STILL LEFT BEHIND? - Tracking children's progress against the pledge to Leave No One Behind - Save the Children UK
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STILL LEFT BEHIND? Tracking children’s progress against the pledge to Leave No One Behind
Save the Children fights for children every single day. Because every child should be able to make their mark on the world and build a better future for us all. We stand side by side with children in the toughest places to be a child. We do whatever it takes to make sure they survive, get protection when they’re in danger, and have the chance to learn. Acknowledgements This report was written by Lisa Wise, Alexis Le Nestour, Oliver Fiala and Beck Smith. We are grateful for invaluable inputs from colleagues across Save the Children including Kevin Watkins, Simon Wright, Kirsty McNeill, Amanda Lenhardt, José Manuel Roche, Richard Morgan, Catherine Woodin, Irene Dotterud-Flaa, Ulrika Cilliers, Katherine Richards, Claire Blanchard, Smita Barua, Michel Anglade and Pedro Hurtado. We would like to thank Mark Hereward and colleagues at UNICEF for their extremely helpful comments on an earlier draft of the report. Thanks also go to Katrina Kyselytzia and our inspiring girl champions for the foreword. We are also grateful for assistance and contributions from Ravi Wickremasinghe, Sue Macpherson, Dominik Danielewicz, Laila Khondkar, Ahmad Muhsen, Aya Abu Sitteh, Jenny Russell, Tanu Anand, Jorge Freyre, Ivonne Arica, Nina Raingold and Sarah Anderson. Published by Save the Children 1 St John’s Lane London EC1M 4AR UK +44 (0)20 7012 6400 savethechildren.org.uk First published 2018 © The Save the Children Fund 2018 The Save the Children Fund is a charity registered in England and Wales (213890) and Scotland (SC039570). Registered Company No. 178159 This publication is copyright, but may be reproduced by any method without fee or prior permission for teaching purposes, but not for resale. For copying in any other circumstances, prior written permission must be obtained from the publisher, and a fee may be payable. Cover photo: Girls at a primary school in Turkana, Kenya (Photo: Allan Gichigi/Save the Children) Typeset by Grasshopper Design Company Printed by Page Bros
Contents Foreword iv Executive summary v Leave No One Behind: the challenge and remarkable opportunity 1 New dawn or empty promise? 1 Uncounted and invisible 2 Proposing a way forward 3 The world’s missing millions 9 Children’s participation 9 Child Mortality: SDG Target 3.2 12 Accelerating progress for the most deprived and marginalised children 13 Child Malnutrition: SDG Target 2.2 16 progress for the most deprived and marginalised children 19 Child Marriage: SDG Target 5.3 20 Accelerating progress for the most deprived and marginalised girls 23 Birth Registration: SDG Target 16.9 24 Accelerating progress for the most deprived and marginalised children 26 Education: SDG Target 4.1 27 Accelerating progress for the most deprived and marginalised children 29 Conclusion and recommendations 31 Appendix: National progress towards the fulfilment of the Leave No One Behind pledge 33 Endnotes 39
Foreword
By Save the Children Girl Champions,
Xhorda from Albania, Saleha from India, and Maryam from Nigeria
In 2015, world leaders promised to Leave No One able to speak and use our voices to hold political
Behind. This means that everyone, everywhere and traditional leaders accountable for their words
should benefit from the Sustainable Development and their actions.
Goals, especially those who are missing out at the
The pledge to Leave No One Behind also means
moment. In our countries, there are many children
that everyone should play a role in reaching
who suffer from poverty, violence, discrimination
the unreached. The SDGs are a motivation for
and a lack of basic services. The Leave No One
us and our peers. They will significantly shape the
Behind principle understands that because these
world we inherit as adults and provide us with an
groups are prone to being excluded, extra effort
opportunity to work together to make the world
must be made to ensure that they are carried along.
a better place. We are currently working on issues
Most importantly, leaders and authorities must in our communities ranging from health, water and
focus on girls. The world over, girls continue to sanitation to girls’ education and empowerment.
suffer and face barriers to reaching their full
The work we do isn’t easy. But we know that we
potential simply because they are girls. Unless girls
won’t go far if we don’t take our friends, family
are educated and empowered, the world cannot
and community members along. The first step is to
progress. We want a world where girls have an
do our bit: we cannot expect others to join unless
equal opportunity, where they dream and also
we do. And once we come together, we can bring
make their dreams a reality.
about bigger change. Like Mahatma Gandhi said,
This report is about accountability for the pledge “be the change you want to see”.
to Leave No One Behind. It is important to hold
We can help lead the change. But we also need
authorities accountable for their promises. We as
our leaders to keep the promise they have made
children try hard to get those who take decisions
to people. Together, we need to make the poverty
to hear our voice on issues that concern us.
and discrimination that children face visible,
Children can understand our issues better than
understand it, and address it.
anyone else and can provide ideas on how to
improve them in our best interests. We want to be We children are part of the fight to ensure that
called upon for our suggestions when it comes to no child is left behind. Join us. Invest in our future.
issues that affect our well-being. We want to be
iv
Executive summary
Governments around the world are failing to honour a pledge to reduce extreme
inequalities in child survival, malnutrition, education, protection and other development
indicators. In 2015, world leaders signed up to the United Nations Sustainable
Development Goals (SDGs) – a set of 2030 targets for eradicating extreme poverty
in all its forms. As part of this agreement, governments committed to ensure that the pace
of change would be fastest for those left furthest behind. Evidence set out in this report
shows that progress to date has been limited, and that SDG monitoring and review is still
focusing on average change rather than those who are furthest behind. This neglect of
unfair inequalities threatens to derail the entire SDG project.
THE LEAVE NO ONE BEHIND PLEDGE: trends, we can only expect a marginal or no
reduction in these gaps by 2030.
A COMMITMENT TO PROGRESS
WITH EQUITY Child survival provides a stark illustration of
the challenge. On current trends there will still
The Leave No One Behind pledge lies at the heart be more than 4 million deaths of children under
of the SDG framework – a commitment ‘to reach the age of five in the year 2030, compared with
the furthest behind first’ and ensure that targets 5.6 million in 2016. Children in the world’s poorest
are met for all segments of society. Monitoring 20% of households are nearly 40% more likely to die
and delivering on this promise is not just a matter before their fifth birthday than the global average.
of equity and fulfilment of fundamental children’s Eliminating this wealth gap would save 4.1 million
rights. It is also a condition for achieving the 2030 lives between now and 2030. However, social
goals. Failure to narrow the gaps between the most disparities in child survival are narrowing far too
marginalised children and the rest of society is slowly. On current trends, the global gap is set to
acting as a brake on progress. fall by only three percentage points.
To illustrate this globally, this report presents In addition to global trends, we looked at what is
inequality trends for five key child poverty happening in individual countries, analysing trends
indicators – child mortality, malnutrition, child for marginalised segments of society including the
marriage, birth registration and primary education. poorest households, rural areas and girls. Our
For each of these, we calculated progress trends analysis shows that in 19 of the 45 countries that
for the world’s poorest 20% of households and are off‑track for achieving the minimum SDG targets
compared them to global average trends. The on child mortality for all segments of society, the
world’s poorest households are located in a mix of gap between the poorest children and the national
middle- and low-income countries. The majority – average is not set to close by the end of the century,
almost a third – are in India, comprising 486 million if at all. 228 million children live in these countries,
people. This is followed by Nigeria (127 million), and they include India and Nigeria, the two countries
Democratic Republic of Congo (71 million), with the highest numbers of child deaths in the world.
Indonesia (68 million) and China (63 million).
As this report argues, there is an urgent need
Across all of the indicators we analysed, we found for governments and aid donors to ensure
that inequality is a major barrier to progress, with that progress is not only fast, but also that it is
the world’s poorest households lagging considerably equitable. To achieve this, governments need to
behind global average rates of change. On current understand the extent of the problem. Yet, to
v
date, SDG monitoring is failing to systematically Girls in this group are 76% more likely to marry
STILL LEFT BEHIND?
track progress for the furthest-behind groups. before 18 than the global average, and this gap is
Governments, supported by the international set to close by a mere three percentage points by
community, must shift their attention from averages 2030. Eliminating this wealth gap would prevent
to focus on the progress that the children who are 20 million child marriages over the next 12 years.
furthest behind are making, and the extent to which Of 68 countries with data, none are set to achieve
they are catching up, or converging, with their more the SDG target for all segments of society by 2030.
advantaged peers.
Birth registration: If current trends continue,
Inequalities in child survival reflect deeper disparities there will still be 101 million children by 2030 across
in access to healthcare and the neglect of major the world under age five who do not officially
killers. Parents of the poorest children are often exist as they were not registered at birth. This
unable to meet the costs of health provision. undermines their access to essential services and
Pneumonia, for example, is the leading cause of rights, and increases their vulnerability to child
child deaths from infectious disease, killing 879,000 marriage and labour. Progress for the poorest
children in 2016, overwhelmingly concentrated in households needs to more than double to reach
South Asia and sub-Saharan Africa.1 If diagnosed the SDG target of universal registration by 2030.
early, the disease can be treated with antibiotics Eliminating the wealth gap between the poorest
that cost a mere $0.40.2 Pursuing equitable and the global average would see 28 million more
pathways towards universal health coverage is children registered by 2030.
essential, ensuring that everyone, and critically
Education: Progress for children in the poorest
the poorest and most marginalised, can access the
households needs to more than triple to ensure
good-quality health services they need without
all children complete primary school by 2030.
financial hardship.3
Eliminating the wealth gap between the poorest
Malnutrition is one of the most important and the global average would allow 31 million
indicators for national progress, providing insight more children to complete primary school over the
into how much support children receive in their next 12 years. However, this gap is set to fall by
early years. Here, too, social disparities loom only 5 percentage points by 2030 if current trends
large: being born into the world’s poorest 20% of continue. Of the 62 countries that are off track for
households increases the chance of being stunted achieving universal primary school completion for
by 60% among children under five. Worryingly, all segments of society, 55 will not see the gap
the gap between the poorest and the global between the poorest and the national average close
average is static. Of countries that have sufficient this century.
disaggregated data to compare trends, none are
on track for achieving the SDG target of ending
malnutrition by 2030 for all segments of society. In RAPID AND EQUITABLE PROGRESS
over two-thirds of these countries, social disparities IS POSSIBLE
are either widening or static.
While the global picture is one of stark failure to
For malnutrition, as for child survival, governments
combat indefensible and avoidable inequalities,
need to address underlying social disparities as
success stories point to what is possible. For
a matter of urgency. For the poorest 20% of
example, for child survival, 30% of the countries in
households the rate of decline needed to achieve
our sample are on track to achieve the SDG target
the SDG target has to increase ten-fold.
for all segments of society, including Bangladesh,
The picture is similarly bleak for the other indicators Indonesia, Vietnam and Nepal. For education,
of child development examined in this report. 23% of countries are on track. While no country is
on track for child marriage, Swaziland and Rwanda
Child marriage: Progress for girls in the poorest
are likely to only just miss the overall target, and
households needs to accelerate by a factor of 13 to
are seeing progress that is both fast and equitable.
reach the target of ending child marriage by 2030.
vi
RECOMMENDATIONS • Civil society organisations to collect
EXECUTIVE SUMMARY
and publish disaggregated data from their
The evidence presented in this report underscores programming, and demand and support
the need for countries and international agencies to participatory monitoring of progress for the
take urgent steps to implement the SDG pledge to furthest behind groups.
Leave No One Behind, pursuing equitable progress
through reaching the furthest behind groups first. Improving SDG monitoring and review is important
Improving monitoring and review processes so that and should incentivise and support action on
they track inequalities in a clear and systematic inequalities. But changes in policy and practice do
way is an important piece of the puzzle. It is only not have to wait for improvements in monitoring.
when inequality trends are made visible and are As well as monitoring inequalities and convergence,
understood that we can expect meaningful action governments and international aid agencies
and accountability. must implement and prioritise policies
Save the Children is therefore calling for that allow for accelerated progress with
governments and international agencies to enhanced equity.
track not just national and global average This should include:
progress, but also the pace at which • A review of financing and investment in children
disparities between socioeconomic groups at local, national and international levels, with
are narrowing. This must be done at international more resources focused on a per capita basis on
and national levels, and in ways that are systematic children in greatest need.
across indicators and accessible for members of • A renewed focus on inequality across all
the public. The graphs and calculations presented government and donor policies. For example:
in this report provide an illustration of how this – For child survival – pursuing universal health
could be done in practice at the international level. coverage, improving nutrition, and reversing
Save the Children’s new Group‑based Inequality neglect of diseases like pneumonia that are
Database (GRID) tools (https://campaigns. exacerbated by poverty and inequality.
savethechildren.net/grid) illustrate how progress • For education – preventing inequalities in
could be monitored nationally, allowing users learning outcomes from emerging in the
to create their own graphs of inequality and early years, and subsequently persisting
convergence trends for different countries and throughout childhood.
child development indicators. – Across the board – tackling gender
There is an urgent need for: inequalities and harmful social norms that
• National governments to use available survey often put the poorest girls at the very back
and other data to report on inequality and of the queue, and that make them vulnerable
convergence trends regularly and transparently, to fundamental rights violations such as
as well as to invest in filling data gaps. child marriage and other forms of
• The UN system and international gender‑based violence.
organisations to report on global and national
inequality and convergence trends, including
through the annual UN SDG Report and
High Level Political Forum.
vii
PHOTO: SEBASTIÁN ENRIQUEZ/SAVE THE CHILDREN Cindy, age 17, participates in the Schools Building Peace project in Mexico. The poster she is holding reads, “as children and adolescents, our voices must be heard and our recommendations should be put into practice”.
Leave No One Behind: the challenge
and remarkable opportunity
“As we embark on this great collective journey, we pledge that no one will be left behind.
Recognising that the dignity of the human person is fundamental, we wish to see the Goals
and targets met for all nations and peoples and for all segments of society. And we will
endeavour to reach the furthest behind first.”
Transforming Our World: The 2030 Agenda for Sustainable Development (paragraph 4)
NEW DAWN OR EMPTY PROMISE? poor countries to shine a spotlight on the most
deprived and marginalised groups, whose lack of
In 2015, world leaders came together to agree progress has historically been hidden from public
a roadmap for achieving global prosperity, and political scrutiny.
peace and sustainability. The 2030 Agenda for
The importance of this cannot be overstated,
Sustainable Development, including the Sustainable
particularly for children – a group that is
Development Goals (SDGs), is a rallying call for
systematically marginalised and disempowered
action to eradicate poverty in all its forms and
across the world, but in whom investment must
ensure that everyone has fair chances in life by
be prioritised if we are to realise the SDG vision
2030. It’s a call for the world’s 385 million children
of a more prosperous and peaceful future for all.
who still live in extreme poverty, and the millions
While the world has made good progress in recent
deprived of their right to education, health and
decades across key dimensions of child poverty,
protection, to be given the chance in life that they
devastating inequities – based on factors such as
deserve – a chance to live healthy and fulfilled lives
family income and resources, geography, gender,
and shape their own futures.4 To achieve that, the
identity and whether they have a disability – are
2030 Agenda calls for efforts to be focused on the
holding particular groups of children back. And
most deprived and marginalised people, putting
those groups of children growing up in conflict
their needs first.
situations and fragile states are among the most
It is this focus on the people who are furthest vulnerable and furthest behind of any in the
behind and on reducing inequality that sets the world.6 The Leave No One behind pledge is first
SDG agenda apart from predecessor agreements, and foremost a commitment to address these
and that holds promise for real, much-needed grossly unfair inequalities in development progress.
change. The Leave No One Behind pledge – a short Children’s life chances should not be determined
but all-important statement set out in the preamble by who they are or where they live.
of the Agenda – states that SDG targets should
The extent of inequalities in the world today is
be met for all segments of society, and that the
illustrated by new research presented in this report.
furthest behind should be reached first.
• Children in the world’s poorest income quintile
This pledge has the potential to revolutionise how are at 60% higher risk – almost twice as likely –
the world defines and strives for progress, in line of being stunted than the global average.
with international human and child rights principles • They are nearly 40% more likely to die before
of equity and non-discrimination.5 Its predecessor, their fifth birthday.
the Millennium Development Goals framework, • Girls in this group are 80% more likely to be
celebrated only global and national average change, married as children.
with a focus on developing countries. In comparison, • Children in this group are 15% less likely to
the 2030 Agenda is truly universal, forcing rich and complete primary school.7
1
If governments are committed to the SDGs, they UNCOUNTED AND INVISIBLE
STILL LEFT BEHIND?
need to get serious about addressing these rights
violations and closing these profoundly unjust Governments’ commitment to the SDGs should
inequalities in children’s basic life chances. start with a pledge to track and report to citizens
on the pace at which the life chances of all groups
Worryingly, we are seeing insufficient reduction
of children are progressing towards the 2030
in unfair inequalities across the world. If recent
goals, and at which the most marginalised children
trends continue, no low- or middle-income country
are converging or catching up with their more
in our sample is set to achieve the SDG targets
advantaged peers. This would allow governments
of eliminating stunting or child marriage for all
and their partners to assess where effort needs
segments of society by 2030.8 This report highlights
to be focused, and civil society organisations and
that, if recent trends continue, 119 million children
the public to hold them to account for change. If
under the age of five will still be stunted in 2030, and
conducted in ways that are open, participatory and
10 million girls will be married under the age of 18.
inclusive, monitoring and review processes have the
Only 30% of countries are on track to meet the
potential to help to raise public awareness about
global SDG child mortality target for all segments
issues of inequality and exclusion. The aim should
of society, and only 23% for universal primary
not be to build purely technocratic SDG monitoring
school completion. Put simply, if progress does not
processes, but rather to promote deliberation about
accelerate for the world’s poorest children, the
barriers and solutions, and thereby generate public
SDG targets will not be achieved.
and political will to drive change.
At the root of these trends is a failure by
Yet not enough is being done to get even the
governments and their donor partners to allocate
basic building blocks of transparent and accessible
sufficient resources to addressing harmful
monitoring of inequalities and convergence rates in
discrimination and to improving access to basic
place. A number of UN agencies are making efforts
services for the most deprived and marginalised
to monitor and report on trends in disaggregated
girls and boys. This includes the widespread failure
data, including for example the recent UNICEF
to tackle two issues that Save the Children has
report Progress for Every Child in the SDG era 11 and the
identified as critical: pneumonia, the world’s leading
World Health Organization’s Health Equity Monitor
infectious killer of children, and the education and
database and tools.12 But more needs to be done to
learning crisis that is entrenched in the early years, consolidate this work across sectors and agencies to
before children even start school. present a systematic, accessible and holistic picture
Three years on from the adoption of the Leave No of inequalities and rates of convergence for the
One Behind pledge there is very little sign of change furthest-behind groups, and place this at the heart
in policy, strategy and monitoring. Every year, of SDG monitoring.
government delegations head to the UN General The UN annual SDG Progress Report focuses on
Assembly in New York and to other summits to global, regional and national averages, with only
reaffirm their pledge to leave no one behind. Yet ad hoc reference to disaggregated data, often for
few have translated the pledge into public spending single data points rather than to highlight trends
commitments or into wider strategies for combating over time. The international SDG database mostly
the inequalities that are holding back the most contains data for global, regional and national
marginalised children.9 The pledge is at risk of averages, with limited disaggregation for selected
becoming empty rhetoric, paid lip service in global
indicators. The Inter-Agency and Expert Group on
meetings, but not accompanied by concrete changes
SDG indicators – the group mandated to define and
in policy or practice.
support the SDG indicator framework – established
Putting those children who are furthest behind first a work stream on data disaggregation in 2016.
is no easy task. It means collecting and reporting Their work, however, has lacked transparency and
disaggregated data to identify the furthest behind is moving at a slow pace. A background document
groups, facing often uncomfortable truths about on guidelines for data disaggregation is not set to
why they have been left behind, and allocating be submitted to the UN Statistical Commission
resources in new ways to reach and help them.10 But until March 2019 – nearly four years on from the
we must face these challenges head on; the future of establishment of the Leave No One Behind pledge.13
the world’s children depends on it.
2Reporting on progress for those who are furthest disaggregated data, and this is becoming available
LEAVE NO ONE BEHIND: THE CHALLENGE AND REMARKABLE OPPORTUNITY
behind is similarly weak at the national level, in for an increasing number of countries and
high-, middle- and low-income countries alike. indicators. New approaches for calculating and
Country reports (known as Voluntary National monitoring progress for the most deprived and
Reviews) presented at the UN High Level Political marginalised people must be explored, with trends
Forum – the body mandated to follow up and presented transparently, accessibly, regularly and
review SDG progress at the global level – have so systematically to gauge progress.
far tended to limit themselves to identifying which
As we argue in our 2016 report Towards a New
groups are furthest behind, rather than tracking
Accountability Paradigm, robust global monitoring and
their progress over time.
accountability must operate across multiple levels,
This lack of progress in incorporating the Leave maximising information and accountability flows
No One Behind pledge into SDG monitoring and from local and national through to regional and
reporting has to change. To address the devastating international levels.14 In line with this, in this report
inequalities that are keeping untold millions of the we present approaches for monitoring progress for
world’s most deprived and marginalised children in the groups that are furthest behind both globally
poverty, we have to make them visible and monitor and nationally. We illustrate these approaches using
progress over time. five SDG indicators:
• under-five child mortality
• under-five stunting
PROPOSING A WAY FORWARD • child marriage
• birth registration
This report illustrates what SDG data monitoring • primary school completion.
focused on the Leave No One Behind pledge could
look like in practice. It proposes steps that could These indicators were selected as they provide
be taken by technical stakeholders involved in SDG critical insights into the rights and welfare of
monitoring and review processes. children across the crucial domains of health,
protection and education, and on the basis
The 2030 Agenda sets out guiding principles for of availability of internationally comparable
SDG monitoring and review processes (see Box 1). disaggregated data. It is not a comprehensive or
These make clear that it is no longer acceptable exhaustive list of the indicators that we deem to
to focus on national or global averages in SDG be important but, taken together, they provide an
reporting, particularly as current approaches important picture of the chances that children have
and technology allow for more and better in life to survive, thrive and claim their rights.
BOX 1: A SELECTION OF THE 2030 AGENDA GUIDING PRINCIPLES
FOR SDG MONITORING AND REVIEW
Follow-up and review processes at all levels will • They will be rigorous and based on evidence,
be guided by the following principles: informed by country-led evaluations and data
• They will be open, inclusive, participatory which is high-quality, accessible, timely,
and transparent for all people and reliable and disaggregated by income,
will support the reporting by all relevant sex, age, race, ethnicity, migration status,
stakeholders. disability and geographic location and other
• They will be people-centred, gender-sensitive, characteristics relevant in national contexts.
respect human rights and have a particular
focus on the poorest, most vulnerable
and those furthest behind.
Source: Transforming Our World: The 2030 Agenda for Sustainable Development (paragraph 74).
3GLOBAL TRENDS ANALYSIS As we look at these separately, our analysis does
STILL LEFT BEHIND?
not capture the multiple, overlapping forms of
To analyse global inequality trends for each of inequality that many children face (eg, being a
the five indicators, we present graphs displaying poor girl in a rural area), or the drivers behind
progress trends and projections for children in the them. But our approach does provide a simple,
world’s poorest 20% of households, in comparison systematic and powerful representation of our
with the global average. These illustrate the rate global collective failure to tackle inequality and
of convergence that is needed to close the gap ensure that all children have a fair start in life.
between the poorest and the average (see Boxes 2 It underscores that urgent action is needed to
and 3).15 We also look at additional group-based achieve the magnitude of change required to fulfil
inequalities that can be aggregated and monitored the Leave No One Behind pledge.
internationally (sex and urban/rural location).
BOX 2: WHO ARE THE WORLD’S POOREST 20%?
To help strengthen accountability from local to Democratic Republic of Congo (DRC). Due to
global levels, it is important to monitor progress demographic and poverty trends, the proportion
for the socioeconomic groups that are furthest of people in the P20 is falling in India (projected
behind at both national and international levels, to decline to 28% by 2030) and rising in Nigeria
and the rate at which they are converging with (to 10% by 2030).
more advantaged groups.
Some countries have a particularly high
To measure progress for the poorest 20% proportion of their population in the world’s
globally, we follow the Development Initiatives poorest 20%. DRC has the largest share of its
‘P20’ approach, which allows for the identification population in this group at 85%, followed by
and comparison of poor households across 65% in Nigeria and Tanzania.
countries.16 The focus on the global P20
According to our calculations, in 2018, the
complements our focus on the poorest 20% for
world’s poorest 20% of households are living on
our national level analysis. See Methodology
less than $3 a day (purchasing power parity).
Paper for further details about this approach.
Around half live below the international extreme
Almost a third of the poorest 20% live in poverty line of $1.90 a day.
India, followed by 8% in Nigeria and 5% in the
THE TOP TEN COUNTRIES CONTRIBUTING THE MOST PEOPLE TO THE WORLD’S
POOREST 20% (2018 ESTIMATES)
Country Contribution to Absolute population in Proportion of population in
poorest 20% (%) poorest 20% (millions) the world’s poorest 20% (%)
India 32 486.0 36
Nigeria 8 127.3 65
DRC 5 71.4 85
Indonesia 5 68.4 26
China 4 62.7 5
Bangladesh 3 49.9 30
Pakistan 3 46.2 23
Ethiopia 3 45.2 42
Tanzania 3 38.4 65
Philippines 2 30.9 29
4LEAVE NO ONE BEHIND: THE CHALLENGE AND REMARKABLE OPPORTUNITY
BOX 3: WHY IS IT IMPORTANT TO MONITOR GROUP CONVERGENCE?
In too many countries across the world, A comparison of child mortality trends in
children’s chances in life depend on factors Bangladesh and Cambodia illustrates why
beyond their control, such as where they were convergence is so important (see Figure 1). Both
born, their family’s income and resources, their countries currently have similar overall levels
gender, or whether they have a disability. This of child mortality and are projected to meet
is unfair, and a violation of children’s rights. the SDG child mortality target of 25 deaths per
1,000 live births by 2030 as a national average.
An ethical approach to SDG monitoring and
Positively, in Bangladesh, the poorest 20% of
implementation would therefore focus on
children have made faster progress than the
convergence – the rate at which disadvantaged
national average, and are on track to achieve
groups are catching up with or falling behind
the target. In comparison, the poorest 20% of
national averages and their more advantaged
children in Cambodia are diverging from the
peers.17 This is the right and just thing to do;
national average. If current trends continue,
it is also sensible. In most countries, the SDG
the child mortality rate among the poorest
targets simply won’t be met unless progress
20% of children could be 35 per 1,000 live
accelerates for the groups that are furthest
births in 2030 – almost double the rate of the
behind. Moreover, research suggests that
poorest 20% in Bangladesh.
pursuing equitable pathways to progress can
both help to accelerate overall rates of change,
and be more cost-effective.*
Figure 1 In Bangladesh children in the poorest households have made faster-than-average progress
on child mortality, but in Cambodia they are diverging from the national average
Bangladesh Cambodia
150 150
(deaths per 1,000 live births)
(deaths per 1,000 live births)
Under-five mortality rate
Under-five mortality rate
100 100
50 50
SDG SDG
target target
0 0
2000 2010 2020 2030 2000 2010 2020 2030
National average Poorest 20% Richest 20%
* UNICEF (2010) Narrowing the Gaps to Meet the Goals. UNICEF: New York; Save the Children (2015) The Lottery of Birth.
Save the Children: London.
Dotted lines indicate projections.
Data: Save the Children calculations based on DHS/MICS.
5While our global trends and projections analysis The four categories are:
STILL LEFT BEHIND?
focuses on the world’s poorest quintile, in our On track: Countries that are on track to
attempt to present a systematic approach for reach the SDG target as a national average,
monitoring progress for the world’s furthest behind and for all furthest-behind groups.
children, this report uses disaggregated data that is
Off track, but with convergence: Countries
publicly available from internationally comparable
that are not on track to reach the SDG
household surveys – the Demographic and Health
target for all furthest-behind groups, but are
Surveys (DHS) and Multiple Indicator Cluster
making overall progress. All of the furthest-
Surveys (MICS). Depending on the indicator, this
behind groups will have converged with
data is available for 89 to 109 mainly low- and
the national average by 2030, representing
middle-income countries, which are home to 92% to
decreasing inequalities.
97% of the children in the world’s poorest quintile.
This means it provides a good picture of progress Off track, with limited convergence:
for the people who are the furthest behind in the Countries that are not on track to reach the
world. However, it must be remembered that the SDG target for all furthest-behind groups, but
SDG agenda is universal, and that considerable are making overall progress, and at least one
inequalities persist in high-income countries. furthest-behind group will have caught up with
the national average by 2030.
Off track with no convergence: Countries
NATIONAL TRENDS ANALYSIS that are either not making national average
progress, and/or where no furthest-behind
To assess national progress, we analysed country- group will have converged with the national
level trends and projections to 2030. For this report, average by 2030. In this case inequalities are
we present a summary for each indicator, placing not reducing, and the furthest-behind groups
countries into four categories, according to whether are being left behind.
they are on track to reach the SDG target, their
average rate of progress, and the rate at which the The appendix provides further details of our
groups that are furthest behind are catching up projections for each country to 2030. Readers
(see Box 4). can also explore our accompanying online
BOX 4: WHAT DO WE MEAN BY THE ‘FURTHEST-BEHIND GROUPS’?
We have borrowed the language of ‘the furthest- of standardisation between surveys makes it
behind groups’ from the wording of the SDG difficult to track and aggregate trends over time
Leave No One Behind pledge in the 2030 for many countries. Data are not available to
Agenda. We define this as the group of children track trends for children with disabilities.
with the highest rates of deprivation according to
We were not able to disaggregate child marriage
data disaggregated by socioeconomic categories
data by sex as data for boys are extremely
such as wealth, sex, location and identity.
limited. We also did not include girls in the
The furthest-behind groups we include in our analysis for child mortality and stunting as girls
analysis are: the poorest 20%, rural areas are systematically less likely to be affected than
and, where possible, girls. These are groups boys for biological reasons; sex differences in
that research shows are often left behind, and these indicators do not necessarily reflect
for which data are easily comparable across discrimination. However, there are a number
countries and across time. While data are also of countries where gender discrimination is
available for sub-national regions and ethnic resulting in higher than expected mortality
groups for some countries, we were not able among girls (see page 14). See endnotes 27
to include these in our analysis because a lack and 28 for further discussion.
6interactive data dashboard (https://campaigns. tools are also available on the site, allowing users
LEAVE NO ONE BEHIND: THE CHALLENGE AND REMARKABLE OPPORTUNITY
savethechildren.net/grid), which allows for the to explore the extent of inequalities between
creation of disaggregated trend graphs for different socioeconomic groups (see Box 5). Further
individual countries, and includes additional child detail on our methodology can be found in the
development indicators. Other inequality data accompanying Methodology Paper.
BOX 5: COUNTING EVERY LAST CHILD: THE GROUP-BASED INEQUALITIES
DATABASE (GRID)
Save the Children’s GRID database contains well‑being indicators. Interactive data
data processed from more than 400 household visualisation tools can be found at
surveys (DHS and MICS) to estimate https://campaigns.savethechildren.net/grid.
group‑based inequalities for selected child
Trends and projections
This tool presents trends in inequalities for
different countries. It displays data for selected
child well-being indicators and socioeconomic
groups, and shows changes over time. The tool
can also be used to project trends to 2030.
Cross-country comparison
This tool allows for the comparison of levels of
inequality in and between different countries.
It displays data for single indicators of
children’s well-being.
Intersecting inequalities
This tool allows for the comparison of levels of
child well‑being between different groups of
children within the same country. It allows for
the identification of children who are furthest
behind as a result of being a member of more
than one disadvantaged group.
7The approach we propose in this report is partial, comparable data on the challenges faced by
STILL LEFT BEHIND?
and focuses on getting the basics of disaggregated children with disabilities.18
data reporting right. There are of course other
Third, an estimated 250 million people across the
approaches that could be pursued to the one we
world are missed by the sampling techniques used by
present here and, with effort invested to interpret
household surveys, most notably homeless people,
and standardise surveys, trends in other forms of
people living in institutions, and people on the move,
group-based inequality could also be monitored
including those displaced by crisis.19 There is an
(such as between sub-national regions and ethnic
urgent need for more and better data on children
groups). This report focuses on internationally
living in and affected by humanitarian contexts.
comparable data for illustrative purposes, but much
The world’s poorest and most vulnerable people
more could be done at the country level, drawing on
are disproportionately represented in the groups
national surveys and administrative data. Including
that are missed by household surveys, a significant
this data was beyond the scope of this report, but
proportion of whom are children. These ‘invisible’
in many countries it offers rich insights for national
groups of children include children living on the
and local reporting. In addition, much more needs
street or in orphanages, and detained or imprisoned
to be done to translate this data into formats
children. So little is known about these groups that
that are accessible and easy to understand by
even estimates of their size are uncertain.
children and other citizens in order to promote
public engagement, deliberation, and change. Much greater investment is required to fill these
critical data gaps, including through dedicated
Whichever approach is taken, and whichever data
surveys, new technology and better birth and death
sources are used, what is important is a systematic
registration systems.20 While this report is limited
focus on the most deprived and marginalised groups,
to using existing household survey data, formal
across all SDG indicators for which sufficient
SDG monitoring and review processes should do
disaggregated data are available. While significant
everything in their power to fill critical data gaps,
data gaps remain (see below), we believe that it is
ensure comparable data for high-, middle- and
far better to make systematic use of existing data
low-income countries, and report systematically on
than to continue to allow inequalities to be masked
progress for groups of children that currently fall
by a reliance on national and international averages.
through the gaps of household surveys.
THE WORLD’S MISSING MILLIONS CHILDREN’S PARTICIPATION
In our attempt to present a systematic approach to
The 2030 Agenda guiding principles of inclusivity
monitoring progress for the world’s furthest-behind
and participation (Box 1) are central to building an
children at the international level, this report uses
SDG monitoring system that has the Leave No One
disaggregated data that is publicly available from
Behind pledge at the centre. However, efforts to
internationally comparable household surveys –
support people’s participation in SDG monitoring,
DHS and MICS. However, while important, these
review and accountability processes have been
data show only part of the picture.
weak to date, from local to global levels. This is
First, coverage is limited, and available for mainly particularly true when it comes to children, whose
low- and middle-income countries (see above). voices and perspectives are too often ignored.
Second, DHSs and MICSs currently lack
As beneficiaries and custodians of the 2030
disaggregation by key dimensions of inequality
Agenda, children have the right to engage in
and marginalisation, such as disability, migration
implementation, monitoring and review – a right
status and, for many countries, ethnicity. Very little
enshrined in Article 12 of the UN Convention
data is disaggregated by age, and surveys rarely
on the Rights of the Child, and supported by the
capture the challenges faced by different age groups,
commitment in SDG 16.7 to ensure responsive,
with 10–14-year-olds often completely invisible.
inclusive, participatory and representative
Positively, UNICEF and partners have recently
decision-making at all levels. This not only helps
released a module on child functioning for censuses
to empower children as active citizens, but also
and surveys, which promises to yield internationally
8enables governments to understand children’s on hidden issues can be assembled by combining
LEAVE NO ONE BEHIND: THE CHALLENGE AND REMARKABLE OPPORTUNITY
perspectives, priorities and challenges, and to design available quantitative data and new qualitative
interventions accordingly. data. This can help bring to light groups otherwise
absent from survey data, such as adolescents and
Participatory research and review activities with
street children, as well as information on sensitive
children, including children in the poorest and
topics that have proven difficult to study through
excluded groups, can also help to fill critical data
traditional surveys – for example, violence and
gaps on the missing millions referred to above,
social norms that support harmful practices, such
as well as complement the limited insights that
as child marriage.21
quantitative data provide (Box 6). Vital information
CHASING DREAMS
“I would like to become an engineer, fighting Child Protection Committee (CBCPC) – on
against the odds, especially poverty and which she is one of two child representatives – to
disability. Children with disabilities need an lobby for special bus fares and reserved seats for
example before them to draw courage from children with disabilities. Shamima was diagnosed
and chase their dreams. I want to set an with cerebral palsy when she was three years old
example for them.” and has limited movement. She has gained
confidence through participating in her local
Shamima, 17, is an activist for children’s rights,
children’s club and CBCPC.
pushing for teachers to follow a code of conduct
at school, and for the Community-based
Adapted from: Save the Children (2017) Hope Against Despair, Save the Children: Dhaka
9Recent research stresses the importance of development indicators. However, this is only
STILL LEFT BEHIND?
ensuring that data collection techniques are selected illustrative of the potential for including children’s
and tailored to be appropriate and meaningful for perspectives in SDG monitoring. We recommend
different groups, ensuring that they feel comfortable that formal national and international SDG review
speaking about sensitive issues.22 This is particularly reports provide ample room for the systematic
important when working with children. If conducted analysis of qualitative data and inputs from children,
in appropriate ways, participatory research and are translated into child‑friendly versions, and are
accountability processes can help marginalised accompanied by child-led shadow reports which
groups of children feel empowered to engage in allow children to report and review directly,
dialogue with government representatives, helping unmediated by government. Save the Children is
to strengthen accountability and shape policies and working in these areas and commits to doing more
interventions that are responsive to these children’s in the future.
needs.23 Box 6 outlines principles for children’s
The remainder of this report presents our
meaningful, inclusive and safe participation in SDG
illustration of how progress for the world’s
monitoring, review and accountability processes.
furthest-behind children could be monitored
This report attempts to provide a platform for more systematically through SDG processes,
the voices of some children and families that before concluding with recommendations for
Save the Children works with, through case studies governments and international agencies.
and quotes that exemplify our focus on child
BOX 6: CHILDREN’S PARTICIPATION IN SDG MONITORING AND REVIEW
Global, national and local SDG monitoring and version of the SDGs, which is available in
review processes must include opportunities different languages (https://uni.cf/2JSkgn2)
for children’s meaningful, inclusive and safe • access to child-friendly, age-appropriate and
participation. These should include: safe spaces where children can engage with
• access to spaces and organisations – online decision-makers and provide input, supported
and offline – where children can meet, learn by ICT, such as webcasts and online
about their rights and the 2030 Agenda, meeting spaces
share experiences, and take joint action • feedback from decision-makers to children
• access to age-appropriate and timely about how their inputs have been considered
information in a language they can and acted upon.
understand, such as the child-friendly
Adapted from Save the Children (2016) Towards a New Accountability Paradigm. Save the Children: London.
10LEAVE NO ONE BEHIND: THE CHALLENGE AND REMARKABLE OPPORTUNITY
EMPOWERING YOUNG PEOPLE TO ADDRESS BARRIERS TO LEARNING
IN JORDAN
Through a youth participatory action research as a key barrier to learning for refugee
project in Jordan, 20 young Syrian refugees children. The young researchers used their
and Jordanians conducted assessments with findings to advocate for change, engaging
nearly 150 Syrian and Jordanian children to with coalitions and partners at local, national
assess marginalised groups’ aspirations for a and international levels. The project helped
good‑quality education and the challenges they to foster social cohesion between Syrian
face in trying to acquire it. and Jordanian youth and demonstrated how
youth‑driven data collection can help to fill
The project identified the unmet need for
data gaps and drive accountability in fragile
psychosocial support and school counselling
and conflict-affected countries.
Case study adapted from Save the Children (2017) Recommendations at the President of the General Assembly
High-Level Action Event on Education.
11CHILD MORTALITY
SDG Target 3.2: End preventable deaths of newborns and
children under 5
Indicator 3.2.1: Under-five mortality rate (no more than 25 deaths per 1,000 live births)
THE GLOBAL PICTURE
On current trends, 4 million children under 5 will die in 2030, with
children in the poorest households at 34% higher risk • 27% of under-five
deaths take place in
Figure 2 Under-five mortality rate (per 1,000 live births) the world’s poorest
20% of households.
125
• Inequality is almost
static: the world’s
100 poorest children are
Poorest 20% globally 37% more likely to die
than the global average.
75 This is set to fall by only
3 percentage points
by 2030.
50
• Eliminating this wealth
Global average
gap would save 4.1 million
25 lives between now
SDG target and 2030.
• Progress for the poorest
0
2000 2010 2020 2030 20% of children needs
to more than double to
Data: Save the Children calculations based on UN Inter-agency Group for Child Mortality Estimation, reach the SDG target
DHS/MICS, and other sources (see Methodology Paper). Dotted lines indicate projections.
by 2030.
THE NATIONAL PICTURE
Will the furthest-behind groups meet the SDG target and converge with the national average
by 2030?
On track
Off track but with
convergence
Off track with limited
30% 16% 25% 30%
convergence
Off track with no
convergence
Analysis of convergence rates is based on 64 countries where sufficient data are available, representing 72% of children aged 0–4.
Groups include poorest 20% and rural areas. Data: DHS/MICS
12One of the starkest measures of inequality in life chances in the world today is the
CHILD MORTALITY SDG TARGET 3.2
chance a child has of surviving beyond their fifth birthday. This chance is not random;
it is inextricably linked to where they are born, the wealth and cultural identity of
their parents, and, in many countries, their gender (see Box 7).
The last 26 years have seen significant reductions countries as well. For example, recent research
in global child mortality rates, falling 56% between shows that infant mortality rates in the UK are
1990 and 2016. The number of under-five deaths much higher for children born into more deprived
has fallen from 12.6 million per year to 5.6 million, groups, with mortality among children born
with nearly half of these deaths taking place in the to mothers working in manual and routine
newborn period.24 However, the most deprived and occupations more than double that of children
marginalised children are lagging behind. born to mothers working in managerial and
professional occupations.25
Our analysis shows that children who die young
are disproportionately represented in the world’s While the overall picture is bleak, there are
poorest 20%, with 28% of all deaths occurring in this examples of rapid and inclusive progress in some
group. Children in this group are nearly 40% more low- and middle-income countries, which should
likely to die before age five than the global average. inspire change in other countries. 30% of countries
Child mortality rates for the world’s poorest in our sample are on track to reach the SDG
children are only very slowly catching up with the target for all furthest-behind groups if recent trends
global average, and this rate of convergence is not continue. These include Bangladesh, Indonesia,
fast enough to put them on track to achieve the Vietnam and Nepal (although these countries need
SDG target of 25 deaths per 1,000 live births by to make faster progress on convergence). There
2030. While the world is set to meet the SDG target are also a number of countries – such as Kenya,
as a global average if recent trends continue, the Republic of Congo, Tanzania and Ethiopia – that had
rate of progress for the poorest 20% needs to more high levels of child mortality in 2018 and are likely
than double. to miss the target in 2030, but where progress is
nonetheless rapid and inclusive.
Looking at national trends, 30% of countries for
which data are available are seeing either no
progress as a national average or no convergence
ACCELERATING PROGRESS
between the furthest-behind groups and the national
average. These include, for example, India and FOR THE MOST DEPRIVED AND
Cambodia. Both are expected to reach the SDG MARGINALISED CHILDREN
target by 2030 as a national average. However,
the poorest 20% are diverging from the average Accelerated progress and convergence in child
in Cambodia, and in India this group of children survival requires integrated strategies that focus
is not expected to converge until after 2100 and on the most marginalised children. Pursuing
is far from achieving the SDG target. Nigeria, equitable pathways towards universal health
with 733,000 under-five deaths per year – more coverage is critical, ensuring that everyone, and
than 10% of the global burden – has a very slow urgently the poorest and most marginalised, can
rate of national progress, and is expected to see access the good‑quality health services they need
convergence between groups only after 2100. without financial hardship.26 Too many children are
effectively priced out of healthcare because their
More than 2.1 million under-five deaths (71% of all parents are too poor to pay fees. Many more are
deaths in our sample) are occurring in countries in living in areas that are poorly served by health
categories 3 or 4 – countries that are seeing either systems, with shortages of trained health workers.
no or limited convergence for the furthest-behind
groups. Almost all of these are in South Asia and In addition, background risks associated with
sub-Saharan Africa. poverty and malnutrition must be addressed
(see below), coupled with a strengthened focus
While the sample used for our analysis contains on neo-natal and neglected killers. Good quality
mainly low- and middle-income countries, maternal and child health services are particularly
inequalities play a crucial role in high-income important at the beginning of a baby’s life, with
13STILL LEFT BEHIND?
BOX 7: GENDER BIAS IN CHILD MORTALITY
Under normal conditions, Figure 3 10 countries where mortality rates for girls are higher
under-five mortality rates than expected
are generally lower for girls
than for boys. However, India 13.5
research papers published in
Afghanistan 5.2
The Lancet show evidence for
higher-than-expected female Pakistan 4.7
mortality rates in selected Nepal 2.9
countries.27 This suggests
significant levels of gender- Egypt 2.4
based discrimination, ranging Bangladesh 2.1
from deliberate neglect
in healthcare provision to Jordan 1.9
invisible biases in allocation Iran 1.8
of food. This is displayed in
Bahrain 1.1
the adjacent graph as ‘excess
female mortality’. Estimates China 1
suggest that 239,000 girls
0 5 10 15
under 5 in India alone are
Excess female mortality rate in 2012 (per 1000 live births)
dying per year due to
gender bias.28 Data: Alkema et al. (2014)
deaths in the first month of life accounting for spending 15% of general government expenditure
close to half – 44% – of all under-five mortality. on health, and only one third of government health
Pneumonia is the leading cause of child deaths from expenditure is currently dedicated to primary
infectious disease, killing 879,000 children in 2016, health care.33
overwhelmingly concentrated in South Asia and
International donors also have a critical role to play,
sub-Saharan Africa.29 If diagnosed early, the disease
both in supporting domestic resource mobilisation
can be treated with antibiotics that cost a mere
through progressive taxation in low- and middle-
$0.40.30 That the poorest and more marginalised
income countries so that governments have more to
children are still dying in such vast numbers from
invest in health systems, and in helping to fill funding
this preventable and treatable disease paints a grim
gaps through high-quality aid for those countries
picture of the extent and impact of inequalities that
where increased public spending will still be
persist in the world today (see Save the Children’s
inadequate. New, innovative financing mechanisms
Fighting for Breath report for further discussion).31
are promising – like the Global Financing Facility
In most countries, progress for those left behind (GFF), which provides catalytic grants to countries
will rely on increasing public investment in health to generate domestic resources, and to leverage
(and nutrition – see page 19), to fill the estimated other sources of financing. However, to realise
$33.3 billion per year gap in health services their full potential, the GFF and other innovative
for women, adolescents and children.32 There mechanisms must focus on assisting governments
is considerable scope for governments to both to develop holistic, equitable and sustainable
increase their health budgets and increase the approaches to health system financing – protecting
proportion of these spent on primary healthcare, countries from bad or unsustainable debt, ensuring
starting with a focus on the most deprived regions transparency and accountability, and keeping the
and population groups. Only 14% of low-income focus on promoting universal access to good-quality
and lower middle-income countries have reached primary healthcare services.34
the African Union’s Abuja Declaration target of
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