55354020 millennium development goals report 2010

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U N I T E D N A T I O N S

The Millennium Development Goals Report

2010

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Cover Inside

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 wereidentified 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 DEVELOPMENT 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 CHILDRENS 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

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THE MILLENNIUM DEVELOPMENT GOALS REPORT 2010

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The MillenniumDevelopment GoalsReport2010

U N I T E D N A T I O N S

N E W Y O R K , 2010

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Foreword

The Millennium Declaration in 2000 was a milestonein international cooperation, inspiring developmenteorts that have improved the lives o hundreds omillions o people around the world. Ten years later,world leaders will gather again at the United Nationsin New York to review progress, assess obstaclesand gaps, and agree on concrete strategies andactions to meet the eight Millennium DevelopmentGoals by 2015.

The Goals represent human needs and basic rightsthat every individual around the world should beable to enjoyreedom rom extreme poverty and

hunger; quality education, productive and decentemployment, good health and shelter; the right owomen to give birth without risking their lives; and aworld where environmental sustainability is a priority,and women and men live in equality. Leaders alsopledged to orge a wide-ranging global partnershipor development to achieve these universalobjectives.

This report shows how much progress has beenmade. Perhaps most important, it shows that

the Goals are achievable when nationally owneddevelopment strategies, policies and programmesare supported by international development partners.

At the same time, it is clear that improvements inthe lives o the poor have been unacceptably slow,and some hard-won gains are being eroded by theclimate, ood and economic crises.

The world possesses the resources and knowledgeto ensure that even the poorest countries, and othersheld back by disease, geographic isolation or civilstrie, can be empowered to achieve the MDGs.

Meeting the goals is everyones business. Fallingshort would multiply the dangers o our world rominstability to epidemic diseases to environmentaldegradation. But achieving the goals will put us ona ast track to a world that is more stable, more just,and more secure.

Billions o people are looking to the internationalcommunity to realize the great vision embodied in theMillennium Declaration. Let us keep that promise.

Ban Ki-moonSecretary-General, United Nations



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Overview

Keeping the promise

Five years rom the target date or the MillenniumDevelopment Goals, leaders rom around the worldwill be gathering at the United Nations to undertake acomprehensive review o progress and together chart acourse or accelerated action on the MDGs between nowand 2015.

Many countries are moving orward, including some o thepoorest, demonstrating that setting bold, collective goalsin the fght against poverty yields results. For every lie thathas benefted rom the establishment o a quantitative,time-bound ramework o accountability, the MDGs havemade a real dierence.

But unmet commitments, inadequate resources, lack oocus and accountability, and insufcient dedication tosustainable development have created shortalls in many

areas. Some o these shortalls were aggravated by theglobal ood and economic and fnancial crises.

Nevertheless, the data and analysis on the ollowingpages provide clear evidence that targeted interventions,sustained by adequate unding and political commitment,have resulted in rapid progress in some areas. In others, thepoorest groups, those without education or living in moreremote areas, have been neglected and not provided theconditions to improve their lives.

Bridging the gaps

Though progress has been made, it is uneven. And withouta major push orward, many o the MDG targets are likelyto be missed in most regions. Old and new challengesthreaten to urther slow progress in some areas or evenundo successes achieved so ar.

The most severe impact o climate change is being eltby vulnerable populations who have contributed least tothe problem. The risk o death or disability and economicloss due to natural disasters is increasing globally and isconcentrated in poorer countries. Armed conict remains

a major threat to human security and to hard-won MDGgains. Large populations o reugees remain in campswith limited opportunities to improve their lives. In 2009,42 million people had been displaced by conict orpersecution, our fths o them in developing countries.

The number o people who are undernourished hascontinued to grow, while slow progress in reducing theprevalence o hunger stalledor even reversed itselinsome regions between 2000-2002 and 2005-2007. Aboutone in our children under the age o fve are underweight,mainly due to lack o ood and quality ood, inadequatewater, sanitation and health services, and poor care andeeding practices.

An estimated 1.4 billion people were still living in extremepoverty in 2005. Moreover, the eects o the global fnancialcrisis are likely to persist: poverty rates will be slightlyhigher in 2015 and even beyond, to 2020, than they wouldhave been had the world economy grown steadily at itspre-crisis pace.

Gender equality and the empowerment o women are at theheart o the MDGs and are preconditions or overcomingpoverty, hunger and disease. But progress has beensluggish on all rontsrom education to access to politicaldecision-making.

Building on successes

The collective eorts towards achievement o the MDGshave made inroads in many areas. Encouraging trendsbeore 2008 had put many regions on track to achieve atleast some o the goals. The economic growth momentum

in developing regions remains strong and, learning rom themany successes o even the most challenged countries,achieving the MDGs is still within our grasp:

Progress on poverty reduction is still being made,despite signifcant setbacks due to the 2008-2009economic downturn, and ood and energy crises. Thedeveloping world as a whole remains on track to achievethe poverty reduction target by 2015. The overall povertyrate is still expected to all to 15 per cent by 2015, whichtranslates to around 920 million people living under theinternational poverty linehal the number in 1990.

Major advances have been made in getting children intoschool in many o the poorest countries, most o them insub-Saharan Arica.

Remarkable improvements in key interventionsor

malaria and HIV control, and measles immunization,or examplehave cut child deaths rom 12.5 million in1990 to 8.8 million in 2008.

Between 2003 and 2008, the number o peoplereceiving antiretroviral therapy increased tenoldrom400,000 to 4 millioncorresponding to 42 per cent othe 8.8 million people who needed treatment or HIV.

Major increases in unding and a stronger commitmentto control malaria have accelerated delivery o malaria

interventions. Across Arica, more communities arebenefting rom bed net protection and more childrenare being treated with eective drugs.

The rate o deorestation, though still alarmingly high,appears to have slowed, due to tree-planting schemescombined with the natural expansion o orests.

Increased use o improved water sources in ruralareas has narrowed the large gap with urban areas,where coverage has remained at 94 per centalmostunchanged since 1990. However, the saety o watersupplies remains a challenge and urgently needs to beaddressed.

Mobile telephony continues to expand in the developingworld and is increasingly being used or m-banking,disaster management and other non-voice applications

or development. By the end o 2009, cellularsubscriptions per 100 people had reached the 50 percent mark.



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Towards 2015

The Millennium Declaration represents the most importantpromise ever made to the worlds most vulnerable people.The MDG ramework or accountability derived rom theDeclaration has generated an unprecedented level ocommitment and partnership in building decent, healthierlives or billions o people and in creating an environmentthat contributes to peace and security.

The Millennium Development Goals are still attainable.The critical question today is how to transorm the pace ochange rom what we have seen over the last decade intodramatically aster progress. The experience o these lastten years oers ample evidence o what works and hasprovided tools that can help us achieve the MDGs by 2015.The Millennium Development Goals summit in Septemberwill be an opportunity or world leaders to translate thisevidence into a concrete agenda or action.

SHA ZUKANGUnder-Secretary-General or Economic and Social Aairs

Achieving the MDGs will also require increased attention

to those most vulnerable. Policies and interventions willbe needed to eliminate the persistent or even increasinginequalities between the rich and the poor, between thoseliving in rural or remote areas or in slums versus better-ourban populations, and those disadvantaged by geographiclocation, sex, age, disability or ethnicity:

In all developing regions, children in rural areas aremore likely to be underweight than urban children. InLatin America and the Caribbean and parts o Asia, thisdisparity increased between 1990 and 2008.

The gap between the richest and the pooresthouseholds remains enormous. In Southern Asia, 60 percent o children in the poorest areas are underweightcompared to 25 per cent o children in the richesthouseholds.

In developing regions overall, girls in the poorest 20 percent o households are 3.5 times more likely to be outo school than girls in the richest households and ourtimes more likely to be out o school than boys rom therichest households.

Even in countries close to achieving universal primaryeducation, children with disabilities are the majority othose excluded.

Maternal health is one o the areas in which the gapbetween rich and poor is most conspicuous. Whilealmost all births are attended by skilled health personnelin the developed countries, less than hal o womenreceive such care when giving birth in parts o thedeveloping world.

Disparities in access to care during pregnancy are also

striking, with women in the richest households 1.7 timesmore likely to visit a skilled health worker at least oncebeore birth than the poorest women.

Lack o education is another major obstacle toaccessing tools that could improve peoples lives. Forinstance, poverty and unequal access to schoolingperpetuate high adolescent birth rates, jeopardizing thehealth o girls and diminishing their opportunities orsocial and economic advancement.

Contraceptive use is our times higher among womenwith a secondary education than among those with noeducation. For women in the poorest households andamong those with no education, negligible progress wasseen over the last decade.

Only about hal o the developing worlds populationare using improved sanitation, and addressingthis inequality will have a major impact on severalo the MDGs. Disparities between rural and urbanareas remain daunting, with only 40 per cent o ruralpopulations covered. And while 77 per cent o thepopulation in the richest 20 per cent o households useimproved sanitation acilities, the share is only 16 percent o those in the poorest households.



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The global economic crisis has slowedprogress, but the world is still on track tomeet the poverty reduction target

Robust growth in the frst hal o the decade reduced thenumber o people in developing regions living on less than$1.25 a day rom 1.8 billion in 1990 to 1.4 billion in 2005,while the poverty rate dropped rom 46 per cent to 27 per

cent. The global economic and fnancial crisis, which beganin the advanced economies o North America and Europein 2008, sparked abrupt declines in exports and commodityprices and reduced trade and investment, slowing growthin developing countries. Nevertheless, the momentum oeconomic growth in developing countries is strong enoughto sustain progress on the poverty reduction target. Theoverall poverty rate is still expected to all to 15 per cent by

TARGET

Halve, between 1990 and 2015, the proportion o peoplewhose income is less than $1 a dayGoal 1

Eradicateextremepoverty andhunger

0 10 20 30 40 50 60 70

Developing regions

CIS, Europe

Transition countries of South-Eastern Europe

Northern Africa

Western Asia

Latin America & the Caribbean

Eastern Asia

South-Eastern Asia

CIS, Asia

Southern Asia, excluding India

Southern Asia

Sub-Saharan Africa

Proportion of people living on less than $1.25 a day,

1990 and 2005 (Percentage)

60

58

51

49

39

45

31

6

19

39

19

16

11

8

2

6

5

3

46

27

0.1

0.3

1

2

1990

2005

2015 Target



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Prior to the crisis, the depth o povertyhad diminished in almost every region

2015, indicating that the Millennium DevelopmentGoal (MDG) target can be met. This translatesinto around 920 million people living under theinternational poverty linehal the number in 1990.

Newly updated estimates rom the World Banksuggest that the crisis will leave an additional50 million people in extreme poverty in 2009and some 64 million by the end o 2010 relativeto a no-crisis scenario, principally in sub-Saharan Arica and Eastern and South-Eastern

Asia. Moreover, the eects o the crisis arelikely to persist: poverty rates will be slightlyhigher in 2015 and even beyond, to 2020, thanthey would have been had the world economygrown steadily at its pre-crisis pace.

The astest growth and sharpest reductionsin poverty continue to be recorded in Eastern

Asia. Poverty rates in China are expected to

all to around 5 per cent by 2015. India, too,has contributed to the large reduction in globalpoverty. Measured at the $1.25 a day povertyline, poverty rates there are expected to allrom 51 per cent in 1990 to 24 per cent in 2015,and the number o people living in extremepoverty will likely decrease by 188 million. Alldeveloping regions except sub-Saharan Arica,Western Asia and parts o Eastern Europe andCentral Asia are expected to achieve the MDGtarget. These shortalls reect slow growthin sub-Saharan Arica in the 1990s and thetransition rom planned to market economiesthat saw poverty increase, albeit rom very low

levels, in some countries o Eastern Europeand the ormer Soviet Union.

The lack o good quality surveys carried outat regular intervals and delays in reportingsurvey results continue to hamper themonitoring o poverty. Gaps are particularlyacute in sub-Saharan Arica, where morethan hal o countries lack sufcient datato make comparisons over the ull range othe MDGs, and among small island statesin the Pacifc and the Caribbean. Surveysdeliver important inormationnot just in thechange in average income or consumption,but also in its distribution. This years poverty

estimates integrate 31 new household surveys.Combining these new surveys with last yearsgrowth orecast suggests a 0.5 percentagepoint decline (ater taking into account theeect o the fnancial crisis) in the aggregatepoverty headcount index in 2015rom 15.5per cent to 15.0 per cent. Only with more timelydata can accurate reports on progress towardsthe MDGs be provided.

The poverty gap measures the shortall in incomes opeople living below the poverty line. While the internationalpoverty line is set at a level typical o very poor countries,many people live on even less than that amount. Economicgrowth and improvements in the distribution o income orconsumption reduce the depth o poverty. Since 1990, thedepth o poverty has decreased in all regions except Western

Asia. In 2005, the average income o people living belowthe poverty line stood at $0.88. The depth o poverty wasgreatest in sub-Saharan Arica, but has allen since 1999 toreach the level o Eastern Asia in 1990.

0 10 20 30

Developing regions

CIS, Europe

Transition countries o South-Eastern Europe

Northern Arica

Western Asia


Eastern Asia

South-Eastern Asia

CIS, Asia


Southern Asia

Sub-Saharan Arica

Poverty gap ratio at $1.25 a day, 1990 and 2005

(Percentage)


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Investments in disaster riskreduction can yield long-termbenefts, including progress

on the MDGs

The risk o death or disability andeconomic loss resulting rom naturaldisasters is increasing globally and isconcentrated in poorer countries. Reducingsuch risk can have multiplier eects thatcan accelerate achievement o the MDGs.The horrifc loss o lie rom earthquakesin Haiti, Chile and China, and oods inBrazil, underscore the need to make thebuilt environment more resilient in the aceo potential hazardsboth seismic andclimatic (or weather-related).

Urbanization, climate change andecosystem degradation are increasing thetoll o natural disasters, and countries leastable to reduce their risk are suering themost. An estimated 97 per cent o globalmortality risk rom natural disasters isaced by populations in low- and lower-middle-income countries, which alsoexperience higher economic losses relativeto the size o their economies. From thestart o 2008 through March 2010, 470,000people were reportedly killed as a result onatural disasters; economic losses were

estimated to be more than $262 billion (notincluding 2010). Small island developingstates and landlocked developing countriestogether constitute 60 per cent and 67per cent, respectively, o the countriesconsidered to have a high or very higheconomic vulnerability to natural hazards.

Experience rom countries has shownthat investments in disaster risk reductionproduce long-term beneftsrom reduceduture losses and avoided reconstructionto co-benefts such as more robustlivelihoods, resilient communities, andprotective and productive ecosystems.

In Peru, incorporation o risk reductioninto development has led to benefts thatexceeded costs by as much as 37 times.When China spent $3.15 billion on reducingthe impact o oods between 1960 and2000, it averted losses estimated at $12billion.

TARGET

Achieve, ull and productive employment and decentwork or all, including women and young people

Deterioration o the labour market,triggered by the economic crisis, hasresulted in a decline in employment

The bursting o the housing bubble in the United States in2007 and subsequent paralysis o the global fnancial systembecame an economic and labour market crisis that plaguedthe world throughout 2009. The cascading crisis crippledeconomies, reduced enterprise capacities and orced millionso people out o work. Many workers resorted to vulnerableorms o employment as the ranks o the working poor swell.

0 10 20 30 40 50 60 70 80

Developing regions

Developed regions

Western Asia

Northern Arica


Southern Asia

CIS


Sub-Saharan Arica

South-Eastern Asia

Oceania

Eastern Asia

Employment-to-population ratio, 1998, 2008 and

2009 preliminary estimates

747070

6666

666666

646565

5861

60

5358

57

5756

55

5349

48

444646

4746

44

5657

55

636262

67

* Data for 2009 are preliminary.

199820082009*



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and recourse to eective mechanisms orsocial dialogue. Vulnerable employment isoten characterized by inadequate earnings,low productivity and substandard workingconditions that undermine undamental labour

rights.

Prior to the economic crisis, over threequarters o workers in Oceania, Southern

Asia and sub-Saharan Arica were without thesecurity that wage and salaried jobs couldprovide. The crisis is likely to have urtherincreased the number o workers engagedin vulnerable employment in these regions in2009. The International Labour Organization(ILO) estimates* the global vulnerableemployment rate in 2009 to be between 49per cent and 53 per cent, which translatesinto 1.5 billion to 1.6 billion people who areworking on their own or as unpaid amily

workers worldwide.* Details are available at http://mdgs.un.org

Since the economic crisis, more workersfnd themselves and their amilies livingin extreme poverty

The working poor are defned as those who are employedbut live in households where individual members subsist onless than $1.25 a day. Most o these workers are engaged

in jobs that lack the social protection and saety nets thatguard against times o low economic demand, and they areoten unable to generate sufcient savings to oset hardtimes. Since vulnerable employment is oten characterizedby low productivity work, and the global fnancial crisis hasresulted in declining output per worker, working poverty islikely to have increased as well. The small decreases in thepercentage o working poor in 2009 that would result rom a

0 10 20 30 40 50 60 70 80

Developing regions

CIS, Europe


Northern Arica


Western Asia

Eastern Asia

CIS, Asia

South-Eastern Asia

Oceania

Southern Asia

Sub-Saharan Arica

Proportion of employed people living below

$1.25 a day, 1998, 2008 and 2009 second

scenario (Percentage)

6758

64

5544

51

4546

50

4523

28

2619

21

5211

88

12

137

8

63

4

4

4826

31

0.10.2

1

0.40.6

13

*Data for 2009 are based on the ILOs second scenario.

Details are available at mdgs.un.org

199820082009*



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continuation o historical trends (scenario 1)are thereore not likely to have materialized.Rather, it is estimated that an additional 3.6per cent o the worlds workers were at risko alling into poverty between 2008 and

2009 (scenario 2), an alarming increase and asetback o many years o steady progress.

The largest negative impact is most likelyto be seen in sub-Saharan Arica, Southern

Asia, South-Eastern Asia and Oceania, whereextreme poverty among the employed mayhave increased by our percentage points ormore in the second scenario. These estimatesreect the act that, prior to the crisis, manyworkers in these regions were only slightlyabove the poverty line. In the case o sub-Saharan Arica, the large majority o workers(63.5 per cent) were at risk o alling below theextreme poverty line in this scenario.

Hunger may have spiked in 2009, one othe many dire consequences o the globalood and fnancial crises

Since 1990, developing regions have made some progresstowards the MDG target o halving the proportion opeople suering rom hunger. The share o undernourished

populations decreased rom 20 per cent in 1990-1992 to 16per cent in 2005-2007, the latest period with available data.However, progress has stalled since 2000-2002. Overallprogress in reducing the prevalence o hunger has not beensufcient to reduce the number o undernourished people. In2005-2007, the last period assessed, 830 million people werestill undernourished, an increase rom 817 million in 1990-1992.

Food prices spiked in 2008 and alling income due to thefnancial crisis urther worsened the situation. The Food and

Agricultural Organization o the United Nations estimates thatthe number o people who were undernourished in 2008 maybe as high as 915 million and exceed 1 billion in 2009.

TARGET

Halve, between 1990 and 2015, the proportion o peoplewho suer rom hunger

0

300

600

900

1200

1500

Proportion of people who are undernourished in the

developing regions (Percentage) and number of

undernourished people (Millions), 1990-1992,

1995-1997, 2000-2002 and 2005-2007

817 797 805 830

Millions

Percentage

0

5

10

15

20

25

2005-20072000-20021995-19971990-1992

Number of undernourished people

Percentage of undernourished people



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Progress to end hunger hasbeen stymied in most regions

Beore the onset o the ood and fnancialcrises, a number o regions were well on theirway to halving, by 2015, the proportion o theirpopulation that were undernourished. South-Eastern Asia, which was already close to thetarget in 2005-2007 made additional progress,as did Latin America and the Caribbean andEastern Asia. Progress in the latter region waslargely due to reductions in hunger in China.

The prevalence o hunger also declined insub-Saharan Arica, although not at a pacethat was sufciently ast to compensate orpopulation growth and to put the region ontrack to meet the MDG target.

Prices o staple oods remained high in 2009, ater the initialood crisis o 2008. At the same time, the incomes o poorhouseholds diminished because o higher unemploymentollowing the economic downturn. Both crises contributed toa considerable reduction in the eective purchasing power

o poor consumers, who spend a substantial share o theirincome on basic oodstus.

Though international ood prices continued to decline inthe second hal o 2008, consumer ood price indexes rose.International ood prices have not yet stabilized and threats onew ood crises loom.

Aggregate ood availability globally was relatively goodin 2008 and 2009, but higher ood prices and reducedemployment and incomes meant that the poor had lessaccess to that ood.

0 5 10 15 20 25 30 35

Developing regions

Northern Arica

Western Asia


Eastern Asia

Eastern Asia, excluding China

Oceania

South-Eastern Asia

Southern Asia


Sub-Saharan Arica

Proportion of undernourished population,

1990-1992, 2000-2002 and 2005-2007

(Percentage)

3130

26

262323

2120

21

2417

14

12

1613

813

12

181010

12109

5


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Despite some progress, one inour children in the developingworld are still underweight

From 1990 to 2008, the proportion o childrenunder fve in the developing regions who areunderweight declined rom 31 per cent to 26per cent. Progress in reducing underweightprevalence among children has been madein all regions except Western Asia. Eastern

Asia, Latin America and the Caribbean, andCIS countries in Asia have reached or nearlyreached the MDG target, and South-Eastern

Asia and Northern Arica are on track.

Progress is being made, but not ast enoughto reach the MDG target. Data are not yetavailable to ully understand the impact othe ood and fnancial crises on underweightprevalence, but the achievement o the MDGtarget may be urther threatened by them.

Halving the prevalence o underweight children by 2015(rom a 1990 baseline) will require accelerated and concertedaction to scale up interventions that eectively combatundernutrition. A number o simple and cost-eectiveinterventions at key stages in a childs lie could go a long way

in reducing undernutrition, such as breasteeding within onehour o birth, exclusive breasteeding or the frst six monthso lie, adequate complementary eeding and micronutrientsupplementation between six and 24 months o age.

Undernutrition among children under fve continues to bewidely prevalent, due to both a lack o ood and lack oquality ood, inadequate water, sanitation and health servicesas well as less than optimal caring and eeding practices.Until improvements are made in all these areas, progress willbe limited. In Southern Asia, or example, eeding practicesare oten poor and shortages o quality ood are common.But in addition, nearly two thirds o the population are withoutimproved sanitation and nearly hal practise open deecation,resulting in repeated episodes o diarrheal diseases in

children. Moreover, more than 25 per cent o inants areunderweight at birth. Many o these children are never ableto catch up in terms o their nutritional status. All o theseactors have made underweight prevalence in Southern

Asiaat 46 per centthe highest in the world.

0 10 20 30 40 50 60

Developing regions


Northern Arica

Eastern Asia

Western Asia

South-Eastern Asia

Sub-Saharan Arica

Southern Asia

Proportion of children under age five who

are underweight, 1990 and 2008

(Percentage)

Note: Prevalence of underweight children is estimated

based on the NCHS/WHO/CDC reference population.

The United Nations Childrens Fund (UNICEF) is in the

process of converting its entire child un dernutrition

database according to the new World Health Organization

(WHO) Child Growth Standards.

51

46

31

27

37

25

14

14

17

7

11

7

11

6

31

26

1990

2008



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Children in rural areas arenearly twice as likely to beunderweight as those in urbanareas

In all developing regions, children in ruralareas are more likely to be underweight than

children living in cities and towns. In parts oAsia and in Latin America and the Caribbean,the relative disparity actually increasedbetween 1990 and 2008. In Eastern Asia,there was a striking increase in the rural/urban ratio (rom 2.1 to 4.8), indicating that, in2008, children in rural areas were almost fvetimes as likely to be underweight as childrenin urban areas. This region, however, hasalready achieved the targetin both rural andurban areaso halving the 1990 underweightprevalence: only 2 per cent o children inurban areas are underweight, versus 9 percent o rural children.

South-Eastern Asia, sub-Saharan Arica andNorthern Arica have succeeded in reducingchild malnutrition more rapidly in rural areasand in narrowing the gap with the urbanpopulation, demonstrating that more equitableprogress is indeed possible.

In some regions, the prevalence ounderweight children is dramaticallyhigher among the poor

Across the developing world, children rom the pooresthouseholds are twice as likely to be underweight as childrenrom the richest households. The disparity is most dramaticin regions with a high prevalence o underweight children.This is the situation in Southern Asia, where as many as 60

per cent o children in the poorest amilies are underweight,compared to about 25 per cent in the richest households.

0.0 1.0 2.0 3.0 4.0 5.0

Developing regions

Eastern Asia

Western Asia


Northern Arica

Sub-Saharan Arica

South-Eastern Asia

Southern Asia

Ratio between the proportion of under-five

children who are underweight in rural

areas and urban areas, 1990 and 2008

1.3

1.4

1.4

1.2

1.5

1.4

1.7

1.5

2.02.4

2.1

2.5

2.1

1.7

1.9

4.8

Rural children disadvantaged

Around 1990

Around 2008

Parity

0

10

20

30

40

50

60

70

Richest 20%Richer 20%Middle 20%Poorer 20%Poorest 20%

Proportion of under-five children who are underweight,

by household wealth, around 2008 (Percentage)

Southern Asia

Developing regions

Sub-Saharan Africa

Northern Africa

CIS, Asia



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Over 42 million people have beenuprooted by conict or persecution

Conicts are a major threat to human security and tohard-won MDG gains. Years ater a conict has ended,large populations o reugees remain in camps with limitedemployment and education opportunities and inadequatehealth services. Not surprisingly, reugees oten becomedependent on subsistence-level assistance and lead lives opoverty and unrealized potential.More than 42 million people are currently displaced byconict or persecution. O these, 15.2 million are reugees(residing outside their countries o origin) and 27.1 million

people have been uprooted but remain within the borders otheir own countries. Developing countries hosted our fthso the global reugee population in 2009. They included 10.4million people who all under the aegis o the United NationsHigh Commissioner or Reugees (UNHCR) and 4.8 millionPalestinian reugees, who are the responsibility o the UnitedNations Relie and Works Agency or Palestine Reugees inthe Near East (UNRWA).

The number o reugees has remained relatively stable overthe past two yearsabout 15 millionin part because o thelack o durable solutions. In 2009, some 250,000 reugeeswere able to return to their homes voluntarily, the lowest levelin 20 years. Aghans and Iraqis continue to be the largestreugee populations under the UNHCR mandate, totalling

2.9 million and 1.8 million people, respectively, at the end o2009. Together they account or nearly hal o all reugeesunder UNHCR care.

Number of refugees and internally displaced

persons, 2000-2009 (Millions)

0

10

20

30

40

2009200820072006200520042003200220012000

In te rn al ly di s pl aced pers ons R efu ge es

15.9

16.0 14.6 13.7 13.813.0

14.3

16.0 15.215.2

21.225.0 25.0 24.6 25.3 23.7 24.4

26.0 26.0 27.1



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16

Hope dims or universal education by2015, even as many poor countries maketremendous strides

Enrolment in primary education has continued to rise,reaching 89 per cent in the developing world. But the pace oprogress is insufcient to ensure that, by 2015, all girls andboys complete a ull course o primary schooling.

TARGET

Ensure that, by 2015, children everywhere, boys and girlsalike, will be able to complete a ull course o primaryschooling

Goal 2Achieveuniversalprimaryeducation

0 20 40 60 80 100

World

Developed regions

Developing regions

Eastern Asia


South-Eastern Asia

Northern Africa

CIS, Asia

Southern Asia

Western Asia

CIS, Europe

Sub-Saharan Africa

Adjusted net enrolment ratio in primary education,*

1998/1999 and 2007/2008 (Percentage)

58

76

89

93

83

88

79

90

95

94

86

94

93

95

94

95

95

96

82

89

97

96

84

90

* Defined as the number of pupils of the theoretical school age for primary

education enrolled in either primary or secondary school, expressed as a

percentage of the total population in that age group.

Note: Data for Oceania are not available.

1999

2008



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17

Sub-Saharan Arica and Southern Asiaare home to the vast majority o childrenout o school

Even as the number o school-age children continues to rise,the total number o children out o school is decreasingrom

106 million in 1999 to 69 million in 2008. Almost hal o thesechildren (31 million) are in sub-Saharan Arica, and more thana quarter (18 million) are in Southern Asia.

The gender gap in the out-o-school population has alsonarrowed: the share o girls in this group decreased rom 57per cent to 53 per cent globally between 1999 and 2008. Insome regions, however, the share is much larger; in Northern

Arica, 66 per cent o out-o-school children are girls.

0

20

40

60

80

100

20081999

Distribution of out-of-school children by region,1999 and 2008 (Percentage)

Sub-Saharan Africa

Southern Asia

Eastern Asia

South-Eastern Asia

Latin America

& the Caribbean

Western Asia

Developed regions

CIS

Northern Africa

Rest of the world46

43

27

6

5

4

4

4

2

34

6

4

3

4

30.2

12

2

0.7

To achieve the goal by the target date, allchildren at the ofcial entry age or primaryschool would have had to be attendingclasses by 2009 or so, depending on theduration o the primary level and how well

schools retain pupils to the end o thecycle. But in hal o the sub-Saharan Aricancountries with available data, at least one inour children o primary-school age were outo school in 2008.

To meet the goal, countries will also need toensure that there are enough teachers andclassrooms to meet the demand. Betweennow and 2015, the number o new teachersneeded in sub-Saharan Arica alone equalsthe current teaching orce in the region.

Despite these challenges, a good deal hasbeen accomplished in many regions. Though

enrolment in sub-Saharan Arica remains thelowest o all regions, it still increased by 18percentage pointsrom 58 per cent to 76per centbetween 1999 and 2008. Progresswas also made in Southern Asia and Northern

Arica, where enrolment increased by 11 and 8percentage points, respectively, over the lastdecade.

Major advances have been made even insome o the poorest countries, most othem in sub-Saharan Arica. The abolitiono primary school ees in Burundi resultedin a threeold increase in primary-school

enrolment since 1999, reaching 99 per centin 2008. Similarly, the United Republic oTanzania doubled its enrolment ratio overthe same period.Guatemala, Nicaragua andZambia also broke through the 90 per centthreshold towards greater access to primaryeducation.

Getting children into school is a vital frst step.But to receive the ull benefts o education,they must continue to attend classes. Inhal the countries in sub-Saharan Aricawith available data, more than 30 per cento primary-school students drop out beorereaching the fnal grade.



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barriers to education are also common. In many countries,educating girls is widely perceived as being o less valuethan educating boys. And children with disabilities acrossthe world ace ar more limited opportunities than their non-disabled peers.

The link between disability and marginalization in educationis evident in countries at all levels o development. In Malawiand the United Republic o Tanzania, being disabled doublesthe probability that a child will never attend school, and inBurkina Faso the risk rises to two and a hal times. Evenin some countries that are closer to achieving the goalo universal primary education, children with disabilitiesrepresent the majority o those who are excluded. In Bulgaria

and Romania, net enrolment ratios or children aged 7 to15 were over 90 per cent in 2002, but only 58 per cent orchildren with disabilities.

Inequality thwarts progress towards universal education

0

10

20

30

40

UrbanRuralRichest 20%Fourth 20%Middle 20%Second 20%Poorest 20%

Out-of-school children by wealth quintile and area of residence, girls and boys,

42 countries, 2000/2008 (Percentage)

Girls

Boys

1110

1917

2523

31

28

39

36

1514

31

27

Household data rom 42 countries show thatrural children are twice as likely to be out oschool as children living in urban areas. Thedata also show that the rural-urban gap isslightly wider or girls than or boys. But thebiggest obstacle to education is poverty. Girlsin the poorest 20 per cent o households havethe least chance o getting an education: theyare 3.5 times more likely to be out o schoolthan girls in the richest households and ourtimes more likely to be out o school as boysin the richest households. Boys rom therichest households are the least likely to beout o school (10 per cent), compared to all

other groups.

Children remain out o school or a variety oreasons, including cost. Social and cultural



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20

TARGET

Eliminate gender disparity in primary and secondaryeducation, preerably by 2005, and in all levels oeducation no later than 2015

Goal 3Promotegenderequality andempowerwomen

For girls in some regions, educationremains elusive

The developing regions as a whole are approaching genderparity in educational enrolment. In 2008, there were 96 girlsor every 100 boys enrolled in primary school, and 95 girlsor every 100 boys enrolled in secondary school. In 1999, theratios were 91:100 and 88:100 or the two levels o education,respectively. Despite this progress, gender parity in primaryand secondary educationa target that was to be met by

0 60 120

Developing regions

CIS


South-Eastern Asia

Eastern Asia

Northern Arica

Western Asia

Oceania

Southern Asia

Sub-Saharan Arica

Developing regions


Eastern Asia

South-Eastern Asia

Northern Arica

CIS

Oceania

Southern Asia

Western Asia

Sub-Saharan Arica

Developing regions

Eastern Asia

CIS

South-Eastern Asia


Southern Asia

Northern Arica

Western Asia

Sub-Saharan Arica

Oceania

20 40 80 100 140

82

121

115

95

66

74

82

81

65

71

88

107

93

95

93

101

89

75

76

83

91

101

99

96

97

84

90

87

85

91

97

130

125

107

100

95

92

84

76

67

95

108

105

103

98

98

87

87

86

79

96

104

99

97

97

96

94

92

91

89

Girls primary-school enrolment in relation to boys,

1998/1999 and 2007/2008 (Girls per 100 boys)

Primary

Secondary

Tertiary

1999

2008

2015

Target

= GPI

between97 and 103



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21

Poverty is a major barrier to education,especially among older girls

Poverty puts girls at a distinct disadvantage in terms oeducation. Girls o primary-school age rom the poorest 60per cent o households are three times more likely to be outo school as those rom the wealthiest households. Theirchances o attending secondary school are even slimmer,and older girls in general are more likely to be out o school.In the poorest households, about twice as many girls osecondary-school age are out o school compared to theirwealthier peers.

Household survey data also indicate that girls in rural areasace added challenges in getting an education and that thegender gap is much wider or girls o secondary-school age.

2005is still out o reach or many developingregions. For primary education, the steepestchallenges are ound in Oceania, sub-Saharan

Arica and Western Asia.

In secondary education, the gender gap inenrolment is most evident in the three regionswhere overall enrolment is lowestsub-Saharan Arica, Western Asia and Southern

Asia. In contrast, more girls than boys havesigned up or secondary school in Latin

America and the Caribbean, Eastern Asia andSouth-Eastern Asia.

In tertiary education, the ratio between girlsand boys in the developing regions is close toparity, at 97 girls per 100 boys. This is largelydue to the act that many more girls than boysare enrolled in higher education in the CIScountries, Latin America and the Caribbean,

Northern Arica and South-Eastern Asia. Butin most other regions, the number o boysheavily outweighs that o girls in collegesand universities. In sub-Saharan Arica andSouthern Asia, or example, only 67 and 76girls per 100 boys, respectively, are enrolled intertiary levels o education.

Other gender disparities ound in tertiaryeducation relate to areas o study, withwomen being overrepresented in thehumanities and social sciences andsignifcantly underrepresented in science,technology and, in particular, engineering.

Completion rates also tend to be lower amongwomen than men.

0

10

20

30

40

50

Proportion of girls and boys who are out of school, by

age and household wealth, in 42 countries with surveysduring 2001/2008 (Percentage)

109

30

25 24

19

50

37

Primary-school age Secondary-school age

Poorest 60%Wealthiest 40%Poorest 60%Wealthiest 40%

Girls

Boys



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In every developing region except theCIS, men outnumber women in paidemployment

Globally, the share o women in paid employment outsidethe agricultural sector has continued to increase slowly andreached 41 per cent in 2008. But women in some regionsare seriously lagging behind. In Southern Asia, Northern

Arica and Western Asia, only 20 per cent o those employedoutside agriculture are women. Gender equality in the labourmarket is also a concern in sub-Saharan Arica, where onlyone in three paid jobs outside o agriculture are occupied bywomen.

But even when women represent a large share o wagedworkers, it does not mean that they have secure, decent jobs.In act, women are typically paid less and have less secureemployment than men.

In countries where the agricultural sector predominates,women are mostly employed in agriculture and largely invulnerable jobsin subsistence arming, as unpaid amilyworkers or as own-account workerswith no or little fnancial

security or social benefts.

201520082005200019951990

Employees in non-agricultural wage employment who

are women, 19902008, and projections to 2015

(Percentage)

0

10

20

30

40

50

60

CIS


Eastern AsiaSouth-Eastern Asia

Sub-SaharanArica

Northern Arica

Southern Asia

Oceania

Western Asia

50.6 51.5

42.4

45.1

41.2

42.5

38.1

39.2

36.0

37.1

20.1 21.8

32.4

36.7

19.2

22.2

19.2 19.2



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23

Women are largely relegatedto more vulnerable orms oemployment

0 20 40 60 80 100

Developing regions


CIS


Western Asia

Northern Arica

Eastern Asia

South-Eastern Asia

Southern Asia

Sub-Saharan Arica

Oceania

Proportion of own-account and

contributing family workers in total

employment, 2009 projections

(Percentage)

65

26

17

31

37

53

58

65

84

84

85

57

30

20

32

26

28

50

58

74

71

73

Women

Men

The 2008 fnancial crisis has eroded employment aroundthe world. As both women and men lost their jobs,unemployment rates shot up, especially in the frst hal o2009. The good news is that the rate at which unemploymentis increasing appears to be slowing, according to the latest

data. However, the act that women are disproportionatelyrepresented in temporary employment, and occupy asubstantial share o jobs in export-oriented manuacturingindustries in many developing countries, may result in higherunemployment rates or women.

While the crisis has drawn attention to the levels ounemployment, the qualityo available jobs is also worrisome.Many wage and salaried workers who lost their jobs, aswell as many frst-time job seekers who entered the labourmarket in the midst o the fnancial turmoil, have resorted toown-account or unpaid amily work, resulting in deterioratingworking conditions and lower incomes or the poorest.Women are more likely than men to be in vulnerable jobs,with the gap being particularly evident in those regions where

paid employment opportunities or women are the lowestinWestern Asia and Northern Arica.



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Top-level jobs still go to men to anoverwhelming degree

Though the number o women who secured paid jobsoutside the agricultural sector increased between 1990 and2008, women have generally ailed to access higher-levelpositions. The top jobsas senior ofcials or managersarestill dominated by men. Globally, only one in our seniorofcials or managers are women. And in all regions, womenare underrepresented among high-level workers, accountingor 30 per cent or more o such positions in only three outo 10 regions. In Western Asia, Southern Asia and Northern

Arica, less than 10 per cent o top-level positions are held bywomen.

Women are overrepresented ininormal employment, with itslack o benefts and security

It is likely that the recent fnancial crisis hasalso led to a surge in inormal employmentdue to job losses in the ormal sector. Insome developing countries, over 80 per cento workers have inormal jobsas ownerso inormal-sector businesses, contributingamily workers or employees without written

contracts or social security benefts (includingsubcontracted workers operating rom homeand domestic services workers). In most othese countries, women are overrepresentedin inormal employment.

0 20 40 60 80 100

Russian Federation

Republic o Moldova

Turkey

Kyrgyzstan

Panama

Venezuela

Brazil (urban areas)

Mexico

Colombia

South Arica

Peru (metropolitan Lima)

Ecuador (urban areas)

India

Mali

Informal employment as a percentage

of total non-agricultural employment,

women and men, selected countries,

2003/2005 (Percentage)

10

25

35

47

49

47

50

48

61

51

65

73

84

74

8

18

36

41

50

52

52

54

62

65

72

77

88

89

Women

Men

0 10 20 30 40 50

Developed regions

Southern Asia

Northern Arica

Western Asia

Eastern Asia

Oceania

South-Eastern Asia

Sub-Saharan Arica


CIS

Share of women in top-level and all occupations,

average for the period 2000/2008 (Percentage)

20

20

24

45

39

39

45

36

45

49

9

9

10

16

21

26

29

32

32

37

All occupations

Senior officials

and managers



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25

Women are slowly rising topolitical power, but mainlywhen boosted by quotas andother special measures

The global share o women in parliamentcontinues to increase slowly and reachedan all-time high o 19 per cent in 2010.This represents a gain o 67 per cent since1995, when 11 per cent o parliamentariansworldwide were women. But it is ar shorto the target o 30 per cent o women in

leadership positions that was to be met by1995, and urther still rom the MDG target ogender parity.

Women make up 30 per cent or more o themembers o lower houses o parliament in 26countries and 40 per cent or more in sevencountries. There were 35 women presiding

0 5 10 15 20 25

World

Developing regions

Developed regions


Eastern Asia

South-Eastern Asia

Sub-Saharan Arica

Southern Asia

CIS

Western Asia

Northern Arica

Oceania

Proportion of seats held by women

in single or lower houses of national

parliaments, 2000 and 2010 (Percentage)

19

18

24

23

19.5

19

18

18

15

9

9

2.5

12

11

17

15

19.9

10

9

7

7

5

2

3.42000

2010

ofcers in 269 parliamentary chambers (13 per cent) inJanuary 2010, up rom 24 in 1995.

Following parliamentary elections and renewals in 2009, gainsor women were registered in sub-Saharan Arica, where 29

per cent o the renewed seats went to women, bringing theregional average up to 18 per cent. In South Arica, womentook 44 per cent o seats in the lower-house election, placingit third in terms o global ranking, ater Rwanda and Sweden.Similarly, there was some progress in most countries in Latin

America and the Caribbean, with 25 per cent o seats up orrenewal going to women. Bolivias upper house elected morethan 40 per cent women members, bringing the regionalaverage up to 23 per cent.

At the opposite end o the spectrum, 58 countries have 10per cent or ewer women members o parliament and, innine chambers, women have no seats at all. During 2009,no women gained seats in parliamentary renewals in theComoros, the Federated States o Micronesia and Saudi

Arabia.

Electoral systems, quota arrangements and other afrmativeaction measures taken by political parties continue to be keypredictors o progress or women. During 2009, the averageshare o women elected to parliament reached 27 per centin countries that applied such measures; in contrast, womengained only a 14 per cent share o seats in countries that didnot. Women are also elected in ar greater numbers undersystems o proportional representation, rather than majority/plurality systems.

In addition to electoral systems and quotas, gender-sensitiveelectoral arrangements, well-trained and fnanced women

candidates and political will at the highest levels o politicalparties and governments are key to overcoming genderimbalances in the worlds parliaments. Given that there arestill our men or every one woman in parliament, eorts willbe needed on all these ronts i the target o 30 per cent is tobe met.

Progress in achieving greater representation by women in theexecutive branches o government is even slower than in thelegislative branches. In 2010, just nine o 151 elected headso state (6 per cent) and 11 o 192 heads o government (6per cent) were women. This is an improvement over 2008,when only seven women were elected as heads o state andeight as heads o government. On average, women hold16 per cent o ministerial posts and only 30 countries have

more than 30 per cent women ministers. On the other hand,16 countries have no women ministers at all. The majority othese countries are in Northern Arica and Western Asia, theCaribbean and Oceania.



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Child deaths are alling, but not quicklyenough to reach the target

Substantial progress has been made in reducing childdeaths. Since 1990, the mortality rate or children under agefve in developing countries dropped by 28 per centrom100 deaths per 1,000 live births to 72 in 2008. Globally, the

total number o under-fve deaths declined rom 12.5 million in1990 to 8.8 million in 2008. This means that, in 2008, 10,000ewer children died each day than in 1990. An encouragingsign is the acceleration o progress ater the year 2000: theaverage annual rate o decline increased to 2.3 per cent orthe period 2000 to 2008, compared to 1.4 per cent in the1990s.

TARGET

Reduce by two thirds, between 1990 and 2015, theunder-fve mortality rateGoal 4

Reduce childmortality

0 50 100 150 200

Developing regions

Developed regions


CIS, Europe

Eastern Asia


Northern Arica

Western Asia

South-Eastern Asia

CIS, Asia

Oceania

Southern Asia

Sub-Saharan Arica

Under-five mortality rate per 1,000 live births,

1990 and 2008

184

144

121

74

76

60

39

73

38

66

32

80

29

52

23

45

21

26

14

30

12

12

6

100

72

78 1990

2008

2015 Target



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27

Revitalizing eorts against pneumoniaand diarrhoea, while bolstering nutrition,could save millions o children

Four diseasespneumonia, diarrhoea, malaria and AIDSaccounted or 43 per cent o all deaths in children underfve worldwide in 2008. Most o these lives could have beensaved through low-cost prevention and treatment measures,including antibiotics or acute respiratory inections, oralrehydration or diarrhoea, immunization, and the use oinsecticide-treated mosquito nets and appropriate drugs ormalaria. The need to reocus attention on pneumonia anddiarrhoeatwo o the three leading killers o childrenisurgent. The use o new tools, such as vaccines againstpneumococcal pneumonia and rotaviral diarrhoea, could addmomentum to the fght against these common diseases and

provide an entry point or the revitalization o comprehensiveprogramming. Ensuring proper nutrition is a critical aspect oprevention, since malnutrition increases the risk o death.

The greatest advances were made in NorthernArica, Eastern Asia, Western Asia, LatinAmerica and the Caribbean, and the countrieso the CIS. But most striking is the progressthat has been made in some o the worlds

poorest countries. Against steep odds,Bangladesh, Bolivia, Eritrea, Lao PeoplesDemocratic Republic, Malawi, Mongoliaand Nepal have all reduced their under-fvemortality rates by 4.5 per cent annually ormore. Ethiopia, Malawi, Mozambique andNiger have seen absolute reductions o morethan 100 per 1,000 live births since 1990.

Despite these achievements, and the actthat most child deaths are preventableor treatable, many countries still haveunacceptably high levels o child mortalityand have made little or no progress in recentyears. Whats more, among the 67 countries

with high child mortality rates (defned as 40or more deaths per 1,000 live births), only 10are on track to meet the MDG target on childsurvival. The highest rates o child mortalitycontinue to be ound in sub-Saharan Arica. In2008, one in seven children there died beoretheir fth birthday; the highest levels werein Western and Central Arica, where one insix children died beore age fve (169 deathsper 1,000 live births). All 34 countries withunder-fve mortality rates exceeding 100 per1,000 live births in 2008 are in sub-Saharan

Arica, except Aghanistan. Although under-fve mortality in sub-Saharan Arica has

declined by 22 per cent since 1990, the rate oimprovement is insufcient to meet the target.Furthermore, high levels o ertility, combinedwith a still large percentage o under-fvedeaths, have resulted in an increase inthe absolute number o children who havediedrom 4.0 million in 1990 to 4.4 million in2008. Sub-Saharan Arica accounted or halo the 8.8 million deaths in children under fveworldwide in 2008.

Under-fve mortality also remains very high inSouthern Asia, where about one in 14 childrendied beore age fve in 2008 and whereprogress is too slow to meet the 2015 target.

Causes of deaths among children under age five, 2008(Percentage)

41Neonatal

causes

12 Preterm births

9 Asphyxia

6 Sepsis

1 Diarrhoeal diseases

4 Pneumonia

1Tetanus

3 Congenitalanomalies

5 Other neonatalcauses

8Malaria

3 Injuries

2 AIDS 1 Measles

16Other causes

Globally, morethan one third ofchild deaths areattributable toundernutrition

14Pneu-monia

14Diarrhoeal

diseases



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Globally, routine immunization against measles has continuedto rise and protect millions o children against this otenatal disease. In 2008, coverage reached 81 per cent in thedeveloping regions as a whole, up rom 70 per cent in 2000.Such averages, however, mask signifcant inequalities in

access to the vaccine. Data rom 178 Demographic andHealth Surveys suggest that access to measles vaccinationsvaries across dierent social and economic groups, withlower coverage or children in households that are poor orlocated in rural areas, or whose parents have lower levelso education. Higher birth order (that is, having many oldersiblings) is also associated with lower measles vaccinecoverage. Disparities between girls and boys in immunizationcoverage are not signifcant, except in some South Asiancountries.

A single-dose vaccine strategy is not sufcient to preventmeasles outbreaks. As o 2008, a total o 132 countries useda two-dose schedule routinely. In countries with weak healthsystems, the second dose is oered during campaigns

to ensure high coverage. Between 2000 and 2008, thecombination o improved routine immunization coverage andthe provision o a second-dose opportunity led to a 78 percent reduction in measles deaths globallyrom an estimated733,000 deaths in 2000 to 164,000 in 2008.

But recent successes may be short-lived. Funding ormeasles-control activities has recently declined, andmany priority countries are conronting unding gaps orimmunization campaigns. Projections show that withoutsupplementary immunization activities in these countries,mortality will quickly rebound, resulting in approximately1.7 million measles-related deaths between 2010 and 2013.However, with sufcient unding, political commitment and

high-quality implementation o the second-dose measlesstrategy in priority countries, the exceptional gains made soar can be maintained.

Recent success in controllingmeasles may be short-lived iunding gaps are not bridged

0 20 40 60 80 100

Developing regions

Developed regions

CIS


Eastern Asia


Northern Arica

South-Eastern Asia

Western Asia

Southern Asia

Sub-Saharan Arica

Oceania

Proportion of children 12-23 months old

who received at least one dose of

measles vaccine, 2000 and 2008

(Percentage)

2000

2008

68

58

55

72

58

75

83

80

88

93

92

92

93

85

94

93

95

95

96

91

93

70

81

84



31/80


29



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30

Achieving good maternal health requires quality reproductivehealth services and a series o well-timed interventions toensure a womens sae passage to motherhood. Failure toprovide these results in hundreds o thousands o needlessdeaths each yeara sad reminder o the low status accordedto women in many societies.

Measuring maternal mortalitydeath resulting rom thecomplications o pregnancy or childbirthis challengingat best. Systematic underreporting and misreporting arecommon, and estimates lie within large ranges o uncertainty.Nevertheless, an acceleration in the provision o maternal andreproductive health services to women in all regions, alongwith positive trend data on maternal mortality and morbidity,

suggest that the world is making some progress on MDG 5.

New estimates o maternal mortality are currently beingfnalized by the World Health Organization (WHO), the UnitedNations Childrens Fund (UNICEF), the United NationsPopulation Fund (UNFPA) and the World Bank. Preliminarydata show signs o progress, with some countries achievingsignifcant declines in maternal mortality ratios. However, therate o reduction is still well short o the 5.5 per cent annualdecline needed to meet the MDG target. The complete dataset will be available at mdgs.un.org

TARGET

Reduce by three quarters, between 1990 and 2015, thematernal mortality ratioGoal 5

Improvematernalhealth



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31

Most maternal deaths could beavoided

The leading causes o maternal mortality indeveloping regions are haemorrhage andhypertension, which together account or halo all deaths in expectant or new mothers.Indirect causes, including malaria, HIV/

AIDS and heart disease, result in 18 per cento maternal deaths. Other direct causes,such as obstructed labour, complicationso anaesthesia or caesarean section, andectopic pregnancy, lead to 11 per cent o alldeaths during pregnancy or childbirth.

The vast majority o these deaths are

avoidable. Haemorrhage, or example, whichaccounts or over one third o maternaldeaths, can be prevented or managedthrough a range o interventions administeredby a skilled health-care provider withadequate equipment and supplies.

Giving birth is especially risky inSouthern Asia and sub-Saharan Arica,where most women deliver withoutskilled care

The proportion o women in developing countries whoreceived skilled assistance during delivery rose rom 53 percent in 1990 to 63 per cent in 2008. Progress was made in allregions, but was especially dramatic in Northern Arica andSouth-Eastern Asia, with increases o 74 per cent and 63 percent, respectively. Southern Asia also progressed, although

coverage there, as well as in sub-Saharan Arica, remainsinadequate. Less than hal the women giving birth in theseregions are attended by skilled health personnel.

Causes of maternal deaths, developing

regions, 1997/2007 (Percentage)

35Haemorrhage

18Indirect causes

18Hypertension

11Other direct

causes

9Abortion and

miscarriage

1 Embolism

8Sepsis

0 20 40 60 80 100

Developing regions

Developed regions


Eastern Asia

CIS

Latin America & the Caribbean*

Northern Arica

Western Asia

South-Eastern Asia

Oceania

Sub-Saharan Arica

Southern Asia

Proportion of deliveries attended by skilled health

personnel, 1990 and 2008 (Percentage)

94

97

72

46

62

46

54

41

98

30

98

98

86

80

78

75

57

46

99

9999

53

63

45

* Includes only deliveries in health-care institutions.

1990

2008



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UNITED NATIONS

32

The rural-urban gap in skilledcare during childbirth hasnarrowed

More rural women are receiving skilled assistance

during delivery, reducing long-standing disparitiesbetween urban and rural areas. In Southern Asia,or example, urban women were three timesmore likely as their rural counterparts to receiveproessional care at childbirth in 1990; by 2008,they were only twice as likely to receive such care,indicating some improvement. Still, inequalitiespersist, especially in regions where attendance byskilled personnel is lowest and maternal mortalityhighestnotably in sub-Saharan Arica, Southern

Asia and Oceania.

Serious disparities in coverage are also oundbetween the wealthiest and the pooresthouseholds. The widest gaps are in Southern Asia

and sub-Saharan Arica, where the wealthiestwomen are fve times more likely and three timesmore likely, respectively, as the poorest womento be attended by trained health-care workersat delivery. In the developing regions as a whole,women in the richest households are three timesas likely as women in the poorest households toreceive proessional care during childbirth.

More women are receiving antenatal care

TARGET

Achieve, by 2015, universal access to reproductivehealth

In all regions, progress is being made in providing pregnantwomen with antenatal care. Remarkable gains were recordedin Northern Arica, where the share o women who sawa skilled health worker at least once during pregnancy

increased by 70 per cent. Southern Asia and Western Asiareported increases o almost 50 per cent.

0.0 1.0 2.0 3.0 4.0

Eastern Asia

CIS in Asia

South-Eastern Asia

Northern Arica

Latin America & the Caribbean*

Western Asia

Oceania

Southern Asia

Sub-Saharan Arica

Ratio of urban women to rural women

attended by skilled health personnel during

delivery, 1990 and 2008

1.0

1.0

1.1

1.0

1.8

1.2

2.5

1.3

1.8

1.5

1.9

1.6

2.0

1.9

2.9

2.0

2.3

2.2

* Includes only deliveries in health-care institutions.

1990

2008

Parity: Rural women and urban women equally likely to

receive skilled care at delivery

0 20 40 60 80 100

Developing regions

CIS, Asia


South-Eastern Asia

Eastern Asia

Western Asia

Northern Arica

Sub-Saharan Arica

Southern Asia

Proportion of women attended at least once

during pregnancy by skilled health-care personnel,

1990 and 2008 (Percentage)

48

70

67

46

78

53

79

80

91

72

93

79

90

64

80

96

94

76

1990

2008



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UNITED NATIONS

34

Only one in three rural womenin developing regions receivethe recommended care duringpregnancy

Women should receive care rom atrained health-care practitioner at least

our times during the course o theirpregnancies, according to WHO and UNICEFrecommendations. However, less than halo pregnant women in developing regionsand only a third o rural women receive therecommended our visits. Among rural womenin Southern Asia, the share is only 25 percent.

Progress has stalled in reducing thenumber o teenage pregnancies, puttingmore young mothers at risk

In all regions, the adolescent birth rate (the number o births

per 1,000 women aged 15 to 19) decreased between 1990and 2000. Since that time, progress has slowed and, in someregions, increases have even been recorded. The highestbirth rate among adolescents is ound in sub-Saharan Arica,which has seen little progress since 1990. Adolescents,in general, ace greater obstacles than adult women inaccessing reproductive health services.

0 20 40 60 80 100

Developing regions

South-Eastern Asia

Southern Asia


Sub-Saharan Arica

Northern Arica

Proportion of women attended four or

more times during pregnancy by

area of residence, 2003/2008 (Percentage)

49

70

37

63

63

84

25

58

68

84

34

67

Rural

Urban

0 20 40 60 80 100 120 140

Developing regions

Developed regions

Eastern Asia

CIS

Northern Arica

South-Eastern Asia

Western Asia

Southern Asia

Oceania


Sub-Saharan Arica

Number of births per 1,000 women aged 15-19, 1990,

2000 and 2007

124

119

121

91

80

74

8363

61

89

5953

6252

53

53

39

44

43

3131

52

28

29

156

5

29

25

23

65

5552

199020002007



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35

Poverty and lack o education perpetuate high adolescent birth rates

Data or 24 countries in sub-Saharan Aricashow that adolescents in the pooresthouseholds are three times more likelyto become pregnant and give birth thanthose in the richest households. In ruralareas, adolescent birth rates are almostdouble those o urban areas. But the largestdisparities are linked to education: girls witha secondary education are the least likely tobecome mothers. The birth rate among girlswith no education is over our times higher.

Even more worrisome is the widening o

disparities over time. The adolescent birthrate declined in 18 o the 24 sub-Saharancountries studied. However, in almost allthese 18 countries the decline was largestamong adolescents living in urban areas,among those with at least a secondaryeducation, and among those belonging tothe richest 20 per cent o households. Thus,disparities between those groups and rural,less educated and poorer adolescents haveincreased, rather than decreased, over time.

0

50

100

150

200

250

RuralUrbanNo educationPrimaryeducation

Secondaryeducation

or more

Poorest20%

Second20%

Middle20%

Fourth20%

Richest20%

Adolescent birth rates by background characteristics in 24 sub-Saharan African countries,

1998/2008 (Number of births to women aged 15-19 per 1,000 women)

58

113

141

164

184

48

139

207

79

149



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UNITED NATIONS

36

2000 and a widening gap among regions. From 2000 to2007, the annual rate o increase in contraceptive prevalencein almost all regions was lower than it had been during the1990s. Moreover, contraceptive prevalence in sub-Saharan

Arica and Oceania continues to be very low. And in several

subregions, traditional and less eective methods ocontraception are still widely used.

Satisying womens unmet need or amily planningthat is,acilitating access to modern contraceptives by women whodesire to delay or avoid pregnancy but who are currently notusing contraceptioncould improve maternal health andreduce the number o maternal deaths. Recent estimatesindicate that meeting that need could result in a 27 percent drop in maternal deaths each year by reducing theannual number o unintended pregnancies rom 75 millionto 22 million. Preventing closely spaced pregnancies andpregnancies among adolescents would also improve thehealth o women and girls and increase the chances that theirchildren will survive.

The unmet need or amily planning remains moderate to highin most regions, particularly in sub-Saharan Arica, where onein our women aged 15 to 49 who are married or in union andhave expressed the desire to use contraceptives do not haveaccess to them.

Progress in expanding the useo contraceptives by womenhas slowed

During the 1990s, use o contraceptivesincreased among women in almost everyregion. By 2007, over 60 per cent o womenaged 15 to 49 who were married or in unionwere using some orm o contraception. Yetthis average masks two disturbing trends:a considerable slowdown in progress since

0 20 40 60 80 100

Developing regions

Developed regions

Eastern Asia


CIS

South-Eastern Asia

Northern Arica

Western Asia

Southern Asia

Oceania

Sub-Saharan Arica

Proportion of women who are using any

method of contraception among women

aged 15-49, married or in union,

1990, 2000 and 2007 (Percentage)

12

20

22

28

28

28

40

47

54

46

51

55

44

59

60

48

57

62

61

69

70

6271

72

78

86

86

70

71

71

52

60

62

199020002007



39/80


37

Use o contraception is lowest among the poorest women and those withno education

Ensuring that amily planning services reachpoor women and those with little educationremains particularly challenging. Surveysconducted in 22 countries in sub-Saharan

Arica show that contraceptive use to avoidor delay pregnancy is lowest among ruralwomen, among women with no schooling andamong those living in the poorest households.

0

10

20

30

40

50

Richest20%

Fourth20%

Middle20%

Second20%

Poorest20%

Secondaryeducation

or more

Primaryeducation

No educationUrbanRural

Contraceptive prevalence by background characteristics in 22 sub-Saharan African countries,

surveys around 1994-2003 and 1998-2008 (Percentage of women using at least onecontraceptive method among women aged 15-49, married or in union)

34

34

14

17

30

34

10 10

21

24

3942

10 10 1113 14

18

34

38

25

19

First survey: 1994-2003

Second survey: 1999-2008

In these countries, contraceptive use is our times higheramong women with a secondary education than among thosewith no education, and is almost our times higher amongwomen in the richest households than those in the pooresthouseholds. Almost no improvement has been made overtime in increasing contraceptive prevalence among women inthe poorest households and among those with no education.



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38

Inadequate unding or amily planning is a major ailure in ulfllingcommitments to improving womens reproductive health

Ensuring that even the poorest and mostmarginalized women can reely decide thetiming and spacing o their pregnanciesrequires targeted policies and adequatelyunded interventions. Yet fnancial resourcesor amily planning services and supplieshave not kept pace with demand. Aid or

amily planning as a proportion o total aid to

health declined sharply between 2000 and 2008, rom 8.2 percent to 3.2 per cent. Aid to reproductive health services hasuctuated between 8.1 per cent and 8.5 per cent. Externalunding or amily planning in constant 2008 US dollarsactually declined during the frst ew years o this decade andhas not yet returned to its 2000 level.

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

200820072006200520042003200220012000

0

20

40

60

80

100

Official development assistance to health, total (Constant 2008 US$ millions) and proportion

going to reproductive health care and family planning, 2000-2008 (Pe

55354020 millennium development goals report 2010

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