The Situation for Children in South Asia
South Asia is home to about 627 million children under 18 years of age1 - approximately 36 percent of the total population of 1.82 billion2.
Countries in South Asia have made remarkable progress in human development. Most are now classified middle-income countries, with rapid economic growth and improving social indicators. In the last five years alone over 150 million people have climbed out of income poverty3.
South Asia’s rich ecological, geographic and cultural diversity make the region unique but also explains why it is volatile and vulnerable in social, economic and environmental terms. Bangladesh, India, and Pakistan are among the ten most populous countries in the world while Bhutan and Maldives are among those with the smallest population. Urbanization is also shaping South Asia’s development trajectory. Nearly 130 million South Asians currently live in informal urban settlements4, but with rapid and uncontrolled urbanization this may increase to 42 percent by 20355. The region faces continuing challenges from weak urban governance, poor provision of public services, lack of effective social protection systems and mounting urban poverty to the impact of climate change, natural hazards, political turmoil, gender inequality, etc.
Progress has been made in recent decades to reduce the number of child deaths worldwide, however neonatal mortality rates have declined at a slower pace. As a result, newborn deaths now account for 44 percent of under-5 deaths globally and almost 60 percent of the deaths in South Asia. The majority can be attributed to preventable and treatable causes such as preterm birth complication, intrapartum-related complication, and infections. Disparities between and within countries are significant and the utilisation of key life-saving interventions, such as neonatal care and skilled birth attendants, vary by poverty level, class, caste, geographic access and maternal education.
Globally, there are 23 million children who are not fully immunized and 8 million of them live in South Asia6. It is the last region still fighting Poliovirus. Inequalities remain both in terms of immunisation coverage and access within countries. Several factors explain why progress has been slow, mostly relating to the poor health system, geographic barriers and weak governance of social services. This is a missed opportunity as vaccination is considered the most cost-effective intervention, with huge USD16 return on investment for each dollar spent on immunization7.
South Asia is home to more than half the world’s wasted children, a key driver of the high stunting prevalence. As a result, it has the highest burden of stunting in the world; recent global estimates indicate that half of the world’s 158 million stunted children live in the region8. Deprivation profiling has shown that stunting is concentrated among children born in the poorest households, children who live in rural areas, children from families with specific social identities (caste or ethnicity) and children born to particularly vulnerable women (young, malnourished, uneducated and disempowered)9.
Access to early childhood education is low with only half of the children attending pre-school today. This is worrying especially because pre-school is crucial to ensuring enrolment and school retention at later ages. According to MICS 4 data, only two-thirds of children between the ages of 36 to 59 months are developmentally on track in South Asia. The proportion of children aged 0 – 59 months old who are left in inadequate care is also alarmingly high, meaning that several young children do not receive the nurturing and responsive care they require for achieving their developmental potential. According to data from UIS, only half the children in South Asia attend early learning programmes. This, in turn, affects their school enrolment, participation, and retention.
The prevalence of gender-based violence (GBV) and violence against children in the region remain high and many people, including women, have an acceptance towards domestic violence and violence against children. According to the upcoming Violence in Childhood Index10, South Asia is the third highest region for violence against children scoring 37.211. An important contribution to preventing violence against children (and also ending child marriage) is birth registration. While birth registration is the right of every child, only 39 percent of all children under the age of five years are reported to be registered12, this means 103 million children’s birth is not registered13.
The proportion of people practicing open defecation (OD) fell from 65 percent in 1990 to 34 percent in 2015 with India, Bangladesh, Nepal, and Pakistan all achieving more than a 30 percent reduction in OD. Access to improved water increased from 73 percent to 93 percent over the same period14. The past decade also saw greater government commitments and increased investments for WASH in schools and in health institutions. However, more needs to be done. There are still 610 million people practicing open defecation (over 60% of the global burden) and over 119 million people do not have access to even a basic level of drinking water.
While schools are supposed to be safe havens for children, significant levels of violence, including (widely accepted) corporal punishment, occur in schools across the region. Notwithstanding the strides in achieving Universal Primary Education globally and in South Asia, the issue of out-of-school children remains huge. South Asia is home to the largest numbers of out-of-school children and youths at 31.8 million with 8.2 million at primary level (6 to 9 years) and 23.6 million at the secondary level (10 to 14 years)15. At the same time, millions of children are completing primary education and not able to master foundational literacy and numeracy.
High rates of OOSC are an important contributing factor to the high incidence of child marriages and child labour. Nowhere else in the world is the incidence of child marriage as high as it is in South Asia. Ending child marriage by 2030 is one of the Sustainable Development Goals (SDGs) but achieving this will be difficult as the practice is deeply rooted in gender inequality. Despite clear commitments from governments in the region, for example, the Kathmandu declaration16, child marriage remains highly prevalent in 6 of the 8 countries in the region. It was estimated that in 2013 half of all child brides worldwide were living in South Asia, which is especially high in a region that is home to about 30 percent of the world’s adolescents.
India has more adolescents than any other country at around 250 million adolescents, which accounts for 73 percent of the approximately 340 million adolescents in South Asia17. Afghanistan, Bangladesh, India, Nepal, and Pakistan have large rapidly growing children populations and young people. These population trends, if properly matched with purposively enhanced social sector investments could lead to huge demographic dividends, during which more than 300 million people will enter the prime working age population in the next decade. This is easier said than done. Adolescents in South Asia today remain largely invisible and voiceless. Girls get married and have children before they reach adulthood, many adolescents are out-of-school and those that are in school are poorly educated and lack skills. When adolescents reach the working age, they face unstable labour markets, poor wages and evolving (and disappearing) demand for cheap and unskilled workers...
... Girls and young women tend to face more extensive limitations on society’s perception of their worth, their ability to move freely and make a decision about work, education, marriage, and social relationships.It has been estimated that 55 percent of all adolescent girls aged 15 to 19 are anemic18 (which translates into approximately 89 million adolescent girls) and this contributes significantly to low body mass index and higher risk pregnancies and childbirth. Menstrual hygiene management is an important gender issue that affects one-quarter of the world population (1.8 billion women and girls of reproductive age). Menstruation continues to be a taboo in many countries in South Asia and there are social norms and practices that do not allow women and girls to use sanitation facilities while they are menstruating.
South Asia is highly prone to disasters including flooding, droughts, earthquakes, refugee flows and climate change which has led to human suffering. The obligatory return migration of refugees to Afghanistan will affect 1.5 million people, of whom 60 percent are children, in 2017 alone. Pakistan and Iran have seen internal clashes between government forces and armed groups, triggering internal displacements. Children in Nepal are still suffering from the effects of the 2015 earthquakes as their homes and schools have not been adequately reconstructed and landslide risks remain high. Weather patterns across the region are changing, which is leading to both droughts and unpredictable monsoons. As sea levels rise the Maldives and other Pacific islands will start to disappear.
State fragility is a major issue facing countries in the region with almost all countries scoring high in the 'Fragile States Index' 19. Several countries are plagued by conflict and or terrorism, while others have only recently emerged from civil conflicts and still in the process of healing and state-building. In this context, defense expenditure is a dominant feature of many national budgets20, reducing budgetary space for children and adolescents further. Low tax to GDP ratios (between 8 – 17 percent across the region21), combined with weak governance and inefficiencies, have meant that most governments in South Asia do not generate enough revenue to adequately finance public spending. As a result, South Asia spends only limited resources on health, education and social welfare.
1 The State of the world’s Children 2016, UNICEF, https://www.unicef.org/sowc2016/
2 United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision, DVD Edition.
3The World Bank, Databank Poverty and Equity database at: http://databank.worldbank.org/data/reports.aspx?source=poverty-and-equity-database
4 Leveraging Urbanization in South Asia, 2016. World Bank. https://openknowledge.worldbank.org/bitstream/handle/10986/22549/9781464806629.pdf?sequence=17
5 Office of the Director of National Intelligence, Paradox of Progress – South Asia report 2017 at: https://www.dni.gov/index.php/the-next-five-years/south-asia (accessed on 5 April 2017)
6 Hasman A, Noble DJ. Childhood immunisation in South Asia - overcoming the hurdles to progress. Perspectives in Public Health. 2016 Sep; 136(5):273-7
7 Ozawa S., Clark S., Portnoy A., Grewal S., Brenzel L., Walker DG. Return On Investment From Childhood Immunization In Low- And Middle-Income Countries, 2011-20, Health Affairs (Millwood). 2016 Feb;35 (2):199-207
8 UNICEF, WHO & World Bank Group (2016). Levels and Trends in Child Malnutrition. Joint Child Malnutrition Estimates. Key Findings of the 2016 Edition.
9 UNICEF, WHO & World Bank Group (2016). Levels and Trends in Child Malnutrition. Joint Child Malnutrition Estimates. Key Findings of the 2016 Edition.
10 Know Violence in Childhood (upcoming) Out of Harm’s Way: Ending Violence in Childhood, Global Report 2017.
11The VIC index includes corporal punishment, peer violence, violence against adolescent girls and violence against women. Out of 170 countries the ranking for countries in South Asia is Afghanistan (132), Bangladesh (170), Bhutan (103), India (122), Maldives (64), Nepal (107), Pakistan (133), and Sri Lanka (118)
12 https://data.unicef.org/topic/child-protection/birth-registration/ (accessed 30 March 2017).
13 UNICEF, Every Child’s Birth Right: Inequities and trends in birth registration, UNICEF, New York, 2013
14 WHO/UNICEF, Progress on Sanitation and Drinking Water, Joint Monitoring Programme for Water Supply and Sanitation Data Update with estimates for 2015, https://www.wssinfo.org/ (accessed on 11 April 2017)
15 UNESCO, 2017.
16 The Kathmandu Declaration was endorsed by all countries and states and states that no marriage should happen before the age of 18 years
17 UNICEF, State of the World’s Children, 2016.
18 Aguayo Víctor M, Paintal Kajali. Nutrition in adolescent girls in South Asia BMJ 2017; 357 :j1309
19 Fragile States Index, 2016, http://fsi.fundforpeace.org/rankings-2016
20 Based on Stockholm International Peace Research Institute Data
21 World Bank, http://data.worldbank.org/indicator/GC.TAX.TOTL.GD.ZS (accessed 25 Jan. 2017)