THE STATE OF THE WORLD’S CHILDREN 2009 Maternal and Newborn Health unite for children © United Nations Children’s Fund (UNICEF) December 2008 Permission to reproduce any part of this publication is required Please contact: Division of Communication, UNICEF United Nations Plaza, New York, NY 10017, USA Tel: (+1-212) 326-7434 Email: nyhqdoc.permit@unicef.org Permission will be freely granted to educational or non-profit organizations Others will be requested to pay a small fee Commentaries represent the personal views of the authors and not necessarily reflect positions of the United Nations Children’s Fund For any corrigenda found subsequent to printing, please visit our website at For any data updates subsequent to printing, please visit ISBN: 978-92-806-4318-3 Sales no.: E.09.XX.1 United Nations Children’s Fund United Nations Plaza New York, NY 10017, USA Email: pubdoc@unicef.org Website: www.unicef.org Cover photo: © UNICEF/HQ04-1216/Ami Vitale THE STATE OF THE WORLD’S CHILDREN 2009 Acknowledgements This report was made possible with the advice and contributions of many people, both inside and outside UNICEF Important contributions were received from the following UNICEF field offices: Afghanistan, Bangladesh, Benin, Brazil, Burundi, Central African Republic, Chad, Côte d’Ivoire, Ghana, Guatemala, Haiti, India, Indonesia, Kenya, Lao People’s Democratic Republic, Liberia, Madagascar, Mexico, Morocco, Mozambique, Nepal, Niger, Nigeria, Occupied Palestinian Territory, Pakistan, Peru, Rwanda, Sierra Leone, Sri Lanka, Sudan, Togo, Tunisia and Uganda Input was also received from UNICEF regional offices and the Innocenti Research Centre Special thanks to H M Queen Rania Al Abdullah of Jordan, the Honourable Vabah Gayflor, Zulfiqar A Bhutta, Sarah Brown, Jennifer Harris Requejo, Joy Lawn, Mario Merialdi, Rosa Maria Nuñez-Urquiza and Cesar G Victora EDITORIAL AND RESEARCH PROGRAMME AND POLICY GUIDANCE Patricia Moccia, Editor-in-Chief; David Anthony, Editor; Chris Brazier; Marilia Di Noia; Hirut Gebre-Egziabher; Emily Goodman; Yasmine Hage; Nelly Ingraham; Pamela Knight; Amy Lai; Charlotte Maitre; Meedan Mekonnen; Gabrielle Mitchell-Marell; Kristin Moehlmann; Michelle Risley; Catherine Rutgers; Karin Shankar; Shobana Shankar; Judith Yemane UNICEF Programme Division, the Division of Policy and Practice and Innocenti Research Centre, with particular thanks to Nicholas Alipui, Director, Programme Division; Dan Rohrmann, Deputy Director, Programme Division; Maniza Zaman, Deputy Director, Programme Division; Peter Salama, Associate Director, Health; Jimmy Kolker, Associate Director, HIV and AIDS; Clarissa Brocklehurst, Associate Director, Water, Sanitation and Hygiene; Werner Schultink, Associate Director, Nutrition; Touria Barakat; Linda Bartlett; Wivina Belmonte; Robert Cohen; Robert Gass; Asha George; Christine Jaulmes; Grace Kariwiga; Noreen Khan; Patience Kuruneri; Nuné Mangasaryan; Mariana Muzzi; Robin Nandy; Shirin Nayernouri; Kayode Oyegbite; David Parker; Luwei Pearson; Ian Pett; Bolor Purevdorj; Melanie Renshaw; Daniel Seymour; Fouzia Shafique; Judith Standley; David Stewart; Abdelmajid Tibouti; Mark Young; Alex Yuster STATISTICAL TABLES Tessa Wardlaw, Chief, Strategic Information, Division of Policy and Practice; Priscilla Akwara; Danielle Burke; Xiaodong Cai; Claudia Cappa; Ngagne Diakhate; Archana Dwivedi; Friedrich Huebler; Rouslan Karimov; Julia Krasevec; Edilberto Loaiza; Rolf Luyendijk; Nyein Nyein Lwin; Maryanne Neill; Holly Newby; Khin Wityee Oo; Emily White Johansson; Danzhen You PRODUCTION AND DISTRIBUTION Jaclyn Tierney, Chief, Production and Translation; Edward Ying, Jr.; Germain Ake; Fanuel Endalew; Eki Kairupan; Farid Rashid; Elias Salem DESIGN AND PRE-PRESS PRODUCTION TRANSLATION PRINTING French edition: Marc Chalamet Spanish edition: Carlos Perellón Colorcraft of Virginia, Inc Prographics, Inc DEDICATION The State of the World’s Children 2009 is dedicated to Allan Rosenfield, MD, Dean Emeritus, Mailman School of Public Health, Columbia University, who passed away on 12 October 2008 A pioneer in the field of public health, Dr Rosenfield worked tirelessly to avert maternal deaths and provide care and treatment for women and children affected by HIV and AIDS in resource-poor settings He lent his energy and intellect to numerous groundbreaking programmes and institutions, and his passion, dedication, courage and commitment to bringing women’s health and human rights to the fore of development remain a source of inspiration ii Foreword The State of the World’s Children 2009 focuses on maternal and neonatal health and identifies the interventions and actions that must be scaled up to save lives Most maternal and neonatal deaths can be averted through proven interventions – including adequate nutrition, improved hygiene practices, antenatal care, skilled health workers assisting at births, emergency obstetric and newborn care, and post-natal visits for both mothers and newborns – delivered through a continuum of care linking households and communities to health systems Research indicates that around 80 per cent of maternal deaths are preventable if women have access to essential maternity and basic health-care services A stronger focus on Africa and Asia is imperative to accelerate progress on maternal and newborn health These two continents present the greatest challenges to the survival and health of women and newborns, accounting for an estimated 95 per cent of maternal deaths and around 90 per cent of neonatal deaths Two thirds of all maternal deaths occur in just 10 countries; India and Nigeria together account for one third of maternal deaths worldwide In 2008, UNICEF, the World Health Organization, the United Nations Population Fund and the World Bank agreed to work together to help accelerate progress on maternal and newborn health in the 25 countries with the highest rates of mortality Premature pregnancy and motherhood pose considerable risks to the health of girls The younger a girl is when she becomes pregnant, the greater the health risks for herself and her baby Maternal deaths related to pregnancy and childbirth are an important cause of mortality for girls aged 15–19 worldwide, accounting for nearly 70,000 deaths each year Early marriage and pregnancy, HIV and AIDS, sexual violence and other gender-related abuses also increase the risk that adolescent girls will drop out of school This, in turn, entrenches the vicious cycle of gender discrimination, poverty and high rates of maternal and neonatal mortality © UNICEF/HQ05-0653/Nicole Toutounji Niger has the highest lifetime risk of maternal mortality of any country in the world, in The comparable risk in the developed world is in 8,000 Since 1990, the base year for the Millennium Development Goals, an estimated 10 million women have died from complications related to pregnancy and childbirth, and some million newborns have died each year within the first 28 days of life Advances in maternal and neonatal health have not matched those of child survival, which registered a 27 per cent reduction in the global under-five mortality rate between 1990 and 2007 Educating girls and young women is one of the most powerful ways of breaking the poverty trap and creating a supportive environment for maternal and newborn health Combining efforts to expand coverage of essential services and strengthen health systems with actions to empower and protect girls and women has real potential to accelerate progress As the 2015 deadline for the Millennium Development Goals draws closer, the challenge for improving maternal and newborn health goes beyond meeting the goals; it lies in preventing needless human tragedy Success will be measured in terms of lives saved and lives improved Ann M Veneman Executive Director United Nations Children’s Fund iii CONTENTS Acknowledgements ii Dedication ii Foreword Ann M Veneman Executive Director, UNICEF iii Adapting maternity services to the cultures of rural Peru 42 Southern Sudan: After the peace, a new battle against maternal mortality 43 Figures 2.1 The continuum of care 27 Maternal and newborn health: Where we stand Panels Challenges in measuring maternal deaths Creating a supportive environment for mothers and newborns by H M Queen Rania Al Abdullah of Jordan, UNICEF’s Eminent Advocate for Children 11 Maternal and newborn health in Nigeria: Developing strategies to accelerate progress 19 2.2 Although improving, the educational status of young women is still low in several developing regions 30 2.3 Gender parity in attendance has improved markedly, but there are still slightly more girls than boys out of primary school 33 2.4 Child marriage is highly prevalent in South Asia and sub-Saharan Africa 34 2.5 Female genital mutilation/cutting, though in decline, is still prevalent in many developing countries 37 2.6 Mothers who received skilled attendance at delivery, by wealth quintile and region 38 Prioritizing maternal health in Sri Lanka 21 2.7 Women in Mali receiving three or more antenatal care visits, before and after the implementation of the Accelerated Child Survival and Development (ACSD) initiative 39 The centrality of Africa and Asia in the global challenges for children and women 22 2.8 Many women in developing countries have no say in their own health-care needs 40 Expanding Millennium Development Goal 5: Universal access to reproductive health by 2015 20 The global food crisis and its potential impact on maternal and newborn health 24 Figures 1.1 Millennium Development Goals on maternal and child health 3 The continuum of care across time and location: Risks and opportunities 45 1.2 Regional distribution of maternal deaths Panels 1.3 Trends, levels and lifetime risk of maternal mortality Eliminating maternal and neonatal tetanus 49 1.4 Regional rates of neonatal mortality 10 Hypertensive disorders: Common yet complex 53 1.5 Direct causes of maternal deaths, 1997–2002 14 1.6 Direct causes of neonatal deaths, 2000 15 1.7 Conceptual framework for maternal and neonatal mortality and morbidity 17 1.8 Food prices have risen sharply across the board 24 The first 28 days of life by Zulfiqar A Bhutta, Professor and Chairman, Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan 57 Midwifery in Afghanistan 60 Kangaroo mother care in Ghana 62 HIV/malaria co-infection in pregnancy 63 Creating a supportive environment for maternal and newborn health 25 The challenges faced by adolescent girls in Liberia by the Honourable Vabah Gayflor, Minister of Gender and Development, Liberia 64 Panels Figures Promoting healthy behaviours for mothers, newborns and children: The Facts for Life guide 29 3.1 Protection against neonatal tetanus 48 Primary health care: 30 years since Alma-Ata 31 3.2 Antiretroviral prophylaxis for HIV-positive mothers to prevent mother-to-child transmission of HIV 50 Addressing the health worker shortage: A critical action for improving maternal and newborn health 35 3.3 Antenatal care coverage 51 Towards greater equity in health for mothers and newborns by Cesar G Victora, Professor of Epidemiology, Universidade Federal de Pelotas, Brazil 38 3.5 Emergency obstetric care: Rural Caesarean section 54 iv 3.4 Delivery care coverage 52 3.6 Early and exclusive breastfeeding 59 THE STATE OF THE WORLD’S CHILDREN 2009 Maternal and Newborn Health Strengthening health systems to improve maternal and newborn health 67 Panels Using critical link methodology in health-care systems to prevent maternal deaths by Rosa Maria Nuñez-Urquiza, National Institute of Public Health, Mexico 73 New directions in maternal health by Mario Merialdi, World Health Organization, and Jennifer Harris Requejo, Partnership for Maternal, Newborn and Child Health 75 Strengthening the health system in the Lao People’s Democratic Republic 76 Saving mothers and newborn lives – the crucial first days after birth by Joy Lawn, Senior Research and Policy Advisor, Saving Newborn Lives/Save the Children-US, South Africa 80 Burundi: Government commitment to maternal and child health care 83 Integrating maternal and newborn health care in India 85 Partnering for mothers and newborns in the Central African Republic 99 UN agencies strengthen their collaboration in support of maternal and newborn health 102 Enhancing health information systems: The Health Metrics Network 105 Figures 5.1 Key global health initiatives aimed at strengthening health systems and scaling up essential interventions 97 5.2 Official development assistance for maternal and neonatal health has risen rapidly since 2004 98 5.3 Nutrition, PMTCT and child health have seen substantial rises in financing 100 5.4 Financing for maternal, newborn and child health from global health initiatives has increased sharply in recent years 101 5.5 Focal and partner agencies for each component of the continuum of maternal and newborn care and related functions 103 References 106 Figures 4.1 Emergency obstetric care: United Nations process indicators and recommended levels 70 Statistical Tables 113 4.2 Distribution of key data sources used to derive the 2005 maternal mortality estimates 71 Table Basic indicators 118 4.3 Skilled health workers are in short supply in Africa and South-East Asia in particular 74 Table Health 126 4.4 Uptake of key maternal, newborn and child health policies by the 68 Countdown to 2015 priority countries 78 4.5 Asia has among the lowest levels of government spending on health care as a share of overall public expenditure 79 4.6 Post-natal care strategies: Feasibility and implementation challenges 81 4.7 Lower-income countries pay most of their private health-care spending out of pocket 82 Under-five mortality rankings 117 Table Nutrition 122 Table HIV/AIDS 130 Table Education 134 Table Demographic indicators 138 Table Economic indicators 142 Table Women 146 Table Child protection 150 Table 10 The rate of progress 154 Acronyms 158 4.8 Low-income countries have only 10 hospital beds per 10,000 people 84 Working together for maternal and newborn health 91 Panels Working together for maternal and newborn health by Sarah Brown, Patron of the White Ribbon Alliance for Safe Motherhood and wife of Gordon Brown, Prime Minister of the Government of the United Kingdom 94 Key global health partnerships for maternal and newborn health 96 v T H E S TAT E O F T H E W O R L D ’ S C H I L D R E N 0 © UNICEF/HQ06-2706/Shehzad Noorani Maternal and newborn health: Where we stand Each year, more than half a million women die from causes related to pregnancy and childbirth, and nearly million newborns die within 28 days of birth Millions more suffer from disability, disease, infection and injury Cost-effective solutions are available that could bring rapid improvements, but urgency and commitment are required to implement them and to meet the Millennium Development Goals related to maternal and child health The first chapter of The State of the World’s Children 2009 examines trends and levels of maternal and neonatal health in each of the major regions, using mortality ratios as benchmark indicators It briefly explores the main proximal and underlying causes of maternal and neonatal mortality and morbidity, and outlines a framework for accelerating progress P regnancy and childbirth are generally times of joy for parents and families Pregnancy, birth and motherhood, in an environment that respects women, can powerfully affirm women’s rights and social status without jeopardizing their health The enabling environment for safe motherhood and childbirth depends on the care and attention provided to pregnant women and newborns by communities and families, the acumen of skilled health personnel and the availability of adequate health-care facilities, equipment, and medicines and emergency care when needed Many women in the developing world – and most women in the world’s least developed countries – give birth at home without skilled attendants, yet their newborns are usually healthy and survive past their first few weeks of life until their fifth birthday and beyond Despite the multitude of risks associated with pregnancy and childbirth, the majority of mothers also survive But the health risks associated with pregnancy and childbirth are far greater in developing countries than in industrialized ones They are especially prevalent in the least developed and lowest-income countries, and among less affluent and marginalized families and communities everywhere Globally, efforts to reduce deaths among women from complications related to pregnancy and childbirth have been less successful than other areas of human development – with the result that having a child remains among the most serious health risks for women On average, each day around 1,500 women die from complications related to pregnancy and childbirth, most of them in sub-Saharan Africa and South Asia The divide between industrialized countries and developing regions – particularly the least developed countries – is perhaps greater on maternal mortality than on almost any other issue This claim is borne out by the numbers: Based on 2005 data, the average lifetime risk of a woman in a least developed country dying from T H E S TAT E O F T H E W O R L D ’ S C H I L D R E N 0 complications related to pregnancy or childbirth is more than 300 times greater than for a woman living in an industrialized country No other mortality rate is so unequal Millions of women who survive childbirth suffer from pregnancyrelated injuries, infections, diseases and disabilities, often with lifelong consequences The truth is that most of these deaths and conditions are preventable – research has shown that approximately 80 per cent of maternal deaths could be averted if women had access to essential maternity and basic health-care services.1 Deaths of newborns in developing countries have also received far too little attention Almost 40 per cent of under-five deaths – or 3.7 million in 2004, according to the latest World Health Organization estimates – occur in the first 28 days of life Three quarters of neonatal deaths take place in the first seven days, the early neonatal period; most of these are also preventable.2 TABLE WOMEN Maternal mortality ratio† Countries and territories Life expectancy: females as a % of males 2007 Adult literacy rate: females as a % of males 2000–2007* Enrolment and attendance ratios: females as a % of males Net Net Contraceptive primary school secondary school prevalence 2000–2007* 2000–2007* (%) enrolled attending enrolled attending 2000–2007* Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d’Ivoire Croatia Cuba Cyprus Czech Republic 100 109 104 – 108 – 111 110 106 107 112 108 104 103 107 119 108 108 104 105 107 107 100 111 106 110 106 106 109 102 106 109 106 105 108 105 111 107 105 – 106 104 110 105 107 108 29 99 79 – 65 – 100 100 – – 99 – 96 82 – 100 – – 53 63 90 95 100 101 96 99 59 78 79 78 – 88 52 31 100 93 100 87 89 – 101 63 98 100 98 – 63 99 98 101 – – 99 105 101 101 97 103 100 104 99 98 100 101 84 100 101 – 103 102 100 99 82 97 98 – 100 99 72 70 – 100 100 95 90 103 102 80 99 101 100 103 Democratic People’s Republic of Korea 106 – – – Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon 106 106 105 – 109 108 107 109 105 109 117 105 107 108 109 101 67 – – – 101 98 73 94 86 – 100 46 – – – 91 – 101 82 106 103 101 96 100 90 87 99 92 100 100 100 99 89 – 97 – 104 – 97 – 98 93 – 101 – – – 100 146 60 100 99 – 102 – – 99 – – 98 – 100 106 – 101 – 100 87 91 99 97 103 100x – – 90 97 102 94 – 100x 84 76 – – 102 100 101 – 102 87 – – – – – 98 106 103 – – 110 104 102 – 96 102 105 104 101 102 96 108 50 101 98 – 114 111 105 98 72 – 85 – – 113 71 33 – – 111 101 – 110 110 57 102 103 102 – Antenatal care coverage (%) 2000–2007* At least once At least four times Delivery care coverage (%) 2000–2007* Skilled attendant Institutional at birth delivery 2005 2000–2007* reported Adjusted Lifetime risk of maternal death in: 33 97 112 – 90 – – 102 – – 98 – 111 114 – 102 – 103 66 – 98 100 122 119x – – 91 79 90 93 – – 64 51 – – 111 103 104 – 110 69 – – – – 10 60 61 – 53 – 53 – 51x 51 – 62x 56 55x 73 78x 34 17 35y 58 36 48 77x – 86x 17 40 29 75x 61 19 58y 85 78 26 21 44 96 13 – 77 – 69x 16 97 89 – 80 100 99 93 100x 100x 77 98 97x 51 100 99 – 94 84 88 79 99 97 97 100x – 85 92 69 82 – 98 69 39 95x 90 94 75 86 – 92 85 – 100 – 99x – – – – – – 89y 71 – – 45 – – 21 – – – 76x 61 – 58 – – 87 – – 18 – 27 60 – 64x 40x 18 – – 83 52x 75 – – 45 – – – 97x 14 100 95 – 47 100 99 98 100x 100x 88 99 98x 18 100 100 – 96 74 56 67 100 94 88x 99x 99 54 34 44 63 98 78 53 14 100 98 96 62 83 98 99 57 100 100 – 100 13 98 95 – 46 – 99 97 – – 78 – 98x 15 – 100 – 88 78 55 57 100 80x 97 – – 51 29 22 61 – 78 51 13 100 88 92 43x 82 – 94 54 – – – – 1600 20 120x – – 48 27 – – 29 – 46x 320 0x 12 – 42 400 260 230 330x 53 0x 480x 620 470 670 – 15 540 1100 20 41 73 380 780 6x 36 540 10 21 0x 1800 92 180 – 1400 – 77 76 4 82 16 32 570 16 18 52 840 440 290 380 110 13 11 700 1100 540 1000 210 980 1500 16 45 130 400 740 – 30 810 45 10 490 220 – 12 – 530 980 13300 21500 670 2700 1300 51 4400 4800 7800 560 20 55 89 29000 130 370 2900 7400 22 16 48 24 11000 120 25 11 3200 1300 290 52 22 – 1400 27 10500 1400 6400 18100 – – 62x – – 97 – 110x 370 140 – 103 66 110 122 102 94 105 – 67 102 65 110 100 102 – 81 – 84 – 145 – 93 – 95 92 – 77 – – – 106 31 – 18 50x 73 73 59 67 – 70 15 44 – 75x 33 85 – 92 100 99 84 70 86 86 70 – 28 – 100x 99x 94 – – – 95 58 59 71 – 41 – 12 – – – 63 74 – 61 99 98 99x 74 92 65 28 100 99 100x 99x 86 70 – 74 – 98 74 65 69 – 26 – – 100 – 85 1300 10x 74x 160 110 84 71 – 1000x 670 34 6x 10x 520 1100 650 – 150 210 130 170 680 450 25 720 210 520 13 17800 35 – 230 170 230 190 28 44 2900 27 160 8500 6900 53 T H E S TAT E O F T H E W O R L D ’ S C H I L D R E N 0 …TABLE Maternal mortality ratio† Countries and territories Life expectancy: females as a % of males 2007 Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan 103 112 107 101 106 105 111 106 107 109 106 – 110 112 104 105 106 105 107 106 105 108 108 109 105 118 104 – 105 113 Lao People’s Democratic Republic Adult literacy rate: females as a % of males 2000–2007* – – – 81 98 – 86 42 72 – 106 – 102 100 – 71 93 88 76 – – 99 113 – 93 100 90 – 97 100 Enrolment and attendance ratios: females as a % of males Net Net Contraceptive primary school secondary school prevalence 2000–2007* 2000–2007* (%) enrolled attending enrolled attending 2000–2007* Antenatal care coverage (%) 2000–2007* At least once At least four times 109 103 100 97 100 99 96 86 71 – – – 102 99 99 96 97 110 86 101 101 99 100 100 102 100 102 101 99 99 103 101 – 100 – – 94x 87 97 100 107 – 104 – – 96 101 97 88 – – – 100 – 100 99 100 – – 103 94 105 – 91 101 102 92 57 55 – – – – 100 102 – 100 94 70 106 100 101 105 100 103 100 97 111 105 102 87 98 – 99 – – 103x 66 88 110 117 – 123 – – 83 104 – 75 – – – 105 – 104 100 114 – – 103 18 47 75x 17 – 54y 43 10 34 32 – 65 77x – 56 61 79 50 – – 60x 69 56 57 51 39 21x 50x 48 98 94 – 92 – 100 84 82 78 81 85 – 92 – – 74 93 77x 84 – – – 91 – 99 100 88 88x 95x 97 – 75 – 69 – – – 49 – – 54 – 81 – – 37 81 94y – – – – 87x – 94 70x 52 – – 81x Delivery care coverage (%) 2000–2007* Skilled attendant Institutional at birth delivery 2005 2000–2007* reported Lifetime risk of maternal death in: Adjusted 57 98 – 50 – 100 41 38 39 83 26 – 67 100 – 47 72 97 89 100 – – 97 100x 99 100 42 85x 98x 98 55 96 – 49 – – 42 31 36 83 25 – 67 – – 39 40 96 63 100 – – 94 – 99 100 40 – 98x 97 730 23 8x 210x 1x 130 980 410 120 630 – 110x – 300 310 25 84 6x 5x 7x 95 8x 41x 70 410 56 5x 100 690 66 560 – 290 910 1100 470 670 – 280 450 420 140 300 170 62 140 560 – 150 32 1100 19200 45 25900 – 71 19 13 90 44 – 93 13300 12700 70 97 300 72 47600 7800 26600 240 11600 450 360 39 – 9600 240 104 83 94 95 86 84 38 27 – 19 – 410 660 33 Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) 116 106 99 104 107 – 116 108 106 101 107 102 109 105 – 106 110 107 100 – 123 85 83 – 100 – 85 82 95 100 51 104 – 76 94 96 103 99 104 97 – 103 99 101 100 106 100 100 79 99 99 105 102 99 – 99 108 – – – – – 104 102 – – 74 – – 105 – 100 – 110 154 58 – 111 101 105 104 93 110 109 – 107 108 90 102 99 – 113 171 – – – – – 125 96 – – 68 – – 82 – – 48x 58 37 11 45x – 47x – 27 42 55x 39 – 34 76 71 – 96 90 85 81x – – – 80 92 79 81 70 – – 64 – 86x – – 70 – – – – – 40 57 – – 35 – – 16 – – 100 98x 55 51 94x – 100 100 51 54 98 84 45 98x 95x 57 98 93 – – 52 37 – – – – 32 54 98 – 45 – – 49 98 86 100x 760x 580x 77x – 13 0x 470 810 28 140 460 – 74 750 22 62 10 150 960 1200 97 – 11 12 510 1100 62 120 970 – 820 15 60 8500 290 45 12 350 – 7800 5000 38 18 560 200 15 8300 – 22 3300 670 102 – – – – – 270x Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru 111 – 110 106 106 102 111 101 – 99 – 101 – 63 58 92 99 – 100 – 102 – 94 93 101 106 – 102 – 102 99 95 90 102 101 – 104 – 113 – 84 91 100 132 – 103 – 106 101 93 80 94 132 – 45x – – 88 – 68 – 66 39 63 17 34 55 – 98 – 99 97 68 85 76 95 – 89 – – – 31 53 – 70 – 100 – 99 99 63 48 57 81 – 99 – 99 100 61 48 16 81 – 16 – 90 23 230 410 320 270 – – – 22 – 46 – 240 520 380 210 – 3700 – 840 – 150 45 110 170 – S TAT I S T I C A L TA B L E S 147 TABLE WOMEN Maternal mortality ratio† Countries and territories Life expectancy: females as a % of males 2007 Adult literacy rate: females as a % of males 2000–2007* Enrolment and attendance ratios: females as a % of males Net Net Contraceptive primary school secondary school prevalence 2000–2007* 2000–2007* (%) enrolled attending enrolled attending 2000–2007* 83 – – 132 65 87 – – 48 79x 75x 72 11 13 – – Antenatal care coverage (%) 2000–2007* Delivery care coverage (%) 2000–2007* Skilled attendant Institutional at birth delivery At least once At least four times 44 – 95x 90 46 58 – – 29 – – 78 15 47 – – 19 100x 100x 74 33 35 100 – 18 – – 66 17 33 – – 2005 2000–2007* reported Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway 102 106 105 109 97 102 – 106 62 – – 102 37 80 – – 96 99 100 100 71 86 – 101 95 – – 108 70 88 – – – 101 103 116 63 84 105x 101 280 – 15x 87 650 – – 6x Occupied Palestinian Territory 104 92 100 101 106 – 50 99 – 99 97 – Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia 104 101 – 107 111 106 107 106 112 108 102 110 110 123 107 – 105 87 59 – 99 86 99 90 101 99 97 100 – 99 100 84 – – 102 78 96 99 – 101 102 102 101 99 101 93 100 100 107 122 98 – 85 – – – 100 101 102 – – – – – – 103 – – 99 77 – 111 – 106 100 121 102 110 98 94 98 – – 87 124 – 78 – – – 99 100 127 – – – – – – 88 – – 32 30 17 – 26x 73 71 51 49x – 43x 81x 70 – 17 54y 47x 100 61 – 72x 78x 94 91 88 – – – – 94 – 94 100 99 83y 28 – – – 79 87 70 – – – – 76 – 13 – – 98 39 100 91 41 77 71 60 100 100 99x 100x 98 100 39 100 100 98 34 – 92 – 74 72 38 – – 98x – 98 – 28 – – 13 530x 0x 66 370x 120 190 160 8x 10x 20x 15 24 750 0 Saint Vincent and the Grenadines 830 170 1800 1100 – 31 10200 5900 150 18 – 7700 – – 64 320 – 130 470 150 240 230 11 12 14 24 28 1300 – – 420 74 – 270 55 170 140 140 10600 6400 2700 6100 3200 2700 16 – – – – – – – 18 980 – – 2100 14 6 220 1400 400 58 450 72 390 130 170 110 – – – 1400 21 – – 6200 13800 14200 100 12 110 16400 850 53 530 120 17400 13800 210 160 500 106 – 96 – 124 – 48y 95 – 100 – Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand The former Yugoslav Republic of Macedonia 109 – 106 106 107 106 – 108 105 111 110 103 105 103 108 111 105 110 100 106 107 105 108 113 99 – 89 89 61 – 101 54 94 – 100 – – 98 98 96 73 95 97 – – 85 100 97 100 – 101 – 98 100 101 – – 101 100 99 – 100 99 100 83 103 101 100 99 95 96 99 – – 101 – 102 100 – 101 – – – – 82 104x – – 93 99 103 – – 100 99 100 114 – 111 – 76 – 106 71 – – 101 87 – 112 103 – – 138 121 100 95 95 84 111 – – 105 – 78 103 – 79 – – – – 51 117x – – 133 121 132 – – 101 83 109 43x – 30 32x 12 41 – 62x 74x 74x 15 60 81x 68 46 51 – 82x 58 38 77 – – 97 90x 87 98 – 81 – – 98x – 26 92 – 99 60 90 85 – – 84 77 98 – – – – 40 – – – – – – – 73x – – – – 79 – – – – – 100x – 81 91x 52 99 – 43 100x 100 100 85x 33 92 – 99 87 90 69 – – 93 83 97 – – 78 91x 62 99 – 19 – – – – – – 98 – 88 74 – – 70 62 97 107 97 100 96 98 99 – 94 – 99 99 10 6500 Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan 103 106 103 106 106 107 114 – 56 100 99 80 84 100 96 87 97 100 101 96 – 98 93 – 100 98 96 100 – 48 125 104 110 86 – – 70 – 107 – 83 100 20 17 33 43 66 71 48 61 84 – 96 92 81 99 30 46x – – – 54 83 18 62 95 98 90 83 100 10 63 – 97 89 78 98 – 480x 78 45x 69x 29 14 380 510 – 45 100 44 130 35 38 – 1400 500 880 290 148 T H E S TAT E O F T H E W O R L D ’ S C H I L D R E N 0 Adjusted Lifetime risk of maternal death in: 29 – 150 – 400 13 57 1800 6x 17 140x 1000 170 6x 43 550x 150 590 5x 5x 65 97 12 …TABLE Maternal mortality ratio† Life expectancy: females as a % of males 2007 Countries and territories Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States Uruguay Uzbekistan Vanuatu Adult literacy rate: females as a % of males 2000–2007* Enrolment and attendance ratios: females as a % of males Net Net Contraceptive primary school secondary school prevalence 2000–2007* 2000–2007* (%) enrolled attending enrolled attending 2000–2007* Antenatal care coverage (%) 2000–2007* At least once At least four times Delivery care coverage (%) 2000–2007* Skilled attendant Institutional at birth delivery 2005 2000–2007* reported Adjusted Lifetime risk of maternal death in: – 103 119 106 106 – 80 100 98 – – – 100 100 101 – 99 102 – – – 90 101 102 104 – 94 102 – – 32 24 67 28x 84 – 94 99 97x – – 47 – – – 100 42 99 99x 99x – 41 99 99x – – 440 17 3x 7x – 550 18 37 – 25 5200 1000 8200 104 107 110 110 106 83 – 101 98 95 99 102 100 – 99 106 – – 100 – 90 100 – – 87 108 – – 98 – 26 76x 84 65 28 78 – 94x 99 – 62 – 97 79x – 43 99x 100x 100 88x 47 – – 97 – 580 8x 35 28 68x 950 11 20 24 – 24 4800 2100 1400 – Venezuela (Bolivarian Republic of) 108 99 100 102 114 147 77x 94 – 95 95 61 57 610 Viet Nam Yemen Zambia Zimbabwe 105 105 101 97 93x 53 78x 94 – 76 104 101 100 60x 105 102 – 53 80 96 102 37x 112 93 76 28 34 60 91 41 93 94 29 11x 72 71 88 36 43 69 64 24 44 68 160 370 730 560 150 430 830 880 280 39 27 43 93 95 84 87 23 72 42 45 40 – 920 22 SUMMARY INDICATORS Sub-Saharan Africa 104 Eastern and Southern Africa 104 79 98 101 90 92 30 72 40 40 33 – 760 29 West and Central Africa 103 72 86 89 77 84 17 71 44 49 46 – 1100 17 Middle East and North Africa 75 105 South Asia East Asia and Pacific Latin America and Caribbean CEE/CIS Industrialized countries§ Developing countries§ Least developed countries§ World 78 94 96 92 97 56 72 – 81 71 – 210 140 104 106 71 93 94 99 95 101** – 103** 85 105** 53 78 68 89 34 66** 41 87 35 73 – – 500 150 59 350 109 115 108 105 104 106 99 97 – 86 72 88 100 98 101 96 94 97 101 98 – 96** 97 96** 107 95 101 97** 86 98** – 96 – 91** 94 91** 69 64 72 60 29 62 94 90 – 77 64 77 83 – – 46** 32 47** 85 94 – 61 39 62 86 89 – 54 32 54 – – – – – – 130 46 450 870 400 280 1300 8000 76 24 92 § Also includes territories within each country category or regional group Countries and territories in each country category or regional group are listed on page 152 DEFINITIONS OF THE INDICATORS Life expectancy at birth – Number of years newborn children would live if subject to the mortality risks prevailing for the cross section of population at the time of their birth Adult literacy rate – Number of literate persons aged 15 and above, expressed as a percentage of the total population in that age group Enrolment and attendance ratios: females as a % of males – Girls’ net enrolment and attendance ratios divided by those of boys, as a percentage Primary or secondary school net enrolment ratio – Number of children enrolled in primary or secondary school who are of official primary or secondary school age, expressed as a percentage of the total number of children of official primary or secondary school age Primary school net attendance ratio – Number of children attending primary or secondary school who are of official primary school age, expressed as a percentage of the total number of children of official primary school age Secondary school net attendance ratio – Number of children attending secondary or tertiary school who are of official secondary school age, expressed as a percentage of the total number of children of official secondary school age Contraceptive prevalence – Percentage of women in union aged 15–49 currently using contraception Antenatal care coverage – Percentage of women 15–49 years old attended at least once during pregnancy by skilled health personnel (doctors, nurses or midwives) and the percentage attended by any provider at least four times Skilled attendant at birth – Percentage of births attended by skilled health personnel (doctors, nurses or midwives) Institutional delivery – Proportion of women 15–49 years old who gave birth during the two years preceding the survey and delivered in a health facility Maternal mortality ratio – Annual number of deaths of women from pregnancy-related causes per 100,000 live births The ‘reported’ column shows country-reported figures that are not adjusted for under-reporting and misclassification Lifetime risk of maternal death – Lifetime risk of maternal death takes into account both the probability of becoming pregnant and the probability of dying as a result of that pregnancy accumulated across a woman’s reproductive years NOTES – x y * ** MAIN DATA SOURCES Life expectancy – United Nations Population Division Adult literacy – UNESCO Institute for Statistics (UIS) Primary and secondary school enrolment – UIS Primary and secondary school attendance – Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) Contraceptive prevalence – DHS, MICS, United Nations Population Division and UNICEF Antenatal care coverage – DHS, MICS and other national household surveys Skilled attendant at birth – DHS, MICS, WHO and UNICEF Institutional delivery – DHS, MICS, WHO and UNICEF Maternal mortality – WHO and UNICEF Lifetime risk – WHO and UNICEF † The maternal mortality data in the column headed ‘reported’ are those reported by national authorities Periodically, UNICEF, WHO, UNFPA and the World Bank evaluate these data and make adjustments to account for the well-documented problems of under-reporting and misclassification of maternal deaths and to develop estimates for countries with no data The column with ‘adjusted’ estimates for the year 2005 reflects the most recent of these reviews Data not available Data refer to years or periods other than those specified in the column heading, differ from the standard definition or refer to only part of a country Such data are not included in the calculation of regional and global averages Data refer to years or periods other than those specified in the column heading, differ from the standard definition or refer to only part of a country Such data are included in the calculation of regional and global averages Data refer to the most recent year available during the period specified in the column heading Excludes China S TAT I S T I C A L TA B L E S 149 TABLE CHILD PROTECTION daughters Attitude towards domestic violence 2001–2007* total urban rural total total total total – – – – – – – – – – – 13 – – – – – 73 – – – 26 45 – – – – – – 36 – – – 93 – – 96 – – 89 74 – 78 – – 96 45 – – – – – – – – – 32 – – – – – – – – 85 72 – – – – – – – – – – 19 – – – – – – – – – – – – – – – – – – – – 76 – – – 21 47 – – – – – – 34 – – – 93 – – 92 – – 86 69 – 72 – – 94 39 – – – – – – – – – 21 – – – – – – – – 81 60 – – – – – – – – – – 28 – – – – – – – – – – – – – – – 15 – – – – – 71 – – – 29 44 – – – – – – 39 – – – 96 – – 98 – – 91 76 – 83 – – 96 48 – – – – – – – – – 36 – – – – – – – – 87 84 – – – – – – – – – – 14 – – – – – – – – – – – – – – – – – – – – 25 – – – 21 – – – – – – – – – 49 – – 28y – – 63 38 – 64 – – 57 35 – – – – – – – – – 21 – – – – – – – – 69 66 – – – – – – – – – – 10 – – – – – 30 68 – – 22 49 – – – 12 47 – – – – 71 – 55 56 – – – – – – – 76 – 65 – – – – – 50 – – – 81 – 74 47 – 86 52 18 29 16 54 25 59 90 10 68 38 – – – – 28 28 70 75 – – 21 20 11 – – – 35 23 17 70 65 – – – – – 16 1y – – 12y – – 21 – 44 – – – 10 – – – – – 33 1y 48 3y – 2y 3y – – – – – – – – 5y – 8y – – – – – – 30 21 2y – – – – – – – 21 24 – – – – – – – – – – – – 30 – – 26 14 – – – – – – – – – – – – – 49 86 – – – 75 – – 83 68 – – – 36 – – 83 – – 92 – 88 – – – – – – – 90 – – – 70 83 – 92 – – – – – 84 66 89 – – 80 74 – – – – 84 87 – 52 – 51 – – – – – – – – – – – 79 61 – – – – – – – – 95 – – – Female genital mutilation/cutting 2002–2007* Child labour (5–14 years) 1999–2007* Countries and territories Afghanistan Albania Algeria Angola Argentina Armenia Azerbaijan Bahrain Bangladesh Belarus Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Burkina Faso Burundi Cambodia Cameroon Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d’Ivoire Cuba Democratic People’s Republic of Korea Democratic Republic of the Congo Djibouti Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Ethiopia Gabon Gambia Georgia Ghana Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras India Indonesia Iraq Jamaica Jordan Kazakhstan Kenya Kyrgyzstan Lao People’s Democratic Republic Lebanon Lesotho Liberia Madagascar Malawi Maldives Mali Mauritania Mexico Moldova Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nepal Nicaragua Niger Nigeria Occupied Palestinian Territory Pakistan Panama Paraguay 150 total male female 30 12 24 7y 4y 7y 13 40 46 19y 22 – 6y 47y 19 45y 31 3y 47 53 – 27 25 35 – – 32 10 12 6y 28 – 53 – 25 18 34 29 25 39 19 21 16 12 4y 11 – 26 25 23 – 32 29 – 34 4y 16y 32 18 10 11y – – 13y 31y 15 43 13y – – 15 28 14 22 8y – 8y 18 39 47 16y 22 – 7y 46y 19 45y 31 4y 44 54 – 26 24 36 – – 29 12 12 9y 28 – 59 – 20 20 34 25 26 41 21 22 16 12 5y 12 – 27 24 25 – 36 28 – 35 5y 15y 32 19 12 13y – – 15y 30y 18 43 – – – 17 33 25 5y – 5y 42 45 22y 22 – 4y 48y 19 45y 30 3y 49 51 – 28 25 34 – – 34 13 4y 28 – 46 – 29 17 34 32 24 37 17 19 15 12 4y – 25 26 21 – 28 29 – 33 3y 16y 33 17 9y – – 12y 33y 11 43 – – – 12 Child marriage 1998–2007* Birth registration 2000–2007* total urban rural total urban rural 43 – – 10 12 – 64 – 34 – 26 10x 24x 48 18 23 36 – 61 72 – – 23 30x 31 – 35 – – – 40 22 17 27 – 47 49 34 36 17 22 34 63 24 20 30 39 47 24 17 10 25 10 – 11 23 40 39 50 – 71 35 28x 19 16 56 – 51 43 75 43 19 32x – 24x – – – – – 58 – 19 – 22 13x 22x 29 14 18 23 – 57 65 – – 19 23x 24 – 27 – – – 38 – – – 31 27 30 24 12 15 25 45 14 15 27 33 29 15 16 – 19 – – 13 – 29 38 – 60 27 31x 16 12 41 – – 41 36 42 27 – 21x – 18x – – – 16 – – 69 10 – 47 – 37 9x 30x 61 18 25 57 – 64 73 – – 38 33x 40 – 43 – – – 13 47 – 22 – – 60 55 49 45 23 28 44 75 32 22 33 46 56 33 19 11 – 27 14 – – 26 – 42 53 – 77 44 21x 22 12 21 66 – – 54 55 84 52 – 37x – 32x 98 99 29 91y 96 94 – 10 – 94 60 – 74 100 58 89y 64 60 66 70 – 49 95y – 90 83 81y – 55 100y 99 34 89 78 85 99 – 32 – 89 55 92 51 – 43 39 93 81 94 41 55 95 89 – 99 48y 94 59 – 26 – 75 – 73 53 56 – 98 98 98 85 – 65y 67 35 81 32 33y 96y – – – 12 97 98 99 99 34 19 – – 97 95 96 92 – – 13 – – 92 97 68 56 – – 76 72 99 100 66 52 – – 86 58 62 60 71 66 86 58 – – 72 36 36 – – – – 97 77 87 83 88y 75y – – 79 41 100y 100y 99 99 30 36 90 82 82 70 85 85 99 99 – – 43 24 – – 29 90 87 57 54 97 87 69 42 – – 78 33 53 33 96 92 87 78 95 93 59 35 69 43 95 96 88 89 – – 99 99 64y 44y 96 93 71 56 – – 39 24 – – 87 72 – – – – 75 45 75 42 – – 98 98 98 99 98 99 92 80 – – 88y 59y 83 59 42 34 90 73 71 25 52y 25y 97y 96y – – – – – – T H E S TAT E O F T H E W O R L D ’ S C H I L D R E N 0 a b women (15–49 years) Child disability◊ 1999–2007* Child discipline 2005–2007* …TABLE daughters Attitude towards domestic violence 2001–2007* Child disability◊ 1999–2007* Child discipline 2005–2007* total Female genital mutilation/cutting 2002–2007* Child labour (5–14 years) 1999–2007* Countries and territories total Child marriage 1998–2007* Birth registration 2000–2007* total urban rural total urban rural male female 20 13 4y 36 24 49 45 – 14 – 9 29 – – 37 37 8y 15 11y 11y 12y 19 11 3y 35 21 48 54 – 12 – 11 30 – – 36 34 8y 16 12y 12y 14y 18 14 – – 13 33 39 56 45 12y 34 19 13 13 20 – 24 10x 18 46 41 – – 10 32 42 34 13 10 – – 31 23 34 35 – 24 14 15 13 12 – 15 – 7x 17 27 23 – – 28 32 20 31 22 – – 14 37 55 66 52 12 – 40 33 12 13 23 – 36 – 14x 22 52 10 49 – – 13 35 49 44 36n 38 34n 10 13 11** 11 – 17*** 31 – 34n 33 35n 12 10** 10 – 15*** 28 – 40 36 44 18 49 19** – 11 – 36** 49 – 25 20 28 12 32 12** – 11 – 22** 37 – 48 43 55 23 58 25** – 13 – 46** 55 – Peru 19 Philippines 12 Portugal 3y Romania Rwanda 35 Sao Tome and Principe Senegal 22 Serbia Sierra Leone 48 Somalia 49 South Africa – Sri Lanka Sudan 13 Suriname – Swaziland Syrian Arab Republic Tajikistan 10 Thailand The former Yugoslav Republic of Macedonia Timor-Leste Togo 29 Trinidad and Tobago Tunisia – Turkey Turkmenistan – Uganda 36 Ukraine United Republic of Tanzania 36 Uruguay 8y Uzbekistan Venezuela (Bolivarian Republic of) Viet Nam 16 Yemen 11y Zambia 12y Zimbabwe 13y 93 83 – – 82 69 55 99 48 78y – 33 97 30 95 88 99 94 53y 78 96 – 84 96 21 100 – 100 92 88 22 10 74 95 87 – – 79 70 75 99 62 – – 53 98 38 96 85 100 95 – 93 – – 87 96 24 100 22 – 100 – 94 38 16 83 90 78 – – 83 67 44 99 44 – – 22 95 28 95 90 99 93 – 69 – – 79 95 21 100 – 100 – 86 16 71 a b women (15–49 years) total total total – – – – – – 28 – 94 98 – – 89 – – – – – – – – – – – – 15 – – – – 23x – – – – – – – 22 – 86 97 – – 88 – – – – – – – – – – – – – – – – 26x – – – – – – – 34 – 97 98 – – 90 – – – – – – – – – – – – 18 – – – – 22x – – – – – – – 20 – 35 46 – – 43y – – – – – – – – – – – – – – – – – 20x – – – 24 – – 48 32 65 85 76y – – – 13 38 – 74y – 21 – 53 – 39 38y 70 60 – 70 – 64 – 85 48 – – – – 2y 29 – 14 34 – – – – 39 – – – 15 21 – – – – – – 11y – – – – 4y 29 – – – – – – – – – 73 92 – – – – 84 – 87 74 – 69 – 90 75 – – – – 70 – – – – 93 94 – – 34 43 28 – – – – – – – – – 30 36 28 – – – – – – – – – 37 46 29 – – – – – – – – – 19 28 14 – – – – – – – – – 65 65 64 – 53 34** – 32 – 51** – – – – – – – – – – – – – – – – 89 – – – – – – – – total urban rural SUMMARY INDICATORS Sub-Saharan Africa Eastern and Southern Africa West and Central Africa Middle East and North Africa South Asia East Asia and Pacific Latin America and Caribbean CEE/CIS Industrialized countries§ Developing countries§ Least developed countries§ World 35n 36 35n 13 10** 11 – 16*** 30 – 37 32 41 75 36 72** 89 92 – 50** 29 – 52 41 57 86 52 81** 92 93 – 65** 42 – 30 24 35 67 30 67** 82 92 – 39** 25 – § Also includes territories within each country category or regional group Countries and territories in each country category or regional group are listed on page 152 MAIN DATA SOURCES DEFINITIONS OF THE INDICATORS Child labour – Percentage of children 5–14 years old involved in child labour at the moment of the survey A child is considered to be involved in child labour under the following conditions: (a) children 5–11 years old who, during the week preceding the survey, did at least one hour of economic activity or at least 28 hours of domestic work, or (b) children 12–14 years old who, during the week preceding the survey, did at least 14 hours of economic activity or at least 28 hours of domestic work Child labour background variables – Sex of the child; urban or rural place of residence; poorest 20 per cent or richest 20 per cent of the population constructed from household assets (a more detailed description of the household wealth estimation procedure can be found at ); mother’s education, reflecting mothers with and without some level of education Child marriage – Percentage of women 20–24 years old who were married or in union before they were 18 years old Birth registration – Percentage of children less than five years old who were registered at the moment of the survey The numerator of this indicator includes children whose birth certificate was seen by the interviewer or whose mother or caretaker says the birth has been registered MICS data refer to children alive at the time of the survey Female genital mutilation/cutting – (a) Women – the percentage of women 15–49 years old who have been mutilated/cut (b) Daughters – the percentage of women 15–49 years old with at least one mutilated/cut daughter Female genital mutilation/cutting is the cutting or alteration of the female genitalia for social reasons Attitudes towards domestic violence – Percentage of women 15–49 years old who consider a husband to be justified in hitting or beating his wife for at least one of the specified reasons Women were asked whether a husband is justified in hitting or beating his wife under a series of circumstances, i.e., if his wife burns the food, argues with him, goes out without telling him, neglects the children or refuses sexual relations Child disability – Percentage of children 2–9 years old with at least one reported disability (i.e., cognitive, motor, seizure, vision, hearing or speech) Child discipline – Percentage of children 2–14 years old who experience any psychological or physical punishment NOTES – x y n ◊ * ** *** Child labour – Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS) Child marriage – MICS, DHS and other national surveys Birth registration – MICS, DHS, other national surveys and vital registration systems Female genital mutilation/cutting – MICS, DHS and other national surveys Attitudes towards domestic violence – MICS, DHS and other national surveys Child disability – MICS, DHS and other national surveys Child discipline – MICS, DHS and other national surveys Data not available Data refer to years or periods other than those specified in the column heading, differ from the standard definition or refer to only part of a country Such data are not included in the calculation of regional and global averages Data refer to years or periods other than those specified in the column heading, differ from the standard definition or refer to only part of a country Such data are included in the calculation of regional and global averages Excludes Nigeria A fuller explanation of the methodology and the recent changes in calculating these estimates can be found in the General note on the data, page 114 Data refer to the most recent year available during the period specified in the column heading Excludes China Excludes China and Nigeria S TAT I S T I C A L TA B L E S 151 Summary indicators Averages given at the end of each table are calculated using data from the countries and territories as grouped below Sub-Saharan Africa Angola; Benin; Botswana; Burkina Faso; Burundi; Cameroon; Cape Verde; Central African Republic; Chad; Comoros; Congo; Côte d’Ivoire; Democratic Republic of the Congo; Equatorial Guinea; Eritrea; Ethiopia; Gabon; Gambia; Ghana; Guinea; GuineaBissau; Kenya; Lesotho; Liberia; Madagascar; Malawi; Mali; Mauritania; Mauritius; Mozambique; Namibia; Niger; Nigeria; Rwanda; Sao Tome and Principe; Senegal; Seychelles; Sierra Leone; Somalia; South Africa; Swaziland; Togo; Uganda; United Republic of Tanzania; Zambia; Zimbabwe Middle East and North Africa Algeria; Bahrain; Djibouti; Egypt; Iran (Islamic Republic of); Iraq; Jordan; Kuwait; Lebanon; Libyan Arab Jamahiriya; Morocco; Occupied Palestinian Territory; Oman; Qatar; Saudi Arabia; Sudan; Syrian Arab Republic; Tunisia; United Arab Emirates; Yemen South Asia Afghanistan; Bangladesh; Bhutan; India; Maldives; Nepal; Pakistan; Sri Lanka East Asia and Pacific Brunei Darussalam; Cambodia; China; Cook Islands; Democratic People’s Republic of Korea; Fiji; Indonesia; Kiribati; Lao People’s Democratic Republic; Malaysia; Marshall Islands; Micronesia (Federated States of); Mongolia; Myanmar; Nauru; Niue; Palau; Papua New Guinea; Philippines; Republic of Korea; Samoa; Singapore; Solomon Islands; Thailand; Timor-Leste; Tonga; Tuvalu; Vanuatu; Viet Nam Latin America and Caribbean Antigua and Barbuda; Argentina; Bahamas; Barbados; Belize; Bolivia; Brazil; Chile; 152 Colombia; Costa Rica; Cuba; Dominica; Dominican Republic; Ecuador; El Salvador; Grenada; Guatemala; Guyana; Haiti; Honduras; Jamaica; Mexico; Nicaragua; Panama; Paraguay; Peru; Saint Kitts and Nevis; Saint Lucia; Saint Vincent and the Grenadines; Suriname; Trinidad and Tobago; Uruguay; Venezuela (Bolivarian Republic of) CEE/CIS Albania; Armenia; Azerbaijan; Belarus; Bosnia and Herzegovina; Bulgaria; Croatia; Georgia; Kazakhstan; Kyrgyzstan; Moldova, Republic of; Montenegro; Romania; Russian Federation; Serbia; Tajikistan; The former Yugoslav Republic of Macedonia; Turkey; Turkmenistan; Ukraine; Uzbekistan Industrialized countries/territories Andorra; Australia; Austria; Belgium; Canada; Cyprus; Czech Republic; Denmark; Estonia; Finland; France; Germany; Greece; Holy See; Hungary; Iceland; Ireland; Israel; Italy; Japan; Latvia; Liechtenstein; Lithuania; Luxembourg; Malta; Monaco; Netherlands; New Zealand; Norway; Poland; Portugal; San Marino; Slovakia; Slovenia; Spain; Sweden; Switzerland; United Kingdom; United States Developing countries/territories Afghanistan; Algeria; Angola; Antigua and Barbuda; Argentina; Armenia; Azerbaijan; Bahamas; Bahrain; Bangladesh; Barbados; Belize; Benin; Bhutan; Bolivia; Botswana; Brazil; Brunei Darussalam; Burkina Faso; Burundi; Cambodia; Cameroon; Cape Verde; Central African Republic; Chad; Chile; China; Colombia; Comoros; Congo; Cook Islands; Costa Rica; Côte d’Ivoire; Cuba; Cyprus; Democratic Republic of the Congo; Democratic People’s Republic of Korea; Djibouti; Dominica; Dominican Republic; Ecuador; Egypt; El Salvador; Equatorial Guinea; Eritrea; Ethiopia; Fiji; Gabon; Gambia; Georgia; Ghana; Grenada; Guatemala; Guinea; Guinea-Bissau; Guyana; Haiti; Honduras; India; Indonesia; Iran (Islamic T H E S TAT E O F T H E W O R L D ’ S C H I L D R E N 0 Republic of); Iraq; Israel; Jamaica; Jordan; Kazakhstan; Kenya; Kiribati; Kuwait; Kyrgyzstan; Lao People’s Democratic Republic; Lebanon; Lesotho; Liberia; Libyan Arab Jamahiriya; Madagascar; Malawi; Malaysia; Maldives; Mali; Marshall Islands; Mauritania; Mauritius; Mexico; Micronesia (Federated States of); Mongolia; Morocco; Mozambique; Myanmar; Namibia; Nauru; Nepal; Nicaragua; Niger; Nigeria; Niue; Occupied Palestinian Territory; Oman; Pakistan; Palau; Panama; Papua New Guinea; Paraguay; Peru; Philippines; Qatar; Republic of Korea; Rwanda; Saint Kitts and Nevis; Saint Lucia; Saint Vincent and the Grenadines; Samoa; Sao Tome and Principe; Saudi Arabia; Senegal; Seychelles; Sierra Leone; Singapore; Solomon Islands; Somalia; South Africa; Sri Lanka; Sudan; Suriname; Swaziland; Syrian Arab Republic; Tajikistan; Thailand; Timor-Leste; Togo; Tonga; Trinidad and Tobago; Tunisia; Turkey; Turkmenistan; Tuvalu; Uganda; United Arab Emirates; United Republic of Tanzania; Uruguay; Uzbekistan; Vanuatu; Venezuela (Bolivarian Republic of); Viet Nam; Yemen; Zambia; Zimbabwe Least developed countries/territories Afghanistan; Angola; Bangladesh; Benin; Bhutan; Burkina Faso; Burundi; Cambodia; Cape Verde; Central African Republic; Chad; Comoros; Democratic Republic of the Congo; Djibouti; Equatorial Guinea; Eritrea; Ethiopia; Gambia; Guinea; Guinea-Bissau; Haiti; Kiribati; Lao People’s Democratic Republic; Lesotho; Liberia; Madagascar; Malawi; Maldives; Mali; Mauritania; Mozambique; Myanmar; Nepal; Niger; Rwanda; Samoa; Sao Tome and Principe; Senegal; Sierra Leone; Solomon Islands; Somalia; Sudan; Timor-Leste; Togo; Tuvalu; Uganda; United Republic of Tanzania; Vanuatu; Yemen; Zambia Measuring human development An introduction to Table 10 If development is to be measured by a comprehensive and inclusive assessment, then the need arises for a method of measuring human as well as economic progress From UNICEF’s point of view, there is a need for an agreed method of measuring the level of child well-being and its rate of change The under-five mortality rate (U5MR) is used in Table 10 (pages 150–153 ) as the principal indicator of such progress In 2007, the number of children dying before their fifth birthday fell to 9.2 million In comparison, in 1960, approximately 20 million children were dying every year – highlighting an important longterm decline in the global number of underfive deaths The U5MR has several advantages First, it measures an end result of the development process rather than an ‘input’, such as school enrolment level, per capita calorie availability or the number of doctors per thousand population – all of which are means to an end Second, the U5MR is known to be the result of a wide variety of inputs: antibiotics to treat pneumonia; insecticide-treated mosquito nets to prevent malaria; the nutritional health and the health knowledge of mothers; the level of immunization and oral rehydration therapy use; the availability of maternal and child health services, including prenatal care; income and food availability in the family; the availability of safe drinking water and basic sanitation; and the overall safety of the child’s environment Third, the U5MR is less susceptible to the fallacy of the average than, for example, per capita gross national income (GNI) This is because the natural scale does not allow the children of the rich to be one thousand times as likely to survive, even if the human-made scale does permit them to have one thousand times as much income In other words, it is much more difficult for a wealthy minority to affect a nation’s U5MR, and it therefore presents a more accurate, if far from perfect, picture of the health status of the majority of children and of society as a whole The speed of progress in reducing the U5MR can be measured by calculating its average annual rate of reduction (AARR) Unlike the comparison of absolute changes, the AARR reflects the fact that the lower limits to U5MR are approached only with increasing difficulty As lower levels of under-five mortality are reached, for example, the same absolute reduction obviously represents a greater percentage reduction The AARR therefore shows a higher rate of progress for a 10-point reduction, for example, if that reduction happens at a lower level of underfive mortality A fall in the U5MR of 10 points from 100 to 90 represents a reduction of 10 per cent, whereas the same 10-point fall from 20 to 10 represents a reduction of 50 per cent (A negative value for the percentage reduction indicates an increase in the U5MR over the period specified.) When used in conjunction with gross domestic product (GDP) growth rates, the U5MR and its rate of reduction can therefore give a picture of the progress being made by any country, territory or region, and over any period of time, towards the satisfaction of some of the most essential of human needs As Table 10 shows, there is no fixed relationship between the annual reduction rate of the U5MR and the annual rate of growth in per capita GDP Such comparisons help to shed light on the relationship between economic advances and human development Finally, the table gives the total fertility rate for each country and territory and the corresponding average annual rate of reduction It is clear that many of the nations that have achieved significant reductions in their U5MR have also achieved significant reductions in fertility S TAT I S T I C A L TA B L E S 153 TABLE 10 THE RATE OF PROGRESS Countries and territories Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Côte d’Ivoire Croatia Cuba Cyprus Czech Republic Democratic People’s Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland 154 Under-5 mortality rate Average annual rate of reduction (%)Θ Under-5 mortality rank 1970 1990 2007 126 75 189 16 140 125 99 160 173 71 134 145 58 137 134 166 97 25 45 61 132 69 107 148 137 10 40 18 160 84 12 148 107 112 55 24 117 140 22 160 156 166 173 320 107 220 – – – 68 – 21 29 – 49 82 238 54 – 24 – 256 288 243 82 144 134 78 33 281 219 – 215 22 – 232 – 98 118 105 215 142 – 83 236 42 39 31 24 260 46 69 258 – 29 56 9 98 29 19 151 17 24 10 43 184 148 125 22 57 58 11 18 206 189 119 139 60 171 201 21 45 35 120 104 32 18 151 13 13 11 12 257 15 37 158 11 16 24 39 13 10 61 12 13 25 123 84 57 14 40 22 12 191 180 91 148 32 172 209 22 20 66 125 18 11 127 1.0 4.2 5.8 – – – 4.3 – 4.2 5.9 – 2.6 7.3 2.3 5.8 – 4.4 – 1.7 3.3 3.3 6.6 4.6 4.2 9.8 3.0 1.6 0.7 – 2.2 5.1 – 1.5 – 7.7 4.8 5.5 2.9 1.6 – 7.6 2.2 5.9 5.5 5.2 3.5 0.1 6.6 3.7 4.1 2.9 – 3.5 5.0 2.4 4.8 5.4 4.7 3.8 5.3 2.0 3.6 4.1 3.2 2.4 3.3 4.6 2.7 2.1 5.7 1.2 2.4 0.4 0.3 1.6 -0.4 1.7 3.7 0.0 -0.2 5.0 4.2 3.3 3.5 -1.1 3.4 2.9 1.0 4.5 3.6 4.6 6.5 67 46 50 39 – 45 57 33 56 60 55 47 60 29 46 50 42 33 43 54 36 30 62 18 33 24 -6 25 47 -1 -4 57 51 43 45 -20 44 39 16 54 46 55 67 62 70 55 55 1.2 0.0 15 173 22 140 73 107 77 99 50 160 27 117 173 235 16 – 60 131 140 236 162 – 237 20 241 – 16 200 175 18 66 57 93 60 170 147 18 204 22 161 127 11 38 22 36 24 206 70 119 18 0.8 2.9 – 6.0 3.4 4.5 4.7 5.0 – 2.4 0.5 0.8 – 4.1 1.3 4.8 1.9 2.9 3.2 5.6 5.6 5.4 -1.1 4.4 6.5 3.2 1.2 3.3 20 56 27 39 42 61 61 60 -21 52 67 42 18 43 1970–1990 1990–2007 T H E S TAT E O F T H E W O R L D ’ S C H I L D R E N 0 Reduction since 1990 (%)Θ GDP per capita average annual growth rate (%) 1970–1990 1990–2007 – -0.7x 1.6 – 0.4x 8.3x -0.7 – 1.5 2.4 – 1.8 -1.3x 0.6 1.5 – 2.2 2.9 6.8x -1.1 – 8.2 2.3 -2.2x 3.4x 1.3 1.1 – 3.3 – -1.3 -1 1.5 6.6 0.1x 3.2 – 0.7 -1.9 – – 5.9x – – -2.4 – 4.7x 2.1 1.3 4.3 -1.8 – – 1.5x – 0.6x 2.8 – 5.2 1.4 – 2.9 1.7 1.5 5.8 2.4 1.8 2.8 0.4x 2.4x 3.1 1.3x 3.4 1.8 2.4 1.3 5.2 1.3 10.8x 4.2 1.2 -0.3x 2.3 2.5 -2.7 6.2x 0.6 2.2 3.3 -0.8 2.4 3.7 8.9 -0.4 -0.2 – 2.5 -0.7 3.6x 2.2 2.4 – -4.3 1.9 -2.1 2.4 3.8 1.2 2.5 1.8 21.1 -0.3x 5.2 2.2 1.5x 2.8 Total fertility rate Average annual rate of reduction (%) 1970 1990 2007 7.7 4.9 7.4 – 7.3 – 3.1 3.2 2.7 2.3 4.6 3.6 6.5 6.4 3.1 2.3 2.2 6.3 7.0 6.7 6.6 2.9 6.6 5.0 5.7 2.2 7.6 6.8 5.9 6.2 2.2 7.0 5.7 6.5 4.0 5.6 5.6 7.1 6.3 – 5.0 7.4 2.0 4.0 2.6 2.0 8.0 2.9 4.7 – 7.2 – 3.0 2.5 1.9 1.5 3.0 2.6 3.7 4.4 1.7 1.9 1.6 4.5 6.8 5.9 4.9 1.7 4.7 2.8 3.2 1.7 7.3 6.8 5.8 5.9 1.7 5.5 5.7 6.7 2.6 2.2 3.0 6.1 5.4 – 3.2 6.6 1.7 1.8 2.4 1.8 7.1 2.1 2.4 – 6.5 – 2.3 1.4 1.8 1.4 1.8 2.0 2.3 2.9 1.5 1.2 1.6 3.0 5.5 2.2 3.5 1.2 2.9 2.3 2.3 1.3 6.0 6.8 3.2 4.4 1.5 3.4 4.6 6.2 1.9 1.7 2.2 4.4 4.5 – 2.1 4.5 1.3 1.5 1.6 1.2 1970–1990 1990–2007 -0.2 2.6 2.3 – 0.1 – 0.1 1.2 1.9 2.3 2.2 1.6 2.8 1.9 3.1 1.0 1.7 1.7 0.2 0.6 1.5 2.6 1.7 2.9 2.8 1.2 0.2 0.0 0.1 0.2 1.5 1.2 0.0 -0.1 2.1 4.7 3.1 0.7 0.8 – 2.3 0.5 0.9 4.2 0.4 0.5 0.7 2.0 4.0 – 0.6 – 1.7 3.7 0.3 0.2 3.1 1.5 2.8 2.5 0.6 2.6 -0.2 2.5 1.3 5.7 1.9 2.0 2.8 1.3 2.0 1.6 1.1 0.0 3.5 1.8 0.5 2.8 1.2 0.4 1.8 1.4 1.8 2.0 1.0 – 2.4 2.2 1.3 0.9 2.5 2.3 4.0 2.4 1.9 2.6 1.5 6.4 2.1 7.4 – 6.2 6.3 6.2 6.4 5.7 6.6 2.1 6.8 4.5 1.9 6.7 1.7 6.2 – 3.3 3.7 4.4 3.7 5.9 6.2 1.9 6.8 3.4 1.7 6.7 1.8 4.0 – 2.8 2.6 2.9 2.7 5.4 5.1 1.5 5.3 2.8 1.8 -0.3 1.2 0.9 – 3.1 2.7 1.7 2.7 -0.2 0.3 0.4 0.0 1.5 0.3 0.0 -0.5 2.5 – 0.9 2.0 2.4 1.8 0.5 1.2 1.6 1.4 1.2 -0.2 …TABLE 10 Under-5 mortality rate Average annual rate of reduction (%)Θ GDP per capita average annual growth rate (%) Total fertility rate Average annual rate of reduction (%) Under-5 mortality rank France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru 1970 1990 2007 1970 1990 2007 173 40 34 88 173 30 173 114 71 17 59 47 – 99 156 189 49 86 83 66 173 166 173 86 173 99 84 26 57 140 73 18 – 311 – 26 183 32 – 168 326 – – 222 – 169 40 16 190 172 191 125 23 29 33 62 17 107 88 156 – 59 – 92 153 47 120 11 37 82 231 240 88 152 – 58 17 117 91 72 53 12 10 33 40 60 97 88 15 74 91 109 30 115 19 39 150 198 60 76 – 24 72 31 33 44 31 24 32 121 63 11 38 3.5 – 3.5 – 5.3 2.1 5.3 – 3.6 1.7 – – 1.9 – 5.3 4.3 4.1 2.4 3.2 4.9 4.3 4.7 4.4 6.0 3.2 5.2 4.9 1.9 2.4 – 6.8 – 4.8 0.1 2.0 2.6 4.8 0.3 6.0 3.9 4.4 2.5 1.1 2.3 4.1 – 5.2 5.2 5.0 2.9 6.3 4.6 1.1 4.8 5.1 5.4 0.4 2.4 3.0 3.7 -1.3 2.0 1.8 3.9 56 29 36 56 64 49 52 35 18 32 50 – 59 59 57 38 66 54 17 56 58 60 33 40 47 -25 28 27 49 2.2 0.3 0.9 3.2 2.3x -2.1 1.3 4.9 0.2 0.3x -0.2 -1.5 -0.3 – 0.8 3.2 2.1 4.7 -2.3 – 2.8 1.9 2.8 -1.3 2.5x – 1.2 -5.3 -6.8x – 1.6 -0.7 0.2 1.8 1.4 2.1 2.7 2.5 1.4 1.3 -2.6 3.1 -2.1 – 1.5 3.3 2.4 4.5 2.3 2.5 – 5.8 1.7 1.2 0.8 0.9 3.2 1.8 1.1x -0.5 2.5 4.8 6.7 2.6 2.0 6.7 2.4 4.6 6.2 7.0 6.8 5.6 5.8 – 7.3 2.0 3.0 5.4 5.5 6.6 7.2 3.9 3.8 2.4 5.5 2.1 7.9 3.5 8.1 – 7.2 4.9 1.8 4.8 6.0 2.1 1.4 5.8 1.4 3.7 5.6 6.7 7.1 2.6 5.4 – 5.1 1.8 2.2 4.0 3.1 5.0 5.9 2.1 3.0 1.3 2.9 1.6 5.5 2.8 5.9 – 3.5 3.9 1.9 3.1 4.8 1.4 1.4 3.9 1.3 2.3 4.2 5.5 7.1 2.3 3.6 – 3.3 1.3 2.0 2.8 2.2 2.0 4.3 2.0 2.8 1.4 2.5 1.3 3.1 2.3 5.0 – 2.2 2.5 1.7 0.0 0.5 1.0 1.9 0.7 2.5 1.1 0.6 0.2 -0.2 3.8 0.3 – 1.7 0.6 1.6 1.5 2.8 1.3 1.0 3.1 1.2 3.1 3.1 1.3 1.8 1.1 1.6 – 3.6 1.2 -0.5 2.6 1.4 2.4 0.0 2.3 0.5 2.8 1.7 1.2 0.0 0.6 2.5 – 2.5 2.0 0.3 2.0 2.1 5.3 1.9 0.4 0.4 -0.3 1.1 1.3 3.3 1.3 1.0 – 2.8 2.7 50 148 91 45 20 117 189 151 189 32 33 140 88 166 64 27 126 78 218 20 54 171 284 160 – 22 23 180 334 70 – 372 28 – 233 86 111 163 17 37 102 205 41 10 16 168 209 22 111 250 11 92 130 24 52 70 29 84 133 18 112 111 11 30 196 54 119 15 35 1.5 0.8 1.9 2.6 1.6 6.8 – 1.6 4.7 0.3 2.3 5.8 – 2.0 4.7 – 2.9 6.4 3.8 5.0 3.7 1.4 1.1 2.5 4.8 7.1 4.1 6.5 2.4 3.7 4.1 7.7 1.4 4.6 3.1 0.5 2.8 2.3 57 47 22 18 35 56 70 50 67 33 47 50 73 22 55 41 38 33 – 3.4 – 3.1 -4.2 -4.9x – – 2.7 -2.4 -0.1 – -0.3 6.5 – -0.9 5.1x 1.6 4.2 4.7 2.5 1.8 1.9 – – 3.2 -0.4 0.3 3.2 5.5x 2.2 2.7x -2 0.6 3.7 1.6 6.4 1.9 5.1 5.8 6.9 7.6 – 2.3 2.0 6.8 7.3 5.6 7.0 7.5 2.1 – 6.6 3.7 6.7 6.2 1.9 3.1 4.9 6.9 4.8 – 2.0 1.6 6.2 7.0 3.7 6.2 7.4 2.0 – 5.8 2.2 3.4 3.2 1.3 2.2 3.4 6.8 2.8 – 1.3 1.7 4.8 5.6 2.6 2.6 6.5 1.4 – 4.4 1.9 2.2 0.2 0.0 2.4 0.8 0.0 2.3 – 0.7 1.1 0.4 0.2 2.0 0.6 0.0 0.0 – 0.6 2.5 3.4 3.9 2.3 2.1 2.2 0.1 3.3 – 2.7 -0.3 1.5 1.2 2.1 5.1 0.8 2.4 – 1.6 1.1 2.5 69 117 173 67 145 81 14 36 53 88 – 65 – – – 184 277 179 126 – 58 37 98 16 89 201 130 87 – 40 18 43 10 34 168 103 68 30 – 2.8 – – – 3.6 1.6 1.6 1.9 – 2.2 4.2 4.8 4.8 2.8 5.7 1.1 1.4 1.4 – 31 51 56 56 38 62 16 21 22 – – 1.8x – – – -1x 1.5 -2.3x – -0.2 -1.3 – 2.2 3.4x 4.1 6.8x 1.8 – 6.9 2.6 – 7.5 2.4 7.1 6.6 6.1 6.5 – 5.0 2.4 – 4.1 2.0 4.0 6.2 3.4 5.8 – 3.8 1.4 – 1.9 1.8 2.4 5.2 2.1 3.2 – 1.7 0.3 – 3.0 0.9 2.8 0.3 2.8 0.5 – 1.6 3.2 – 4.6 0.6 3.1 1.1 3.0 3.5 – 1970–1990 1990–2007 Reduction since 1990 (%)Θ 1970–1990 1990–2007 1970–1990 1990–2007 S TAT I S T I C A L TA B L E S 155 TABLE 10 THE RATE OF PROGRESS Under-5 mortality rate Average annual rate of reduction (%)Θ GDP per capita average annual growth rate (%) Total fertility rate Average annual rate of reduction (%) Under-5 mortality rank Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Occupied Palestinian Territory Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand The former Yugoslav Republic of Macedonia Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan 156 1970 1990 2007 1970 1990 2007 62 166 160 78 11 – 173 95 137 43 145 104 56 91 112 94 156 173 126 166 126 126 117 117 237 16 21 165 318 265 – 16 – 200 184 – 68 156 75 170 89 35 66 51 54 52 40 223 – 66 142 11 68 304 230 – 38 32 132 21 34 94 41 78 62 17 15 26 32 27 195 36 21 55 35 176 189 – 27 12 90 10 23 65 29 20 28 15 15 15 181 18 18 2.6 3.5 3.2 4.4 0.2 0.7 – 2.9 – 9.2 1.7 – 3.5 2.5 3.0 3.9 1.8 3.6 7.4 3.4 9.0 2.4 2.0 0.7 – 5.7 5.6 2.8 3.6 3.9 3.2 1.2 – 4.8 2.0 5.8 2.3 4.4 2.3 2.2 2.0 8.0 4.7 5.2 7.8 3.2 3.5 4.5 3.5 0.4 4.1 0.9 61 38 45 49 42 18 – 56 29 63 32 52 32 31 29 74 55 59 73 42 44 53 44 50 14 1.2 1.5 0.8 -3.7 -2.2 -1.4 – 3.2 – 3.3 – 0.3 -0.7 2.8 -0.6 0.8 – 2.6 – 6.2 0.9x – 1.1 6.3x 5.3x 1.9 2.1 1.9 -0.6 1.2 – 2.6 -2.9x 2.2x 1.6 – 2.6 -0.6 -0.3 2.7 1.7 4.4 1.9 – 4.4 2.3 1.2 1.1 2.8 1.3 5.9 2.4 3.1 6.9 8.1 6.9 – 2.5 7.9 7.2 6.6 – 5.3 6.2 5.7 6.3 6.3 2.2 2.8 6.9 4.5 2.9 2.0 8.2 – 6.1 5.2 1.6 2.1 4.8 7.9 6.8 – 1.9 6.4 6.6 6.3 – 3.0 4.8 4.5 3.9 4.3 2.0 1.5 4.4 1.6 1.9 1.9 7.6 – 3.3 3.3 1.7 2.0 2.8 7.2 5.4 – 1.8 5.2 3.0 3.5 – 2.6 3.8 3.1 2.5 3.3 1.2 1.5 2.7 1.2 1.3 1.3 5.9 – 2.2 0.6 2.2 2.0 1.9 0.1 0.1 – 1.5 1.0 0.4 0.2 – 2.8 1.2 1.2 2.4 1.8 0.4 3.0 2.3 5.2 2.0 0.3 0.4 – 3.0 2.6 -0.6 0.2 3.2 0.5 1.3 – 0.1 1.3 4.6 3.4 – 0.9 1.3 2.2 2.6 1.7 3.0 0.3 2.9 1.7 2.3 2.0 1.5 – 2.5 114 95 173 38 97 31 151 134 189 151 173 50 19 60 173 110 34 91 40 189 166 123 54 156 72 101 – 104 185 276 – 59 371 27 31 29 – – 113 25 100 168 – 199 13 18 128 138 103 22 50 13 101 44 149 – 19 290 15 11 121 203 64 32 125 51 96 37 117 31 19 27 99 25 114 13 262 70 142 59 21 109 29 91 17 67 5.9 3.5 – 0.1 7.2 3.1 – 5.7 1.2 6.1 3.6 4.8 – – 2.8 5.1 5.7 1.5 – 3.6 3.1 4.1 6.2 0.8 6.0 0.9 3.6 6.9 0.1 3.3 1.6 – 2.2 0.6 5.8 3.7 6.0 3.2 2.1 0.5 4.8 2.5 0.8 3.3 0.3 5.0 2.8 4.6 3.3 8.8 14 46 69 43 23 – 32 10 63 47 64 42 30 56 34 13 43 57 38 54 43 77 3.3 – – – -1.5 -0.7 – 2.9 -0.4 5.6 – – 3.4 -0.9 0.1 1.9 0.1 -2.4x 3.1 1.8 1.2 – 2.6 – – 0.3 1.1 2.6x 1.4 -0.4 3.8 3.3 3.5 -1.6 – 2.4 3.9 3.6 1.8 -0.3 2.2 0.7 1.5 -2.2 2.9 6.0 6.1 – 6.5 7.3 7.0 2.4 – 6.5 3.0 2.5 2.3 6.9 7.3 5.6 2.9 4.4 6.6 5.7 6.9 2.0 2.0 7.6 6.9 5.5 3.0 4.8 – 5.4 5.8 6.6 2.1 – 6.5 1.8 2.0 1.5 5.9 6.8 3.6 1.3 2.5 6.0 2.7 5.7 2.0 1.5 5.5 5.2 2.1 2.2 4.0 – 3.9 3.4 4.7 1.8 – 6.5 1.3 1.2 1.3 3.9 6.1 2.7 1.4 1.9 4.3 2.4 3.5 1.8 1.4 3.1 3.4 1.8 3.5 1.2 – 0.9 1.1 0.3 0.6 – 0.0 2.7 1.0 2.0 0.8 0.3 2.2 3.9 2.7 0.5 3.6 0.9 0.1 1.4 1.6 1.4 4.8 1.8 1.0 – 1.9 3.2 1.9 1.0 – 0.0 1.9 2.9 1.0 2.4 0.6 1.7 -0.2 1.7 1.9 0.7 2.9 0.7 0.5 3.4 2.5 0.8 123 39 37 104 78 110 104 65 119 – 219 50 54 201 201 – 38 184 150 32 34 52 82 99 17 97 100 23 35 21 23 50 5.7 – 1.9 2.2 2.3 6.8 4.5 – 4.7 3.8 2.4 1.9 -0.2 5.3 7.5 4.0 55 47 33 28 -3 60 72 49 – – -0.6 – 0.5 2.5 1.9 – 0.5 – -0.2 5.1 3.4 2.2 -6.8x 3.2 6.3 7.0 5.9 3.5 6.6 5.5 6.3 1.9 5.3 6.4 4.6 2.4 3.6 3.0 4.3 1.4 6.6 4.9 3.8 1.6 1.9 2.1 2.5 2.4 0.8 0.5 1.3 1.8 3.0 3.0 1.9 1.8 -1.2 1.6 1.2 2.4 3.7 2.1 3.2 1970–1990 1990–2007 T H E S TAT E O F T H E W O R L D ’ S C H I L D R E N 0 Reduction since 1990 (%)Θ 1970–1990 1990–2007 1970–1990 1990–2007 …TABLE 10 Under-5 mortality rate Average annual rate of reduction (%)Θ GDP per capita average annual growth rate (%) Total fertility rate Average annual rate of reduction (%) Under-5 mortality rank Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe 1970 1990 2007 1970 1990 2007 75 21 99 151 160 29 151 132 68 81 – 195 36 84 21 217 23 60 – 155 53 175 25 15 157 11 25 74 62 37 130 24 116 14 41 34 – 0.5 1.8 8.6 4.2 1.6 3.7 4.4 – 4.6 2.1 1.7 0.2 3.7 2.4 1.8 1.9 3.4 3.5 3.5 30 26 47 33 26 27 44 45 45 – – – -4.8x – 2.2 0.9 – 1.1x – 3.1 -0.7 -0.3x 2.4 1.8 1.5 1.2 -0.4 – 7.1 2.1 6.6 2.3 6.8 2.2 2.9 6.5 6.3 – 7.1 1.9 4.4 1.8 6.1 2.0 2.5 4.2 4.9 – 6.5 1.2 2.3 1.8 5.2 2.1 2.1 2.5 3.8 – 0.0 0.6 2.1 1.2 0.5 0.6 0.7 2.2 1.2 – 0.5 2.6 3.8 0.0 0.9 -0.2 1.0 3.0 1.6 114 126 48 13 43 62 85 309 179 131 32 56 127 163 95 19 15 73 170 90 3.3 2.1 4.4 0.5 1.6 3.1 7.7 3.3 -0.2 0.3 41 73 43 -4 -1.6 – – -2.3 -0.4 -0.2 1.6 0.1 -2.1x 5.4 7.0 8.6 7.4 7.4 3.4 3.7 8.1 6.5 5.2 2.6 2.2 5.5 5.2 3.2 2.2 3.2 0.3 0.7 1.8 1.7 3.2 2.2 1.2 2.8 232 202 260 195 197 121 122 91 24 162 241 143 186 165 206 79 125 56 55 53 10 103 179 93 148 123 169 46 78 27 26 25 74 130 68 1.1 1.0 1.2 4.5 2.3 3.9 4.0 2.7 4.4 2.3 1.5 2.2 1.3 1.7 1.2 3.2 2.8 4.3 4.4 4.4 3.0 1.9 1.9 1.8 20 25 18 42 38 52 53 53 40 28 27 27 -0.1 – -0.6 -0.1 2.1 5.7 1.4 – 2.3 2.4 -0.2 2.3 1.3 1.4 1.3 1.6 4.1 6.8 1.5 1.6 1.9 2.5 2.4 6.8 6.8 6.8 6.8 5.7 5.6 5.3 2.8 2.3 5.8 6.7 4.7 6.3 6.0 6.6 5.0 4.3 2.5 3.2 2.3 1.7 3.6 5.8 3.2 5.2 4.9 5.5 3.0 3.0 1.9 2.4 1.7 1.7 2.8 4.7 2.6 0.4 0.6 0.1 1.5 1.4 4.1 2.5 0.9 1.3 2.3 0.7 1.9 1.1 1.2 1.1 3.0 2.2 1.6 1.8 1.9 0.2 1.6 1.3 1.3 1970–1990 1990–2007 Reduction since 1990 (%)Θ 1970–1990 1990–2007 1970–1990 1990–2007 SUMMARY INDICATORS Sub-Saharan Africa Eastern and Southern Africa West and Central Africa Middle East and North Africa South Asia East Asia and Pacific Latin America and Caribbean CEE/CIS Industrialized countries§ Developing countries§ Least developed countries§ World § Also includes territories within each country category or regional group Countries and territories in each country category or regional group are listed on page 152 DEFINITIONS OF THE INDICATORS MAIN DATA SOURCES Under-five mortality rate – Probability of dying between birth and exactly five years of age, expressed per 1,000 live births Under-five mortality rate – UNICEF, United Nations Population Division and United Nations Statistics Division Reduction since 1990 (%) – Percentage reduction in the under-five mortality rate (U5MR) from 1990 to 2007 The United Nations Millennium Declaration in 2000 established a goal of a twothirds (67 per cent) reduction in U5MR from 1990 to 2015 This indicator provides a current assessment of progress towards this goal GDP per capita – World Bank Fertility – United Nations Population Division GDP per capita – Gross domestic product (GDP) is the sum of value added by all resident producers plus any product taxes (less subsidies) not included in the valuation of output GDP per capita is gross domestic product divided by midyear population Growth is calculated from constant price GDP data in local currency Total fertility rate – Number of children who would be born per woman if she lived to the end of her childbearing years and bore children at each age in accordance with prevailing age-specific fertility rates NOTES – x Θ Data not available Data refer to years or periods other than those specified in the column heading, differ from the standard definition or refer to only part of a country Such data are not included in the calculation of regional and global averages A negative value indicates an increase in the under-five mortality rate since 1990 S TAT I S T I C A L TA B L E S 157 Acronyms ACSD Accelerated Child Survival and Development MICS Multiple Indicator Cluster Surveys AIDS acquired immune deficiency syndrome OECD Organisation of Economic Co-operation and Development EmOC emergency obstetric care PMTCT prevention of mother-to-child transmission (of HIV) FGM/C female genital mutilation/cutting GDP gross domestic product UN SG United Nations Secretary-General HIV human immunodeficiency virus UNAIDS Joint United Nations Programme on HIV/AIDS HMN Health Metrics Network UNESCO United Nations Educational, Scientific and Cultural Organization IMCI Integrated Management of Childhood Illness UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund WHO World Health Organization IMNCH Integrated Management of Newborn and Child Health MDG Millennium Development Goal 158 T H E S TAT E O F T H E W O R L D ’ S C H I L D R E N 0 UNICEF Offices UNICEF Headquarters UNICEF House United Nations Plaza New York, NY 10017, USA UNICEF Regional Office for Europe Palais des Nations CH-1211 Geneva 10, Switzerland UNICEF Central and Eastern Europe/ Commonwealth of Independent States Regional Office Palais des Nations CH-1211 Geneva 10, Switzerland UNICEF Eastern and Southern Africa Regional Office United Nations Complex Gigiri P.O Box 44145-00100 Nairobi, Kenya UNICEF West and Central Africa Regional Office P.O Box 29720 Yoff Dakar, Senegal UNICEF The Americas and Caribbean Regional Office Avenida Morse Ciudad del Saber Clayton Edificio #102 Apartado 0843-03045 Panama City, Panama UNICEF East Asia and the Pacific Regional Office P.O Box 2-154 19 Phra Atit Road Bangkok 10200, Thailand UNICEF Middle East and North Africa Regional Office P.O Box 1551 Amman 11821, Jordan UNICEF South Asia Regional Office P.O Box 5815 Lekhnath Marg Kathmandu, Nepal Further information is available at our website United Nations Children’s Fund United Nations Plaza New York, NY 10017, USA Email: pubdoc@unicef.org Website: www.unicef.org US $25.00 UK £12.10 €16.80 ISBN: 978-92-806-4318-3 Sales no.: E.09.XX.1 © United Nations Children’s Fund (UNICEF) December 2008 ... Goals related to maternal and child health The first chapter of The State of the World’s Children 2009 examines trends and levels of maternal and neonatal health in each of the major regions,... 52 3.6 Early and exclusive breastfeeding 59 THE STATE OF THE WORLD’S CHILDREN 2009 Maternal and Newborn Health Strengthening health systems to improve maternal and newborn health 67... some of the critical issues in maternal and newborn health and nutrition today The current situation of maternal and neonatal health Since 1990, the estimate of the global annual number of maternal