An overview of progress
The Special Session of the United Nations General Assembly in May 2002 was an incomparable historic occasion. For the first time, the General Assembly gathered with the exclusive intent of discussing children’s issues. In the resulting outcome document, Heads of State and Government committed themselves to building ‘A World Fit for Children’ and set targets in vital areas of children’s well-being and development, to be achieved during the decade ending in 2010. Five years on, UNICEF is responsible for reporting on progress towards these commitments. It is able to do so thanks to improved data collection and analysis, identified as a priority during the Special Session.
There is much good news to report on the four overarching categories of goals and targets set forth in ‘A World Fit for Children’, although the progress being reported is often mixed.
Promoting healthy lives
In 2006, for the first time, the number of children dying before their fifth birthday fell below 10 million, to 9.7 million – an important milestone in child survival. Around 1960, an estimated 20 million children under age five were dying every year – highlighting an important long-term decline in the global number of child deaths. These estimates were produced by the Inter-agency Group for Child Mortality Estimation, which includes UNICEF, the World Health Organization, the World Bank and the United Nations Population Division.
Yet, there are many countries that still have unacceptably high levels of child mortality, particularly in sub-Saharan Africa and South Asia, and have made little or no progress in reducing the number of child deaths in recent years. Many of these countries have been affected by conflict or ravaged by the AIDS epidemic.
The most recent survey data indicate significant improvements in several key child survival interventions that may result in measurable reductions in under-five mortality during the next several years. More than four times as many children received the recommended two doses of vitamin A in 2005 as in 1999. All countries with trend data in sub-Saharan Africa made progress in expanding coverage of insecticide-treated nets, a fundamental tool in halting malaria, with 16 of these 20 countries at least tripling coverage since 2000. In the 47 countries where 95 per cent of measles deaths occur, measles immunization coverage increased from 57 per cent in 1990 to 68 per cent in 2006. Rates of exclusive breastfeeding of infants have significantly improved in 16 countries of sub-Saharan Africa over the past decade, with 7 of these countries making gains of 20 percentage points or more. Yet, there has been less progress in expanding treatment coverage for major childhood diseases, such as pneumonia and malaria.
A recent analysis of trends between 1990 and 2005 suggests that insufficient progress has been made globally to reduce the maternal mortality ratio – Millennium Development Goal (MDG) 5 – although significant progress has been achieved in the East Asia/Pacific, Latin America/Caribbean, and Central and Eastern Europe/ Commonwealth of Independent States (CEE/CIS) regions. Progress has also been made in expanding coverage of antenatal care and skilled care at delivery – both critical for improving maternal health and well-being – with every region showing improvements during the past decade.
In addition, between 1990 and 2004, more than 1.2 billion people gained access to improved sources of drinking water, and the world is on track – although barely – to achieve the target for MDG 7. Sanitation coverage also increased during this same time period, though not at a rate sufficient to meet the MDG target.
Providing a quality education
Almost all regions have made significant progress in education. The gender gap at both primary and secondary levels began closing between 1990 and 2005. Increases in enrolment and attendance reduced the number of primary-school-age children who are out of school from 115 million in 2002 to 93 million in 2005–2006. Many countries are close to providing universal primary education, although some regions – the Middle East/North Africa, South Asia and sub-Saharan Africa – have net enrolment/attendance ratios of less than 90 per cent. Progress has also been made in secondary education, although less than in primary education. In sub-Saharan Africa, only one out of four children of secondary school age attends secondary school; throughout the world, one out of six children of secondary school age is still in primary school.
Combating HIV and AIDS
The number of people living with HIV worldwide has continued to rise; almost two thirds of all people with the virus live in sub-Saharan Africa. There has been some progress in increasing knowledge of how to prevent HIV transmission among young people aged 15–24, but levels of comprehensive correct knowledge of HIV are still too low, and condom use during higher-risk sex among young people remains low in most countries.
The same applies to the scaling up of services for preventing mother-to-child transmission of HIV and providing paediatric HIV treatment – some progress but not enough. Only 11 per cent of more than 2 million pregnant women living with HIV in low- and middle-income countries in 2005 received antiretroviral prophylaxis to prevent them from infecting their babies; Botswana, Brazil and Thailand are among seven countries that provided antiretroviral prophylaxis to more than 40 per cent of pregnant women with HIV. In low- and middle-income countries, only 15 per cent of children under age 15 in need of antiretroviral treatment in 2006 actually received it.
Protecting against abuse, exploitation and violence
Many child protection issues are now part of the measurement obtained through Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS). About 51 million children born in 2006 have not had their births registered; yet, important improvements in birth registration rates have occurred in such countries as Cambodia, the Gambia and Viet Nam. The prevalence of female genital mutilation/cutting has declined slowly but steadily during the past 15 years, and older girls and younger women are less likely to have undergone any form of this harmful traditional practice than older women. Child marriage is becoming less common in some countries, but the pace of change is often slow. UNICEF estimates that 158 million children between ages 5 and 14 are engaged in child labour. The challenge is in making use of household survey results to improve the lives of children affected by exclusion, abuse, exploitation and violence.
‘A World Fit for Children‘ and the Millennium Development Goals
These are just the headline developments; detailed reports of progress – or lack of it – on a wide range of indicators follow. This special issue of Progress for Children analyses progress at global, regional and country levels, and it highlights disparities within populations. The publication extends and develops the 2000 statistical review of progress since the World Summit for Children in 1990 and is a major effort to gather and analyse information on how well world leaders have kept their promises to children.
This statistical review is structured around the Millennium Development Goals because these are currently the focus of the world’s development efforts. Many of the World Fit for Children targets set at the Special Session are effectively stepping stones towards the 2015 MDGs, and governments will henceforth concentrate primarily on their MDG commitments. The World Fit for Children agenda includes vital issues for children not covered by the MDGs, and this publication represents a unique opportunity to report on these concerns.
Progress for Children is a statistical publication. But each statistic represents the lives of individual children, many of them blighted by ill-treatment or a lack of opportunity. Behind every one of these statistical assessments is a vision of a world in which children are healthy and reach their full potential, in which they are protected from disease and abuse – a world in which children’s rights across the board are fully realized.