Two of three unattended births are in fragile States
Despite global economic and social progress in recent decades, there is a large and growing portion of humanity living with greater insecurity and instability. It is from these countries that the major challenges to stability, development, and achievement of social progress exist. Gates et al. (2010) summarized the impact with data showing that close to half the people in low-income countries in 2010 were in States that are fragile, in conflict, or recovering from conflict. These same areas accounted for 60 per cent of the world’s people who are undernourished, 77 per cent of the children not attending primary school, 70 per cent of infant deaths and 64 per cent of unattended births.
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CHAPTER 1
A FRAG I LE WO RLD
When States’ fragility is matched against key reproductive health indicators, correlations emerge, showing that extremely fragile countries are likely to have fewer births assisted by skilled attendants, higher rates of adolescent pregnancy and greater unmet need for family planning. Measuring fragility
A number of groups have developed means for measuring whether a State is fragile, and thus vulnerable to conflict or the effects of disasters. (OECD, 2015). The Organisation for Economic Co-operation and Development (OECD) each year issues a Fragile States Index, which shows countries’ and territories’ vulnerability to conflict and disaster by looking at five key dimensions: the level of violence, the extent to which there is access to justice and rule of law, whether national institutions are effective, accountable and inclusive, the level of economic stability, and the level of resilience to withstand and adapt to shocks and disasters.
PERCENTAGE OF BIRTHS ATTENDED BY SKILLED HEALTH PERSONNEL LOWER IN FRAGILE STATES 100
Percentage of births attended by skilled health personnel
middle-income countries. Despite this change in income level, poverty remains concentrated in fragile States (OECD, 2013). Fragile middle-income countries share common characteristics such as high levels of urban and criminal violence, growth of violent megacities and large, underemployed youth populations (Castillejo, 2015). Fragile States are home to one third of the world’s poor. More than 1 billion people, or about 15 per cent of the world’s population, are in extreme poverty, according to estimates from the World Bank (World Bank, 2015a). Extreme poverty, previously concentrated in East Asia, has shifted to sub-Saharan Africa and South Asia, which today accounts for 80 per cent of the world’s poor, the majority of which are women and children (World Bank 2015b). The poor are especially vulnerable to the effects of conflict, and various measurements of fragility suggest that high levels of poverty and income inequality can contribute to instability. The poor have fewer economic, social and other resources to help them withstand or recover from conflicts, which can in turn exacerbate poverty.
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40 60 80 100 Level of state fragility
120
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