GL OBAL CHILDHOOD REPORT 2019 CHANGING LIVES IN OUR LIFETIME

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CHANGING LIVESIN OUR LIFETIMEG L O B A LC H I L D H O O DR E P O RT2 0 19

Photo: Victoria Zegler / Save the ChildrenCONTENTS1Introduction4 End of Childhood Index Results2000 vs. 20199 10 Factors Driving Changefor Children Since 200013 More Children Are Healthyand Surviving to Age 516 Fewer Children Suffer Malnutritionthat Causes Stunting19 More Children Are AttendingSchool and Learning23Fewer Children Are Forced into Work26 Fewer Children Are MarriedBefore Age 1829Fewer Girls Are Becoming Mothers32Fewer Children Are Being Murdered35 More Children Are SufferingDue to Conflict41Recommendations47Progress Rankings 2000-201949End of Childhood Index Rankings 201950 Complete End of Childhood Index 201954Methodology and Research Notes59Endnotes64AcknowledgementsSome names of parents and children havebeen changed to protect identities.##SAVE THE CHILDREN

IntroductionChildren born today have a better chance than at any time in history togrow up healthy, educated and protected, with the opportunity to reach theirfull potential. Even a generation ago, a child was twice as likely to die beforereaching age 5, 70 percent more likely to be involved in child labor and 20percent more likely to be murdered.1In commemoration of its founding 100 years ago, Save theChildren is releasing its third annual Global Childhood Reportto celebrate progress for children. We examine the majorreasons why childhood comes to an early end, and findsignificantly fewer children suffering ill-health, malnutrition,exclusion from education, child labor, child marriage, earlypregnancy and violent death. In the year 2000, an estimated970 million children were robbed of their childhoods due tothese causes. That number today has been reduced to 690million2 – meaning at least 280 million children are betteroff today than they would have been two decades ago.A comparison of End of Childhood Index scores finds theoverall situation for children has improved in 173 out of 176countries since 2000. This is welcome news – and it shows thatinvestments and policies are working to lift up many of ourchildren. Tremendous progress for children is taking place insome of the poorest countries in the world, providing everincreasing evidence that development work is paying hugedividends in countries where needs are greatest.Drilling down to look at the individual indicators in theindex, we find countries have made impressive progress infulfilling children’s rights by reducing under-5 mortality.Countries have also made substantial progress in enrollingchildren in school and reducing malnutrition, child labor andchild marriage. Progress in these areas has resulted in millionsfewer children missing out on childhood. However, the worldhas made less progress in reducing adolescent births and childhomicide, and there has been no progress at all in reducingthe number of children living in areas of violence and conflict.In fact, the number of children living in war zones or forced toflee their homes due to conflict has skyrocketed since 2000.Today, 1 child in 4 is being denied the right to a childhood– a time of life that should be safe for growing, learning andplaying. These stolen childhoods are increasingly concentratedin the world’s conflict zones. As noted above, of the eightindicators we examine, displacement due to conflict is the onlyone that is on the rise. There are 30.5 million more forciblydisplaced people now than there were in 2000, an 80 percentHUNDREDS OF MILLIONS OFCHILDREN HAVE BEEN SAVEDGlobal progress has saved millions of childhoodssince the year 2000. Now1 there are: 4.4 49million fewer child deaths per yearmillion fewer stunted children 115million fewer children out of school 94million fewer child laborers 11million fewer married girls 3million fewer teen births per year 12,000fewer child homicides per yearincrease. Finding ways to fulfill children’s health, education andprotection rights in conflict zones is central to the challengeof ensuring every child has the childhood they deserve.WHAT DRIVES PROGRESS?In the 1990s, Save the Children pioneered a radicalapproach to making change that came to be known as“positive deviance.” The approach was based on the ideathat within every community, there are some people who,with the same resources and constraints as everyone else,do things differently and achieve better results than thenorm. Their children are healthier, better educated or better protected than one would expect, given the challengesthey face. Learning from these success stories proved to beGLOBALGLOBALCHILDHOODCHILDHOODREPORTREPORT ##1

SUCCESS STORIESThis report includes case studies of countries that have made strong progress in improving children’s well-beingin recent decades. For example:Bangladesh has achieved remarkable reductions inunder-5 mortality following sustained investments in health.Ethiopia has dramatically lowered the prevalence ofstunting through a package of interventions to improvechildren’s nutrition.Mexico has greatly reduced the proportion of childreninvolved in child labor by investing in education andpoverty reduction.Philippines achieved an impressive rise in the numberof children enrolled in school by offering incentives andflexible options.India has greatly reduced child marriage through legal reforms, programs to educate and empower girls, and publicawareness campaigns.Afghanistan has slashed its adolescent birth rate byincreasing girls’ education and improving health services,with donor assistance.Colombia is making good gains to reduce violenceagainst children through public investments in safety andprograms for at-risk youth.a powerful tool to improve the well-being of children andcommunities, and also the effectiveness of organizations. Inour centennial year, we are paying tribute to this innovativeidea, and using it to identify countries that are achievingbetter than average progress for children. By looking at thestrategies employed successfully within these countries, wefind inspiration to inform work elsewhere.Even in the poorest countries in the world, there are manyexamples of extraordinary progress. This is a clear demonstration that, when the right steps are taken, “developmentworks.” Building on this evidence, this report makes a powerfulcase for greater investment in child-sensitive development.Success stories in this report illustrate some of the strategies that are working to save children around the world. Theyinclude: strengthening legal frameworks, improving healthsystems, investing in education, improving household incomes,and empowering teenagers to make life choices that set themon a path to realize their full potential.The moral case for investing in children is compelling. In aworld so rich in resources, know-how and technology, it is2SAVE THE CHILDRENPhoto: Veejay Villafranca / Save the Childrenunacceptable that we allow today’s levels of child deprivationto continue.Lost childhoods are a result of choices that exclude particular groups of children by design or neglect. A child’s experience of childhood is largely determined by the care andprotection they receive, or fail to receive, from adults. TheConvention on the Rights of the Child affirms children’s right tosurvival, food and nutrition, health and shelter. Children alsohave the right to be educated, both formally and informally.They have the right to live free from fear and discrimination,safe from violence, and protected from abuse and exploitation.And they have a right to be heard and to participate in decisions that affect them.3In 2015, world leaders gathered at the United Nations tomake a bold commitment – to end poverty in all its forms by2030 and protect the planet for future generations. Takentogether, the Sustainable Development Goals (SDGs) theyestablished paint a vision of a future in which all childrenenjoy their rights to health, education and protection – thebuilding blocks of childhood.4 Crucially, signatories to the

agreement promised to ensure this would happen for all segments of society – regardless of income, geography, gender oridentity. And they promised that those who are furthest behind– the most excluded in society – would be reached first.This pledge to leave no one behind must be upheld. Onlythen will we realize its potential to transform the lives of millions of children across the world, guaranteeing every lastchild the childhood they deserve.WHAT HAS CHANGED IN 100 YEARS?Millions of children are alive and thrivingtoday because of medical and technologicaladvances we tend to take for granted. Breakthrough discoveries of vaccines to preventchildhood diseases, coupled with better carefor mothers and babies, have saved countlesslives and improved overall health. The worldhas also made good progress in buildinghuman and institutional capacity to deliverlifesaving solutions to the hardest to reachand most vulnerable children.But perhaps the most important change inthe last 100 years is in how we think aboutchildren. In 1919, when Eglantyne Jebb foundedSave the Children, her conviction that childrenhave a right to food, health care, educationand protection from exploitation was nota mainstream idea. The Declaration on theRights of the Child, drafted by Jebb, wasadopted by the League of Nations in 1924. Itasserted these rights for all children and madeit the duty of the international community toput children’s rights in the forefront of planning.The Convention on the Rights of the Child, whichwas adopted in 1989 and has been ratified byall but one country, further changed the waychildren are viewed and treated – as humanbeings with a distinct set of rights, instead of aspassive objects of care and charity.As these visionary frameworks have gainedacceptance, public opinion about children hasbeen slowly but steadily shifting worldwide. Forexample, more people around the world nowbelieve children belong in school, not toiling infields and factories. And more governmentshave enacted laws to prevent child labor andchild marriage, and to make school free andmandatory for all children, regardless of theirgender, race, refugee status or special needs.The world has come a long way in 100years, but we still have a long way to go to ensure every child, everywhere, grows up healthy,educated and protected from harm.Photo: Save the ChildrenIn the 1920s in Hungary, these children and their six siblings had lost theirmother and were suffering from rickets.GLOBAL CHILDHOOD REPORT3

End of Childhood Index Results2000 vs. 2019Save the Children’s third annual End of Childhood Index compares the latest datafor 176 countries – more than any other year – and assesses where the most andfewest children are missing out on childhood. Singapore tops the ranking with ascore of 989. Eight Western European countries and South Korea also rank in thetop 10, attaining very high scores for children’s health, education and protectionstatus. Central African Republic ranks last among countries surveyed, scoring 394.The 10 bottom-ranked countries – eight from West andCentral Africa – are a reverse image of the top, performingpoorly on most indicators. Children in these countries arethe least likely to fully experience childhood, a time thatshould be dedicated to emotional, social and physical development, as well as play. Low index rankings also highlightthe challenges of armed conflict and poverty. Nine of the4bottom 10 countries are low-income and six of the bottom10 are fragile and conflict-affected states. 5 In these and2019 END OF CHILDHOODINDEX RANKINGSTOP 10BOTTOM 10WHAT DO THE SCORES MEAN?Where childhood ismost protectedEnd of Childhood Index scores for countries are calculated on a scale of 1 to 1,000. The scores measure theextent to which children in each country experience“childhood enders” such as death, severe malnutrition,being out of school and shouldering the burdens ofadult roles in work, marriage and motherhood. Here’sa quick guide on how to interpret country scores:RANK COUNTRYRANK COUNTRYWhere childhood is most threatened1Singapore167Burkina Faso2Sweden168DR Congo3Finland169Guinea3Norway170Nigeria940 or above – Few children missing out on childhood760 to 939 – Some children missing out on childhood600 to 759 – Many children missing out on childhood380 to 599 – Most children missing out on childhood379 or below – Nearly all children missing out onchildhood3Slovenia171Somalia6Germany172South Sudan6Ireland173Mali8Italy174Chad8South Korea175NigerFor more details, see the Methodology and ResearchNotes beginning on page 54.10Belgium176Central African RepublicSAVE THE CHILDREN

END OF CHILDHOOD INDEX SCORES ARE BETTER NOW IN ALL REGIONS1,000CEE/CIS*900End of Childhood Index ScoreEast Asia and PacificMiddle East and North Africa800Latin America and CaribbeanSouth Asia700Eastern and Southern AfricaWest and Central Africa60050040020002019*Central and Eastern Europe and the Commonwealth of Independent Statesmany other countries around the world, children are robbedof significant portions of their childhoods.The United States, China and Russia may be the threemost powerful countries in the world – in terms of their economic, military and technological strength and global influence – but all three badly trail most of Western Europe inhelping children reach their full potential. China and the U.S.are tied for 36th place, and Russia ranks 38th. Their scoresare 941, 941 and 940, respectively – at least 30 points behindmost Western European countries. China has made the mostprogress of the three in recent decades, steadily improvingconditions for its children, while Russia and the U.S. havemade less progress.GREAT GLOBAL PROGRESS FOR CHILDRENSave the Children took a look back at the data for the year2000 and found a remarkable story of progress, in almostevery country, in just one generation. A comparison of Endof Childhood Index scores for 2000 and 2019 shows 173 out of176 countries are doing better at giving their children fulland stable childhoods. The most dramatic progress has beenamong some of the world’s poorest countries. Thesesuccesses show that poverty does not have to be a barrierto progress, and political choices can matter more thannational wealth.Sierra Leone has achieved a 246-point increase in itsindex score since 2000, rising from 345 to 591. Two decadesafter the end of the 11-year civil war, and just a few yearsafter a devastating Ebola outbreak, the country has madestrong gains for children on almost all indicators. Child marriage is down nearly 60 percent. Under-5 mortality has beencut by more than half (53 percent). Child labor is down by atleast 40 percent. Fewer children are stunted and there arefewer teen births (rates for both are down by about 30 percent). Child homicide declined 20 percent. But, by far, thegreatest progress is that fewer families are affected by conflict. In 2000, 1 in every 5 people in Sierra Leone had beenforcibly displaced from home. Today, that figure is 1 in 700 –a 99 percent reduction.GLOBAL CHILDHOOD REPORT5

“ I feel like I own the world.Gaining literacy and numeracy skills,and creating my own business, isthe gateway to controlling my own life.”– Sabreen, age 15Rwanda’s score rose 241 points, from 503 to 744. Twentyfive years after the Rwandan genocide, the country hasimproved on most indicators. Under-5 mortality is down 79percent. Many more children are in school and many fewerchildren are married before age 18 (the out-of-school rateand child marriage rate are both down by 60 percent).Rwanda has also cut child labor, adolescent births and childhomicides in half since 2000.Ethiopia increased its score by 237 points, rising from 414to 651. Improvements in child survival and education havebeen the main drivers of progress, but reductions in malnutrition and child marriage have also been important. Child mortality, children out of school and child marriage have all been6SAVE THE CHILDRENcut by about half or more. The adolescent birth rate is down41 percent, stunting is down 33 percent, and child homicide isdown 30 percent.Niger has more than doubled its score since 2000, from167 to 402. In relative terms, this is the greatest increase ofany country. Niger was the lowest-ranked country on theindex in 2017 and 2018, but this year it rises from the bottom,as the situation for children has continued to improve, whileconditions have worsened in Central African Republic. Niger’sunder-5 mortality rate is down 62 percent since 2000 – that’s44,000 fewer child deaths each year. School enrollment rateshave more than doubled (from 19 to 48 percent). And childhomicide is down 36 percent. In 2000, nearly all children in

Sabreen, age 15,dropped out ofschool in fourthgrade to helpsupport her familyin Egypt. She laterenrolled in Save theChildren’s Youth inAction program toimprove her readingand math skills.After graduating,she began abusiness raisinglivestock.Photo: Joseph Raouf / Save the ChildrenNiger were missing out on childhood. One child in 4 did notsurvive to age 5. Over 80 percent of children were out ofschool and over half were chronically malnourished. Twothirds of girls aged 15 to 19 were already married and morethan 1 in 5 gave birth each year. Niger still has a long way togo – especially with regard to child marriage and early childbearing – but sustained improvements over the years point toa brighter future for many of Niger’s children.Many other countries in sub-Saharan Africa also havemade tremendous progress since 2000. Burkina Faso achieveda 220-point score increase, from 345 to 565, by improvingchild survival and school enrollment. Zambia’s score is up 201points, from 422 to 623, due mainly to improvements in childsurvival. Liberia is up 182 points, from 417 to 599, due to 60percent fewer deaths under age 5. Kenya, Malawi, Mali,Mozambique and Uganda all increased their scores by about160 points or more. Improvements in children’s health andsurvival were the main drivers of progress in these countriesas well. Uganda also significantly cut teen births.In South Asia, Bhutan achieved a 194-point increase, risingfrom 617 to 811, mostly by getting more children into school.Afghanistan also made excellent progress, increasing its score185 points, from 411 to 596, by cutting child deaths and teenbirths in half. Bangladesh’s score rose 153 points, from 575 to728, primarily because of improvements in child survival.Nepal’s score is up 142 points, from 543 to 685, due mostly todecreases in mortality, malnutrition and teen births. AndIndia’s score is up 137 points, from 632 to 769, largely becauseof improvements in child health and survival.In East Asia and the Pacific, Timor-Leste raised its score199 points, from 526 to 725, mostly due to reductions in childdeaths and displacement. The score for Cambodia increased149 points, from 606 to 755, because of gains in child survival,nutrition and school enrollment. China’s score rose 80 points,from 861 to 941, due to reductions in child deaths and malnutrition. Indonesia lifted its score 71 points, from 721 to 792 byimproving child health and getting more children into school.And Vietnam’s score is up 67 points, from 764 to 831, due tosignificant reductions in stunting.In Latin America and the Caribbean, the most progresswas made by Haiti and Nicaragua, with 98- and 97-pointincreases, respectively. Haiti’s score rose from 620 to 718.Nicaragua’s score rose from 698 to 795. Both countriesimproved child survival and school enrollment. Bolivia achievedan 81-point increase, from 685 to 766, by cutting under-5 mortality and stunting in half. Ecuador rose 78 points, from 739 to817, primarily by getting more children into school. Colombia,Guatemala and Peru all had score increases in the 65- to75-point range. The biggest driver of progress in Colombia wasthe decline in child homicide. Guatemala’s score increase wasdue to fewer adolescent births, child deaths and children out ofschool. Peru cut its stunting rate by 58 per

OBAL CHILDHOOD REPORT 2019 GLOBAL CHILDHOOD REPORT 2019 . 47 Progress Rankings 2000-2019 . of ensuring every child has the childhood they deserve.

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