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Women and Children in Poverty - Poor Women's Health

It is not surprising that poor people suffer from more health problems and receive a lower quality of health care than their nonpoor counterparts. Women, however, suffer disproportionately, first because there simply are more poor women than poor men in the world, and second because, as the bearers of children, women face a different set of potential diseases, illnesses, and injuries related to their reproductive systems.

The Millennium Development Goal of improving maternal health, as opposed to women's health, points to the significance of reproduction in the overall picture of women's health, as well as in the social and economic status of their families. A mother's health typically reflects the health of her entire family, just as a mother's education reflects that of her children (see section below). Of the link between poverty and maternal health, United Nations Population Fund (UNFPA) executive director Thoraya Obaid stated in October 2005: "If women are healthy then they can jump start the life of their family and the economy" ("Women's Health Fuelling Poverty," BBC News, October 12, 2005, http://news.bbc.co.uk/2/hi/health/4331996.stm).

Reproductive Health and Poverty

In State of World Population 2005. The Promise of Equality: Gender Equity, Reproductive Health, and the MDGs the UNFPA cites illnesses of the reproductive system as the leading cause of death and disability of women globally and the second most common cause of poor health in the world after communicable diseases. According to an estimate by the Alan Guttmacher Institute, women's reproductive health issues result in the loss of as much as 250 million years' worth of productive time each year and a 20% reduction of women's overall productivity ("The Benefits of Investing in Sexual and Reproductive Health," Issues in Brief, 2004). The UNFPA reported in 2005 that complications of pregnancy and childbirth kill one woman every minute and injure twenty others—99% of them in developing countries. Figure 7.4 provides a breakdown of the causes of maternal death as reported by the World Health Organization (WHO) in 2005. According to the State of the World Population, several aspects of reproductive health have wide-reaching and long-term socioeconomic effects on families, communities, countries, and even entire regions.

Because most maternal deaths occur in already impoverished countries that are clustered together geographically, their regional impact is particularly acute. At the most personal level, children who lose their mothers tend to experience emotional problems that eventually may make them less productive as adults, and households lose valuable income without an adult female wage earner; many families, in fact, are pushed over the brink of poverty as a result of the

FIGURE 7.4 Causes of maternal death "Figure 4.1. Causes of Maternal Death," in The World Health Report 2005: Make Every Mother and Child Count, World Health Organization, 2005, http://www.who.int/whr/2005/whr2005_en.pdf (accessed April 10, 2006)

TABLE 7.4 Economic effects of fatal illness in the household, 1992 Margaret E. Greene and Thomas Merrick, "Table 1. Economic Effects of Fatal Illness in the Household," in Poverty Reduction: Does Reproductive Health Matter?, HNP Discussion Paper 33399, The World Bank, The International Bank for Reconstruction and Development, July 2005, http://www-wds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2005/08/22/000012009_20050822094645/Rendered/PDF/333990HNP0Gree1tyReduction01public1.pdf (accessed April 10, 2006). Data based on Over et al., 1992.

TABLE 7.4
Economic effects of fatal illness in the household, 1992
Timing of Impact
Type of effects Before illness During illness Immediate effect of death Long term effect of death
SOURCE: Margaret E. Greene and Thomas Merrick, "Table 1. Economic Effects of Fatal Illness in the Household," in Poverty Reduction: Does Reproductive Health Matter?, HNP Discussion Paper 33399, The World Bank, The International Bank for Reconstruction and Development, July 2005, http://www-wds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2005/08/22/000012009_20050822094645/Rendered/PDF/333990HNP0Gree1tyReduction01public1.pdf (accessed April 10, 2006). Data based on Over et al., 1992.
Effect on production and earnings Organization of economic activity
Residential location
Reduced productivity of ill adult

Reallocation of labor
Lost output of deceased Lost output of deceased
Reallocation of land and labor
Effect on investment and consumption Insurance
Medical costs of prevention
Precautionary savings
Transfer to other households
Medical cost of treatment
Dissaving
Changes in consumption and investment
Funeral costs
Transfers
Legal fees
Changes in type and quantity of investment and consumption
Effect on household health and composition Extended family
Fertility
Reduced allocation of labor to health maintaining activities Loss of deceased Poor health of surviving household members
Dissolution or reconstitution of household
Psychic costs Disutility of ill person Disutility to person
Grief of loved ones

high cost of health care when a mother becomes sick. (See Table 7.4.) Communities feel the loss because women in developing countries perform so many essential unpaid tasks, such as caring for children and elders, growing and harvesting food, and gathering fuel and water. High rates of maternal deaths affect the overall economic situation in a region in terms of lost productivity and lost potential for economic, cultural, and technological expansion.

WHO's World Health Report 2005: Make Every Mother and Child Count warns that if progress on improving maternal health continues at the slow rate it has seen since the 1990s, the Millennium Development Goals will not be met by 2015. Of the 136 million births every year, 529,000 result in the death of the mother; as of 2005, 300 million women were experiencing illnesses brought on by pregnancy or childbirth. WHO maintains that most of those deaths could be prevented with increased access to skilled care during and following childbirth. In 2005, 43% of mothers and newborns received some care at birth, but not enough to prevent the complications that often arise. Additionally, WHO reports that increased public expenditures on health care, higher wages for health care workers, and universal access to medical care are essential to reaching the MDGs, especially those that relate to women and children.

Table 7.5 illustrates the link between reproductive rights and the MDGs. Included in reproductive rights are issues such as violence against women and the rights to marry voluntarily, space children as desired, receive clear and accurate information about the reproductive process, and benefit from scientific progress. For women living in low-income countries, these rights cannot be TABLE 7.5 Reproductive rights and the MDGs (Millennium Development Goals) "Reproductive Rights and the MDGs," in State of World Population 2005, United Nations Population Fund, 2005, http://www.unfpa.org/swp/2005/pdf/en_swp05.pdf (accessed April 8, 2006)

TABLE 7.5
Reproductive rights and the MDGs (Millennium Development Goals)
Elements of reproductive rights Examples of rights-based actions Relevance to specific Millennium Development Goals (MDGs)
SOURCE: "Reproductive Rights and the MDGs," in State of World Population 2005, United Nations Population Fund, 2005, http://www.unfpa.org/swp/2005/pdf/en_swp05.pdf (accessed April 8, 2006)
Right to life and survival Prevent avoidable maternal and infant deaths
End neglect of and discrimination against girls that can contribute to premature deaths
Ensure access to information and methods to prevent sexually transmitted infections, including HIV
Promote gender equality and empower women (MDG 3)
Reduce child mortality (MDG 4)
Improve maternal health (MDG 5)
Combat HIV/AIDS, malaria and other diseases (MDG 6)
Right to liberty and security of the person Take measures to prevent, punish and eradicate all forms of gender-based violence
Enable women, men and adolescents to make reproductive decisions free of coercion, violence and discrimination
Eliminate female genital mutilation/cutting
Stop sexual trafficking
Eradicate extreme poverty and hunger (MDG 1)
Promote gender equality and empower women (MDG 3)
Reduce child mortality (MDG 4)
Improve maternal health (MDG 5)
Combat HIV/AIDS, malaria and other diseases (MDG 6)
Right to seek, receive and impart information Make information about reproductive health and rights issues and related policies and laws widely and freely available
Provide full information for people to make informed reproductive health decisions
Support reproductive health and family life education both in and out of schools
Promote gender equality and empower women (MDG 3)
Combat HIV/AIDS, malaria and other diseases (MDG 6)
Right to decide the number, timing and spacing of children Provide people with full information that enables them to choose and correctly use a family planning method
Provide access to a full range of modern contraceptive methods
Enable adolescent girls to delay pregnancy
Eradicate extreme poverty and hunger (MDG 1)
Achieve universal primary education (MDG 2)
Promote gender equality and empower women (MDG 3)
Ensure environmental stability (MDG 7)
Right to voluntarily marry and establish a family Prevent and legislate against child and forced marriages
Prevent and treat sexually transmitted infections that cause infertility
Provide reproductive health services, including for HIV prevention, to married adolescent girls and their husbands
Achieve universal primary education (MDG 2)
Promote gender equality and empower women (MDG 3)
Reduce child mortality (MDG 4)
Improve maternal health (MDG 5)
Combat HIV/AIDS, malaria and other diseases (MDG 6)
Right to the highest attainable standard of health Provide access to affordable, acceptable, comprehensive and quality reproductive health information and services
Allocate available resources fairly, prioritizing those with least access to reproductive health education and services
Eradicate extreme poverty and hunger (MDG 1)
Promote gender equality and empower women (MDG 3)
Reduce child mortality (MDG 4)
Improve maternal health (MDG 5)
Combat HIV/AIDS, malaria and other diseases (MDG 6)
Right to the benefits of scientific progress Fund contraceptive research, including female-controlled methods, microbicides and male methods
Offer a variety of contraceptive options
Provide access to emergency obstetric care that can prevent maternal deaths and obstetric fistula
Promote gender equality and empower women (MDG 3)
Reduce child mortality (MDG 4)
Improve maternal health (MDG 5)
Combat HIV/AIDS, malaria and other diseases (MDG 6)
Right to non-discrimination and equality in education and employment Prohibit discrimination in employment based on pregnancy, proof of contraceptive use or motherhood
Establish programmes to keep girls in schools
Ensure pregnant and married adolescent girls, and young mothers, are able to complete their education
Eradicate extreme poverty and hunger (MDG 1)
Achieve universal primary education (MDG 2)
Promote gender equality and empower women (MDG 3)
Combat HIV/AIDS, malaria and other diseases (MDG 6)

taken for granted. In fact, many are prohibited from using contraception—or from even receiving information about it—and must marry whomever their families choose for them. In some cultures, going against these conventions can place the woman in a position that results in physical and emotional violence. The inability to decide how many children to have or how many years apart to have them can easily overwhelm a family's finances, particularly a family that is already poor. There are also health considerations: a woman who can control her reproductive choices is more likely to receive adequate health care, and thus less likely to die in childbirth.

In Poverty Reduction: Does Reproductive Health Matter? (World Bank Health, Nutrition and Population, July 2005), Margaret E. Greene and Thomas Merrick argue that controversy over reproductive rights—namely, abortion and birth control—has hit poor women particularly hard. According to Greene and Merrick, the issue has actually harmed poor women's health: governments have been pressured to cut funding for medical care and family planning, and the United Nations was forced to drop the goal of achieving universal reproductive health care from the Millennium Declaration. The United Nations Population Fund reports in State of the World Population 2005 that as of 2005 the world's women suffered disproportionately from sexual and reproductive health problems—nearly 35% of women globally versus less than 20% of men.

Figure 7.5 shows the percentages of the poorest and wealthiest women who give birth with the attendance of skilled medical personnel in selected low-income countries. Poor women are far less likely to have a skilled attendant present during the births of their children. In Vietnam, where 100% of the richest women have access to medical personnel during childbirth, only 58% of the poorest women do. In Ethiopia just 1% of the poorest FIGURE 7.5 Births attended by skilled personnel among the poorest and richest women, selected countries, 2004 "Figure 2. Births Attended by Skilled Personnel among the Poorest and Richest Women," in State of World Population 2005, United Nations Population Fund, 2005, http://www.unfpa.org/swp/2005/pdf/en_swp05.pdf (accessed April 8, 2006). Data from World Bank, 2004, Round II Country Reports on Health, Nutrition, and Population Conditions among the Poor and the Better-Off in 56 Countries.women receive medical attendance at childbirth, versus 25% of the wealthiest women. These numbers demonstrate that the world's poorest women do not have reproductive rights equal to those of their nonpoor counterparts.

Lack of family planning options most strongly affects poor young women, who may not be prepared for pregnancy and parenthood physically, emotionally, or financially. Figure 7.6 shows the disparity of contraceptive use among the poorest and richest women in Ghana, Yemen, Guatemala, the Philippines, India, and Kazakhstan. In Guatemala, for example, only 5% of the nation's poorest women use contraceptives compared with 60% of wealthy women. Figure 7.7 compares childbearing among the poorest and richest women under age eighteen in Niger, Nicaragua, Nepal, Tanzania, Kenya, Bolivia, and Turkey. In Niger nearly three-quarters (72%) of poor women had given birth by age eighteen, FIGURE 7.6 Contraceptive use according to wealth, selected countries, 2004 "Figure 3. Contraceptive Use according to Wealth," in State of World Population 2005, United Nations Population Fund, 2005, http://www.unfpa.org/swp/2005/pdf/en_swp05.pdf (accessed April 8, 2006). Data from World Bank, 2004, Round II Country Reports on Health, Nutrition, and Population Conditions among the Poor and the Better-Off in 56 Countries.compared with two-fifths (39%) of wealthy women. In reviewing economic and sociological publications on the link between poverty and early childbearing, Greene and Merrick cite the following points of connection:

  • Poor health outcomes for the young mother and her child: higher risk of obstetric complications, leading to higher maternal mortality and morbidity (illness or disease) if she survives; increased risk of abortion and abortion complications if the abortion is unsafe; and low birth weight and other problems for the newborn
  • Poor educational outcomes for both the mother and her child, including dropping out of school and less schooling for the child
  • Lower and/or altered investment and spending patterns in the mother's immediate and extended family (costs of medical care and child care, for example, can make it difficult or impossible to save money)
  • Possibly lower labor force participation by the young mother, with less opportunity to contribute to household income
  • Reduced community participation and greater chances of divorce or single parenthood

Early childbearing tends to occur more often in poor countries but even in wealthier countries the highest rates of fertility among adolescents are found among the FIGURE 7.7 Childbearing among the poorest and richest adolescents, selected countries, 2004 "Figure 4. Childbearing among the Poorest and Richest Adolest Adolescents," in State of World Population 2005, United Nations Population Fund, 2005, http://www.unfpa.org/swp/2005/pdf/en_swp05.pdf (accessed April 8, 2006). Data from Rani, M. and E. Lule, 2004, "Exploring the Socioeconomic Dimension of Adolescent Reproductive Health: A Multicountry Analysis" International Family Planning Perspectives, 30 (3): 112.poorest groups. Greene and Merrick reported that in 2004, for example, out of a sample of fifty-five countries, the average adolescent fertility rate (the number of women who had given birth before age twenty) for the richest group was 62.6 per 100,000 population, versus 148.6 per 100,000 population for the poorest group. The highest regional rates for adolescent poor women were in Latin America and the Caribbean (172.6 births per 100,000 population), followed by sub-Saharan Africa (169.6). The sampled region with the lowest adolescent fertility rate was East Asia, at forty-six births per 100,000, but it is important to note that in that region only four countries were sample, compared with twenty-nine countries in sub-Saharan.

According to Greene and Merrick, studies have shown that poor women of all ages experience more difficulties with pregnancy and childbearing, but adolescent mothers have more extreme problems because their bodies may not be developed enough to sustain the physical challenges of giving birth. In developing countries women aged fifteen to nineteen are twice as likely to die from complications of childbirth than women in their twenties. Women in poor countries tend to marry and begin having children earlier than women in wealthier countries. This is partly the cause of the significantly higher number of maternal deaths in underdeveloped and developing regions. (See Table 7.6.) In fact, as Table 7.6 illustrates, the total number of maternal deaths increased annually from 515,000 in 1995 to 529,000 in 2000. Developing regions overall saw an increase from 512,000 in 1995 to 527,000 in 2000, with Asia experiencing the greatest increase. Figure 7.8 shows the various factors that link early pregnancy with poverty. Factors such as a lack of education, childhood and adult illness and malnutrition, a lack of access to natural resources and involvement in the global economy, and high mortality rates can all be linked to higher fertility rates, which in turn lead to lower per capita income.

OBSTETRIC FISTULA

One of the most serious health and social consequences of childbirth in poor countries—particularly in sub-Saharan Africa and South Asia—is the development of obstetric fistula. This childbirth-related injury is caused by exceptionally long labor, often as long as five to seven days, that cuts off blood flow to the vagina, bladder, and/or rectum. The resulting holes in the tissue leave women unable to control the flow of TABLE 7.6 Comparison of 1995 and 2000 regional and global totals of maternal mortality Margaret E. Greene and Thomas Merrick, "Table 5. Comparison of 1995 and 2000 Regional and Global Totals," in Poverty Reduction: Does Reproductive Health Matter?, HNP Discussion Paper 33399, The World Bank, The International Bank for Reconstruction and Development, July 2005, http://www-wds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2005/08/22/000012009_20050822094645/Rendered/PDF/333990HNP0Gree1tyReduction01public1.pdf (accessed April 10, 2006). Data from AbouZahr and Wardlaw, 2004.

TABLE 7.6
Comparison of 1995 and 2000 regional and global totals of maternal mortality
Region 2000 1995
Maternal mortality ratio Maternal deaths (in thousands) Maternal mortality ratio Maternal deaths (in thousands)
*Developed regions include Canada, United States of America, Japan, Australia and New Zealand, which are excluded from the regional averages.
SOURCE: Margaret E. Greene and Thomas Merrick, "Table 5. Comparison of 1995 and 2000 Regional and Global Totals," in Poverty Reduction: Does Reproductive Health Matter?, HNP Discussion Paper 33399, The World Bank, The International Bank for Reconstruction and Development, July 2005, http://www-wds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2005/08/22/000012009_20050822094645/Rendered/PDF/333990HNP0Gree1tyReduction01public1.pdf (accessed April 10, 2006). Data from AbouZahr and Wardlaw, 2004.
World total 400 529,000 400 515,000
Developed regions* 20 2,500 21 2,800
Europe 28 2.2 36 3.2
Developing regions 440 527,000 440 512,000
Africa 830 251,000 1,000 273,000
Northern Africa 130 4,600 200 7,200
Sub-Saharan Africa 920 247,000 1,100 265,000
Asia 330 253,000 280 217,000
Eastern Asia 55 11,000 60 13,000
South-central Asia 520 207,000 410 158,000
South-eastern Asia 210 25,000 300 35,000
Western Asia 190 9,800 230 11,000
Latin America & the Caribbean 190 22,000 190 22,000
Oceania 240 530 260 560

FIGURE 7.8 Channels linking early pregnancy and childbearing to poverty Margaret E. Greene and Thomas Merrick, "Figure 2. Channels Linking Early Pregnancy and Childbearing to Poverty," in Poverty Reduction: Does Reproductive Health Matter?, HNP Discussion Paper 33399, The World Bank, The International Bank for Reconstruction and Development, July 2005, http://www-wds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2005/08/22/000012009_20050822094645/Rendered/PDF/333990HNP0Gree1tyReduction01public1.pdf (accessed April 10, 2006). Data from Ruger et al., 2001.urine and feces, which leak out constantly. Nerve damage to the legs, severe infections, and kidney disease are also common among fistula sufferers.

According to the Fistula Foundation (www.fistulafoundation.org/) and the United Nations Population Fund (UNFPA), more than two million women in the developing world are known to suffer from obstetric fistula, which was virtually eradicated in wealthier countries when caesarian sections became commonplace in the late nineteenth century. The actual number of women who live with the condition is believed to be much higher, since it is rarely discussed and most women who suffer from it never get medical help. WHO estimates that in Nigeria alone, for example, as many as 800,000 women have fistulas, with 20,000 more developing the condition every year ("545 Women Operated on during 'Fistula Fortnight,'" March 7, 2005). Globally, obstetric fistula is believed to occur in 50,000 to 100,000 women per year, most of them under the age of twenty.

According to UNFPA's Campaign to End Fistula (www.endfistula.org/):

Poverty, malnutrition, poor health services, early marriage, and gender discrimination are interlinked root causes of obstetric fistula. Poverty is the main social risk factor because it is associated with early marriage and malnutrition and because poverty reduces a woman's chances of getting timely obstetric care.

Obstetric fistula is a cause of poverty among women as well as a consequence. Sufferers are often abandoned by their husbands and families and ostracized by their communities because of the stigma attached to their condition. Many are driven from their homes and left to survive or die on their own. The condition can, however, be repaired with surgery, which has about a 93% cure rate, according to the Fistula Foundation. However, few women in affected regions either know about the surgery, which costs from $100 to $400, or have access to it, and most cannot afford it.

In 2003 the first major report on fistula—Obstetric Fistula Needs Assessment Report: Findings from Nine African Countries—was published jointly by the UNFPA and the nonprofit organization EngenderHealth. Focusing on the countries most affected by obstetric fistula, the report identified seven critical needs of regions with the highest numbers of fistula sufferers, including education about the physical dangers of early marriage and pregnancy, family planning and maternal health; increased medical care in the form of prevention and treatment; social support services to address the physical and psychological needs of fistula sufferers.

EDUCATION: A TOOL TO LIFT WOMEN OUT OF POVERTY

The Beijing Platform declared that education is an essential human right that contributes to economic development at all levels of society—a declaration that has been supported by the UN, UN Educational, Scientific, and Cultural Organization (UNESCO), the World Bank, and most nongovernmental organizations. However, according to the Education for All Global Monitoring Report 2006: Literacy for Life (2005, http://portal.unesco.org/education/en/ev.php-URL_ID1/443283&URL_DO1/4DO_TOPIC&URL_SECTION1/4201.html), at least 771 million adults over the age of fifteen—one-fifth of the world's adult population—cannot read or write at a functional level; at least two-thirds of them are women.

In its State of the World Population 2002: People, Poverty, and Possibilities (2002, http://www.unfpa.org/swp/2002/english/ch1/), the United Nations Population Fund (UNFPA) reports that 31% of women had no formal education in 2000, versus 18% of men. There are many reasons for this disparity, and poverty is chief among them: although women are almost universally less likely to attain high levels of education, being female and poor is, according to the UNFPA report, a "double disadvantage." In rural areas the long walking distances to schools discourage families from sending girls because they fear girls will be sexually assaulted on the way. Fees for attendance, books, and uniforms can also affect whether girls are sent to school. Again, girls in some regions are vulnerable to sexual exploitation from wealthier men who offer to pay for girls' schooling in exchange for sex. Early marriage and pregnancy also cause millions of girls to drop out of school every year. Many families decide to keep daughters at home to help tend and harvest crops, do housework, and care for elders and young siblings. The costs associated with educating girls are generally not seen as worthwhile because girls are not expected to continue their education or earn a living when they grow up. More simply, in many cultures girls are not valued in the same way that boys are, so to many impoverished families educating them seems like a waste of time and money—and in some places it is altogether forbidden.

Barbara Herz and Gene B. Sperling report in What Works in Girls' Education: Evidence and Policies from the Developing World (2004, http://www.cfr.org/content/publications/attachments/Girls_Education_full.pdf) that education for girls in developing countries is essential for economic success at all levels of society. The benefits of educating girls are seen from families to nations, in the forms of higher wages, faster economic growth, and more productive farming. This in turn results in decreased levels of malnutrition; women having smaller, healthier, more educated families; reducing the spread of HIV/AIDS; reducing rates of violence against women; and fostering democratic participation in society.

According to Herz and Sperling, when girls attend school just one year beyond the average, they eventually earn 10% to 20% more than average as adults. On the macroeconomic level, even modest increases in the number of women receiving a secondary education can lead to an increase in annual per capita income of 0.3%; likewise, as per capita growth continues, more girls achieve higher levels of education—a cycle that is beneficial, ultimately, for everyone. Similarly, the more education women have, the lower their rates of fertility will be. In Brazil, for example, illiterate women have an average of six children each, whereas literate women average 2.5 children each. Lower overall fertility rates lead to healthier, better-educated children. In fact, infant mortality rates are between 5% and 10% lower among girls who stay in school just one year longer than average. In countries where girls receive as many years of schooling as boys, infant mortality rates are 25% lower than in countries that do not have educational gender parity (equality).

Herz and Sperling conclude that governments of low-income countries can encourage families to educate their daughters and increase overall educational gender parity by eliminating school fees, providing local schools with flexible schedules that are safe for girls, and focusing on providing a quality education that realistically takes into account the needs of girls and their families.

Table 7.7 shows which countries achieved the Millennium Development Goal of gender parity in education as of 2002, those that are likely to achieve the goal by 2005, those that are likely to achieve the goal by 2015, and those countries that are in danger of not achieving the goal by 2015.

VIOLENCE AGAINST WOMEN

Violence against women happens in every economic class of every culture around the world. While it is a TABLE 7.7 Country prospects for the achievement of gender parity in primary and secondary education by 2005 and 2015 "Table 2. 10. Country Prospects for the Achievement of Gender Parity in Primary and Secondary Education by 2005 and 2015," in Education for All Global Monitoring Report 2006: Literacy for Life, United Nations Educational, Scientific and Cultural Organization, 2005, http://www.unesco.org/education/GMR2006/full/chapt2_eng.pdf (accessed April 8, 2006). Copyright © UNESCO, 2005multifaceted social problem, many experts consider it to be largely a health issue because of the physical and emotional havoc it wreaks on its victims; the other dimension of violence against women is that it is a human rights issue. Amnesty International calls it "a major human rights scandal and a public health crisis" ("Women, Violence, and Health," March 2004, http://www.web.amnesty.org/library/Index/ENGACT770012005?open&of1/4ENG-366). Although hard data are difficult to obtain because of the covert nature of the problem, there is a known link between violence against women and poverty. Figure 7.9 shows percentages of women in selected low-income countries who believed wife-beating was justified as of 2004. The reasons given—presented in the graph's "Note"—are indicative of the status of women in these cultures.

In Addressing Violence against Women and Achieving the Millennium Development Goals (2005, http://www.who.int/gender/documents/MDGs&VAWSept05.pdf), the WHO cites two main reasons poor women are more vulnerable to violence than their nonpoor counterparts: fewer resources—in terms of both money and support services—to help women avoid or escape violence; and the stressors of poverty, such as hunger, unemployment, and lack of education, that may lead some men to become violent or exacerbate an already violent situation. In addition, women who work in unregulated, informal employment are often subject to physical, sexual, or psychological abuse by their employers. In both developing and developed countries, social standards and enforced gender roles contribute to the incidence of violence.

The WHO report recommends several global economic actions that can affect women who are routine victims of violence:

  • Promote increased access to postprimary, vocational and technical education for women
  • Address gender gaps in earnings as well as barriers to accessing credit for women
  • Extend and upgrade childcare benefits to enable women's full participation in the paid labor market
  • Address issues of occupational segregation that often translate into inferior conditions of employment for women

FIGURE 7.9 Women who believe wife beating is justified for at least one reason, selected countries, 2004 "Figure 5. Women Who Believe Wife Beating Is Justified for at Least One Reason," in State of World Population 2005, United Nations Population Fund, 2005, http://www.unfpa.org/swp/2005/pdf/en_swp05.pdf (accessed April 8, 2006). Data from Kishor, S. and K. Johnson, 2004, Profiling Domestic Violence: A Multicountry Study, Calverton, MD: ORC Macro, Measure DHS+:66.

  • Ensure social protection and benefits for women in precarious employment situations—often those involved in informal employment

The WHO report notes, however, that increasing women's economic and social opportunities can actually put them at greater risk of violence, as such opportunities can breed resentment from the men in their lives. The WHO emphasizes that a well-funded and developed social support system is essential if poor women are to permanently escape violence. Educational programs are particularly important, for both women and men, if perceived gender roles are to be expanded to include advancement for women without the danger of violence.

Exact figures for incidences of violence are almost impossible to obtain, because most violent acts committed against women—especially in developing countries—go unreported. However, it is estimated that 10% to 50% of women around the world have been assaulted by their husbands or male partners at some point. The numbers rise when brothers and other male relatives who perpetrate the violence are counted. In fact, physical and sexual assaults committed by male family members are the most common type of violence against women. In developing countries this type of violence is largely the result of traditional gender norms, most of which have evolved out of men's social and economic dominance over women.

The connection between poverty and violence against women lies primarily in that dominance. In many cultures women are completely dependent on their husbands and male relatives for survival. Amnesty International cites laws that prohibit women from owning or inheriting property and from divorcing abusive husbands; hierarchies that allow fathers, brothers, and husbands to withhold access to food, clothing, and shelter; and customs, such as "wife inheritance" and honor crimes, that force women to obey male relatives or risk exile or death.

In addition, violent conflicts at the village, tribal, and national level reduce millions of women and children to refugee status, leaving them vulnerable to unemployment, disease, starvation, rape, and kidnapping. Millions more women and children (the UN estimates thirty million worldwide) end up as victims of international sex trafficking; the U.S. Department of Health and Human Services' Administration for Children and Families reports that poor women may be lured into the sex trade by promises of a good job in another country, or they may be sold into the trade by their parents, brothers, husbands, or male partners. Others are abducted and forced into the trade. Taken together, these factors leave poor women especially vulnerable to physical, sexual, and psychological violence.

Furthermore, a woman who has suffered domestic violence is more likely to become impoverished. Globally, with as many as one in three women being violently assaulted in her lifetime, the chances of severe, debilitating injury to a large number of abused women are high. In a November 2005 address before the U.S. Congressional Human Rights Caucus, S. K. Guha of UNIFEM noted that violence against women is increasingly acknowledged to be both a consequence and a cause of poverty among women and children. Severely abused women are generally unable to work, especially if they are also responsible for performing the physical labor of harvesting food and gathering fuel and water for their families.

Violence against Women in the United States

In the United States domestic violence is conclusively linked to homelessness among women and children. The American Civil Liberties Union (ACLU) reports that domestic violence was cited by 50% of U.S cities surveyed in 2005 as a primary cause of homelessness (http://www.aclu.org/pdfs/dvhomelessness032106.pdf). Further, the ACLU notes that 50% of homeless women in San Diego, California, reported being the victims of domestic violence, and that in Minnesota, one-third of homeless women indicated that they left their homes to escape domestic violence. Overall, according to the National Network to End Domestic Violence, Domestic Violence (September 2004; http://www.nnedv.org/pdf/Homelessness.pdf), 92% of homeless women in the United States have at some point been the victims of severe physical and/or sexual abuse.

VIOLENCE AGAINST WOMEN ACT 2005

In December 2005 both the U.S. Senate and House of Representatives passed the Violence against Women Act 2005 (VAWA), which was part of the larger Department of Justice authorization bill. The VAWA 2005 is a reauthorization of an earlier act passed in 1994. The 2005 version of VAWA enhanced the provisions of its earlier version, with increased funding for violence-prevention programs, emergency shelter for women and children, and long-term housing solutions for low-income women and their children. The act also mandates that abused women be allowed to take ten days off from work each year to attend court or to look for housing, and it provides greater access to law enforcement and the justice system for abused immigrant woman who would otherwise have no legal recourse and might have to leave the country with abusive partners. Because violent relationships tend to affect poor women disproportionately in the United States, the provisions of the VAWA that allow time off from work and help for immigrant women mean that more poor women will be able to keep their jobs and remain in the country while they make arrangements to leave and/or prosecute their abusers.

POVERTY'S YOUNGEST VICTIMS

According to the report State of the World's Children 2006: Excluded and Invisible (2005, http://www.unicef.org/egypt/sowc06_fullreport.pdf) by the United Nations Children's Fund's (UNICEF), the least developed FIGURE 7.10 The least developed countries are the richest in children, 2004 "Figure 2.1. The Least Developed Countries Are the Richest In Children," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc0506_eps_charts.pdf (accessed April 8, 2006). Data based on calculations from United Nations Population Division.countries in the world are home to the greatest number of children—49% of the total population of least developed countries was under eighteen years old in 2004; in developing countries children under eighteen made up 37% of the total population. (See Figure 7.10.)

Children are more vulnerable to the effects of poverty than any other demographic group, and because their numbers in poor countries are so high, they suffer disproportionately from the disease, hunger, abuse, and exploitation that so often go hand in hand with poverty. UNICEF reports that "more than one billion children suffer from one or more extreme forms of deprivation in adequate nutrition, safe drinking water, decent sanitation facilities, health-care services, shelter, education and information." As Figure 7.11 shows, 30.7% of children in developing countries have no access to a toilet, while 33.9% live in homes with more than five people per room. For 21.1%, there is access only to untreated, potentially hazardous, water sources. Furthermore, 13.1% have never been to school. Underdeveloped and developing countries overall have the highest rates of children not attending school, as shown in Figure 7.12. Whereas 96% of girls and 95% of boys in developed countries are enrolled in primary school, just 65% of girls and 71% of boys in underdeveloped ("least developed") countries are enrolled in primary school. Even fewer poor children are enrolled in secondary school: 26% of girls and 30% of boys in underdeveloped countries, versus 92% of girls and 91% of boys in developed countries.

FIGURE 7.11 Severe deprivation among children in the developing world, by different deprivations, 2003 "Figure 2.1. Severe Deprivation among Children in the Developing World, by Different Deprivations," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/figure2_1_2005.pdf (accessed April 8, 2006). Data from Gordon, David, et al., Child Poverty in the Developing World, The Policy Press, Bristol, UK, October 2003.

FIGURE 7.12 Children living in the poorest countries are most at risk of missing out on primary and secondary school, 2000–04 "Figure 2.2 Children Living in the Poorest Countries Are Most at Risk of Missing Out on Primary and Secondary School," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc0506_eps_charts.pdf (accessed April 8, 2006). Data from Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS)

Table 7.8 lists each country's rank according to its under-five mortality rate, as well as each country's infant and under-five mortality rates, life expectancy, literacy and education rates, and gross national per capita income. In general, life expectancy at birth increases as gross national income per capita increases. Infant and under-five mortality rates improved overall between 1990 and 2004 in least developed, developing, and industrialized countries.

Table 7.9 shows the status of child protection in countries around the world. Western and Central African countries have the overall highest percentage of children involved in child labor (41% of both girls and boys). At 46%, South Asia has the highest rate of child marriage of any geographic region, followed closely by Western and Central Africa, at 45%.

Child poverty is not limited to low-income countries. In eleven out of the fifteen countries belonging to the Organization for Economic Cooperation and Development (OECD), child poverty increased from the period of the late 1980s–early 1990s through the late 1990s–early 2000s. In this group, Mexico had the highest rate of child poverty, rising from 24.7% in the earlier period to 27.7% in the later period. The United States had the second highest rate; even with a drop from 24.3% to 21.9%, the U.S. child poverty rate far exceeded the rate of all other OECD countries except Mexico. In the United Kingdom the drop from 18.5% to 15.4% was due in large part to the commitment

TABLE 7.8 Under-five mortality rank and other development indicators, by country, 1990–2004

TABLE 7.8
Under-five mortality rank and other development indicators, by country, 1990–2004
Countries and territories Under-5 mortality rank Under-5 mortality rate Infant mortality rate (under 1)a Total population (thousands) 2004 Annual number of births (thousands) 2004 Annual number of under-5 deaths (thousands) 2004 Gross national income per capita (US$)b 2004 Life expectancy at birth (years)c 2004 Total adult literacy rated 2000–2004g Net primary school enrolment/attendance (percent)e 1996–2004g Percent share of household Incomef 1993–2003g
1990 2004 1990 2004 Lowest 40% Highest 20%
Afghanistan 4 260 257 168 165 28,574 1,395 359    250m 46  53l
Albania 125 45 19 37 17 3,112 53 1  2,080 74 99  95 23 37
Algeria 79 69 40 54 35 32,358 671 27  2,280 71 70  94l 19 43
Andorra 159 7 6 67 1 0      k  89
Angola 2 260 260 154 154 15,490 749 195  1,030 41 67  58l
Antigua and Barbuda 143 12 11 81 2 0 10,000  —
Argentina 127 29 18 26 16 38,372 685 12  3,720 75 97  — 10 56
Armenia 90 60 32 52 29 3,026 34 1  1,120 72 99  97l 18 45
Australia 162 10 6 8 5 19,942 249 1 26,900 81  97 18 41
Austria 172 10 5 8 5 8,171 75 0 32,300 79  90 21 39
Azerbaijan 51 105 90 84 75 8,355 132 12    950 67 99  91l 19 45
Bahamas 140 29 13 24 10 319 6 0 14,920m 70  86
Bahrain 148 19 11 15 9 716 13 0 10,840m 75 88  86l
Bangladesh 58 149 77 100 56 139,215 3,738 288    440 63 41  79l 22 41
Barbados 143 16 12 14 10 269 3 0  9,270m 75 100 100
Belarus 148 17 11 13 9 9,811 91 1  2,120 68 100  94 21 39
Belgium 172 10 5 8 4 10,400 111 1 31,030 79 100 22 37
Belize 81 49 39 39 32 264 7 0  3,940 72 77  99
Benin 23 185 152 111 90 8,177 341 52    530 54 34  54l
Bhutan 56 166 80 107 67 2,116 64 5    760 63  —
Bolivia 62 125 69 89 54 9,009 265 18    960 64 87  78l 13 49
Bosnia and Herzegovina 131 22 15 18 13 3,909 37 1  2,040 74 95  86l 24 36
Botswana 41 58 116 45 84 1,769 46 5  4,340 35 79  84l 7 70
Brazil 88 60 34 50 32 183,913 3,728 127  3,090 71 88  95l 8 63
Brunei Darussalam 150 11 9 10 8 366 8 0 24,100m 77 93  —
Bulgaria 131 18 15 15 12 7,780 67 1  2,740 72 98  90 20 39
Burkina Faso 16 210 192 113 97 12,822 601 115    360 48 13  321 12 61
Burundi 17 190 190 114 114 7,282 330 63     90 44 59  47l 15 48
Cambodia 26 115 141 80 97 13,798 422 60    320 57 74  65l 18 48
Cameroon 25 139 149 85 87 16,038 562 84    800 46 68  75l 15 51
Canada 162 8 6 7 5 31,958 328 2 28,390 80 100 20 40
Cape Verde 86 60 36 45 27 495 15 1  1,770 71 76  99
Central African Republic 15 168 193 102 115 3,986 149 29    310 39 49  43l 7 65
Chad 12 203 200 117 117 9,448 456 91    260 44 26  391
Chile 152 21 8 17 8 16,124 249 2  4,910 78 96  85 10 62
China 93 49 31 38 26 1,307,989 17,372 539  1,290 72 91  99 14 50
Colombia 113 36 21 30 18 44,915 970 20  2,000 73 94  931 9 62
Comoros 61 120 70 88 52 777 28 2    530 64 56  31l
Congo 44 110 108 83 81 3,883 172 19    770 52 83  54
Congo, Democratic Republic of the 8 205 205 129 129 55,853 2,788 572    120 44 65  52l

TABLE 7.8 Under-five mortality rank and other development indicators, by country, 1990–2004 [CONTINUED]

TABLE 7.8
Under-five mortality rank and other development indicators, by country, 1990–2004 [CONTINUED]
Countries and territories Under-5 mortality rank Under-5 mortality rate Infant mortality rate (under 1)a Total population (thousands) 2004 Annual number of births (thousands) 2004 Annual number of under-5 deaths (thousands) 2004 Gross national income per capita (US$)b 2004 Life expectancy at birth (years)c 2004 Total adult literacy rated 2000–2004g Net primary school enrolment/attendance (percent)e 1996–2004g Percent share of household Incomef 1993–2003g
1990 2004 1990 2004 Lowest 40% Highest 20%
Cook Islands 113 32 21 26 18 18 0 0     —  —
Costa Rica 140 18 13 16 11 4,253 79 1  4,670 78 96  90 13 52
Côte d'Ivoire 14 157 194 103 117 17,872 661 128    770 46 48  58l 14 51
Croatia 159 12 7 11 6 4,540 41 0  6,590 75 98  89 21 40
Cuba 159 13 7 11 6 11,245 136 1  1,170m 78 100  93
Cyprus 172 12 5 10 5 826 10 0 17,580 79 97  96
Czech Republic 185 13 4 11 4 10,229 91 0  9,150 76  87 25 36
Denmark 172 9 5 8 4 5,414 63 0 40,650 77 100 23 36
Djibouti 31 163 126 122 101 779 27 3  1,030 53  36
Dominica 135 17 14 15 13 79 2 0  3,650  81
Dominican Republic 90 65 32 50 27 8,768 211 7  2,080 68 88  92l 14 53
Ecuador 104 57 26 43 23 13,040 296 8  2,180 75 91 100 11 58
Egypt 86 104 36 76 26 72,642 1,890 68  1,310 70 56  83l 21 44
El Salvador 98 60 28 47 24 6,762 166 5  2,350 71 80  90 10 57
Equatorial Guinea 9 170 204 103 122 492 21 4      j 43 84  62l
Eritrea 54 147 82 88 52 4,232 166 14    180 54  63l
Estonia 152 16 8 12 6 1,335 13 0  7,010 72 100  95 18 44
Ethiopia 20 204 166 131 110 75,600 3,064 509    110 48 42  31l 22 39
Fiji 120 31 20 25 16 841 19 0  2,690 68 93 100
Finland 185 7 4 6 3 5,235 55 0 32,790 79 100 24 37
France 172 9 5 7 4 60,257 744 4 30,090 80  99 20 40
Gabon 49 92 91 60 60 1,362 42 4  3,940 54  94l
Gambia 36 154 122 103 89 1,478 52 6    290 56  53l 14 53
Georgia 75 47 45 43 41 4,518 50 2  1,040 71  89 18 44
Germany 172 9 5 7 4 82,645 687 3 30,120 79  83 22 37
Ghana 42 122 112 75 68 21,664 679 76    380 57 54  61l 16 47
Greece 172 11 5 10 4 11,098 102 1 16,610 78 91  99 19 44
Grenada 113 37 21 30 18 102 2 0  3,760  84
Guatemala 75 82 45 60 33 12,295 433 19  2,130 68 69  78l 9 64
Guinea 22 240 155 145 101 9,202 383 59    460 54  57l 17 47
Guinea-Bissau 10 253 203 153 126 1,540 77 16    160 45  41l 14 53
Guyana 67 88 64 64 48 750 16 1    990 64  97l
Haiti 40 150 117 102 74 8,407 253 30    390 52 52  54l
Holy See 1     —  —
Honduras 78 59 41 44 31 7,048 206 8  1,030 68 80  87 9 59
Hungary 152 17 8 15 7 10,124 95 1  8,270 73 99  91 23 37
Iceland 192 7 3 6 2 292 4 0 38,620 81 100
India 52 123 85 84 62 1,087,124 26,000 2,210    620 64 61  77l 21 43
Indonesia 83 91 38 60 30 220,077 4,513 171  1,140 67 88  94l 20 43

TABLE 7.8 Under-five mortality rank and other development indicators, by country, 1990–2004 [CONTINUED]

TABLE 7.8
Under-five mortality rank and other development indicators, by country, 1990–2004 [CONTINUED]
Countries and territories Under-5 mortality rank Under-5 mortality rate Infant mortality rate (under 1)a Total population (thousands) 2004 Annual number of births (thousands) 2004 Annual number of under-5 deaths (thousands) 2004 Gross national income per capita (US$)b 2004 Life expectancy at birth (years)c 2004 Total adult literacy rated 2000–2004g Net primary school enrolment/attendance (percent)e 1996–2004g Percent share of household Incomef 1993–2003g
1990 2004 1990 2004 Lowest 40% Highest 20%
Iran (Islamic Republic of) 83 72 38 54 32 68,803 1,308 50  2,300 71 77  86 15 50
Iraq 33 50 125 40 102 28,057 972 122  2,170m 59  78l
Ireland 162 10 6 8 5 4,080 63 0 34,280 78  96 19 43
Israel 162 12 6 10 5 6,601 134 1 17,380 80 97  99 18 44
Italy 172 9 5 9 4 58,033 531 3 26,120 80  99 19 42
Jamaica 120 20 20 17 17 2,639 52 1  2,900 71 88  95 17 46
Japan 185 6 4 5 3 127,923 1,169 5 37,180 82 100 25 36
Jordan 101 40 27 33 23 5,561 150 4  2,140 72 90  99l 19 44
Kazakhstan 60 63 73 53 63 14,839 237 17  2,260 63 100  91l 20 40
Kenya 37 97 120 64 79 33,467 1,322 159    460 48 74  78l 16 49
Kiribati 66 88 65 65 49 97 2 0    970  —
Korea, Democratic People's Republic of 71 55 55 42 42 22,384 349 19      h 63  —
Korea, Republic of 162 9 6 8 5 47,645 467 3 13,980 77 100 22 38
Kuwait 143 16 12 14 10 2,606 50 1 16,340m 77 83  83
Kyrgyzstan 64 80 68 68 58 5,204 116 8    400 67 99  89l 20 43
Lao People's Democratic Republic 53 163 83 120 65 5,792 204 17    390 55 69  62l 19 45
Latvia 143 18 12 14 10 2,318 21 0  5,460 72 100  86 20 41
Lebanon 93 37 31 32 27 3,540 66 2  4,980 72  97l
Lesotho 54 120 82 84 61 1,798 50 4    740 35 81  65l 6 67
Liberia 5 235 235 157 157 3,241 164 39    110 42 56  70
Libyan Arab Jamahiriya 120 41 20 35 18 5,740 133 3  4,450 74 82  —
Liechtenstein 172 10 5 9 4 34 0 0      k  —
Lithuania 152 13 8 10 8 3,443 31 0  5,740 73 100  91 21 40
Luxembourg 162 10 6 7 5 459 6 0 56,230 79  90
Madagascar 35 168 123 103 76 18,113 704 87    300 56 71  76l 13 54
Malawi 19 241 175 146 110 12,608 550 96    170 40 64  76l 13 56
Malaysia 143 22 12 16 10 24,894 549 7  4,650 73 89  93 13 54
Maldives 74 111 46 79 35 321 10 0  2,510 67 96  92
Mali 7 250 219 140 121 13,124 647 142    360 48 19  39l 13 56
Malta 162 11 6 9 5 400 4 0 12,250 79 88  96
Marshall lslands 69 92 59 63 52 60 0 0  2,370  84
Mauritania 33 133 125 85 78 2,980 123 15    420 53 51  44l 17 46
Mauritius 131 23 15 21 14 1,233 20 0  4,640 72 84  97
Mexico 98 46 28 37 23 105,699 2,201 62  6,770 75 90  99 10 59
Micronesia (Federated States of) 110 31 23 26 19 110 3 0  1,990 68  —
Moldova, Republic of 98 40 28 30 23 4,218 43 1    710 68 96  98l 18 44
Monaco 172 9 5 7 4 35 0 0      k  —

TABLE 7.8 Under-five mortality rank and other development indicators, by country, 1990–2004 [CONTINUED]

TABLE 7.8
Under-five mortality rank and other development indicators, by country, 1990–2004 [CONTINUED]
Countries and territories Under-5 mortality rank Under-5 mortality rate Infant mortality rate (under 1)a Total population (thousands) 2004 Annual number of births (thousands) 2004 Annual number of under-5 deaths (thousands) 2004 Gross national income per capita (US$)b 2004 Life expectancy at birth (years)c 2004 Total adult literacy rated 2000–2004g Net primary school enrolment/attendance (percent)e 1996–2004g Percent share of household Incomef 1993–2003g
1990 2004 1990 2004 Lowest 40% Highest 20%
Mongolia 72 108 52 78 41 2,614 58 3    590 65 98  79l 16 51
Morocco 77 89 43 69 38 31,020 713 31  1,520 70 51  89l 17 47
Mozambique 23 235 152 158 104 19,424 769 117    250 42 46  60l 17 47
Myanmar 45 130 106 91 76 50,004 992 105    220m 61 90  80l
Namibia 68 86 63 60 47 2,009 56 4  2,370 47 85  78l  4 79
Nauru 95 30 25 13 0 0     —  81
Nepal 59 145 76 100 59 26,591 786 60    260 62 49  74l 19 45
Netherlands 162 9 6 7 5 16,226 190 1 31,700 79  99 21 39
New Zealand 162 11 6 8 5 3,989 55 0 20,310 79 100 18 44
Nicaragua 83 68 38 52 31 5,376 153 6    790 70 77  80l 15 49
Niger 3 320 259 191 152 13,499 734 190    230 45 14  30l 10 53
Nigeria 13 230 197 120 101 128,709 5,323 1,049    390 43 67  62l 13 56
Niue 1 0     —  99
Norway 185 9 4 7 4 4,598 55 0 52,030 80 100 24 37
Occupied Palestinian territory 107 40 24 34 22 3,587 136 3  1,110m 73 92  91
Oman 140 32 13 25 10 2,534 64 1  7,830m 74 74  72
Pakistan 47 130 101 100 80 154,794 4,729 478    600 63 49  56l 21 42
Palau 101 34 27 28 22 20 0 0  6,870  96
Panama 107 34 24 27 19 3,175 70 2  4,450 75 92 100  9 60
Papua New Guinea 48 101 93 74 68 5,772 176 16    580 56 57  74 12 57
Paraguay 107 41 24 33 21 6,017 175 4  1,170 71 92  89  9 61
Peru 97 80 29 60 24 27,562 627 18  2,360 70 88  96l 11 53
Philippines 88 62 34 41 26 81,617 2,026 69  1,170 71 93  88l 14 52
Poland 152 18 8 19 7 38,559 365 3  6,090 75  98 20 41
Portugal 172 14 5 11 4 10,441 112 1 14,350 78 100 17 46
Qatar 113 26 21 21 18 777 14 0 12,000m 73 89  94
Romania 120 31 20 27 17 21,790 213 4  2,920 72 97  89 20 41
Russian Federation 113 29 21 23 17 143,899 1,511 32  3,410 65 99  90 21 39
Rwanda 10 173 203 103 118 8,882 365 74    220 44 64  75l 23m 39m
Saint Kitts and Nevis 113 36 21 30 18 42 1 0  7,600  95
Saint Lucia 135 21 14 20 13 159 3 0  4,310 73 90  99
Saint Vincent and the Grenadines 112 25 22 22 18 118 2 0  3,650 71  90
Samoa 95 50 30 40 25 184 5 0  1,860 71 99  98
San Marino 185 14 4 13 3 28 0 0      k  —
Sao Tome and Principe 38 118 118 75 75 153 5 1    370 63  78l
Saudi Arabia 101 44 27 35 21 23,950 665 18 10,430 72 79  54
Senegal 29 148 137 90 78 11,386 419 57    670 56 39  48l 17 48
Serbia and Montenegro 131 28 15 24 13 10,510 122 2  2,620 74 96  96

TABLE 7.8 Under-five mortality rank and other development indicators, by country, 1990–2004 [CONTINUED]

TABLE 7.8
Under-five mortality rank and other development indicators, by country, 1990–2004 [CONTINUED]
Countries and territories Under-5 mortality rank Under-5 mortality rate Infant mortality rate (under 1)a Total population (thousands) 2004 Annual number of births (thousands) 2004 Annual number of under-5 deaths (thousands) 2004 Gross national income per capita (US$)b 2004 Life expectancy at birth (years)c 2004 Total adult literacy rated 2000–2004g Net primary school enrolment/attendance (percent)e 1996–2004g Percent share of household Incomef 1993–2003g
1990 2004 1990 2004 Lowest 40% Highest 20%
Seychelles 135 19 14 17 12 80 3 0  8,090 92 100
Sierra Leone 1 302 283 175 165 5,336 245 69    200 41 30  41l  3m 63m
Singapore 192 9 3 7 3 4,273 40 0 24,220 79 93  — 14 49
Slovakia 150 14 9 12 6 5,401 51 0  6,480 74 100  86 24 35
Slovenia 185 10 4 8 4 1,967 17 0 14,810 77 100  93 23 36
Solomon Islands 70 63 56 38 34 466 15 1    550 63  —
Somalia 6 225 225 133 133 7,964 359 81    130m 47  11l
South Africa 65 60 67 45 54 47,208 1,093 73  3,630 47 82  89l 10 62
Spain 172 9 5 8 3 42,646 447 2 21,210 80 100 20m 40m
Sri Lanka 135 32 14 26 12 20,570 330 5  1,010 74 90  — 21 42
Sudan 49 120 91 74 63 35,523 1,163 106    530 57 59  53l
Suriname 81 48 39 35 30 446 9 0  2,250 69 88  90l
Swaziland 21 110 156 78 108 1,034 30 5  1,660 31 79  72l  9 64
Sweden 185 7 4 6 3 9,008 95 0 35,770 80 100 23 37
Switzerland 172 9 5 7 5 7,240 68 0 48,230 81  99 20m 40m
Syrian Arab Republic 130 44 16 35 15 18,582 526 8  1,190 74 83  98
Tajikistan 38 128 118 99 91 6,430 186 22    280 64 99  81l 20 41
Tanzania, United Repubic of 31 161 126 102 78 37,627 1,403 177    330 46 69  82l 18 46
Thailand 113 37 21 31 18 63,694 1,015 21  2,540 70 93  85 16 50
The former Yugoslav Republic of Macedonia 135 38 14 33 13 2,030 23 0  2,350 74 96  91 22 37
Timor-Leste 56 172 80 130 64 887 45 4    550 56  —
Togo 27 152 140 88 78 5,988 233 33    380 55 53  64l
Tonga 105 32 25 26 20 102 2 0  1,830 72 99 100
Trinidad and Tobago 120 33 20 28 18 1,301 19 0  8,580 70 98  96l 16m 46m
Tunisia 105 52 25 41 21 9,995 166 4  2,630 74 74  97 16 47
Turkey 90 82 32 67 28 72,220 1,505 48  3,750 69 88  88l 17 47
Turkmenistan 46 97 103 80 80 4,766 107 11  1,340 63 99  85l 16 48
Tuvalu 73 56 51 40 36 10 0 0     —  —
Uganda 28 160 138 93 80 27,821 1,412 195    270 48 69  79l 16 50
Ukraine 127 26 18 19 14 46,989 391 7  1,260 66 99  84 22 38
United Arab Emirates 152 14 8 12 7 4,284 67 1 18,060m 78 77  83
United Kingdom 162 10 6 8 5 59,479 663 4 33,940 79 100 18 44
United States 152 12 8 9 7 295,410 4,134 33 41,400 78  92 16 46
Uruguay 129 25 17 20 15 3,439 57 1  3,950 76 98  90 14 50
Uzbekistan 62 79 69 65 57 26,209 611 42    460 67 99  80l 23 36
Vanuatu 79 62 40 48 32 207 6 0  1,340 69 74  94
Venezuela 125 27 19 24 16 26,282 590 11  4,020 73 93  94l 11 53
Vietnam 110 53 23 38 17 83,123 1,644 38    550 71 90  96l 19 45
Yemen 43 142 111 98 82 20,329 826 92    570 61 49  72l 20 41
Zambia 18 180 182 101 102 11479 468 85    450 38 68  68l 11 57
Zimbabwe 30 80 129 53 79 12936 384 50    480m 37 90  79l 13 56

TABLE 7.8 Under-five mortality rank and other development indicators, by country, 1990–2004 [CONTINUED] "Table 1. Basic Indicators," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc06_tables.pdf (accessed April 8, 2006). Data from the United Nations, The World Bank and the World Health Organization.

TABLE 7.8
Under-five mortality rank and other development indicators, by country, 1990–2004 [CONTINUED]
Countries and territories Under-5 mortality rank Under-5 mortality rate Infant mortality rate (under 1)a Total population (thousands) 2004 Annual number of births (thousands) 2004 Annual number of under-5 deaths (thousands) 2004 Gross national income per capita (US$)b 2004 Life expectancy at birth (years)c 2004 Total adult literacy rated 2000–2004g Net primary school enrolment/attendance (percent)e 1996–2004g Percent share of household Incomef 1993–2003g
1990 2004 1990 2004 Lowest 40% Highest 20%
Notes: "—" indicates data not available.
aProbability of dying between birth and exactly one year of age expressed per 1,000 live births.
bGross national income (GNI) is the sum of value added by all resident producers plus any product taxes (less subsidies) not included in the valuation of output plus net receipts of primary income (compensation of employees and property income) from abroad. GNI per capita is gross national income divided by mid-year population. GNI per capita in US dollars is converted using the World Bank Atlas method.
cThe 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.
dPercentage of persons aged 15 and over who can read and write.
eDerived from net primary school enrolment rates as reported by UNESCO/UIS (UNESCO Institute of Statistics) and from national household survey reports of attendance at primary school or higher. The net primary school attendance ratio is defined as the percentage of children in the age group that officially corresponds to primary schooling who attend primary school or higher.
fPercentage of income received by the 20 percent of households with the highest income and by the 40 percent of households with the lowest income.
gData refer to the most recent year available during the period specified in the column heading.
hRange $825 or less.
iRange $826 to $3,255.
jRange $3,256 to $10,065.
kRange $10,066 or more.
lNational household survey.
mIndicates data that refer to years or periods other than those specified in the column heading or refer to only part of a country.
nCentral and Eastern Europe/Commonwealth of Independent States (formerly the USSR).
SOURCE: "Table 1. Basic Indicators," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc06_tables.pdf (accessed April 8, 2006). Data from the United Nations, The World Bank and the World Health Organization.
Summary indicators
Sub-Saharan Africa 188 171 112 102 697,561 28,263 4,833 611 46 60 60 12 57
Eastern and Southern Africa 167 149 105 95 348,833 13,371 1,992 836 46 63 65 11 59
Western and Central Africa 209 191 119 109 348,728 14,892 2,844 399 46 58 55 13 53
Middle East and North Africa 81 56 59 44 371,384 9,620 539 2,308 68 67 79 17 46
South Asia 129 92 89 67 1,459,305 37,052 3,409 600 63 58 74 21 43
East Asia and Pacific 58 36 43 29 1,937,058 29,932 1,078 1,686 71 90 96 16 47
Latin America and Caribbean 54 31 43 26 548,273 11,674 362 3,649 72 90 93 10 59
CEE/CISn 54 38 44 32 404,154 5,570 212 2,667 67 97 88 20 41
Industrialized countries 10 6 9 5 956,315 10,839 65 32,232 79 95 19 42
Developing countries 105 87 72 59 5,166,574 119,663 10,411 1,524 65 77 80 15 50
Least developed countries 182 155 115 98 741,597 27,823 4,313 345 52 54 60 18 46
World 95 79 65 54 6,374,050 132,950 10,503 6,298 67 78 82 18 43

TABLE 7.9 Child protection by selected characteristics, selected years 1986–2004

TABLE 7.9
Child protection by selected characteristics, selected years 1986–2004
Countries and territories Child labour (5-14 year) 1999–2004a, g Child marriage 1986–2004b, g Birth registration 1999–2004c, g Female genital mutilation/cutting 1998–2004d, g
Womene (15-49 years) Daughtersf
Total Male Female Total Urban Rural Total Urban Rural Total Urban Rural Total
Afghanistan 34h 31h 38h 43   6  12   4
Albania 23 26 19  99  99  99
Angola 22 21 23  29  34  19
Armenia 19 12 31  97 100  94
Azerbaijan  8  9  7  97  98  96
Bahrain  5  6  3
Bangladesh  7 10  4 65 44 72   7   9   7
Benin 26h 23h 29h 37 25 45  70  78  66 17 13 20 6
Bolivia 21 22 20 26 22 37  82  83  79
Bosnia and
Herzegovina 11 12 10  98  98  99
Botswana 10 13  9  58  66  52
Brazil  7h  9h  4h 24 22 30  76
Burkina Faso 57h 52 22 62 77 75 77 32
Burundi 24 26 23 17h 36h 17h  75  71  75
Cambodia 25 19 26  22  30  21
Cameroon 51 52 50 43 30 51  79  94  73 1.4 1 2
Central African Republic 56 54 57 57 54 59  73  88  63 36 29 41
Chad 57 60 55 71 65 74  25  53  18 45 43 46
Colombia  5  7  4 21 18 34  91  95  84
Comoros 28 27 29 30 23 33  83  87  83
Congo, Democratic Republic of the 28h 26h 29h  34  30  36
Costa Rica 50h 71h 29h
Cote d'lvoire 35 34 36 33 24 43  72  88  60 45 39 48 24
Cuba 100 100 100
Dominican Republic  9 11  6 41 37 51  75  82  66
Ecuador  6h  9h  4h 26h 21h 34h
Egypt  6  6  5 19 11 24 97 95 99 47
El Salvador 27
Equatorial Guinea 27 27 27  32  43  24
Eritrea 47 31 60 89 86 91 63
Ethiopia 43h 47h 37h 49 32 53 80 80 80 48
Gabon 34 30 49  89  90  87
Gambia 22 23 22  32  37  29
Georgia  95  97  92
Ghana 57h 57h 58h 28 18 39  21 5 4 7
Guatemala 24h 34 25 44
Guinea 65 46 75  67  88  56 99 98 99 54
Guinea-Bissau 54 54 54  42  32  47
Guyana 19 21 17  97  99  96
Haiti 24 18 31  70  78  66
India 14 14 15 46 26 55  35  54  29
Indonesia  4h  5h  4h 24 15 33  55  69  43
Iraq  8 11  5  98  99  97
Jamaica  2  3  1  96  95  96
Jordan 11 11 12
Kazakhstan 14 12 17
Kenya 26 27 25 25 19 27  48h  64h  44h 32 21 36 21
Korea, Democratic
People's Republic of  99  99  99
Kyrgyzstan 21 19 22
Lao People's Democratic
Republic 24 23 25  59  71  56
Lebanon  6  8  4 11

of the government to eliminating child poverty by entirely by 2020 (see Chapter 6)

UNICEF's 2000 publication Poverty Reduction Begins with Children (http://www.unicef.org/publications/files/pub_poverty_reduction_en.pdf) emphasizes the special challenges of children who live in poverty and discusses how child poverty differs from poverty in general. Because childhood—particularly the first few months of a person's life—is a time of key developmental changes physically, emotionally, and intellectually, neglect in any of these areas can be a permanent detriment to future well-being. According to UNICEF, impoverished children become "transmitters" of poverty to the next generation when they become parents themselves. The report maintains that this cycle can be broken only when poverty is considered a human rights violation instead of simply a matter of income deprivation.

TABLE 7.9 Child protection by selected characteristics, selected years 1986–2004 [CONTINUED]

TABLE 7.9
Child protection by selected characteristics, selected years 1986–2004 [CONTINUED]
Countries and territories Child labour (5-14 year) 1999–2004a, g Child marriage 1986–2004b, g Birth registration 1999–2004c, g Female genital mutilation/cutting 1998–2004d, g
Womene (15-49 years) Daughtersf
Total Male Female Total Urban Rural Total Urban Rural Total Urban Rural Total
Lesotho 17 19 14  51  41  53
Liberia 48h 38h 58h
Madagascar 30 35 26 39 29 42  75  87  72
Malawi 17 18 16 47 32 50
Maldives  73
Mali 30 33 28 65 46 74  48  71  41 92 90 93 73
Mauritania 10h 37 32 42  55  72  42 71 65 77 66
Mexico 16h 15h 16h 28h 31h 21h
Moldova, Republic of 28 29 28  98  98  98
Mongolia 30 30 30  98  98  97
Morocco 11h 16 12 21  85  92  80
Mozambique 56 41 66
Myanmar  65h  66h  64h
Pakistan 32 21 37
Namibia 10  9 10  71  82  64
Nepal 31 30 33 56 34 60  34  37  34
Nicaragua 10h 43 36 55  81  90  73
Niger 66 69 64 77 46 86  46  85  40 5 2 5 4
Nigeria 39h 43 27 52  30  53  20 19 28 14 10
Occupied Palestinian territory  98  98  97
Pakistan 32 21 37
Paraguay  8h 10h  6h 24 18 32
Peru 19 12 35  93  93  92
Philippines 11 12 10 14 10 22  83  87  78
Romania  1h
Rwanda 31 31 30 20 21 19  65  61  66
Sao Tome and Principe 14 15 13  70  73  67
Senegal 33 36 30 36 15 53  62  82  51
Sierra Leone 57 57 57  46  66  40
Somalia 32 29 36
South Africa  8  5 12
Sri Lanka 14h 10h 15h
Sudan 13 14 12 27h 19h 34h  64  82  46 90 92 88 58
Suriname  95  94  94
Swaziland  8  8  8  53  72  50
Syrian Arab Republic  8h 10h 6h
Tajikistan 18 19 17  75  77  74
Tanzania, United Republic of 32 34 30 39 23 48   6  22   3 18 10 20 7
Thailand 21h 13h 23h
Timor-Leste  4h  4h  4h  22  32  20
Togo 60 62 59 31 17 41  82  93  78
Trinidad and Tobago  2  3  2 34h 37h 32h  95
Tunisia 10h  7h 14h
Turkey 23 19 30
Turkmenistan  9 12  7
Uganda 34 34 33 54 34 59   4  11   3
Uzbekistan 15 18 12 13 16 11 100 100 100
Venezuela  7  9  5  92
Viet Nam 23 23 22 11  5 13  72  92  68
Yemen 48 39 53 23 26 22 20
Zambia 11 10 11 42 32 49  10  16   6
Zimbabwe 26h 29 21 36  42  56  35

Children's Health and Mortality

Improving children's health and reducing rates of child mortality is an implicit factor of the Convention on the Rights of the Child and is explicitly listed as one of the Millennium Development Goals. The most fundamental and important indicators of poverty among children are the state of their health and their rates of mortality. Child mortality rates are also a major indicator of the overall social and economic stability of nations. How much a country invests—or does not invest—in measures to cut back preventable deaths and diseases of children is ultimately indicative of its commitment to its own economic development.

Table 7.10 and Table 7.11 show basic human development indicators in industrialized and developing countries, respectively. Notice that in industrialized countries the percentage of moderately or severely underweight children under five is negligible, while in developing countries the rate is high, at 27%. Additionally, rates of childhood immunization differ markedly in the two income categories. In industrialized countries at least TABLE 7.9 Child protection by selected characteristics, selected years 1986–2004 [CONTINUED] "Table 9. Child Protection," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc06_tables.pdf (accessed April 8, 2006). Data from Multiple Indicator Cluster Survey (MICS) and Demographic and Health Surveys (DHS).92% of children are immunized against measles, diphtheria/pertussis/tetanus, polio, and haemophilus influenzae, while, at most, 79% of children in developing countries have been immunized against these common illnesses.

TABLE 7.9
characteristics, selected years 1986–2004 [CONTINUED]
Countries and territories Child labour (5-14 year) 1999–2004a, g Child marriage 1986–2004b, g Birth registration 1999–2004c, g Female genital mutilation/cutting 1998–2004d, g
Womene (15-49 years) Daughtersf
Total Male Female Total Urban Rural Total Urban Rural Total Urban Rural Total
Notes: "—" indicates data not available
aPercentage of children aged 5 to 14 years of age involved in child labour activities at the moment of the survey. A child is considered to be involved in child labour activities under the following classification: (a) children 5 to 11 years of age that during the week preceding the survey did at least one hour of economic activity or at least 28 hours of domestic work, and (b) children 12 to 14 years of age that during the week preceding the survey did at least 14 hours of economic activity or at least 42 hours of economic activity and domestic work combined. Child labour background variables: Sex of the child; urban or rural place of residence; poorest 20% or richest 20% of the population constructed from household assets; mother's education, reflecting mothers with and without some level of education.
bPercentage of women 20-24 years of age that were married or in union before they were 18 years old.
cPercentage of children less than five years of age that 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.
dFemale genital mutilation/cutting (FGM/C) involves the cutting or alteration of the female genitalia for social reasons. Generally, there are three recognized types of FGM/C: clitoridectomy, excision and infibulation. Clitoridectomy is the removal of the prepuce with or without excision of all or part of the clitoris. Excision is the removal of the prepuce and clitoris along with all or part of the labia minora. Infibulation is the most severe form and consists of removal of all or part of the external genitalia, followed by joining together of the two sides of the labia minora using threads, thorns or other materials to narrow the vaginal opening.
eThe percentage of women aged 15 to 49 years of age who have been mutilated/cut.
fThe percentage of women aged 15 to 49 with at least one mutilated/cut daughter.
gData refer to the most recent year available during the period specified in the column heading.
hIndicates data that differ from the standard definition or refer to only part of a country but are included in the calculation of regional and global averages.
iExcludes China.
jCentral and Eastern Europe/Commonwealth of Independent States (formerly the USSR).
SOURCE: "Table 9. Child Protection," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc06_tables.pdf (accessed April 8, 2006). Data from Multiple Indicator Cluster Survey (MICS) and Demographic and Health Surveys (DHS).
Summary indicators
Sub-Saharan Africa 36 37 34 40 25 48 38 55 33 38 31 42 24
    Eastern and Southern Africa 32 34 29 36 21 43 32 44 28
    Western and Central Africa 41 41 41 45 28 56 41 59 35 29 29 29 19
Middle East and North Africa  9  9  7
South Asia 14 14 15 46 27 54 30 47 25
East Asia and Pacific 10i 11i 10i 20i 12i 25i 65h 77i 56i
Latin America and Caribbean 11 11  8 25 24 31 82 92 80
CEE/CISj
Industrialized countries
Developing countries 18i 18i 17i 36i 22i 45i 45h 62i 35i
Least developed countries 28 29 26 50 33 57 32 44 28
World 18i 18i 17i 36i 22i 45i 45h 62i 35i

INFANT MORTALITY

The WHO's World Health Report 2005 states that of the approximately 136 million babies born each year, at least 3.3 million are stillborn, more than four million die before they are twenty-eight days old, and 6.6 million die before their fifth birthday. The WHO estimates that 98% of all newborn deaths happen in the developing world—28% in sub-Saharan Africa and 36% in Southeast Asia. As of 2005, newborn deaths accounted for more than half of all infant deaths and 40% of all deaths of children under five. As a region, Southeast Asia had the highest overall number of stillbirths and newborn deaths—1.3 million and 1.4 million, respectively—but sub-Saharan Africa had the highest newborn death rate, at about forty-five newborn deaths per 1,000 live births in that region.

By comparison, in the United States the infant death rate (counting all infants under twelve months old) was 6.84 per 1,000 live births in 2003, down slightly from the 2002 rate of 6.95, according to the Rights for Disease Control (CDC) in "Infant Mortality Statistics from the 2003 Period Linked Birth/Infant Death Data Set" (National Vital Statistics Reports, vol. 54, no. 16, May 3, 2006). Wide disparities in infant death rates exist among racial and ethnic groups in the United States, ranging from a low of 4.83 per 1,000 live births for Asians and Pacific Islanders to a high of 13.6 per 1,000 live births for African-Americans. In addition, infants born to teenagers and women over forty have higher rates of mortality than those in the middle years of childbearing age. Likewise, infant death rates decrease among women with higher levels of education, and rates tend to be higher among unmarried women. According to the CDC report, all of these risk factors may be linked to a mother's socioeconomic status, which is in itself a major risk factor in infant death. Lower-income women are less likely to have the financial means to get early prenatal care, and their babies are also less likely to receive quality health care.

TABLE 7.10 Basic indicators of human development in industrialized countries, selected years 1986–2004 "Industrialized Countries," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/regional_stat_sum_s21_ic.pdf (accessed April 8, 2006)

TABLE 7.10
Basic indicators of human development in industrialized countries, selected years 1986–2004
Indicator Region World Indicator Region World
aData refer to the most recent years available during the period specified.
bExcludes China.
SOURCE: "Industrialized Countries," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/regional_stat_sum_s21_ic.pdf (accessed April 8, 2006)
Demographic indicators Economic indicators
    Total population (2004) 956,315,000 6,374,050,000 Gross national income per capita (US$, 2004) 32,232 6,298
Population under 18 (2004) 205,133,000 2,181,991,000 Percentage of population living on less than $1 a day (1993–2003a) 21
Population under 5 (2004) 54,200,000 614,399,000 Percentage share of central government expenditure (1993–2004a) allocated to:
Survival     Health 16 13
Life expectancy at birth (2004) 79 67     Education 4 5
Infant mortality rate (under 1), per 1,000 live births (2004) 5 54     Defence 11 11
Under-5 mortality rate, per 1,000 live births (2004) 6 79 Percentage share of household income (1993–2003a):
Under-5 mortality rate, average annual rate of reduction (1990–2004) 3.6 1.3     Lowest 40 percent 19 18
Maternal mortality ratio, per 100,000 live births (2000, adjusted) 13 400     Highest 20 percent 42 43
Health and nutrition Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS)
Percentage of infants with low birthweight (1998–2004a) 7 16 Adult prevalence rate (15–49 years, end 2003) 0.4 1.1
Percentage of under-5s who are moderately or severely underweight (1996–2004a) 26 Estimated number of adults and children (0-49 years) living with HIV/AIDS (2003) 1,600,00 37,800,000
Percentage of population using improved drinking water sources (2002) 100 83 Estimated number of children (0-14 years) living with HIV/AIDS (2003) 170,000 2,100,000
    Urban 100 95
    Rural 100 72
Percentage of population using adequate sanitation facilities (2002) 100 58 Estimated number of children (0-17 years) orphaned by HIV/AIDS (2003)
Percentage of 1-year-old children immunized (2004) against: Child protection
    Tuberculosis (BCG) (bacillus of Calmette and Guerin) 84 Birth registration (1999–2004a) 45b
    Urban 62b
    Diphtheria/pertussis/tetanus (DPT3) 96 78     Rural 35b
    Polio (polio3) 94 80 Child marriage (1986–2004a) 36b
    Measles 92 76     Urban 22b
    Hepatitis B (hepB3) 63 49     Rural 45b
    Haemophilus influenzae (Hib3) 92 Child labour (5-14 years, 1999–2004a) 18b
Education     Male 18b
    Female 17b
Percentage of primary school entrants reaching grade 5 (administrative data; 2000–2004a) 79 Women
Net primary school attendance ratio (1996–2004a) Adult literacy parity rate (females as a percentage of males, 2000–2004a) 86
    Male 76 Antenatal care coverage (percentage, 1996–2004a) 71
    Female 72 Skilled attendant at delivery (percentage, 1996–2004a) 99 63
Net secondary school attendance ratio (1996–2004a) Lifetime risk of maternal death (2000) 1 in … 4,000 74
    Male 40b
    Female 37b
Adult literacy rate (2000–2004a) 78

Although the overall U.S. infant mortality rate is significantly lower than rates in developing countries, the U.S. rate is more than double that of the countries with the lowest infant mortality. According to statistics reported by the UNDP in its Human Development Report 2005, Hong Kong, Singapore, Iceland, Japan and Sweden had the lowest rates in 2003 at three per 1,000 live births, and Sierra Leone had the highest with 182 deaths per 1,000 live births in 2003.

MORTALITY OF CHILDREN UNDER FIVE

Children's health programs begun in the 1970s and 1980s have significantly reduced certain diseases and illnesses. Incidence of polio, for example, went from 350,000 cases reported in 1988 to 1,185 cases reported in 2005, thanks to the success of polio vaccination programs (World Health Report 2005). However, approximately 10.6 million children per year still die before their fifth birthday. Table 7.12 ranks countries according to their under-five mortality rate ("value" refers to the number of deaths per 1,000 live births; countries are listed in worst-to-best order).

Figure 7.13 shows that progress has been made since 1970 in reducing the mortality rate of children under five years old. In 1970 the worldwide mortality rate for young TABLE 7.11 Basic indicators of human development in developing countries, selected years 1986–2004 "Developing Countries," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/regional_stat_sum_s21_ic.pdf (accessed April 8, 2006)children was 146 per 1,000 live births; by 2003 it was 79 per 1,000. Still, more than 70% of child deaths in 2003 occurred in just two regions: Africa and Southeast Asia. The WHO further notes in World Health Report 2005 that half of all deaths of children under five in 2003 occurred in just six countries: China, the Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan.

TABLE 7.11
Basic indicators of human development in developing countries, selected years 1986–2004
Indicator Region World Indicator Region World
aData refer to the most recent years available during the period specified.
bExcludes China.
SOURCE: "Developing Countries," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/regional_stat_sum_s21_ic.pdf (accessed April 8, 2006)
Demographic indicators Economic indicators
    Total population (2004) 5,166,574,000 6,374,050,000 Gross national income per capita (US$, 2004) 1,524 6,298
Population under 18 (2004) 1,925,281,000 2,181,991,000 Percentage of population living on less than $1 a day (1993–2003a) 22 21
Population under 5 (2004) 548,486,000 614,399,000 Percentage share of central government expenditure (1993–2004a) allocated to:
Survival     Health 4 13
Life expectancy at birth (2004) 65 67     Education 11 5
Infant mortality rate (under 1), per 1,000 live births (2004) 59 54     Defence 10 11
Under-5 mortality rate, per 1,000 live births (2004) 87 79 Percentage share of household income (1993–2003a): 15 18
Under-5 mortality rate, average annual rate of reduction (1990–2004) 1.3 1.3     Lowest 40 percent
Maternal mortality ratio, per 100,000 live births (2000, adjusted) 440 400     Highest 20 percent 50 43
Health and nutrition Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS)
Percentage of infants with low birthweight (1998–2004a) 17 16 Adult prevalence rate (15–49 years, end 2003) 1.2 1.1
Percentage of under-5s who are moderately or severely underweight (1996–2004a) 27 26 Estimated number of adults and children (0-49 years) living with HIV/AIDS (2003) 34,900,00 37,800,000
Percentage of population using improved drinking water sources (2002) 79 83 Estimated number of children (0-14 years) living with HIV/AIDS (2003) 2,100,000 2,100,000
    Urban 92 95 Estimated number of children (0-17 years) orphaned by HIV/AIDS (2003)
    Rural 70 72 Child protection
Percentage of population using adequate sanitation facilities (2002) 49 58 Birth registration (1999–2004a) 45b 45b
Percentage of 1-year-old children immunized (2004) against:     Urban 62b 62b
    Tuberculosis (BCG) (bacillus of Calmette and Guerin) 84 84     Rural 35b 35b
    Diphtheria/pertussis/tetanus (DPT3) 76 78 Child marriage (1986–2004a) 36b 36b
    Polio (polio3) 79 80     Urban 22b 22b
    Measles 74 76     Rural 45b 45b
    Hepatitis B (hepB3) 76 49 Child labour (5-14 years, 1999–2004a) 18b 18b
    Haemophilus influenzae (Hib3)     Male 18b 18b
Education     Female 17b 17b
Percentage of primary school entrants reaching grade 5 (administrative data; 2000–2004a) 78 79 Women
Net primary school attendance ratio (1996–2004a) Adult literacy parity rate (females as a percentage of males, 2000–2004a) 84 86
    Male 76 76 Antenatal care coverage (percentage, 1996–2004a) 71 71
    Female 72 72 Skilled attendant at delivery (percentage, 1996–2004a) 59 63
Net secondary school attendance ratio (1996–2004a)     Lifetime risk of maternal death (2000) 1 in … 61 74
    Male 40b 40b
    Female 37b 37b
Adult literacy rate (2000–2004a) 77 78

According to the WHO, just six illnesses account for 70% to 90% of the deaths of young children: 19% are from acute lower respiratory infections (typically pneumonia), 17% from diarrhea, 8% from malaria, 4% from measles, 3% from HIV/AIDS, and 37% from neonatal conditions. Africa by far accounts for the most deaths of children from malaria and HIV/AIDS (90%), measles (more than 50%), and pneumonia and diarrhea (40%). (See Figures 7.14 and 7.15.)

Child Labor

Children from poor families frequently must go to work to contribute income to their household, and of all the poverty-related abuses and deprivations children suffer, child labor is among the worst, resulting in physical and psychological damage and, frequently, premature TABLE 7.12 Mortality rankings, children under five, 2004death. The United Nations, the International Labor Organization (ILO), and other NGOs distinguish, however, between "child work" (economic activity by children at least twelve years old that is not hazardous and does not interfere with their education) and "child labor" (all work by children under age twelve; hazardous work by children aged twelve to fourteen; and all work defined as "worst forms of child labor"). "Worst forms of child labor," as defined by the ILO, include:

TABLE 7.12
Mortality rankings, children under five, 2004
Under-5 mortality rate (2004) Under-5 mortality rate (2004) Under-5 mortality rate (2004)
Value Rank Value Rank Value Rank
Sierra Leone 283 1 Kiribati 65 66 Bulgaria 15 131
Angola 260 2 Guyana 64 67 Mauritius 15 131
Niger 259 3 Namibia 63 68 Serbia and Montenegro 15 131
Afghanistan 257 4 Marshall Islands 59 69 Dominica 14 135
Liberia 235 5 Solomon Islands 56 70 Saint Lucia 14 135
Somalia 225 6 Korea, Democratic People's Republic of 55 71 Seychelles 14 135
Mali 219 7 Sri Lanka 14 135
Congo, Democratic Republic of the 205 8 Mongolia 52 72 The former Yugoslav Republic of Macedonia 14 135
Tuvalu 51 73
Equatorial Guinea 204 9 Maldives 46 74 Bahamas 13 140
Guinea-Bissau 203 10 Georgia 45 75 Costa Rica 13 140
Rwanda 203 10 Guatemala 45 75 Oman 13 140
Chad 200 12 Morocco 43 77 Antigua and Barbuda 12 143
Nigeria 197 13 Honduras 41 78 Barbados 12 143
Côte d'lvoire 194 14 Algeria 40 79 Kuwait 12 143
Central African Republic 193 15 Vanuatu 40 79 Latvia 12 143
Burkina Faso 192 16 Belize 39 81 Malaysia 12 143
Burundi 190 17 Suriname 39 81 Bahrain 11 148
Zambia 182 18 Indonesia 38 83 Belarus 11 148
Malawi 175 19 Iran (Islamic Republic of) 38 83 Brunei Darussalam 9 150
Ethiopia 166 20 Nicaragua 38 83 Slovakia 9 150
Swaziland 156 21 Cape Verde 36 86 Chile 8 152
Guinea 155 22 Egypt 36 86 Estonia 8 152
Benin 152 23 Brazil 34 88 Hungary 8 152
Mozambique 152 23 Philippines 34 88 Lithuania 8 152
Cameroon 149 25 Armenia 32 90 Poland 8 152
Cambodia 141 26 Dominican Republic 32 90 United Arab Emirates 8 152
Togo 140 27 Turkey 32 90 United States 8 152
Uganda 138 28 China 31 93 Andorra 7 159
Senegal 137 29 Lebanon 31 93 Croatia 7 159
Zimbabwe 129 30 Nauru 30 95 Cuba 7 159
Djibouti 126 31 Samoa 30 95 Australia 6 162
Tanzania, United Republic of 126 31 Peru 29 97 Canada 6 162
Iraq 125 33 El Salvador 28 98 Ireland 6 162
Mauritania 125 33 Mexico 28 98 Israel 6 162
Madagascar 123 35 Moldova, Republic of 28 98 Korea, Republic of 6 162
Gambia 122 36 Jordan 27 101 Luxembourg 6 162
Kenya 120 37 Palau 27 101 Malta 6 162
Sao Tome and Principe 118 38 Saudi Arabia 27 101 Netherlands 6 162
Tajikistan 118 38 Ecuador 26 104 New Zealand 6 162
Haiti 117 40 Tonga 25 105 United Kingdom 6 162
Botswana 116 41 Tunisia 25 105 Austria 5 172
Ghana 112 42 Occupied Palestinian Territory 24 107 Belgium 5 172
Yemen 111 43 Panama 24 107 Cyprus 5 172
Congo 108 44 Paraguay 24 107 Denmark 5 172
Myanmar 106 45 Micronesia (Federated States of) 23 110 France 5 172
Turkmenistan 103 46 Viet Nam 23 110 Germany 5 172
Pakistan 101 47 Saint Vincent and the Grenadines 22 112 Greece 5 172
Papua New Guinea 93 48 Colombia 21 113 Italy 5 172
Gabon 91 49 Cook Islands 21 113 Liechtenstein 5 172
Sudan 91 49 Grenada 21 113 Monaco 5 172
Azerbaijan 90 51 Qatar 21 113 Portugal 5 172
India 85 52 Russian Federation 21 113 Spain 5 172
Lao People's Democratic Republic 83 53 Saint Kitts and Nevis 21 113 Switzerland 5 172
Thailand 21 113 Czech Republic 4 185
Eritrea 82 54 Fiji 20 120 Bhutan 80 56
Lesotho 82 54 Bosnia and Herzegovina 15 131 Timor-Leste 80 56
  • All forms of slavery or practices similar to slavery, such as the sale and trafficking of children, debt bondage and serfdom and forced or compulsory labor, including forced or compulsory recruitment, of children for use in armed conflict
  • The use, procuring or offering a child for prostitution, for the production of pornography or for pornographic performances

TABLE 7.12 Mortality rankings, children under five, 2004 [CONTINUED] "Under-Five Mortality Rankings," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc06_tables.pdf (accessed April 8, 2006)

TABLE 7.12
Mortality rankings, children under five, 2004 [CONTINUED]
Under-5 mortality rate (2004) Under-5 mortality rate (2004) Under-5 mortality rate (2004)
Value Rank Value Rank Value Rank
SOURCE: "Under-Five Mortality Rankings," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc06_tables.pdf (accessed April 8, 2006)
Bangladesh 77 58 Romania 20 120 Norway 4 185
Nepal 76 59 Trinidad and Tobago 20 120 San Marino 4 185
Kazakhstan 73 60 Albania 19 125 Slovenia 4 185
Comoros 70 61 Venezuela 19 125 Sweden 4 185
Bolivia 69 62 Argentina 18 127 Iceland 3 192
Uzbekistan 69 62 Ukraine 18 127 Singapore 3 192
Kyrgyzstan 68 64 Uruguay 17 129 Holy See No data
South Africa 67 65 Syrian Arab Republic 16 130 Niue No data
Jamaica 20 12 Finland 4 185
Libyan Arab Jamahiriya 20 120 Japan 4 185

FIGURE 7.13 Reducing child mortality, selected regions, 1970–2003 "Figure 1.1. Slowing Progress in Child Mortality: How Africa Is Faring Worst," in The World Health Report 2005: Make Every Mother and Child Count, World Health Organization, 2005, http://www.who.int/whr/2005/whr2005_en.pdf (accessed April 10, 2006)

  • The use, procuring or offering of a child for illicit activities, in particular for the production and trafficking of drugs

According to the ILO in Every Child Counts: New Global Estimates on Child Labor (April 2002, http://www.ilo.org/public/english/standards/ipec/simpoc/others/globalest.pdf), approximately 352 million children aged five to seventeen (about 23% of the total 1.5 billion children in the world) were working in 2000. Of this number, approximately 246 million children under age seventeen were counted as child laborers; 186.3 million of them were younger than fifteen years old, and 110 million were younger than age twelve.

Child labor occurs everywhere in the world. According to UNICEF in Child Protection from Violence, Exploitation, and Abuse (http://www.unicef.org/protection/index_childlabour.html), East Asia and the Pacific have the highest number of child laborers: an estimated 19% of children in the region work, with 127.3 million of them in the five-to-fourteen age group. Sub-Saharan Africa has approximately forty-eight million child laborers (29% of all children under age fifteen in the region). In Latin America and the Caribbean about 17.4 million children work (16% of all children in the region). In the Middle East and North Africa about 15% of children work. In the developed world (including Europe and the United States) about 2.5 million children work, and in transition economies about 2.4 million work. Figure 7.16 shows the percent of male and female child workers in different world regions between 1999 and 2004.

According to the ILO, as of 2000 approximately 171 million children aged five to seventeen were involved in "hazardous work." Hazardous work as defined for children includes occupations that result in physical deformities of young, undeveloped bodies; chronic illnesses such as respiratory diseases in children who work in mines and factories; injuries that can include severe burns, disfigurement, and amputated limbs; vision and hearing impairment; and chronic headaches and gastrointestinal illnesses. UNICEF's State of the World's Children 2006 reports that as many as 70% of laboring children work in agriculture, an industry that puts children at high risk of accidents and exposure to pesticides.

Injuries and impairments of individual children are not the only risks of child labor, however, which also FIGURE 7.14 Major causes of death among children five under years old and among children less than one month old, 2000–2003 "Box 6.1. What Do Children Die of Today?", in The World Health Report 2005: Make Every Mother and Child Count, World Health Organization, 2005, http://www.who.int/whr/2005/whr2005_en.pdf (accessed April 10, 2006)has long-term global economic consequences. The more hours children spend working, the less time they spend in school, which in turn affects their ability to improve their economic status later in life. This in effect traps these children—and later their children—in the cycle of poverty and prolongs the economic instability of poor countries. According to the State of the World's Children 2006, the total international economic benefit of ending child labor would be $5,106.4 billion. Even after subtracting the cost of eliminating child labor—estimated at $760.3 billion—the net benefits would still total $4,132.5 billion. (See Table 7.13.)

Both children's economic activity and child labor can be direct results of poverty. Child labor, however, is far more insidious, dangerous, and disturbing. Experts often comment that child labor robs children of their childhood, not only because it usually means exceptionally long hours performing difficult, often crippling, work for very little pay but also because it exploits children—typically to satisfy the needs or desires of adults. Children sometimes are abducted, sold, or drawn into prostitution or pornography, armed conflict, forced or bonded labor, drug trafficking, and other illicit activities.

The ILO estimates that about 8.4 million children are employed in the unconditional worst forms of child labor. As of 2000 about 5.7 million children worked in forced or bonded labor (in other words, forms of slavery); 1.8 million were in prostitution and pornography; 1.2 million were trafficked; 300,000 were involved in armed conflict; and 600,000 were engaged in other illicit activities. (See Figure 7.17 and Table 7.14.)

Child Trafficking

Poor children are especially vulnerable to child trafficking—the illegal moving of children across cities, countries, or borders for the purpose of using them in various kinds of labor. Children may be abducted, sold, or coerced into the underground world of trafficking. Or they may go willingly, believing that a better life awaits them elsewhere. While exact numbers are impossible to ascertain because of the secretive nature of trafficking, UNICEF and other agencies believe approximately 1.2 million children are trafficked each year. Usually, they are forced into the commercial sex trade (prostitution and/or pornography); are sold as child brides; work as domestic slaves or in mines, factories, or sweatshops; or serve in one of the many instances of ongoing armed conflict across the globe.

FIGURE 7.15 Major causes of death among children under five years old, by region, 2000–2003 "Box 6.1. What Do Children Die of Today?", in The World Health Report 2005: Make Every Mother and Child Count, World Health Organization, 2005, http://www.who.int/whr/2005/whr2005_en.pdf (accessed April 10, 2006)

The ILO report Facts on Trafficking of Children (March 2003, http://www.ilo.org/public/english/standards/ipec/publ/download/factsheets/fs_trafficking_0303.pdf) notes that trafficked children typically come from poor, usually rural, areas and have parents who are uneducated and illiterate. The majority are from marginalized ethnic groups. The ILO identifies the following "supply factors" in the trafficking of children, meaning that they are factors that perpetuate the supply of children for trafficking:

  • Poverty and the need to earn a living or to support the family
  • The desire for a better life
  • Ignorance or lack of understanding of the children, parents, or other caregivers of the negative consequences that may be associated with children leaving their homes to work
  • Lack of schools or means to pay for education
  • Lack of appreciation on the part of parents or children on the value of education
  • Family violence or other dysfunction
  • Political conflict or natural disasters that devastate local economies
  • Traditions of migration for labor, land, or fodder
  • Traditions of placement of rural children with urban-based relatives (particularly in Africa);
  • Gender discrimination
  • Being a member of a marginalized ethnic group or subservient caste

CHILDREN AT WAR

One of the less common but most horrific uses of trafficked children is as soldiers in armed combat. Children as young as nine have been kidnapped and forced to participate in the world's many conflicts and civil wars. Or children may willingly join in combat to escape poverty or abuse at home. Exact numbers are unknown, but it is thought that tens of thousands of children in regions all over the world are trafficked for the purposes of combat. According to the Child Soldiers Global Report 2004 (2004, http://www.child-soldiers.org/document_get.php?id=966), from 2001 to 2004 children under age eighteen were used as soldiers in ongoing armed conflicts in Afghanistan, Angola, Burundi, Colombia, the Democratic Republic of the Congo (DRC), Côte d'Ivoire, Guinea, India, Iraq, Israel and the Occupied Palestinian Territories, Indonesia, Liberia, Myanmar, Nepal, Philippines, the Russian Federation, Rwanda, Sri Lanka, Somalia, Sudan, and Uganda. Children are used in armed combat, to lay mines and explosives, as spies and decoys, for cooking and domestic labor, and as sex slaves for older soldiers. As of August 2004, seventy-seven countries had FIGURE 7.16 Percentage of children ages 5-14 involved in child labor activities, 1990–2004 "Figure 3.6. Child Labor in the Developing World," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc0506_eps_charts.pdf (accessed April 8, 2006). Data from Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS).ratified the 2002 Optional Protocol to the UN Convention on the Rights of the Child that sets eighteen as the legal age at which people are eligible to participate in combat operations. The International Criminal Court's Rome Statute defines all recruitment of children under age eighteen a war crime.

THE SEX INDUSTRY

Also illegal under international law is trafficking in children for the commercial sex industry, which has grown significantly since the 1980s. In fact, according to Trafficking in Women, Girls, and Boys. Key Issues for Population and Development Programmes (October 2002, http://www.unfpa.org/upload/lib_pub_file/266_filename_Trafficking.pdf), the UNFPA reports that TABLE 7.13 Total economic costs and benefits of eliminating child labor over the period 2000–20 "Figure 3.4. Total Economic Costs and Benefits of Eliminating Child Labor over the Period 2000#2020," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc0506_eps_charts.pdf (accessed April 8, 2006). Data from International Labour Organization, Investing in Every Child: An Economic Study on the Costs and Benefits of Eliminating Child Labour, International Programme on the Elimination of Child Labour, ILO, Geneva, 2004. Copyright © 2005, International Labour Organization.FIGURE 7.17 Children in unconditional worst forms of child labour and explotation, 2002 "Figure 3.7. Children in Unconditional Worst Forms of Child Labour and Exploitation," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc0506_eps_charts.pdf (accessed April 8, 2006). Data from International Labour Organization, Every Child Counts: New Global Estimates on Child Labour, ILO, International Programme on the Elimination of Child Labour, Statistical Informational and Monitoring Programme on Child Labour, April 2002. Copyright © 2005, International Labour Organization.TABLE 7.14 Estimated number of children in the worst forms of child labor, 2000 "Estimated Number of Children in Unconditional Worst Forms of Child Labour," in Every Child Counts: New Global Estimates on Child Labour, International Labour Organization, International Programme on the Elimination of Child Labour/Statistical Information and Monitoring Programme on Child Labour, International Labour Office, April 2002, http://www.ilo.org/public/english/standards/ipec/simpoc/others/globalest.pdf (accessed April 8, 2006)70% of trafficked women and children end up working in the sex industry, and those working in other industries are also at risk of sexual exploitation. Children who end up forced into prostitution are usually girls between the ages of twelve and eighteen, but children as young as five have been found working as sex slaves. According to UNICEF inState of the World's Children 2006, trafficking children for the commercial sex industry is most common in East Asia and the Pacific, South Asia, Europe, and Latin America and the Caribbean. Many of the trafficked children who end up working as prostitutes are poor and go willingly with their traffickers because they are offered legitimate-sounding work as waitresses or maids. By the time they have been moved to unfamiliar cities or countries, where they may not speak the language, they have no choice but to work as prostitutes. Of those forced into commercial sexual exploitation worldwide, 98% are women or girls and 2% are men or boys. (See Figure 7.18.)

TABLE 7.13
Total economic costs and benefits of eliminating child labor over the period 2000–20
US$ billion, at purchasing power parity
SOURCE: "Figure 3.4. Total Economic Costs and Benefits of Eliminating Child Labor over the Period 2000#2020," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc0506_eps_charts.pdf (accessed April 8, 2006). Data from International Labour Organization, Investing in Every Child: An Economic Study on the Costs and Benefits of Eliminating Child Labour, International Programme on the Elimination of Child Labour, ILO, Geneva, 2004. Copyright © 2005, International Labour Organization.
Economic costs
Education supply 493.4
Transfer implementation 10.7
Interventions 9.4
Opportunity costs 246.8
    Total costs 760.3
Economic benefits
Education 5,078.4
Health 28.0
    Total benefits 5,106.4
Net economic benefit (total benefits—total costs) 4,346.1
Transfer payments 213.6
Net financial benefit (net economic benefit—transfer payments) 4,132.5
TABLE 7.14
Estimated number of children in the worst forms of child labor, 2000
Unconditional worst form of child labor Global estimate (in thousands)
*The total excludes the category of trafficked children because of the risk of double-counting.
SOURCE: "Estimated Number of Children in Unconditional Worst Forms of Child Labour," in Every Child Counts: New Global Estimates on Child Labour, International Labour Organization, International Programme on the Elimination of Child Labour/Statistical Information and Monitoring Programme on Child Labour, International Labour Office, April 2002, http://www.ilo.org/public/english/standards/ipec/simpoc/others/globalest.pdf (accessed April 8, 2006)
Trafficked children 1,200
Children in forced & bonded labor 5,700
Children in armed conflict   300
Children in prostitution & pornography 1,800
Children in illicit activities   600
    Total 8,400*

International tourism and the widening poverty gap are at least partly responsible for the rise in trafficking and child prostitution in the early twenty-first century. Developing countries are heavily dependent on their tourism industries for economic growth, and demand for prostitutes is typically high in tourist regions. Trafficking in Women, Girls, and Boys cites studies from Japan, Sweden, the United States, the Ukraine, and Moldova that find that most customers of trafficked prostitutes are married men of all races, nationalities, and ages. The common thread in the studies was the ability to pay for services—meaning that a relatively stable economic situation was necessary to maintain the market for prostitutes. The UNFPA reports that countries that have experienced expanding economies and growing middle classes—along with growing lower classes—have seen the greatest increase in prostitution. However, the FIGURE 7.18 Forced commercial sexual exploitation, 2005 "Figure 3.5. Forced Commercial Sexual Exploitation, 2005," in The State of the World's Children 2006, United Nations Children's Fund, 2005, http://www.unicef.org/sowc06/pdfs/sowc0506_eps_charts.pdf (accessed April 8, 2006). Data from International Labour Organization, "A Global Alliance against Forced Labour," ILO, Geneva, 2005. Copyright © 2005, International Labour Organization.demand for younger and younger "prostitutes"—some just four or five years old—is due to men's fears and superstitions about HIV/AIDS: men who frequent prostitutes are willing to pay for sex with children so young they cannot possibly give them AIDS.

IN THE UNITED STATES

In January 2006 President George W. Bush signed into law the Trafficking Victims Protection Reauthorization Act of 2005, which expanded and strengthened the Trafficking Victims Protection Act (TVPA) of 2000. According to the U.S. Department of State's Trafficking in Persons Report 2005 (June 2005, http://www.state.gov/documents/organization/47255.pdf), an estimated 18,000 to 20,000 people, most of them women and children, are trafficked to the United States annually.

Debt Bondage and Forced Labor

Debt bondage (also called bonded labor, forced labor, or indentured servitude), is a way for people to pay off their debts to others with labor instead of money. This definition, however, fails to express the true nature of debt bondage, which is essentially a form of modern slavery, according to the UN and other international agencies. It is not unusual for very poor families—particularly in underdeveloped and developing countries—to place their children into debt bondage to pay off money they owe. Families also may sell a child into bonded labor for an advance of money, believing that they will be able to buy the child back when they earn enough money or when the child performs enough work to cover the cash advance. However, poor families can rarely buy their children back, and often debt bondage crosses gen-erations—with children sold into labor to pay off the debts or loans of their grandparents or great-grandparents.

The reason debt bondage is common in the developing world is that poor countries generally lack systems of credit and bankruptcy, so there may be no other way for poor families to repay debts. The ILO includes any kind of work done by children under debt bondage in its classification of unconditional worst forms of child labor. Debt bondage sometimes overlaps with trafficking, as people performing debt bondage—again, usually women and children—may be trafficked to other countries or overseas; conversely, trafficking victims may later be sold into debt bondage.

The study Forced and Bonded Child Labor (2006, http://www.dol.gov/ILAB/media/reports/iclp/sweat2/bonded.htm) by the U.S. Department of Labor's International Labor Affairs Bureau (ILAB) names Asia and Latin America as the regions where debt bondage and forced labor of children are most common and most extreme. In South Asia as many as one million children are bonded to work in the carpet-making industry of India, Pakistan, and Nepal. Children from age five to fifteen are forced to work up to twenty hours a day, seven days a week. They are not allowed to go outside, and they may be made to sleep and eat in the same room in which they work. They are punished brutally for any transgressions, from crying to making mistakes in weaving to trying to escape. Reports of children being chained to carpet looms are not uncommon.

Millions of children also perform forced and bonded labor in South Asia's glass-making factories, stone quarries, silk manufacturers, lock-making factories, brass industry, fireworks industry, brick kilns, and cigar makers. Children in Thailand and the Philippines are forced to labor in sweatshops, although number estimates are uncertain. In China the numbers of children being kidnapped and bonded to work in textile factories and mines are believed to be on the rise.

According to the ILAB in Forced and Bonded Child Labor, in Latin American countries entire families—including children of all ages—are bonded in Brazil's charcoal manufacturing industry and Peru's gold mines. As with all bonded labor, working conditions for these families are essentially those of slavery. Families working in Brazil's charcoal operations are commonly shipped hundreds of miles from their homes, to remote areas with no schools or medical facilities, and they may be kept at the charcoal plants by armed guards. They are also forced to buy food and supplies from their employers, who inflate the prices to keep the families in debt. Injuries and malnourishment are common among these families. In Peru malaria is one of the many ailments suffered by the children who pan for gold in the Madre de Dios riverbed. Recruiters use deception to convince Peruvian children to go to work at the gold mines; when the children agree to work, the gold mine employers break their promises, knowing the children have no labor rights, and the children become indentured.

FORCED LABOR IN THE UNITED STATES

According to Hidden Slaves: Forced Labor in the United States (September 2004, http://www.hrcberkeley.org/download/hiddenslaves_report.pdf), the University of California-Berkeley's Human Rights Center notes that at any given time there are at least 10,000 people—particularly young women and girls—being forced to labor against their will in the United States. The majority are from China, Mexico, and Vietnam, although victims are known to have been brought to the United States from at least thirty-eight countries (see Table 2.3 in Chapter 2), and there have been cases of young U.S. citizens being held captive and forced to labor, particularly in prostitution rings. Once in the United States, most victims end up in large states with many immigrants; forced laborers and/or people in debt bondage have been discovered in at least ninety U.S. cities. (See Figure 2.4 in Chapter 2.) The most common sectors forced laborers work in are prostitution and sex services (46%), domestic service (27%), agriculture (10%), sweatshop/factory (5%), and restaurant and hotel work (4%). Others become involved in the sexual exploitation of children (as victims or perpetrators; 3.1%), the entertainment industry (3.1%), or become mail-order brides (0.8%).

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