and children themselves. A protective environment includes national child protection systems, and we push for legislation to ban violence against children whenever and wherever it occurs. In 2008, for example, we helped to amend the Criminal Code in the former Yugoslav Republic of Macedonia to ensure harsher penalties for perpetrators of sexual abuse.

UNICEF also has a long track record of support for the growing Ombudsperson system across the region, building its capacity to speak out on child protection issues. And we build the capacity of professionals to detect, refer and report cases of violence. In Ukraine, for example, training courses for social workers, teachers and police were integrated into the curricula at three universities.

Juvenile justice in Moldova.

UNICEF’s work with the Government of Moldova, largely supported by the Swedish International Development Agency, has contributed to major reforms of the juvenile justice system that have brought Moldova closer to European and international standards.

Progress has included amendments in legislation that tightened criteria for both pre-trial detention and custodial sentences, and the setting up of probation services. At least one specialized judge and prosecutor were designated in each trial court. As a result of these and other measures, between 2002 and 2010, the number of children in pre-trial detention decreased by 80 per cent and the number of children in post-sentence detention decreased by 54 per cent.

We push for specialized juvenile justice systems to reintegrate children into the community, with a strong focus on alternatives to judicial proceedings and deprivation of liberty, and on close links to the social welfare system.

Protecting children from violence and exploitation Equity is at the heart of UNICEF’s response to child protection. This requires a strong focus on the most disadvantaged to ensure that they are the first in line for our interventions. Our call to action is clear. First, no child under the age of three should ever be in an institution. For this reason, we advocate for greater investment in family-based care and specialized child-care services. The placement in institutional care of children below three years of age must be restricted to a short-term emergency measure or a planned stay not exceeding six months, and only as a last resort, when it is absolutely necessary and in the best interests of the child. We believe the time to act is now. We need to work together to make the change.

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Protecting children from violence HIV and and exploitation AIDS

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The expansion of the HIV epidemic in this region has been alarmingly rapid, with HIV prevalence doubling over a 10- year period since 2000. This is the only region in the world where the HIV epidemic continues to be clearly 16 on the rise.

The total number of people living with HIV has tripled between 2000 and 2010, with up to seven-fold increases in certain countries and regions in the past couple of years alone. The region includes five of the seven countries with the highest HIV incidence rates in the world: Armenia, Georgia, Kazakhstan, Kyrgyzstan and Tajikistan. Around 90 per cent of those living with HIV in the region are in Ukraine and the Russian Federation.

The epidemic is driven by an explosive mix of unprotected sex and injecting drug use in a region that has an estimated 3.7 million injecting drug users – one quarter of the world’s total.17 But sexual transmission is on the rise, affecting socially excluded and stigmatized populations and, increasingly, women.

HIV and AIDS Women now account for around 40 per cent of new cases, up from 24 per cent less than a decade ago.18 The number of HIV-positive pregnancies has doubled since 2005. Almost 100,000 HIV-positive mothers have given birth since the beginning of the HIV epidemic, most within the past five years.19 An estimated 18,000 children in the region were living with HIV in 2009, up from 4,000 in 2001.20

The challenges Important progress in prevention, care and support for people living with HIV has been achieved in the region, including notable successes in reducing rates of mother-to-child transmission (MTCT) of HIV.

But further progress is hampered by stigma and discrimination, social exclusion and inequity and violations of the basic rights and dignity of children and families at risk of, and affected by, HIV. In general, punitive policies drive those at risk away from the help they need.

This, coupled with the failure of social protection measures to adequately support the families of those with HIV, is fuelling the epidemic.

Large numbers of children have been abandoned by vulnerable young mothers who are HIV positive and, often 21 injecting drugs. Some end up living in hospitals. Those in institutions will probably grow up there, isolated from other children and from their families with little hope of being fostered or adopted by local families. Children who are HIV positive or from affected families are often unwelcome in mainstream schools and are, therefore, denied the chance to reach their full potential.

The health and social services that are available are often under-used by those most affected and in greatest need, especially when they inject drugs.

Estimates suggest that 60 per cent of people living with HIV in the region are not aware of their status, while access to antiretroviral treatment is the second lowest in the world, with 80 per cent of those in need not receiving treatment.22

HIV and AIDS Desperation and loss of hope are leading growing numbers of adolescents into sex work and drug abuse, creating a vicious cycle of risk and vulnerability.

Around 20 per cent of all female sex workers in Ukraine and Romania, for 23 example, are under the age of 19. And in this region, injecting drug use starts early, with up to 30 per cent of young drug users under 15 when they first inject drugs.24 The risks overlap, with many young sex workers also injecting drugs. For many adolescents who are shut out of society because of poverty, their ethnicity, or family breakdown or because of their own risky behaviour, their vulnerability to HIV increases. A study of street youth aged 15 -19 in St. Petersburg, for example, found HIV infection rates of almost 25 40 per cent.

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HIV and AIDS

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These are uncomfortable truths in a region where, one generation ago, drug abuse and sex work were uncommon and HIV was unknown. The response from policy-makers, health services and the general public is often to punish drug users and those engaging in risky behaviour instead of providing care and support, excluding them still further. Despite some progress, there are still major gaps in addressing their pressing needs for HIV prevention, care and broader social protection and support.

UNICEF in action We work with regional and national partners across the region, including governments, international donors, civil society, and other UN agencies to support advocacy, policy development, knowledge management and quality assurance to strengthen the response to HIV and AIDS. Our goals include support for the elimination of MTCT of HIV in CEECIS, which means ensuring truly universal access to HIV prevention, treatment, care and support, including for those who are most marginalized and excluded from society. We work with our partners to increase access to services for drug-dependent pregnant women, prevent HIV infection among most-atrisk adolescents (MARA) and improve the quality of services, and access to social support and protection, for affected children and families.

Our strategic approach: Prevention of HIV among Adolescents and Young People; Prevention of Mother-to-Child Transmission (PMTCT), to reach the global goal of elimination of HIV transmission to infants by 2015; Paediatric AIDS Care and Treatment, and Protection of Families and Children Affected by AIDS. These are the current `four Ps`approach.

UNICEF supports adolescents through a fifth ‘P’, Adolescent Development and Participation.

Prevention of HIV among Mostat- Risk Adolescents in Ukraine and South Eastern Europe.

This ground-breaking programme has supported adolescents at risk of HIV while influencing policy-makers across seven countries in the region. The programme was launched in 2006 with one clear goal: to ensure that MARA were included in national AIDS strategies, and monitoring and evaluation plans, in seven countries: Albania, Bosnia and Herzegovina, Moldova, Montenegro, Romania, Serbia and Ukraine.

That goal has been surpassed.

As well as influencing policy, the programme has improved the lives of thousands of adolescents and contributed to a critical shift in perceptions. Our current goal is to expand the programme into Central Asia, building new programmes in Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan.

Tackling stigma in the classroom.

In the Russian Federation, access to kindergartens and schools for HIV-positive children is jeopardized by pervasive stigmatization. UNICEF has worked with the national Ministry of Education and Science and regional education departments in seven of the most -affected regions to raise educators’ awareness of HIV and of Russian laws that prohibit discrimination against people living with the disease.

A special programme was developed for use with administrators, parents, teachers and caregivers, reaching more than 2,000 schools, kindergartens and residential institutions, and more than 400,000 students aged 3–18 years.

Around 8,400 educators learned how to support HIV-positive learners in the classroom. Before the training, only 45 per cent of teachers and caregivers said that they would not object to having HIV-positive children in the classroom and would protect them against discrimination. After the training, this had risen to 90 per cent.

HIV and AIDS

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A voice for children

50

A voice for children Young people have the right to be involved in the decisions that affect them. The more they participate in decisions, the more they develop confidence, skills and aspirations. And the more they are involved in development programmes, the more effective these programmes become.

Active participation also fosters confidence, self-esteem and civic responsibility, and helps young people reach their potential. But children and young people are often discouraged from speaking up because of various constraints.

Children and young people who are well-informed, educated- and self-confident, and who are involved in decisions, are better able to protect themselves against HIV infection, human trafficking, exploitation and other challenges confronting the region.

UNICEF in action UNICEF supports programmes that encourage child and youth participation, including: Implementing the Child-friendly School (CFS) Framework, which focuses on child-centred learning methods and child-friendly environments.

Encouraging children’s representation in local government bodies, childfriendly city planning and policy -making processes.

Supporting student associations and councils and child-run media.

Maximizing the One Minute Jr ‘s-video workshops and networks as a visual tool to help children to articulate their hopes, fears and dreams, and integrating them into a powerful advocacy tool.

Promoting peer education training for young people, especially in life skills, health, and HIV and AIDS. Conducting child-led research on issues such as violence against children, exploitation, and education.

Using a child -rights-based syllabus to train student journalists to get a grounding in child rights and childfriendly, ethical reporting.

A voice for children

53

Regional commitments to children

54

Regional commitments to children Governments in the CEECIS region have repeatedly pledged to defend the rights of all children, regardless of where or who they are. All have ratified the UN Convention on the Rights of the Child (1989) and most have ratified its Optional Protocols on children in armed conflict, and on the sale of children, child prostitution and child pornography. In 2000, world leaders adopted the MDGs to tackle the key challenges to human development, and every country in the CEECIS region has been working towards the MDG deadline of 2015, with the committed support of UNICEF.

The region has made solid overall progress towards most MDGs, but a closer look reveals the worrying levels of disparity and inequity that often lie behind positive national averages.

MDG 1: Eradicate extreme poverty and hunger The region is broadly on track to reach this goal, but a number of countries and communities are lagging behind.

The regional average for child stunting is 16 per cent, for example, but rises to 40 per cent in Tajikistan. In Bosnia and Herzegovina, half of all Roma children aged 0-6 months suffer from chronic malnutrition.

Regional commitments to children

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MDG 2: Achieve universal primary education Many countries are nearing this goal, and enrolment rates increased by 1-4 per cent in the region between 1999 and 2007, according to the 2010 UNESCO Global Monitoring Report. But only 18 per cent of Roma children attend school, compared with 75 per cent of the majority population.

MDG 3: Promote gender equality and empower women While much of the region still has a strong legacy of gender equity, this is being eroded in some areas.

Tajikistan and Turkey, for example, are not on track to achieve this MDG, which calls for gender-equal access to primary school.

MDG 4: Reduce child mortality The region is broadly on track to reach this MDG, but there are alarming health disparities between countries in the region and, within countries, between geographic areas and population groups.

The under-five mortality rate in many countries is 50 to 100 percent higher in the poorest families than in the richest.

In Roma communities, child mortality is two or three times higher than national averages.

MDG 5: Improve maternal health Again, the region is on track to reach this MDG. But recent health reforms in the region have focused on financial sustainability, often at the expense of better care for mothers and their children. An estimated 50 per cent of pregnancies are unplanned or unwanted, exposing women and their babies to the risk of HIV infection.

MDG 6: Combat HIV and AIDS, malaria and other diseases Progress on this goal is simply inadequate. This is the only region in the world where the HIV epidemic is clearly on the rise.

MDG 7: Ensure environmental sustainability The region carries a legacy of abandoned industry, rushed urban development and nuclear testing, but there is growing environmental awareness with children, in particular, taking the lead. To prepare for natural disasters, UNICEF is implementing a regional DRR programme supported by DIPECHO under the Directorate General for Humanitarian Aid and Civil Protection of the European Commission.

It aims to help governments integrate a child-focused DRR policy into education systems and legislation, and strengthen local communities resilience.

MDG 8: Develop a global partnership for children UNICEF has engaged in global programme partnerships to tackle inequity, including promoting international solidarity on financing equitable development. This includes deepening partnerships with regional organizations such as the European Union and Council of Europe, and working with hundreds of corporate partners and donors.

References 1. United Nations Children’s Fund, State of the World’s Children Report, UNICEF, New York, 2011.

2. United Nations Children’s Fund, ‘Multi-indicator Cluster Survey’, UNICEF, 2006.

3. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions, An EU Framework for National Roma Integration Strategies up to 2020, Brussels, 5 April 2011.

4. United Nations Children’s Fund, ‘TransMONEE database’, UNICEF Innocenti Research Centre, Florence, 2010.

5. World Health Organization Europe, ‘Health for All Database’, Geneva, 2010.

6. Ministry of Health of the Republic of Tajikistan, ’Tajikistan Micronutrient Status Survey’, 2009.

7. United Nations Children’s Fund, ‘State of the World’s Children Report’, UNICEF, New York, 2011.

8. Engle, P., The Untapped Developmental Potential of Early Childhood in the CEECIS Region, UNICEF RO CEECIS, Geneva, 2009.

9. United Nations Children’s Fund, ‘Learning achievement in the CEECIS region: a comparative analysis of the PISA 2006 results’, UNICEF RO CEECIS, Geneva, 2009.

10. Ivanov A., At Risk: Roma and the Displaced in Southeast Europe.- UNDP Regional Bureau for Europe and the CIS, Bratislava, 2006.

11. United Nations Education, Scientific and Cultural Organization, Education for All Global Monitoring Report 2007.

12. United Nations Children’s Fund, Child Disciplinary Practices at Home, Evidence from a Range of Low- and Middle-Income Countries, UNICEF, New York, 2010.

13. United Nations Children’s Fund, ‘TransMONEE’ database, UNICEF Innocenti Research Centre, Florence, 2009.

14. Data available for Romania, Bosnia- and Herzegovina, Serbia, Belarus, Russia and Azerbaijan.

15.Tobias D., ‘The Continuum of Child Wel fare Services: Principles and Practices for Central and Eastern Europe’. -Paper given at the regional seminar for Central and Eastern Europe, Sofia, Bulgaria, September/October 1992. Cited in Carter R (2005) Family Matters: A study in Institutional Childcare in Central and Eastern Europe.

16. UNAIDS, Report on the Global AIDS Epidemic, UNAIDS, Geneva, 2010.

17. UNAIDS web-page on Eastern Europe and Central Asia: http://www.unaids.org/ en/regionscountries/regions/easter neuropeandcentralasia/ accessed on 15 May 2011.

18. UNAIDS, Report on the Global AIDS Epidemic, UNAIDS, Geneva, 2008.

19. WHO, UNICEF, Towards the elimination of mother-to-child transmission of HIV in low-prevalence and concentrated epidemic settings in Eastern Europe and Central Asia, WHO/UNICEF, Geneva, 2011.

20. UNAIDS, 2010 (Op. cit).

21. United Nations Children’s Fund, Blame and Banishment, UNICEF RO CEECIS, Geneva, 2010,.p.11.

22. UNAIDS, WHO, UNICEF, “Towards Universal Access “ Progress Report 2010, p. 53.

23.Teltschik, A., Sakovich, O., MA, Poutiain en, R., Balakireva, O., ‘Adolescent Fe male Sex Workers in Ukraine – Discriminated Against and Excluded, Evidencebased Service Provision and Empower ment’, Paper presented to UNICEF/New School for Social Research Conference on the Adolescent Girl, New York, New York, 2010.

24. Douthwaite, M., Busza, J., `“Injecting Drug Users aged 15 -24 years in Albania, Moldova, Romania and Serbia: characteristics and risk behaviours”, London School of Hygiene and Tropical Medicine, Paper submitted for publication, 2010.

25. Kissin, Dmitri M. et. al., HIV seropreva lence in street youth, St. Petersburg, Russia, AIDS, 2007, vol. 21, p. 2333, US Centers for Disease Control, Atlanta, 2007.

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Writer: Angela Hawke.

Editors: Lely Djuhari and John Budd.

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Contact: Communication United Nations Children`s Fund Regional Office for CEECIS Palais des Nations CH-1211 Geneva 10, Switzerland Tel: +41 22 909 5433 To find out more, please visit our website: http://www.unicef.org/ceecis