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Children Around the World

chapter 10

Childhood should be a time of nurturing, growing, learning, playing, and preparing for adulthood. For many children, childhood is essentially a carefree, positive experience. For many others, however, even surviving childhood is a challenge.


In 1990 children from all over the world met with more than seventy world leaders at the United Nations (UN) in New York City to ask for a better future for the children of the world. They determined that four of the main problems that face children throughout the world are death, disease, hunger, and illiteracy. Based on this meeting, the United Nations International Children's Emergency Fund (UNICEF) set goals it hoped to achieve by the year 2000. UNICEF goals for the year 2000 included reducing the death rates for children under the age of five by one-third, as well as ensuring access to prenatal care for all women, making family-planning education and services available to all couples, and increasing recognition of the special health and nutritional needs of women at all life stages.


According to the U.S. Census Bureau report World Population Profile: 2002 (2004), the global under-age-five mortality rate in 2002 was seventy-seven per one thousand live births. In more developed countries the mortality rate was ten per one thousand live births for children under five; in less developed countries the under-five rate was eighty-five per one thousand live births. The global AIDS epidemic is responsible for a rise in child mortality rates in many less-developed countries. In some sub-Saharan African countries, the infant mortality rates have doubled due to AIDS. Countries torn by war, disease, or famine also have high child mortality rates. (See Figure 10.1.)

Political upheaval around the world in the late twentieth century (including in Bosnia, Somalia, Rwanda, Kosovo, Eastern Europe, and the former Soviet Union) subjected untold numbers of children to war, hunger, injury, and death. UNICEF estimated that in the late 1990s alone, 1.5 million children were killed in armed conflicts and four million more were disabled, maimed, blinded, or braindamaged. At least five million became refugees and twelve million more were uprooted from their communities. Many other children suffered harm to their health, nutrition, and education as conflicts destroyed their countries' crops, schools, clinics, and infrastructure.

In the early twenty-first century UNICEF made the humanitarian situation of the children of Iraq a priority. In 2003 Iraq was at war for the third time in twenty years—this time with the United States—making conditions for Iraqi children even worse than they had been under the previous twelve years of United Nations sanctions. Even before the war, one in eight Iraqi children died before his or her fifth birthday. After the initial wave of combat ended, UNICEF determined that 8% of children in Iraq suffered from acute malnutrition, double the percentage from just one year before. Children in Iraq were injured or killed daily from playing with live ammunition that littered the cities and countryside. And no immunizations had been available since before the start of the war.

the unicef goals. The UNICEF goal was to reduce the child mortality rate to seventy deaths per one thousand live births, or to two-thirds of the 1990 level—whichever was less—by 2000. The objective for 2015 was for fewer than forty-five deaths per one thousand births—a goal that most experts consider ambitious.

progress toward goals and the future. In 1999 the United Nations invited countries around the world to review the progress they had made since the 1990 World Summit for Children and to submit a report. The results were summarized in two 2001 UN reports, Progress since the World Summit for Children: A Statistical


Report and We the Children: Meeting the Promises of the World Summit for Children.

The UN reported that the average global under-five mortality rate declined by 11%, from ninety-three deaths per one thousand live births in the early 1990s to eighty-three deaths per one thousand births in 2000, and sixty-three countries achieved the targeted one-third reduction. Looking ahead to 2010, the UN predicted that more than half of all under-five deaths will occur in sub-Saharan Africa, where the child mortality rate in 2002 was 153 per one thousand live births. High rates of HIV/AIDS and low immunization coverage due to weak health care systems contributed to the high child mortality rate there.


Estimates of the proportion of deaths of children under age five caused by various factors are uncertain, because often vital registration systems that provide cause of death are nonexistent in developing countries, and often there are multiple conditions leading to death. It is estimated that more than half of childhood deaths globally are due to disease and other preventable conditions: diarrhea, respiratory infections and pneumonia, measles, and newborn tetanus. Malnutrition is a factor in half of all of these deaths.

UNICEF hoped to eradicate polio by 2000; eliminate tetanus in newborns; eliminate guinea worm disease; reduce deaths due to acute respiratory infection by one-third among children under five; reduce measles cases by 90% and measles deaths by 95%; cut deaths from diarrhea among children under five in half; and make safe water and sanitation available to every family. Also, immunization rates were to be maintained at "a high level."

progress report. The UN reported in Progress since the World Summit for Children that the results of efforts to reduce childhood disease worldwide were mixed. Polio was nearing eradication, tetanus deaths of newborns had decreased by more than half from 470,000 to 215,000, guinea worm infection—a parasite—had dropped by 88% worldwide and had been eradicated in India, and deaths from diarrhea had been cut in half. Although reported annual cases of measles had declined by 40%, measles continued to be a major killer of children in sub-Saharan Africa and South Asia because many children in those regions were not immunized. Over a billion people still lacked access to safe drinking water, and 2.4 billion people lacked access to sanitation facilities (although that coverage had increased, from 51% to 61%). In more than forty countries, fewer than half the children with acute respiratory infection were taken to the doctor to be treated with antibiotics. Immunization levels globally remained above 70% through the 1990s (72% in 1999), but in sub-Saharan Africa less than half of the children received routine immunizations in 2000.

sexually transmitted diseases and hiv/aids. According to the World Health Organization (WHO) fact sheet "Young People and Sexually Transmitted Diseases" (December 1997), 333 million new cases of sexually transmitted diseases (STDs) occur worldwide each year, and at least one-third of them (111 million) are contracted by young people under twenty-five years old. Adolescents are at high risk for STDs because they tend to engage in short-term relationships and do not use condoms consistently. In some countries cultural expectations encourage young men to express their sexual masculinity at a young age, have multiple partners, or visit prostitutes, increasing the risk of STDs and AIDS.

In countries like Thailand, Guatemala, and Ecuador, young men are as likely to experience their first inter-course with a prostitute as with a girlfriend or wife. In some countries girls are sold into prostitution. Throughout Latin America, sexual activity begins earlier for males than for females, and first partners are frequently older women. These factors potentially jeopardize the reproductive health of young men by increasing the number and type of their sexual contacts.

Cultural factors can also make young women vulnerable to STDs. When young women are paired with older men with more experience and more prior sexual contacts, they are more likely to become infected. They are also less likely to be able to demand condom use. Furthermore, STDs are often asymptomatic in women, and young women often lack the information to identify STD symptoms when they do encounter them.

Sexually transmitted diseases increase the risk of HIV transmission as much as fivefold. The WHO, in The World Health Report 2004—Changing History (2004), reported that by 2004 thirty-four to forty-six million people were living with HIV/AIDS, and more than twenty million people had already died of the disease. Of the five million people who became infected in 2003 alone, seven hundred thousand were children, infected by transmission from HIV-infected mothers during pregnancy, birth, or breastfeeding. Because of lack of treatment of HIV-positive pregnant women, almost one-third of babies born to HIV-infected mothers in sub-Saharan Africa contract HIV.

One impact of AIDS and HIV on children is the loss of one or both parents to the disease. A joint U.S. Agency for International Development (USAID), UNICEF, and UNAIDS report, Children on the Brink 2004 (July 2004), noted that at the end of 2003, fifteen million children had lost one or both parents to AIDS, up from 11.5 million just two years previously.

Other consequences of the epidemic are also dire. In The World Health Report 2004—Changing History, WHO emphasized that people in poverty are the most likely to become infected and are also the hardest hit by the suffering caused by HIV/AIDS. The financial burden of the disease forces poor families even deeper into poverty, causing them to turn in desperation to child labor, sale of assets, and migration. Decreasing numbers of working adults in the African countries with the most AIDS cases increases the numbers of children and elderly people who depend on each wage earner. And, WHO argued, as children and adolescents watch their parents and other adults die, the psychological impact is immeasurable; in addition, the high rate of premature deaths of young adults "weakens the process through which human capital—people's experience, skill and knowledge—is accumulated and transmitted across generations." It would be difficult to overestimate the impact the epidemic is having on the countries most affected.

Hunger and Malnutrition

According to 2001 UNICEF data, an estimated 150 million children under age five in developing countries were malnourished. Malnutrition contributes to about half of child deaths globally, because malnourished children have low resistance to common infections. In 1990 UNICEF set as one of its goals the reduction of malnutrition among children under five by 50% by the year 2000. Although this goal was not achieved, prevalence of low weight in developing countries dropped from 32% to 28% between 1990 and 2000. However, South Asia and sub-Saharan Africa still suffer high malnutrition levels. In South Asia nearly half of all children under age five were underweight in 2000. Half of all malnourished children lived in South Asia, and another one-fifth in sub-Saharan Africa.

Other UNICEF goals related to nutrition were the elimination of vitamin A deficiency, which can cause blindness, and the elimination of iodine deficiency, which can cause mental retardation. According to UNICEF data, one million child deaths were prevented between 1998 and 2000 simply by providing vitamin A supplements. In addition, the goal of elimination of iodine deficiency disorders encouraged programs that increased the use of iodized salt from 20% of households in the developing world to 70% in 2000.

Education and Illiteracy

According to UNICEF's report The State of the World's Children 2004, 121 million primary-school-age children worldwide were not in school. The children most likely not to attend school were children who were working; those who had been affected by HIV/AIDS, conflict, or disability; those who were poor or minorities; and those who lived in rural areas. Worldwide, girls were less likely to receive education than boys. UNICEF argues that the negative effects of not attending school are greater for girls than for boys—mothers' lack of education puts the next generation in danger of repeating the cycle, and uneducated girls are at a greater risk for sexual exploitation and exposure to sexually transmitted diseases and HIV/AIDS.

Education of girls has a big impact on the next generation. According to the UN, fertility rates decline as education rises. Children of mothers with no education are more than twice as likely to die or to be malnourished than are children of mothers with a secondary or higher-level education. Education for girls also leads to reduced infant and mother mortality, as well as better nourished and healthier children and families.

The 2000 World Education Forum in Dakar, Senegal, underscored the importance of ensuring education for girls and women. Following that conference, initiatives were formed with the goal of accelerating progress in girls' education and achieving the Millennium Development Goal of gender parity in primary and secondary education by 2005: thirteen agencies formed the United Nations Girls' Education Initiative; and UNICEF launched the "25 by 2005 Girls Education Campaign," which focuses on getting girls into schools in twenty-five specified countries.

In spite of formal commitments by governments, funding for elementary education generally receives low priority, and, according to The State of the World's Children 2004, when money gets tight, girls' education is sacrificed first. We the Children reported that only a small percent of government budgets in the developing world and less than 2% of all international aid for development are directed toward elementary education. Many countries are unable to meet their educational goals because war or political conflicts and the high cost of HIV/AIDS are decimating their budgets.


In 2002 29% of the world's population of six billion people were fourteen or younger, but the proportion of young people to the total global population is projected to decrease until 2050 (Global Population Profile: 2002, U.S. Census Bureau, International Population Reports WP/02, 2004). The population pyramids of regions around the world, however, reflected remarkable diversity in the age makeup of populations. (See Figure 10.2.) More than one-third of the population in the Middle East/North Africa (34.6%) and almost half the population in Sub-Saharan Africa (43.8%) were fourteen years old or younger.

Birth Rates for Teens and Adults

According to the United Nations report World Population Prospects: The 2002 Revision: Highlights (, in 2000 there were 2.7 births per woman, but there were great regional differences. Fertility rates were far lower in developed nations than in developing countries. The forty-nine least-developed countries had a fertility rate of 5.46 children per woman, well above the global population replacement rate of 2.3. In the most developed regions the total fertility rate was 1.58 children per woman, well below the population replacement rate for developed countries of 2.1. In these countries more people died each year than new children were born; their populations were either declining or would have been declining if not for immigration from other countries.

According to the U.S. Census Bureau's Global Population Profile, a few regions contribute most of the world's population increase. Of the 128.6 million babies born in 2002, one of every three was born either in India (24.6 million) or mainland China (17.2 million). Another one-third of the globe's babies were born in the rest of Asia (43.5 million). More than 26.5 million babies were born in sub-Saharan Africa, nearly 11.3 million in Latin America and the Caribbean, and 8.5 million in the Near East and North Africa. Figure 10.3 shows the contributors to world population by region and the proportion of growth attributable to the largest contributors in each region. According to the United Nations report, World Population Prospects: The 2002 Revision, by about 2050, fertility levels in the majority of developing countries are expected to fall below the population replacement rate.

Globally, the period of adolescence is lengthening. Girls are reaching puberty at a younger age at the same time that the age of marriage is rising. Thus, young people face a longer period of time during which they are sexually mature and may be sexually active. Many youths are postponing marriage to stay in school or for socioeconomic reasons. As a consequence, many first pregnancies and first births occur outside of marriage.

The UN predicts that between 2000 and 2005 about thirteen million babies will be born worldwide to young women fifteen to nineteen years old. About 9.5 of ten of these babies (12.8 million) will be born in the developing countries of Asia, Africa, and Latin America. The proportion of teens having a child by the age of twenty in these regions is high—around 50% in West Africa and South-Central Asia, and one-third in Latin America. The UN reported that in sub-Saharan Africa, adolescent females (aged fifteen to nineteen) had a fertility rate in 2002 of 116 births per one thousand women, far higher than in any other region of the world. The number of adolescent women capable of bearing children was projected to increase in the less developed countries between 1998 and 2025. Because childbearing among older women has declined more rapidly than among teens, a larger proportion of all births now occur among adolescents.

Among developed countries the United States has the highest rate of teen childbearing. According to the UN, the five countries with the lowest teenage birth rates are Korea, Japan, Switzerland, the Netherlands, and Sweden; all have teen birth rates of fewer than seven per one thousand.

Young women are more likely than mature women to have pregnancy-related complications that can endanger



their lives or lead to infertility. Maternal mortality rates for women fifteen to nineteen may be double those of older women, and young women are also more likely to consider unsafe late-term abortions as an alternative to carrying a pregnancy to term.


Children in Families

The structure of family life is undergoing profound change around the world. Trends such as single motherhood, rising divorce rates, smaller households, and increased poverty among women and their children are not unique to the United States but are a worldwide phenomenon. For example, the percentage of children in single-parent families among member countries of the Paris-based Organisation for Economic Co-operation and Development (OECD) was 21.3% for Sweden, 20% for the United Kingdom, and 16.6% for the United States (UNICEF Innocenti Research Centre, Florence, Italy, A League Table of Child Poverty in Rich Nations, June 2000). OECD countries with the lowest percentage of children in single-parent families were Turkey (0.7%), Spain (2.3%), and Italy (2.8%).

Economic Status

According to Social Policies, Family Type, and Child Outcomes in Selected OECD Countries (2003), a report from the Organisation for Economic Co-operation and Development, child poverty was of particular concern in the United States and the United Kingdom because in those two countries poverty among young children was more pronounced and persistent than among the adult population. UNICEF Innocenti Research Centre's A League Table of Child Poverty in Rich Nations (2000) reported that children in the United States were more likely to experience poverty than children in every other industrialized nation except Mexico. More than 22% of American children lived in households with incomes below 50% of the national median. In comparison, only 2.6% of Swedish children lived in poor households. UNICEF concluded that one in six of the "rich world's" children (forty-six million) lived in poverty.

Infant Mortality

Differences in infant mortality rates reflect differences in the health status of women before and during pregnancy, and the quality of health care available to women and their infants. Although the United States greatly reduced its infant mortality rate from twenty-six per one thousand live births in 1960 to 6.8 per one thousand live births in 2001, in 1999 the nation ranked twenty-eighth out of thirty-seven among developed countries with at least one million population. (See Table 10.1.) The U.S. infant mortality rate for children twelve months old or younger in 1999 was 7.1 deaths per one thousand births, one of the highest in the industrialized world. In comparison, the 1999 rate in Japan was 3.4 deaths per one thousand births, and Hong Kong, the top-ranked country, reported less than half the U.S. rate (3.1).


Child labor is a problem for which the world community has sought solutions and has seen some successes, according to the International Labor Organization (ILO). The ILO, created in 1919 and incorporated into the UN in the 1940s, brings together unions, employers, and governments from UN member states to pursue safe and just work environments. In 2002 the ILO report "Every Child Counts: New Global Estimates on Child Labour" estimated that 211 million five- to fourteen-year-old children worked in 2000, a 16% decrease from the 250 million who were working in 1996. Nearly one-fifth (17.6%) of the world's five- to fourteen-year-olds worked and about one-third (seventy-three million) of working children were under the age of ten.

According to another ILO publication, Investing in Every Child: An Economic Study of the Costs and Benefits of Eliminating Child Labor (2004), 60.6% of working

TABLE 10.1

Infant mortality rates and international rankings, selected countries, selected years 1960–99
(Data are based on reporting by countries)
International rankings1
Country2 1960 1970 1980 1990 1995 1998 19993 1960 1999
Infant4 deaths per 1,000 live births
— Data not available.
1Rankings are from lowest to highest infant mortality rates (IMR). Countries with the same IMR receive the same rank. The country with the next highest IMR is assigned the rank it would have received had the lower-ranked countries not been tied, i.e., skip a rank. Some of the variation in infant mortality rate is due to differences among countries in distinguishing between fetal and infant deaths.
2Refers to countries, territories, cities, or geographic areas with at least 1 million population and with "complete" counts of live births and infant deaths as indicated in the United Nations Demographic yearbook.
3Rates for lsrael and New Zealand are from 1998.
4Under 1 year of age.
5Rates for 1990 and earlier years were calculated by combining information from the Federal Republic of Germany and the German Democratic Republic.
6Includes data for East Jerusalem and Israeli residents in certain other territories under occupation by Israel military forces since June 1967.
7Excludes infants born alive after less than 28 weeks' gestation, of less than 1,000 grams in weight and 35 centimeters in length, who die within 7 days of birth.
Note: Some rates were revised.
source: "Table 25. Infant Mortality Rates and International Rankings: Selected Countries, Selected Years 1960–99," in Health, United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, 2003, (accessed September 16, 2004)
Costa Rica67.865.420.315.313.312.611.83334
Czech Republic20.020.216.910.
England and Wales22.518.512.
Hong Kong41.519.
New Zealand22.616.713.
Northern Ireland27.222.913.
Puerto Rico43.327.918.513.412.710.510.62733
Russian Federation722.017.618.216.417.136
United States26.

children (110.4 million) lived in the Asia-Pacific region, 20.8% (37.9 million) lived in sub-Saharan Africa, and 9% (16.5 million) lived in Latin America and the Caribbean.

Every Child Counts noted that 55% of working children under age twelve worked in hazardous situations. In Sri Lanka, for example, those hazards resulted in more child deaths each year from pesticide poisoning than from malaria, tetanus, diphtheria, whooping cough, and polio combined. Child-trafficking, forced labor, armed conflict, prostitution, pornography, and illegal activities—what the authors called the "unconditional worst forms of child labor"—employed 8.4 million of the world's children.

Working conditions for children in overseas factories became a growing concern in the United States in the early 1990s as imports of apparel steadily climbed. A 1996 ILO report, "Child Labour: Targeting the Intolerable," noted that more than half the $178 billion worth of garments sold in the United States in 1995 were imported, compared with 30% in 1980. By 1996, thirty-six of the forty-two largest apparel companies had adopted formal standards prohibiting child labor, and the number of children working overseas to make apparel sold in the United States appeared to be decreasing. However, the ILO report stressed that American companies did not adequately enforce their own standards. Child labor remained pervasive in some countries, particularly in Asia, where children in India, Pakistan, and the Philippines worked for small contractors or in their parents' homes.

Finding Solutions

A 2002 report from the U.S. Department of Labor ("Advancing the Campaign against Child Labor, Volume II: Addressing the Worst Forms of Child Labor") described some projects that have been implemented in Nicaragua, Costa Rica, and Nepal to eradicate the worst and most hazardous child labor. The projects were carried out by the ILO with financial contributions from the U.S. Department of Labor. For example, one project undertaken in the poor Municipality of León in Nicaragua in the fall of 1998 was called "The Elimination of Child Labor and Risk of Sexual Exploitation of Girls and Teenagers in the Bus Station of León." A four-phase action plan was developed. First the bus station was identified as a center of informal trade, where child vendors and beggars congregated. Some of the girls who gathered there were victims of abuse, and some depended on income from prostitution to survive. Influential people in the community were educated about the physical and mental consequences of child commercial sexual exploitation and their role in helping the children. Families that participated in the project were given loans to make improvements to an existing business or start a new business. Finally, attention was devoted to rehabilitation of the girls and their families (most often, the families were headed by poverty-stricken single mothers). With a U.S. contribution of $148,940, forty-nine girls were removed completely from commercial sexual exploitation work, and fifty-nine girls working in other activities decreased their workloads and began attending school.

The ILO undertook a study published in 2004 (Investing in Every Child: An Economic Study of the Costs and Benefits of Eliminating Child Labor) that estimated the costs associated with eliminating child labor. The study found that the economic benefits associated with a more highly educated and healthier populace would far out-weigh the costs of supplying quality education for all children, of defraying the loss of income from child labor for families, and of the social and governmental interventions needed to eliminate the worst forms of child labor. The ILO hoped to give countries an idea of the economic benefits of eliminating child labor.

The U.S. Department of Labor produced a 2004 report that detailed the progress made around the world in eliminating the worst forms of child labor—slavery, prostitution or the production of pornography, production or trafficking of drugs, or work that is harmful to the health, safety, or morale of children (2003 Findings on the Worst Forms of Child Labor, U.S. Department of Labor, Bureau of International Labor Affairs). The report noted that many governments (including those of Afghanistan, Indonesia, Nepal, Bulgaria, Haiti, and others) were implementing new trafficking laws meant to protect children from abduction, slavery, and forced prostitution; that the government of Costa Rica was at the forefront of global efforts to end the commercial sexual exploitation of children; that several countries (including Costa Rica, El Salvador, Honduras, Guatemala, Nicaragua, Panama, and the Dominican Republic) were working to eliminate hazardous child labor in agriculture; and that many governments (including those of Indonesia, Bulgaria, and Russia) were working to remove children from illegal activities like drug trafficking and provide them with education, counseling, and rehabilitation programs.

Many scholars who study the subject of child labor suggest that general economic development will help to reduce its prevalence. Anne O. Krueger, First Deputy Managing Director of the International Monetary Fund, summed this theory up in a speech before the attendees of the conference "National Security for the Twenty-first Century: Anticipated Challenges, Seizing Opportunities, Building Capabilities" in September, 2002:

Child labor is something prevalent in developing countries because the alternatives are so much worse: starvation or malnutrition, forced early marriages (for girls) or prostitution, or begging on the streets. Ample evidence suggests that parents in developing countries, like parents everywhere, choose schooling for their young when they can afford to do so, and the quickest path to that outcome is through more rapid economic growth.

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