Women and Children in Poverty

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Chapter 7
Women and Children in Poverty

Women are poorer than men because they are often denied equal rights and opportunities, lack access to assets, and do not have the same entitlements as men. They also carry the burden of reproductive and care work and represent the majority of unpaid labour.

United Nations Development Program, Gender and Poverty Reduction

The quality of a child's life depends on decisions made every day in households, communities and in the halls of government…. As children go, so go nations. It's that simple.

—UNICEF Executive Director Carol Bellamy

Virtually all groups that study poverty—from international organizations like the United Nations and the World Bank to small local charities—agree that the most effective way to reduce it is to improve the social, economic, and political situation of women and, by extension, children. Women's levels of health, education, and security reflect those of their families. When a mother suffers the effects of poverty, future generations of her family do as well, creating a cycle of impoverishment from which it is very difficult to escape.


UN Convention on the Rights of the Child, 1989

In 1989 the United Nations (UN) adopted a treaty called the Convention on the Rights of the Child (CRC). Considered one of the most wide-ranging and important human rights documents the global community had ever agreed upon, the CRC was charged with establishing "norms" and standards for the lives of children to which all countries could hold themselves accountable, including:

  • Protection from violence, abuse, and abduction
  • Protection from hazardous employment and exploitation
  • Adequate nutrition
  • Free compulsory primary education
  • Adequate health care
  • Equal treatment regardless of gender, race, or cultural background

The CRC became the most widely ratified human rights treaty in history, passed by 192 countries. As of 2006 only two countries had not ratified it: Somalia and the United States. (Ratification by the United States was hampered by the fact that the Convention forbids capital punishment of minors. Before the U.S. Supreme Court outlawed it in Roper v. Simmons (2005), several states had allowed the death penalty for those who were between sixteen years old and eighteen years old at the time they committed their crimes.)

Beijing Declaration and Platform for Action, 1995

In September 1995 at the United Nations Fourth World Conference on Women in Beijing, China, representatives of 189 countries unanimously adopted a program intended to promote gender equality around the world, which became known as the Beijing Declaration and Platform for Action. One of the main goals outlined by the Platform was addressing the enormous increase of women living in poverty in the late twentieth century—a trend that has come to be known as the "feminization of poverty." The Platform sought to:

  • Review, adopt, and maintain macroeconomic policies and development strategies that address the needs and efforts of women in poverty
  • Revise laws and administrative practices in order to ensure women's equal rights and access to economic resources
  • Provide women with access to savings and credit mechanisms and institutions
  • Develop gender-based methodologies and conduct research to address the feminization of poverty

UN Millennium Development Goals and Other Conventions

In 2000 all member countries of the United Nations pledged to meet eight human development goals outlined in the Millennium Campaign, an international effort to eradicate extreme poverty, along with its causes and consequences. These Millennium Development Goals (MDGs) include four that specifically address the needs and challenges of women and children affected by poverty:

  • Achieve universal primary education
  • Promote gender equality and empower women
  • Reduce child mortality
  • Improve maternal health

The standards of the CRC, the Beijing Platform, and the Millennium Campaign together have led to a global acknowledgment that the protection of children and the eradication of gender disparities are essential to combating poverty. Figure 7.1 shows how many countries have ratified the Convention on the Rights of the Child, the Convention on the Elimination of All Forms of Discrimination against Women (1979), and the International Convention on the Worst Forms of Child Labour (1999). Also included is information on the Optional Protocols to the Convention on the Rights of the Child on child prostitution and pornography (2000) and on the involvement of children in armed conflict (2000).


Progress has been made toward many of the development goals outlined by the UN during the 1990s. According to the UNDP (http://hdr.undp.org/reports/global/2005/pdf/presskit/HDR05_PR1E.pdf), since the 1990s more than 135 million people have been lifted out of extreme poverty (having an income of less that one dollar per day per person), 1.2 billion people have gained access to clean water, thirty million more children attend school, and child deaths have been reduced by two million per year. However, as of 2005, 2.5 billion people stilled lived on an income less than two dollars per person per day, more than one billion people still did not have access to safe water, 115 million children were still not in school, and more than ten million children per year still died of preventable causes.


In March 2005 during a conference in New York City that became known as Beijing+10, the UN Commission on the Status of Women assessed progress toward the goals outlined in the Beijing Platform (http://daccessdds.un.org/doc/UNDOC/GEN/N04/636/83/PDF/N0463683.pdf?OpenElement). According to the report, as of 2004 women were more likely than men to be poor, and female-headed households were more likely than male-headed households to be poor. Among the statistics cited by the UN, in Malawi a full three-quarters of the poor are women; in Zimbabwe, 72% of female-headed households are poor, compared with 58% of households headed by men. Even in the developed world women fared worse than men; according to the UN report, for instance, women headed 62% of poor households in the Netherlands. Only Burkina Faso reported that men experienced higher poverty rates: 46.9% of households headed by men experienced poverty in that west African country, compared with 36.5% of households headed by women.

Many of the national programs begun since the Beijing Platform focus on increasing women's employment opportunities, ensuring social safety nets, and improving training and education. Some countries instituted minimum wage laws, affecting the poor women who make up the majority of low-income workers. In Portugal, for example, 69% of the people who benefited from the country's minimum wage in 2003 were poor women, according to the UN report. Other countries created lines of credit, loans, and other incentives for self-employment and entrepreneurship. In 2002 Vietnam's program granted loans to more than 20% of poor households headed by women. Some developing countries—including Liberia, Namibia, Zimbabwe, and the Dominican Republic—have changed their laws on inheritance and land ownership to include women.


However, implementation of programs consistent with the goals of the Beijing Platform has not been uniform throughout the world. In Beijing Betrayed: Women Worldwide Report That Governments Have Failed to Turn the Platform into Action (Women's Environment and Development Organization [WEDO], March 2005, http://www.wedo.org/files/beijingbetrayed.htm), organizations from 150 countries reported on actions taken—or not taken—since 1995.

One of the trends cited by WEDO as having a significant impact on women in poverty is the proliferation of informal paid labor, or work that is outside the formal labor sector and therefore not subject to legal protections such as safety and wage regulations. The WEDO report estimates that at least 60% of women in developing countries are employed in the informal work sector, although precise figures are impossible to obtain because this type of work falls outside government purview. In Figure 7.2 the three pyramids represent the top-to-bottom structure of informal work and poverty according to gender. Employers—the highest paid people in the informal sector—are overwhelmingly male, while those working exclusively in the informal sector and those performing industrial outwork—overwhelmingly female sectors—have the highest risk of living in poverty.


Costs of informal work

Direct costs

  1. High costs of running informal businesses, including direct and indirect taxes
  2. High costs of informal wage work
    • Long hours and unscheduled overtime
    • Occupational health hazards
  3. High costs of accessing capital in informal financial markets and high indebtedness
  4. High costs associated with periodic 'shocks' to work

Indirect costs

  1. Lack of secure work and income
    • Greater insecurity of work
    • Variability and volatility of income
  2. Lack of worker benefits and social protection
    • Few (if any) rights such as paid sick leave, overtime compensation or severance pay
    • No childcare provisions
    • Little (if any) employment-based social protection
    • No health, disability, property, unemployment or life insurance
  3. Lack of training and career prospects
  4. Lack of capital and other assets
    • Lack of/vulnerability of productive assets
    • Limited (if any) access to formal financial services
  5. Lack of legal status, organization and voice
    • Uncertain legal status
    • Lack of organization and voice

source: Martha Chen, Joann Vanek, Francie Lund, James Heintz, with Renana Jhabvala, and Christine Bonner, "Box 4.1. Costs of Informal Work," in Progress of the World's Women 2005: Women, Work, and Poverty, United Nations Development Fund for Women, 2005, http://www.unifem.org/attachments/products/PoWW2005_eng.pdf (accessed April 8, 2006)

Table 7.1 lists the direct and indirect costs involved in working in the informal sector. Of particular concern to women are the indirect costs related to a lack of child care, health benefits, sick leave, and insurance. With women largely responsible for the care of children and the home, the daily insecurity of having no options for child and health care or time off to care for an ill family member, along with the longer-term problem of having no disability or employment insurance, makes working in the informal economy an extremely difficult task.


Another global issue highlighted by the Beijing Platform is the lack of female representation in governments and public administration. One of the specific goals of the Platform was to increase the proportion of women serving in national parliaments around the world to 30%. In some countries positive results have been realized: in Rwanda gender quotas led to women comprising 48.8% of the national parliament in 2005. That same year 36% of members of the Cuban parliament were female, and in South Africa 32.8% were female. Still, twelve countries had no female representatives: Bahrain, Kuwait, Micronesia, Nauru, Palau, Saint Kitts and Nevis, Saudi Arabia, Solomon Islands, Tonga, Tuvalu, United Arab Emirates, and Guinea-Bissau. Even in the United States, where women outnumber men in the population 51% to 49%, representation is not equal: women made up only 15.1% of the U.S. Congress in 2006.

In 2005 the African country of Liberia ushered in what international observers believe could be the beginning of change for the entire continent and for the developing world overall, electing Africa's first female president, Ellen Johnson-Sirleaf, a Harvard-educated economist who once headed the United Nations Development Program and advised the World Bank. Chile also elected its first female president, Michelle Bachelet, in 2006, beginning a new era of government in Latin America. With women gaining positions of power and influence, legislation that addresses female poverty should have a better chance of ratification.

The Millennium Development Goals: Five Years Later

In 2005 the United Nations published a five-year review of movement toward the MDGs (http://millenniumindicators.un.org/unsd/mi/pdf/MDG%20Book.pdf). While the UN report found progress, it conceded that the goals are not on track to be fulfilled by the 2015 deadline. For example, the goal to halve extreme poverty between 1990 and 2015 is off track, even though poverty overall has been reduced in most regions. More than 800 million people in developing countries suffer from chronic hunger—an increase since 1990—and about a quarter of children younger than five in the developing world are malnourished. Of the estimated eleven million children who die each year from treatable causes, more than half die as a direct result of malnourishment and disease. Figure 7.3 shows how achievement of the MDGs would improve children's lives. Among children under five years old, 5.5 million lives would be saved in 2015 alone.

Between 1990–91 and 2001–02, enrollment in primary school in developing regions overall increased from 80% to 83%. In five regions—Latin America and the Caribbean (LAC), East Asia, Central Asia, Northern Africa, and Southeast Asia—enrollment reached greater than 90%. While this level of enrollment is considered an impressive advance, the MDG of achieving universal primary school enrollment is moving slowly. More than a third of school-age children in sub-Saharan Africa do not attend school. In South Asia, West Asia, and the Pacific Rim countries, 20% of children do not attend school.

Progress toward the MDGs that specifically address women's issues has been disappointing. The UN's MDG report found that women by far outnumber men in the informal workforce, both paid and unpaid; 62% of unpaid family workers are women. The UN also reported that maternal mortality rates are not dropping in the countries where pregnancy and childbirth are already the most dangerous. While in the developed world the rate was fourteen maternal deaths per 100,000 live births in 2000, in developing regions the rate was 450 deaths per 100,000 live births. At the same time in sub-Saharan Africa, the rate was 920 deaths per 100,000 live births—by far the highest rate in the world. On the other hand, there have been a few significant advances in the goal of improving health services for pregnant women and new mothers. For instance, the proportion of deliveries in the developing world attended by skilled professionals increased from 41% in 1990 to 57% in 2003.


The term the "feminization of poverty" was first used in 1978 by a researcher named Diana Pearce, who had found that two-thirds of poor adults over age sixteen in the United States were female. Although Pearce was referring specifically to U.S. data, the term entered common usage in both poverty research and women's studies. The feminization of poverty is generally understood to have three main causes:

  • The increasing number of female-headed households
  • Individual and cultural stereotypes about and discrimination against women and girls
  • Macroeconomic trends such as globalization and trade that fail to take into account women's roles in economies

There are many reasons women tend to be poorer than men. Lower wages, failed social safety nets, fewer educational opportunities, substandard health care, and a lack of employee protections and benefits such as paid maternity leave and child care all contribute to the problem. In addition, women typically are the primary caretakers of children and elders, which also makes them more vulnerable to impoverishment as they have less time to earn money outside the home.

Women's Work

The United Nations Development Fund for Women (UNIFEM) explains in its report Progress of the World's Women 2005: Women, Work, and Poverty that, although globalization has brought new opportunities for highly educated and skilled workers, it has in many cases had the opposite effect on those with less training and education, who typically come from poor backgrounds in the first place. According to the UNIFEM report:

Increasingly, rather than informal work becoming formalized as economies grow, work is moving from formal to informal, from regulated to unregulated, and workers lose job security as well as medical and other benefits. What we are seeing is that growth does not automatically "trickle down" to the poor. It can in fact widen the gap between rich and poor. As globalization intensifies, the likelihood of obtaining formal employment is decreasing in many places, with "footloose" companies shifting production from one unregulated zone to an even less regulated one elsewhere, employing workers in informal contract or casual work with low earnings and little or no benefits.

This situation has become common in developing countries, where 50% to 80% of nonagricultural employment is in the informal sector. More than 60% of women in developing countries perform nonagricultural paid informal labor; the figure rises when informal paid agricultural work is factored in. Additionally, many women perform informal unpaid agricultural work on family or community farms. Average wages are lower for both informal and agricultural workers, male and female, and the risk of falling into or remaining in poverty is higher for those workers as well.

In addition to earning lower wages and having a greater risk of poverty, workers in the informal sector are at a higher risk of experiencing human rights abuses, including a lack of access to social services and basic infrastructure (passable roads, clean water, reliable sanitation, etc.); a greater chance of becoming ill or disabled and of losing property; fewer work-related benefits and securities; fewer housing and property rights; and generally worse health, less education, and shorter life spans. Some specific risks for garment workers, street vendors, and waste pickers are outlined in Table 7.2.


Occupational health and safety hazards

Problems associated with poor health and safety in the workplace vary from job to job and are also heavily dependent on the environment in which each job is undertaken Some of the common problems associated with different types of informal work include

  1. Garment makers
    • Neck and backache
    • Pain in limbs and joints
    • Poor vision resulting from eye strain
    • Headaches, dizziness and fatigue
    • Respiratory problems associated with dust and textile fibres
  2. Street vendors
    • Exposure to weather—extreme temperatures, wind, rain and sun
    • Poor access to clean water
    • Poor sanitation from dirty streets and poor drainage, as well as waste produce from other vendors
    • Diseases transmitted by vermin
    • Lead poisoning and respiratory problems from vehicle fumes
    • Musculoskeletal problems associated with ergonomic hazards at workstations and static postures
    • Risk of physical harm from municipal authorities, members of the public or other traders
  3. Waste pickers
    • Exposure to weather—extreme temperatures, wind, rain and sun
    • Poor sanitation and limited or no access to clean water
    • Exposure to dangerous domestic and industrial waste, including toxic substances such as lead and asbestos
    • Exposure to other dangerous matter, including blood, faecal matter, broken glass needles, sharp metal objects and animal carcasses
    • Back and limb pain, itchy skin/rashes
    • Diseases transmitted by vermin, flies and mosquitoes
    • Specific high risk of tuberculosis, bronchitis, asthma, pneumonia, dysentery and parasites

source: Martha Chen, Joann Vanek, Francie Lund, James Heintz, with Renana Jhabvala, and Christine Bonner, "Box 4.2. Occupational Health and Safety Hazards," in Progress of the World's Women 2005: Women, Work, and Poverty, United Nations Development Fund for Women, 2005, http://www.unifem.org/attachments/products/PoWW2005_eng.pdf (accessed April 8, 2006)

Female workers are at a higher risk of poverty not only because average wages are lower for women than for men (see Table 7.3; "own account" workers are those who produce goods for their own use; "private wage" earners are those working in the private sector; "public wage" earners work in the public sector; "domestic" earners work in cleaning, cooking, child care, etc.) but also because women tend to work fewer hours due to their unpaid responsibilities in the home and community. These responsibilities—which include the care of children, elderly, and sick family members; domestic chores such as cooking, cleaning, making clothing, and growing food; and unpaid work in the community—are referred to as "unpaid care work." This designation helps to distinguish it from paid domestic labor (formal or informal), such as cooking, cleaning, and/or child care in other people's homes or businesses.

UNIFEM identifies four "dimensions" that create the relationship between work—paid and unpaid—and poverty for women:

  • The temporal dimension: Because women spend more time doing unpaid work within the home, performing housework and child care, they have less time to spend doing paid work outside the home, although studies have shown that, overall, women spend more time working overall than men do. This means that women tend to do more part-time paid work, which in turn means that they earn less money. In developing countries women spend much of their unpaid time performing heavier physical chores such as collecting water and fuel and growing and harvesting crops, leaving them even less time for paid work as well as for child care.
  • The spatial dimension: Women in both developing and developed countries sometimes are forced to migrate to other areas, regions, or even countries to find paid work. This might mean leaving a rural home to work in a city (or vice versa) or migrating from, for example, a country like Mexico to perform seasonal farm work in a country like the United States. In either case, a woman who migrates for work will have to find someone to care for her family while she is away. At the same time, however, women who have children often are not able to migrate to regions with better work opportunities.
  • The employment segmentation dimension: Women's traditional role as caretakers within the home has led to a narrow choice of work outside the home. Without specific training or education, women in almost every culture tend to fall into the same occupations: domestic servants, clothing and textile workers, teachers, and care workers. These occupations tend to be relatively unstable, informal, lower-paying, and, in some cases (such as in the textile industry), more dangerous than other jobs.
  • The valuation dimension: The value placed on work that is seen as traditionally female is related to employment segmentation. "Women's work," meaning the kind of work that women typically do for free within their homes and communities, generally is considered less valuable than work that is perceived to require more training or education. Therefore, it is less regulated and brings in lower pay.

Gender is not the only factor that determines women's greater likelihood of impoverishment and

Women's hourly earnings as a percentage of men's hourly earnings, by selected country and type of employment, 2005
Costa RicaEgyptEl SalvadorGhanaSouth Africa
Notes: n.a.=data not available or insufficient observations to derive statistically significant estimates. Hourly earnings include all reported employment income. Usual hours worked were used to compute a standard hourly rate. Individuals reporting excessive hours worked (generally more than 140 per week) were dropped. The value of non-wage benefits and in-kind payments were included in earnings calculations. However, there is a tendency to underestimate these contributions. Also, only employed persons who reported their income are included in the estimations. The computation of self-employment income varies from country to country. For the Egyptian household data, no information on self-employment income is provided. In most cases, self-employment earnings included the value of goods produced in a family enterprise.
source: Martha Chen, Joann Vanek, Francie Lund, James Heintz, with Renana Jhabvala and Christine Bonner, "Table 3.6. Women's Hourly Earnings as a Percentage of Men's Hourly Earnings," in Progress of the World's Women 2005: Women, Work, and Poverty, United Nations Development Fund for Women, 2005, http://www.unifem.org/attachments/products/PoWW2005_eng.pdf (accessed April 8, 2006)
    Private wage84.6151.987.5n.a.89.5
    Public wage87.7107.6116.284.295.6
    Private wage85.1n.a.105.4n.a.66.3
    All wagen.a.263.3n.a.69.8n.a.
    Private wage79.5317.175.4n.a.107.0
    Public wagen.a.n.a.
    Private wagen.a.n.a.86.4n.a.98.5
    Public wagen.a.n.a.177.6n.a.n.a.

difficulty obtaining and holding on to work. In different cultures religion, race, and especially class play a role. However, as the dimensions of work described above demonstrate, women in general—in nearly every culture—experience living and working conditions that make economic advancement difficult.

Poor women who do work typically find employment in more or less undesirable jobs. Some are degrading; others are dangerous. Some cause health problems, while others are simply monotonous. Women living in extreme poverty tend to fall into the same types of work regardless of where they live in the world: begging, digging for garbage, sweatshop labor, farm work, street vending, and prostitution—voluntary and forced—are some of the most common types of employment for poor women.

Women's Wages and Poverty Rates in the Developed World

According to the Women's Learning Partnership for Rights, Development, and Peace (WLP), a nongovernmental organization (NGO) that works as a consultant group to the United Nations, in every country in the world women's pay is lower than men's, including countries in the developed world. Globally speaking, women earn an average of 30% to 40% of what men earn. Living in a developed country does not guarantee a working woman equity in wages: the WLP reports that in France, Germany, Italy, and the United Kingdom, women earn an average of 75% of what men earn, while in Australia, Sri Lanka, Tanzania, and Vietnam women's wages are 90% of men's.


Median weekly full-time earnings of American women in 2004 were about 80% of the earnings of men (Bureau of Labor Statistics, Women in the Labor Force: A Databook, May 2005). This is in spite of the Equal Pay Act of 1963 (EPA), which outlawed unequal pay for equal work. (American women at that time had median earnings equal to fifty-eight cents for every dollar earned by American men.) The National Women's Law Center reports that as of 2004 African-American women in the United States had median earnings of sixty-five cents for every dollar earned by white men, and Hispanic women earned just fifty-six cents for every dollar earned by white men (http://www.nwlc.org/pdf/PaycheckFairnessActApr06.pdf).

Among U.S. workers active in the labor force for at least twenty-seven weeks during 2004, a slightly higher percentage of women (6.2%) than men (5%) lived in poverty (Bureau of Labor Statistics, A Profile of the Working Poor, 2004, May 2006). However, for working families (those with at least one family member in the labor force for half the year or more), the rates displayed a wider gap, with families headed by single women (22.6%) experiencing a significantly higher poverty rate than families headed by single men (13.2%).

According to a joint report by the AFL-CIO (American Federation of Labor-Congress of Industrial Organizations) and the Institute for Women's Policy Research ("Equal Pay for Working Families: National and State Data on Pay Gap and Its Costs," 1999), closing the wage gap between the sexes would increase women's total family income by $4,000 a year and could cut poverty rates in half.


According to the Canadian Research Institute for the Advancement of Women (CRIAW), as of 2005 one in seven Canadian women (2.4 million in total) was living in poverty, and women working full-time, year-round earned just 71% of what men earned ("Women in Poverty," 2005 http://www.criaw-icref.ca/). In fact, Canada, which is one of the wealthiest countries in the world, had the fifth-largest wage gap in the developed world in 2004, after Japan, Korea, Portugal, and Spain (OECD in Figures, 2004). Statistics Canada reports that as of 2001 (the most recent figures available at the time of publication) the average income of women with a post-secondary degree was Can$29,539; average income for men with less than a ninth-grade education was Can$30,731, indicating that higher levels of education do not necessarily lead to higher pay for Canadian women.

Unmarried women under age sixty-five living alone had a poverty incidence of 38.4% in 2004, according to Statistics Canada (http://www40.statcan.ca/l01/cst01/famil41a.htm). Because many of these single women also headed families, children under age eighteen who lived in households headed by a single woman suffered a higher incidence of poverty (52.1%) than children living in two-parent families (11.6%). Average total income in families headed by single women (Can$34,100) was significantly less than in families headed by men alone (Can$52,900) in 2004 (http://www40.statcan.ca/l01/cst01/famil05a.htm). In fact, 37% of single mothers who work make less than Can$10 an hour, according to the CRIAW. "Women in Poverty," also observes that the highest rates of poverty and the lowest wages for women in Canada occur among Aboriginal (Native Canadian), immigrant, minority, and disabled women. The average annual income of Aboriginal women is Can$13,300, compared with Can$19,350 for non-Aboriginal women. Immigrant women who have college degrees earn an average of Can$14,000 less than Canadian-born women with college degrees. Minority women in Canada earn an average of Can$16,621 annually, while disabled women earn about Can$17,000 a year.


In the European Union (EU) women's earnings averaged about 16% lower than men's, according to the European Commission's (EC) publication The Social Situation in the European Union 2004. This finding was confirmed by the EC's Report from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions on Equality between Women and Men, 2005, which also noted that the gap had closed slightly—to 15%—with the addition of ten more countries to the Union in 2004 (the Czech Republic, Estonia, Cyprus, Latvia, Lithuania, Hungary, Malta, Poland, Slovenia, and Slovakia).


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

Economic effects of fatal illness in the household, 1992
Timing of Impact
Type of effectsBefore illnessDuring illnessImmediate effect of deathLong 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 earningsOrganization of economic activity
Residential location
Reduced productivity of ill adult

Reallocation of labor
Lost output of deceasedLost output of deceased
Reallocation of land and labor
Effect on investment and consumptionInsurance
Medical costs of prevention
Precautionary savings
Transfer to other households
Medical cost of treatment
Changes in consumption and investment
Funeral costs
Legal fees
Changes in type and quantity of investment and consumption
Effect on household health and compositionExtended family
Reduced allocation of labor to health maintaining activitiesLoss of deceasedPoor health of surviving household members
Dissolution or reconstitution of household
Psychic costsDisutility of ill personDisutility 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

Reproductive rights and the MDGs (Millennium Development Goals)
Elements of reproductive rightsExamples of rights-based actionsRelevance 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 survivalPrevent 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 personTake 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 informationMake 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 childrenProvide 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 familyPrevent 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 healthProvide 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 progressFund 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 employmentProhibit 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 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, 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 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.


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

Comparison of 1995 and 2000 regional and global totals of maternal mortality
Maternal mortality ratioMaternal deaths (in thousands)Maternal mortality ratioMaternal 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 total400529,000400515,000
Developed regions*202,500212,800
Developing regions440527,000440512,000
Northern Africa1304,6002007,200
Sub-Saharan Africa920247,0001,100265,000
Eastern Asia5511,0006013,000
South-central Asia520207,000410158,000
South-eastern Asia21025,00030035,000
Western Asia1909,80023011,000
Latin America & the Caribbean19022,00019022,000

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.


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 happens in every economic class of every culture around the world. While it is a multifaceted 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
  • 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.


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.


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 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.

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

Under-five mortality rank and other development indicators, by country, 1990–2004
Countries and territoriesUnder-5 mortality rankUnder-5 mortality rateInfant mortality rate (under 1)aTotal population (thousands) 2004Annual number of births (thousands) 2004Annual number of under-5 deaths (thousands) 2004Gross national income per capita (US$)b 2004Life expectancy at birth (years)c 2004Total adult literacy rated 2000–2004gNet primary school enrolment/attendance (percent)e 1996–2004gPercent share of household Incomef 1993–2003g
1990200419902004Lowest 40%Highest 20%
Afghanistan426025716816528,5741,395359   250m46 53l
Albania125451937173,112531 2,0807499 952337
Algeria796940543532,35867127 2,2807170 94l1943
Andorra159766710     k 89
Angola226026015415415,490749195 1,0304167 58l
Antigua and Barbuda1431211812010,000 —
Argentina1272918261638,37268512 3,7207597 —1056
Armenia90603252293,026341 1,1207299 97l1845
Australia1621068519,942249126,90081 971841
Austria172105858,17175032,30079 902139
Azerbaijan511059084758,35513212   9506799 91l1945
Bahamas140291324103196014,920m70 86
Bahrain148191115971613010,840m7588 86l
Bangladesh581497710056139,2153,738288   4406341 79l2241
Barbados1431612141026930 9,270m75100100
Belarus14817111399,811911 2,12068100 942139
Belize814939393226470 3,9407277 99
Benin23185152111908,17734152   5305434 54l
Bhutan5616680107672,116645   76063 —
Bolivia621256989549,00926518   9606487 78l1349
Bosnia and Herzegovina131221518133,909371 2,0407495 86l2436
Botswana415811645841,769465 4,3403579 84l770
Brazil8860345032183,9133,728127 3,0907188 95l863
Brunei Darussalam1501191083668024,100m7793 —
Bulgaria131181515127,780671 2,7407298 902039
Burkina Faso162101921139712,822601115   3604813 3211261
Burundi171901901141147,28233063    904459 47l1548
Cambodia26115141809713,79842260   3205774 65l1848
Cameroon25139149858716,03856284   8004668 75l1551
Cape Verde8660364527495151 1,7707176 99
Central African Republic151681931021153,98614929   3103949 43l765
Chad122032001171179,44845691   2604426 391
Chile15221817816,1242492 4,9107896 851062
China93493138261,307,98917,372539 1,2907291 991450
Colombia1133621301844,91597020 2,0007394 931962
Comoros61120708852777282   5306456 31l
Congo4411010883813,88317219   7705283 54
Congo, Democratic Republic of the820520512912955,8532,788572   1204465 52l
Under-five mortality rank and other development indicators, by country, 1990–2004 [continued]
Countries and territoriesUnder-5 mortality rankUnder-5 mortality rateInfant mortality rate (under 1)aTotal population (thousands) 2004Annual number of births (thousands) 2004Annual number of under-5 deaths (thousands) 2004Gross national income per capita (US$)b 2004Life expectancy at birth (years)c 2004Total adult literacy rated 2000–2004gNet primary school enrolment/attendance (percent)e 1996–2004gPercent share of household Incomef 1993–2003g
1990200419902004Lowest 40%Highest 20%
Cook Islands113322126181800    — —
Costa Rica140181316114,253791 4,6707896 901352
Côte d'Ivoire1415719410311717,872661128   7704648 58l1451
Croatia1591271164,540410 6,5907598 892140
Cuba15913711611,2451361 1,170m78100 93
Cyprus17212510582610017,5807997 96
Czech Republic18513411410,229910 9,15076 872536
Djibouti31163126122101779273 1,03053 36
Dominica135171415137920 3,650 81
Dominican Republic90653250278,7682117 2,0806888 92l1453
Ecuador1045726432313,0402968 2,18075911001158
Egypt8610436762672,6421,89068 1,3107056 83l2144
El Salvador98602847246,7621665 2,3507180 901057
Equatorial Guinea9170204103122492214     j4384 62l
Eritrea541478288524,23216614   18054 63l
Estonia1521681261,335130 7,01072100 951844
Ethiopia2020416613111075,6003,064509   1104842 31l2239
Fiji12031202516841190 2,6906893100
France172957460,257744430,09080 992040
Gabon49929160601,362424 3,94054 94l
Gambia36154122103891,478526   29056 53l1453
Georgia75474543414,518502 1,04071 891844
Germany172957482,645687330,12079 832237
Ghana42122112756821,66467976   3805754 61l1647
Greece17211510411,098102116,6107891 991944
Grenada1133721301810220 3,760 84
Guatemala758245603312,29543319 2,1306869 78l964
Guinea222401551451019,20238359   46054 57l1747
Guinea-Bissau102532031531261,5407716   16045 41l1453
Guyana6788646448750161   99064 97l
Haiti40150117102748,40725330   3905252 54l
Holy See1    — —
Honduras78594144317,0482068 1,0306880 87959
Hungary15217815710,124951 8,2707399 912337
India521238584621,087,12426,0002,210   6206461 77l2143
Indonesia8391386030220,0774,513171 1,1406788 94l2043
Under-five mortality rank and other development indicators, by country, 1990–2004 [continued]
Countries and territoriesUnder-5 mortality rankUnder-5 mortality rateInfant mortality rate (under 1)aTotal population (thousands) 2004Annual number of births (thousands) 2004Annual number of under-5 deaths (thousands) 2004Gross national income per capita (US$)b 2004Life expectancy at birth (years)c 2004Total adult literacy rated 2000–2004gNet primary school enrolment/attendance (percent)e 1996–2004gPercent share of household Incomef 1993–2003g
1990200419902004Lowest 40%Highest 20%
Iran (Islamic Republic of)837238543268,8031,30850 2,3007177 861550
Iraq33501254010228,057972122 2,170m59 78l
Ireland162106854,08063034,28078 961943
Israel1621261056,601134117,3808097 991844
Italy172959458,033531326,12080 991942
Jamaica120202017172,639521 2,9007188 951746
Jordan101402733235,5611504 2,1407290 99l1944
Kazakhstan606373536314,83923717 2,26063100 91l2040
Kenya3797120647933,4671,322159   4604874 78l1649
Kiribati66886565499720   970 —
Korea, Democratic People's Republic of715555424222,38434919     h63 —
Korea, Republic of162968547,645467313,980771002238
Kuwait143161214102,60650116,340m7783 83
Kyrgyzstan64806868585,2041168   4006799 89l2043
Lao People's Democratic Republic5316383120655,79220417   3905569 62l1945
Latvia143181214102,318210 5,46072100 862041
Lebanon93373132273,540662 4,98072 97l
Lesotho541208284611,798504   7403581 65l667
Liberia52352351571573,24116439   1104256 70
Libyan Arab Jamahiriya120412035185,7401333 4,4507482 —
Liechtenstein172105943400     k —
Lithuania1521381083,443310 5,74073100 912140
Luxembourg162106754596056,23079 90
Madagascar351681231037618,11370487   3005671 76l1354
Malawi1924117514611012,60855096   1704064 76l1356
Malaysia1432212161024,8945497 4,6507389 931354
Maldives74111467935321100 2,5106796 92
Mali725021914012113,124647142   3604819 39l1356
Malta162116954004012,2507988 96
Marshall lslands69925963526000 2,370 84
Mauritania3313312585782,98012315   4205351 44l1746
Mauritius131231521141,233200 4,6407284 97
Mexico9846283723105,6992,20162 6,7707590 991059
Micronesia (Federated States of)1103123261911030 1,99068 —
Moldova, Republic of98402830234,218431   7106896 98l1844
Monaco17295743500     k —
Under-five mortality rank and other development indicators, by country, 1990–2004 [continued]
Countries and territoriesUnder-5 mortality rankUnder-5 mortality rateInfant mortality rate (under 1)aTotal population (thousands) 2004Annual number of births (thousands) 2004Annual number of under-5 deaths (thousands) 2004Gross national income per capita (US$)b 2004Life expectancy at birth (years)c 2004Total adult literacy rated 2000–2004gNet primary school enrolment/attendance (percent)e 1996–2004gPercent share of household Incomef 1993–2003g
1990200419902004Lowest 40%Highest 20%
Mongolia721085278412,614583   5906598 79l1651
Morocco778943693831,02071331 1,5207051 89l1747
Mozambique2323515215810419,424769117   2504246 60l1747
Myanmar45130106917650,004992105   220m6190 80l
Namibia68866360472,009564 2,3704785 78l 479
Nauru9530251300    — 81
Nepal59145761005926,59178660   2606249 74l1945
Netherlands162967516,226190131,70079 992139
New Zealand162116853,98955020,310791001844
Nicaragua83683852315,3761536   7907077 80l1549
Niger332025919115213,499734190   2304514 30l1053
Nigeria13230197120101128,7095,3231,049   3904367 62l1356
Niue10    — 99
Occupied Palestinian territory107402434223,5871363 1,110m7392 91
Oman140321325102,534641 7,830m7474 72
Pakistan4713010110080154,7944,729478   6006349 56l2142
Palau101342728222000 6,870 96
Panama107342427193,175702 4,4507592100 960
Papua New Guinea481019374685,77217616   5805657 741257
Paraguay107412433216,0171754 1,1707192 89 961
Peru978029602427,56262718 2,3607088 96l1153
Philippines886234412681,6172,02669 1,1707193 88l1452
Poland15218819738,5593653 6,09075 982041
Qatar1132621211877714012,000m7389 94
Romania1203120271721,7902134 2,9207297 892041
Russian Federation11329212317143,8991,51132 3,4106599 902139
Rwanda101732031031188,88236574   2204464 75l23m39m
Saint Kitts and Nevis113362130184210 7,600 95
Saint Lucia1352114201315930 4,3107390 99
Saint Vincent and the Grenadines1122522221811820 3,65071 90
Samoa955030402518450 1,8607199 98
San Marino1851441332800     k —
Sao Tome and Principe38118118757515351   37063 78l
Saudi Arabia1014427352123,9506651810,4307279 54
Senegal29148137907811,38641957   6705639 48l1748
Serbia and Montenegro1312815241310,5101222 2,6207496 96
Under-five mortality rank and other development indicators, by country, 1990–2004 [continued]
Countries and territoriesUnder-5 mortality rankUnder-5 mortality rateInfant mortality rate (under 1)aTotal population (thousands) 2004Annual number of births (thousands) 2004Annual number of under-5 deaths (thousands) 2004Gross national income per capita (US$)b 2004Life expectancy at birth (years)c 2004Total adult literacy rated 2000–2004gNet primary school enrolment/attendance (percent)e 1996–2004gPercent share of household Incomef 1993–2003g
1990200419902004Lowest 40%Highest 20%
Seychelles135191417128030 8,09092100
Sierra Leone13022831751655,33624569   2004130 41l 3m63m
Singapore19293734,27340024,2207993 —1449
Slovakia1501491265,401510 6,48074100 862435
Slovenia185104841,96717014,81077100 932336
Solomon Islands7063563834466151   55063 —
Somalia62252251331337,96435981   130m47 11l
South Africa656067455447,2081,09373 3,6304782 89l1062
Sri Lanka1353214261220,5703305 1,0107490 —2142
Sudan4912091746335,5231,163106   5305759 53l
Suriname814839353044690 2,2506988 90l
Swaziland21110156781081,034305 1,6603179 72l 964
Switzerland17295757,24068048,23081 9920m40m
Syrian Arab Republic1304416351518,5825268 1,1907483 98
Tajikistan3812811899916,43018622   2806499 81l2041
Tanzania, United Repubic of311611261027837,6271,403177   3304669 82l1846
Thailand1133721311863,6941,01521 2,5407093 851650
The former Yugoslav Republic of Macedonia135381433132,030230 2,3507496 912237
Timor-Leste561728013064887454   55056 —
Togo2715214088785,98823333   3805553 64l
Tonga1053225262010220 1,8307299100
Trinidad and Tobago120332028181,301190 8,5807098 96l16m46m
Tunisia105522541219,9951664 2,6307474 971647
Turkey908232672872,2201,50548 3,7506988 88l1747
Turkmenistan469710380804,76610711 1,3406399 85l1648
Tuvalu73565140361000    — —
Uganda28160138938027,8211,412195   2704869 79l1650
Ukraine1272618191446,9893917 1,2606699 842238
United Arab Emirates1521481274,28467118,060m7877 83
United Kingdom1621068559,479663433,940791001844
United States15212897295,4104,1343341,40078 921646
Uruguay129251720153,439571 3,9507698 901450
Uzbekistan627969655726,20961142   4606799 80l2336
Vanuatu796240483220760 1,3406974 94
Venezuela1252719241626,28259011 4,0207393 94l1153
Vietnam1105323381783,1231,64438   5507190 96l1945
Yemen43142111988220,32982692   5706149 72l2041
Zambia181801821011021147946885   4503868 68l1157
Zimbabwe308012953791293638450   480m3790 79l1356
Under-five mortality rank and other development indicators, by country, 1990–2004 [continued]
Countries and territoriesUnder-5 mortality rankUnder-5 mortality rateInfant mortality rate (under 1)aTotal population (thousands) 2004Annual number of births (thousands) 2004Annual number of under-5 deaths (thousands) 2004Gross national income per capita (US$)b 2004Life expectancy at birth (years)c 2004Total adult literacy rated 2000–2004gNet primary school enrolment/attendance (percent)e 1996–2004gPercent share of household Incomef 1993–2003g
1990200419902004Lowest 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 Africa188171112102697,56128,2634,8336114660601257
Eastern and Southern Africa16714910595348,83313,3711,9928364663651159
Western and Central Africa209191119109348,72814,8922,8443994658551353
Middle East and North Africa81565944371,3849,6205392,3086867791746
South Asia1299289671,459,30537,0523,4096006358742143
East Asia and Pacific583643291,937,05829,9321,0781,6867190961647
Latin America and Caribbean54314326548,27311,6743623,6497290931059
Industrialized countries10695956,31510,8396532,23279951942
Developing countries1058772595,166,574119,66310,4111,5246577801550
Least developed countries18215511598741,59727,8234,3133455254601846
Child protection by selected characteristics, selected years 1986–2004
Countries and territoriesChild labour (5-14 year) 1999–2004a, gChild marriage 1986–2004b, gBirth registration 1999–2004c, gFemale genital mutilation/cutting 1998–2004d, g
Womene (15-49 years)Daughtersf
Afghanistan34h31h38h43  6 12  4
Albania232619 99 99 99
Angola222123 29 34 19
Armenia191231 97100 94
Azerbaijan 8 9 7 97 98 96
Bahrain 5 6 3
Bangladesh 710 4654472  7  9  7
Benin26h23h29h372545 70 78 661713206
Bolivia212220262237 82 83 79
Bosnia and
Herzegovina111210 98 98 99
Botswana1013 9 58 66 52
Brazil 7h 9h 4h242230 76
Burkina Faso57h52226277757732
Burundi24262317h36h17h 75 71 75
Cambodia251926 22 30 21
Cameroon515250433051 79 94 731.412
Central African Republic565457575459 73 88 63362941
Chad576055716574 25 53 18454346
Colombia 5 7 4211834 91 95 84
Comoros282729302333 83 87 83
Congo, Democratic Republic of the28h26h29h 34 30 36
Costa Rica50h71h29h
Cote d'lvoire353436332443 72 88 6045394824
Dominican Republic 911 6413751 75 82 66
Ecuador 6h 9h 4h26h21h34h
Egypt 6 6 519112497959947
El Salvador27
Equatorial Guinea272727 32 43 24
Gabon343049 89 90 87
Gambia222322 32 37 29
Georgia 95 97 92
Ghana57h57h58h281839 21547
Guinea654675 67 88 5699989954
Guinea-Bissau545454 42 32 47
Guyana192117 97 99 96
Haiti241831 70 78 66
India141415462655 35 54 29
Indonesia 4h 5h 4h241533 55 69 43
Iraq 811 5 98 99 97
Jamaica 2 3 1 96 95 96
Kenya262725251927 48h 64h 44h32213621
Korea, Democratic
People's Republic of 99 99 99
Lao People's Democratic
Republic242325 59 71 56
Lebanon 6 8 411

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.

Child protection by selected characteristics, selected years 1986–2004 [continued]
Countries and territoriesChild labour (5-14 year) 1999–2004a, gChild marriage 1986–2004b, gBirth registration 1999–2004c, gFemale genital mutilation/cutting 1998–2004d, g
Womene (15-49 years)Daughtersf
Lesotho171914 51 41 53
Madagascar303526392942 75 87 72
Maldives 73
Mali303328654674 48 71 4192909373
Mauritania10h373242 55 72 4271657766
Moldova, Republic of282928 98 98 98
Mongolia303030 98 98 97
Morocco11h161221 85 92 80
Myanmar 65h 66h 64h
Namibia10 910 71 82 64
Nepal313033563460 34 37 34
Nicaragua10h433655 81 90 73
Niger666964774686 46 85 405254
Nigeria39h432752 30 53 2019281410
Occupied Palestinian territory 98 98 97
Paraguay 8h10h 6h241832
Peru191235 93 93 92
Philippines111210141022 83 87 78
Romania 1h
Rwanda313130202119 65 61 66
Sao Tome and Principe141513 70 73 67
Senegal333630361553 62 82 51
Sierra Leone575757 46 66 40
South Africa 8 512
Sri Lanka14h10h15h
Sudan13141227h19h34h 64 82 4690928858
Suriname 95 94 94
Swaziland 8 8 8 53 72 50
Syrian Arab Republic 8h10h6h
Tajikistan181917 75 77 74
Tanzania, United Republic of323430392348  6 22  31810207
Timor-Leste 4h 4h 4h 22 32 20
Togo606259311741 82 93 78
Trinidad and Tobago 2 3 234h37h32h 95
Tunisia10h 7h14h
Turkmenistan 912 7
Uganda343433543459  4 11  3
Venezuela 7 9 5 92
Viet Nam23232211 513 72 92 68
Zambia111011423249 10 16  6
Zimbabwe26h292136 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 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.

characteristics, selected years 1986–2004 [continued]
Countries and territoriesChild labour (5-14 year) 1999–2004a, gChild marriage 1986–2004b, gBirth registration 1999–2004c, gFemale genital mutilation/cutting 1998–2004d, g
Womene (15-49 years)Daughtersf
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 Africa36373440254838553338314224
    Eastern and Southern Africa323429362143324428
    Western and Central Africa41414145285641593529292919
Middle East and North Africa 9 9 7
South Asia141415462754304725
East Asia and Pacific10i11i10i20i12i25i65h77i56i
Latin America and Caribbean1111 8252431829280
Industrialized countries
Developing countries18i18i17i36i22i45i45h62i35i
Least developed countries282926503357324428


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
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 indicatorsEconomic indicators
    Total population (2004)956,315,0006,374,050,000Gross national income per capita (US$, 2004)32,2326,298
Population under 18 (2004)205,133,0002,181,991,000Percentage of population living on less than $1 a day (1993–2003a)21
Population under 5 (2004)54,200,000614,399,000Percentage share of central government expenditure (1993–2004a) allocated to:
Survival    Health1613
Life expectancy at birth (2004)7967    Education45
Infant mortality rate (under 1), per 1,000 live births (2004)554    Defence1111
Under-5 mortality rate, per 1,000 live births (2004)679Percentage share of household income (1993–2003a):
Under-5 mortality rate, average annual rate of reduction (1990–2004)3.61.3    Lowest 40 percent1918
Maternal mortality ratio, per 100,000 live births (2000, adjusted)13400    Highest 20 percent4243
Health and nutritionHuman Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS)
Percentage of infants with low birthweight (1998–2004a)716Adult prevalence rate (15–49 years, end 2003)0.41.1
Percentage of under-5s who are moderately or severely underweight (1996–2004a)26Estimated number of adults and children (0-49 years) living with HIV/AIDS (2003)1,600,0037,800,000
Percentage of population using improved drinking water sources (2002)10083Estimated number of children (0-14 years) living with HIV/AIDS (2003)170,0002,100,000
Percentage of population using adequate sanitation facilities (2002)10058Estimated 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)84Birth registration (1999–2004a)45b
    Diphtheria/pertussis/tetanus (DPT3)9678    Rural35b
    Polio (polio3)9480Child marriage (1986–2004a)36b
    Measles9276    Urban22b
    Hepatitis B (hepB3)6349    Rural45b
    Haemophilus influenzae (Hib3)92Child labour (5-14 years, 1999–2004a)18b
Education    Male18b
Percentage of primary school entrants reaching grade 5 (administrative data; 2000–2004a)79Women
Net primary school attendance ratio (1996–2004a)Adult literacy parity rate (females as a percentage of males, 2000–2004a)86
    Male76Antenatal care coverage (percentage, 1996–2004a)71
    Female72Skilled attendant at delivery (percentage, 1996–2004a)9963
Net secondary school attendance ratio (1996–2004a)Lifetime risk of maternal death (2000) 1 in …4,00074
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.


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 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
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 indicatorsEconomic indicators
    Total population (2004)5,166,574,0006,374,050,000Gross national income per capita (US$, 2004)1,5246,298
Population under 18 (2004)1,925,281,0002,181,991,000Percentage of population living on less than $1 a day (1993–2003a)2221
Population under 5 (2004)548,486,000614,399,000Percentage share of central government expenditure (1993–2004a) allocated to:
Survival    Health413
Life expectancy at birth (2004)6567    Education115
Infant mortality rate (under 1), per 1,000 live births (2004)5954    Defence1011
Under-5 mortality rate, per 1,000 live births (2004)8779Percentage share of household income (1993–2003a):1518
Under-5 mortality rate, average annual rate of reduction (1990–2004)1.31.3    Lowest 40 percent
Maternal mortality ratio, per 100,000 live births (2000, adjusted)440400    Highest 20 percent5043
Health and nutritionHuman Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS)
Percentage of infants with low birthweight (1998–2004a)1716Adult prevalence rate (15–49 years, end 2003)1.21.1
Percentage of under-5s who are moderately or severely underweight (1996–2004a)2726Estimated number of adults and children (0-49 years) living with HIV/AIDS (2003)34,900,0037,800,000
Percentage of population using improved drinking water sources (2002)7983Estimated number of children (0-14 years) living with HIV/AIDS (2003)2,100,0002,100,000
    Urban9295Estimated number of children (0-17 years) orphaned by HIV/AIDS (2003)
    Rural7072Child protection
Percentage of population using adequate sanitation facilities (2002)4958Birth registration (1999–2004a)45b45b
Percentage of 1-year-old children immunized (2004) against:    Urban62b62b
    Tuberculosis (BCG) (bacillus of Calmette and Guerin)8484    Rural35b35b
    Diphtheria/pertussis/tetanus (DPT3)7678Child marriage (1986–2004a)36b36b
    Polio (polio3)7980    Urban22b22b
    Measles7476    Rural45b45b
    Hepatitis B (hepB3)7649Child labour (5-14 years, 1999–2004a)18b18b
    Haemophilus influenzae (Hib3)    Male18b18b
Education    Female17b17b
Percentage of primary school entrants reaching grade 5 (administrative data; 2000–2004a)7879Women
Net primary school attendance ratio (1996–2004a)Adult literacy parity rate (females as a percentage of males, 2000–2004a)8486
    Male7676Antenatal care coverage (percentage, 1996–2004a)7171
    Female7272Skilled attendant at delivery (percentage, 1996–2004a)5963
Net secondary school attendance ratio (1996–2004a)    Lifetime risk of maternal death (2000) 1 in …6174
Adult literacy rate (2000–2004a)7778

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 death. 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)
Sierra Leone2831Kiribati6566Bulgaria15131
Niger2593Namibia6368Serbia and Montenegro15131
Afghanistan2574Marshall Islands5969Dominica14135
Liberia2355Solomon Islands5670Saint Lucia14135
Somalia2256Korea, Democratic People's Republic of5571Seychelles14135
Mali2197Sri Lanka14135
Congo, Democratic Republic of the2058Mongolia5272The former Yugoslav Republic of Macedonia14135
Equatorial Guinea2049Maldives4674Bahamas13140
Guinea-Bissau20310Georgia4575Costa Rica13140
Chad20012Morocco4377Antigua and Barbuda12143
Côte d'lvoire19414Algeria4079Kuwait12143
Central African Republic19315Vanuatu4079Latvia12143
Burkina Faso19216Belize3981Malaysia12143
Malawi17519Iran (Islamic Republic of)3883Brunei Darussalam9150
Swaziland15621Cape Verde3686Chile8152
Cambodia14126Dominican Republic3290United Arab Emirates8152
Togo14027Turkey3290United States8152
Tanzania, United Republic of12631Peru2997Canada6162
Iraq12533El Salvador2898Ireland6162
Madagascar12335Moldova, Republic of2898Korea, Republic of6162
Sao Tome and Principe11838Saudi Arabia27101Netherlands6162
Tajikistan11838Ecuador26104New Zealand6162
Haiti11740Tonga25105United Kingdom6162
Ghana11242Occupied Palestinian Territory24107Belgium5172
Myanmar10645Micronesia (Federated States of)23110France5172
Turkmenistan10346Viet Nam23110Germany5172
Pakistan10147Saint Vincent and the Grenadines22112Greece5172
Papua New Guinea9348Colombia21113Italy5172
Gabon9149Cook Islands21113Liechtenstein5172
India8552Russian Federation21113Spain5172
Lao People's Democratic Republic8353Saint Kitts and Nevis21113Switzerland5172
Thailand21113Czech Republic4185
Lesotho8254Bosnia and Herzegovina15131Timor-Leste8056
  • 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-5 mortality rate (2004)Under-5 mortality rate (2004)Under-5 mortality rate (2004)
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)
Nepal7659Trinidad and Tobago20120San Marino4185
Kyrgyzstan6864Uruguay17129Holy SeeNo data
South Africa6765Syrian Arab Republic16130NiueNo data
Libyan Arab Jamahiriya20120Japan4185
  • 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 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.

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


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 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.


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 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 supply493.4
Transfer implementation10.7
Opportunity costs246.8
    Total costs760.3
Economic benefits
    Total benefits5,106.4
Net economic benefit (total benefits—total costs)4,346.1
Transfer payments213.6
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 laborGlobal 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 children1,200
Children in forced & bonded labor5,700
Children in armed conflict  300
Children in prostitution & pornography1,800
Children in illicit activities  600

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 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 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.


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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Women and Children in Poverty