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United Nations Children s Fund Regional Office for South Asia The Millennium Development Goals Progress and Challenges in South Asia 2006 For every child Health, Education, Equality, Protection ADVANCE HUMANITY

This report draws on several sources of data compiled by United Nations organisations, on data from MDG progress reports produced by the governments of South Asian countries, and on national statistics. United Nations Children's Fund (UNICEF) Regional Office for South Asia, 2006 Cover Photo: UNICEF/HQ05-0224/Tom Pietrasik For further information and copies, please contact UNICEF Regional Office for South Asia (ROSA) P.O. Box 5818, Lekhnath Marg Kathmandu, Nepal Tel: 977-1-4417082 Fax: 977-1-4418466/4419479 Email: rosa@unicef.org Web: http://www.unicef.org Design and Colour Separations: DigiScan Pre-Press, Kathmandu, Nepal Printing: Format Printing Press, Kathmandu, Nepal

The Millennium Development Goals Progress and Challenges in South Asia 2006

Acknowledgements This report was produced under the overall guidance of Cecilia Lotse, Regional Director, UNICEF Regional Office for South Asia (ROSA) and Frances Turner, Deputy Regional Director. Soma De Silva, Regional Monitoring and Evaluation Officer, led a team consisting of Jennifer Keane, Satish Raj Pandey, Ian Pett, and Mariana Stirbu, which produced written analyses based on regional, national, and sub-national data collected and compiled by Yendra Rai. Martin Dawes, Regional Advisor - Communication; Susan Durston, Regional Advisor - Education; William Fellows, Regional Advisor - Water and Sanitation; Gabriele Köhler, Regional Advisor - Social Policy; Ian MacLeod, Regional Advisor - HIV/AIDS; Ian Pett, Regional Advisor - Child Survival and Development; Adriana Zarrelli, Regional Advisor - Emergency Planning; Anthony Raby, Project Officer - Emergency Planning; and Raka Rashid, Project Officer - Education contributed comments. Matthew Zalichin provided editorial services. 2 The Millennium Development Goals Progress and Challenges in South Asia 2006

Foreword In 2015 the world will take stock of what happened to the promises made to people when countries agreed to the Millennium Development Goals. South Asia is home to one quarter of the world s children and in a very real sense it is children who are the owners of the MDG promise. The Goals fundamentally embrace child rights, and children are at the very heart of the MDGs. Their world and their futures would be transformed if the number of people living on less than a dollar a day were halved, if all children received a good primary education, and if the terrible toll of children dying before the age of five were slashed by two thirds. Some improvements have already been realised. And some children in this region are experiencing benefits as a result of the focus given to development efforts by the MDGs. But the sheer number of vulnerable children in South Asia, the poor standards of nutrition, sanitation, public service provision, and acute gender disparity mean that most countries are not on track to hit the targets. There is however still just enough time to prevent the map of South Asia being painted again with the all too familiar colours of underachievement. This report has two aims. The first is to present South Asia s considerable progress and effort towards the MDGs. The second is to highlight areas that require intensified attention and special measures at the regional, national and local levels, if the Goals are to be achieved by 2015. Primarily, though, this report is an urgent call to action for children. Their survival and developmental needs tolerate no delay and steps taken towards meeting the Goals bring immediate benefits to millions. As South Asia sees mushrooming economies and glittering prospects, the attainment of MDG targets offers the tantalising vision of a region where childhood is not a needlessly dangerous journey, but a protected passage in which all children have a decent quality of life ad the opportunity to realise their full potential. Cecilia Lotse Regional Director UNICEF Regional Office for South Asia The Millennium Development Goals Progress and Challenges in South Asia 2006 3

4 The Millennium Development Goals Progress and Challenges in South Asia 2006

Introduction The South Asia region includes five least developed countries Afghanistan, Bhutan, and Nepal, which are landlocked; Maldives, a small island developing state; and Bangladesh, India, Pakistan and Sri Lanka. South Asia is home to 584 million children more than any other region in the world. Children make up 35 to 50 percent of the population of the individual countries. Advancement towards the Millennium Development Goals (MDGs) is vital for children s survival and development, yet progress towards the MDGs in South Asia has been far too slow. With respect to most MDG targets, South Asia is the poorest performing sub-region of Asia, and one of the poorest performing regions globally. Significant progress in increasing access to improved drinking water and sanitation has been made, but South Asia s sanitation coverage remains among the lowest in the world. Levels of child malnutrition are the world s highest, and child mortality and maternal mortality levels are among the highest globally. School enrolment and literacy rates are also low, with 42 million South Asian children out of school. Progress among South Asian countries in meeting the Goals varies greatly. For example, South Asia as a whole seems likely to meet part of the first Millennium Development Goal to halve extreme poverty by 2015 but this is due largely to India s progress on this indicator. Even if South Asia achieves this MDG target as a region, many national and sub-national areas will remain impoverished. In general, Sri Lanka and Maldives have already achieved some MDG targets and are on track to meet others earlier than other countries, while for Afghanistan and Pakistan, most targets will be unattainable at current rates of progress. In addition to variation between countries, there are wide geographical disparities within countries. For example, while India has made significant progress in reducing poverty, poverty rates range from less than 10 percent in the richest states to well above 40 percent in the two poorest, Orissa and Bihar. 1 With respect to the other Goals, poor, rural, remote, and conflict-affected districts generally perform much worse than other areas. Focusing solely on national averages thus does not reflect the situation of vast numbers of the poor and needy. The paucity of data in many South Asian countries makes assessing progress towards the Goals challenging. Data collection must improve to provide regular, reliable data at both national and sub-national levels, relating to most indicators of poverty, child malnutrition, education, maternal mortality, HIV/AIDS, youth unemployment, and access to essential drugs. In conclusion, the children of South Asia face a myriad of challenges which compound those relating to poverty and access to quality social services. Social exclusion due to gender, caste, religion, ethnicity, language, disability, and geographical location figures prominently in many children s lives, and impedes their access to education and health services. Children also suffer systemic abuse of their rights through such practices as child labour, bonded labour, and trafficking. Frequent and severe natural disasters and longstanding, pervasive armed conflict affect children in many of the South Asian countries, robbing them of their childhood and in many cases, their lives. Only concerted efforts to address such obstacles at the regional, national, and sub-national levels will create an enabling environment for children in which all will be able to realise their full potential. Note: The boundaries and the names shown and the designations used on these maps do not imply official endorsement or acceptance by the United Nations. The Millennium Development Goals Progress and Challenges in South Asia 2006 5

GOAL 1 ERADICATE EXTREME POVERTY AND HUNGER Target 1 Halve, between 1990 and 2015, the proportion of people whose income is less than $1 a day Indicator: Proportion of population below $1 (PPP) per day While some countries in South Asia are on track to halve poverty by 2015, most are progressing slowly. Percentage of population living below $1 (PPP) per day, 1990-01 and 2000-04 Pakistan 64% decrease 17.0 Nepal India Bangladesh 28% decrease 21% decrease No change Sri Lanka 47% increase 5.6 3.8 24.1 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 33.5 36.0 36.0 35.9 45.5 2000-04 1990-91 Percentage of population living below $1 (PPP) per day, 1990 and 2001 East Asia and Pacific 99% of target achieved South Asia 14.8 14.9 Latin America & Caribbean 32% of target achieved 5.7 9.5 11.3 Middle East & North Africa No change 1.2 2.4 2.3 Sub-Saharan Africa Regression 22.3 Europe & Central Asia 0.3 3.6 0.5 48% of target achieved Regression 20.7 29.6 31.3 41.3 2015 Target 2001 1990 47.8 46.4 44.6 0.0 10.0 20.0 30.0 40.0 50.0 Although South Asia is on track for meeting part of the first Millennium Development Goal to halve extreme poverty by 2015 about 31% of the region s population still lives on less than $1 a day, a rate only exceeded by Sub-Saharan Africa. Regional progress towards reducing poverty is largely due to the progress in India, masking the stark poverty that exists in many other countries. Even in India, however, more than one third of the population still lives in poverty. The percentage of people living on less than $1 a day has increased in Bangladesh and Sri Lanka. In many cases, this MDG indicator differs substantially from another poverty measurement: the proportion of people living below the national poverty line. 2 Pakistan has significantly reduced its percentage of people whose income is less than $1 a day, but poverty as measured by the national poverty line has increased from 26% in 1990-91 to 32% in 2000-01. 3 Similarly, while only 5.6% of Sri Lankans were living on less than $1 a day in 2002, between 1995 and 2001, 25% of the country s population was living below the poverty line. 4 In Afghanistan, no data are available regarding the percentage of people living on less than $1 a day, but most of the population live below the national poverty line. 5 Income inequality within countries has been increasing and economic growth has not reached the poor and marginalised populations. In general, the incidence of poverty disproportionately affects women and those residing in rural areas, and geographical disparities persist. For example, while India has made significant progress in poverty reduction nationally, the eastern states experience much higher levels of poverty than the rest of the country. 6 6 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 1 ERADICATE EXTREME POVERTY AND HUNGER Target 2 Halve, between 1990 and 2015, the proportion of people who suffer from hunger Indicator: Prevalence of underweight children under five years of age South Asia has the highest percentage of underweight children in the world, yet is making very little progress in reducing child malnutrition. Percentage of under-fives suffering from underweight (moderate & severe), 1990-91 and 2000-04* Bhutan Maldives Bangladesh Sri Lanka Afghanistan India Nepal CEE/CIS Percentage of under-fives suffering from underweight (moderate & severe), 1996-2004 5 Latin America & Caribbean Middle East & North Africa 7 East Asia & Pacific Sub-Saharan Africa South Asia Target achieved 19 19 64% of target achieved 23 56% of target achieved 53% of target achieved 18.9 36% of target achieved 24 28% of target achieved 14% of target achieved Pakistan 12% of target achieved 20 14 15 27.4 29 30.4 29.4 33 38 38 40.4 0 5 10 15 20 25 30 35 40 45 50 39.3 0 20 40 60 80 41.3 43.7 28 47.5 48 47 53 54.8 57 65.8 2015 Target 2000-04 1990-91 46 Overall, a staggering 46 percent of all children in South Asia are underweight. Three countries India, Bangladesh and Pakistan account for half the world s underweight children (73 million), despite having just 29 percent of the developing world s under-five population. 7 At current rates of progress, India, Nepal, and Pakistan will not meet their MDG targets. While Bangladesh is on track to halve its percentage of underweight children by 2015, its child malnutrition rates are among the highest in the world, surpassing those of countries in Sub-Saharan Africa and many Asian countries. 8 In 1998, 90% of children Nepal were suffering from some form of malnutrition. 9 Approximately 47 percent of India s under-five population is underweight, dragging down the regional average. 10 Though child malnutrition in Sri Lanka has been declining, 29.4% of children are still underweight. 11 Afghanistan has made significant progress, but malnutrition still affects almost half of the country s children. 12 Wide geographical disparities exist even within countries that are performing well. While Bhutan has successfully halved its percentage of underweight children, largely due to its Nutrition Programme, malnutrition remains more prevalent in the eastern parts of the country. 13 Maldives is on track to reach its MDG target, but the prevalence of underweight, stunting, and wasting is still very high in the outer atolls; 1 in 4 children may be underweight even by 2015. 14 In many South Asian countries, malnutrition due to a chronically poor diet and lack of access to safe sanitation is compounded by gender discrimination. South Asia is the only region in which girls are more likely to be underweight than boys. Poverty and malnutrition are also linked children living in the poorest households are more likely to be underweight than children living in the richest households. 15 The Millennium Development Goals Progress and Challenges in South Asia 2006 7

GOAL 1 ERADICATE EXTREME POVERTY AND HUNGER Target 2 Halve, between 1990 and 2015, the proportion of people who suffer from hunger Indicator: Prevalence of underweight children under five years of age Percentage of underweight children (moderate and severe), 1999-2004 Percent <30 30-49 50-74 Data not available This map is not to scale. It does not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. With the exception of Sri Lanka and a few small geographical pockets in other countries, more than one third of children in South Asia are underweight. In most of India, half of Nepal, eastern Bangladesh, and some districts in Pakistan, more than half of children are underweight. The South Asian countries with the highest prevalence of underweight children India, Pakistan, Nepal and Bangladesh are also those with the greatest geographical disparities. In India, the prevalence of underweight among children is highest in the poorer states of Uttar Pradesh, Rajasthan, Madhya Pradesh, Bihar, Orissa, Maharashtra, Chhattisgarh, and Jharkhand. In Nepal, more children are underweight in the mountain regions, where poverty levels are higher, than in the terai (plains), and over fifty percent of children are underweight in the central, mid western and far western regions of the country, with the latter two regions also experiencing far greater incidence of poverty than the national average. 16 The eastern region of Bangladesh fares much worse than the rest of the country, and in Pakistan the prevalence of underweight children is concentrated in districts in the far northwest, southwest, and east. 8 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 2 ACHIEVE UNIVERSAL PRIMARY EDUCATION Target 3 Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling Indicator: Net enrolment ratio in primary education While enrolment in primary education has increased in South Asia, a number of countries are unlikely to achieve universal enrolment by 2015. Net enrolment in primary education, 1990-91 and 2000-05 Sri Lanka 97.1 90 Bangladesh 93.8 71 Maldives 89.7 86.7 India 89.7 Nepal 84 64 Pakistan 52 2000-05 33.4 1990-91 Afghanistan 54 27 0 20 40 60 80 100 South Asia lags behind most other regions in primary school enrolment/attendance, with a net primary school enrolment/attendance ratio of 74%. Sri Lanka is the region s best performer, and Bangladesh has made good progress due to an increase in the government s budget allocations for girls education, free primary education, massive stipend programmes, and the Food for Education Programme. 17 Maldives is also on track to achieve nearuniversal primary enrolment by 2015. 18 Given current rates of progress, it is unlikely that Nepal will achieve 100% net enrolment in time, and Pakistan and Afghanistan are severely off track. Despite a recent enrolment surge in Afghanistan, the primary enrolment rate is among the lowest in the world and a third of children are not in school. Schools in Afghanistan have become the targets of increasingly dramatic attacks; schools are closing, students are staying home, and hard-won progress is at risk. 19 Net primary school enrolment/attendance, 1996-2004 East Asia & Pacific Latin America & Caribbean CEE/CIS Middle East & North Africa South Asia Sub-Saharan Africa 88 79 74 60 93 96 While net enrolment rates have increased, access to education for children from lowincome and socially marginalised groups remains a challenge and contributes to the high proportion of children (26%, or 42 million) in South Asia who are out of school. Additionally, to achieve MDG 2, increasing enrolment must be accompanied by correspondingly high retention and completion rates, but gaps remain in many countries. Quality of education is an important contributing factor to universal primary completion and is a great concern for all South Asian countries. 0 20 40 60 80 100 The Millennium Development Goals Progress and Challenges in South Asia 2006 9

GOAL 2 ACHIEVE UNIVERSAL PRIMARY EDUCATION Target 3 Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling Indicator: Net enrolment ratio in primary education Net enrolment ratio in primary education, 2000-04 This map is not to scale. It does not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. Percent <70 70-89 90-100 Data not available Within Afghanistan and Pakistan, all regions and districts have extremely low enrolment rates, but stark geographical disparities in net enrolment exist within the other countries. In India, the states of Maharashtra, Punjab and Haryana have much lower levels of net enrolment than the rest of the country. In Bhutan, enrolment is low in most parts except the central region, and in Nepal, enrolment rates in the central region lag behind those of other regions. 10 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 2 ACHIEVE UNIVERSAL PRIMARY EDUCATION Target 3 Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling Indicator: Percentage of children of primary school age out of school, total and by sex The greatest numbers of out-of-school children live in South Asia and access for marginalised groups is a significant challenge. Percentage of children of primary school age out of school, total and by sex, 2000-03 Sri Lanka < 1 < 1 < 1 Maldives 2.5 1.9 3 Bangladesh India Nepal Pakistan Bhutan 4.3 10 8.8 11.2 11.4 19 22.3 26.8 31.6 32.4 Total out of school children (% of total primary school age population) Out of school females (as % of total primary school age females) Out of school males (as % of total primary school age males) 39.3 46.6 49.3 52 46.7 0 10 20 30 40 50 60 Percentage of children of primary school age out of school, total and by sex, 2001-02 East Asia & Pacific 5.7 5.8 5.6 Latin America & Caribbean 5.7 5.3 6.1 Central & Eastern Europe/CIS 11.7 12.9 10.5 Middle East & North Africa South Asia Eastern & Southern Africa West & Central Africa 15.4 18.7 22.1 22.3 26 Total out of school children (% of total primary school age population) Out of school females (as % of total primary school age females) Out of school males (as % of total primary school age males) 29.9 38.5 39.1 37.8 0 5 10 15 20 25 30 35 40 45 50 41.3 45.3 49.3 With 26% of its primary school age children out of school, South Asia is surpassed only by Sub- Saharan Africa, and stands in stark contrast to East Asia and Pacific, where only 5.7% of children are out of school. Globally, the greatest number of out-ofschool children (42 million) live in South Asia. 20 Almost half of children of primary school age in Bhutan are out of school. Nepal has made rapid progress towards universal primary education and gender parity, but there are persistent gender, caste and ethnic disparities, and girls from low income and marginalised groups are doubly disadvantaged. For example, Dalit girls are almost twice as likely to be excluded from school as higher caste girls. Among children in poor households, the percentage of 6-10 year olds and 11-15 year olds out of school is 36 and 42 percent, respectively, and more than two-thirds of these are girls. 21 India has the world s largest number of out of-school children, over 50% of whom live in the states of Uttar Pradesh, Bihar and West Bengal, and access to education for so-called lower caste children and for girls is a key concern. 22 Major factors relating to low enrolment and high dropout rates in Pakistan are the poor quality and high cost of education (school charges and fees), distance from schools, and low value placed on girls education; 23 33% of boys in Pakistan are out of school, compared with 47% of girls. While Sri Lanka has the lowest number of out-ofschool children, there are still children from marginalised groups who are out of the schooling system. 24 Maldives also has a low percentage of outof-school children, but is challenged with providing access to primary education for children with special needs. 25 In general, while many South Asian countries have made progress in improving gender parity in primary education, in the region as a whole, 29.9% of primary school girls are out of school compared with 22.3% of boys. This translates to about 23.5 million girls who are deprived of an education. 26 In countries with the highest percentages of out-of-school children Bhutan, Pakistan, Nepal, and India the percentage of girls who are out of school exceeds that of boys. If MDG 2 is to be met, inclusive quality primary education must be a priority. The Millennium Development Goals Progress and Challenges in South Asia 2006 11

GOAL 3 PROMOTE GENDER EQUALITY AND EMPOWER WOMEN Target 4 Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015 Indicator: Share of women in non-agricultural wage employment Few women in South Asia are engaged in non-agricultural wage employment, rendering women and their children more vulnerable to poverty. Sri Lanka Maldives Share of women in non-agricultural wage employment, 1990 and 2004 (Percentage) Bangladesh Nepal India Pakistan 8.6 6.6 11.8 12.7 17.6 17.4 17.3 23.1 31.1 35.6 39.1 2004 1990 43.2 0.0 10.0 20.0 30.0 40.0 50.0 Women represent a small proportion of the labour market in South Asia. Only 18% of wage employment in the non-agricultural sector is held by women, in contrast to 39% in East Asia and Pacific. The percentage of non-agricultural jobs held by women is below 20% in Nepal and India, and lowest in Pakistan, at 8.6%. In Nepal, the feminisation of agriculture combined with the recent conflict have contributed to greater vulnerability among women in the farming sector, with women replacing the outgoing men in subsistence agriculture. 27 The low share of women in wage employment in the non-agricultural sector in Pakistan has only increased two percent over 14 years. 28 Share of women in non-agricultural wage employment, 1990 and 2002 (Percentage) Europe & Central Asia 46 46 Latin America & Caribbean East Asia & Pacific 39 39 38 43 2002 1990 South Asia 18 13 0 10 20 30 40 50 12 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 3 PROMOTE GENDER EQUALITY AND EMPOWER WOMEN Target 4 Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015 Indicator: Proportion of seats held by women in national parliaments Women s political participation at the national level in South Asia is extremely low. Seats held by women in national parliaments, 1990 and 2006 (Percentage) Afghanistan Pakistan 2 3.7 Bangladesh Maldives Bhutan India Nepal Sri Lanka 5 4.9 4.9 6.3 5.9 6.1 8.3 9.3 10.1 10.3 12 14.9 21.3 2006 1990 27.3 0 5 10 15 20 25 30 Seats held by women in national parliaments, 2004 (Percentage) Latin America & Caribbean East Asia & Pacific Sub-Saharan Africa Europe & Central Asia South Asia Middle East & North Africa 6 9 12 13 0 5 10 15 20 25 30 17 19 Women occupy only 9% of seats in South Asia s national parliaments. Only the Middle East and North Africa region has a lower share. Afghanistan has the highest participation rate, with its success largely attributed to guaranteed quotas of reserved seats in Parliament and ministerial representation in the cabinet. 29 Bhutan, India, Nepal, and Sri Lanka have the lowest participation of women in national parliaments. In Bhutan, the under-representation of women is attributed to lower educational qualifications and literacy levels, which were due to lower enrolment rates for females in the past. However, an increase in women s representation from 2% in 1990 to 9.3% in 2006 is a promising trend. 30 In India, the number of women in leadership positions at the local administration level has significantly increased, but the percentage of women at senior levels of government remains low. 31 In Nepal, existing affirmative policies to increase women s representation in all decisionmaking bodies need to be more strictly enforced. 32 Sri Lanka stands out with seven decades of a democratic system of governance, universal franchise, equal participation of women voters, and elected women leaders in the highest seats of political power, but nevertheless has the region s lowest percentage of women in Parliament (4.9%), a rate which has remained unchanged since 1990. The low participation rate of women in Sri Lanka is mainly due to the gendered norm of male leadership, time constraints due to domestic tasks and child care, lack of adequate financial resources, and a climate of political violence. In addition, political parties have made little effort to groom women members for election. 33 Similarly in India, despite the prominence or one or two women at the very top, the internal structure of political parties remains a great obstacle to women s full political participation at the national level, with male-dominated parties reluctant to nominate women. 34 The Millennium Development Goals Progress and Challenges in South Asia 2006 13

GOAL 4 REDUCE CHILD MORTALITY Target 5 Reduce by two thirds, between 1990 and 2015, the under-five mortality rate Indicator: Under-five mortality rate Despite a moderate decline in under-five mortality rates in many South Asian countries, approximately one child in ten still dies before his/her fifth birthday. Maldives Sri Lanka 11 14 Bhutan Pakistan Under-five mortality rate per 1,000 live births, 1990 and 2004 Bangladesh Nepal India Afghanistan 87.8% of target achieved 37 46 32 84.4% of target achieved 77.7% of target achieved 55 80 72.5% of target achieved 50 77 71.4% of target achieved 48 76 46.3% of target achieved 41 85 33.5% of target achieved 43 101 1.7% of target achieved 87 111 123 130 149 145 2015 Target 2004 1990 257 260 0 50 100 150 200 250 300 Under-five mortality rate per 1,000 live births, 1990 and 2004 Latin America & Caribbean 18 19 South Asia 27 31 East Asia & Pacific 36 CEE/CIS & Baltic States 18 38 Sub-Saharan Africa 54 Middle East & North Africa 54 58 56 43% of target achieved 43 63.9% of target achieved 56.9% of target achieved 46.3% of target achieved 81 44.4% of target achieved 92 13.6% of target achieved 63 0 20 40 60 80 100 120 140 160 180 200 166 129 2015 Target 2004 1990 171 188 Five South Asian countries have achieved over 70% of their child survival targets. Although the region has experienced a gradual decline in under-five and under-one mortality, South Asia s child mortality rates are exceeded only by those in Sub-Saharan Africa. One out of every three child deaths occurs in South Asia, 35 and almost one child in ten dies before his/her fifth birthday. 36 Most of the under-five deaths in South Asia result from diarrhoea, acute respiratory infections, and vaccine-preventable diseases. Malnutrition continues to be a major underlying cause of death. 37 There is great disparity within the region, with under-five child mortality rates as low as 14 per thousand live births in Sri Lanka and as high as 257 per thousand live births in Afghanistan. 38 Along with Maldives and Sri Lanka, which have experienced considerable reductions, Bhutan, Bangladesh, and Nepal have also made significant progress in reducing under-five mortality. By 2004, these five countries had already achieved more than 70% of their targets for 2015. Neonatal mortality greatly contributes to under-five mortality in South Asia. Although South Asia accounts for only 28% of global births, its share of total neonatal mortality is more than 41%, mainly due to low birth weight, asphyxia, birth injuries, and infections. In most South Asian countries, early neonatal mortality constitutes nearly 75% of all neonatal deaths, highlighting the importance of the first seven days for child survival. 39 Neonatal survival is closely linked with the availability of comprehensive essential services for neonatal care, the presence of skilled birth attendants during delivery, and timely provision of postnatal care. 14 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 4 REDUCE CHILD MORTALITY Target 5 Reduce by two thirds, between 1990 and 2015, the under-five mortality rate Indicator: Proportion of 1 year-old children immunised against measles To stop the spread of measles, children must be given a second chance to be immunised and immunisation rates must be increased to above 90%. Maldives Sri Lanka Bhutan Bangladesh Nepal Pakistan Afghanistan India Percentage of 1 year-old children immunised against measles, 1990 and 2004 20 0 20 40 60 80 100 Percentage of 1 year-old children immunised against measles, 2004 CEE/CIS Latin America & Caribbean Middle East & North Africa East Asia & Pacific Sub-Saharan Africa South Asia 50 57 56 56 61 61 65 66 67 73 77 80 83 87 89 93 93 92 97 96 96 2004 1990 All South Asian countries except for Afghanistan, Pakistan, and India have managed to immunise over 70% of oneyear-old children against measles. However, only three countries have reached over 80%, and globally the region has the largest number of unprotected children in the world, 40 with only 61% of children immunised compared to 66% in Sub-Saharan Africa. Due to the contagious nature of the disease, coverage needs to be above 90% to stop transmission of the virus. 41 As demonstrated by most of the South Asian countries, prevention of measles deaths is achievable. Therefore, countries like India and Pakistan that have a very large population base but low coverage, need to strengthen their measles immunisation programs to effectively protect children and advance progress towards this MDG goal. Routine immunisation services need to be strengthened and catch-up campaigns, such as those so successfully conducted in Bangladesh and Bhutan in 2006, are needed to give children in low-coverage countries a second chance to be immunised. After successful campaigns, a routine second dose at two years of age should be introduced. Routine immunisation coverage remains low in some areas of the region because districts lack planning capacities, funds to conduct outreach and supervision, and monitoring systems to track progress. However, there are also weaknesses in the region s wider health systems, with poor basic facilities and low salaries for health staff that give them little incentive to stay in the more remote areas. 42 Strengthening the overall health system is essential to achieving and sustaining high immunisation rates and preventing child death. 0 20 40 60 80 100 The Millennium Development Goals Progress and Challenges in South Asia 2006 15

GOAL 5 IMPROVE MATERNAL HEALTH Target 6 Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Indicator: Proportion of births attended by skilled health personnel At current low rates of skilled attendance at birth, South Asia is unlikely to reduce maternal mortality sufficiently to meet this Goal. Sri Lanka Maldives India Bhutan Pakistan Nepal Percentage of deliveries attended by skilled health care personnel, 1995 and 2000-04 8 8 9 Afghanistan Bangladesh 15 14.3 13.2 18 15.4 31 34.2 36.5 42.5 0 20 40 60 80 100 CEE/CIS 70.3 2000-04 1995 Percentage of deliveries attended by skilled health care personnel, 1996-2004 Latin America & Caribbean Middle East & North Africa East Asia & Pacific Sub-Saharan Africa South Asia 36 42 76 87 86 93 97 More than 200,000 of the world s 529,000 annual maternal deaths occur in South Asia, 43 thus contributing to the deficit of females in seven of eight South Asian countries. Given equal access to food, shelter, and medical care, any country s population will have roughly 105 women for every 100 men. South Asia s skewed demographics result from many causes, including sex-selection of foetuses and cultural practices that give men and male children priority in receiving food, medical care, and education. South Asia and Sub-Saharan Africa together account for nearly 95% of all the world s maternal deaths. Women in South Asia have a 1 in 43 risk of dying in pregnancy or childbirth compared to the 1 in 74 global average and 1 in 60 in developing countries as a whole. 44 In India, a woman dies in childbirth every five minutes 45 and maternal mortality is among the leading causes of death in Afghanistan. 46 As the maternal mortality ratio is difficult to measure, the proportion of births attended by skilled health personnel is used as a close proxy. While all countries have seen marginal progress in skilled attendance, South Asia as a region is still progressing very slowly; its 36% attendance rate is the world s lowest. Further investments are required to make skilled delivery and postpartum care available to all women. Sri Lanka and Bangladesh have made significant progress in low resource settings through political commitment and investments in policies aimed at increasing the availability of skilled health personnel, health infrastructure, and referral systems. 0 20 40 60 80 100 16 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 5 IMPROVE MATERNAL HEALTH Target 6 Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Indicator: Proportion of births attended by skilled health personnel Percentage of births attended by skilled health personnel, 2001-04 This map is not to scale. It does not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. Percent <50 50-74 75-96 Data not available In most South Asian countries, fewer than half of women have skilled assistance at birth. Most countries have low coverage across all sub-national areas. In India, although the states of Tamil Nadu, Kerala, and Goa provide coverage exceeding 75%, the rest of the country is performing poorly, with fewer than 50% of births in the northern states attended by skilled personnel. Only Sri Lanka has managed to provide almost universal coverage of skilled birth attendance to women across the whole country. The Millennium Development Goals Progress and Challenges in South Asia 2006 17

GOAL 6 COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES Target 7 Have halted by 2015 and begun to reverse the spread of HIV/AIDS Indicator: Contraceptive prevalence rate Limited contraceptive use in most South Asian countries puts their populations at higher risk of HIV/AIDS. Sri Lanka Contraceptive prevalence rate, 1996-2004 (Percentage) Bangladesh India Maldives Nepal Bhutan Pakistan Afghanistan 10 28 31 39 38 47 0 20 40 60 80 100 India Pakistan 56 000 Nepal 85 000 75 000 65 000 Bangladesh 11 000 7500 Sri Lanka 5000 3100 Afghanistan <1000 <500 Bhutan <500 <100 59 70 1996-2004 Estimated number of adults and children living with HIV, 2003 and 2005 2005 2003 5 700 000 5 300 000 1000000 2000000 3000000 4000000 5000000 6000000 200 million women worldwide face an unmet need for safe and effective contraceptive services that would help improve maternal health and save women s lives. 47 In addition to its very high maternal death rate, 48 South Asia has one of the world s lowest contraceptive prevalence rates, only second to Sub-Saharan Africa. Statistics on South Asia conceal strong variation within the region. Sri Lanka has reached and maintained a contraception prevalence rate of 70%. Other countries are at much lower levels, such as Afghanistan, where only 10% of the population uses contraception. The limited use of contraception in South Asia is linked with such factors as custom and traditional lack of family planning, women s subordinate position resulting in denial of their reproductive rights, 49 and the overall low level of education, especially of women, in many of the low-performing countries. In 2004, young adult (age 15-24) female literacy rates in Afghanistan and Pakistan the two countries with the lowest rates of contraceptive use were 18% and 55%, respectively, compared to Sri Lanka s near universal rate of 96%. 50 Given contraception s important role in reproductive health and also in HIV prevention, increased access to services and education (especially for women) through inclusive education policies, as well as special efforts aimed at behavioural change (such as healthcare education and awareness programs for women and youth) are needed. The prohibitively high costs of healthcare and healthcare access 51 for the poor, except in countries such as Sri Lanka, could also contribute to the low use of contraception. This points to a need for increased coverage of primary health care, especially in remote and disadvantaged areas. Some countries in the region already implement outreach programmes, such as the Lady Health Workers Programme in Pakistan and Female Community Health Volunteers in Nepal. 52 These measures, which are part of a larger agenda of universalising basic services, can greatly increase women s access to contraception. 18 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 6 COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES Target 7 Have halted by 2015 and begun to reverse the spread of HIV/AIDS Indicator: Prevalence and death rates associated with tuberculosis Although tuberculosis incidence has been decreasing in all of South Asia, prevalence is still high and the spread of HIV/AIDS could prevent further progress. Tuberculosis prevalence rate per 100,000 population, 1990 and 2004 Maldives 57 155 Sri Lanka 91 109 Bhutan 184 371 Nepal 257 2004 616 India 1990 312 570 Pakistan 329 430 Bangladesh 435 640 Afghanistan 661 826 0 100 200 300 400 500 600 700 800 900 Tuberculosis prevalence rate per 100,000 population, 2003 South Asia is only second to Sub-Saharan Africa in tuberculosis prevalence rates. Maldives, Bhutan, Nepal and India are the region s best performers, and on average have halved tuberculosis rates since 1990. Their success is in large part attributed to Directly Observed Treatment Short courses (DOTS) implemented under the national tuberculosis control programmes, which have enabled reliable information on case detection and success rates. 53 The same programme, however, has been less successful in the region s other countries. For instance, in Bangladesh the detection rate has remained virtually unchanged since 2000, at 34%. 54 Tuberculosis incidence is alarming in Afghanistan, which ranks highest in the region and 12 th in the world, 55 following a group of mostly Sub-Saharan countries. 70% of the infected people in Afghanistan are women, who face a high risk of motherto-child transmission. 56 While little analysis has been done to determine the genderrelated causes of this, it can be assumed that one factor is the generally low access of women to healthcare services and facilities, and the low availability of female medical staff, which may impede women from availing themselves of health services. 57 Middle East & North Africa 55 Latin America & Caribbean 66 Europe & Central Asia 82 East Asia & Pacific South Asia Sub-Saharan Africa 143 179 353 Tuberculosis incidence is closely linked with the incidence of HIV/AIDS; therefore failing to halt the latter will also prevent the tuberculosis reduction and reversal target from being met. The situation in the region is all the more disquieting as most South Asian countries have few reliable statistics about the incidence of HIV/AIDS, especially among children. According to most recent estimates, 5.3 million people in South Asia are living with HIV, of which one quarter are children. 58 This means that roughly 3% of all children aged 0-14 are infected. 59 0 50 100 150 200 250 300 350 400 The Millennium Development Goals Progress and Challenges in South Asia 2006 19

GOAL 6 COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES Target 7 Have halted by 2015 and begun to reverse the spread of HIV/AIDS Indicator: Prevalence and death rates associated with tuberculosis Despite an overall decrease in tuberculosis death rates in South Asia, they remain high in many countries. Tuberculosis death rate per 100,000 population, 1990 and 2004 Maldives 3.6 8.5 Sri Lanka 9 10.5 Bhutan 19.8 39.8 Nepal 2004 24.2 1990 51.2 India 30.3 42.5 Pakistan 40.5 49.3 Bangladesh 50.6 77.5 Afghanistan 91.7 107.7 Significant reductions in tuberculosis death rates since 1990 have been achieved in Bangladesh, Nepal, and Bhutan. Deaths from tuberculosis remain highest in Afghanistan, followed by Bangladesh, Pakistan, and India. While relatively low immunisation rates partially explain the high incidence of tuberculosis deaths in Afghanistan, Pakistan and India (where 78%, 80%, and 73% of 1-year-olds, respectively, were immunised in 2004), this is not the case in Bangladesh, where the immunisation rate was 95%. 60 The disparities within the region point to structural problems inherent in the low coverage, under-financing, and/or inefficiency of South Asian countries healthcare systems. Expanding tuberculosis immunisation coverage to low-income groups, children and women, and improving access to curative treatment, are essential to prevent and reduce deaths from tuberculosis. 0 20 40 60 80 100 120 Source: United Nations Statics Division, Department of Economics and Social Affairs, web site: http://mdgs.un.org/unsd/mdg/data.aspx 20 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 7 ENSURE ENVIRONMENTAL SUSTAINABILITY Target 9 Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources Indicator: GDP per unit of energy use, PPP $ per kg oil equivalent South Asia is steadily increasing its demand for energy, thus facing the mounting challenge of conserving natural resources and protecting the environment. GDP per unit of energy use, PPP $ per kg oil equivalent, 1990 and 2002 Nepal Pakistan India Sri Lanka Bangladesh 3.9 2.6 4.4 3.2 5.2 3.2 8.3 5.7 11.0 8.2 2002 1990 0 5 10 15 GDP per unit of energy use, PPP $ per kg oil equivalent, 1990 and 2002 Europe & Central Asia 2.6 2002 1.7 1990 Sub-Saharan Africa 2.9 2.3 Middle East & North Africa 3.7 3.3 South Asia 5.3 3.4 Latin America & Caribbean 6.3 4.8 0 5 10 South Asia is witnessing a rapid growth in energy consumption, despite per capita use that remains low. In terms of GDP per unit of energy use, only the region of Latin America and the Caribbean is more efficient than South Asia. Since 1990, all countries in South Asia have increased their energy efficiency with Bangladesh and Sri Lanka being the most energy efficient. Although its large population makes Bangladesh a country with low per capita energy use, it has an overall high level of energy consumption; 55% of all energy consumed in Bangladesh comes from traditional organic fuels. Natural gas meets 24% of domestic fuel needs, hydroelectricity another 2%, and 19% is imported. 61 Sri Lanka, which uses three primary sources of energy hydroelectricity, biomass, and petroleum, representing 9%, 49%, and 42% respectively of the 8,348 tonnes of oil equivalent consumed in 2000 expects its energy demand to continue to grow at the current rate. 62 Industrialisation has caused air pollution to become a problem, especially in the western provinces, and has increased health hazards especially for children and the elderly. According to the national MDG report, India s per capita emission of carbon dioxide in 2004 was about one tonne, the highest among the South Asian countries 63, and roughly one-fourth of the global average. 64 A large number of households 85% in rural areas and 26% in urban areas use coke, coal, firewood, cow-dung cake, or charcoal as primary sources of energy for cooking. 65 The Millennium Development Goals Progress and Challenges in South Asia 2006 21

GOAL 7 ENSURE ENVIRONMENTAL SUSTAINABILITY Target 9 Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources Indicator: Proportion of population with sustainable access to an improved water source Nearly all countries in South Asia have made significant progress in increasing access to an improved source of drinking water. Percentage of population with access to improved drinking water source, 1990 and 2004 Nepal India Pakistan Bhutan Afghanistan 4 Sri Lanka Bangladesh Maldives Target achieved Target achieved 89% of target achieved 79% of target achieved 73% of target achieved 39 69% of target achieved 14% of target achieved Regression 52 62 68 70 70 79 85 86 83 84 79 85 90 0 20 40 60 80 100 120 74 72 83 86 92 91 96 98 2015 Target 2004 1990 Percentage of population with access to improved drinking water source, 1990 and 2004 South Asia Latin America & Caribbean East Asia & Pacific Middle East & North Africa Sub-Saharan Africa CEE/CIS 93% of target achieved No change 89% of target achieved 50% of target achieved 29% of target achieved 27% of target achieved 48 55 71 72 74 79 86 85 83 86 92 91 93 88 86 96 91 91 2015 Target 2004 1990 Increasing sustainable access to safe drinking water is one of the few MDG targets where South Asia has made good progress, and the region could achieve the MDG target of providing 86% of the population with access to an improved water source before 2015. Between 1990 and 2004, the number of people without access to safe drinking water decreased from 326 million to 222 million. 66 Currently, 94% of the urban population and 80% of those living in rural areas have access to an improved water source. 67 India and Nepal have already met the MDG water target, and Pakistan has nearly achieved it. Only Bangladesh and Maldives are currently making insufficient progress and unlikely to achieve their targets. Maldives slow progress is explained by the population s dependence on shallow wells for their access to the islands freshwater lenses, which are highly susceptible to pollution. 68 Although the national policy has been to shift from well water to rainwater in many of the islands, 30% of the atoll s population reported water shortages in 2004. Bangladesh s water shortage is caused by the presence of arsenic in its groundwater. The target of ensuring near 100% coverage by 2015 means that almost 25 million people must gain access to safe, arsenic-free water over the next 10 years. 69 Afghanistan, while its 39% access rate represents 75% of the 52% target, nevertheless has the third-lowest access to improved drinking water sources in the world. Coupled with the problem of urban population explosion, improving access to safe drinking water beyond the current rate may be a target beyond reach. Furthermore, the water management system presents the additional challenges of contaminated groundwater and inadequate water treatment, which have caused a significant deterioration in sanitary conditions. 70 0 20 40 60 80 100 120 22 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 7 ENSURE ENVIRONMENTAL SUSTAINABILITY Target 10 Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation Indicator: Proportion of population with sustainable access to an improved water source Percentage of population with sustainable access to an improved water source, 2000-04 Note: Data refer to the most recent year available during the period specified. Percent <50 50-84 85-100 Data not available This map is not to scale. It does not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. In most parts of South Asia, more than 85% of the population has access to an improved source of water. Within India, the best coverage of safe drinking water and water facilities is concentrated in the south and north-eastern states, with the central states suffering more from lack of adequate water supplies, including the two large states of Rajasthan and Madhya Pradesh. The widest disparities are found in Pakistan. In the districts bordering India to the south and east, close to 90% of the population has access to safe drinking water, while the parts bordering Afghanistan to the northwest are very short of safe water supplies. In Nepal, the Western Development District is by far the best supplied with improved water and water facilities. The Millennium Development Goals Progress and Challenges in South Asia 2006 23

GOAL 7 ENSURE ENVIRONMENTAL SUSTAINABILITY Target 10 Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation Indicator: Proportion of urban and rural population with access to improved sanitation Despite considerable gains in sanitation, over 900 million people in South Asia live without access to improved sanitation facilities. Percentage of population with access to improved sanitation, 1990 and 2004 Sri Lanka Bhutan Maldives Pakistan Afghanistan 3 Nepal 11 Bangladesh India Percentage of population with access to improved sanitation, 1990 and 2004 East Asia & Pacific 30 Latin America & Caribbean South Asia 17 Middle East & North Africa Sub-Saharan Africa CEE/CIS 14 100% of target achieved 84% of target achieved 78% of target achieved 69% of target achieved 20 48% of target achieved No change 32 34 33 35 37 63% of target achieved 53% of target achieved 48% of target achieved 44% of target achieved 60% of target achieved 37 15% of target achieved 37 39 0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100 52 51 56 57 56% of target achieved 38% of target achieved 59 59 60 59 65 66 69 68 68 70 69 74 76 77 83 84 84 85 84 84 91 2015 Target 2004 1990 2015 Target 2004 1990 92 South Asia has made great gains in sanitation, more than doubling the percentage of the population with access to improved sanitation from 17% in 1990 to 37% in 2004. However, coverage is still among the lowest in the world. More than 921 million people, including 106 million children, live without access to improved sanitation in South Asia, one third of the global total. 71 Four of the countries with the largest populations India, Bangladesh, Nepal, and Afghanistan lag far behind the countries with smaller populations, and their people s access to improved sanitation is way below the regional target of 60%. The only exception among the larger countries is Pakistan, which has achieved almost 60% coverage of its estimated 166 million population. While access to improved sanitation in India rose from 14% in 1990 to 33% of the population in 2004, two-thirds of the population, numbering 730 million, are still left without access. Although India had managed to provide 59% of its urban population, compared with 22% of its rural population, with access to sewage and sanitation by 2004, adequacy and equitable distribution remain problems. 72 The poor people living in slums and squatter settlements have inadequate access to these basic services. In Bangladesh, patchy sanitation service in different districts is a major challenge. While 43% of urban households use water-sealed latrines, only 14% of slum dwellers have access to sanitary latrines, and more than 85% of them use hanging latrines. 73 For the region to meet its overall MDG sanitation access target of 59% by 2015, the pace of improvement must be accelerated to reach a further 24 million persons each year. 74 The emphasis must be on improving access in rural areas, as South Asia s urban rural disparities in sanitation in are the worst in the world, with 64% of the urban versus 23% of the rural population having access to improved sanitation in 2002. 75 24 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 7 ENSURE ENVIRONMENTAL SUSTAINABILITY Target 11 By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers Indicator: Proportion of households without access to secure tenure Few countries in South Asia have made progress in reducing their large slum populations. Slum population as percentage of urban (proportion of households with access to secure tenure), 1990 and 2001 Maldives 0 0 Sri Lanka 13.6 Bhutan India Pakistan Bangladesh Nepal Afghanistan 24.8 44.1 55.5 60.8 70 73.6 78.7 84.7 87.3 2001 1990 92.4 96.9 98.5 98.5 0 20 40 60 80 100 120 In 2001, over 230 million people in South Asia lived in slums, i.e. on average more than half of the countries urban populations 76. South Asia s annual slum population growth rate is lower than in other regions of the world (in Sub-Saharan Africa it is almost the same as the total population growth rate), yet it translates into a large number of people due to the sheer size of the countries populations. Without providing access to secure tenure to the poor in South Asia, poverty reduction efforts will fail, as secure tenure is the basis for raising living standards through improved housing and access to water and sanitation. Few of the South Asian countries are on track to meet this target. Currently, nearly all the urban populations in Afghanistan, Nepal, and Bangladesh are slum dwellers. Afghanistan, which already ranks thirdlowest in the world in access to safe drinking water, expects its urban population to more than double in the next ten years. 77 Such a population explosion will present both constraints and challenges to improving access to clean drinking water and improving the lives of slum dwellers, and thwart efforts aimed at achieving this MDG target. Sri Lanka and Bhutan had the best records in reducing their slum populations before 2001. However, the absolute number of Sri Lanka s people without access to secure tenure almost tripled from 273,000 in 1990 to 780,000 people in 2000. About half of the capital s residents live in slums and shanties. 78 The problem of slum expansion has been aggravated by the effects of the tsunami of December 2004, which left many people homeless. 79 26 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 8 DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT Target 12 Develop further an open, rule-based, predictable, non-discriminatory trading and financial system Indicator: Proportion of imports from developing countries (excluding arms and oil) admitted to developed countries duty free More quota and duty-free exports for the South Asian countries have also meant more competition for a share of foreign markets. Value of goods exports, percent change from previous year Bhutan 39.7 8.9 India 24.9 20.4 Bangladesh 15.9 9.5 Pakistan 2004 13.5 2003 19.6 Maldives 13 14.9 Sri Lanka 12.7 9.2 Nepal 12.4-13.8 Afghanistan 11.6 45.8-20 -10 0 10 20 30 40 50 Worldwide, the share of duty-free imports from developing countries has increased over the period 1996-2004, reaching 79% for the least developed countries. 80 Within the South Asian region, international trade arrangements have differential impact on the countries, with some countries experiencing better results. Until 2005, Bangladesh s textile exports to the EU and Canada were quota and duty free. These exports, which accounted for almost half of the country s total, 81 led to a strong development of Bangladeshi industries. However, the ending of the Agreement on Textiles and Clothing (formerly known as the Multi-Fibre Agreement) in 2005 is expected to have an impact on the textile and apparelexporting countries of South Asia. The leastdeveloped countries, including Bangladesh, may not be competitive enough to maintain their share of foreign markets. But even some of the low-to-middle income countries, such as Sri Lanka, expect employment, especially of female workers, to decrease. 82 Lowering trading barriers for the least developed South Asian countries products could bring significant economic and social benefits. While contributing to the countries economic growth, the trading gains could effectively trickle down to the poor through appropriate redistributive policies, and thus contribute to poverty reduction efforts. Yet one downside of growing export industries could be increasing demand for child labour. In India, for instance, an estimated 14% of children aged 5-14 are engaged in child labour, including the production of goods for export. 83 In South Asia as a whole, over 1999-2004, 15% of girls and 14% of boys aged 5-14 were involved in child labour. 84 Provided that child labour violations are eliminated, more exports within a more fair trading system could help the countries of South Asia generate valuable sources of funding for achieving the MDGs. The Millennium Development Goals Progress and Challenges in South Asia 2006 27

GOAL 8 DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT Targets 13 & 14 Address the special needs of the least developed countries, landlocked countries, and small island developing states Indicator: Official development assistance received from developed countries, 1990 and 2004 Increases in official development assistance to the landlocked countries of South Asia have not translated into better-targeted poverty reduction. Bhutan Official development assistance received in landlocked developing countries and small island developing states, 1990 and 2004 (million US$) Maldives 21.2 Nepal 27.9 46.9 78 2004 1990 427.3 426 0 50 100 150 200 250 300 350 400 450 Despite developed countries continuous commitments to increase official development assistance (ODA) to developing countries, such aid to landlocked Bhutan and Nepal, and the small island developing country of Maldives, has not increased substantially since 1990. 85 Afghanistan did experience an increase, but is obviously a special case. 86 Increases in ODA can be deceptive, as worldwide, debt relief has accounted for over half of the increase in ODA since 1997 and three-quarters of it in 2005. This is not equivalent to spending more on poverty reduction. 87 More official development assistance is required if the MDG targets relating to reducing hunger, and improving education and health are to be met. Recent estimates for Nepal suggest that over US$ 16 billion at 2004/05 prices would be required for 2005-2015 for the government to meet the MDGs relating to poverty reduction, education, health, agriculture, and rural infrastructure. Almost half of this amount, roughly US$ 7.6 billion, would need to come in the form of external development assistance. 88 Furthermore, ODA has not been effectively channelled into social programmes. The target suggested by the 20/20 initiative is for 20% of all ODA (bilateral and multilateral combined) to go to the core areas of health, education, and related social sectors. But in 2003-04, less than 9% of bilateral ODA to Afghanistan was spent on education and health combined 89. Nepal performed higher on this measure than Bhutan and Maldives two better-performing countries in this lot, but still needs to improve. Higher levels of ODA aimed at poverty reduction, especially for the landlocked countries of South Asia, remains a priority. 28 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 8 DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT Target 15 Deal comprehensively with developing countries debt Indicator: Debt service as percentage of exports of goods and services Although South Asian countries have not experienced substantial reductions in debt service ratios, most remain below the critical point of concern. Maldives Debt service as percentage of exports of goods and services and net income from abroad, 1990 and 2004 4 Bangladesh Sri Lanka Nepal India Pakistan 4.5 6.9 8.8 8.9 14.8 15.2 19.5 22.8 22.9 0 5 10 15 20 25 30 35 40 29.3 2004 1990 34.8 Globally, future debt service for 29 heavily indebted countries has fallen by US$ 59 billion since 1998, bringing down the ratio of debt service to export earnings to less than 7% in 2004. 90 Although none of the South Asian countries are included in the heavily indebted poor countries (HIPC) initiative, some countries debt service ratios are quite large, though below the critical point of 25%. 91 Debt service levels have stayed the same since 1990 in some South Asian countries like Pakistan, or even increased, as in Maldives. The sharpest reductions in the ratio of debt service to export earnings since 1990 have been experienced by Bangladesh. Bangladesh s debt sustainability has been an outcome of the favourable loan conditions of official bilateral and multilateral debt and of its place as a leading exporter of labour-intensive garments. 92 The situation is more difficult in Afghanistan, where most of the recurrent budget is externally financed and where development assistance will continue to determine most of the country s economic development and MDG achievement rates. 93 Afghanistan s US$ 8.5 billion in external debt exceeds 18 times its official exports (minus re-exports), and US$ 8 billion of that total represents bilateral debt, mostly to Russia. 94 The Millennium Development Goals Progress and Challenges in South Asia 2006 29

GOAL 8 DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT Target 16 In cooperation with developing countries, develop and implement strategies for decent and productive work for youth Indicator: Youth unemployment rate The future of South Asia s youth will remain uncertain, unless more jobs are created for its young and rapidly growing population. Sri Lanka Pakistan Maldives India 0.7 Share of youth unemployment in youth population, both sexes, 1995 and 2000 1.7 Bangladesh 3.5 4.1 4.4 4.7 5.4 6.6 10.3 2000 1995 0 2 4 6 8 10 12 14 16 14.2 Although the number and share of youth in South Asian countries total population has increased since 1995, job prospects have not, and the youth unemployment rate has risen from 9.4% in 1995 to 11.3% by 2005. 95 Among the South Asian countries for which statistics are available, only Sri Lanka has managed to decrease youth unemployment rates (by 27%) over the period 1995-2000, yet over the last decade its teenage and young adult age groups accounted for over 60% of total unemployment. 96 Unemployment among young women remains well above the male unemployment rate in lower middle income countries like Sri Lanka and Maldives. 97 Young women in South Asia, as in most other developing countries, 98 face a double barrier to entering the job market and retaining a decent job. Also, in most countries youth participation in the labour market is higher in rural than in urban areas. Country MDG reports identify the main causes of youth unemployment in South Asia as the mismatch between supply and demand in the labour market, due to the slow pace of generation of formal employment, but also due to inappropriate and inadequate skills and the sectoral composition of growth. 99 The risk remains that if employment creation in South Asia does not keep pace with the increase in the young population, it will cause unrest, stress and disillusionment among youth, many of whom will feel compelled to migrate abroad. Many governments in South Asia see a solution in providing adequate support to the development of the private sector based on small and medium-sized enterprises, which are generally known for their large capacity to absorb labour. 30 The Millennium Development Goals Progress and Challenges in South Asia 2006

GOAL 8 DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT Target 17 In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries Indicator: Proportion of population with access to affordable essential drugs on a sustainable basis The availability and affordability of essential drugs in South Asia is vital, especially given the recent increase in HIV/AIDS in some countries A doctor shows a child s growth chart to a woman at a hospital in Nepal. Photo Credit UNICEF/ROSA/Thomas L Kelly Statistics on the availability and affordability of essential drugs in the countries of South Asia are unreliable and sketchy. For Afghanistan, the share of population with access to affordable essential drugs on a sustainable basis was estimated at 50-80% in 1999. 100 For Bangladesh, which has had a National Drug Policy in place since 1982, the estimate was around 80% in 1997. 101 However, over the 1982-1993 period it reduced the number of price-controlled essential drugs from 150 to 117. Although estimates are not available for Nepal, the national MDG report warns of a moderate risk of price increases for essential drugs once it starts implementing its commitments under TRIPS due at the end of 2006. 102 It is assumed that prices for most drugs prescribed in Nepal might surge if more effective drugs enter the market and replace the existing ones. It is imperative to increase the availability and affordability of essential drugs, including antiretroviral ones, in the South Asia region, where some countries are entering the state of concentrated epidemics. The Millennium Development Goals Progress and Challenges in South Asia 2006 31