Save The Children Report 2019

CHANGING LIVES
IN OUR LIFETIME
G L O B A L C H I L D H O O D R E P O RT 2 0 19
S U M M A RY
Photo: Victoria Zegler / Save the Children
CONTENTS
1 Introduction
4 End of Childhood Index Results
2000 vs. 2019
9 10 Factors Driving Change
for Children Since 2000
13 Recommendations
19 Progress Rankings 2000-2019
21 End of Childhood Index Rankings 2019
22 Complete End of Childhood Index 2019
26 Endnotes
28 Acknowledgements
Some names of parents and children have

been changed to protect identities.
ii SAVE THE CHILDREN

Introduction
Children born today have a better chance than at any time in history to
grow up healthy, educated and protected, with the opportunity to reach
their full potential. Even a generation ago, a child was twice as likely to die
before reaching age 5, 70 percent more likely to be involved in child labor
and 20 percent more likely to be murdered. 1
In commemoration of its founding 100 years ago, Save the

Children is releasing its third annual Global Childhood
Report to celebrate progress for children. We examine the HUNDREDS OF MILLIONS OF
major reasons why childhood comes to an early end, and
find significantly fewer children suffering ill-health, CHILDREN HAVE BEEN SAVED
malnutrition, exclusion from education, child labor, child
Global progress has saved millions
marriage, early pregnancy and violent death. In the year
of childhoods since the year 2000.
2000, an estimated 970 million children were robbed of
Now1 there are:
their childhoods due to these causes. That number today
has been reduced to 690 million2 – meaning at least
• 4.4 million fewer child deaths per year
280 million children are better off today than they would
have been two decades ago. • 49 million fewer stunted children
A comparison of End of Childhood Index scores finds the
overall situation for children has improved in 173 out of • 115 million fewer children out of school
176 countries since 2000. This is welcome news – and it
shows that investments and policies are working to lift up • 94 million fewer child laborers
many of our children. Tremendous progress for children is
taking place in some of the poorest countries in the world, • 11 million fewer married girls
providing ever-increasing evidence that development work
is paying huge dividends in countries where needs • 3 million fewer teen births per year
are greatest.
• 12,000 fewer child homicides per year
Drilling down to look at the individual indicators in the
index, we find countries have made impressive progress in
fulfilling children’s rights by reducing under-5 mortality.
Countries have also made substantial progress in enrolling
children in school and reducing malnutrition, child labor now than there were in 2000, an 80 percent increase.
and child marriage. Progress in these areas has resulted in Finding ways to fulfill children’s health, education and
millions fewer children missing out on childhood. However, protection rights in conflict zones is central to the
the world has made less progress in reducing adolescent challenge of ensuring every child has the childhood
births and child homicide, and there has been no progress they deserve.
at all in reducing the number of children living in areas of
violence and conflict. In fact, the number of children living
in war zones or forced to flee their homes due to conflict WHAT DRIVES PROGRESS?
has skyrocketed since 2000. In the 1990s, Save the Children pioneered a radical
Today, 1 child in 4 is being denied the right to a approach to making change that came to be known as
childhood – a time of life that should be safe for growing, “positive deviance.” The approach was based on the idea
learning and playing. These stolen childhoods are that within every community, there are some people who,
increasingly concentrated in the world’s conflict zones. with the same resources and constraints as everyone else,
As noted above, of the eight indicators we examine, do things differently and achieve better results than the
displacement due to conflict is the only one that is on the norm. Their children are healthier, better educated or
rise. There are 30.5 million more forcibly displaced people better protected than one would expect, given the
GLOBAL CHILDHOOD REPORT 1

SUCCESS STORIES
This report includes case studies of countries that have made strong progress in improving children’s well-being
in recent decades. For example:
Bangladesh has achieved remarkable reductions
in under-5 mortality following sustained investments
in health.
Ethiopia has dramatically lowered the prevalence of
stunting through a package of interventions to improve
children’s nutrition.
Mexico has greatly reduced the proportion of children
involved in child labor by investing in education and
poverty reduction.
Philippines achieved an impressive rise in the number
of children enrolled in school by offering incentives and
flexible options.
India has greatly reduced child marriage through legal
reforms, programs to educate and empower girls, and
public awareness campaigns.
Afghanistan has slashed its adolescent birth rate by
increasing girls’ education and improving health services,
with donor assistance.
Colombia is making good gains to reduce violence
against children through public investments in safety
Photo: Veejay Villafranca / Save the Children
and programs for at-risk youth.
challenges they face. Learning from these success stories The moral case for investing in children is compelling.
proved to be a powerful tool to improve the well-being In a world so rich in resources, know-how and technology,
of children and communities, and also the effectiveness it is unacceptable that we allow today’s levels of child
of organizations. In our centennial year, we are paying deprivation to continue.
tribute to this innovative idea, and using it to identify Lost childhoods are a result of choices that exclude
countries that are achieving better than average progress particular groups of children by design or neglect. A child’s
for children. By looking at the strategies employed experience of childhood is largely determined by the care
successfully within these countries, we find inspiration and protection they receive, or fail to receive, from adults.
to inform work elsewhere. The Convention on the Rights of the Child affirms children’s
Even in the poorest countries in the world, there are right to survival, food and nutrition, health and shelter.
many examples of extraordinary progress. This is a clear Children also have the right to be educated, both formally
demonstration that, when the right steps are taken, and informally. They have the right to live free from fear
“development works.” Building on this evidence, this and discrimination, safe from violence, and protected from
report makes a powerful case for greater investment in abuse and exploitation. And they have a right to be heard
child-sensitive development. and to participate in decisions that affect them.3
Success stories in this report illustrate some of the In 2015, world leaders gathered at the United Nations
strategies that are working to save children around the to make a bold commitment – to end poverty in all its
world. They include: strengthening legal frameworks, forms by 2030 and protect the planet for future
improving health systems, investing in education, improving generations. Taken together, the Sustainable Development
household incomes, and empowering teenagers to make Goals (SDGs) they established paint a vision of a future in
life choices that set them on a path to realize their which all children enjoy their rights to health, education
full potential. and protection – the building blocks of childhood.4
2 SAVE THE CHILDREN

Crucially, signatories to the agreement promised to ensure This pledge to leave no one behind must be upheld. Only
this would happen for all segments of society – regardless then will we realize its potential to transform the lives of
of income, geography, gender or identity. And they millions of children across the world, guaranteeing every
promised that those who are furthest behind – the most last child the childhood they deserve.
excluded in society – would be reached first.
WHAT HAS CHANGED IN 100 YEARS?

Millions of children are alive and thriving today
Photo: Save the Children

because of medical and technological advances
we tend to take for granted. Breakthrough
discoveries of vaccines to prevent childhood
diseases, coupled with better care for mothers
and babies, have saved countless lives and
improved overall health. The world has also
made good progress in building human and
institutional capacity to deliver lifesaving
solutions to the hardest to reach and most
vulnerable children.
But perhaps the most important change in
the last 100 years is in how we think about
children. In 1919, when Eglantyne Jebb founded
Save the Children, her conviction that children
have a right to food, health care, education
and protection from exploitation was not
a mainstream idea. The Declaration on the
Rights of the Child, drafted by Jebb, was
adopted by the League of Nations in 1924. It
asserted these rights for all children and made
it the duty of the international community to
put children’s rights in the forefront of planning.
The Convention on the Rights of the Child, which
was adopted in 1989 and has been ratified by
all but one country, further changed the way
children are viewed and treated – as human
beings with a distinct set of rights, instead of as
passive objects of care and charity.
As these visionary frameworks have gained
acceptance, public opinion about children has
been slowly but steadily shifting worldwide. For
example, more people around the world now
believe children belong in school, not toiling
in fields and factories. And more governments
have enacted laws to prevent child labor and
child marriage, and to make school free and
mandatory for all children, regardless of their
gender, race, refugee status or special needs.
The world has come a long way in 100 years,
but we still have a long way to go to ensure
every child, everywhere, grows up healthy, In the 1920s in Hungary, these children and their six siblings had lost their
educated and protected from harm. mother and were suffering from rickets.

End of Childhood Index Results
2000 vs. 2019
Save the Children’s third annual End of Childhood Index compares the latest data
for 176 countries – more than any other year – and assesses where the most
and fewest children are missing out on childhood. Singapore tops the ranking
with a score of 989. Eight Western European countries and South Korea also
rank in the top 10, attaining very high scores for children’s health, education
and protection status. Central African Republic ranks last among countries
surveyed, scoring 394.
The 10 bottom-ranked countries – eight from West and the world, children are robbed of significant portions of
Central Africa – are a reverse image of the top, their childhoods.
performing poorly on most indicators. Children in these The United States, China and Russia may be the three
countries are the least likely to fully experience childhood, most powerful countries in the world – in terms of their
a time that should be dedicated to emotional, social and economic, military and technological strength and global
physical development, as well as play. Low index rankings
also highlight the challenges of armed conflict and
poverty. Nine of the bottom 10 countries are low-income
and six of the bottom 10 are fragile and conflict-affected
states. 5 In these and many other countries around
2019 END OF CHILDHOOD

INDEX RANKINGS
TOP 10 BOTTOM 10
WHAT DO THE SCORES MEAN? Where childhood is
most protected
Where childhood is most threatened
End of Childhood Index scores for countries are

RANK COUNTRY RANK COUNTRY
calculated on a scale of 1 to 1,000. The scores
measure the extent to which children in each country
1 Singapore 167 Burkina Faso
experience “childhood enders” such as death, severe
malnutrition, being out of school and shouldering 2 Sweden 168 DR Congo
the burdens of adult roles in work, marriage and
3 Finland 169 Guinea
motherhood. Here’s a quick guide on how to interpret
country scores: 3 Norway 170 Nigeria
940 or above – Few children missing out on childhood 3 Slovenia 171 Somalia
760 to 939 – Some children missing out on childhood 6 Germany 172 South Sudan
600 to 759 – Many children missing out on childhood
6 Ireland 173 Mali
380 to 599 – Most children missing out on childhood
379 or below – Nearly all children missing out on 8 Italy 174 Chad
childhood
8 South Korea 175 Niger
For more details, see the Methodology and Research 10 Belgium 176 Central African Republic
Notes beginning on page 54 of the full report.
4 SAVE THE CHILDREN
4 SAVE THE CHILDREN

END OF CHILDHOOD INDEX SCORES ARE BETTER NOW IN ALL REGIONS
1,000
900 CEE/CIS*
East Asia and Pacific
Middle East and North Africa

End of Childhood Index Score
800
Latin America and Caribbean
South Asia
700 Eastern and Southern Africa
West and Central Africa
600
500
400
2000 2019
*Central and Eastern Europe and the Commonwealth of Independent States
influence – but all three badly trail most of Western Sierra Leone has achieved a 246-point increase in its
Europe in helping children reach their full potential. China index score since 2000, rising from 345 to 591. Two
and the U.S. are tied for 36th place, and Russia ranks 38th. decades after the end of the 11-year civil war, and just a
Their scores are 941, 941 and 940, respectively – at least few years after a devastating Ebola outbreak, the country
30 points behind most Western European countries. has made strong gains for children on almost all indicators.
China has made the most progress of the three in recent Child marriage is down nearly 60 percent. Under-5
decades, steadily improving conditions for its children, mortality has been cut by more than half (53 percent).
while Russia and the U.S. have made less progress. Child labor is down by at least 40 percent. Fewer children
are stunted and there are fewer teen births (rates for both
are down by about 30 percent). Child homicide declined
GREAT GLOBAL PROGRESS FOR CHILDREN 20 percent. But, by far, the greatest progress is that fewer
Save the Children took a look back at the data for the families are affected by conflict. In 2000, 1 in every 5
year 2000 and found a remarkable story of progress, people in Sierra Leone had been forcibly displaced from
in almost every country, in just one generation. A home. Today, that figure is 1 in 700 – a 99 percent
comparison of End of Childhood Index scores for 2000 and reduction.
2019 shows 173 out of 176 countries are doing better at Rwanda’s score rose 241 points, from 503 to 744.
giving their children full and stable childhoods. The most Twenty-five years after the Rwandan genocide, the
dramatic progress has been among some of the world’s country has improved on most indicators. Under-5
poorest countries. These successes show that poverty mortality is down 79 percent. Many more children are in
does not have to be a barrier to progress, and political school and many fewer children are married before age 18
choices can matter more than national wealth. (the out-of-school rate and child marriage rate are both

“I feel like I own the world....
Gaining literacy and numeracy skills,
and creating my own business, is
the gateway to controlling my own life.”
– Sabreen, age 15
down by 60 percent). Rwanda has also cut child labor, bottom, as the situation for children has continued to
adolescent births and child homicides in half since 2000. improve, while conditions have worsened in Central
Ethiopia increased its score by 237 points, rising from African Republic. Niger’s under-5 mortality rate is down
414 to 651. Improvements in child survival and education 62 percent since 2000 – that’s 44,000 fewer child deaths
have been the main drivers of progress, but reductions in each year. School enrollment rates have more than
malnutrition and child marriage have also been important. doubled (from 19 to 48 percent). And child homicide is
Child mortality, children out of school and child marriage down 36 percent. In 2000, nearly all children in Niger were
have all been cut by about half or more. The adolescent missing out on childhood. One child in 4 did not survive to
birth rate is down 41 percent, stunting is down 33 percent, age 5. Over 80 percent of children were out of school and
and child homicide is down 30 percent. over half were chronically malnourished. Two-thirds of
Niger has more than doubled its score since 2000, from girls aged 15 to 19 were already married and more than
167 to 402. In relative terms, this is the greatest increase 1 in 5 gave birth each year. Niger still has a long way to
of any country. Niger was the lowest-ranked country on go – especially with regard to child marriage and early
the index in 2017 and 2018, but this year it rises from the childbearing – but sustained improvements over the years
6 SAVE THE CHILDREN

Sabreen, age 15, dropped
out of school in fourth grade
to help support her family in
Egypt. She later enrolled in
Save the Children’s Youth in
Action program to improve
her reading and math skills.
After graduating, she began rising from 617 to 811, mostly by getting more children
a business raising livestock. into school. Afghanistan also made excellent progress,
increasing its score 185 points, from 411 to 596, by cutting
child deaths and teen births in half. Bangladesh’s score
rose 153 points, from 575 to 728, primarily because of
improvements in child survival. Nepal’s score is up
142 points, from 543 to 685, due mostly to decreases in
mortality, malnutrition and teen births. And India’s score
is up 137 points, from 632 to 769, largely because of
improvements in child health and survival.
In East Asia and the Pacific, Timor-Leste raised its
score 199 points, from 526 to 725, mostly due to
reductions in child deaths and displacement. The score for
Cambodia increased 149 points, from 606 to 755, because
of gains in child survival, nutrition and school enrollment.
China’s score rose 80 points, from 861 to 941, due to
reductions in child deaths and malnutrition. Indonesia lifted
its score 71 points, from 721 to 792 by improving child
health and getting more children into school. And
Vietnam’s score is up 67 points, from 764 to 831, due to
significant reductions in stunting.
In Latin America and the Caribbean, the most
progress was made by Haiti and Nicaragua, with 98- and
97-point increases, respectively. Haiti’s score rose from 620
to 718. Nicaragua’s score rose from 698 to 795. Both
countries improved child survival and school enrollment.
Bolivia achieved an 81-point increase, from 685 to 766, by
cutting under-5 mortality and stunting in half. Ecuador rose
78 points, from 739 to 817, primarily by getting more
children into school. Colombia, Guatemala and Peru all had
score increases in the 65- to 75-point range. The biggest
driver of progress in Colombia was the decline in child
homicide. Guatemala’s score increase was due to fewer
adolescent births, child deaths and children out of school.
Peru cut its stunting rate by 58 percent.
In Eastern Europe and Central Asia, Tajikistan
achieved a 124-point increase, rising from 718 to 842, due
to improvement in child survival and nutrition. Uzbekistan’s
score rose 98 points, from 789 to 887, primarily because of
improvements in child health and survival. Kyrgyzstan’s
Photo: Joseph Raouf / Save the Children
score is up 84 points, from 748 to 832, due to impressive
reductions in stunting. Bosnia and Herzegovina’s score
increased 77 points, from 863 to 940, because
point to a brighter future for many of Niger’s children. displacement is down significantly. Ukraine’s score is up
Many other countries in sub-Saharan Africa also have 65 points, from 867 to 932 due to improvements in child
made tremendous progress since 2000. Burkina Faso survival. And Georgia raised its score 68 points, from 815
achieved a 220-point score increase, from 345 to 565, by to 883, by getting more children into school and improving
improving child survival and school enrollment. Zambia’s child health.
score is up 201 points, from 422 to 623, due mainly to In the Middle East , progress for children since 2000
improvements in child survival. Liberia is up 182 points, has been greatly affected by continued violence and
from 417 to 599, due to 60 percent fewer deaths under conflict. Iraq’s score is up 82 points, from 686 to 768, due
age 5. Kenya, Malawi, Mali, Mozambique and Uganda all to improvements on every indicator but displacement and
increased their scores by about 160 points or more. adolescent fertility. Jordan, currently the home of millions
Improvements in children’s health and survival were the of refugee children, increased its score 52 points, from
main drivers of progress in these countries as well. Uganda 857 to 909. Child deaths, malnutrition, child marriage
also significantly cut teen births. and adolescent births are all down by more than a third
In South Asia, Bhutan achieved a 194-point increase, in Jordan.

Photo: David Wardell / Save the Children
Narom has a checkup with midwife Soeung Sokha, who is part

of an outreach team that goes to villages every month in Stung
Treng Province, Cambodia. The team provides prenatal care,
contraception, vaccinations and promotes health awareness.
Developed countries made more modest gains and • Venezuela, experiencing a socioeconomic and
we often see rising inequality despite overall progress. The political crisis since 2010, has a score drop of
biggest score increases are in Latvia and Estonia (both up 32 points, from 739 to 707. The under-5 mortality
40 points from 927 to 967) and Lithuania (up 39 points rate has risen 40 percent and child homicide is up
from 934 to 973). Child mortality is down more than 60 percent. Displacement has also risen sharply.
70 percent in Latvia and Estonia. Lithuania made good
gains across five indicators. • Trinidad and Tobago’s score fell 29 points, from
Only three countries have seen a decline in their scores 885 to 856. Chronic malnutrition has led to a
since 2000: doubling of the stunting rate (from 5 to 11 percent
of children under age 5) and data suggest the child
• Syria, now in its ninth year of war, has lost 151 points homicide rate has quadrupled, from 4 to 16 deaths
from its 2000 score, dropping from 794 to 643. per 100,000 children.
Threats to childhood have risen steadily, with
significant increases in malnutrition, children out of See the 2000-2019 Progress Rankings, 2019 Country
school and displacement. In 2000, there was almost Rankings, the Complete End of Childhood Index
no forced displacement in Syria. Today, 75 percent (pages 19-25) and an explanation of the methodology,
of the population is displaced from their homes by beginning on page 47 of the full report.
the conflict.
8 SAVE THE CHILDREN

10 Factors Driving Change
for Children Since 2000
Here are 10 key factors that have contributed to global progress
for children in recent decades.
1
The MDG agenda – Launched in 2000, the children with a free and compulsory education and set a
Millennium Development Goals (MDGs) galvanized minimum age for employment, though implementation of
a 15-year global campaign to end poverty in all these policies remains challenging in both countries.
its forms. This was the first-ever global strategy with
3
quantifiable targets to be agreed upon by all United Social investment and economic growth –
Nations member states. Thanks to concerted global, Economic growth on its own does not guarantee
regional, national and local efforts, the MDGs saved the greater resources for social investment in children’s
lives of millions and improved conditions for many more. programs, but a number of countries have used additional
A recent Brookings Institution study found as many as resources resulting from economic growth to create highly
19 million extra child lives – most of them in Africa – were effective programs benefitting children (for example,
saved because of MDG-accelerated action.6 Major Bangladesh, Brazil, Ethiopia and Vietnam).12 Economic
increases in rates of progress also resulted in as many as growth has driven malnutrition reductions in China and
111 million more children completing primary school and Mongolia and child labor reductions in Central Asia. In
at least 471 million extra people being lifted out of addition, revising fiscal and tax policies and making them
extreme poverty.7 And yet, for all these gains, progress more equitable can boost household incomes, providing
was uneven. Extreme poverty and inequalities persist. additional funds to parents to pay for their children’s health
This is especially true for the roughly 1.5 billion people in care, nutrition and education.
conflict-affected countries and on the extreme margins of Conditional cash transfers are another social protection
society who benefited least from the goals.8 strategy that has proven effective in many countries.
Governments or organizations transfer money to people
2
Government commitment – Strong political who meet certain criteria, such as enrolling children in
leadership at the national level – among heads of school or receiving vaccinations. Food and other incentives
government and key policymakers – has played a have also been used this way. For example, in Bangladesh,
crucial role in helping millions more children survive and girls received incentives to delay marriage, avoid teenage
thrive.9 In Ethiopia, for example, the nation’s steadfast childbearing and stay in school.13
commitment and leadership over several decades to save
4
the lives of newborns in both urban and remote rural areas Improved planning and implementation –
has resulted not only in global recognition of the country’s Policy commitments are important but they require
advances, but also the recent appointment of its former detailed and coordinated programs to succeed.
top health administrator as the head of the World Health The most effective programs often involve a number
Organization. Of course, changes in government can of sectors participating toward the same goal while
undermine such efforts, but in countries like Bangladesh, seeking support and buy-in from local communities and
Colombia and Ethiopia, progress has continued despite major donors. Practitioners have found that coordinated
changes in leadership.10 investments in education, health, poverty reduction,
In addition, in sharp contrast to 2000, more national water and sanitation (i.e., “whole systems” approaches)
governments recognize the value of increased social can have a much greater impact on improving the lives
investment and poverty reduction and have created of children than interventions from individual sectors.14
enabling legislation that addresses these issues. Progress India’s comprehensive approach to tackling child marriage,
against child labor in Brazil and Mexico, for example, for example – including policy reforms and investments
would not have happened without active government in education, livelihoods and community mobilization
policies.11 Several countries – including Burkina Faso, India, for change – has been the key to its success. Similarly,
Malawi and Sierra Leone – have recently created multisectoral programs have been critical drivers of
legislation addressing the basic right of children not to be nutrition gains in Ethiopia and across Africa.
married at an early age. And Ghana and Sierra Leone are Timing is also important. Typically, investments in
the latest countries to take important steps to provide education come first and support later gains in health and

nutrition. Throughout the planning and implementation tuberculosis, to name only a few. Today more than
process, governments need to acknowledge the role that 90 percent of people in 131 countries have been vaccinated
NGOs and donors play in filling gaps that invariably against many of these diseases.22 Progress also requires
develop in translating detailed plans into action. that countries themselves take ownership of their own
development, and as this report’s case studies illustrate,
5
Reducing inequities – Progress in child well- many developing countries are doing just that.
being has often been greatest where there has
7
been an explicit emphasis on directing resources Empowering women and young girls –
to and improving the situation of the poorest and most Advances in girls’ education (including equal access
marginalized groups. Vietnam has targeted programs to to primary school), falling fertility rates, delays
disadvantaged minority ethnic groups. Bangladesh has in marriage and first pregnancy, greater participation
worked to reduce sex differentials in child mortality and in the labor market, and a stronger political voice all
school enrollment, and Brazil has had success in reducing represent major advances for women since the year 2000.
malnutrition and child mortality among the poorest And not surprisingly they have had a direct and major
quintiles and in the poorest parts of the country.15 Egypt, impact on the health, social and economic well-being of
Mali, Malawi, Niger and Sierra Leone have done especially women and their children. As this report shows, rising
well at reaching the poorest children with lifesaving health education rates among women and girls have been critical
interventions. All are examples of countries taking the to improvements in child health in Bangladesh and child
extra step as they seek to improve the lives of their most protection in Afghanistan and India.23
marginalized citizens – including millions of children whose Empowering women and girls also leads to strengthened
lives remain untouched throughout decades of progress. economies and more equitable societies.24 Investing in
Much remains to be done to reach the poorest children education programs for girls and increasing the age at
who tend to be the furthest behind. Studies by Save the which they marry can return $5 for every dollar spent.25
Children and UNICEF suggest that global development Investing in programs improving incomes for women can
goals would be reached faster with a focus on the most return $7 dollars for every dollar spent.26 And yet, despite
disadvantaged children and communities.16 this progress, gender inequalities remain pervasive in each
and every dimension of sustainable development.27
6
Development assistance – Global aid declined in
8
the 1990s, but has doubled since 2000.17 Development Women’s leadership – Since 1995, when the
assistance plays a key role in improving children’s Beijing Platform for Action was adopted, the
well-being, particularly in low-income countries. An proportion of women serving in parliaments around
analysis by the Overseas Development Institute and the world has more than doubled, growing from 11 percent
Save the Children found countries in sub-Saharan Africa that year to 24 percent in 2019.28 Women in government
that received the most aid over the period 1998-2008 also have gained ground in 90 percent of the 174 countries for
made the most progress in child well-being.18 which data are available for 1995 to 2019.29 The number
Targeting aid to children not only improves their lives in of single or lower houses of parliament where women
the short term, but also can pay huge dividends for a poor occupy 30 percent or more of the seats (the target
country’s economy over the longer term. One recent study identified in Beijing) has increased from 5 to 50, while those
found that spending $1 on childhood vaccines in a low- with 40 percent or more have jumped from 1 to 15. The
income country can generate as much as $44 in future number of male-only parliaments dropped, from 10 to 3.
savings.19 Other studies have shown that girls’ education As of January 1, 2019, there were three countries with
can be the single best investment a poor country can make over half of parliamentary seats held by women: Rwanda
to improve its economic future.20 Early childhood care and (61 percent), Cuba (53 percent) and Bolivia (53 percent). 30
development interventions also promise high rates of Evidence is growing of the positive impact women’s
return to families, societies and nations.21 participation has on policy outcomes for children and
Of course, aid alone will not drive progress. Aid is most families and development outcomes more broadly. 31 Issues
effective for children where national commitments to child like gender-based violence, equal pay, child care, health
well-being already exist and can strengthen and facilitate care, reproductive rights, family leave, violence against
the implementation of effective programs and services. It children and child marriage are increasingly on the
often takes innovative initiatives – coupled with good local political agendas of countries. A robust body of research
governance, political commitment and donor support – to shows that a greater proportion of women legislators has
ensure major progress. Consider the dramatic reduction in a profound impact on peace and security.32 Female
children’s deaths due to infectious diseases. In many of the legislators also tend to increase foreign aid, particularly
world’s poorest neighborhoods, local physicians with for education and health.33 At the grassroots level, women
government support have worked tirelessly with global and girls are leading efforts to end child marriage in India,
alliances like Gavi, the Vaccine Alliance, to help children Indonesia, Lebanon, Mexico, Pakistan, Senegal and
survive malaria, diphtheria, tetanus, pertussis, HIV and other countries. 34
10 SAVE THE CHILDREN

Niger, one of the poorest countries in the world, has
made tremendous progress since 2000 in improving
conditions for children. A significant portion of
Niger’s national budget during this period has come
from foreign aid (45% in 2002 and 15% in 2017). 51
The United States has been the largest donor,
contributing $437 million in 2018. 52
Photo: Victoria Zegler / Save the Children
9
New technologies – Since 2000, the spread of improve early diagnosis of HIV in infants, monitor
mobile phones, computers and the Internet have malnutrition in children and to educate individuals about
transformed the way people live, work and interact. family planning, adolescent health and prenatal care.
Nearly the entire world population (96 percent) now During the recent Ebola outbreak in Sierra Leone, mobile
live within reach of a mobile cellular network, up from phones were used to send emergency alerts, support
58 percent in 2001.35 And more than half of the world’s health worker responses and increase access to help lines.
population is now online, up from just over 6 percent Digital tools and technologies are being used to
in 2000. improve livelihoods (for example, e-commerce platforms
New, compelling evidence shows digital solutions are help expand market opportunities and mobile banking
positively linked to progress on most (11 of 17) Sustainable allows poor families to save and gain access to credit).
Development Goals. 36 Information and communications ICTs are also increasing access to quality education
technologies (ICTs) have had a positive impact on and promoting learning. This progress has been especially
economic growth, boosting incomes for people from all valuable for girls, refugees, children with disabilities and
segments of society. There is growing evidence that ICTs others who might otherwise be out of school.37,38,39,40,41
have also contributed to improvements in child survival,
10
health and well-being. Social media – Facebook, Twitter, YouTube,
Telemedicine is making medical advice and treatment Instagram and other social media platforms have
options available to people no matter where they live. spread around the world with remarkable speed.
Digital health platforms are being used by frontline health The Pew Research Center surveyed adults in 37 countries
workers to diagnose and treat pneumonia, remind parents and found social media usage varied from a high of
about actions that keep their babies healthy, and improve 75 percent in Jordan to a low of 20 percent in Tanzania
the coordination of vaccination campaigns and bed net and India.42 Across the 19 developing countries surveyed,
distributions to prevent mosquito bites that spread 53 percent of adults said they used social media, up from
malaria. Mobile phones are being used to register births, 34 percent just five years earlier.

Photo: Susan Warner / Save the Children
In Indonesia, Nurul participates

in a Save the Children
employment skills training
program to improve her future
opportunities and reduce her
risk for exploitive labor.
Social media has had a huge impact on how people social activism, boost economic activity, facilitate disaster
communicate with one another and access information. response and relief, bolster civic engagement, enhance
By giving a platform to anyone who wants to use it, advocacy efforts and mobilize for peace. The public profile
social media has the potential to open and democratize of child marriage, for example, has been boosted through
societies.43 It can facilitate discussions, inspire action increased media attention globally. 47 Similarly, socially
and vastly speed up the diffusion of information, ideas, conscious consumerism may be contributing to declines in
practices, values and social norms that support positive child labor. 48
change.44 Children and adolescents are using social media While there are important concerns about the social,
to amplify their voices and seek solutions to problems political and economic fallout from the spread of digital
affecting them and their communities.45 activities – for example, misuse of social media that
There is some evidence that social media has had a encourages violence, bullying and suicide – most experts
positive impact on global development.46 It has been used believe the good outweighs the bad.49,50
to support greater engagement in health issues, promote

Recommendations
In 2015, world leaders agreed to the United Nations Sustainable
Development Goals – a set of 2030 targets for eradicating extreme poverty
in all its forms. As part of this agreement, governments committed to a
Pledge to Leave No One Behind, which, if realized, should mean the pace
of change will be fastest for those left furthest behind.
Putting those children who are furthest behind first is no • Increase investments in children – To achieve
easy task. It means collecting and reporting the data the SDGs and ensure that all children have access
necessary to identify those children furthest behind, and to quality basic services, including protection and
then developing strategies and allocating resources to social protection services, governments (including
improve their health and education outcomes, protect donor nations) need to raise the necessary resources.
them from violence and forced labor, and empower all Governments must ensure these resources reach
of them, especially girls, to reach their full potential. excluded children in keeping with the focus on public
This year countries have the opportunity to renew their investment in children outlined by the UN Committee
commitment to achieving the SDGs. In July, national on the Rights of the Child. Improved public investment
representatives will gather for the annual High-Level to assist excluded children must include the removal
Political Forum to review a subset of the SDGs, including of cost barriers to services as well as measures to
three goals critical to children’s progress – providing ensure minimum financial security for all children
access to quality education (SDG 4), reducing inequality through child-sensitive social protection. Children who
(SDG 10) and promoting peaceful societies (SDG16). Later, are furthest behind must be identified and prioritized
in September, under the auspices of the United Nations in terms of investments, service provision and
General Assembly, world leaders will gather to report on decision making.
where countries stand in achieving the SDGs by 2030 in a
gathering now being referred to as the SDG Summit. The • Take action to ensure all children are treated
summit represents the first heads-of-state level meeting on equally – This includes ending discriminatory policies,
the SDGs since they were adopted in 2015 and provides an norms and behaviors such as preventing girls from
opportunity for national leaders to reinvigorate their accessing health services or denying education to a
commitment and identify ways to accelerate progress. child because of their ethnicity or gender. To facilitate
This year, the United Nations marks the 30 th children accessing quality services, governments
anniversary of the Convention on the Rights of the Child. must also put in place systems to register every child
Save the Children believes that the SDGs are a necessary at birth.
and critical step toward respecting and supporting
children’s rights – especially those of girls – including their • Count and include all children, regardless of who
rights to health, education, and protection. The SDGs are they are or where they are from – Governments
also important in helping children become equal and active need to ensure that all children, especially excluded
members of society. children, are counted in data that are used to measure
progress on the SDGs. Data should be collected and
disaggregated by age, economic group, gender, sex,
WHAT WE MUST GUARANTEE race, ethnicity and geography or migratory status,
FOR ALL CHILDREN and be reported publicly in accessible formats. In
addition, excluded children – girls and boys – should
As countries review progress towards the SDGs, Save the
participate in policy making and budgeting, and be
Children calls on policy makers to make three critical
supported to monitor progress and hold governments
guarantees to ensure children are a priority in their
to account.
specific plans:

A GLOBAL ACTION PLAN FOR CHILDREN • Donor governments must provide external financial
support, including pledging new and additional
To further ensure that children remain a priority in
resources to the Gavi Alliance in the upcoming
achieving SDGs, Save the Children is calling on country
replenishment conference in 2020.
governments, donor nations and other stakeholders to
put a greater emphasis on ending child poverty, • Countries must commit to investing in building strong
eliminating under-5 child mortality, helping all children primary health care systems that deliver high-quality,
have access to a quality education and improved learning accessible services free at the point of use.
outcomes, ending wars and conflicts and empowering all
• Countries must commit to supporting health services
girls, no matter their race, creed or color, while also
that seek to leave no one behind and to address first
putting an end to child marriage. What steps can be taken
those furthest from coverage.
now toward achieving these specific goals for children?
Here’s Save the Children’s own set of recommendations • Countries must commit to public financing for health
for a global action plan for children. through fair revenue-pooling such as taxes and the
elimination of out-of-pocket payments.
Steps to address child poverty: • Donor governments must commit to supporting
• All countries should adopt a national action plan to countries to mobilize domestic resources to increase
reduce and eliminate child poverty, together with investment in achieving UHC and to increase
dedicated budgets and monitoring systems that track efficiencies and transparency for the way health funds
improvements in poverty-related deprivations among are spent, as well as to align their aid to build strong
girls and boys of all ages. national systems.
• Countries must ensure the final UHC declaration
• All governments should ensure that children in poverty includes references to essential services such as those
(and their families) benefit from universal social that can prevent pneumonia (the largest infectious
protection measures, such as child grants, and should disease killer of children under the age of 5), improve
expand program coverage as quickly as possible to nutrition (malnutrition remains the underlying cause
reach all children who are poor. of 45 percent of deaths in children under the age of 5),
and ensure adolescent reproductive health. Globally,
Steps to ensure no child dies before age 5: more than 13 million adolescents give birth each year.
Sustainable Development Goal 3 is a commitment to Adolescent mothers face a higher risk of maternal
ensure healthy lives, including ending preventable child mortality and morbidity than older women, and their
deaths. To achieve this goal, world leaders, donors and children face a higher risk of neonatal, infant, and
other stakeholders must commit to the following key child mortality and morbidity.
action steps:
• Countries must build a workforce of community
health workers as part of a system of UHC. This is an
1. Achieve universal health coverage
important step for low-resource settings. Countries
Universal health coverage (UHC) would ensure all must also have plans to invest in and empower
citizens have access to affordable, quality care regardless community health workers.
of their wealth, ethnicity, gender or location and without
being pushed into financial hardship or denied services 2. Focus on child nutrition in planning for
because of how they are paid for. It is a way forward for the 2020 Nutrition for Growth Summit
achieving the Health for All goal under the SDG
As part of the SDG framework, world leaders agreed to
framework. This year (2019) provides an opportunity for
end all forms of malnutrition by 2030. First held in 2013,
countries to recommit or pledge concrete steps toward
the Nutrition for Growth Summit brings together
achieving UHC.
stakeholders, including country and donor governments,
In September, world leaders will gather for the UN
to invest in solutions to fight malnutrition and achieve the
High-Level Meeting on Universal Health Coverage to
goal. The third summit will be held in Japan in 2020.
discuss ways to achieve this goal under the auspices of the
Leading up to and at the Nutrition for Growth Summit
UN General Assembly. The final outcome document
2020, donor and country governments should:
should be a roadmap to help guide national governments,
civil society, donors and the private sector to work • Prepare to commit to making substantial financial
together to achieve UHC. This roadmap must include commitments and to invest in costed national plans
steps countries will take to overcome remaining barriers for addressing malnutrition in children under the
to ensuring no child dies before age 5, including: age of 5. Plans should also include efforts to address
maternal and adolescent nutrition.

Photo: Charlie Forgham-Bailey / Save the Children
In the Democratic Republic of the

Congo, baby Joy has pneumonia.
She is being examined and
treated by head nurse Hubert
Matondo at a health center on
the outskirts of Kinshasa.
• Make current investments in nutrition more targeted 3. Increase resources to end pneumonia deaths
and effective through better tracking, analysis and among children
reporting, ensuring they are age- and gender- While other major causes of child deaths such as diarrhea
responsive, and by building strong accountability and malaria have fallen, pneumonia remains the largest
mechanisms to ensure investments reach those that infectious killer of children under the age of 5. To achieve
are most vulnerable and in need. the goal of ending preventable child deaths by 2030, world
• Develop targets (for those countries and donor leaders must increase their attention to pneumonia and
governments without targets) to demonstrate take concrete steps to prevent and treat it.
progress toward meeting the globally agreed upon
World Health Assembly nutrition targets. Specifically, Save the Children calls for:
• Ensure that governments incorporate the World • High-burden countries to develop pneumonia action
Health Organization’s International Code of plans that can be integrated into plans to achieve
Marketing of Breast Milk Substitutes and distributors UHC
of breast milk substitutes publicly commit to • Stakeholders to improve case management of
upholding the Code and its subsequent resolutions. pneumonia by strengthening health systems
Governments should agree to meet targets set to
achieve full compliance and to integrate subsequent • Stakeholders to aim to achieve universal immunization
resolutions fully into their laws and regulations. by ensuring that the pneumococcal conjugate vaccine
(PCV) is available, accessible and affordable.

In rural Uganda, Save the Children
has trained teachers to use
participatory learning approaches
that make it fun for children to
build literacy and math skills.
Photo: Andrew Pacutho / Save the Children
Steps to ensure all children have access to • Provide sufficient, gender-responsive and more
quality learning and improved learning equitable allocation of public resources to deliver
outcomes: safe, inclusive and equitable quality education, with
Sustainable Development Goal 4 is the commitment to a focus on those left behind.
ensure inclusive and equitable quality education for all. • Ensure that donor governments commit to supporting
To achieve this goal, world leaders, donors and other countries to mobilize domestic resources to increase
stakeholders must commit to the following: investment in education.
• Create national plans to ensure that all girls and • Advocate for G20 leaders to commit to bring
boys complete free, equitable, safe and quality basic reforms in the global tax system that will enable
education leading to relevant and effective learning countries to expand their tax base to increase
outcomes, including literacy, numeracy and social- domestic budget.
emotional skills.

• Ensure that donor governments provide external Steps to empower all girls and end
resources and contribute to multilateral institutions child marriage:
such as the Global Partnership for Education and As this report shows, persistent structural gender
Education Cannot Wait. inequality, including discrimination against girls, remains
• Follow through on G7 commitments to close the a barrier to achieving many of the SDGs. The goals
gap in access to education during conflict and highlight that gender equality is not only a fundamental
crisis, and for refugees and the internally displaced human right, but a necessary foundation for a peaceful,
(especially for girls), including through prioritizing a prosperous and sustainable world. Simply put: we will not
gender-responsive approach across the continuum be successful in tackling the biggest development
of immediate humanitarian response and long-term challenges of our time, for and with the most deprived
development programming, and by identifying and children, without a priority focus on and investment in
addressing the specific gender-related barriers faced gender equality. Save the Children calls on country
by girls in accessing education. governments and donors to:
• Be held accountable to girls for accelerating progress
Steps to stop the war on children: for advancing girls’ rights in order to end child
One in five children in today’s world lives in an area marriage and its consequences and increase gender
affected by conflict, and the lack of practical help on equality. This includes commitments to:
the ground to keep children safe or help them recover – Accelerate action to address child marriage at
from harm is a disgrace. Eglantyne Jebb – who founded national, regional, and international levels through
Save the Children 100 years ago – said “Every war is a utilization of transparent accountability mechanisms.
war against children.” A century later, the world is still – Ensure development and implementation of costed
failing to protect our most vulnerable from the horrors national action plans to end child marriage and ensure
of that war. the meaningful participation and engagement of girls
The war on children will only stop when all of us – from and community leaders – traditional and religious – in
citizens and community leaders to military commanders the development, implementation, monitoring and
and heads of state – respect the idea that children should evaluation of such plans.
always be off-limits in war. We can help make the war on • Increase donor and national government investment
children stop if we work together, and force world leaders to end child marriage and mitigate its consequences
to listen and act decisively. through gender-responsive budgeting across sectors
Specifically, Save the Children is calling on governments and stand-alone financing for gender equality,
to do one or more of the following – depending on including increased funding to support the provision
national context: of and access to sexual and reproductive health
• Uphold international standards by strengthening services and information, protection from all forms
child protection principles in military doctrine and of violence, and safe, quality education for the most
trainings, regulating and improving transparency deprived and marginalized girls.
on international arms transfers, and committing • Work together to empower girls as agents of change
to sign and implement international standards and in their own lives and communities and transform
laws critical to protecting children, including the Safe patriarchal laws and social norms that allow and
Schools Declaration, Arms Trade Treaty, Optional accept child marriage and other forms of sexual and
Protocol to the Convention on the Rights of the Child, gender-based violence.
and Paris Principles and Commitments.
• Develop and maintain a comprehensive database on
• Hold perpetrators of crimes against children to child marriage in humanitarian contexts to fill current
account through judicial and political mechanisms gaps that hamper addressing comprehensively the
and support international and domestic mechanisms drivers of the practice as well as the needs of already
to prosecute cases of violations of children’s rights married girls.
in conflict.
• Take practical action to protect children and
support their recovery by increasing multi-
year investments in humanitarian child protection,
ensuring mental health and psychosocial support for
children and their families are well resourced and
mainstreamed, increasing investments in education
and programs to address sexual and gender-based
violence, and including children in peacemaking and
peacebuilding initiatives.

Photo: Talitha Brauer / Save the Children
Rabiou, 19 months old, was treated

for malnutrition at the stabilization
center funded by Save the Children
in Aguie hospital, Niger.
Progress Rankings 2000-2019
2000 END 2019 END CHANGE 2000 END 2019 END CHANGE
COUNTRY OF CHILDHOOD OF CHILDHOOD IN SCORE COUNTRY OF CHILDHOOD OF CHILDHOOD IN SCORE
INDEX SCORE INDEX SCORE 2000-2019 INDEX SCORE INDEX SCORE 2000-2019
Sierra Leone 345 591 246 DR Congo 472 556 84
Rwanda 503 744 241 Kyrgyzstan 748 832 84
Ethiopia 414 651 237 Namibia 676 760 84
Niger 167 402 235 Iraq 686 768 82
Burkina Faso 345 565 220 Bolivia 685 766 81
Angola 369 581 212 China 861 941 80
Guinea-Bissau 388 597 209 Iran 789 869 80
Zambia 422 623 201 State of Palestine 784 863 79
Timor-Leste 526 725 199 Ecuador 739 817 78
Bhutan 617 811 194 Bosnia & Herzegovina 863 940 77
Afghanistan 411 596 185 Sudan 539 615 76
Liberia 417 599 182 Djibouti 657 732 75
Eritrea 429 606 177 Guatemala 566 639 73
Kenya 573 747 174 Indonesia 721 792 71
Mozambique 394 567 173 Kazakhstan 864 933 69
Equatorial Guinea 411 581 170 Peru 766 835 69
Malawi 446 615 169 Colombia 693 761 68
Guinea 366 531 165 Georgia 815 883 68
Senegal 528 691 163 Oman 857 925 68
Uganda 523 683 160 Vietnam 764 831 67
Mali 271 430 159 Ukraine 867 932 65
Bangladesh 575 728 153 Turkmenistan 840 902 62
Cambodia 606 755 149 Azerbaijan 789 849 60
Burundi 530 676 146 Botswana 741 800 59
Maldives 774 917 143 Honduras 624 682 58
DPR Korea 764 906 142 United Arab Emirates 874 931 57
Nepal 543 685 142 Algeria 851 907 56
Ghana 623 763 140 Armenia 852 908 56
India 632 769 137 Russia 884 940 56
Madagascar 463 596 133 Paraguay 748 803 55
Sao Tome & Principe 618 751 133 Romania 865 920 55
Chad 277 408 131 Saudi Arabia 873 928 55
South Africa 639 769 130 Costa Rica 846 900 54
Cameroon 457 582 125 Mexico 772 826 54
Côte d’Ivoire 483 608 125 Bahrain 905 958 53
Tajikistan 718 842 124 Jordan 857 909 52
Gabon 664 775 111 Cuba 867 918 51
Mongolia 766 877 111 El Salvador 694 745 51
Tanzania 493 604 111 Mauritius 869 919 50
Eswatini 637 747 110 Lebanon 878 926 48
Nigeria 395 504 109 Sri Lanka 867 915 48
Zimbabwe 569 677 108 Suriname 812 860 48
Lesotho 472 579 107 Croatia 919 965 46
Yemen* 548 652 104 Dominican Republic 748 794 46
South Sudan 358 461 103 Kuwait 896 942 46
Togo 576 679 103 Samoa 868 911 43
Myanmar 684 786 102 Bulgaria 882 923 41
Congo 614 715 101 Jamaica 816 857 41
Laos 543 643 100 Moldova 827 868 41
Albania 809 908 99 Estonia 927 967 40
Haiti 620 718 98 Latvia 927 967 40
Uzbekistan 789 887 98 Lithuania 934 973 39
Benin 534 631 97 Tunisia 891 929 38
Nicaragua 698 795 97 Philippines 763 800 37
Mauritania 487 582 95 Serbia 890 927 37
Gambia 571 661 90 Bahamas 866 901 35
Morocco 774 864 90 Egypt 798 833 35
Comoros 597 684 87 Hungary 928 963 35
Pakistan 540 626 86 Argentina 848 881 33
Turkey 818 904 86 Papua New Guinea 642 675 33
Few children missing out on childhood * Most of the available data for these countries predate escalations of
Some children missing out on childhood violence and do not reflect the harsh realities for children in these settings.
Many children missing out on childhood Coloring reflects the extent to which children are missing out on childhood.
Most children missing out on childhood For details, see Methodology and Research Notes in the full report.
Nearly all children missing out on childhood

PROGRESS RANKINGS 2000-2019
2000 END 2019 END CHANGE

COUNTRY OF CHILDHOOD OF CHILDHOOD IN SCORE
INDEX SCORE INDEX SCORE 2000-2019
Portugal 945 978 33
Qatar 900 933 33
United States 909 941 32
Solomon Islands 658 689 31
Thailand 829 859 30
Cabo Verde 811 840 29
New Zealand 939 968 29
Guyana 759 786 27
Saint Vincent & the 842 869 27
Grenadines
Uruguay 850 877 27
Iceland 952 978 26
North Macedonia 876 900 24
United Kingdom 948 972 24
Vanuatu 774 798 24
Finland 962 985 23
Marshall Islands 749 772 23
Brazil 785 806 21
Ireland 961 982 21
Greece 944 964 20
Israel 954 974 20
Italy 960 980 20
Poland 948 968 20
Belize 782 801 19
Montenegro 902 921 19
Slovenia 966 985 19
Somalia 449 468 19
Belarus 933 951 18
Australia 958 975 17
Cyprus 960 977 17
Singapore 972 989 17
Canada 955 971 16
Norway 969 985 16
Brunei Darussalam 892 907 15
Chile 901 916 15
France 959 973 14
Luxembourg 960 974 14
Spain 963 977 14
Belgium 966 979 13
Germany 969 982 13
Panama 779 792 13
Sweden 974 986 12
Switzerland 963 975 12
Republic of Korea 969 980 11
Barbados 905 915 10
Denmark 961 971 10
Central African Republic 385 394 9
Malaysia 883 890 7
Malta 954 961 7
Fiji 870 876 6
Japan 968 973 5
Saint Lucia 878 881 3
Tonga 908 910 2
Seychelles 864 865 1
Trinidad & Tobago 885 856 -29
Venezuela 739 707 -32
Syria* 794 643 -151
Few children missing out on childhood * Most of the available data for these
Some children missing out on childhood countries predate escalations of
Many children missing out on childhood violence and do not reflect the harsh
realities for children in these settings.
Most children missing out on childhood
Nearly all children missing out Coloring reflects the extent to which
on childhood children are missing out on childhood.
For details, see Methodology and
Research Notes in the full report.

End of Childhood Index Rankings 2019
RANK COUNTRY SCORE RANK COUNTRY SCORE RANK COUNTRY SCORE
1 Singapore 989 ∧ 60 Jordan 909 ∨ 119 Namibia 760 ∨
2 Sweden 986 ∧ 61 Albania 908 ∧ 120 Cambodia 755 ∧
3 Finland 985 ∧ 61 Armenia 908 ∨ 121 Sao Tome & Principe 751 ∨
3 Norway 985 63 Algeria 907 ∧ 122 Eswatini 747 ∨
3 Slovenia 985 ∨ 63 Brunei Darussalam 907 ∧ 122 Kenya 747 ∧
6 Germany 982 ∧ 65 DPR Korea 906 ∧ 124 El Salvador 745 ∨
6 Ireland 982 ∧ 66 Turkey 904 125 Rwanda 744 ∨
8 Italy 980 67 Turkmenistan 902 ∧ 126 Djibouti 732 ∧
8 Republic of Korea 980 68 Bahamas 901 ∨ 127 Bangladesh 728 ∧
10 Belgium 979 ∧ 69 Costa Rica 900 ∧ 128 Timor-Leste 725 ∧
11 Iceland 978 ∨ 69 North Macedonia 900 129 Haiti 718 ∨
11 Portugal 978 ∨ 71 Malaysia 890 ∨ 130 Congo 715 ∨
13 Cyprus 977 ∨ 72 Uzbekistan 887 ∧ 131 Venezuela 707 ∨
13 Spain 977 73 Georgia 883 ∨ 132 Senegal 691 ∧
15 Australia 975 74 Argentina 881 ∨ 133 Solomon Islands 689 ∧
15 Switzerland 975 74 Saint Lucia 881 ∧ 134 Nepal 685 ∧
17 Israel 974 ∧ 76 Mongolia 877 ∨ 135 Comoros 684 ∨
17 Luxembourg 974 ∧ 76 Uruguay 877 ∧ 136 Uganda 683 ∨
19 France 973 ∨ 78 Fiji 876 ∨ 137 Honduras 682 ∧
19 Japan 973 79 Iran 869 ∧ 138 Togo 679 ∨
19 Lithuania 973 ∧ 79 Saint Vincent & the Grenadines 869 139 Zimbabwe 677 ∨
22 United Kingdom 972 ∧ 81 Moldova 868 ∧ 140 Burundi 676 ∧
23 Canada 971 ∧ 82 Seychelles 865 ∨ 141 Papua New Guinea 675 ∨
23 Denmark 971 83 Morocco 864 ∧ 142 Gambia 661 ∧
25 New Zealand 968 ∧ 84 State of Palestine 863 ∨ 143 Yemen* 652 ∧
25 Poland 968 85 Suriname 860 ∧ 144 Ethiopia 651 ∨
27 Estonia 967 ∧ 86 Thailand 859 ∨ 145 Laos 643 ∨
27 Latvia 967 ∧ 87 Jamaica 857 ∨ 145 Syria* 643 ∨
29 Croatia 965 88 Trinidad & Tobago 856 ∨ 147 Guatemala 639 ∧
30 Greece 964 ∨ 89 Azerbaijan 849 ∧ 148 Benin 631 ∧
31 Hungary 963 ∧ 90 Tajikistan 842 ∧ 149 Pakistan 626 ∨
32 Malta 961 91 Cabo Verde 840 150 Zambia 623 ∨
33 Bahrain 958 ∧ 92 Peru 835 ∧ 151 Malawi 615 ∨
34 Belarus 951 ∨ 93 Egypt 833 ∧ 151 Sudan 615 ∨
35 Kuwait 942 ∨ 94 Kyrgyzstan 832 ∧ 153 Côte d'Ivoire 608 ∨
36 China 941 ∧ 95 Vietnam 831 ∧ 154 Eritrea 606 ∨
36 United States 941 ∨ 96 Mexico 826 ∧ 155 Tanzania 604 ∨
38 Bosnia & Herzegovina 940 ∨ 97 Ecuador 817 ∧ 156 Liberia 599 ∨
38 Russia 940 ∨ 98 Bhutan 811 ∧ 157 Guinea-Bissau 597 ∨
40 Kazakhstan 933 ∧ 99 Brazil 806 ∨ 158 Afghanistan 596 ∧
40 Qatar 933 ∨ 100 Paraguay 803 ∨ 158 Madagascar 596 ∧
42 Ukraine 932 101 Belize 801 ∨ 160 Sierra Leone 591 ∧
43 United Arab Emirates 931 ∨ 102 Botswana 800 161 Cameroon 582 ∨
44 Tunisia 929 ∧ 102 Philippines 800 ∧ 161 Mauritania 582 ∨
45 Saudi Arabia 928 ∧ 104 Vanuatu 798 ∨ 163 Angola 581 ∧
46 Serbia 927 ∨ 105 Nicaragua 795 ∧ 163 Equatorial Guinea 581 ∨
47 Lebanon 926 ∧ 106 Dominican Republic 794 ∧ 165 Lesotho 579 ∨
48 Oman 925 ∨ 107 Indonesia 792 ∨ 166 Mozambique 567 ∨
49 Bulgaria 923 ∨ 107 Panama 792 167 Burkina Faso 565 ∧
50 Montenegro 921 ∧ 109 Guyana 786 ∨ 168 DR Congo 556
51 Romania 920 ∧ 109 Myanmar* 786 ∨ 169 Guinea 531 ∧
52 Mauritius 919 ∧ 111 Gabon 775 ∨ 170 Nigeria 504 ∨
53 Cuba 918 ∧ 112 Marshall Islands 772 171 Somalia 468 ∨
54 Maldives 917 ∨ 113 India 769 ∧ 172 South Sudan 461 ∨
55 Chile 916 ∧ 113 South Africa 769 ∨ 173 Mali 430 ∧
56 Barbados 915 ∧ 115 Iraq* 768 ∧ 174 Chad 408 ∨
56 Sri Lanka 915 ∧ 116 Bolivia 766 ∧ 175 Niger 402 ∧
58 Samoa 911 117 Ghana 763 ∧ 176 Central African Republic 394 ∨
59 Tonga 910 ∨ 118 Colombia 761 ∧
Few children missing out on childhood** Index scores reflect the average level of performance across a set of eight indicators related to child health, education, labor,
Some children missing out on childhood marriage, childbirth and violence. The only reason a country was not included in this analysis was insufficient data (e.g., the
Many children missing out on childhood country was missing values for three or more indicators). To see the underlying dataset, including data gaps, turn to pages 50-53
in the full report. Performance bands reflect the extent to which children are missing out on childhood. For details, see
Most children missing out on childhood
Methodology and Research Notes in the full report.
∧ Score is up from last year
∨ Score is down from last year * Data collection in times of conflict is difficult and dangerous. Latest available data for conflict-affected countries often predate
escalations of violence and do not capture the harsh realities for children in these settings. In Syria and Yemen, for example, recent
evidence suggests rates of child labor and child marriage have risen. These trends are not reflected in the data or index ranking.
** Although relatively few children in these countries are missing out on childhood, the absolute number of children missing
out likely totals in the millions. This is especially true in more populous countries at the bottom of the performance band
(e.g., United States, Russia).

Complete End of Childhood Index 2019
CHILD IS CHILD IS OUT CHILD BEGINS CHILD CHILD HAS CHILD IS A VICTIM
CHILDHOOD ENDER CHILD DIES SEVERELY
MALNOURISHED OF SCHOOL WORK LIFE MARRIES A CHILD OF EXTREME VIOLENCE
END OF
Under-5 Child stunting Out-of-school Adolescents Adolescent birth Population Child homicide CHILDHOOD
Children
mortality rate children of currently forcibly rate (deaths INDEX 2019
(% children engaged in rate (births per
INDICATOR (deaths per primary and married or in 1,000 displaced per 100,000
aged 0-59 child labor girls aged
1,000 live secondary union (% girls by conflict population
months) school age (%) (% ages 5-17) 15-19)
births) aged 15-19) (% of total)† aged 0-19)
Score Rank
2017 2013-2018 + 2013-2018 + 2013-2018 + 2013-2018 + 2016 2018 2016
(out of 1,000) (out of 176)
Afghanistan* 67.9 40.9 41.9 z 29.4 16.9 b 68.8 14.9 c 3.0 596 158
Albania 8.8 11.3 a 6.9 5.1 x,y 6.7 a 20.7 1.0 2.0 908 61
Algeria* 24.0 11.7 x 9.7 x,z 5.0 y 3.1 b 10.4 0.0 1.6 907 63
Angola 81.1 37.6 36.4 x 23.4 18.2 154.5 0.1 5.0 581 163
Antigua and Barbuda 7.4 … 18.9 … … 44.7 0.1 0.7 – –
Argentina 10.4 8.2 x 2.9 4.4 x,y 12.7 x 63.0 0.0 3.1 881 74
Armenia 12.6 9.4 7.1 x 8.7 y 4.6 24.0 0.8 0.6 908 61
Australia 3.5 2.0 x 2.4 … 0.5 b 13.3 0.0 0.4 975 15
Austria 3.6 … … … 2.7 x 7.2 0.0 0.2 – –
Azerbaijan 23.0 18.0 6.4 6.5 x,y 8.9 a,x 52.6 6.4 0.9 849 89
Bahamas 7.2 … 11.2 … 2.4 x 28.0 0.2 10.1 901 68
Bahrain 7.3 … 2.3 … 5.3 b,x 13.5 0.0 0.3 958 33
Bangladesh 32.4 36.1 17.4 4.3 y 32.4 x 84.4 0.0 1.5 728 127
Barbados 12.4 7.7 x 6.5 1.9 x,y 1.4 a,x 39.2 0.1 3.9 915 56
Belarus 3.7 4.5 x 2.4 1.4 x,y 7.4 x 18.0 0.1 0.5 951 34
Belgium 3.8 … 1.6 … 2.2 x 5.1 0.0 0.4 979 10
Belize 14.2 15.0 10.2 3.2 y 20.8 a 64.7 0.1 11.9 801 101
Benin 98.3 32.2 a 23.8 32.9 a 16.0 a 88.1 0.0 3.8 631 148
Bhutan 30.8 33.6 x 19.1 2.9 x,y 15.2 x 22.1 0.9 0.6 811 98
Bolivia 34.9 16.1 11.7 26.4 x,y 11.6 x 69.0 0.0 6.0 766 116
(Plurinational State of)
Bosnia and Herzegovina 5.7 8.9 x … 5.3 x,y 0.6 x 10.4 4.7 0.7 940 38
Botswana 37.6 31.4 x … 9.0 x,y 7.1 x 31.7 0.0 4.6 800 102
Brazil 14.8 7.1 x 7.2 6.6 y 15.1 x 62.7 0.0 17.7 806 99
Brunei Darussalam 10.5 19.7 x 9.1 … 3.1 b,x 10.9 0.0 1.0 907 63
Bulgaria 7.5 … 7.9 … 8.4 x 40.3 0.0 0.4 923 49
Burkina Faso 81.2 27.3 38.5 39.2 x,y 31.5 x 106.5 0.2 5.0 565 167
Burundi 61.2 55.9 20.6 26.3 x,y 5.9 a 27.4 6.3 4.1 676 140
Cabo Verde 17.4 … 20.5 6.4 x,y 8.1 x 74.7 0.0 4.4 840 91
Cambodia 29.2 32.4 22.5 x 19.3 y 15.6 49.9 0.1 0.7 755 120
Cameroon 84.0 31.7 22.6 47.0 20.1 108.8 1.1 6.2 582 161
Canada 5.1 … 2.4 … 1.7 9.8 0.0 0.7 971 23
Central African Republic 121.5 40.7 x 49.1 x 28.5 x,y 54.8 x 105.8 29.3 c 7.7 394 176
Chad 123.2 39.9 46.1 51.5 38.3 164.5 1.1 5.7 408 174
Chile 7.4 1.8 6.2 6.6 x,y 5.7 x 46.6 0.0 1.9 916 55
China* 9.3 8.1 7.6 z … 3.1 b 6.5 0.0 e 0.6 941 36
Colombia 14.7 12.7 x 7.9 7.8 y 12.7 49.5 16.1 c 20.9 761 118
Comoros 69.0 32.1 x 28.1 22.0 x,y 16.4 x 67.2 0.1 3.7 684 135
Congo* 47.5 21.2 11.0 x,z 23.3 16.1 a 114.1 3.4 4.4 715 130
Costa Rica 9.0 5.6 x 5.3 4.1 x,y 7.1 54.6 0.0 3.3 900 69
Côte d’Ivoire 88.8 21.6 30.9 31.3 a 18.4 a 133.4 0.2 6.7 608 153
Croatia 4.6 … 6.3 … 2.0 x 9.4 0.7 0.2 965 29
Cuba 5.4 … 6.6 … 11.1 45.0 0.2 1.3 918 53
Cyprus 2.7 … 3.0 … 3.1 x 4.7 0.0 0.5 977 13
Czech Republic 3.3 … … … 0.9 x 10.2 0.0 0.2 – –
Democratic People’s 19.0 19.1 a … 5.1 a 0.0 a 0.3 0.0 2.7 906 65
Republic of Korea
Democratic Republic 91.1 42.6 16.6 z 38.4 21.3 125.2 6.6 c 7.3 556 168
of the Congo*
Denmark 4.3 … 3.8 … 3.5 x 4.2 0.0 0.3 971 23
Djibouti 61.7 33.5 x 52.9 7.7 x,y 2.6 b,x 19.4 0.3 3.4 732 126
Dominican Republic 29.9 7.1 10.8 12.8 18.1 96.1 0.0 5.3 794 106
Coloring reflects prevalence: Moderate High Very high

COMPLETE END OF CHILDHOOD INDEX 2019
END OF
Children
aged 0-59 child labor girls aged by
1,000 live secondary union (% girls conflict population
Score Rank
2017 2013-2018 + 2013-2018 + 2013-2018 + 2013-2018 + 2016 2018 2016
(out of 1,000) (out of 176)
Ecuador 14.5 23.9 5.3 4.9 y 20.0 x 74.6 0.1 2.9 817 97
Egypt 22.1 22.3 8.0 7.0 14.4 b 51.0 0.0 2.2 833 93
El Salvador 14.5 13.6 22.5 8.9 y 16.3 70.3 3.3 17.9 745 124
Equatorial Guinea 89.6 26.2 x … … 22.0 x 157.9 0.0 1.0 581 163
Eritrea 43.1 50.3 x 62.7 … … 53.5 11.0 3.2 606 154
Estonia 2.7 … 4.5 … 4.4 x 13.3 0.0 0.3 967 27
Eswatini 53.9 25.5 21.8 7.3 x,y 3.7 78.5 0.0 10.8 747 122
Ethiopia 58.5 38.4 33.6 27.4 x,y 17.4 64.9 1.3 4.2 651 144
Fiji 25.3 … 7.8 x … 7.6 b,x 43.7 0.2 1.4 876 78
Finland 2.3 … 1.7 … 0.3 6.9 0.0 0.5 985 3
France 4.2 … 2.5 … 2.7 8.8 0.0 0.4 973 19
Gabon* 48.3 17.5 x 7.7 x,z 13.4 x,y 13.5 x 98.5 0.0 3.8 775 111
Gambia* 63.6 25.0 35.9 z 19.2 x,y 23.8 81.9 1.6 5.5 661 142
Georgia 10.8 11.3 x 2.0 4.2 y 10.6 x 47.1 7.8 1.1 883 73
Germany 3.7 1.3 x … … 0.4 6.8 0.0 0.3 982 6
Ghana 49.3 18.8 19.0 21.8 y 6.4 67.6 0.1 4.5 763 117
Greece 5.3 … 7.8 … 1.8 x 7.5 0.0 0.2 964 30
Grenada 16.7 … 10.5 … … 30.4 0.1 1.8 – –
Guatemala 27.6 46.5 28.6 25.8 x,y 19.8 72.5 0.5 10.4 639 147
Guinea 85.7 30.3 a 37.8 38.1 a 35.2 a 137.4 0.4 5.2 531 169
Guinea-Bissau* 84.2 27.6 30.6 z 51.1 11.4 87.2 0.3 6.9 597 157
Guyana 31.3 12.0 9.5 x 18.3 13.3 a 86.7 0.1 6.0 786 109
Haiti* 71.7 21.9 a 14.3 x,z 24.4 x,y 6.9 a 38.2 0.6 14.9 718 129
Honduras 18.2 22.7 x 30.1 14.1 y 22.6 x 72.2 2.7 18.3 682 137
Hungary 4.5 … 6.4 … 0.7 19.8 0.1 0.3 963 31
Iceland 2.1 … 4.9 … 0.4 7.3 0.0 0.7 978 11
India 39.4 38.4 20.2 11.8 x,y 15.2 a,b 24.5 0.0 1.3 769 113
Indonesia 25.4 36.4 14.2 6.9 x,y 12.8 x 48.0 0.0 2.8 792 107
Iran (Islamic Republic of) 14.9 6.8 x 6.8 11.4 x,y 21.1 b,x 25.7 0.2 c 1.4 869 79
Iraq 30.4 9.9 a 21.9 x 7.3 a 18.4 a,b 79.8 8.3 c 6.7 768 115
Ireland 3.5 … 0.2 … 1.1 x 10.1 0.0 0.3 982 6
Israel 3.6 … 1.9 … 2.5 b 9.7 0.0 0.8 974 17
Italy 3.4 … 2.4 … 1.5 x 6.2 0.0 0.2 980 8
Jamaica 15.2 6.2 … 3.3 x,y 3.4 x 54.4 0.1 15.0 857 87
Japan 2.6 7.1 x 1.7 … 0.5 b 4.2 0.0 0.1 973 19
Jordan 17.0 7.8 x … 1.7 y 11.0 b 23.3 0.1 1.5 909 60
Kazakhstan 10.0 8.0 0.9 2.2 x,y 6.0 28.4 0.0 1.2 933 40
Kenya 45.6 26.0 20.5 x … 12.0 81.8 0.0 2.5 747 122
Kiribati 54.6 … … … 15.8 x 17.2 0.0 6.9 – –
Kuwait 8.1 4.9 7.5 … 5.3 b,x 9.4 0.1 0.9 942 35
Kyrgyzstan 20.0 12.9 5.5 25.8 13.1 38.8 0.1 1.2 832 94
Lao People’s 63.4 33.0 a 19.2 42.5 a 23.5 a 63.3 0.1 3.9 643 145
Democratic Republic
Latvia 4.2 … 2.8 … 2.6 x 13.8 0.0 0.9 967 27
Lebanon 7.8 … 20.1 x 1.9 x,y 3.3 b,x 12.2 0.2 1.4 926 47
Lesotho 85.9 33.2 24.7 … 17.7 89.7 0.0 19.2 579 165
Liberia 74.7 32.1 49.7 20.8 x,y 14.3 128.8 0.2 5.9 599 156
Libya 12.4 21.0 x … … … 5.7 4.0 0.9 – –
Lithuania 4.3 … 0.8 … 2.1 x 11.4 0.0 1.0 973 19
Luxembourg 2.6 … 7.5 … 1.0 x 5.4 0.0 0.1 974 17
Madagascar* 44.2 49.2 x 29.2 x,z 22.9 y 33.7 x 111.7 0.0 4.4 596 158
Malawi 55.4 37.1 17.5 39.3 23.5 141.0 0.0 0.8 615 151
Malaysia 7.9 20.7 13.4 … 6.0 b,x 13.4 0.0 1.9 890 71
Maldives* 7.9 15.3 a 11.1 x,z … 3.8 a 6.5 0.0 1.3 917 54
Mali 106.0 26.9 a 46.0 55.8 38.9 a 171.1 1.2 c 6.9 430 173

END OF
Children
Score Rank
2017 2013-2018 + 2013-2018 + 2013-2018 + 2013-2018 + 2016 2018 2016
(out of 1,000) (out of 176)
Malta 6.4 … 5.7 … 0.5 x 16.8 0.0 0.4 961 32
Marshall Islands 34.0 … 23.7 … 21.1 x 84.5 x,z 0.0 1.6 z 772 112
Mauritania 79.0 27.9 39.6 37.6 27.8 a,b 80.5 1.0 7.0 582 161
Mauritius 13.1 … 8.9 … 7.0 x 26.9 0.0 0.5 919 52
Mexico 13.4 12.4 10.4 12.4 15.4 61.4 0.1 4.9 826 96
Mongolia 17.2 10.8 8.6 x 17.3 4.9 24.2 0.2 1.4 877 76
Montenegro 3.5 9.4 7.2 12.5 2.1 12.1 0.2 0.5 921 50
Morocco 23.3 14.9 x 11.5 8.3 x,y 11.0 b,x 31.7 0.0 0.7 864 83
Mozambique 72.4 43.1 x 26.5 22.2 x,y 43.1 a 138.9 0.1 1.6 567 166
Myanmar 48.6 29.2 18.8 9.3 y 11.9 b 29.0 2.9 c 2.0 786 109
Namibia 44.2 23.1 15.1 x … 5.4 75.0 0.1 8.7 760 119
Nauru 33.0 24.0 x 22.0 … 18.3 x 94.0 z 0.0 … – –
Nepal 33.7 35.8 13.8 37.4 27.1 a 62.1 0.1 1.5 685 134
Netherlands 3.9 … … … 0.1 4.1 0.0 0.3 – –
New Zealand 5.3 … 1.5 … 0.5 b,x 20.6 0.0 0.7 968 25
Nicaragua 17.2 17.3 x 10.4 x … 22.4 x 86.9 0.1 5.2 795 105
Niger 84.5 42.2 51.6 30.5 x,y 59.8 x 194.0 0.8 c 7.5 402 175
Nigeria* 100.2 43.6 38.0 z 50.8 a 22.2 a 109.3 1.3 c 5.4 504 170
North Macedonia 13.7 4.9 x 15.7 x 12.5 x,y 4.3 x 16.6 0.2 0.4 900 69
Norway 2.6 … 2.1 … 0.1 5.7 0.0 0.2 985 3
Oman 11.3 14.1 3.9 … 3.3 a,b 7.9 0.0 1.9 925 48
Pakistan 74.9 47.2 a 40.8 … 13.5 a,b 37.7 0.2 6.5 626 149
Panama 16.1 19.1 x 16.8 2.5 y 14.1 a 82.8 0.0 9.6 792 107
Papua New Guinea 53.4 49.5 x 27.5 … 14.8 x 53.4 0.0 4.5 675 141
Paraguay 21.0 5.6 15.4 x 26.4 a 16.1 a 56.6 0.0 3.0 803 100
Peru 15.0 13.1 4.1 x 21.8 y 11.3 48.4 0.0 3.7 835 92
Philippines 28.1 33.4 6.1 11.1 x,y 8.5 a 59.9 0.5 c 3.5 800 102
Poland 4.7 … 5.3 … 1.2 x 13.0 0.0 0.2 968 25
Portugal 3.7 … 2.4 … 0.6 b,x 9.9 0.0 0.4 978 11
Qatar 7.6 … 10.7 … 4.0 a,b 10.2 0.0 3.8 933 40
Republic of Korea 3.3 2.5 x 3.1 … 0.4 b,x 1.7 0.0 0.4 980 8
Republic of Moldova 15.5 6.4 x 17.0 16.3 x,y 9.9 x 22.7 0.2 0.8 868 81
Romania 7.8 … 13.8 … 6.7 x 33.7 0.0 0.3 920 51
Russian Federation 7.6 … 3.4 … 7.5 x 22.5 0.1 1.5 940 38
Rwanda* 37.9 37.9 22.6 z 28.5 x,y 3.0 26.8 2.2 2.9 744 125
Saint Lucia 16.6 2.5 x 10.6 x 3.9 x,y … 41.3 0.6 5.1 881 74
Saint Vincent and the 16.2 … 3.5 … 16.7 x 50.1 1.3 4.4 869 79
Grenadines
Samoa 16.5 4.7 8.8 … 7.8 a 24.8 0.0 1.2 911 58
Sao Tome and Principe 32.4 17.2 10.9 26.0 15.3 96.3 0.0 4.1 751 121
Saudi Arabia 7.4 9.3 x 4.0 … 5.6 b,x 8.3 0.0 4.1 928 45
Senegal 45.4 16.5 a 39.3 23.0 23.3 a 74.9 0.3 4.4 691 132
Serbia 5.7 6.0 4.7 9.5 3.1 19.3 3.0 d 0.3 927 46
Seychelles 14.2 7.9 x 9.5 … … 57.8 0.0 1.5 865 82
Sierra Leone 110.5 26.4 a 26.1 39.0 a 15.3 a 115.6 0.1 6.4 591 160
Singapore 2.8 … 0.1 … 0.4 b,x 3.7 0.0 0.1 989 1
Slovakia 5.6 … … … 1.6 x 22.2 0.0 0.3 – –
Slovenia 2.1 … 2.8 … 0.5 x 4.3 0.0 0.1 985 3
Solomon Islands 20.6 31.6 31.3 x 47.8 y 11.4 a 47.8 0.0 1.9 689 133
Somalia* 127.2 25.3 x 48.7 x,z 49.0 x,y 24.6 b,x 102.2 25.8 c 3.1 468 171
South Africa 37.1 27.4 9.8 … 3.1 a 44.4 0.0 15.6 769 113
South Sudan 96.4 31.1 x 66.7 … 40.1 x 65.2 31.6 c 2.4 461 172
Spain 3.1 … 1.1 … x 3.5 8.7 0.0 0.2 977 13
Sri Lanka 8.8 17.3 6.4 1.0 y 6.0 a 14.8 0.8 0.8 915 56
State of Palestine 20.9 7.4 12.3 5.7 x,y 9.1 b 57.2 2.2 2.7 z 863 84

END OF
Children
Score Rank
2017 2013-2018 + 2013-2018 + 2013-2018 + 2013-2018 + 2016 2018 2016
(out of 1,000) (out of 176)
Sudan 63.2 38.2 47.3 x 24.9 20.0 b 67.2 6.7 c 3.1 615 151
Suriname 19.6 8.8 x 15.8 4.1 x,y 11.8 x 46.7 0.0 3.5 860 85
Sweden 2.8 … 0.7 … 0.3 5.3 0.0 0.6 986 2
Switzerland 4.2 … 6.1 … 0.4 3.1 0.0 0.3 975 15
Syrian Arab Republic 17.0 27.5 x 45.0 4.0 x,y 9.7 b,x 39.5 74.5 c 1.0 643 145
Tajikistan 33.6 17.5 a 10.9 x 10.0 x 12.6 a 36.9 0.1 0.5 842 90
Thailand 9.5 10.5 12.4 x 8.3 x,y 14.1 a 51.8 0.0 2.0 859 86
Timor-Leste 47.6 45.6 a 19.7 … 8.2 a 45.6 0.0 4.6 725 128
Togo 72.9 27.5 21.6 27.9 12.7 89.6 0.1 4.8 679 138
Tonga 16.0 8.1 x 10.3 … 4.6 x 15.1 0.1 2.2 910 59
Trinidad and Tobago* 26.1 11.0 x 4.2 x,z 2.3 a,x,y 2.1 b,x 31.0 0.0 16.4 856 88
Tunisia* 13.0 10.1 x 13.3 x,z 2.1 x,y 1.2 b,x 7.6 0.0 0.6 929 44
Turkey 11.6 9.5 10.4 5.9 x,y 6.6 b 26.9 0.1 0.9 904 66
Turkmenistan* 47.3 11.5 0.4 z 0.3 6.0 24.8 0.0 1.5 902 67
Tuvalu 24.9 10.0 x 16.3 … 8.0 b,x 28.0 x,z 0.0 … – –
Uganda* 49.0 28.9 23.3 z 16.3 x,y 19.9 a 110.5 0.4 6.4 683 136
Ukraine 8.8 … 4.9 2.4 x,y 6.5 x 24.7 4.4 0.7 932 42
United Arab Emirates 9.1 … 5.1 … 6.7 b,x 28.2 0.0 1.7 931 43
United Kingdom 4.3 … 0.8 … 2.9 x 13.5 0.0 0.6 972 22
United Republic of 54.0 34.4 42.7 28.8 y 22.3 116.6 0.0 4.1 604 155
Tanzania
United States 6.6 2.1 x 3.4 … 5.8 x 20.6 0.0 3.4 941 36
Uruguay 8.2 10.7 x 6.2 7.9 x,y 7.4 55.4 0.0 3.6 877 76
Uzbekistan 22.5 19.6 x 6.3 … 4.9 x 16.7 0.0 0.5 887 72
Vanuatu 26.9 28.5 16.1 15.2 y 11.3 a 42.5 0.0 1.3 798 104
Venezuela 30.9 13.4 x 17.3 … 15.8 x 85.8 2.7 23.8 707 131
(Bolivarian Republic of)
Vietnam* 20.9 24.6 10.2 z 16.4 9.7 29.0 0.4 1.2 831 95
Yemen 55.4 46.5 28.9 22.7 x,y 16.7 b 61.8 7.6 c 2.8 652 143
Zambia* 60.0 40.0 22.2 z 40.6 x,y 16.9 86.0 0.0 5.5 623 150
Zimbabwe 50.3 26.8 24.9 … 19.6 105.8 0.2 8.3 677 139
GLOBAL AND REGIONAL AVERAGES +
Sub-Saharan Africa§ 75.5 33.9 31.7 29.4 23.0 122.0 2.3 5.4 593 –
Eastern and 59.1 34.1 29.5 25.8 20.0 112.8 2.1 5.1 631 –
Southern Africa
West and Central Africa 91.2 33.7 32.7 31.9 26.7 129.8 2.1 5.9 559 –
Middle East and 23.0 15.0 17.9 6.9 12.8 41.0 4.7 2.5 829 –
North Africa
South Asia 44.8 35.0 22.8 12.4 y,z 29.0 z 44.3 0.3 2.0 722 –
East Asia and Pacific 15.8 9.0 9.7 10.0 y,z** 5.7 21.2 0.1 1.4 897 –
Latin America 17.7 9.6 9.9 10.5 10.9 74.3 1.5 11.4 808 –
and Caribbean
CEE/CIS‡ 13.1 8.5 6.7 5.4 y,z 7.3 29.0 0.9 1.0 908 –
World 39.1 22.2 17.6 12.6 y,z** 16.0 50.4 0.9 z 3.3 781 –
… Data are unavailable or outdated (i.e., pre-2005) ‡ Central and Eastern Europe and the Commonwealth of Independent States
+ Data refer to the most recent year available during the reference period ** Excludes China
a Estimate from recent MICS or DHS (pending reanalysis) * To include as many countries as possible in the rankings, school attendance data for
b Estimate does not include consensual unions these 20 countries were sourced from surveys because recent enrollment data were
c There is evidence of recruitment and use of children (e.g., as child soliders) not available
d Includes displaced populations from Serbia and Kosovo † Includes refugees, asylum-seekers, internally displaced persons (IDPs), returnees
(refugees and IDPs) and others of concern to UNHCR
e Includes displaced populations of Tibetan origin
x Data refer to the most recent year available during the period 2005-2012
Note: For indicator definitions, primary and secondary data sources, prevalence
y Data differ from the standard definition (interpret with caution) thresholds and regional classifications, see Methodology and Research Notes in the
z Data are from the secondary source (interpret with caution) full report.
§ Includes Eastern and Southern Africa, West and Central Africa, Djibouti, Sudan

Endnotes
1
These figures represent the difference between the total number of 18
Save the Children. Progress in Child Well-Being: Building on What Works.
children affected by each childhood ender in 2000 and the total number (London: 2012)
affected at last estimate. The most recent year for which these global
estimates are available is 2018 for stunting, 2017 for under-5 mortality,
19
Ozawa, Sachiko, et al. “Return on Investment From Childhood
children out of school and child marriage, and 2016 for child labor, adolescent Immunization in Low- and Middle-Income Countries, 2011–20.” Health Affairs.
births and child homicide. Vol. 35, No. 2. February 2016
2
One-fifth of these children have died. The rest – 545 million or 24 percent
20
See, for example: Chaaban, Jad and Wendy Cunningham. Measuring the
of children under the age of 18 worldwide – are alive and missing out on Economic Gains of Investing in Girls: The Girl Effect Dividend. (World Bank:
childhood. For details on this analysis, see the Methodology and Research 2011) and Mercy Tembon and Lucia Fort. Girls’ Education in the 21st Century:
Notes. Gender Equality, Empowerment,and Economic Growth (World Bank: 2008)
3
Queen’s University Belfast and Save the Children. Enabling the Exercise of
21
See, for example: UNICEF, www.unicef.org/earlychildhood/index_69851.
Civil and Political Rights: The Views of Children. (2016) html
4
The Convention on the Rights of the Child (CRC) represents a global
22
Gavi, the Vaccine Alliance. Vaccine Support. www.gavi.org/support/nvs/
consensus on the terms of childhood. It recognizes childhood as a 23
See also: ODI and Save the Children. Progress in Child Well-Being: Building
separate space from adulthood defined by a specific set of rights. It is the on What Works. (London: 2012)
responsibility of all duty bearers for children – governments, international
organizations, civil society, families and individuals – to ensure that
24
See, for example: Chaaban, Jad and Wendy Cunningham. Measuring the
children’s rights are fulfilled and protected. When children are left Economic Gains of Investing in Girls: The Girl Effect Dividend. (World Bank:
unprotected and vulnerable to exploitation and abuse, their childhood 2011); Mercy Tembon and Lucia Fort. Girls’ Education in the 21st Century:
is undermined. A protective environment is pivotal to governments’ and Gender Equality, Empowerment, and Economic Growth and OECD. Gender
societies’ commitment to ensuring that no child is deprived of the material, Equality in Education, Employment and Entrepreneurship: Final Report to the
spiritual and emotional resources needed to achieve their potential or MCM 2012. (Paris: 2012)
participate as full and equal members of society. This report shows that for 25
Sustainable Development Goals. Gender Equality: Why it Matters. (2018)
hundreds of millions of children, the promise of childhood that undergirds
the Convention is a broken one. For more on the CRC’s role in defining the 26
Ibid.
concept of childhood, see UNICEF’s State of the World’s Children 2005. 27
UN Women. Turning Promises into Action: Gender Equality in the 2030 Agenda
5
This set of countries refers to those included on the World Bank Group’s for Sustainable Development. (New York: 2018)
Harmonized List of Fragile Situations from FY06 to FY19. The full list with
details can be found at worldbank.org/en/topic/fragilityconflictviolence/
28
Inter-Parliamentary Union. Women in National Parliaments. archive.ipu.org/
brief/harmonized-list-of-fragile-situations wmn-e/world.htm. Accessed 12 March 2019
6
McArthur, J.W. and K. Rasmussen. “Change of Pace: Accelerations and
29
Inter-Parliamentary Union Open Data. data.ipu.org. Accessed 12 March
Advances during the Millennium Development Goal Era.” World Development 2019
105 (2018) 132–143 30
Inter-Parliamentary Union. Women in National Parliaments. archive.ipu.org/
7
The same Brookings study found that for undernourishment and access wmn-e/classif.htm. Accessed 12 March 2019
to safe water, accelerations in the majority of developing countries were 31
See, for example: UN Women. In Brief: Women’s Leadership and Political
outweighed by slowdowns in the rate of progress in many populous Participation; Inter-Parliamentary Union. Equality in Politics: A Survey of
countries (i.e., more people were undernourished and without water in Men and Women in Parliaments (2008); Klugman, et al. Voice and Agency:
2015 than would have been had 1990s trends continued). Empowering Women and Girls for Shared Prosperity. (World Bank: 2014);
8
The World Bank. “Ending Extreme Poverty Hinges on Progress in Fragile and UNDAW. Equal Participation of Women and Men in Decision-Making Processes,
Conflict-affected Situations.” 30 April 2013; UN ESCAP. “Make the Voices Heard with Particular Emphasis on Political Participation and Leadership, Report of
of the 1.5 Billion People in Fragile & Conflict-Affected Areas.” 27 February the Expert Group Meeting Addis-Ababa, Ethiopia 24-27 October 2005; Susan
2013 Markham. “Women as Agents of Change: Having Voice in Society and
Influencing Policy.” Women’s Voice, Agency, and Participation Research Paper 5.
9
See, for example: Understanding Children’s Work Programme. (World Bank: 2013)
Understanding Trends in Child Labour: A Joint ILO-UNICEF-The World Bank
Report. (Rome: 2017); Girls Not Brides. Lessons Learned from Selected
32
One study, for example, found that as the percentage of women in
National Initiatives to End Child Marriage - 2016. (London: 2017) and Overseas parliament increases by 5%, a nation is 5 times less likely to use violence
Development Institute and Save the Children. Progress in Child Well-Being: when faced with an international crisis. Another showed that when at least
Building on What Works. (London: 2012) 35% of the legislature is female, the likelihood of a state relapsing into civil
war is virtually zero. Including women in peace processes makes them 64%
10
See, for example: General Economics Division (GED), Planning less likely to fail and 35% more likely to last at least 15 years. For more,
Commission, Government of the People’s Republic of Bangladesh; UNDP. see: Our Secure Future. The Evidence for Women, Peace and Security. (2018)
Briefing Note for Countries on the 2018 Statistical Update - Colombia. (2018) and
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33
Report 2014 Ethiopia (2015) and Foreign Aid.” European Journal of Political Economy, Volume 41, 2016
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Understanding Children’s Work Programme. Understanding Trends in Child
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ACKNOWLEDGEMENTS
This report was written and project-managed by Tracy Geoghegan from Save the Children. The
researchers were Beryl Levinger and Nikki Gillette.
Production of this report would not have been possible without valuable inputs and feedback from
many colleagues across the global Save the Children movement. We are grateful for the contributions of:
Simine Alam, Nahashon Aluoka, Kitty Arie, Mariam Atahi, Smita Baruah, Jeniffer Campos, Wendy
Christian, Daphnee Cook, Carol da Silva, Eric Eversmann, Azucena Garcia, Kimberley Gardiner, Davina
Hagan, Sharon Hauser, Eric Hazard, Ramatu Jalloh, Negin Janati, Joan Jennings, Madhu Kalra, Laila
Khondkar, Michael Klosson, Mónica Kuljich, Kristen Lacey, Ana Lagidze, Claire Leigh, Jessica Lenz, Laurel
MacLaren, Caitlin Macquarrie, Ishtiaq Mannan, Tracy Manners, Carolyn Miles, Elizabeth Muiruri, Grace
Nyoro, Shannon Orcutt, Sierra Mae Paraan, Silvia Paruzzolo, Ivonne Piedras, Jennifer Roberti, Bernice
Romero, Hagar Russ, Sean Ryan, Rukayah Sarumi, Sokpheap Say, Vishna Shah, Callie Simon, Alison
Sutton, Eric Swedberg, Devendra Singh Tak, Patrick Watt, Simon Wright, Victoria Zegler, Lucia Zoro and
many others around the world.
We especially want to thank colleagues who contributed case studies for this report who are based
in Afghanistan, Bangladesh, Colombia, Ethiopia, India, Mexico and Philippines.
A special thank you to Angelica Cadavid for her many contributions to report content and project
management. Thanks also to Charlotte Green, Gabriel Smith and Kirsten Walkom for global
coordination and project management. Thank you to Judy Cusick, Lois Jensen and Mike Kiernan for
editorial support. And to Joe Ansah, Senad Ibrahimbegovic and Maribel Paredes for their work on
design and production.
Design by Alison Wilkes.

These Mexican girls enjoy music
and dance activities that build
their reading skills.
GLOBAL CHILDHOOD
Photo: Save REPORT
the Children 29
Mexico
Save the Children believes every child deserves a future. Around
the world, we give children a healthy start in life, the opportunity
to learn and protection from harm. We do whatever it takes for
children – every day and in times of crisis – transforming their
lives and the future we share.
Published by Save the Children
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+44 (0)20 3272-0300 Djeneba, age 11, is a
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CHANGING LIVES

Some names of parents and children have

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In commemoration of its founding 100 years ago, Save the

GLOBAL CHILDHOOD REPORT 1

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WHAT HAS CHANGED IN 100 YEARS?

Photo: Save the Children

GLOBAL CHILDHOOD REPORT 3

2019 END OF CHILDHOOD

End of Childhood Index scores for countries are

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East Asia and Pacific

Middle East and North Africa

West and Central Africa

*Central and Eastern Europe and the Commonwealth of Independent States

GLOBAL CHILDHOOD REPORT 5

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GLOBAL CHILDHOOD REPORT 7

Narom has a checkup with midwife Soeung Sokha, who is part

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GLOBAL CHILDHOOD REPORT 9

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Photo: Victoria Zegler / Save the Children

GLOBAL CHILDHOOD REPORT 11

In Indonesia, Nurul participates

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GLOBAL CHILDHOOD REPORT 13

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In the Democratic Republic of the

GLOBAL CHILDHOOD REPORT 15

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GLOBAL CHILDHOOD REPORT 17

Rabiou, 19 months old, was treated

GLOBAL CHILDHOOD REPORT 19

2000 END 2019 END CHANGE

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GLOBAL CHILDHOOD REPORT 21

Coloring reflects prevalence: Moderate High Very high

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Coloring reflects prevalence: Moderate High Very high

GLOBAL CHILDHOOD REPORT 23

Coloring reflects prevalence: Moderate High Very high

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Coloring reflects prevalence: Moderate High Very high

GLOBAL CHILDHOOD REPORT 25

Overseas Development Institute (ODI) and Save the Children. Progress in

Mehrotra, S. (2004) Improving Child Well-being in Developing Countries:

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GLOBAL CHILDHOOD REPORT 27

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Published by Save the Children

Save the Children USA

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