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U N I T E D N A T I O N S
The Millennium Development Goals Report
2010
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Cr i
This report is based on a master set of data that has been compiled by an Inter-Agency and Expert
Group on MDG Indicators led by the Department of Economic and Social Affairs of the United
Nations Secretariat, in response to the wishes of the General Assembly for periodic assessment of
progress towards the MDGs. The Group comprises representatives of the international organizations
whose activities include the preparation of one or more of the series of statistical indicators that were
identied as appropriate for monitoring progress towards the MDGs, as reected in the list below. A
number of national statisticians and outside expert advisers also contributed.
INTERNATIONAL LABOUR ORGANIZATION
FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS
UNITED NATIONS EDUCATIONAL, SCIENTIFIC AND CULTURAL ORGANIZATION
UNITED NATIONS INDUSTRIAL DEVELOPMENT ORGANIZATION
WORLD HEALTH ORGANIZATION
THE WORLD BANK
INTERNATIONAL MONETARY FUND
INTERNATIONAL TELECOMMUNICATION UNION
ECONOMIC COMMISSION FOR AFRICA
ECONOMIC COMMISSION FOR EUROPE
ECONOMIC COMMISSION FOR LATIN AMERICA AND THE CARIBBEAN
ECONOMIC AND SOCIAL COMMISSION FOR ASIA AND THE PACIFIC
ECONOMIC AND SOCIAL COMMISSION FOR WESTERN ASIA
JOINT UNITED NATIONS PROGRAMME ON HIV/AIDS
UNITED NATIONS CHILDRENS FUND
UNITED NATIONS CONFERENCE ON TRADE AND DEVELOPMENT
UNITED NATIONS DEVELOPMENT FUND FOR WOMEN
UNITED NATIONS DEVELOPMENT PROGRAMME
UNITED NATIONS ENVIRONMENT PROGRAMME
UNITED NATIONS FRAMEWORK CONVENTION ON CLIMATE CHANGE
UNITED NATIONS HIGH COMMISSIONER FOR REFUGEES
UNITED NATIONS HUMAN SETTLEMENTS PROGRAMME
UNITED NATIONS POPULATION FUND
INTERNATIONAL TRADE CENTRE
INTER-PARLIAMENTARY UNION
ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT
WORLD TRADE ORGANIZATION
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The Millennium
Development GoalsReport2010
U N I T E D N A T I O N S
N E W Y O R K , 2010
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Foreword
The Millennium Declaration in 2000 was a milestonein international cooperation, inspiring developmenteorts that have improved the lives o hundreds omillions o people around the world. Ten years later,world leaders will gather again at the United Nationsin New York to review progress, assess obstaclesand gaps, and agree on concrete strategies andactions to meet the eight Millennium DevelopmentGoals by 2015.
The Goals represent human needs and basic rightsthat every individual around the world should beable to enjoyreedom rom extreme poverty and
hunger; quality education, productive and decentemployment, good health and shelter; the right owomen to give birth without risking their lives; and aworld where environmental sustainability is a priority,and women and men live in equality. Leaders alsopledged to orge a wide-ranging global partnershipor development to achieve these universalobjectives.
This report shows how much progress has beenmade. Perhaps most important, it shows that
the Goals are achievable when nationally owneddevelopment strategies, policies and programmesare supported by international development partners.At the same time, it is clear that improvements inthe lives o the poor have been unacceptably slow,and some hard-won gains are being eroded by theclimate, ood and economic crises.
The world possesses the resources and knowledgeto ensure that even the poorest countries, and othersheld back by disease, geographic isolation or civilstrie, can be empowered to achieve the MDGs.
Meeting the goals is everyones business. Fallingshort would multiply the dangers o our world rominstability to epidemic diseases to environmentaldegradation. But achieving the goals will put us ona ast track to a world that is more stable, more just,and more secure.
Billions o people are looking to the internationalcommunity to realize the great vision embodied in theMillennium Declaration. Let us keep that promise.
Ban Ki-moonSecretary-General, United Nations
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Overview
Kg rmFive years rom the target date or the MillenniumDevelopment Goals, leaders rom around the world
will be gathering at the United Nations to undertake acomprehensive review o progress and together chart acourse or accelerated action on the MDGs between nowand 2015.
Many countries are moving orward, including some o thepoorest, demonstrating that setting bold, collective goalsin the ght against poverty yields results. For every lie thathas beneted rom the establishment o a quantitative,time-bound ramework o accountability, the MDGs havemade a real dierence.
But unmet commitments, inadequate resources, lack oocus and accountability, and insucient dedication tosustainable development have created shortalls in many
areas. Some o these shortalls were aggravated by theglobal ood and economic and nancial crises.
Nevertheless, the data and analysis on the ollowingpages provide clear evidence that targeted interventions,sustained by adequate unding and political commitment,have resulted in rapid progress in some areas. In others, thepoorest groups, those without education or living in moreremote areas, have been neglected and not provided theconditions to improve their lives.
Brgg gThough progress has been made, it is uneven. And withouta major push orward, many o the MDG targets are likelyto be missed in most regions. Old and new challengesthreaten to urther slow progress in some areas or evenundo successes achieved so ar.
The most severe impact o climate change is being eltby vulnerable populations who have contributed least tothe problem. The risk o death or disability and economicloss due to natural disasters is increasing globally and isconcentrated in poorer countries. Armed confict remainsa major threat to human security and to hard-won MDGgains. Large populations o reugees remain in campswith limited opportunities to improve their lives. In 2009,42 million people had been displaced by confict orpersecution, our ths o them in developing countries.
The number o people who are undernourished hascontinued to grow, while slow progress in reducing theprevalence o hunger stalledor even reversed itselinsome regions between 2000-2002 and 2005-2007. Aboutone in our children under the age o ve are underweight,mainly due to lack o ood and quality ood, inadequatewater, sanitation and health services, and poor care and
eeding practices.An estimated 1.4 billion people were still living in extremepoverty in 2005. Moreover, the eects o the global nancialcrisis are likely to persist: poverty rates will be slightlyhigher in 2015 and even beyond, to 2020, than they wouldhave been had the world economy grown steadily at itspre-crisis pace.
Gender equality and the empowerment o women are at theheart o the MDGs and are preconditions or overcomingpoverty, hunger and disease. But progress has beensluggish on all rontsrom education to access to politicaldecision-making.
Bug uccThe collective eorts towards achievement o the MDGshave made inroads in many areas. Encouraging trends
beore 2008 had put many regions on track to achieve atleast some o the goals. The economic growth momentumin developing regions remains strong and, learning rom themany successes o even the most challenged countries,achieving the MDGs is still within our grasp:
Progress on poverty reduction is still being made,despite signicant setbacks due to the 2008-2009economic downturn, and ood and energy crises. Thedeveloping world as a whole remains on track to achievethe poverty reduction target by 2015. The overall povertyrate is still expected to all to 15 per cent by 2015, whichtranslates to around 920 million people living under theinternational poverty linehal the number in 1990.
Major advances have been made in getting children intoschool in many o the poorest countries, most o them insub-Saharan Arica.
Remarkable improvements in key interventionsormalaria and HIV control, and measles immunization,or examplehave cut child deaths rom 12.5 million in1990 to 8.8 million in 2008.
Between 2003 and 2008, the number o peoplereceiving antiretroviral therapy increased tenoldrom400,000 to 4 millioncorresponding to 42 per cent othe 8.8 million people who needed treatment or HIV.
Major increases in unding and a stronger commitmentto control malaria have accelerated delivery o malariainterventions. Across Arica, more communities arebeneting rom bed net protection and more childrenare being treated with eective drugs.
The rate o deorestation, though still alarmingly high,appears to have slowed, due to tree-planting schemescombined with the natural expansion o orests.
Increased use o improved water sources in ruralareas has narrowed the large gap with urban areas,where coverage has remained at 94 per centalmostunchanged since 1990. However, the saety o watersupplies remains a challenge and urgently needs to beaddressed.
Mobile telephony continues to expand in the developingworld and is increasingly being used or m-banking,disaster management and other non-voice applications
or development. By the end o 2009, cellularsubscriptions per 100 people had reached the 50 percent mark.
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twr 2015The Millennium Declaration represents the most importantpromise ever made to the worlds most vulnerable people.
The MDG ramework or accountability derived rom theDeclaration has generated an unprecedented level ocommitment and partnership in building decent, healthierlives or billions o people and in creating an environmentthat contributes to peace and security.
The Millennium Development Goals are still attainable.The critical question today is how to transorm the pace ochange rom what we have seen over the last decade intodramatically aster progress. The experience o these lastten years oers ample evidence o what works and hasprovided tools that can help us achieve the MDGs by 2015.The Millennium Development Goals summit in Septemberwill be an opportunity or world leaders to translate thisevidence into a concrete agenda or action.
SHA ZUKANGUnder-Secretary-General or Economic and Social Aairs
Achieving the MDGs will also require increased attentionto those most vulnerable. Policies and interventions willbe needed to eliminate the persistent or even increasinginequalities between the rich and the poor, between thoseliving in rural or remote areas or in slums versus better-ourban populations, and those disadvantaged by geographiclocation, sex, age, disability or ethnicity:
In all developing regions, children in rural areas aremore likely to be underweight than urban children. InLatin America and the Caribbean and parts o Asia, thisdisparity increased between 1990 and 2008.
The gap between the richest and the pooresthouseholds remains enormous. In Southern Asia, 60 percent o children in the poorest areas are underweightcompared to 25 per cent o children in the richesthouseholds.
In developing regions overall, girls in the poorest 20 percent o households are 3.5 times more likely to be outo school than girls in the richest households and ourtimes more likely to be out o school than boys rom therichest households.
Even in countries close to achieving universal primaryeducation, children with disabilities are the majority othose excluded.
Maternal health is one o the areas in which the gapbetween rich and poor is most conspicuous. Whilealmost all births are attended by skilled health personnelin the developed countries, less than hal o womenreceive such care when giving birth in parts o thedeveloping world.
Disparities in access to care during pregnancy are alsostriking, with women in the richest households 1.7 timesmore likely to visit a skilled health worker at least oncebeore birth than the poorest women.
Lack o education is another major obstacle toaccessing tools that could improve peoples lives. Forinstance, poverty and unequal access to schoolingperpetuate high adolescent birth rates, jeopardizing thehealth o girls and diminishing their opportunities orsocial and economic advancement.
Contraceptive use is our times higher among womenwith a secondary education than among those with no
education. For women in the poorest households andamong those with no education, negligible progress wasseen over the last decade.
Only about hal o the developing worlds populationare using improved sanitation, and addressingthis inequality will have a major impact on severalo the MDGs. Disparities between rural and urbanareas remain daunting, with only 40 per cent o ruralpopulations covered. And while 77 per cent o thepopulation in the richest 20 per cent o households useimproved sanitation acilities, the share is only 16 percent o those in the poorest households.
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Robust growth in the rst hal o the decade reduced thenumber o people in developing regions living on less than$1.25 a day rom 1.8 billion in 1990 to 1.4 billion in 2005,while the poverty rate dropped rom 46 per cent to 27 percent. The global economic and nancial crisis, which beganin the advanced economies o North America and Europein 2008, sparked abrupt declines in exports and commodityprices and reduced trade and investment, slowing growthin developing countries. Nevertheless, the momentum oeconomic growth in developing countries is strong enoughto sustain progress on the poverty reduction target. Theoverall poverty rate is still expected to all to 15 per cent by
TargeT
Halve, between 1990 and 2015, the proportion o peoplewhose income is less than $1 a dayGoal 1
Eradicateextremepoverty andhunger
0 10 20 30 40 50 60 70
Developing regions
CIS, Europe
Transition countries of South-Eastern Europe
Northern Africa
Western Asia
Latin America & the Caribbean
Eastern Asia
South-Eastern Asia
CIS, Asia
Southern Asia, excluding India
Southern Asia
Sub-Saharan Africa
Proportion of people living on less than $1.25 a day,
1990 and 2005 (Percentage)
60
58
51
49
39
45
31
6
19
39
19
16
11
8
2
6
5
3
46
27
0.1
0.3
1
2
1990
2005
2015 Target
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2015, indicating that the Millennium DevelopmentGoal (MDG) target can be met. This translatesinto around 920 million people living under theinternational poverty linehal the number in 1990.
Newly updated estimates rom the World Banksuggest that the crisis will leave an additional
50 million people in extreme poverty in 2009and some 64 million by the end o 2010 relativeto a no-crisis scenario, principally in sub-Saharan Arica and Eastern and South-EasternAsia. Moreover, the eects o the crisis arelikely to persist: poverty rates will be slightlyhigher in 2015 and even beyond, to 2020, thanthey would have been had the world economygrown steadily at its pre-crisis pace.
The astest growth and sharpest reductionsin poverty continue to be recorded in EasternAsia. Poverty rates in China are expected to
all to around 5 per cent by 2015. India, too,has contributed to the large reduction in globalpoverty. Measured at the $1.25 a day povertyline, poverty rates there are expected to allrom 51 per cent in 1990 to 24 per cent in 2015,and the number o people living in extremepoverty will likely decrease by 188 million. Alldeveloping regions except sub-Saharan Arica,Western Asia and parts o Eastern Europe andCentral Asia are expected to achieve the MDGtarget. These shortalls refect slow growthin sub-Saharan Arica in the 1990s and the
transition rom planned to market economiesthat saw poverty increase, albeit rom very lowlevels, in some countries o Eastern Europeand the ormer Soviet Union.
The lack o good quality surveys carried outat regular intervals and delays in reportingsurvey results continue to hamper themonitoring o poverty. Gaps are particularlyacute in sub-Saharan Arica, where morethan hal o countries lack sucient datato make comparisons over the ull range othe MDGs, and among small island states
in the Pacic and the Caribbean. Surveysdeliver important inormationnot just in thechange in average income or consumption,but also in its distribution. This years povertyestimates integrate 31 new household surveys.Combining these new surveys with last yearsgrowth orecast suggests a 0.5 percentagepoint decline (ater taking into account theeect o the nancial crisis) in the aggregatepoverty headcount index in 2015rom 15.5per cent to 15.0 per cent. Only with more timelydata can accurate reports on progress towardsthe MDGs be provided.
The poverty gap measures the shortall in incomes opeople living below the poverty line. While the internationalpoverty line is set at a level typical o very poor countries,many people live on even less than that amount. Economicgrowth and improvements in the distribution o income orconsumption reduce the depth o poverty. Since 1990, thedepth o poverty has decreased in all regions except Western
Asia. In 2005, the average income o people living belowthe poverty line stood at $0.88. The depth o poverty wasgreatest in sub-Saharan Arica, but has allen since 1999 toreach the level o Eastern Asia in 1990.
0 10 20 30
Developing regions
CIS, Europe
Transition countries of South-Eastern Europe
Northern Africa
Western Asia
Latin America & the Caribbean
Eastern Asia
South-Eastern Asia
CIS, Asia
Southern Asia, excluding India
Southern Asia
Sub-Saharan Africa
Poverty gap ratio at $1.25 a day, 1990 and 2005
(Percentage)
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im r rkruc c y g-rmb, cug rgr MdG
The risk o death or disability andeconomic loss resulting rom naturaldisasters is increasing globally and isconcentrated in poorer countries. Reducingsuch risk can have multiplier eects thatcan accelerate achievement o the MDGs.The horric loss o lie rom earthquakesin Haiti, Chile and China, and foods inBrazil, underscore the need to make thebuilt environment more resilient in the aceo potential hazardsboth seismic andclimatic (or weather-related).
Urbanization, climate change andecosystem degradation are increasing thetoll o natural disasters, and countries leastable to reduce their risk are suering themost. An estimated 97 per cent o globalmortality risk rom natural disasters isaced by populations in low- and lower-middle-income countries, which alsoexperience higher economic losses relativeto the size o their economies. From thestart o 2008 through March 2010, 470,000
people were reportedly killed as a result onatural disasters; economic losses wereestimated to be more than $262 billion (notincluding 2010). Small island developingstates and landlocked developing countriestogether constitute 60 per cent and 67per cent, respectively, o the countriesconsidered to have a high or very higheconomic vulnerability to natural hazards.
Experience rom countries has shownthat investments in disaster risk reductionproduce long-term benetsrom reduced
uture losses and avoided reconstructionto co-benets such as more robustlivelihoods, resilient communities, andprotective and productive ecosystems.In Peru, incorporation o risk reductioninto development has led to benets thatexceeded costs by as much as 37 times.When China spent $3.15 billion on reducingthe impact o foods between 1960 and2000, it averted losses estimated at $12billion.
TargeT
Achieve, ull and productive employment and decentwork or all, including women and young people
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The bursting o the housing bubble in the United States in2007 and subsequent paralysis o the global nancial systembecame an economic and labour market crisis that plaguedthe world throughout 2009. The cascading crisis crippledeconomies, reduced enterprise capacities and orced millionso people out o work. Many workers resorted to vulnerableorms o employment as the ranks o the working poor swell.
0 10 20 30 40 50 60 70 80
Developing regions
Developed regions
Western Asia
Northern Africa
Transition countries of South-Eastern Europe
Southern Asia
CIS
Latin America & the Caribbean
Sub-Saharan Africa
South-Eastern Asia
Oceania
Eastern Asia
Employment-to-population ratio, 1998, 2008 and
2009 preliminary estimates
747070
6666
666666
646565
5861
60
5358
57
5756
55
5349
48
444646
4746
44
5657
55
6362
62
67
* Data for 2009 are preliminary.
199820082009*
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As the crisis deepened, governmentstimulus measures began to curb the slidein economic activity and lessen the impacto global job losses. The coordinated eortso countries responding to the crisis havebeen instrumental in averting even greatersocial and economic hardships. However,
labour market conditions have continued todeteriorate in many countries and will likelythreaten much o the progress made over thelast decade towards decent work.
The economic deterioration resulted in asharp drop in employment-to-populationratios. In addition, labour productivitydeclined in 2009. In most regions, thedecrease in gross domestic product waseven greater than the decline in employment,resulting in diminishing output per worker.Preliminary estimates indicate a negative
growth in output per worker in all regionsexcept Northern Arica, Eastern Asia andSouthern Asia. The largest all in output perworker was in CIS countries in Europe, thetransition countries o South-Eastern Europeand in Latin America and the Caribbean.Declining labour output contributes to poorerworking conditions, worsening the plight oworkers in regions where labour productivitywas already low beore the economic crisis,as in sub-Saharan Arica.
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The positive downward trend in vulnerable employment wasinterrupted by deteriorating conditions on the labour marketollowing the nancial crisis. For many wage and salariedworkers who lost their jobs, as well as rst-time job seekerswho entered the labour market in the midst o the crisis, own-account and unpaid amily work are options o last resort.
Those engaged in vulnerable employment, dened as thesum o own-account workers and contributing amily workers,are not typically bound by ormal work arrangements. Theyare thereore more likely to lack benets associated withdecent employment, such as adequate social security
0 10 20 30 40 50 60 70 80 90
Developing regions
Developed regions
CIS, Europe
Western Asia
Transition countries of South-Eastern Europe
Latin America & the Caribbean
Northern Africa
CIS, Asia
Eastern Asia
South-Eastern Asia
Sub-Saharan Africa
Southern Asia
Oceania
Proportion of own-account and contributing family
workers in total employment, 1998, 2008 and
2009 second scenario (Percentage)
7478
79
8076
77
8275
77
636161
625353
4741
44
3531
34
3531
32
3224
29
3927
28
8910
1110
11
6559
60
*Forecasts for 2009 are based on the International Labour Organizations
second scenario. Details are available at mdgs.un.org
199820082009*
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continuation o historical trends (scenario 1)are thereore not likely to have materialized.Rather, it is estimated that an additional 3.6per cent o the worlds workers were at risko alling into poverty between 2008 and2009 (scenario 2), an alarming increase and asetback o many years o steady progress.
The largest negative impact is most likelyto be seen in sub-Saharan Arica, SouthernAsia, South-Eastern Asia and Oceania, whereextreme poverty among the employed mayhave increased by our percentage points ormore in the second scenario. These estimatesrefect the act that, prior to the crisis, manyworkers in these regions were only slightlyabove the poverty line. In the case o sub-Saharan Arica, the large majority o workers(63.5 per cent) were at risk o alling below theextreme poverty line in this scenario.
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Since 1990, developing regions have made some progress
towards the MDG target o halving the proportion opeople suering rom hunger. The share o undernourishedpopulations decreased rom 20 per cent in 1990-1992 to 16per cent in 2005-2007, the latest period with available data.However, progress has stalled since 2000-2002. Overallprogress in reducing the prevalence o hunger has not beensucient to reduce the number o undernourished people. In2005-2007, the last period assessed, 830 million people werestill undernourished, an increase rom 817 million in 1990-1992.
Food prices spiked in 2008 and alling income due to thenancial crisis urther worsened the situation. The Food and
Agricultural Organization o the United Nations estimates thatthe number o people who were undernourished in 2008 maybe as high as 915 million and exceed 1 billion in 2009.
TargeT
Halve, between 1990 and 2015, the proportion o peoplewho suer rom hunger
0
300
600
900
1200
1500
Proportion of people who are undernourished in the
developing regions (Percentage) and number of
undernourished people (Millions), 1990-1992,
1995-1997, 2000-2002 and 2005-2007
817 797 805 830
Millions
Percentage
0
5
10
15
20
25
2005-20072000-20021995-19971990-1992
Number of undernourished people
Percentage of undernourished people
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d m rgr, ur cr gwr r urwg
From 1990 to 2008, the proportion o childrenunder ve in the developing regions who areunderweight declined rom 31 per cent to 26per cent. Progress in reducing underweightprevalence among children has been madein all regions except Western Asia. EasternAsia, Latin America and the Caribbean, and
CIS countries in Asia have reached or nearlyreached the MDG target, and South-EasternAsia and Northern Arica are on track.
Progress is being made, but not ast enoughto reach the MDG target. Data are not yetavailable to ully understand the impact othe ood and nancial crises on underweightprevalence, but the achievement o the MDGtarget may be urther threatened by them.
Halving the prevalence o underweight children by 2015(rom a 1990 baseline) will require accelerated and concertedaction to scale up interventions that eectively combatundernutrition. A number o simple and cost-eectiveinterventions at key stages in a childs lie could go a long wayin reducing undernutrition, such as breasteeding within onehour o birth, exclusive breasteeding or the rst six months
o lie, adequate complementary eeding and micronutrientsupplementation between six and 24 months o age.
Undernutrition among children under ve continues to bewidely prevalent, due to both a lack o ood and lack oquality ood, inadequate water, sanitation and health servicesas well as less than optimal caring and eeding practices.Until improvements are made in all these areas, progress willbe limited. In Southern Asia, or example, eeding practicesare oten poor and shortages o quality ood are common.But in addition, nearly two thirds o the population are withoutimproved sanitation and nearly hal practise open deecation,resulting in repeated episodes o diarrheal diseases in
children. Moreover, more than 25 per cent o inants areunderweight at birth. Many o these children are never ableto catch up in terms o their nutritional status. All o theseactors have made underweight prevalence in SouthernAsiaat 46 per centthe highest in the world.
0 10 20 30 40 50 60
Developing regions
Latin America & the Caribbean
Northern Africa
Eastern Asia
Western Asia
South-Eastern Asia
Sub-Saharan Africa
Southern Asia
Proportion of children under age five who
are underweight, 1990 and 2008(Percentage)
Note: Prevalence of underweight children is estimated
based on the NCHS/WHO/CDC reference population.The United Nations Childrens Fund (UNICEF) is in the
process of converting its entire child undernutrition
database according to the new World Health Organization
(WHO) Child Growth Standards.
51
46
31
27
37
25
14
14
17
7
11
7
11
6
31
26
1990
2008
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Cr rur r rry wc ky burwg urbr
In all developing regions, children in ruralareas are more likely to be underweight thanchildren living in cities and towns. In parts oAsia and in Latin America and the Caribbean,the relative disparity actually increasedbetween 1990 and 2008. In Eastern Asia,there was a striking increase in the rural/urban ratio (rom 2.1 to 4.8), indicating that, in2008, children in rural areas were almost vetimes as likely to be underweight as childrenin urban areas. This region, however, hasalready achieved the targetin both rural andurban areaso halving the 1990 underweight
prevalence: only 2 per cent o children inurban areas are underweight, versus 9 percent o rural children.
South-Eastern Asia, sub-Saharan Arica andNorthern Arica have succeeded in reducingchild malnutrition more rapidly in rural areasand in narrowing the gap with the urbanpopulation, demonstrating that more equitableprogress is indeed possible.
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Across the developing world, children rom the pooresthouseholds are twice as likely to be underweight as childrenrom the richest households. The disparity is most dramatic
in regions with a high prevalence o underweight children.This is the situation in Southern Asia, where as many as 60per cent o children in the poorest amilies are underweight,compared to about 25 per cent in the richest households.
0.0 1.0 2.0 3.0 4.0 5.0
Developing regions
Eastern Asia
Western Asia
Latin America & the Caribbean
Northern Africa
Sub-Saharan Africa
South-Eastern Asia
Southern Asia
Ratio between the proportion of under-fivechildren who are underweight in rural
areas and urban areas, 1990 and 2008
1.3
1.4
1.4
1.2
1.5
1.4
1.7
1.5
2.02.4
2.1
2.5
2.1
1.7
1.9
4.8
Rural children disadvantaged
Around 1990
Around 2008
Parity
0
10
20
30
40
50
60
70
Richest 20%Richer 20%Middle 20%Poorer 20%Poorest 20%
Proportion of under-five children who are underweight,
by household wealth, around 2008 (Percentage)
Southern Asia
Developing regions
Sub-Saharan Africa
Northern Africa
CIS, Asia
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or 42 m bur by cfc r rcu
Conficts are a major threat to human security and tohard-won MDG gains. Years ater a confict has ended,large populations o reugees remain in camps with limitedemployment and education opportunities and inadequatehealth services. Not surprisingly, reugees oten becomedependent on subsistence-level assistance and lead lives opoverty and unrealized potential.More than 42 million people are currently displaced by
confict or persecution. O these, 15.2 million are reugees(residing outside their countries o origin) and 27.1 millionpeople have been uprooted but remain within the borders otheir own countries. Developing countries hosted our thso the global reugee population in 2009. They included 10.4million people who all under the aegis o the United NationsHigh Commissioner or Reugees (UNHCR) and 4.8 millionPalestinian reugees, who are the responsibility o the UnitedNations Relie and Works Agency or Palestine Reugees inthe Near East (UNRWA).
The number o reugees has remained relatively stable overthe past two yearsabout 15 millionin part because o the
lack o durable solutions. In 2009, some 250,000 reugeeswere able to return to their homes voluntarily, the lowest levelin 20 years. Aghans and Iraqis continue to be the largestreugee populations under the UNHCR mandate, totalling2.9 million and 1.8 million people, respectively, at the end o2009. Together they account or nearly hal o all reugeesunder UNHCR care.
Number of refugees and internally displaced
persons, 2000-2009 (Millions)
0
10
20
30
40
2009200820072006200520042003200220012000
Internally displaced persons Refugees
15.9
16.0 14.613.7 13.8
13.014.3
16.0 15.215.2
21.225.0 25.0 24.6 25.3 23.7 24.4
26.0 26.0 27.1
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h m r ur uc by2015, my r cur mkrmu r
Enrolment in primary education has continued to rise,reaching 89 per cent in the developing world. But the pace oprogress is insucient to ensure that, by 2015, all girls andboys complete a ull course o primary schooling.
TargeT
Ensure that, by 2015, children everywhere, boys and girlsalike, will be able to complete a ull course o primaryschooling
Goal 2
Achieveuniversalprimaryeducation
0 20 40 60 80 100
World
Developed regions
Developing regions
Eastern Asia
Latin America & the Caribbean
South-Eastern Asia
Northern Africa
CIS, Asia
Southern Asia
Western Asia
CIS, Europe
Sub-Saharan Africa
Adjusted net enrolment ratio in primary education,*
1998/1999 and 2007/2008 (Percentage)
58
76
89
93
83
88
79
90
95
94
86
94
93
95
9495
95
96
82
89
97
96
84
90
* Defined as the number of pupils of the theoretical school age for primary
education enrolled in either primary or secondary school, expressed as a
percentage of the total population in that age group.
Note: Data for Oceania are not available.
1999
2008
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sub-sr arc sur ar m mjry cru c
Even as the number o school-age children continues to rise,the total number o children out o school is decreasingrom106 million in 1999 to 69 million in 2008. Almost hal o thesechildren (31 million) are in sub-Saharan Arica, and more thana quarter (18 million) are in Southern Asia.
The gender gap in the out-o-school population has alsonarrowed: the share o girls in this group decreased rom 57per cent to 53 per cent globally between 1999 and 2008. Insome regions, however, the share is much larger; in NorthernArica, 66 per cent o out-o-school children are girls.
0
20
40
60
80
100
20081999
Distribution of out-of-school children by region,
1999 and 2008 (Percentage)
Sub-Saharan Africa
Southern Asia
Eastern Asia
South-Eastern Asia
Latin America
& the Caribbean
Western Asia
Developed regions
CIS
Northern Africa
Rest of the world46
43
27
6
5
4
4
4
2
34
6
4
3
4
30.2
12
2
0.7
To achieve the goal by the target date, allchildren at the ocial entry age or primaryschool would have had to be attendingclasses by 2009 or so, depending on theduration o the primary level and how wellschools retain pupils to the end o thecycle. But in hal o the sub-Saharan Arican
countries with available data, at least one inour children o primary-school age were outo school in 2008.
To meet the goal, countries will also need toensure that there are enough teachers andclassrooms to meet the demand. Betweennow and 2015, the number o new teachersneeded in sub-Saharan Arica alone equalsthe current teaching orce in the region.
Despite these challenges, a good deal hasbeen accomplished in many regions. Though
enrolment in sub-Saharan Arica remains thelowest o all regions, it still increased by 18percentage pointsrom 58 per cent to 76per centbetween 1999 and 2008. Progresswas also made in Southern Asia and NorthernArica, where enrolment increased by 11 and 8percentage points, respectively, over the lastdecade.
Major advances have been made even insome o the poorest countries, most othem in sub-Saharan Arica. The abolition
o primary school ees in Burundi resultedin a threeold increase in primary-schoolenrolment since 1999, reaching 99 per centin 2008. Similarly, the United Republic oTanzania doubled its enrolment ratio overthe same period.Guatemala, Nicaragua andZambia also broke through the 90 per centthreshold towards greater access to primaryeducation.
Getting children into school is a vital rst step.But to receive the ull benets o education,they must continue to attend classes. In
hal the countries in sub-Saharan Aricawith available data, more than 30 per cento primary-school students drop out beorereaching the nal grade.
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barriers to education are also common. In many countries,educating girls is widely perceived as being o less valuethan educating boys. And children with disabilities acrossthe world ace ar more limited opportunities than their non-disabled peers.
The link between disability and marginalization in educationis evident in countries at all levels o development. In Malawiand the United Republic o Tanzania, being disabled doublesthe probability that a child will never attend school, and inBurkina Faso the risk rises to two and a hal times. Evenin some countries that are closer to achieving the goal
o universal primary education, children with disabilitiesrepresent the majority o those who are excluded. In Bulgariaand Romania, net enrolment ratios or children aged 7 to15 were over 90 per cent in 2002, but only 58 per cent orchildren with disabilities.
iquy wr rgr wr ur uc
0
10
20
30
40
UrbanRuralRichest 20%Fourth 20%Middle 20%Second 20%Poorest 20%
Out-of-school children by wealth quintile and area of residence, girls and boys,
42 countries, 2000/2008 (Percentage)
Girls
Boys
1110
1917
2523
31
28
39
36
1514
31
27
Household data rom 42 countries show thatrural children are twice as likely to be out oschool as children living in urban areas. Thedata also show that the rural-urban gap isslightly wider or girls than or boys. But thebiggest obstacle to education is poverty. Girlsin the poorest 20 per cent o households havethe least chance o getting an education: theyare 3.5 times more likely to be out o schoolthan girls in the richest households and ourtimes more likely to be out o school as boysin the richest households. Boys rom the
richest households are the least likely to beout o school (10 per cent), compared to allother groups.
Children remain out o school or a variety oreasons, including cost. Social and cultural
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TargeT
Eliminate gender disparity in primary and secondaryeducation, preerably by 2005, and in all levels oeducation no later than 2015
Goal 3
Promotegenderequality andempowerwomen
Fr gr m rg, ucrm u
The developing regions as a whole are approaching genderparity in educational enrolment. In 2008, there were 96 girlsor every 100 boys enrolled in primary school, and 95 girlsor every 100 boys enrolled in secondary school. In 1999, theratios were 91:100 and 88:100 or the two levels o education,respectively. Despite this progress, gender parity in primaryand secondary educationa target that was to be met by
0 60 120
Developing regionsCIS
Latin America & the Caribbean
South-Eastern Asia
Eastern Asia
Northern Africa
Western Asia
Oceania
Southern Asia
Sub-Saharan Africa
Developing regions
Latin America & the Caribbean
Eastern Asia
South-Eastern Asia
Northern Africa
CIS
Oceania
Southern Asia
Western Asia
Sub-Saharan Africa
Developing regions
Eastern Asia
CIS
South-Eastern Asia
Latin America & the Caribbean
Southern Asia
Northern Africa
Western Asia
Sub-Saharan Africa
Oceania
20 40 80 100 140
82121
115
95
66
74
82
81
65
71
88
107
93
95
93
101
89
75
76
83
91
101
99
96
97
84
90
87
85
91
97130
125
107
100
95
92
84
76
67
95
108
105
103
98
98
87
87
86
79
96
104
99
97
97
96
94
92
91
89
Girls primary-school enrolment in relation to boys,
1998/1999 and 2007/2008 (Girls per 100 boys)
Primary
Secondary
Tertiary
1999
2008
2015
Target
= GPI
between97 and 103
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pry mjr brrr uc,cy mg r gr
Poverty puts girls at a distinct disadvantage in terms oeducation. Girls o primary-school age rom the poorest 60per cent o households are three times more likely to be outo school as those rom the wealthiest households. Theirchances o attending secondary school are even slimmer,and older girls in general are more likely to be out o school.In the poorest households, about twice as many girls osecondary-school age are out o school compared to their
wealthier peers.
Household survey data also indicate that girls in rural areasace added challenges in getting an education and that thegender gap is much wider or girls o secondary-school age.
2005is still out o reach or many developingregions. For primary education, the steepestchallenges are ound in Oceania, sub-SaharanArica and Western Asia.
In secondary education, the gender gap inenrolment is most evident in the three regions
where overall enrolment is lowestsub-Saharan Arica, Western Asia and SouthernAsia. In contrast, more girls than boys havesigned up or secondary school in LatinAmerica and the Caribbean, Eastern Asia andSouth-Eastern Asia.
In tertiary education, the ratio between girlsand boys in the developing regions is close toparity, at 97 girls per 100 boys. This is largelydue to the act that many more girls than boysare enrolled in higher education in the CIScountries, Latin America and the Caribbean,
Northern Arica and South-Eastern Asia. Butin most other regions, the number o boysheavily outweighs that o girls in collegesand universities. In sub-Saharan Arica andSouthern Asia, or example, only 67 and 76girls per 100 boys, respectively, are enrolled intertiary levels o education.
Other gender disparities ound in tertiaryeducation relate to areas o study, withwomen being overrepresented in thehumanities and social sciences and
signicantly underrepresented in science,technology and, in particular, engineering.Completion rates also tend to be lower amongwomen than men.
0
10
20
30
40
50
Proportion of girls and boys who are out of school, by
age and household wealth, in 42 countries with surveys
during 2001/2008 (Percentage)
109
30
25 24
19
50
37
Primar y-school age Secondar y-school age
Poorest 60%Wealthiest 40%Poorest 60%Wealthiest 40%
Girls
Boys
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i ry g rg xc Cis, m uumbr wm mym
Globally, the share o women in paid employment outsidethe agricultural sector has continued to increase slowly and
reached 41 per cent in 2008. But women in some regionsare seriously lagging behind. In Southern Asia, NorthernArica and Western Asia, only 20 per cent o those employedoutside agriculture are women. Gender equality in the labourmarket is also a concern in sub-Saharan Arica, where onlyone in three paid jobs outside o agriculture are occupied bywomen.
But even when women represent a large share o wagedworkers, it does not mean that they have secure, decent jobs.In act, women are typically paid less and have less secureemployment than men.
In countries where the agricultural sector predominates,women are mostly employed in agriculture and largely invulnerable jobsin subsistence arming, as unpaid amilyworkers or as own-account workerswith no or little nancialsecurity or social benets.
201520082005200019951990
Employees in non-agricultural wage employment who
are women, 19902008, and projections to 2015(Percentage)
0
10
20
30
40
50
60
CIS
Latin America & the Caribbean
Eastern AsiaSouth-Eastern Asia
Sub-Saharan
Africa
Northern Africa
Southern Asia
Oceania
Western Asia
50.6 51.5
42.4
45.1
41.2
42.5
38.1
39.2
36.0
37.1
20.1 21.8
32.4
36.7
19.2
22.2
19.219.2
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Wm r rgy rg mr urb rm mym
0 20 40 60 80 100
Developing regions
Transition countries of South-Eastern Europe
CIS
Latin America & the Caribbean
Western Asia
Northern Africa
Eastern Asia
South-Eastern Asia
Southern Asia
Sub-Saharan Africa
Oceania
Proportion of own-account and
contributing family workers in totalemployment, 2009 projections
(Percentage)
65
26
17
31
37
53
58
65
84
84
85
57
30
20
32
26
28
50
58
74
71
73
Women
Men
The 2008 nancial crisis has eroded employment aroundthe world. As both women and men lost their jobs,unemployment rates shot up, especially in the rst hal o2009. The good news is that the rate at which unemploymentis increasing appears to be slowing, according to the latestdata. However, the act that women are disproportionatelyrepresented in temporary employment, and occupy a
substantial share o jobs in export-oriented manuacturingindustries in many developing countries, may result in higherunemployment rates or women.
While the crisis has drawn attention to the levels ounemployment, the qualityo available jobs is also worrisome.Many wage and salaried workers who lost their jobs, aswell as many rst-time job seekers who entered the labourmarket in the midst o the nancial turmoil, have resorted toown-account or unpaid amily work, resulting in deterioratingworking conditions and lower incomes or the poorest.Women are more likely than men to be in vulnerable jobs,with the gap being particularly evident in those regions where
paid employment opportunities or women are the lowestinWestern Asia and Northern Arica.
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t- jb g m rwmg gr
Though the number o women who secured paid jobsoutside the agricultural sector increased between 1990 and2008, women have generally ailed to access higher-levelpositions. The top jobsas senior ocials or managersarestill dominated by men. Globally, only one in our seniorocials or managers are women. And in all regions, womenare underrepresented among high-level workers, accounting
or 30 per cent or more o such positions in only three outo 10 regions. In Western Asia, Southern Asia and NorthernArica, less than 10 per cent o top-level positions are held bywomen.
Wm r rrr rm mym, w ck b cury
It is likely that the recent nancial crisis hasalso led to a surge in inormal employmentdue to job losses in the ormal sector. In
some developing countries, over 80 per cento workers have inormal jobsas ownerso inormal-sector businesses, contributingamily workers or employees without writtencontracts or social security benets (includingsubcontracted workers operating rom homeand domestic services workers). In most othese countries, women are overrepresentedin inormal employment.
0 20 40 60 80 100
Russian Federation
Republic of Moldova
Turkey
Kyrgyzstan
Panama
Venezuela
Brazil (urban areas)
Mexico
Colombia
South Africa
Peru (metropolitan Lima)
Ecuador (urban areas)
India
Mali
Informal employment as a percentage
of total non-agricultural employment,women and men, selected countries,
2003/2005 (Percentage)
10
25
35
47
49
47
50
48
61
51
65
73
84
74
8
18
36
41
50
52
52
54
62
65
72
77
88
89
Women
Men
0 10 20 30 40 50
Developed regions
Southern Asia
Northern Africa
Western Asia
Eastern Asia
Oceania
South-Eastern Asia
Sub-Saharan Africa
Latin America & the Caribbean
CIS
Share of women in top-level and all occupations,
average for the period 2000/2008 (Percentage)
20
20
24
45
39
39
45
36
45
49
9
9
10
16
21
26
29
32
32
37
All occupations
Senior officials
and managers
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Wm r wy rg c wr, bu myw b by qu r c mur
The global share o women in parliamentcontinues to increase slowly and reachedan all-time high o 19 per cent in 2010.
This represents a gain o 67 per cent since1995, when 11 per cent o parliamentariansworldwide were women. But it is ar shorto the target o 30 per cent o women inleadership positions that was to be met by1995, and urther still rom the MDG target ogender parity.
Women make up 30 per cent or more o themembers o lower houses o parliament in 26countries and 40 per cent or more in sevencountries. There were 35 women presiding
0 5 10 15 20 25
World
Developing regions
Developed regions
Latin America & the Caribbean
Eastern Asia
South-Eastern Asia
Sub-Saharan Africa
Southern Asia
CIS
Western Asia
Northern Africa
Oceania
Proportion of seats held by womenin single or lower houses of national
parliaments, 2000 and 2010 (Percentage)
19
18
24
23
19.5
19
18
18
15
9
9
2.5
12
11
17
15
19.9
10
9
7
7
5
2
3.42000
2010
ocers in 269 parliamentary chambers (13 per cent) inJanuary 2010, up rom 24 in 1995.
Following parliamentary elections and renewals in 2009, gainsor women were registered in sub-Saharan Arica, where 29per cent o the renewed seats went to women, bringing theregional average up to 18 per cent. In South Arica, women
took 44 per cent o seats in the lower-house election, placingit third in terms o global ranking, ater Rwanda and Sweden.Similarly, there was some progress in most countries in LatinAmerica and the Caribbean, with 25 per cent o seats up orrenewal going to women. Bolivias upper house elected morethan 40 per cent women members, bringing the regionalaverage up to 23 per cent.
At the opposite end o the spectrum, 58 countries have 10per cent or ewer women members o parliament and, innine chambers, women have no seats at all. During 2009,no women gained seats in parliamentary renewals in theComoros, the Federated States o Micronesia and Saudi
Arabia.
Electoral systems, quota arrangements and other armativeaction measures taken by political parties continue to be keypredictors o progress or women. During 2009, the averageshare o women elected to parliament reached 27 per centin countries that applied such measures; in contrast, womengained only a 14 per cent share o seats in countries that didnot. Women are also elected in ar greater numbers undersystems o proportional representation, rather than majority/plurality systems.
In addition to electoral systems and quotas, gender-sensitiveelectoral arrangements, well-trained and nanced womencandidates and political will at the highest levels o politicalparties and governments are key to overcoming genderimbalances in the worlds parliaments. Given that there arestill our men or every one woman in parliament, eorts willbe needed on all these ronts i the target o 30 per cent is tobe met.
Progress in achieving greater representation by women in theexecutive branches o government is even slower than in thelegislative branches. In 2010, just nine o 151 elected headso state (6 per cent) and 11 o 192 heads o government (6
per cent) were women. This is an improvement over 2008,when only seven women were elected as heads o state andeight as heads o government. On average, women hold16 per cent o ministerial posts and only 30 countries havemore than 30 per cent women ministers. On the other hand,16 countries have no women ministers at all. The majority othese countries are in Northern Arica and Western Asia, theCaribbean and Oceania.
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C r g, bu qucky
ug rc rg
Substantial progress has been made in reducing childdeaths. Since 1990, the mortality rate or children under ageve in developing countries dropped by 28 per centrom100 deaths per 1,000 live births to 72 in 2008. Globally, thetotal number o under-ve deaths declined rom 12.5 million in1990 to 8.8 million in 2008. This means that, in 2008, 10,000ewer children died each day than in 1990. An encouragingsign is the acceleration o progress ater the year 2000: theaverage annual rate o decline increased to 2.3 per cent orthe period 2000 to 2008, compared to 1.4 per cent in the1990s.
TargeT
Reduce by two thirds, between 1990 and 2015, theunder-ve mortality rateGoal 4
Reduce childmortality
0 50 100 150 200
Developing regions
Developed regions
Transition countries of South-Eastern Europe
CIS, Europe
Eastern Asia
Latin America & the Caribbean
Northern Africa
Western Asia
South-Eastern Asia
CIS, Asia
Oceania
Southern Asia
Sub-Saharan Africa
Under-five mortality rate per 1,000 live births,
1990 and 2008
184
144
121
74
76
60
39
73
38
66
32
80
29
52
23
45
21
26
14
30
12
12
6
100
72
78 1990
2008
2015 Target
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Rzg r g um rr, w brg ur,cu m cr
Four diseasespneumonia, diarrhoea, malaria and AIDSaccounted or 43 per cent o all deaths in children underve worldwide in 2008. Most o these lives could have beensaved through low-cost prevention and treatment measures,including antibiotics or acute respiratory inections, oralrehydration or diarrhoea, immunization, and the use oinsecticide-treated mosquito nets and appropriate drugs ormalaria. The need to reocus attention on pneumonia anddiarrhoeatwo o the three leading killers o childrenisurgent. The use o new tools, such as vaccines against
pneumococcal pneumonia and rotaviral diarrhoea, could addmomentum to the ght against these common diseases andprovide an entry point or the revitalization o comprehensiveprogramming. Ensuring proper nutrition is a critical aspect oprevention, since malnutrition increases the risk o death.
The greatest advances were made in NorthernArica, Eastern Asia, Western Asia, LatinAmerica and the Caribbean, and the countrieso the CIS. But most striking is the progressthat has been made in some o the worldspoorest countries. Against steep odds,Bangladesh, Bolivia, Eritrea, Lao Peoples
Democratic Republic, Malawi, Mongoliaand Nepal have all reduced their under-vemortality rates by 4.5 per cent annually ormore. Ethiopia, Malawi, Mozambique andNiger have seen absolute reductions o morethan 100 per 1,000 live births since 1990.
Despite these achievements, and the actthat most child deaths are preventableor treatable, many countries still haveunacceptably high levels o child mortalityand have made little or no progress in recentyears. Whats more, among the 67 countries
with high child mortality rates (dened as 40or more deaths per 1,000 live births), only 10are on track to meet the MDG target on childsurvival. The highest rates o child mortalitycontinue to be ound in sub-Saharan Arica. In2008, one in seven children there died beoretheir th birthday; the highest levels werein Western and Central Arica, where one insix children died beore age ve (169 deathsper 1,000 live births). All 34 countries withunder-ve mortality rates exceeding 100 per1,000 live births in 2008 are in sub-Saharan
Arica, except Aghanistan. Although under-ve mortality in sub-Saharan Arica hasdeclined by 22 per cent since 1990, the rate oimprovement is insucient to meet the target.Furthermore, high levels o ertility, combinedwith a still large percentage o under-vedeaths, have resulted in an increase inthe absolute number o children who havediedrom 4.0 million in 1990 to 4.4 million in2008. Sub-Saharan Arica accounted or halo the 8.8 million deaths in children under veworldwide in 2008.
Under-ve mortality also remains very high inSouthern Asia, where about one in 14 childrendied beore age ve in 2008 and whereprogress is too slow to meet the 2015 target.
Causes of deaths among children under age five, 2008
(Percentage)
41Neonatal
causes
12 Preterm births
9 Asphyxia
6 Sepsis
1 Diarrhoeal diseases
4 Pneumonia
1Tetanus
3 Congenitalanomalies
5 Other neonatalcauses
8Malaria
3 Injuries
2 AIDS 1 Measles
16Other causes
Globally, morethan one third ofchild deaths areattributable toundernutrition
14Pneu-monia
14Diarrhoeal
diseases
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Globally, routine immunization against measles has continuedto rise and protect millions o children against this otenatal disease. In 2008, coverage reached 81 per cent in thedeveloping regions as a whole, up rom 70 per cent in 2000.Such averages, however, mask signicant inequalities inaccess to the vaccine. Data rom 178 Demographic andHealth Surveys suggest that access to measles vaccinations
varies across dierent social and economic groups, withlower coverage or children in households that are poor orlocated in rural areas, or whose parents have lower levelso education. Higher birth order (that is, having many oldersiblings) is also associated with lower measles vaccinecoverage. Disparities between girls and boys in immunizationcoverage are not signicant, except in some South Asiancountries.
A single-dose vaccine strategy is not sucient to preventmeasles outbreaks. As o 2008, a total o 132 countries useda two-dose schedule routinely. In countries with weak healthsystems, the second dose is oered during campaigns
to ensure high coverage. Between 2000 and 2008, thecombination o improved routine immunization coverage andthe provision o a second-dose opportunity led to a 78 percent reduction in measles deaths globallyrom an estimated733,000 deaths in 2000 to 164,000 in 2008.
But recent successes may be short-lived. Funding ormeasles-control activities has recently declined, andmany priority countries are conronting unding gaps orimmunization campaigns. Projections show that withoutsupplementary immunization activities in these countries,mortality will quickly rebound, resulting in approximately
1.7 million measles-related deaths between 2010 and 2013.However, with sucient unding, political commitment andhigh-quality implementation o the second-dose measlesstrategy in priority countries, the exceptional gains made soar can be maintained.
Rc ucc crgm my b r- ug g r brg
0 20 40 60 80 100
Developing regions
Developed regions
CIS
Transition countries of South-Eastern Europe
Eastern Asia
Latin America & the Caribbean
Northern Africa
South-Eastern Asia
Western Asia
Southern Asia
Sub-Saharan Africa
Oceania
Proportion of children 12-23 months old
who received at least one dose ofmeasles vaccine, 2000 and 2008
(Percentage)
2000
2008
68
58
55
72
58
75
83
80
88
93
92
92
93
85
94
93
95
95
96
91
93
70
81
84
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Achieving good maternal health requires quality reproductive
health services and a series o well-timed interventions toensure a womens sae passage to motherhood. Failure toprovide these results in hundreds o thousands o needlessdeaths each yeara sad reminder o the low status accordedto women in many societies.
Measuring maternal mortalitydeath resulting rom thecomplications o pregnancy or childbirthis challengingat best. Systematic underreporting and misreporting arecommon, and estimates lie within large ranges o uncertainty.Nevertheless, an acceleration in the provision o maternal andreproductive health services to women in all regions, alongwith positive trend data on maternal mortality and morbidity,
suggest that the world is making some progress on MDG 5.
New estimates o maternal mortality are currently beingnalized by the World Health Organization (WHO), the UnitedNations Childrens Fund (UNICEF), the United NationsPopulation Fund (UNFPA) and the World Bank. Preliminarydata show signs o progress, with some countries achievingsignicant declines in maternal mortality ratios. However, therate o reduction is still well short o the 5.5 per cent annualdecline needed to meet the MDG target. The complete dataset will be available at mdgs.un.org
TargeT
Reduce by three quarters, between 1990 and 2015, thematernal mortality ratioGoal 5
Improvematernalhealth
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M mr cu b
The leading causes o maternal mortality indeveloping regions are haemorrhage andhypertension, which together account or halo all deaths in expectant or new mothers.Indirect causes, including malaria, HIV/AIDS and heart disease, result in 18 per cento maternal deaths. Other direct causes,such as obstructed labour, complicationso anaesthesia or caesarean section, andectopic pregnancy, lead to 11 per cent o alldeaths during pregnancy or childbirth.
The vast majority o these deaths areavoidable. Haemorrhage, or example, whichaccounts or over one third o maternaldeaths, can be prevented or managedthrough a range o interventions administeredby a skilled health-care provider withadequate equipment and supplies.
Gg br cy rky sur a ub-sr arc,wr m wm r wuk cr
The proportion o women in developing countries whoreceived skilled assistance during delivery rose rom 53 per
cent in 1990 to 63 per cent in 2008. Progress was made in allregions, but was especially dramatic in Northern Arica andSouth-Eastern Asia, with increases o 74 per cent and 63 percent, respectively. Southern Asia also progressed, althoughcoverage there, as well as in sub-Saharan Arica, remainsinadequate. Less than hal the women giving birth in theseregions are attended by skilled health personnel.
Causes of maternal deaths, developing
regions, 1997/2007 (Percentage)
35
Haemorrhage
18
Indirect causes18
Hypertension
11
Other directcauses
9
Abortion andmiscarriage
1 Embolism
8
Sepsis
0 20 40 60 80 100
Developing regions
Developed regions
Transition countries of South-Eastern Europe
Eastern Asia
CIS
Latin America & the Caribbean*
Northern Africa
Western Asia
South-Eastern Asia
Oceania
Sub-Saharan Africa
Southern Asia
Proportion of deliveries attended by skilled healthpersonnel, 1990 and 2008 (Percentage)
94
97
72
46
62
46
54
41
98
30
98
98
86
80
78
75
57
46
99
99
99
53
63
45
* Includes only deliveries in health-care institutions.
1990
2008
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t rur-urb g kcr urg cbr rrw
More rural women are receiving skilled assistanceduring delivery, reducing long-standing disparitiesbetween urban and rural areas. In Southern Asia,or example, urban women were three timesmore likely as their rural counterparts to receiveproessional care at childbirth in 1990; by 2008,they were only twice as likely to receive such care,indicating some improvement. Still, inequalitiespersist, especially in regions where attendance byskilled personnel is lowest and maternal mortalityhighestnotably in sub-Saharan Arica, SouthernAsia and Oceania.
Serious disparities in coverage are also oundbetween the wealthiest and the pooresthouseholds. The widest gaps are in Southern Asiaand sub-Saharan Arica, where the wealthiestwomen are ve times more likely and three timesmore likely, respectively, as the poorest womento be attended by trained health-care workersat delivery. In the developing regions as a whole,women in the richest households are three timesas likely as women in the poorest households toreceive proessional care during childbirth.
Mr wm r rcg cr
TargeT
Achieve, by 2015, universal access to reproductivehealth
In all regions, progress is being made in providing pregnantwomen with antenatal care. Remarkable gains were recordedin Northern Arica, where the share o women who sawa skilled health worker at least once during pregnancyincreased by 70 per cent. Southern Asia and Western Asiareported increases o almost 50 per cent.
0.0 1.0 2.0 3.0 4.0
Eastern Asia
CIS in Asia
South-Eastern Asia
Northern Africa
Latin America & the Caribbean*
Western Asia
Oceania
Southern Asia
Sub-Saharan Africa
Ratio of urban women to rural women
attended by skilled health personnel duringdelivery, 1990 and 2008
1.0
1.0
1.1
1.0
1.8
1.2
2.5
1.3
1.8
1.5
1.9
1.6
2.0
1.9
2.9
2.0
2.3
2.2
* Includes only deliveries in health-care institutions.
1990
2008
Parity: Rural women and urban women equally likely to
receive skilled care at delivery
0 20 40 60 80 100
Developing regions
CIS, Asia
Latin America & the Caribbean
South-Eastern Asia
Eastern Asia
Western Asia
Northern Africa
Sub-Saharan Africa
Southern Asia
Proportion of women attended at least once
during pregnancy by skilled health-care personnel,
1990 and 2008 (Percentage)
48
70
67
46
78
53
79
80
91
72
93
79
90
64
80
96
94
76
1990
2008
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iqu cr urg rgcy r rkg
40
50
60
70
80
90
100
Richest 20%Fourth 20%Middle 20%Second 20%Poorest 20%
Proportion of women attended at least once during pregnancy by skilled health personnel,
by household wealth quintile, 2003/2008 (Percentage)
South-Eastern Asia
CIS
Developing regions
Northern Africa
Southern Asia
Sub-Saharan Africa
Disparities in the share o women receivingantenatal care by wealth are striking,particularly in Southern Asia, Northern Aricaand sub-Saharan Arica. Even in South-EasternAsia, where over 90 per cent o women receiveskilled care during pregnancy, only 77 percent o women in the poorest households are
covered, versus almost 100 per cent o womenin the wealthiest households.
Large disparities also exist between women living in rural andurban areas, although the gap narrowed between 1990 and2008. In sub-Saharan Arica, the proportion o urban womenwho received antenatal care at least once increased rom 84per cent in 1990 to 89 per cent in 2008. The correspondingproportions or rural women are 55 to 66 per cent, indicatingthat coverage has improved at a aster pace among rural
women.
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oy r rur wm g rg rc rcmm cr urgrgcy
Women should receive care rom atrained health-care practitioner at leastour times during the course o theirpregnancies, according to WHO and UNICEFrecommendations. However, less than halo pregnant women in developing regionsand only a third o rural women receive therecommended our visits. Among rural womenin Southern Asia, the share is only 25 percent.
prgr rucg umbr g rgc, ugmr yug mr rk
In all regions, the adolescent birth rate (the number o birthsper 1,000 women aged 15 to 19) decreased between 1990and 2000. Since that time, progress has slowed and, in someregions, increases have even been recorded. The highestbirth rate among adolescents is ound in sub-Saharan Arica,which has seen little progress since 1990. Adolescents,in general, ace greater obstacles than adult women inaccessing reproductive health services.
0 20 40 60 80 100
Developing regions
South-Eastern Asia
Southern Asia
Latin America & the Caribbean
Sub-Saharan Africa
Northern Africa
Proportion of women attended four ormore times during pregnancy by
area of residence, 2003/2008 (Percentage)
49
70
37
63
63
84
25
58
68
84
34
67
Rural
Urban
0 20 40 60 80 100 120 140
Developing regions
Developed regions
Eastern Asia
CIS
Northern Africa
South-Eastern Asia
Western Asia
Southern Asia
Oceania
Latin America & the Caribbean
Sub-Saharan Africa
Number of births per 1,000 women aged 15-19, 1990,
2000 and 2007
124
119
121
91
80
74
83
63
61
89
5953
62
52
53
53
39
44
43
31
31
52
28
29
156
5
29
25
23
65
55
52
199020002007
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pry ck uc ru g c br r
Data or 24 countries in sub-Saharan Aricashow that adolescents in the pooresthouseholds are three times more likelyto become pregnant and give birth thanthose in the richest households. In ruralareas, adolescent birth rates are almostdouble those o urban areas. But the largestdisparities are linked to education: girls witha secondary education are the least likely tobecome mothers. The birth rate among girlswith no education is over our times higher.
Even more worrisome is the widening odisparities over time. The adolescent birthrate declined in 18 o the 24 sub-Saharancountries studied. However, in almost allthese 18 countries the decline was largestamong adolescents living in urban areas,among those with at least a secondaryeducation, and among those belonging tothe richest 20 per cent o households. Thus,disparities between those groups and rural,less educated and poorer adolescents haveincreased, rather than decreased, over time.
0
50
100
150
200
250
RuralUrbanNo educationPrimaryeducation
Secondaryeducation
or more
Poorest20%
Second20%
Middle20%
Fourth20%
Richest20%
Adolescent birth rates by background characteristics in 24 sub-Saharan African countries,
1998/2008 (Number of births to women aged 15-19 per 1,000 women)
58
113
141
164
184
48
139
207
79
149
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2000 and a widening gap among regions. From 2000 to2007, the annual rate o increase in contraceptive prevalencein almost all regions was lower than it had been during the1990s. Moreover, contraceptive prevalence in sub-SaharanArica and Oceania continues to be very low. And in severalsubregions, traditional and less eective methods ocontraception are still widely used.
Satisying womens unmet need or amily planningthat is,acilitating access to modern contraceptives by women whodesire to delay or avoid pregnancy but who are currently notusing contraceptioncould improve maternal health andreduce the number o maternal deaths. Recent estimatesindicate that meeting that need could result in a 27 percent drop in maternal deaths each year by reducing theannual number o unintended pregnancies rom 75 millionto 22 million. Preventing closely spaced pregnancies andpregnancies among adolescents would also improve thehealth o women and girls and increase the chances that theirchildren will survive.
The unmet need or amily planning remains moderate to highin most regions, particularly in sub-Saharan Arica, where onein our women aged 15 to 49 who are married or in union andhave expressed the desire to use contraceptives do not haveaccess to them.
prgr xg u crc by wm w
During the 1990s, use o contraceptivesincreased among women in almost everyregion. By 2007, over 60 per cent o womenaged 15 to 49 who were married or in unionwere using some orm o contraception. Yetthis average masks two disturbing trends:a considerable slowdown in progress since
0 20 40 60 80 100
Developing regions
Developed regions
Eastern Asia
Latin America & the Caribbean
CIS
South-Eastern Asia
Northern Africa
Western Asia
Southern Asia
Oceania
Sub-Saharan Africa
Proportion of women who are using any
method of contraception among womenaged 15-49, married or in union,
1990, 2000 and 2007 (Percentage)
12
20
22
28
28
28
40
47
54
46
51
55
44
59
60
48
57
62
61
69
70
62
71
72
78
86
86
70
71
71
52
6062
199020002007
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iqu ug r my g mjr ur ugcmmm mrg wm rruc
Ensuring that even the poorest and mostmarginalized women can reely decide thetiming and spacing o their pregnanciesrequires targeted policies and adequatelyunded interventions. Yet nancial resources
or amily planning services and supplieshave not kept pace with demand. Aid oramily planning as a proportion o total aid to
health declined sharply between 2000 and 2008, rom 8.2 percent to 3.2 per cent. Aid to reproductive health services hasfuctuated between 8.1 per cent and 8.5 per cent. Externalunding or amily planning in constant 2008 US dollarsactually declined during the rst ew years o this decade and
has not yet returned to its 2000 level.
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
200820072006200520042003200220012000
0
20
40
60
80
100
Official development assistance to health, total (Constant 2008 US$ millions) and proportion
going to reproductive health care and family planning, 2000-2008 (Percentage)
Constant2008millionsofUS$
Percentage
39Totalaidtohealth(Constant2008US$millions )Reproductivehealthcare(Percentage)Familyplanning(Percentage)
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t r hiv r
bz m rg, mr r urg gr
The latest epidemiological data indicate that, globally, thespread o HIV appears to have peaked in 1996, when 3.5million* people were newly inected. By 2008, that numberhad dropped to an estimated 2.7 million. AIDS-relatedmortality peaked in 2004, with 2.2 million deaths. By 2008,that toll had dropped to 2 million, although HIV remains theworlds leading inectious killer.
The epidemic appears to have stabilized in most regions,although prevalence continues to rise in Eastern Europe,Central Asia and other parts o Asia due to a high rate o newHIV inections. Sub-Saharan Arica remains the most heavilyaected region, accounting or 72 per cent o all new HIVinections in 2008.
* All AIDS-related gures cited are the midpoint in a range. The estimate of 3.5
million new infections, for example, is based on a range of 3.2 million-3.8 million.
The complete data series of ranges and corresponding midpoints is available at
mdgs.un.org
TargeT
Have halted by 2015 and begun to reverse the spread oHIV/AIDSGoal 6
CombatHIV/AIDS,malaria &other diseases
2008200620042002200019981996199419921990
Number of people living with HIV, number of people
newly infected with HIV and number of AIDS deaths
worldwide, 1990-2008 (Millions)
7.3
9.2
11.3
13.5
15.9
18.3
20.6
22.7
24.6
26.3
27.8
29.030.0
30.8 31.4 31.9
32.4 32.833.4
0
5
10
15
20
25
30
35
40
0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Peop
lenewlyinfectedwithHIVanddeathsduetoAID
S(Millions)
PeoplelivingwithHIV(Millions)
NumberofpeoplelivingwithHIVNumberofpeoplenewlyinfectedwithHIVNumberofdeathsduetoAIDS
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My yug ck kwg rc m
g hiv
Though new inections have peaked, thenumber o people living with the virus isstill rising, largely due to the lie-sustainingimpact o antiretroviral therapy. An estimated
Women and men aged 1524 with comprehensive correct knowledge
of HIV in developing countries, 2003/2008 (Percentage)
Less than 30%
30%49%
50% or more
No data
Women aged 1524 (87 countries)
Men aged 15-24 (51 countries)
Understanding how to prevent transmissiono HIV is the rst step to avoiding inection.This is especially important or young people
(aged 15 to 24), who, in 2008, accounted or40 per cent o new HIV inections amongadults worldwide. Though some progresshas been made, comprehensive and correctknowledge o HIV among young people isstill unacceptably low in most countries. Less
than one third o young men and less than one th o youngwomen in developing countries claim such knowledge aboutHIV. The lowest levels (8 per cent) are ound among young
women in Northern Arica, according to surveys undertakenbetween 2003 and 2008. These levels are well below the2010 target o 95 per cent set at the United Nations GeneralAssembly Special Session on HIV/AIDS in 2001.
33.4 million people were living with HIV in 2008, o whom22.4 million are in sub-Saharan Arica.
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i ub-sr arc, kwg hiv cr w w mg g urb r
In sub-Saharan Arica, disparities in knowledge about HIVprevention among women and men aged 15 to 24 are linkedto gender, household wealth and place o residence. For bothmen and women, the likelihood o being inormed about HIVincreases with the income level o ones household. Genderdisparities in knowledge also diminish slightly among the richand among those living in urban areas.
emwrg wm rugaids uc b, umbr cur w
A number o countries have made impressivestrides in educating their young peopleabout HIV, despite disappointing global andregional averages. In 18 out o 49 countrieswith available trend data, comprehensiveand correct knowledge o HIV increasedby 10 percentage points or more amongwomen aged 15 to 24; the same success was
0 10 20 30 40 50 60 70
Jordan
Central African Republic
Armenia
Uzbekistan
Cameroon
Haiti
United Republic of Tanzania
Gambia
Dominican Republic
Suriname
Republic of Moldova
Sao Tome and Principe
Viet Nam
Cambodia
Guyana
Rwanda
Trinidad and Tobago
Namibia
Young women aged 15-24 withcomprehensive correct knowledge of HIV
in selected countries, 2000 and
2007 (Percentage)
2000
2007
31
65
33
54
23
51
36
50
3750
25
44
11
44
19
42
27
41
18
41
15
39
26
39
15
34
16
32
3
31
7
23
5
17
3
13
0
10
20
30
40
50
TotalUrbanRuralPoorest
20%
Second
20%
Middle
20%
Fourth
20%
Richest
20%
Young women and men aged 15-24 years in selected
sub-Saharan African countries with comprehensive
correct knowledge of HIV by sex, residence and
wealth status, 2003/2008 (Percentage)
Women
Men
36
43
26
35
25
3332
20
41
29
14
20
25
17
30
21
achieved among young men in 8 out o 16 countries. Between2000 and 2008, Cambodia, Guyana, Namibia, Rwanda,and Trinidad and Tobago reported remarkable increasesin knowledge about HIV prevention among young women(reaching levels o 50 per cent or more); similar progress wasreported among young men in Namibia and Rwanda.
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Cm u urg g-rk x gg ccc m cur c c hiv r
Although the use o condoms during high-risk sex remainslow overall, young people in some countries are proving thatthe right policies and interventions can yield results. Between2000 and 2008, increases o 10 or more percentage points in
condom use during risky sex were reported among womenin 11 o the 22 countries where trends can be documented,reaching levels o 60 per cent or more in some o them. Asimilar increase was ound among men in 11 o 17 countrieswith available trend data. Such progress is ultimately theresult o individual action, supported by a combination obehavioural, biomedical and structural interventions and thecollective eorts o government, development partners andcivil society.
dr r u cm u by wm m mg rm rc r u
In most developing countries, the majority oyoung people ail to use condoms during sex,even when there is the risk o contracting HIV.On average, less than 50 per cent o young
men and less than a third o young womenused condoms during their last higher-risksexual activity.
In sub-Saharan Arica, men aged 15 to 24are ar more likely to use condoms thanwomen o the same age. For both womenand men, condom use increases dramaticallywith wealth and among those living in urbanareas. Similar disparities were observed in allcountries with available data.
0 10 20 30 40 50 60 70 80
Ethiopia
Haiti
Peru
Nigeria
Kenya
Dominican Republic
Mozambique
Republic of Moldova
Cameroon
Burkina Faso
Namibia
Condom use at last higher-risk sex among young
women aged 15-24 in selected countries, 2000and 2007 (Percentage)
19
24
25
29
29
44
47
54
19
48
34
36
40
44
44
60
62
64
29
17
28
64
2000
2007
Young women and men aged 15-24 years in