MDG Update: Accelerate Progress for Children – Towards a Post-2015

MDG Update:

Accelerate Progress for Children Towards a Post-2015 development agenda for all children

The MDGs are the most successful global anti-poverty initiative in history. They stand for a world of prosperity, equity, freedom, dignity and peace – as embodied in the Millennium Declaration. This publication presents an assessment of progress towards the MDG targets using a selection of child and maternal related MDG indicators. It highlights remaining challenges and lists key interventions that are indispensable to contribute to a post-2015 world fit for all children.

The insert to this publication contains UNICEF’s guiding principles to contribute to the new development agenda and a list of key issues relevant to children for consideration by the international development community for inclusion under the post-2015 development agenda.

MDG

1

Eradicate Extreme Poverty and Hunger Target 1C Indicator Progress

Halve, between 1990 and 2015, the proportion of people who suffer from hunger Prevalence of underweight children under-five years of age







Underweight prevalence has declined from 25% in 1990 to 15% in 2012 99 million children under-five years of age remain underweight, 162 million are stunted Stunting is associated with a weakened immune response and impaired cognitive development among young children - the effects of the latter are irreversible

Chronic undernutrition is highest in sub-Saharan Africa and South Asia Percentage of children under age five who are moderately or severely stunted. 2008-20121

Sustainable development starts with safe, healthy and well-nourished children

Less than 10% 10 – 19% 20 – 29% 30 – 39% 40% or more Data not available

Chronic undernutrition is declining but still one in four children were stunted

The continuing agenda for children

Stunting prevalence, by MDG region, 1990 & 2012

2

60

Southern Asia Southern Asia

35

South-Eastern Asia South-Eastern Asia

47

28 41% decline

Caucasus && Central CentralAsia Asia Caucasus

17

Eastern Asia Eastern Asia

 Improve women’s nutrition

39

 Practice early and exclusive breastfeeding

57% decline

37 8 79% decline

37 Oceania Oceania

38

Northern Africa Northern Africa

29 19 37% decline

Western Asia Western Asia

29

18 38% decline

Latin Latin America America & & Caribbean Caribbean

Key interventions to prevent child under nutrition include:

41% decline

 Provide timely, safe, appropriate and highquality complementary food 4% increase

23

50% decline 11

 Appropriate micronutrient interventions  Reduce the incidence of infectious diseases, such as diarrhoea, pneumonia, and malaria

1990 2012

1990

Global Global

40

38% decline

25

Source: UNICEF global databases 2013, based on DHS, MICS, and other national surveys.

Source for stunting trend: UNICEF-WHO-WB Joint Child Malnutrition Estimates, 2012.

1 2

 Improve access to safe drinking water and sanitation, stop open defecation and improve overall household hygiene

Million

MDG

2

Achieve Universal Primary Education Target 2A

Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling

Indicator

 Net enrolment ratio in primary education  Survival rate to the last grade of primary education

Progress

 Primary net enrolment ratio (adjusted) increased from 85% in 2000 to 91% in 2011  Only three out of four children who start primary school actually finish it

Progress has slowed since 2004, making the goal of universal primary education difficult to achieve Number of primary school age children out-of-school,by region,2000-20113 South and West Asia

120

Sub-Saharan Africa

Total 102 million 100

Rest of world

80

37.8 million Total 57 million South & West Asia

60

12.4 million 40.6 million

40

Sub-Saharan Africa

29.8 million

Rest of the world

14.9 million

Education is the single most powerful investment for development.

Educate a girl, you educate a nation.

20 23.5 million 0 2000

2011

Four out of ten children fail to reach minimum learning levels Estimates of minimum learning levels among primary school age children4

130 million

400 million

attend school and achieve minimum level of learning

attend school but fail to achieve a minimum level of learning

120 million will not reach grade 4

The continuing agenda for children How to ensure that all boys and girls go to school and receive a quality education? `` Expand early learning opportunities to increase children’s school readiness `` Address specific needs of the most disadvantaged children (e.g. poor, rural, and children with disabilities), especially girls `` Promote child-friendly education for quality enhancement and improved learning outcomes `` Provide alternative delivery mechanisms for those who dropped out or have never been to school `` Ensure safe and protective access to quality education in humanitarian emergencies

Source: UNESCO Institute for Statistics Fact Sheet, June 2013, No.25.

Source: UNESCO EFA-GMR, 2012

3 4

MDG

3

Promote Gender Equality Target 3A

Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015

Indicator Progress

Ratios of girls to boys in primary, secondary and tertiary education

 The MDG target for primary education has been achieved  In most regions fewer girls 13 are enrolled in secondary school than boys Urban 12 13 Urban 12

24

Rural 23 24

Rural 23 Gender parity in primary education has been achieved Primary, secondary and tertiary school gross enrolment rates by sex and region, 2011 (%)5 32

East Asia & the Pacific East Asia & the Pacific

Poorest

Latin America & Caribbean Latin America & Caribbean

Poorest

South & West Asia South & West Asia North America & Western North America & Western Europe Europe Central & Eastern Europe Central & Eastern Europe

Second

Central Asia Central Asia

Fourth

Sub-Saharan Africa Sub-Saharan Africa

Fourth

Arab States Arab States

Richest

30 32 25

30

23 25 Second 20 23 Middle 19 20 Middle 16 19 14 16 10

Female

14

8 10

Female Male

8

Male

Richest

Investing in children, especially girls, yields high and long-lasting returns for families, societies and future generations

World World

0 0

25 25

50 75 50 75 Primary

100 100

0 0

25 50 75 100 25 50 75 100 Secondary

More primary school age girls are out-of-school than boys

32 Poorest 30 32 Poorest 25 23 25

16 19 20 14 16 19

Fourth Middle Fourth 10 Richest Fourth Richest

30 32

14 16

8 10 14 8 10

Female Female Male Female Male

Richest 8

Male

Note: Original source for wealth quintile and urban/rural data: DHS and MICS Surveys from 57 countries

Source: UNESCO Institute for Statistics (UIS), 2011 Source: UNESCO Institute for Statistics Fact Sheet, June 2013, No.25.

5 6

Key interventions to reduce gender disparities in education include: `` Increase demand for education through community-based interventions `` Create inclusive gender-responsive learning environment through child-friendly education `` Tackle multiple drivers of out-of-school children (e.g. gender, poverty and geography) through innovative approaches

30

20 23 25 19 20 23

Middle Second Middle

25 50 75 100 25 50 75 100 Tertiary

The continuing agenda for children

Average rate of male and 13 female out-of-school children of primary Urban school age, by area of residence and wealth quintiles, 57 countries.6 12 13 Urban 12 24 13 Rural Urban 23 24 12 Rural 23 24 Rural 23

Second Poorest Second

0 0

`` Address gender disparity in access, progression and learning outcomes

MDG

4

Reduce Child Mortality Target 4A Indicator

Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate  Under-five mortality rate and infant mortality rate  Proportion of 1-year old children immunized against measles

Progress

 Under-five deaths have declined from 12.6 million in 1990 to 6.6 million in 2012  About 44 percent of the under-five deaths occur within the first 28 days of life  Global under-five mortality dropped from 90 deaths per 1,000 live births to 48 in 2012

Under-five mortality declined but falls short of the two-thirds reduction required to achieve the MDG target Under-five mortality rate (per 1,000 live births), by region, 1990 and 20127

Deaths per 1,000 live births Deaths Deaths per per 1,000 1,000 live live births births

200 200 200

1990 1990 1990 2012 2012 2012 MDG4 MDG4 MDG4 target target target for for for 2015 2015 2015

177 177 177

1990

160 160 160

2012

MDG4 target for 2015

126 126 126

120 120 120

99 99 99

98 98 98 74 74 74

80 80 80

58 58 58

73 73 73

71 71 71

55 55 55 36 36 36

40 40 40

30 30 30

90 90 90

73 73 73

65 65 65

54 54 54

25 25 25

22 22 22

19 19 19

53 53 53

53 53 53

48 48 48

15 15 15 6 6 6

14 14 14

The rate of decline in under-five mortality has accelerated significantly in the last decade

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Diseases of poverty like pneumonia, diarrhoea and malaria accounted for a third of under-five deaths in 20128 Pneumonia (neonatal) (5%) Pneumonia (neonatal) (5%)

Pneumonia (13%) Pneumonia (13%)

PretermPreterm birth birth complications (15%) complications (15%)

Pneumonia (17%)

The continuing agenda for children Key interventions to reduce child mortality include: `` Focus on the poorest, most marginalized and most-vulnerable `` Ensure clean and safe delivery practices `` Improve ante-natal care

Other (19%)

Other (19%)

All Other (24%)

Neonatal (44%)

Intrapartum-related Intrapartum-related complications (10%) complications (10%)

`` Reduce deaths from preventable diseases of poverty: pneumonia, diarrhoea, and malaria `` Encourage exclusive breastfeeding

Measles Measles (1%) (1%)

Sepsis/meningitis (5%)

Sepsis/meningitis (5%)

AIDS (2%) AIDS (2%)

Tetanus (1%)

Meningitis (3%)

Diarrhoea (9%)

Meningitis (3%)

Injury (5%) Injury (5%) Malaria (7%) Malaria (7%)

Diarrhoea (8%) Diarrhoea (8%)

Tetanus (1%) Other neonatal (3%) Other neonatal (3%) Congenital abnormalities

Congenital abnormalities (4%) (4%) Diarrhoea (neonatal) (1%) Diarrhoea (neonatal) (1%)

Globally, almost half of the under-five deaths are attributable to malnutrition

`` Immunize children against measles and other diseases `` Eliminate open defecation `` Promote washing hands with water and soap `` Let children sleep under insecticide treated bednets

Source: The UN Interagency Expert Group for Mortality Estimation, Levels and Trends in Child Mortality Report 2013, UNICEF 2013 Source: UNICEF, Committing to Child Survival: A Promise Renewed Progress Report 2013

7 8

MDG

5

Improve Maternal Health Target 5A Indicator

Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio  Maternal mortality ratio  Proportion of births attended by skilled health personnel

Progress

 Since 1990, the maternal mortality ratio has declined by 47% from 400 to 210 per 100,000 live births in 2010

 About two thirds of women delivered with the assistance of a skilled birth attendant

Regions with the largest number of maternal deaths have highest levels of births NOT attended by skilled health personnel9 % of births NOT attended by skilled health personnel, 2011

Maternal deaths, 2010 (in 1,000s) 162 83

17

8.8

Sub-Saharan Africa

52

Southern Asia

50

South-Eastern Asia Latin America and the Caribbean

25 10

6.4

Eastern Asia

1

3.5

Western Asia

26

2.8

Northern Africa

0.8

Caucasus and Central Asia

Target 5B Indicator Progress

Making pregnancies wanted and childbirths safe prevents maternal deaths and saves children’s lives

18 3

Achieve, by 2015, universal access to reproductive health  Contraceptive prevalence rate

 Adolescent birth rate

 Antenatal care coverage

 In 2011, approximately half of all pregnant women in developing regions did not have the recommended minimum number of 4 antenatal care visits

One in five women gave birth before age 18* Proportion of women age 20-24 who have given birth before age 18, 2000-20109

The continuing agenda for children Key maternal and reproductive health interventions include: `` Increase assistance from skilled health personnel at delivery with proper supplies and equipment `` Improve access to emergency obstetric care

Less than 10% 10 – 19% 20 – 29% 30 – 39% Greater than or equal to 40%

`` Ensure a minimum of four visits with quality antenatal care `` Expand access to information, counseling an supplies for a wide range of contraceptive methods

Data not available

`` Lower birth rates among adolescents

* Excluding China

Source for both graphs: UNICEF Global databases, 2013 Based on MICS and DHS household surveys and other national sources

9

MDG

6

Combat HIV/AIDS, Malaria and Other Diseases Target 6A Indicator Progress

Have halted by 2015 and begun to reverse the spread of HIV/AIDS HIV prevalence among population aged 15-24 years







Globally, new HIV infections dropped by 21% to 2.5 million between 2001 and 2011 Access to antiretrovirals for adults has increased to 59%, but only to 28% for children in 2011 Since 2005, AIDS-related mortality declined from 2.3 million to 1.7 million, but adolescent AIDS deaths increased

In 2011, an estimated 4.6 million young people 15-24 were living with HIV; 64% were girls and 78% were in sub-Saharan Africa HIV prevalence among young people aged 15-24, 2011 (%)10

We now have the knowledge and the means to make an AIDS-free generation a reality

Less than 0.2% 0.2 – 0.9% 1.0 – 2.9% 3.0 – 4.9% 5.0 – 7.9% 8.0% or more Data not available

Target 6C Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases Indicator  Incidence and death rates associated with malaria  Proportion of children under-five sleeping under insecticide-treated bednets (ITN)

Progress 

In 2012, more than a third of children sleep under an ITN, up from less than 5% in 2000

Over half of the households in sub-Saharan Africa own an ITN but only 37% of children under-five sleep under one Children under-five sleeping under insecticide treated nets (ITNs), Africa, 2012 (%)11

2012 2000

The continuing agenda for children Key interventions to reduce HIV/AIDS and malaria include: `` Increase antiretroviral coverage for treatment and the prevention of mother-to-child transmission of HIV `` Scale up high impact HIV prevention, treatment and care in adolescents including key populations `` Provide protection, care and support for children and families affected by HIV and AIDS

0 – 9% 10 – 25% 26 – 50% 51 – 75% Not malaria endemic Data not available

10 11

Source: UNAIDS unpublished estimates, 2012 Source: UNICEF global databases 2013, based on MICS, DHS and MIS

`` Ensure that children and pregnant women sleep under a ITN `` Expand the use of artemisinin-based combination therapy `` Expand rapid diagnostic testing before commencing malaria treatment

MDG

7

Ensure Environmental Sustainability Target 7C

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

Indicator

 Proportion of the population using an improved drinking water source  Proportion of the population using an improved sanitation facility

Progress

 The proportion of population without drinking water declined from 24% in 1990 to 11% in 2011  The proportion of population without sanitation declined from 51% in 1990 to 36% in 2011

The drinking water target will be surpassed by >150 million people; the sanitation target will likely be missed by more than 600 million Population without an improved drinking water source and improved sanitation facility, current and MDG trends, 1990-201512 3,000

Population (x 1,000)

Sanitation

May be m Current trend issed by >600 mill ion May be m issed

Sanitatio

n

2,500 2,000

by >600

2.5 billion million

MDG target 1.8 billion

1,500 Drinking water

Drinking w

Cur Mrent trend

ater

1,000

MDG target

et by >15

0 million 871 million Met by >150 million 692 million

Children are at the heart of sustainable development

MDG target 871 million 692 million

500 0

2015

1990

Open defecation rates declined in all regions, but still over 1 billion people continue the practice

The continuing agenda for children

Open defecation rates, 1990 and 201112 Southern Asia

39 39% decline

64

A post-2015 vision for water and sanitation:

Sub-Saharan Africa

36

26 28% decline

`` No one practices open defecation

South-Eastern Asia

31 31

14 55% decline

`` Everyone has water, sanitation and hygiene at home

Latin America & Caribbean

17 4 76% decline

Northern Africa

16 4 75% decline

Oceania

13 10 23% decline

Western Asia

8

63% decline 3

Eastern Asia

7

4 43% decline

Caucasus & Central Asia

World

1990 2011

`` All schools and health centres have water, sanitation and hygiene `` Water, sanitation and hygiene are sustainable and inequalities in access have been progressively eliminated

1 0

24

24 15 36% decline

`` Water supply, sanitation and hygiene services are resilient to disasters

Source: WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), 2013

12

UNICEF is a global leader on statistics for children UNICEF as a global leader in statistics for children is proud to continue to provide the global development community with the latest statistics on children and women, many of which appear every year in the United National Secretary General’s Report on the MDGs. We reaffirm our commitment to work with governments in strengthening the collection and analysis of the evidence that allows for the monitoring of progress towards global development goals which has made such a measurable difference in children’s lives across the world.

Prepared by: UNICEF Data & Analytics Division of Policy & Strategy, September 2013

Find the latest statistics on children at the UNICEF-Statistics website: www.childfinfo.org

Front cover photo credit: © UNICEF/NYHQ2010-1548/Asselin

Towards a Post-2015 agenda for all children

Key Issues for Children in the Post-2015 Development Agenda Further reduction of under-five mortality Elimination of all preventable maternal and child deaths Reduction of child malnutrition Achievement of universal coverage of:  basic health services  safe drinking water and sanitation Completion by all children of quality basic education Protection of all children from all forms of violence, abuse and exploitation Protection and support of children and their families affected by conflict and humanitarian disasters Prioritize the worst-off and most deprived children, families and their communities Monitoring of progress and investment in supporting national statistics systems to collect disaggregated data to ensure that no child is left behind

Guiding Principles to ensure a Post-2015 World Fit for All Children The Millennium Development Goals have been a success and achieved a lot for children and young people. However they have not fully been met. The unfinished and continuing business of investing in the rights and well-being of children – as well as emerging and neglected issues - must be boldly addressed in a vision of a world fit for children and future generations, with achievable goals for the post-2015 development agenda.

Governments should reaffirm their existing commitments – specifically to the Millennium Declaration and to the Convention on the Rights of the Child – to underpin future efforts for inclusive and equitable human progress.

Sustainable Development starts with safe, healthy and well-educated children. And safe and sustainable societies are, in turn, essential for children. The post-2015 development agenda must provide comprehensive solutions to advance peace, prosperity and a sustainable world – for both the present and future generations.

The new development agenda needs to be universal – relevant for all societies and about all people regardless of where they live.

Countries cannot achieve sustained growth and shared prosperity without investing effectively in their people, and above all, in their children.

Photo credit: © UNICEF/NYHQ2006-1914/Pietrasik

Different Faces of Disparities The poorest children are those more often stunted

More than one third of women in the world marry during childhood, with one in nine of them being married before their 15th birthday

Percentage of children under age 5 who are moderately or severely stunted by selected regions, LDCs and the world1 Poorest 20%

Poorer 20%

Middle 20%

Richer 20%

Percentage of women aged 20-24 years old who were first married or in union before age 18 and before age 15, in the 15 countries with the highest prevalence of child marriage among women and the world2

Richest 20% (%)

(%) 70

100 100 100

59

80 80 80

53

50

48 46 42

40

43 40

36

51

49 46 42

47

36

25

50 50 50

35

27

25

30 30 30

20

45 45

10 10 10 South Asia

East Asia and the Pacific*

Least developed countries

0 0 0

World*

* Excluding China Note: Analysis is based on a subset of countries with available data by subnational groupings and regional estimates are presented only where adequate coverage is met.

Data from 2007 to 2011, except for Brazil and India

3rd

52 52

52 52

4th

26

29

20 20

18 18

8 8

39

38 34 43

34 34

41 34

38

37

18 18

39

56 56

43

41

32 32 21 21

14 14

12 12

9 9

10 10

36 36 29 29

29 29

23

20 20

15 15

11 11

Percentage of girls and women aged 15 to 49 years who have undergone FGM/C in the ethnic groups with the highest and lowest FGM/C prevalence4

Richest 6 1

55 55

Levels of female genital mutilation/cutting (FGM/C) prevalence vary dramatically among ethnic groups

Southern Asia: Sanitation coverage trends by wealth quintiles, based on population-weighted averages from three countries, 1995 and 20083 2nd

50 50

* Excludes China

The poorest 40 percent of the population in Southern Asia have barely benefited from improvements in sanitation

Poorest

48 48

66 66

68 68

Si Si er er ra ra LeLe onon SoSo e e mm ali al a ia Er Er itr itr eaea

M M IndInd adad ia ia agag asas caca r r MM SoSo al al ut ut awaw h h i i BuB SuSdud rkurk anan in in aa Ethnic group with the highest FaFa soso prevalence

MM MM Ethnic group with the lowest ozoz a a prevalence amam li li bi bi ququ ee CeC GG e ui ui nt nt B B ra ra a a nene l Al A ngng a a fri fri la la caca dede n n shsh ReR peupu bl bl ic ic

ChC ahdad

Ni N geige r r

Sub-Saharan Africa

47 47

35 27

20 20 20

10

(%) 100 100

44 44

47 47

40 40 40

26 23

20

63 63

60 60 60

41

32

30

70 70 70

46

38

75 75 68 68

WW or or ld ld * *

60

0

Married or in union at age 15 or after but before age 18 #REF! #REF! #REF! Married #REF! or in union before age 15

90 90 90

Eritrea 2 4

18

Ethiopia Guinea Mali Gambia

80 80 51

6

Kenya

56 74

60 60

86

Guinea-Bissau Chad

77

Sierra Leone

87

94

Burkina Faso

4 93

40 40

94

Senegal C么te d'Ivoire

76

8

Benin Niger 8

20 20

00

4

45

Nigeria

36

4 2 1995

7

5

7

8

Central African Republic 18

2008 1995

19

Ghana Togo

2008 1995

2008 1995

2008 1995

2008

Ethnic group with the higest prevalence Ethnic group with the lowest prevalence

Cameroon Uganda

Improved + shared

Unimproved

Open defecation

0 0

10 10

20 20

30 30

40 40

50 50

Source: Adapted from Improving Child Malnutrition: The achievable imperative for global progress, based on UNICEF Global Databases, 2012.

Sources: UNICEF global databases, 2012. Based on AIDS Indicator Surveys (AIS), DHS, MICS and other national surveys, 2002-2011.

Sources: India: NFHS 1993, 1999, 2006; Bangladesh: DHS 1993, 1997, 2000, 2004, 2007; Nepal: DHS 1996, 2001, 2006 4 Sources: MICS and DHS 2002-1011 as presented in Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change, UNICEF, 2013.

1 2 3

60 60

70 70

80 80

90 90

100 (%) 100