THE STATE

OF THEWORLD'S
CHILDREN
1990

\
,i

United Nations Children's Fund

(UNICEF)
THE STATE OF THE WORLD'S CHILDREN
1990
oq,d l./No"'lII) Pma, r .... s.-.
OJ/ft OX } tnI'
oq,d ~ 1'",* T_ Dtn. ~ CooIcwu
AI__ ~", PrnI,. Je- S • i 11..., K..,
T-':J!o S Ol'" r"Nh~ c.,w T M/~
A",~ uJ -wri ..."...... No B",. 11m,.
TMJ•• Nj""y
0>:fi0.J " • ,,.;, ..... of o.jorJ (j'. ""'""J I......
l"IoI" JII/ I. ,lit /J.llrJ Still" /Iy 0 ' 1"" l/.,romIty
I...... NtI' Yol'I'Il •
tI .. ".. " of 1lt YoU, of ,. WorlJ', (M um. 010)' N
jrtrl'lrrPMlwri "",.l , . ~, Ml-.lIJ~.
8m... /..IJInry C........ ..
',.., _ II{ ,• ....u.. ~ /9H
PWbr.,,.. OIl.
I 0 ' f"" r.... .J.,."..
61I /HI? R]/ fli
lS&" I- J'J-}"'!1-6
ISS.\' L-.J-lI X

.
nr _.'*"
_""'~ . e..- - .
. ,n
~ .
-" o, ~
' , J ... .....

OJ!-Jl'.. ,....) ~ Jo< m1CJo:F k-"llL,

I'M I '.....
~ ."1.....,[. Bq:a f"IUt- .. 198D.
I CiiIhn_Dl"",..,<MMnn_PmMwh. 1.
CInUrrot- c... ..J ..,.,..,...-n. .. I.¥,.., r-....-
PrnoJorIll.. I UNK"JiI-:
110 19}]S ' J U -MJHD 1617 I'DfIJ14
UNIl.t:F, UNICIiF 11_ . 1 U.N. I~.... 1'"" I'art.
N.Y./OOI JflS .A.
IINICl:"J-: l'oJ./J Jn N""", ~ CH 1111
C........ 10. :itnI::nluJ.
r_ _ _ .......-..J c.._ r _ ' I'K
,_
r
_ """"_'¥o'_'~ "L
"' Soo' _ J I.ol I' l

f-..,
r-.,.,.
~..J ".AtJ ,. mlCD·.-I r~
(to LA,,"- " , - ~. U K.
 THE STATE
OF THEWORLD'S
CHILDREN
1990
@
James P. Gram
Executive Director of the
United Nations Children's Fund
(UNICEF)

PU ' US H ~D F()II U NICEF

Oxford University Press

 -~ 0 ....
i!' ;;I ~ " ~ ~ ;t:t ttl;;
~" " 0
- ~~ ~~
~ a 2" n "_ . ' ~
~ o
=-" H 0 .1;r
~.
.- ' i;$
=~. b~
-"" " '"~"'Il
~
~
~

,z
" n'~ ~Il· ~IJlliH
U'fI I ·r I .ilf'
~ 1. 1
ItlUUi
ii
1J
)t t.
Ii, tiff Hili i
f ,Ill f ' ' lr l~lrll~jJ~
'It, I !l'lfWit
lIt Iii
l~. r'I ill'
, . IHII '1 ~I!t lri l
1 u r prl'''V
H liil
1111 It trArl'(I 1 r T '1
ll, 'Ii
li~>J ill~ Ilt!!f~' ,.iiit,th
:lJ t t IW
IlJIf ja • nh![ r:
l'iWfi
I
hi~lI I
1:1' I }tljlN
,t '
.lfm ,If! .h,! ~h !IHldH!i
STATISTICS

Table 1
basic indicators

Table 2 ....... _·•• O _·~ O _D food ~D

<>lo<.. ",,>to 0 foo<l opc1lIIm(
nutrmc n

Table 3 n """" 10 D ............. - of dlOkIrnI uocI

-"
Aa>n< ,• ....."
I"' P " " _ OORS ...
health
Table 4 .\lal< .... r...w. ~ 0 ,.... .... _ 0 prio>ory _
. . . . -, 0I>d <OGIpIo1"" [] .......J.Iy .....,.. .....
education

Table 5 llIiIIl.-u- 0 ~_lf<I"IU .... O <nlllrd",nlo n .. O m":ld .1I!l

demograph ic indicators ,... [] ill< .. p«UD<)' 0 1m...,..... 0 ..toon...""
-"
T able 6
economic indicators
Tab le 7
women
-"
Table 8
less populous countries

Table 9
the rate of progress .
,,,tJl MIl ...No... "''''' 0 liS P p<' ""'.. _ .... nO.. 0 fertility _-"
notes

-"
Il\NELS

lmmu ni~"tion:
1 Lit",
a league table
-Tne- Convention:
Facts for
the lOP ten messages 12
Aii for Heaitil:
-
on the "\l hts 01 the chlld 2 an Inlormallon revolut Ion 13
Ad just m ent:
- - Hea lth worker.:
Wllh a human lace 3 what !hey can do 14
Egypt :
-
shots lind sailS 4 Indonesia:
800,000 voIuotHrs 15
~

Mellsle. and tetanue:

pecemee for ee 90s 5 Uganda:
health in 8.000 SChools 16
-
Mis n d opportu ni'lie.: Zimba bwe,
fOf 80% ,mmunlZlIHon 6 educ:auon fo' all 17
Bre a st-feeding :
11m OUt of ten SeMCe 7 Ed ucatio n:
brea kthfough III BlIngladesh
18
Iodine:
th6 len yea's war 8 Aid. :
ee lhreat to chdd'en 19
Vitamin A: Debt relief:
Ihe story so far 9 for child 5UI\'IV81 20
Guinea worm disease:
elJmll'Mlt'on by m,d 90s 10 Goals for the 90s;
wh at can be achlcved 21
Sc:lence for children:
reseafch on Ihe 19905 11 ()4fl6IS ttdmx- Glen Wdluims
TEXT FIGURES

' 'II A1lcmauw giollalll'O!8C1OOOS 01 under-1M! dCIItllS aNI IM!$ saved. 1980-2000

Fog 2 TOtal I\lJI'Ilber 01 6 to 11.ye",.oIds not er1I'OlIed ., pmlaTV schools ., lhe dewIopo"ll wor~.
1960- 1987

Fill 5 Result> 01 fVIl'<~1 'm<U«! OllPO<1uroes SUJVtly' 1dW<l'en attomd"'ll cIItlIc5 lor """" purpos\l!. I'<too
were 001 screened 10' 1It1mIJIIIlsuoni

Fog 7 P _ 1 9 oj ClUldr.... ~ IMI ""\I> d,armoea t>eHlg Ir...llKl ""lh OflT. .........11 deallls p'''''''''tcd
¥Ill 51" occunong, llev1IbpIrIg couomes. 1984-88

tog 8 'manl morl ll!ny l7y I'\lCl 01 mo1ll<>r . borIh "'de<. and "'1"",11 bIllWee" birtIl•• 8IaDI. 1976-86

' 'II 9 P<>puIa""" I)/OW1II '" the ~ WOtld , 1990-2025

F'll 11 Pe<renlllgl!01 CCfll'/Ji oovernmCI"l\ cxperI(IolUte 01" helllT/l allocated 10nospuats. sete<:led coonmes.
198 7

F'II 12 Pubic: expend,t u,e on e<luclIt"'" _ ~""" ..-.d as a porccnU'90 of GNP, SUt>-5aII¥.... Afnca,
1975-86

Fog 15 AId from western lflIlustnll\lled naliOO. (DECDI. 1988

- -- -1- - - -
THE STATE
OF THE WORLD'S
CHILDREN
1990
James P. G rant

The principle of first call

The specific opportunities
Priority 10 the poor
The role of the industrialized world
THE STATE OF THE WORLD'S CHILDREN 1990

The under·five monality r:I1e (U5MR} i. tbe

num~r (If childrcll who die before lbe age of
fi,'. for .,"".,.' 1,000 live births. It is lhe
princip31 indicator used by UNICEF to me."",.
1e.'cI. of, .m! changes in, the ..."U-being of
chddren. The USMR .Iso gevems the order;n
which countries .,.listed i., me .l.li.rica! t.bles
. nnexed 10 the Sm. orlbe World'. Child","
'opon.
Figures given for ,b. USMR of p.nicubr
cceruries, in both the tell! and liI31i.,ic31 t3bl~s,
or. c.tim:I.l•• pr.p.ml b)' the United N.,;on.
Population Division on an intcmauon.Uy
comp.aublc basi.. uling v.rious ~ In
so'!', C2$C$, these may differ from national
csumares.
 The principle of first call
Greal ch. ngt i$ in the air u rhe 1990s begin.
And ~.( change is needed if • century of
unprec edented progress is nOl to cnd in • d=d.
of decline and despair for hlf the nations of the
"·odd. In many countries poverty, child malnutri·
tion, .M ill hullh are ad,,;ncing ~in aflc,
decades of sleady IcIUI I. And ahhOllgh the
",•..,ns are many .nd complex, owrshlldO\\ing
all is the fact lhat rhe governments of 1M
develo1?ing world .. a whole h>"" now rcadled
the pornl of devoting I/ldl of rlrtir IO/<Jl """"AI
exptlldillim In the mairuen ancc of 1M military
and the servicing of debt" , Th..., two e...,ntWly
IlJIprodu<:!;V(! . "ivili" are """. costing rhe na-
tions of Africa, ,uu., and Ullin Ammc. almost $1
billion every day, or more lhan $400 • year for
each family in rhe developing world. Half·way
through ,hi. ccnlU'y, ~s iden, Eisenbov.-Cl de-
~ bed Ihe vasl scale of military expenditure as
'humanity hanging from a oro» of iwn': if he
"'ete alive rc ob5e"'e the impacr of the okbt cri.is
as the cenNry come. to an end, rhen he woold
ha'''' to add thOl humanity is also hanging from a
c:rt>S:I of gold.
The .um. involved are 110 large thl' ir is
difIi",lr to see rhem in any <ludy perspective.
Dc/II attd iMtrtJr /Xly/flt1rtSin 1988, rhe latest year
for whicb figures are available, totalled 5178
billion - three rim"" as much as all me aid
received from rbe indu.uialized countri"- Mili·
tary Ipm"iJw in rhe d"'-.:loping nation. amounted
to 5145 billion - an aonual expenditure whicb
would be enougb t<l l'1ld absolute poverty on rhis
planet within rhe nnt 10 years, enabling people
C" e'Y"'M,e to meet their own and rheirchild'en'.
needs fo, food, W:lIe" health <;are and education.
It is therefore obli ou. rbal for much of lh.
world, $Orne .ignifican, ..wucrion in deb' scrvic-
ing and defm<:e spending has b«ome the sint I/JI<I
""" of a resumption in human progress.
The ..lnd. or clLaa,.,
BUI IS weenler the 199Os, rhewinds of political
cMng<' are again wginning 10 slit rhe humin con-
dition. And the moslimpornnl of thee hinges rhey
are bringing is lhelUWin lh. wid war. As World
Bank I'l'esidenr Barbel Conable has $.lid, "TIt,
palitic<J1 o"J idtaJogicol forru ",hicJr /row palomaJ
lire ",.,rl d lar /rollo cfll/lJ.ry orc di",itrillrill('.
More rapidly than r:oold have been imagined,
the r••uh has been a relaxing of ideological
tensions, a stumbling fo......ud of d.moct:I~·, •
THE STATE OF THE WORLD'S CHILDREN 1990

Im m unizat ion:
a league table
n... 'O ~ _ ... .... _ " ' . . . . . . .;;;;;0..,
..-or._
--_--..--.....
dcI .......
• ... "'-1ono"l>II."
Dl"f ........ .. llil88 - .. _ ..... ,
a.c...m
~ vlIl17 ... "" .... 'Y"
.....m .....
"'~ _ _ ',.,7_, _ _
d _ _ ... _
•_ _ --...0 .... ~
..........,.._.. '_3ol . .
.....
".rv- ~ _

- '. , -_ -_ .-
--,
.
.. .... ..,--.-
..._-
- ." - - -- :.. ii": ,1"1
, ,- ,
:=--_ -. 1. , '

., .. "
.",. : :n: l , " e-_ 00 "~ ~
" ~
....
• 1 I 1,
.".", .."
'',"-,---
"-1' ~,_ " ~- ""
,-
\:i1:F: " .. _
e-_
.-..-..
..- .,I, "'It 1 -.
~~--!L.
,_
"" "

.
1rT '".---l!I\~
..
,-,,,
-
'"
l · t"
:...~~
:7'..:" ...."
!""---l.... ·n,
I

-
.. ' ~ o" "
~ : '": "'I,, _ ,....... ,.,
'-_ -a '- •. ..

_.
~'- - I' ll
....
ttli
,
ir }'": I' ~ ' -
" ,

- ''"',
"
_ . J<l"
~.....- "" 1''' 1,'
-..
--... . .. ,.,,.. 'lJ' "," eaoo-
--
.........
-
~ 1"1 '

. • · '_ I'"
" "'"' I' ''I
"~ !?"!'.__

-
~ n>0 11ll .'"
0---..._- .",
"""'" " '" I , ..
.'......
",, "n
:::...
-
.
::" r: ! ,
,, ~
1_,.",
.. -" - - ·
'" ,,1ft, " I • III
,
• ""
•
,_
.,.,..
oJ
,
.. "

,,: -_ a _,,;
_, = • *t"
..,.... ....
... --- - .
s....... g
... "

. . ! 0:-..__ 4>iHS ". -- ·

. --..!OJ' oJ. , ,
"-'-
... •• " " ' - . . .
..- ll'OI ,. I .. .., II>! II

... _,--
~

::-
-

--
-.-
......
0-...... • = .. -,. _. .
. ,

.,~
"'"' " - .
-- . •. ----
..
V""'"'"lI"
jQp

,IlOo
.. ::=--
.:'"
.. .ET
-
"
......',,''· '1
~"I> "'rT"l!Jo
I
l\lr' ,. ""
10I
'.
""
,"' "
" 12!<" .
alrT II
11""'
L.!l.- '"
II

,- . - ..
,- -_ _ »"" , ,
-
_

,-
_-..-
-- -- --
. .. ... --
r-

~-
--
..2!......!1..

,"" "
~_

-- ... .... ...

,
~
•

,., , . -
-

m.
---
'"

,.
..
.~ "
,,,
'"'

.."..
....---.,...
~I.
"
• >1,

"

- . ..
.. ""-L"
,,,,,,.
~­
II

•
... ,
•• •,m , •
, I • ...,
~
~
,.
,. "t'
,.,,,
" ..
.,- ,...",. .~ ..!l.. .,.. , ...

__ ---
~
~

::...--- ... ,-
I· ...
.,
--- .
_, ,~

--~
'-
..

-=..- - -, >So .. """

""Ii ..
·,.. r ..
.
.- _--_
,
..• U-+-I .... _,-
--
="-...
'-
1\1
..
~
r:: ,
,l1li • ' "
'N ,.""
" .. 1""
-
... .. ""'
-~----_
...
,
defusing of regional conflias, and a re.ex.min. ·
rion of the cemmirmem 10 present levels of
military spending. The INt' [mil)' :md the
Strategic Arms RN uCl ion Talks ..... lhe Am
results: • reduCliOl1 in the numbers of tactical
nuclear we, pons dC'J'l~ in Eu~ m ~y we'D
follow.
In OIher ",gions of the world, • dimini!.hing
mml:u y im'ol\1.'mcm by the superpowers is
already becoming evident. And in ",me of the
!'rg<'Sl COIIOtn e", induding China, India, and
Pakisl. n, which together account for half the
population nf the developing world, le>..,ls of
mil,,,!)' sp<'oding have begun (0 faU for the An t
,ime in 50 yun.
Armed conllicu 5liU SOIl the sunK. of the
planel. But it i. no nctbcl c5li Ibe case tb.1 f""""
wan arc being fought inlb. IO"OTId al lhis moment
than at any time in lh. 11$1 half-anNl)'. IT is
therefore nat impouibk: 10 Ihink in termS of In
outb"" k of pesee, nor is il any longer idle to
think [hal . more Id\'alIccl diplomacy, including
lhc incrcasing usc ofimemalioo. l erganiuuons,
mighl One d. y replace lhe primacy of force in
human ./f.in.
H~r long rhe journcy, e"cry step in lhi,
direction brings closer the possib~irl' of. more
rundamenl.1 re-examination of the world's rom·
mitmem re present levels of milit.ry spending.
And rhe resources in'"Oh-cd in such. re~3min3'
lion arc"" v...l that any oignificam change eould
not help bul have a profoond effect on almcsr
every ether aspect of thc human.ndeavour. Tor.l
m~ilary ""penditurti, in both indUS1l1a1iz<>d and
dC"eloping worlds, casily esceee 1M <omhiJwi
",,"w1 ill"'..... of l~t JIOOtt'l ~illl of ~um<lll'il}'. The
diversion of ev-en 5" or lIN of lhi. VU l scm
would be enough rOreaceelcrate progr.ss towards.
a wor\d in whicb lb. basic human n<:<:d, of .U
were mel.
If rhc world were rO begin moving in rhis
direction in lhe 1990s, then finance would n01 be
lhe only resource 10 be released. For the SOyears
since 1939 OUr world has been preoccupied by
war, by lbe ligbring of war, by lbe threar of ..·.r,
by the deterring of ..'ar, by the preparing for war,
hy rhe p.1ying for war. In one or aUof rheseforms,
war has durone<! our economies, deOected our
indus"ies, dominllled our rese.rcb and develop-
ment, and di'·.ne<! ee finesl scienrific minds of
lWC gencm ions. E\'co more impon. m rh.n rh.
claim. it ha. mM. on our r('S(Jllrc.., wor has
claimed 100 large a share of our humIn capacity
and concern: it has sebomed our science and
lechnology; it has usu<ped Our enet{ies and
ingenuirin; il ha. distncred the human lIlIoginl.
tion.
If th.... human Clpaciri.. "' well IS society'.
financial and ph~'Sicai resources .... re rc be
released, even paniaUy, from lhis preoccup,l1ion
with war, then il foUows rhll new VI" a. of buml n
IChi......mens weald draw nearer and rhar progress
lowalds a merc genuinely civilized world would
become more possible. Peac" is n01 only"",, of
the mcstloeged-lor ofhuman goals; it is also an
end wbich would become a means.
The eevlronm ea tal challenge
There would of course "" no shonagc of
challenges ro human inll"nuil)' and imaginllion
in a world struggling free of its preoccuparion
wirb Mr. The profound sociII Ind ps~chological
problemsarising in the turbulent wakeof inrn" "
ing prospcnry will undoubtfdly preoccupy much
of the energies of rh" indusrnalized world in thf
y~an .h~ad, and lhe ovenrthing problem of the
envlronmenl, including rbe avoidance of a maior
eco~cal C3taSfroph", will provide a chaUcnge
SUffiClfnllO absorb far more physical and inteU....,.
mal rcsourCfS lhan are at Pl'C'SCnl assigned to the
ra.k.
But alongside these great social and environ-
menIal issues, .nd imepara.bly linked to rhem,
rhere remlins rhe quiet.r bul even more funda·
mfDlal claim of rhOM: inbabitants of the planel
\IIho have not yet had rhe IWlury nf \IIOrrying
abool rh" problems of prosperiry Ot rhe cease-
qcences of coll.umen$Jll. Over I b~lion people,
a liflh of mankind, .rilllack adC<J.Ual" food., clean
waltr, elemen13ry eduCluion, and basic heallh
can:. And for both mora.l and practical rcasons,
rhere can be no rfal advance 10WllrdS a more
gf nuinely civilized and envirollmemally suuain·
.bI<! world society \IIithour addreosing the residual
problem of groos ioequil)' and absolulc pcserry.
,
THE STATE OF THE WORLD'S CHILDREN 1990
In plIrlicubr, it it the cencem of UNICEF 10
argue that the n""ds of <1Ii/drm, and panicubrly
of lho~ mllllens of children who Ill: still living
and dying in malnutrition and ill health as the
l'A'em;eth century dr:lws to • dose, should have
lim d.im on OUr COncern. and capacities and on
the ....'eO greater resourcn which 1I\ll)'
be released if the wc rld wen: indeed 10 move
.......y from ill long and ,,'uteful preO<cupatioo
with war.
~ largqt r u ...tion
The mo ral dimension of this argument i. of
11 is Ihe ~ate~ condemnalioD of
<;OUrSi' familiar.
our 6=. [h3\ more than a quarter of . miUion
small chadr~ should .till be dying twry r«d of
e~!l!Y preventable ;1I'!e~ a!!!! malnutrition. c!'f!}'
day m.... ~.. whooping cough and !<tanus, . 11 of
which an be prevented by an intllprnsive COII' $i'
of '"3ccines, kill almost 8,000 children. Eoery dav
dimhoe.l dehydration, which <lin be prt'\'enlcd
II a1mOSl no ccsr, Ilill kills almOSI 7,000 children.
Ewry day pneumon ia, "'hieh a D he tre ated by
low<Ott ~libiotiCl, kill! mor~ than 6,000 chil-
dnn. Drath and suff~ring on thi5 scale i5limply
no longer necessary, and it is tl>er~fon no longer
acc~ptable. Moralily mUlt marth wilh capacity.
EveI}' single One of th\I$C d~ alhs is the d~ath of
• child "'ho IuId a penoJUlity and a potential, a
family and a furore. And for every child who di(!$,
5Ov ~ral rnor ~ live on with malnU'rilion and ill
heallh and are thereby unable to fulfil the menial
and physical pot~ ntial wilh which 'hey "w e born.
Sorh facl' ahamc and diminish us aU. Civiliu-
lion . nd progr..s .n nm ~ntilil'S 10 be measured
only by G NP and lechnological C3jncity. Th~y
an also m~asured by the dewlopmml of the
human conseiena, by Ibe degree to which it is
offended and the extent 10 which il 3m wh~n
faced by lb~ f.CIS of buman suffering, the denial
of human need$, th~ viol>tion of human right•.
But •• is often the C'50, Ih~ moral''l'Iment is
ultim at~ll' in$Cjnrabl~ from tb~ prmlC3l. The
long-t..m con~uencco of poverty and 5uffcring
00 this scale are well known. And they wilI affl'C!
•
U5 all, and aff~ us increuingly, 3$ we mow
t""'ords • new m~l ennium . Malnutrition mean.
poor physical aod mental growm, poor perform·
a"", at "boo! ond at work, and the perpetuali(m
of poverty from one g~neration 10 Ihe next, billh
cbild duth rall'S mean higb birth ralCS ond raptd
gndullly population growth, lad of lXlucation precludl'S
peopl ~ from contribuTing fully Ill, or benefiting
fully from, Th~ ~velopmem of t h~ir commuoitiCl
and tbeir oation!; bopclCSlfl~ and tbe denial of
oppommity ero'k s self'r(specI and sows the
seeds of a1mOlt insolubl~ K>cial rrobl~ms for
fU1ur~ generations; entrenched ;niusticcs and th~
parading of unatlain.ble ~,h befor~ the eye. of
poverty pTOlloke an ;nll ability aod violence wbicb
ofteo takes on a life of ill; own; and, fioally, it i.
be<:oming increasingly obvious that tbe extreme.
of deprivation preclude environmental sensitivity,
forcing millions 10 \IVer-exploil theirSlIrroundingo
in the oame of .u",iY'!.
A maior ,....,......1 of effon 10 protect tbe lives
and The development of children, and to end the
WOrsI a. pecn of pcverry, ""Quid tberefore be Ihe
greatest long·lerm iovestmm t whicb tbe human
race could makein iu ruluR cwoomic prosperity,
political liability, aod environmental integrity.
The time to llIake Ibal in''CItment is no.... Ooe
and a balf biDion children will be bam in the
decade of The 1990s and, toward. tbe end of th.t
deade, a billoric turning poinl will be reacl>ed 3$
lh1: number of children being born into the world
finally roache. it. ped: and beginl to decline. It is
UNICEf's most fundamental belief" . the world
muggl es to free illeJf from the old preoccupation
with wor, tbat mere could be no more import.nT
~m> pft«CJj/JIUiml than protCClIDg the liyco and
the development of the l.~ generation of
children ever to be entrusled to mankind.
ne ripD of tile child
In Ibe c1osing)'ffn oflb. 1980.., ..,'..etal new
dewlopmenl$ and lOIne practical acbievemm t.
IuIvc suggeoted that this n~w priority for children
may be beginniog 10 emerge.
In both indusuialized and developing worldl
lbere is dearly a lP"owing recogniTion lbat the
 Fig. I SovIng children'slives 1981)-2000
The lOP two lines on !he chart _ two possible
trendS in !he arnJal numt>er al dIild deaths from
19l1O 10 2000, The lowe< line It..,$IiIl0$lhe dilltIrenCle
be_ t t - two lIends into !h& IIoClUIII number 01
chi!drI!f't'S Iiwl$ wtlich could be saved.
AllerllClltVe global projections
of under-/IVe oeotrs and lives
ph}'Sical, Imntal, and emotional needs of Ihe
)'QIlng arc • Iegilima,e matter of concern for a
nation's poli[icaI leaders. The Presidem of the
Uni[ed S[a,eS, for nampk, has u prO$$Od [he
belief lhal ~<Pl/r MI;oMl clrarrwtT OWl 6e tfmlSMmJ
by AOIO Wt ,IIrt for 011' cAildrtlf". And ill making
rho same point .bou, [he ,,"Orld's respons.ibilily
for it. children, President Gorbacb"" has smed
simply [ha[ ~ ",odUrJ <WlIW lo"ftT plli "" rrilAlA,

20

ts
saved, 1900--20:0

--
.....
M __

,
,~ -
fat:1 IA~ ",iJlWIlS of dtiJdrtlf dit n>try)'tll. III dI,
close of lA, IlMUitl/l eMlllry".
The growing impolWltt o[[his issue maysoon
find u preuion in the firs, e-.'Or World S/lIft".it for
ClriJdr", "'hlch " 'U suggened in this repo" WI
year and "'hich hIS since been endorsed by over
te 100 goyernmenu. Proiecled for [he second half of
1990, the Summit would bring IOgetber Presi·

14 ~""" ....~
""Q;
dents and Prime Minisle.. from all regimu of the
world [0 discuss and dra'" world allemion to the
need for a n.... preoo:up,a[ion ",ilb children. On
12 111 the agenda VI'OIIld be the glaring oppomlnities
no'" available fOf saving the lives of up to 50
~IO million young children and proieering the normal
gtowtb of many millions mere in the deade
> ahead (ftg. I). Chapler 11 of this year's Stlllt ofillt
W~rId '. Clrildrtlf repo" i, deVOled to a discussion
8

6
"" of lhe oix mOSI olMnua and universal of those
opportUllities and is In[etlded as a specilk input [0
the prepara[lons for the Summit.

, / A Summil for Clrildrtlf would also ron.wer

sncther major development in lhe emergence of
[his priority.
2 Afler 10 yell'S of delai!ed negotialions, lhe
c.mw..n.m OIl I/le R ielw of die Clrild has finally
been bl'Qllgbl before !be General Assembly of the
o19'k 85 88., United Nl tions. $elting minimum stlndardS of
'00' proleerion (er children's survival, health and
education, IS..,.Il u providing nplicit proieerlon
against nploimion II work, agamot pbysical or
seKuaI abuse, and 19ainst lhe degradauons of war,
_ U5MR... . - . - bI' ''l.-''/ Pcpuboion DiYiIb1 "" the Convention is the fillt ogreemert! among lbe
\::II. nwoa!llWlhe~III1ail
"..... \::I_ .. " caniIs
~1I<lI'"
nalions of ,he world on tbe legally defined rights
til''" l'"" 200(1 ~ • U5MR ol1O or!lllllhl 19130 of the child (paneI 2). Like miny suchdocuments

--_
\J5MR,_ _ .) in history, il is the Sllremen[ of in ideal which f.....
_

-'---
~ol~

_--" --
----
!8Ck.clion IIIrgIOlS _ meL

__"'- -"'----
... ... ...
_'/NI'U5MR

...
if any nitions have ~ far achieved. Bu! IS more
and more nanons raliff ilS [eK! and begin to enlet
i,S provisions inlo na!lonal la"" and IS Ihe press
and public become more concerned to ensure i[s
,
THE STATE OF THE WORLD'S CHILDREN 1990

The Convention:
on the rights of the child
1\, "'" $"I<l 011989 Iho Co<wenliO'''''' \he RlQI>l. kooclom 01 ...,........... _ """"""_. on<! to
II-. 0\0I(l "'0$ brougn, 10/ <'dOP1w:ltl 10 Iho
01
~ .. AssemIlt; 01 .... lkI.l$<l N",_
Tho lruol
lretdom 01 I/>ought. ~ .,..., ' elogoon h
...., . bPU!alU thaI_IO""" 0"'" '_ vveoghf
at ''''' VMtS 01 - . . . . . <:oI'lS\AollOOl ~ to llle ."...... 01 C/lold<on. ... lIa:Of\laIl<:e WlII1 U -
m.ony _ " ,• . UN """"""'" .., -... 50 -sI" ""'" ""'t\lllly
NGOI. 11'<1 Cono<en'OOf1 ...... to M' ......... . .,....
dordll klr \hi: dftl""'" 01 <:/oIdr.., "IJo""S' negloct. o
_
Pr<l1O<:I1/• .,. MoWlV 01 t/le CIl<MIn,,,,,,'. ""'"
..... <I8Iogne<l to prtIIOde ll'DtIlC1IOII for
""l*Jot.""" on<! .......
c!Ioklrerl ., a . - r.....,.. of <;:IfC\.<nSlances Some
n... <lo<:<.oment .. .nQU(I III ... tQadI/l. bMgong deal WIIl'l monl.... or physicolll' _ cI>lOr.....
lOQIther .. <>"Ill COf'OPtetlenslve C<l<Ie "'" ~ - . ""'" relugees Of ll/I<ontlOorchl(tM. OfWllh
b<wlet.. _ .\II><JIOIlOI>S oonc:onong children. cI>oIdo.... who lire _ ","" ...." _ lIlIrena h
......" were preo.owsiv scatt.. oo lIVtllJgh 5C(lfM oi 01$0 recogroes 11m. Ih some C8SIIi. ohoId<\!h_
<>tho' ""em.oonal eg<_ 1S 01 _ _ 10 IlO PI'Ou.cl<>d tn>m "'.... own PN """. '" may IlO
and . ,. ,"" I, applies to 011 age
pel"""" - . . . " " .. a somallOn wI.r. tho lIlIron" "'"" IlO ....... 10
o>cePI_sclloldl"".'__
of 18,
an _ _ .cccwdong to nallOl'loOl !.ow
!NlOMYaI lote Pi'<lQO/ car" oIl111m
Tile C""""""", a!!(l <XIYI><. """""""'C. _ uaI
TIle /lQ/llS ens/Wlocl III t~ Co<lI<errt"'" IIPllIv Ilrld IlIhe< lor",. 0/ <:hold .. pbt.,.",.
IN! _ _,"'" measures bO; , _ to protOCl
end """"'..
_ ' " III ... d'ol<l<en. WIl'>OO1 _ d to ...,..
~. - . langoage, ""'?on. POO1a1 Of 0...... "-en!rom t/le .... _ """ of dnlgs.ln _ . " , .
~. tIOItOr>Ol. '""""" '" ~ "''II'''. proper!\,. " eel$' out 11>0 r-qt>1S III c/1Idf<lrl., r...... III """""
dIsaboIrr;. bonn or othllr . Ill.... Anolhor toodan>en-
..,
confto::t. ond of ctWcj,,,,,
who Ole .. _ WIth "'"
t..r ......... .. 1M' !he "!1M, rll"'esfS" oIlhe <:/lkI.
_ be use<! lIS , "" toUCI1..""" lot all d8<:ISo(lnS
a/lec''''II cIloklran's '"e8I1n. -.u _ digroll' Once rat<fo!d by 20 <X>J<1"_. t/le Conve<>llOfl
."'.......to for". _ "" pl"0"SI0I>f ~ blnd"'ll
Tho prlMllOrll oI 1he CorMmllOO apply to tl'wee .. . ad> "1ifvollI counuy
man or.,.. 01 <:t'oIdron"s ng/11' ............ ~
tneOl. and IlfOI<lCllOn The Coover""", alOO """"""" • MlOIlbet or
o Survlvol The In, loPeClloc fI\ll11 _ IS
1/lIow-up ""'0""''''
<loSlQnBd to ~ <:om-
pOarce WIth I1S ll/OYIIllOOS by ~ts . pr..Ol.
tho "1her , "'OJh' to 1.10 S, must .n. "to CflIIIR-<lI\IOIIS and _ A C",,,,,,,,,..""
11>0
the mwm 1lOS_. !lie "'" ar<l develop- FIlghlS 01 tnoI O"ikl wf tle e s t _ WIth ten
"""" 01 !hoi <;hold " Tho eom...nllOn rocogt"O<8S ,"" B:>q>III:I """""lI ... t . - ~ CIPICI\IeJ. ond
non' 01 tle«Ss to he..ltI e..... _ lsuc:h IS SI.,.. whod> ,auIytho ~ wf repon 1C llle
................"'" """ "'Ill ,~._ thIIrllJlll1 , and to Cotrntm"" "" TI>o S,""" ,~ .... , - - _ 1 0 """'Il!Y
... adequ/lt. ol8n<l¥d 01 """"" (nc:!IIcIong food , WIth '10 pr""' ........
dean ,... on<! • place k> """I In _,""'. the
11 os expeclBO thol ltIe slan/!8/(lS $OIl by tile
chIIcl Iho "Il"l \(I •
o oe..IOPo,......, To _
chaI>ce '0 develop 10 ....
"""'" ...., • nal""'oIitV
""'"'" _ lOe
'" hfIf POlMuaI. ,1>0
__conc_
Corr!IorIllOn lOll ~ lI>o -.t
III' 0 1 _ !or
wnIItho _rh. "",,,q.'IIO"
and prllt"" '''''' 01 ~ The eonw...t"'" lOll
C<:inYen'' ' '
c"okr.
COnt_ proo.- . . 'ola llng 10 !he
rI{lh1 10 ~uon, 10 reJl lind ifI<JII"t, '0
I'''''' P'O>'Idc> 0 ......... sottv
on _ "*'
ba SIl !or ~
oIl:1lr1dml ..........-e

•
oo.ervanu, il may gr.d~ally become lhe 5landud
below whicb any civiliud nalion. rich or poor,
will be ashamed to fall.
The p riJleiplc or finl c all
Tr.n5Cending in detailed provision.. lhe Clm·
""'fI,'" 1»/ fht Rif hl5 of fhl C,Jrj/J emb9dies a
f~ndamemal prin<:lpl. whicb UNICEF believes
should alfecl the COlI.,. of polil iaJ, social and
eccncmic progfO'Sl in til nationo over lbe nexl
decade and be}"Ond. ThaI principle is thaI lhe
lives and the normal de\1:lopmem of children
sho~ld ha'~ jim t oll on socie!}''' eOm:emS and
... pacil~S and thaI children should be abk 10
depcnd upon lhal commilmenl in ~ time• • nd
in b.d, in nonnti l\m~ .nd in limes of emer-
gency, in times of peace and in nmes of war, in
times of prosperit)" and in limes of rcc.,...;on.
If lbe ue nch of sucb a principle could be d~g
3< l'QS5lhe baltleground. Gf poIilical and coonGmic
ch. nge in lh. deade ahead, lben civ~izotion it""lf
would h.ve m.dc a significam advance. The
essence of civaizatioo is the protection of lbe
vulnerahle . nd of lhe f~IDre: children, like the
en"ironme01, are both lhe vulnerable and lbe
fDturt. F.~ure to prGu'ct rhc phj" i<:al, mental and
emOOon:d developrncnl of children is 1M princi·
pal means by " 'bicll h~m "nit)"'. difficullies .re
compounded and ilS problems pcrpe1~.ted. I\ nd
.ptc;fJl lImllum to prolect children from e e
inadequacies and mistakes or the adult world is a
principal means by which many of mankind's
m051 fundamental problems mighl u1tim'lel}' be
a11aj'ed. The principle of fim tall lherefore
underlies all "f lb. il5Uts dilCUssed in lhis year's
report, iusl as UNICEF belie"es it should under·
lie lhe man)' decisions and aoiom whirh will
shape rhe decade aheld.
The ea.rly eu.mpln
The 1980. have Illready $«n lhc first examp1l's
of lhio principle of first all beins: pill into
practice, aibeil pania11y. In 1985, El Sol,ador
became rhc firsl coonrry ever IG suspend. civil
w:tr for lbe purpose of respecting lbe right of il$
children ro be immunized. It "'1$ an historic
decisioo, and marks one of rhe firsl "tps on lhe
road to acr.::prio~ that proteclion for the li"es and
rhe gt0l'1h of children sllould nO!. havc to depend
on tbe vagaries of adull socie!}', on "'hether I
ecemry is at war or at peace, GO "'helber a
panKubr pany is in power, on ",hcrher lhe
econamy has betn " ...ll managed or bungled, on
"'helbt r deblS esve been paid Or rtso:hed"l<Xl, on
"'herher commodity prien b..'t fallen or risen,Or
00 any ether Uougb or crest in lhe endless and
intvitable undulaliGns Gf poIiticlll and ccaOllmic
life in lhe modem nallon $lare.
Through the ,lI;ood offices af rhe Catholic
Churcb and lbo Red Cross, both ~es in 1:1
Solvador's war h..c sin,", agreed to I funher 14
scpante 'days of tranquillity' O'o'er the lasr5 )~In,
during whicb lime over 3 million dM<'!! ohaccine
blve been adminis.. rt'd . And as a funher develop-
menr of that concept, both sides in Sudan's civil
war agreed, in 1989, ro crealc 'corridors of
lranquilli!}" tbrough which 120,000 merric IOnn!!!
of food and other supplies, including immuni>:a.
lion supplies, have sinct: reached lhe 1\\"0 and a
quarter million ,;i'ilian victims of that war. So far,
this unprecedenled compact hu .voidtd a reperi.
,iGn of rhe e,'e015 of 1988" 'hich clli med lhe lives
of an csrimlled 250,000 civili;UJs - the ma;"ri!}' of
lhem wOmen and children. Recendy, both tM
new milirary government in Kbanoum and lhe
leadt rs of ,"" Sudan People's Liberalioo Anny
ha.'e "!r"ecd to keep open rhe 'corridors of
lranquillit)" and requesled thaI the rdicf effort be
rontinurd ;nto 1990. I, is nOI inconceivable lbal
the channell of communication unblishcd by this
process mighr quiclren lhe pulse of peace in lhe
re/lion or lb.at the exampl. being scr 11\ th. Sudan
mtgbt ant day become the aettploo norm in the
condoct of civil or inremational war. It i.
significanl, for example, lh., «KlpCralion from
all siOO is now allowing lhe child immoni>:arion
programme ro proceed in Afgbanistan md lbal
rhe nanon of Sri un4, racked b)' "l)R('ning
.;olence .ne! disruplion, is able ro annoonet this
momh (~mber 1989) rhar , wirh rhe co-
operaliun of 1111 parrie.. lbe goal of onivenal child
immunizolion has new been ruched.
BOI if the principle Gf first Cllll and the
ClJIfI'Olrljolr Olr fht Righll of 1M Clrrld are ,,; dely
,
THE STATE OF THEWORLD'S CHILDREN 1990
pt'rcei"N ,. t>cing "I'Pli<;:1bk QIlly to abnormal
cir<:UmSl ln«1 or spe<:ltk abu$«, then the hean of
the m3lt~r \lilt ha"c been missed. The impcrtam
point aboullhe principle of'firsl caU for children'
;. tMI those cMdren should be able to depend on
that commitment at alltimes and in 311 circum-
stanctt And it is in what !mY appn! 10 be mo«,
norm>.l limes and more e\-cryday cirromslinres
that tho need for thi. principle an be moll easily
<Wl:rlooked.
Nothing could demcnstratc [hal need more
dUlly than the impact of th. debt crili$, and of
ron~""n[ <'Conomic :adjustment progromml$,
on SO many n.tions of the developing " ....rld
during the serond half of Ihe 1980s. For if Ih.
principle of firs! caU h.ad aJrtoady bet-n enu \"1lthed
m the conscience "f nalion smes and of the
;nlOrnational community, then lhe .1(1)' of lhese
years for many millions of Ihe world's children
\\'ould hava becu very d:.'fm:m. ;'oS u is, lb~ lid;
of such • principl~, ....hich i~ p<1l<:tice h.u m~an1
lhe lack of lfrUific ProiCCliQM . ffordeJ 10 chUdrtn
during lite process or economic .djuSlmrnl, hu
m~.nl lhal lhe heaviesl burde~ of lhe d~bt cri,is
has undoubledly fallen on lhe growing miDd~ and
bodies of Ih~ poor"l .nd mosT vulnerable mem·
bers of lhe riSing ~ne"l1ion.
ClilldRtl paylq
Despil" a 101.lIy inadtq\lale 60'" or informa·
lion ebcurthc eff"". of lh~ r«<!ssion on chUdnn,
il i< possible 10 demor,l;lr'le lh.1 Ihe lack of . ny
.... ide.pr~ad accepl3ncc of the principle of firsll:llU
has onneccss;lrily exposed million' of children 10
lhe sharpe" edges of lhe odjoSlmenl process.
Firsl of al~ the poD,",,' .nd mcs, vulne..ble
children h.ve paid Ih~ Ihird ,,·orld'. debl ....i,h the
sacrifice of Iheir 'WnIlrd grotrlh.
O..er Ihe course of the 19801, aver.ge income~
ha,~ f.n.n by I Mi in mosl of Ullin '\ meric' .nd
by o,'or 20%10 SIlb-Saharan Africa. FOi many, Ihe
"ory h.. bttn ~·..~n ....orse Ih.n lUCh figures
suggesl. In m.ny uman areas, rcal minimum
Yl'3ges h. ,·. declined by u much u SOW . For lh~
very poorest, those who are forC<'ti 10 spend lhrO<'
quarters of Iheir incomes on food,!:\lu in income
•
on lhis 1IC;l1. "'nOOI mean anything else b<lllhe
malnouri$hmenl of Iheir children.
Had nalional governmenls and lhe intemo·
lional communily chosen 10 do so, the inaca.< in
child m.lnulrilion could h.v. been prev.nled.
f:ff.eti,'e lC/W,oSl muns an now avaUable to
prot~ lhe nUlritionai health of chUdren (see
pages 27 10 3S), and Ihose mean. could ""~ be<:n
deployed if The principle h.ad be<:n widely ac-
"p'led ,h., lhe growing minds and bodies of
child r~n have a righl 10 firsT coli on socie'Y"
con~m .Dd rcsou""", ill tn.d tim.s as ....11 as
good . In p<1lClice, 100 f. .... gov.mmenlS h.ve
laken special prOI""ivc .etlon in lhe 1980, and
m3JlY M'lons have seen ma.lnulrition rising 3S a
rcsult.
Sewnd, Ihe poorest .nd mDS! vulnerable child·
ren have paid lb. third Wllrld's debt wiTh their
"lalrk.
(h'er \he loS! rew years, a decline In healIh
spending per person has been documented in
more lhan three qu.rtcrs of Ihe n.tion, of " rria
and LaTin America, .nd lbe decline IS oImosl
cenoinly more widelprC.d lh3n 'hese figurcs
sugsesr. Hundreds of beallh (~ni<:s h..·• be<:n
closed dIMl1, and many ·hich remoin open are
undem.ffcd .nd Ilcting nIWSllpplics.l'. mi·
Iy planningservice-! have be<:n CUI back, imported
drugs ha~ become more exponsi..., . nd in lhe
firsl p.rt of 1989 lhe heallh scrvices of Ecuador,
Panama, Panguay, and Peru ha,~ been uubll:
even 10 ooy vaccines'.
Fn gmemary evidence of the lfagic and inevita-
ble rCSIJlI. i. gndu.Uy b«oming avail.hle.lnf.nt
monality i. knQ\\l1 to have risen in pUIS of Latin
Americ> and Arne> SOUlh of lh. Sahara. The
incidence of lowbinb ",eighl, ' sensilive indialor
of Ihe ,,-en·being of women, has increasro in 7
n.lions 0111 of'he IS for "'hich recem inform.tion
is .... nable-'.
In Ih. [;ISC of health, many $"~mmenIS ha'..
II 10111 "'PM10 .etlvate the pnnciple of lim [;111
and 10 implement some of ,h.low<o$1 ......ys and
means now available for prot""ing lbe li,'cs 3Jld
tbe gtO\\-lh of lheir young children. More will be
said aboul lhose achic,-c mcnlS 1o1 0r, bul ,Hrig
Moer\'cs lpCCiai "cdil in lhis con,e~l for ilS
cenrincm-..idc effort whicb has@ed immunin·
t.- ~ fn>m. lIDdcr 11M 10 lMJ 6QllIo
d6pae ee dt/IiQoln($ of lM Iasl ~.
llurd, !he r-n' ...., _ ......., dlllcI. t t

ffil b:n--e also paocI tb< durd wurId'I debt wnb ~

_ of thnr ~ 10 hi: "'• .,'" (Ii&. Z).
In !he }7 pDIIftSt cauallXi, "P"""i". ~ bead
OD Idlocls has dKIixd by tJlPioxi>lul~ 1S" m
dw lui dtcadt>. Capi!al tptDdirIc, ind"di..,
~e 011. boob and 1ITt1irlc .... auls, Iaa
00_ 10 I halt ill maD)" nations and tbDuwIds of
ltxbcn ~ Idt their posts alit< months ,.;ma..l
bl:Ulll paid. 1be cmnlI ,mpKI lw 1I«n sumnwd
up II)' ,he DU«tor-Ge1leral or UNESCO m his fig. 2 Progress reversed
\ 989 oddrn:o lO UXICEp. EllfCUtM! \loud,
The 19605 and 19705 saw I rapid ' I<pllI1SOOtl 01
~71It ptISI frc ytaI1 ...... rruMf:ltd 11M . , . " . . " " ,.
Icd ~(lJ1 i./M rrowlr !1{/JQsic rdllfgtlOllQ/W1Ikt" « ~
d'le ed>ooIillQ
number ~ ......
01 chIldl,," . ' '" MIIId,
out of 'IdlooI ...tuancl
IO 50 million.
Il"l'/QUOII ••, dutrWrtJl;on of t<lru"rjr»tlll Il"0l- In Itw mid 1960s.... POOPOO\lOl'lot ~ _oa.d
lIy . q . beoen 10lei ~ the total nul'rlMl of children
0CIIlIinJed to glOW, As " null, !he numbef of
"Era""""• .." " iolt 4IId II" t'OfI" '" IM'buJ"rn of chiIdIen 0Ul of school hal Incfeased 1060 mlllIon -
Ih, Sm<th hll'flf! ,." daubi had " ...jar 1"'" i" 11m .... tifSI slgnilicanl rise in • decades.
tJllflllo,,1Il o/ro_ . . . I. Iftllrly hill! tlrt dn-tlopi",
ron" l ntI, liltgotd ofUlliTHl'llll Pn""'';' EiIl(IlJIlNf Totd runber 016 to II·yoor- olds
1$ m:tJi.., rwlMr 1"'/1 d,rnd,., ""m". 1. ..../.Y not e1 l o1ed ~ pl'mol~ schools In
_ _ otffiw d_l~ (HIll'riu., priJlUUy IlwM.l the developil lg ""'OfId. 1960-1 987
....-6ttI 1lIOlly Il#ff'wi 11«1"""1..• 1. tw 120 -- -
_ of tfW'J Mwlt>pilc '"*t'Itf JIf1IJi",'"
Il llilnll, III IftJ lit*$, oWl Juli",d

- ' 1MamIfI<Jl-- "tmoiJ _ ,. W

I ll8O.
F• .,... 1Ia t.ha I...... . nor. fiw 1M 1nPfV •.•
/ -""
m.a
~ 100 -
JIl8"'. o
. . tII(. . . . . .

WI)'" and IDl::lIIS of r~

lhe m:lld will k go> •
lhe danm'''' ilem
11"" '" C
tb: . - of !he I!nt
J"'- _ Ehaf_
OIl
fw AJlIO be Idd
m Tllaibnd '" .\t:udl 1'J'90. But aD)' and all. tM
JUaltpI:S .II. ~ woald faD OIl. IDIlI"l:
krtik IfOUIld if II -=
10 bawic 1M XC'PCN
~
~ "'
.. - -
.,
ftluo: of 1lI-.tties lllaIIM .... ..,... of dIiIdr",
.bouI.:f be prIlC«Kd at all rima and at all _
~ .,-
o
M julcmeol wilb .II. ".men face
i ai -

----_ _-
III ill lby-io-<h)' work III O\~r I bund~ - ' ="'--;;;-"-;;;, " , , 0 -

--"'---_
~Iopinc ....tiom., UNICEF i, comumly
1lroIij:hl f~ 10 fltt with 1M mall)' oebrl WI)'J ill
. ·tu<b child"'n arc bring
prOlce:tl'd from, lho-
~poscd
rnn~UffI~
10, ...Ibcr Ibln
of debt, reees-
-- _- ........ ...
•
;; I I

~»
_. Q.
~en
'*_.
=rC
. , [j" " . , - ••
g(~~ ~I~ HI,U!l,ilfllfnli ~lUff[nm~l !ilf HilW
l ~ . ' ~ .,
Im~
. , .< ~.o!, 5:!
.'~!' ·i~ ,l·l~i ~~l .' Lh'k 1;~ f~hH ~!q Gl!!:. ;j
=r3 ~
I] i lfWii!l ~~HI~ fl~f,lfH!!i hill mt C CD
IIi ~Hi!uh:'! ~1 l!h~!lif~[; ~!<!H P~! 3;a
Gl •• ~
HWmr1rj ::l
..
n i ~phH
&~
iUhB
l~ i ~~ .
Il;l~ Ih~1
§ 1I
;~ a if i!1l 11 ..... s
Ii I l~jmHm[';l hlt~hl!iil filii un ~ ~
rjj
n
:I:
.. ,,2 , I. Hr . j!• . ,,1- a. " I ~IS , "II t=I
' .·'l!i'i PlFj . '. ",I ·' . ~
('! H~~~ <ill~h §" !~ ir!1l~i- ;i - i~ III
!]
~
~ 1'l & ;l~ ~ §~~SJ:lll.-t :£~§§ [pi~; ~~;li - §- a n
;i ; ~ ~, 'ilj
.ithh ni~'!U'!!j iH~'i.
-
<I .. " .. 51.
i. L
001'
l'!ll'~~ Iitf
g lK&~~ ..i
~ _~1<l2. 2. : _,!l!_~
~. U""'ir
__ .. 'PI- ~ :§,~ i
consuming chores of child n rc. And >llhough
impossible 10 quamify, UN ICl: F s!~ff in many
n>lions mo.... from tilt mdence OflhClf 0I\'n eyes
, h., , he d.b! crisis :md lhe conscqocm f. ll in
incomes rOf ,he poor h~. comribuloo 10 incrt.S<:'
in iu'·enue delinquency, in lhe numbers of
child",n 3bandon~ on lhe SIr"",..,
in attidem..,
~ nd in drug abllse.'
Because UNICEF i5 so frequeml)' confronted
wilh ,he'" con$('quonccs of lhe d.bl erisi.. il is
difficult to '¥9id frus1r.non wilh p re$('m pro-
Wl'SS. In lhe intlumialized .."Orld, 11 seem , ,h.,
oo,m.al ..n.i li,·i,ie, or. being dulled by lhelengrh
of the debt dram.. lhe di"ance from the sl:1lle,
~nd the complexiry ohhe pin!. No one .....nl~ Ihe
debl c,isis. And ';dlhough SOme h. ve prOfiled, il is
in nu cnc's l\ln~"erm imereSl . The blame lies
with irrespon, ible hQrrowel'$ .nd irrespo nsihle
lenders, and with in ternational economic arrange-
mem.. indooing lrade regul"ions and com-
modil)' price.. 0Vtl ....hich ,he de,..loping "m id
has little control bIlt within which it must earn its
li,~ng. Meanwh ile lhe ecnseqccnccs arc falling in
' m. lly disproponion31e m...u,c on !hose who
are le~" responsible for the d.b, and hi>" the
le"l capaciry 10 rep. y. T ruly, as l'residem
Mu~be of 7.imb3\N·, h. s said, ~ Fm $(1I11'i'" ' "
hIImo" Irilro,:>' ,,,,, (/oi ", U> mo"y "..iWmSIOl today 's
debt c riris~.
,\ s lh• •b,we examples sh""" lhe young and
lhe vulner:lble .rc nflen hit first and harde$!.
Wi, h f. ...· eacepuon.. 1I'1r<JJ frt lire ' Ir /OCI "';"1 is
Iht mUl OPpIJSilf of 1M pri1rdplr Ihllt tlrt grwirrg
minJ, oud OOdifl Dfcltildre" sJuJulJ It,..".fi nl call""
Iht prolw iOlr 0/u>eUly. Yet som.how lh. "hillin~
inilUlic.l of ...·hat is happenin g is escaping cur
."(nlion, p~ssing hy our winduw. on lhe smoolh
Ro.... of economic . n.I)"Sis, diW'ising il"'U in lhe
fespKt ablc clolhing of lh. Iin.nei.1 vQCOhul~ry.
We . ", inlermiuently lold l~l ",,, . re moodling
lhrough, • repayment r(schedull-d here, a d.bt
""';l1 en dOl''n lhere, masking from our vicv.· the
closed dinic, Ih. eml'lr desks al school, the
u n'~ried diet, ,he .n~~m", morh.r, lhe child ,,'ho
n. ,·cr pul. on ...·.ighl.
It is for aU of these reUOM lhal, lbroughoulthe
1981ls, UN IC EF has advocated • 51r3tegy of
'. diuslmenl Wilh • hom.n face' (pan.1 31. It
makes bmh . conomic sense :In<! buman sense 10
protect ,he ~r "nd lhe vulner.bl. -.nd espe-
cially the chIldren - when =nomi~s have 10 111'
adlusttd 10 n..... and mor e difficuh external
citcumS1allcct. AI UNICEF Depuly beculive
llireclor Richard Jolly told a Commin~ of lhc
Unhed 51"., Cun~ss in 1999;-
~Humo" <opila! is 0 m"'" imporlonl /aclor l or
<lC1t,m lr8 tco/Wlflk grrrwllt Ilton plt)~icol ' Ilpi·
lal. ..• 11ltJfl1"'tlfl in Itumon capital in Iltt form 0/
~ulriJio ... Iwu;, rducotim., OlrJ Ittoillt Clm/WI Itt
poUpllMd: ;/ t Um lakt' ploet III air apPrIJprilll1 ogr
n
1I'/rIn 11r1 fIffd prot/U- '" U does "01. 1'", Iltt
YOV"8 eltild. rltm iJ ~o I«o"d clto~<e. TIt,
u~d,"",pJrolt:ud tragMy o/ Illt JIltIrflnItIIllU in
""man capirol ilr Ilr. 1980s il tlrOltlt, m illIS ~illitt
ellmed forreo N '" UII"ItJ IJ.xJm o"J dtficitlll
rdllc01uJIIS lI.'tll Ilrlo lite IfNNI~fil1l <enlury~.'
No economic lhC<lry Or po~fjcal idC1llogy an
iUSlir)· . ,·en • lempor:lry ..erili.. of chudren's
growmg minds and bodict. And the st{':ll. g)' of
' adjuSlmem wilh • human fact' is One of lh. mOSI
impon~ n! elUmpl•• of the spiril of the Umvt~lio"
i11t rllt Riglrls of tltt Qllid and of irs central
principle lhal all <hildren should be prOlt<"1ed
from lhe WOI'$' conseql>Cncq,s of lhe adull world'.
excesses and mi.,.k"" wh., her ..... or. !>lking
.boo! violence and ...·ar'If the cumula,ive efft<"1s
of economic misma nagement.
The deln trap
The . heer scale of Ih. debt cTisis, which n",,'
claims an eW:n larger share of the de"eloping
world' l rtsOUlttS , h. n lh. milil3l)', meanS that
spc<:iJie aClion 10 protect the he>l,h, nuuition, .nd
edocat i<ln of )'OUDg children is unlikely to be
$\Illicienl, in m.ny countri . ......ithoul oume sign;·
fiant progress .g)inSl ,he problem of dehl ilself.
Unfonu natel)', the d~b, crisis h:l$ nO\l,' berome
rhe debt nap. The " " y out is Ih""'8h a ",rum ' 0
he. lthy eronomie growth, bUl the h.rd·won
Sllrpluses ...'hich should be *vauabl. 10 im= in
thal grO\\-1h are instead being sluiced . ..... y into
lhe servicing oflh. d,bl itself, If lhe lr:lp;S pried
open by .1T0n. ' 0 incr..., .xport> and foreign
..rninll'> lh. n il is ~kely 10 be snapped shur .gain
by sudden inc~.ses in inl~,esl roles. Latin
u
THE STATE OF THE WORLD'S CHILDREN 1990
.\ moncII's Jdu,lOreumplo. we. _ foul' umos
:110 Iugr 'llJ 11$ ,<01 :ulmW nporu. ..hoch mnDS
tbJ,t ddl pm:t1l12gt polnl I1Jt In mll:1"nt r:otrl
rt'qUUo a 4'l6 ~ ;" n~i mtl'oi)' '0 I:np
up d'K' nlUrnt1lI\ll1l of ~.ltIC1Ill;. 1kr.t."«1IlM filII
qllan,,, l>f 19118 and ,II<, fir¥I 'l"'n", 0{ 1%9,
IIII~r~~llOn:ll IIII~rest <>I'" rtM by l h= pcrcen-
rI lle p<lIllU.
II)' compansen Afti..,.'. dchl~ are small, tlll.U·
rn!! ",II,' 3t>oul 10'l010 15,. or tht amQ~m. ""...'<1
11)' tM highl)' indoi,IN u.tin Arne,i...n <DUnn;."
whIC h 'fe l~ llI;un f\Kll$ of 1M Ii:lk.:r pl:w. HUI
...·bon mu",rtd ,n ,d,,_ 101M unlv "Ilenan
. '!llth rnanffS 10 Afna -ItS Cllporl eain,np and
,Is :ability to 1'1)" - 1M dclJl hoankn of !\fOCI l$ ill
faa""" .. .lorft'I. tIw of 1.21111 ,\mCnCL And
Mna.'s Ilf05llC'CU for xroaUl, dapllf aIlll~ ddM
raluLT_ mil rachrdulinp 10 <Jolt. see aiD
......x-nnmN 11). tho fa:t m.r ~ .'hid
m;:!!! ~~ ~ ~~ ~ ~=! = daullIin& olw ll\IttIbr. vi hotrdc-ufo.=ibes.. ADd
iflloIf:ad ,J1':lI""'''' tnt: m Jdlc mol 't llfteR pI}~
~
~ dtbI emil lbcr&Ja as:lllslbdoor.:ross
tbe I'CllI ,Jeade • ",,0 31 tho lui.
~ "fe ~
...wJ "'It''l of~. In lbe lui
.h..' lttm. lhe 10ial <kill wlh<: d<.....~
allm for lh,- fin! ItlUI' Jjnu lilt Ikbl
Id
iJi.
beg.n ,n the cnl)' 19Min. .~nd allhWj(h lkb1
iCI\'lU r.l'M have II\Il )"<1 begun 10 decline, thel\'
i. at If' l' a 1l'(I\Io;og 'lwgnuioo lh~T more d '"~li.:
and de.;;$;vc mion on dehl - iodudin~ lhe wril·
inlt-<>fT or ~l of Ito.. rtmaiOlDl{ delll. lII''C\l by
Afn.:~ III , hi: ,uwrnmtnlS ofl"" ......-slem lndosrn-
oll1N 1U1IOns and funlK'r n.'lilll"l1OlU: In 1M
romJnI:m.oI delllS ol many tolm Ammco.n COIl...
1Tll:S-1S 10 lbe mu:rn<i olbolb mdusrrw.z.N and
oJm:,lopl\Jl 'fI'OClli.
Ikn '" 1M JIIWtU or ~ 10 re~ lblll
- - . l of ;be fJI'O grnI ~ 011 llumuI
~ " IS • essl:I11lol lMIIM Illl/lmUlllnal
"""lNlfIll}· make 11II01OI" ..... eotIlllIItIPmI '" llw
IpIf1I WIlle e.--__ .., /bPIJ I{ 11M C1nU
and 10 lbe 1'uDdImcDaII)' lIlOR CII'I1ll!ed PIWJ*
IMIIIlt J""lecbOrl vidlild=l's LM'sand ~
menl >h<.uId be 1M bsI and DCII lbe firll
obbgouon 10 be AClIIiccd ...'hen lImeJ are hard.
\1i' ithoul sud. I commnmcnl. It II 1MV11ablc lha'
lhe ~'"<5, lhe halth, the grll"lb. and lbe ooua·
"
tJOIl of 1fI·1""" .... dlildml,n ,be 1990s'OiI sg:na
be ~ OIl ;be shit of debt repl)1MlIU:ulII
...........' """"""'"
For btUtr, for_1'M
1'he lrnPJcl of lilt deb! crisison chiIJ'tn il one
iUusln tioo of lhe n«d fa, a n~w [,Jue ...·h'ch w,1l
ensure Ib' Ihe prOl ~ ion or children has firs' coli
OIl the = ml and the <"P0cmes of ildullllUCkl)·
in Uma of turbulence and transition.
!lull!..-ouId ~bo be I numkl' 10 ,_,..., thaI
IhlS _ elluc III DCedc:d only '" ltlt poo<L':lI
COUlIlfJC'l or only .. the IDOSl n l """" QleI of
«OIlOIIlOC Iwdship or 0TiI tIlI"mOiI.
1n boIb Ibl' u.... ~ SQla :lfId >be UIll1N
~ for mmpk. ' 0 }"\'IJ1 or
!Indy
(1 1. : m" cr-th has bftn IIttUmpIrlIIN by I
'Oililo W A!cI)' llCU ol-.sl ...mea hsvc - i }'
ff"l}"N, lbe IIUIlIbcr of dIiJdrnr, IinDg ID poo<eny
ill lbe U~ SulCI has risclI by tlltIU dun 3
million tfrom " " ofthl: child P'¥,bl_ 10 1979
10 "'..,.. IS" lOlbyj. Tocb}·, Ipprc«imslely """
tblfd of IbspalllC Al:ICnc:IInJ IIld one balf of
Mnc:IIn,J\me" C11U1 Ire liriflll: below ,he acwpIed
po\"crty hoe , U Ire 41N of 1M children of Nr'O'
York, the fioancill copilOl or the WOI"ld'.
Such fil(\l ,," lVptt'lCIIl ius' as Jll"C"' I viol~, ion
of lbe nt.'W elhic embod iw in 1M ('_JU'o~ I S
aO)'lhUlg wbleb hu bappeoed io lhe deb'-<lff_'l:led
COUIllfJC'l of Iht dnc10pmg ...m ld OWr the Iu,
dc:=le. The gtoWUlJl mindJ and bodln of t htit
cbildren of lhe ind""nali:zed nllIOns M\"4l "'"
beee ItCOfdcd 6rst aU on tbc mme proopftlly vi
lb= ooaetift. nor has thl: prot«llUl1 ol tbe
IIundnds vi ' .....'SXMk U dli:drr:a whoM lives an:
b¥1td by malnlllnnorl, by dn<p, by oq\M
and IbusIc.
n.s _ JIf1IICPk' W ......
!box okw" is ~'
COIlIImes _iadI bsw ......x.l
thl: doIb! trJP IlId lIWlIWned sr.cai)', :md to lOIlll'
III
C2$Cl sptX,.ubr, nltl of c.:..1IIIWCfI"lII\'M 0'0't't
lbe bsl de<:ack. MOM of ,w. fslb into tillS
Cllegur)l. The dynlllllC a po:tirl( IlIIIIODI vi I:a:st
,w.s are \I'C'n.J<-n enmples. but lbe 1>1111
ec:onontlCl of ChIlli snd 11Id;" I nd Ihe popWout
M'Klns of Bangl.desh, " . kim n and Thailaod
h""e also e~per~",ed 10 )'ears of rising per
c.pin inoomes and slow falll In ,hc proportionsof
'heir populations living below Ihe 1X""'l)" line.
Some uf ,h...., nalions have ron""iou>ly pu'
c<enomir gro",h 10 "'<Irk for ,he "-ell·being of
Illl>ir child,.n. In Tha~.nd, for eumple, ,he
speei6c gool of dimin'ling "'''''''' m>!nurririon
was buill imo the Fiflh Nation .l Develcpmem
PI.n .nd Ihe resull has been a redllC1ion of gndc
2 and grade 3 malnullili<lll las defined by Thai
reference vahles) 10 less men 2" in almost every
village. In Ihe Rc-puhlic of Korea, 2S )"'" of
npid cwnomic gr0"1h ha'" been .oco mpa n~d
by spc<ilic .ct;On '0 ,nnslalc economic progress
inlo human progress: malnuTr;lion has been
virtually eliminated; the under-five denh rale h.l.1
been broughl down from 120 10 33 per 1,000;
and almllSl every child has a=ss lu bulh primary
and l«onduy education.
Suslalned economic growth has m.de lIICh
achie>"em.nls ealier. BUI m.ny coumri'" h3\'c
seen sleady «onomic !laim "';lhoMI lh. equiva·
lenl soo;;>! ad"allCl', showing Iha, . conseiDlls and
specific rommilmem is nC<C5lary 10 1l.nslale Ihe
on. inlO Ihe olh.r. And perhaps lhe most
liJ':1'ificanl aspecr of ,he Korean $10')' is 'ha' "'hen
c<onomK: progress f3lim~d badly, as it did in
1979 and 1980, lhe sIlingenl econumic adiuS!·
mcm prognmmc "'hich " "" imrooucw 'u cope
"i lh Ih. crisis "''lIS 001 allowed 10 erode the moll
b.sic "pC<IS uf human ....elfar•. The nUlrilion>!
.mu, of child"'n was monilllred and maim .ined ,
lhsic health services ....ere not allc.... ed 10 sufTer.
And ,he righl of:ill children 10 educ:rrion ...·31 nOI
compromised by spending roll. In Ol her \\-oros.,
Ihe W3)' Ihal ,he crisis "'as cOp"d " i 'h was. model
of 'adJIlSTmenl "ilh • hum.n face' .nd . n eumple
of the principle " 'hieh lkm.nds Ih3llhe commil·
menl 10 prolectlhe l(I......ing mind' .nd bodic< of
children be m.inlained , ~botk (fwd /i"us a1lJ IxJJ.
Asia', challenge:
For I\ si••s a whule, till> SIOry is more mixed.
Wilh Ihc imponaDl exeepnons of Indonesia
M}'lInm. r (Hurma) .nd Ihe Philipp;ne., the
conl i n~nl h.. avoided ,h. deb, tr:lP which has so
dominaled Ih~ developmem ' lOT)" in Lalin
Americo . 00 Africo for lhe las, decade. I\nd for
lhe most part, Ihe .Ie.dy beal ofeconomic grmnh
has be<:n maintained and in many calC. quick·
en<>d.
Despite this, Ihe probl.m of .bsolUIC pm'crty
;n ,h. world srill h.s its centre of grovity in Soulh
Asi•. Approximalel)' 41l" of . Il Ihe young chil·
dren " '00 die in me world eiCh }"U, 45" oflhe
children ...'ho are malnourished, 35" of meee who
are nOI in school, and o"er SO'K of Ih,," ...·ho ~v.
in absolule pov.rty, . '" 10 be fuund in ,,,"'Ihret
cllWllries _ Indi. , p.kislan, and Bangladeoh.
II is nm only a question of absolul~ numbers.
The prrmuflKt of Children who are m.lnoorishcd
. nd Ihe pcrr'"liJH of bahies who .'" born wilb
10'" bin h " -e ighls., alThough f.llinl:: slO"'ly, is still
si~nificanll y higher in Sou'h ASI> 'han in .ny
olher region of the world - indud ing .ub-Sah. n o
Mrica. T~ chollen!:" of Soulh Asia is Ibcrdore
,he ch:utenge of finding efficienl way. and means
of con""n;ng irs Sl~ady economic progrCSli into
equiVlllem improvcmcn,s in the he. llh, nUlrilion,
and education of ilS children. Pioneering cffons
in the 19l1Os 113,·. illustrated the dramatic prO'
grcss which could be achieved if Ihi. challellJf\:
"''C lC' 1U be widely a«epled, .nd mOre .... iIl be .,,,0,1
On Thi, subject laler. Butlhe point al issue hc'" ill
Ihallhe principle uffillli call is as r.I.,.. nl'o Ali.,
U il mO''<!' into wh~1 may be anOlher decade of
lignitiCUll Konomic progress, 31 11 is in 'he mosl
debt·burdened roumries of Afri", or Latin
America.
In lum, the Co/WC1Ili"" 011 Ih. R igh.. of Ih.
eJr,IJ, and ill fund.men'>! principle of first ",II
for children on soo;;ety's capacilil'S and con,,'Cml,
III univeruUy :lpphc.blc. I\ nd a' ,he ....orld·Wlde
adlUllmen, of economIC. luwards a gre.. cr rolc
for m'I ~1 econcmics In aJrnuS! all WCi<:UCl KCl>
under I'..y, rh.. principle ,,'ill become ewn more
oe«ssar)' 10 protec t children from the turbulence
,h.. will be QUsed .nd the mimkcs th.. will
ine\i l3bly be mad......... 'be prohlem. f:ICinglhe
children of lOllar's free mar ~l l'Ctlnomiei dearly
oliO"', Ih. mar~'-pl3Ce ClIn be. bro,al plaCl' for
'h05O who IKk Ih. purchasing 1"""" 10 make 'I
se"'e Iheir rn,ed•. 'Adjuslmem ...11h • hum.n
face', Which UNICEF h•• advocored in rclalion 10
lhe developing " 'O rld's debt cruis IhroulthoU1lh~
u
THE STATE OF THE WORLD'S CHILDREN 1990
bsI doau." II ttwrrfoft abo rdt'nnl 10 the
mdusmahad wwkl. ""'-tine tbr Sonn U,,-
3fld tbt C(IUIllnft or t-. HImI EIlropc IS !bey lllO\'e
--roo the rnm"rn"ulJ{ f){ dInr euJDOtmc
S)"SlmJl, and 10 lilt l'I"I<~d Suvs as II ~
tilt :M!)usImtlll III Q 0'Inl «momy ... tllt rnliry
of 'If h~ ~ :aDd u»t dd'Iciu. \Ul.att""tr
1I1Oe lfirKtIOn 01' (-..st orpolin....] and tcDDlIftIX
~ In rill: WWt WlXIcl, dliIdrea shoIIId lit
spccialI)' pnll«Iod, .. far as is bumanI)' pos:s;lIle,
from us " "On{ e:trocu.
The aclo.JntmtUU of the 110I
TM (o;> oh«>mmg WlPrld S....'I fi1r ("Adm,.,
rbe r« I:1l II)' WoplN Co~W./lQII (11I 1.( RlfIrll ll{
I.' CJIIIJ ~nd rhe prOll'cu ,,-bleh has been made
w fa, ;n impkmenung Ih~ rontep' of aJj~lI",r"l
!ru~ Q !II!I!IU~ [a« ere m! J'J1 !!ndm!I ~::; !n !h~
rm<I¥" '...." uf . new pr ior il}' (or children and ;n
thc al1cm pt to entrench the 'pnn clple orlim call',
aUI the .....:ood h:ilf of the 1980s h.l . Iso 5«n
mawr pr.>ttjg.) ~ klh roughs ,,,,,,,,rd.
,hat nc....
pn ofll)',
In ~cr:al, Ih...., bre.ktl>ruuf!:bs tl>", :ill l/I'
rul....-d the mcb~lU"on of lOd")". tomllluni.
elllOll' Qp;lI'.'l)' 1ft 0100 10 begin puru:og tbr
~6u or ""..ultlh-<fllllll}' ~ 1\ 11M' dil.-
pouI 01 tt... INlOflI)' of 1M hWIWI f~·. ~ W.
_ ruOPI:t.~ A)'1 1>1', HiroW Nabuag,
l>!r<'clor-Gmtnl or lilt \t'orId lka:lb Orpniu.
f>OIl, '"r/wi _ 1/ ,lit WtIJ ', . . , 1oNh'
,,-u.. aJ ~ _ Jutlu "" JI«t'-.JIk
'...... ' ''''''wn .. , _ .............. 1Inr
teJl. r t Ainf , . , _ _ Ill - ' u r ~ ..
,ItI'f ,. ... "WIj.>i_i _ t/frt""""'-.
,iii wll1' 1twI. Aonw, - ' ~ ,..,.."
"'1'Pf1"ti. ,..Ii ",roc rw " ,..... tift H ..n_
<,tlJmt ...... III' m"'Y 'fl. ~ if ~ ,., 'l<'tFl
".rt, 'lif«-tl.
M
..\ beglnnlll& lias bttn matH..
From ' "aJ low Jr..eh II tilt ~ iii tilt
198Os, Immun~noll lou _ - '<"KIlN ~ppruxt­
m~ldy "'" flunk of lilt d~'..elopll1g .. wid',
duLl,en (fig. 3). From be,n/: almost ""tnooo"
w tloKk' Kio:nllnc e,n:ko a d<:adto agu, 0~1
rehyd ",ion thmpy lOl1.'11 1S IWW being IISC'd by
"
_.
_ ramily '" nny thrft llii. 7). ADd from Daly
15M or 21lt' '" tilt 196Os, ~ nwd..l<lt iii
pbntuna: bIrtho an: __ bn:Ig used ~ :IJIPIUUo
nwrly SOM iii all caozpIo$ iIII !b:ir miIdlwar~
Tb: ,nub _ tim tilt 6ra lWO oi thnc
t«tanoolocw' aIoIx, IlDDlwUza1lllll &lid ORT, arc
_ ttllD'lllttd 10 be A>"DllI: own 3 rrun- )~
"''" m )'1::1I" lfigL 6 mel 7).
ImllllllllZlllUll, 111 particular. h.H b«lI tIlt_
drarmlne public Iltallb _ " Of). of 1M lui
~. At tbe end iii tile 19'7OJ, tbe Il'"orld
Heallh hManbly adopted lbe largtl of U.flllf'Ul1
(A,I<I 1•••", :"'..... 6y 19'XJ ..-bich meUll. IJl
p~ioe, 'tl~ml'"J1ll 10 immUfmt 80M of OM-
)·~a'·ol'" m the dc-vdoping world l~' which point
lhe tun'nll uion panems of man)" of 1ht: vattlM·
prevenl~ble diso:a~. a,t so intcrrupltd. Ihal a
dC8= or prot<'(1inn j, conferred ~vc n on unim-
muniztd. ehildren}.
A, 1M limc, vaccines v,ere " ",hing OI1 ly ~OOUI
l ()lt to 2096 of tM developiog world'. child ren
:mJ the SlIM wJtl W'n rcgarde<I by many II In
,mprlellal pi ..·hicb ..'OUld. be talked l boIIl Ina
:u1<lltu as 1990 d-r~ doIIer and dole,. Today,
lfIIIIII&ElWt "", """'~ Iw; M<.n lifted to :al_
10M and .ben: II MiJJ lIM I1IOR ) "C;ll" III co-
l r ~ bad rcuuJN at 1m ......- dt, lben
If'(II'(IWIIaIdy 5 miIIioa young thiJdrm IrOUId
Jw.~ dlfld 1ft tIw last .......... .-dt1 from ......... ~
pm~abIC' d~ "., arnW dnlll tol 'InS
lU'l- wdn 3 miIlioD.. "., :II.U~in« IJ1IIDIImU-
11011 dfon IIllbl 11M dea&.> II lb:more smnc
~trly 1 tni:Iiorl c!Iildml ndI ynr me
4nlb by --... _'" •• ,« C1IOJ&h, orlCWllII.. In
"ldition, tbcrl: arc :aa ~led 011I: :anlI • baJf
million d1iJdml wa1bnc. ~ and I'b>-m«
~. III lbI ~ and rwch!looathoods III
tile <kn\opula: workl 1OIb). ...110 1I'OOIid "" cnp-
pkd by pobo wtn' • _ ror Ilw IllUIlUI1JZI1al
riforu 0(1"" Ia dtade.
,\I "'" nm d1apltr ..iD ~'looI", 1Iw road wad.
may be Iotlfler llwi these ligum~. Bill " II
plXliaI IC"~~' of ,his I:md, ..nslf<! rrvrn
,ho JCllP or tM de\'~Jopinl: world" "'0""
T«ftfion
fln« 1M 19l{ls, .. Inch makes n realnl..: to thInk
ul l n ~mcrJ:,nl! 1ll."4' r1hlC for childl'l:n snd In",'
 priority for ladJing the problem$\,fmalnullilion,
Flg.3 Immunizing 011 children by 1990 prevenlable illness, and early death, in lhe dKllde
ThIIl!iOO'$'- witnesIilId anlrnmunizitlion~ ahud.
irllt1e <IBveicProg world. M an • • D...... ""Y e/Ion is
still rBqIirfId to III8ll1lhllla1J8t at 80% co-q by lhll As Dr. Nakajima poinn cor, present knowl·
end at 1990. edge aboul.ueh issue. I i immun;Zlllion, dchydrll'
lion, breasl·feeding, child grOWth, rtspiralory
lrlYrlurliWtlor1 coverage of ctWdren under infeclions, binh sj)a<ing, wfe motherbood, rna·
009Yoor in Ih8 dev&lopiog wOlid. 1980-88 bria, and tl>e prevemion of illness, m'R il
possible, at an affordable roll, 10 build a wa.Il of
so protcction amtIIId the growing mind• •nd bodies
of lhe children of lhe 1990s. KUl fulfiUinjl: lhal
potential, a potenlia.! 10 save the lives of well ever
50 million children during lhc next decade and 10
'" protect lbe nuuirional heahh and normalgrowth
of many millions more, depends aboveall on lhe
poliTieoJ rommilmenl to give lbo5e cbildren fim
eaII on our ecncems and ~p.cilies.
MOIing TOI''lIrdS new nalional rommllmemS 10
undenal:c lh'l lask., and new inlemalional com·
milmenTl ro $Uppon iI, is the praerical purJlO>C of
me ploposed Wvrld 5'l'1r",ir /fJT (;IIiIJ"".
In prcpar:l1ion for SlI<:h a 5" ",,,,ir, chapter II of
this repon SCIS ourrhe main praetieoJ and specifie
opporrumlies for prOtCCling the lives, the health,
and the nUlrition of wi children in lhe yean
immediatcly ahead. h is, in effCCl, an invenlOry of
the most basie and obvious actions wbicb would
indicate [hal lhe n"",' rommiunem [0 [he world's
ehildren was becoming a reality. Ch'p[cr III
looks a[ .ffordable opponunilies for moving
10 lowards lbc broader goals of primary bealth cue
for all and basic education for aU in Ibe 19905.
C~ 'p'~r IV dillCUSSe!l • possiblc new role for the
indumializcd nalion5 in assisting tbe developing
world 10 implemem the principle of finl ealJ and
10 accord a new priority 10 the absolutc poor, 10
t~ildren, and to the en,·ironmem.
DPT3 PoIioJ BeG vecses m
CPU · DiI>Iihene. - . . . (""""",,,, <:oo.<jl). lew...
BOG · BOG _1"CI8C:II ",,_ ~
(..... -onIyl·
.......... . One ...... only _ eo dose .. poosibIe 10 & """"'"-
TT2 -T-... 1_ ~ In p-egnarq to P"'\8CI
..... _ol,.~) .

( ~ Io '"" _ _ ill,. Hg... lor 1980).

_ 1lNO _ _ "" _

"
THE STATE OF THEWORLD'S CHILDREN 1900
The specific opportunities
On pr.... "l t~nd., more ,h'D lOll million
children ",Uj di.. from Wnes' .nd m.lnmorion in
(he 199O!l.
These children will DOl be the victims of any
sudden flood or f.minc. There will be no
reltvision ",mf ru "' rh..ir dUlh£, no ("'hlic
oulnge, no dem.nd for lC1Wn. "11l¢'Y ore children
who will die ~nJc nmieN by tho world.
The ..uses of Ihose delth. c:m be li,ted on the
lingers of one ha nd. Almcsr sll of lh<»e cbildren
will die of di..,..., "'hiloh "'ell' Oncf' juS! ., r.mili••
Ln the indu>ui alizcd n. tion,. Th")' will die in ,h..
.unkcn..,)~ com. of dehydr.IUOfl, or in th.
gasp ing e'l~milif'$ of pneumonia, or in the iron
grip of (e,.nus, or in the fC\'et ofmc.slts,or onth..
r:lck of wboopillJl: oougb. These li,~ Common
mnc<<e$, all r..loucely usy and inupcnsivc 10
prevent or UUI, will accOWll for ""'H h.irds of all
child deaths . nd ovt, boJfof.1l child malnutrition
In The deade which be. ahe.d (fig. 4).
T1Ie measure ofllu~ pl"3Ctical opponunily nO'o\'
avail>ble for protet.1 ms tbe hes and tbe grOVo1h
of man}' million. of children, even on difficult
eccncrmc limes, is that IOW<OliI vaccines, oral
"'hydration Iherapy, and . nlibiotic., could be·
",'<'Cn lhe m prevenl lhe m.j(lril}' of child d~lh.
and child malnulrition in me developing wor ld.
Tbe time i. m"rd"" for thOK basic $CicntiJic
ad" ances to be pul al Ihe disposal of the Whole
human f.mily r;lthcr th.n being restricted ro the
min~rilY in lhe industri.ili.cd natiOlU to whom
ther h.,,, long been . nibble". The vaccines cost
less th.n S\ ,SOpe r fully immuniRd child. Sochets
of 0[":11 rchrd..,ion !:Ilts C<>S1 3.1'proxim'lely 10
cents each. A course of antibiotics rom epproxi-
m.tely $ 1.
lt is not only • queslion of money and
lechnology. It is al.., • q""Mion of lhe dolivery
systems and Ihe ,nfr,slructure, the m. nagement
."''''_<,('" rrloti><Iy rtmO . -...y, URT . ,I>< <fi<l'I_
,j,: '~ '''''' <Ili>l''''' ill ,he ~ IfI'<dl .... !I«o
u.._.....
11'IIoip<uIo..
~ i""..._ r<lIyIIr.",. ,h,,1'r
U"'fII '.., .. ,I>< ...""
~ ..
.....u .r< _ ol<>oIy
, ~ -..f< ...... ...-.... ,~ ~, ......._ ...
""'·1"" "."'_ for JcIly.Jno ....
"
WlIs and the t.. ining, . nd the usc of.n possible
chaoneu 10 infOllll .nd suppon parent' in
appl~ing today's l:nowledg e. But 10 put the
problem into an overall pe~ive, the adJ,'·
tio~al rOlll, including deli''<'I)\ ora programme to
preVent lhe greal m'lorilY of child dealhs and
child molnutri tioo in the d.,..de abead might
reach approximately Sl .5 billion per ~".r by the
late \990s.
T wo "" d • half hillioo doU:m is • SIIMlam ial
sum. II is 2% of Ihe poor world's own Inns
spending. It is the ,ppr01Cim3te COSI of five Stealth
bomber!. It is Q much .. the Soviet Union has
been spendi ng on vooJ b each month. II is IS
mIlCh IS U.S, companies hi" e been spendi ng each
year to ad""ni$e c;garen ... " is \CMt of tbe
European Eccncmic Community's IIln u31 sub-
sidy to il$ farmers. It is as much . s the developing
world i. paying t \1>ry wttk to soniCI:' its debts. h
i, . s much Q 'h e world •• a " 'holo 'p""d. on 'h e
military twry Jay.
Wh'lever ether reasons m.y be givtn, and
hO'il'e"er diffictdl the cccnomi< climate of the
dceode .he.d may be, it is impossihle to accopt
for one momem the notion thar Ibe world CIWrOl
afford 10 prevent 1M dealhs and lhe malnutr ition
of 10 many millions of iu yvung children.
Nor ClIn il be acrepted Ihallhe children al risk
"'" too difficulllOre.ch. In III era when Coke and
Pepsi have reached into virtually overy vill.ogt
IIld every neighbour bood in the developing
wo,ld with bolh their producu and their III...•
sages, it cannot be impossible to reach those same
communities with a l~nt packet of ORS IIld
the message ' hal i' can sa",, ' child's life. Over ' he
laSI 20 years, the developing world has rcvolu.
lioniaed ito capacity to communiclle with the V'Sl
lIIa;oriry of its mizens; 1IC\l"Jparcrs, radio or
lelevision nOlI' le ach into almost e,·cry home;
education and he. lth :service, nO'" h"'e some
presence in almosl every community, employcrs,
lnde union... nd co-opcrativcs ore now in "'gular
communication " 'i' h their work-fore.. and mem-
berslli~ retail indllJlrics, public servce, and
ad'1>m sing agencies re¥";larly speal: to • huge
puhlic; IhI' ....k"" of religion, of the non-govern-
monlOl o'tflnia'lions, of the women's llt(WC-
ments, of the WS and entenai nmen' industries,
nO\lo' le:och unpre<:e<.lentcd eudicnces.
 The deficit is therefore nol primarily in the
technology, nor in the finances, nor in the
OUl r~h ClIp.ciry. h ;, in the . """eness that the
job 010 be done and in the determination [0
"",bili•• 011 pouiblc resources 10 do it.
The commitment of . nation'. poIiti<::l.llca<krs
will be necessary if this sr'"1 potential is to be
unlocktd, :uld • SM",,,,i/ fOT Child...,. toIIld [<><:us
that tOmmiUToCnl Utile 1990s begin. But k.de,-
wp of all kinds at aU levels - from the wQrld. of
religion, politics, cdo",!;on, hcallh, media, an,
commerce, bbour, public 5O:fVice, <men.iornent,
and people's mew.moms -is also <»ential if
families everywhere a, e 10 be informed and
supponed in using; today'. knowledge 10 impro-"e
th.;, 0\I0'tl and .hel' children'. li,-cs.
Fig. 4 Causes of child deaths
AJltlO$t two thi'ds of the t4 m!1lfoo child deaths NCh
yea' ani accou nted to< by JuSI fou' specilic ealtM'S -
dlatT!loea. ,espi,atory intectionl, measles. and
Annual deoths of c hildren under tlve bV main causes"
~.~
0.1'1 _ (6,."
.f(f"'_
Ior-n_-'ln~.
olll'iodwl, <nI causa tolII-' ~
_ _ dool""""
_.", -- -
_ n1 ........... is a<aWtla:rycausa ln ,.
Cfle1tW<lol 4llchlol ,. ., .
For the proposed World s""",,"
[or CJtilJrt",
and fOf an tbose who b<:rome ioV<llnd in
responding to 1M great ch.1.Uenge, ..'hat follows is
• brief summ ary of ,h. Jix "",joJr opporfWnilm to
protect the livei and the normtl gtOI'1h of
child""n in virruaUy ewry de..-eJoping roumry in
the decade ahead.
1. VnlveruJ. child lmmW1iutiOll
Dnpile Ihe "'pid progm$ of the 1980s,
immunization remains one of t~ grealest ohll nf
thoae opponuniues. T" "0 thirds of aUlhe child~n
in tbe dI:""loping world have already been
rt!achcd by ..ccinC'$ and apprm<imatcly 2 miUi<>n
"",,·natalle\anW;. The ;reat majority oIlllesa
daalllS oould now be pnlV6Iltad at ""'Y low cosl.
_I>"'*"""""'
ac<a ,""'*..,--'•• _ e M_ _
ol..-.....-. . _ ~ M"""""", "'
__,
rcl is """" hi ........ . - . lor. _ 1or-..tic:t1
_"~I
tr
THE STATE OF THEWORLD'S CHILDREN 1990

I..." "IO'U'_ is D 'Y. SimibrI)", ion"",",....

_mwds rg . ("tIyshowllwllO'»wofl<ct
mlId M rocbed if aD cbildrtll 'trilo reuiw I flr1I
daM fIl 'f1IIXJDt - . . . 10 cumpIow mefll6~ .
E.",.'". tile. \WO opporr.llliUls, by almillc II
bQltll stafl'1O tbc Ilftd 10 lake nuy opporNlIIIJ
10 imm..nia and by ilIeniDe all punts 10 tbe
Ilftd for I full courv 01 , - , ; ..... ~ qwctIy
lift ~ by m&:I)' ptrtn. poillll Illd *'
~latMly link txm "*- Ii is ill tbr dimuwioa
of wa$lro ~ md IX benn 11K of
c:xisung $lair and focifuies, ralMr tIwl ill any
Ag. 5 MIs.Jed opportunities lq)Irll~ ~ or ....., Ikliw}" initia:ivn, 11m
n,. *9"l oI8O%~~ 0DIAIf1M
ad .. <'Id ... cHdNt\ ~ ... bnlughIm dirics
Ibc: grt l lt$l gam. ~ _ waitiD,g 10 be lIIIdt.
-lot whI_ P\o"IlOH - __ 1O'0!IIWI8d Irld his) matteT of plIn icuiu COI>Cem thJl t~ Two
imt'Iu'Iized Mj . "y. haw killt.. among Ibc: YKrint- ptrvt'll llble
dixllcs - measles and neo~ llal lell nU$ _ m lhe
Re$\JIl' 01 typlcol "rTissed opporTl.rli1ies "'"'0 fot which immunization lag> furtMSI bohind.
SlJV9y' (children attending ~ fOl Meul... $till d .im. U million younll ~VtH Kh
Dine! ,OI.!~ \-,-no we!e neteceeoeo yea r, aDd Inue deaths are bur the monaiilY lip of
I morbid,ry i«~fg. Other illne.ses and malnutri.
lio n I re now known to bt up [0 I", limn IIIore'

.... C(l1II1I\QIl in the lIIonths wI! )l:in followin& •

lII~asln outlll'ok lpan~l 5).

--.-
. ". _.'"9~

.....,"'"'" """"".-.cI
Mnslet is Ibem _ OM of tho , . . lI>OIl
dc~1y threalS 10 ~ dlildrnl oll~ 1990s .1Id
unMnal mnsln immuniulio:o lUllS! remaia_
ollbe clea<k's i = '[esl: pis.
lmnllllliDtIOIl Ipinsl IeWIUS Ilso !nils M-
bill,t ~ 01 lftJ1Wl1 lI'OmnI ID 1M
do: ,.... C 1I'IlIId. SliD !WIlls II bs IhIn J.tM,IlId
tbe IlIIIIlber 01 It UHded ItIIDIlS cues IlDOllC
_1lId _ bolll bIbieo has ~ falIota
wry Iiulr ID the 19l1lls. b is • lIUlnllf <Ii IlIIIOllI1
aad IDICfW,UIIIlal oIwx iIw ~ 10 nsiIy
IlId _ ~ pre-uublt oiIoxIld IliI be
tiIitIc ~ IhIn tIuH ~ <Ii I lIIillioa

----
For all YXti nn, and m . : - 011 (OI1fIlrin,
mfllllS sad ......,.
nell r- (paM 51-
~ plobltl'll$ .... ~
!lip fud com, " uk .
~
.hem·.... at )'OU:Illl ~

probkms of Il,mpcr:lrun. IlId

mx
1~ _ lIII
n,
, ufI' 1Jlo<'.

there ~ l(l(\Jy Two OUWIlldillI oppclIlIllIl1ia fOf of tbaoe mllU the lOb 01 W1i ,~ immunlmion
~ immlDliuuOll ~ to 81M or lIIOU diffiruIr. Bu. the t980s ~ UlowIl 1M bigh
"nlUn 1M nw l'fo~ momhs ~l 6l. Fig. S ~ CIII Ix IChieved 0ftfI in thc pIl<lf'UI
sbao., thaI ""'tnge' 00llld to> quidI}' ' ''JW''kd IllUotut Uld cvnI in the lIIOSI diffKlJll of tcOIIOlIIic
by Km'nin( every child ..'iw is broughl 10 • 11ma.. Procrw hIS bet" lImply acceltnled, for
bt~hh dimc, for whatever purpose, 10 _ If tumple, III 41 OUI of I~ 4ti Iow·;nromt Afria.rl

"
 COUntries in the last 6,'c ycars despite all thc sumined ccmrrutmcm to the immunization
rominenl's difficulti<'s. And in Chin. , stiD among ca u ~ .

the pooJresI twenty countries in the .."OT1d, lmmu-

ni2ation coverage hIS alre.dy re.c hed 85% in
rotry pn>tJi"'t and (\\'er 95% n.tion."oide for
polio, OPT, measles, and BeG vaccines,
The toIt of immunizotion programmes is nOt
prohibitive for .ny country. The "",,,ial f' C"lor in
FIg. 6 VaccInes prevent two mJJllon
deaths 0 year
Oo!er two millon child de aths a year are now being
Pf'MKlled by VaecinllS. 1M almost U-- million
childr"" are IIIiII dying, amually. !rom \'accina
preventable disea.... TaIanU. to,old immurization
(10 pnlI$CI thlI molhar·to-be MId her new·oom child)
lags disastrous~ beNnd.
voccoe p<6VEr\tOOle osecses: oectbs.
cod CCJ!ieS 01 polio. p<e\lEr\tad and sl~
occU'tirg. 1988
1.5 ~ st
Still occumog
• Plevented
1.25
Immuni2ation hIS depended, .nd wiU depend,
on the often unl«Ogni~ commilJlll'nt of ~le
in ""ery country " 'ho ho"" communico,ed with
,he parents, wrestled with the logistics, driven the
vehides, maint. ined the refriger.to,," organiud
,he dinics, rnd vatrin.ted ,he chUdren.
Bu' in tbe difficult ye.n of the 198Os, the
mainspring of immuniznion's eXp;lnsion has
been the poJitial commitment, at the highest
levels, which h.s en. bled lIOtional resotlrttS to be
mobilized on the scale required.
It is sale 10 say that never before MV. so man)"
President!, Prime Ministers and senior political
I...d.... been ptrsa nolly involved in the promo-
tion of any public bealth initiative. Ministries of
the In'erior, of EduClllion, of Information, as well
as Minislries of Health, have shared in the
. chievement and m.ny He.ds of Stale ha,'C
ml int. ined their involvement by . sting '0 see
quanerly progress repcru from their ministers,
provincial g(\\.. mo .... Or ~nior health officw.. As
the World Health Org. niu tion has said, "'l<x:i<d
vtJI/it l)'llt"'-' JrttW 11m. tlra..gU so IJral ;"''''I/m",,·
lien il ""'" rt<"f1IiMd 4.1 a JrigJr prioriI') '" ""'Jr
" arumal and ill/mllI/itmal ltadm".

i 1.0

'5 0.75
Th. t rOOlgllilion is ... hot has mode pmible tbe
~chi evement so for. Oe.r1y, it is oIso imponrnt
for political Ieode.. to know th.t immuniution
servite1 mllSl be permanent, th.,
continuous

i
investment is reqUIred, and lhot imm\llliution
programmes mllSt both Slrengrhen, and be
0.5 strengthened by, the infrastruCllne of prill13ry
heallh core. BUI the commitment to panicul. r ond
achievable gwls has a crucial pan 10 play, ond
0.25- nothing is as likely to accelerare progresstowards
OllIe, gnoIs as success in relcbing the goolwhich
is now within !'e.ch.
In $Um, the immunizotioo L:lrget C1n be
t.AeoslEts Neo-ooIoI Whoopi'lg Polio' ochieved. The ~ves of 3 million more ch~d ren.
tetanvs cough )"ear can be savedfrom meules, whooping cough,
and tetanus. The pneumonio, diarrhoea, vitomin
• Tl1a larJIe i.. . . . In Itla .......w 01 POliO eases
, "... -.d. _ _yNr.ern.- .
Itla
....-ga In polio ImmurimIon In
io c.lMd ""'"'" I>f Itla
CIMI<8III"
A los.s, malnutri,ion rnd n utritioo~l blindness
c.used by measles can be l.rg ely pre\'Cmed. Polio
_ "-_ 95'1011'1 \989. con be endicltcd. It is MIt now ~ question of
_ ,....._lMIeHl.O_ "'bether it is ph}'sieilly Or lin. nciaUy possible: it is

"
THE STATE OF THE WORLD'S CHILDREN 1990

Egypt:
shots and salts
Eq;pI-.._ _*1
IUCCIM
cNd_
... -
*I
'" -...-.otlg
000"_<1 _
.
,.._·I
"''''" •

COft\'U"It\I - . . Ai ......... _ N I
~
It
__
' ..... ~-. ~"

!'IO __
_ fOl'lTl .-.J - """- "' ...
h_oI _ot_OIcnlc1refl ~ Clriy 12'llo 01 1"'11"'*" ......... __
..-
In lQ6( 11>0 ~ 01 !fo;tl1 _ _ • _
~ ..... _01 ......... _ . _
a br.llh II'e ... "w" and".,. moIllII-CU·
lORSI_ ~-
_ _ ll'0QI-' _ l>r USAlO. 10
POOl""'" 1ho .... 01 .... r ~ _ "" , ,•••", <toooo<l 10 ..._ • "'*"""
.",..,...,.,.. ~ !OfPec..... _ ~ t 0\,0" """"*Ilft. I1Y 1ho Monot1.. d IlNIIh .....
"'lI ""'"""* 01 <t>at_ "'-ge10Cl OIl ,,,,,,,lIId """ ...,., ptegrootll
.......... <llInr1l;I1tIO' IIIsI _ monllls d 1968
o..ur . 0.000 "",,,"'•. !lO,It$ell aM ~ "

• now ,*, '" 1hoCIJI""'*"'>

All (l(M!<R'N!IlI
d"-..
he""" teceies 0Ml0'Ill
<lrtlf\ " - "",... .,. OIlS,..,., '" CfIorll'l..... 3.XIO
rd~ 19S'!l.. ......
cen".. _
"'*""'
.u""""",,
MIl ~ ~
oeJIooJl¥
""ll\ cJIil. . . _11'_" tr_
~

_ _ted
'" ,""""' ... ..... "'!"":' ~~!:"~
' . ,""'. _

Tr~
~ ~-.. '" ""WO"I '" IN
GorI Guocles, ~ MCIo!l wot\:eIl .
~
c\twIg ~-..c

tor
__
I;WIIl

1_ _.'.....'*
""O<IWS ...,., _ 10 "'..........
II"""
.. ...,..
_ ... "'" "*"""'" OIlS
0& .... I<llcl. w.n-.t
.;aonsl ~
lei ...............

F......., III oo._lllIIwed

_rca
~_",_G.OOO_-...... .. IN ~
loul ol
QfIIGuCIOl ""<_
'-" 5 5 W - 1IIdets. ,0
.. OIlS
from 23
_ cn.coI
~
toll """'lI
'1ioItoI * - a lwlg S'\l"'bClI 01 IN
j
1CItt'A.
A __

__F
_ ..... .. 1982105 _ _ ..
~
,
.
,
.
,
.
.
,
,
,
.
~

no. _
""
~ I• .-., .. • • • I!WlU
' ''- _ _ 01 . . _ _ ...._ ~""_"1'lDPe"'_01821.~
_ _ r.oo_llI _
".. _ ~.-.. "_''Il1''1*:
_IotORS_
II!' '
<XItfICI... .~
r "'_000
01 ORS • ""'"' ___
_2111.000_ .... 0C>se &,
11l88, <11 .......
8~
<11
to..- ........
___ me:cl>e'S.""" _ _
--~
~

_ _ IIW ....... I:tw"! llOl' an l!'"C D.lIDn ~ IlI-.o Iouons kim Ego~'S ~ ..

_'le_ ... ""'"'

........... AI _ _ 01

- " .. _ I '~
~ _
1(l.2O!II '" 1983
01 d...,....,
OIlS. w '. .""
F--.g
__ .. 00 .... ....,.,.,..,.,.....
,"0'_...

_._ ...
90'lIo01 N pnp""P>'U"l1O
__
~_'-'" 1~""_

----
-_
. d._ ,_ _ 01_'..... _ ......
..pt«;l.Ol
_ _ -.v _
0III>ciugtI ..............
_ pr_plWlT iN

Eauoil\I on'Op;)O:Wnt. _ • • 1he ..... 01 IN

E n ........... _ " " ..........,·0 peIot!coll ... " Tho .....' ••• '•• <II
_ _ Mglbl'-"-~pol~ PI , ._~_...,~.­
a.u...., ....... s......... _ ...' -
_............... --.. ,... ""
1988 _
~

~1IIlIIt OII"lift
l>r II-. _ 1990 &I'
llO% 01 \!'Ill ~-s '/OIl"lI ~

or c''lldiiOOCl.
...., ......,...,.
~ •
..-<1111>0 F.nIlM:t\I, Mr.
_
b' _
CNC1/Il .. " ........ olIl:a _publlc.-J
....::_ _ 01 pr<>\eC\oI>g Iho _ _
_1tJw lI'O"'Ih OIl!'I <n.r>lJVS j<U'll chIcnn
a queslion of wh~ther thert i. lhe political
commitment, a' ,"" highest Itvel$, 10 set lht tad<
through.
The immunization of 8091 of children would
tberefore provide the lil"$l ~p<'cilic cballenge for a
Wllrid S~", ,,,il fiw Clrildr", and the 61"$1 leSt of
whether national leaders.bies "" prtpar ed 10 act
decisivd>' to pml«l the children of the 19900.
Major killen
h is thO! SlIme polilicll ccmmameru wbich is
rcquiffil 10 liberne lhe potonlial of lh~ olher
oquany powerful and equally lov.'oCOst means (If
prol«ling tbe live. and the grolA1h of children u
tbe 1990s begio.
Two (If lbe most importanl of those means art
oralre hydration therapy (ORT) and anlibi(ltKs.
In almoM every developing COUIItry, d" rrhou l
disease and respinl(lf)' infeaions :ll'e thefitsl and
SI'C(lnd most CUmm(ln causes (If illness and death
among tbe under Ii,·es. Togetber they claim OVer
16,000 young livcs tll<:. dllJ.
A. with "aceinc prevemable infecti(lns, the
hour h3S oow COme 10 pot an end 10 lh.
dominance (If t""~ t" (1 diseeses o,," r rholi,'os of
so many millions of children.
AI the 19801 have demomrnlcd, the most
striking upccl of these 1"'(1 stll of infoai ons ill
rrull horh could now be defeated "' link COIl
lhrough the l\I~ti1Uti(ln of fIIllII rhtrapy IlJr biuJ.
Bc:.... use diarrh...a :md coughs and colds arc
the most common illoc;ses of childhood, the
parents of rhe developing "'(lrId ~r. already
spending an estimated 51 billion each year 00
ami-dimbo<:al drt.lgs, cold remedin , syrups,
dC'Coot.'Cs'an,$, and similar prodUClS, almost all of
whicb are ineffective, Thai same amount of
money WOIIId be enough to pay for effective
"ealmem _ if i, were available _ and to u"e many
million. of childreo'. [i-,... esch year.
For both diarrlwcal dioease and respira'ory
infections, the ch.anRt" from twJ therapy 10 good
mOSf begin in lhe homo. It is the righl of aU
parent. ro knOVo' how to reall rationll!1y, in rhe
light of lodlY" knowledge, when thei, children
are il1. And jf paren,. a n be reached and
persuaded by invalid messages abour incffccrh-e
medicin... then ir mUSf allO be possihlc ro r. ach
,hem 1A1th accura'e infonnarion and 101A'-(0$1
lrca,mcm. which will genuinely protect their
children'.livos and health.
To prolCCl children rrom life-tbn:arening :md
nurritionaUy damaging horus of darrheeal dis·
ease, parenu need ro knOVo' th. essentials of bolb
prevenlion and rrealmenl. U. illJl all poiiiblc
channels, all families sllould be inlcrmed that
diarrhoeal disease ran be prrotJUtJ. 11 can be
prevenled by brcut.reeding, by having children
fully immoni•.ed, by \IIing latrines, by keeping
food and waler dean , and hy washing hand.
before louching food. Similitrl)', many rcspintoty
inrecrions can be p'C'\-'en'C<! by brea$l'·rceding,
immunization, and safe " 'C aning.
In rhe COnlcxt of pu"el1)', and in rhe aboe n.., of
basic seMCCS ouch as waler iIlpply and safc
Unilation, not all familics will be able ro acr on
that informarion. But that docs nOl mean that
lhey do nOi have rhe righl to know lA'hy it is thai
lbei, child'en are 100ften illor wha, it i.rba[ ,her
,helO$l'l"cs nn do aboo' il.
When illness doe1 strike, parenlS !bould know
tb31 food and liquid . re essenlial. h is lKIt
d"rrhoea itself bul the accom r.anying dehydra·
lion which kill. l\l'O million children each year .
And i, is nor anti-diurh...al drugs bUl oral
rehydration sailS(ORS), breasr -m~ k, gruels, soup,
ric~ wain , fruit iuiccs, rca, coconur wa,er, and
d ean waler itself whicb C2Jt pre\'Cnt rMr dthydf3-
tion in .Imost all co....
It ill al10 vital thai parenli know wilen an
episode of diarrhoea Of a coogh or cold h••
reached the point where the child's life is
[hrcalened. MOil mOlhel"$ know "'hen diarrhoca
has become more ~riOllS rhan usual. Apan from
rhe frequency of walery ilool1, specific . igns of
dehydralion arc sunken eyes, extra rhirs[, and no
ttl"""""
• or [ll< ~ /lIiII... dlad d<>tIIo p<r~"" &omd""lIonI
"""..... ~ lIOII ........ o - l br<k,ydnI.... ...t
........Jon: """I"ihl< to ORl ',
THE STATE OF THE WORLD'S CHILDREN 1990
lcars when the child crics. Al IIUs point, IIrlp i.
,"du. Similarly, on)' pareOl of a child wilh a
cough or cold needs [0 kno\I,' lhe OllC symptom
wbicb mean. lha' the child'. ~fe is in dang« .
~mi$ls arc no.... agTt'edon thatone symplom.lf
a child ;1 lu.clng diflicUll)' in breathing Or is
6"'''11,,'''11 mMc,," ItWU rapiJIy th"" ...""at,Ib"! it i.
esscnrialm gel the child to a clinic immediately,
Thernfter, replacing bed Iherapy with good
<!llltnd. on improving health Sl'r\'i«s, and on
he.llh workers who hove the ujHlHl atc know!·
C<lgc and the luw-<:",[ tcdrnologies to prevent
Math from dehydration or ,espirnory infection.
In tbe calC of di,m hoeal dchyd",lion, tbe
tc<.:hnology required is • recent u ehet of ORS
" 'bit h aU bealth " 'nrM rs can keep in >lock and
which . UporenlS C1II be t.ught how 10 use. In the
case oheut. rrspir:uory infrct:ion1 the ,,,,,hoolog)'
is. course of amibiotia, taken o..lIy, and um:llJ)"
t:l)$Iing jO " than $1.
These N.XI tl"Chnologies, wilh the capaciry to
SlI~ up to 4 miUion lives eacb year, are lWO of
mankind's most powerful instrumenl$ for lhe
protection of ill ~hildrcn. It is therefore essential
that all he alth IO'Orkers arc cmpov.t\:rcd to use
them. Yel m~l comm unity health worbrs toda~'
a.. forbidlkn to prescribe: antibiotics and mosl
have not be en lrain l'd to lIS': ORT . Th e training
of all beahh workers in the use of O RT and
antibiotics is l""refote perhaps the greate51 public
heallh prio rity ufthe 19900. And il is lbe I"th b>'
which . lmoS! e·..ety single developing country
could reduct' child illness and child deathli on a
,ignifi Clfll scale in the decade ahead.
2. Oral rebydntioll th erapy (ORn
Al the moment, according til I 198& WHO
reporT based on evidence from 46 cQUnlries, only
14% of docrots, 4% of nunes, 8,. of paramedics,
and 99t of communiI)' IleaIth IOXlrke" /La.-e bc:om
lra ined to use onl ..hydration lherapy-despite
unanimouli e~pen a~knowledgement that il i,
" p.sWt/iolly 1M WII!St i"'pofIM / ",tJi,ol brio.·
IkrtJ~fk ,lIis '''''Iury'''''.
Some counlties b..'e m. de progre5$ in lraining
health wmket5 to use the thera py - notably
"
Brazil., Colombia, Egypt , le1ioIbo, MeKico, Pakis-
ran, Peru", the Pbilippinca, Sudao. Thailand, Viel
Nam and l..aire. Even more widely, many nation!
h.ve begun to put today" knowledge . boul
pre.eoting diarrhoeal deh)"Iir'lioo 31 the dispoul
of paren". After a deade of sucb effons, one
tbird of the dc"eloping "'Orld" families know
about the breakt hrough and Ire .nempling to put
it into practice l6g. 7).
Thl rtSlllr u /.01 a~ . sti",OIld I mii/ion liM orr
..- Mill ",,,,d ."'* }l or.
On the port of :llJ tbose individ\l.tls who have
been iO' "(Jlved in promotin g ORT O\l"r the lnl
deade, the saving of one million tivese.ch }'(Oar is
ao impre ssi"" .chievemem . BUI more than 2
million children .re ,till dying each year from
diarrhoe.1 dehydrat ion wben an effective low<QSt
.herapy hilS been 'lI:lilable for nearly lIO'Cn~'
years.
T he question whicb would Iace a World S~",,,,i/
for CJrildrtll is therefore wbetber or not the
ohvjOU$ thing willbedone- ,,';0 ORT be made ilS
"'ailable and as ,,'ell knov.ll ilS Coke.nd Pepsi or
will we w'lIch 25 million more childre n die of
dehydrati on in the dcclIde ~bead~
The arrno.'Cr 10 that qtl~ion will be one of the
mllSl obvious les" of any broader rommitmem to
Ibe principle of first call for the children of lhe
19900.
3. Aeuu ....pintory ilIfectio.,.
Similarly, the question of whether . ntibiotia
are to be made more widely available through
primary level health worken is a qUC'Slion whi~b
mus, be resolved befo"" the 1990s ore more than
a ycar or lIO'O old.
There il slill eeeere about lhis issue. But WHO
and UN ICEF belie"" thn enough evidence h.!
• 10 p.,. ..... 1"" (I'm) ~ ,ooo _ ....... <loaN 01
- . 01)' "'P".......... _ lr«II ,..'-I '0 """"11<-...0.
_ .... reIIj'llr>' 1OII """'"
 now been accumuJlled lO shO\lo' lbl hundreds of
thouund. of eh.ild",n'slives eould be saved each
~ar if community health workers ,,~re Irained in
and CnltuStOO wilh the usc of .imple, basic MI·
line .ntimicrobials ""ch .s COlnmOK01.ole which
are inexpensive, nsy to score, and likely to be
effective in the majority of cases.
In some counlricl, it will mean chongiog the
I.w. [0 oImo.t an countric., il will mean changing
convcntioll3l medical wiJdom. BUI the lime N.5
Sllfcly come to grasp the nettle of ",.idual medic'al
I'<'5iltanee. It ....... in 1973 thO! it WlI. £"',
dcmonm.too, in the Punjab, lh01 ehild deaths
from pneumonia could be almO$t hal,'cd at very
low COSt by luining village heolth " 'o,kel'$ 10
diognose seve re infections Ind to nelt tbem with
penicillin. Since then thediognoSlic breakthrough
has been made lbal I child with a cough or cold
who ~ brel lbin* more lb.n 50 timtu minute (or
more than 40 Urnes pcr minute if over nne ~31
old} i. I child wb"," life is threalened. A parallel
.d'1.IJce in Ueatmenl i5 the confinuation of the
effectiveness of orally I.kco . ntimicrobials.

Fig. 7 The spread of oral rehydration Itl ero py

LowCOSI 0011rehj'dration therapy (OAT) can be Almost unknown at the beQinrWlg III t~ decade .
used to preven1 lit treal1he deI1ydralOon. caused by ORTis oow being used by one in !II<ee of !he
diarrhoea . which ie ttle single mostcommon cause ~ work:I'slarniies aIId is preventil'lg an
III death among children undet·liYe. estirnaled one miIion child dealhs every year.

35
,.
Pelcanloge 01chklreo Ulder live with diarrhoea being treated w1Ih oor.
OMOOI ceotre prev anlad c od stiI occurring. developing countries ' . 1984-88

"" .~
ao
~ as
~
2Yfo./
1\ 20
• 15
11l'K..'
~ 11"10./
• 10
1 5

ea ee &I.,...lI<Ic_ _ ",., .. _
1980 81

Fo< ... _
83 "
V~
8S

cI """ <:Nt!. M T ineU:lM",., uN III Dom

"
also _
<n<I doccl.Ollng.l9M
"""""""" cI _ and _ .. _ _
IIaChelJ II! ora!, ..,J\li , $Ab (known as ORS). ,.,........ e ,econrneolllea lor the poe... n... , of dIIllydratiOll,
,,",,,,,,,,, .. _ ~ fOt \rNImOt1I cI--,.,rzion. """
_ . """ r<XlCI/ ... . . . . . . . - _ ' En:l.dng CIW>L

"
THE STATE OF THEWORLD'S CHILDREN 1990

Measles and tetanus:

priorities for the 90s
__ rhe l'OoO tlolIlJllIl laIl!n
...--'

.... ' _
. ~~ttlI

,... ....
·_ 00 "'......- ~ - . _
......
~ !tie - . . . .
l'M>b~

31
al""'_3~

!lui ~ " -
_
_ 110m h tQlI ot I5 I1'ClJ'11W; - . •
addlool 10 "'" _
...... tIl ..
In _
. - ~ .• ..,.

....... . . . - ....... _
r---'V_ -...", &.II _ _
...-.._be
""'"

- . . . dNI '" .,.. 19E1O1 111M; rreaoICS .. _ loOn 'YS_ IlraMly - . lllrft o.aner. III "'"
..... 01 "'-_~al:ct'Old~ __ a dO .' :111 iQ 1OOIlll",.,.,..,g <Jlolct.... _ bo pro-
~ Io'IUm<l A dIIfuci.. ¥ lhM ~ .. ICIOd """'"' IN I'I(!I<I ......,.. """"ll'lf;
- ............. IreQuIn """" - . . T . _ .. co..o....."'" IIlIo'og """" Ik.. ol
....... 01 ulhot _ " ,.... P<WI"""- "",00<1 .. . . - . now.!>Or"" <laCtl _ - _ ......--..
.6<:alodo'll lU roc"" _ , ......
II'Odera <:J
_ . pi 'I'OOIll ""'""" Yet lliIlII4l "re<I\.ftd
- . .... dOaln " , .... "'""""" """-II ., '" ""', ,.,..... """,gllle ~ "'" '" C<>nlOCl ""Ih
outt!!ellk o! "'C~ e:. ce :;::: ::rr-.;; tl';;:';::- !hoi ~ L.-nbIkai cord ElornM ~ ~
cI>I<n<> ....... ..,.,".'' <!fl l.......,...,
omonu""'"!hOM !he ,.... 01 bo'" R """" .,.....
IIWl _ ..no dol rIOt AIl~_ lIf boon ..»l~,N..........
Moo..,...

- ............ " rnoJI.,..,

~""" _ 0/ ... ~ .-...... WlIh two _ 01
_ _ ". '"" 0.",,,,,·0.-01 of !hoi World Wla"<lt , _ ..., .. OlOe.... ' 10
OM'"~'
~ OronmoOll (WHO) _ ..., ....., _ _ ....., .--.l>om o;tW;l As _ _

. "",,~ -"""'.,.,,,.. ~
1'"'f¥CO'I"""" _IN""""""" ".~.I
__
_
~

..........-lY ...., OUCh

"" 0UCh~

"'-"l • •-.roan
•

E~-ve d._.IHI_
25"__-'''__."",6,,-
...., - . - .... _ _ 01......."...... c.e IIy
, _ ..............- • IIIedIo f _ :Ie>
£r~_tn""_
-.rtrv ........ . ; ,
~ 1I'lJeeoouI. "" _
....-.e__.. :
'n_.
,-
.m.... ~
-.. .
_
19l1 bI7.....
~ al
..............
3O'Ilo o/lhe
-....,
-. ". ~
' . '11-• ...,......,., .........
-"'~-
Iilde lUO'Ig ......,-
__

.- ..
_ _ .... _"'.........-

_._-",...-,-....,..,..
_._ Thio_".-.._ -",--.........,
Clr'Iv ..... _
n._", ._=.. _ _
<II .... -.:7>0 '" _
llClS

..
II • • oce:*:
II
""""" . . . - • 11'"*"'1
TN 0 . - ", WH(h
.......... - . . . ....... Dr IIolpl> l"_ m~
.....,.,,,
r--
Pn:>-

_ ..

- -_...",._---
h ,br-dlM n os _ _
....
....... at IN Y.,.",.. .... """'_
. . . . . . . .. . . . t _ _
....
.
".
lJIaleCI ~ ,.,.,.... bu: '"' l""""Il d lhM 0"4

....
~....
d"", _ _ ", _ _ .r-=m , ,.._
Ioo;:looe VKCnI1. _1IUI h _ _ be t'l' _ II> /lCaO" lleII:v1I 1995, , . " " " -
'"<P"W'M' '" . . -
--=-_.
_ o."..tlal_ .._ _
Al ... - . . . . . .
l)()4'''''''_ '' '" _
- . . . ....... ol9.....-
d*on _ '*- .

A llIIl<ltc!nI..- _ - ..... E- . .
1. .", SIr. . _ gtOIIIl '"
_ _ " " ...

I"'I1II_.""""
ba elIec-
,_ h _ uI
,m .. . _
---
_
lIlJI>d.

_
~ -
/It . .,.
u.-. _...., .
llJlllI ..... " - _
1 .. ~ ""'""'" We_
(Wl;l nI-..t ~

AI 1110 ..., ", 19B1l• • _ _

,
.......... t<orn 1lti 10
..... _

..--_ '" 0ft9'I'I"

!IOl' lIJatoel 4 )
•

.,.. boI

"
 Reviewing lix pilO! 5ludie. in [nd'., Indnnesia,
Nepal, I'll!cisun, the I'hilippines and Tan7.ani:o,
Dr. Feliciry Sa"2ge has summed up Ihe present
po5ition:
" Tdk", "'gtl~". 1M sludi.. s.+=l~aI Pile ,""'. ...
CjVI lit mli",d 10 WIle}, 0 d iU Iwt.u.ing, 10 o/nnw
flW ttrrol~illg IV11/ dCli i"dro.~i"g, 10 apply tile
simple ""'''0#''''''1 prwocoll, 10 tit>< uml Olfl!bWf·
icl, IlIfd 10 nploi1J fupfJlJn.TYt corr 10 m(l/~m, Willi
rtg1<lor IUprtvisio". Pile ~r,,*m do uS( ""li~lJ1l (1
mpg" ,lbly. .. il""WI abuse or owr-use. . . .
"Alllroug/t_ ,,,mliO"1 rt11UIiTJ, Ilr. rwJl1'"""
lINiI<tbIt prrroide IUfdlllo"1Il roldt IKe 10 juslify lire
IJfclusioJf of ocwl< mp'ralilry iII/wi"" c01lrrol 'If
primOl)'lmzJl1r COrt OWC) progrommn Tlril ""'.I'
obo i/tCTtoS( botlr Ilrt crtdimJlty of Pile fl'D7im
o"J lire QCccplo~lity of Pile progrom_I"."
Dr. Savage adds:
"Alllroug~ Ilr. nuio difJ" Ilf dttip. 0,", _ t of
Ilr. results ort nill prtll mlJfO.ry. 11rt}'1I11 poilU IIrt
SIl .... ""'Y . Tlrty ruggnllilal Imp"""d crut munogr-
"'till of QCule mpiralOl)' ill/ww1JS CQuid rtdUft
c!rild d.ollrs fro'" ptml_io ~ aI I/'IIJI 1016 ond
pmhahIy in moll)' nlUlSlicns by 5Q-7()K"."
On. of the $Ix S1lldi", sponsorod b)' UNICEF
and rond<Kted in Ihe th= y.ars up 101987 on
the ouukirn of Kathmandu, saw child <kith nics
from acute r'ijliratol)· iefectiuns f, U b)' almOSI
60% in thc fi rst year and by. further 2S.. in the
5eCOnd yeas". The principal 1001, were h.al th
edmtion, immunil:alion, and amibiotil;$ made
a'"1ilabl. Ihrough communiry heallh "'<lrken.
The ' Iudies will continue. Butthe time bas now
rome 10 set on "'hal we already know.
onl anlibi<llK$ and ORT have been of proven
effmiven... for two dead..., during which time
approximalely 100 million children have died
f,om illne,"", which these IWO inrervcmioes " n
treat or pr......n'. How much longer are children
going 10 h,"e 10 waill
It is as if a cure had finally been found for
ca""" r bUI Ihen linle u,.d for I"''enry yean.
Diarrhoeal disea,. and respil'lllory infection. kill
more p''Ople than 311 the different ClI~ers pul
IOgelMr, and moot of their victim. are nOI oves SO
m,t under 5. Tbe d~isive diff erence, 10 be
explici, aboul it, is lhat lhe victim. of dias,horal
dehydration and respirarory inf«lion. are pre-
dominantly tile children of the poor.
We have 1M knowledge and the low-cosl
means of d' ''''licaJiy reducing the impaa of
diarrh""al discase and acute rcspira,ory inf",,·
I;Ons - Ihe !WO mo:sr common caD"", of dealh and
iUness among Ihe ehi1d,en of almosl every
developing COUlllry. And in view of Ihe rate of
progress so far and lhe OOl\$eQllenr... of funher
dela)'5, i, is reasonable to suggest Ihat heads of
'late and their senior adviKn should n0'3' lake a
personal imeresl io Ihe delay.When a hondred of
a cnunlry'. cilizens are killed in a pl:mc crashor a
rail :t«ident, ,he event can be $Ure 10 demand Ihe
auemion of press, public,arld politicians. \t'hen 4
million children a y. ar are kill~ because IWO
known and inexpensive soIurron. hne no' been
made l''Jilable, ,hen Ihi. 100 ought to be worthy
of the anemion of nations aod Ihe inle,,·enooo of
polilical leaden .
Applying these solutinn. on Ibe same scale as
rhe problems would thercfure be one of lbe mo:sr
imponam and obvious agenda irem. for a 5;<", ,,,11
f.. CllilJrtJf. For il is clear thaI high·lcvel political
intervention is now necessary to overcome lbe
obstacle.. ,., Ihe goals, and mobilize Ihe reo
~. 10 apply mese knrl\\'O Low<Ol.I S(l\ulion. 10
lhese known hlgh-<:ool problem..
4. B..,ul-tcccllllll
Alongside 1M pre\tCminn and treatment of
diarrhoeal, respinlory and vll, ine·pr\'VCmable
di,..,.., the i.......
of brelWfttJi~1 and InnJl
sp«illg also claim a place among Ihe w.
mosl
crucial .ptl:ifie factors for the protCClion of
children 10 the decade a.head.
Brea$l·f..,ding appca.. 10 ~ on rhe decl,ne in
many developing nations as commercial pres-
sures, Ih. use of mill: powder and feoding bonle.
in hospilals (panel7j, and the in=sed panicipa·
lion nf women in Ihe labour force, aUcenspire 10
make bottle f<:<:<ling oecm Ihe aUrxli\'c option.
The continuation of this In'nd would be
diwtrous.
"
THE STATE OF THE WORLD'S CHILDREN 1990
h hil ,,"n OQIl1;SICntJr de llWfl ~nlc<l, ever
many yUrt and in many nations, ,h., bottle-fed
,"fJIlIS OOlllTXI far more illnesses . n d :ue IS
much >5 25 times more likely to die in ch~dhood
' hall infam_who :ore ~clusiw ly breasr-Ied forIhc
lim six months of life. In those earl~' momhs,
.....,11 supplementing bl'C'ut-f.,.,.jing with 1'0'\"
dered milk can bring 3 len·fold incre3~ ;n the
rid of death" .
Thu ri",- incre. sc. with ~. In depo" ed
and "ften ilIiterone communities, expensive 1'0""
d.rcd :nilks are often Ol"cnlilullxj with un~fe
"'a ler and fed to infant. from unslentil e<! ruding
bottles, ~bl n U1f iti(ln and inf. a ion result. Breas,·
{«ding, by con" " " is nutridon.lly perfect,
.1,,'3)'1 h~'gi en ;c, promotes he.llh y gw.<1h, 'im'
mumzes' infants .pinSl common infCClion;,
help. prevrnl dehyd.. til>ll, and n-duces the
se>1:rity of ,espiralOf}' infections.
A minorityofnaTions have m td On thest i, cts
by I,unching pub~c informalion prognmm~. and
by ~na Cl1n g imo law Ihe WHOIUNICI:I' IlIlmra·
twlUll Cod, Df IlIdrkli ing of 8 rtQjimilk S~bJtinlltl,
"'hk h is deSlgfled '0 promote the """, n'ages of
brcaSl·f""ding . nd 10 p re,~m tM irresponsible
promotion of f"'--ding boltks and powd<:rlPd baby
milk. h i. a 1()'<l.'<DS! option for rlPducing beth
child de.th, and child malnulrilion in Ihe decade
.bud, and i, is an option open 10 the poIilical
le. dership of all nations.
S«ond, fr~uenl and on-dem. nd brcas!·fefll·
ing supprc'SSCi ovulation for """tal mootlu afrer
a birth and so prevo:nlS or poslponC'l ,he ne~'
prcgn'!K1·. Rcgat'lllcss of any cffect on (I\'erall
fcnili!)', the benefil to mOlher and child of
spacing bin hs at le"l 1"'0 yun ap"n i, in iudf
one of lhe mOSI imponant and le••I·known issues
in public health, Brcas!·fefllin,ll: helps to confcr
that enormous health adl'3mage.
S. Birth spacial
Figure 8 ilIllStntc'S the impcnancc or birtb
,pocing for improving the health of both women
and children. It ,hows 'h a' Ihe majority of deaths
happen wheD binbJ arc mUre tilan four in tOlal, or
are dos.. togelber than ,w" years, Of ar. 10
women Il'ho arc younger than 18 or older ' han 3S.
"
Empowering people with knowledge aboul the
importance of timing binhs, and enabling'hom to
an on Ih. ! knowled,ll:!.' by providing culrorall)'
mplable mtlbod. of family planning, ' herefor.
tom m.1Id a place ilmong tod. y'. oulSlanding
opponuniti~ for prolming tile lives and the
hull h of many millions of women and children.
Aswen "" oonsidering bllW Ihese ram might be
made mere widely known, nalinnal lcaderships
mighl also wilh In consider Ibeir implicatinns fOf
Ih. question or the lcpi minimum age .1
marriagl:. Cultutal differences and traditional
",I ""s make ,bi. a difficult IIld $<noitiv. issue. Bo'
loday's knowledge ~esu that ,he chances of a
woman dying in childbtrth, or of a baby dying in
inf~ncy, ~re !",rhaps 5096 greater if a woman
becomes prc~anr before 'h e age of 18. By thaI
age, S096 of gJrl. in ."' fria and 4096 of girls in Asi.
are already ....rrilPd.
Family piJ.nning is ~ ronrroversiai issut ",hk h
generat« pusion. and principleson aII .ides. Bo'
illouch•• and is louched by so many ether raCCIS
of homan progress that it simply cannot be
ignored. There are today 300 million couples in
the developing world wbn do 001 want an)' more
children bUl wbo are not using any effc<:tive
mean. of ~mil;ng fam~y size". A strong demand
for planning binhJ therefore aJrndy exists. If that
demand Well' 10 be met, then a number nf major
gain. could be made:
First, Ihere would be • steep reduction in the
more than 100.000 illegal abonions wbich arc
now performed totry d"y Df1M )'t'"r . ud in tbe
SOO deaths of young wOIIIen which ~re the dWl)'
lC'SIllt.... The suffering i. unim.gin . ble. Its contio·
O3IIce is unconscionable.
Second, there would be a signifiC3nl improve.
men! in Ih. h.a lth of many mil~ons or women
who ,,'OU!d be relined of the enormO'J$ ph)'siClI
and meuul bunlcnJ of hl'ing tOO many children
too dose together or al tOO early Of '00 late an
age. An estimated half a million ll'O men die every
year of causes related to childbinh and . majorily
of!hose deaths could nllW be preven,c<! by the
well-informed spacing and timing of births.
Third, the li,'C;S of the <!lildren who ,,'" born
"'DIl1d be immeasurably imp",wd. Not nnl)'
"'DIltd child dc31 h racs fall, perhaps by as mucb
as I tbird, bul the quality of child cue, ofheallh, Fig , 8 nmlng births and saving lives
nUTrition, and tdUC'luion, would in"";tabl)" .lst ,..
pa rents we re able 10 invest more of their lime, BirIh spacing is OIMI of Ih8 moIlr vital 01 ilII fat:lQfS n
Ih8 health 01 0011 n'oOIhers and childl'&O. 80lh inIant
energy and mo~y in a smaller num~r or
and malemaIdealh5 are heavily CO/ICOOrrated IlOIOO\I
children. lhos.e birlh$ whic:h at9'too many 0/ too close' 0/ 10
Founh, population grcwth would be sI"",ed. mothets wtlo are 'too I'OOIllI Of too okl'.
livid...,,,,, from the WorldFmilily SU""J'.uggellJ
thai if wo men who do nOI wa nt 10 become Inlonl mortaNty b y oge 01 mother, birth
pregnant ....ere empowered [0 elCerc~ that choice order. and nlervol between births. Brozl.
then the me of popwation gt'O"lh in the 1976-86
developing Wllrld would faU by approximately In!"", mortolty role
31m (fig. 9). Meeting the exisling demand for (deoths per lOOJ..... bi1hs)
l<nDWledge about binh planning would iherejcre
also oonlJibutc to an improvement in ~r capita 20 eo W 80 100 120 140 IW
income. and 3 reduction in environmental prcs- I I I I
sures.
\'('i, b $0 many subSI:llltialadv.ntages to be had
from the meeting of an cxisling demand .1 an
affordable "",n, Ihe promution of ,he knDWled~
.1lIl the means of liming b;nhs also lays claim 10
,,,.,.
ronsidemion 3S one of the finl priorities of the
,
IImRVAl SINCE I'R£VJOUS BIRTH

6. TIl. an-clt on maltl utridol1

The last '!em on this a~nda of specific aciicns
for the , hUd rcl1 of the 1990s ConCCrnS lhe
:::_, ~" I
progrcss that rould IIOW be lmde in improving
child nutrition,
The roots of malnvtnncn ir e so deeply em-
bedded in the soU of poveny, il is oftcn argued, , ,
..
lhal only economicdcw lopmml can Ioooen their
BIRTHOlIDfR
grip. Bur such. rupoMe arnounrs rn tillle more
i i
rhin opting 001 of rhe problem.
f in r, ;r is simply un.ccepl.bl e lh.l over ISO lMs I1'lon 18
miUion children under five should $IIffer from
m.lnurrition in • world whk h hOI rhc copu-hy ro 181024
p",,·.nt il (6g. to).
Second, lIl.l.lnurrilion irop.;~ the ph)'$ic.1 .l1d
memill development of children and lhe working
ond coming capociry of . dulU; il is lherdnre a
cause as ,,'CII 35;\ COOKqUCIlCe of poverty. , , ,

---
Third, severo! counrries h3\'C m' mg ed ro AGE Of M01'l1EJ1
rNUCC m31nurririon dr35ric:ally, even rhough per _· 0 • 4_ . . . . _ _
capita illCOmes rtm';n low.
THE STATE OF THE WORLD'S CHILDREN 1990

Missed opportunities:
for 80% immunization
_I" """,nr_. '*4
-""""'Q"""
fQII III~. a"ICl .. 1hat " " - _ ~ ......... ¥MY_
. . l00.y twO ~ opporI...- !<It _ - """'. ot........... _ l o r ... ~ '-'11 ~
"'II .............., ~..,. 10 I3Imlo """ "",,"0
_ ",., tIt'<I ~ ""'lI"1IlI lloIn g:Ua be Tho_ol ... b

_on
_
on " *.
' l I'*'-'
_ ..."" 01
......-
-.no -'
~
"eM
" ",'_
-
........
__
~
~ """""9.10_
_ao ."CI'
"'~_IOW'
,_ oiIhn_ _•
...... NU
_
F~ , _ _ "'" . - at • l'KlCII __
.......· III . cf>III ........ "., "'" lll:III' '"'V'tl be
..... _ 1Oll.<JIcnb.-I . .
0- . -..--_ _ -. "' . __ At ... """"" ~

--------- __
""'" tlul ~ II> r. <Me ... _
~Io _ " ".,..""tor_1O
.....- a: _ .'., T '9. _".;..-,
F« .. ..........,. . t>r"<9"CI ..... CI'IIIhrl
- - .... -• _ _ 01..,."..
......... p/ooc>o .......
M
""'" _<UQCl """. _ . """'"
1*110 SO'....-.g _ _ '"
NIl_ e- ~ - . , .... _ lbr .. ~ _
_<twf
_
~
"
"
.
ctonc•. "" _ _ ~,

,CIbnng - . . b
"'II .......' lit
_ """' ...........
-.on. •
(I Of. "'*"""'" '"
...... 80S "'.,..... _
OPr ..",.,.,. "'*-Ie .....
~"." ....'..,..
_ " "• • "'''I 01 QUIl'Jlti ' 0 11
.,.,.... -'\I .....""'0 _WI ....0
'0"""""""
t~ T!'oI
.,..11 _ KQte;f /tit • /Ql - . ... 1lI lIe_
_ _"'" .. ., - . . . . . ~ Dr
ICOPlI for IlIlonlI <Ill 1M !llAct " " l>of/Il """""" ~ ~ __, "'...."' 01 _
~ ~
_ ••" ........ ~ """"" 0PIII>:1.... 1Y ",In III eM, l>o,.. ......... ,..."r
1l8% "' ThaoIand, 57110 10 8 1'" '" ~IIN. Milo ..
~ 45% .. """"""_, 4!>% '" P...,..,. ancl
lIlotne< _ , lIlCt """"""drew ............1......
41\1o .. E _ .. ...."."... .. \/'Ie ~
M-'I' ...- .. .,. , 9llOI. N _ _ ' " - '

... lD_._.,..,. _
At ' - lqJ<eI suggoot. It-. gOIII III 8Oll.
............_ ""'*'-.-. ...........
be NIIC!le<l .. .. _ _ --'II"" _ Ill .....
"""'V's _ _ . - orcIu<lof1g"" _
_ II """"'- ~ """""' .. _01 ...........

_.. -..--- •.---

_ IN .... -'!No _ n Ihlt
__ _ b<!ng .....,. *'
II' _ to< .........., ""
~

t> __
_ _ , ... lIle PM!. IlIa-.,.. beI:!r' , u _ tII..- """"' -...;men"i)'llI'",W.oonf

,--, "'---
!

10#18_01.....-....,..,....,_ "~l
"'_""" h _4 ' 1Illl"""" _,•• - 11-. _
1IIl ... ~_
CO ............,
~

, ...
£..... _ '" . . ....,.., _ . . '-.:ell'
_ _......-....,.,
_ _ 20S." ""- ii_U'
~
_ ..

-----..-"'._-__..,..
_''''II'lI~ 0.- .... _
_ _ ............ ~m . _ IlepOIl, . . _ '" _ "oot& ., """'"
_ ol _ _ .. - . . . mlill .... .......I!'>II .. _ .... _lhe,.gonr _
b • .w_oI :: .d<nlgNWsl_
~_ d • d'IIIll'. loIe
 Ending molnulrition is lhereforc l\\ll jllSt 1
question of time md oc<>nomic devek>pmenl, it is
I question of polky and commhmem. AI Alan
Berg, nutrition 1<hiSl'r [0 the World Bank, h..
written: ""Tir. poo....1 c"~,,,,' rcail. A dim:/ al/4l1t
an matuurrilion u ,,"dcd er u't/l, "n" gqn<nIlfltnlS
",illinr '0 ",ake thQ/ 1fort _ how .ffmiw <lIfd
ojf",J"hle lflt<Uurn '0 mak. il Jr"PPtn".
FIg, 9 If women c oulcl choose
This dIart shows two prcjBdb .. gl pop..ClIlioo grO'to1h
., I!Ie deveIopi'"Ig _.0". The list .. lh8 normal UN
'madi..m varlanf ~ ancl1hll saonncl shows
whal""""Jkj happen ~ lhIl "'OOlen gllh8 "'" ,1;piIog
world could choose how maR)' cliIdren 10 have.ThIs
1llOODd prcjBdb l is based on lh8 WatId F~
Survey's lilcing lha! women_ ha\olJ enaverage gl
I.SI Iewet children ~ tII8)' were IIr1ilIbled 10 tI8dcla on
~ siz8. Thediflerenl;:e _lO~
'.3 biIon more peo:ipQ " 3S y&aIIl. time.
Pop.iclion growth ... the developing
world, 1<x:IJ----2025
--_.....---_._
__..._----
_---
190Cl 1995 am zos 2010 2015 2lIXl La25
y~
...
For mmy PiSCn1S, f«ding ,hildten properly is
mode vimuJly impossible by fami nt:, war, or
I bIoIulC poverty. BUI One of Ih. impom.n[
odvl nc." In knowled!;" over the lui dcn<le has
b«n Ihe ""aliu[ion ,hal much of loday's malnu·
tririon, possibw even lhe majority, ruides in
hom.. wbe.. ade<juale food is availahle, and lhal
the <:UIpri[ is juSt u likely 10 be frequem illl>CS1,
poor beahh ca.r., and Ibe lack of kn.,.,.itdge.
Common childbood illneS5C1 - npcciaUy diar·
rhoea, meul es, wbooping rough and Ol hcr r",p i·
ralOry inft<li0n1·1 ~ke away a child's appe[ile
. nd lower food ;'uake. Each illness Ilbo inbibits
Ih. absorption of food, bums up calories, and
drains ...-"ay nUlrienlS in dial"fh\lCll and V(lmiling.
Each day of 3CUte di.rrb...., for cx:unple, can
r,-due. a young child's body ...·eighl by aboul
2" ". Mcasles can [akelw3y7% of body weigbt in
a mailer of d3YS".
In poor communitieswi,houl either d ean w:olcr
or I'Ife I'Inilllion, it is nOl UnCOmmon for cbild,en
to have between sir; and twelve SIl<h ~lnC$S<S a
year. Molnulrilioo is the almost inevitable result.
For tbis tenon, m3IIy of the priority .awns
already discussed in lhis repon _ and ..peciall)·
musles immuni1.ation, brea$l·fted ;ng, and lbe
prevention and proper lfe3unent of diarrhoeal
dise.se - wuld at... mi",. c1rilJ ",a1~"lrilil>/l.·
li pan from frequenl illnCM, 1M'" I re a, W3S1
six causes of child malnutrition U/hj(b have lillie
IU do with Whelher [hcre is food in the home and
mU<b In do with lh. p3renls' knowledge of Ihe
<hild's nUlrilional needs.
The l<flowlcdge i~lf ;s not oomplkatcd. Every
parem should know:
o Th. t bre3Sl·milk alono IS Ihe best possible
food for lilt first four 10 si~ months of a child's
fife . It provides I li lhe child's nmrilion.1nteds, il
is alwa)·$ h)·gienic, and il 'immunizes' the child
againsl COmmOn infCC'lions iiI«: diarrhoe•.
• 1, 1<mII p"'...t« . . «>ao-il>Jn, .. III>!autnuoo ...r io__
_ dc_ _ . ........... Ol<I!>odof _ _ ~....t
......-..1 .......
THE STATE OF THEWORLD'S CHILDREN 1990

a Th~1 by lb. a~ of four to six months, the All channels of commuruc:ation can support
child num other foods in addi,ion to breast-milk. 11m effon bill, as with maey olher advon«s in
Introducing solid foods earlier in=~. the risk he.lth knowledge, it 1$ lhe community health
of infmion; leaving il much La,.r leads 10 ..'orker who CUI do mOSt 10 inform and suppon
malnutrition . parents in PUlling nutrilionol knowledge into
o ThaI a child under Ih~ years of age needs practice.
feeding twice '$ cnen :IS an Idull with ~m.llcr IdeaJly, a communiI}' health WQtkl: l should
amounts of more . ""rgy-rich food' .... bo\o'iful of Issist III mothers in the monthl)' weighing"f olI
walery porridge or ~I is likely 10 fill • child's children under the age of three.
$lom.:lcb and lake away ns hunger wilbout
meeting ilS propon ion. tcly great« energy needs.
Staples tan ~ enriched by mashing in small Fig. 10 Sovlng 100 million child ren
, moun" of oil or f. ts, and a few gree nJ. from malnutrition
o Tb. [ food and drink should not be witbheld WHO and UNICEF believe Ihlrl ~ Ihe rata 01
cl\jld rnat....\rilion and Glimirlating _ _
when a child is ill or has diarrbae3. !.b ny mothers
malnuDilion by !tie ero:l o! !tie century is a leastio1
and many doctors bolie.." in •.....ting the child's taroel. ThOl' graph b8Iow shows ee numllllf 01
gut'. BUI this is c~.<:tly [h. wrong tbing [0 do. A c:hiIdr"" Bff""'lId by pmo.... _ Of IhG lad< 01 ~ ­
lick child, and especially a child 1'I';[b diarrhoc'l, towards this tarll'll, AlmOSlI\alr of tuday's
needs [0 be coaxed into •• !lOll and drinking lIllIlnc>ufished d'lildran .... in 1hG eoighl r>ations of
fr~uen!l)' in small amounts. B~nl·recding i.
MpKiolly im?Onal1l,
o Thai alier an illness, a child need. extra
meals Il' <:alch up on the gr"", h lost, Any child
wiU en mort when recoveritlg from an illness,
"""'- Prevolenc:e of moInutrI!lon' "
children t.rdef live. dovelopIog
wOOd (eilCkJdIog Cl1Ino)
and al Ihis time lhe body is I'n>gr;I mmcd 10 pul
on ...,<iglu more r.pidly lhan normal. Paym!:
special m ention '0 freqU<'nl feeding in the ..'eek
or lI''Q after illness e.n tho,cfore help to mde
good ee nutritional dam"llc done.
o That leaving It leut lI''Q ye.n between
binhs, and m. king $Ure lhe mother-to-be has
enough food and rest, is esscmiol for the guod
health of lhe mother and for the nUlrition.1 well·
being of the child, Too many births with tOO lillie
time in bereee n l':in cause irnemia, low bin b
,,".. ight .nd subsequent poor growth.
PractiCilI " eps TOWard. ending child malnUlri·
tion could lhorefore be taken in the eorly 1m.
by implememing IOW<OSI melhods of pr"veOling
and trouing child mncss . nd hy mounting nation·
wide effons \0 pultod.y'. nutritional kn0\\1cdge 1988 0;0 95
al the d1$(lOPI of 011 p.renu< v~

ofI<'/I
~,
.\...........fof""p""'.' lot d,;ld . ....-, fro<rotru ""'"" ..
"""......... "'""
...... l""""h .. !Or ~ _ fud.".. ... ,
.....a: ,!It _ lot
"" r<adil)' .............
_
n_.._.____
• _ _ to lion _
_
_ _ . <>0-.

-___ " .....,.,_.....

• .os .. _
• """" ""'" IWO I IaMatd
Ihe' . . . . . . ""G¢!Ior.

"',= . -
'_ _ "
:~ .
$ •
 In any child, pott'lJr is the moSI imponant
lingle indir.olor of health. If • ch~d ill regubrly
PUlliDtr, on wejghr every month, then there ill
unlike to be anyt hing fundamenllily 1Io'T<>f\g.
the eh" d is not gaining "~;ght , sofll(!thing is very
definitely wrong and action has 10 be taken.
The problem with this simplebut .n·impomm
rule is th. t • child's grOWlb is . slow pro<:ns and
rnat filtering growth cannot usually be dctcrtcd,
in its early Slagei, by either a mother or a
p"edi.trician. That i. why rcgul3r _;ghing .nd
growth monitoring arc so <:n><i.1. A molher who
weiglls her chUd every momh and enters the
result 00 her chUd's gr(nl,'t/lchan, with the belp of
• community hullh worker, I' able 10 lit grOWlh
or the lack of il. In this way, tbe first sigm of .ny
problem are made visibk to the one person who
cues mosl and can do mOSllO prevent Ihe child
from ber;(lming m.lnoorished. A health worker
no tben diSC\lss the poS$ibJe wilh the
C'-\lS('$
p... nl. Is lb. child Ix:'ng br.3SI·fed? Is powdered
milk ~ing ove,.diluled, or milled with ulIufe
...ater, nr fed from an unclean bollle? Has
...eaning ~gun? H.,... mmy rim.. i. the child fed
each day? 15 oU or fal being added to the ......ning
food? Are green v.gelable. mashed in each day?
Hu the chUd been immuni2C'd? Doc. Ih. child
have frequent diorrhoeo? Is food withheld? Does
the mother know how 10 prevent deh~'dn nion11s
food kept o*an? Are hand. washed before eating
and after usingthe b.lrinc? Do.. lhe mOlb.r Irn<noI
about catch-up fceding after iUness? Is there
enough rood in lbe housc?
With only a fe... momh.' training, a heshh
""'rke' <:an perform lbeso and many O11>or vital
servkes, pulling at th. disposal of parents not
abstnICI eduanion bUI timely, pracricall'ps about
the hcabh and gro..."th of Iheir 0W'Il children.
The petenrial of lbi. approachhas been proven
in Ihc 1980.. In Indonesia (pan.1 IS), Thanand,
and in the Tanunian provinc. of Jringa and Ihe
Indian stale of Tamil Nadn, Ibe re~ar monitor-
ing of child grmvth ond lb. educauon of parents
has reduced malnutrition on a lignifica.m scale
and al an affordable COSt, Th. World BonI<·
assisted proiect in Tamil Nadu, for example, has
redllCCd cbild malnulrilion by approximalely Sllt6
in oine Iboosa.nd viUages al a COSI ofless lhan SI 0
per child per year".
The question of 1M availability and trainmg of
community health "''O rl<crs - a crucial common
faCior in pUlling imo pracrice mOSI of the specific
If aCiions discussed so r.. -wiIl he discussed in
chapler III.
BUI finl, Ihere is one olher Iner against the
malnulril,on problem which a n'lion'. political
luders toUld 1lOVo' lI k. into lbeir hand•.
Nutrition . ......rillu u
If malnutriticn is 10 be ended, then trlllril ;O"
n.rwillatrlt on a regular, nllion'wkle basis will
almosl cenainly be n«<SW)'. Go,...mmem poUcy
across • wide speclrum - n change rates, credil
avail.biUty and inlere51 rales, investmenl priori·
lies, lariff. and dUlies, food subsidies, bealth
lICrvKes, inftl5llllClure planning- can .ilber an.·
viale Or exaccrbale Ihe burden of malnutrition.
Withoul a feedba.k mechanism, without accurae
and ulHo-dale informalion on the effCC1S of sucb
poIici.. on the nutritional wcJl.being of children,
II will be almost impossible 10 gear olher social
and economic policies to the task of .nding
malnulrition.
At 'he momenl, very f..... na'ions b"'e lUCh
inlcrrnarien regularly at their disposal. BUI iflhe
principle Ihat lhe growing minds and bodies of
children should have firsl ca.U on a society's
COncern and apaalies - in limes of harthhip as
weU as tim.. of pl'O$perity ~ i. 10 be taken
seriously, then some m.ans of measuring succeu
or faUure will have to be pUI in pl3cc. Th.re could
be no more im!?"nanl meUIJre of a lIalion'. real
progress. For II is a measure tlOI only of the
struggle aga.in.t malnutri lion today, but of the
moo essen,ial of all inve5\meot< in 10molTOW.
Tracking lh. nutrilional .ta tU5 of s nation'.
children, a1lbough n01 easy, is a good deal Icss
difficull lhan tric king tbe hea.lth of a nation's
economy. All countriesproduce frequenl statUlics:
on indicators JUCb I I impon and espen 10talS,
inllari(l1! mes, and the gt'O\\,b in Gross National
ProdUCT. II is time thaI lb. equivalent indicat0T5
....ere ..aHable, and with lhe Jame frequency, for
lbe grOWlh of children.
"
THE STATE OF THE WORLD'S CHILDREN 1990

Breast-feeding:

_ -.--
ten out of ten service
..................
drn "" bIlloIs.. 1m 10m llu ID ... ....... ltaI "' ...
Ylll ... ".."... _
0'_"'-'11_ .. IlIdnI
III It-. _ Ihe ll'IC!IDO 01
.... o _ .. ~....,..,..,_Iho
. . ~ at ~,1II<ldr'og
o .... ~ n t>ote l>fOa1.-.g -... •
......

/\awl hoII....,.". '" borl!'

0/1""
~.I _ _N . _ _ ~.
o Shaw ,,_ _ to _t~r<l_'"
~ I<l ""' <lo<:iw"oe M.".. I"0Il>'"
_ (Il/I:emolY<:lrocl ~lIlIlllCk
10 Il' OCtol, u. _ ."..,t.... .,11'..... __ .."_ tto<l !rom
~ ,."....
thH .monu
.-duCt lhO Ch....:", 01 I """"" bre,..\·~
."",,,...1IlII' Too olTon. n - er.
_
_.led
~om
" _ " .. 00rtI> lIn<l led QIuc:otc W II", or
o c;,.,. ........<ll<Im
tr- br_ l",""",
no or "'" 0\1""
!OO(l
~ .ndo::/Iled
........... "" bottle..-.:l lINt ~ t!le "'OltIetO' ""'"
l-. . _ ,,' E..., cne or lWII lKI11lI lw<lI o "'oOC1JM ~- _ _.........
___ lhe "" l/lM • ~ ..... ' - <lIllIwItv tonlll<l 'l'\IlOOfl"'t' - 2 4 ""'" • deY
lltusH-.c o E"""",_ 1>'_' ~ ..., .........,.
_
~'"
01
can _ • - . . 0illuerI0t ....
.....". - . . '" bI _ _ o e;",. "" I<bIoIl __ '" ~ l*' ~
__....., _OlIO ----..nu."...
......... .., _
o k>Iw
__. ,..,...,-
..... IluDCMm .. dIIrog III Yel lte . . . . - ..
1I'~_.,_d......,_ IN . ._ '" _ .....-.g

_.""...,.,., "-"' .......

..:II 10 lit'" _ "' J:I ~ _ ~ mtICIJ8I5 10 _ 0fI

-~ " - _ - . -. ' Q'O

<J ... ~ '" ~.-.g
_cNCI .._ .. bOlt>
ID _ '"""-
.. holp '-
___ - . _.-.0...,.".,. __ aIIClI\I IO_*-.... --....,
_ _ """
.<I'M '
01 to;"l11 '"' og
_
"'_
......" ..

_
_-_·m. '
.... ! N I . _ ~

--..e 10 _
;f

lI>I
_

_
£--.
dine
.... ~ IO. lO
' i ... _ < 1 " . . _

_
... _ _
• ., 11>1..,('" """'-*_
lO·tw 1. _ ... _
01

-.-01_ '-'" ...... tlDacn.rnal 0, , ...

.....1t_1D 1lI "",WM;IItNIlI>~

..., U«:Ef _ _ . . . , . . - _'\11 lo _ ~"'~ · _
-=-on _VOMl _ UfollCn ... _ - - . . . •
•• _ ..
" '1tf _ _ ....... _ bom....... 10 ~ cr.dt .. 01 "'.".... __ ~ ......
_ IN r.. S _ /I> S< '4 _ . ~ _ " ... "'" dine.,., ""'" .. ...-to
~The _ _ .. lI'QIl'IOIOI _ - . "'" tn<:t<:e III _

o HIlle . ....lllIn IJ'_-~ IllIkv_ l1\li • -

• _. ; n. T.,
tlong - . . , . _ Pl........ 41- s-.

-
"""'""" -....-eo ID .. _ ~

~_-""V_r--.g "," SPe'

o f '.... _c.e.l.OII .. t . ..... , ....., . . _01 _ _ . ~ ....... W
~l U.
to ':/dey
"'" ""'"
"

T arptlq fMoII ....MidlQ
Nauonal n<lIDlIOD SllIYt'~ l)"$lCIDI couIcI
also belp ill 1M wping of 0lIC achcr illSllUl1lClll
of numlion policy. For 1"- bouIcbolds II-heft
abMIIutc !Kit of iDcorDc or food is !he basic:
problem, IOlllC Iwld of food subsod~ will remain
CSICtIliaI. No nllion or cconom.. S)..ICm, IlOl lbe
Uniw:! Stiles, IlOl :1It Sovie1 Union, not Chllll,
bas ~r managed 10 rcd lltt malnulntioo l<l ftf)'
\oIII levds witboot food subsidies of _ kind.
Bu, gcnn1lI food SIIbsidia em qcick1y bttlllD<
I signifianl drain on rnources, ~ lOtior
e>ft 20.. of gonnunm' bo.l«m III _
COlIII~ """ Wy arf: ~ oCt,." ,lit ~
itam to (ffi EM knil"e " iwn JOftmmmu: bcJin '0
CUI public S\A'oding. In tbc process 1lI1dJURiD&: to
dcbI-' m'"...... tbc witbdmnl of lDbP;lics 011
_.
food hu beee , mmnwm fal\lfC - and lilt _
which has aoaocd tbc moR IwdsI:ip, suIJcna,.
- ' ~ l'car and ~r IolllOlII Ibc
10 ,tal tm:25, tbc vaboc of bld p*,-"in at
Brazil, <:ololrtbA, Jaroaa, ,\OIeU:O, Pmr., and
......, Olhcr utioos !Iaa &IJn c!unQg tbc 19805-
The "ft)' poor, who spclld t!lltt' qumcn iii tbc1r
• , 011 fOod, ~ obriously ee _ doepn-
dent. Yet wbo:D sod Ii.. 112ft bec:n "duc:u!,
tbcft has lIIUIiJy been 1IO pmIId artftOpl 10
rrix:RS 'NotN ~ 00 Ibooc..- in tftd.
Alld irI :all of Ibc mmpIa lIlCGtiorlcd 1bcM,
more lh.m S(M of lbc remaimng rood P""ictie
arc _ accnrinc ro the makIlc aDd lIf'PCI"
d O" " . lD CKhcr IlItiarl1, partlClIbrly III Africa,
IOodo socb as rom and turn hi", bml IIJbIt.
diud e>ft EIoauP they .... rvdy _ ..,. the
plIOI mil lbe ~
The obrious ctIDduNoa &om tltnc e:tpC'KlICn
II tIlII If food a:batdia .... 10 ploy I pan at
mdine nu1nl:trmort, :and j( ~ lire ' 0 tit'
affordable and """In"bIc, then they ...... be
bene< wge'N 10 Ebosoe in IlCC'd.
h has ofr<::l bml argued. tIlII _lIIIl~ and
,ll'gCting is ' 00 dlfficull, 100 poIjtjeJ!'>. amai~
' 00 compIe:c and expcnsi'fc to arL"lIinllfn. BuI
reeer ~ has sboom tbi here 100
ptKlial progress is potsiblc.
A OItiomJ nl:triOOnal PrrVCillilJltt S)'SIml
wooId olMnusIy lXililllC targnutg food ~ics
10 panlcuW SKI0:'S of a counllY, or of, CIty, or
even 10 panicuw"....,... of lhe t'Cor.
..
THE STATE OF THEWORLD'S CHI LDREN 1990
Bo.al ffttl ID 1M ~ willlid)' Ilallonal cbu,
lheu art "'I)' of matdIirla IaIlIIR"rS ...m netds..
In Afnca, JOllIe JO'=ulIC1llS art ~ 10
tUFt food .. """'ItS 10 ee partinIbr lime. 011M
ycar when tbe poor :ore uyi na 10 m.ak ~
. ...I<,Ii.n&' bmo~ .. 1m: eDd of OM )'u n '"'l' and
chi: ~nnm, of tbe n= h lfWS\. In Dmi!, 101M
SUbsidlfS are being made ayaillb~ only IU sm:lll
slorOS in tbe hean of !he shamie. an<l /tl T!tltu
"'hm , the poorc.t !'Wple !hop and the bencr-orr
mely vemure. In other ooWlcrics, subsidir:s are
being ~ I~k only for pmicular food.
. 'hKh ee booc bl "",inly by the poor, ...,h IS
SOI'Jhurn. milICt, Of lrn'ils. In placa ....bell! Iargt
numbers of duldrn rqubrIy Un tIleir rr-th
cb«ked, U 1ft Tamil N"3du, supp!cmmwy Iftd.
"'I an be IIIIlk ~ sptei."icaIly for Ibaw
bouMh ' " .10= absolute lack of IOod iI...-a
10 be 1M rod-bN of 1M plOb......
Vltaa:liIl A aDd ~
~ It""",, the q.InllOCl .... 1M Ip«iIic
act .... ....hich an be taken agaffisI ma!nUIl...... in
tM 19'J1lls, _nlion shoWd be made of tw\I olllflr
DUlritiollallkfM;iency ~ms, Milher of which
should be :alklv.1.'d 10 survive thc lWt'nliclh
«otury.
FlIT forty years, il has been MO'. ln that the I.l.d:
ofvitamin A ina child's dietcan ",usc ir......crsibk
bJlrnlMU (p,aMI 9). Only mere anndy hu thl:
Kale of rht: pmblcm bct:n l\'.P:'"ccillt·d. E~ry
~ar, I QU1ncr of . million childrtrl I rt )lfttIU-
nmtly blinded and :tl'OlIlff qIlU't. of. miDian
1llI,~ 1I1~1l" rynq:hl impai.O'd by the bd: 01
vnOl.llllD ,I, . AI Insl 100,000 01tIlok dliIdren die
..tun a f,.. Wftb.
M(ft R«lUIy ail, • ~ bt<om< dnr aha.
dIildrm dtlioenl m viIamm A Uo ~ ~
~ mfect...... anymp " and poor pb)-m
· " - "' a _ DoU., dtoe o!rrl••
...._.-1_.. .. .=_.__ . -
~.=
.... h _ "' . . . - . .... _ _ 'UI ilIlensdied rueucb Jll'lII'ImtIlC "'lIUi<I
_ _ tl IO _ _ ~ _I ....
~-_
«""'""- tOYftI arnoq dlildren who 1ft OIbcrwiw
01 lM _ IlW1UDDaI IU=, IbrR I.ad:mc III
,lDlllin A a~ a1llg1lificmtly gt'9 1~ risk. Amlrd ·
~ 10 Dr, Alfml Somll:er, ..... of thc Indmc
~~~ in this field, "'1M f"UlI ..",.. ir _
. . UfItN1 rpk 1PU~"'. A pllfJl ill ad '" WK
<lJ'f&I btu II,," 11m u"'plt IIIIff'it>rr " 'II III ptP/QIllfdty
aff"' drildml ~M ~rt ~I ID _ fllpf, DhmI
i1lfl_ ftf"',"
The driicifncy a n be prevcmO'd by informing
parenra lhal add;" g a =:I1l amO\lllI of Ihc
chcapul ~ leafy Y~ables illlO eMir child's
..nning food will belp 10 protect hisor her bnllh
aad eyesrgIn, AlICmatiYdy, a Yilamm ... apcule
all be gi~ 10 11·ria!< dliIdren ~ ail _!hi.
The fOSI 01 the ~ IS 2 US cmtL Tho: CWI
111 igDomlfl 1M pl~m will be thor ~ 01
0ftJ 2 DlIlIion ~ ill !be 1990s aDd the ill
hnIl1I aDd po« ~ 01 many milIiDnIlDCft.
The KaIIId Oieary doficimc) wbidI QIl aDd
sboaId be CDdod ill lbt I""""
is the bck oIiodiM,
..-hid all"tCIa childno maiIlIy ill lllOIIIlWllGCll or
Jlood.~ oms wbrre JO<line IS Inched r.....
"""".
lodinr cScfior,ncy disordm sap the weD·bellll
aDd thor produniYily of t..... Dr millions of .duh.
aDd imparably dam~ 1M menIal W pII)'Oinl
OI~ licJ of many miUiollJ of children. For
dl'Clldn il hal been known that lhe' p.oblem can
be overCOmCby Ihe iodizalion of ...IT (plInel 8) or,
;" 'l""ia1 cirtwTlll. llOi.~s, by iodized oil in,ecrionL
The of taking up eilbcr 0( ,Mtc oplions ;"
C05I
tbI! affected ~ of the II'Drid, II1th I local
popubliun of perUpc I billion 1'"'JlIe, is IlOI
more lban 10 mlU ~ pt'nOQ per r:ar. Tbe
of _ ,.~ ;~. up t!IoIoe "'I'Dom .. thai llWIy
"'*
IIIilIions ~ riI be born bn.mda:Dapl ill
1M <lec:ade ahead.
~ UfWllIy )'>'lId alller ~, hrcll-,lOpact
flrau~ (or pro'«tulC dla:l=l Ion: !WK'illl.
bul Ihll O\'m'lC\\' of lbe progTCSl w poImliai oi
immunization, oral n:byllnlion, amibiolia,
breast -feeding, birth spacing, and I lrl1Og;e. for
impl'llVing nutritional hullh, 1115 $Ougbt III sho....
Ih., rlfcClive solutions 10 tbe rnost imponam
CIUX' of iUne.... malnutrition, and de3lh among
tile children of the 19'JOs arc available and
alTordable today.
UN ICEF be~ ....... that they add up to a case for
making the 1990s into a lJ«4IIr [ Of Do,,,, lite
OInJimIf. And il i, in scuch of. commitment [0
do the obvious on I sufficient scale thaI UNICEF
lIu p~ • Su",,,,iI fl)T Citildrrn. Fer it is only
t~ ccmmament of . n.t;on'.lc. dcn, the aware-
neSS of. nat;!)n" people, and the mobilwnion of
• n.t ion', organi.«<:l rc~", which "'" pilI
todly'S solutions into df«t on the sale required.
The fin anci.l r~ implied by these 0001·
mitments are ncr large. If the ~ of tbe deb!
problem Cl n be brol<cn ;" the early 199Os, t~n
the adJitio,,41 "''''''1s lequi~ 10 scj~e the sec:ci6c
and obvioll. opportunities for proleaing child~n,
.s discuSK<! in thi. chapter, would be in !hi'
region of S2 billion to S3 billion a year by the
mid·I99Ql;. II " 'O\lkl be a . mall price TO pay for
The saving of so many miUion. of young Ii...,.. for
a dreslc reduetion in iii health and matnutriticn,
and fur the faU in population gfO\\.lh rates which
"'O\lkl reRilT. Approximale!r half of thai addi·
lional $Um, or about Sl billion to SLS billion .
yur, mighl renon.bl)· be expected 10 come from
Ihe indumialized natoon, if" could be ..... me<!
that these additional resources would be used for
Ihese specific purpose..
BUI iT is equally obvious that the available
soluTion. Tn m. io! child health problems cannoT
be . pplied in • tOlal vacuum. Permanent sy.tem.
of communicalion, .e""," to ...",ices, and pracTi-
cal support arc necessary iftod ay's health knewl-
edgt' is 10 be truly put al the disposal of the
maioriTy. And this in IUrn d<:p<'nds in ,ignificanr
degree on the training of health workers, the
developmem of primary healTh care 'y1Olem.. Ihe
availabiliTy of "':I.le1 and !I3TliTation seMel'S, and
the level of liTeracy and educalion among The
population al large.
These are Ihe dimension. of d"""lopmem
which are most threatened by the precess of
Idjustment to debt and recession Ind \llhich t!ll'
SIIIfl"';' far CJriJdre" mUst l iso address. And it is 10
Ih. question of \IIhal progreso could be achieved
in Ih. 19900 t""':I.rd. Ihm' broader goalsof social
development Ihal this repen now rum..
"
THE STATE OFTHE WORLD'S CHILDREN 1990

Iodine deficiency:
the ten years war
A. n"w ""'"- .. 'lIIlM1 llacl<OO by the UMe<l """"""'" IhIIl !he prookm """"'.....,. A SIJIYrJ'; ..
'I.,.,.,. hoI<U. <JUI lIIe 'q,e of """"""\InU on<! 01 "-",, lo< e-npIe, kNnd INIl ~ oI"oe pcpuIO-
1M WO",fs Iwadwlg <:aU!;1IS or ~1V-0()(I0;g 1101" "'" rool IMlI'l ,""""""'" ",lI\lIlIS(I'I ' " g<>tte .. "'"
def>c~"""""'" 1100) IllI-_ """"""II 01 II>! lI¥oocI gIoond ., 1/>0 base cI
H......., bw>go ""'><l only • ",. .-...1uI <JI o<ICIonft
m.. !lYooI- .. "-'th ",obloms
.. !her diet OYCI • """"*'
we""", Bu1 ~t _
y",mucll rwa!JYllS '0 cconba, 100 tIaw! stDWn
fresh eM boo _
""""" can"'..., on '"........... ~ to t/f..,..-.d
body '" /log!> ""'. . _ whet...... ,.. tJfDll '" floods
w","" """"" !mm ,.. ..,.,. <hI<IrctI _ o In Papoe New Guir>ee, end 1*10 01-....
.1""'-"<1, """'I~ ftll4lI'ded , ~ llC . _ """"P&"
<4l
8twJ,..,. ern. O/'Ill N81)IlI, prtIg'iJ/1lI'\'IeS ~
bI<! <II _ ~l. - " '" ~
""""'" ~ . tooetlw ..Ilh _ ()j/ ~I<>no,

Seve,. IOllIne ~ III tMrII1 Il/a<. c114dron II I...... ~'""" _11K! "'........"'
ioil: VI ;;;'·~ i .-"'T, Eo;., ,TO:;; WloOi>-;;, i1;;;ws Uii
la'8I on ill.. a< QOClI petfnmw'Ice .t _ ..., poor
o NOj,;;l'. >idWf"i,,,,-, iftiOTlii jjj~ ,ojw ~
~ end ,"""'"' A CAP$Ules 10 II>e mos, '""""0

,.. . "'to._
P<tIdoctM1'/ on
cvcJo 01 ""'''''''_tv _
ocIuIlI>ood. lDcUlg"",• • """"""'...
PO'<flOV
~."..." "'" hamlGlS
o In IlII:l3 lIle ~, 01 arNll 00gaI1
~ de-.:v o/$l> c....... _ """". sit- PO'"""""" .,.

- "'"
Il'lMdflo salt llfQduoeI. ""'" " ....
Dorl!IS ""'" 1I"IQ'1lSe<l ""¥II /If'IdChIiIl rnon"ty lliI1 ~ fl ~ SIlr'o"'I'S In om SlaTe round IhII \lClIIJlI

A.n . 'll/nlIlL'd ll()J ....... pe<JllIo worid....... 810 raT... '" _ " " ',ocI dr<>pped I'''''' 85% to
I I "'"' ()! """"" lW!IJr.oencv. WI'" TOO " ......,
w"cmg lrom gO<t!l.', 3 I'I'Illoo1 Imm overt ",.tnsm o In Iocloe. llfOllutl>orl cI oort ~ sail tin ...
""" moIIoon. """" hom """'" ."~'ulll <!MIa. ~ _kJId """'" \98.1 end 1/>0 """"""
tnenl .. .....-,g 10 lO<l.ie .. salI ouapIoc:o bv 1992.
Add"'ll «""e t<> !abIe P
I '" WIlt'" """1. """'" $
r.en l.~. person ;V'lrllJlllly
Fll' /JIXIyl 10 unlS1 11Iar. o ~ na. QUO<lrullIe<l producl101" 01 m.-.d
sail .....,. 19114 ...,; .. OIg,anoz.ng uIl (IfOIluC....
...,...... 01 _ OIl "'''''''''' "" w fwo ""...
1~ O<&C'oon. And ~ abnu! IWOyear " ,,"ctlJC- c<HJl)O<l1!VOlllO UNI .. "'" ""_'. ..... lly \\19 t
,m In !he """""tlmo lI'J<ll>U/\tl_ end 12.000
'1eo>lti ....m of Iho _Id'.
PtlIdo .,.. >d '" g.e
hml r!IIIu $I<T(l/oI, '(lw.(:a;l me<lSIK... ""'" 300
""""'''''''• .., <h lr'bul"'ll COl>SIJ\o. 01 _
l!"OUgh spClC>Jl compaogne ... Augus' '968, ""
P.><lIIl'IIlII. """"'" ~ . _ _ 0<51001>111I<I10 1 ~
001

""""" on o-.n.. ....,lh/Ir 3l.Xl """"" on ",_ A$oan

oour>\fI<llI. 100 ......, on AIr"", . 60""'" on La"" t'I\oIoorl poo<J(lIe - . QlIOtlOl of "'" lO!aI POPUIa",,"
..."""""". as small. $OIatOd _ "' f ", ,,,,,, In M""", 1987 tho lIn<tod NaI.... onro..n:ed
... "on 01 • ,,,,...,.... ""'"_ _, IDO.
!lilt 1M "' 1Im '" 100 """ .,...,...00 """'PIo><
Pa5S><IllI.1ws rc ood<I<o oat! doeI "'" ..........., m<'M "'''''ll II""
!Nt ,..11 pr<>do.,.,. \MIl comuIY r", ~ poor ooun,.....
l!le " """'"' or ,,,,,,ung ....
ll"C~ SIIIl .., """"
""" t<IdI.c:lWl 01 (pile
...,....... ~ ..._ _ 'lOt>
, . ... :0 - . . ,"" ..
• d<I<:_ TI'Io
re'_ "'- ..,."... mav "" o.«tonlllll An<! ~ _ COIlIrU01 rOD, be<:aus<l 01 'IS _"" .e
"'P"'"
"'-»r. """ ••,,,,, _ '''''is
on tIlCI ",_" tew "" lho~ryol' fe, QtOducrM'YJItltJ~ryol
moIt<m. .-.1/1 ,,_ • ~ , e:t>r1,1Il>urO'I to
<:llOS\.II'rIeIS wi' P8Y 8>1'. klr mil!<! Mil unloIss
It>e'y ... !\.jOy _ e 01 1/>0 _~l$ c"" ,... """"""11 1M P 01 I_m "" .. &y rhe VI-""
aHlH:led l'f """"" oolli::llloqo, tli:llMMIf e of,oo zoo-

•
Priority to the poor
The undermining of soc;'l progms by the
effects of the deb' crisis has already been touc.btd
upon: clinics and schools have been dosed,
cucn!;.I service. have broken down, ,he incomes
of !he poor have fallen and so have their
cxpt'nditum on food, SChooling, and he. llll care.
In su<h • ronlnt, it is $Ormumes argued, only
• complete KOoomic turn<lround can make any
fundamemal dllfercl\(C to the we ll-being of ,h.
poor and lbeir children.
While acknowledging lhe ..verity of ,b. debl
crisis and [hi: urgto! need for its ,uolulion,
UNICEF cannot accept ,b. propc>sition ,hat
significam progress for childttn mus, av.'ail an
improl"C'meOI in the ovenU economic climate
sometime in the latc 1990s Or in Ihe early pan of
,he ,weoty-first crntury.
Children moO! "",it umU our economic nUs.
take!!and omission. have been rectified. It is /lOW
!M., ,heir minds and bodies . '" Ming formed and
il is MUI lIla! thc)" need adequate food, h••hh
a rc, and education.
As chapter I of thi.! report us argued, even .
return 10 .collomic gTOII.,h is no guarantee Wt
cbildren would ~vc lim call On that g""", h or
Ihat tlleir t!oSe ntial nttds would be met by i,.
Whit i, also required is a new rommiuneTll to ~
"yle of denlopment which Mahatma Gandhi
caIIod Qnlyod<l)'II, a de,-clopm.nl which gi'·e,
priorily to lhe poor and p~rticul.r1y to the health,
outritioo and eduC31l0n of their childreo.
Such ~ commitment is necessary ill good lillltf
f/1/d ill bad. There is therefore no nason to ",,. it
for grllW1h'. Th. time to hegin bu~ding thot
commitment and translafing it into effioot
policies is now.
To be politicaUy fe1lsihlc, IlICh a shift io
development prioritie, \IIOUld need, in mosr c~ ....
the fin.ulcial support of the industrialized o~tiOlls .
This question of increased .id . nd rc$Ources will
be discussed in ch.pter IV of this report. But in
trying 10 <lise the level of social development,
positioning the Iever of policy i. as impomnt '$
mcreosmg e e force of Ihe resources applied.
In p"rtiallar, poli")" commitmenlll to univeruJ
bealth C3re .nd uni'·em l e<Jue:l1ion, the l\IIO grel t
goals of social development, I re of fundameot.1
importaoce to tlXlly'. children - and tomorrow's
world.
Ilolh schoolill$ and health care acT. a. multipli·
ers on all other ,nvestment' in developmcar, not
Ie. " on the efro"s 10 improve child health
disculo$l'd $0 far in this report. And in both., the
cx~ritoncc of the 19805 has s/lQv,lI that there are
pnaical and a«ordable ' I'ps which ao bc t.un
to'lluds these great goals even in tb. difficult
ealoomic )'Cars of the early 1990<.
He. llh for all
A notioo in wbich a third of tbe adult
population is ill ~t I ny given time and in which a
third of all ch~dren are failing to grow up
properly in mind Ind body is a fIItion whose
economic and social progrm is being sapped
frum wilhin. Yet mln y de,.. loping natloo, today
Ire in exactly that position. And Ihat is why it is
nOVo· widely acknowledged thaI improvement. in
national Ilealrh arc a cause a, well a, a Cl)tIIe-
quence of overall development.
Adequale food, d Oln water, and ufe ..nitation
are "ill the three most powerful medicines in tbe
wc tld. And a job and an intomc a~ SliD the bcsI
pcssiblc guarantee lhal rhe"" needs ",in be met.
Health tmnCl therefore be divorced frnm ffi)-
nnmic circum$lance and the ava~ability nf hasic
seTYKes. But ill bcalth among the adults and
thildnn of many developing nations tlXby is far
greater than would bc dictlled by economic
circumstance alone ' .
Food and nutritinn have already been toucbed
upon. "" .ler .nd ..nila\ion, the OIlier "'ti ler of
the basic health n ipod, pose nnc nr the greaH's<
challenges of tbe ncxr decade: 6096 of rural
fam~ies and 25" nf urban homes $till lack !:arc
water supplies. BUI formidable "' Ihe cballenge
may be, it is nnl an impossible une.Todly's costs
• ~,~ .. . _01 1"_ """"'"" "'t."
t><' G:-;P
ood .... _ !I<oI:l~ . " " <Old)" " ' , _ torn. ~
...... <llif< """"""1' _·fiw
ltIol d.>Ib...... _ . , . f...
'" _ <I _ _ ""'" "" <*f"" GNP" '"" "'" ..... ,ll=
n.... hi,bot.
"
THE STATE OFTHEWORLD'S CHILDREN 1990

Vitamin A:
the story so far
EO<:!' _ , 250.000 'o'Qtlni <:!IildrM lose a<Jeqy.at e . """ ....., "'" C/lIIar9n". _ _ . -
thelr "'llh' !Of 1 1001. SInaI amount 01 .......... \I'tHl" leafy ""l/D_ PI yeIc>w """" __
A .. . lIOtt<llOt As _ ... be<ny ttle "*""'ll ~ 01 tOOle<.• ~ tkl 001 '" f", 110 -.sI KISOtj>l>Of\J. lind
CI'lIIdhoocI t>IIn<Incso ..,
<IeIIoencV eo
"""""""''0 "",-",""'".ott>er
IOta- meal or <l8orI """""'" ~ eli_

-"
I'IWl A 'edUCeS '1!SISlan<:<l1O I'M"""" oduunoo'I ,8QUIIItS ....._ "",_
""""'..... rod _ _.... .....,.,... """ "'-0<1
etk>1 ""'" many year$ 9••1 the ptoblem of-.narnn
Po C1e1oencv ..... ~ M.,y ""'-""""S . . . mer...
[);o;u;.-, lid; u: ll';; i m;;;: ,',1... .., ii i M,m li;;ij U"" ';; w
;;;;;,;;l;;;;:: ;;;v->.::okoWi .:-.:.:r..-, ..
it:;
Marth '""" , 34 coun1fl8S. o>cUcIong -..._.oI"I A....suet,orwco . ..... In
"""'"' 01 tile flIOSlll<lll'Jf<>u!l Ra\IOnlI 01Asli. Am 1r'\<lOtIesI;I... 1I>Igol ~ llo:otnbYI" capgjes 81
and La.." AmeflCll. The p<oblem c-. occur '" .. tI>o montl"l¥ _ (per.el Ill. In In<loe. rno
oges.. bin !he moo! _able "'. _ choIdrun """"""lido c:I>oId e... ce,rreo. Nhocll r o N . -
_ P I _ ' or Iacl.l"'11 """'*' Worl<I-_. _ .............btlh01 '"" """",,', ~"". "-'<e
Ibou1 40 ....,., ll''''_c/"okl'"" ...H.. k..... """"s 01 thG "'..... "' soIu"""
some <leg''''' of "''''''''' A " " ' - ' Il" These ~ ... .nexpeflSIYO C~ sUI>
e""" - . IIle eHee,. on "'" ..... ... _ornI\I
,""",,1, (:hold _ _ """""aI ~ bO _slv'" ploe<l by UNICEf ""'" IKo 1hen 2 "",,,s.
WIiO IS roN ",,,.,"""....' "'11 W t .._ A
'Q In IndonosIa. crwar..
"'til on"l m.Id.........., A ouppIemelll!l tie _ 10 \I3COI\lIl"'" Ilf'O-
<lIIlcoIr>cy """. !<lurid to be _01 Iomes mare
Ioketr tD die b<Il..... years 01 "Ill. rsclO"I101'/
11'''''''''. _ """" reach tho """"'1'/ 01 VOJ'>g
ontOCIlOre and _ _ wet_ """ """. ""' ,,, .. , <:/lild<e<l '" deYelopong """"u- E.chcontecl W11!1
the""""""'""'" _ SI"OuId AlOO tHo a <:fIarICe
I!>an Jl childrun ...,It> <>OeQu;l:e "1am.1 A lOIakG.
10< "'11/1"W(lIi;e<-o to
~ r.t.
1 _ 'OCOIWlU regula< "1af'\'IIr'l A ~I"'ts ha(l
.30% """'" In T.." ..... obo. tho _ pr<WIdjI chldron .,..j .........'" wl1ll .. _ A

--
<lolOlh '0'. """"'II <:I'Ioklron worn . . . . - wi'<> ~".,, "s
recoovcd _ VI\.OfJ"of> A d\.n"lg * - WItS
- uu, eye ",0l>Io1, .. """ 10"""""" A <lOI"'..-.:v
r... Wo<l<l Healm o.~ I\NHOI 8O<l - promo,. tlo'eaS'-Iee<long
UNICEF "IC<;ImrJ'Itnd !flat .. c:holdr... WJItl measIU
,,"'.... """"'" lI1O~.. e<:mtT'O:l_ bO
- """""'000 !tie U'"'II 01 toods
..t"""" A
"""'"rotIlI
lI"'t" """
~ ~
<lO$e5 of """,,",
_ PI""""I •
A 10 """"'_
damage
,.,." eoum.... well .. Br..... a....tI....... Hoot'. Mar
end 1ncIone... ~ o/<ody Ideo .............
MUInIlI.
pt oblem ",,,.., ,,,,, • ~ 01
C0«t>01"'11 I". ,"""" WI1h " tamon A ~,.t"'" 10< sh:w1
n. 1_ roN .. It> .... t. . hse . - - .

.-
me...... ~ he""" ...,..,.,....
ognc:uIlurol ponods
8<troe lIOI:I ,..,lnlOO flduGata\ E-v!1l<llhllr""" 0IllI e!fCWl$ lIMd extend I!\etI1 to oll>er COI.01lnes
needs 10 _ ,"", t><e llSHeooding woI QfOleC t her _ . "',.".., A <loflcoo>lq .. . _""" _ 111
I>Bbr "" IonD lOS h8r ""'" "I"""" A kMIls lInl

"
for providing sare wa,er ,-il "and.pip<" vu ies
bell"~n 52 Ind 55 per per10n per year. To,al
im'cstmem in IUter supply in the developing
world now amounl$ 10 appr01imald y S12 billion
per yeu - of which S10 billion is devoted 10
IIervices fo,,h. 3'
~tter "'\lff an .v.r~ rosI of
approltimatdy SbOO per person per year.
Such figum iIluslnlle thepolO! ,hat policies are
as important as incnuts m resources. Even a
smaU llhift in tM b.l.Iancc towards 1M poer, for
enrn.ple by planning for rasler e. pansion of low-
rost Rrvi~1 in future programmes, could go a
long way toward, m... ting the nec:d1 of oIl
f.m ilies for clean "..Ier and safe sanim ion by the
end of [his century.
Prl.n:lary braltk "~
Turning to the health Rrvites, ilt.... bttn dear
for some time rhar significant gains in health are
now possible even ;n the race of Wlnomic
d'flkuJry.
For tbe 1..1 decade, ther.' h•• ban vi~
unanimity among the n,tiolLl of [he ,,'Orld ,hal
lhe .,ntegy known .. primary h••lIb care (PHC)
is the way to achic~ tbe greattS! health of the
greatest nurob<.r at tht l"","cst ro$I and in lhe
.<hOrt..,t time.
Primary heallh nre is a common sense,
practical approach to lhe improvement of human
healt h, emph.,~ !he importa""" of nu!riti<:>n,
....t~r, SlInilalion, health edmlion, and the effici·
enl and equil3ble aUoca!i<:>n of health f('S()\Ir«s-
lIS cssentialsimplicity j. wonh rm.iting:
The firsl line in the def.!\«' <:>f ~alth i. lh.
individual, lhe family, and the rommunity. A
pcople well armed with loday'skn"",iedge, and a
community which i. organized 10 press for and
participate in the ..rvices il nffi:ls, are lhe
principle agents of bener health.
For young children, in ponicull r, the mOSt
pov..erful heallh worker of aU is tile well·informed
and ,,-ell·supported parent.
The hulth informalion which all famili• • and
rommunilies ha'-e a right rc know has new been
collected t~the, in I sel of ten 'pacbge. of
knowledge' under tile overall lide of F4Cl$forLifl ,
published by UNICEF, WHO, and UNESCO in
partnership with over ()Ile hundred non-govern-
mental organiutions (pvlel 12). In non·medi~1
laDg1l~. it ..u 0111 todIY" scLemmc consensus
lbout the timing <:>f hirths, SlIfe motherhood,
hreUI-feeding, promoting child growrh, immuai-
lation, diarrhoea, roug:h. Ind colds, home h)'gi·
ene, malaria, and AIDS. II is information "'hich
almost all medical experts Ire agreed on Ind
Which almcm III parents can act on. Yet it is
inf<:> rmllion which could, jf pur into practice,
reduce child d.a lhs and cMd malnUlrilioo by as
much I. half over the neat 10 yoars.
BUI lhe larger task remain. . How can this
health informltion be communicated in such a
way that families arc genuinely emJlO"'-ered and
encounged to uSC ii,
The task is clearly too hig for th. h~lh
services alone. And it will be achieved only when
it b«omn lhe responl.ibility of society as • wh<:> le:
ihe schools and college systems.; the mass media;
the religiOOll org<Ulization.o; lhe political panin
and members of parliamems; the emplo)"ers and
'he bul.iness communities; the lrode uru<:>ns and
co-npcrativcs; lhe maior pub~c scMce instiru-
lions and non'J<'vernmental organizations; the
women's Org<Ul1ZllU()IlS and community groups;
the yooth movementS; and the an j,,. and
entenainen (panel 13).
The mob~intion of lhese eailting resource.
and channels of communicalion can unlock 'e>-
day'. I:nowledge, making it accessihle 10 all. But
S\ICCf$S will n01 come suddenly. The ,elationship
between informari()ll and behavioural change i.
alltlOSl a1"lIYS complea, and achieving this nISI
level of primary heal,h care -lhe d emy.tifi~tion
of scientific knowledge in orckr 10 . mpawl'!" !he
maiority with practical health inforrnaricn _ will
in i,..lf be a long and difficult road. But il is nol
prirnnily finance which bars lhe .....y.
CommUlliIy .......th .... rke...
The ..coed level of primary health ~re bring!
US 10 the question ,,'hich hn been begged
"
e I i

I~ ~H!I!f Hili llBF1h !HH'P~ liii~ !2.G) -'c

~
rn
o! i l ! " '1 iid' ti, ' ;!l' ~!lll,i~ l il ii 3_ ,:::l_. ;;i'
uu ~I': ¥·'ll S'lll:,,: dd !., 3,~ • :::l CD ;J
.' ' ';' j ; I II j! U IhP,Iq li'l [fli "~l 1»1»
r+
H [Hl!;~ Uh~ !'~i!!j" l,,!j. 'f" I'H~ c':!: ~
",.,.!'~ I!Jh ' I lh' !.F!~ ru p, :::l0 ..
;~ j~!WJ ~lih !JahH~ il1iii i:l .~~~ 5'3 ~
i~ lliii~l'iill qfiHI;! tj~ll§ ~i! Wi r+c.
~_.
s
n .b ••• ll. hHlhi di.l L •• fl CD Ol
Ill:!:
~th
h 00l
Hth llii!la mjU!I!!IPliilit~ n~ iH Ol CD
..
~, Ii I." !-!. 'fl" , , fq. , " H'
-;h. hlP . ~ll 1 ' i"h h It:' "1 li~
li
'.-, "ldi'l" i: ·'i"' II !.! 'j H, q'
~g
~Iii! h:Hr!H~ i.H·~!glf~i; i'l :H Ii! fi
.hi ljim: Ii ~!II:HW'fll . H, ';~ ~
!'H ii°j';;!I,! ~!I!h:I'11 H I H' H
1 ,1 ],it".!, tlll~~~j,!", ,Ii! .j,
e I a~· !. t! l l " a :l. ~ S $ S t~ ~ Si e,
'.
I~H ,laliL. m ,M, ,;•• 51 i:
Ihroughout thi! repan. MOll of the child health
actions whicb could nO"- do SO mucb to protect SO
many, and for so little, eventually depend, in
""me: .~n ifitan t Ikgru, on Ihe availability of a
'rained primal)' heallb are wor~tr .
It ISthe beallb worker wirh perhapnix mon,b,
of training, plus supervision and re~Jar retrain-
ing, who a n respond '" rbrn qUl ners of a
communi!)" s health ca.t nffds, including immu-
niz..ion, oral rehydralion, an,ibio,ics, 6'''''''h
moni,oring, nu,ri,ion kn"",led~, and advice and
help with aotenu al elI re, sare births, breaSl·
fttding, binh , pacing, W(!aning, villmin A sup-
plemen,s, and the prcvenrion of common ill·
IICS$CS. The dUli.., and qualifications of soch
heahh IO"Orkers will of course varyfrom oountry ro
country, but a mere derailed descriptinn of the
,asia ,bey can be eXpcCled to perform il given in
panel 14.
In many oommumt;n of the dl'Vtloping world
today, some kind of healm worker i$ already
available: the lasi:; i. therefore one of 'raining and
retraining health perwnncllo bring tbem up to
dlte with today'a knO"'led!le .00 to help them to
put tUt knowledge II the d"posaJ of the majnrity.
Dqlending on the kind of community, a h~th
wo rker can serve perhaps 200 OT 250 falnUi....
But how practical is Ibe idel of ' n up-'o-date
health worker fOf eve!)· 20\1 or 2SO famili... in the
developing world?
l.ooking at the bcnefill before me costs, it is
above In the presence of a m ined health worktr
.-
which permi" I chlll~ of gnr, 10 a much higher
Ie\'el of efficiency, in Ihe relatiooMip between .
nuion'll heallh resoUl'l:CS and a nation's heahh
The central efficiency i, an obvious one. It
li mply docs nol need I fully qualified medical
doctot, wilh seven yea" of expensive training, 10
p",.ent or 're" the greOl mlJori!}" of illnesses in
the oommunities of the dC"o'eloping wor ld.
The COSI of training I primary health care
worker is perhaps 5500. The COSt of tl'llining I
fully qualIDc:d doctor ill al lelst S60,OOO. The
trained primlry heallh worker, \I'bo is also more
liktly to remain in the rural Ire.., tberefore
makes p<mible a 'luanrum leap in cost-effecri,"t-
ness. And it is this increased efficiency which
" 'O\lld make it possible to bring about improve-
ments in lhe bealth of lhe majority 01 an
.ffordable CO$I before rhe end or the l\O'entleth
century.
In a wen·functioning primary bealth care
system, healrh \\'o rken refer more difficulr prob-
lems ro tbe next le"el of primary health care -Ibe
more higbly qualified doctnrs and medical pee-
sonnel "'orking in dinic. and hospitals. Wirhout
that link, primary heallh cere is, at be.t, , second
dass htahb service for the poor. With thaI link, it
ill an eflicienr system for matching Ihe le~l of
care to the level of nffd ".
UnfonunOlcly, ,be PHe Itrategy, although
fuJly inllated ll'itb rbetori<: in , lmos! aU nations,
has failed to lift nff in aU bul a few. \'e'h at lies it
down ill nnt doubt ever ill greater efficiency bul a
reluctance 10 accept its greater equil)'.
The result i. thaI primary healtb care hu
ulually been treated u • separate, Inw-coSl service:
for tht pool and the Jess aa:l.'S$ihlt. Opeming
parcbily in periphttal lie,.. financially Itatwd
and politinlly unimponant, sttuggl~ along
witboul adequate traintng, regular supcrvlSion, or
meaningful powell of referral, mos, primary
health care wolken have bcrome . minor add -en
to existing health services rather lhan a means of
rcorientin, lhe bealth rl'SOUrCCI of I nlt ion,
mdudinlllS doctors Ind hospitals, ro the health
needs 0 the ma joril)~ I .
Many govcmments, for eKlmple, havc at·
It mpted primary health cate without incurring
additional Sllal)' cnSlSon the ~ tbat b..llh
"'"Orkers olwuId either be volunteers or be 6n·
• 1'10<.. " " _ In <100 too:< 19SOl. 11m ""................
""'"" <100 OINQI .. _ ' an btp!lldIR to _ _ •
,..."""""". AI Ih< tm Coolf.. enc. J "" 'iCorid Falcn ...
10< Me>JaI EW<&,......... lII&piIy>oQ.uu (tom 011 -.1<1
~ "" ~ lJ«(_ .. ~.d ple<l,t<d "" FaI< .....
_b_ J ,.
... ~ ~ I ... . . .. .. oIm ,'" _ ..... ., _ _
"""riM". _""""I.. <IIJ'I'i<uIulo ,Un,!:<> to f<ft«t d••
_ I ) ', <be ll«lu..- «>6<bl<d th&J .....
... -{.wi«< "",riM ~ .. ,.... do<.... ....
_ ., .u ,... . _ -tI.¥ MI_ ,.....,..,.
t<iII_,..
_ " .........
.... .... .,.,1 ;, "''''/0<'- N u ..m,"""'IUV',N
.,
THE STATE OF THE WORLD'S CHILDREN 1990

Science for children:

research in the 90s
Tha dIr.'.Icp;'lI _ Il.. 80% o! the 'MlIIcl", WI\h lh9 pot,,".", 10 llrllmlTlCalIy 'eot.aI _ .
pCIp<OI.toon on:! .,.,... 90% <JIm. _ "s bl.<oen of _lotio III"Id """,h ....-.,.,g young cl>iIdrln .,
*-s _ dIsKM1V '1'01"",,,5% at gloMI eweMt- ~ <Ountr.... Ml>CI1 01 11M onk>rrnaton
,''. on I>N'U> "'... ..ch IS <levol9d to lho _ C<I<.CIlHIut*lld b¥PME'nt" '_lpaooI I 21
JYOb_ of dlr.11"",'9 <:<:UttOU
Sc>ence hM lho "•.",,,...oD.lY. "'"'" "'" Comrn<s.
DeWmo thiS "'"S/l'Ialch b e _ ,.-eo """ - . on _h fIes&arctl lot ~t. n(l t on!y
'-s.• group 01 lolldonQ ... ahh """ " 'OlOQo'' ' ' ' \0 creole ....... holil/l l:;nowIe<lg<I but olso '0 l&8m
_ "" 1$ now "'II"'Q • mop' ~.!.,., of _ Ie IlllllV tNt ~ , ~ to till
tIM/l/l ,.,."",cn pnonnes .... report to be pub- mop hoolth ~ of cI>IcIf,"", women, III"Id
- . . cM¥ ... , 990. 1110 Com-nos""" on ......... Olhor ~_ ll'OUPS
Fle:5otard1 10l o.-,"loOfTI" UI-on rodeQenOen1 Tho q". to "IlQIvIng e>osMg ..... _
group 01 ploCl"""'." llIId ..-etws !tom 12
OlUItnes - Gals for gr....,.. ""'~ on eMl>Iong
edoo rod ' ~. oays till Comrros.slon, II
\;n<Mf..

e SS8l'lu.! ""t'Ot'lIJI ........", trv<lo\ ,t:e 'll <:ountt,..

~ count...... to CllfIY OUt 'es<!arc/'I on ",.,
;:-.;m.,;,·.~ , n ...;;;w VI i~ ;;';';; "-, '~ ~
own hNlth problem.
""""7'01 _ "lJdIo', hoolth comrnunocotJon ....
Ilornedical f\lS(I;orcIo l\3s m.JOO ." WT"(lOr\OOl .......... aM .,. - of _llIJI ~ S\.lp(lIIeI. tle oltt\
coo,""","'" '" r~ lho. lOll 01 ooall> "'" u<VIC<I !onancOlg , """ tNI'IlIQ8f'JJI' .,""""'_

t_
_ _ ~ \'O\<fIg choI<lre<1 <k.mg the past
~~
ltv. . TN ..-adlC:allOO 01 omalII>o> W8$
"- ~hy 1he ~ oI.""" .. Such reselrdl Il<OYIlle:I 1lea'1t1 pIarvIers and
I.... O'IIo<maoon - ., tl>o
bolt.orea,.., ~. WIth _
vOCQf'lfl by
"""'*
k~ 0ll00"I
and.
for ca<r\M'lI w, ~oons Tho "'......,
WHON NlCEF forrn"M fer aral re/IydI"!JO'l SlJIIS
1000Sl .. "'" resUI cl ......."d) .. DMl.o . C3'Iou".
"""til, """ tl>o IlOIl'JIonon QfC'JP$
_ ~ . to
moat._
fl'lO$t eornmotl C8U$eS 01 ...... ~ III"Id

ItO_delfp''''''''' _ to
t,
desogn pmg!MII'I'IO)$ _ o n \hi ,e'; _ttone<r<ls
_ e!seY.nere on tho UeatmMl '" t/IOIeI. 00"""
ell ..... m.tlO<UV, '11'10o 1M1II~ Omted rftOU"C•• 1O
11>0 1951n.,..; 601.
$<WOO mo<I kves'
But the successlul 0IPPca1JO'l 01tt>eH and _
lI!&-&ilWIO SCOII ,pfo:: 1ltU<1lJ'ougIIS ha< b<i<Irl """ lO
e..c. OSI thos lVPI 01 researett CIIr't ""P'O"" ' hoi
o>st-ellec.....".... of ho olth 1IJ(pII,.j"..... tho
~ ty....".".." _

tr'lo.nUlU\, _'-Itn~_,--l
on~. com-
hea!Ii1 ..a lIC<lIIDIl1IC re,utrII......
coot oIlho ... llIJI _ ,
'If
fIU"""'Oh tho
TM """"""'" '" the WHO srnaIpox carnoaogn ot "'"
19605 _ 101. 1"' ..,,;amplo. w.. _lorllO'V to 8<Jt for mart{ of ..... deveIopong WOIId'0ll<" " Sl
~ .. IIeIcl .,uo;lon WIoc;ll ~ m.J heoltfl P<Oblems. IaVI ttllI CommIooIoo, CUfllIlt

v~. _
""'....,., l'lleo:-!J>'e strategy ...... '" locate caoes oM
v/IOCtflIll e ~ cootact ,.the< than anemplJng '"
sue«ss!'" Pi<>-
p<IPUlotJons The
~ CI C/lIkll'Ioocl...........,..liOl1_ orol'e/lvOr;o-
~ III"Id ,ooIt •• ~ ~ tI FunIIeI
.""""',.,,..,., _ tt5UfCf1. bOth boOot_1II"Id
smaI. os o;gemIy r-oed Pnmo examPes "",lucie
",,,,,,.tOl'/ 1i'lklctloM. ~ d<ae_. wbet·
lIOn "*"1>( 00nng 'fie 1980J ".... m..o::h to CI.liois<a, malana, III"Id AIDS The pOt.""" re:umo
'-.0...,., ,-.ch' ~ to onIorm p i - . !tom ......ch ., !hose flIIdo • •••"....,." hogI1
_ "'<9"'"'' m"""!l"" Ilt:o:>ut the ~th _ Such teSNrett, _ os bft$, eame<l Q<Jl tIvoo.>gj'I
~. """"""". and ~ oIl*""ts ., tlm"hOne! ooIat>or...", III"Id 0>lCIIMae. al>o<*;I
'1'., _ • •
liI .....,. "" ............... bId:log 01 _ ns..""",," ., bol/l till ~ oncl lhI
....-."'*'e<! ,.",'111
~ ...-.I loch1'clo\JV """'"maIote<l MllO<lS 01 ..... """"'"

"
anced by Ihe communiti•• in ....bich th~ ~rv. · .
Vulan''''''. and communiI}' fulancing may b..·• •
role 10 play, and heallh workers should, ideaDy,
be local people who are scn.it;~ 'D. J:nowlw~
able about, and responsible 10, th. ir communities.
But Ih. fm of ,hl' maner ;S Ihl! ffiOSl hcal1h
" 'Orkers, like evcry<>ne doe, . Iso want job$,
incomC$, wd if possible • little IilalUS. WithOUT
th<'$e ,....rds. the drop-out rate . mong primary
health ".." keB h.1. p"",cd 10 be unacctptably
high.
Th. success 01 failure <If primary health cere
II.ill depend on ...-beth.,.,. b rgo numbers of healTh
w<),kers fi nd .'abl. and rewarding jobs in the
$CIVic. of their communities and on whether or
not they are respKlod ODd supponed by the
mtdjcal profession. Although l~r in COST !han
any Cllhe, appTOKh, the linchpin of primary
h.alth car. wiD not come cheap. A weU·tnined,
"'d]''''l''' rvi",d, and ",<,U·suppon ed he.llb
""(lIke, is ,h. key to •• hi",,~ universal health
care and dr$ervcs 10 be rerognned and rewarded
as SIKh.
The rlcr Ibal real primlry healLh are eat) be
p"1 inlo pl'K1i<:e It In affordable COSI bas ,euntly
been dcmcnnmed in Lhe lragiC circunu,an«1 of
Ibe eigbl·year-Iong Irln·'nq wa,. In bolh ecua-
lries, the death rate among yaung children b..
been sharpl)' reduced during Ihe 1980. by
efficient pnmary beallb care systemS which ba,'e
made available aU of the advances in knowledge
and Iccbnique diSCUMed in chapler II of lhis
repon througb well lrained, closely supponed,
and adequalely mr.'Uded heahh workers..
Perbap$ ihe lew-cest natllre of pl'imary beallb
eare bas bNon Slrt'SSCd 100 mlKb . AltemPII 10
implemem primary health e:are I I 100 low I COS!
arc now in dange, of discrediling an idea which
"'preMn" mankind's bell hope of 'health (or all',
As a revi...., this )'ell by rbe London School of
Hygiene and Tropical Medicine concluded:
"'If DdjT<ll,,",,1S arr IWI .. Ddt .•• """"",,ply If.al/If
",eM (CHW) program",.. frill drift '_rd,
JtIIlUt, dflJWli", i~ n lrortaticrl, M/ btcalUl CHW.
,~IM (a" ~(){ dtij_ bw 1Hc,,1ISt l ite .lIJIJ>Oll
u.
,lfm ....... 11f.". ./fw i.,. iII,.,.eral. ab.lt>S,"P
The message is elt:ar. Primlry heallh .:Ire is
COSl-<,fTecrive. BUI il is not COII.f=.
Rntn>e:turiD.lD b.... th
We Ire therefore brOllght bad 10 Ihc queslion
of whether or not an Ur-IO-date healtll worker for
....ery 200 or 250 famil,"s is a pncricaJ possibility
in tile foreseeable future.
To gain some perspective on the qU. Slion, 1M
m io of 1 10 ....ery 200 families ~Sll lhal 1
million health " -orkers would need 10 hi! I",ined
10 se~ lb. poorest fiflh of mankind, the poorest
billion pen!?le in the d~eloping world. Al an
avenge \raming COSI of SSOO, the IOlaI training
COSI would be SSOO million. SlKb a sum is the
equivaleol nf one 6flicfh of one percent of tlle
developing world's GNP, or ooe perceOt of the
induslrialized world's aid budgel, or one day's
imereS! on tlle Ihird world's debt.
Such figures Rrve 10 sbow that whatever ceer
difficulties there may be it ;s ab1i~ rd 10 suggesl
Ihal II is financially impossible 10 pilI a lrained
health worker within en y ~aCh of every famdy in
""".
BUI lhe world is nOl yet maTChing in that
direction. 10 ee 199Os, the developing 113li(lnS
..e set ro train leo. of IhOIlsand. of addilional
doctors, many of whom wiUbe un. mployed and
few of whom will work in 11lI'lI1 areas. M. llica has
4,000 doctOr1 unemployed loday, Pal:itilan has
6,000. In Iitt Il1ir five )'tlTli, Latin Americf, has
tr.med an eslimated 200,000 doctors even
Ihough, for Ih. sam. npenditure over Ih. same
period of lime, it could have 'nine<!, say, 150,000
docrors and both trained and paid a decem salary
10 Aaif a ",j /lilm pri",,,,, Awl/If wo'*m.
Meanwhile, lhe impacI of Ihe debt crisis and
adj1.l$lmenl programmes means IhO! ellisting
training schemes are running inlO lrouble. In
coumries stICh as Botswana 3J\d Jamaica, lhe
"
THE STATE OF THEWORLD'S CHILDREN 1990

lnima« of comtIUUlIIY bnIlb -un Iw: . . Fig. 11 Hospitaf spending

andy 11=1 ~ For dillmm retSOllS, 1M
«IUlIuy ""bidI Iw deal: IIlOU tlwI my odlc:r 10 Tlw ~ al a i'I hi Olt ' , ' 'II WOIt::I <XUcl

pionftJ&.~ bnh). cart, lIM: Peopk's ~

ad""_
I.- ..... t". .......,~ ........
lit til b:as a1so ~ dismandrd JU
bard"_ donor S)"Itml.
who . . . ., 1bJ_
~n
.....lIl tl ........ ..,c.\.."........
platllL,LIlI pow<W)' IIUlIl en il ltIr-..:l alum
q. M 1

t ,, ' $ uLIlIlIW ........ onlW . ......

Ulba ll "oopolh ~ laftcly acaped 1M am.
Iu fIcure' 11 ~ aImoII lhrN quuters af
cmtr:ll P'~ mourttS ITliJlbilI ror Mill
... _
ptI4IOOb, Ill
"' ..... ll" .,
pubic. ~ 75'll
........,. ..
on-..
"'lDrhuIIitL
3

III !be: Ik-oclopirrc '*Orid arc Ilia ~ ~ ' 0

~ ~ rebnvtly ~ CWlI~ PeUli doge of central QO'o'elTJTl8l lf
ca... for I IllIllOrity of 1M popubrion. 8suiI, for expel dt\I'e on he<;fth <*:>cotad to
hosp/Iob. $8IeCIed COU'1Iries. 1987

-
(""mplt, <kva:n :I1mosI lIO" of its lLI'ionaI

---
hultb budget to hosp!lll are ill \lInm 1JUS, (approldmofeti>
....IDly ill 1M MIl,lIh o( the counU)', ..bile llIIes of

-- •
i.IlDns Ind ,nfant """nl ~ty in tbe nonh"'al/ Ire
. mong t1l<: higMsl III the ....".ld. ft
Reducmg 1M propon;on or h!llth c~ndi· •
V

•••
IUltS dl."YOlNl 0 hOlp11 111 (ro m . n .... rage"f7S" ~oao. i1U.

-..........
to ;crn" bir.g in u e r.¢on of45¥o cr50%, even if
erbe ved IlradUJJly by postponing new upend;- ~
rurts and lI1Iowing pnm.'Y hfalth a fC to ul'lod
It, Sly , twice tbe rI'e of hospit>J att, . "QU\d
•
,.1.._ si{tni1icam researees for meeting till: basic ~- "•"
Malth cue lIffii1 of ee poor.
Some f;OW\Ultt :arc tryllIg 1llO'I~ 1II this
10
dir«tion. AJcffia, Ilolma, India, I ~ Mn·
ico, 1'Ikislan, and Zimlllbft h2\~ 111I bn:n
ItlmIplUIg to mmin cspmdilUra lID Ilospiub I
---
. .1Ol' ....

•
=o . n
••
•

•• •
.~ :Reppiftc lip low a. bftItb smi«s for lilt
.0, 1 N"

.--_-
~
lllajOOI)'. Commt'llIIll( lID tbne clfons, J>U:i$. _. 4

•• •
un's IGnnrr ~er oIl'lDaIICt IDcI Iln'dop-
man PIamunc writes: •,,,.=
"Ifh 1'dula tMfi-n tAr -ftrIIY J- _
~".":_,...' /«- dilMrtr, ",_1M
if /11M} J _ ......... J- PMar_~
~ awJ j pur-ftwJt-n . it" 75~ -
,..,. " • .,.,. .." . _ it.-i€_ f/

f. ndw,.. ...
IlIt'INlUII tJnU _ wllOlll, aJ ., ...... Joo.(J(J(J
..,...-lIs .. i"'_cJ rrJrr1".. A.atI .....
iii u ,tJId M_ afi1I. ., ""' fIIlrMi.' Or ~ It
,,""rd, nl/W
.... J>DSl,...., ,. '«aIM'"
N~ Il71lu il ,_
bwi/4 .... apom ..
-

_
-- -- _ _ II

lhfolch I toaItI\irme>l1lO ClOClUllUlliry

''''''

....... ItII1pilfll fiw fiw J"l". Tbl. &j' inti/, ,«1IJIy bnllh....un, 10 rho r.iDcipIr: olprimaryhultb
Ji-w" ,In ""',., tli'Jlft4intrt ... /M ~ carr, and 10 I $mIlIlobift iD p~ lOOl'ard1 the
' 1fMP'I".".'" ",...
TMre is lhtrtfore ,~. considenble ~ for Pri.nwy htalth elfe bold. 0111 the promise 0( .
mking moo: use or both existing ilDd addniolUl lKoal!bieT hUtnln and economic future. But it will

"
not t><, che~p in eilher financial Or political term~
It will require .ignificanl national rescurc.... It
will require practical suppo n from foreign aid
prognmme~ Above all, II will requite courage
and commitmern by national l.ad enhips and
notion.1 medical profe$$ion~
Education for all
EdUC3.li",. for all, the otMI grn t goal of social
dew=lopmenl, poses considerably more dif6<:U1·
lie•. The ol".iO\l$ difference il Ihal health care
may involve 3 child ~ing a health worker for a
r.... minutes on a doz<:n or so occasions eachyear,
,,'h. reas <Xlucation usually in ,~l>'''' coOlaet with
teachers and schools for many houn of each day
over many yean of a child's life.
Vet <Xl"""tion for all must somehow bo
aeh i~...,j .
Failure is diubling for both the individual and
""''''Iy. Not to bo educated,OOl roacquire at ~asl
basic lileracy and nurneracy, is now a ~rious
di53bility for any child. And a society's failure 10
inve$! in edue:nion will disable, in some degree:,
all other de,...lopment effcrrs whelher it bo Ihe
d fon ll> ,ncrease agri<:U1rural prooUCli",. or the
efTon 10 rnch p«Iple wilh neo.o·ltnovo'ledgl' ~bout
cJtild care.
The all·rwnd value ohhe ,nYCSllDenl ill nOI in
doubt. Ed \1'-...tion i. strongly associ..ed " ; th
boner health and nutrition, bigher child sorvival
rates, and lower fel1iliTy.ln addilion, World a ank
SOldies consi'lemly show that econnmic reiwns
from cduation are highel than from mesi ether
kind! of inv.sunent: foor y.ars of primary
education, for eumplc, i. associalw "; Ih an
average increase in farm prod~vily, all ether
things boing ~ of l~ or more".
Lib h.alth, education is Iherefore • cause as
" 'ell as a consequence of economic d..-elcpmcm
and ""me ~n ha.... alCribed to ,tlhe crucial
role in e~p12ining me diffelent utCS of economic
~ adli.ved by differenl nallollll in thc WIle
regron:
" WllrllfN all<l IU II l/un""II)'
S<lt:!tlits willr li",it"r
dt'OtloPllltlll pormrial IHutd 011 Ilrtir IIolurol ft·
lOIIrel ffldw.,"'tIIlS IrIlfN dt'Otlo/'fJ wry dif/tmrtly
due 10 difftmtrn ;" tilt;r IrJI...II (~pabilitin. TAis
lo.cllargtlyuplaim 1M mil problmu IJIUi dif/mrr·
rio! dtfHllop",... 1 PJIllrs 01 Africil1l, AsUur ~II J !Alitr
A ..tri!/III c""..me loday. w. Ira... !UII ,m,lrbors
o.chinJi"l fHlSlly dif/tml l OUIpllU fro'" sillfitlU
;1I1HSI1fItII1I, alld growllr ram N";"K fro'" J per
m rl ill Olll toWtr"y 10 7 ptr Ctlll itt allMhtr witIr
n ",i1~ r ;1l'/>tJIlfltIIlJ. III .o.clr .1IJt, IIrt. ( ';Iical
difftrtttu 1r41 /1m IIIOdt by hw_ Mill. attd
murprist, atrd by Iht illlrinrriolll rtlp<IIIrihl. I~r
prod"'"'t Ih.u".'"
The education of girls is puticularly importanl.
In addition to the improvemenu it offers to the
lives of ...."...,n th<!m",IV<'s, education is slrongly
associaled with bighu ~vcls of ch~d health and
nutrition acd lower levels of ferti/ily and inrant
mortality. On a~rage, every additional year a
moth.r spends 01 ",hool ii 3SSQI:iatN with a fan in
the infanl mol1a1ily rate of approximately 9 per
1,000. Only one lhird of mis effect an be
acrountN for by the fact that more educated
....Omen Iud 10 Ixlong to t><,l1n-off or urban
f'llll~ies. Two-third. of th<! fall is anribu l~b le 10
the edUC1liOll i!SC'll'"'.
With ",ch higb returns l vailable in the quali')"
of life and ,be brNdening of options,in C"COnotlUC
growlh and agri<:U1lUlaI productiviTy, in better
maternal and child bealIh, and in Ihe slowing of
popu!ali",. grOWlb, education for all is an in....SI·
meat which no COUntry can Ifford 110110 IIl<Ll:c.
EclllCatiO..... decliJte
Vel oflC< de<:adcs of wucational e~pansion in
the d....loping world, the goal of universal
NIXation has receded in the decade of the 1980s
(fig. 2). In many nllions, npenditure on schools
has d«lined and so bave enrolment ratti. Few
changM could have as mIlCh long·lerm lignifi·
cance, yet few eould have I nracred so little
anenrion. The Dirt<:lOr Omenl of UNESCO,
Federico Mayor, has sounded th. WlIming:
""llodjwlllfItIII poli<:in art 10 11< ."mod old "'IMus
rtgJITd to 1M pour tllld 'l'wI1ItrDbI., if dtbl rtf'tIYIII(III
is 10 IU. prtu drou:. OWl' W trtu lSl1fy ;rrHSlrTltIIl ,'tt
..
lire sorio1 IWOrs ;"dllJi"l tducaliMl, IJim 1M
THE STATE OF THE WORLD'S CHILDREN 1990

Facts for Life:

the top ten messages
Taw....s <:lo/(l _<11 b10wIedga coukl r-b '0 kom . c ,f$!lo<tV So ,hit IoQuod lost eoch ""'" IN!
"",,,,ct me lives or<! lilA _111 0/ ........... of cI>Id _ water'! 0I0oI m..c1 til 'Olllacld by
_"''''''~_ Ths~ ~ ,tie chid I'ioInll' 01 lho nghI IoQI.ocIo '0
.... now been bI"""'" IC>!)II""" un<le< rhe Olio <lnnk -_,-mol<. """'lid II"J"I. -'P. or • &pe08I
,c.::::r::: to: l;.'; J:::r.J!'j ~':;d 0', \..'N iCf,c. WHO ::r:,-;!: ~ ORS ff;:-,;; ;It-.;lii ;; ;;-.o." i ~;m lI'oio,
_ UNESCO, WI _ " ' " _ ....... TOO ".,... us..... "'" chid nee<lo "'"" !rom a _11 .........". _
I):MlmrnetlIIl or~l&!IOnS, FIICtskY life set. 01>1. or<l 1110 spIlOIi OfIS dIri'.. A CIIik! w>m ll<arJhOe.l
.. _ ~. !!Ie onIorm<I_ on """"'" IIso _ Ioocl LO IhIJIw • IlOOd ~

modoc~ ~ a<& 0Q<\Md. ""

.,.."". car> 0Cl. Wid !mm
w!'W:/I ......., III
wI'Io<:tl_, ~ch<klr""
o _ p r o'OCISagaotIS' .......... ......._
can - . ThIt chahnlle _ e ... wtwoI1 C«I <:aUSIl POD' l/I'O'Mh. _IV .....
"'JoN .. I"
_1>10 ~ t"'" cl'IonneIs 10 p.ll1hlS .. for· 000"'. AI ..............a'...... _
!lie Inl _
""
cl lI>O cnicfs 101. £WIIV womM 01
"""""""8<1 "'
mallon .t Iho - ' " of " The k>iIDwIng .0 1110' ehi<I~ og,o _ be 0MUI0l<Id aga,rw
lOP ,.", mcsug<!S Q<s'_
IflIm FltCrs /oI1.J!e
I.'anus
o Tho hoW' of 00lh """"""' ..... _ . " Cal' b<I
o
Mo$I <:ooghs ""'" cold.... gel ben..-on ""'""
~1Iv ~ ~ sP/IOI>ll b!rIll\l a, _, lWO
own &I, d • Child WI'" • C""'I1I". b<....I~ mucl>
ye.-s ~. by ~ lYeonanc:teS before me more ,-"" 1hon _ . then \he eNd .. ~
Il/O 0/ 18. an<! by ,,,,,,,.ng
,he ,<>WI ........- 0/
II" to • ~~h
• • """ 11 '" .........IlOl 10 cen".
," ~ 10 !"'"
A Chl<I WIth " cOlJlli' Of cold . - be
QOI<l:lv
o T" ,~ me """QO<I of cI>ik:t>cNmg. III
_tt> -."
"*PelI1O eal _ 10 dm' pltf'1'I cll!QuIds
ptogoonl women _
pte-nal lll ca<e. _
go Ie •
III bo1fls _
lot
be . .... lCdllY
o IMrTy _ ar.. <:ar.JS&ll be<:ouse IIC""S

• \f..""" per=n "'' Of ..... """"" Tfn """ "" P"- " Ie<l by .....-.g
" I"",,". by "'ashIng t>lIn<Is ""'" soap end "'""
o Far "'" hrsl tow montho"'. baby'. Me, ""'oa,' -"'" US"'lI ""' ..I _ be1<n1\oodllng food , by
"'*' """"'" '.o\l>et
lnI"",.,-' !he be., PO$sCle 100d _ ltollt
/00<10. '" ",oooao'·m.lk.
Odd " "", dnnIong _Of ..
I<eeprog lood ..-.I
~ ~
'er
doon. oM by bQtIoro,l
not fmm .....1. - , ."""""
wt_ t!"'f arc lour 10 ... montnl old o -..... __ • c"",·. All .. ""
glOWth
o 0wIdr1ll ur>deI uw... r..... spcaal fee<ltng *"'".• ChiiCl needS .... ...". me'" ""lIlY lIilV "" •
",""",. no"" """" 10 HI flve or "'" ,"""".
<lay, ...., ....... to nW.e uP tho 1I'0W1h "'"
1h/II< load !iI"ould bOI 0IIUClIfv lnCl1ll<l by lMXlln(I
ma$Il<ld -.ge'_ and ....... '"""""'IS 01 toto '"
o CIloldten 1lO.- "'" "'lIN <Jt ... monttls _
Irw... ve... ~ be """"lIhlIa every mon1h ~
~
,I,,,,,. os no l)/1li" "' _gill I", two monlhl.
o D.'JllI"". can \II by Ill""""" tOO moch kqI.I(l somelhng IS W10nu

•
(~rrtIII diJefllilihria aM ccaMIlfi£ muio... '"
N<mh-SO~lh rtllJlw....ipJ a" lib.ly W I~m i"lo a
JIlJIlffl'IlS m1lioll of 1nt"'<I1l rtsOt/n:u 1!lIJl ril.b
~"Jo;lIf lill td~clUwMl progrm uhitwd IJlIIl ""gh,
III Nck Ih. (a~"lritl G/ Ih, So~lh h)' a ,,/tol.
gntnaJ'o" Dr ...... ""'rt.
~ Whfll iI $0 prtOCC"pyi"l illlr", Ilr. grtaItSI Jat//iJit
JHlM to haw b«Il Jo", fIl lh. wryfo~"dlUw" of1M
,JlICllIio"GI pyrtJt//id, Ihlll iI in pn't//Ilry tdllCillw"
<mJ i" Iuuic litmuy for aJ~IIJ alld O"H{JCJrooI
YO~lh". "
In more lhw hill of lhe 100 de-o.·eJoping
coun,rie. r"enlly SU/Vt~'ed by UNESCO, expen·
dirure per primary school pupil i. falling in real
term.... For those nationl, even the pertenlageof
n.lional bud~" devcred 10 edllQ,ion hIS de-
clined in lhe 1980s (fig. 12). As a n!'. u1I, 1M
proporrion of 6 to l l·~ar-old. who an!' .n rolled
in primary school i. alse nov.' f~in g in many
countries including B.1ng:!adesh, Guyana, Mada.
guol, and Me:.ico, and 10 many African nalion5
""'t h of the Sahara.
Fig. 12 Africa's education dOwntum
Althcugh figures ere ~ a. ailable up ro 1986. a
downturn in 8clucalOon is BlrIIady becoming Yis~ in
wb-saha"'" Africa.
Public expenditure on ecocctco per
penon ond OS 0 'l 01 GNP. SobSOhorcn
Afllca.1975-86
aa
~ 5-0
o need sehool 10 be: s wife .n<! I lllOlher; tb.
'0 4.e
•(3 4~
~ 4A
~"
0"
H W. i$hed in this scale, education ilself is
Overall, the prcblem " DC' Ihl chikll<'n do no'
have scboob te go tc . Over 90%of the developing
world's children still stan schooL lIUt of Ihc 100
million s;';·year",k" who will begin their school
car.... in 1990, wer 40 million will drop oul
be:f= completing primary education. Almost ~
of those childl<'n will be illitcrare for Ibc resl of
rheir lives, and Ibl:~' willlhereby be unable to fully
pan;,;ip"C in, or bc:ncfi' from, ' hc gr'" chwgtS
which will sulely sun ound Iheir lives IS lhe
r.... rtry fir5t ~en1Ury begin5.
TOO.y'. drop-ou, rates are thercfcre the figures
which t~lI th. saddest 5tOry ofeduc.tional decline.
It has ~ said ,hit ,here .re a. many n!'asons
for dropping OIlt of school as mere an!' dlllJKIUlS.
BUI tb~ fundamental n!'aSOO i. that lhe COSI. of
edllQlion In!' riling relorivf fo irs perceiv~ wl u.
" ' lim. ,,·h. n real ;ncomu arc falling in m.ny of
the pooresl communities. liven ...hcre primary
educalion iuelf is free, Ibe <ml llf sending. child
'0 "'hool, in c101h... .~uipmen[, bu. far.1,
'don.uons', and contribullon. to "'hool fund-
rai.inR crfonl, can be • Iargc oIice of • poor
f.mily'. income. To Ihest direct COStS mu.t be
:u.ldcd lite oppornmiry eons Offllrgoing I child's
work in fi. ld. 01 homes.
F.ducallon rherno.. has 10 be weighed in [h~
balance. And it is Ih.n that other fa<:ton begin 10
Cl'O\l"ll into the scales: the ovetWOrW woman
...1\0 is despenlle for ber d.ughler's h.lp in the
hom. or with the h.""es,; Ihe fll hcr who h..
n.v.r been b.ppy abOlll hi. d.ughler going 10 a
mi><ed...,x scboo~ Ih. pcr", pllon Ihar even child.-
ren ...ho SJl"nd ten ~.rs.' ",boo! srill cannOt find
iobs; Ihe notion th. t • daugbtel doun~ really
thought thll • 00)1 only future is in the field. or
the wOlkshop where his farher ClIn teech him all
he ne.:ds to lutaw; Ihe memory of thebsl school
repan which shov.ed lbol the child .... . n~ plying
enough enemicn; the faCl that new shoes will be
needed for nnl t.rm Or Ihal the parent.'
associ.,ion will SOOn be: coming round for .nother
dennicn 10 the school fund.
incr...mgly being found " 'a ming IS expenditure
on "'b oob declines. Capil.1 spending in mlny
nalions has almost ce\lscd, and cut-bsces in
THE STATE OF THE WORLD'S CHILDREN 1990
n:aarT1IlI n~ h:r>'t mnm lhal lnd>rn'
AIann an aI>sorbmc 3 risiac ~. 01 lOCal
It:XllfndilUra. 1M muh is 3 ~:.uag bdt 01
OJICnUnc CORl. To ~ O~ of 1M wonl
enmpw., I rftenl ......~ cl ochools III • I'l.lnI
' '''' of MoumtMqu<:' fllllDd {Ill! only)" of pupib
had KIIS or dnb, onl)' 1'N of cla$srwms had .
desk for the Icad er, only SOtl> had a bb\:kboud,
only S.. o r lim-yeln had I l.ngu~ ICII book
and onl)' IH. hId . ml lhorn.t iel manu.I'".
Ag.irm web difliculties, il is nOlIUJ'llI'isina: lha.
so many .\\Ideou b.... 10 ",pU\ ~.", or tb>110
_.
many fail to become ~lcntc, Of 111.1 aVIlng4'
a nmlMOI Ir.-ds I a SO lIllll:h IovM tlwI in ibe
iDilusInalittd woc\d". Of
IIw: pa«nu drode W t
~ axri6ea tHy ~ makin« ,.,." DOl mlIy
Sadly, .--., thaDtwo thuds of tboM: chiIdml
who _ CO 10 sdloaI Of wbo drop 0IIl • 100
nriy. $lap. an iema. As 1M 1m btp,.
girl bora ... Saucb Asia 0( ID 1M MidcDf EaRIlas
leu lhan • 00lI:-1fl-lhrft dwl<e 01 compIrIiDg
primary tcfInrion
IlalNCtW'illr III cd...,.tioa
Amid rontinlling ~ difficulties, 110.- can
this dcdirx be reversed .nd progrt$$ ftsUmcd
tow,ud, elIucllion for .UI Thil ..Ul be the
qutJllon fadog the W<>rId Co..jtmftt <HI f:dur41io ~
fin' 1/11, spllMOred by UNESCO, tM United
Nations ~Jopmcnl Progr:lfDlJll', 1M World
Bank Illd UNICEF, .... hich IlilI be COIl...:nftl in
Jom~ l 11ailand, in Mm:b 1990. II will be Ihc
fin! ~ ..ood «>Ilfn~ 011 eduatiua aDd it
'OlD brillf lCIIftMr educaUocalINdm from 0 =
100 ~11O'" 10 shan !hoar cxpt"licacc in all
nWllpf 10 l\nd • new "I)' fonrJJd.
Bat ~ ;are ~ sbon tulJ. N(IO>IGrmaI
educ:IboG, adulI liIerIe)' das:sa, IlId dlPa na'
Ieu1line idle all iml"'rtml buI they ...
Iqdy for IboK ~ btto fWed by formal
~ I)~ The minimllJll roal _ be
fur e'IftY boy and &irl1D iI2w five or lID ynn ia
pnnwy «hool, brninc 10 become liIeme,
Dumm.t<, md IIlOft a~ of' Id l plina 10 md
taking mon: COCltrol o>,<,r rm, chaDJmg circwn·
•
SlIDDtI of tbcIr Mvre \iota. Thil CIlll* he
acllim'd wnhouI " " f t raDllI'ta for alumioft,
lDlR priorily fox pnnwy fdloob WItbia eduea-
lioa tJudaas, Inc! men aid for IhII ~r.;
po.tlllOI" from tile in<IusuUliud wwid. The
:oltf;fll.luve is tM f~ 10 N oate I billion
thiklren in the 1990l llld the lou of III opportu.
nity 10 mau Whll il possibly the mort vilal of III
inYfltmenl$ in lhe twenty firu <eDtury (lig. Ill.
But as wilh helllh, !he firll queSlion is.... helher
!he resourcel rortemly ~N 10 eduation ClIn
be llIOle efficit'o~y used.
The IllOSI otwiouI itIlPf1lV=mI in effiritncy in
l'IWly dationl would be to restnKIIlR p«KfIl
Mualional ~ in ardo!r 10 tih the baIantt
tooranb the pi......,. ..t.riI
0¥enII, the pera:nage I'flIInI 10 iaftllDlCDl •
hiper for pnawy fducuion!baa ......mIrY md
~; fQO iO'W-1;')' ~ eru..if)". Yll tIi;;
"" ,• • ' of reKUta 10 ............... th.t
ICOlDliary and hiPet edur;:oUoa aft' ,"""i'iac the
lion.. shan: of edI'CIriorll ~ in III ~
!u the Warid Banlr. his mnduded,
",... is m4nec• . . . dHu ... . . , ........mn rAe
ftlmlIl' dDl/irr tJl1If#eJ til fJri-pydllltu_ ~
mice <II .id <II _ lJIt¥Jl.d i. ~ rJw.llfWtf.
\'tl ft'I'l"'-..uI • . . JruviJy nJoWIist ..~ nile"·
rio. Q/ IU t~""'''' f1/ pri"'W] d~ ,"
The wmj»riton wilh primary health e"u, Ind
the d liciencin ....hich it suggestS, is In obvioul
one. FOt jUlI U lOll community bealth worun
ClD b< fielded for 1M cost of' ODI: ruDy qualified
doxtot, 10 100 d Uldu n C2JI gndualC ffOlD
prinwy ICbooI rot the toR of ODe ,..adtwc flllll1l
uninnity.
III IlUllY ~ the ramxrurinc pI'OC1tII Deed
_ be ~ dnslic ill order to ~ the desired
dfea. !u the Warid BInk bas abo..-.i:
Scb oo! efficiency
In,reasing the efficiency of schools lhem""lvc.
is also a po$Sibie 'resource' for the 1990$, BUI il is
not an eny option,
There i. 1Il in-buill inefficiency in ",h oob
where u~ndi lUres juve been so reduced thaI
95% of lh. remaining budget is n~ed 10 p"y lhe
salarie. o( le..her! whose effeaivene.. is reduced
through lock of books, ",'filing materials. and
blackboards,
Second, low ll!~ls of h.allh and nUlrilion lead
10 a ,,·.sle of resour"". by prevenling cbildren
from u king full advanlage Oflh. education lhal i.
m.df' available,
Third, high repe.t rales and d""!H"'l levels of
40% to Sm. add up 10 a maior inefficiency
because lbe rC$Ol1rCCS d.....,led to children wbo
drop OIlt aflor lWO or lhrec y.al'$ are lawly
wasted.
Many of these issues lie oulside the scope 0(
Minislries of Ed~lion. Wilhin lhe school sys-
lem, lhe greatCSl scope (or improved efficiency
$«m$ to reslde in slrengthening in-service
leacbe, lraining, inspeClion and mpervision, In
all ~ons, it i. lbe provisioo of adequ'le re.ding
and wriling supplies for lhe ",bookhildrcn them-
sci..... which u.uaUy hu lhe mOS' significant
impact on learning. Efficiency could therefOrl! be:
improved if guvem menlS were 10 SCI ' minimum

FIg. 13 The literacy chollel'lg&

The chari shews 1hlI pen::8nIilgII andabsoiuIu IUJtler.; e. .olmeod oonIinues arxl b) ~ lhlllarget rJ uriversal
rJ ac11ls """ are ililerale arxl projecls whBI wi happen pmwy sthooI...... ' Ollid is nIlIChed by II1e yew 2000.
in Ihe Mur8 aJ ~ 1hlI prBSOl('Il dowrUn in sthooI

Numbers 0I"ld perCMlage of od<JI ilfIe<ates 1950-85

CI'"Id projection to 2025, developing world
1100 ~

-,--....,._ _- _ _..
1960

. . . . . _LM'OC:O
1971l

....
1980 85 1990
Voo'
2010

... LM'9CO .... _ _ . ... _ • _ _• _ _

..
THE STATE OF THE WORLD'S CHILDREN 1990

All for HeaIth:

an information revolution
A good Iltl'TW'I' SCf100I -.&alJOn IS ~lSM'bll 10 lIl'e!I/l IMVlCeS lntI PfO/esSIon8l lISSOCIlIOOI>S. lho
WW'f e".Ie""
Jnpa'aIlOn lor 8<lufI "'" All etloId<.... -.dun, ~ """ "'" <;<lIlVTll.noIy groupo
~e shDukl ~ 1M choral 10 1IlXl""" M ...,-,pIn 01 ""'~ comrt'Ut"OUt"'" ~
baSoO ~ . "'''''' ' 11 ..a 'ilia _ . Ihrough ....., M 0C<Xl!"~ ,~ bo<JIde', AI Ir.>r
me "'"""'" """"'" ..... \@m _ . stlows __ .-.atIh p<omooon IS - '" -...:I
Ve, TO<lIfv. edl.eat>:l!lllD!S e global CflSlS In many bo - " ••-eI',boo{s llo..o8roe$5· how. lot C:\III'IIPIIl.
~ COUI>U'" !hoi r"P'd adv¥1Cll '" DmlMV 'o\IgIoU5 lead"", .. Btozil. CoIomboa. _ ....
school O<loclIootllln<l ~"CV P/oyo eoiim". of !hoi I\kl~ and SrllIri<> ... ITIlIlanij _ cllokllle8hh
19l1Ooor>d7O'_-.. Itll/IIII.,,,' ••r/:lefol IO'I/otmlIlJOIl " " _ to _""s _~ ,
d'vIdn:t> ",moot ....,.,... lOpr """"........ _ ,lido<>. ~ ond IT'oIlg&JltIe5 ... P'O<I'lO\lnlI
.,.... 50 _ ..... oM m" g 0<. _"""" lM<Itf>I_
_ AIQeno.
NC!l ...
...........,.lJOIl !n ........
s....-
Egwl. "'" AIel>
M...,.. - . . . '" _di<l , ICQUI'1I lIItclo.Jgh
sc!Ioolonll me !bfo Mel I<nowIc>dgo _ to AOPJbIi(: lII"d TlJtI<eII t'ON... BengIede5h. Com-
~ lho) """"IV of ~ _ - .. tho, t>ecau... ..""" ond P. ....... _ 8 ~ p<CIM1.
d1Iio:i ne.;m ily PR"UIO _ 1'00 messages OIl
Il>ov """" 0 _ to CU'lQIele '" ........ an"""
beeaJse If_ scl ..... '11 "'M_OI'fI'-
$(:ftl)QI, 0< ""'~ """" ~'I "'\ll'l'iAlIO,," "'
e lOl to _ ... need. Ctlona. Ind<o on<! !{QovlI help 10 "lIorm ri>eIt mem-
boo<s obool l!IelO ""'" he.. 1t> 110O 'fI.ot 01 It>eO"
I'ert>&pr !hol m(l$'''''''''''''of !he 'It" ....· II
I:ti<>wlecIge reL1!ed lC cIlIkl <:MO A I l _ ,. _ 10
_.... ..-.I _ coon""" ouen as ~
and UgancIa ..,. u...-.g ..... ~ ~'om I<>
_ wha, t/'IeV """ de> lO "",,,,et U- lNdron'. me.... ~s choId he""" ~ .... _ :e
I<>
_ . . . . promQtl! toot healthy ~ , A

"""'" ",.... "" .....lJO<III .., _ "'" """'_llOld

"""""",,'s """"'IS
The FIle/5 lor l.JfoI omJlt"'" ....,"" ....,"""""'....
wl1c/1 ........ ll> help S\If1Ied tr... ~ <05
10 ~ !he wreOd 01 SUCh ~ "" l/Ial
- ~~ eve<Y pareo, .... c:onmo.n, ~ eat~ '1tCo>IWl
1M W<rtl
UNESCO _
Heal,n 0<""",,,,\100>. UNICEf """
jIIV'Ie(l "'til (»'l.~ 100 'lOI>1IO"81""
lhe< ""orma_ kom .......at """"""

",,,..It81 IIgetICIO'S .. F/IC,. /of UIJ1 - .... ", "' mallOl'llll

The msono .....r>eCl !rom _,..-.;" ouo:n ..
tho5o _ l e d .. All /01 He4l!N "'. 0150 o..lIlIe<l
t>uhh promo,,,,,, ntIM.... tl8Sed 00 " CXIII'IllIIatlOn " I<> IweIvc SlWS whIc:t> CM\ help communoca,OtI' I<>
ol lhcl"''' 'U ""ll'JO'\Ont poeces oI l;;now1eOge on t"" 01 pion """ """'" <:<lmI'I'IIJr1oliOO IId_ _ pro-
!hO ~t """"""0111"_ 01_ eatO .~

n... tomIl'faOOn Il',""",\$. III 0001"", lotm. lhe Wl'olfI File/$ fo< LJfe rocuses .., "'" _rt> ot
mosl up-to-date ,"""""fie consensus ..._ .... womeo _ _ eo . lhocommuroJCaloOnPloceS5 ..
pracl1CoI. Iow-<:osl. I~ W"IS to ""Ilf(IV(l
"'" as valid "" ~ """ ...... 11uIl>endry.
choId IIeallll _
eee-
ror !lie f"""" Dow!Io<>o,l@< "
(1990-199 91. <MIl" " " " . - , C<IllIe$
~,0(lI'I0I1III1d
WIll.,. _ .....
""""""-""'lI
sloI:s. pr"""''''9ul<l
'.,1011. _
IN PlO,ec""" 01 IN
' - .....1Oy t>oletl ptJ<\led .... - . Merem
~ _. """,,, "',rntlo< 01COUI'l!l"tS also lIboo,
- ,.
The IM$I moortl'" con<I,,,,,,, .. mat .. forfnenon
ea...".,.
10 PUblIIll l!lClr """"
otlOIlkll>e somotlw>g whcI, """"'" """ ........ and
El<II P\.CICa""" """~ Hts IM . _ b lhol ,e3I
~ , """"'" .. lO motlIlttfI ..-., o<gar>rod
.,,, """" From 11\0' .""'lnIl POI'lI. "'" PO"""ool
........ """',. I<> mal:e people mo<e ......... 01 -"'"
"....one 01 ~1'O'l -1 ~ sc!'IoQI$ ...... ~'" I"",,",,,,. !letl"- . . . I<> fuIfJI- _ """'''' capal;'ll'
""'"" . . -. d POii\lc:aIlWld """"""" """""'~. 10 tnanag<I !he 100;". _ " " - It.- ...... T!lal
ltlO 11'000 _ _r>IoVerl loder.toMS. ,he tapaQ\"j li the mosl /u:lclamen,. 01 .. 'lIle sbII."
ratic of operational COSIS 10 teacbers' salaries so
tbal every class had a minimum package of
<eadin!( ~nd "Tiring m tttUls. AI tbt momt nt,
the proponion of primary KhooJ budgets avail-
able for item, olhu Iban salarie, i, oflen as Iowa,
196 to l W".
P ayiJlg for ed""a t1011
liven if patterns of educational spending were
to be ch~ngt'd and efficiency increased, !he go.a.l
of universal eduatioo will continue Kl recede
unless extn resources can be found.
One source of extra funds, much talked about
a, pub~c spending stagnates or declines under !he
pressure of debl and adiusrmem programmes, iii
tbe imrooooion of school fees, In the 19SOs,
many f:un~ics bave shown themselve, willing to
pay OIl' of !heir own pockers for more Or better
~uCltionai opporTuni,;es: in India, for uampl.,
private u penditures on educalion already C'lual
public COSlS" . OaK it !h.rtfor. m. ke ~D$O to put
eIistinj practice on • rational ba,is by instinlllng
Kh. mes of parental .nd community chargc1 in
ord. r 10 release Utr. I"tSOIIltes for edl>Calion?
If this is to be lb. way of lb. future, then
cen.in obvious warnings need to be sound~ .
First, relying on any significant degree of private
finance for primary ~ucation in poorcountries is
Ilmost cenainly incompalible with the ideal of
education for . U. For the pooresl 2S~ to l~ of
f.ma i.... th. decision on ,,'hether Dr nOt to ""nd a
cb~d 10 Khool is finely balanced, real.dvantages
agaimt real COSts, even wber. educ.ation is free.
Charging for eduat;nn would make that decision
easier for many parents. As the World Ban k
repon on EJw:atiM In SM~SaJlaJ'lVl Africa ha,
concluded, "'FM ",(U/ AftU411 CCMnlrin /Ilt s£opt
fM fimlln ' aU $IIorinl in primary ,dM'atUm u
nrgligihJt "" ,,,,,,-ffisUll/" ,'"
Dieect Or indirect charges are already. f.eror
in rising drop-out ratcs. To rite iust one such
communication this yur, the UNICEF office in
KampaJ. bas recently reported that the mosl
common reason for • cbild dropping OUt of
primary schoo! is The parcn,,' in. bility to pay
Kbool f~~. Andwben finantial pressures mount,
it is usu.llythe daughter who Is forced to drop OUt
of Khool lin t. The proponion of girls to boys in
Ibe Ii"t I/rade of Kampala's primary JChools is
close 10 S~ BUI by lhe seventh grad~, not only
havc balf the pupil, dropped out ofscbool bu, tbe
proportion of girls ball tillen 10 31M.
The policy of increasing rescurees by ch. rging
families for education shouldtberefore be m.inly
directed towards bigher education. Typically, a
,hird of government spending on univonitiesand
college. is devoted to studenl welf. re costs, as
opposed 10 leadt ing costs, and it is Ilere that
charge, might be mOre justified. ~nainly tbe
sucre.. siorie, in education [and in economic
performance] such a, the R~public of Korea and
T.iwan suggest !hat primary sdIools should b<-
free to all and Ihal private finance should play.
significant pat! only on tbe higber rungs of tbe
educational l. dder".
One experiment which does include parental
contributions bUI which m.y olT~r hope of an
effect.i'"" low-<:OS1 breaktbrough i, the new school
$~ te m now being pioneered in Banl/ladcsh by
lhe Rangladesb Rul'lJ Advancement Cernmirtee
(BRAe) . Wilb 2,s OO scbools &0 far, and a funher
2,000 scheduled to open by 19'91 , tbe BRAe
programme is demOl1$trating thaI l».sic educa·
lion, including literacy, numera'Y m d social
studies, can be provided for an approximate cost
{IO BRAt.1 of SIS per pupa per ye.r by invol';ng
parents in paning up simple classroonu and
!l'IKling educated members of the community 10
act 3S teachers (p.anel 18), Aimed p.nicul.rly 3t
tbe children of the poor and tbe l.ndl ess, tbe
programme has been remarkably successful in
giv~1g three YCOlrs of basic education 10810 10-
ycar-<llds, of whom over half are girls, and
graduat;nl/ 95% of tbem into tht fourTh grade of
the official primary ~UCIlion s)'St.m.
NOD- form al educati orl
In an its varicesforms, there is no su~tilUle for
primary ~ucation, as a minimum, ror every child.
But in lhe 1990s there is • new opportunity for
education whirh rouId tOl><h the lives of all,
whether or not they ba,.., had or ..i U h. v. tbe
benefit of formal educlrinn.
"
THE STATE OF THE WORLD'S CHILDREN 1990

Health workers:
what they can do
Tht - . ..........-..rIO t1I_ ..........
.... IoomClCll.OlVVIO~ n. og ••• d -_-......1JfL'*l..
- - -0<II. -.
-'.1IO'\$lIb..
.. 0 -
_ . __ - - -.. IhI e--'" _ ClIhIa"""
- _ _'_DoW _ _.....-_01

--
Ir""-'; - . . , IIlI _ 1CI11O
o """- "",.............,,01
" - _••''''-dnlg--

...
- .................. '" ~ '90"'1' onIoclIOuI
1 I - ........ ~ "",U<XIIneol .. _

..........
- !lOll" 11'''''Clg .... 1N1lI. . . ao.oI .............,

- btUSl.\Hdollg tor.. !llISt 12 >lUlthI;

o ~""""'
~.
(.g_
ltjwn(ery, _ e IlIarl!'oeal dehy(Ir..
_ ~.,.; ~ drw>kong W
I'" ton)""""" _t:spromp!tyfol_'., Iho
""""1 "'a/lh t~
- regUlar cheek-""" tetar... VlICCIf'IMoona ...,
_ allllllieo,oeo'lS 0u0''''O pregn!JnCY o 0.... ,,", oo;l tnr "'!'J'~
o
- 'II"""lI ~en !I'
Of01 ......".,"'" ....
<lW_ pIcn1yet-.or
- <XlIIln.loI'll to f1*l Cl'lIlch<1
1~_1
IlUmg *- _.
O~
~ v-...._ correedy _ a1 "'" 1IIllIl"",,"
.,. _
__
to dIIdf.., 3fld """"""". 01 lIfONll'l

chid
.. -
"'~at>onwo"'Ioc"_

lJ'l"'llI " .._....... • __

,
- 1l0l'tl'l(lIOOW_"""_ II ""'" ""II'lIl'lI ~
.... l-.g'o'OU'V-... _ _ - . o.
....1I'Cl 1CU'll-....•• weghed...., ""'-"
-"-,dO'\' ........ _ _ .............. abOuI!<IP<'tSldt.
btNII-tNang, -.no Iooclil, _
--"'l ....
- ~ "'" IIll"I t1I .."..,.... .......

-_ICI.. . . . "__
- . ..-.. ""'" _ _ dIiIU¥

01'1"
ll/lIafllla-
co,d . . bdI.

o_1Klioro_.
_"'- tlO8\Ji_".
...."._ _..
~
pr-=--'_
JU<1I oI1l>e IJ""ClIICIl

..._
oumg
-
-

o
'*""'-
_ , .... "'"

"'-~R4JIli'o' ...... g.
~ ~.-.I ......
d .... '.'0' d__
_
lot '"'lIN"I - . , . ....... " b' fOI,flQ ~

-"'--_
_"'el 1 OG"-'
~
1CI o 1diInlIIV ....
~

-
OUII

- ...-",_
br _ _

_d,'
~
~~,_~u_,.•_.~.
,................
ItS tl.cfI ..

lIWlll _ _ Ill -.c.,.

,_ _ ~_ol__._,__ - ....
_0I~.lH; '

~ -_IrOmI'Wc>:lImUO!'/'" IN ~

o 1WPKl' in M'"~d>Id<.-.'''''''''
n-.or",
""
~

- ......-.0 "'" _ _ of .. lIfOOOI'I .... _ol.......-__ .

...~_b _ _
='''IlI_
_ " "·
o "-'
_
0lt'I0 hNtIl _ _ - "" ~ .....
eowaI_ -.::0-_eIIooc-
_ ~ ..
- ...-.I>.... t.m/v,,,•••••__,. _ _
-..110 "' "" ...............
-.... """"'QhI.lg b\t..-g_-. olO-..Woo\l doMIf """ <'o<h1V'IIIV _ /doOuI
~._..,.-""--- ~~00ld""'"*'·.
o r........".. ,_SSl.dl .. or- " ......,_'11 d'IIrl MMth ROI\OJII:Jp'.'

"
 T"e~ exists l00ay a fonnidable body of
pnctical knowlNge which <wid enabl e ~pJc
and CGmmonili<:1i to bring about improvemeuu in
th cir 0"'" ~"" •. AI"'h of ,his knowlfdgc co n""m s
the prOiecrion Or promOl;on of human h..J,b, the
child care elementl of which b. ,.., already been
ootlin.,.J in this report. Bot . 150 available is •
Nd Jog of pl'3Cticalblowle.:lj!:c 'OOUt farming and
food pr odlll."lion, about m.mtaining Ioafe ,,',ter
wpplies, .bou t fuel·dlkieol 51"""" .bout protect-
ing the environment, .'oout avoiding AIDS and
sexually transm;"oo diseases, about the dange..
of smoking, . bout h",,' to p..voo, hUrl disease,
or .bout the ott<! (0 .,imol. te the mental
development of young children. Increasingly,
also, b\o'6'le<lge needs 10 be made.v;oib.blf about
new COn«pts, about Itgal and democnlic rigb!$,
abou' 'be rights of women and children, md
abool 'be precesses of change and adaptation.
10 the pUt, adv:lnces ;o kno...d edge wne often
«106M'll to Ihc privileged, or rM tileule, or 1M
physinlly xce$Sihk Teday, rh r need no longer
be JO. Recent deades have revolutionized. the
apmlY of almost all developinll countries to
communica le wlth the majority of their peoplCc!
and 10 pur newkr.owledge at Iheir di.~L Radio
SlatiOllS now reach 600 million t", nSISlors in the
majority of the developing world" homes;televi·
sion now reaches direcdy into a m jority of rhe
developing world's communities; tens of lhous-
and. of new'P apers rexll out 10 Ihe 60M ol the
developing "'Orld which is lIOW tirer.te; vidt(!
parlourl and einem.s ,m Ud minions nf people,
....-en in Ihe poorest communitiCc!. Political and
religious leaders have le:lml to u... this new
Clp""ity. And il i. time thOl roday', communi.
"'"i on' a pad lies welC . lsomohilized in Ihe cause
of health,
For 'he kind of perscn-tc-perscn communi·
Cltion which is often "",,,tial, t.be developing
world tOOay hOI many miUions of le.chers,
. w lant nurse·midwives, commonity heallh
,,"Orkers, trainod binb .nend.n's, . griruJtur.s1
cxlension workers, and community development
officers. h is also mere possible Ihanever before
rn J'<'och nul to people Ihrou~h lheir own organi·
u rions, the VIllage councils, people'l he.l,h
comminre5, consumer organiulions, ","Omen's
groups, . nd }"Outh muvements, "'hich h"'e been
org. niu<! in neighbourhoods and viJla~ .. in
almost evel)" developing country. Meanwhile, 'he
growth ofprofeS$ion.1 Orgllniulions and employ·
ers' '5$oOClIlions, of tme unions and co-opera..
li"es, of hanking and postal servi<:.... ofeloctricity
. nd "'3ler supply CQmpanies, has epened up
permllleni eh.nnets by which hundreds of mil·
lionl of farnilies could be regularly rm hed. Ten
of IhllUS.1nd, of ""luntol)" orga.nizolions arc also
working with Ihc poorest people .nd communi·
lies in almosl t\~ry ccumry,
The po'co,;.l thcrefore e~isls, for the firsl lime,
to mount an information revolution fiW 1M f"XlT.
'\ nd l/tl second lane on the road IDw:lro.
..due.tion for aU ;s therefore tbe mobilizing of rhi,
\'lot new communications Clpacity in order 10
empower people with lhe J:.nowledge necessary
(or heollh, (or continued leaming, for malting
informed decisions, for responding 10 ne.... oppor-
tunities, and for improving rlIe quolily o( Ii(e ill
tbeir own homes and rommunities (panel U ).
Devdopmenl witll • buman r.ec
By such means, prngr<:SS 'O"'3I'ds un;-"erlal
primary heal1 h care and unh"CrsaJ edL>C3.1ion con
bf! l"fiU/Oed in tile decade ahead- if the COrnmil·
menl is m.de 10 a 'lyle of d....,lopment which
$i"cs mOre priority 10 meering 'he needs and
lnve$l ing in the copodlies of the poor.
This l..ger lask of moving 1000'3rds 'develop-
ment with a human face' would of COUlV require
signifiCllm additional reSOU.eel. AlSIImilll! rlI31
real progress i. mide in reducing rhe OIlrtlow of
debt . nd inlerc!ll p.ymcnu and inaeosing tbe
inOuw of investments, then il can bf! C'$Iim. t..d
that an additional S50 billion a }"Clr would be
requ ired, Ihroughout the 19'9Os, to move (orw..d
IOW.rd, rhe grea' human goals ohdequate food,
w.'cr, hcalth at, and ellucolion for e,"Cry man,
,,'Om. n and child on emh. The .pproxim.Ie
price'lOg for moving ronvincingly in lhis dlrec-
tion i. 1~_erefOle less Ihan one half of 1% of the
world's gross internation.l product OIahoUI 5~ of
the amount which the world eurrenrly spendson
me mililOry each year.
Half of rlIis SUm might come frnm Ihe d....,lop-
ing countries lhcnu;clwi if, .. thls chapl" has
"
THE STATE OF THE WORLD'S CHILDREN 1990

Indonesia:
800,000 volunteers
In 57,OOOol-.......' .58 .000~ . ...... . . . . . - f<lt • ...,.;,0, 1<> ,.... h<w ChIld lO !till
800.000.........- ,.,."" ..... '" - . . '"'~_­ ~~ IOt:>e~ . .........
"'Il l<> "'"'" par""'Sll'ot<>etlhclr t/lIIcnn"s tIe.lI1> v".......
rote<l. ' '''''''''''
_~
A ouppi<ImenlO. ond be
ruse or<rodwIl.lrom the iOCIIi he"""
by •
TtwI 10C3I POlO! of Ih« _ IS. ~
ijoithot"", ol m,,,""" . ...,.,,·fMl ctIiIdIen and "'"'lie She con lII$o coIlc<:' hOr I....... ~
1l' 000natl t women. held e""" """,m ., _ . stJI>PIIM or _an ""1""" 01 """""""''''''
""""""""" ~ ~,. 1<J'I<:M.n .. !tIII "O\t8lI'S'e<! The ~ also ....... os .... eduCallOMl
_ poe," , 01 ~. Ira fMIIv """"""" os '*'trIl.where f"Ott-J; ' " ' " _ 1 the CllUS8I of
now It>e _ fol ptomotng l1li _h at Ir<lone. ~lnl>Of1 ond dose ond will' par . ." con
..... _ cllildtV<1 do 10 p'QIIX)1e lI>e'II ¢IIIOr ' heatlhy 5I'<""l!',
1 ho11 ~ ' - ItS or ~ III <:I'OId ~ Sn:e 19B6."",*,PrOlo:len1 SJi"l¥to""""""'"
~ rlarlt>d by the F~ Well.... ~ I lno .,.... of 1Moneoo.·.'Decade tc< C!'Iol&en' , ......
.....-..g
tM 1970.. I,.""""" now"- ""n" the _ ""'p.",,.
01 the "'''''' tc< ~
o GtDwttl n'ollrIo"""'ll and IIIJlrlloM8ll ""1'"'_' _ .,..m,n:m"",. lhellU'l'lbero! posyondu$
h a s _ ' _ 1 0 217.0C0'J n...e.>q>ar1IIOrI.. . .
K1IOf!rs -.gil ucll d'Old""" 18COfd thol ",forma'''''' tJ>emor. '......_ forhaYlng _ _ d"""ll
"' • g<OW1I> _ 1<ept bv !till oTlO\I'Iet They also
do$CuM the ct>oIcl'. P'OO'ess .....:h '"e moIher and • lltIOXI 01 Il<:OI1Ofl'\O:; rece....".,. ,• ...etlng "' DJI·
e'l)lore POSS'ble r _ fol tl!ilenng growlh Mal-
"""'_choId<en
V~ '""" A"."..,..,.
releffe<! t<>!tIe
lrWl.... , ~
_cenu. be<:o .. "..,.1 .._ o! g(NOr"""'" _ ' " ' "
_
Ted...., 85 "" oIlnd<>nBs..•• moth«"'> ...... cl-.IdreJ'
ecce•• '0 t\nlC healln .......:a Itvot.ogI11l111
o I""",",""""""ogaonstdloldllood_ Stall POSY""'*' """""'" E..... """'ttl, oImo'lt 12 _
""""'-tve chib'.. or>d lhoo mott>oro Ol1ond a
1IealI~ cen1fIl ~ >'lSI! It>e
from !he lac..
~tovocona l."q"l'_llf09"'I"l""",*, ~ "' 11>00" own nooghbouIIlOod By the j'M<
o Doat 0000'01 K- . and .... aIttl
1991 lICCeI!I to ~ . - be .most
1(J()% ...._
<:enl<e . taII ~t. n'lDIt1efo ab<>Jl the pte\1!llllOn Tho,OQOd 01 __
01" " _ ' ' ' ' 11'' be1tot ~ . ...., . _ ....
~

a "'""" boos' 10
~NII

............uon OO\Iefago ond tile

sal. Ilr"""c w;>le<, 8nd demorlstrlll!hll COlT",,! COf>Uol 01 _ ~ og....,
"" 01 oral ro/lydrO'''''' tlMr8JJ\l (ORT) Sooche'" 01
oral . ........ ,,,,... .a,. 10051 ... also dioltbJtod measIeS,'or~. 'OM !rom ~ 2'" on \980
10'- 50% on 1997 . ond the _ _ case
o MollleH,n<H:o kl nealTh ' A I'I1I<fwIte /rem 1he tauo ly tal. 'el by 7~ be """"" 1980 lIfId 1985
IocBI """"" centre condIIc'" ""lIn",oI _ _
fI(WI!I ..... PI(M(lfI< ll'l"'I'aI Qlo ...... ..a..ce on
Somo pl_". .... _ . Thor1t "'" .w 100
",eg~ Pregnao1,women.e~Wlm«"" chan _
"""""tarl(! "'"
""""" rrotI>or. ""'" do not ,¥<>Mh
... fI01 '''''''''''''9 PfOl)IIf _ . kQfll
lola! one! lact.""II....,!hets .." lJV"" spII(;IIII
coore I<IVIC<I• • g abou1 1l, ... t.Jeed,r,g _ _ s, ""'" r-..e ~ ""ee or lour"""'" ltMwlll
_ oft...... <10 no! hIM! S<A'flcoInf l:r<MoIo<lge or
-~ COfTO'l'\UflICl okao. Ah~ .. oIso """""".
of amotv 111""'"'11 &lWVlCe. Fwnoll'lllarlfWlll ~
"""""'" end _
_
Pf<l"l(!ol n1<>r/lWlOn. """"="
~ to enablo fa<Noes '.0 ..,..,.. bO'Ihs

The _ I V 01 - . . farrotvt>ealtt1""""'es.,
_S
'anglfl(l kQfll 25 '" in ""'" voIIIge$ 10 9O'll. on Olhenl
To Iacldo _ POOl>lemo. ~." 'Olf""""ll 01
Moo now be<ln Ollfo<luced In 1987/88,
350,000 - . """. 'WOOflOll, concen,,01IIlll on
1110 ....... time one! place .. -......... • gt 8a'
_ , _ In mDIl\ 1rldDoIs"" VI!IBQM n II now
Wlage. ""111 low pos~ . ".,,_ and _0
many <:hklron were mI g....-.g """'Il'U , ~

"
discussed, pnonues ""eN: re-u.amiIled and lhe
bal.n~ uppffi mor~ in riVOll' of 'he poor. "The
other half, or approximn d )' S2S billion a year,
might be u pected 10 COme In increased aid from
lbe indusuialized n.[ions. To put SIKh. Sum into
perspective, it "'OIIId mean increasing today'l aid
level. by approIima,cly SO% 50 lha" for cumple,
lhe Western indnsmtliud nalions would be
giving In .'~r'ge of O.S" oltheir GNPs inll••d
of today'! O.3SK. TlK" aid I.'i'" agr..N in lh.
1960s "'lIS O.79l
Rc~ ning to lhemorelimited obirctivcl SCIOUt
in chapler 11, it i. "'onh repell ing lb., drulic
The role of the rich world
Althoogh mOre reSOUr<:es for RaJ development
rould be r.lea~ th.ougb ch""ging the bil1an~ of
nisting ex~ndilUres in fa\'O\lr of ,he poor
maiority, it IS lI<l easy task to tnginHr a shift in
prioritie' from urb"" hO$pitils 10 rural dinics,
from natiomJ airline. to domestic bu. rout.,.,
from prestigiouslecture baU. to bumble primary
scbools, from meeting lhl: focused oxptcutionsof
tbe polilically JlOI"erful to lhe diff\1$l' bopn of the
poor majority.
10 g<>neral, the tuk will be easier where
democracy is Slto1lier. But in mo5l WWllTies il
will be \'t ry mucb easier and more liloely to
happeo if onr:all ,..,sou"'es are expanding rO!lItr
lhan cOntrlniog.
For Lal;o Americo and Arrin, In ioer. a"" in
o\'trall reSOUrces in the 1990s is '~nuaJly synony-
mOll5 Wltb the resolution of the debt cri$l$. Merely
rt~htduling loan. 10 en:tble nations to maintain
repayments is nOl I fonnull ....ith a ful\1\'('.
Inl'estment flows must be resumed Ind the
indebted nations mllSt be allowed to grow mil of
llltir debts, Ind rhat COnnOl be IChiel~ if debt
repayment, sluiceaway all in\'tsunent in growth.
gains for <~it"rtIt, for their surviva~ for thei,
h••l1h, for lheir nnuition. l weU.heinlt and normal
development, could IlOW be . cllltvl'd at :ul
additional cost of.. littleas $2 billion 10 $3 billion
a yel r.
Hut it remains the case thaI these great social
goals, on which so many oth.... polentitl advances
ultimately d'1""'d, win 00' be realized in [he
1990s Wlthou, a resolution of the debt crisis and
an incn:35t in !he cwcrall rC5OIIJ'<:eS available to
,he naOOm of the developing world, HOI" tlu,
migbt be acb.iel"e<l will be !.be subjeCi of !.be oext
chapter of this ""pon.
Funher debl reduction by Western govcrn-
meO\$ (paniC\ll lrly for AfricI) IIld funher writing
dcwn of loans by WtIlern banks (panicularly for
Latin America) is the only dir~ion wbieh leads
anywhere for ""yone.
tlul it i. nO hmger ",ffu:ient to speak b~th ely of
I return to higher mes of economic growTb,
howel'or difficult thaI might be to Icbieve, wilhout
lim Isking what kind of RJOWIh Ind for whom.
Many developing coumries Irt nOW in the
thnlC' of economic adjuSlmen, progn mmes
which, with or without the lnternatienal Mone-
tary Fund (IMF), art Inempting to restore
growth in the new Ind diffe,..,nl ciro:umSllllces of
their indcbtedllCSl. The kind of growth which is
eventually Icbieved, if it i. 10 be Ichieved I ' :all,
"i U be determined by tbe way in which tbat
adjustment pro<:css i, designed.
In the last five years, there bas been a growing
=ognition of the principle Ibal both Idj\Wmcnt
IIld growth should be aimed It improving the
~ve. ""d tbe capacities of the poor majority.
Allowing lhe poor to bear the main burden of the
"
THE STATE OF THE WORLD'S CHILDREN 1990

Uganda:
health in 8,000 schools
lIgonlM'llI'JmIIV _ ............ -.g..- _ _ b.o _ _ P o q ~ ~

_ lOPOOOlOO.. ". ' . ,.aOlIN I>Mlg """"""'"' on. NlICI'IIl_ 0... S,liOO
..."",'. _ A '- _
WI - 1Drrrw'G ~ or II'ie ~ W"'oNn ..0
1 ~ or.. . taCIW'O _
8.000 ptWI'Ialy IIdlooIll
owII>-
e<luclI.....

- .. .-. - . ; tal.I!7>ln .. .....

-~-....,---­
~ gnu. f;OIMIl\ on:! "..,~ .... 01 the.-

"- $I:IlO<II-''' ~... on " " " - W .....

1n1~ n!>loy 1988. IIJI ~ II"'" fw1.1 n s..lIlO'1. ~ DIs.- _ A!OS
01 M ....., ., b.t """ ee..tral /l.lrJQ I.-"'!II' '""" Cor>'roI_ ..... - . producett 11'<I <loll/c.,.., to
01'*

-......
the ,ecogrola1 !N1 the odI.callOn system .. tho oc:hoo/I. C!Wn:l'lllfOUlll _ ~
_ , ChMVItl 10( ,"'9: ,.,aIm I<n<1w- tal 0Igar>l.~ . EocI! 101 <:<>n.ons 01 ...., cI
lecIge ....., 1IfO"'lOl"'ll "'" trlt tndes _ tlehlo- _, "IIomII..... _IS, ca<IDCIIII. r",_"
_ MlnY oI ..... o.. thatond~.OOC\II'lI"Ig..

- n.....-.......
Ug.-clII 00JIcI I)t; _ t l l < l ~ ........ f. . . . ...,., ~by. ·T_·.
comm.nl'/ lMdetI _ . 1l'OP'I"v nformt(J ...,
Guodo' Wl1I'I .. tr~
~ Io;f ...:to ll''''' Gowl> ~ 'S'_ _
"'''''''''''''''"''IIII"'*'
_
"_PM'_ _
II IiCUII """ _
"'~""_ """ llIM .................ogec:I "" '0l'Il'S """" •
(l&II by " . . " ~ !he ""0.:1 d _ _ a'ld !IIO .... d ' - -
_ . . l'IOIlf_ . . . C ....... _ _
buI¥ _....,..". e-e om.lon'lSul ...........
__.... _""u-. _
...

,eo, _.<11
..... .... jj60

_ _ _ _ !Dr. . . . h
NDS
b'~
A~
_PI'og".......
_
l<lp ll>Ne P'W'*'l'
_ " " _ _, "" . . . . . re«:l> tJrly ........
10!li or1t>t _ _•....., .. l i f t . ! _ _ 0 . - AIOS •• ~ . . .1Ill>C._
.......,. _ _ :tIK _ ecluteotl_.,
=
~

--..:.rv
n __
.._ . vor-v_
v., Jml. '" 1JIIondo'. 3""" 6., 11....._
""'*'
III lleooo'o>e
n....._
~ ".. _ .
- t t _ .........
_ .. tV_
__ _.-.:l _
Thli.'...
OI• • "" .. o,-.g
0.. _
dh_
lhII""'"
,_ _

IIl ~!IIO_d obl. ThlioCV."'.

""" _ .\l ' " _ '" lllO'l(lfI_ _ .. MIn::II 1989 550.400 _
_ - . . . . .. 182
~.500 _
II'*" "'50 "'II''''' ctu<>Ol _ _ _ AIDS The - ' I AIgt .. .,-...loco
............. "'" _alll.ol.oe __ ._.sc--~b' _ _, _
Set It: ' IM _ _ ~ . .,.",,-..1 AlDS _ _ -...-
__ .......__""""'t....
'_loI_~ n-
_ 11'• • , • ..., •
!"I'o'ouQI\ h
~-._.~.~"ctI
01_..... _ _ ...., _... _ ... _ __
-.....;
OIl -. __ __
lO'Ol'IWY
<it ""0'_ ..
d_
Ugrdo.'

r... _ _ .,..,.. __ 1 9 _ ....... '_ Cl -

.
'"'lI _ _ ~

drG
__ 1<1, IU!""
00""0.. toocl _ fan'IIf
. . -..on. I'lI:fJIUI.
__ IiDCt" n.e ClClOJo:l Il1I' no ~ d
_ ~ ~ _ lefled In 17 )ltItI"Ia"f ,..
__q '" .... ~ tuu.'e d "... .

•
deb! eri. is, lbrnugb • declin e ;n income. and in
Illeir level of health, nutrition, and cd~tion, i.
fundamcntl1ly incompatible "i th ,bi, aim. Ai
Ed.... .rd Jaycox "rthc World Bank hu soid:
"'71. aim oj adjllSl"""t progrnm..... is /0 ki fp
/'ffi(dt fi"olf(;al Slilbilily ani I'cctl~t grouill. b~1
I~t baJic <JI1«ti!>t is always /0 hrlp <tlltl)i()j,
fll'W"J. ... To lit pI>Iiric<dly nutainablr, " jMU-
IIIl'IIt program",,, "M I lit dnigtted /0 tllunallU lllIY
wi,,"" '!furs OJ! ;1«0"''' and ttttpIO)""tfll. . . . A d-
pm"""l prttgram.... . "'WI lot Inm",,,," by tuftqlUllt
Progt'fllllllKJ in tdJlc(liilm, hew/Ir, flU/liJy pllJllllilll.
WI/I n4f/ln>J ITWln'(t prom:rirJn"."
The problem is thaI NlICJlion, health., binh
planmng scfYices and natunl reSOUrce protoction
aU in"ol\~ govcrnment ,pending, a habit which
mo,. adjUSTment progn mm('$ arc = king 10
discou~. Heal')' com are jnvol,~. And mere
is at prescnt no generaUy agreed plan on how
lhooc COSt. might be met.
Shifting prioritiO$, and spending, 10 lew-cost
buic services, primary, hca11h care, primary
education, and mOle corefully targeted food
subsi<!iH, co~ go part (If the wa y. But many
"""nllie< a'~ limited, politically, in Ih~ resuurtur-
ing they can achie..., in the co~lul of ohrinking
(lYenU re\"C~ uei. "lIjri. an tguru fa P Wfl Wt and
dupt" 1M rtf_ proem," uys the S«retary
Gent:ral I>f the 0r1t3~inti<ln of ,\f.ican Unity,
".a........ « JwmnnrJ ituJtjiniuly in Ihe/ «e of ""
IUIvtrn u ,mrDl l'Ilvi""""'t>l1 wilhow UrcrtlU<d
JIlpport from Ihr ilfltl1llUicnaJ .o",,,,,,,,ity."
The barsbness of tbe adjustment process, in
politicol d:mgcrs, md its envirl>nmental ccnse-
quenccs, ha\'e nor entirely ~suped Ike nOli<:t' of
tke oid·giving 031io(ll and mere is considerable
symp3'hy, in many quarters, fl>' lh~ ca..... of
elling ,he mln.itio~ to JlTO"1h and prou:ctlng the
p<><>R1l. ;0 the proce...
No'" ia thetdore th. lime for the de~loping
nlli<los lo In.ly.. whit .esUUCIuring in favour of
the poor il possible within their own 'C$OIItCU
3nd 10 dl3W up "'ell Ihought·through pl'~1 for
mointli~ing and uponding primary educ;nioo,
for primary h.a1lh care I)'$tems, for 031ion31
nutnti<ln plognmme", and for environmental
protection.
Such plan. could fonn the basis for In in·
creased 3nd newly diltCltd aid 3nd investment
errOrt in the dcrule wad (fig. 14).
It i$ unlikdy that web propo6<lU would fall on
deaf ears. Increased aid, in some musult,llIOOld
hi: likely to hi: forthcoming from an indumi.1liztd
world which is increasingly coming 10 =pl, for
both ml>raJ :md practical reasens, rhe necessity I>f
doing something tl> help restore the momentum
of development.
BUI WbOlevl:r pasl or prestot injustiao m.ty bl'
responsible for underdt'o'elopmenl, rhe f3Cl of the
matter il that significanT increases in aid will bave
to be po.id for by Ihe WlJlll~rs of the industrial-
ized nations, There are lOereasing signs rhar
increases in aid would be ""pponed by the public
of the industrialiw:l wo rld ifit was widely felt thaI
3id was bl'iDg used for the 3n3ck en peverry and
Ihe defence of the environmenl.
Much rnor~ IIftds tl> be done to mobilize
support for increases in lid . BUI it must al$(l be
rtcOgllized that one of !he limil1tions il th~
u pmry of d.....ell>pin,l countries to use th31 lid
ror convincing JlII1'IlOKS. .... nd that is a reslriction
which only Ihe d~vclopinll W()rld can reml>v~.
Anaid p~p
Two Slatemenrs in 1989, I>ne on behalf of the
aid.~ving nationl and one on behalf of an l id·
r«eJVing nation, scm up Ihe new role thaI tid
could play in the decade Ibm!. The lim is I
stalemenl m3de by the cll3irman of the Paris-
b~ o"..·elopmont Assi$tan<:t' Committee, ....hicb
ClX>rdinales the 3id policies I>f the Weslern
industrialized (OECD) n3tion.:
" We dum II W<u~", in plll",ri"l lU Ihowelor fllfd
s..1rS€u or Itwf. lis II m llil. t()ll "'~oh lIid is
ptl'1Cidtd i" Ilrt f - Dj ~IltOMWtd proj«u I'IllIur
IJrM i" SIIpptm Dj II .11 of poIjoiD "'" II ' /T<IItg)'
Iclri€1r IrIU MtII IJr~1u Ih","Ch iM m!pi",. liM
",iMiJlrin, clHlrdiMlUtd with plannillgllMd jinlUlCt
IIMd appmwd 11/ 1M poIilical level. lis II mull, I()II
lI/teMrtl{lt<Sls lI"d fflpqtrm fl)r lIid ItM 10 fo_
t~itt< "'" ttJf1l unsustaitwb/' • .."ilaJ·iMlnlJiw
'JfoflS /jJ"ly ro bnotjit llr. lriglu,.·ioKo"g ~Q"'tIS r"
l«i,ty and Imd 10 neg/m tJr, lINd f M' lnt'iI:tJ
"
THE STATE OF THE WORLD'S CHILDREN 1990

Zimbabwe:
education for all
WI>In
1980. _

_1tl_O_..
_ 10 . . . -
all AI ",. MW _
~
d
_ .~ . . CG ..
. - gooe,,,••., .......
Il'""'r*'I 1IC!>DOl ~ ""

!hoC _ . fnflWlll "" .... ~ OOUIH

INn Ill!' 01 all oo::l>oCIlragoo
pr ........ od1OOl . .-.lonll'.
-
~ '•
' £~ .....,, ~.
....clI;

.".,...,....,..,.. ... ~ '"

.. ~... IIleory_prlCl"" AJToI. . .. ~
sc.er.:e.

"'*'!leI. !at ~ . oc:tlO<lIlWIIo duij • btwnd

--
The ...-c>I"= now • on

'" l!IlI It.- d • v.orlIl map T!YoIql IM prOflCl

~

W,~"" """ '!'l'. ... 'M!U'J1llO< of pnmarv

t-.o .....,., _ oncj ~ Lmttt ,
""""'*'
.. .... chkl
"....,. ......., "'" only - . , 6sIl ''''''''''IJ, b<,II _
a/!oo.Il gooogr....,
""",-.. 1M _ _, , _
~ ltlCIIi'IoQt>M ,
~
Iood aorI(I

~ ::cI1OOI :a;;c 1'.":l:5 ~ :;r \." ;.c."~ :1'; 1:ltl:l. ~ total

01 1 3 "*'" thoklt..
Id'IOd ..., _ 7~
_ 0l'0f'Idw\g Ill........
1l<lIJdotng tt-..
_
COIlfW
'"" COIIuol
doH_""""" "*"'"
~. 01 w...........,. .

n. ,.......- ....... ."...1. _10""

!lO"G"'••
~ Puplr; ... ...., ........,,-oe<!lOcon.......'• .."..<11
1M "'"'"" 01 III.- _ _ to ...... ",.
P"(rl1'l ~ 10 -.or>
""" l1li: ~ .. ~ EIIUCatU1 now ~
bv bol~ ~'"

22% 01 II-. -...... bu<lgooI- ........ INn " " _

1
.............
/lIe ......_
,.,-'---....,~
s.....r- SCIIOQI .. ~ . lor.
. . . . ., ..... S50ll ~ _ Irtlm h _ of !Ill

- .. "'- obit'"" -
11'<1 o.tanot luIgetI co me WlI'II'ogt-.t lI'OllJ<e Plols of ~ _ pIotIled by h
_.~ EIlllQI _ !l'll'OdI \Ill DDrmIIM\I __

-,*"",-"'. . . _--
_

._-
_
f<>_l.CI _c'
• ~!I.nl

.....
......... tor "" _ _
........ -""""-
'" _
_'d.""""0CI'I00Ii0""
I)ntllt_

• • ..t.;t. _ _ _
~.,.......,. ........
z",_'. "'........, _ _ . .. ........,
od'lOIII "" _ _ ..,. _
__ f
_ ..De.u.,""'_.....' _
w.\I"Ol<"'~
....., t-....

n..I10' ...,...._ _ _ 01_ 5O"--....t.....,.q,-.

-----
'.s' .. ' .. "' ... -.v"l
~_
_ .b .
0.'_«1_",- ,," Po:_ 'II '*'0_._., ~

'*'II~ __

. _QI
. 'SOllCNO.

-----_
1oI¥fw' ....... _ - . . ... ~ _

.. __ - ..
1'tIf ... _ '. _ _ ~_ ..
10 _ . . _ o I n ".

Ir_
· _. _ h ~ ol .-
go "' • • -.....c .... z-...~_
T_F
8.000
<.....,l&>T~~..
-. _ ~
....,,,. .conncJI_.._ "*"
1981 0.-
I'M
......... ~

..-.- _
0»._"""....""""'-.at
. """'" ..... ,.,.'" S Q. 110

- '... a.n z..- ".. .. '0'"',

d _ .. I :' .. "' ....
• , ••• ...." IoIIC lUIO'S. _ lIl'o1 _ _ \hII" ......
--eI~.... ·., "''' • • __ d
.,.. 1;l:ImmI,IMy• • • llQISIlle lor • de .
r... '*' a.ma.Ium,,..,racea....I7w a llnl<Of>
,.. grldully - .
~ ..-.
10lb1i<l 10
U'le
_ U'o' W ....... I>HIC .....,.."., _
Il'9III fniP"lI' of <til d'oll:W..
'" .....
1 ""' ..
rM<1r'~8 0"' 10 II/( ",Aolt /'<'P"lmio~. EXGmplt>
ahmI ~d. TJrtrt U II/( c~pit'" <iI)' Iu>,pil'" ",ltost
malllJt~a~cr ""d optrllliml< gOOb/t lip Ilrt no/gel
""'"!Ttf ~ttdtd i~ 'ht COIIII I'JNt for ~ primary
h''''11t ,ort-Orimwi progromml. U~lffl obj«fiTJtf
1J1Io/ u""!gia ll/ tltt sw ar lrod Irllllt bttllllrOllglr1
IJlroJlglr, !I't ,o~ tIId "p ff'illr a K I ofpraj«" « ltid,
laktll l"itllrtr, prt-tmpt Ilrt " un",:" "mitd la ","I
a ' 011111"' ) objtcrl.." ."
Fig. 14 Aid lor health and education
The chaI1 beiow shows that aid for !'lIIrition, hfalth.
aod educa1io<l is a small aod dimln~ paMof lhIII
lOtaI aid aIlort.
Parcentoge of 10101 o ld from western
lr'ldu:sffIoliled notions oDoco ted to key
socioI seclors

"". . . ",Iuu i am 'lIggntilll if lilt lit'" fur .... 1979

I'bjtcl;..,s..,rintrtd appra<u:1r u:1rtrt "'" a"inUOI'
mrm duuly ff'1r0i it ;, Ilrm fU art 11)'' '1/0 «1tif'fJt.
Tlrls . 1r""ld lrrlp "' 10 Ifl/lilt programllltS 10 ......
I<lXPGYm alld IIrnr IN Irrld aaOllllJabit for maJtllSl
smollS p"'lJ'f" ill Ilrt arras ..... art fiIlOJl(i~I. If wt
(all III(I/rt lhi, (o",", riall INIWfflf ollr global agnuio
'"
--
a~ d lilt 11M of {lmd$, wlrf/htr it Is for Mltalfrillf
t,mw mic acrivil)' i/:Jtl[a' nU'i2JI(ilfl Ilrt (OIfdlllall of
Iltt fHvP/t of ,lit dnulapi", tallnln,., ,,:r rrililraw
a btlltr ,ltfUfCt of ItUI", PT /upaym a" lilt idta of
ill<rr<lSi", futld;", foT w«ld dtwlap",MI"."
The IICCOnd ..a1emen1 comes frnrn Paki"an's
former .\ Iinisler of Trade and Developm ~nl
Planning, whose 1989 Paul Hoffman !cttUre al
rhe Unir\"d N ations also lpo ke of dnwing up oew·
Ilyle dt'o'elopmenl plans;
""Plall la'i'lS "'"It fill( /if t~PruHJ III/trIllS ofbllsi'
hI/molt lit"'. IJ1Id 0"1y llIbstqWmly "~JIJllutd ima
physi(/Il loTftIl for prodllrlilm altd calmlmpliatt.
TIlls mtalU Iltlll rltm r&iII 40.., 10 bt a dtar -. 0 = . C = m, _ ~ _

t~posi1iolt of Ih' 'orr'" for aw~ IlJUnl l"" lnuls,

tdllCOlilm O!/d Ataillt Irwb, 1r01l"·'" O1Id 1TO~'porI
'" a w ry ",i~lmu",. TMrt ",1ISt bt .... apt~
dlltrmio~ of r&IrOlltwi ofbo,it IItttis lit' :IOrit" CIJ1I
afford IU in ,"mill ptr 'apila i""omt IJ1Id lilt.
praj«rrd I""'IIr rOill. Tilt b1Jsi<: NtCd, largl1S frill
Ilren Itaw /0 /if boill ilUo Iftloiled plll1llting for
pradll,ri"" alld cOlUl/mpliolo. 111 OIm r«mts, =
shoolJ prtXmf from t lld, ,a mtOlr< ",,4 1101 Ilrt OIlttr
ff'oy rolllld~."
If IIICh 1hinking we re 10become the ccnsens es of
the 1991)s" lhen ir " w Id be poss.ible ro think in
lennI of w mpacrl between iToup$ of donor
nllion. IfId indi.'iduol d<:v~lop,ng counrri~ for
the specific purpose of making meuurable pro-
gress IOwards agreed goal. which migbr include
uni, 'ersal prim:uy \"d""'tion, low cost warer aod
:sanilation services, a halving of child malnUlri·
ri,lO, lh~ reduaion of measles and neonatal
lelaOU" and a num~r of ocM. maior ld vutes
which :m 00\fl feasible (~flCI 2 1 ) .
10 many COIlQ1riel, lign ificanrly ;ncn'a~ aid
for $U(h prognmm.. would M needed to make
them polilically feasible. And eoh ncing Ih.
political feasibility of Iong·rerm action in faWllr of
!he poor, and of lh. environment, i. lhe mOSl
impomnt role which lid ( I f ! play in th~ 1990s.
FK¢d with SO many shon ·rum proble ml and
pressure" in addition 10 rhe OXigenClel of poIilical
and economic IUrvivaJ, many ~vemmeQ1s find il
very difficu1r, even if the . ill lS there, ro increase
reSOllfCCI for loog-remt lr"'''' of which rh~ poor,
the future, and the envucnme nr are lhe main

"
THE STATE OF THE WORLD'S CHILDREN 1990

Education:
•
breakthrough In Bangladesh
Tho ",....te.oet>er _ 01 the ~ mQlt '" It>eoo CIliIdnlIl ""'" ""'0 rt\lI<le 1IJo 1'_lIM
A",ej l\<Ivaooc<>meo1l ComtMl"" (BRAel ..e _ 10 lJ'lWIMW't ~
moosU810lQ • ' - model of baM<: pnmaty ~ Tho IlUIll-I.,.t.aci>ar ,.,,, ., BRAe oct>c:do ..
lO1 , occ_t>le!OlIIe ~ at lIIe POOl...."....
~I .tnetly at 30 l<> lIfltI "" lIIlIl ct1oI<II<Ion 0&Il
;:,nd relev3<n 10 1IlCIf rlCI!ds
P/IItlCtI>IIta""tM!Iy .,IearTq aclMbeS 10""""'"
At< In """"" otrte< ~ ""llOnI."'" _ fQilow 0 hognly ttt\ICtUle<l CW"1C:INn. ~ "'"II I• .....,.
P' '''IKY """""f""l system ., Sanu'_ to lID! vel "'II ...... . - """ teachonll """'" "'"""">POd by
~'" Soma 31).35% oJ ctWm!n do 001 even BAAC t/nItJgII_aI \'93fS III e~t.tofl
..an sc:I'><lOl , &<ld lly ~ ttlotd 1;1'_ 60% "'lhoIe 1_he's are not Jutr u_ prlll..._ , but
wtlo <tart Mve aIr&ady <!n>pc><ld QUI Sd»oIC.>SIS.
oe l ~-educatOd . ~. mornod ~. who
.-.xes'b11Iy. an<I 1IIck of 0l<1<:0UI~ 1_ · Ialw Pall ., ..., .,_ . 12-oay ueorong COI.OO
till' """""'" tho! <:hIIclIen oI 1heflOOr In _ ... ... 'm
_ . dasses Ole _I>upe (70 per ,aacflt< "' ""'" ,~ ,~ \llIIO¥ICO. """""'""'" ""'"
rile _ _ 1. l&IIChers or" olton s><><>tt1 """"'a _
ttJ!rtJ$hef U;llfWlQ 1hCV Ill. p;ood • SI'IIIlI IIIMil"lV
. _ lor t&achonu "Il to _ tI<luI. a lI3y, SOl
ui " '"
,........,ed to 1he _
lio-", Uiiiity ,;upiif• •• ;;j,i. """'" <;:1>"'
............ III"Id ",
"
II
IS
an davs • wool< Aboot 75'" CIIIO_. ... -..eo
ill _""""", sct\o<>lf, by <X,flU..t. only 14'4'"
lICIJle shottIge of tll><lt>oDll:s
lea::!le<a *.""""'""
""""'-'Is
ond ...".. _
_10
In 198 5. "' r~ to <WnlIn<l$ !fum ~
paten ,s , BRAe .1.... 0<1 22 e><pet""""'a1 VIlago
prtM:.!II bal;o;: ' leI'' '''I'. numer""l'
...... to "'" cNcIr"" 01 Iao"ldIcu
_
P".... I$ and WIIgO .....,.,..... 1ICl,.e/v """""'*<J

.. QPanO(l , "'" Wi_.

'" M'o/>IIshonr,I_runnong 8AAC - . Be!ore.
mu.. pmyode •
Cla$mw;m (for """"" BRAe PIIVS • smoII rentl, _
t.moIoes &i late 198 9 ,Oft P'Ol/IamrtIC had "". ...,lt;·
PIf1'CIe<j to 2.500 ~ schooIr;. wnh _
2.llOO to _ tIV 1991
_ OIl _
IIIMIIlly ood ar. _
t>clo.n P..
lI11eo<led
"-'fIllS .... ""'"

1lle cUll'OJlom CII tho BRAe sctooIs .. mill.

The BAAC schools emil 8 to HI-ye..-<Jlds ",. ~ <lnOItlOd t....,
lIIat '" g<JYeIJl""""
~ "'(y"1l/TlITl& Of BMgIo (I!'e no\lOn8l $Cl'oXIlJ Am\lmollC. lor ll>;OItlIllo. !IlClJ<l<>II srnpIe
Ianguoogol. anl'lm<l""....... SIlQal 01utloo.
or" fIeI/l "
BCCOUf1' '"II...........""""'1> , !!lid the
_ SocIIlI .1JJdoes tocuses
'*"""'" '"
Q<l pr8C1ICII 1QPa

---
C\a$ses • ~ ...- 01 - .
bamboo Of mud. ""'" ,"'-1 '" ' "' 'ool such os MeIth """ WCIfl8<.'''''
""""'lI neogI>-
bllUtS. 0IId PIQbIemf such .. NIIy _008 ond
ChoIdten "I Clf'l " " " 1Id ""'" lI>/l eM il JIoor
Eoct> <hold _ • sill". p<>rIOIs, nolfl!>OO/<:1.
,e_ "" a
lap -.:I T,""",,",," "'<M<le<I or" The r;:o5I to BRAC CII o .~ """, runnong "'"
\WI1 • llIocld;Ioard. • stool, &'l(l • lfUOi< ., whoch
"","'
The _
, III Itotr, !lie POOl'" IIwodIns
~ iii
_
ibOvl $ 15 PQI Il'JpoI ~ The
Otofl ,""""". IUn<ls for "'" progr• ....,.,.
from """"oI_1tQOnCJ<!O
r...... r orllculal elTlP/la3d IS placed on enrok>g i1 1988. BRAe e.opr..~ """" ,ed W11!l • JeC(lOI:j
gorls 6 3" 01 PUlIIIS aoegorJo. lNI'allJ<Il bguno .. 70%
Th<l BRAe """"""
el'......,n.<lr,",..'
ll.""."".... The
I>8v(l ~ b<Iyond
. . . . . rec_
'\'PO '" _ . for 11 "' \4 .....__ who_

_
fQlmli fl/IUCO''''''.
2251..ch $CII()(IlI
""""'been QPCI(IQd TN! ~ has ~
."'.""li
,.onIy""~ '"101. crve.- 95"
1 5%...- ...... \'11... A od8\" ed ""'" lMo' t>H<l ., "'" 0<:!J0QIs for B 10 10-
_-010•. bul .. ~ ., two years
"",,,,,_ 95,,,III ~ lIaWIpasoocI~liO f"
klr entry .,l<> tM ""'"" class C11IM CIIhaaI PI""""" PIanIl... """'" bell'lg made l<> ~ s<:aleUlllho
od""allM svst..... To tM OUIpIISfI 01all _ _ s. J'lUIl'lbors <It 00';' """"" of - .
beneficiaries. [n the 199Os, enlarge<! aid pro.
gnmmu should be designed to reduce the
po~{ical will required for, or to enhance the
po~rical amaetiveness of, those measures "'hieb
olT~r little immed~ te political or economicad....n·
tage but which art cSSoCm~1 for the long-term
improvement nf buman ~v~. and a~ties.
For 20 years, aid hI> remained at approxi-
mately 00. third of 196 of ihe indunrialiled
"'arid's GNP. It is pitifully small (fig. IS}. The
firu.ncial I'flOUrc~ . . .... ~able to the developing
world must be increased - through deb! reduc-
tion, ttade reform, and improvement. in both the
qu.mity and quality of aid _ if progress is to be
fig. 15 1he aid league
Oftlclal d9vIlInpmenl ~ (ooN In:lm lhe OECD
COI.01ri8:s loIaIIed $47.6 t6In in 1988 . an Ok> 01
&7% in real tl/nTl$ CMlr 1987. The 0DA1lS 8 ~
oI h comtlined GNP'50I1heDECO C<lUIllries also rtISIl
Aid from westem indJsillol ~ notions (OECD)_ 1988
o 0,2 0.4 0.6 0,8 1.0 1.2
Percentage GN P
_ 0 = ._ "-__,,_,,,-,0f<lI. __ '.
nude. Bu, theoe resources need to be enlarged ..
pan of a long-term and conKioudy piannedefron
10 protect the poor from the immediate effects of
adjll$tmeot prognmmu and to in.·..t in the m06t
reliable of all engines for furore growth- a
healthy, wen-nourished and weU~uca ted people,
f inally, if the world is to move to"'Uds
development for the poor in lhe deade ahead,
then the World Bank and the [MF will need to
lean th.ir weight in the same direction . At the
momem, Bank and IMF loans aft conditional nn
the fulfilment of economic criteria SllCb iii reduc-
ing public>pending .nd stabilizing lhe bm.n~ of
l'Iyme-nlS- But it is nOVo' e""mial 10 take a wider
In:lm 0.34% in H187 100.35% in 1988. Thil is SlI nnty
h8Il lht UN 1argIIC 01 0.7'% established in U. 1960's.
Nnr\ol'i" I I ~ may be thal hlong cXdnII in !tMl .....
01 aid is ""'" toming to"" rd.
AId n billor\$ Of U.S. 00CI0rs
2 46810
Bi1lions of SU.S.
"
THE STATE OF THEWORLD'S CHILDREN 1990
AIDS:
the threat to children
AlDS .. now a "'lip' ' treal '" !tie "",,"Ih .....
$"""'111 of d'IOdren tond ""'""'" " """"V <:«orI\fleS.
an<l ' 15 1l>PlICl IS
,,~
_ ,0<1 10 !reM' "''''''Cl l1l<I
_~ to "'" World HeMlh ~t"'"
(WHO ). who<;:h os cooo:lin8l>n\j ~ eI!<wls 10
"",,"01 '""" ll'oYet>I AIDS , It _ , 1 & _
..........., _ ...""l"",O<l ...ltl """'"'" """"'"
""""flcooncy """" IliM - 1"'01 WUII wroeI> causes
AIDS aaes w ~ (v \OiioT.ijr. .-JOCiii<i ...lr, H:V
r.o.o 1I 2&~ 40% "'"""'" oI-.g """,>l"'" bel",.
'" doong lwtt> These t.N<IIen AlO almost C1l/lHl 10
die bolfor" me _ oIlivo
In "'" Un 'od 5'.'....kltexample. _ , 2.000
d*lretl h beeo ChagrI<>W<l asI\M'lg MiV/AiDS.
I>tI<l " """"011 tMl lllu" toer 10.0Cl0 '0 20.000
w.I t>e """"1<.<1
by 1991 AIDS os also 1I """"'S
"""""'" .. the ~. and " ',,''''' If<.'fId• .,
~. III l.a1" AmIIrJ<:a and Aw "'" .n~
Bur ~ .. ., """"Sol"...,, A!nca tha' AIDS _
I/lIII
wMIfIr'l
IJ'-"" lie"""
.IIIUI TO "'" oJ choIdoon on<!
In ...... EM' AIncao count"". 14 % ol ..
'''l'O''0<l AIDS CMeS ..... ""'"""'" ....",. fouf.....-
mag" Tt>o World IlMIm 0Igar>it1l""" . . t """'~
1 ~ a1 aT k!ast """ moIIIon Alrtcat1 wo<TIIlfl are <nTl!Cled
",m lilV. ar<l 4I.OV8Vl' ., Utl>ar\ ore,," 01 _
A/ncarl CCM..o:lll'. .. ~ """ _ up to 25%of"""""'"
10 bot.-.l<lcle<l M....,. Il>oo_ of _ WIt 0<1
born "" h!-l1V onIec,,,,,, dur"'lllllo 19905. atId ..
_ Alncan CWf\,nos ''''' chkl ........... gans
""""""'" mnng 1M pas' lhr"" ~ "'"'Y SOOt'
~,-
In All"",. AlOS I\a$ ~ and f.... cod1ng coo....
0' tile fMW< The lNog"","
QOIJtn<:1OII for.. l i . . . ibEri.
S<$ of HlY/ AlDS on.
VQU1U CflIld ISuauaIiy 1ho "'"
1ndoc1lOOf1 lttat 11>0 "':111'. - _ proI)abIy , ""
lathe< lIS weoII- IS Mel " reeled 68100. 1Ong_ boIl1
potl" " " ..... ....... 10 IHlcom<> dw"""""v . ..... to
ee 01 AlOS.' 6\Il,ed ~ The fl/obletn ot flow 10
"
car.
-
po<Mdo -'"<l ~ . lew tr.! ...........-.g _ .....
tho oo-eakd 'AlOS C>'PhIns' , ut{/MII\I <IIledo '0 bot
E~ ~ , os tho _ IOpr""'<ieJ)OOIlIII ""'"
Hr'I/AIOS ", bIIsc medICal "..• . ~ rod
..,.,... IIUJ>IlOfI W1U>on their ""'" to-es. $I"lCe
~, ....... _P<tv .,...·s".ldled and . . . - '0
IltCM<lC ~J"J!e core and trC. lm8IlI lor t.... 'lIPIdI'I'
es<:aIm"'ll ~ 01 HIV/AlOS ~..",s
ne•• lo1l111 P osPIICl 01 • cur. 10< HlY/AiDS. or
iVI-"-.::IMI YKC..... be fore the end 0/ 1t111 19 !1Os
lluI tim rllPldly QrO'MnII nu<rt>ers 01 AIDS """",.
omonu yQ<>"lg ~en "'. not......,,_. The loy 10
pro""mg ~ .... !rom AIDS os the _ allOn 01
he81ttl ......-. _ soaaI -'-s. """""""'IY
and reQous - . . !he m. .. _ and !he
scIloob. prO~ llSS<IC<&l>O<lS. aod ~
.mme,,," 0I"!JI'WIlD'l5 0/ fl\3tIV <>roao to ... rOlll'l
PllOllia h:)w they cen I......
r ~ S!t>oIiIy '0_ .
tho ..... ad 01 HJV otIf,,,"-on ""ltun mo.r r _ and
~-
~ moboiwI_ 01 u.s bn<I IS now b<!goMotl\I
to hoippen "'. ~ 01 001II\,_
In T _.
""""",,S" haY!> """ U _ to ~,.
&I """"'.'. onIom..tlOn ot>ou1 H/V/AiDS ,1ItOugtI , ....
mass _ In Keny".~ 1" "'0"'"'''
"""" tIIM;r PlI"'"fll'I U-'II COUI"ses .. AIDS
llW9IC'f\Ol'<S tot "'Omen ·s~. t>eaIlt> """""""
aM cIlutc!l 1111"*' In l./gaI'd. lJ)ooneI ' 6l.
fIwl,nd.. and Blo'undo. sd>ooI hNllt> edu:aIoot1
.,.,...scs ..... _ , _ 10 """""" AIDS _ .....
""'" - fl"!Ve'1l1On
Thet. os _ 10< • lui...... """""', me thrw.., 01
AIDS. TtIII he""" """ SUMVal 01 <;I1oIdren "'" be
r1r""""~ _ , """ "'" sP'.3CI Of AIDS
greill!Y redlad. ~ IIil 10t1lllies ... """JlOWftf8d WIth
essenUOI """" heallh ~ , rdu<htIg onloI-
mIIt-on about tho co''''cl and Of<l\tflr\l-on 01 AIDS
"iew of Ihe$e conditions. In ct>-openlion ..ilh
olbcr donon and ether intcrnational a~ncits, as
well as ihe goyemrnenls of the countries ro n·
cerned, economic adill5lmCnl programm c. a!5o
nred In lake inlO aC<O\ln' the social i"'p<u1 of
thosc co nditions in order 10 ensure that nutri.
lional .tandard. are not ondermino:d, lbat the
incidence of low birth ..-eighl and childhood
di$ahiliry doe. nOi increase, that immunization
n tCS do not bll, th.t Idiu. ,mcnl will nOt lcad 10
the closure of clinks and prillW}' schools. The
days are gonc wben financial inllilUliom rould
confine their concoms to the purely economic.
The meeting of agreed social goa.Is is also
essential to pre •..::nt both immediotc human
depr;....non and the disj,we &l:ment in propl. which
undermines long·lerm growth .
T'be pinI foc W h"hulrlaUud .. orid
Opening up the debt trap, ren",iog in.-ell·
ment, bbcraliring trade, compcnuting for lleep
falls in commodity prices, . nd increu ing the le,·cl
of aid, Ire tbe ccndiricra for re"ersing the
disa1lrous trcnd s of the 1980. and allowing •
renewal of progress 10w",d. tbe p at material
lI:0al.ohdequate food, health care, and eduClition
(or all.
Within a shon time, such measures would also
begin to rescre health 10 the world economy and
bring tangible benefit. 10 the industrialized l:OUII.
tri'" lhermelYC5. In panicular, the United Stat"
sand. to gain from an end 10 the debt cri$is.
Faced with its own enormous trade deficit, lhe
United Stalcs needs CIl5tOmerl. At the moment ,
many of those potent ial ecsrereers are spending
l llH to 5llH of their foreign nchangc e.minglO on
scrvicing debts rather than importing good•. h is
rherelore American and European manurarom"s,
rather tban Amerian and European bankers, wbo
Ite suffering lhe consequences of the developing
",-orld's indebtedne... CoTwe rsely, a resohrrioo of
lhe debt crisis could muce the US lrllde deficit by
up 10 $30 bUbon a }..::ar". [n 10tal, the dcbl Crills
and IIlc consequent CUt backs in impo", by tbe
developing nations c e eSt~'1lated 10 have COIl
Europe, North America, and AlI5tri!asia approxi·
mately 6 million iobs during the 19801" .
The economies of both de.'Cloping and ind us-
trialized nations would also fttl the bIInefil of
increucd aid programmes spctifical.ly designed
10 meet J«W r""rtf! such as universal primary
education, primary heallh aI'C, ""'ler and san;ta·
tion sel1lictS, and improved nutritional levels.
MOSI of lhe e~pendiNJes required to move
10000rds Illeh goals would he expendilUl'C in 1«4/
cum..nn: fOl'Cign aid which helped to finance
these inve.trnenll ",,,old !heref"", inCl'C' se !he
foreign "changl' 'earnings ' of the recipient
nation$, thet'Cby racilitati"$ the opening...p of
economies m d an increuc ,n lrade.
Poverty and the c""lrolUDeot
In addition 10 th.... economic benefils, an end
to the debt crisis and a renewed rcmmnment to
ptogress for the poor it also in lhe interests of lhe
entire world communit)" in irs dependent'C on a
common coosyslem.
As the world enters a cl1lCial de<:ade for the
envirooment , many govemmenlll in the develop-
ing world arc findlOg themsclves caught between
the confliaing domands of preserving the en,i ·
ronment and PJying their debts. Ac<:ordin~ 10 a
special report on 'En'lironm.nl and 5ll5talnable
development' prepared by UNICEF in 1989:
"M""y <QU~Irin, t!puial/y i~ Afri'''- rurd Uui~
A",tritll, 1r/l'fJt linlt fNJuilJilily Itf pumn/lf tlr,
'"",,,-,·MbJ, ,,0IWIIfiL poiicin· rtCo",lIItIrd,d l>y tilt
B"wl,,~d Co",miuimr wlrm rlrry ,," lore.d to
dip/lit Ilrtir lorwJ, wiJ, 1OIlltT, ,,~ d OIlrtr mlflmll
rtJOIIrrt! i~ Md" ro pay Ilrtir ' :trmraJ dtb<. procid.
1M mtIl rial i".".,m IDUl ",ur 11m. u~atJOidohl.
/mdlfUary tlMigal;.,......
Environment.l degradation need. no passport,
r~i~C$ no Frontier, respcas no nation', im·
mumty, Whallu.ppcns to the environment in the
de.'Cloping world is lherefore everyone'. pr-ob-
lem. And thc grnatcS! !hrCat i. nOi progress bul
poverty.
Poverry and thc lack of alternatives are lbe
forces which dri.-e tori! pe<lple to !he buming of
forests, the tilling of marginal lands, the overde-
pe ndence on finding gra zing for caule, the
overcuning of lrees for fuel. Pov.rty and lack of
"
THE STATE OF THEWORLD'S CHILDREN 1990

Debt relief:
for child survival
I....· tul$ documented lho If.
UNICEF', """~ OIl adpJSImIlf\' WI\Il • """"'"
l1I.lIrnn_
qoences '" Lhe """'''''''''' C t$ll aM ~ .. ....._
detlt blood.., crI ......... oevelopo>o CO\.01lmt d<n>g
l~ M ...e . _

<lell''''
lQ rcwprepa<ed1O ...
o/!" Ihoo Third World loa>s l~ 10 1hII
~'* Iherns8M!sl . 1 dtscoun1s
,aogong fmm 5% UP to 98" In eltecl. t>.n<s ar.
"'" t S900 00Idr"". ....,."..., r.d """" ""'*'*'_
gr"'-'PO '" most counlnls of Alrca ...... .....,..,
I'<'IIng to""'*'_ a <klller Ql det>, whoCI1 he. . ....
• 25'" ,;:Iww;. <II Iloo"'11 _ ..., ,epa'll . ,
""""""'c. ....,. '" _~ ....... """",nes, "- _I~ _ fQ< 2 5 C.... ,' C<lSh to<1a'Y.
lx>mc lho bruni 01 !he suft9mg
WhOre dlscou<l..... ""1Iune/v1"\18• • numl>8t
Hcavtlv ndct>le<l~lS h.... cui _ _ ol _ _ bee<1 "'1lPIt9d '" lago ""I' ~
,,,,e an """"" UMCeo. """""'"""'" tho _It> """ er.
rrWIl. prtM<l&d Iho t the f\.onds ~
odueatJOn Ql _ . . . prtI....... to meet ...1"""'0. ~ t>Jm"" de>
The e1opo... " '"
m~ Wbi "'-'oCi; iJUlosii;""" .., w..,:;:w ""'" ...-, ..'1'....'o.-.T>imil P;Oli'i"l'.. r~. ~,;;J
.. ;:-.. u: ;; i'~
."d..., """,,·term >r.ac:r......... "",c., lIaS 'I."PUlObIoo Ii t"""'l!Pf\lII
00 ~
0100 clM:tnod ......... (ltD1Ot ~""I . _ lrom UNiCEF II c_ lIy ~", _oc_ • .,
UIe Q'OII 01 fflII$""Il .. _ ~l "'""" Europeen ll"" 0/1 dell,. owed
Ito .-...on. <:IllS '" ou. ""'... '" II'M"fl'l""'t
bv Suden , ..-..g 11>8 Suo...-.. 9'J1"1f1'1'Y1't to
SlM'''''''Il o1IICl the neoo 10 011/" Ior9Igrl~ by , _ loceI CU'r """l' for U NICEF"'-"PPflJl~
boool"'ll e>.poou 011"" C!IUSO .."..,.,. _ ".,m..,. _th, 19Ioru'._ """ ~ __
PfCleCl$
," _ _ ~ ~ to lho ."''''''m llml. fur1heI Tho Soc>8I ......."""'" Fund recunlly _
~ Lhe PlCSQeC1I lot sus~ __
bv 11>8 t"" " Amercen DfN''''''' 'I8I1'
8lri; 1108) """
~,
UNICEF II encntw ~ ..1,.1.... FonencecI
T h e ~... ofthe... ~ .... ~ .. ~ by " I",es,ed donors. 11>8 FIltId ..... meI<e
'~<!CI lho ""all"_ wes oncl weI-Oe<>g ol rut",_ """'" to ~" "' ~ ""'*"'" """
C-..n. ~ !hom 10 bill' Nck lhtor .. Ieme!
I!lot
II"'' ·..'.,....

_
lr>crease<l .. lema,,,,,,. _ ""..... 01 Lhe magro.
tWo 00<1 ~IO$ ' " The deIlt or.... /'.as Iood
10 mJW\V QfOPOSIlI !or debt reduClO:l _
,• •1tUC1V<V>ll Troro _
pr~ - less _ _
Ibo I>c!Iln _
IlCO-

ttll po,ertllaill' ""POI.

' ..... """ cer<Y • •1_
deIlI. "' I!lot sec(llld8IV met'<8t at _ . 'an....
doocounto, The.. K>Mr..... be .. rot<llJCe<l ."
9'''''' • ..., """"""."""
PIlfIO(ls Tho bar""""" _ , " " " "t. . . . boo r...
,

....ed . Ii IId<J,toon. to o;:onlflt',l le funds Ii lotlII

~ 10 _ _ ' , ' , ,,.,, IltOQIIIrTlfIIH
1"'" ~ WI>iCh 10 . >dIaoge the <le t"s owed by "Ilreoo be:w-l I!IIl lJ"MII1Vl""'l. the lOB arld
~ co<.w> lor _ . to lI'OlOOCl me UNICEF
errwonment. ~ w'lt,nl ~1ageO, and ~
Thoo ............ o/Iorl deIll<ll ijQYe<rImanlO I!lot
mQlo me .""""eI or>d ~ '" _on
<l(lllO'tln<y to reduce Iheo' ...... naI oebts, """ III
II may """' p I I < _ to _ _, lI\lIl tho the ......... llm8 .... 51 f1 ho.>man ""'''*'''',.....,.
pr<Jblem ollleb1 can be converted <"110 .... 0IlP0l'l'" ThrOugh ~ me....n. lII<e 1 _. the
'''II !of ~ d •• •Iopo'''''',_
lI\ lact, Ifut
" '8O'i1Ioona1 ~ _ IV can mal>! • mod·
type 01 ~ '" r~tl< """""'""'"
Th& i<oV .... '" "'" so-co!Ie<l "secono:l¥V ~'
tOl trlKlo/lg co<To .oe,c", ""'0 debTS Fo<:Od ""'" "'" t.m .. 1IIIrI to _tt .
..,!>oJ, ~ contrJlJy, "", to tho ..... *>g ol
tho chidran Qltho dl!' !'»''Il WOI'Icl, _ _
~ 01 _ or'Q.OTe<l

~- -
PI<>Sp<H:l of _ no< be,"II '''''''''' at All '" me

"
",n!idenee in lhe fuN~ lfC lbo engines of rapid
popubtion gr""1h.
hi, therefor. developmem and rising prospe r-
it)' .... hich can do mo' t 10 prolca rnl l environ-
menlo SmaUholde" who have =urity of ' enur e,
who are Iiterale, who have 1= $$ 10 credit and
$ci01llific adm, who have mu ket. for their c'''I''
100 roads to gel them th.~, who b,ve ,mall rarm
mlchin~ and a degreeof security instead of large
families, are the besl safeglUrdl for su.toin. bl .
development.
Tho po<ll of ,b. develcping " "Orld a", far
removtd from ee ecological concernsof ihe ri<:b.
For them, environment and den lol?mem ate nOI
$tpanne issues, let alone oPJlOSlllg concepti.
Envircnmerual plan n~ in poor are•• mu.s' be
based on more produetI(In not leu, more use of
resources net Ins, and if it is 10 depend on [b. co-
opl'nlion of lhe poor then it must also offer
fa mili.. improvement. in their live, today and a
dear ,,"ke m I bener Iifc,omorrow.The increase
in concern for !he g10hal en,i , orunont and for
sustainable dt\...,lopmenl is one of the moot
hopcful ligm for the decadeahead. BUI il will be I
less pf1laical force for good in 1M world if il d~
nOl lake into accccnt the right and lhe need of
large numbers of the poor 10 produce and
OOnswne /liMe.
Marbl fo...,"
Finally, in lhi, review of the mlin practical
opponuniriC5 for social developmenl in lhe difli.
.wI economie decade ahead, .oe ""me 10 th e
qoeslion of 'II hal 3dv' n1:lge ean be t.ken of the
prev:liling wind, of frO(' enlerprise now blowing
' Cl"O$$ both denloping and ind ustrialized worlds.
As well I S being lhe decade in which develop-
IMnl "."s hahed for much of mankind, lhe 1980,
will pu h.P'S . lso be remembered as lhe decade in
....hich economic lheorie' began 10 change with
T<'markahle suddennC$l. Enterprise ')'$ferns and
m>rm mechanism. I re now being mOT<' fer·
vemly embraced by Ilmost every nalion, im:lud·
ing many witb long mlrri agcslO other idoologin.
BUI in the pme. ... lessons aT<' being k u n<'d. And
if lh. 1990s are to see mOnmem lowards lbe
kind of civilizalion which allows all people to meet
Iheir minimum human needs, in both indUSlrial·
iled and developing worlds, then one of lhe mOSl
importanl lasJ<s 0( lhe decade will be 10 gel !bt
T<'l ationship righl between lhe l'C'S ponsibililies of
government and lhe mechanisms of the markel'
place.
Fe..' would now deny lhat decentrolizW de·
cision-making hued on market mechanisms has a
key role 10 play if a nalion's full weight of .kills
Ind resources is 10 be broughl 10 bear on the
doors to growth.
Agr;.wNre-led growth 10 provide employmenl
I nd ri.ing incomes for !bt rura1 poor, for
tumple, is unlikely 10 happen wilhoutl reason·
ably rr....funa ;Ooing market syslem. Success
depends on lbe energies and enterprise of
thOUWllb of small farmers making lens of
thousands of individual decisions over lhe invest·
m. m of th. ir labour, !bti. land, lheir capital, and
lhe balanct of risks and mvard' in lbe OOn!UI of
tbeir local knowledge and Iheir OWII ramily
ciKwl'lSl~. It is lbef'lJ ore an essenlially decen-
lfalized p<OCC$I, Ind one ....hich has pro' -ed far 100
oomplex, dynamic and local·specific to be sllCCCSSo-
fully managtd by SOVCmmenlS. The genuinely
.pect acular growrh 1D ~Iurli productivity in
Chilli during the 19Ws u evidence, on ,he largell
possible scale, of tb••nergies and lh. productiv·
rty " 'bleh ClIn be released by ,rusling people 10
make lheir own decisions and aUOI'ing them 10
benefi l from lheir OWII labours. The more recent
quadrupling of maize producrion in Zimbabwe
sbo..'$ that sucb achie...emerra are also po~bl. in
tbe different and difficult circunu,an... of sub-
Sahaf'l/l Arri....
But ss ro nlinenlal shifts towards free markel
systems gather momentum, Ih. experience of lb.
19805 also srand, IS a ..."ming again1l allowing
any economic ideology to obscure lhe human race
of progress..
Mention has alr.ad y been m3de of th. rising
povt'rty whicb bas accompanied I decade of
eoonomic growth in severaJ indusrrialized na·
l;ons. Thai fact, plus persislent social probl.ms
$!lcb as tobacco, alcohol lIld drug abuse, show
'hI! lhe market system cannot solve all problems..
And ..;tbOOI a strong framework of dc....lopm. nl
.
THE STATE OFTHE WORLD'S CHILDREN 1990

Human development:
goals for the 90s
As ,"" IOtcmo\lQl\Ol wrnmur>lV l<lrJTW.1ta'<>i d<>- UNICEf -~'hef "'lh WHO. UNESCO and
""""'1'*11QfOWI'IO
IJO"I< and Illl ' _ lor "'" 19900.
~ III (:CIIISlIf\S"" lhallll.omM <!eYeIoP-
<>!her "'Il'l""'GS -Ms also !den""""
III """""" 01
Iller" SUPP01"'11 goals whoch. ~ l>o!lng n1Il<l'UI"l '"
",.." ......., now ""'" C8I'I1'" Slogo U- .-. ''IIhI. _ CCW'lObu l. . . ~ to

In 1111 pas!. <:NYeIopn_ ""...,.,,. ....... _ 8<:tIoe'¥rog lIIoI ....... go.ols ."tId _ The...
llI'f!OCCl.JPII'(! _ fICQO IOmOC ~ suer. IS . -. lor """"Pie
GNP . ....-.go........ lrtlIItIl. ,, _. ond ptoducuon
'argetS [ COO O(lm(: gtowm alone. however. IS flO
o GIDt>oI or8OlCanOn 01 P<lIoo IhB year 2000by

gu",,,,,,,,, II,., l>4SoC: 1lU'nI ~ ""oda .... be mol o ElImonabon 01 ...."...'111 ,.U..... 1995 by

"""""" OIr. olopo... " . "" I!lIt ather hand. k>- a E~ "", '" ~a WDm'1 _ _
""""" or!
ttle most
!tMI fuli'lIrTleI1' of bMo: human _
onpon"", ,'I<Ioc&"" 01 ~1 o v., u.aI _
., al v"..,.., A _ <>done

Tile "1J1lng peonl of IJffl !>.dl '''''OIIY """" be

<lei"""'". . ,""",Oer'
chII<lr<lfl A _ 1I'I'o1!Stme'11 on dl!I<lr",,'._. o Aa;e.. by aI CIl\.des, 8SPODOllV """""". \0
nlo<rNo""" _ ......,.. for ChI<l *""""'II
""'noon and """""00n 1oun<Io_ .,""'" lor
IS ....
.0 ""'onnol
deYeIoomen' N~t "'ll choIcIfe<>'. o Growm promo""" .-..I it . reg~ fI'IOf'Olonng '"
~ .... by """'".... cc.n<let'm Ihe'n ..-.I Iheor all counl'... by Ihe _ at the 1990s
0DCiety to a ""'""" <;ttIoI 01 Il'J'o"'fI'I and _ ",a-
~ a RoducIoon by 95% '" musIos duN _
I' '" ... tII Ihs """""'lOOfl !hill UNiCEF .... <tf
,,,,,,,';I,,,,, by 9O"i '" meMIos o;ases '" 1995,
part1l<lf3 have ",,,,,,,",,,, "'" ~ majOr goIlIII
cornp,ved ....th Pl 'at "'" llM!Is
lot c'Wl ........... _elopo, ,,, ,, and pro1""_
<lIUIg ",. 1990s
o ~oW::l"'" 70% <leolP'!3 due Kl OiiVthoeo
by
'" chkIron undo< fJvlt - " oj "l;'8
o ~ 1900"""1hI_ 2'OOO.• re<luc\lon o ~<rdI.octoon 25"" III <lea.... duo '0 """ ,. by
01 "',...., ond <.<><lftr·flve man ........ t". '" .. 'tsPorltQry rllcet...... '" chkIr." l.ndo!r !rYe iV¥$.
""""""'" try 50'5, or It> 50 """ 70 per 10Cl0
r !SPIIC (~ ~ . _ IS less Thea _ 0","" ........... go<Ils n not JIlll
_ _• l>\II ,''''''''''''' ' teasIIlIo an<! ~
o a~l_ 1980 ancl ""' .... 2OCO. " '~ offOfll&M. Tho "'¥l' 'llQI.lIremarn 10< :tl/lO'
of "'" """.mal mo<lam- ,.te by 50% _ • • "..,1 .. poIrocaIWil. --. .-..1
~

o The Wl.... _ .... lless !hall ' '', 01_ _ ~ .. UNICEF . hope tIIat It>e ~ '" 1Iw_
maInul"""" and • SO% 'eclucloon .,
moohullitoon
""""".te an<! l!Ie de>...... '''', " CQoTW1Ulity ..... ''''''
ct>ollorigo '" mese llO'*. """"" 8' ~ ~
10 " '"

a u _ a.xesl 10 dnnq W3101 .... WOf\Il ITIlItIIh>l"",on. ol IlO""'1'I t'""9" \fie on-
No"'"',,.••·,, ol twman ~
W\IUIfY .......,. 01 """' <IosposaI

...,,-
o U........
o
olII basic '~I <lCI<.1Cal"'" lot ct>olc:I"'"
a;:C<!IerarOCllldvll "erocv ptt>g<o'lmmes.
&r'I(I

IrnpmwId Ilroleel _
ddbeuh c.-eurns!aliCK
of - . . . "' ~
~
_ed
Tho _ ••" "" ,, oj 1/leStl 1l'>als

lk»led N_
01 lhII Clltld l/Illn&I 2l. _
.mpIame",,,,,,,,,
C~uon

"" .... """""'*" ..

goaIo p<op<>sed by UNiCEF tor rIl. 19900.
_
way 1""""'00 '_o>g .... 1"""'"'01"1$ oIl/1e '«;""liV
go along

on IIw R¢ ll
18* . """ BOd
IlIso one oIl!la

•
policy and clear sociil .ims, dcmocn tia lly d r3wn
up and <OUUlle<! to governments 10 pursue, lhe
martet will f:lil the majority (If those m051 in
,,",.
Many oflhe mOSt basic hwnon neWs discuoscd
in this reporT, for example, are unlikely '0 be mel
by the undirected play of markel rOT«$. The
unrestricted low of the market·place is . 1ru dy
railing those families, throughOUt the poor world,
who al C spending $500 million each year on
in.lTcClivc ami..liarrhoeal drug. in ' ••pon.. 10
child iUn~. which could be prcvcnltd and
tre.ted b)' low-wst method. OUt of which Iher. is
.-1'1)· linle profit to be made. The unrestricte<l law
of [h. markel-place is failing tho... millions of
mothers who arc being l"rsu.dcd 10 risk their
cbildren's livcs and health bychanging from w.."
roll breasl milk 10 high<l'lSl artificial 5Ubsr;tutc.
in the ind~ belief that bollie f~ing i. mnre
modem or mere fashionable. And lh. unrestric-
ted 1:1.... of Ibe mmc[.pla« is also failing those
families ,,·110 are spending SK to 10K of their
incomes 0 0 water in s1um.s :IJId sh:lJlti"" ,,·hen
cle:IJI, saf~ water could be pro..;det! from public
stand-pipes at a fraction of th~ cost .
In a positi~ sense, allO, the role of govcrnmcm
~m.ins critic. l. Especially in poor Coon[OO
where iDl·~m~nlS in b. sic lnfmtruct1lrc ClnnOt
be made by priv"c em~rprise .lone (as in [he
u rly dev~lopmem of [od. y's induSlmJ ru.[;"ns),
government ClIn b~lp to mobilize the investment
ne<o=ry to ~bel'll.te the energies of enterprise.
The already·meminnN gains in foed production
in Zimbabwe, forcumplc,ha'·e been achiclltd by
[he effons of thoul:lnds of sm:l1l f.rmers and
pan;cul.1rly by [h•• fforts of rural women. Bu!
those effons hove been liberated hy government
action in redistributing land to smallholden; in
mobilizing national scientific capacities; in Iinanc·
ing research and developmcnt imn seeds, feniliz·
ers, and pcoticides relevant tn [he small farmers'
needs; in p.ying for the training and sal.ri "" of
ex[enslon " llrkc:-s [0 ocr as ~nk.s between scion·
tilts :IJId farmers; in makin! UNit a,·ail.ble to Ihe
pool by occep[ing e...,nlua Clops as coU.tcra~ in
Icg. lizmg .gricullunl uad e unions; in investing
in roads to ge[ surpl... crops to market. Similarly
the su"",,"" of rural dt\'el opment in J'!X'D, [he
Republic on ::ore., .nd Taiwan during [he 19SOS
and the 1960s" " " based flO[ only on free m.rkel
systems and incentives bur also on govcmmen'
policies wbieh rNiistributoo land (slipulating a
Ihrc<'-h<"C1.re muimum holding) and promotN
f.rm ers' a.social;o"".
In lhe su«.... >lori.. of eam omic develop-
ment, from the establishal industrial powers of
Europe and Non h Americ. 10 the rapidly indus·
trializing nation.! ofSouth -~ st Asi., g<l\"rnmenlS
ha," SOUghT to ..t the parameters for develop-
ment and to discipline the energy of enterprise to
lhe benefit of $DCi~ty :u a whole. Even in the
dynamic free enterprise mel$ stoOO of East
Am, it is govemmcm wbicb ba.s invested in
modem infrastructure, introduced land reform,
provided stability, ensured that tbe bureaueney
actively helps exporters, acted against corruption,
and controlled the 60w of foreign c~change.
Proponionatd y, government plays as big a pan
in the economic bfe of the Republic of Korea as it
dOC1 in India" .
In the lask of ensurin~ th at people are able to
meet their basic needs - rnd uding their needs for
• minimum sundard of nutrition, edun,ion and
health <lire - the role of g<l\·emmenl ha, always
been essenlial. "'S
economist Amanya ~n has
wrlllCn'
"EtltlI i>r llu _is/Dry cf Q c""nlry nlr_ QS BrisQin is i,
/_, ddiM}' <yllnl cf flNJd QM /Itdl/Jr rQI't - eM'
Qnd ahuw Tiu WI'tIlJ(J in mf""",ir Cp~/ftl<' _ Uti"
_ QS pi")"" a lI'Q/fgK ",If in m<cia./ periqdJ of
fXfHlnsiow i>r /ht d Nntn/aryfr«Jc'" 10 liN Iii/Ii Qwd
livr U'f/f"...
Gove ra...... t and eIill ........
It is the paniculll responsibility of govern-
mem, in both industri.liud and developing
" llrlds, to SCt tbe p' l1Imeters for a nOW deal for
children in the 1990s.
In the lC'1SCning of ~gional . nd ideoiogica.l
oonflictl, in the betPnn;ng of progress lowards
disarmamem, and In the binh of a new global
awuenel$ of environmental i$$ues, it is possible
That, as Soviet Foreign Minister Eduard Shevard·
nadze has pUI it, " A _ ""Ii/ira! ,,,,rllm is
prtVlSi/i"l ........ /h f dam ItglUY of lIu p.w".
"
THE STATE OFTHE WORLD'S CHILDREN 1990
If the Nienty first century is to be a benor one
for mankind than the twentieth has been, then it
is essential that me princi ple of finT call for
children bc<"IM • ~n of W I nlOW politinl
imd lm.
It is within OUr llO"'cr to end cbild deaths, child
3b~, child iIlnus, and child malnutrition on the
scale "'hich defaces OUr civilization today. And it
is within OUr pO" '" to COM>' th. t every child ha,
3 school!o go to, 3 hulth worker to refer to, and a
diet .... hidl .Uows normal mcmil and physial
grO\O,1h.
But a, the 1990s begin , it i, imponanl to bern
till' icarne)' towards those great g031s by laking
lhe most obvious lim Steps. ~';.r2l of the
8re3te't health adv:tncn in hum.n history nOW
foil "i' bio the n og. of the pr1lClical and the
afronlable. For !he healtb and well-being of
women and children, in panicu1ll1", d.......tK
pr(Ig!"tss is posuble even in lb••arlyyearsah h.
1990s. !li . rrhoc. l diSt!~, stin the single bigge.t
cause of illness, malnutrition and d~th among
the world 's ~hild ren, ClIn be brough t under
conu·oJ. Vaccine-preventable disease, wd espc·
~ially the tetanus and meaoJe< " 'hich togclber kill
onr 2 million child"'n each yelr, can be "'duced
to a smaU fraction of i~ pr= m proportion..
Poliomyelitis, II'hieh no.... crippl~ a quarter of a
million )"1>ung IiVl'$ each )-eor, can be eradicated.
Child lII.1lnutrition, whith now Aps Ibe gro....th of
150 million under·fives, can be reduced by at least
50%. And the ill health of SO many millions of
women ca.,:," M drastically improved by . t«Irding
tbem the rlg ht . nd the knowle<lgt Ind the mews
10 cheese he...· many children they ...·iU have I nd
when.
All of these ad~anccs, meaning so much to 10
m""y of those whose voice< are usu.illy unltcard
in the great debates ever the 1j:lection of society's
goals and the allocation of its resoureu, are
clearly wilhin t..huinland finllOCial ",.ch in the
decode which lies ahead . Rea~hing those goals is
no \o~r a question of physical Or financial
possibility. It i, a qurs tion of poIitic.l priority.
•
In the developing world, from the tnlwn.atic
events of the 1980. must be born I new
comrrutlll"nt to s~ of development " 'hicll give
priority to meenng the minimum ne<:d1 and
enh ancing the productive 'kiIIt of the poor
majority during the 199Qs.
In rhe industrialized "w id, a new commitment
to the international dcvelopmeot effOiI is 100
de m.nded of polilic:ai leaders, press, wd ptlblic.
Debts mUll be reduced wd :tid and inveumcm
muSI flow more freely. SigniJicant progress is
simply not possible withoUI w inereaSl' in the
resources available to tbe developing world.
Public opinion will M !.be fund:unental fiCiOf in
bri~ng such changt about. And tragic and
1l>OVlDg: as piclures of starving children may M ,
Ihe lime h•• come to ask why the " 'od d ",aeu
with outrag e and demandsactlO!l when . quart..
ill i million children are threatened by lamine 001
relllJ.in, unperturbed by the Innual death . of
scme 5 million young children from iUn..... as
simple I nd cheaply pm'em~ n measles and
dehydnlhon.
Amid so many other pres.<ing concerns, it is
difficull to lind time on the ....orld's agen"" for
problems which, il O1a)' be argued, have always
be<:n ....ith u. and cannOI therefor<' be regarded ••
exceplional or urgent. But fot tM ehildrtn who
will unneces.sarily foIl to malnutri tion, discase,
disahility, and an urly death in tM deade ahead,
and for the families of Ihose children, weh an
argu menl will any ftry Iinle weighl.
From the brooder pcrspecti "e of our common
fUlUre, ensuring the healthy physical and mem.1
d...-elcpment of children IS the most import. m
investment tUt can M made in the M:oIthy social
and economic development or our societie•.
Doing wh. t can now be done to achieve that goal
is therefore an issue worthy of iu place on the
agenda of the world', po~tictl leade .... the world's
prua, . nd the world's public, IS we enter the ~St
decade of tbe "'"!'nrieth cemury.
References
• ,__, _

_,_ .,_1 __
--_
... ----.. ... __. .
----
....... 1>tOOO-
'= ""'--
.
._._. . .... ,
. "
,
... _- -- ,-_. -' -
_._t iC
11
,
,,-
_ _._ _c
'"=~~~f m~~m~·~;":.~
= _

_ _ e-o _r_ _
---
.... - ,.,. .. ,- ... __ ..
:11_-_._'.
._
'
_"'" 0fCl'.!la_ •
', 0. _-.. ,.. _,, _
F* •
. ' 16. '
_
__1
... til'''''
-"
lHaI' .~ ._-"
• I•
_

' _

-"""----
--- ,-
_ I o.s.".
-..

-,-
~

D.
-~_

J _ ..
. . ._"-_ .. _._
- "".......1-._......
-
lMCO _ _ • 000lO
• • ""'".

..._
-- __e-_.
_

-
" _ 'k........ "C>.. _ _
.. _ _ .... lM«1Ie.- ..........
a_....

lID .. _
hro E'.·~=~
_ loom......UIOlKo

0..-
-.
,,~ _ _ "'"

--
..... .-...0... _ _

--
s..-. c... _

_--
'-""'CU

. . . _._L.. .
_ . . ()oOf _ ...

-,
U'ICf' • ...,.. 1_
.,_ _ c......_fa_
-.Go- ~._,_.-_ '§"II ,_ ,. tN CH

-""_....-_ ,.. . . . . _._c.. .

_ ~

1- . l.I/oIInI' . _
...
_ _ """'s.._
......
"'"" -........-.~--
~ J ' , '""'-'
_bro
£ . . - .. _
r"" _
s.o

w_
eO
....,. _
_Slu<Irr,
. DC
, _

-""'<0_ __
" -. _• . USA
tI, ',, _ _ e -, _ .1toOo

,""-----
PIoooI . _ _ _ f". 32 ~ .... "'" e-.

,-
_ _ Ox " ' - " "" I,
M _ \~ """'"
~ " t,.....
_ '" ..
Coo """""""
_ _ ..
,tI4w _ ""'_ __ IIo!IMo $00'...... 3)0,
, ........ _ _ OJNESI;O, . . . .
...
b._
_ _ _ OS . '91' _-. w....,., DC .......
-..._e-
- .... .
. r_ _ , Go-
,T
__._ _ Go-
_ _ e.-... .... f .. _
1'01_
_ _ e-
___
_
a..s.". _
_ ..1-.-·. _ _
_ ,_. r.....
_ _ s..... _ ...
_. 0...5<0<
,"'",...",,-_
_Or
-,-
r-.
00
. . . . . . "
l,NlV , _ _ .. 0-
...
-,-
_ ""........1.-._......
e-.-..._,
... _. ,_ v-... -
C
00
__
_ ...
\NCU ' " _"" "'""
e-.r-._ " " _ ... 1
EDTt&.~
»_ 00
__ ,
_(lo . c-.
'11'

1_._
, -. ,_
DC . ''''
1M "'"

__0-_.
21 ,,_ ....

--_ -
_ ..
, l_o... _ '=_""
--.-,--
... OOo_Wl ____ CA.'*'3ID.
_

-'-"-- -,-
• .....-.:v. _ _ " , .. c.

,- ,_,._
e, _ .... _ _ _ ,DC

..
... _ ,.--
__ • _ :7D-25r _ .30"'_0..- " _ _ "'"

'._._' - .... ...- ..",--

__ I • __

.......
..........
-- _--- ---
n-n..,......"D e-
r-.

_.. - . -_.- ..
\.elf 0= ..
, ... " ,_ ' - ' l.MCU
2:100-.0- _
_---.~ D C .,-
... _
.
""'-- .... :J" .. , . ... '_1' "_'G I"'~"_

,-
DoOIoO~_ '. f* .. 11 ' ' ' ' L ...

_...... _..
u___..__ _..... u-..a_ lH-
.... T, " :PrI-O , .
CV. _ __. . . . :Ie _ .. s....soow.. ....,. .....
r _ .._,.". _ _

' - _...... . ".. -

n_ D '• •
_ _ to,"" _
_ DC ,••....
, _ __ DC USo\

-~
CA... _ _ , _..
_ ......
, u " CA _ _..
C ~ 21'_ S _ ....,. .....
_ _ _DC No 3:'0. ( ," Slu<Irr.

---_.• •
__ _
_ - . ·. ...... . OC ."'"
1 1 I _ .. _ ....
.... _ ' _ .. ,._26 .....
CU _ _ . . .
_ _ ....
380.- ..
e - ..
0-_.'.'_"
D. . . . .. .oc-
 It -jl'I'!J
H~ ~oi ii~ ji]iUj: jU!ll] ill) !l~ JIII!j 'tl illI
l'!;"~ oIJ'Pl' 1 fl, I jl - 'Ij . _.1,
'II II" j"
13• l~lll of ,ll;l!h I!! :I il~ 1'1 d1 HJn 1'1 Ill.
'Ii - - If f ~l 1 I 'I'·' I I' I~'!
~ I 'r"· .liz:'~ j"5M". Ij:!:I;H Wild. 1111jll; luH; a! ii!g
IH .
, jihbi! bl!tH ufwd 1 ! ;}~i julli Ih h!J~
j~H i~fl IjPi ;j I'li H : ijj:f- flU
H,U
~~ ~ '6 H
'1 " l~ II" ill!
!- J I
l'~ ~:!; In!
' I ' -
lU!! HI! ~'Ih J ililill"li l'j jl.l
f[J
~ !if !jl~l II') 1-I,:llIIIW Jill
-i'i
Pi, ,]11 hi! i hi d i :WI~
111 1- A'I! ,I- I" 1
II! ~!HI ,hll!
.,],
:'6 " , . 1 !h l - d j
~
. :Ii~ "" 0 I~ ~~
-• - hIf hIll jUdi l!; II I I!iilg!lm .Hll
u u II ·
•
'"15 11'·';111 HI;!' tHjll1 It ~!- H l'~ :'1 l!' ! ;li!
f:;
lif!JgjJl.li,!i!~ I" tl'~ n ' ! ,1- ill, II!; 1 I'll
'"\( Jlil!lll!! vll ,'~lJ ~ Inl! HIi! il !, ill ~ ill! j.i -
~ "j" i"" !'ll' ~ llj'ill'il ul II! !" Jill Hi H i"! !ll~
~ ,lblilm ,hlilli g~ :!llm, 'e' 1-1 .Ii ! I II' 'ji- JI III. I Vj"
H! jg. :l! I ,! h ! I I; !i hili ,
 . __:J4_
---
-----
"
_A_..__
-
.... _.
,_,
-
~-~­

-
I., ..
__,__. _ e- -----
-,.
-- _' .....
_ .. ,- , .-.-
~

_ hd ..... _ , .. I ..
f_""
I. . . . .
.
•

-,-,-
_ . ,_ _
-----_.
-.'.·._0
__
_ _ _ _ _ _ v ..

...
:

..
1
_
- -
--__-"
II_ !

-
......
e.-._.....
_t.-.-'_"
_
_ _, e
.. ,
'"
_ , Ie
" - _.
~,

••
... ...._,_n
•
J
=, _ .. 0 -
_ _ ,_

'
_ ",_
.....

',--- -
_ _ _A' - ,_
,'"
-,-""-_ .. _._-'"
__ .. eu_ _ ._- "'
' ... ~ ~ l J , - .
__ "
"
_ _ 0-0

.......
...... 0<_'.., _1.; ....
- .. _
_ .. - . _,_ - """"_ .. e- d
' tIIII _ ~ S I
e
"'_
I 0.-0-. ..... .
~ Po

_ ..
..... .. 11
_ , _ _ .-.Q

'
...._
_
_
1'ol'1O. ........... _
..
'''-lIn-
•
s

-"
.. ...... _

-..-
...... l,I$,t,

,_ .,_.,
--'
_ _ v_......
'MIO. no.:u-. ~ "
' IIIOo .
lIo. ,
"*"" n. ,,,, .. _
........ ... "

.. ....,.;:iI"Of'
f _
_
' MI

0 - . ....'"f""o"

_.-
- "' .- I.QalO lloo_ _ 1;1 ""&04''' w.. , _ _
_ "" ..... ' 2
'''''''' ... 0.00 _
_e..w
'''- ' .
Thoc.. "'-
"'" •. m.." .......,
I.NICf ' _
,~
~

. .... ......... I. _
.,_.
'M' .
""' . ....
' 9118 ,_ _
_ "anoo
~ USA, ...
,.,. ,- ~,-
,.,.",
_ en..,-.._1_ -
.. _ ..."""'.........-­
,_
_.

.- _ _-- ._, --_

'_J "''ll''''
e.- ..'"o..-
_, 10.r_
......__"' ''''' ..
,- '"'

S_ A'_." ~
-.."'_I
- ..-. __~
_ l"noo> ..... '" .. _" _.....
UHlCI',f' 7»<1_
.... "'
~ -""'""'" r _ _
oc- ,.... _
_ . Colot . _ . 17..2 '
1'<tq'I,y.
I~ _e
...thoIFs..-.- • • _ , , _ _... ,.., ,..."..
Dgoo.- ... :ICI3'_ , _

"
 ---11---
STATISTICS
Economic and social Statistics on the
nations of the world, with particular
reference ro children 's well-being.
( ;'".,a1 ""'" .. .w. SgnI ilI>J r.p."lI00a>
Il< llt_~ TO U lIWT IUI",
T AKUS

t : a uk illdi~.to",
U5MR 0 IMR 0 population 0 births ~nd i"fam and child
dcath~ 0 GNP ~r ""pita 0 lift c~peclanC)' 0 adult litof1C)'
o school enrol ment 0 inrom~ di1tribul;on
2: Nutrition
!...mo' hinh''''c~hl 0 brCa51·fe<1Jjng 0 malnutrition 0 food
producllon 0 calorie intake 0 food spendIng
) ' Health
Accei\S to water 0 access 10 Ilcalth strvkcs 0 jmmUn i7~rioD of
children . r>d pregnant ..." ,mll 0 ORS uSC
4: Ed"".lIol1
Male .lId fcm.k h' ...ary 0 radio and lclc'Vwon sets 0 primary school
enrolment and comple1 ion 0 ilCWnd.ry school cnrolmem
s: ~mOJ:l'.ph1c Inellealon
Child population 0 population growth ..te 0 crude death m e
crude birth rate 0 life 'lXpcCl.nC)' 0 fenilily me 0 urb.nintion
6: &<tnomic inelle.ton
GNP 1'"' (apit. and onn"al KJOWIb r:llel 0 infi31iun 0 I'0 nny
oK"'"rnmtnl .xpcndilur<: 0 aid 0 debls
7:Women
Life npectar.cy 0 literary 0 enrolmcnr in school 0 oomr:lc~pli.... usc
o l",anus immuniu lion 0 lrainrd .n.nd.nce . 1 binhs
o
malern.1 mon .li,y
I: Bas;c indica'o.. on I...s populou. cO. IIlui...
9: n . ".'10
of p~
USMR reduClion ralel 0 GNI' per capil' growth rata
o
fenilily reduction ral.s
General note on the data
.....
Tt>e dala pr<Mded on these t_. o~ ·
~ dc~"lJO<IS. $OU<C<lt, expl""eltOrlll Of Il7Ili and
............. 1001""1<1" _ . the dlllir.lion 01 ~'"
mnllln 01 ddle '""l Itom me genetal <lef'OIIKlll llIl"'ll
U$OI1 T_ dttr1V<!<l 110m sa '"""Y wurr.cs - ""'"
m:ojlll l;llO.JlClIS ;we 1ISlM In tna lWlIOlIIatllfV m ~ ")f l ­
81_ WIll "'llVfIab/v cove< • ..- 'anr,n 01 (lala rllli**
"V OIfiCi3I 1/0'" "",,*,1 <!.tl. rec~ by lhol rc s lXK1-
_ U.. ted Nali<lnl age<1CV M>oe been U2<l wt\en.
""'" posso!lle In 11><1 mwlV ca~ y,+,e,n 'Iwl' n ate ""
",liable att>c>.l flgv_, e.t..,ftlcs m..oo trv UIII ' (I-
.!>OOsobIa Ututllll Nat""'" agan<:'/ h...... l>IltIn "MId
Wt1crc slIch lfllCfMuonaUy SU""lard ,lW<! f!!;!JmlIl"S
OD not """1. tho lob..... d r"", on data '''''~ I,,,,,,
l/Ie 3PP'OllI'OllC UNICEF IieId olfM':e he,,"1 lor th"
"""""'tor on lIC<:aSS to ooa lth """""as ..1<1 \htI
oodIcltors on """",""at"", """"'''lI''. """". UNICEF
.. """'"Iied ... a ""'"' OOIJrCQ. ... daw from UNICEF
IJckl olhco sources are '"",i<e<l Wlth.., · or . y
1t>e <!lite ' 01 Lm<let fIVe and .,1..,1"""''''1'1 ,a lllS.
Ide e"P"Clant:y. l:fUOe borlh en<!"""111 "tcs, ale s,,,
p8tl 01 !tltI reguW worI: on ""bmat.,..or.<! 1I'''l'''0l1C>i'lS
lJ'ldal1akcn by tIlIl UnIted Nal Ollll Populeoon OM-
..", T _ end olt>Bl ontem al<lt)o1l/y Ilfoduced ... t ~
ma:1lS are ,........,d peoodocally. wtw:h cxp/altl$ who,<
son\(l oIlh<1 da ta will dlHer !rom lhosIl 100<1<1 on . _
UNICE; PUbIocauons In tho caw 01 GNP pet """".
MId ODA. the dal. a«l !he ' ''....h 01 • conn","""",
1"0<:00$ of '8VISU\g ...... Updlll.,g by 100 WotId BMIl<
""" OECO f~llYC!y
Whc<c possible 0'W,r comprchensM! or r~(!SI!n­
l>IWIl "a,..-...I <!IIta tIlIvc - . u.ed V\fIIcre !hol da,a
,~f<lf 10 only a f>Ml oj 0", country this IS oldlCated on a
1001""'"

Signs and explanations

UniMs orhefw..... .,a'M. thol SUmmary _a:wt"
for tt>e lout U5 M A (uM'" h\tc mortaloly fa te) gf<lUPS
oj ~t"cs il<C the median valoos 101 each \IlO'Jl).
ItIc mcdl""l 1$ lhe mllkfle VlIIue 01 a dala .c,
.....¥i{lCd on 0100< oj "';tgnlludt1 TI", median" the
.......a(lC commonly used whet e O"'fe 1lI. 8 larg a
""moor ot 'Iems 01 o;la:a Wllh a great , lIIIgft. a.
on thcsc tllblOS. _ ,\ has le...w.,~ 01 nol
CIlS<:
bcong ""'10l1C\J by I"" I'CfY ~ ... lIN! """' ....oc
countnO, In cMe' whete ll>e '''''ge r. nol 50
IlICIens "",. "'" m()$I """","'""" """" """'!IQO! IS me
"",an . _ os ''''' surn 01 all \tie I,,,,,,," dr.ode<l by
I!le n.....bot 01 Items, _ . eececee we Ml!
deaOng ""'8 Wllt1 count"",,, 01 VCfV dtll.,ent SI>I!$ of
1lO!lWa1lOl'l. we I'oU'.id rnmcdlillety 811C1l\lr11C1 1""
ptolllcm 01 weogh \lng d """ ""'" U", me an Iicncc
IS th<I 11'1<1 ctloo<:c 01 medoon 10 O!VO thol 'older some dea III
tno .. tua""" on a l'/IIIC&I "",",,1fY 0Ili>e appropnale
U5 M A (lft'UP

Da,a "'" ......_

UNICEF ~1Ik! oil"'. I(lUICC
(I Los. lhan h,.... I!Io ......, $l\O'wr1
1 10 1al I... 0IllX>5Cd to a mood<anl
x
V
Sec JOOlflO\i a, lNl and oIlhoo IablM
UNICEF hci<l esce (;OIJICC. see lool""t" lJl It>! end oI lroe 1_.
Mo.t ol the U5MA end IMR figures are lnterpolationl ba-..:I .... fi'ofe·...... r estimates prepa.... by the
UN Populallon Divialon .... . n Inl.....llonallv cornpoll .. ble beaia uaing varioua ......"... In acm.
cues. u..... Inte rpolaWd e.tlmates may diffaf from 1M IatHI ....tional fig"",a, In !I........a!. data
......... during apprt>J<lmal..ty th. Iaat 18 n .... '_ _ not In<:orporated in th... esllmaln .
Index to countries
Irll!'e ""'-\1 **. ~ .........,... '00 ... ordor ot v- _._ 1ll88....- ... mo<WIoIV
.....an roaunu ... ...
. . . ...",..", " . """' bcm IUlRiIcIIO It-. _5"""'" IVIW ThlI i• • ' "
... \11'*1'"

....-
Itw.v_ " 1st ot _ _ below
,
--_.
.• ....... ....
.... ., .
--- ..",."
,~

"
"'-
~ 55 P_Hew &.olM

-.-_.
n
........ '"
.....
rca
"""
..... ee ,
"eo63"
oes
l'I ......

-..... '"
=
lnQoI

......~-
..... IINmc Rep ot
'" ' 01
"
_. "eere
.~

..., '"aa
.......
" 5
""'00 '"-.... .,
...
.""-.,..,
""'~
_~

"" "'"
ea
ee -.. o..m
'"
'""re
...-"""'-
Soerra tecoe e
rra
ta

,-- '"s "ea

Kao''oI>UCl>M.
BurloN ~"" li S
~
"ea
as
" .....
Ktl<u , Oem flop III S" lJIn""

""""
Cof,lI.-l Atncan ReP
o~

"'"
ae
'"""
.,."
lAo
-~ _...... .." ...
,
Kiltel. AliI> 01

Peo!lIll', Oem Rep

"
"so
""'"
5_
,~
~.., A1/1b~
T.-v_. U Rep ot
25
''0
,n
"zt
-"'"""'. ""
"""
"""- so
'"., ...-
lJbyan lV"~
'- "et, ,-
"""""
T. . - r. Tot.go
,....,
"as
""
--- ..
C60<_ ~.w
"at
--
"-'-
-""
""
""
'"es"
---- ,. -- ,. """'"
...........
ra
a
"""
'-"-' Atlll m_ "so
'"
..-- ., .,, USA
.~

--
''0

--
Mao ....... sa
''''s. ",
--_l_
EI • v..
"
"ta ,- ""n
-........ ""
"~
""""'"""
<>-"....._f .a ""'"
""""
01
m
'"az
'"
'"as
----"""" ...
Nt" . . . .
'. """ " ,-
'"n'sa ,..•
y,

""""
" ..- "
55

"«
0-
..... ''''ss za

-- "
• P"~
'"aa" '' - '
 _. -- _ .-
TABLE I' BASIC INDICATORS

- --- ..
•- - ---
_.
•• .-
-- --
-
-- -
......- - - ,. - --, • • • -
• • -~

- -
- -.. .
n~'
-
••
••
-
~

- --
~

• -
- ..
•• -
-
_ _ 'l'II

--
-
o'

- - "...
.,
== .
m

-,. ." •• •
-- -
• m •n
•• ......
0
,."..
• 0
•• . ••
•••" •• • ." ••

•• -
,• ,-
;.;;:0-..-.

- . '" -
- ••
-- ,. - - -'"," •'•. ... =
• ..
•
n

•• .."
• .
· eo

-- ,
,....
" i /, lO
'0

'
••
,.
.
•
.
.
.
.
• •• -
-
n •
•
n

-
." 1:._- --
-
m
0
••

- -
'"

.. ,"'
.
"
.. ,-
..... -
-
,
'. •
•• •. •"
..
" •
"•

"• - - -
.
ra u

--
•
-
0

-
,
0

. ' .
,. - ,. .," -
'"m
,"' "
" . ,
'::ill •
- •
•• .".n
•"
• --"•• -
•
•• ,.
-
,...-
'
,..
,. -
m
m - on
on
on ,. n "'/22

" ....
,-,

••.. - -
..- - "
•
• ". •
n
" • ••

• ,",. ••,. -
" " " • 0

• ,. • •
o.
0

•• .... :.,' • • '"

•• " ,. " •" •• " •
•
•• 1i:
n

-
•'" ," • • ••
n.

- -
!t o' m 0

, .
0
• ,-
•• - '
0 o'
n •
::I::
.¥
-
.'" ".
...-- .' •• ,,, • ,-
on
m
'0
110
-
••
• ~~
". ,."" • •"
~
••." .",
~t~'3I -
•
'" "
"
"
0'

•
•• •
•
•
" " ••

-
0 1~

_~ 1111
• •
- • - -
J'-'"m<m
"
•• -
0
••%* •
,.
••
o.
-'" •
• ,.,
-~
'""
-
.- •
•• -" • •
•
..
-
m
~.

.,.
~
m •• •• " .
• ••
- - •• •• -
n
'"
•• '-
•• -
,
-
'" •
•'" •• ..
•
•
u

-_ . •
• ,." •
•. - - - - -
~
'"
-
.,
'" '" .~ Zl'_13t'O

". .. .
m
•,. " •
•• • •
,. -
'" ••
-
•• n

-
0 0
• • •
•• •" .
n
~-

••" , -
== -
'"
•'"• - • "" -". -
,.
-
, . '. •
,-
••
-
...,.,
."
- •
•
"• •• ."•• ..
•. - ..... .. ,,. ••• ,".••". _.
•• •• • •"
-
m
. . . 0

= -
" '" " ,
•• -
...
- • -
~"'ot>.-...-

••" ;.'-
,
0

,.
'"
o.
,n

on
,
,,,

'. •
'"
.... ., " ,=
..
., . ~
~
•
•
•" •"
•
•• " • ... .. "
0

,.
..
•

-- -- • •" • • •
m ~

•
'" • •'" • ••.
~ m m
'" •• • •• •• •• • a
•
--
- -
••
••
" ,

'"
m
~
..•
,. ••
••
~

•• •
~

'" •
'" •
• 0 ' w'"
••" .;:::0.
•• - ~
•
••
•"
•
".
• ••
"
n
n

_____....__.. _f1Ir- I._.. . . . . . _~ . _~

•
 _-. _.. . .-
.- _..
-' -
• -
- -- - .0. -- - --. ----..
-- .- - .- • ~
_ H
•
••
,. ~.

-- , ~

• • • • • • ," ," ,"

---
a -
----
••"
_

i;l.,
1'. ...)

..... .. --,,.. - '. - .,., -, ..-,. .. ,...

'0
m
". "a
•"
'"
'0
,a
," "a
•
0
"m
'"
••
"
_/2111T

~''''
\ ~I-o
."
,~

'~I O
0

••
0
• ,.
"". ".'"" "
•"" ".
0

-.... .. .. -m.._ .. ,.
0
"" D' 2'7!>IllIIl

.- • ,,, ••
m '0 :11:'>1/181

••• ,. . '" "n '",a , "

,~

••"
••
---
--
---
"n"
,- M

"'
M '. ,"""
'"
'"
••
••
••"
•
IOU

••
,.
181/ ' 6
, ,
23~ 1I
~'f11
"a
M
~

m
•
••"
••
•• '" " "
•• ",•" " "
'. . . ..
11111/102 ~

.. -
,.• ".
•• • ••
o·
" _ ,a
••
~
,m
••" a
"""
.... .. .,.... -. "ace- '"
0

• " a, ,~
'" "

-
-
••
n
11:.
I'!OVJOl'
".
m
,., ••• '"• •-e
••aa
'" ",a•
••
,." ,w.
,~

0"
M
•
0
•
••
• ,a"
• ,.• ,. '"

-- '.
•
"
• R
"" ,a• ,2,¥O
,~

~
•"
. ,.....
" • •
••"
•••
..- ,"" """ •
a ,u
'" ~Z DR

,."" .." "" 0

••"
.~
'" ",
.
_ Jla ~

,.
•••
••
---
~
t;;::o:-
=.'t".o_ a,.
m
,."
..'.
," •••"
••
'"•
•"
,.,•
•"" .,
za

•" "
110<.•

..'"",
Ii~
~,

~ "- .... ••"

,,I,.
n
•• ". .., •
• 'ro
,-.
" ,ro• "" •
"
a• "
-=-
:::l\"'

--- 0•
,.,"•
. •" •• •"
" " -'-.
IU
!'ce;1li\
ap "a "
-..-...
"
"
.•
••" ",
0

•-
••• ,- - ',..••" ,••
..,•" "
•"
",•
••" .,
• •• -.
"'
''IO''I'T/1m

~
,~

n
a
""
,a
,. ""
,.•" ""
•a
a

•- ,"• ".

,',.,.'.. -
~ ,2.7 n
• ••• •" "" ' 3'0
,.,D •• ,ro •
' _ ... r........

... ,:m."..."
~

. ,,...•", •"
,.•
~

'"
--- ....
~-
~.
'"a
•""
•"""
"""
••
•""
"" "
"" '0."
""" ••
.." ,".. ,
.. ,,." '
"'/3 -..-- ".
,,~

""
~

••"
.•"
a

~
,.•
0

•
'.. -......
,., ~
",•
••" .""" "•" ....
...."",, ',n"
IN :
.."
m" = •
.....""
•" on

,.,",. " •
......-
..•" :16<~ ' , a a
,a ,"" ••
.
-
~.

", •• "" \17" ,, ~ ,ro

•
,",",
.. =.
--- : "Il
•• ". " .
"1lO'
•v a,
"" •,, .,"" il ..
,,''" -......
,.,,"",'".. :::.... ,.
0
•v
•• ."""
"" •"
n
,• •,, ••
, ., "
-I., ..
~ '
~
a ..
,-111m
'
IT
.."
.."" a

" ,•
"" ••
',...
• ""
.... - •• ..
,, a"., ,
,.'.•" •"""

'..'.. --
,,,,n ,-
H<r>jII5<r!g

........... ,••
•"
...", ""
".."
0 ...
,,, "
,, .,",
""
'lm
a"
,,*
11111.
,va
".
IT
.." •
•
,.
'",ro
"
••""
•••
,• •" ....... "'''
,, ~ IT
" '" •a
'. - .. ,,
....
on
•" ~" •"
1511:l IT
• 'it •n ••
,,~

"•• ,,• " ,, "

,,~

,' •
.., •"
'" ,- ••
,a
•"
IT
al~ l 0

n
TABLE 2' NlITRlTION
.-- • -- .. - _. . . . --
-..... -
_ ....
•
~ .
••• • - .- - -
.- -
.
r-~

-
_

--
.-
-. -• -• •- ....- .--- ---• -•'~ -••• .-• •
_

..
-_.- . ~
~

oO •

,, - _,
......
..". -- -.. •• :, "" " • ••" .'"••
" 0 0 ".

,
-....... ••
". .I. 0
0
I

---_..
~
,• , '"0 0

-
t ."

, •• • ..•• •• -
••
.."., - -• •.. ..1. • • • •• "",
• 0
o·•• :l 0

••"
0 n
w
o·
0 I
=-.
.. -
""•" . . .." • •• • -.••o-,. • " "• •••"" ...,,
, '"•• Ir

-- • -
0 0

"---
w

""
•"" '- -
-- •• •• •'" , r • •
,.
- ,,,
'" •• •
oo
0
r

-
j
, " •• • ~ w
=W
0"

. • '" , 0

.
0
••" ,..£. •• • • • '"
• "
- . •
~
o· 0
• 0
• ......
t::. • • '"0 ."

-
o· o· o' o' 'O.
0 ". • ~
" ' '" it"

-" --
0

0• '-
• :::
..--
" •• •
•". •
•• e-
0
0 ~

.If;•
",
o'
• •
•
0
0
0
••
•
•
0 .
.'"•
!!JI'I

,.• •
!1' lI',':' II" ~,.

_ fM. '1'II
. •o' • " .", ..•
.•
•
,. ..'"
• .,,"
••"
••-'- . - ..,
!!":'dO
o'
••
0

•• •
•
.
0
.POl....
•
0

••
••
'0
0 5O~ '
,
-- . • .,•• .. 0 0

•• ~

• • • n-
.1
·... • ",•• • lli'
•• •• •• n •••
w '"
-...-== -- - ... ..
0 w"
• ~- •• 0
0 0
0 '
"0 '"
0 '"•
,,, Ii.
'O

••• "••"."
,
o· o·
o·
• •
• ::~
."••• ..•
0
•
'"
,.•
0
••
'"•
,. =•
---•
•• ... .. - . •
•
• •
'O 1~
•
.."
0

•• ,,,
--
:;'

- -- ..• •.. -• •• ...-.>

."
0 G 0 ~
• ,
'•.
0 ~

•• •• • • $..~ • • ,,,
'"
0
•w 0
'"• ••
" --
,.
"
•"
.. -- ..• ;;,;
••
•
• • •w
•o ' w . 1.
••
•
~•
0

0•
•
.. ••
-..• .. '..,,,'". -
:I"
•

---
" • o' a ,t
~ I •
••" ", ". '" 0 '0 j
w. ""
 !HjiiEj lijiSII 1!iiiii=: 14; ia~ 1=ill'lllflHl!llllll8"Sllllllr lSlIl~l!Il11ln"'t!lSlIS~l!I~~ 1~ ..0lI t:i:sI~ "'.t1.lnDII3!:1l

1l11! Iml~fI'i 1'lfJwi'm IfUIII/'11! "l fijjJ Illfi iflfln,rllf~nii'lllfI' IIIl

i f II I i II I I I" If ! i
.... 'I! .. ·I .... ~.I ....'1 ~I· - ..··I.. ~ ..•..· I··".. ci "ll...... '1"1 1. 1.. · os.... I~· "J11l"l;;l ,<,"h· <1!1i=llilit!"'~"Il.li""I. .. I· I!I -t i·

e ;jl!llil ~I Ir III tl III 1f'!lllI ~lI!q ;,j tl l!! ~ Ii i31l" "l!llSl!!~ lS~lflSlQq.. I!lllil. II" I' I-
..,t::i l/ll!ll I a III ~ 0\1 t! lUI 'fl!llj II: If q ~ lI:flIlS lSq~~" ~lf:JlIi~lf if lIJ::l1l % II~ iii

• .. 1 Ilft1lfii'1 a !:t 1:; !:l1lqlf 41f~lf'lf IQ ~Inl l o:l!:; 1&

,-,- Iii
I~ ......... _ I<- ~ I<--.......... I_...._........ I-....._ ............ I-..._ ...e~ ~.:!~ __ ~
~---+·,-I~·~--, IH~-v~~.-l~~~~Eoi- l g iii! . •

-: ..'<'1 .... - iii , ~ 1.... 0 - .. I.... ., "t1.. .IIq~ I ..

I,", I
II I
•• 11:'14 If il ij 'l1 I~ ... ~ !fllllljll/&'l<"!'llIllS''': I~
I II
III"'
Illlliilllli =lieU I'o:: ~llIIlIlii B =Il :: l.dtllll Jllllblll ::1i5.n Ii iHiii. elsllIlSIlSI.llIll! =:, 1:;, lJ!lIIlnel5l=lllIiIOllIlI! I' ·!jlil
J I

aailiiil5iiiii15iiiillli liiiii i ilii.:e U lliiiiiii I iii15V:f Ii sss lilia.= li ii9iii!ii J5 i iiillUl5'1::1, l i . fiIi J a
ll:li·
--" "'-'''Il'---~--'- ~----- ~---l'~-!--! I, I'-'-"I--!!- ~'U_II __" _~B~ll'--~'- I! 11'1:
• • !I
 ·n ·1;: ...,....... 1..........1·.."....1
e~" ~ ;: - :'!;:-'" ..-....·1
"'llj - ~ " "e:'!'l" ··'·-1·
so ....'-1lI~_"~ e,, :~
·I
;:
-I .,........ I..........I.."......
~ ,, - ;:~.S' . S'~I:;; ~~ .. .. ........I· .-
~ :'! ~
I ~
-te~~:: ~ !3~
III ~1.·,·~ I··*I·~ul·."·lls··~1 H~;' ~1~·~.~I.m~I ..··~1 .·~~·I~·FI·-••
I II !I·~··~I ~g~~%I·~~¥~I· ~~~~1 ~"'~I ~.~~;, ~I ~·~g~1 ~'ml ~'ml ~'NI ~·i~.1 H'
• 1I
1I !I~~··~I~·!·I '~~~~I ·~'~~I .~··~I ;·~~! lllt*gllg!~~~I~ti~il;~~~~li~~!~I~~~g
so
/Ill ~lll··~I ~··~· I'~·~~I·~~~~II~· J~I ;·~~! 11~·~;~I,~i~~I~·~~~I~~~·~li·~l~I~-~§
o
!
!
• il.n·~1 i~.~il·i~~~I· ~~l~ 1 i~'~~1 Hil! il~(~~' I~~~~~li~~~!I~~~~II'~'I~I~~I~ !
f
,jill I i'~~~ ~~~H ~~_L ~~~~~ ~~U~ ~~~~
I I
Ilj~--- ~--!i ~~~-i !-~-~I --~-I i~~~~
; ~i"ii"i;l~ 2"iiii":i R~~R~ Si"iP iit a-~i"~ e~ij"i3"i~1 i a-~iiiii;r ;-~n ini!~ i!~"2"~ ~~~i-~ ~..,~& !
I
!
•
1':I ,jml !!~~!!: !~!!! ~~;~! ~!!=! !!!!! !:I!l! ~ ~'aU ~~3~~ §'~u ~~;~; a~lS~ I~~
i ijiii~ll: R~Ui" ~~~i\"~ :lfi"tii~ - !;fai it ii~i~
!
~ ~ I [ t f,
cc
II "I I I IS
:ll J IH Illh lull Jill! lm JIll! til UJu IlIH !ljb !lib hid ilf!
I! I" I • II
I
I
i _N. . . . . . I .. ~ . ...el ;:!!\'!:'!~I !'::~!!'R;I &1ll!3<'111!l1 tel:;;lllllll~ n~~~~I~~~~~I ~ ~ ~ ~~l t ~ tw ~I~~~ ~~I~~ ~ ~
!
j
•
 -- .. ..
-- - '
_. -""' _ .. .
-- -- --- - -- -- ,~

-- .,- -
_1"_ ,.- "'. ~" ,,
~

. -
•
.. "'.
~

,----" ~.~
,,,. ..
." "" ",.. "" ' •• .,
:w ." ' ." "" !i s .0
"' 0'''''
'"
ee

--
lI3/ fII {/O

•• '" ""I ".~

:; "" & .. .0
riJ~'r1l~

- '" ." "" ""

/06
,er "'/Oll ".
...,.." -.. "" .,.
•• .. .,. 'i'J, "" .,
. .- ."
1101'00/75
,~:gr
• ,-
':IJi !I(.lI
'"s4 "" " ••
---
-- "'"
~ 781 1IS/5&

•" ~,~
lIOJ.o
"" "" ' ."
:li::
0"
.~ lO)t~
", ~~ •• ,,.
',
IOI'OO!1O
=~ ~
• ... ~= ••nfl!
Al
i0 / ."
SIt!! ""
,,~
m um ",.
n" ~
r .
/
n
~

"""0 11::. ....

w,'<l(IjUj
I !Il l "
.,.2M~
"OM
." ~:b
/
""
:.=
m.~
"" .. ""'" ''''.... i ,,.
."
u"
. m "" .m
"'"
""
om"
''is' "'
••
••
.. -
~ II/ lID@II

fII; lI&~ "" ."

·m
.~

. . .. ".
--==-
"" :'='" ~,001- ~ ~ u", b u.
"'"
•"0 .- ~=
..-'"" ..=...." r, ..
1'~' ~
/ / M

Of " ..
"'~ '"i~
"j" /
/
." " f" <IS .""j" ••ee
/
"'"' .,
•
.. --
0
0
u
" - --
/ 0/
':IJi i3J 11
"""'00"-
i i '",I ,'"
.,
/
13~
""
'oO
"'" ."
.".
" m m~
.~

"'" .p,
'" "m
, $0

! l {/O
•"•
"
/

=
'¥JI ~I"
•" :=- " / 10/<11
:f: .~

~ 20F ".
=
...-"''''''- e4 . Ir. / ."
•• ....,

•• ,----
,,--
---
~ask
,
">t/ OO""
I
.,j ,~
/,
, ,,
' OO}l(l;l/1llCI
,at

.w
'm.~
'""3 ''"0
..::: ........... =.... ....iJ /H

'",, ..
• I r
...." /

°•
,. --
","
--
~
T........ _

'",w :=0."':'
'_
~ ~,
"''''''
!I'
I

""
~I I

'"f100/&
"''" I
' Of
. /
~'
,
/ /
/

... "
/
'

& ,~
0"
'" ~
."
~ .'"
0"

~ ::: n;
u..
... :r .';' .'"
u
"'
1I . -s:.
,'.. -
'w ~
,/
j // 51 -"
~ ij ."
0" /
I .,

.,. '" =
'w
," t:::r" ,I / / /
,.", ~ oO /

••
I.
/ I / /

~ ,,
/
lli" ~ .."... , /
/

,. --
/ / /
'"
m :::=
~
I II '$ m
•m /

'"
=- I I / /
,. ""
·oO
"'" = .'" .'"
"" ;r J-
,
,. -=-....
.oO
~""
100(100/
/ , ,~

'" il:"••
," /
,
.....,.."..." .,...".... .... ,... ,,
~
I / / /
", I I / .I" vf,l'<J:I oO /
· to "JIl' .to
'" _ 0.
,,' I/ ,I Jr , /
/
r' M
/
/
",
,, ,, .'#
,. ---........
/.
on ..,., !<Gog
I I ' M m
,ro /,, I / ·M ~
S$ ~
/

'"'" ,.
I~
j, ·1 .j;
,. -
I /
/,, I , .a:'" ,/
/
"on '

'. -
'"
'"
--
I-
/
/
II II
/
I I
1I
/
/
/
...
.:.,
~
il>
lIli=-
.,.' .! .'"
.(W
sA ,
/
/
'I
"
TABLE 4' EDUCATION
..- --
-. ... _,
-- -- -- ---.. ---
- -..---
~

..-
__ a

- -- '"
- • -.'.•
,
- '
-. ,
--
~,

v.., .-. USIlll

,
,
=
.,
- - ,-"',,
"
.
... ... om 2lI1 1 ~

"'"
.,. • 'm

- "' . . 'm
.., 'm ••
,~
i::t " 'PI"
<i~'
ill1l
, "'I.. "'",
••
,- '" ,.,
"""' .,. •
>3/"
;:::-.. 'w
•
.. -
- ,m "m -4 .,.,
~, ~,

,• "'.. "'," •.
- ,"" ~
",
;0
,:1,2
-'.
.m
•• ... .,
2~' ~'" ~
",
44"5
.,,,,
JIM
..•" '
'.'

. --.
'm M ..".
.m 'i'
"" .,.
- '" "
""
""
.. --
~

""
"'" ..
"'''
'lj1
., ,
000/"
I~,#
, ,~l
.n ~"
'm'
",
~
"'~
."
,,,..
~
..:. .'..• "•"
:r,:
~
,--
~

...•" =. ..."..:. .'" ..

'" M'I't>' '
,.",
~ :m ..!.,,
", .."
.,., ::.'i

-- .....5S: D_.'"..,,. -."" ••

' M 3'" 0 '

'- ~~ I~ "'"
"'I"l
.,.,,. ...•
•" :::t""""
•" ,"

•"v , -
-=::
Q-

...
0".

"'.
~~
om
33"/14'
:::I'
'M'

'.,
'''''''''
v,
3I:I1'~

~
~
.,.,
",.
.",,
- •,,' ,
.m

M'
0
~,
~,
m
•• ~,. .1m _..
" =
-- .. ~
, .. ." ~
~m
-,-
... ..,.,.,,
!!~ ~I!:
-,. •
01
~
" w
4

-
~~ ";~ ,~

_ f5-1 1tll
.,. ..,.. ,,.,,
'Of"

-..--'- .'""'" .,.,.""'".. ... .,..,., ,-". - ..:.

" ' ' . ".
~ ~~ ,~ ,
m
, ••... 'm,
.,,,
•••" "I"
=:'
f;~
,.,.
MI l< ""1'3
~ ~
• lliil ' ,,1M •
•••
-~

...."'.. ... ,.,.. =

"'"
v,
... 'Wp2
..
111l1 '00
llJ,ll1 I • :lI!i

-- ..= , ,
.,."
~
•• ~.- IlIl I
"'" ... "" .,. :w .... ..,. "'...
. "a' '''154
,.,., • "
." ' •
0 • =:
••
'M

''''' - -
....
'
1'1'11

... ,_" v ,t "" 'iI,a

'

-- - .. ".'". -..,-,.,. , -,, , -...,

•" ~ ....
•"
~ .,.
"
~
=~
"M
·'m
,.
"m
"m
"".
"'".
,!Ill
1 ~ ' 20

'lqI'"
-I.,
om
•"",
0
0
'

,-
0

'" - - -
,,~

•'" I
'""
-- .,. .
"M
"m ,
om
"
_.- "" "'" ...
= -
""'~ "e ~
':.l,Pll'1
" , ,
0
•• :- .. ~f.
.~

om
... , '"
!ll;1i
0"
"" !1Oa
vm ,
-- ",., .'"
..
,, ~
5'13'
.,. •"
0
"" , .... , , " '13'- rJ;V ~~ ",,~ '"n -
0
0
"
-
-.. i!:lI
, ,
." ~
~~()O
, '" +
 ...-,,.-
-- _,
-
- ---
-.. - - -- - -
-- --
,--
-- ----.---
..- _.,.,-
--
....

• <.
-- .
_(31-". . ...
.0/'1
...
,-- ...,,,. :::.,..-.,. ,-""',-... ....,. -:m.. .",...
.".
,~

.,. 105(1000
,~,
",
,.
"••
.,.
",,, ",.
- ••
' fill\12 ' ;>'1113
•" "" 'n· m /'"
,, ••
••"
•
,-
~-
,- .-
. ... _

..
fIo<> d

....
,;j"

---- .,.-" ... ." ...".... $ .... .,.

. . ,.,. .
.m
Dh
1ll1 '(f>
'0' /901
"Ii'" ""0
."
",
-- -
~ .".
17~' 11 ~
DlIII

••"• " ~ :m
171'-
,.".
.' '281'°1 "n
= 'w "• 'm

,.;-- ...,
" I,m
~ ••
"
A'
• ~
""'" ,
,.,. ...
~ HI
1Dl/ '0Il
11~ '6
"•""
",,"
2<1/ '20
llill ,;>~.
"•""
••
~

~
:"fl'
"'''
.... 161"/""
za,,. ,.,.
1121""5
,.,.,,~ ' oo
~
,4
-
'''f1 ~
~
- ".
~...,
" • ""
•••
••" -- ~Z""

.~ ... .:=.,..,.",....,.
..",.
.",
'm
.,. ,,,.,
""'". ,....". "".
0 '"
"'/'03
.",
'" /31
:~
~

-,""'",,,,.,,"',. =
,
,~

_"m -,
101~0I'
""'.
,
'~'00
•
••
•"
:::::
",.
i;:
.....,. ',.,..,- ,-....;-, .m
•• ,.",

---. .. _-
-- .11/11
i- "
~
=0:-
.,., ...
• ,, , , '
"","0
• :::i!
" .,,
••"
•
-
••"
....-
:=- m"
",.
.n"
.,r.,
, -,..-',.." ,.... "",,. ,.,,
",,"
3'''''00
""~ 1001'00
1(ItJ'(IO
. ". •••
••"
...:m,,
-........ ."-....
"'/101
...,..
''' 1111

• ,- -
~--
1:.:::-
.,. ..""'."",.. ,-.... .,.... .,.,
_ ' ~1l13 '0')/101 I'm •
••
•" _.
''.. :-
-
• 1_...,'-
~

-=:
~,

.,. ,
'." .,.
"'"
~l:
"",
",,,.
3ZI/ii81
113/1.
111/'01
,3'1'02
..,n

_.-... ..........,. ",m""." ""'"..

,o:t.Ol I
••
"
•••
~
~
.".

~
' 000} '0II
,.". oi.

',...,..- ....,.z .....,. ...

'" ~- ••"
,'. = . J.
..!...
" - I Jl.TI'8Il
.,.
~ w~
~ 'CD/":ll
"0/10'
'011'011
' 01/101
'0>/100
..,,. ••
•
""" , = ... ...
.". !QOI10, 'aeI'(Il

,,' -
'''/115
2'21'S11 "'l 'Z!
• "

-i; _.... .....,. ...-,..'.,.

~ '321'29
.i- ~77/2ll'
~ ~
..,..,
- , ..,.,
-=
,",,,<Xl ~,~,

.....
~

...
W ill'"
, 111roll .". • !I/'OO
'" ""
,.'" - """3 ' '''IIQli
''"" oi. ' 11 /113 n ll/'" ' 001'00 •
'" --
'" ;:""1,:""
, , ...,
~,.

oi. .i- t10{101l

'06/110
'Df/ 1Oe
113(11 1
, •• filM?
,~ n

-,
1?I:{ 103

..... .;-, !iII1',

....'. ,--....,...,..... ..,. ,,
'~QO
," ::.. " M al
'~'(Il .,. •
'" ,. lVO/Cl
~""
.,,.. oi.
...
'0'/101
oi. •• .,.~,
R
r .. ,..""'.
~, 1O!{'(lI
'"
••
''.. --_...
,.".
'DeI'1lO 10:1/ '0'
II'~'
.,.. ,.,- .",
.'.. ". •
",,
'N 110m3 .." "
~_

j I

= -=
~
107/112 100/' 00
' ''/1111 oi. •
.....
'0/'03

''.. ,-
on

'" - ,
,
oJ.
I I W
,.".
"&1'" '."
l~KI'
,.".
I
•
•
""/Il1O

.'
!!{l "

•
TABLE ~ DEMOGRAPHIC INDICATORS

-_.
- _.
-
- -
-- - - -- -
-_. -
-
--
.-. ,.

-_
..... -.. - -- --• • --• --• - •
• ..
-~-
~

•
•

••
••
- =-........ ... ••... ,••• ••"• ••• •.•• •••• •.. .... ,•"" "..... ..."
trll'
u
u
u

u •
• •
••
u
u
•
u
~
u

•• •• • • • . .. .. . "
.~ ,

- "... •• •• ••• •. ••• •.. .. •• .. .."

"
.~ .

""
• -
. "
0

• • •• ... •• • . .. .. "".
0
,-
- ,. .
"
o~.

...." -
• t ."...
" • "
0
"."
l I..,a

. ..
• • .. • •• ..." •.. ... .....
0
"" 0

" -
...
t.".
.... ,
"
U /U

•
" "" •• •• •• •. ,• •• . ••, ". ..
.. "
"
• •• • "
--
-- ~
...." ._-
3 ~U
"
• •
" "" " .. • .. • • .
,,,. . ." •" .. •• .. •• •.... . .. "
a",..
" . u u

..• :.:..:.
" ..., ..." ...."" ••" •" ••• ••• • •. .. ••• "."". ....""
u, n ' 0>
" ""

.• . .... .."" "" •••• ••" ..• ••• •••. ..•• ...... •••• ..." ..
11/10
" ••
••" ...
'- 311....
~ H,(II
~' ....u
• • u

.... • •• .. •" " ..

:

•• "
-
....:
I ',Q'
. " " •
.... .. .".. •• • •..• •• •. .• ... ••• .,. ."..
. " :uo;t
" • • •• • • ••
~
••"

..---
'- " " •
••" ~.

• == g •
.w
~ "
u,:;t
" "~
" • •• ~ ~
_11I-'1'11
":R'_
.. .."
., •• •• ... ..• .... ..."
•• w:=
•• -- ....
...
"13 <
0411' ,
"
"".. ... •• ..
v ••" ••.
• •.. •
••• ..••. • •
• •
•. ..•
u

•
... ..•• ... "
u
"III' •. •• ..••
......" .....••
0'
• '- ' •
---
u
••
••
~

---- ..
... ' , "
.... ....
~"fo'1 1l '
"
....." ••".. ..."""
U

•• .
• •.• •
••• •. • u
... •••" ..
"00 •
' lIlt
" •• •• '.'
•..
... . . ..... •••. ••
....". .....
•
""• ,-
,--
1::l:
'&,lJIa
J 2J13
,
.... , .."
It,,.,
• OJ· I
"" ..""" ""•"" •""" .. . .
•• ••.
. . . ..."
• "
•••
••
••
• •
... ••... ....... .......,
"

.-
---
..••
-
-
•
"
....
....
IO '/l'
~.

..... ..""
.~o
U
u
.."". •.•. ."
.."" ".•"• •""••
u
0
0 "•• ••
• "•
.•
. . ••"
•• •
•
••
.
•••
"
"
...." .•""" ...." ......
••" <~- ""'" .." .... •.
,¥.
"•" •..••
• u

. --
"
•
""-
alp

..... ...
.~.

"M
~ ,

·w
,

U
...."" ••"" •••,
" " •
. . ••"
• ••
"" ••
•.
•" .. .•" .... "." u

_ . .. _ " " III _ d .... l B _ ... .....-ro6Iy ..,.(_ _ I}

..
 - -
--
- -
-- -
.- - - --
--
.-.
_
--
---_
-
--' -
.. ....
Pl-M)
~,..,
- - -
,- -
.... . ..
~.- ~~

,
~-

• ••
" '- •
~

,•
~,

••,. .,
.... ....
,. " •" "
"••
••"
•
-.- ..
e,
~-
H /H
'''M
O,I,{l2
~~1
""u ""
. .. ..
" ""aa
,•"
• "•
0
••
,
""
""
""
•"
••""
•"
""
"•" •••
"
••""
" "
," ". "U
•• •" """ O.as
..
H /Il
""
••
•
,"""
---
"-
'-
....
~

"""L_
~-

-
... ..
. ..
501 &lIU
H~I
U I' ,
If(O.I
.. . ..
1.8/ 1.

. ..
l'S.',10
• ."AI
•""., ""
"" za "
""
"
"""
"""
,••
"•,
••,
""
""
"" ,••
••
•• •
••""
•
•••
•
•• ••" "" "
"" •" "", .,
,"
,"
•n
~

~
""'"'
309/11.
.... ,
"UI2I
0.''-:>3
UiOJl
...." .."
" " •""
0 ",
, •"
""
"""
••
•"" •"
•""
•••
••"
• "" •" " ".,"U
.."" "" "U "
.... ..
•"
••
----
~r-
QifO·3
10/0. 1
, 1,0:1 '
1i '150
..""" ."""
U
0' """
•"•
0
••
, ""c
•
•"" •""se •
•" . "ee •
U
""
•
ea
U

""
..
•
-- •,• •• •• " ,• "" ""
71/H
,•" ""
•" ." .."
~.I'"
" :mtt"1l,Q
."" ,."""
,. •"
.."""
••
••"
•• --
~:::. '~~~j
, ,.e.'
" 130
"
u

,"" .
.." '.'."
,.
"•
""
""
••
• •
•••
""
""
•""
""
"•
"""
•"
••"
n

...."" ••" . "

"

• .." .....
at

-
=~-
I liJ O

•"" "" .."

~'102
•"" "" n
""• """"
" 0

••" :::r ~ .",J

"" ••"
as

---
.~,

"" ""
...." .."
0.1,(12
" "
" " ".. ,".
',. ---
••
•
••"
-
I:=:-

~
1''''/85'
0.3,(1.'
H /le
HI"
" ..
"
...' .."""" ...."" "
"
0

"" "••
0

" ••
•"
""
•""
"
"""
"
•
••
•
••""
•"
"" """ •••" ... ...
" "
." •" . ..." u
"
,.,,.'". -=~ ""
'2/"
•••
1 _ ..... ' _ 0·'10·1 0

"." ••• .." "

~

" •• 0
• ""
..." ....
0.9,')3 0 u
~~ 1 ' 10 '
10,0.'
U U
., " "0
,""" •" •• "" "
•
," -
'oo "..

••" ..." ""

" ", "" " " • ""
..
'0:1/32
••" "•" "
0

•" """, •
~ 2510,1 0
" "
''." ..-.....
,oo

",
=.. ....
UM
2'/01
'M'
u"",
" "
..,,, .,"" ..""
.Iu "n
"
u
.. "• "
0
•
"""
"" """
""
•""
•" ,""
""
" ."" """ .."" ".."""
""

"" " "" .."

2 0,0 8
" " ,."• " "
""•• ""•• ""
,"
---
ti r7 ••" "•""
"
"" ••" "" ..""
0 .'
,"
,,, 1 0 1,0.2
" "" ""
"". ..""" "
OM'
• "• "

.. .""" .,.,."".
u
'"
'" "" "" ""
"" •• . """
~ 10,,;1-' 0
" "
'"
".
," ~

- 11.5(,l 1
"213 0
" ""• "",
", "• "•""
" ""
""
•""
••
•"
,•"
" • •
-- " "" ." .."
- ",r.. OM'
'"
'" !!>ftQ """Y 14/0._
" " " U U

" .. •"
14/0.'
'" ,""
,"
'" "-
,.
,"
,.
,.'" e::.- -- _....... ..." "..
Uill"
123(.1.&
, ',o S
"jIl.'
U I19

,.'Ml··
.
"" ." O.

"
"• ""
""• "•
•• ,,
0
"""
•
""
"
"""
""
"" •"
""
"" ""n
n•
"" ••," "" ."
u

"
" " •" """ ..".
""" •• ,."" .
"

,"'" ,- "" "" """ "" •" ,

n
" 0
" "
"
TABLE 6' ECONOMIC INDICATORS
..
- --
--
" •• -
-
--
_M
- -_.
u_""
- -
~ . .-
..
.
- -
~.-
. ..- '
.-- ~.
D_
~-
~.

...... -
", " ~
••
M' ~.

-
.~
~-
M ~

- _
.. " .....
1_ '101
=, , ...
u . ."
" om. •
,
, .".
• - - '.
.......
...., "
. ,,,
,~

!I<Il~ '
-,- - ", "' "
0
• • zr=f... It f~
• '"
- :. .~ r

• - ,-
0
-
,- " ., •,
_.
, • ...
,"
.
w
,.."" • •"
"
~3~ ."
"

-
'flIP
r
,. """ " 'w ." w_
"r
,.
.... •
0
,.. , ~,~j"
, • ...
~
;", •• '!. " : '0

..
;.
"
" =__
".." -
,.. ."
."".. ••• ...
.,
.' • "
" •0 ~M
'\73116
•
• •

- ••
110o m
" " I,

"" -
.", 0 0

., ..
" .:. ~
•
•• • " ' >&I II
..." ,
a
" ,
. "

•" -
" - ,..,.. .," " ••
'--
-...-
,. • Jt ~
'w
•
... " " ,
•ee
0 ~,,~
r
~3

,-
<JJ17/

""
"""
800
"
' , 'w
".
". ""
••
.'.
.0
at
"0
"0
:!,,.
' /"{7l

"'81"0
"""1'
OJ'"
r
'921"
,~ .

•
0
0
• •",
w

""•
:mill
m
•I ..."
• '-
-
••" :=
'w
ON

-
"
"
""
"
."
~,

"!" '.
,• 1/
••
."1
' / 3(3 7"
ee,
"
•
• "
'"
... -
~.
'i;'Z~ ~
" = = -'O!!
•
"
...
,....
...
-<:: ••

-...=
~; " Dl N

_ ..... '1Gl

,..- .."
" ."
."as
0

•,, •
' /' 'J' O 0
, •"
:r..,
wom
"ww ,..
0,..
;0
~.
Ij3~ ~ 0 ,•
...-'- .." ", "
," -~ ~
",
,
--
••"
~
'"
m
m
m
w
"

--.. . ...
""
••"
"
.0
0
0
0
••
,~

"
'~'3~
4/1311
"1/'0111
'm ...
' 13110

""'''" ,, ""
0 0

--- ,. "
·,
""" , •"
!iIY(31" ~ 0
• ~,..

., <t>',. ~,

""
"• <=
--
•"" '-'
ON

•
~

... .
.""
.
." .
~

.0" "..
•
0

0
.1-
~
,j..}.o
~~~
.. , ,.,,,-,-
RI/11

....'
6oQ/ l .
_m
,• "
0• "..•
• "

_. -.
• ~"""'''''''''' ".
-- . ..
.," - 1.0

"'
- '0 5
,
,W ~
~"
ooi,.
31"/1.
,.:10 ", •"
0

-...._.- • "
- •
w w li M
• '- m er " " ,."
.""
0

,,.. " "

""
-='. ...... ..
""" ~
~I"
m " 0
,• ""
""
". <0
'"•e :;:,. ,•
~~
~ •r ••"
• "' m ~.
.,"
.•
.--- _111
·u

-
z,ili "" "i
.."
_
.
~
•• m " ~ ,
•"a t,~!,~ ,
14\/.
= "

•
 rs
1.. 1i I ,I a- o:.l,,\'!,"~ QI Rl:l~ ;:;1 :tl:l\'! 1~~ I, , ,I ~!,,~ ;:; I" I ~l'l ~
I I I
",
lJ; 1f I I !! J::l- "'I~ ~~- ""I l;~:: ~I

J:;j
~ ''''::I''fII e llil .. fil l " I"l! 'S'!'" I"l! I:i I ......
Iii:,"a
a.;ii il -~~--RljjiMftiEh.~·~I-I'~·~f'·-Ni-' itl~ir'zj~li--''''' .i$-~"'-j -'if---j --......~I - ...--...I...- ...- ...I
~ill ......
:1- .., -..
'I -;:::<!:~-"~<:!'~II!.Il!.IIl.~_::'_8JJ:!I_iktllt~_'Il!.
~ "';;,5"~-_ ~~~~i; ;;;:=--:;,~~ "'~-i~~ -N'~ - ~ii- -:'_",
__l~t ~ __.. ~I i~~~-~I -~-~--I ---~!;I -~~S$lg~~~. "'_N_
~~~~~I!--~$~I
_ ;;;--;;;-;:-;:-
~ ..."';:...-", ::-;p ;;.-- ---"'i>;;; -"'~ii~ i:!2"!i!"-
.:.;:-;:-.,.:=- __
:Ill! I II +,~ -~m~I --H+H"HH -. ...1§__... e.-1 i. __"''''--l -- -..1 ....... -.1-... 1----'
"' '
I li
, R;;" iOI !Ii:: ..... ee :! lll ~ :: 'r ;::; • '";:!:!' -i ' • -• • ..:; ;:;.. ~ .. . ,
" i!!" " -'1!';:- .. (!' .. .. .. ....... l!'" ...- .....
.. ....,--.... --.;. "sea · - , -• ••••
•, . •• ••• ... .,.. '" :;:::::1 •••
" -" .- -.- .... -:::tI .... 1 1" _..."..
••
l •• -"1 ...... -
T "' __ N ;;;::I~:;::
lit Ii
"',_ PO
't - ..I....' ~"1 'f7°"' '"'l' -r , -00
...... ..'" .........-" ..•• •• .,. • .•• ,
--. - ,-...- •--• --.
:JIl l_ •• ... ••• .-- - " "''' "'-" "' .."'., .. .... '" .. ....
No.. o .. ~~~
:""'''-0- .... Q-;;'
! . . oj . . ", . . " ..... 0"0 " ",~
;1;' I ll!! ~ ~i!~f}!iI li!§~nli ! il~ il! 11011 ! ~_!l*o,
_!i ~
i~~~~ Illl!! ~!1O!1 m!11 !!!!!I!!~!j
!~ i J, I ! II f I II ~,
IIl ldJll lldli l!1.1~tlllU dlll ill-If !1I Iii!!! ilnlJ nIl~Igd h!l~jf!ll hin
!il;;:;IlI&1<&lll !l£lIil Sile::::1 J:1J:!~I!!l'!l::.II!!I!! Iil."ni IJO IIlIl~ .llIlli:.!lISl ~ 1l1 111 l;; I£i1 1 ei2~!!~!$1 ~§!!! l'g:: I;;~;!;~~I:: ~~~!:i Il;l'l'H~19~ 16~~ !H!
TABLE 7' WOMEN
_
---• -'-
.. _ -- -- ..
.- -
- ' ---• _.'---
.. - -
,- .. •• ••-
- - ••, , ----
-----
M M
• ••
,
- - '!'II '.. 0 • 0 0 0 0
--
- • • •
-
a. 0 0
,• • • a, 0
• 0 ,•, 0 0

••
•• .-=-- •• •
a.

--_.. • • • ••- • ,,
a,
••
0
0
0
n 0

•
••" •••
- •

• -
0 0 0 0

••
0
•• a' • •"
.' -
0 0
a,

--
M
a.
0
• "• 0
•
•" -
0 0 0
"
n ~ a, •• 0 0
• ,
- .'• •
a, •0 0 0 0
a,
a, , 0 ••

--
0 0 0

• ....
"
- • •
a, n

".-
0 0 0 ~
,,
•" - .. .
•
M
"
••
• .-
0 0
•
••
•• -
0 0
•,
0
• •• o. • 0 ,. •
.
., ..
-
0
" "
• -
=:. • ••
0 0 0 ' 0 0
"• •
o.
a, 0 , "• •
•..
••"
-
0 0 0
0
• ,- " •• • ••
"'=::"'
0 0

• - , .'.• ::-
0 ••
••
0 0 0 0 0

•• ••
-
0 0 s 0

••
~ n 0 0
• • • •
...-_fa-''''
~ iill!:

.. .. -
0
••"
• '. ----
*t":"
,~

'0'•
•••
.,••
•'0'•
0
0
0
0
0
•
•
0
0

..,•
0
0

•
0
•
"
•
•.
••,
0

.' --
0
0

•
-
•••
• --
--
~

.,• •
. 0
••
0

"
0
0
0
>
••
•,
•••
•
•• ...
-
0 0 0
0
.• 1::1: • 0 0
•
0

•" -- ",..
0 '
o.0 - - -
0

..•" ••
••
•0
•
"•,
•
t 0
•
0
•
0

•",
- ...--,.
"
0

.• •,
., • •• •• •

----,...
0 0 0 0
"00
• ,
~_.

.'••
0'
0
0
0
0

••
0

•
•••
•
0

•
~

•"
•
•
0
••

... -
.'.o.,
0 0
"• 00
• • •",
0
• •• •
'.
0
••
--
0 0 0
• • • •"
- -
0

0
0
0
• .••
'.,,
•• n,
• •
• 0
••
•
•
0 0
- •"

•
 _.
_. --- --_..-_.- - --- ..-.---- --
--_.,- -_'...
.
•
--
- -
- p .....

..
c

a.
a ,
a

•"
0 0

••
; • II •
a .

0
•
C.

•
•,
a .

•
•
a'

M
•
•"
0 0
,a. •• a G
••" •" ••"
a
••• •
a ,
•• ••
0 G ' 0' ~
•
•.
a. 0
• •• a

--
,u, ••• •m• •.a
... -.. ••
a.
••" •••
a
••a a , •
•a• • • . ••
....
0
•0
•..
- •.
0

--- •
a ,

..
a a

••
,..,
•• ~ -•• .. ..•
G '
,~

G.

a.
. •
0
••
••
• a
0
•
G
•
a•
0'
•••
••a .... ••
••.
•
,a

--
a
••"
0

•.
--
a'
aa'.
..• ,.• a
0
a
• •
•.•
..
0

.
••
•• a

.-
a . 0
•• a,
a, 0
'a
0 ,a
• •
0
0

•
•a --
•• .=:-
-......- ,a
a'
a.
••
"OD

a .
.
•••
•
.
0
a
••
,.
'a
..,,'•,
•
'.
• •
•
•" .
••
• .•.•
•
~

- ,- ••••
~

:::r '011,0 'a 'a • ••

••" "39
a. • "
" •
••
~--
e:=-
--'- -'-
.- a,
• '0
a '••. "w. •
•
...' ,.•"•
• a
.
•••
.... --
~
a.
a '
'0'
•"
•• ..
•
•
a,
a
..
•
" •, ••• ,.••
"
-
G . a
• • a•

... - "'.
a.
a
G.
a.
a.
..•• .•
• .
a"
0 ..
a a
0
•
•a •
..•• ••
a•
•
-
a a
;;:;' ..13

a ~

",.
a .
,.
a
a ••
....•• "••
"

-
a. a 0
•
• ~-
a . 0
•a a •w a a
•• •
."'. ---
a 'a
,a
?!
a '
~
•
0
•• •
"' •
'. - =- -
•• •• • ••
....• ••
a ,

.... ••..
0
,. a . • a
••"
0 0

,,'.. --
0 a 0
,. ~
• a
•••
-- "•
a.
".
,.
m

'" ,-
m

---
-- .'
..........
,... --........ .,..
•aa '•,
a ,
,a.
a ,
0

•
a

a
••
,a•
• a
•
0
••a
,..
a 0
•"
"n'n ' •
•
--..•
•
a
•
",•
..,
,. --
111,3

, •• •• • 0 "•,
,G . •n ' •
,.
-•
a
••
a • 0 ••
.' ,.•
!lw" ...

•• •
,a a.
''OJ • •0
TABLE 8' BASIC INDICATORS ON LESS POPULOUS COUNTRIES
_--.. _ .
_.
--
-- --_-. -
-,,, '... -.....••
~
--- -••'"
-- ~.

--.," -.,.--, ---,

,
••
~

••
~' .-

-
--
,a, ....
~

•,• =:..
~
'" ,
es
~
.
".
~
~
".
'M
'M
,"
'"
,M ,"

.....
,•. ,..
..'" '..
= w
M
.,
.--,., ,
"0'
-
.. ,.
~.

.- .. "",, --..
,
15',vo
w ". m W M

-
••• 500 '_' _
~ ". ,"". ," '0••" ,;j, sa
~,..

.,.. Vlik
,

---
"""--
" ~ .-, .,,,..
50.<;1.

..
'" ."
" ," •'
•• .
M'

..... , ,-
oo
J\
I
'w
" ",.,
"", ,
" J!1l,IIj

--- -- . ,... ,I
~ ,~

.-..
~

"" I I
~ ""
::...
M
M
" • ••
• •' " w"
.... !l =". """0 M
•
w ,s,·
, ''22I"~
31{, 21

•"" ..,.. ,,, -•• ". '"0"

- I~l
,~
·w
• l(IO"/ IW

.. " " ,,
'oO l11/U

••" ~o::- "~•".

.... .,-
,"-
~ ! ,
-- ",,. ,I
_. ,
,~

". ,..'w
---_.
"" ~.::- I
••"" • "" ••" """• ....•• .•, ,-=-
oo 5~
•"
,,,
, 113'k
•
"
_
""
•" "•• "" •• oo
".
'~
,= •""
. """"'" ... . 0Id ., ........'" otdtJt (J/ ...... '9B!I_I-wty ,~,. ........ no ...-- tw ~ ',Ie ... -.
!
,
..
lOll/1m
"'
 l~, Hl'm~~h
;-.... - li;;l-o.
iii e>' HUHh
i."~("i~~ <[lfh
~'l!-.-:o Hi
:L~ lU!:!f' ~
.;j!ll~~- 1~ m
~~f "~3~~n:~ ~:i i iQ';Jg~:. !;.~~{
goo ~"!l~" i!}q
~!! "'!!.§
"ils ::: g. .. K; .... Q. l
:I;"~l~! •~ ~
~
... ~: i~~ ~~§;g€~: a;:'l!~; .q~
g'l"li! i ~ J: ; S!. - s S·
" !ll'l !II.
S 'i~ -" .. _.~!Il. ._ " 5' '':- e s e -g a .. it ' is ce
U~ m~[hiE! I~Jl'i; : "[f~ h iH!;~ i =r
~.~ H~!,~,i~! IH~I'd
;oS ,§: e ,..;:: g. iil 6.812 - i!::_
~!~ 1 ~, l.~j!~ . §m
~:Is /Ill -Ii: i ti illlm~aiili
Hi mHiHlf mHI~ hi!! niH:~il
i~! ~~ fi i l nj'~ hnl-! ;!It! ~i Hh .
~
~
ii~ S!.5f.i~ .. S!iii !.h~ if .. lIl i iO h ~, q Q. ~ a U 0
all !!!
Hl~; Hilil" Hm~ mH j~'WWi f - 'I
--< ..
s~
~§.""P' i ·" - a- q ~~ §-~ ·h~if }~~li§~ t1 § t 9..Jr
ni.~ ~~ ~,! H'il 'f! ~l~h !~:ij~~ ~ H- -i •
-
·W ~ .!!~[! l ;~'!' ~i:dH~n~ ~~ ~'] ; 'i
i ", '. II I'- ••• ~ ~, ~ ' .. ~- "i3~ i ' ~_!' ~ o.
~3 ~:I s tfi iiIg ~ § ~ " ~!E~ ~ I: ~~c:~ ; ;' a s ~

h~~~ j!'il- i!~j~ ~.iJ'UJiF f" ~ iq -'.

"1- ." . -
,!!.!~• !'~li~~
} s a 's -l.' g ~~H~l: ~'~~ '-l~ ' '.
~-,~'li!-=!
-!l !lOlit .. Ii", d :" , ii c - :'2..!\!iIll,"g e"'>Is 6 "
j ~~~~ ~lg ~ r;;i ~~ ~~ t ~ t~ B~!hj;]~ ~ Ii
, " I ., ' ,, ~ I! " o. " 8' ·.h ~ , 1"
f~~~ ~; :t~l~ !~~ ~ j ~lo iin~ l ~~gi! i"
'.
TABLE9' THERATE OFPROGRESS
_._ ..-_ ... ..-
_. -. -- -- _
--
_. .
_.
,-- -
... _- --- - --.. - ."- -- -
• ••

,, - -
_ _ 'Ill

- .. .. .. .. .... .... ..... .,., .....

, ,, •
-
~

-
--
-
---
W
~
~
-
- ~
.. "
-". .
"" . ",..
" ., ..' ,
.'
,
"
,. ..... .. ... .,.,.. ..
"

.... ...." ..... .,

.0

..
,• - - " '"
,,'
•0 ;* ....
-
--
m ~

.... . . ••
.. ..
,
, ~••i.
• --
.. -
---
- - -
~
~
. ". ••
.
..
,
.. .,
..
...... ....." ...." .,.." ......
"-
'0
•• "o.
»

---
-
~
m

.." .. ..
"
.. . .,"
"
.'
,." --~
-
..." - ---
"- - - -
~
a' m

- -
m
,.
"
"
"
" ..
..
.. ..
, -es
" " .. .... ••. .,
..".. ... ... .,.." .....
..
"
•- '-- - - ,,, ,--. ... .. .... ..""
m m
~
"
~ ,

"".. ,

••" - ..... ......" ..". .,••.... .....

m " n

- - " .'
m m
" "
~:
~

•• ..
-
m
o. . " " .
" ..
.. ". .. .'
n

•" -'
••
0-
- -
"'
'm0
.,
..
'
o•

. .
"" "
.. ..
•• .,
.... ..."" .."." .,.,.."" ...
"" "."
a
a
• ~
:r:
--
-
"0
m

-
..
.'
0- ,"
,.
on
i iii ;;; " "" "" ""

".. .... ..
<,i ,." ••"
... .-..
0 '
<'

.... ...... .... .... ....."

d
" " ' .
- -
_1II-'7Il

- "
... ..... .." .... .
~

" »':-
••
- m
- ,.
o.

- '-.
o.
..
. .. ..
" ..
.... .. . ••
" n" " " "

-'- --
u
"
...,. .... .....,. .,••... ...."""
a o. ""
•
'.
o.

--•• -_.- --
~

~ m

- -
~

. ..
"n "
.. ..
.
.. ..
" "" ,

- -- ....." .... ... ..."", ...."

o-
," M' " " " "
-...- '"-- .
- ,'--.. .." ,.""" ..... .... ..
"
.. "
"
•
"r s " "
•" ..•• ==
-
a,

- ",.
'0 m n"
""
' , ... .""" ...." ••.. "
.", ...."
-
m

-••" --- ".." ...." ...." .,

" "
" "" ....
•
"
--
m

-- -
~
~

,
m

. '
,. .
m

,,. ..
.
"" "
" ..
,.. '0

...." ....." ...." ....... .."

u

-
" " "
•• -
a,
, m

'
m

. ''". .. u
.
"" ..
.. .. .
.. .",
"o' n '
'. - " .." ""
m
"
••
•" --
:;-a. m
m

-
w •
- . , .. ..
. " ",
"
...."" ....." "..." .. ..""
" "

-- •• .. .. ...
m
• '"
'.
m
m m "" " " ~, o'
" " "
m • " " "

_ ;..-. ..........__•••",,_<11 _ ,_ _ ... -'"">'_ r_ _ II

 _1 _ _

-. _.
-.-
-- --
_.

~
_
.
--"".
,- -"-- -- - - -,- .- • ••

--
-
_ r.n_...
•
,. •
'w

,''"...
•
• " " "
••
.. .. .. .. .
.... ..
•

...." "..
•

...." .. "..."" """ ...."""

••" ---
• \:I.,
•• -- ~- "'" '"
W
~

~
m ,'...
,.'. ',.'"" -
'" •••
•
•"•
""" " "
".." ."
""er " "
" . ...." ..""
U
"
U

" " . ". "

.... .." ..". "" ..." "

---
w ••

--
•"w 0 ,--
• .. •
--
~
~

..,. '-'".'"••
"'
m

,,..
•"
""'"
"
"" ..""
."..." "."
as
"
".....""
.."
.."", .."""
...." ...." aa ...."" .." ".," ."". .."" "

"... ." ..." .."". ...""

"" ..-
:

. ,.".. •..
,~ u
"".. l:::. ' es
.." .,"
~

...... •• "
." - " .." "
~,

" ""
,"
...", .....".
m
"
,'... •
•
•"•
"
•• -
•• ..-
n

,'"•.. ••" - "• ...""" ••

.." "".."
"..
..."" .." ...."""" .."""" ..."""
"
"

-- ...... ,."".• ;1
".." """ .. .," ."
"
• ;-:::-
----- ,. "
~

~
,.,.,"" ••" .
'" •• "
•"
•
"
zr
aa
." .." .." .
,.
"" """ "". """
n

"
•• ..-- ....,-- ,oo
ea
••" ..."" .""" """
."" .," .," ...."" .." ...." .,..""" .,..""..
- .. ..
~

•" :=- "" , •• "

•" " "" " "
.... .... ". .. ",. .. "••
" " "

....... "' ,. •"" ••"

="'~ --
•• ..... ...." .... ..."
..... ."""" .""".. .,."" ...."
" u

• - ...."" "."" ..,."" .," n

," "
"
••
T_

',,'... ----
~ _ T_
."" ••" •••
..•
" •• ,••
......" """"
" "
••.. ••.." """ "." "". .. ..
~
'"• ,••" •..
......, ."""" ."""" " ..
'

...." ." " ." .."."" "

,,". -
,.
~,
~

=,
"•
" ," ...."
..."" ." ."" "" ... .... ".. " .. .. ""
"

',",". •• I'.
,,'"
•""
•..
" """
....". ...." ...." ."".."" ""." """ ...."
" " "

". -- ...... ,.....""

" "
..". "".." """ ..."" .."""
~
• "" "
"" ".
'" "'V'
"" ""
,,' ...
"
'"
=- "•"" "" """ ""
,,","".'".-- .. "..,. ..." .." .. ...""
," "
""" ".
• "
...." "" ""
"." .. ...
~
" " " " "
""
~
-~ _,V ••" "
""
"" " ..
..." .." ... ..."" .."" ".. """ ..""" ..."
" " "

," ,-
n
•" .""" .." . .." ......"" ".... ." ....". ...
""''51
:g
',•....• ---......
;;: •,••" "" "",• ...." ."
"" n

.." "",.
"""
" "
,
..." .."""
""" ." ." "" ,... ••."
"

,--
m "" •• " "
••"" ""•
•,, "" "" "
", " " "" "" "" "" " ""
' OO
• " " ..
Footnotes to Tables
,.,.,••
....
Table 1:
lrII:Ig:oo-s --
---...---
-~-
-~-
-~-
,-.
,f.' _'1I
••
_

'.
--- ---
~::::..

--
~

---
..••
r

,,..--
••
•
:

-~.
\1ft

---
=
•

--
-~-

---
--
••
••
••
~

.-.....
-~-
,_u .....
'- ---
--
u..... ... _ _

---..._-
•
••

Table 2:
NlIIr.\lOII
---
..- •• .. ..

.--

i"

~rr
t..: ,.
u ..
::::: e'
_
G- _ ,r........
U...

Si s
::::: •±
:
--
s_
...... "
---
t::t-.
"''''';1'0
::::
-- --
e:
lOa ..
w _
...... " ,.

-- "
 _
.... .......
--
-- ......__..-
Il.. ". -~.
;.-:: ... 1" ItI1
~
.....
IMO _

5:'
---... _....... ..
""'" f9"
.
--
...._-
..-.-
Itll •

...
-
.. .
--
.....
;:;
'

---
• n_
5:'"
g;,a
:=t...
--
'In_

--
.... -
---_. ... -,-
--- ~­
l "'l&_
~­ ,
.....
' 9J.

~­

...,.-
Il.... 0'"
l""" _

--- "'- "

=::t...
.. _ ", • • 'U
~­
1"''<& _

.. --
loaoIl _
•••
, ". . . "" '

s":
- --
,--
,
111S-«I

,
~_

<1OIo _ _ I J ! ' I _

--_.-..
~-­
""- ......
<""'--~­
., "!'
•••
0-"_
.".--
~
0."_
..... .....-
"" __
.Im,
"JII_
Itlloll
~ ....
~~­
1<·""'_

...
~~,
.1l1t

~­
,~ -

......."*'
_
---- -
,- ..... ,-""...
~­
~­

..........,"-,--
0/'_

---
O/!_

'- --
.- --
=..-:::....

•
 1111-1

--
~_

~- .". 1170-1
S.. " .,
.:=:
..10-1 _ _
" 1l ~

- _
_ a_
. _ _ 01__15'lI.d
_ _ _
",_ .. -....
_ ",
_ -_' ,__,'. _

,.
,,-,
.•.-
-
Table 3:
'
'
'.,
.,. -
.,................
,-,.
lMI_n_ .....

Pl. _

Table 4:
~ ~­
EdUUlIon

--:.:::..c:::
~

d
. . . -_1.".
~.-
~--
_ _ 111101
~-

,---
ffi
,_u ..... ..
::"1::'~
~­
~­
~-
...... _
1OU
_ _ 1"111

,..7!01

_. -- ..
Table 6 :
ECOllOU ~ ---
--
---
---
....... _--
--- " ---
GN'

GHI'_.-_,.
....... .-._,...
--_
---
,_

--_.- ::::-
~
~
.. ...
......... -.._,
--
-----, ,.........
.......
....... ...

-- - =..
-
Table 7:
-- ,.........
~­
~-
Coo
e.o. 10'
.. U ~_d'I I~"'J8

~
--
U
e.o. • '''I -

--
w
~- • =

--
Coo

,,,,
--
--
'.'
~

-
~
:=:.t_
~
c t. --
-- .... --
e - _"
C

eo.. .. w=
• .... ----
....
::r.
'111
' .' ... 10
'II!I _ _ ' _

'I"
_
 I
i ~! !! j I II
· ij I i IIII r
.....-..'
..... ......
~~~~~~~~
i
1_ _ "'-il-I"'"
__ !,,_
~2' !"
' j,
"'1'·"'.........."'·,,· I'"..
!"!"~ _ !"~!"!" !"
I 1·'·
1..:· 1"1'
... .. ••]
i" ,.."....
_ !"!"!"!"_!"!"!"1iI_!" .-- ....".'
;:!"!,, ........ :1:" ~I_I"
!"!"~~_~_~
I I.....II.........
"N"," ........
!,,_!,,!." lIli............
........ __ !"!"!"!" __i _ __
g
llli:!llll
__ _
1 _ ...- ... "'!!!- - ... !!101!!1!!- .............. .o ..
:Ilii:llillllllii:aiililillll:l:lilll11i"
_ !"
i ill L I If fl II II I f III I . I I II f i ,i! I, mil i'll!! '
!ll1Il!III ill'II! llllll!IIIIillillillil ,!l!l!ilJI1IlllIII III! ,f!" Iii,!f!MlIfIIlfj,I,lffJ
+
l
11ll!f!1ll!1 Il!.! d llllllllllill II Imllii! I mll!ll. lill!!<l!lllilHlm!!l!!lllll
,i I d J
•
! II
i. 'I Ill" i
!I
lliHJ!n, If Ii JI! idE Jl Ulibl t 1 ! ilillld j f Iii Ii JIll lill! I III
'"
_
.c
Ql ~
O",
"' ..
;l
1;j ", .Q S
~
~ ""_
!~'.'
.... 88.8
•
Table 9 :
"'"
rate of
........
GNP _.-to _
GNP
_,...
_r...

GNP _ _,, _ _
_
Pro _

~' -. .='...-
progress
...-.
GNP _

'--fIw"....... ' ...

"
Definitions
:__
_ _ __ __ oI_al_ .--.: _._--
---- ......
--"'" _

~Ity
.... po' " ,"'<too'lI .........._
1",- ........ _al
__
•• •• : Mo<a _""¥ _
"'"

.... ,..."'.
a I . 1M' 1.000 ...
'

_al _ _
"lJXI~_

.... . . - . . (t
_....... . . ..
_
o_al,_a__'
. ..... "' ,'
_,' ,,,. .... _ _ al._ ..... _ .
.......... ""'"
-
......
110

_
........ 1>0_ _ ..., """"Itt ..... _
OPT: _ ............ I _ ' I l ...q.1

a NI>::
"-
lI'_ _
.... """"'" 1'1"""'" _.. """""
...........
lhMO S,., . - . GNP _ ..-.
(lNP",
..... "',-
OR8 ....: ""'_ _
~ _
01 all aMO '" _ _ ..
M _ ' ''' • •_

.......... - """""
--"._
~.-

'
....

--'" _:-
'""" -~- .....
"
"
'
~
1
!
l
r
V
GI'lf' _ _ __ _,,,IN. lmlF_"''''''''' __
CNIIlren lII«*lllIgI! '" ... cNIIr .. ...-mg . .

1&'_.-"''''__ "'""""" - ,"*'".... _ ..-

, _ .. .... -
~

UloI . . ..,.-- '" - . _ ""'" ~

: ~_ ~- ~ _ '" "'-''''.000

--
"llio'I:h: "
_ ' ' " ,11:0 ......,. aI_tJonO
'" '" . ;:

... _. .•. ,_ ..... -

..........
e.- .... _ _ al_1M' 1,000
. ._ _ "'_0U00l·5 .... _
-......., - ~ - - -
..,.
_al _ _ ".
T_

- ----.. . ...
~ .... ....-ar

--.~-
.. 'd • • -"'-'"
..

- ""'- .........
.... ....... _ ''' _ _
..,
,.110-:: -,. _1&'_
_ _ 0' . . . . . .
- . . .... ..."
-po<,"","_~-'-
......-
- - ....- •• ---..="' ....
'" n. .... U!botI _ _ " ' _ ' " ........

_t. ---
• ........,."
~ I&' 1t'oIt _ popuIetlon: _ . _ _ "' ....
_ ,' .,. ""eo """""'" '" not>onoI-..... """,
et'olclAw> lOW<IIlo<l SC!ltIOIng _ ......,

_s ,_....-.. --
lI<Ilnng "' "'" . _ . " • -
~ ... prClll1100 (t !hoi WT" lho • """""""
"""*'"" '" """"" .. 1I'IM . _ -..v _ : ,.,.",.,."", _ IH'l _ .-.....

- '"""""'" "'"
:..-... .....,.".. d _ • ...,...,. _ ..
......, """ hglesIl'a.. nl _ , ~ ...
0 0'"

_'I --...-.._--
"9""' _ _ ..... '"
DebI _ ......... d
_
_ _' . . . . . .
d """"""" " " . . -

......... _-
1MdIolI:
r.... m...._- _ Coo ... ' i " _ ....... .,.
_~

.. . .1__. 1_ 11---..-" we

_-_
1.10_
.....
_

------
•• • _ _ -a"I

W..d", :
.... _'
......... _

_0
,
"'
- -----"',,-
---
............... aI

_ _
.,.....",. ;:
't

.......
~_
~,

.
:
., ........
"'" CIl """" _
1

.....
... -... ...
...
_

....:""" ........
.-..lIty """"""'"'" _ _ . . '00.000

,.
.... N>gI'!Id'_.... _ _
 u_
Main sources
m.. l.J<'olod '10
and lnf.no Ur>,od N
mornl~
""""""...., 0..-., _
5'....'''''' ()ff.",
AcoI...o _
drinking
WII • . ,:
11001'" ~"""" (WHOI

Int.n• • nd lim"" N. ,,,,,,, " -\"'" ~ """

ehikl du. ...: UNIC[F ORS ....: I""""" _ 0rQ/ItI0t._ l'M101
GNP _ Wor1tl Ban" _ and Urote<l !'IM..... ~duclrl....... Sc!o<IIn:
..pita: ......oiotI: """ Cutturol Or-..,,,,, (U"I!:SCOI

Adu lt lIroloo N>tOll

11,.,_, _ ~ ...
t","",,,,,,,,,,. S<:ooo1\iIIc
0._"", (UNfSCOI
--
C,,",- _

.0"""
III lhlod No\>Oflf 1'oo<Jo'''''' 0.......,.,

-
School U...... N..,...... ~_. 50",,,,,,,,,,
_ n o """ Cult",. . Orw,n,,.,,,,,,,, IUNESCOI
"""'pleli,..>:

low birth· W",I e . - 0 . -0"' " (WHO)

weight:

Bre...- .......... _'" ~o""" 1'MiO)

-"II:
ODA: ~ lot E""""""" Co OPel.,....
Und.. .. . ight. W _ _, Or........,., (WUOla'><! _~IQ(CDI

w ••ting ."" ~"" ""..-..I

. ...,ltl . .: W.. t ~
_ Surwys•

Food r""" ...... ~1lI 011)'1'III.'''''' (ll "'" C"""'_pllYo .... to<I N.t...... F'<>puIal"", ~
production """'<Hl No,,,,,,, (FAaI prev.lonce:
.nd . .lo<Ie
In.....:

M."' ~ WaIIlIlr.ollh OrpllfllU,., (WHO)

mornlll.,:

'"
llKICEF l ~ rtm
USICf.f 11_ , J US l'Iu.. ll<'O' York. SY l OOI 7 . l'S.~

lIKICf.F e........ 0tIi<:<

him <In S .._ CII 1111 e....... 10, So'o'....blkl
'-'' '' ICEI' Rq.moI lll'&<. for F.-n <nJ - . . . Af"",
1'.0. So. U .. s, S""""" K, ny>
1!l'l ICf.l' R- ' Offl« for ( :.m , ~ 1<'. .. Mro<>
' .0.110. ' .l. A........, 04. e.60. d1 '"
IISICF.F Rop>tI>I Offi« for tho """""". ood tho l:>nlIto<,.
Ap.atWo Mo m 7S lS, Sopl. ~
t INlnf Rop>n>I Offic< fo< _
".0. 1\0. l _I S>. B.l~
Aao ....
I02Qll, Th,il.>nil
,.towI
lINlCU' l\qIo<W ()ffi,;o fo< ri>o MIdOI< Eqa ,nil K..... M"",
1'.0. .... I I I'm. _ Jo<d>o
US' C!:f ~ Offic< for Suo,h C<;moI .\ ...
IlSrcn' II...... 7J l.odo F , ll... n.tI>< ' 11l003, r"d;.
usrl;EF 0lrK. fo< ..."" .",j s.., Z<obnd
P,O. 110>. QU!. QI>«<I \"o.-io 1loU<lO.... ~yda<y N's'It'. lOOG.
"'"",olio
USICEF orr... lor ,",poo <10 I I""," N....... lofot<=.l....
so... ....,.....
1luil.Ii." N""ibll I _I .
Uot... llool Hoo••
,_ - AGpmo l . lIon<• .\\ ,...,.1. Tot)", 107. "P'"
(0)
THE STATE OF THEWORLD'S CHILDREN 1990
NociDg thaI !be goftlllIIIelltS u 1M
dc .~ world as • .-boIe Iaw_lUdled
1M pou>I .. ""'~ baIf ol r-... IOUll ~
1ft beillg dnotfd 10 lkfnIu spmdinc :and ~
tm"Itirt&. doe 1990 $I." tf'" r .u.,
CIald_
rt'pOll: SUlIUlUri5a W 1'"1 Wl.t.cb and CJal
~ fA the 1980s and XU out die
~nll. ~ b' lbe dtadt ahead.
Oft pltieftl Ift fllb, O'l'tf 100 mi1lJ:ln dUIdrm
will dlr In Illt 199Ot-5O milboa of lhem from
JUlI 1brff COlIIlllOII diaflM'S wbl<.b an be
iMJptlUively l~aled or pr~nted. Many times
Ih.1 number will VOW up m. ln/)llrisbed,
unlle.llhy, and illiterate,
A w ry different future 11 P'*iblc! _ If the
19901 were ,0 becalM • 'dtc:Hk of domg Tile
olmous' for the world'l dl~ft. MeasIu,
lkhydmion, and pneumonia, tile grUln<
I(l«Ific entmies, could be (MlWl!M' II :an
at.-. Ilqbcibk I»R. Today>. nw ~
aboul blAi ilion, ~ ond but1I spxmc
add be pili ill. !be ditpcp! of all famM
~ $Icp1 ..-.e tOUId rtdIn dliId dmhI llld
child rml" ...,i"oll by:at mudl. baIf llftO" dlr
IIItIJ rt- ~ Money __ a.IIllOIl idiom:
duE: Il>o IUSlIinnl c:omDlIlll'Iell1 of politial
lndm and III tilt . . . . P'l"ibk range of.
~ mourus.;]l aho be DfUS$lf)". BUlm
6nmc:ial1Cfml, tbt COlI lI\idII ee III tilt rqiga
of 12 10 53 billion. )'W" - koa than tbt worid
sptnds 011 umamenll tM)' Uy.
With lilt pouibilil}' in 1M au of liJoifx::mt
,wlK1ions in military sptnding, lIw urn. bu
rome to give th is ne-l priorit), 10 the "'elI·being
of lh. world's children. In p. rtiCllbr, 1M"" is.
OXFORD UN IYERSITY PRESS
0 .50 net in UK S8.SDUS."
eeed 10 tsubliUl me pi iuciple, in all ,,>riMs,
IbouId bit pro!«Ied _ oqJy from
~ tu: from tilt sharp5I fd&n rJ tile
"*'"
WI Ib: ...-we IJ>dIIb and bodia ol ~ ...
poliOCol.1ld «O- "!"'t ........... rJ IIIhIIl
- . y.
As the 19900 beain, thefe ' " _ .... rJ
progrta lOIO'Il'do ihio pnllCIpIe. 1M proopK1 cI
• W",u Sa-ir /t1r 0ilJm<, tilt- lIN
e....-.e.. .... tM RlPu If lilt OJU, IIld
pnctial ldvancn such 11 1M nelr K!Ikvmlml
of UllitltfJlll Child 1 _, could mart the
htginnill3 of a new pncriry fO/' child ren.
F.ilurc to protect the phylk.l, mentllaoo
emotional dewlopmtnl of 1M young is lIM:
prilKipal me:W by wlUcb bumaniTY's diffio:ulcies
art compounded md its problems pnpem1led.
And sp«iiIJ _ ........ 10 prDI ta c1lildn:n from
tile ~ md mimk.. of tile 1dWf
'<I'llrid 11 a pnl'tipa IllQ/Ij by wludllNllf of
mank'lld'I _ fimd'W'PP! probk/l1l micbt be
......rron1M.. 1M prulecl*I of 10 ID1llY miffiom
rJ die worid'a )"VUIIC dlildral .. tbtttfort bodI
""" I'"tllltli oxnl obIirto- IIld Ollf Ifnltll
pocent:Lll _mI'ftl in the -'d's t -"K
P' 0ipt1lll'. polno~, md ttmrOIllllaIt1l
IDlrgntY.
TIw. .. ..by the prinapIt of lCCOrdinl
cbildrtll 'finI all' OIl oocitty'l COlI«IllO IIld
apac:iuts uncltrlits all of the iosun dllCl.lUtd in
lhia yen'& $l4It If 1M 11"""'''''ail"""' rtpon,
11 UNICEF belu-s it should undtrlit 1M
many de.:isions andarnons .. hil:h will olIlpt lilt
deIe.de ahead.
ISBN 0- 19-26 1927-6