Progress for Every Child in the SDG era
PROGRESS FOR EVERY CHILD IN THE SDG ERA This publication was developed by the Data and Analytics Section, Division of Data, Research and Policy in UNICEF HQ. Laurence Chandy, Mark Hereward and Priscilla Idele guided the strategic conceptualization and technical oversight for the development of this report. Analytical inputs, data analysis and further research were provided by Robert Bain, Jan Beise, Nassim Benali, Claudia Cappa, Liliana Carvajal-Aguirre, Mamadou Diallo, Martin Evans, Chika Hayashi, Lucia Hug, Aleya Khalifa, Julia Krasevec, Richard Kumapley, Chibwe Lwamba, Vrinda Mehra, Christina Misunas, Suguru Mizunoya, Padraic Murphy, Colleen Murray, Nicole Petrowski, Tyler Andrew Porth, David Sharrow, Tom Slaymaker, Pablo Suarez, Danzhen You and Xinxin Yu. Nassim Benali, Anna Grojec and Rada Noeva oversaw the project management and production of the report with editorial support from Anna Grojec, Erin Tettensor, Catherine Rutgers and Anna Mukerjee; graphic design by Camila Garay, Ane Louise Gaudert, Purva Sawant and Nona Reuter; and data checking and review support from Khin Wityee Oo and Ma. Eleanor Reserva. UNICEF Data and Analytics Section Division of Data, Research and Policy 3 UN Plaza, New York, NY 10017 www.data.unicef.org United Nations Children's Fund (UNICEF) March 2018 Are we on track to achieve the SDGs for children? Foreword 6 Abbreviations 8 Every child survives andthrives Child mortality 25 Births attended by skilled health personnel 30 Immunization 35 HIV 39 Nutrition 44 Every child learns Pre-primary education 54 Learning outcomes 58 Every child is protected fromviolence, exploitation andharmful practices Child marriage 65 Birth registration 69 Violent discipline 71 The SDGs and children Tracking progress for every child 9 Data and the SDGs 10 Trajectories towards the targets 15 Translating countries trajectories into prospects for children 15 Leaving no one behind 16 An agenda for action 17 9 22 52 62 Progress for Every Child in the SDG Era 5 76 86 94 Every child lives in a safeand cleanenvironment Basic drinking water, sanitation and hygiene services 78 Call to actionThe scope of the challenge 94 To change the situation of children, count them 99 An agenda for action on data 100 Every child has a fair chance in life Child poverty 87 Foreword The Sustainable Development Goals embody our highest aspirations for a better world and reflect our greatest responsibility as a global community: To provide children and young people today with the services, skills and opportunities they need tomorrow to build better futures for themselves, their families, and their societies. This understanding that a sustainable future depends on how we meet the needs of children and young people today is at the core of the SDGs, which include 44 child-related indicators integrated throughout the 17 goals. Progress for Every Child in the SDG Era, the first report of UNICEFs new SDG tracking series, provides a preliminary assessment of how the world is doing thus far on achieving these critical targets. Even for early days, the outlook the report reveals is foreboding. Most urgently, UNICEFs comprehensive report on SDG progress for children reveals that more than 650 million children approaching one-third of the worlds children live in 52 countries that are off track on at least two-thirds of the child-related SDG indicators for which they have data. The concerns raised by this news are compounded by the fact that these are only the children we know about. Progress for Every Child in the SDG Era also reveals that over half a billion of the worlds children live in 64 countries that lack sufficient data for us even to assess if they are on or off track for at least two-thirds of all child-related SDG indicators. This is a critical juncture in the SDG era: A time when the decisions we take and the investments we make can pay enormous dividends or extract an impossible price. While it would be both counterproductive and premature to predict failure, it is never too soon to calculate its potential costs. Given current trends, unless we accelerate progress to meet the child-related SDG targets, between 2017 and 2030, 10 million children will die from preventable causes before reaching their fifth birthdays. As many as 31 million children will be stunted, robbed of the opportunity to fulfil their potential for lack of adequate nutrition. At least 22 million children will miss out on pre-primary education, so critical to their later ability to succeed in school and beyond. And without faster progress, 670 million people worldwide will still be without basic drinking water, in turn threatening childrens survival and healthy development. We have a responsibility to reach these children and young people. They are depending on us to do so. But we cannot reach them unless we know who they are, where they are, and what challenges they face. And they cannot count on us unless we can count every one of them. Now, in these early years of opportunity and urgency, we must commit ourselves to leveraging every tool we have to help them in turn make the most of their lives. That means improving how we collect, analyse and use data. As this report shows, we are already seeing how global partnerships, national leadership and regional co-operation, and other shifts are improving our ability to collect data about the situation of children and young people, to identify those who are being left behind, and to monitor our efforts to reach them. We need to learn from these successes and build on them. UNICEF is committed to working with our partners to improve data for children and young people throughout the first two decades of life, to better understand the continuum and the unique challenges young people face as they transition into adulthood. Progress for Every Child in the SDG Era identifies three principles that will guide our own efforts. First, we need to improve the quality, coverage, and coordination of data systems, understanding that this is the foundation of strengthening delivery systems to save and improve the lives of children and young people. Second, just as we have pledged to leave no child behind, we must also leave no country behind, working actively together to ensure that every country has adequate data on children. This extends from encouraging the governments of high-income countries to systematically report on SDG performance, to Progress for Every Child in the SDG Era 7 developing innovative data solutions for conflict- and disaster-affected countries where regular surveys and routine data systems may not be feasible. Third, the global community needs to commit itself to developing international norms and standards for data collection and analysis that all countries can use and adapt to meet their particular circumstances and that we can all use to develop common approaches to reaching the children in greatest need and at greatest risk. Cutting across all of these is the need to shift our focus from short-term fixes to long-term investments that yield more sustainable benefits, as well as the equally great need to work in partnerships, co-creating solutions to overcome barriers to our progress. With so much at stake, we cannot afford to blindfold ourselves with the hope that we are moving in the right direction. Achieving a sustainable tomorrow depends on identifying the needs of children and young people today. And achieving the SDGs for everyone means making progress for every child by counting every child. UNICEF Executive DirectorHenrietta Fore AARC average annual rate of change AARR average annual rate of reduction DHS Demographic and Health Surveys DTP3 three doses of combined diphtheria-tetanus-pertussis vaccine ECDI Early Childhood Development Index FGM/C female genital mutilation/cutting MCV1 first dose of measles-containing vaccine MDGs Millennium Development Goals MICS Multiple Indicator Cluster Surveys MMEIG Maternal Mortality Estimation Inter-Agency Group (United Nations) MPI Multidimensional Poverty Index OECD Organisation for Economic Co-operation and Development OPHI Oxford Poverty and Human Development Initiative PISA Programme for International Student Assessment (OECD) SDGs Sustainable Development Goals UIS UNESCO Institute for Statistics UNAIDS Joint United Nations Programme on HIV/AIDS UNESCO United Nations Educational, Scientific and Cultural Organization UNDP United Nations Development Programme UNEP United Nations Environment Programme UNFPA United Nations Population Fund UN IGME United Nations Inter-agency Group for Child Mortality Estimation WASH water, sanitation and hygiene WHA World Health Assembly WHO World Health Organization Abbreviations Progress for Every Child in the SDG Era 9 It has been two years since the international community unanimously agreed on the 2030 Agenda for Sustainable Development and the associated Sustainable Development Goals (SDGs), and the transformation this new agenda calls for is still being worked out. While the processes through which the goals are being implemented may seem far removed from realities on the ground, the consequences of their outcomes could not be more concrete. For millions of children, the extent to which the world delivers on the SDG promise will determine the course of their lives affecting their chances of surviving their early years, growing and thriving physically, learning and developing their minds to their full potential, and participating actively in their communities and the wider world. And childrens lives determine the future of this planet. The SDGs are not just a continuation of previous efforts, like the Millennium Development Goals, that sought to measure and thereby spur progress in global development. They are a quantum leap above them. The new agenda is universal in scope, speaking to the range of challenges facing the worlds countries, rich and poor alike. It covers a broad array of topics with an expansive monitoring framework of 17 goals, 169 targets and 232 indicators. And it embodies sheer ambition aiming to not just reduce the occurrence of preventable child deaths or extreme poverty, but to eliminate them outright, and to not merely expand access to vaccines or basic sanitation, but to make that coverage universal, so that no one is left behind. These goals place the worlds most vulnerable and marginalized people, including children, at the top of the agenda. But its plan will remain unfulfilled if, when 2030 comes, girls continue to see their options curtailed due to gender discrimination. It will have failed if efforts to ensure that women receive maternity care stop short of dismantling the barriers that keep women in ethnic or racial minorities from accessing those services. The SDGs and children The SDG promise will have faltered if the push to bring children into schools and learning does not include accommodations for children with disabilities, or provide for children whose education is disrupted by conflict or disaster. And it will not be fulfilled if children in remote rural areas remain deprived of the identity documents they need to claim their rights, or if children living in cities poorest neighbourhoods do not have access to safe water. The SDGs address a full range of issues relating to childrens rights and welfare, amounting to a strong expression of the Convention on the Rights of the Child. And their explicit aim to leave no one behind raises the stakes: In making and measuring progress towards the SDGs, every child counts. Tracking progress for every child Progress for Every Child in the SDG Era assesses advancements towards achieving the global SDG targets that have a bearing on childrens rights and well-being. Based on current trends, this report makes projections to 2030 in order to identify areas where greater efforts are needed. In the process, it spotlights the availability of internationally comparable data to track progress towards the global targets (see Box 0.1). In addition to tracing national trajectories to the targets, the report examines trends among subnational groups of children, such as girls and boys, and children in urban and rural areas. The overall conclusion is that it is very hard to measure trajectories towards the global targets in many cases, the data are not available. When trajectories can be measured, many countries are not on track to reach the global targets by 2030. The SDGs and children Data and the SDGs Various United Nations agencies have been requested to support countries in data collection for specific sets of indicators, leaving the broader targets and goals to be supported by all. Instead of producing goal-by-goal reports, agencies are encouraged to report on themes that bring together issues across goals. This is the first full thematic report on the SDGs that directly concerns children. The 44 SDG indicators, situated under nine goals, are directly relevant to childrens rights and welfare (see the Methodology Note document at ). This report maps the indicators onto five dimensions of childrens rights: the right to good health, to learn, to be protected from violence and exploitation, to live in a safe and clean environment, and to have a fair chance to succeed in life. Organizing the indicators in this way reflects the fact that the issues and solutions they concern are interrelated rather than confined to individual sectors (see Table 0.1). In most cases, the data used in this report were drawn from UNICEF global databases, compiled annually from countries and quality assured for comparability. Other data were accessed from the SDG online databases maintained by the United Nations Statistics Division. Among the total 44 indicators, there are five for which a target or trend cannot be established for various reasons (italicized in Table 0.1). Three more do not have any comparable data available at the global level, in part because they are new and agreed-upon methodologies have not yet been established. From among the remaining 36 indicators, 14 have been chosen for more in-depth analysis in this report. For these indicators, it is possible to perform disaggregated analysis that looks beyond national aggregates to compare progress for subnational groups of children for instance, those belonging to wealthier or poorer households. This analysis, however, merely scratches the surface of inequity: Other important disparities, such as ethnicity or disability, cannot be captured in this global report based on internationally comparable data. BOX 0.1 Internationally comparable data and global targets This thematic SDG report uses internationally comparable data from the global databases held by UNICEF and other agencies on behalf of the international community. (Details on the methodology and data sources, by indicator, are listed in the Methodology Note document at ). National data sets that address the same issues, but are not directly comparable cannot be used for the purposes of the report. Similarly, global rather than national targets are used to gauge progress on the SDG indicators, including in the country profiles that complement this report and can be accessed at . UNICEF remains committed to the localization of SDG targets, but in a global report, only the global indicators are available and comparable. Progress for Every Child in the SDG Era 11 Notes: The official list of SDG indicators includes 232 indicators on which general agreement has been reached. Please note that the total number of indicators listed in the global indicator framework of SDG indicators is 244. However, since nine indicators repeat under two or three different targets, the actual total number of individual indicators in the list is 232 (see ). While all 44 indicators covered in this report relate to the SDG agenda, some marginally differ from those adopted in the SDG monitoring framework. SDG 1: No PovertySDG 2: Zero HungerSDG 3: Good Health and Well-beingSDG 4: Quality EducationSDG 5: Gender EqualitySDG 6: Clean Water and Sanitation SDG 7: Affordable and Clean Energy SDG 8: Decent Work and Economic GrowthSDG 9: Industry, Innovation and Infrastructure SDG 10: Reduced InequalitySDG 11: Sustainable Cities and CommunitiesSDG 12: Responsible Consumption and Production SDG 13: Climate ActionSDG 14: Life Below Water SDG 15: Life on LandSDG 16: Peace, Justice and Strong InstitutionsSDG 17: Partnerships for the Goals Figure 0.1 Child-related SDG indicators and the subsets examined in this report 44 child-related indicators are integrated across the 17 SDGs. This report arranges these indicators into five dimensions of childrens rights: the rights to survive and thrive, to learn, to be protected from violence, to live in a safe and clean environment, and to have an equal opportunity to succeed. Progress for Every Child in the SDG Era 13 SDG 2: Stunting, wasting, overweight SDG 3: Births attended by skilled personnel, under-five mortality, neonatal mortality, new HIV infections (children under 5, adolescent girls and boys 10-19 years), essential health services, MCV1, DTP3, maternal mortality ratio, malaria incidence, adolescent birth rate* SDG 4: Minimum proficiency in reading and mathematics in lower secondary, children under-five developmentally on track, participation in organized learning one year before primary, proportion of schools with access to WASH SDG 1: Basic drinking water, sanitation and hygiene services SDG 1: Extreme poverty, below national poverty line, multi-dimensional poverty, social protection floors/system SDG 3: Mortality rate from household/ambient air pollution SDG 6: Safely managed drinking water, safely managed sanitation services, handwashing facilities, open defecation SDG 7: Clean fuels used SDG 13: Deaths from natural disasters* SDG 5: Violence against girls by intimate partner, violence against girls by someone other than intimate partner, child marriage, female genital mutilation/cutting SDG 8: Child labour SDG 16: Intentional homicide, conflict-related deaths*, violence from caregiver, sexual violence on girls and boys under 18, birth registration Every child survives and thrives Every child learns Every child is protected from violence, exploitation and harmful practices Every child lives in a safe and clean environment Every child has a fair chance in life Five dimensions of childrens rights * Five italicized indicators are excluded from a full assessment due to methodological or measurement challenges. Source: UNICEF analysis of global databases, 2017. In the analysis for this report, 39 indicators were assessed for progress, subject to availability of data. Whenever possible, trajectories for the indicators were established to determine whether: the associated global targets have already been met; the current trend would lead to achievement of the global targets; or progress would need to speed up to achieve the global targets by 2030. In some cases, there are no data or the available data are not sufficient to calculate a trend, making it impossible for the assessment to determine a trajectory. The methodology used to identify trajectories varied across indicators, according to established practices from simple linear extrapolations to the sophisticated curve fitting of annual estimates produced by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Further details on methodology and data sources are provided in the Methodology Note document at . The results of this analysis are presented in a series of dials, which appear in figures throughout the report. Each dial has five categories: Data availability and progress vary across the five broad dimensions of childrens rights Figure 0.2Share of countries assessed on progress towards global SDG targets, averaged across indicators grouped into five dimensions of childrens rights Every Child Survives and Thrives Every Child Learns Every Child is Protected from Violence and Exploitation Every Child Lives in a Clean and Safe Environment Every Child has a Fair Chance in Life 2225 29 1113 15 5 5 12 63 64 4 16 14 2 34 12 16 14 24 34 3 63 BOX 0.2 How to read the dials Target met the country has already achieved the global SDG target. On track the current rate of progress is sufficient to achieve the global target by 2030. Acceleration needed on current trends, the global target will not be met by 2030. Insufficient trend data there are not enough data points to establish a trend and make a projection to 2030. No data internationally comparable data of sufficient quality, coverage and recency are not available in UNICEF global databases. The dials in Figure 0.2, for example, illustrate progress across 39 indicators, organized into the five dimensions of child rights and weighted by the number of countries. Each dial represents a vast aggregation exercise, combining the performance of each country on each of the relevant indicators in that dimension. The survive and thrive dimension, for instance, comprises 12 indicators assessed across 202 countries, generating 2,424 country-indicator pairs. Just 11 per cent of these are on track, illustrated by the dark blue section of the dial. That rate of achievement will be distributed unevenly across the 12 indicators included in the dimension and across the countries, with some recording an achievement rate of global SDG targets far better than 11 per cent, and others faring much worse. No data Insufficient trend data On track Target metAcceleration needed Progress for Every Child in the SDG Era 15 Trajectories towards the global targets Many SDG reports have focussed on establishing baselines to indicate the starting point for achieving the goals. However, this approach can be limited as the results reinforce what is already known that the SDGs are ambitious, and that poor countries, and especially those in fragile conditions, start furthest from the goals. Establishing trajectories makes it possible to see whether countries are on track to achieve the targets. A countrys trajectory is more than a starting point it indicates the speed of movement towards reaching the target. Determining existing trajectories shows where and when countries need to correct their course, and where they should apply additional efforts to reach the subgroups of children at greatest risk of being left behind. The overview of progress and data availability encapsulated in Figure 0.2 offers a grim picture and a foreboding outlook: In each of the five dimensions, only a minority of countries have met targets or are on track to meet them by 2030. And for most indicators and countries, there are insufficient data to be able to assess whether targets are on track or not. Where data are available for particular countries and indicators, an alarming number require an acceleration if global targets are to be reached. Over half a billion (520 million) children are effectively uncounted, living in countries that have insufficient data to assess whether they are on track for at least two-thirds of the global targets. An additional half a billion (533 million)* children live in countries where the promise of the SDGs remains out of reach, as their current trajectory will leave them short of at least two-thirds of the targets on which they can be assessed. Progress varies across the five dimensions of child rights, as does the availability of trend data, because the balance between indicators that have long been measured and those for which measurement is just beginning varies from one dimension to another. In this regard: Progress on the survive and thrive dimension is relatively strong, with a slim majority of targets having been met or being on track, among those countries and indicators for which we have data. Data coverage is far from complete, but is strongest in this dimension compared to the others. Building on the data coverage developed under the MDG framework, most countries can be assessed on most of the 15 indicators. In the learning dimension, among those countries for which there are data, only a minority can claim to be on track on the five indicators analysed for this report. Data are insufficient to draw trends for the bulk of countries and indicators, reflecting the failure to agree and roll out measures of learning achievement at the global level. The situation looks similar or worse under the protection dimension. A combination of ambitious targets and a relatively immature monitoring framework result in a very small number of countries being on track for just a few of the nine indicators that are analysed. In most cases, data are insufficient to uncover trends. The environment dimension is mixed, with a majority of targets for the eight indicators analysed having been met or being on track, among those countries and indicators with data. But insufficient data still dominate the dimension as a whole. The availability of data in the fair chance dimension is the worst among all five dimensions. It is almost impossible to assess performance against targets for the four indicators analysed here. Baselines are just now being established for child poverty measures in many countries, so reliable trajectories cannot yet be developed. The thematic chapters that follow look at progress, one indicator at a time, across the five broad dimensions of child rights. Translating countries trajectories into prospects for children While all countries have a role to play in achieving the SDGs, the agenda is also intended to be people centred which implies we should care equally for every child, no matter what country they live in. For this reason, this report presents trajectories towards the targets in two ways: The first is weighting by country to show the proportion of countries in each of the five dimensions. (This approach is illustrated in Figure 0.2) The second type of analysis is weighting by country population to account for the number of affected children. Because countries populations vary widely, this can shift the resulting picture. Figure 0.3 examines the six WASH indicators of the environment dimension, weighted by country (left) and by child population (right). When analysis shifts from one to the other, the share of targets already met shrinks from 14 per cent to 8 per cent, while the share needing acceleration rises from 18 per cent to 27 per cent. Those countries that need to move more quickly to meet the targets are home to large numbers of children. * When analyzing the number of children who live in countries where the promise of the SDGs remains out of reach independently from the number of children who are effectively uncounted this figure becomes 650 million children who live in countries where at least two-thirds of the SDGs are out of reach without accelerated progress. The SDGs and children Leaving no one behind The overarching SDG principle of leaving no one behind raises the stakes: It is no longer enough to monitor progress by global aggregates or national averages alone. Results need to be disaggregated to monitor progress among subnational groups of people, especially those who are more vulnerable such as girls, children living in remote rural areas or informal urban settlements, those living in poverty or close to it, or children with disabilities. Some countries reporting on the 14 indicators examined in depth in this report have sufficient data to disaggregate performance by subnational population groups and in some cases to investigate the trajectories for those subgroups. For example, while 8 per cent of children across the world live in countries that have achieved targets for the six WASH indicators in the environment dimension, the same can be said for just 3 per cent of the rural population, but 12 per cent Figure 0.3Progress towards SDG targets for six WASH indicators of a safe and clean environment: (a) Proportion of countries in each category (b) Proportion of children living in countries in each category 14 16 2118 30 8 15 1927 31 No data Insufficient trend data On track Target metAcceleration needed Source: WHO/UNICEF JMP 2017. Trajectories are often different when viewed by child populations rather than number of countries of the urban population (see Figure 0.4). Compared to children in urban areas, 50 per cent more children living in rural areas will not see the global targets met unless progress accelerates. This approach reveals significant subnational disparities across the five dimensions of childrens rights, showing that prospects for achieving the targets are worse among particular groups of children such as children from poorer households, for the under-five mortality target and rural children for universal birth registration. Beyond what is highlighted here, other types of disparities curtail childrens opportunities and compromise their rights and well-being. Across the world, children with disabilities, refugee and migrant children, children belonging to indigenous groups or other ethnic or Progress for Every Child in the SDG Era 17 BOX 0.3 Country-by-country analysis In addition to analysing all countries together in each thematic chapter, this report is accompanied by a collection of 202 country profiles (available at ). Each profile provides a stocktaking of the countrys performance against the 44 child-related SDG indicators, and aggregates the results into five dials to provide an overall assessment of child welfare organized into the dimensions used throughout the report. The countries are assessed using the global targets, as we do not have access to most countries national targets. The profiles offer a powerful tool for quantifying the scale of the challenge posed by the SDG targets and identifying areas where the most effort is required to reach targets or improve monitoring. An agenda for action For all the fanfare of the past two years, it will take a concerted effort to get the world on track to achieve the SDGs. A step change is needed to document the situation of children, and based on that assessment, to target efforts to reach those facing the greatest risk of being left behind. The SDG monitoring framework must catch up with the aspirations of the new goals, which required identifying new indicators and determining how to measure them. This entails rewiring existing data systems and building new ones an effort that will take time to develop and institutionalize by expanding household surveys and improving administrative data. Many types of data are derived from civil registration systems, which are still under development in many countries. Norms for credible monitoring are yet to be established in some emerging and sensitive areas, such as violence against children, with little tradition of monitoring or know-how to carry it out correctly. The race is on, both to improve monitoring and to accelerate performance against the goals. The stakes are high for the most indispensable constituency of the 2030 Agenda children as they rely on the leadership of todays international community to secure their present well-being, their future, and the well-being of the planet that sustains us all. Achieving water, sanitation and hygiene targets will take greater efforts among rural populations Figure 0.4Proportion of urban (outer dial) and rural (inner dial ) child population living in countries in each category of progress towards SDG targets, for six WASH indicators of a safe and clean environment 13 22 13 23 23 12 3028 33 3 Rural Urban No data Insufficient trend data Acceleration needed On track Target met racial minorities among others are at risk of being left behind, even as their countries may make progress. Likewise, the trends for poor children in rural areas that show less progress compared to urban areas on many indicators can also remain largely invisible in the data. Lack of internationally comparable data disaggregated by disability, migration status, ethnicity and other factors means that this global report cannot provide a full picture of the inequities that hamper the worlds chances of achieving the SDGs and childrens chances of realizing their rights. Source: WHO/UNICEF JMP 2017. The SDGs and children Some data may be older than it appears A major focus of this report is the availability of data, but not all data have equal quality. Some are too old to provide a reliable assessment of the status quo, or to predict how children would fare if rates of progress continue. Just over half of the 8,888 country indicators 44 indicators across 202 countries include data points from the past seven years, as indicated in the figure below However, some data that fall under 2011-2017 were actually produced by models fitted to older data points and projected or extrapolated forward to the most recent year. This is the case for indicators of under-five and neonatal mortality, maternal mortality, HIV incidence, immunization, and water and sanitation. While there seem to be plenty of recent data for crucial indicators in these areas, the data problem is bigger than it first appears. Progress for Every Child in the SDG Era 19 No data 2006-2010 2011-2017projected estimates (in some cases based on pre-2011 data) 2011-2017 2005 or earlier 71 Figure 0.5Proportion of countries, by average of latest data for all child-related SDG indicators, for each dimension of childrens rights and all indicators together All indicators across the five dimensions of childrens rights Every Child Survives and Thrives Every Child Learns Every Child is Protected from Violence and Exploitation Every Child Lives in a Clean and Safe Environment Every Child has a Fair Chance in Life Proportion of countries Source: UNICEF analysis of global databases, 2017. 28 0.2 1 56 14 63 0.2 4 33 0.3 2 35 1 5 29 21 63 21 2 7 52 18 44 1 7 22 Milana, 2 years old, stands in the house where she lives with her family. The house was severely damaged by shelling during the conflict in eastern Ukraine. UNICEF/UN048874/Filippov survive + thrive 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture 2.1 By 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round. 2.1.2 Prevalence of moderate or severe food insecurity in the population, based on the Food Insecurity Experience Scale (FIES) - - - 2.2 By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons. 2.2.1 Prevalence of stunting among children under 5 (numbers and %) 0.0003 mil-lion (1.8%)-46.1 million (55.9%) 155 million (22.9%) 99 million** 2.2.2.a Prevalence of wasting among children under 5 (%) 0.3%-21.5% 7.7% <5% 2.2.2.b Prevalence of overweight among children under 5 (%) 0.6%-22.3% 6.0% 5.7%*** 3: Ensure healthy lives and promote well-being for all at all ages 3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births. 3.1.1 Maternal mortality ratio (maternal deaths per 100,000 live births) 3-1360 216 70**** 3.1.2 Proportion of births attended by skilled health personnel (%) 19%-100% 78% Universal coverage 3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-five mortality to at least as low as 25 per 1,000 live births. 3.2.1 Under-five mortality rate (deaths per 1,000 live births) 2-133 41 25 3.2.2 Neonatal mortality rate (deaths per 1,000 live births) 1-46 19 12 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. 3.3.1 Number of new HIV infections per 1,000 uninfected population (children under 5) <0.01-4.5 0.29 <0.001 3.3.1 Number of new HIV infections per 1,000 uninfected population (adolescent girls 15-19) 0.01-24.34 0.59 <0.001 3.3.1 Number of new HIV infections per 1,000 uninfected population (adolescent boys 15-19) <0.01-6.09 0.30 <0.001 3.3.3 Malaria incidence per 1,000 population <1-449 63 Reduction of at least 90% from 2015 baseline Progress for Every Child in the SDG Era 23 Table 1.1Indicators related to childrens right to survive and thrive GOAL TARGET INDICATORRange of country estimates* Global estimate 2030 Global target 3: Ensure healthy lives and promote well-being for all at all ages 3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. 3.7.1 Percentage of women of reproductive age (15-49 years) who have their need for family planning satisfied with modern methods (%) 16%-90% 78% Universal coverage 3.7.2 Adolescent birth rate (births per 1,000 girls 15-19) 1.6-206 44 - 3.8 Achieve universal health coverage (UHC), including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all. 3.8.1 Population coverage of essential health services (%) - - - 3.b Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all. 3.b.1 Proportion of the target population covered by all vaccines included in their national programme MCV1 (%) 20-99% 85% 95% 3.b.1 Proportion of the target population covered by all vaccines included in their national programme DTP3 (%) 19-99% 86% 95% Notes: Under SDG 2, the original SDG targets refer to the World Health Assembly targets for 2025. 2030 targets have been proposed and noted in January 2018 but are not used in this report. The 2030 targets can be accessed by visiting .Under SDG 3, our analysis assumes universal coverage as a target for the skilled birth attendant indicator, which does not have an explicit SDG target. This is based on the target Ending Preventable Maternal Mortality (EPMM), for which one of the strategic objectives is to ensure universal health coverage for comprehensive sexual, reproductive, maternal and newborn health care.Under SDG 3, globally agreed-upon targets for the three indicators under 3.3.1 were only available for 2020 as of August 2017. The AARR necessary to achieve 2020 targets was extrapolated to determine a 2030 target. Using this method, each countrys 2030 target for both children (18% AARR) and adolescents (10% AARR) was below 0.001 new HIV infections per 1,000 uninfected population. - Not available.* The country estimates in this table are based on 2011-2016 data.** The target for stunting is a 40 per cent reduction, by 2025, in the number of children stunted from the 2012 baseline. Taking into account the projected population under age 5, this translates into a prevalence of around 14.7 per cent for stunting in children in 2025.*** The target for overweight is zero increase in prevalence from the 2012 baseline.**** 70 maternal deaths per 100,000 live births is the global target. At the country level, the target is a reduction of at least two thirds from the 2010 baseline (no country should have a ratio higher than 140 deaths per 100,000 live births). Only country-specific (rather than global) targets are set for indicators 3.2.1 and 3.2.2. As of August 2017, final immunization indicators had not been adopted for targets 3.8.1 and 3.b.1. In the absence of globally agreed indicators, the targets of at least 95 per cent for coverage of MCV1 and DTP3 are considered in this report. survive + thrive Childrens prospects in life begin to take shape before they are born, while the circumstances of their earliest and most vulnerable years have a critical impact on their ability to survive, grow and develop to their full physical and cognitive potential. Ensuring that every child survives and thrives hinges on a combination of high-impact interventions including quality antenatal, delivery and postnatal care for mothers and their newborns, prevention of mother-to-child transmission of HIV, immunization to protect children from infectious diseases and access to adequate and nutritious food. These interventions and related issues are addressed in SDG 2 and SDG 3. Of the range of indicators that contribute to the survive and thrive dimension of child rights, on average: about one quarter has been achieved by countries; more than one quarter needs acceleration; and about one third have insufficient (or no) data. Many indicators do not have enough data coverage to be examined in depth. But data are available concerning under-five mortality, skilled attendant at birth, immunization, HIV infection and malnutrition, among others. The trajectories for these indicators show the extent to which SDG 2 and SDG 3 are on track, while disparities in those trajectories spotlight the children at risk of being left out if the world does not make greater efforts to reach them. Every child survives and thrives Figure 1.1Proportion of countries in each category of progress towards SDG targets for indicators of child and maternal mortality, nutrition, delivery care, adolescent birth rate, new HIV infections, and immunization 2225 29 1113 No data Insufficient trend data Acceleration needed On track Target met Note: For an explanation of the dial charts throughout this report, see How to read the dials, p. 14.Source: UNICEF analysis of global databases, 2017. Faster progress is needed on 1/4 of indicators related to a childs ability to survive and thrive Progress for Every Child in the SDG Era 25 Many factors play into whether or not a child survives her or his early years. Neonatal complications and infectious diseases such as pneumonia, diarrhoea and malaria are the leading causes of death among children under age 5. Undernutrition contributes directly or indirectly to nearly half of these deaths, while maternal health is another important factor, especially regarding newborn mortality. Child mortality is thus a key indicator not only for child health and well-being, but for overall progress towards the SDGs. The world has made tremendous strides in promoting child survival. Since 2000, the global under-five mortality rate has been reduced by 47 per cent from 78 deaths per 1,000 live births in 2000 to 41 deaths per 1,000 live births in 2016. That translates into some 50 million childrens lives saved, many of them in low-income and lower-middle-income countries. Even so, the number of children dying before age 5 remains very high: 5.6 million died in 2016 alone. And the burden is not evenly shared: Newborns now account for a growing share of under-five deaths, as progress in reducing neonatal mortality has been slower. Mortality levels tend to be higher among poorer children, and even as levels have decreased overall, relative disparities remain. Child mortality Trajectories The SDG target aims to reduce countries under-five mortality rate to 25 deaths per 1,000 live births or below, ending preventable deaths among children under age 5. To reach the child mortality target, nearly 3 in 10 countries will have to accelerate their progress. About the same proportion of the worlds children under age 5 live in these countries, which amounts to 191 million children in the 195 countries with available mortality estimates in 2016. If current trends continue in each country: Globally, some 60 million children under 5 will die between 2017 and 2030 from largely preventable causes but meeting the target would avert 10 million of these deaths. More than half of these deaths will occur in sub-Saharan Africa, and close to a third in South Asia. Countries vary widely in the size of their population so the number of countries that have met the targets, are on track or need acceleration may not clearly illuminate prospects for the worlds children. Figure 1.2 offers a comparison of the mortality trajectories by country (on the left) and by number of children under 5 (on the right). When progress is assessed by child population: The proportion on track grows, as the 14 per cent of countries in this category represent 32 per cent of all children under age 5. The category includes India, which accounts for 18 per cent of the worlds children under 5. The proportion for target met shrinks, and the 59 per cent of countries represent just 40 per cent of the worlds children. While the target met category includes one very populous country China, which accounts for 13 per cent of the under-five population many of the other countries have much smaller populations. survive + thrive Figure 1.2Progress towards SDG under-five mortality target: (a) Proportion of countries in each category (b) Proportion of under-five population living in countries in each category 59 14 27 191 millionchildren 40 28 32 No data Insufficient trend data On track Target metAcceleration needed Source: UNICEF analysis based on United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) estimates 2017. Nearly 3 in 10 countries need to accelerate progress and they account for about the same proportion of the worlds children under 5 Child mortality Progress for Every Child in the SDG Era 27 Figure 1.3Projected neonatal mortality rate by 2030 if current trends continue, in countries that need to accelerate progress in reducing their neonatal mortality rate to achieve the SDG target BOX 1.1 Countries lag even further behind in reducing neonatal mortality Almost 40 countries need to at least double their current rate of progress to meet the neonatal mortality target by 2030 Less than 2x 2 3x 3 5x 5x or more On current trends, more than 60 countries will miss the SDG neonatal mortality target for 2030. About half of these countries would not reach the target even by 2050, and nearly 40 will need to double, at least, their current rate of progress to achieve the target by 2030 (see Figure 1.3). Note: Excludes countries with less than 10,000 live births in 2016.Source: UNICEF analysis based on UN IGME estimates 2017.Neonatal mortality rate (deaths per 1,000 live births) LesothoCentral African Republic PakistanSomalia Cte d'IvoireChad MauritaniaAfghanistan Guinea-BissauComoros South SudanBenin DjiboutiNigeriaSudan Equatorial GuineaMali Sierra LeoneDemocratic Republic of the Congo GhanaHaiti Lao People's Democratic RepublicZimbabwe YemenGambia TogoSwaziland Papua New GuineaAngolaKenya Dominican RepublicMozambique GabonCameroon Burkina FasoEthiopia TurkmenistanMyanmar BurundiNiger NamibiaBotswana GuyanaIndia ZambiaUnited Republic of Tanzania GuineaIraq MalawiTajikistan UgandaCongo Timor-LesteLiberia Bolivia (Plurinational State of)Eritrea 0 12 20 30 Excess mortalitySDG target = 12 survive + thrive Disparities Mortality estimates can be broken down by wealth for just over half of the 195 countries that have estimates, making it possible to compare rates among wealth quintiles (whereby the child population is divided into five equally sized groups by household wealth). These 99 low- and middle-income countries account for 71 per cent of the global under-five population, or 477 million children, and more than 90 per cent of the worlds under-five deaths. Trajectories towards the SDG target by household wealth show a clear pattern: Prospects for children in poorer households are worse than for children in the wealthiest households (see Figure 1.4). Without faster progress, under-five mortality rates in 2030 will continue to exceed the target among three quarters of children in the poorest quintiles of households in their countries, compared with about a quarter of children in the wealthiest households. Among the 99 countries with wealth-disaggregated data: Almost half (including 18 countries in sub-Saharan Africa) will miss the target among the poorest quintile, even though they will meet or have already met the target among the wealthiest households. Another quarter will miss the target among both the poorest and wealthiest quintiles. These countries and many others need to especially speed up progress among the poorest children. Making a concerted effort to reduce under-five mortality among the poorest households, and thus eliminating disparities between regions within countries, could save millions of childrens lives. Figure 1.4Proportion of under-five population in the poorest (outer ring) and wealthiest (inner ring) quintiles in their countries, in each category of progress towards SDG under-five mortality target, for 99 countries 73 18 9 27 19 55 Richest Poorest No data Insufficient trend data Acceleration needed On track Target met Source: UNICEF analysis based on UN IGME estimates, 2017. Unless countries accelerate progress, prospects for reducing under-five mortality in line with the SDG target are worse among poorer children Child mortality Progress for Every Child in the SDG Era 29 Data Data on child mortality come from several different sources, including vital registration systems, sample vital registration systems, censuses and household surveys. The estimates in this chapter are based on available data from 195 countries. Estimating child mortality rates is challenging in the absence of well-functioning vital registration systems, which many low- and middle-income countries lack. Only 62 of the 195 countries for which under-five mortality is estimated
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